cjl mbmmas03 07/08/2010 14:07 board minutes page 2 minute ... min 7-06-2010..pdf · fax (60 \)...

$: CJL MBMMAS03 07/08/2010 14:07 Board Minutes PAGE 2 Minute ... Min 7-06-2010..pdf · Fax (60 \) 403-2344 To: The Honorable Board of Supervisors of Pearl River County, Mississippi$
CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 1 OPENING FOR JULY 6, 2010 Date 7/ 6/2010

JULY 6, 2010

The Board of Supervisors met at 9:00 a.m. the 6th day of July, 2010, in the Supervisor's Board Room, in the Chancery Court Facilities Building at the Pearl River County Courthouse in the City of Poplarville, Mississippi, with the following members of said Board and officers of said County were present to-wit:

President, Anthony Hales, member from District One; Vice President, Patrick Lee, member from District Four; Joyce Culpepper, member from District Two; Hudson Holliday, member from District Three; Sandy Kane Smith, member from District Five; County Administrator, Adrain Lumpkin, Jr.; Board Attorney, Joe Montgomery; Chancery Clerk, David Earl Johnson; Sheriff, David Allison.

The following proceedings were had and entered of record to-wit:

PAGE 2

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 2 AGENDA & SUPPLEMENTAL AGENDA FOR 7/6/10 Date 7/ 6/2010 SHERIFF'S DEPARTMENT PERSONNEL

ORDER TO ACCEPT AGENDA

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of agenda.

Upon the motion made by Sandy Kane Smith and seconded by Hudson Holliday, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to accept the attached Agenda and Supplemental Agenda for July 6, 2010 meeting.

Ordered and adopted, this the 6th day of July, 2010.

voting AYE: Anthony Hales, Joyce Culpepper, Hudson Holliday, Patrick Lee, and Sandy Kane smith

voting NAY: None

ORDER TO ACCEPT SHERIFF'S DEPARTMENT PERSONNEL

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of personnel changes in the Sheriff's Department.

Upon the motion made by Sandy Kane Smith and seconded by Joyce Culpepper, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to approve the following and attached personnel changes in the Sheriff's Department:

Erin MacDonald Dispatcher Hire full time


voting AYE: Anthony Hales, Joyce Culpepper, Hudson Holliday, Patrick Lee, and Sandy Kane Smith

voting NAY: None

PAGE 3

Meeting Agenda Pearl River County Board of Supervisors

July 6, 2010 Welcome & Call to Order 9:00 A.M. (President)

Routine Business: 1r Sheriff:

• Personnel • Declaration of Forfeiture

Book 0144 Po". 3

• Vehicle assigned to Hospital & authorize to remove from inventory • Request payment for GED Test • Consider approval for signature of COPS Technology Grant

9:15 1r AG Crowe Re: Opening new business & emergency preparedness '" E-911 AddreSSing: Consider approving change of private road name McRae Dr to

private road name Ramos Dr. 1r Authorize President to sign Waste Tire Grant '" Semi-Annual bid tabulation sheet 1r Asphalt and Emulsion bid tabulation sheet '" Consider payment to JH&H invoice #10 '" Appraisal Engagement Letter '" MEMA Hurricane Katrina Reimbursement #86 1r Consider approving June 2010 Board Minutes '" Consider approving Poll Worker training checks turned in late '" Authorize President to sign CDBG Requisitions with invoices and Cash Request Forms '" Budget Request Forms out to Departments - due back on 7/20/10

Travel: '" Circuit Clerk to Convention in Biloxi, MS on July 7-9, 2010

NEXT BOARD MEETING - MONDAY, JULY 12TH

SUPPLEMENTAL AGENDA FOR

TUESDAY, JULY 6, 2010

1. Road Manager - Discuss stop sign on Glover Road

2. Chancery Clerk - Disallowance of Homestead

3. County Administrator - President to Sign Lease

4. County Administrator - Health Assurance

5. Executive Session - Economic Development

boY'·

June 29,2010

PEARL RIVER COUNTY SHERIFF'S DEPARTMENT DAVID ALLISON, SIIERIFF

(6(11) 403-2500 Fax (60 \) 403-2344

To: The Honorable Board of Supervisors of Pearl River County, Mississippi.

Please acknowledge upon the minutes the following personnel matters concerning the Sheriffs Department:

Please hire Erin MacDonald as a full time dispatcher effective July 9,2010 at a pay rate of $12.10 per hour. She is replacing Brandy Seals.

Thank You,

David Allison, Sheriff

In Gad IVe Trust

005

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 6 DECLARATION OF FORFEITURE Date 7/ 6/2010

ORDER TO ACCEPT FORFEITURE AND ADD VEHICLE TO COUNTY INVENTORY

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of forfeiture from the Sheriff's Department.

Upon the motion made by Sandy Kane Smith and seconded by Patrick Lee, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to accept the attached Declaration of Forfeiture under Mississippi Law from Pearl River County Sheriff's Department and the 15th Circuit Court District Attorney's Office and add vehicle to the County Inventory.

Declaration of Forfeiture:

Christopher Edward Rhody

Vehicle:

(1) One 2004 Dodge pick Up Model 6000

Vin 1D7GL12K14S545005

Declared that the above described property is forfeited under the provisions of Mississippi Law to the Pearl River County Sheriff's Department receiving eighty (80%) percent and the 15th Circuit Court District Attorney's Office receiving twenty (20%) percent of the proceeds of the property from the sale thereof. (See attached documents)


Voting AYE: Anthony Hales, Joyce Culpepper, Patrick Lee, and Sandy Kane Smith

Voting NAY: Hudson Holliday

PAGE 5

'" _. _. 00']

PEARL RIVER COUNTY SHERIFF'S DEPARTMENT DAVID ALLISON, SHERIFF Boor. 0144 P'9" 7

(601) 403-2500 ~'ax (601) 403-2344

June 29, 2010


Please acknowledge upon the minutes the following matters concerning the Sheriff's Department:

Attached, please find a copy ofa Declaration of Forfeiture regarding seizure ofa vehicle. Please add to inventory.

Seized From Christopher Edward Rhody

Thank you,

Description ofltem (I) One 2004 Dodge Pick Up Model 6000 Vin 1D7GLI2KI4S545005

Q (,,,.°fPrM David Allison, Sheri

in God We Trllst

~,.

VO/I.OII.Vj,V r\U" ;11.)Q J'ltA OU'" 'tU,J ".);).) l:n::n U.l tJ'j'l<.l \.:1' 1\'.1'1'Y ....... KIHHtU\ tgJU U l/ U Ui! c::ne..

DECLARATION OF FORFEITURE Soak 0144 f'~9. B

STATE OF MISSISSIPPI !

COUNTY OF PEARL RIVER

WHEREAS the Pearl River County Sheriffs Department, on the 8th day of APRIL,

2010, in Pearl River County, MISSissippi, seized from CHRISTOPHER EDWARD RHODY

property descrlbed as ONE (1) 2004 DODGE PICK UP, MODEL 6000, VIN

1D7GL12K14SS4S00S which property has an approximate value of $ 6,375.00 and

WHEREAS notice has been provided to parties as required by law, and

WHEREAS there was no petition to claim an interest In the property or to contest

the administrative forfeiture in the manner or within the time provided by law, Now,

therefore, be it

DECLARED that the above described property is forfeited under the provisions of

Mississippi law to the Pearl River County Sheriffs Department and the 15th Circuit Court

District Attorney's Office, to be used or disposed of according to law with the Pearl River

County Sheriffs Department receiving possession of the vehicle and the 15th Circuit Court

District Attomey's Office receiving 20% of the proceeds of the property from the sale

thereof.

SO DECLARED on this, the dJ'!!aay of JUNE, 2010.

-t/}f)dJ/t1/I fh I t/wI &16 LAUREN BARNES HARLESS ASSISTANT DISTRICT ATTORNEY 15th Circuit Court District Attorney for the Forfeiting Law Enforcement Agency

•

STATE OF MISSISSIPPI COUNTY OF PEARL RIVER

This day personally appeared before me, the undersigned authority in and for the state and county aforesaid, the above named Lauren Barnes Harless, Who solemnly and truly declared and affirmed before me that the matters and facts set forth in the foregoing Declaration of Forfeiture are true and correct as herein stated.

Affirmed and subscribed before me on this the"day of JUNE, 2010. .............. ~ .... or MISs/. ". i. tiL ~ /~.··!iu·ip··~~~··. ~dJ

/t:t~o~ ~I):.{;\~\ OTARY PUBLIC ;*;0 NOTMYPU6UO~: ~

MY COMMISSION EXPI~E~~':'" i ! \. ~ ......... ~ ... "'., ... c;l'.: ... / ./

" .............. .' '. A/VEfI .' ..................

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 10 VEHICLE TRANSFERED TO PRC HOSPITAL Date 7/ 6/2010 GED INVOICE ADD TO DOCKET

ORDER TO DECLARE VEHICLE SURPLUS AND TRANSFER TO PEARL RIVER COUNTY HOSPITAL AND NURSING HOME

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of transfer of vehicle to Pearl River County Hospital and Nursing Home.

Upon the motion made by Patrick Lee and seconded by Sandy Kane Smith, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to declare attached vehicle as surplus and authorize transfer of vehicle to Pearl River County Hospital and Nursing Home as follows:

1993 Chev GC1 Vin 2GCEC19K5P1200958

Be It Further Ordered to authorize Clerk to remove said vehicle from Sheriff's Department Inventory.


Voting AYE: Anthony Hales, Joyce Culpepper, Hudson Holliday, Patrick Lee, and Sandy Kane Smith

Voting NAY: None

ORDER TO APPROVE GED TESTING INVOICE

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of GED Testing invoice.

Upon the motion made by Patrick Lee and seconded by Joyce Culpepper, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to authorize GED Testing invoice from Pearl River Community College for $224.00 to be added to Docket for payment.



Voting NAY: None

PAGE 7

\

June 29,2010

PEARL RIVER COUNTY SHERIFF'S DEPARTMENT DA YID ALLISON, SHERIFF

(6(H) 403-2S00 Fax (601) 403-2344 Book 0144 rag.


11

Please acknowledge upon the minutes the following personnel matters concerning the Sheriff s Department:

Please be advised the following vehicle will be assigned to the Pearl River County Hospital and Nursing Home. Also, please remove from the Sheriff's Department Inventory.

1993 Chev GCl Vin2GCECI9K5PI200958

Thank You,

David Allison, Sheri

III God We Trust

01/

~.: ,,," r· I

, Form 79·001-05·7·'·000 sr A TEOiF iVllSSaSSlf''PJ OBlG1NAL

VEHICLE IDENTIFICATION NUMBER MAKE YEAR MODEL BODY TiTle NUMBER

2GCEC19K5P1200958 CHEV 1993 GCl PC E933129-01

DATE OF FIRST SALE PASS. TITLE DATE FOR USE NEW ONLY NO.CYL NEW I USED TYPE OF VEHICLE OR GVW

06262008 08

OWNER

PEARL RIVER CO SHERIFF OFFICE 200 S MAIN ST POPLARVILLE MS 39470

1ST LIENHOlDER lOR OWNER IF NO LIEN)

PEARL RIVER CO SHERIFF OFFICE .200 S MAIN ST p.oplARVILLE MS 39470

2ND UEM-IOLOEA

X TRUCK 000 Book 0144 P'9~

ODOMETER - TENTHS NOT INCLUDED

000000

EXEMPT FROM DISCLOSURE REQUIREMENTS

DATE:

MONTH I DI,Y I 'lEAR

DATE:

MONTH DAY YEAR

12

1ST LIEN _____ ---,;'''''''''''".---------- (UEIIHOLOER) BY-----~,,=,,=,~=v=,,~~=~~"'=~~I----THIS ___________ _ DAyOF ________ __

2ND L1EN _______ === _______ _ liJEllii&iIeR)

THIS ________ _ DAYOF _______ _

CONTROL NUMBER

IN WITNESS WHEREOF I HAVE HEREUNTO SeT MY HAND THIS

THE 26 OAYOF JUNE 08176239033

20 08 00213

COMMISSION

V"'_"v..·-<- I~

20 __

20 ___ _

Th" M:ni$sippi S!ahl Ta..c ~ommiS$iQf\ hereby carN,es that on eppfcation rJv:y made. the persoo nam60 tleleln is reg..SI&ft)d bV Ih;s OffiCe- as the lawful Q\YIler 01 Ih~ vehicle d~scribed 5!Jbjecllo the liffiS <.>r secun!y inlel&SI~· iii!' may sub$~tIo:ntJy ba ~led .... i1h the State Tax COmrr.I$~on. ThIs certorICate 01 tille is issuedpursuant 10 the 1.·tss~51PllI Molor Veh;~le TiI'e law Stcbor. 1>3·21·1, MisSl5$ltJpl Code 01 1972. and sublec1 10 the provisions 1ilereDf

.. ~ ...... ' ..

PEARL RIVER COUNTY SHERIFF'S DEPARTMENT DAVID ALLISON, SHERIFF

(6(H) 403-2~00 Fa> (601) 403-2344

Book 0144 PJ9' 13

June 29,2010



Request for payment of Pearl River Community College, Invoice # 176 for GED Test Administration.

Please make check payable to: Mail to:

Thank you,

So.8~ Davi d Allison, Sheri .

GED Testing Services in the amount of $224.00 PRCC Business Office 101 Highway 11 N Poplarville, MS 39470

In God We Trust

013

PEARL RIVER COMMUNITY COLLEGE MISSISSIPPI'S PIONEER COMMUNITY COLLEGE

- ,~,: •• -. ~ •• .;.' • "1\ .• ".-" '. '. -.! ......... .

INVOICE

TO:

INVOICE # 176 DATE: JUNE 1, 2010

Pearl River County Jail Attention Major Flowers 513 North Jackson Street Poplarville, MS 39470-2001

FOR: GED Test Administration

P.O. #:

DESCRIPTION AMOUNT

GED Test Administration, May 17 & 18, 2010: $224.00

5 full tests @ $40 = $200.00

2 partial tests @ $12 := $24

TOTAL $224.00

Make check payable to GED Testing Services. Mail to PRCC Business Office at 101 Highway UN, Poplarville, MS 39470.

If you have any questions concerning this Invoice, contact Dr. Ann Moore, 601-403-1098 or Judy Smyly, 601-736-8389.

101 Highway 11 North. Poplarville. Mississippi 39470.601-403-1000· Website: wlVlV.prcc.edu

O}~

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 15 SIGN COPS TECHNOLOGY GRANT APPLICATION Date 7/ 6/2010 CHANGE MCRAE DR TO RAMOS DR

ORDER TO AUTHORIZE PRESIDENT TO SIGN COPS TECHNOLOGY GRANT APPLICATION

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of COPS Technology Grant application.


Be It Ordered by the Pearl River County Board of Supervisors to authorize President to sign attached COPS Technology Grant application.



Voting NAY: None

ORDER TO APPROVE PRIVATE ROAD NAME MCRAE DR TO CHANGE TO PRIVATE ROAD NAME RAMOS DR

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of private road name McRae Dr.


Be It Ordered by the Pearl River County Board of Supervisors to approve request of property owner of McRae Dr to change the private road name to Ramos Dr. on the recommendation of Planning & Development Director.



Voting NAY: None

PAGE 9

June 29,2010

PEARL RIVER COUNTY SHERIFF'S DEPARTMENT DAVID ALLISON, SHERIFF

(601) 403-2500 Fax (601) 403-2344

Boof: 0144 Pag"



In and for your consideration, approval for signature of COPS Teclmology Grant.

Thank You,

David Allison, Sheriff

[11 God lVe 'Ii'list

[6

COPS Technology Grant SUBGRANT APPLICATION PACKAGE

all

•• • ., .l '__ ~ ~. ~ •• ' •• - • - •• - • • - ••• ,'.

-". . ...

Mississippi Department of Public Safety Division of Public Safety Planning

3750 Interstate 55-North Frontage Road Jackson, MS 39211

(601) 987-4990

'-:'," ' 0.15

- - STATE OF MISSISSIPPI DEPARTMENT OF PUBLIC SAFETY

DIVISION OF PUBLIC SAFETY PLANNING

SUBGRANT APPUCAnON SUMMARY

1. Applicant (Name, Address, Zip, Telephone)

pe.arl River Co S.O.

2. Project Director (Name, Address, Zip, Telephone) 3. Flnanctal Officer (Name, TItle, Address, Zip, ------- - --- ----- -oelejlliOhey 1M&i~141f%9<S 18_

4.

Poplarville, MS 39470 601-403-2500

COPS

Poplarville, MS 39470 601-403-2500

200 South Main Street poplarville, MS 39470 601-916-6455

6. TYpe of Application 2M Yr. orO __ Yr. Funding 7. Desired Project Duration Three (3) Months

o COnUnuatJon of Grant No.

B. Brief project summary To reduce the opportunity for crime within our communi ties, by providing more visibility of deputies throughout Pearl River County. With the requested technology, it will give -the deputies more time in the neighborhoods rather than in the office reports, etc,

Catego!y

a.

a!. Fringe Benefits

b.

c. Constructlon

d. Travel

e. Operating

g, Miscellaneous

10. Source of funds federal % St/LocaIMatch % Total

Anthony Hales CIllef Administrative Officer (Type or PrInt)

Board of Supervisors, President

, PrOject Director ( Ignature and Date) _

II ',7 ; - c:--/ '" <':-,--\C ip/-a:;«:· '7 ~ 6 0- Zeit!

financial Officer (Signature and Date)

%

B. UIPMENT:

I H 1m", pROWer N 100fT

REQUESTED ·BUDGET

. Ap~k6\iEb;" .. ISi!D!i$f'

STATE OF MISSISSIPPI DEPARTMENT OF PUBLIC SAFETY

DIVISION OF PUBUC SAFElY PLANNING

BUDGET SUMMARY

'. !llII1.GETCATEGORL ' .. 'RE_QUESTED BUDGET

76 432.36

1$76,432.36

SUMMARY FUNDING DATA

Federal % . State/LooaI % Total

$76,432.36 100 $0.00 0 $76,432.36

. ,

01'1

opSP . USE ONLY'

%

100

'" "

" ; ,

I· .~~~~ j . .:, , " . I' !

! I ! PART IV. i !

STATE OF MISSISSIPPI

DEPARTMENT OF PUBLIC SAFETY DIVISION OF PUBUC SAFETY PLANNING

-." .. -.-_ ... _.' ....... , .. '~ .... ~.-.. ,.,.,

olfOGET NARRATIVE (liinlt 1 page)

A, PERSONNEL TOTAL: NONE

B, EQUIPMENT TOTAL: $76,432.36

$53.494.56 - 21 Rugged MDT's for patrol @ $2,547.36 each

Book 0144 Pa9~ 20·

19,412.40.21 Docking stations for computers wI mount hardware & adapter' @ $924.40 each

2.579,87· 1 Rugged MOT for patrol @ $2.579,87 945,53 • 1 Docking station for computer wi mount hardware & adapter, .

C, CONSTRUCTION TOTAL: NONE

D. TRAVELCAOST:NONE

'. 'O~b . ,~'.

DPSP. USE

. ONLY

GENERAL

INSTRUCTIONS FOR COMPLETING BUDGE NARRATIVE (DPSP Form A-4a)

o~,

The purpose of this form Is to provide (ull explanation, andjuslificatlonfor all Items budgeted to support project activities, After using DPSP Form A-4-b, add as many 81{2" x 11" continuation pages as necessary,

~EravideJbeJnformation-"equ/red.below.ln.the.order-and-fonnat-s/iown.--+raAsfeHet-aIs·RrBtfflgeKttmma,nl yr, -~---~~~

A, PERSONNEL: % of Time

Name of Devoted to Date EmRI~ee Title Proj§!;!; Hired xxxxxxxx xxxx xxxxxxxx xxxxx

Show Computations for totals here, Including all other Information needed to derive the toals on the right,

Salary Rate

xxxxx

+

+

+

Soc, Sec, Match

xxxxxxxx

Total Salaries & Wages

Total Soc, Sec, Match'

Total Retirement Match

Total other

Total Personnel

~et.irelJ1ent Match

XXXXXXXXXX

Book Q144 Page 21

Other Fringe Benefits

xxxxxxxxxxx

$,---

$,----

$_--

$

$0,00

Justify low the above relate to project activities in the Project Plan, If the employees are not to be hired specifically for this project, but will be transferred from other duties, explain how the resulting vacancies will be filled,

B, EQUIPMENT: (list each non-expendable Item to be purchased as show below), Item Quantity Unit Price Total Price

SEE ATTACHED Total Equipment $ 76,432,36

... ' )14St!fy low the. above relatEhto.project activities. in -the Project:.Plan" ~x~lflin .what 9tePS'V0U have 10ken,'or wil~ take; to 1r1$Uic' that , , you receive the best value for least cost, conSistent with State and Federal Purchasing Regulations,

c, CONSTRUCTION: Total Construction $ 0.00

Explain and justify costs to be Incurred and relationships to project activities In Project Plan,

D, TRAVEL: (See the Division of Public Safety Planning subcontractor Travel Policy, to determine allowable expenses, Travel expenses Incurred by consultants are to be Induded In the Contractual Services budget category),

Show computations here, including number of trips expected, number of personnel Involved, and all other Information needed to derive the to10ls show on the right,

lustify and explain the need for the travel as 'elated to project activities in the Project Plan,

To101 Mileage

+ Total Commercial Carrier

+ Total Meals

+ Total Lodging

+ Total Other

= Total Travel

$

$

$

$

$ 0,00

$

, .

PARTV.

. ". '" .-


DEPARTMENT OF PUBLIC SAFETY DIVISION OF PUBLIC SAFElY PLANNING

BUDGET NARRATIVE

BUDGET NARRArniE(CONT.) .

Sook 0144 Page 22 E. OPERATING EXPENSES: NONE

F. CONTRACTUAL SERVICES TOTAL: NONE

G.1flSCELLANEOUSTOTAL:NONE

H. OVERHEAD: NONE

TOTAL PROJECT COST: $76,432.36

. .:.:. .. " ..... - ... .c· ...•. ,. . .'~"

DPSP USE

ONLY

E. OPERATING EXPENSES:

Show computations here, Including all information needed to derive the totals show on the right.

Total Supplies $ _____ _

+ Total Rental $ _____ _

+ Total Printing & Reproduction $ _____ _

+ Total communlcatioJrk 0144 r'9" l3 ------(Telephone, Postage, etc.)

+ Total Other $ _____ _

= Total Operating Expenses $,.,0,;..0;;,;0;;,,'====

Justify and explain each of these expenditures In relationship to Project Plan. '

F. CONTRACTUAL SERVICES:

Ust by type and name (If available) each Individual consultant of firm to be engaged In Total Contracts with Individuals project related activities. Include proposed fee rates, cost of expenses and travel, and the + Total Contracts with organizations amount of time to be devoted to such services. Fees are limited to a proven = Total Contractual Services reasonable rate not exceeding $135 per day or $16.87 per hour.

$_--

$_---

$ 0.00

Justify and explain In relationship to project activities In the Project Plan. This section must contain the selection basis for any contract or prospective contract mentioned.

G. MISCELLANEOUS: .•••••• ""_._....,......._ .• _.~_~~~~'~. ~.~,~ ••. "" • ...., •• 0< •. ' ,"" >,

Total Tuitions Show computations here, Including all Information needed to derive the totals show on the right. + Total Training materials

+ Total Other

= Total Miscellaneous

Justify and explain relationship to project activities In Project Plan.

OVERHEAD:

Show computations here. These costs cannot exceed 10% of direct labor cost (including fringe benefits) or 5% of total project cost unless there Is . Total Miscellaneous a documented approved rate.

• ':' " ~ • 0' •••••• • '. _-~ .'., _ -, - -", •

$_--

$_--

$_--$ 0.00

$0.00

Justify and explain relationship to project activities in the Project Plan, subgrantee administrative services, structure and 'olley, and specific services provided by the "Overhead" category. 1. TOTAL PROJECT BUDGET:

$ 76,432.36

. , ,

, ......... '" .. --.


DEPARTMENT OF PUBLIC SAFETY DIVISION OF PUBLIC SAFETY PLANNING

EQUAL EMPLOYMENT OPPORTUNITY COMPUANCE

DPSP USE

ONLY

PART VI.

A. The Pearl River County Sh~riff I s Department (Applicant) hereby certifies that It has formulated an Equal Employment Opportunity Program In accordance with 28,CFR42,301, et seq., Subpart E. Of the Code of Federal Regulations, and that It Is

8,

on flie in the office of Adrian Lumpkin (Name) Poplarville. HS 39470 (Address) County Admoni:strator (Title), for review

or audit by officials of the Division of Public Safety Planning or the Office of Justice Programs, U. S. Department of Justice as required by relevant laws and regulations.

Book 0144 Pa9' 24

• ~ '.' •• .:...'- ••••• , • • J<. • •• - ..... ~. , ..... • .:.... ....", .......... __ .' •• _ .... l '. • " •

. The' (Applicant) herebycertifles that it is in compliance with the terms and conditions of 28 CFR42, 301, et seq., and is not required to file an Equal Employment Opportunity Program.

I


DEPARTMENT OF PUBLIC SAFETY DIVISION OF PUBLIC SAFm PLANNING

"NON"SUPPLANT-CERTIFICATION,

DPSP USE

ONLY

I Book 0144 PO"_ 2S

The PMrl Riv~r 'County Sh~riff I B D~partment (Applicant) hereby assures that Federal funds will not be used to supplant State or local funds and that Federal funds will be used to supplement existing funds for program activities and not to replace those funds which have been appropriated for the same purpose.

Signature: (Chief Executive Officer)

Title:

Date:

... .;.,: .. -... ..... . -."

DPSP Form A-5 (July 1990)

-',

MEMORANDOM

TO: Anthony Hales, President and Board of Supervisors

FROM: Sandy Peters, E911 Coordinator, E911 Addressin~ 0144 Pas. 26

DATE: June 29, 2010

SUBJECT: McRae DrlRamos Dr, request for existing private road name change

This office is presenting a request for the new property owner(s) of McRae Dr to change the private road name to Ramos Dr. Attached you will find the signature and a parcel map of the property owner who recently purchase the property.

sp:

Attachment

cc: Adrian Lumpkin, County Administrator

PEARL RIVER COUNTY ROAD NAME VERIFICATION FORM

PRIVATE

Requested Road Name: RAMOS DR --------------~~~~~--------------

Supervisor: ________ '-P::;at::.:ri;::ck.:..;L"'e:.::e'--______ _ Unit: __ ....:.4 __

Map Location: __ ---!T~5S:::..:.:R.!.:18::.:W.!-. __ Section: 26

Dlrecllons: From: ____ .!.P.:.:.IN:.::E:..:G;::R.:.:O""'V:.::E:..:R..::D~ ___ To: ___ :.::Mc::C.:::SWE.:..:..==.ENc:..:..:Rc::D __ _

Go approximately ___ .=;60::..;4,,-7 ___ Feet on Right to private gravel road.

Address: 9 MCRAE DR PICAYUNE

Post Office: ____ '-PI"'ca"-'yc::u"'ne~ ____ Fire Department: ___ .:...P.::.;inc;;.e..;;G",ro;.:.v.o.e_-4-"7..:;0 __ __

Community: ____ W:..::..:Al::.:K~IA~H~lC::_ ___ GraveVPaved: _____ -=G.:.:ra:.;.ve:::I ____ _

Tax Parcel Number: 5187260000000600 --------------~~~~~=----------------

Comments (subdivision, number of reSidents, etc.):

REQUEST PER NEW PROPERTY

E-911 Addressing Office Employee Signature: SANDY PETERS

Received: 6/28/10 Approved: Filed:

, ). ~

;~;: .',:.,

~ .:':.)~" \.

~~;t·:

PEARL RIVER COUNTY PETITION OF PROPERTY OWNER(S) FOR PRIVATE ROAD NAME

:: n'ate: J.une 25,2010 Book 0144 P'9& 28 ',.. i!' " I.':~·;

:l. .~~ l? ' ...... :.:'. 'J',:;fIlWiie'tition must be signed by all tbe property owner(s) whose property adjoins the new private road. "' ..... : .. ': . ' ...... ,'. ',"

;. Once the road name has been approved and addresscs assigned, thc property owncrs are responsible for . purchasing and erecting a road sign within 30 days in accordance with the Pearl River County Enhanced · 911 Ordinance. Non-Compliance may result in a $50.00 fine.

';;:,The signs shall be blue with white reflective letters .

.. . ,The road name cannot be more than fifteen (15) characters, including spaces. , .' · request tbe following private road namc:

I (we) the property owncl'(s)

,; .i'.:. l '~: ,-: ! I. : RAMOS DR .' .,.

;'

·,t.:,I.:::.: " I,.(we) understand the reason for this request is to improve the emergency response to my (our) residence

[;,;.t~.th;a.:~~ ... my (our) c~rrent address Is snbject to change. ~=

,\i'''IJl\i'' •... ~~£-, . ~ ~ ,:--~~t~~-:·, .. ..!),-·-··, Signature Signature

X:/ "RiCARDO RAMOS ..::C:::R:=.Y.:::.ST::..:AL..:=:.;RAM=~0c=S::.v:::-::;-___ _

·.;;::L~::: 1~'9Ii1c~/J}'moll So"', 4;1.\, \313 q Ma. 'fu!!,NS:t~'~ · "", .Address Pl10ne Address

· ;;',.:; '5 ~ 87260000000600 ' 5187260000000600 (', . '.f .;,~ i.':: . Tax Map Paice\ Number Tax Map Parcel Number .... : .... ,

, ::lh' --------;0--,---------.~ ::-. Signature ',' \ \.,

',' .

:;:.' ;;., ------,N':'".-m-' P,..n:-'n-ied.,---------

Address Phone

: ~ Tax Map Parcel Number

r ,: :.,' •

;:~.'ili:':·'i\~:,.,~\r",-.. ~----;;:S,..ign--'~~tu-re---------~:' "(:

~-----Nua~me~pnI·n~le~d----------

.•.. Phone · '.' Address , .

I ax Map Parcel Number

1'.

Signature

Name Printed

Address

Tax Map Parcel Number

Signature

Name Printed

Address

Tax Map Parcel Number

70 <1, 'lor .cr 'Z 'Z-Phone

Phone

Phone

,: 'The Pearl River County E-911 Addressing Office has checked and approved this road name for use per the Pearl River County . :Elihanced 911 Ordinance.

· :.~ignarure Date

\FOR OFFICE U E ONLY :: ;'p,ECEIVED: APPROVED: FILED:

" . ':.":." .

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 29 WASTE TIRE GRANT Date 7/ 6/2010 SEMI-ANNUAL AWARD TO LOWEST BID

ORDER TO AUTHORIZE PRESIDENT TO SIGN WASTE TIRE GRANT

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of Waste Tire Grant.

Upon the motion made by Patrick Lee and seconded by Hudson Holliday, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to authorize President to sign attached Waste Tire Grant.



Voting NAY: None

ORDER TO AWARD SEMI-ANNUAL BIDS TO LOWEST AND BEST BID

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of Semi-Annual bids.

Upon the motion made by Hudson Holliday and seconded by Sandy Kane Smith, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to award Semi-Annual bids to lowest and best bid as attached.



Voting NAY: None

PAGE 11

ATTACHMENT A MISSISSIPPI DEPARTl\1ENT OF ENVIRONMENTAL QUALITY

ATTN: INVOICES P. O. BOX 2369

JACKSON, MS 39225

REOUEST FOR PAYMENT

Name of Recipient Pearl River County Grant Agreement NO._fil'l.LT3-'"3"'4"-___ _

Address Board of S!lpervisors Person preparing report: Anita Sumrall

P D. Box 569 Telephone number: 601-403-2303

Poplarville. MS 39470 Request period: FromJ. -26-10To 5-17-1 0

1. Amount of this payment request:

2. Total amount of grant:

3. Total prior payments approved:

4. Total funds requested to date (line I plus Ii"e 3):

5. Balance of grant funds remaining after this request (line 2 minus line 4)

$ 5,350.63

$ 40,000.00

$ 26,982.30

$ 32,332.93

$ 7,667.07

TO BE COMPLETED ONLY IF REClPlENT IS PROVIDING FUNDS TO THE GRANT PROJECT.

6. Total funds to be contributed by recipient:

7. Amount contributed by recipient to date:

8, Balance to be contributed by recipient (lille 6 minus line 7):

$_-----

$,-----

$_-----

r hereby certifY that the amount requested is for reimbursement of allowable costs consistent with'the terms of this agreement, that request for reimbursement of these costs has not previously been made, and that the amounts requested herein do not exceed budgeted amounts stipulated in the award,

NOTE: Please attach appropriate documentation that supports this payment request (for example, payroll records for Enforcement officer, billing records, volume of tires disposed, volume of solid wastes disposed, location of solid waste sites cleaned up.

~~~~~~ ~Lt~~=J~ ____ _ ~~

Anthony Hales, President, Board of Supervisors Typed Name and Title of Authorized Official

July 6. 2010 Date· -,

9

30

SEMI ANNUAL BID RESULTS JULY 1 2010 -DECEMBER 31 2010

~pecifications for limestone! gravel, and s~nd.I _____ _ ___ =::J ----1-1 SECONDARj - ----------1-----All materials shall be in accordance with the requirements of the Mississippi --- , l'

Stll!1d.f1.~d SpecificationsfurState Aid Road and Bridge Construction latest edition. _' ________________ _ II

==~-_-__ -_-_=========;IM~·A;.RtT;INI~M~A-~~R~~I~E~T~T~~A~_~~I-~------~-------I-~~====-I-----I----I---~ ..-c::-::=::-::-______ I-;;A"'G"'G"'R;;Eo-;G"'Ac.,TcyE'-'S'----- _____ -·----I----Boo '-OI44-P'9~- 31,----1 Limestone PER TON 1 I~~=~~-~----- ~~"--'-''-=-'-+i----I-------- -----------.-- ----------------Delivered Railside -------1----1----1-----·--1----+-----1-----1 7 Picayune $ 10.75

$ -~----+;------I------~-----+-----+-------I

5/56 Picayune 8.75 I~~~~-------r.-~~H----,----------I----~----I----I-----I 89 Picayune $ 10.75 ! 7 Carriere··-------i'--;$:----:;1-;:c0.-;;;75"" .. ·--------I-----I:----f-----I-----I

5Ts6Car~------!· $ 6.75 I~---- _-_ ----.:---------+Ii=======t_ -_ ---------:...---·+·--------===-1 89 Carriere j $ 10.75 -'-_. ________ _ ~prices will be quoted aJJime on del. ---I-----I----t----I-----I

______ . __ . ______ +-=====+_:======-~-I---==~~==-~--= --==----==-=11-=-=====--.11=======:======-=1 I--------·---I------I-I-----j ·--·---·--------1----·-1+---1,----.-----. -------r----I-----f-----I _._-------------1------- - -----+'------1-------·- -.----- ------------------ ·------~-r-----~-___ -_+I----I---.---_ ----________ 1

-----------t------++----i------I------f--I ---+-----1-----1 ---------~------·-I-.~------I---~---I----I----I

! A&B, ; I-------·---:----I+,;~~.._;,---+_---+---- ------------1

I TRUCKING [ Limestone Loaded/Hauled Only Per Ton ~---~----+I----+-.--~~~~~-=fl=-~~~~~~~-=: From railside !~. ! I -f-----I-.---.---Load & Haul to County Barn in Millard I 1 Unloaj froiO-railsid!!.. onto county truck - - $ 1.50__ 1-------11:----1--_-__ -_::::::+--

1

_-_----

:=_------- .-------.=~--.-.. ~ ==== ___________ .. ______ ' ______ =-______ t 1 SOUTHGATE ! BLACKWELL

1--------------1..1 AGGREGATE_S --: AGGREGf\:rE~"'-~ __ =-=== I

--.. -- Per Ton i Delivered loaded on I Per Ton Delivered loaded on =----:-,.-,=--;-----------H-F~O~B..,P"'la:-::n-;:-ti:'P"'e"-'r'-;-to"'n-=m-=-;;-ile :=c~o~,~tr~u"::ic'-'kt~:::!I~F~O~B~p~I"::a"-'n~t:~:pC'e~r':'..ct~o"-'n:,,-~m~ilEl·---=C-=-o,,--,t,-,ru,-,ccck._

$ 2.50! .. ----I------.-.Lt.. 2.50 .20fTN/MILE _1~$-~5c'cO~0~---~----~I~$,--7~.O~0~1~·~20~fT~N~/M~I~LE~ ______ I

$ 13, 75 ; ____ II~ __ . ___ --;I--'$~_'__11'C,0'_'0' __ F'2"-'O"-fT'-'N-"'/M=IL.::.E----1 ___ $ 14,00 i. __ -+ ______ fl--"$'---1":'4"'.O"'OF'2""OfT'-'-'-"N/"M .... IL--rEc..... ____ _

--:-----1.---.-----------:-----1---.-----1----1 t ____ --+~ __________ I------- _1----1 1

Gravel, Sand Wash Sand Pea Gravel , -----Road Gravel ! .--

i ---

Wash Gravel San~y~lay ! --------

, ------

;

SEMI ANNUAL BID RESULTS JULY 1, 2010 • DECEMBER 31, 2010 '~~~_I-~~-I

~~ticationsf~~ridgeLU~ber, Elgllipment Rental I I '--'--,\; ; Ii_ ~~~ __ I-~~~I

Equipment shall be furnished with fuel, ope rater, and swamper. All workmanshie shall be In accordance with the applicable edition of Standard Specifications for State Aid Road Construction. The contractor shall furnish to the county certificates of workers compensation and generalliabili!y Insurance prior to commencing work. _____ .. __ ~~_ ---8ook-014 -P-"I1"-32-

1 I .

31) x6" 3" x 8'1

---~.

3" X 1011

; --311 x 12" r , Stringers: 6" x 12" x 16' I 6"x 12"x 18'

! ._ .. ! $ 690.00 $ 815.00 $ 855.00

-------1 $ 650.00 I $ 725.00 $ 775,00 $ 825.00 ~~~~--~~- --$ 650:OO'i $ 805.00 -$ 855,00- -$ 905.00

~ .. ~.

$ 795.00 I $ 925.00 $ 975.00 $1,050.00 i I

-----:------·----~~I--~I---.------I

! , i 1--6" x 12" x 20' I

Caps: ,

I I

I-=--"-"'--"--=-~+__~~--~+_~~~~~-c_~----:-~--I----.. --- -----1 I

12" x 12" x 18' I 1211 x 1211 X 20'

12" x 12" x 22' 1~~~~-I------4---~----I---I~--~--~,--~1 I

Piling: _____ I_~~_I~~~-I-~~~+i~~~-1 12"butt & 8" tip minimum class b pile, 20' to 50' 1----1 ___ . F--'-----~------~-~I~--.~.-------------~

---"---I_~~~-=--=--=--=-'::=.LI~~~~~-=-~~~-=--'::I'--==---=--=--:_-_-=--=--=-.-_-:1_-_--_ -_ -_ -.,:11_--_ -_ -_ -_ -_ -_II ~. County Furnished Piling - (14" x 14") ~_~ __ ~J_~~_l~~~_I_~~~_I-_-__ -

$ • I per foot to drive pilinQ and set caps

SEMI ANt:!UAL BID RESULTS JANUARY 1..JUNE 30, 2010 I . 1 ... I i 1 ____ ._ I i

1. ASTM F-405, Siandard Specification for Corrugated Polyethylene Pipe and Fittings. 2. ASTM F-667, Standard Specification for Large Diameler Corrugated Pol~eth~lene Pipe and Fittings. 3. AASHTO M-252, Standard Specification for Polyethylene Corrugated Drainage Pi~J ___ -:: 4. AASHTO-M-294, Standard Specification for Corrugated Polyethylene Pipe, 12" - 48" diameter. 5. Pipe lengths: Available in 20' lengths - 8"-48" T

Available In 24' lengths - 12"-36" ,

I Available in 30' lengths - 12"-24" ___ J-I DIAL G&O Supply

SUPPLY T Diam_~t~~---lJ:ipe perift CouplinQs . Pipe perlft! Couplings JI."._ $ 2.45 $ 3.80 $' - 2.93-$- 3.84 I

---- ---. 1011 !$ 3.85 $ 5.25 $ 4.10 $ 5.28· Bool: 0 ti..l'o~L_...3 -12" ! $ 4.95 $ 6.67 _L .. _~:~.Ll_ 5.95 ---15" ;$ 6.90 $ 11.00 $ 6.18 $ 9.91

1811 I: 8.75 $ 18.00 $ 7.70. $ 16.87

24" 14.65 $ 26.50 $ 13.00 $ 23.79.

30" 1$ 21.50 $ 63.00 ..

$ 20.37 • $ 55.31 ;

36" !$ 27.25 $ 87.00 $ 24.98 $ 76.96 ! 4211 1$ 40.25 $ 128.00 $ 36.65 , $ 112.64 i 4611 $ 47.00 $ 150.00 $ 41.00 $ 132.23

60n $ 89.54 $ 199.61

----- _.

Received bid from Contech Construction Products for galvanlzec!.pJ!le.

Received bid fromHanson PirPrecast bridge comeonen~c __ 1 _ . -See Attached for above bids. I

OFFICE SUPPLIES SEMI ANNUAL BID July 1 - December 31, 2010 ·Southern Lawrence M&M

- QTY' ----__ :,l!ystems . Printing Prlntlng __ .

CHANCERY CLERK , General Index to Deed

----- '-r--'--I $ 693.00 $ 725.00

General Index to Deed of Trust [$ 693.00 $ 725.00 8-112 x 14 Book binders Wllndex i$ 125.00 $ 128.00 Above W/O Index ~$ 78.00 $ 85.00 General Chancery Docket ;$ 650.00 $ 580.00 -Index to Uniform Comm. Code Book 1$ 650.00 $ 580.00 General Transfer Docket !$ 650.00 $ 575.00 11 x 14 Trial Docket 500 $ 65.00 $ 59.60 Section Index Binders ;$ 398.00 $ 288.00 3 Styles,.Sectionallndex Binder ! __ ~OOI $1,200.00 $1,250.00 t.oor.-ill 4 Pag' 34

Homestead Binders #278-19 jEA $ 82.00 $ 100.00 8-1/2 x 14 Recording Paper I $ 160.00 $ 156.00 Civil Fee Bills ;10/BKS $ 169.00 $ 170.00 Filing Recording Abstract Fee Bills i10/BKS $ 169.00 $ 170.00 Casebinders Legal iEA $ 1.73 $ 1.80 Casebinders Letter :EA $ 1.73 $ 1.80 Land Owners Notices $ 69.00 $ 70.00 Lien Owners Notices '---:T- 69.00 $ 70.00 ---- -Affidavits for Uen Owners ! $ 69.00 $ 70.00 Billing Invoices I $ 69.00 $ 70.00 Receipt Book .$ 250.00 $ 242.00 Uniform Arrest Books [10/BKS i $ 223.00 Uniform DUI Books [10/BKS ! .' $ 242.00 1AASummons [$ 69.00 .$ 62.00 Proof of Service Summons ---- i$ 55.00 $ 62.00 Form 1 C Summons b~ Pub. $ 55.00 $ 62.00 Recording Statement 500 $ 90.00 $ 90.00 .-Stationer}' 1000 $ 59.00 $ 58.00 CIRCUIT CLERK Criminal Cost Bill $ 168.00 $ 170.00 Civil Cost Bill [ $ 168.00 $ 170.00 --Civil General Docket I $ 600.00 $ 580.00 State General Docket i $ 600.00 $ 580.00 Marriage Record [ $ 595.00 $ 580.00 ._----Judgement Roll $ 660.00 $ 580.00 Registration Binder $ 80.00 $ 380.00 8-1/2 x 11 Circuit Court Binders [$ 125.00 $ 185.00 8-1/2 x 11 Recording Pap_er 1000[ $ 160.00 $ 152.00 8-1/2 x 14 Election Binder [$ 125.00 $ 185.00 Juror Info Sheet 10001 $ 109.00 $ 110.00 Marriage Certificate · !$ 450.00 $ 440.00 Ap~tication for Marriage License 1000i $ 148.00 Certificate Attendance Election Worksho~ 1000[ $ 118.00 Voter Registration Binder [$ 250.00 $ 218:00 Voter Registration Sheets , 1000[ $ 400.00 $ 400.00 Stationery · 1000[ $ 65.00 $ 78.00 •

JUSTICE COURT [ 1 Criminal Jackets i 25001 $ 320.00 $ - $ 305.00

35

Federal Wage Garnishment 1000 $ 84.00 I $ ---, SHERIFF 4 X 6 Prisoner's Jail Record 1000: $ 70.00 $ 68.00 Complaint Card 5 x 8 1000! $ 70.00 $ 68.00 $ 50.00 RunawaxlWanted Person Card - 1000i $ 70.00 $ 68.00 $ 60.00 Article .Entry Form 10001 $ 70.00 $ 68.00 $ 60.00 ,_.

Stolen Vehicle Form 1000 $ 70.00 $ 68.00 $ 50.00 ,-_ .. _---_ .. Stolen or Recovered Gun 1000 $ 70.00 $ 68.00 $ 60.00 Field Interview/Observation .~Ilport 1006 ''$ 70.00 $ 68.00 $ 55.00 tljlflearance Bond 1000 $ 200.00 I $ 218.00 I Incident Report .. 1000 $ 190.00 $ 195.00 I Voluntary Statement 1000 $ 190.00 $ 195.00 I $ 1 \I§,!)(), Su~plementary Report 1000 $ 190,00 $ 195.00 I Ball Bond 1000 $ 200.00 $ 218.00 I Waiver of Initial A~pearance 1000 $ 190.00 $ 195.001 $ 165.00 Gun Docket $ 585.00 $ 648.00 I Process Docket $ 585.00 $ ,

EXecution Docket $ 585.00 $ 680.00 Receipt Books 1000 $ 240.00 $ 238.00 $ 250.00 Jail Docket 1$ 585.00 $ 680.00 Daily Meal Logs 10001 $ - $ 196.00 ,

I FINANCIAL DEPT L ___ . Req uisition Book 1000 $ 200.00 $ 196.00 , ..,L'§OO.OO_ , -_ .. -Receiving Book 1000 .$ 200.00 $ 196.00 $ 600.00 Receipt Book 1 ree/book -'1000 $ 189.00 $ 196.00 ! Recei~t Book 3 ree/book 1000 $ 189.00 $ 196.00 i Purchase Order Docket $ 500.00 $ 268.00 i Count)' Depository Checks 10M $ 118.00 i Payroll Checks 10M $ r-----118.00, Stationel)' $ 65.00_1 $ 90.00 I

I TAX COLLECTOR Tax Collector Journal $ 200.00 $ 268.00 .Daily Cash Sheets 1000 $ 200.00 $ 218.00 ~rtifications on Mobile Home 10001 $ 215.00 $ 230.00 Homestead Cards 10001 $ 178.00 Stationerv 5001 $ 65.00 $ 90.00

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 36 AWARD ASPHALT & EMULSION BID Date 7/ 6/2010 PAY JH&H INVOICE ON DOCKET

ORDER TO AWARD ASPHALT & EMULSION TO LOWEST AND BEST BID

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of Asphalt and Emulsion bid award.

Upon the motion made by Hudson Holliday and seconded by Sandy Kane Smith, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to award asphalt and emulsion to lowest and best bid as attached.



Voting NAY: None

ORDER TO APPROVE PAYMENT ON DOCKET TO JH&H ARCHITECTS

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of JH&H Architects invoice.


Be It Ordered by the Pearl River County Board of Supervisors to approve payment to JH&H Architects for $90,250.00 on Docket.



Voting NAY: None

PAGE 13

1 1 1 1'1

hQ~U~A~RC=T""EROCL~yc-'B=I""D-=R"'E'"S-:-c!U L TS JU L Y 1, 201 O-S Ej>!~T"'E=M"'BC=E=R-3!~1 ,~2~0~1 O~ 1-~~-bMl;"Ql4n. r-:!7~

Specifications ~or ASPhalt,' Sand, Gra~el' an~~mary . Alternate .. : .

All Materials shall be In accordance with the reqUirements of the Mississippi Standard Specifications for State Aid Road and Bridge Construction latest edition. 1 J. F' i

1 I ! ___ I-__ + ___ ~ 1------. Warren Paving , Huey Stockstill __ +: ___ +1 ___ 1 ____ 1

FOB FOB; -...J _,' ____ 1_. ___ 1 ___ . Plant .. Delivered In Place Plant Delivered

. (Rlus haul) . Jplus haul) _ ----l------HOlmix711.~phal. $ . 57.00 I $ . 57.001 $ 79.20. $~6..:.00 .. -- I ~_I-~~--'~~_._ Cold MIX $ - ,$ .. . $ - $ -Hotmix SC·2 $ 59.00 $ 59.00 i $ 81.55 i $ 58,50 1

Hotmix SC-1 $ 57.50 $ 57.50"$79:75'. $ 58.50 ....LI~-·~ .. --._._-_-;~ __ _ Hotmlx BC-1 $ 55.50 $ 55.50 $ 80.00 ~ $ 53.00 I·---_~~..,i ___ ._:~~~.I-~~-I Holmix BB·1 $ 54.50' $ 54.50 $ 77.30 $ 53.00 - : ___ ~i_. __ +_---I HotmlxAsPhal $ 53.00 $ 53.00 $ 76.10 $._53.0ti-!=,--==~._~+t ~~_I'--~-I Tac (gallon) . $ 6.00 $ - $ 7.00 $ 3'~C::0_1--,!:$'---·~+--~~-l--~~-1.~~-1 Rip Rap i $ 34.85 $ - $ • _. $ • ..I-~~-I-~~--+-~~-I Haul per lon/mile . 17/lon/mile I .. ~~~~~~-I-~~-,~~~+---~-I--~~~--~"-~---I-~~Above In Place per ton

i : I !

1-~~~~I~s~o~U~TH~LA~N~D~--~I~-~-_~~~~~tl~~~"~~'I-~~-I-~._--,!~ __ ~ I-~~-~~~=+'-"-~-'~~--j·

~_'~_'I~O~IL~ I -_ ... Per Ga I 'u _______ _

Delivered FOB Plant. ____ . I

i~!r;;:: . i ;~;;;; I'! ;~;;;; -. -.. ~=~.-~-=I=--.-~~~__= RS-CRS $ 1,8039 '$1.7619 F CRS-2 $ 1,8039 i $ 1.7619 ' -" -. I':;;C~Ro.:;;S-;;.2';;:P~-+~f· 2.0286 $ 1.9866 I I I

I"S .... S--'.1 ___ I,$· $. ..~_.-ii~ ___ I I I! I I I I

I----i---I----~-----I i 1-----1

31

36

INVOICE FOR ARCHITECTURAL SERVICES Project: 2 Story Building Redesign Date: 18-Jun-10

Pearl River County, Mississippi Invoice Number: 10·0147

To: Pearl River County Board of Supervisors Attn: Mr. Adraln Lumpkin Architect's P. O. Box 569 Project Number: 05·137E Poplarville, MS 39420

In accordance with the Owner·Architect Agreement of October 23, 2006, there Is due at this time for Architectural Service on the above project, the sum of Ninety thousand two hundred fifty and noI100 ........ • .... ·($90,250.00). The above amounts shall become due and payable UPON RECEIPT

INTEREST ON OVERDUE ACCOUNTS SHALL ACCRUE AT TEN PERCENT (10%) PER ANNUM.

Basic Services Fee Bidding Phase· 2 Story Building

Fee Thru Bidding (Jay-Van Low Bidder):

$4,760,000.00 x 10% Fee = $476,000.00 $476,000.00 x 5% Bid Phase = $23,800.00 $476,000.00 x 20% Construction Admin Phase = $95,000.00

Fee Thru Construction Admin Phase (95% Complete): Book 1)144 P"y' 38 $95,000.00 x .95 = 90,250.00

TOTAL DUE THIS INVOICE $90,250.00

()ort- /& z -

Thank you for allowing us to serve youl

ARCHITECT: JH&H ARCeJCTS PLANNERS INTERIORS, P. A.

PffltJ ~»-a) BY: J. { arl Franco, AI'A, Principal ADDRESS: 37(. o I-55 North, Suite 200, Jackson, MS 39211-6323 Phone:601·948-4601

I •

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 39 COLLINS & NULL APPRAISAL LETTER Date 7/ 6/2010 MEMA REIMBURSEMENT #86

ORDER TO APPROVE COLLINS & NULL APPRAISAL ENGAGEMENT LETTER

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of Collins & Null Appraisals.


Be It Ordered by the Pearl River County Board of Supervisors to authorize President to sign attached Collins & Null Appraisals engagement letter on the Highland Commons Access Road Project.



Voting NAY: None

ORDER TO ACCEPT MEMA REIMBURSEMENT #86

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of MEMA reimbursement #86.


Be It Ordered by the Pearl River County Board of Supervisors to accept attached MEMA reimbursement #86 for $22,508.78.



Voting NAY: None

PAGE 15

Pearl River County

6760 US Hwy 98, Suite 2 Hattiesburg, MS 39402 601-271-9044 (T) 601-271-9099 (F)

ENGAGEMENTLETIER BOOK 0144 Page 40

clo Adrain Lumpkin, Jr. Pearl River County Administrator P.O. Box 569 Poplarville, MS 39470

June 30, 2010

We can provide summary appraisal reports on the Highland Commons Access Road Project, located in Pearl River County, under the following conditions.

Terms:

Collection:

Conditions of Agreement

At this time there are only two parcels which require an appraisal. This contract is only for the appraisal work on those two parcels and does not include any fees for potential court cases. If any additional parcels are added or court related work is required a new contract will be required.

The hourly fee for the project will be $11 Olhour for appraisal work and $150lhour for depositions, court testimony, and other court related work. A maximum cost not to exceed is based on an estimated maximum of 40 hours per parcel or $8,800 for both parcels. We will only bill for the time allotted and this would represent a cost not to exceed for the initial appraisal work.

The client will provide the following items:

Aerial Photo - Received Title Opinion - We will request from Chris Howdeshell Construction Plans - Received R.O.W. Plat with Aerial Photo - We will request from Dungan Eng. Site Plans or Costs to Cure estimates by engineer (if needed)

The total fee will be due within 30 days of delivery of the report. A late fee of 1.5% will be added to the unpaid balance 30 days after the invoiced date. If the total invoice amount is not paid in full by 60 days, the invoice will be turned over to a collection agency. If this action is necessary, the collection agency will charge us a 50% fee for their services. Therefore, a

Changes:

Cancellation:

Environmental

Engineering

50% fee will be added to the total unpaid invoice amount. The total fee mentioned above does not include court testimony or public hearing appearances.

If the client requests changes, the appraiser must be notified in writing. Changes may result in changes to the terms outlined in this engagement letter and may require a new contract, an increased fee, or a time-based fee that will be added to the original fee. Book (lj4i Pa9" 41

If any files are deleted or changes to the project are made we must be notified immediately. For any unfinished appraisals we will submit an invoice for the professional time and expenses that have accrued.

Unless we are provided a phase one or other environmental report that states a specific problem, our values will assume no environmental problems exist with the subject properties.

Unless we are provided a engineering report that states a specific problem, our values will assume no engineering problems concerning utilities, drainage, roadways, wetlands, or any other engineering problems exist with the subject properties.

If you agree to all of the above outlined terms, please sign below to engage our services. Thank you for this opportunity to serve you.

Should you have any questions, please contact our firm at (601)271-9044.

* Any cost estimales, site plans or engineering reports will be provided by Dungan Engineering or anolher englneeringfirm al no cos( (0 Collins and Null Appralsa/s.

Sincerely, j::J ~ ~~ Georgew.~ Licensed Certified General Real Estate Appraiser, GA-679

Client:

Accepted By:

Date:

Print Nameffitle:

Tax In #:

fI.,!tot.y dJl/ ?/tP$,;j~f t.V,tooo 9§d-.

STATE OF MISSISSIPPI HALEY BARBOUR, GOVERNOR

MISSISSIPPI EMERGENCY MANAGEMENT AGENCY

moMAS M. "MIKE" WOMACK EXECUTIVE DIRECTOR

Mr. Adrian Lumpkin County Administrator PEARL RIVER COUNTY nos PO Box 569 Poplarville, MS 39470

RE: PEARL RIVER COUNTY BOS FEMA·1604-DR-MS # 109·99109·00 Hurricane Katrina Federal Share plus Administrative Costs Payment for Reimbursement #86

Dear Mr. Lumpkin:

June 24, 20 I 0

Boof: 0144 P~9~ 42

We have been recently infonned that the MS Department of Finance and Administration electronically made a financial deposit into the Pearl River County BOS's bank account. According to the attached documents a deposit in Warrant #C0011844946 in the amount of $22,508.78 which represented payment of the Federal Share plus Administrative Costs as shown on the enclosed MEMA PA-4 form was deposited. To assist us to complete our records, please contact the department/section, which has the knowledge and documents to verify that this amount was deposited, so that you can sign and return this acknowledgement receipt letter.

If you have any questions, please contact Mr. Larry Bowman, State Public Assistance Officer, at the Mississippi Recovery Office (MSRO), Mailing Address: 220 Popps Ferry Rd., Bldg. A, Biloxi, MS 39531 at telephone number 228-594-3197.

Enclosure

'--""-Thomas M. "Mike" Womack Governor's Authorized Representative

This acknowledges receipt of Warrant #COOI J 844946 in the Hurricane Katrina which was deposited into the BOS 's bank.£<'I(o)l~

,,'-"":..--

1/~ J 10 Date . A rian Lumpkin, C

Pearl River County BOS

POST OffiCE BOX 5644 • PEARL, MISSISSIPPI 39208·S644 • PHONE 601-933·MEMA EMERGENCY 1·800-222·6362 t24 HOUR)

TDD 1·800·445·6362

FOR'! 11.20'.10 REV. 7-1-89 STATE OF MISSISSIPPI

PAYMENT VOUCHER

06/16/10

TO: DEPARTMENT OF FINANCE & ADMINISTRATION JACKSON, MISSISSIPPI filE COpy

TO SETTLE CLAIM 'AS SHOWN BY INVOICE OR EVIDENCE OF CLAIM ATTACHED, ALL FOR GOODS RECEIVED OR SERVICES RENDERED FOR THE USE AND BENEFIT OF THE STATE, CBARGEABLE AS FOLLOWS: ____ ~ _________ h _______________________ ~ _______________ ________________________ _

BATCH NOM: PV 721 EM1741

PV DATE: ACCTG PRD:

PV NUMBER: PV 721 16040007105

BUDGET FY, 10 ACTION: E PV TYPE: 1 OFF LIAB ACCT: FA IND:

EFT FLAG, C VENDOR CODE: V000012002 0 HIPAA VENDOR NAME: PEARL RIVER CTY BOS

AnDRl: BOARD OF SUPERVISORS

SCII PAY DATE: DOCUMENT TOTAL:

FLAG: N SINGLE CHECK VEND PAYMENT

PRIVACY ADDR2: POBOX 569 ADDR3: POPLARVILLE MS 39470

22,508.78

FLAG: BOIlk 0144 Pa9~ TYPE: FLAG: Y

LN -----REFERENCE----- COM NO CD DEPT NUMBER LN LN

VENDOR INVOICE

SUB APPR ACTI FUND DEPT ORG ORG UNIT VITY

-- ----------~---- ---SUB REV SUB PROJ/GEN REPT B/S,

OBJ OBJ SR9 REV NUMBER CATG ACCT. ACCOUNT

NUMBER

01 64260

DESCRIPTION

CONTRACT #

109-99109-00 RQ86 PW6297

AMOUNT' RBC DATS

16040007102 3729 721 2400 KATR

22,508.78

NAME OF DEPARTMENT: EMERGENCY MANAGEMENT

CERTIFICATION

I/O P/F LOC

2725 SUBG

I HEREBY CERTIFY THAT THE ABOVE CLAIM IS JUST, DUE, CORRECT AND UNPAID, THAT THS GOODS SOLD OR SERVICES RENDERED HAVE BEEN DELIVERED OR PERFORMED IN GOOD ORDER AND THAT ALL STATUTORY REQUIREMENTS COVERING THE AYMENT OF THIS CLAIM HAVE BEEN COMPLIED WITH, AND I NOW REQUEST ISSUANCE OF PARTMENT'S DISBURSEMENT WARRANT IN PAYMENT THEREOF.

COUNTERSIGNED BY' __________________ --(IF REQUIRED)

SIGNED BY: __ -b~~~~~~~~~~

TITLE: _________ _ TITLE : _________ -'<--+ __ DISTRIBUTION: DEPARTMENT OF FINANCE & ADMINISTRATION, VENDOR, DEPARTMENT

43

state of Mississippi Application for

Request for Reimbursement For Public Assistance Funds

Request Number:

Declaration:

Type of Request:

Federallb Number:

Vendor No.:

ATTN: Adrian Lumpkin, County Admlnslrator Period Covered By The Request:

Name: Pearl River (County) BOS From: Aug 29, 2005

Address: PO Box 569 To: Jun 10, 2gJ& 0144 Pa'le Poplarville, MS 39470 Prepared By: Ivy Lacy

Phone: 6014032302 Package(s) Included: 210

Included in this Payment PW Fed Share Paid Admin Paid Federal Total Paid

6297 $22,396.80 S111.98 $22,508.78

Tolal $22,396.80 $111.98 $22,508.78

·Governor's Authorized Representative: I certify that the amount claimed on this voucher is correct and payment has not been received.

Amount Approved: $22,508.78

Thomas M. "Mike" Womack Date

Remarks:

86

1604

Partial

109·99109·00

VOO00120020

44

State Share Paid

SO.OO

SO.OO

This Request Is for the Federal Share plus Administrative Costs for One (1) Large Project, CategOl)' B (Federally Funded at

100%) PW# 6297·1 for Emergency Protective Measures.

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 45 APPROVE JUNE BOARD MINUTES Date 7/ 6/2010 APPROVE POLL WORKER TRAINING CHECKS

ORDER TO APPROVE JUNE 2010 BOARD MINUTES

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of June 2010 Board Minutes.


Be It Ordered by the Pearl River County Board of Supervisors to approve June 2010 Board Minutes.



Voting NAY: None

ORDER TO APPROVE POLL WORKER TRAINING CHECKS

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of poll worker training checks.

Be It Ordered by the Pearl River County Board of Supervisors to approve poll worker training checks for election held on June 1, 2010.



Voting NAY: None

PAGE 17

OJ!. GLMCLH17 06/30/2010 16:12 PEARL RIVER COUNTY 2009-2010 Docket of Claims

Release date from 01/01/1901 thru 01/01/1901

SUMMARY' OF ALL FUNDS

FUND 1 ClAims 2SS3 to 2872 Checks

Tot~ fo~ 411 Fund$ Checkr;

10 "Iotal 24.0.00 Mimuill Hold Total

10 'rotal 240.00 Manual Held Tot.cr.l

- J J2.;-,..;ri "N) -TUp...-J",-c:-.L irJ

~+,,-(L =h~/<:- $. ,'550 <2-d...-

~op- ~I"'!.=-+j'o-J (,,(11,0

"/\GE 2

240.00

240.00

= o o ~

<0 ---";:J '0 ,~

-~

..r: ~

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 47 APPROVE CDBG FORMS AND INVOICES Date 7/ 6/2010

ORDER TO AUTHORIZE PRESIDENT TO SIGN CDBG REQUISITIONS WITH INVOICES AND CASH REQUEST FORMS

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of CDBG requisitions with invoices and cash request forms.


Be It Ordered by the Pearl River County Board of Supervisors to authorize President to sign attached CDBG requisitions with invoices and cash request forms on projects listed below:

CDBG PROJECT NUMBER 1123-06-055-PF-01 MILLARD Casablanca Construction $104,973.10 Sample & Associates $ 5,200.00 JH&H, Dungan & Advertisement $167,047.88

CDBG PROJECT NUMBER R-103-055-01-IKCR CHIMNEY Jay-Van Company Sample & Associates

$244,975.00 $ 16,500.00

DHS/JUSTICE Invoice #3 Invoice #5 Already Paid

SQUARE Invoice Invoice

#16 # 4

CDBG PROJECT NUMBER R-103-055-01-KED Dungan Engineering $

HIGHLAND ACCESS ROAD 29,941.12 Invoice # 5

Be It Further Ordered to authorize Clerk to issue checks.



voting NAY: None

PAGE 19

Post Office Box 320278 1013 NORTH FLOWOOD DRIVE FLOWOOD, MISSISSIPPI 392JZ

TO:

FROM:

DATE:

RE:

Book 0144 P.~~ 48

Sample & Associates, Incorporated

MEMORANDUM

Adrian Lumpkin

Sibby Lewis

06/29/10

CDBG.REQUISITION WITH INVOICES CASH REQUEST FORM

PHONE, (601) 932·9050 FAX, (601) 932·0231

Please find attached requisition, with invoice(s), and cash request for approval. Please return a copy of the signed requisition form, and the original cash request. (signed in two (2) places) to

our office.

Thank you for your assistance and please call if you have any questions

PEARL RIVER COUNTY Bool: 0144 Pa9~ 49

CDBG REQUISITION FORM

REQUISITION NUMBER: __ -,--3 _ CDBG PROJECT NUMBER: 1123-06-055-PF-Ol

DATE: July 6, 2010 CDBG BANK ACCOUNTS NO: ___ _

PAYABLE TO: AMOUNT:

Casablanca Construction $104,973.10(CDBG-$67,275.71 County$37,697.39

JH&H Architects, Dungan Engineering Advertisement $167,047.88(County Already

Paid)

Sample & Associates $ 5,200.00(CDBG)

o l!J Document G702™ - 1992

'. "

Application and Certificate for Payment TO OWNER: PEJIRL RIVER COUNTY BOARD PROJECT: DHS 1 Justice Court Building APPUCATION NO: 3 Distribution to:

= ~ OF SUPERVISORS P.O. BOX 569

153 Savannah Millard Road PERIOD TO: 06117/10 OWNER 0

g POPLARVILLE MS 39470 Poplarville

FROM CON~CT0RcASABLANCA CONSTRUCTIONY!A ARCHITECT: ~

::; #fJ THOMAS lANE ~ HATTIESBURG MS 394027911

Q = CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shCJwn below. in connection with the Contract. AlA Document G703™. Continuation Sheet, is attached.

1. ORIGINAL CONTRACT SUM ..................... ".......................... $ 2 796 000 00

2. NET CHANGE BY CHANGE ORDERS .. ::.......................... $ 000

3. CONTRACT SUM TO DATE (Une 1 ± 2) . ...... ............. ...... ........... $ 279600000

4. TOTAL COMPLETED &STORED·TO DATE (Column Oon 0703) ...... $ 33095000

5. RET,'IINAGE: 3. % 9f GPmph:ted Work ~m';; D + E on 0703) $ 16,547.50

b. ~ % of Stored Material rCdlumn F on 0703) $ 0.00

Tabl Retainage (Lines 5a + 5b, or Total in Column 1 ofG703)...... S 1654750

6. TOTAL EARNED LESS RET A1NAGE (Line 4 minus Line 5 TOlal)

7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ..... (Une 6 from prior Certificate)

8. CURRENT PAYMENT DUE ....... .

9. BALANCE TO FINISH,INCLUDING RETAINAGE (Line 3 minus Line 6)

CHANGE ORDER SUMMARY.,

Total changes approved in previous months by Owner $

Total approyed this month $

TOTAL $

NET CHANGeS by Change Order $

$ ~14A0250

$ 2Q9,12fL1 Q

CL 10497310--J

$ -2,481,597 50

ADDITIONS DEDUCTIONS

n nn $ nnn

nnO $ 000 non $ 0.00

nnn

MS 39470 CONTRACT FOR: ARCHITECT 0

CONTRACT DATE: 02101/10 CONTRACTOR 0

PROJECT NOS: 83 1 FIELD 0

OTHER 0

The undersigned Contractor certifies that to the best of the Contractor's knowledge., information and be1iefthe WorJycovered by this-Application for Payment has been completed ill accordance with the contracyoocumen~, --t all amounts have been paid by the Contractor tor Work for which previo~ €c:nif'icates P~ment were issued and payments received from the Owner. and that current pI:0}i~t sbo-,o h rein is now due.

'/ij By: f l(jI/If;ffi# Sta/,: J1,) t: Date: k' //7;;'

rl

Omnty of: {..fPY!&V"" Subscribed and sworn to before 1...- {)

m. this (7r- day of J'-"V- 8 OJ

r>--' j -'-C:::::::-:-~Le ( -, Notary Publi~-& My commission expires: A __ ,

~\"." :)"', 90/1

ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents. based on on-site observations and the data comprising this applicaticlfi, the Architect certifies to the Owner that to the best of the Architect's knowledge, infonnation and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.

.1,0 (Attach explanation if amount certified differs from the amount applied. initial 19ures on Ihis Application and on the Continuation Sheet that are changed to conform with the amount certified.)

ARCH EC 1 By: Date: ok (-20l to

ificate is n(}t negotiable. The AMOUNf C RTIFlEO is payable only to thc Contractor lerein. Issuance, payment and acceptance 0 yment are without prejudice to nny rights of er or Contractor under this Contract.

CAUTION; You Siloutd sign;Jn original AlA COlltr.lct [)ocument, ()I) which this text am)ears ill REO. An original assures tII:lt chanfjes will not he .>bscnrc-d.

AlA Document G702T/1O -1992. Copyright e 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of ArChitects. All rights reserved. WARNING: TI~is AlA .... OOcUI1I8,n is prut.'.Ch .. d hy tl.$. C"P:1fiul,t U.w and In1ew;;lti0I1 .. 1 ·rreaties. Unauthorizt!d rfipfoouction 01' distribution of this AJA~ Ooculn~I'l, or ,my porlion of It, !nay rOl>ull in wvora civil and crimi,1al pCllatties. "hut will bi! ~HO$ecllted to ttl» IH:,xhmull I:Xt.::'I{ posslblo und&r the- l:low. Purchasers are permltted to tcproduce ten (10) copies of this document when completed. To report copyright "rolatlons or AlA Contract Documents. e-mail The American Instilute of Archllects'leg3l counsel, [email protected].

-lO AlA Document G703lM

- 1992 Continuation Sheet AlA Document G702™, Application and Certification for Payment, containing Contractor's si~d certification is attached.. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contract~here variable retainage for line items may apply.

'" '" "-

o

APPUCATION NO: 06117/10 APPLICATION DATE: 06/1711 0 PERIOD TO: 83 ARCHITECT'S PROJECT NO:

A a: C DIE F G H I :s WORK COMPLETED TOTAL ..:.::. MA TERlALS COMPLElED <) BALANCE ... ~g, SCHEDULED FROM PREVIOUS PRESENTLY AND ST RED YII TO RETAINA(JE

ITEM DESCRlPTI"", OF WORK VALUE APPLICATION THIS PERIOD STORED TOD1'TE (G+C) FINISH (lj,",iabunote) NO. (D+£) (NalmDa,E) (D+£+F' (C-G) 1 8 NOS & INSURANCE 28713.00 28713.00 0.00 0.00' ;."r:;-i M 1no nn 000 14.~5.6L-

2 C NTINGENCY ALLOWANCE 20000.00 0.00 0.00 0.00 0.00 0.00 20000.00 0.00

3 MDBILIZATION & SETIJP 4246.00 2000.00 200.00 0.00 2200.00 51.81 2046.00 110.00

4 . E ~OPE CONSULTANT 30000.00 0.00 1000.00 0.00 1000.00 3.33 29000.00 50.00

"" LOWANCE .

5 U YOUT 9275.00 4000.00 2000.00 0.00 6000.00 64.69 3275.00 300.00

6 B ILOING LAYOUT 4841.00 2000.00 500.00 0.00 2500.00 51.64 2341.00 125.00

7 S PERVISION & MANAGEMENT 186542.00 4000.00 12000.00 0.00 16000.00 8.SS 170542.00 800.00

8 T MP. FACILITIES/CONTROLS 19325.00 1000.00 200.00 0.00 1200.00 6.21 18125.00 60.00

9 F1 ELS 19318.00 500.00 500.00 0.00 1000.00 5.18 18318.00 50.00

10 S ~S TAX 97860.00 7315.00 3737.00 0.00 11052.00 11.29 86808.00 55260

11 IN ERIM CLEANUP 9845.00 100.00 200.00 0.00 300.00 3.05 9545.00 15.00

12 FIIw- CLEANUP 9162.00 0.00 0.00 0.00 0.00 0.00 9162.00 0.00

13 ~UIPMENT RENT-'"L 15620.00 0.00 600.00 0.00 600.00 3.84 15020.00 30.00

14 NTRACTORS EQUIPMENT 46046.00 1000.00 0.00 0.00 1000.00 2.08 47048.00 50.00

15 S IL TESTING 4400.00 2350.00 0.00 0.00 2350.00 53.41 2050.00 117.50

16 C NCRETE TESTING 7600.00 0.00 700.00 0.00 700.00 8.97 7100.00 35.00

17 C EARING & GRUBBING SOOO.OO 8000.00 0.00 0.00 6000.00 100.00 0.00 400.00

18 Orr & FILL ON SITE MATERIALS lS000.00 18000.00 0.00 0.00 18000.00 100.00 0.00 900.00

19 IMPORT @ BUILDING" 10000.00 8000.00 0.00 0.00 8000.00 80.00 2000.00 400.00

~ IMPORT@PAVING 14000.00 SOOO.OO 0.00 0.00 8000.00 57.14 6000.00 400.00

,~~s """",,o.ou 94978.00 210." .uv v.uv 116615.00 20.64 448380.00 5830.75 GRAND TOTAL

CAUTION: You should sign an orioinaf AlA Contract Document. On which this text appears In REO. All otiDinal assures thl'lt chCllloes will not lie j)bscurcd.

AlA Doeumi&nt G71?3 .... -1992. CopyrightC 1963. 1965, 1966. 1967, 1970, 1978. '983 and 1992 by The American Institute of Architects.. All rights reserved. WAJ~NING: 'n~is AIA'"'l)"Ctll1ll;ml I~ ,.,ull.'Cl<.-<l by tJ.:>. c(.pyfigllt Law and btlo:-rnational Tro<:ttios. UII~ulhOti::Od mproductlon or dbWhuliQn 01 this AIA-DoCLIment. or any portion of it. may result in saV.,WIIt civH and ctimim.1 pt:nallll!:S. :lll)d will b". pro-:;'t;:ci1lcd to Ihe 1I\;..lldll1lll'l e):~eHI possible ul)der tho law. Purchasers aTe permitled to, reproduce teo (10) copies ot this document when completed. To report copyright violations of PJA Contract Doetlments, e-mail The American Institute of Architects· legal counsel, copyright@ala,org.

r( UL AlA Document G703'" - 1992

Continuation Sheet AlA Document G702TM. Application and Certification for Payment, containing Contractor'S signed certification is attached. In tabulations below> amountt1re stated to the nearest doUar. Use Column I on Contracts where variable retainage for line items may :apply.

A

ITEM NO.

I"" '"

B

~ ~

'" ~ = ~

DESCRIPTION it WORK

"""00 u," "ne.:>

22 U f..!ESTONE

23 C AYGRAVEL

24 0 WNPOUT UEADERS & DRAINAGE.

25 C NCRETE PIPE DRAINAGE

26 RI P RAP DITCH LINER

27 SI T FENCE & EROSION CONTROLS

28 FI ALGRADING

29 A PHALTBASE

30 A PHALT PAVING SURFACE

31 C NCRETE CURB & GUTTER LBR

32 C i'NCRETE CURB & GUTTER MAT

33 C jlNCRETE CURB & GUTTER EQUIP

34 P VlNG @ NORTH LBR

35 P VlNG@NORTHMAT

36 P VING @ NORTH EQUIP

37 P V1NG @ NORTH EAST LBR

38 P VING@ NORTH EAST MAT

39 P VING @ NORTH EAST EQUIP

40 P VING @ EAST PARKING Ll6R

41 P VING @EASTPARKING MAT

. Gru~&fu

C D I E WORK COMPLETED

SCHEDULED FROM PREVIOUS VALUE APPLICATION THIS PERIOD

(D+E)

OUUV,UV ".UV ".W 2000.00 0.00 0.00

2S00.00 0.00 0.00

4368.00 0.00 2275.00

7S00.00 3600.00 0.00

3000.00 0.00 0.00

3000.00 1000.00 0.00

4000.00 0.00 0.00

12767.00 0.00 0.00

5471.00 0.00 0.00

542208 0.00 0.00

9338.96 0.00 0.00

3436.96 0.00 0.00

1385.23 0.00 0.00

9201.95 0.00 0.00

1781.02 0.00 0.00

1639.17 0.00 0.00

10888.81 0.00 0.00

2107.50 0.00 0.00

1325.SO 0.00 0.00

9712.00 0.00 0.00

668842.18 99478.00 23912.00

F

MATERlALS PRESENTLY

STORED (Not in D Dr E)

".W 0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

APPLICATION NO: . APPLICATION DATE:

3 06/17/10

PERIOD TO: 06/17/1 0

ARCHITECT'S PROJECT NO: 83

G H

TOTAL BALANCE COMPLETED % TO AND STORED

TO DATE (G~C) FlNlSH

(D+E+P) (C- G)

".W v.w ww.w

0.00 0.00 2000.00

0.00 0.00 2500.00

2275.00 52.08 2093.00

3500.00 46.67 4000.00

0.00 0.00 3000.00

1000.00 33.33 2000.00

0.00 0.00 4000.00

0.00 0.00 12767.00

0.00 0.00 5471.00

0.00 .0.00 5422.08

0.00 0.00 9338.96

0.00 0.00 3438.96

0.00 0.00 1385.23

0.00 0.00 9201.95

0.00 0.00 1781.02

0.00 0.00 1639.17

0.00 0.00 10888.81

0.00 0.00 2107.SO

0.00 0.00 1325.50

0.00 0.00 9712.00

123390.00 18.45 545452.18

CAU'nOr-l~ You ~holiid si{ln an orl!1illa1 AlA Contract O()Cumt:lll, Oil VJlllch this text ap(l·e-<'l;rS i,l nED. An orinhl<A1 ;)SSUI\'!-S that charJ!)f:s will nut he: t)b~:urc.:1.

I

RETAlNAGE (II variable f(lfe)

v.w

0.00

0.00

113.75

175.00

0.00

SO.OO

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

6169'::0

AlA Document G703™ -1992. CopyrightC 1963.1965.1966.1967.1970.1978,1983 and 1992 by The American Institute of Architects. All rights reserved. WAI<NlNG: ·!'hi:;. AIA"DocIIII)'ml is ,).j.LOr.[.:;O hy U.:;. C;"l'yd{jld LaW ;lr • .:J Inlctl1Dtiom.l1 ]'r.:: •• tic::::. lJll:.utloori.:£:cd mp(o(ith!tiou .)r distribution ot tl,h,. AlA'"Oocur.)ent.l)r .. ny portion ,)f it. may I'<;:$llil ill ~ve.-" civil arid Gl'imillall~".::.Itios, <ltut wilt L(.I pru:::;ocutoJ 10 ih:: .,,<i)(I.1lI1111 1=!:ltrnl poss..ibl.:t l,ff(ler the !<lW. Purchasers are permitted !O reploduce ten (10) copks of this document when completed. To report copyright violations of AlA Contract Documents, e--mail The American Institule of Architeds' legal counsel. [email protected]'9.

cI) \.0 AlA Document G703

1M

- 1992 Continuation Sheet AlA Document G702™. Application and Certilication for Payment. containing ~ntractor's ~igxied certification is attached. In tabulatiotB below. amounts are stated to the nearest dollar. Use Column} on Contracts where variable retainage for line items may apply.

~

A ... B C D I E

:s WORK COMPLETED

= 0 SO\EDULED FROM PREVIOUS ITEM g DESCRIPTION OF WORK VALUE TIllS PERIOD NO. APPLICA nON

(0+£) !4? : "" "~"T : ~(" liP 17M ?? nM nM

43 P VING @ ENTRANCE LBR 1540.12 0.00 0.00

44 P V1NG @ ENTRANCE MAT 10643·34 0.00 0.00

45 P VING @ ENTRANCE EQUIP 1567.62 0.00 0.00

46 P V1NG @ EAST SIDE SOUTH LBR 1705.80 0.00 0.00

47 P V1NG @ EAST SIDE SOUTH MAT 11331.46 0.00 0.00

48 P VING@ EAST SIDE SOUTH EQUIP 2193.18 0.00 0.00

49 P VING @ WEST SIDE SOUTf! LBR 218126 0.00 0.00

50 P V1NG @ WEST SIDE SOUTH MAT 15374.09 0.00 0.00

51 P V1NG @ WEST SIDE SOUTH EQUIP 2220.21 0.00 0.00

52 P VING @ CENTER LBR 2217.32 0.00

I 0.00

53 P VING@CENTERMAT 15323.29 0.00 0.00

54 P VING@ CENTER EQUIP 2258.91 0.00 0.00

55 S IpEWALK CONCRETE 6278.00 0.00 0.00

56 S IPEWALK ACCESSORIES 4660.00 0.00 0.00

57 S IDEWALK FORMING & PLACING 9383.00 0.00 0.00

58 E UIPMENT PADS CONCRETE 1786.00 0.00 0.00

59 E UIPMENT PADS FORMING & PLACI 5224.00 0.00 0.00

60 S reEL GATE STRUCTURE. 1860.00 0.00 0.00

61 VI pOD FENCE MATERIALS' 2200.00 0.00 0.00 62 F NCE INSTALLATIONS 2820.00 0.00 0.00

"-Totals- 773312.00 99478.00 23912.00 GRANDTQTAL

- --

F

MATERIALS PRESENTLY

STORED (Not in D or E)

nM

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

'--

APPLICATION NO: APPLICATION DATE:

06/17/10

06117/10 ·pERIOD TO: 83 ARCHITECrS PROJECT NO: -,"-- --._- - - - ------ - ----

G H

TOTAL COMPLETED

BALANCE

AND STORED % TO (O-C) FINISH

TOOATE (O+E+F)

(C-O)

nnn JIM ~-

0.00 0.00 1540.12

0.00 0.00 10643.34

0.00 0.00 1567.62

0.00 0.00 17OS.80

0.00 0.00 11331.46

0.00 0.00 2193.18

0.00 0.00 218126

0.00 0.00 15374.09

0.00 0.00 222021

0.00 0.00 2217.32

0.00 0.00 15323.29

0:00 0.00 2256.91

0.00 0.00 6278.00

0.00 0.00 4660.00

0.00 0.00 9383.00

0.00 0.00 1786.00

0.00 0.00 5224.00

0.00 0.00 1860.00

0.00 0.00 2200.00

0.00 0.00 2820.00

123390.00 15.96 649922.00

'-- L.....

CAUTION: You should sign an oriQinal AlA Contracl Document, on which this text appea(s hI REO. An original assures that chanUes will not be ob$Cuj';~d.

I

RETAlNAGE (ljvoriabfe rote)

Jlnn.

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

. 0.00

0.00

0.00

6169.50

-

AlA Document G703™ -1992. Copyright(/:) 1963, 1965. 1966, 1967, 1970, 1978. 1983 and 1992 byThEI American Institute of Architects. An fightS rosorved. WAf(NiNG: Thb AIA ... I)oeu,II .... :ilt '~p'ot<:lt:ttld by U':::" CopyliiJht Law and Inte-rnatlon.1o' TrO<ltios. Ummtllodzed reproolJctiOll ordlstributioll or this AJ.A"'Document, or any por.tlon of it. may rC$ult in sevEI'l'o civil and crimln:lIl p&r\aUies. 3,.d will be proSij,:u\Q~ 10 th~ m:'l)dmum I:':(hmt possible uJld~r the b.w. Purchasers are permitted to reproduce len (10) copies of this document when completed. To report copyright vlOIaUOns of AlA Contract Documents, e-mail The Amerlcanlnstitute of Architects' legal counsel. copyright@ai:a.org. .

-:::r-iO -AlA Document G703™ -1992

Continuation Sheet ALA Document G702™, AppliCation and Certification for Payment,. containing Contractor's signed certification is attached. In tabulati~ below, aIhounts are stated to the nearest dollar. Use 'Column J on Contracts where variable rctainage for line items may apply.

~ ~

A '" B C D I E

::'!; WORK COMPI,fTED .~

g DESCRIPTION OF WORK. SCHEDULED FROM PREVIOUS ITEM VALUE APPLICATION TIUSPERIOD NO. = (D+E)

I "" , "rr,,, , "".w V.VU 0.00

64 T ~FFlC SIGNAGE INSTALlATION 428.00 0.00 0.00

65 S fRlPING 765.00 0.00 0.00

66 P (AN"TING MATERIALS 3364.00 0.00 0.00

67 S DMATERIAL 1062.00 0.00 0.00

68 P jANTlNG INSTALlATION 4015.00 0.00 0.00

'69 S DINSTAUATION 1592.00 0.00 0.00

70 A fw. DRESSING & SEEDING 3539.00 0.00 0.00

71 C PNCRETE@ SPOT FTGS & GR 14235.00 3000.00 11235.00 BfAMS

72 C NCRETE @SLAB ON GRADE 24660.00 0.00 5000.00

73 S OT FOOTINGS & GRADE BEAMS 29760.00 15500.00 14260.00

74 S ABONGRADE 28745.00 5700.00 14000.00 . 75 R INFORCING STEEL MATERIALS 8647.00 8647.00 0.00

76 P1ECAST CONCRETE 2400.00 0.00 0.00

77 M RTAR COMPONENTS 6467.00 0.00 0.00

78 M >.SONRY ACC. FLASHING&BARRIER 17916.00 0.00 0.00

79 M ~ ACC. FLASHING&BARRIER INST 6649.00 0.00 0.00

80 C NCRETE BLOCK 281.00 0.00 0.00 81 AI U.GROUND FACE BLOCK 14469.00 0.00 0.00

82 B ICK (ALLOWANCE @ 4001M) 23956.00 0.00 0.00

Gf<Aif9bl'0fAL 967220.00 132325.00 68407.00

APPLICATION NO: 3

APPLICATION DATE: 06/17/10

PERIOD TO: 06/17/10

ARCHITECT'S PROJECT NO; 83 ..

F G H

TOTAL MATERIALS COMPLETED BAlANCE

PRESENTLY AND STORED % TO STORED (G+C) flNt~H

(N(H in D Of' E) TO DATE (C-G) (D+E+F)

u.uu u.uu u.U" i38:w

0.00 0.00 0.00 428.00

0.00 0.00 0.00 765.00

0.00 0.00 0.00 3384.00

0.00 0.00 0.00 1062.00

0.00 0.00 0.00 4015.00

0.00 0.00 0.00 1592.00

0.00 0.00 0.00 3539.00

0.00 14235.00 100.00 0.00

0.00 5000.00 20.28 19660.00

0.00 29760.00 100.00 0.00

0.00 19700.00 68.53 9045.00

0.00 8647.00 100.00 0.00

0.00 0.00 0.00 2400.00

0.00 0.00 0.00 6467.00

0.00 0.00 0.00 17916.00

0.00 0.00 0.00 6849.00

0.00 0.00 0.00 281.00

0.00 0.00 0.00 14469.00

0.00 0.00 0.00 23956.00

0.00 200732.00 20.75 766488.00

CAUTiON: You should sign au Ofioiliai AlA Contract Oocume'It, on which mis text appears in REO. An ol'i{tinal a$SljfuS Hlal ch<tnges wiU not be oh:>cured.

I

RETAINAGE (lfvariab{e rate)

v.vu

0.00

0.00

0.00

0.00

0.00

0.00

0.00

711.75

250.00

1488.00

985.00

432.35

0.00

0.00

0.00

0.00

0.00

0.00

0.00

10036.60

AlA DOCument G703 ll11 _1992. Copyright ©1963. 1965. 1966. 1967, 197{,). 1978. 1983 and 1992 byTh& American InsllMeof Architects. All rights reserved. WAI'UJINC: 'Chis AIA"'l)O(;ut"ell[ b 1."O["" .. '1.,.\J hy IJ.~;. ell,lv-jul,! ldw and tnte'n<lti~~n31 Treaties. Unautho((.(ed reproduction or dis.triulJ\ioll of Chis AlA"" Documont. or any (')Ol1i.on of it. may (esull ill sC:v~rc civil 0],\(1 cri"lindll)C·Il<llli~. ,H)d will IJ.e wc,::.e.;uh!d 1\, Ih~ m;'j(i,J.UlI> ",~I<:Ht possibJ<:t und~( thO:l law. Purchasers are permitted to reproduc& ten (10) copies ortllis document when completed. ro report copyright violations or AlA Contract Documents, e-mail The American InstfMe of Architects'legal counsel, [email protected]. .

w. ,AlA Document G703T

• - 1992 Continuation Sheet AlA Document G702TM. Application and Certification for Payment. containing Contractor's signed certification is altached. In tabulatio~ below. amounts are stated to tbe nearest dollar. Usc Column I on Contracts where variable retainage tor line items may apply. •. •..

A "- R C D I E

:!; WORK COMPLETED

'" ~ SCHF.OULED FROM PREViOUS ITEM g DESCRIPTION OF WORK NO. = VALUE APPLrCA nON THlS PERIOD

(D+£)

83 ~ j"S0NRY 43710.00 0.1)'0 0.00

84 S RUCTURAL STEEL 155228.00 0.00 0.00

85 S jRUCTURAL STEEL ERECTION 52397.00 0.00 0.00

86 f- jtY GA CF MErAL FRAMING MATERI 29637.00 0.00 0.00

87 L GA CF MErAL FRAMING MATERIA 18974.00 0.00 0.00

88 E PERIOR WALL FRAMING 48200.00 0.00 0.00

89 II rrERIOR WALL FRAMING 27705.00 0.00 0.00

90 0 PWNSPOUT BOOTS 3883.00 0.00 0.00

91 o BOOT INSTALLATION 885.00 0.00 0.00

92 ·L DOER SUPPORTS 510.00 0.00 0.00

93 L DOER SUPPORT INSTALLATION 843.00 0.00 0.00

94 0 paR AND WINDOW BLOCKING 7822.00 0.00 0.00

95 R POF BLOCKING 7268.00 0.00 0.00

96 S EClALTIES & MILWORK BLOCKING 6860.00 0.00 0.00

97 J DGES BENCH & KNEE WALL FRAMI 2737.00 0.00 0.00

98 C rBINErS & VANITY TOPS 13802.00 0.00 0.00

99 P NELING & TRIMS 10623.00 0.00 0.00

00 S PUD SURFACE TOPS & SILLS 45n.OO 0.00 0.00

01 C f.sINET INSTALLATION 2000.00 0.00 0.00

02 P rNEUNG & TRIM INSTALLATION 3422.00 0.00 0.00

03 S \)LIO SURFACE INSTALLATION 2526.00 0.00 0.00

GR'A'NJl)IIlOO'A'L 1410809.00 132325.00 68407.00 -

F

MATERIALS PRESENTLY

STORED (Not in D or £)

U.UU

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00 .

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00


3 06/17110

PERIOD TO: 06/17110

ARCHITECT'S PROJECT NO' 83

G H

TOTAL BALANCE COMPLETED % TO ANOSTORED

TO DATE (G+C) FINISH

(D+E+F) (C- G)

U.OU u.uu 40/1V.UU

0.00 0.00 155228.00

0.00 0.00 52397.00

0.00 0.00 29637.00

0.00 0.00 18974.00

0.00 0.00 48200.00

0.00 0.00 27705.00

0.00 0.00 3883.00

0.00 0.00 865.00

0.00 0.00 510.00

0.00 0.00 643.00

0.00 0.00 7822.00

0.00 0.00 7268.00

0.00 0.00 6860.00

0.00 0.00 2737.00

0.00 0.00 13802.00

0.00 0.00 10623.00

0.00 0.00 4577.00

0.00 0.00 2000.00

0.00 0.00 3422.00

0.00 0.00 2526.00

200732.00 14.23 1209877.00

CAUTION: You should sinn;;an ori!Jinal AlA Contra<::t DOClimCllt, on whIch this text appears in RED. An original assures that Ch'Ul!JO~ will not be ohscured.

r

RE'rAINAGE (If variable ra1e:)

U.VU

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

O.CO

0.00

10036.60

AlA Document G703Y" -1992. Copyrighte 1963. 1965, 1966. 1967, 1970,1978.1983 and 1992 by The American Instllule of Architects. All rights reservod. WARNING: "his AIA""n()C~jjM'nt is prvtvctOld by U.S. CnpYliuht Law .. mllrlt~ruatlonal Treaties.. lh'autll<lri"cd repro..lucliOl. or dblribuliQn of this AIA"'lJocumeul. or 311Y pOitlOtl at it, may rO$1111 in s~ ... o:r<l clvll ~ml crifuiu; .. 1 ptlnallit:s, <l.1l.l will Lw pr~~cul~d h> th" .11;")(["'111" .:wt.:,,\ posslbl~ 11IIIJ<:r tho law. Purchasers are permitted to reproduce ten (10) COptcs of this document when completed. To report copyright violations of AlA Contract Documents, e-mail The Ametk::an Instltute of Architects' legal counsel. copyrigtll@aiaorg.

I

~. ~mu}J. ~ ~.~ TM '='AIX ~ Document G703 - 1992 Continuation Sheet AiA Document G702'fM. Application and Certification for Payment, containing Contractor's signed certification is attached. In tabulatio~below~ amounts are stated to the nearest doUar. Use Column Ion Contracts where variable retainage for line items may apply . ..

",.

'" A B C D 1 E

~ WORK COMPLETED c "'-0 SCHEDUl.ED FROM PRF.VIOUS ITEM gOF.SCRIPTION OF WORK

NO. VALUE APPLlCA TION THtS "PER1OD (D+E)

05 ~ ODIFIED ROOFING INSTAllATION 31388.00 0.00 0.00

OS ~ ETAL WN.L PANELS & METAL TRIM 16200.00 0.00 . 0.00

07 ~ ETAL WALL PANEL INSTALLATION 8037.00 0.00 0.00

08F ):lOFER TRAVELING & HOUSING 10980.00 0.00 0.00

E f<P 09 .( ):lMPOSITE METAL PANEL DESIGNID 2200.00 0.00 0.00

::~ ;~:~~~:~:r:P::~:~T 25225.00 0.00 0.00

5200.00 0.00 0.00

112 t.lASONRY CLEANING & SEALING 7185.00 0.00 0.00

13 t.I ASONRY CAULKING 124$.00 0.00' 0.00

14 S DEWALK & PAVING CAULKING 4034.00 0.00 0.00

115 f OLlOW METAL DOOR FRAMES 7925.00 0.00 0.00

116 f ~DOORFRAMESETTlNG 3208.00 0.00 0.00

117 f pLlOW METAL DOORS 1790.00 0.00 0.00

118 ~ 000 DOORS 19960.00 0.00 0.00

119 ( PORHANGING 1895.00 0.00 i 0.00 I

120 ( POR FINISH HARDWARE 24905.00 0.00 0.00

121 ( POR HARDWARE INSTALLATION 4958.00 0.00 0.00

122 } PCESSDooRS 367.00 0.00 0.00

123 } PCESS DOOR INSTALLATION 190.00 0.00 0.00

GRANT9Tl5TAL 1647837.00 132325.00 68407.00 j

APPLICATION NO: o

APPLICAnON DATE: 06/17/10

06/17/10 PERIOD TO: 83 ARCHITECT'S PROJECT NO'

F G H

TOTAL MATERlALS COMPU:::TED RALANCE PRESENTLY % TO AND STORED STORED TO DATE

(G~C) FINISH (Nor in D or £)

(D+E+F) (C- G) <M"O~

0.00 0.00 0.00 31388.00

0.00 0.00 0.00 16200.00

0.00 0.00 0.00 8037.00

0.00 0.00 0.00 10980.00

0.00 0.00 0.00 2200.00

0.00 0.00 0.00 25225.00

0.00 0.00 0.00 5200.00

0.00 0.00 0.00 7185.00

0.00 0.00 0.00 124$.00

0.00 0.00 0.00 4034.00

0.00 0.00 0.00 7925.00

0.00 0.00 0.00 3208.00

0.00 0.00 0.00 1790.00

0.00 0.00 0.00 19960.00

0.00 0.00 0.00 1895.00

0.00 0.00 0.00 24905.00

0.00 0.00 0.00 4958.00

0.00 0.00 0.00 367.00

0.00 0.00 0.00 190.00

0.00 200732.00 12.18 1447105.00

CAU)'lON: You ::,;.houtd si91~ ~n oriuinal A1A Contf,ict DOCUmdl)t, \')11 Wllich this text appears in RE.n. An original a::i::iures thai Ch<:U1£JE:S wilillot ~ <)b$CUf~~(1.

I

RETAINAGE (If variable rare)

n~

0.00

0.01l

0.01l

0.00

0.00

0.00

0.00

O.~)

0.00

0.00

0.00

O.O()

0.00

0.00

0.00

0.00

0.00

0.00

0.00

10036.60

AlA DocumentG703- -1992. Copyright~ 1963. 1965, 1966. 1.967, 1970, 1978. 1983 and 1992 by The AmerIcan Institute o(Archilect:s. All rights reserved. WARNUJG: This AIA"'Docum~l\t is p((',tl.t.~t.ad l;.y U$, (;l.Jjl'lI'!)hl

l:!w .... )ti Intcl"II.:l(ion<.l1 TI·",ati~s. UI'l:.ulhoriz",d r~prOd~lctiull or dh>lril}tJtioll of thIs AIA""n'>Cllm(tllt. or <Illy pol'llcm of it, may ({rsult ill S,;,VVI& civil afld crimi"':ll r)(m:l!iios. and will Lx: pr(l.st)cltII:J to UII..'I11"':l!J,lUhl ( .... II!"I po%ible u ... 1er tile law. Purchasers are pennitted to reproduce ten (10) copies of this document when completed. To teporl copyright violations of AlA Contract Documents, e-mail The AmerICan Institute of ArChitects' legal counsel, [email protected],

r l..O.

'~~~A'IA ,.:s. '1 .... ~ ";,.:.?~~ .. .: ..._a ... - DocurlJent G703'" - 1992 Continuation Sheet AlA Document G7021M, AppliCatiori~and Certification for Payment, containing Contro.ctor"s·signed'certification is attached. In tabu1atio~below;amouD.ts are stated to the nearest dollar. Use ColulllI'! J o!l"Contiacts where variable retainage for line items may apply.

".'~, ,~

A ~ B C D I E - WORK COMPLETED ;; ~ SCHEDULED FROM PREVIOUS ITEM gDESCRIPTION OF WORK

'VALUE APPLICATION nIls PERIOD = NO. (D+E)

NWAb6S+GR6FR"""""=

25 C RTAJNWAWSTOREFRONT LBR 6780.00 0.00 0.00

26 E ITERlOR GLAZING MAT 29000.00 0.00 0.00

27 'E ITERIOR GLAZING LBR '" , 8654.00 0.00 0.00

28 M ETAL PANELS MAT 2000.00 0.00 0.00

29 M ET AL PANELS LBR 1000.00 0.00 0.00

30 B EAK METAL MAT ., 1200.00 0.00 0.00

31 B EAK METAL LABOR 895.00 0.00 0.00

32 IN IrERIOR'GLAZlNG MAT 1900.00 0.00 0.00

33 I~ irERIOR GLAZING LBR 650.00 0.00 0.00

34 S OP DRAWINGS & ENGINEERING 10000.00 0.00 0.00

35 H t-RDWARE, CAULKING & MISC 12817.00 0.00 0.00

36 S EETROCK & SHEATHING 24393.00 0.00 0.00 M TERIAL

37 S EETROCK ACCESSORIES 3608.00 0.00 0.00

38 E 'rERIOR SHEATHING INSTALLATIO 3489.00 0.00 0.00

39 FI ERGLASS INSULATION 13066.00 0.00 0.00

40 S eETROCK & TILE BOARl) HANGING. 15!128.oo 0.00 0.00 41 C EETROCK FINISHING 20300.00 0.00 0.00 42 W fouPRlMER

.. 11200.00 0.00 0.00

143 W f.LL FlN~SH PAINT 10063.00 0.00 0.00

G~\)9llY;AL 1849780.00 132325.00 68407.00

APPLICATlONNO: 3

APPLICATION DATE: 06117110

PERIOD TO: 06117110

. ARCHITECT'S PROJECT NO: 83 ..

·F G II

TOTAL MATE.RJALS COMPLETED BALANCE PRESENTLY AND STORED % TO

STORED (G+C) FINISH TO DATE (Not in D or E) (e-G)

(D+E+F)

-.v

0.00 0.00 0.00 6780.00

0.00 0.00 0.00. '. 29000.00

0.00 0.00 0:00 8654.00

0.00 0.00 0.00 2000.00

0.00 0.00 0.00 1000.00

0.00 0.00 0.00 1200.00

0.00 0.00 0.00 895.00

0.00 0.00 0.00 1900.00

0.00 0.00 0.00 650.00

0.00 0.00 0.00 10000.00

0.00 0.00 0.00 12817.00

0.00 0.00 0.00 24393.00

0.00 0.00 0.00 3608.00

0.00 0.00 0.00 3489.00

0.00 0.00 0.00 13066.00

0.00 0.00 0.00 15!128.00

0.00 0.00 0.00 20300.00

0.00 0.00 0.00 11200.00

0.00 0.00 0.00 10063.00

0.00 200732.00 10.85 1649048.00

CAUTION: You should :>iYIl an orioinai AlA Contract Document, on whir.h this text al>pcars in REn. All oriuinal assures that changes wilillot be oh$curecl.

I

RETAINAGE (Jfvariobk rale)

v.w

0.00

0.00

am am O.()()

am 0.00

0.00

0.00

0.0·)

0.00

0.00

0.00

0.00

0.00

0.00

0.0<)

0,0<)

0.00

10036.60

AlA Document G7031'M -1992. Copyright® 1963, 1965. 1966, 1967. 1970. 1978. 1983 and 1992 by The American Institute of Architects. All rights reserved. WAI~NING: This ALA"'O~)C~mJt)fOt is PI'¢Ie,:t~d l>y U.:~. COI:.yri~"1 L!:IW and Inlt:ma.tlo~lat Tu .. ·atio:.:, Un .. ulhOi'i:;::1:ld refl'roduClion or (JistriLmtioll M this AIA""Docume,H. or l':Iny portion at it, InaII' r~$,IIJt 11'1 ~""Ve.01: civil 30/\1.1 l:tlllll!I'" p,,"uaIUes, ':'11(./ will btl pro$4)(;ul~,1 to) thu makilllulU c>:torot f..os:,>iblv und.d tilt: Jaw. Purchasers are permi1ted to reproduce ten (1 O) copies of this document when completed. To report copyright vk>lations of AlA Contract Documents, e-mail The American Institute of Architects' togal counsel, [email protected].

I

\£ ~~~~A'IA ._~r;jI_. ~!1;;~;:' . Document G703Tl! -1992 Continuation Sheet AlA Document G702™. Appljcation and Ct!rtification [or Payment. containing Gentractor's signed" certification" is attached. In tabulations below. amounts arc: stated to the nearest dollar. Use Column,J on Contracts where variable retainage for line items may apply.

cr· ~

A - B C D I E

"" WORK COMPLETED = 0

SCHEDULED FROM PREVlOUS g DESCRIPTION OF WORK ITEM VALUE APPLICATION TIllS PERIOD NO. 44. [ POR FRAME & DOORS 3900.00 (0 + R~.OO 0.00

r"" RK FINISHING 2300.00 0.00 0.00 46 R l;SILIENT FLOORING 3460.00 0.00 0.00 47 R ~SILIENT .FLOOR INSTALL 2815.00 0.00 0.00 48 R pSILIENT FLOOR CLEAN & WAX 250.00 0.00 0.00 49 P PRCElAlN tlLE tYPE 1 & TR MS 15916.00 0.00 0.00 50 P PRCELAIN TILE TYPE 2 & TRIMS 11812.00 0.00 0.00 51 P PRCELAIN TILE INSTALLATION 19995.00 0.00 0.00 S2A OUSTICAL CEILING GRID 22280.00 0.00 0.00 53 A j:OUSTICAL CEILING TILE & INSL 11220.00 0.00 0.00 54 C l'RPET TYPE 1 25574.00 0.00 0.00 55 C f.RF'ET TYPE 2 T361.00 0.00 0.00 56 C >.RPET INSTALLATION 8025.00 0.00 0.00 57 R )OMSIGNAGE 3680.00 0.00 0.00 58 C STELETTERS 635.00 0.00 0.00 59 Co STPLAQUES 1895.00 0.00 0.00 60 S I~NAGE INSTALLATION 986.00 0.00 0.00 61 P fRTITION INSTALLATION 1000.00 0.00 0.00 62 T ILET PARTITIONS 4787.00 0.00 0.00 63 'F I E EXllNGUISHERS &.CABINETS 380.00 0.00 0.00 64A f!E EXT INSTALLATION 20.00 0.00 0.00

-J.n!a - .o<>ono· M

GRAND TOTAL

3 APPLICATION NO: 06/17/10

APPLICATION DATE: 06/17/10

PERIOD TO: 83 ARCHITEcrs PROJECT NO:

'F G H

TOTAL BALANCE MATERIALS COMPLETED PRESENTLY % TO ANO~"TORED STORED TO DATE

(G+C) FINISH (Not in D or E)

(ll+E+&lo (e-G)

0.00 0.00 3900.00

0.00 0.00 0.00 2300.00

0.00 0.00 0.00 3460.00

0.00 0.00 0.00 2815.00

0.00 0.00 0.00 250.00

0.00 0.00 0.00 15916.00

0.00 0.00 0.00 11812.00

0.00 0.00 0.00 19995.00

0.00 0.00 0.00 22280.00

0.00 0.00 0.00 11220.00

0.00 0.00 0.00 25574.00

0.00 0.00 0.00 7361.00

0.00 0.00 0.00 6025.00

0.00 0.00 0.00 3630.00

0.00 0.00 0.00 635.00

0.00 0.00 0.00 1895.00

0.00 0.00 0.00 986.00

0.00 0.00 0.00 1000.00

0.00 0.00 0.00 4787.00

0.00 0.00 0.00 380.00

0.00 0.00 0.00 20.00

=~

CAU'nOfoJ; Y<HI should siUn ;:u1 ntiUiu<t1 AlA C()lIif~{!t lJOCUHI':lIt. oJ,L which tlli::; tuxt appea.rs in f.:Eu. All ori!ljr~~ll a~::l.lH·e$ th<tl chC:lII~'::$ will L'tot he ubSCll1'<!d.

I

RETAINAGE (lfv(lr;oble r.Jce)

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

OJ»)

0.0)

0.00

0.00

'VVoo.~,

AlA Document G703T» -1992. Copyright e 1963. 1965, 1966, 1967, 1970, 1978. 1983 and 1992 by The American Institute of Architects. All rights resented. wAI<r.JIN(;: '(hr:~ AIA~' nw:.JI ..... ·1I1 i~ I',c.t;~r:i..,.r hy I),:;. (;'}I.y,'I!)hC L;ow ~Id IJ'lil.:II,;.rirm;)1 'l',i:::Jtiol'S. Uni.lUlhc;.ri::''''(J I'cjJj,,(ltlcdoll nr dish1llotu.ilr ,,1 mi$ AIA"'t'j':,CllH'I~Hr. u,' "roy I)vrlkm or it. u\;;,y f~ult ill ::...,\/<,\: d\Jil Olll(l c:olnltll.:d Ik:I\.,ljl'l:-. ,Iiul will II" I)m:;o.:u;,,,. Ii' ir. ... ;.),pli>U(1I1I 0:> l.!,.[ ])os::.ibll,l tIMid tht: l:iw. Purchasers are permitted to reproduce ten (10) copies. of this document when completed. To report copyright violatiOns of AlA Contract Documents, e-mail The American Institute of Architects'legal <;ounscl, copyright@aia,org.

fh AlA Document G703™ - 1992 Continuation Sheet AlA Document G702™. Application and Certification for Payment, containing ~ntractor's signed certification is attached. In tabulations below. amounts are stated to the nearest dollar. Use ColUIID].:,! on Contracts where variable retainage for line items may apply.

,;;

A ~ B C D ~ E

!

"" WORK COMPL~'TED ~ 0 0 SCHEDULED FROM PREVIOUS ilTEM a::. DESCRIPTION OF WORK

i NO. VALUE APPUCATION THIS PERIOD

(D+Ed.oo 65 T ILET ACCESSORIES 4787.00 0.00

66 T I LET ACCESSORIES INSTALL 1109.00 0.00 0.00

or C >,NOPY MATERIALS 10400.00 0.00 0.00

66 C NOPY INSTAlLATION 5600.00 0.00 0.00

69 a LUSTIC PANELS 1760.00 0.00 0.00

70 B fLUSTIC PANEL INSTALLATION 329.00 0.00 0.00

71 VI NDOW SHADES MATERIALS 4073.00 0.00 0.00

72 VI NDOW SHADES INSTALL 910.00 0.00 0.00

73 VI fJ-K OFF MATS 2S00.00 0.00 0.00

74 VI f.LK OFF MATS INSTALL 481.00 0.00 0.00

75 FI ~E SUPPRESSION SYSTEM DESIGN 3500.00 0.00 0.00

76 S R1NKlER PIPING MATERIAlS 6500.00 0.00 0.00

77 S RINKLER PIPING INSTAlLATION 4S00.00 0.00 0.00

78 FI E RISER MATERIALS lS00.00 0.00 0.00

79 FI E RISER INSTAlL 1000.00 0.00 0.00

80 S R1NKLER HEADS 4500.00 0.00 0.00

81 'IN TALL SPRINKLER HEADS & TRIM 4500.00 0.00 0.00

82 S RINKlER SYSTEM TEST 1000.00 0.00 0.00

83 S RINKlER SYSTEM WAlK 540.00 0.00 0.00 T !ROUGH'

84 M CHANICAL MOBILIZATION 5500.00 3000.00 1400.00

- .-GRAND TOTAL -

3 APPLlCATlON NO: 00117110 APPLICATION DATE: 06117110 PERIOD TO: 83

ARCHITECT'S PROJECT NO,

F G H

TOTAL MATERIALS BALANCE COMPLETED PRESENTLY % TO AND STORED STORED TO DATE

(G~C) F[NISH (Not in Dor Ed (e-G)

0.0 (D+B"O@o 0.00 4787.00

0.00 0.00 0.00 1109.00

0.00 0.00 0.00 10400.00

0.00 0.00 0.00 5600.00

0.00 0.00 0.00 1760.00

0.00 0.00 0.00 329.00

0.00 0.00 0.00 4073.00

0.00 0.00 0.00 910.00

0.00 0.00 0.00 2500.00

0.00 0.00 0.00 481.00

0.00 0.00 0.00 3500.00

0.00 0.00 0.00 6500.00

0.00 0.00 0.00 4500.00

0.00 0.00 0.00 1500.00

0.00 0.00 0.00 1000.00

0.00 0.00 0.00 4500.00

0.00 0.00 0.00 4500.00

0.00 0.00 0.00 1000.00

0.00 0.00 0.00 540.00

0.00 4400.00 80.00 1100.00

CAUTION: YOII should si!Jn all originill AJA Contract Oocurncilt. on which this text Cii'>pears in kED. Ail ori9inal assure::> that changes wiH not he oh$Cun~<I.

I

RETAINAGE (!fvoriable /'Ote)

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

220.00

AlA DOcument G7()3'"" -1992. Copyright<s> 1963, 1005. 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WAl-tNING; )"I'lis AlA"'j}oCllln.""i i:,; 1"'II<.:Ct.:d hy U.$. CHl'y.i~hi l.aw m\d 11l1 .. rl~.,Hol\<l1 T,o::,;,:itts. UlIhutlmri;tt::d ,-oproductiou Of uil>tfitl1uj(lll of I/lll> AlA" o.ocul~l~lli. or ~lIIy pnnk.u of it. may ItrSlilt l,\ l:>6V~I'''' civil ,tlul crirnin .. l pe'l.<llti~ ... "d will b .. fUO!i<!(:CJt.;:d l" the ,,-';";.(;IO\Uu1 ,,:..t.,nl pnssib1e unoQ.( thto' l..w. Purchasers are permitted 10 reproduce len (1 0) copies of this document when completed. To report copyright viola lions of AlA Contract Documents. e-mafl The American Institute of Architect:.' legal counsel, [email protected].

i

o -.3> =AIA Document G703™ - 1992

Continuation Sheet AlA Document G702"(1o.I, Application and Certification for Payment, containing Contractor's signed certification is attached. In ~bulatio'ii$ below, amountS are stated to the nearest doUar. Use Column Ion Contracts where variable reIainage for line items may apply.

~ . ~


~.

06/17/10

06/17/10 PERIOD TO: 83 ARCHITECT'S PROJECT NO·

A ...... ReD E F C H [ :s WORK COMPLETED TOTAL ..::..: MA TERlALS COMPLETED BALANCE

ITEM g DESCRIPTION Of WORK SCHEDULED FROM PREVIOUS PRESENTLY ANDSTORED % TO RETAINA(iE NO. C<:)o VALUE APPLICATION THIS PERTOD S-r:ORED TO DATE (G":" C) FINISH (lfYG'riablc rale)

(D+E) (Not inDorE) (D+E+F) (e-G) ... "

86 SI E SEWER,lABOR 12500.00 11250.00 0.00 0.00 11250.00 90.00 1250.00 562.5<)

87 SlirE WATER, MAT 12500.00 12500.00 0.00 0.00 12500.00 100.00 0.00 625.00

ee SlirE WATER, LABOR 10000.00 0.00 10000.00 0.00 10000.00 100.00 0.00 500.00

89 U DERGROUND ROUGH·IN MAT 11000.00 11000.00 0.00 0.00 11000.00 100.00 0.00 SSO.(})

90 U DERGROUND ROUGH·IN LBR 8000.00 0.00 8000.00 0.00 8000.00 100.00 0.00 400.00

91 A OVE GROUNO STACK OUT MAT 22000.00 22000.00 0.00 0.00 22000.00 100.00 0.00 1100.00

92 A OVE GROUND STACK OUT LBR 15000.00 0.00 1500.00 0.00 1500.00 10.00 13500.00 75.00

93 FljaURES-TRlM-OUT MAT 16000.00 0.00 0.00 0.00 0.00 0.00 18000.00 0.00

94 FljcruRES-TRIM"()UT LBR 11000.00 0.00 0.00 0.00 0.00 0.00 11000.00 0.00

95 P CKAGED ROOFTOP UNIT MAT 52000.00 0.00 0.00 0.00 0.00 0.00 52000.00 0.00

96 P CKAGED ROOF TOP UNIT LBR 2200.00 0.00 0.00 0.00 0.00 0.00 =.00 0.00

97 ,M NI-5PWTS MAT 6000.00 0.00 0.00 0.00 0.00 0.00 8000.00 0.00

98 M 1'l1-5PUTS MAT 600.00 0.00 0.00 0.00 0.00 0.00 600.00 0.00

99 V V BOXES MAT 12000.00 0.00 0.00 0.00 0.00 0.00 12000.00 0.00

~ V V BOXES LBR 1500.00 0.00 0.00 0.00 0.00 0.00 1500.00 0.00

01 EtHAUST FANS MAT 1500.00 0.00 0.00 0.00 0.00 0.00 1500.00 0.00

02 EfHAUST FANS LABOR 100.00 0.00 0.00 0.00 0.00 0.00 100.00 0.00

fa3 D CTWAORK, FABRICATED 39000.00 0.00 0.00 0.00 0.00 0.00 39000.00 0.00 M TERIA

fo4 D CTWORK, INSTALLATION LBR 21000.00 0.00 0.00 0.00 0.00 0.00 21000.00 0.00

GRANB'T'iifAL 2324910.00 201075.00 89307.00 0.00 290382.00 12.49 2034528.00 14519.10

GAUTION: Y.;,u ::'.t It,Uhl :5.i~n <.In migin:11 AlA C .. lltra...:1. [)Ot:IUU<:tlt, ,.11 wlijt~h tlli .. itl)(1 d\)Pl:!af':i III n.~.O. A" \,(i:)\m:ll "l$$\}i'(:'S lll::st t:h"'fiO;~S wm rl.')II ... ; oh:;;.-:ur.cd.

AlA Document G70ll • -1992. Copyright e 1963, 1985, 1966. 1967. 1970, 1978. 1983 and 1992 by The American Institute of Architects.. All rights reserved. WAHI·lltlG: !IIi";; AIA"Il",:uHI"m i:i 1:""~W,.hl.1 hy IJ.:$. (;('I)~.)j!1j'l l.,'IW .:inn 1.,uul);..tiV1l<lt rl'E:arle~. IJI;u.ulh"'fi~e() f~I)I'od"dj('jn or dh;/j'ihutj,...rl (~r litis AIA~llr.(~lllIletlt. Co,' .... ry 1'.Ollioll.,t It, '''(lY .. ..:;$uh ill ::>0VIJI'"" civil ':lIld cliMi'I:31 P"'II;~lli,'}::;, ; .. ).1 will b\.! 1)1,;:;.-;":'(11..:.1 tv II,.} ur .. ),.i ,111;\, CI t.,;,,1 p .... $$iblt. ,.",1,,[ U,u t.lVl. Purchasers are permjtted to reproduce ten (10) copies of this document when completed. To report: copyrigtlt violations of AlA Contract Documents, e-mail The American Institute of AtChllects' legal counsel, copyrighl@aia,org.

IJ'. Document G703'" - 1992 Continuation Sheet AlA Document G702TM. Application and Ct:rtitication for Payment, containing C,aptractor"s signed certification is attached. In tabulationSObelow, amounts are stated to the nearest dollar. Use Column .lon Contracts where variable retainage for line items may apply.

A

rrEM NO.

05 S

06 S

~7 AJ

os A

09 C

10 T

11 M

12 S

13 SI

V· ro

-~ c· ~

"

B

ci5oESCRIPTION OF WORt(

IRAL DUCT MAT

IRAL DUCT LBR

R DISTRlBUnON MAT

f DISTRIBUTION LBR

NTROLS

ST AND BAJLANCE

FCHANICAJL RENTAL EQUIPMENT

irE LIGHTING MATERIALS

irE L\GHTING LABOR

14 Sty. FEED CONDUIT

15 S V. FEED CONDUIT LABOR

16 S ORV. FEED CONDUCTORS

17 S ORV. FEED CONDUCTORS LABOR

18 B ~CH CIRCUITS

19 B ~CH CIRCUITS LABOR

FO F EDER CONDUIT

F1 FEDER CONDUIT LABOR

Fz F EDER CONDUCTORS

~ F EDER CONDUCTORS LABOR

F4 W RING DEVICESIPLATES

rs W RING DEVICESIPLATES LABOR

GRAND TOTAL

C D I E WORK COMPLETED

SCHEDULED FROM PREVlOUS VALUE APPLICATION THISPERlOD

18000.00 (D+Ed

.00 0.00

9000.00 0.00 0.00

9000.00 0.00 0.00

3000.00 0.00 0.00

30000.00 0.00 0.00

7100.00 0.00 0.00

4500.00 0.00 0.00

4000.00 0.00 2000.00

7863.00 0.00 2359.00

3200.00 2240.00 960.00

5925.00 4150.00 1775.00

5800.00 0.00 0.00

4358.00 0.00 0.00

12405.00 0.00 0.00

32973.00 0.00 0.00

5000.00 3500.00 0.00

5100.00 3570.00 0.00

10000.00 0.00 0.00

4755.00 0.00 0.00

1600.00 0.00 0.00

4320.00 0.00 0.00

3 APPLICATION NO: 06117110 APPLICATION OATE: 06117110 PERIOD TO: 83 ARCHITECT'S PROJECT NO:

F G H

TOTAL MATERIALS COMPLETED BALANCE

PRESENTLY % TO STORED

ANDSTOREO (C·.·C) FINISH TO DATE (Not in D or F.)

(D +E+rf.do Ie-G)

0.00 0.00 18000.00

0.00 0.00 0.00 9000.00

0.00 0.00 0.00 9000.00

0.00 0.00 I 0.00 3000.00

0.00 0.00 I 0.00 30000.00

0.00 0.00 I 0.00 7100.00

0.00 0.00 ! 0.00 4500.00

0.00 2000.00 50.00 2000.00

0.00 2359.00 30.00 5504.00

0.00 3200.00 100.00 0.00

0.00 5925.00 100.00 0.00

0.00 0.00 0.00 5800.00

0.00 0.00 0.00 4358.00

0.00 0.00 0.00 12405.00

0.00 0.00 0.00 32973.00

0.00 3500.00 70.00 1500.00

0.00 3570.00 70.00 1530.00

0.00 0.00 0.00 10000.00

0.00 0.00 0.00 4755.00

0.00 0.00 0.00 1600.00

0.00 0.00 (tOO 4320.00

~. 13:0

CAU'nON: You should siUn an ol"iainaJ AlA Contract DoeUfllent. on wllich this to::xt appears ill REO. An 01 i!)inal assures that cha0!1C$ will not be ·ohscu(£'{I.

I

REl'AI'NAGE (Ifva ... ;oble rJte)

0.00

0.00

0.00

0.00

0.00

OJ~)

0.00

100.00

117.95

160.00

296.25

0.00

0.00

0.00

0.00

175.00

178.50

0.00

0.00

0.00

0.00

AlA Document G703'n1-1992. Copyright(S) 1963, 1965. 1966, 1967, 1970, 1978, 1983 and 1992 byThe American Institute of AtChltecls. All rights rosorved. WAr<NING: "nlis AJA~Oocu.l1ent is j:.Int~(:II.:d hV U.S. CoVyriU'.( Law .:lIId Intcm;uion:.1 'fteatlo:s. Urlautlu)rj;:ed (uproduction or di:;;tributJon ot Ihis AIA'"'Oocument. of any portlon ut It, U><aV n)::mlt ill sow.l'& civil anti Clilllln.:.I,.etmltius, and will be ~(oS<:Gul4:"1110 th~ 'h.a:dll)IUU •• flUellt possjbl~ u.\<h:r the law. Purchasers are permitted to reproduce ten (1 O) copies or this document when completed. To report copyright violations of AlA Contract Documents, e~mail The American Institute of Architects'legal counsel, copyf'[email protected].

,

c6 'V

·-~~lAIA· .@ -.;~j[:= ~ Document G703'" - 1992

Continuation Sheet AlA Document G702T><, Application and Certification for Payment, containing Contractor's signed.certification is attached. In tabu\atio~ below. amounts are stated to the nearest dollar. Use Column I on COlltracts where variable retainage for line items may apply.

~ ~.

A "'- R C 0 I E

:'; WORK COMPLETED 0

= SCHEDULED FROM PREVIOUS ITEM gOESCRIPTION OF WORK NO. = VALUE APPLICATION THIS PERIOD

(D+E)

27 P INELBOARDS LABOR 11985.00 0.00 0.00

!28 FI >ITURES 73649.00 0.00 0.00

29 FI >ITURES LABOR 22595.00 0.00 0.00

pO T LCOMM. 4500.00 13SO.00 0.00

31 TI L COMM. LABOR 7975.00 2400.00 0.00

32 .FI <EALARM 12672.00 0.00 0.00

33 FI ~ ALARM LABOR 19070.00 0.00 0.00

p.<S ANDBY EMERGENCY MATERIALS 86390.00 1725.00 11230.00

35 S ANDBY E!'1ERGENCY LABOR 22060.00 442.00 2867.00

I

CRMlS"i'6TAL 2796000.00 220452.00 110498.00

F

MATERIALS PRESENTLY

STORED (Not in D or E)

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0:00

0.00

0.00

APPUCATION NO: :> 06117110

APPLICATION DATE: PERIOD TO' 06117110

. 8 ARCHITECT'S PROJECT NO: 3 - --- ----- - -

G II

TOTAL COMPLETED

BALANCE % TO AND STORED

TO DATE (G~C) FINISH

(D+E+F) (C-G)

u.~

0.00 0.00 11985.00

0.00 0.00 73649.00

0.00 0.00 22595.00

1350.00 30.00 31SO.00

2400.00 30.09 5575.00

0.00 0.00 12672.00

0.00 0.00 19070.00

12955.00 15.00 73435.00

3309.00 15.00 18751.00

330950.00 11.84 246SOSO.00

CAUTION: You !ihould sign an ori9il,~,1 AlA Contract Document, Oil whict, this text appears in HE!). An original <t$Stln~s that chan!l(~s wililiot b<: ol>scuI"C:d.

I

RETAlNAGE (Jfvar-ioble rote)

0.00

0.00

0.00

67.SO

120.00

0.00

0.00

647.75

165.45

16547.50

AlA OocumontG7031/ol -1992. Copyright C 1963. 1965. 1966. 1967. 1970. 1978.1983 and 1992 by The Amerk:an Instituted Architects. All rights reserved. WARNING: This. AfA"'Docwll~nlls pfuh~r:u.:d tiy U.S. C('l!yd~ht L.<:.w and 11It1:fI"l<stior.al TI"(I • .lties. Un.iluU\ori;cod r~production or di:;l .. ibmiotl or tloiS AIA .... t)ocumeht. O¥ any I)Ortion of it. may result in 'likVCfe cilfi( lJlI(I ~'imlh~ll'l>.."~I\iu1:j. • .. nd will h& prosucnl,,..l [I> Ihe maximum ';'Xh,nll pU:iSlbl..: tmdo .. the taw. Purchasern ~re permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AlA Contract Documents. EKnalI The American InstihJte of Archilf!cts· legal counsel, [email protected].

summit Pipe & Supply 450 Industrial Dr JACKSON MS 39209

I N V 0 ICE

phone #: 601-353-0073

Bill To: CASABLANCA CONSTRUCTION 9 THOMAS LANE HATTIESBURG MS 39402

Invoice/Dt 73564

06/07/10

Order#/Dt 24136

OS/27/10

Customer# Customer P.O. 1261 CALL IN

QUANTITY V/M ITEM/DESCRIPTION

126 FT 12SDR35 LO,C 001 SDR35 SEWER GASKET 12" PIPE

320 FT PVCSCH40-6 LOC 001 SCH40 PVC 6" BE

3 EA 6PVCTEE LOC 001 TEE S40 PVC 6"

1 EA 55007 LOC 001 QT MED PVC "PETE 602"

1 EA 55717 LOC 001 QT PURPLE PRIMER "JIM PR-1"

1 EA 30600 LOC 001 PIPE LUBE 32021.

Subtotal Sales Tax Total Due On 07/07/10

Book 0144 Pa9' 63

Ship To: DHS - POPULARVILLE CASABLANCA CONSTRUCTION TYLER FOR DIRECTIONS 601-573-1801 HATTIESBURG MS

Terms NET 30 DAYS

DISC UNIT PRICE

6.972

4.040

30.316

5.785

6.500

0.000

SalesPerson OUR TRUCK

TK

AMOUNT

878.47

1,292.80

90.95

5.79

6.50

.00

2,274.51 159.22

2,433.73

RECEIVED . JUN 10 2010

GASA8LANCA CQNSTFlUCTION. INC

~- .".~ -.-.... - - ... - " .. , ............. ~ .......... ................................... ..

6001: 0144 P"y" 6f

OMASLAIl& ESlll)R6, MiS5[SSII'PI ~940l!'79t t

rHO : 60H64~676-F.AX: 601-264-(!677 MS C 0.£1. 11016 .. 0' LA LlC£l15K 1i2Ufjl

June 17, 2010

JH&H Architects 37601·55 North - Suite 200 Jackson, MS 39211·6323

Attn: Mike Beauchamp

Re: Fearl River County DRS B ilding - 05137F

Dear Mike,

We are not requesting an exten ion of time for the above referenced project.

Sincerely,

. _ .. ___ ._--1-___ ...... .

t() \J

10 !Task Name Start Finish Feb--TMar I APr I MaVIJun TJUiiAug ISep 10c! Nov I Dec I Jan I Feb I Mar Feb '101 Mili'iOTADr'10 I Ma'iOTJun '101 JuT'WTAUO '10 1 SeD '10 1 Oct '10 NOv'10lDec'10lJan'111Feb'111Mar'11

I 1- MOBILIZATIONMOn 3181101 Man3ial1o ~: ' I I I 2 ENGINEERINGANDLAYOUT Tue3/9110 Fri3l12110 ~ i I I 3 SITE WORK (BULIDING) Man 3115110 Thu 4/1/10 ~411 I i I

I 4 SITE UTILITIES Fri 412110 Fr; 4/30/10 I I I ! 5 SPOT FOOTINGS A Moo 513110 Thu 5120/10 ~ , I ! i 6 GRADE BEAMS A Fri 5/21110 Wed 6/9110 . ~ I I I

,

7 INSLJ\II,ROUGHINA Thu6/10/10 Wed 6/16/10 I "~,! ! 8 SOGA Thu6/17110 Thu6/17/10 I ~' ~17 I 9 SPOT~OTlNGS B Fri 6118/10 Wed 7f7110 10 GRADJ;: BEAMS B Thu 7/8/10 Tue 7127/10 i r 1-11 ,IN S~ ROUGHIN B Wed 712Il110 Tue 813/10 iii I ,. 12 SOG B., Wed 814/10 Wed 814110 I : ! I ~4 13 STRLJ.!6fURALSTEELA Thu8l5l10 Thu912110 I ' ! I ~"-~' 14 SPOT FOOTINGS C Thu 815110 Tue 8124/10 I,: 'I ! 1S GRADE BEAMS C Wed 8125/10 Mon 9/13110 ! "

18 STRUCTURAL STEEL B Fri 913/10 Fri 1011/10 1" I I I'~~Q'''' 19 EXT, FRAMING A Fri 913110 Wed 9/22110 I, I : 16 IN SLAB ROUGH IN C Tue 9114/10 Wed 9/22110 i : i ! 17 SOG C Thu 9123/10 Thu 9123/10 'I ' I I I 20 STRUCTURALSTEELC Mon 1014/10 Man 11/1/10 , I i 21 EXT, FRAMING B Mon 10/4/10 Thu 10121110 I 'I 'I'

22 ROOFING A Man 10/4/10 Thu 10121/10 I I 23 MASONRY A Fri 10122110 Thu 1212110 ! : 'I :

26 MEP ROUGH IN A Fri 10/22110 Fr111119110 I 'I I 27 ROOFING B Fri 10122110 Wed 11/10110 I ; I ! 28 MASONRY B Fri 10122110 Thu 1212110 1 " 38 INT, FRAMING A Fri 10122110 Wed 11/10/10 i i 31 EXT, FRAMING C Tue 1112110 Tue 11130110 i ! 35 MASONRY C Tue 1112110 Mon 12/13/10 I 1 1

'I I~' 32 MEP ROUGH IN B Thu 11/11/10 Thu 1219110 'I ' I ,,,~,

33 ROCRNG C Thu 11/11/10 Tue 11/30110 I: I I " ~1*0 39 HANG DRYWALL A Thu 11/11110 Tue 11/30/10 1': I ! i "~ 43 INT, FRAMING B Thu 11111110 Tue 11130/10 I ; I I l'~ " 34 MEP ROUGH IN C Wed 1211/10 Wed 12/29/10 :. I ' ~ 40 'IMEP ROUGH IN A CONT, Wed 1211/10 Wed 12/29110 I I ~ 41 IFINISH DRYWALL A Wed 1211110 Thu 1219/10 I

Project OHS Schedule 5_9_10.mpp Oate: Thu 6117/10

Task

Split

Progress

(':7.: ~-:.:.: h""':;:1 Milestone <> Summary t;- •

Project Summary C;;; V

?age 1

D ExtemaiTasks ( ........ : ... , ....... ~.r.,'.,,1

External Milestone ~

Deadline .0

I i

\ I !

I,

i I , i I

i , I

I I

ID ffaskName Star! Finish Feb _I Mar IApr\Mav L~"iLlJUI _tA!& -.lSe [Oct Nov iDee- IJan 1 Feb I Mar ~ I Feb'10 Mar'10 Aor'10 Mav'10 ~un'10 Jul'10 AuQ'10lSep'10 Oct '10 INov'10 Oec'10 Jan'111Feb'11 Mar'11 I:J . I 24 METAL PANELS A Fri 1213110 Thu 12116110 ! \ i \ 1 CUi· i

29 METAL PANELS 6 Fri 1213110 Thu 12116110 I ' ' I f~' .! 42 ACOUSTICALCEILINGA Fri 12110/10 Wed 12129110 I I I I I . :t) i 53 PAINTING A Frl12110/10 Fri 117111 iii I·· I 36 METAlPANELSC Tue12114110 Mon12127110 I ! ' i ['1 ! 69 SIDEWALKS Tue 12/14/10 Mon 1124111 ! j 'I II • ,.", ~, \ 25 [WINDOm A Fri 12117/10 . Mon 12127110 I , : 30 WINDOWS B Fri 12117110 Mon 12127/10 I I I 'I" 1 45 MEP R~H IN B caNT. Tue 12121110 Tue 1/18111 ii" , ..•.. " '!

49 HANG ~YWALL C Tue 12121110 Fri 117111 i . i I I' ~ i 37 WI NOOl!!lS C. Tue 12128110 Wed 1/5111 , i I; (:D., 1 50 MEPRQl,IGHINCCONT. Mon1/10/11 Mcn2l7111 'I I, \ ' I "', '1'

51 FINISH ~YWALL C Man 1110/11 Fri 1121111 ,! I ~ ; 54 FLOORING A Mon1110/11 Wed 2116111 i I I _.o! 46 FINISH DRYWALLB Wed 1/19111 Tue2l1/11 I: I '1".:.. ~ . 1

' , , 70 PAVING Tue 1125111 Tue2122111 ,I . -c. , 52 !ACOUSTICAL CEILING C Man 1124111 Thu 2110/11 I 1 I I , ~~- i 62 PAINTING C Man 1/24111 Thu 2110111 I , I I : ~~, 47 ACOUSTICAL CEILING B Wed 212111 Man 2121111 i, I I 1 I .'~.' ..... ! 58 PAINTINGS Wed 212111 Man 2121111 '. ! I ~.. I 55 MEPTRIMOUTA Thu2117!11 Tue3/8111 !. i I I I ' ;;;l i 56 MILLWORK A Thu 2117111 Tue 3/8111 i I I '~ I

57 SPECIALTIES A Thu 2117111 Tue 318111 I 1 I I 'I' ~ I 63 FLOORING C Fri 2111111 Tue 3J22I11 i I I I . _. • ! 64 MEP TRIM OUT C Fri 2111111 Thu 2124/11 " ' i I I~. i 65 MILLWORK C Fri 2111111 Thu 2124111 I 1 I ! I .. ~ I'

66 SPECIALTIES C Fri 2111111 Wed 312111 1 i I !, ~ I

59 FLOORING B Tue 2122111 Thu 3131/11 , ! I I . :: .... ,.,,:, 60 MEPTRIM OUT B Tue2122111 Fn3l11/11 I I I .~ I 61 SPECIALTIESB Tue2f22l11 Fri3l11111 I' i I '~ 67 MECH. SYSTEMS STARTUP Fri 2125111 Thu 313111 II i, ~. \ 66 TEST AND BALANCE Fri 314/11 Man 3114111 i i : I :-.

Project. OHS Schedule 5_9_10.mpp Date: Thu 6/17110

Task

Split

Progress

U_' ;,:,':'·:;L!.I~_;·,,',::;c-:::a

• 1 I I,."" "."

Milestone

Summary

<> ~- ill

External Tasks ~' __ e7:;'70! :-: 0/% .J

External Milestone '"

Project Summary (;' V Deadline .().

Page 2

'.

YQI u.( .t:ylV '.r\J~ )II V~ ~A"" ~Vl 'cl~(j IJ~' CA6ABLANt;A CQNSTRUCTION

BODY. 0144 P'9" 67

119 THO I.A:mi IIATrl UI!G, MlSSlSSlI'PI 39,,02-7?11 I'IIOl'/E: C601l!!61l-(l678 on YAX: C601l264~677

DATE: June 17, 2010

TO: J H & !-l Architects 37601·55 North - Suite 200 Jackson, Mississippi 39211-6 23

RE: DRS Justice Court Building JHH_05137F

WE AR:E FORWARDING THE OLLo\VING:

SHOP DRA WINGS-

PLANS & SPECIFICATIONS-

OTHER- Po A licatlon # 3 - .OPIES

THESE ARE TRANSMITTEn S CHECKED BELOW:

VIA: Hand Delivered .

REMARKS:

D_APPROVED AS SUBMITtED O_APPROVED AS NOTED o RETURNED FOR cORRECTIONS O-RESUBMlT o cOPlES FORDISTRlBlJTION

C'l \!J003/003 .

G.B.

FrQflco • BCI~lo}' - Lewis Wood

June 21, 2010

Jason Hicks, Sample & Associates 1013 N. Flowood Drive Flowood, MS 39232

Re: Pay Application #3 DHS/Justice Court Building Millard, MS JH&H Project No. 05-0137F

Jason,

Book 0144 f'a9~ 68

We have reviewed and approved the enclosed pay application #3 in the amount of $104,973.10, and recommend that it be placed In line for payment. All pay applications have the required documentation attached.

Cordially,

JH&H Archltects/Plannersllnteriors P.A.

U~~~l v

:tael T. Beauchamp, AlA Senior Project Architect

CC: Adrain Lumpkin

]. CARL FRANCO. AlA PAUL J. BAGLlY. AlA P~ANDAll. tEW:S. AlA A. BRUCE WOOD. AlA

37601·55 North Svlte 200 Jacl<sol'l, Misslulppi 39211·6323 p 6019484601 f 601 3556200 w www.lhharchflech.com

APi:.. GLMCLM03 02/02/2010 13:36 PEARL RIVER COUNTY 2009-2010 Cash oi~bur8ement~ Ledger

10/01/2009 thru 02/02/2010 Fiscal Year 2009 • 2010

AC1:ount: Number P""yee

00~-610-S21 PlCAYUN£ ITEM PICAYUNE ITEM

003-670-524 DUNGAN ENGINEERING P A DUNGAN ENGINEERING P A JH&lI ARCHITECTS Pl,J>.;NNE:RS JH&H ARCHITECTS PLANNERS Jli&H J\.RCXlTECTS PttANNERS JH~ ARCHITECTS PLANNERS

Deccription

BIDS POR DHS/JUSTICE BIDS FOR DRS/JUSTICE

Invoice Number

ITEM ITEM

DRS TOPOGRARHIC SURVEX- ~ PROJECT 19205004 GEOTECHNICAL INVESTlGAT 09-0180 PROJECTU oS~137F DRS/JUSTICE COURT BLOG 09-0192 PROJECT #OS-1l1F.

Invoice Dat.e

12/16/2009 12/09/2009

07/0'J/2009 01/0'/2009 11/16/2009 11/).G/2009 12/02/2009 12/02/2009

*w***~**~.* ••• ~.****.* ••• _ ••••• * •• **** •• *._.***** ••• ~ • •••• * ••••• ***.** •• • To~~l Dt&burs~ment3 Posted to Ledger * DiDbursement~ voided after being Posted to Ledger

Net: Disbursemp-nts

167.0'47.88 •

167,0·1.7. aa .-••••• * ••••••••••••••• ~* •••••••• **.*.* •••••••••• - ••••• *.*.**~ •••• *.** ••

PAGE 1

Claim Trans Check Check Number Number Number Date Amount: Void

.) "7 -y

4 101471 01/11/2010 4 101471 01/11/2010

71021 71024

25.40 22.49

1 1 2 2 3 3

ACCOUNT TOTAL -;-~~.:..:.:~_~::!:~.~_a.~=s 906157 10/12/2009 69802 ............. 4.S00·.~O .... ~··· ........ 906157 10/12/2009 6'9a02 ~--:-:.:::::.:.;...-=.~__ \ 100936 12/10/20{)9 7{)671 I~:'~ s.ooo·.Oi)"·i-100936 12/10/2009 7067.1. __ :::~"::':-"'-_ •. , 101330 Ql/ll/2010 7lo:h __ 157'.500·~OO .,.--. 101330 01/n/201.0 71023 ." ........ ==:-.... ,, __ ~

ACCOUNT TOTAL 167,000.00

DEPARTMENT TOT.AL 167,0.(7.88

FUND. TOTAL 167.047.Sa

~l tDJ~d) REPORT TOT~L 167,047.88

'r<'.

\\\ " \ <\

" '" .. _L C

{'~, /: ~ \ . J.\ -::. '- -('" :;: ~l - I'''' -'.-' ~ .-. ~. J. v,!..... 'J' .."

\' \' . • .j!; -"". .~ .. (\ ,\,,-' ~

.J \ • . 'J \,\ /' \J 0-, . \ ~ \\j

" . \ ,~ j\ "(,.1 > k

.... '. "", \,\ ~ ".

r· - . . J -<,

":.J:,"

"1 .. ,--:': \ 1

.... ,,/

,J \- , .-"j" '(

~

'. ~.,; .' ." ',' "

'10 " .

INVOICE FOR ARCHITECTURAL SERVICES Project: New DHS I JusUee Court Building Dale: 2-0ee-09

Millard, Mississippi Invoice Number: 09-0192

To: Pearl River County Soard of Supervisors Atln: Mr. Adraln Lumpkin Archllecl's P.O. Box 569 Project Number: D5-137F Poplarville, MS 39420

In accordance wilh lhe Owner-Archllect Agreement of July 6, 2009, Ihere is due at this time for Services on the above proJe~l, Ihe sum of One hundred fifty-seven thousand five hundred and ncl1 00""'($ 157,500.00).

The above amounls shall become due and payable UPON RECEIPT


.. BASIC SERYICES FEE = 7% OF TOTAL CONSTRUCTION COST: Bool: (IJ39 raj" m ..... ' ..

Project Estimate = $3,000,000.00 Tolal Fee = $3,000,000.00 x 7% = $210,000.00

Fee Through Conslruclion Documenls: $210,000.00 x 75% = 157,500.00 Less Previously Invoiced & Paid = -

TOTAL 157,500.00


O()~ - (; 7V---...... ! .. ', '\"

Thank you for allowing us 10 serve you!

ARCHITECT: JH&H ARC~LANNERS INTERIORS, P. A.

~~ Aa") BV' J. pari Franco. AlA, Principal

" 3 100 I-55 North. Sulle 200, Jackson, MS 39211-6323 Phone: 601-948"';601 ADDRESS:

Ii ,

" . ...-.--) :', .;') - " ".'-'

" .

Chec~ Image.

Check Image

'1/ Page I of I

Hem Reference: 71023 Book 0144 P·9~ .J.!ounl: $157,500.00

FRONT

"_"'. , .STATE OF MISSISSIPPI- PEARL RIVER COUNTY . BOARD OF SUPERVISORS

. ' POPlAijYlllE, WSSISSlPPI39170

WlII. Ro'IERCOltirv -I.C~~'$l'AYAm .l!e::v~

'. \ . Ref: 008-0101330 Clalm No, 3

071023 CHECK NO .

71023 \

DATe AMOUNT One Hundred Fifty-Seven Thousand Five Hundred And ~oI10~A~n!l!"~RDER OF:

'''f<,; •

1111/2010 ~,' r $157500.00. ************'********ttt**************** ~ JlI&II AACllITECTS PLAIlNERS INTERIORS PA'H '"~ . 3760 I-55 NORTH .SUITE 200 j), (() P I / I J

JACKSON MS 39211 6323 ~ ~( 1f.!1

BI\CK

12006B&17233 111410 .68420178&'

http5:llwww.e-bankp/us.netJoniineserv/CMlChecklmage.cgi?state=displayCheckImage&ch... 2/2120 I 0

,

r»)~V) " ,

Y:V \

INVOICE FOR ARCHIT Cl URAL SERVICES -

pr~:searl River County DHS Building ') Date: Book 0144 Pa'l~ 716.Nov.09 _ Millard, Misslssipp~ ~

Invoice Number: . 09·0180 = To: Pearl River County Board of Supervisors Attn: Mr. Adraln Lumpkin Architect's P.O. Box 569 Project Number: 05·137F Poplarville, MS 39420

In accordance with the Owner-Architect Agreement, there is due at this time for fees on the above project, the sum of Five thousand and no/1 00fl*""*ud"*'II*,,"*"<,,,*** .. *>I**u"""********""'*"'''''***'********'''*'''*******''($5.000.00). The above amounts shall become due and payable UPON RECEIPT


REIMBURSABLE EXPENSE:

Dungan Engineering, P.A. (Geotechnlcallnvesllgatlon) Inv. #1 (Copy Attached) '" 5,000.00


ooy --~70- j/1 .-oL ,\ .- 1/ f'> i"- ..... L; ,.'\,-'

• I'<I~ ........

//l'-'~7 - I:;' 1-

__ A .~".;v .- \&1'" j!.. , c.:.- ;!..~:,..... ~?l-J

Thank you for allowing us to serve youl .::.: .. .)'"'1 t ,-. 1'1 v

Po.-I p.---

r-..

ARCHITECT: JH&H AR CHI ~ECTS PLANNERS INTERIORS, P. A.

~~' (\)~ ~:lAI/) BY: J. Carl Franco, AlA, Principal ADDRESS: 3 60 1·55 North, Suite 200, Jackson, MS 39211·6323. Phone: 601·948·4601

Dungan Engineering, PA. P. O. Box 150 1574 Highway 98 East Columbia, MS 39429

2009-11-04 Invoi~J:llillWH9~ 773

rnvoice· fo: J H & H Architects

3760 I-55 North, Ste. 200 Jackson, MS 39211

Reference To: Department of Human SeNioes'Geotechnloal Investigation

~hase

)e,ign

'roject Totals:

Millard, MS

Percent Phqse Fee ofTotaf Fee

5,000.00 100.00

. -..

Project: 1920T005

Project Manager: Dewayne Morea o Professional Services foJ' the Period: 2009-09-26 to 2009-10-23

Total Project Amount Percent

Complete Fee Earned Prior Billing

100.00 5,000.00 . 0.00

Total PI/flses: .

Phase Blll/ng Totals: ..

$5,000.00

Current Fee

5,000.00

$5,000.00

$5,MO.00

'*. Totall Project Invoice Amount: 0 =========$=5",,=0=0=0=,0=0

0, fYI tJrtS /I

/1'5'~1

~,~f

Pagel

Check,Image, Page I of I

Check Image

Item Reference: 70671 Book 0144 P'9~ 74

Amount: 55,000,00

FRONT

I lIJ STATE OF MIS.,,,PPI· PEARL RIVER "'UNTv \'O:)'MI"JS@ 1\111A'1~IO'ml$

"""", , BOARD OF SUP,RVISORS '

f\l.lVJ\\'Uf,1It 15-;('((53

.:. " . . POP,LARVlI.I.E, M!S$lSSlPI'1394iO f£iJ1I.l\.Ym COU~JY~~~'(Js PAm.U; ACCOl.'t{r

Ref :008-010093 6 Claim No. 2 '. "

Five Thousand And No/100 Dollars DATe PA no THE ORDER OF: " m ' ' 12/10/2009;'

******f********t1**j*t******tk***k*****t , . I '::< oJIlllH ARCHITECTS PI.ANNERS INTERIORS PA7a '''~ 3760 I-55 NORTH SUITE 200 ~ watA JACKSON MS 39211 6323 . a '

"lmiM-ttos ~TW\f.

UIO?O~? \" r:D~5W20~~r: 182 000" 25 l3u'

-r

., (I

i 1

6"CK

128BBOB03S14 111509 ,08420178£<

f: ;.,

070671 ; ;

CHECK NO, ,

7067'1

AMOUNT

$5000,00

.

https:/ Iwww.e-bankplus.netJoniineserv/CMlCheckImage.cgi?state=displayCheckImage&ch. " 2/2/20 J 0

~~

[l~i:~l~',::;:,;·""" ; .. '"

'75

Dungan Engineering, P.A. P. O. Box 150 1574 Hiqhway 98 East Columbia, MS 39429

Invoice To: J H & H Architects

3760 I-55 North, Ste, 200 Jackson, MS 39211 \

(t c>

'U Reference To: ' Department of Human SelVices Topographic SUTVey

Phase

Design

Project Totals:

Millard, MS

. Percent Phase Fee QCTotal Fee

4,500.00 100.00

'Ehur~da.vjuly 9~, 2.009 fIl'IIbI'&'l'v'iMfOer: ]

Project: 1920S004

Project Manager: Brooks Wallace Professional Services for (he Period: 5/23/2009 to 6/2612009

Total Project Amount Percent

Comolete Fee Eorneq Prior I3Il1illfJ

100,00 4,500,00 0,00

Tout! Pilases:

Phase Billing Tot.ls,

$4.500.00

Current Fee

4,500.00

$4,500.00

$1,500.00

H* Total Project Invoice Amount: $4,500.00

, JUL \5 'lllG9

.. "'-' .

Page I

, /

July 16, 2009

Pearl River County Board of Supervisors Attn: Mr. Adrain Lumpkin P. O. Box 569 Poplarville, MS 39420

RE: Pearl River County DHS Building

Dear Adrain:

Lewl$ Wood

16

Enclosed you will find a copy of invoice # 1 dated 7/9/09 for the amount of $4,500.00 from Dungan Engineering, P.A. J. Carl Franco said that this should be paid directly to the vendor.

If you have any questions please call Carl or me at 601-948-4601.

Sincerely,

~J?hy ?~ Brenda J. Penton Financial Administrator

). CARl FRANCO. AlA PAUL J. SAGLE\', ,.\IA MNDALL LHVIS. AiA A, BRUCE WOOD. ALA

37601·55 North Svlle 20(\ Jackson, II.fBIs~lppi 39211.6323 p 601 9464601 f 601 35.$ 6200 w www.ihharchilec/s.com

Chec~ Image, . '1'7

Page] of]

Check Image

lIem Reference: 69802 Book 0144 Page 7~mounl: $4,500.00

FROI;T

1«'1/C'Wo-fJ 069802 STATE O~ MISSISSIPPI· PEARL RIVER COUNTY M·~ 'lo(m"~

""'''' t BOARO Of SVP,RVISORS ~.Jt.~_! \IS I f.p~UJ CHECK NO , <

~' POPURVIlLE, MiS$ISSIPPll9410

P(lllJ. F.I'(f:1t tC'J'i-V - ACI»',,'H$ PI."B;,! 1(0:.0.:101

69802 Ref: 008-0906157 Claim No. 1

tour Thousand live Hundred And No/100 Dollars DATE AMOUNT PAYTO THE ORDER OF,

lO/12/200e $4500.00 tilt t ~ t t ~ t t ., t * * to t t t t i: t t t tit it' t ., • t t t t t t t t ...... ,I

DUNGAN ENGINEERING P A u It ** t HI h it iii tt it ~ ...

1574 HII'Y 98 EAST Q (t:",L~ ~O~~~iA 150 MS 39429 ~ ,.a.:JJ. "';".;i"",:'/"-' _ ...... _=

,'oGqao/I,' I;ObS3010~~I: 181 000'"1513'" "'OOOO~50000,"

BACK

"

https://www.e·bankplus.netionlineserv/CMlCheckImage.cgi?state=displayCheckImage&ch.,. 2/2/2010

STATE OF MISSISSIPPI COUNTY OF PEARL RIVER

PERSONAllY CAME befole me, tfJe oodersfgned, a hOlal)' potfKl In and for PEARL RIVER County, Mlss1sslppl. TOMAN DREWS. Ptlbrrshel, oITHE PICAYUNE lTaA, a newsp;.pef published!n the lo'IIIl of PiCil)'llil8, Pearl Rive! CoUIlly, In sa~ slale, who b~ing d)Jlysworn, deposes and sa~s VlalThe Pka)\lnEI Item h B nB'''''Spaper a$defined and presaibed In Seilal& Bill No. 203 coacted at the reijtJ!.ar sesslonofthe Misslss.!ppIleglslatura of 1946, smeodirlg Soctbn t658, oftha MlsS!ss!pplCode of 1942. and thai Ih!! putflcaUooof a notlca, ofVrhIctJ!he atlnt:<xed Is acopy. 1ft the m~!!e( of

BIDS FOR DHSlJUSTICE COURT

has been made 10 sald paper 2 O'>IlSec1Jt\'ely !owk

OnTha 9TH da10f DECEMBER 20'" Onlha tGTH dayof DECEMOER 2009

""Tho day 01 201l'l

OoTha doyol 2009

~oTha dafol 2OIl'l

TO PUBLISHING PRe SOARD OF SUPERVISORS

case of BlOS FOR DHS!JUSnce COURT

_~2,,54,-_""'" ,_

rnleS and frW.mg ploof

. . 9heck 1t)1~g« 'If Page 1 of i

Check Image

Item Reference: 71024 79 Amount: $47.86

FRONT

I _STATEOF MISSISSIP". PEARL RlVE";UNTY YCJ~'1m tJ.!I.10 071024 tr:nt1I'l~nu

IJJSVIVI

I' UOARO OF SUPERViSOR~ """""" .. ~- CHECK NO. • . POPI.ARVIU,e, YJSSISSIPPII~10

• . ,£.IK PMA 00lMY .... ACCOIMf$l'AYqlf ACCOJti1 71Q~4

Ref: 008-010l4.77 Claim No. 4 , rort¥·Seve~ An4 88/100 Dollar, DATE AMOUNT

PAY TO THE ORDER OF:

1111/201°. $(7.88

••••• * •• tttt ••••••••••••• *tt.*.** •••• ", '; , . PlCAYON! XTtK •••••••••••••••••••••••••• ~£ • z

POBOX 580 a-:J tiL/IrA PIC,'.Yl!h'E !-IS 39466 0000 4 . . ,l.UTHOfIIHO ~ "\I,,,,, ... ,

"O? 10 1~1I' I:Or,S3020W: 18 c 000'" 151311'

-

BACK

I I ~ 1 ox. I.~~ ~ . g '0 tJ~ ! " . ~ , .'" .~!J ! :" :D ,.~

" ,

·r 'I . "'. ~iol IH 'V' .;; 17' ~ ~~ (d '0 t [;,., : . ~ i~ .. _~O

, ,; Ii ~ ;~ ~~

/:~ I .. r-

t I iO

~ 'I , .. ' " J , !',!;f

.\ i I .. , ; I I p

I~ I ,R ~ J I I , '" , I .. .... . -..... ~ ... - . ... - - --

https:llv.'ww.e-bankpi us.net/oniineserv/CMlCheckImage.cgi ?state=dispiayChecklmage&ch... 2/2/20 1 0

Bill To

SAMPLE AND ASSOCIATES, INC.

P. O. BOX 320278 1013 N. FLOWOOD DRIVE FLOWOOD, MS 39232

PEARL RJVER COUNTY P. O. BOX 569 POPLARVILLE. MS 39470

Quantity Description

2007 CDBO PF PROJECHI123·06·055-PF-01 J CONSTRUCTION CONTRACTS SIONED

P.O. No.

Invoice -

Date Invoice #

612812010 0612010·05 ,

Book 0144 Pa9" BO

Terms ProJecl

Rate Amount

5.200.00 5.200.00

Total $5.200.00

! ••• " ... PEARL RIVER COUNTY

Mai1irlg Addreu P. O. BOX 559

Streol Addres$

ICily, Slate Zip POPLARVILLE, MS 39470

601-403·2300

Ac1lvit)' Descriptlon

1 Administration

2 Pubic FaQltle$

, 4

, 6

7

8

• 10

Tolal;

Mississippi Development Authority Community Services Division

Roquest for Cash

, Ofl'll HI).

lin

COIIvlclNo.

oa-OSSoPF·Ol

s,"';o •• ,"",,'" OOOY. C',,, '"9.

Fro:n To

JWle 1,2010 Thru JIJf)O 30, 2010

MDA Program Budget Tolal Prior Requastlo MOA Program This Amounl Dale Request RemainIng Balance

! 35000.00 S 6500.00 $ 5,200.00 $ 23.300.00

! -415000.00 $ 77,488.88 $ 61,275.71 $ 270235.4 t

$

S

S

S

$

$

S

• ~ ~§!H!QQgO $ 8l1988.88 ! 72 475.71 $ 293,535.41

BI

Prn)tcIN9.

1"' RCq\I4IINo.

, MDASWfIliIiIIl

Activity Number,

I HIftlr/CtrUy Tn •• (.) II'lII U~I eov ... !lb}' 1hi"11~llhI'(. J\O(bHlI nc.lvtd from lilt ffd.l('l! GOVIIT\fI'IeI'lVSI.I\e GOfommeol ot .~I« ,ueI\ larviClIl.'Ildor IlI'/ olhlftor.lrKl lorltmenl or gorIn~ [b) Ulf um~nl reqlo'nltd IYi1 bot b~.i\Otdfl>l .(ow.~. ~11I/1~~di[ulu und" \h.e terml ~flM ,o~lrlel tguullnl or9rlln~ (e) tnt 1'!I)U,t r.qoJflll1 h"ti~ ~l!'1ot u~~d Iht 1~I.l fJtldlllt>llQlrill b)'eo:'Itncl; 11d (o) tI'\.'ur,4, fI' flquul,d lor t'llI1I1NN(liIll dil'[l<JfIf'N~tt.

I HI/lot ClftfyThl1 thl lioodJ ,oIcI'n:\'o.t UIVK4II1Mfre(! hi .... t>un dfwO./lId Ind'orperiDrmedifl gM(llatrW.!'I.n r~1 \.:me htld tbon aM.,. in W1'IP~~ee 'MUI &llltal"\OI}' flQ<1I'mlr.!llnclll~J.'io(oJ. I ~r'IIlyt'\.lll\il rtQ'Jtll

~I nollll¢.Jlj, InYldv1netl OII~MI fOl fuM' ob·I~.6o-Iu.

II this yourflnal requ(tlt (or ca.h on this contract? YeS x NO

'1+, tv:f±.NJ-~ JJ,-. J ,/ 71612010 Sem~e 8. Auocialos, Inc. §l2M:!!]Q Signiltvro of Authol1~ dfflclal Oato Slgnod Propal'8d By Dlte Prepared

AtiIHQffl HAL~S EBJ;tiIOEHI 601·932·9060 Typed Hame and nuo of Authorized Official Pcoparer'1 Telephone No.

Tobe, IbyMDA. I Official

APPROVED BY: DATE: Signalure, Avthpri;r:Cld '-IDA ReptesentatiVe

IDIS VO\l~h" Numwr VI<Hlo(Uumbir Fund N\lmw COllettll*, A,Uvltv Cod. 0.., ~c~,.c. .. bp.nu

WWVo'.mississippl·OCV

6129J~;\Documenls and Settings\oemWy Documell!s\PEARLRIVERCOPFCASHREQ.xts'o(

~ d)

---~ -Mississippi Development Authority

Consolidated Support Sheet Program: Community Development Block Grant Program Recipient PEARL RIVER COUNlY Contract Number. 06-055-PF...o, Request for Cash Number: 3 Total Amount Requested: S 72,475.71

Amount of This MOA Program AmoLlot MOA Program Amount

101$# Line Items Vendor Involco# Total Invoice R .. uest Local Match Bu~getcd Reauested to Date BalancE:-

Gel oIl'I'III ~1nItioo SAMPLE.& ASSOClA TES 55,200.00 55.200.00 531,500.00 $8.200.00 $23300.(',0

AWfdiSn Pnt~ (COBG 0 SAMPLE&AS$OC1ATES $O~oo SO,OO 53500.00 $3.500.00 SO.OO SO.CO

Total ministration $5,200,00 $5.200.00 $0.00 $3$,000.00 $'1,700.00 $23.300,00 ~

EngirreleflnQ I ArChitectural $167,000.00 SO~OO $167,000.00 SO.OO SO.OO SO,OO

= SO.OO ~ SO.OO

= SO.OO

Total En9jneerl~9I Architectural $167,000.00 SO.OO 5167.000.00 SO,OO $0.00 SO.OO

Continqeocies SO.OO SO.OO SO.OO SO.oo SO.OO

$0.00 $0.00

Total Contingencies $0.00 SO.OO so.oo SO.OO SO.DO SO.OO I

Construction SO.OO

Public Buildinq Const Casablanca 3 $104.973.10 SS7,275.71 $37,691.39 $41500Q.00 $144.764.59 $270.235.41

Publi<:: Buildiog Const advertisement 547.88 $0.00 547.88 SO.OO $0.00 $0.00

$0.00 $0.00 SO.OO $0.00 SO.OO

so.oo SO.OO

Total Constructlon $105,020.9a $67.275.71 $37.745.27 $415,000.00 $144,764.59 $270,235.41

GRANDTDTAL 1 1 $277.220.98 1 S72,475.71 $204.745.271 $450,000.00 1 "56.464.591 5293.535.41

SeNices Reru:lercd - Beginning: June 1 2010 ThnJ June 30, 2010

S156464.59 Plus (+) $336,685.79 Equals (=) $493.' SO.38 Cumulative: MOA Program Expendituru L.oc:a1 Matching Expenditure5 Total Expenditures

~ ~~ ~ That (oal the ~ covered byttas.!'8qUO$t ~ I'IOl beentflCRiveG frl)tn thtJ FecI8o'UI/SClktGovemmQmOl'"~td tor.uen ~I unoor~ othe(ax'ItnK:l ~ororwlt; {b) Ihe~ ~$\ed 'MIl be ~ k)r~ ~ I e~n=. undO!'

IetmS of ~~ 8gn!Cmet1t or gram: {e)!he :unounttoqulClllcCthctelndoes not -=-:I C'Ie total fund$ obligatO<! by con1Jaet:.tld (d) Cho Iuncb are ~ fOI'on/)' ~ ~nta.

I HetOby CQrtII'y Trw Il'1O aoocb.mld and/or ~i(:e,. rmdored have been delivered orodIOf"~1n ~ 0I'I1erw/l!\in tho ~ ....... letedaboYe;ana; _In c:ompti.uIc:e....un all ~ ~4ncI~. I torIlI'y lhat1his ~ dOH n«1tld\IdIa 3lty ~ orl.JOda for

.. ,"-"', l~ k- ,---.. . '. J- . /1;~rJ""AJ( ",U-;t;·b." 71612010 Sample & Associates. Inc.

Signature 0: Authorized O~ / Date Signed Prepared By

ANTHONY HALES. PRESIDENT 601-932-9050 TVOPrl N:=om .. -:r.n~ Totl", I'I' A,I1'hI'I,;.,.<>A ~ ... I O~~"",_ ... T ... I ............... '" M ....

www.mississippi.org

6129J2010 C:\Oocuments and Settingslcem\My Documents\PEARlRiVERCOPFCASHREQ.xlsx

PO$t Office Bo~ 320278 lOll NORTH FLOWOOD DRIVE FLOWOOD. MISSISSIPPI 39232

TO:

FROM:

DATE:

RE:

Sample & Associates, Incorporated

MEMORANDUM

Adrian Lumpkin

Sibby Lewis

06/29/10

CDBG.REQUISITION WITH INVOICES CASH REQUEST FORM

PHONE, (601) 931·9050 FAX, (601) 932·0137

Please find attached requisition, with invoice(s), and cash request for approval. Please return a copy of the signed requisition form, and the original cash request. (signed in two (2) places) to our office.


53

Pearl River County Katrina CR Gov. Bldg.


Book 0144 Pa9" 84

REQUISITION NUMBER: _1_8 __ CDBG PROJECT NUMBER: R-I03·055·01-KCR

DATE: _____ Ju_l~y __ 6_,2_0_1_0 ______ _ CDBG BANK ACCOUNTS NO: ___ _

PAYABLE TO: AMOUNT:

Jay-Van Company $244,975.00(CDBG)

Sample & Associates $ 16.500.00(CDBG)

APPR~:

BY: .JiI1;;t} President

)2 -. Document G702™ 1992

Application and Certificate for Payment TO OWNER: PROJECT: Distribution to:

PEARL RI~ COUNTY BOARD OF SUPERVISORS P.O. BOX$!

PEARL RIVER COUNTY OFFICE BUILDING R-1 03-055-01 KCR

APPUCATIONNO: 16

PERIOD TO: 611712010 OWNER 0

ARCHITECT 0

CONTRACTOR 0

FIELD 0

OTHER 0

FR8~cbm~~:S 39470 JAY-VAN cgMPANY P. O. BOX t5427 HATTIESB~G, MS 39404

917 GOODYEAR BLVD.

VIA)''ReHiY~:MS 39466

JH&H ARCHITECTS

CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment. as shown below, in connection with the Contract. Continuation Sheet. AIA Document G703. is attached.

1. ORIGINAL CONTRACT SUM................. ...................... .......... $ 4 760 000 2. Net change by Change Orders $ 0 3. CONTRACT SUM TO DATE (Line 1 ± 2) ............ . $ 4.760.000 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ...... $ 4.676.165 5. RETAiNAGE:

3 . .....§JL % of Completed Work (Column D + E on 0703)

b. ~O_ % of Stored Material (Column F on G703)

$ 233,811

$ 0

Total Retalnage (Lines 5a+ 5b or Total in Column I ofG703) ....... $ 233.811

6. TOTAL EARNED LESS RETAINAGE .... (l.inc 4 Le ... s.l.ine 5 Total)

7. LESS PREVIOUS CERTIFICATES FOR PAYMENT. (Line 6 from prior Certificate)

....... ..... $ 4,442,354

$ 4.197.379

8. CURRENT PAYMENT DUE ....... .............. ........ [5; 244,9751

9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 l~c; Line 6)

CHANGE ORDER SUMMARY Total changes approved in previous months by Owner $

Total approved this Month $

TOTALS $

NET CHANGES by Change Order $

$ 317,646

ADDmONS DEDUCTIONS o $ 0 o $ 0 o $ 0

0

CONTRACT FOR: NEW OFFICE BUILDING

CONTRACT DAnE: 111512009

PROJECT NOS: R-103-055'{l1KCR 1

The undersigned Contractor certifies that to the best of the Contractor' ~ knowledge. information and belief the Work. covered by this Application for Payment has been completed in accordance with the Contract Documents. that all amounts have been paid by the Contractor for Work foc which previou.c; Certiflcates for Payment were issued and payments received from the Owner. and that current payment shown herein is now due.

C~R: ),' By: IS 1'-1 ! , .,D Date: C')· n -to S"'te of: MS

County of: Forres! Subscribed and sworn to before

~daYOf~~10 NotOl}' Public: p~ Cooper ~ , . , . My Commission expires: 21212011

ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents. based on on-site observations and the data comprising chis application. the Architect certifies to the Owner that to the best of the Architect's knowledge. information and belief the Work has progressed as indicated. the quality of the Work is in accordance with the Contract Documents. and the Contractor is entitled to payment of the AMOUNT CERTIFIED .

AMOUNT CERTIFIED .............................................................................. S 4#( q 1"'5. q) (Attach explanation if amount certified differs from the amount applied. Initial alL figures on 1m:; Appiicalion and on the Continuation Sheet that o.re changed to conform with the amount certified.)

ARCH~ l I BY~ , _tH6 Date: ore. 4-\ ~O ificate is not negotiable. The AMOUNT CER is payable only to the Contractor

named \lcrcin. Is.<;uance. payment and acceptance of paym nt arc without prejudice to any rights of the Ow\cr or Contractor under this Contract.

CAUTION: You should sign an original AlA Contract Document. on which this text appears in REO. An original assures that changes will not be obscured. AlA Document G702l'M - 1992. Copyright C 1953, 1963, 1965. 1971. 1978. 1983 and t992 by The American Institute o~ Architects. All rights reserve-d. WARNING: This AlA" Document Is protected by U.S. Copyright Law and IrnernationaJ Treaties. Unauthori%cd reproduction or distribution of this AlA· Document. or any portion of it. may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possibfe under the law. Purchasers are permltted to reproduce ten (10) copies of this document when comple\ed. To report copyright violations 01 AlA Contract Documents. a·mail The American Institute of Architects· legal counsel, [email protected].

~':.' .$;~~ 1-\ I 1-\ D t G703'" 1992 0lJ' -:.1' .. ,... ocumen -Continuation Sheet Page 2 of 9

AlA Document G702, APPUCA nON AND CERnFICA nON FOR PAYMENT, containing Contractor's signed certification is attached. In tabulations li1:low. amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply.

A

~ ~.

~

B C 0 I E ::!: wORK COMPLETED .~

~ SCHEDULED ITEM qgsCRlPIION OF WORK FROM PREVIOUS NO. VALUE APPLICA nON THIS PERIOD

(0+ E)

1 BOND & INSURANCE 50,182 50,182

2 LABORTAX 51,820 51.820

3 SALESTAX 170,766 169,058

4 GENERAL CONDITIONS 50,416 50,416

5 SUPERVISION 82,032 82,032

6 PERMITS 12,263 12,263

7 CONTINGENCY 50,000 13,000

8 BUILDING CONSULTANT 25,000 25,000

9 ENGINEERING FEES 20,314 18,283 2.031

10 EXCAVATION & BACKFILL 75,970 75,970

11 SOIL TREATMENT 789 789

12 STORM DRAINAGE 14,619 14,619

13 AUGERCAST GROUT PILING 105,170 105,170

14 EROSIONISEDEMEN. CONTROL 2,955 2,955

15 REINFORCED CONCRETE PIPE 2,776 2,776

16 CHAIN LINK FENCING 3,116 3,116

17 CURB & GUTTER 12,911 10,974 1,937

731,099 688,423 3,968

F

MATERIALS PRESENTLY

STORED (NOT IN DORE)

0

APPLICATION NO:16

APPLICATION DATE: 6/1712010

PERIOD TO: 6/1712010

ARCHITECrS PROJECT NO: R·103-055-01KCR

G H I

TOTAL. BAlANCE COMPLETED % TO REfAINAGE

AND STORED (IFVARWlLE TO DATE (G.,.O ANISH RATE)

(C ·G) (D+E+F)

50,182 100 2.509

51,820 100 2,592

169,058 99 1,708 8.452

50,416 100 2,521

82,032 100 4,100

12,263 100 613

13,000 26 37,000 650

25,000 100 1,251

20,314 100 1,016

75.970 100 3,799

789 100 39

14,619 100 731

105,170 100 5,259

2,955 100 147

2,776 100 139

3,116 100 158

12,911 100 646

692,391 95 38,708 34,620

CAUTION; You should sign an original AJA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.

AlA Cocument G703™ -1992. Copyright e 1963, 1965, 1966, 1967, 1970. 1978. 1983 and 1992 by The American Institute of Architects. An rights re$erved. WARNING: This AlAftOocument is protected by U.S. Copyright Law and International Treaties. Unaulhorh::ed reproduction or distribution of this AlA- Document. or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten {10) copies 01 this document when completed. To repon copyright viOlations or AlA Contract Documents, e-mail The Amer~ Institute of Architects'logal counsel, [email protected].

,

I

L ~. 0) ,AlA Document G703'" -

Continuation Sheet AIA Document G702, APPLICATION AND CERTIFlCATION FOR PAYMENT. containing Contractor's S~ed certification is attached. In tabulations below. arnomIts are stated to the nearest dollar. Use Column I on Contractg. where variable retainagc for line items may apply.

A

= '" .)l C D

1992

.1 E - WORK COMPLE1ED -=-~

DESCR~ OF WORK SCHEDULED FROM PREVIOUS ITEM VALUE THIS PERIOD NO. APPLICATION

(D+E)

18 LANDSCAPING 52.505 52,505

19 CONCRETE FORMWORK & ACC 12.598 10,708 1,890

20 CONCRETE REINFORCEMENT 26,822 26,822

21 CAST IN PLACE CONCRETE 118,060 100,351 17,709

22 CONCRETE FINISH 50,503 42,928 7,575

23 ARCH IT. PRECAST CONCRETE 28.391 28.391

24 UNIT MASONRY ASSEMBLIES 116,213 116,213

25 STRUCTURAL STEEL 582,532 582,532

26 STEEL FLOOR DECK 78,467 78,467

27 STEEL ROOF TRUSSES 86,618 86,618

28 ALUMINUM lADDERS 7,508

I 7,508

29 ROUGH CARPENTRY 36.967 36,967

30 MILLWORK 104,318 78,236 26,080

31 WATERPROOFING 41,016 I 41,016

32 EXT INSULATION & SYN. STUCC J 10,517 I 10,517

33 FIRESTOPPING 6,836 I 6,836

34 METAL COMPo MAT. WALL PANE S 172,479 172,479

2,263,449 2,115,014 109,727

F

MATERIAlS PRESENTLY


0

APPUCATION NO:16

APPUCATION DATE: 611712010

PERIOD TO: 611712010

Page 3 of 9

ARCHITECT'S PROJECT NO: R-103-055-01KCR

G H I

TOTAL BALANCE COMPLETED

% TO RETAINAGE

AND STORED (IF VARIABLE (G ;. C) FINISH

TO DATE RATE) (D+E+F)

(C-G)

52,505 100 2.625

12,598 100 631

26,822 100 1,341

118,060 100 5,901

50,503 100 2,525

28,391 100 1,420

116,213 100 5,812

582,532 100 29,126

78.467 100 3,924

86,618 100 4,330

7,508 100 376

36,967 100 1,849

104.318 100 5,216

41.016 100 2,052

10,517 100 526

6,836 100 342

172,479 100 8,624

2,224,741 98 38,708 111,240

CAUTlON: You shC)uld sign an angina! AlA Contract Document, on which this text appears In RED. An orlglna1 assures that changes will not be obscured.

AlA Document G703N -1992. Copyright <S:l1963. 1965. f966. 1967. 1970, 1978. 198$ and 1992 by The American Instit~te of Architects. All rightS reserved. WARNING: This AlA'" Document Is protected by U.S. Copyright Law and International Treaties. Unauthoriled reproduction or distribution or this AlAe Document, or any pottlon ot it. may result in severe civil and crlmln.al pcn:l:ltlcs, and wHi be prosecuted to the maximum extent pOssible under the law. Purchasers are permitted to reproduce ten (TO) COpies of this oocument when compJetEXl. To roport copyrlght violations of AlA Contract Documents. e-mail The American Institute ot Architects'legal counsel, copyright@aia,org.

~ ,AlA Document G703™ - 1992 Continuation Sheet AlA Document G702. APPUCA nON AND CERTIFICA nON FOR PAYMENT. containing Contractor's signed certification is attached. Tn tabulations below. amoun~arc stated to the nearest dollar. Use Column I on Contracts where variable retainagc for line items may apply.

A B

~ ~ ~

C D I E ~ WORK COMPLETED = =

ITEM DESCRIPTlON.§F WORK SCHEDULED FROM PREV10lJS VALUE APPLICATION THIS PERIOD NO.

(0+ E)

35 STANDING SEAM MTL ROOFING 164.797 164.797

36 HM & WD DOORS & FRAMES 43.529 43.529

37 ALUMINUM STOREFRONT 352.320 352.320

36 FINISH HARDWARE 54.709 54.709

39 MTL STUDIDW/ACOUS CEILING

40 METAL FRAMING MATERIALS 68.353 68.353

41 METAL FRAMING LABOR 57.214 57,214

42 INSULATION IN STUDS MATEF AL 31.545 31.545

43 INSULAnON IN STUDS LABOR 10.515 10.515

44 METAL STUD FRAMING MATEI IAL 31.545 31.545

45 METAL STUD FRAMING LABOF 36.697 36.697

46 FURRING MATERIAL 1.683 1.683

47 FURRING LABOR 1.052 1.052

48 GYPSUM DRYWALL MATERIAL 68.348 68.348

49 GYPSUM DRYWALL LABOR 58.884 58.884 50 PORCELAIN TILE MATERIAL 24.185 24.185

51 PORCELAIN TILE LABOR 27.339 26,245

3.296.164 3.146.635 109.727

F

MATERIALS PRESENTI..Y


0

APPLICATION NO:16



Page 4 of 9

ARCHITECT'S PROJECT NO: R·l03-055-01KCR

G H I

TOTAL BALANCE COMPLETED % TO RETAINAGE AND STORED (IF v ARlABLE

TO DATE (G+C) FINISH RATE) (C·G) (D+E+f]

164.797 100 8.240

43.529 100 2.176

352.320 100 17.616

54.709 100 2.736

68.353 100 3.417

57.214 100 2.860

31.545 100 1.577

10.515 100 526

31.545 100 1.577

36.697 100 1.835

1.683 100 84

1.052 100 53

68.348 100 3,417

58.884 100 2.944

24.185 100 1.209

26,245 96 1.094 1.312

3.256.362 99 39.802 162.819

CAUTION: You should sign an original AlA Contract Document, on which this text appears in RED. An orrginal assures that changes win not be obscured.

AlA Document G7031Jo1 -1992. Copyright e 1963, 1965, 1966, 19B7. 1970, 1973. 1983 and 1992 by Tho American Instil1Jte 01 Architects. All rights reserved. WARN~NG: This AIA·Oocument is protected by U.s. Copyright Lew and International Treaties. Unauthorized reproduction or distribution of this AlA- Doeument, or any portion 01 It, may result in severe elyll and criminal penalties., and will be prosecuted to the maximum cxtent possible under the taw. Purchasers are p~rmitted 10 reproduce ten (10) copies of this document when completed. To report c:opyright violations 01 AlA Contract Documents. e-mall The American Institute of Architects'legal counsel. [email protected].

~ Document G703™ -1992 Continuation Sheet AlA Document G702, APPUCATION AND CERTIFICATION FOR PAYMENr, containing ConEractor's signed certification is attaChed. In tabulations fOlow. amount~ are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line itt:rns may apply.

A

~

= B C D J E

::'!; WORK COMPLETED ,~

= SCHEDULED ITEM IjsCRlPTION Of WORK FROM PREVlOUS NO, VALUO APPUCATION THIS PERIOD

(D+E)

52 DRYWALL SUSPEN MATERIAL 3,155 3,155

53 DRYWALL SUSPEN LABOR 2,100 2,100

54 ACOUS PANEL CEILING MA 27,000 27,000

55 ACOUS PANEL CEILING LABO 10,515 3,575 6,940

56 FLOORING CARPET & TILE

57 RESILIENT FLOOR TILE MAT 6,520 6,520

58 RESILIENT FLOOR TILE lASO 4,206 4,206

59 RESILIENT WALL BASIACC M~1r 3,155 2,209 946

60 RESILIENT WALL BASIACC LA OR 2,103 2,103

61 CARPET MATERIAL 29.442 20,904 8,538

62 CARPET LABOR 6,099 6,099

63 CARPET TILE MATERIAL 10,515 7,676 2.839

64 CARPET TILE LABOR 1,577 1,577

65 TERRAZZO FLOOR 10,517

66 PAINTING 99,202 79,362 19,840

67 'PRK STRIPINGICAR BUMPERS 1,417 1.417

66 TOILET PARTITIONS 7,548 7,548

3,521,235 3,310,890 I 160,026 -

F

MATERIALS PRESENTLY

STORED (NOT IN OORE)

0

APPLICATION NO:16



Page 5 of 9

ARCHITECT'S PROJECT NO: R-103-055-01KCR

G H I

TOTAL BALANCE; COMPLETED % TO RETAIN AGE AND STORED (IF VAlUABLE

TO DATE (G~C) FINISH RATE)

(D+E+F) (C - G)

3,155 100 158

2,100 100 105

27,000 100 1,351

10,515 100 525

6,520 100 326

4,206 100 210

3,155 100 157

2,103 100 105

29,442 100 1,472

6,099 100 305

10,515 100 526

1,577 100 79

10,517

99,202 100 4,960

1,417 100 71

7,548 100 377

3,470,916 99 50,319 173,546

CAUTION: You should sign an origrnal AlA Contract Document, on which this text appears in RED. An ortginal assures that changes will not be obscured.

AlA Document G703lM -1992. Copyright 0 1963, 1965, 1966, 1967, 1970, 1978. 1983 and 1992 by The American Institute of Architects. AU rights reserved. WARNING: Thls AlAe: Document is protected by U.s. Copyright Law and International Treaties. Unauthorized reproduction or distribution of thl$ AlA- Documenl. or any portion at It. may result ,n severe civil and crlminal penalties. and wfil be prosecuted to the maximum extent possible under the law. Purchasers ate permitted 10 reproduCG len (10) copies of this document when completed. To report copyright violations of AlA Contract Documents. e-mail The American InstiMe 01 Architects' legal counsel, [email protected].

o (J" -AlA ""' ...... ~ - -Document G703'"

Continuation Sheet AlA Document G702, APPUCA110N AND CERTlACA110N FOR PAYMENT. CODtalning Contractor's signed certification is attached. In tabulations OiIow .. amDunts are stated to the nearest dollar. Use Column I on CO)'ltractS where variable rerainage for line items may apply.

~

A B C D

1992

I E ::: WORK COMPLETED = ~

SCHEDULED ITEM ~CRIPTION OF WORK FROM PREVIOUS NO. VALUE APPUCATION THIS PERIOD

(D+E)

69 SIGNAGE 10.149 10.149

70 CANOPY 9,503 9.503

71 TOILET ACCESSORIES 9,250 9,250

72 MISC SPEC. PLAQUES 6,415 3,208 3,207

73 FLAG POLE 1,036 1,036

74 MARKERBOAROSJTACKBOARO~ 3,276 3,276

75 FIRE EXTINGUISHERS 4,616 4,616

76 ENTRANCE MAT 3,260

77 SPECIAL EQUIPMENT 21,034 21,034

78 WINDOW TREATMENTS 28,396

79 ELEVATORS 66,047 64,726

80 FIRE PROTECTION SYSTEM 41,910 35,624 6.286

81 MECHANICAL

82 PLUMBING UTILITIES 31.006 31,006

83 PLUMBING ROUGH-IN 29.934 29,934

84 PLUMBING STACK-OUT LABOI 42.735 42,735

85 PLUMBING STACK-OUT MAT 25.545 25.545

3.855.347 3.592.383 179,666 - --

f

MATERlI\LS PRESENTLY


0

APPLICATION NO: 16



Page 6 of 9

ARCHITECT'S PROJECT NO: R-103-055-01 KCR

G H I

TOTAL BALANCE COMPLETED % TO RETAINAGE AND STORED (IF V AR!ABLE

TO DATE (G.,.C) FlNISH RATE)

CD+E+f) (C'G)

10,149 100 507

9,503 100 475

9,250 100 463

6,415 100 320

1,036 100 52

3,276 100 164

4,616 100 231

3,260

21,034 100 1,052

28,396

64,726 98 1,321 3,236

41,910 100 2,095

31.006 100 1.551

29.934 100 1.496

42,735 100 2.136

25,545 100 1,277

3.772.051 98 83.29~L.- 188.601

CAUTION: You should sign an original AlA Contract Document, on which this text appears.n REO. An original assures that changes will not be obscured.

AlA Document G703n1 -1992. Copyright¢> 1563. 1965, 1966. 1967. 1970. 1978. 1983 a.nd 1992 by The Amorican Institute Of Architects. An righb reserved. WARNfNG: This AJA$Oocument rs protecte<:l by U.s. Copyright Law Zlnd International Treatres. Unauthorized reproduction or distribution 01 this AlA4Document. or any portion 01 It, may result In severe civil and crlminal.oenaltles., and will be prosecuted to the maximum extent pOSSible under the faw. Purchasers are permitted to reproduco ten (10) copies of ihls document when completed. To report copyright violatlons of ArA Contract Documents, o-mail The American Institute 01 Architects'legal counsel, [email protected].

-cr:

I

.AIA Document G703™ -1992 Continuation Sheet AlA Document 0702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed certification is attached. In tabulations ~ow, amounts arc stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply . ..

~

'" A B C D I 0

~ WORK COMPLETED ;;

~

SCHEDULED ITEM riSCRIPTION OF WORK FROM PREVIOUS

NO, VALUE APPUCA110N THlSPERlOD (D+ 0)

86 PLUMBING TRIM-OUT LABOR 15,750 11,812 3,938

87 PLUMBING FIXTURES 12,245 6,857 5,388

88 INSULATION 10,500 10,500

89 HVAC PIPING LABOR 51,345 51,345

90 HVAC PIPING MATERIAL 22,957 22,957

91 HVAC EQUIPMENT & CONTRO S 157,500 138,868 18,632

92 AIR DISTRIBUTION 33,180 33,180

93 AIR BALANCE 10,369 10,369

94 HVAC ROUGH-IN LABOR 88,133 86,133

95 HVAC ROUGH-IN MATERIALS 72,492 72,492

96 HVAC TRIM-OUT LABOR 7,350 6,982 368

97 ClO 1 REPLACE EXIST 6" SEW 945 945

98 ELECTRICAL

99 MOBILIZE LABOR 621 621

100 MOBilIZE MAT 857 857

101 UNDER GROUND COND, LABe ~ 7,347 7,347

102 UNDER GROUND COND, MAT 11,969 11,989

4,356,927 4,055,268 218,363

F

MA1ERlALS PRESENTLY

STORED (NOTlN DORE)

0

APPLICATION NO:16



Page 7 of 9

ARCHITECT'S PROJECT NO: R-103-055-01 KCR

G H I

TOTAL BALANCE COMPLf:TED % TO RETAINAGE AND STORED (IFVARlABLE

TO DATE (G~C) FINISH RATE)

CDtE+F} (e-G)

15,750 I 100 788

12,245 I 100 612 I

I 10,500 100 525

51,345 100 2,567

I

22,957 100 1,148

157,500 100 7,875

33,180 100 1,659

I 10,369 100 518 I

86,133 100 4,306

72,492 100 3,625

7,350 100 368

945 100 47

621 100 31

857 100 43

7,347 100 368

11,989 100 600

4,273,631 98 83,296 213,681

CAUTION: You should sign an original AlA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.

AlA Document G703T111 - 1992. Copyright t') 1963, 1965, 1966. 1967. 1970. 1978. 1983 and T992 by The American Institute of Architects. All rightS reserved. W ARNlNG: This AlAe Document Is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution ot this AIA"'Document. or sny portion of n. may result in severe civil and criminal penalties. and wit! be prosecuted to the maximum extent possible under the law. Purchasers are permitted to ropl'oduce ten (10) copies of this document when completed. To report copyright violations of AlA Contract Documents. ~I The Amencan Institute of Architects'legaf counsel, [email protected].

~ 0: Document G703'" -1992

Continuation Sheet AlA Document G702. APPLICATION AND CERTIFICATION FOR PAYMENT. containing Contractor's signed certification is attached. In tabulations ~w. amounts are stated to the nearest doHar. Usc Column Ion Contracts where variable rctainage for line items may apply .

A

•. ~ ro

B C D I E :;!; WORK COMPLETED = ~

SCHEDULED !TEM DjsCRlPTION OF WORK FROM PREVIOUS NO. VALUE APPUCA TION TIllS PERIOD

(D+E)

103 SlAB ROUGH-IN LABOR 4.873 4.873

104 SLAB ROUGH-IN MAT 7.012 7.012

105 INTERIOR ROUGH-IN LABOR 21.275 21.275

106 INTERIOR ROUGH-IN MAT 45.180 45.180

107 COPPER WIRING LABOR 6.555 5.900 655

106 COPPER WIRING MAT 36.389 36.389

109 EXT & SITE LIGHT FIXT. LABO 4.940 1.482 3.458

110 EXT & SITE LIGHT FIXT. MAT 20.707 20.707

111 FIXTURES LABOR 9.989 7,492 2.497

112 FIXTURES MAT 57.003 54.153 2.850

113 PANELS & GEAR LABOR 14.164 13.456 708

114 PANELS & GEAR MAT 25,281 25.281

115 DEVICES LABOR 3.356 2.853 503

116 DEVICES MAT 7.524 7.148 376

117 GENERATOR LABOR 15.209 12.928 2.281

118 GENERATOR MAT 105.791 64.633 21.158

119 INSTALL CONDUIT LABOR 2.205 1.764 441

4.744.380 4.407.794 253.290

F

MATERIALS PRESENTLY

STORED (NOT!N DORE)

0

APPLICATION NO:16



Page 8 of 9

ARCHITECT'S PROJECT NO: R-103-055-01KCR -~- --- - .-

G H 1

TOTAL BALANCE COMPLETED % TO RETAINAGE AND STORED (IF v ARli\.BLE

TO DATE (G~C) FINISH RATE) (D+E+F)

(C·G)

4.873 100 244

7.012 100 351 , 21.275 100 I 1.064

45.180 100 2.259

6.555 100 329

36.389 100 1.820

4.940 100 247

20.707 100 1.035

9.989 100 500

57.003 100 2.851

14.164 100 708

25.281 100 1.263

3.356 100 168

7.524 100 377

15.209 100 760

105.791 100 5.290

2,205 100 110

4.661.084 98 83.296 233.057

CAUTION: You shouJd sign an Original AlA Contract Docoment, on which this text appears in RED. Iu1 original assures that changes will not be obscured.

AlA Document G7U3™ -1992. Copyright e 19£3, 1965, 1966, , 967. 1970. 1978, 1983 and 1992 by The American instituTe 01 Architects. All rlg.hts reserved. WARNING: ThIs AIA°Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution 01 this AIA~ Document, or any portion of It, may result in seves-e chili and criminal penalties.. ~nd ¥l'iU be prosecuted to tile maximum extent possible under the law. Purchasers are permitted to reproduce ten {to) copies 01 this document when completed. To report copyright violations 01 AlA Contract Documents, e-mail The American Institute 01 Architects'legal counsel. [email protected].

I

I ,

P': :AIA Document G703™ - 1992 Continuation Sheet AIA Document G702. APPUCATION AND CERTIFICATION FOR PAYMENT, containing Contr.lctor's signed certification is attached. In tabulations ~low. amount.<; arc stated to the nearest dollar. Use Column I on Contracts where variable tctainagc for line: items mayapply.

*-~ A ~ B C D I E

~ WORK COMPLETED -=-~ 0 SCHEDULED FROM PREVIOUS ITEM m;sCRIPTION OF WORK

NO. VALUE APPUCATION THIS PERIOD (D+E)

120 INSTALL CONDUIT MAT 2,695 2,156

121 FIRE ALARM LABOR 2.001 700 1.301

122 FIRE ALARM MAT 10,924 7,647 3,277

4.760,000 I 4.418.297 257,868

F

MATERIALS PRESENTLY


0

APPLICATION NO:16



Page 9 of 9

ARCHITECT'S PROJECT NO: R,103-055·01KCR

G H I

TOTAL COMPLETED BALANCE RETAlNAGE

% TO AND STORED (WVARlABLE TO DATE

(G~C) FINISH RATE) (D+E+f)

(C ,G)

2.156 80 539 108

2.001 100 100

10,924 100 546

4,676,165 98 83.835 233.811

CAUTION: You should sign an originaJ AlA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.

AlA Document G703'no1 -1992. Copyright It) 1963, 1965, 1966. 1967, 1970, 1978, 1983 and' 992 by The American Institute at Archilects. An right!! reserved. WARNING: Tnis A1AttOocurnent 1$ protected by US. Copyright law and International Treaties. Unauthorized reprodtidlon or distribution 01 this AlAe Oocument. or any portion 01 it, may rosYlt In severe civil and alm~nal penalties, and will be pro:recuted to the maximum extent possible under the law. Purchasers arc permitted to re;xoduce ten ('to) copies of this document when completcd. To report copyright violations of AlA Contract Documents. e-mail The American Institute of ArChltects'legal counsel, copyrioht~a.org.

P. O. BOX 15427 24 BONHOMIE ROAD HA'ITlESBURG, MS 39401

June 17,2010

Mr. Michael T. Beauchamp

JAY-VAN COMPANY GENERAL CONTRACTOR

HATTIESBURG, MISSISSIPPI 39404-5427

JH & H ArchitectslPlanners/lnteriors 3760 I-55 North Suite 200 Jackson, MS 3921 I

RE: PEARL RIVER COUNTY OFFICE BUILDING PICAYUNE, MS PROJECT NO. 05-137-D

Dear Mr. Beauchamp:

PHONE-601-545-1161 FAX-601-583-2340

Book 0144 Page 94

This letter is to inform you that we are not requesting an extension of time due to rain or grounds too wet to work on the above referenced project.

If you should have any questions, please do not hesitate to call.

Sincerely,

JAY-VAN COMPANY

Raymond Hudson

, .

."

, II i I

I ,

.0 1 ~. . .. •

. . ~ ~.

1

P. O. IlOX 15427 24 BONHOMIE ROAD HATTIESBURG, MS 39402

June 17, 2010

Mr. Michael T. Beauchamp

JAY-VAN COMPANY GENERAL CONTRACTOR

HATTIESBURG, MISSISSIPPI 39404-5427

JH & H ArchitectslPlannerslInteriors 3760 I-55 North Suite 200

. Jackson, MS 39211

RE: PEARL RIVER COUNTY OFFICE BUILDING PICAYUNE, MS PROJECT NO. 05-137-D

Deal' Mr. Beauchamp:

PHO NE-60 1-545-U 61 FAX-601-583-2340

Please find enclosed five (5) Application and Certificates for Payment Number Sixteen, in the amount of $244,975.00, along with Construction Schedule and an Extension of Time Letter, on the above referenced project.

If you should have any questions, please do not hesitate to call.

Sincerely,

JAY-VAN COMPANY

REHipc

Enclosures

. ,''110 .......

.,9,

June 21, 2010

Jason Hicks, Sample & Associates 1013 N. Flowood Drive Flowood, MS 39232

Re: Pay Application #16

Jason,

Pearl River County Office Building Picayune, MS JH&H Project No. 05-0137E

ronco • Bagley • Lowls Wood,

We have reviewed the enclosed pay application #16 and approved an amount of $244,975.00, and recommend that it be placed in line for payment. All pay applications have the required documentation attached.

Cordially,

JH&H Architects/Planners/Interiors P.A.

~~\,~ Michael T. Beauchamp, AlA I Senior Proiect Architect

cc: Ray Snapp Adrain Lumpkin

A Prl)foulonol AHOclollon

I. CARL fRANCO. AlA PAUl J. BAGL~Y. AlA RANDALL LEWIS. 11111 II. BRUCF. WOOD. 11111

37601·55 Norlh Sulle 200 Jackson, Mluhslppl 3921 J~6323 P 601 9484601 f 601 3556200 w www.!hharchlle(fs.COnl

';-< /-" .

Bill To

SAMPLE AND ASSOCIATES, INC.

P. O. BOX 320278 1013 N. FLOWOOD DRNE FLOWOOD, MS 39232

PEARL RIVER COUNTY P. O. flOX 569 POPLARVILLE. MS 39470

Quantity Description

P.O. No.

2006 KATRINA CDRG· COMMUNITY REVITALIZATION (GOY.BUILDING) I CONSTRUCTION 95% COMPLETE

Date

6128/2010

Terms

Rate

16.500.00

Total

96 Invoice

Invoice #

06/2010·04

Project

Amount

16,500.00

$16.500.00

f:.

F ,,'~

Mississippi DevelopmentAuthority REQUEST FOR CASH

~'A: 'Geoornllnfotmatlon""" ~. :W{..".'·i·"~,:J' . ... :.,"-'\ .... :,~~:" :...'~' -':;'';-' .. :_- ··":_,:,':,.'i7 • .I"~' .-~ -:' "."". B2nk:lnforii1:aticn "V:.:, ": ";.~.---';:!----=---V' ;;.,' . Section B:z Information- "' .. '\. ~ ~:" ,.

IEIectronic T r.ansfer 1-- 065301948

1820005203

",""No, """"" No,

_No. R-103-tlSS-01.J<CR " ~

_N_ P€AAl.RlVERCOUNTY

lingAdciro::s P.O.BOX569

S~Address

, Stale Zip POPlARVILLE, MS 39470 (':,:" ~::~·:(~~:J~¥:~~J:{3:!·<:t BANKPLUS Bank NOO1tI:

1-= 105 SOl1rH MAIN ~ ~

'alephone No.

Fax Number

!:mail Acklress !Project iOescription

601-403-2300 EXT 302

~ ~,

'" ~ ~ ~

KCRGOVB~

r. St3teZlP

'~ephooo No.

From Junc-1, 2010

POPLARVILLE, MS 39470

ScM=R"""""'"

To

Junol30. :1010

VUIdorNQ.

IDCS Voucher Number

I

C:'R. P ... :':' " .. 0· :

=

Activity ~ptiol'1 BudgetAmoum

ADMINISTRATION $100.000.00

2 PUBLIC FACILITIES S2,525,536.00

3

4

5

6

Total: $2,625,536.00

..'

Total Prior Request to Dote

S81.0oo.00

$1,923.430.60

$2,004,4.30.60

Thru ;.

TIlts Request

$1$.500.0!}

$'-44,97~_OO

$261,475,00

AI for Payment

S".gnature

Oate

Remaining Balance Activity Numbers

S2,SO!}.OO

S357.130.40

SO.OO

SO,OO

SO,OO

$0,00

$359,630,40

I Hereby Certify That (a) the services covered by this request have not been received from the Federal Government or expended for such services under any other contract agreement or grant, (b) the amount requested will be expended for allowable costs I expenditures under the tenns of the contract agreement or grant; (c) the amount requested herein does not exceed the total funds obligated by contract; and (d) the funds are requested for only immediate disbursements.

I Hereby Certify That the goods sold and/or services rendered have been delivered and/or performed in good order within the time listed above and are in compliance with all statutory requirements and regulations. I certify that this request does not include any advances or fundSforMure~A

A~ cJ.» 7JSl2010 Sam"'&Auociat .. ,,"~ SignatlJre of Official Date Signed Prepared By

ANTHONY HALES, PRESIDENT 601·932·9050 Typed Name and TItle d Authorized 0fTiciaI Preparer's TelephOne No,

612912010

Date Prep.afed

9 --- - .•

,. Appficant: PEARL RIVER COUNTY

Period Cost - Beg~nning

1. Activity: ADMINISTRATION

Line 1terR:::=. :;;: A ADMINISTRATION ,

o· B. ~

"-~

C. :::; '" D. ~ 0

" =

2. Activity: PUBLIC FACILITIES

Line Item

A Construction of Gov. Bldg.

B. Construction of Gov. BidS.

C.

D.

3. Activity:

Line Item

A

B.

C.

D.

June 1. 2010

Vendor Name

Mississippi Development Authority Cash Summary Support Sheet

Request No: 13 Grant Number.

Ending Date: June 30. 2010 Contract Number:

(a) = (b)

Invoice # Invoice Amount Match Share

+

SAMPLE & ASSOCIATES $16,500.00 $0.00

Subtotal: ~16 5QO QO ~Q QO

(a) = (b) +

Vendor Name Invoice # Invoice Amount Match Share

Ja:t-Van Co. 16 $306.060.00 $306.060.00

Ja:t,-Van Co. 17 $244.975.00 $0.00

Subtotal: :5551 Q3500 ~306 Q6Q QO

(a) = (b) +

Vendor Name Invoice # Invoice Amount Matdl Share

Subtotal: $0 00 $0

o R-103-055-01-KCR

+

Federal Share

$16,500.00

~16 ~QQ QQ

+

Federal Share

$0.00

$244.975.00

S?44 9Z5 QQ

+

Federal Share

$000

Cumulative Match Expended To Date: $2.781,221.71 GRAND TOTAL: I $567.535.00 I $306.060.00 I $261,475.00 I Cumulative Federal Expended To Date: $2,265,905.60

I hereby Certify That a} the SeMce5 covered by thts request have not been received from the Federal Government or expended for such services under any other contract agreement or grant b) the amount requested will be expended for allowable costs/expenditures under the tenns of the contract agreement or grant c) the amount requested herein does not exceed the total funds obligated by contract and d) the funds are requested for only immediate disbursements. I Hereby Certify tthat the goods sold andior services rendered have been delivered and/or performed in good 0 are in cbmpliance with S~uto requirements and regulations. '1- I J. .tJ, ~

AN I HUNY HALI=S. I-'KI=SIUI=N I /YI, ~ Typed Name and Tille of Authorized Official 'Sig ature of A Offiolal

L..

· ... -~, -o

Community Development Block Grant Consolidated Support Sheet

Applicant: ..... PEARL RIVER COUNTY Contract Number:

Request for Cash Number: ::.:; 13 Total Amount Requested: ~tt''':::':~,'';?- '.~~~~.,.'~'~~'. ;"';'-.,'!,'/' · .. 03;-:·:' '(.~: \~::~·:~:,:l'r.';·'·'~ _·r:·:·:~': .:~.\;; .• '/,.; ,':' ·:-~.·,;,~:·.:,;~<,:;r_~~.;·! ... -",;... . _ .. ,. I.' *

Iunel;;'ms ..' . , E .- . -I •• A;;;~~.rt B~d9;ted . 1 Amo.:;rt Reguested to D~ LAmount of This Req';~ '1 Administration:-; $100.000.00 $81,000.00 $16,500.00 Engineering:;:: $0.00 $0.00 Specific line Items as Listed in the-Sudget: Construction of Public Building Ji5 $2,525,536.00 $1,923,430.60 $244,975.00

$0.00

$0.00

R-103-05S-01-KCR

$2,265,905.60 :' ,~~;, ,,,,,-t'_ ' • - , •

Balance $2,500.00

$0.00

$0.00 $357.130.40

$0.00

$0.00 $0.00 $0.00

$0.00 $0.00 $0.00

$0.00 $0.00 $0.00

Total Budget $2.625,536.00 ======$~2;;;,O:;;04;;f,43~0.6O $261,475.00 $359,630.40

.. - ,-; ~'~;~'~J.' _,', Tatar Funds Request to Date: Amount of Other Funds Expended to Date: COBG Project Balance Period of Projected Cash Needs - Beginning:

Today Date Contract Begin Date

Contract End Date Contract Extension (Months) (Enter # of Mths or 0) Final Contract Completion Date Contract Duration (Months)

% of Contract Period Elapsed

% of Contract Period Remaining

"~

$2,265,905.60 $2,781,221.71

$359,630.40

June 1, 2010

June 29. 2010 January 2. 2008

January 2, 2011 o

,~~:,> ;<~<~::4'£:;

Thru Ending Date June 30, 2010

Total Contract Budget $2,625,536.00 Total Amount Spent to Date $2,265,905.60

% Total Contract Budget Spent 86% % Contract Budget Remaining 14% Enter Number form Cash

36 Construction Budget Amount $2,525,535.00 Request

83% Total Construction Dollars

17% Spent to Date

% Consb'". Budget Remaining

$2,168,405.60 Enter Numberfrom Cash

________ ...:1C!4!:!..% Request

" ",

Post om" Box J1021S IOIJ NORTH FLOWOOD DRIVE FLOWOOD, MISSISSIPPI 391Jl

TO:

FROM:

DATE:

RE:

Sample & Associates. Incorporated

MEMORANDUM

Adrian Lumpkin

Sibby Lewis

06/29/10

Book OI~MMt (661''/932-9050 PAJ(, (601) 932-0231

CDBG-REQUISITION WITH INVOICES CASH REQUEST FORM

Please find attached requisition, with invoice(s), and cash request for approval. Please return a copy of the signed requisition form, and the original cash request. (signed in two (2) places) to our office,


IOd.

/03 · ,'.

Pearl River County


REQUISITION NUMBER: ----"5 __ _ PROJECT NUMBER ~~\ 8j~M??o d~rlD

DATE: July 6, 2010 BANK ACCOUNTS NO: _____ _

PAYABLE TO: AMOUNT:

Dungan Engineering $29,941.12(CDBG)

APPROVED:

BY:

Dungan Engineering, P.A. P. 0. Box 150 1574 Highway 98 East Columbia, MS 39429

Invoice To: Pearl River County Board of Supervisors

P. O. Box 569 Poplarville, MS 39470

In Reference To: Highland Commons Parkway Access Road Picayune, MS S12;T6S;R17W

Phase Percent

Phase Fee o[Tolal Fee

ltem 1 a - Design Phase Engineering 299,411.25 41.47

Item I b - Construction Phase Engineering 99,803.75 13.82

Item 2 - BOlmdary Surveys 39,921.00 5.53

Item 3 - Geotechnical Investigations 66,536.00 9.22

Item 4 - Traffic Analysis 49,902.00 6.91

Item 5 - Construction Material Testing 99,804.00 13.82

Item 6 - Construction Staking 66,536.00 9.22

Project Totals:

2010-05-28 . Invoice Number: 5

Project Manager: Les Dungan, III Professional Services for the Period: 2010-04-24 to 2010-05-21

Total Project Amount

Percent Comelele FeeEarned Prior Billing

60.00 179,646.15 149,705.63

0.00 0.00 0.00

. 90.00 35,928,90 35,928.90

0.00 0,00 0.00 0,00 0,00 0.00

0.00 0.00 0.00

0.00 0.00 0.00

Total Phases:

Ph ••• Billing Totals:

$721,914,00

Current Fee

29,941.12

0.00

0.00

0.00

0.00

0.00

0.00

$29,941,}2

$29,94],12

••• Total Project Invoice Amount: $2f!,941.12

FCElvr~"'" Rt: eLi RECF'\/=O JU"

Pagel

lOY

'& - Section A: Generallnforrnatlon

fAw!ic3nt Namc:r. PEARL RIVER COUfIlTY

MailingAd~ P. O. BOX 569

Street Address.

City, State 2jp POPL.ARVrLl.E, MS 39470

Telephone No, 601-403-2309 '" :8 Fmc Number

'" Email Address ~

'" KATRINA ED "-~ ~ -SectionC: R uestPerAc 0 0 =

Aaivity Description Budget Amourlt

, ADMINISTRATION $150000,00

2 PUBLIC FACILmES $4 850 000.00

3

4

5

6

Total; $5,000,000.00

Mississippi Development Authority REQUEST FOR CASH

Bank InfOllTl.2l:ion

Elcdton'lC Transfer 0653-01948

...... """"'" 1820005203

SolnkNamo: BANKPLUS

f"""= 1<lS SOuni MAIN

~Ity. STato ZIP POPlARVILLE, MS 39470

TcK'lOt'lOM No. 601-403-2244

Services Rendered.

From ./t.lne 1 2010 Thru

Total Prior Request to

To

June 30 ~10

D.te This Request Remaining Balance

$20000.00 $0,00 $130000.00

S16S 634.53 ~2994U2 S4 634 424.35

$0.00

$0.00

$0.00

$0,00

$205,634.53 £9941.12 $4,764,424.35

Section B: P ect Information

c.w.o.. """"""'. "'" ~.tQ3.l)$.Q1-KED

FOR MDA USE ONLY

V~No.

lOIS Vouc:tMtNumbv

T()\I;»1orP

Signaturo

Date

Activity Numbers

I H<!reby Certify That (a) the services cDvered by this request have nDt been received frDm the Federal GDvernment Dr expended fDr such services under any Dther contract agreement or grant (b) the amDunt requested will be expended fDr allowable costs I expenditures under the terms of the cDntract agreement or grant; (c) the amount requested herein does not exceed the tDtal funds Dbligated by contract and (d) the funds are requested for onty immediate disbursements.

I Hereby Certify That the goods sold and/or services rendered have been delivered and/or performed in good order within the time listed above and are in compliance with all statutory requirements and regulations. I certify that this request does not include any advances or funds for future obligations.

'-il·~;~ ~,.D •. 7/6/2010 SAMPLE & ASSOCIATES. INC. 612912010 Si§n;dure of Authorized Offic:ia! Oate Signed Pre~ay Dale Prepared ,

MTIiONY HAlES, PRESIDENT 601~932·9050

Typed Name and TrtJe t?f AtJ1horized OffdaJ Prep3rer's Telephone No.

_,No. 5

<3 Mississippi Development Authority

Cash Summary Support Sheet

Request No: ,5 Grant Number: 2006 Applicant: PEARL RIVER COUNlY

Period Cost - Beginning June 1. 2010 Ending Date: June 30, 2010 Contract Number: R-103-0S5-01-KED

1, Activity: ADMINISTRATION (a) = (b) + +

Line Uem Vendor Name !nvoice# Invoice Amount Match Share Federal Share ~

A. ADMINISTRATION ~ Samele & Associates $0.00 SO.OO

B. ,', $0.00 SO.OO ", . • 1)

C. ~ -..".

D. 0

'" 0

$OOQ ~Q QQ ~Q QO 0 Subtotal: =

2. Activity: PUBLIC FACILmES (a) = (b) + +

wne Item Vendor Name lnvoice# Invoice Amount Match Share Federal Share

A. BOUNDARY SURVEYS DUNGAN ENGINEERING $0.00 SO.OO $0.00

B. ARCH/ENGINEER DUNGAN ENGINEERING $29,941.50 $0.00 $29,941.50

C. STREET/ROAD $0,00 SO.OO $0.00

D. $0.00 $0,00 $0.00

Subtotal: ~211911 Sl lOQ QQ ~211 a11 50

3. Activity: (a) = (b) + +

Line Item Vendor Name Invoice # Invoice Amount Match Share Federal Share

A

B.

C.

D.

Subtotal: ).00 l.OO ~ Cumulative Match Expended To Date: GRAND TOTAL: I $29,941.50 I $0.00 I $29,941.50 I Cumulative Federal Expended To Date: $235,575.65

I hereby Certify That: a) the services covered by this request have not been received from the Federal Government or expended for such services under any other contract agreement or grant, b) the amount requested will be expended for allowable costs/expenditures under the tenns of the contract agreement or grant. c) the amount requested herein does not exceed the total funds obligated by contract and d) the funds are requested for only immediate disbursements. I Hereby Certify tthat the goods sold and/or services rendered have been delivered and/or performed i~c:7.1nd are in compliance with all staMory requirements and regulatlons. \...- ck \ D

AN I HQNY HALt::;, >'Kt::;llJt:N I . -. "e""-'Ie-' -I'li p"iY Typed Name and nUe of Authorized Official ~- Signatu"l, O¥Adthonzed Official

co

Community Development Block Grant Consolidated Support Sheet

Applicant:

Request for Cash Number: s: -a·

'" "-

ILine Items ~ ~ -Administration "" ~

Engineering g Specific Line Items as Listed in the Budget:

Acquisition

Legal Strppt & Rnrl.dJmnmvp:mp.nt~

Boundary Surveys

Geotechnical investigations

Traffic Analysis

Construction Material Testing

Construction Staking (':ontinnpnr.;pc:;

Total Budget

Total Funds Request to Date:

Amount of Other Funds Expended to Date:

CDBG Project Balance

Period of Projected Cash Needs - Beginning:

PEARL RIVER COUNTY

5

Amount Budgeted

$150.000.00 S399.215.00

$700,000.00

$25,000.00

$3,326,791.00 S39,921.00 $66,536.00 $49,902.00 $9980400 $6653600 $76,295.00

$5,000,000.00

$235,575.65

$0.00 $4,764,424.35

June 1, 2010

Contract Number: R-103-0S5-01-KED Total Amount Requested: $ 235.575.65

Amount Requested to Date Amount of This Request Balance

$20.000.00 SO.OO $130.000.00

$149.705.63 $29.941.12 $219,568.25

SO.OO

SO.OO SO.OO $700,000.00

$0.00 SO.OO $25,000.00

$0.00 SO.OO $3.326,791.00

$35,928.90 $0.00 $3,992.10

$0.00 $0.00 S66,536.00 $0.00 $0.00 $49,902.00 $0.00 $0.00 $99,804.00 $0.00 $0.00 S66,536.00 SO.OO SO.OO $76,295.00

$0.00 $0.00

$205,634.53 $29,941.12 $4,764,424.35

Thru Ending Date June 30, 2010

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 108 APPROVE BUDGET REQUEST OUT TO DEPTS. Date 7/ 6/2010 TRAVEL

ORDER TO APPROVE BUDGET REQUEST SENT OUT TO DEPARTMENTS WITH A REQUEST MEMO ADDITION OF NO INCREASE IN BUDGET REQUEST FROM PREVIOUS YEAR

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of Budget Memo sent out to Departments.

Upon the motion made by Sandy Kane Smith and seconded by Hudson Holliday, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to approve Budget Request sent out to Departments with a request memo addition of no increase in budget request from previous year.

Ordered and adopted,this the 6th day of July, 2010.


Voting NAY: None

ORDER TO APPROVE TRAVEL

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of travel for county employees and officials.


Be It Ordered by the Pearl River County Board of Supervisors to approve travel for the following listed officials and county employees to attend various workshops, seminars and meetings listed below and that reimbursement for any expenses incurred be and is hereby approved, including, but not limited to, travel, meals, lodging registration fees and other expenses incidental to said workshops, seminars, and meetings.

Vicki Hariel to Convention in Biloxi, MS on July 7-9, 2010



Voting NAY: None

PAGE 21

County Administrator

Memo Book 0144 Pa9~ 109

To: Department Heads

From: Adraln Lumpkin, Jr.

Date: June 30,2010

Re: Budget Request

It is budget time again. I have provided each department with a request form. The form contains this year's current budget and your estimated expenditures for this year. If you need any reports showing detail of accounts please let Anita or myself know. All forms need to be returned by July 20, 2010. Social Security should be figured at 7.65% and Retirement should be figured at 12%. Insurance should be figured at $7,300.00 per employee .

• Page 1

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 110 STOP SIGN ON GLOVER ROAD Date 7/ 6/2010 REINSTATING HOMESTEAD EXEMPTION

ORDER TO APPROVE ADDITION OF STOP SIGN ON GLOVER ROAD

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of stop sign on Glover Road.

Upon the motion made by Sandy Kane Smith and seconded by Joyce Culpepper, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to approve erecting stop sign on Glover Road at intersection of Peters and Glover Road.



Voting NAY: None

ORDER TO AUTHORIZE BOARD ATTORNEY TO REVIEW REINSTATING HOMESTEAD EXEMPTION

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of reinstating homestead exemption.


Be It Ordered by the Pearl River County Board of Supervisors to authorize Board Attorney to review reinstating homestead exemption on Sherman Gaspard based upon information provided.



Voting NAY: None

PAGE 23

CJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 111 TRACTOR LEASE WITH BANCORPSOUTH Date 7/ 6/2010 HEALTH ASSURANCE AGREEMENT

ORDER TO APPROVE EXECUTION OF LEASE WITH BANCORPSOUTH ON SEVEN TRACTORS

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of lease with Bancorpsouth on seven tractors.


Be It Ordered by the Pearl River County Board of Supervisors to authorize President to execute attached lease-purchase agreement with Bancorpsouth Bank on seven tractors.


Voting AYE:

Voting NAY: Absent:

Anthony Hales, Joyce Culpepper, Hudson Holliday, and Patrick Lee None Sandy Kane Smith

ORDER TO APPROVE EXECUTION OF HEALTH SERVICES AGREEMENT

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of health services agreement with Health Assurance, LLC.

Upon the motion made by Hudson Holliday and seconded by Patrick Lee, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to authorize execution of attached health services agreement between Health Assurance, LLC and Pearl River County to provide health care for the inmates in the Pearl River County Adult Detention Facility.


Voting AYE:

Voting NAY: Absent:

Anthony Hales, Joyce Culpepper, Hudson Holliday, and Patrick Lee None Sandy Kane Smith

PAGE 24

7023 70049-025

RESOLUTION AU,THOruZING AND APPROVING EXECUTION OF AN EQUIPMENT LEASE·PURCHASE AGREEMENT WITH

BANCORPSOUTH EQUIPMENT FINANCE, A DIVISION OF tiN(j'O~OIITH BANK

FOR THE PURPOSE OF LEASE-PURCHASING CERTAIN EQUIPMENT

WHEREAS, the Board of Supervisors, the Governing Body (the "Goveming Body") ·of Pearl River County, Mississippi (the "Lessee"), acting for and on the behalf of the Lessee hereby finds, deteooines and adjudicates as follows:

1. The Lessee desires to enter into an Equipment Lease-Purchase Agreement with the Exhibits attached thereto in substantially the same fOlm as attached hereto as Exhibit "A" (the "Agreement") with BancorpSouth Equipment Finance, a division of BancorpSouth Bank (the "Lessor") for the purpose of presently purchasing the equipment as described therein for the total cost specified therein (collectively the "Equipment") and to purchase such other equipment from time to time in the future upon appropriate approval;

2. The Lessee is authorized pursuant to Section 31-7-13(e) of the Mississippi Code of 1972, as amended, to acquire equipment and furniture by Lease-Purchase agreement and pay interest thereon by contract for a teoo not to exceed 5 years;

3. It is in the best interest of the resideuts sen'ed by Lessee that the Lessee acquire the Equipment pursuant to and in accordance with the terms of the Agreement; and

4. It is necessary for the Lessee to approve and authorize the Agreement.

5. The Lessee desires to designate the Agreement as a qualified tax-exempt obligation of Lessee for purposes of Section 265(b)(3) of the Intemal Revenue Code of 1986 (the "Code").

NOW, THEREFORE, BE IT RESOLVED by this Governing Body for and on behalf of the Lessee as follows:

Section 1. The Agreement and Exhibits attached thereto in substantially the same fonn as attached hereto as Exhibit "A" by and between the Lessor and the Lessee is hereby approved and --c:-_-;-___ :---;-~---_,_,(the "Authorized Officer") is hereby authorized and directed to execute said Agreement on behalf of the Lessee.

Section 2. The Agreement is being issued in calendar year __ ~_

Section 3. Neither any portion of the gross' proceeds of the Agreement nor the Equipment identified to the Agreement shall be used (directly or indirectly) in a trade or business carried on by any person other than a govemmental unit, except for snch use as a member of the general public.

Section 4. No portion of the rental payments identified in the Agreement (a) is secured, directly or indirectly, by property used or to be used in a trade or business carried on by a person other than a governmental unit, except for such use as a member of the general public, or by payments in respect of such property; or (b) is to be derived from payments (whether or not to Lessee) in respect of property or borrowed money used or to be used for a trade or business carried on by any person other than a governmental unit.

Section 5. No portion of the gross proceeds of the Agreement are used (directly or indirectly) to make or finance loans to persons other than govemmental units.

Section 6. Lessee hereby designates the Agreement as a qualified tax· exempt obligation for purposes of Section 265(b) of the Code.

Section 7. In calendar year , Lessee 8@l!s0144_n1tt~d $ -----;--;:--;-----=--;----0: oftax-exempt obligations (including the Agreement) as qualified tax-exempt obligations. Including the Agreement herein so designated, Lessee will not designate more than $30,000,000 of obligations issued during calendar year as qualified tax·exempt obligations.

Section 8. Lessee reasonably anticipates that the total amount of tax·exempt obligations (other than private activity bonds) to be issued by Lessee during calendar year will not exceed $30,000,000.

Section 9. For purposes of this resolution, the amount of Tax-exempt obligations stated as either issued or designated as qualified tax· exempt obligations includes tax·exempt obligations issued by all entities deriving their issuing authority from Lessee or by an entity subject to substantial control by Lessee, as provided in Section 265(b)(3)(E) ofthe Code.

Section 10. The Authorized Officer is further authorized for and on behalf of the Governing Body and the Lessee to do all things necessary in furtherance of the obligations of the Lessee pursuant to the Agreement, including execution and delivery of all other documents necessary or appropriate to carry out the transactions contemplated thereby in accordance with the terms and provisions thereof.

11'3

Following the reading of the foregoinJj resolution, ~/Jx." 41/:cL..~ moved that the foregoing resolutionbe adopted, 1"& f c.;' c/c 1. +' . seconded e motion for its adoption. The J'..ee?, ,/"" A..-..L put the question to a roll call vote and the result was as follows:

Voted: fpz /

Voted: Yt-? I

Voted: 'Yr .t" Voted: b

11/ Voted: Ur:

I Voted: ___ _

Voted: ____ ~

Book 0144 Pa9~ 114

notion having received the affirmative vote of all members present, the f4e."",!>!.e.~~_-=-_.,----,~ declared the motion carried and the resolution adopted this the --"J,,--' #-.=--' __ day of ...j" 20 ( Q

RE: Counsel's Opinion for Lease·Purchase

Please be advised that the first paragraph of the Counsel's Opinion for Lease Purchase letter refers to the Master Lease signed on March 8, 2005. TIlls date is different than the date of the schednle. The date on the fonn letter is the correct date of your Master Lease.

Book 0144 Page 115

''''m 8038·GC (Rev. November 20(0)

Inrormation Return ror Small Tax.Exempt Governmental Bond Issues, ·leases, and Installment Sales

,.. Under Internal Revenue Code saction 149(0) OMS No. 1545·0120

Caution: If the Issue price of the issue is $100,000 or more, use Form B038-G.

employer Idcntlflclulon number

3

6 010<.

8a Issue price of obllgatlon(s) (see Instructions) . 210,500.00

b Issue date (single issue) or calendar year (consolidated} (see instructions)'" ............ . 9 Amount of the reported obligatlon{s) on line 8a: a Used to refund prior Issue(s) . b Representing a loan from the proceeds of another tax-exempt obligation (e.g., bond bank)

10 If the issuer has designated any Issue under section 265(b)(3)(B)(I)(III) (small Issuer exception). check this box 11 If any obligation is In the form of a lease or installment sale, check this box. . . .

.~o

. HZ!

.~O 12 If the issuer has elected to a a enatt In lieu of arbitra e rebate. check this box

Sign Here

Under penalties of perjury, I de<:lare thaI I have examined this return and BCJ;ompanying schedu'es and slalemBilts. and to the best of my knowledge and bellaf, they are true. coned, and c<lmp!e!e.

~. J , , Issuef's authorized repf(l5ell

General Instructions Section references sre 10 the Internal Revonue Code unless otherwise noted.

Purpose of Form Form a038·GC is lIsed by the Issuers of tax·exempt governmental obligaunns to provide the IRS wilh the information required by section 149(e) and to monitor the requirements of secUons 141 through 150.

Who Must File ISsuers of tax-exempt governmental obligations with issue prices of less than $100.000 must file Form 8038·GC.

Issuers of a tax·exempt governmental obligation with an Issue price of $100,000 or more must file Form 8038·G, Information Rewm for Tax·Exempt Governmental Obligations. Filing a separate return. Issuers have the option to file 8 separate Form 1I038·GC for any tax·exempt governmental obligation with an Issue price of less Ihan $100,000.

An issuer of a tax·exempt bond used to finance constructlon expenditures must file a separate Form B038·GC for each Issue to give notice to the IRS that an election was made to pay a penalty In lieu of arbitrage rebate (see the line 12 instluctions),

FlIJng a consolidated return. For all tax·exempt govemmental obJlgations with issue prices of less than $100,000 that are not reported on a separate Form B03B·GC, M issuer must file a consolidated Information return Including all such issues issued within the calendar year.

Date

Thus, an ISSuer may fife a separate Form 8038·GC for each of n number of small iSsues and repan the remainder of small issues issued during the calendar year on one consolidated Form B038·GC. However. a separate FOfm B038-GC must be filed to give the IRS notice of the election to pay a penalty in lieu of arbitrage rebate.

When To File To fife a separate return. file Form 803B-GC on Of before the 15th day of the second ci3lendar month after the close of the calendar quarter In whIch the issue is Issued.

To file a consolidated return, file Form 8038·GC on or before February 15th of the calendar year fOllowing the year in which the Issue is issued.

Late filing. An Issuer may be granted an extension of time to file torm 8038·GC under SectIon 3 of Rev. Proc. 88·10, 1988·1 C.B. 635, if It is determined that the failure to file on Orne is not due to wlUful neglect. Type or print at the top of the form. ~This Statement Is Submitted in Accordance with Rev. Proe. 88·10." Attach to the Form 8038·GC a letter briefly stating why the form was not SUbmitted to the IRS on Ume. Also Indicate whether the obligation in question Is under examInation by the IRS. Do not submit copies of any bond documents, leases, or installment sale documents. See Where To File below.

Where To File File Fonn B038-GC, and eny attachments. with the Internal Revenue Service Center, ogden. UT 84201.

CIlt. No. 6"108B

~to~~Ldi6: &s,~~ Other Forms That May Be Required For rebating arbitrage (or paying a penalty in Heu of arbItrage rebate) to the Federal government, USe Form 8038-1, Arbitrage Rebate and Penalty In lieu of Arbitrage Rebate. For private a.ctlvi1y bonds, use Form 8038, Information Return for Tax·Exempt Private Activity Bond Issues.

Rounding to Whole Dollars You may show the money items on this return as whOle·doliar amounts. To do so, drop any amount less than 50 cents and increase any amount from 50 to 99 cents to the next higher dollar,

Definitions Obligations. TIlls refers to a single tax·exempt governmental obllgatlon If form 8038·GC is used for separate reporting or to multiple tax·exempt governmental obligations if the form Is used for consolidated reporting.

Tax~exempt obligation. This is a bond, Installment purChase agreement or financial fease, on which the Interest Is e;>:cluded (rom income under section 103_

lax·exempt governmental obligation. A tax· exempt obligation that is not a private activity bond (see balow) Is a tax-exempt governmental obligation. This Includes a bond Issued by a qualified volunteer fire departmenl under secti0!l150(e}.

Prillste aclivity bond. This InchJdes an obligation Issued as pi3rt of an issue In which: • More Ihan 10% of the proceeds are to be used for any private aCUvity business use, and

Form 8038-GC (Rev. 11-20(3)

SPECIAL STIPULATIONS

LESSOR: BancorpSouth Equipment Finance, a division of BancorpSouth BaIlk P.O. Box 15097 302 Second Avenue

7023 70049·025

Hattiesburg, MS 39404.5097 Bool, 0144 P~9' 117

By: ----------------------Title: ______________________ _

Date: ______________________ _

LESSEE: Pearl River County, Mississippi P. O. Box 569 Poplarville, MS 39470·0569

··NONE··

By: =f\C\ctL~a ~k Title: he'? i J <ltV 1-Date: 1 -, -"2 L> ( 0

EXHIBIT A

1/1

EQUIPMENT LEASE SCHEDULE

Lease Schedule Number 025

This Lease Schedule No. 025 to the Equipment Lease-Purchase Agreement dated as of March 8, 2005 (the "Agreement") between BancorpSouth Equipment Finance, a division of BancorpSonth Bank, a Mississippi Corporation (the "Lessor") and Pearl River County, Mississippi (the "Lessee"), acting by and through the Board of Supervisors, the Governing Body of the Lessee, is made as of tlus date.

I. Description of the Equipment. The quantity, item, manufacturer, and model and serial number of the Equipment subject to the Agreement are as appeal' on Exhibit "B-1" attached hereto and made a part hereof.

2.Location of the Equipment. The Equipmeut is to be located and delivered to Lessee's premises at ___________________________ _

3.0ri~inal Rental Term. The tenu of the Agreement shall be 4 years.

4.Rental Payments. The Lessee agrees to pay the Lessor the original cost of $21 0,500.00 for the Equipment hereof described in Exhibit "B-1" attached hereto, upon the tenns, and at the times as provided in the Payment Amortization Schedule, attached hereto as Exhibit "B-2" and made a part hereof, with an interest rate of 3.34 percent per annum as provided thereby.

5. This Schedule and its tenns and conditions are hereby incorporated by reference in the Agreement. .

DATED, this the ? 'II day of-=-~....::V,-,,-,-\ --'~~ ___ " Z-o (6

LESSOR:

BancolpSouth Equipment Finance, a division ofBancorpSoulh Bank

By: __________ _

Title: __________ _

LESSEE:

Pearl River County, Mississippi

EXHlBITB

)·1"1

ExmmTB-l Book 0144 P.~. 119

PearllUver County, Mississippi

Master Lease Number: 7023 Schedule Number: 25

2005 MASSEY FERGUSON TRACTOR, SN: ______ _






2005 MASSEY !'ERGUSON TRACTOR, SN: ______ _

Prepared by: First Continental LeasIng

Customer: Pearl River County, Missis.sippi

OuololD: 026·245g.o26·002

Quote Entered Date; 6/29/10

Interest Rate:

Per Oate

o 7125110

8125110

2 9/25110

3 10125110

4 11/25110

5 12/25110

2010

6 1125111

7 2125111

8 3125111

9 4125111

10 5/25/11

11 6125111

12 7/25111

13 8125/11

14 9125/11

15 10/25/11

16 11/25111

17 12125111

2011

18 1125112

19 2125112

20 3125/12

21 4/25112

22 5125/12

23 6125112

24 7/25/12

25 8125/12

26 9/25112

27 10/25112

28 11125112

29 12125112

30

31

2012

1125113

2125113

Version B.Oc

3.3400% (Monthly)

Payment

0.00

4.690.97

4.690.97

4.690.97

4,690.97

4,690.97

23,454.87

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

56.291.70

4,690.97

4,690.97

4,690.97

4,690.97

4.690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

4,690.97

56,291.70

4,690.97

4,690.97

Principal

0.00

4,105.08

4,116.51

4,127.97

4,139.46

4,150.98

20,639.99

4,162.53

4,174.12

4,185.73

4,197.38

4.209.07

4,220.78

4,232.53

4,244.31

4.256.12

4,267.97

4,279.85

4,291.76

50,722.17

4,303.71

4,315.69

4.327.70

4,339.74

4,351.82

4,363.94

4,376.08

4.388.26

4,400.48

4,412.72

4,425.01

4,437.32

52,442.46

4,449.67

4,462.06

InfoAnalysis Payment Amortization Report

Interest

0.00

585.89

574.47

563.01

551.52

540.00

2,814.88

528.44

516.86

505.24

493.59

481.91

470,19

456.44

446.66

434.85

423.00

411.12

399.21

5,569.53

387.27

375.29

363.28

351.23

339.15

327.04

314.89

302.71

290.50

278.25

265.97

253,65

3,849.23

241.30

228.92

Page 1

Principal

Balanco

210,500.00

206,394.92

202,278.41

198,150.44

194,010.99

189,860.01

185,697.48

181,523,36

177,337.63

173,140.24

168,931.17

164,710.39

160,477.86

156,233.55

151,977.42

147,709.45

143,429.60

139,137.84

134,834.13

130,518.45

126,190.75

121,851.01

117,499.18

113,135.25

108,759.17

104,370.90

99,970.43

95,557,71

91,132.70

86,695.38

82,245.70

77.783.65

Exhibit B-2

I ;;M,)

7111201012:15:55 PM

File Name: Infoa.ladx

~ook 0144 hl~ 120

Accrued

Interast

0.00

585.89

574.47

563,01

551.52

540,00

2,B14.88

528,44

516.86

505.24

493.59

481.91

470.19

458.44

446.66

434.85

423.00

411,12

399.21

5,569.53

387.27

375.29

363.28

351.23

339.15

327,04

314.89

302.71

290.50

278.25

265.97

253.65

3,849.23

241.30

228.92

Accrued

Int Bal

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0,00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

Net Balance

210,500.00 .

206,394,92

202,278.41

198,150.44

194,010.99

189,860.01

185,697.48

181,523.36

177,337.83

173,140.24

168,931.17

164,710.39

160,477.86

156,233.55

151,977.42

147,709.45

143,429,60

139,137.84

134,834.13

130,518.45

126,190.75

121,851.01

117,499.18

113,135.25

108,759.17

104,370.90

99,970.43

95,557.71

91,132.70

86,695.38

82,245.70

77,783.65

J ?-/

Prepa~ed by: First ContJnenlal Leasing InfoAnalysl& 7/1/201012:15:55 PM

Payment Amortization Report File Name: infoa.ladx

Customer: Peart RIver County. Mississippi

QuolelD: 026·2459.026·002

Quolo Enlsreo Dais: 6129/10

Interesl Rale: 3.3400% (Monl~IYI

Principal Accrued Accrued

Per Date Payment Principal Interest Balance Interest Int Bal Net Balance

32 3/25/13 4.690.97 4.474.46 216.50 73.309.17 216.50 0.00 73.309.17

33 4/25113 4.690.97 4.486.93 204.04 68.822.24 Bao~.IIiII44 rag' 121 0.00 68.822.24

34 5/25113 4.690.97 4,499.42 191.56 64.322.82 191.56 0.00 64.322.82

35 6125113 4.690.97 4.511.94 179.03 59.810.88 179.03 0.00 59.810.88

36 7125113 4.690.97 4.524.50 166.47 55.286.38 166.47 0.00 55.286.36

37 8125113 4.690.97 4.537.09 153.88 50.749.28 153.86 0.00 50.749.26

36 9125/13 4.690.97 4.549.72 141.25 46.199.56 141.25 0.00 46.199.56

39 10/25113 4.690.97 4.562.39 128.59 41.637.17 128.59 0.00 41.637.17

40 11125113 4.690.97 4.575.08 115.89 37.062.09 115.89 0.00 37.062.09

41 12125113 4.690.97 4.587.82 103.16 32,474.27 103.16 0.00 32,474.27

2013 58.291.70 54.221.11 2.070.59 2.070.59

42 1/25114 4.690.97 4.600.59 90.39 27.873.68 90.39 0.00 27.873.68

43 2125/14 4.690.97 4.613.39 77.58 23.260.29 77.58 0.00 23.260.29

44 3125114 4.690.97 4.626.23 64.74 16.634.06 64.74 0.00 18.634.06

45 4125114 4.690.97 4.639.11 51.86 13.994.95 51.66 0.00 13.994.95

46 5125114 4.690.97 4.652.02 38.95 9.342.92 38.95 0.00 9.342.92

47 6125114 4.690.97 4.664.97 26.00 4.677.95 26.00 0.00 4.677.95

46 7/25/14 4.690.97 4.677.95 13.02 0.00 13.02 0.00 0.00

2014 32.836.82 32.474.27 362.55 362.55

Totals: 225.166.78 Z10.500.00 14.666.78 14.666.78

Version B.Oc page 2

7023 70049-025 EQUIPMENT ACCEPTANCE NOTICE

TO: BancorpSouth Equipment Finance, a division of Ban corp South Bank

RE: Equipment Lease-Purchase Agreement dated as of March 8, 2005.

Book 0144 P'9~ 122

Pearl River County, Mississippi (the "Lessee"), acting by and through the Board of Supervisors, the Governing Body of the Lessee, hereby acknowledge receipt in good condition and working order of the equipment (the "Equipment") as listed on Exhibit "C-I" attached hereto and made a part hereof and further described in the invoices attached hereto and made a part hereof. The Equiplnent is subject to the Equipment Lease-Purchase Agreement dated as of March 8, 2005 between Lessor and Lessee. Lessee certifies to Lessor that the Lessee has inspected the Equipment and that the Equipment is acceptable and approves supplier's(s') invoices for the Equipment and requests that Lessor make payment of such invoices.

Lessee further acknowledges that it selected the Equipment so received. LESSEE AGREES THAT LESSOR MADE NO REPRESENTATIONS AND WARRANTIES WHATEVER, DIRECTLY OR INDIRECTLY, EXPRESS OR IMPLIED, AS TO THE SUITABILITY, DURABILITY, FITNESS FOR USE, MERCHANTABILITY, CONDITION, QUALITY, OR OTHERWISE OF SUCH EQUIPMENT. LESSEE SPECIFICALLY W AlVES ALL RIGHT TO MAKE ANY CLAIM AGAINST LESSOR ITS ASSIGNS FOR BREACH OF ANY WARRANTY, OR TO INTERPOSE OR ASSERT ANY SUCH DEFENSE, COUNTERCLAIM OR SETOFF.

LESSEE:


EXHIBITC

1(}.3

EXHIBITC-l


Master Lease Number: 7023 Schedule Number: 25

2005 MASSEY FERGUSON TRACTOR, SN: ______ _ Book 0144 P3<). 123



2005 MASSEY FERGUSON TRACTOR, SN: _____ . __




Please indicate \vho fimds are to be released to:

Customer (if customer is to be paid, please send copy of check where vendor has been paid)

--4- Vendor

Sook 0144 p"»" 124

BancorpSouth Equipment Finance a division of BallcOIpSoutlt Bank

P. O. Box 15097 Hattiesburg, MS 39404-5097

601-544-3252 - 800-222-1610 - FAX 800-322-1611

July 1, 2010


RE: 7- 2005 Massey Ferguson Tractors

Insurance must be maintained on any leased equipment or vehicles. Please forward insurance certificate for our files from your insurance company. We require BancorpSouth Equipment Finance be listed as loss payee for leased equipment and or vehicles as our interest may appear.

Please contact your insurance agent to update your coverage and provide us the necessary. evidence of insurance.

Your prompt attention is needed and appreciated in tIlls matter. If you need further information or have any question, please contact me at 800-222-1610.

Please list BancorpSouth Equipment Finance as loss payee.

Thank you,

Jessica Cooksey

BancorpSouth Equipment Finance Phone: (601) 544-3252

P.O. Box 15097 Toll Free: (800) 222-1610

Hattiesburg, MS 39404 Fax: (800) 322-1611

(601) 545-1830

HEALTH SERVICES AGREEMENT

THIS AGREEMENT between Pearl River County, Mississippi (hereinafter

referred to as the "Client"), and Health Assurance, LLC, (hereinafter referred to as tt. .J,;(y

"HALLC"), is entered into upon entered into as of the L day of JtIRe, 2010. Services

under this Agreement shall commence 12:01 A.M. an the date set out above, and shall Book QI44 Pa9~ 126

continue for a period of thirty-six (36) months with two one-year options to be exercised

by either party, in accordance with Section 8.1 .

. WITNESSETH:

WHEREAS, the Client is charged by law with the responsibility for obtaining and

providing reasonably necessary health care for the inmates in the Pearl River County

Adult Detention Facility, 200 South Main Street Poplarville, Mississippi 39470

(hereinafter known as the "Facility"); and

WHEREAS, the Client desires to provide for health care to these Inmates in

accordance with applicable law; and

WHEREAS, the Client, which receives funding for the Facility as approved by the

Pearl River County Board of Supervisors, desires to enter into this Agreement with

HALLC to promote this objective; and

WHEREAS, HALLC is in the business of providing correctional health care

services and desires to provide such services for the Client under the terms and

conditions hereof,

NOW, THEREFORE, in consideration of the covenants and promises hereinafter

made, the parties hereto agree as follOWS:

ARTICLE I: HEALTHCARE SERVICES

1.1 General Engagement. The Client hereby cont~~"~tgj~if~g~HAt!Lc to

provide for the delivery of reasonably necessary health care services to Individuals

under the custody and control of the Client at the Facilities. HALLC enters into this

Agreement according to the terms and provisions hereof.

1.2 Scope of General Services. The responsibility of HALLC to deliver

reasonably necessary health care to inmates commences with the booking and physical

placement of said inmates into the Facilities. HALLC shall provide health care services

for all persons committed to the custody of the facilities.

HALLC shall provide the following services, which shall constitute Reasonable

Health Care Services in accordance with NCCHC standards:

a. Review Intake Screenings;

b. Oral Screenings;

c. Detoxification;

d. Heath Assessments;

e Sick Call (Monday through Friday);

f. Special Needs Treatment plans;

g. Nursing Care;

h. Regular Physician visits to the Facility; Including OB/GYN Visits

I. On-Site Clinical Laboratory Services; and

j. On-Site X-Ray Services.

HALLC will be responsible to assure that medications will be passed to the

appropriate inmates two times per day at the Facility or as deemed medically necessary

by HALLC. Medications prescribed by HALLC physicians on an as-needed ("PRN")

basis will be distributed per those instructions. HALLC medical staff will prepare and

I? '1

distribute all medication within the Facility. A deputy/correctional officer will escort the

medical staff while distributing medications at the Facility.

1.3 Responsibility for Off-Site Costs. HALLC shall have no responsibility for

costs associated with any off-site services, including, but not limited to, off-site specialty

clinics, on-site specialty clinics, ambulance services, off-site radiology services,

emergency room visits and inpatient hospitalization. These services shall be arranged

for by HALLC in coordination with the jail administrator or his designee, however, HALLe

shall not be liable for any costs associated with these services.

1.4 Further Exceptions to Treatment. HALLC will not be financially

responsible for the cost of any medical treatment or health care services provided to any

inmate prior to the inmate's formal booking and physical commitment into the Facilities.

The Client will maintain financial responsibility for pharmacy services, including

the cost of medications.

The Client will maintain financial responsibility for the cost of any medical

treatment or health care services provided to medically stabilize any inmate presented at

booking with a life threatening injury or illness or In need of immediate emergency

medical care.

Once an inmate has been medically stabilized and physically committed to the

facility, HALLC will be financially responsible for the cost of Reasonable Health Care

Services set forth in this Agreement regardless of the nature of the illness or injury or

whether or not the illness or injury occurred prior or subsequent to the individual's

incarceration at the Facility. An inmate shall be considered medically stabilized when, In

the judgment of a licensed medical provider, the medical condition no longer requires

immediate emergency medical care or outSide hospitalization so that the inmate

reasonably can be housed inside the Facility. HALLC will not be responsible for the cost

of any health care services not provided at the Facility.

The Client will maintain financial responsibility for medical costs associated with

the delivery of or the medical care of any infants born to inmates. HALLC shall provide

health care services to pregnant inmates' which can be provided on site, but health care

services provided to an infant following birth will not be the responsibility of HALLe. Book 0144 P.9~ 129

HALLC shall not he responsible for any costs associated with abortions, or terminations

of pregnancies for whatever reason.

The Client will maintain financial responsibility for any medical testing or

obtaining samples, which are forensic nature.

1.5 Change in Standard of Care or Scope of Services. The price in Section 8,

below, reflects compensation for the scope of services as finally agreed upon by the

parties to this agreement. This final, negotiated agreement represents the total and

completed agreement between the parties and all prior proposals, correspondence and

understandings whether written or oral, are superseded by this written agreement.

Should there be any change in standards of care/treatment or scope of services that

results in sustained and material increase in prices to HALLC, the increases in price

related to such changes are not covered in this proposal and the parties will renegotiate

the terms of this agreement which are affected by the material change.

1.6 Inmates Outside the Facilities. Inmates outside the Facilities shall not be

the responsibility of HALLC, nor shall such inmates be included in the daily population

count. Inmates on any sort of temporary release, including, but not limited to, inmates

temporarily released for the purpose of attending funerals or other family emergencies,

inmates on escape status, inmates on work release, furlough, pass, parole or supervised

custody who do not sleep in the Facility at night, will not be included in the dally

population count, and will not be the responsibility of HALLC with respect to the payment

or furnishing of health care services. The cost of medical services provided to inmates

who become ill or are injured while on temporary release will not be the financial

responsibility of HALLC after their return to the Facilities. This relates solely to the costs

relating to the particular illness or injury incurred while on such temporary release. The

cost of medical services provided at the Facilities for other illnesses and Injuries will be

the responsibility of HALLC. Book 0144 Pa9~ 130

Inmates in the custody of other police or other penal jurisdictions at the request

of the County are likewise excluded from the population count and are not the

responsibility of HALLC for the furnishing or payment of health care services.

1.7 Elective Medical Care. HALLC will not be responsible for providing

elective medical care to inmates. For purposes of the Agreement, "elective medical

care" means medical care which, if not provided, would not, in the opinion of HALLC's

Medical Director, cause the inmate's health to deteriorate or cause definite harm to the

inmate's well being. Such decisions concerning medical care shall be consistent with

general NCCHC standards. Any referral of inmates for elective medical care must be

reviewed by the Client prior to provision of such services.

ARTICLE Ii: PERSONNEL

2.1 Staffing. HALLC shall provide medical, technical and support personnel

as necessary for the rendering of health care services to inmates at the Facility as

described in and required by this agreement. Staffing pattern shall be based on the

assumption that there will be on the average up to 370 Inmates. Should the inmate

population increase to a level greater than 370 inmates average daily population on a

monthly basis, HALLC will charge a variable cost in accordance with ARTICLE Vii,

Section 8.2 to cover the incremental variable costs of providing services to this additional

population,(this does not reflect any additional staffing costs). Should a sustained

increase in the inmate population occur, HALLC reserves the right to review the staffing

and contract price and, with the Client's participation and approval, which shall not be

.unreasonably withheld, make necessary adjustments in staffing and contract price In

130

order to accommodate any additional staff positions, which may be needed to serve the

increased Inmate population.

2.2 Licensure. Certification and Registration of Personnel. HALLC ensures

that all personnel provided or made available by HALLC to render services hereunder,

shall be licensed, certified or registered as appropriate, in their respective areas of

expertise as required by applicable law. HALLC shall provide to the appropriate,

deSignated office or department a copy of the license, certificate or registration of

personnel employed by HALLC at the Facilities.

2.3 Client's Satisfaction with HealthCare Personnel. The Client reserves the

right to reject any HALLC personnel, whether employee or subcontractor, whether

employed now or in the future. Any such rejection shall be given to HALLC in writing

and shall not be unreasonably exercised by the Client. The Client may do background

investigations on all prospective HALLC employees before such personnel shall perform

services hereunder. In the event the Client rejects any HALLC job applicant, employee

or subcontractor, it agrees to Inform HALLC, on a confidential basis, the reasons for said

rejection. Due to the sensitive nature of the jail environment, HALLC agrees that in the

event the Client is dissatisfied with any of the personnel provided under this contract, it

may deny access of such. personnel into the correctional facility. Should removal of an

individual become necessary, HALLC will be allowed reasonable time, prior to removal,

to find an acceptable replacement, without penalty or any prejudice to the interests of

HALLC.

2.4 Use of Inmates in the Provision of Health Care Services. Inmates shall

not be employed or otherwise engaged by either HALLC or the Client in the direct

rendering of any health care services. Upon prior written approval of the Client, inmates

may be used in positions not involving the rendering of health care services directly to

inmates.

13/

2.5 Subcontractor and Delegation. In order to discharge its obligations

hereunder, HALLC will engage certain heath care professio~'iJ~ oy~ Pr~~eWndent

contractors rather than as employees. Subject to the approval described in Section 2.3

above, as if such persons were HALLC employees, the Client consents to such

subcontracting or delegation. As the relationship between HALLC and these health care

professionals will be that of independent contractor, HALLC will not be considered or

deemed to be engaged in the practice of medicine or other professions practiced by

these professionals. HALLC will not exercise control over the manner or means by

which these independent contractors perform their professional medical duties.

However, HALLC shall exercise administrative supervision over such professionals

necessary to ensure the strict fulfillment of their obligations contained in this Agreement.

For each agent and subcontractor, including all medical professionals, physicians

dentists and nurses performing duties as agents or independent contractors of HALLC

under this Agreement, HALLC shall provide the Client proof, if requested, that there is in

effect a professional liability or medical malpractice Insurance policy covering

professional of at least One Million Dollars ($1,000,000) per occurrence and Three Million

Qollars ($3,000,000) aggregate. Such policy(ies) shall also meet the requirements set

forth in Section 9.1 hereof.

2.6 Discrimination. During the performance of this Agreement, HALLC, the

Client, Its employees, agents, subcontractors, and assignees agree as follows:

(a) None will discriminate against any employee or applicant for employment

because of race, religion, color, sex or national origin except where religion, sex or

national origin is a bona fide occupational qualification reasonably necessary to normal

operation of the contractor. Each will agree to post in conspicuous places, available to

employees and applicants for employment, notices setting forth the provisions of this

nondiscrimination clause.

(b) In all solicitations or advertisements for employees each will state that it is

an equal opportunity employer. Book 0144 P~ge 133

(c) Notices, advertisements and solicitations placed In accordance with

federal law, rule or regulation shall be deemed sufficient for the purpose of meeting the

requirements of this section.

ARTICLE III: STANDARD OF CARE

3.1 Obligation of HALLC. HALLC's services shall be provided in accordance

with the standards promulgated by the National Commission on Correctional Health

Care (NCCHC) for Health Services in Facilities (1996 Edition) and standards in the

community.

ARTICLE IV: REPORTS AND RECORDS

4.1 Medical Records. HALLC shall cause and require to be maintained

complete and accurate medical records for each inmate who has received health care

services. Each medical record will be maintained in accordance with applicable laws,

NCCHC standards and the Client's policies and procedures. The medical records shall

be kept separate from the inmate's confinement records. A complete legible copy of the

applicable medical record shall be available at all times. A medical transfer sheet shall

accompany each inmate who is transferred from the Facility to another location for oft

site services or transferred to another institution. Medical records shall be kept

confidential. Subject to applicable law regarding confidentiality of such records, HALLC

shall comply with Mississippi law and the Client's policy with regard to access by

inmates and Facility staft to medical records.

No information contained in the medical records shall be released by HALLC

except as provided by the Client's policy, by a court order, or otherwise in accordance

with the applicable law. HALLC shall, at its own cost, provide all medical records, forms,

jackets, and other materials necessary to maintain the medical records. At the

133

termination of this Agreement, such medical records shall be delivered to and remain

with the Client. However, the Client shall provide HALLC with reasonable ongoing

access to all medical records even after the termination of this Agreement for the

purposes of defending claims and litigation. Boof; 0144 Pa9~ 134

4.2 Regular Reports by HALLC to the Client and the County. HALLC shall

provide to the Client, on a date and in a form mutually acceptable to HALLC and the

Client, monthly and annual reports relating to known costs and services rendered under

this Agreement and shall also provide reports approving claims for payment by the

County for services to inmates for which neither the Client nor HALLC is financially

responsible under this Agreement. The review and approval of such claims for payment

by the County shall be in accordance with terms agreed to by the County and HALLC

and shall be performed in accordance with standard HALLC's business practices.

4.3 Inmate Information. Subject to the applicable state law In order to assist

HALLC in providing the best possible health care services to Inmates, the Client wiii

provide HALLC with information pertaining to inmates that HALLC and the Client

mutually identify as reasonable and necessary for HALLC to adequately perform Its

obligations hereunder.

4.4 HALLC Records Available to the Client with Limitations on Disclosure.

Subject to Section 4.1 HALLC shall make available to the Client, at the Client's request,

all records, documents and other papers relating to the direct delivery of health care

services to inmates hereunder. The Client understands .that many of the systems,

methods, procedures, written materials, computer programs and other controls

employed by HALLC in the performance of its obligations hereunder are proprietary in

nature and will remain the property of HALLC. After the termination of this agreement,

information concerning such may not, at any time, be used, distributed, copied or

otherwise utilized by the Cttent, except as permitted or required by taw, unless such

disclosure is approved in advance writing by HALLC. Book 0144 Pa90 13S

4.5 Client's Records Available to HALLC with Limitations on Disclosure.

During the term of this Agreement and for a reasonable time thereafter. the Client will

provide HALLC, at HALLC's request, the Client's records relating to the provision of

health care services to Inmates as may be reasonably requested by HALLC or as are

pertinent to the investigation or defense of any claim related to HALLC's conduct and

performance. Consistent with applicable law, the Client will make available to HALLC

such records as are maintained by the Client, hospitals and other outside health care

providers involved in the care or treatment of inmates {to the extent the Client has any

control over those records)as HALLC may reasonably request. Any such information

provided by the Client to HALLC that the Client considers confidential shall be kept

confidential by HALLC and shall not, except as may be required by law, be distributed to

any third party without the prior written approval of the Client.

ARTICLE V; SECURITY

5.1 General. HALLC and the Client understand the importance of security

services to the safety of the agents, employees and subcontractors of HALLC as well as

for the security of inmates and Client's staff, consistent with the correctional setting.

Accordingly, both the Client and HALLC will cooperate with each other in addressing

security Issues. Nothing herein shall be construed to make the Client, its deputies or

employees a guarantor of the safety of HALLC employees, agents or subcontractors,

including their employees.

5.2 Loss of Equipment and Supplies. The Client shall not be liable for loss of

or damage to equipment and supplies of HALLC, its agents, employees or

subcontractors unless such loss or damage was caused by the intentional conduct or

grossly negligent act or omission of the Client or its employees.

· 5.3 Security During Transportation Off·Site. The Client will provide security as

is customary in connection with the transportation of any inmate between the Facility and

any other location for off-site services as contemplated herein.

ARTICLE VI: OFFICE SPACE, EQUIPMENT, INVENTOW iIJ6 ~ijpP~IES 6.1 General. The Client agrees to provide HALLC with office space, facilities,

equipment, utilities (including all local telephone costs, but excluding long distance

telephone costs which HALLC shall reimburse monthly to the Client). The Client will

provide necessary maintenance and housekeeping of the office space and facilities.

HALLC agrees it has inspected the Facility and medical office space and facilities and

that such space and facilities are sufficient for its agents, employees and subcontractors

to perform all of the obligations required under this Agreement. Client shall be

responsible for providing substitute space should the designated facilities become

inadequate for the purposes hereof.

6.2 Deliverv of Possession. The Facility will continue to provide to HALLe,

beginning on the date of commencement of this Agreement, possession and control of

all Client medical and office equipment and supplies in place at the Facility's health care

unit that are in the possession of the Client. At the termination of this or any subsequent

Agreement, HALLC will return to the Client possession and control of all supplies,

medical and office equipment, in working order, reasonable wear and tear excepted,

which were in place at the Facility's health care unit prior to the commencement of

services under this Agreement.

6.3 Maintenance and Replenishment of Equipment. The Client will continue

to maintain all Client equipment necessary for the performance of this contract by

HALLC in working order during the term of this Agreement. If HALLC requires additional

equipment and instruments with a cost under $500 per piece during the term of this

Agreement, it shall be the responsibility of HALLC to purchase such items at its own

cost. At the end of this Agreement, or upon termination, the Client or the County shall

be entitled to purchase HALLC's equipment and instruments priced upon HALLC's

depreciation schedule based upon generally accepted accounting practices.

6.4 General Maintenance Services. The Client will provide for each inmate

. . . . BQof; 0144 P~9~ q7 receiving health care services the same services and facililles provided by ttie Client for

all inmates at the Facility, including, but not limited to, daily housekeeping services,

dietary services, personal hygiene supplies and services, and linen supplies.

ARTICLE VII; TERM AND TERMINATION OF AGREEMENT

7.1 Term. The initial term of this Agreement shall be for thirty-six (36) months

from the start of this agreement. Agreement may be extended for two additional one-

year terms unless terminated by either party as provided by Section 7.2.

7.2 Termination. This Agreement may be terminated as otherwise provided

in this Agreement or as follows:

(a) Termination by Agreement. In the event that each of the parties mutually

agrees in writing, this Agreement may be terminated on the terms and date stipulated

therein.

(b) Termination by Cancellation. This Agreement may be cancelled without

cause by either party upon ninety (90) days prior written notice in accordance with

Section 10.3 of this Agreement.

(c) Annual Appropriations and Funding. This Agreement may be subject to

the annual appropriation of funds by a funding authority other than the Client.

NotWithstanding any provision herein to the contrary, if funds are not appropriated for

this Agreement, then the Client shall be entitled to immediately terminate this

Agreement, without penalty or liability.

1'31

7.3 Responsibility for Inmate Health Care. Upon termination of this

Agreement, all responsibility for providing health care services to all inmates, including

inmates receiving health care services at sites outside the Facility, will be transferred

from HALLC to the Client.

ARTICLE VIII: COMPENSATION BODY. 0144 Pa9~ 138

8.1 Base Compensation. The Client will pay to HALLC a first-year annual

base price of $446,250.00 paid in equal monthly installments of $37,187.50 each.

HALLC will invoice the Client thirty (30) days prior to the month in which services are to

be provided. The Client agrees \0 pay HALLC on the first (1', day of the month in which

services are rendered. In the event this Agreement should commence or terminate on a

date other than the first or last day of any calendar month, compensation to HALLC will

be prorated accordingly for the shortened month. If the Client fails to make any

undisputed payment to HALLC hereunder within ten (10) days fOllowing HALLC's notice

to the Client of non-payment, HALLC, among any other rights and remedies pursuant to

this Agreement or otherwise available at law or in equity, shall have the right to terminate

this Agreement immediately. Failure to terminate this Agreement shall not waive any

breach of this Agreement. A waiver of any breach of this Agreement shall not constitute

a waiver of any future breaches of this Agreement, whether of a similar or dissimilar

nature. The Client shall pay HALLC interest on all undisputed payments hereunder that

are not paid when due. The Client shall bear the costs of any legal or collection fees

and expenses incurred by HALLC in attempting to enforce Client's payment obligations

hereunder upon any judicial determination that such payments were due and payable.

(a) In the event that HALLC should declare the Client in default, all

subsequent installments, which would come due during the remainder of the contract

term shall be deemed to have matured and be accelerated for the purposes of enabling

13CO

the parties to resolve all outstanding contractual issues in an expeditions and efficient

manner. Boo~ 0144 P.3g_ 139

(b) In the event that either party should declare the other in default, Section

7.2 (b) above shall not be available to affect the rights or obligations of either party.

8.2 Increases in Inmate Population. The parties agree that the annual base

price is calculated based upon an average daily inmate population of up to 370. If the

daily inmate population exceeds 370 Inmates, then the compensation payable to

HALLC by the Client shail be Increased by a per diem rate of $1.05 for each inmate

over 370. This per diem rate, which will be Invoiced on the next month's invoice,

includes all of the above described services. The average dailY inmate resident

population shall be determined and recorded by the Client. The Client shall provide this

information to HALLC monthly by the fifth day of the following month. This per diem is

Intended to cover additional costs In those instances where minor short term increases

in the inmate population result in the higher utilization of routine supplies and services.

However, the per diem is not intended to provide for any additional fixed costs, such as

new staffing positions, which might prove necessary if the inmate population grows

significantly and if the population increase is sustained. In such cases, HALLC reserves

the right to increase its staffing complement and adjust its contract price in order to

continue to provide services to the increased number of inmates and maintain its quality

of care. This would be done with the full knowledge and approval of and notification to

the Client.

8.3 Compensation Escalator. The compensation (i.e., annual base price and

per diem rate as defined in Sections 8.1 and B.2, respectively) for such successive

contract year including extensions shall include a reasonable increase to insure the

delivery of the same quality and quantity of health services. HALLC's compensation will

be Increased by the annual change in the Consumer Price Index, Medical Care

component for the Southern Region for March of the then current year. In the event that

there is a general market increase for Insurance coverage, type a~ke9cWn!:¥eqll\ged by

the Client, and/or rates for surety bonds, if applicable, or a change in the scope of

services or standard of care, the parties will negotiate a greater increase. The resultant

percentage increase shall be multiplied by the annual base price and shall also be

multiplied by the per diem rate to determine the subsequent annual price and the

subsequent per diem rate.

8.4 Inmates from Other Jurisdictions. Medical care rendered within the

Facility to inmates from other jurisdictions housed in the Facility, pursuant to contracts

between the County and such other jurisdictions, will be the responsibility of HALLC as

provided for, and limited by, Article I of this Agreement. Inmates from other jurisdictions

housed in the Facility will be included in the average dally inmate resident population as

described in Section 8.2.

8.5 Responsibility for Work Release Inmates. Notwithstanding any other

provisions of this Agreement to the contrary, both parties agree that inmates assigned to

Work Release are personally responsible for the costs of any medical services provided

to them. Trustees in county work programs that are housed in the facilities at night are

not considered "Work Release Inmates" in this section.

8.6 Changes In the Law. If any statute, rule or regulation is passed or any

order issued or any statute or guideline adopted, materially increasing the cost to HALlC

of providing health care services hereunder, HALLC and the Client will agree on

additional compensation to be paid by the Client to HALLC as a result of such changes,

provided, however, that if the parties are unable to agree on appropriate compensation,

either party may terminate this agreement with 30 days advance notice.

-ARTICLE IX: LIABILITY AND RISK MANAGEMENT

9.1 Insurance. In addition to the insurance maintained !!IWYpPo~cfe(finl~ction

2:6, HALLC will at all times during this Agreement, maintain professional liability

insurance covering HALLC, its employees, and its officers in the minimum amount of at

least One Million Dollars ($1,000,000) per occurrence and Three Million Dollars

($3,000,000) in the aggregate. HALLC shall also maintain commercial general liability

insurance in the minimum amount of at least One Million Dollars ($1,000,000) per

occurrence and Three Million Dollars ($3,000,000) in the aggregate. In the event that

the coverage changes, HALLC shall notify the Client in writing. HALLC shall also notify

the Client, in writing, of any reduction in policy amounts or cancellation of insurance

coverage.

9.2 Hold Harmless. To the fullest extent permitted by law, HALLC agrees to

indemnify, defend and hold harmless Pearl River County, Mississippi, its agents, officers

and employees, from and against all loss or expense, including a reasonable attorney

fee, for bodily injury, including death, and property loss or damage (excluding loss of use

thereof) arising out of the sole negligence of HALLC, its agents, employees or

subcontractors.

The Client shall promptly notify HALLC of any incident, accident, claim or lawsuit

arising out of the sole negligence of HAlLC, its agents, employees or subcontractors. of

which the Client becomes aware and shall fully cooperate in the defense of such claim,

but HALLC shall retain sole control of the defense while the action is pending.

ARTICLE X: MISCELLANEOUS

10.1 Independent Contractor Status. The parties acknowledge that HALLC is

an independent contractor. Nothing in this Agreement is intended, nor shall be

construed to create an agency relationship, an employer/employee relationship, or a

Joint venture relationship among the parties.

)~ }

10.2 Assignment and Subcontracting. Except as provided in Section 2.5,

HALLC shall not assign this Agreement or any of its rights or 'l%IiQlMlbl1w'unt%r this

Agreement to any other corporation without the express written consent of the County

and Client, which consent shall not be unreasonably withheld provided the assignee is a

qualified provider of services such as those to be provided hereunder and shall have

equal or more financial resources than HALLC. Any such assignment or subcontract

shall include the obligations contained in this Agreement. Unless otherwise agreed in

writing between the parties, any assignment or subcontract shall not relieve HALLC of Its

independent obligation to provide the services and be bound by the requirements of this

Agreement.

10.3 Notice. Unless otherwise provided herein, all notices or other

communications required or pertained to be given under this Agreement shall be in

writing and shall be deemed to have been duly given if delivered personally in hand or

sent by certified mail, return receipt requested, postage prepaid, and addressed to the

appropriate party at the following address or to any other person at any other address as

may be deSignated In writing by the parties:

(a) Client:

with a copy to:

(b)

with a copy to:

(c)

Pearl River County, Mississippi Pearl River County Board of Supervisors

Sheriff David Allison Sheriff of Pearl River County 200 South Main Street Poplarville, Mississippi 39470

Health Assurance, LLC Carl Reddix, M.D. 5903 Ridgewood Road, Suite 310 Jackson, Mississippi 39211-3702

with a copy to:

Melvin V. Priester Priester Law Firm 820 North Street Jackson, Mississippi 39202

Notices shall be effective upon receipt.

Book 0144 P"9< 143

1 0.4 Governing Law. This Agreement and the rights and obligations of the

parties hereto shall be governed by, and construed according to the laws of the State of

Mississippi, except as specifically noted.

10.5 Amendment. This Agreement may be amended or revised only in writing

and signed by all parties.

10.6 Waiver of Breach. The waiver by either party of a breach or violation of

any provision of this Agreement shall not operate as, or be construed to be, a waiver of

any subsequent breach of same or other provision hereof.

10.7 Other Contracts and Third-Party Beneficiaries. The parties agree that

they have not entered into this Agreement for the benefit of any third person or persons,

and it is their express intention that the Agreement is intended to be for their respective

benefit only and not for the benefit of any non-party who might otherwise claim to be

deemed to constitute third party beneficiaries hereof.

10.8 Severability. In the event any provision of this Agreement is held to be

unenforceable for any reason, the unenforceability thereof shall not affect the reminder

of the Agreement, which shall remain in full force and effect and enforceable in

accordance with its terms.

10.9 Force Majeure. Neither party shall be held responsible for any delay or

failure In performance (other than payment obligations) to the extent that such delay or

failure is caused by fire, riot, flood, explosion, war, strike, embargo, government

· . regulation, civil, or· military authority, act of God, acts or omissions of carriers or other

similar causes beyond its control. Book 0144 P"9' 144

10.10 Litigation Duty. In the event HALLC's personnel are required to devote

time with regard to settlement or consent orders, orders, litigation or threatened litigation

by or against client, said time shall be part of their service time pursuant to this

agreement. Client shall be responsible for reasonable costs for personnel time or

substitute personnel to fill positions which would be vacant due to such court or trial

appearance requirements. Client shall not be responsible for any costs for personnel

time or substitute personnel when HALLC is a party to the action.

10.11 Effect of this Agreement. This Agreement and the HALLC proposal

constitute the complete understanding between the parties with respect to the terms and

conditions set forth herein and supersede all previous written or oral agreements and

representations. However, in the event of conflict or ambiguity, the terms and conditions

of this Agreement shall control over any terms and conditions of any other document.

This Agreement may be modified only in a writing that expressly references this

Agreement and is executed by both of the parties hereto.

10.12 Administration of Health Services Provided Under this Agreement.

HALLC shall designate one person who shall be responsible for and have the authority

to direct all of HALLC's personnel in the provision of ·services described hereunder. in

cases where professional ethics rules or laws prohibit the supervision of specific

professional judgments, HALLC shall nonetheless control all other aspects of service

provision and administration of such services. In administering the services hereunder,

HALLC agrees to cooperate and interface with the Client and any of Client's committees,

task forces or designees in matters relating to HALLC's performance hereunder and the

care to be delivered. Likewise, Client agrees to be the administrative coordinator of

activilies within the Facility and the personnel under his control there.

.....

10.13 Limited Role of Pearl River County. Mississippi Board of Supervisors. The

parties acknowledge that the corporate body of Pearl River County Is an

acknowledgment party, only and its sole responsibility hereunder is to provide funding

for the compensation which is to be provided to HALLC hereunder. Accordingly, the

County shall not be responsible for any other act, duty or resprrua~il?iijljyp~}luip.!jrated

hereunder.

10.14 Survival'. The provisions of this Agreement pertaining to the obligation to

pay for services rendered shall survive the termination hereof.

10.15 Privacy of Personal Health Information. HALLe and Client shall comply

with all Health Insurance Portability and Accountability Act of 1996 (HIPAA)

requirements. HALLC shall use best efforts to continually advise the Client of any laws,

regulations or standards applicable to the personal Identifiable health information which

is created and disseminated in the course of performance hereunder. HALLe agrees

that it will comply with any such requirements that shall be made applicable from time to

time.

IN WITNESS WHEREOF, the parties have executed this Agreement in their

official capacities with legal authority to do so.

PEARL RIVER COUNTY, MS

BOARD OF SUPERVISORS

1{, JJALL~ Pl~ Anthony Hales, President

Date: 1-b - ZO/O

HERIFF DA VlD ALLISON

Date',, ___ 7/-.-"..;b"'-' _' -t-/~{) __ Book 0144 Page 146

CJL MBMMAS03 07/09/2010 15:19 Board Minutes Minute Book Text Detail Book 0144 Page 147 LETTER TO BP & WASTE MANAGEMENT ON OIL Date 7/ 6/2010 2010 REAL ROLL & PERSONAL ROLLS

ORDER TO AUTHORIZE BOARD ATTORNEY TO DRAFT LETTER TO AUTHORITIES OPPOSING OIL SPILL DEBRIS TO BE BROUGHT INTO PEARL RIVER COUNTY

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of materials being brought in from the oil spill in Gulf.


Be It Ordered by the Pearl River County Board of Supervisors to authorize Board Attorney to draft letter to BP, Waste Management and MDEQ opposing oil spill debris from Gulf to be disposed of in Pearl River County.



Voting NAY: None

ORDER TO ACCEPT 2010 REAL AND PERSONAL ROLLS

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter to accept 2010 Real Roll and 2010 Personal Roll from the Tax Assessor/Collector.


Be It Ordered by the Pearl River County Board of Supervisors to accept 2010 Real Roll and 2010 Personal Roll from the Tax Assessor/Collector. (See State Form 2 on Page 150A)



Voting NAY: None

PAGE 2

.FoI1'llSo.e07 (Rev. 6199)

Formeri)' 71.(}()7

STATE OF MISSISSIPPI,

Pearl River _______ COUN1Y.

20 10

ASSESSO::':R:":':' S::-AF:-:::::::F1D::::7A VIT TO THE

LAND ROLL Boor. 0144 h9~ 148

Personally appeared before me _-"D"'av=id"-. ...!E"'a=.!r"'l'--"'J""o,.,hn!!.s"'o"'n"--__________ '--__ ------

Chancery Clerk of said County, _.ooG;.::a"'r.z.v-=-Be=-e"'c"'h"-________________________ _

Tax Assessor of said County, who presented his real roll for the year WID containing assessments as of January 1, 20 .... 1":-0....,..,._ and who being duly sworn deposes and states that be faithfully endeavored to ascertain and assess all the persons and property in his county; that he has not omitted any person or thing, or placed upon, Or accepted an undervaluation of any property through fear, favor or partiaUty, and that he has required every taxpayer to make the oath required to be taken by the person rendering a list of his taxable propertywberever poSSible; that he has administered the oath required in every case, where it was in power to do so, and called attention to its provisions; and that he has flied with the clerk of the~Board of S rvisors, under oath, a list showing the. name of every taxpayer. who has f~ed or refused to make oath on his tax list. _ ~_.

\, '. Tax Assessor

SWOII\ to and subscribed before me, this the_-=.2n_d_day of July A.D., 20.",10,,--_

;(:k:JJfLe ~ By C!1~ ~./~~./ .

~Clerk Clerk must be sure to affIX his Seal.

Filed in the office of Stale Tax COmmission'--_____ day of _____________ , 20. __ _

State Tax Commission

By

Final Recapitulation Appears on Page. _______ _

F0m160·S05 (Re-v. 6/99)

Form'!r!y 7H~06

STATE OF MISSISSIPPI,

-=:.Pe~a"-r,,,l~R~i:::.v~e.o.r ___ COUNTY.

20 10 ----ASSESSOR'S AFFIDAVIT

TO TIlE

PERSONAL ROLL Book 0144 P",)e 149

Personally appeared before me __ D~av!..:!;id~E!:a,,-r:.:l=-..:J:.:o~h~n:;s~o~n~ __________________ _

Chancery Clerk of said COunly, __ -'G"'a"r.Ly--"B"'e"'e"'c"'h _________________________ _

Tax Assessor of said County, who presented his persoilal roll for the y= 20~ containing assessments as of January I, 20~ and who being duly sworn deposes and states that he faithfully endeavored 10 ascertain and assess all the persons and property in his C()uncy; that he has not omitted any person or thing, or placed upon,or accepted an underValuation of any property through fear, favor or partiality, and that he has required every taxpayer to make the oath required to be taken by the person rendering a list of his taXable property wherever possible; that he bas administered the oath required in every case, where it was in power to do so, and

w,'" .,~'oo '0 ,. "~_" "' •• ,,"" ". w'." d,,' "'.'~ """" 00 ••• "" _ow;" ""_ of every taxpayer who bas failed or refused to make oath on his tax list. ~

,~ Tax Assessor

Sworn to and subscribed ·before me, this the 2nd day of

Clerk must be sure to affix his Seal.

CLERK'S CERTIFICATE OF FILING

[, _---">:::LI.l<..L..i.L __ ~.!'-~~iiiiiiiiiit,~'-':L.=-"'-C!c..!C~-----------Chancery Clerk of said County

d{-?:=L

Filed in the office of State Tax COmmiSSioD' ______ day of ------,c;----------' 20, __ _

State Tax Commission

By

Final Recapitulation App"-'lIS on Page, ________ _

CJL MBMMAS03 07/09/2010 15:22 Board Minutes Minute Book Text Detail Book 0144 Page 150 PROCEED TO EQUALIZE 2010 ROLLS Date 7/ 6/2010 CLOSE SESSION

ORDER FOR THE BOARD OF SUPERVISORS TO PROCEED TO EQUALIZE REAL AND PERSONAL ROLLS FOR 2010

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of the Board of Supervisors to proceed to equalize real and personal rolls for 2010.


Be It Ordered by the Pearl River County Board of Supervisors to proceed to equalize real and personal rolls for 2010. (See State Form 2 on page 150A)



Voting NAY: None

ORDER TO CLOSE SESSION

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter to close session.

Upon the motion made by Hudson Holliday and seconded by Patrick Lee, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to close the session to determine the need for executive session.



Voting NAY: None

PAGE 2

FORM NO. 2

SUGGESTED ORDER OF BOARD OF SUPERVISORS OF THE OPENING SESSION FOR EQUALIZJ,TION OF ASSESSMEN~!'Pk 0144 f'3ge 150 A

OF REAL AND PERSONAL ·PROPERTY

JULy TERM - 20/0

IN THE MATTER OF REAL AND PERSONAL ASSESSMENT ROLLS OF COUNTY, MISSISSIPPI

This4ay came on to be considered by the Board of Supervisors of !k/ / ,q; vaiL County, Mississippi, the matter of equalizing assessments of real and personal property for the year 20~ and the Board affirmatively finds and !a,djudicates that Ge&V B('c:c.-1. ,Tax Assessor of !ttl!'/ N,;e~ County, has completed , aAd filed the 20~ real and personal assessment rolls of tea,l te'vUL County, Mississippi, and in accordance wi th the provisions of Section 27-35-81, Miss. Code PJill., has delivered the said rolls in legal form to the Clerk of the Board of Supervisors of this county on or. before the First Monday of July, 20_, and that the said Assessor has made and appended to said real and personal property rolls the affidavit in the form and as provided by law.

NOW THEREFORE, it is ordered that this Board of Supervisors will immediately at its ...:fvlv & __ , 20Li2... meeting proceed to equalize such rolls and will' cause to be assessed any person, or thing, found to be omitted, and correctly value any property found to be undervalued, and do all things required by Section 27-35-87, Miss. Code ~'n., and other laws, and cause all corrections to be made in the said rolls, and will complete such equaliultion at least ten (10) days before the August, 20LQ meeting, and upon adjournment will immediately by newspaper publication notify the public that such rolls so equalized are ready and open for inspection and examination.

ORDERED AND ADJUDGED this t. fI, day Of--<.<r1:...;ju><c-,-/"1-Y ___ ' 20/p .

/501

CJL MBI~MAS03 07/08/2010 14: 07 Board Minutes PAGE 11inute Book Text Detail Book 0144 Page 151 EXECUTIVE SESSION Date 7/ 6/2010 RETURN TO REGULAR SESSION

-------------------------------------------------------------------------

ORDER TO GO INTO EXECUTIVE SESSION

Upon the motion made by Hudson Holliday and· seconded by Patrick Lee, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to retire into executive session at 10:53 a.m. to discuss personnel matters.



Voting NAY: None

ORDER TO RETUrn, TO REGULAR SESSION


Be It Ordered by the Pearl River County Board of Supervisors that this Board does now return to regular session at 12:10 p.m. after taking no action in executive session.



Voting NAY: None

CJL MBMMAS03 07/08/2010 14:07 Board Minutes PAGE lvrinute Book Text Detail Book 0144 Page 152 EMERGENCY l-lANAGEMENT PERSONNEL Date 7/ 6/2010 DAVID MOORE CONTRACT

-------------------------------------------------------------------------ORDER TO ACCEPT EMERGENCY MANAGEMENT PERSO~WEL CHANGES

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of personnel changes in Emergency Management.

upon the motion made by Hudson Holliday and seconded by Sandy Kane Smith, the following order was adopted, to-wit:

Be It Ordered by the Pearl River County Board of Supervisors to approve the following and attached personnel changes in Emergency Management:

Michell Leleux Hire full time



Voting NAY: None

ORDER TO EXTEND DAVID MOORE'S CONTRACT

There came on this day to be considered by the Board of Supervisors of Pearl River County, Mississippi, the matter of David Moore's contract.


Be It Ordered by the Pearl River County Board of Supervisors to extend David lvroore' s contract until September 30, 2010.



Voting NAY: None

,.

"\

Pearl River County Emergency Management

. Danny Manley, Direc!or 530 Hwy 26 Eas! Poplarville, MS 39470 Email: [email protected]

July 7, 2010

~'Kecping fln eye on the county."

To: Pearl River County Board of Supervisors

Office: 601-795-3058 Cell: 601-273-1394 Fax: 601-795-3074

Book 0144 f'.39. 153

I would like to request the immediate hire of Michelle Leleux fill the position of administrative assistant. After a lengthy interview process she emerged as the top candidate. She will start at the same salary, benefits and responsibilities as the person she replaced.

Thank you,

;lli MrullkcJ,Q PRC ~Cy Management Director

153

GJL MBMMAS03 07/08/2010 14:07 Board Minutes Minute Book Text Detail Book 0144 Page 154 ORDER TO RECESS Date 7/ 6/2010

PAGE

-------------------------------------------------------------------------ORDER TO RECESS

upon the motion made by Patrick Lee and. seconded by Sandy Kane Smith, the following order was adopted, to-wit:

Be It Ordered that this Board does now take a recess until the next scheduled meeting to be held at 9:00 a.m., Monday the 12th day of July, 2010, at the Board of Supervisors meeting room in the Chancery Court Facilities Building at the Pearl River County Courthouse in Poplarville.


Voting NAY: None

PRESIDENT CLERK OF THE BOARD

3: