BID RESPONSE PACKET SP-19-0050

BID SIGNATURE PAGE T e or Print the fol/owin information.

PROSPECTIVE CONTRACTOR'S INFORMATION

Company:

Address:

City: Zip Code:

Business Designation:

~ ndividual

□ Partnership

□ Sole Proprietorship □ Public Service Corp

□ Corporation □ Nonprofit

9--Not Applicable D American Indian

□ Hispanic American

□ Service Disabled Veteran Minority and Women-Owned □ African American □ Women-Owned

Designation*: □ Asian American D Pacific Islander American

AR Certification #: * See Minority and Women-Owned Business Policy

PROSPECTIVE CONTRACTOR CONTACT INFORMATION Provide contact information to be used for bid solicitation related matters.

Contact Person: /Cl, , ... .11A. l.d n✓ If,.(( Title: /J WtJ er-Phone: <P-1 _111=' - qcfc.,c,. Alternate Phone: s'bt - ?'l' o 'I 1v.f/ Email: -Jhal/5 J tf /.,,,-"" P'J . "1 ~ -f 't.J,),., ~

,, ..... .. CONFIRMATION OF REDACTED COPY

□ YES, a redacted copy of submission documents is enclosed . .B"f\JO, a redacted copy of submission documents is not enclosed. I understand a full copy of non-redacted

submission documents will be released if requested.

Note: If a redacted copy of the submission documents is not provided with Prospective Contractor's response packet, and neither box is checked, a copy of the non-redacted documents, with the exception of financial data (other than pricing), will be released in response to any request made under the Arkansas Freedom of Information Act (FOIA). See Bid Solicitation for additional information.

ILLEGAL IMMIGRANT CONFIRMATION

By signing and submitting a response to this Bid Solicitation, a Prospective Contractor agrees and certifies that they do not employ or contract with illegal immigrants. If selected, the Prospective Contractor certifies that they will not employ or contract with illegal immigrants during the aggregate term of a contract.

ISRAEL BOYCOTT RESTRICTION CONFIRMATION

By checking the box below, a Prospective Contractor agrees and certifies that they do not boycott Israel, and if selected, will not boycott Israel during the aggregate term of the contract.

0"Prospective Contractor does not and will not boycott Israel.

An official authorized to bind the Prospective Contractor to a resultant contract must sign below.

The signature below signifies agreement that any exception that conflicts with a Requirement of this Bid Solicitation will cause the Prospective Contractor's bid to be rejected:

Authorized Signature: t:2.1~ 11 <...., f[ g.}..( Title: Use Ink Only. /

Printed/Typed Name: Oe,,.; ✓. n <:_ 1-/0, I { Date: __ '-fL--~ .a:..:LS"-..,- ~-~- - -Bid Response Packet SP-19-0050 of 6

Official Bid Pri ce Sheet SP-19-0050 Process Server Services

Table A: Primary Service Types 1<e5,111 7 (To be used in determinina lowest cost.)

Cost Per Estimoted Successful Serves Per

Cost Per Estimated

Service Type Successful Unsuccessful Unsuccessful Serves Year

Service Service Per Year

Standard Service $40.00 540 $25.00 360

Rush Service $50.00 60 $25.00 40

Expedited Service $60.00 60 $25.00 40

Urgent Service $75.00 60 $25.00 40 Estimated Total for Table A

Table B: Secondary Service Types

(To be used in determining lowest cost.)

Cost Per Add-On Estimated Number of Add-Ons

Service Type ta the Primary Extended Cost

Service Type Per Year

Substitute Service $0.00 100 $0.00

Standby Service $25.00 100 $2,500.00

Multiple Address Service $25.00 200 $5,000.00

Estimated Total for Table B $7,500.00

Estimated Grand Total for the Initial Contract Term

(Totals combined from Tables A and Bl $52,200.00

Table C: Other Service Types

( NOT to be used in determining lowest cost.)

Service Type Cost Per Service

Skip Trace/ Attempt to Locate $25.00

Court Hearing/ Testimony $50.00

Extended Cost

$30,600.00

$4,000.00

$4,600.00

$5,500.00 $44,700.00

Table A: Primary Service Types

(To be used in determinina lowest cost.)

Official Bid Prices Sheet SP-19·0050 Process Server Services

~ .. er: Q,,, I l Cost Per

Estimated Sucassful Serves Cost Per Estimated

Servia Type Successful Unsuccessful Unsuccessful Serves

Servla Per Year

Service Per Year

Standard Service $40.00 SAO $25.00 360

Rush Service $50.00 60 $2S.00 40

Expedited Service $60.00 60 $25.00 40

Urgent Service $75.00 60 $25.00 40

Estimated Total for Table A

Table B: Secondary Service Types

{To be used in determining lowest cost.)

Cost Per Add-On Estimated Number of Add-Ons

Service Type to the Primary Extended Cost Service Type

Per Year

Substitute Service $0.00 100 $0.00

Standby Service $25.00 100 $2,500.00

Multiple Addre5S Servlce $25.00 200 $5,000.00

Estimated Total for Table B $7,500.00

Estimated Grand Total for the Initial Contract Term (Totals combined from Tables A and 8} $52,200.00

Table C: Other Service Types

( NOT to be used in determininq lowesr cost.)

Service Type Cost Per Servia,

Skip Trace/ Attempt to Locate $25.00

Court Hearing/ Testimony $50.00

Extended Cost

$30,600.00

$4,000.00

$4,600.00

$5,500.00

$44,700.00

REGION SELECTION CHECKLIST

For Statewide Coverage: Check the blue box next to Statewide Coverage below if your company intends to serve legal process in all Regions.

For Regional Coverage: Check each blue box in the Selected Reqion(s) column for each Region in which your company intends to serve legal process.

Statewide Coverage

Selected Region(s) Region

Number

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Bid Response Packet SP-19-0050

Counties included in Region

Benton, Carroll, Washington, Madison (only Sherriff can serve Madison County)

Boone, Newton, Marion, Baxter

Fulton, Izard, Stone, Cleburne, Independence

Sharp, Randolph, Lawrence, Jackson

Clay, Greene, Craighead, Poinsett, Mississippi, Crittenden

Crawford, Sebastian, Franklin, Johnson, Pope

Searcy, Van Buren, Faulkner

White, Lonoke, Prairie

Woodruff, Monroe, Cross, St. Francis, Lee, Phillips

Logan, Scott, Yell, Conway

Perry, Saline, Pulaski

Polk, Montgomery, Garland, Hot Spring, Grant

Jefferson, Arkansas, Lincoln

Little River, Sevier, Howard, Pike, Clark

Miller, Lafayette, Hempstead, Nevada

Dallas, Cleveland, Ouachita, Calhoun, Columbia, Union

Bradley, Drew, Desha, Ashley, Chicot

Judicial Districts included in Region

4, 19W, 19E

14

16

3

2

5, 12, 21

20

17, 23

1

15

6, 22

7, 18W, 18E

11W, 11E

9W, 9E

8S, 8N

13

10

of6

Order 20, alkr

wrmin,'tt(;d e:irlier by ..:uun order.

Coui1t[v 1r1·csl ,., i.··111· r-11 I ., Jl J _J • • v. - ·

authorized la serve procc'.;.s:

. FIL'.::D ,:r5v-E ...{)_-l5:-- \tr\ e,, ,opr,-.,

DAT~-.01 .., Crystal Taylor; e,~ . · By . OC

process

Dewayne Hau ---'l..._..,e _gaJ..Rrocess-Sm'V~----

P .O. Box 1262 . - Conway, AR 7203~ ...,...,.,-._ 5G'i -:.?'33-9966 ...._...___ _____ _

·-..... ~

. . ..

the process scn:cr. and ihe circuil dt:rk ·,m;-l sheriff of ea,~h <.:01!!1\ ;' uf (hi~: judicial cir{'.uiL

va!id driver·s lio~nsc. when :;;erving procc.ss ;.incl shall, upon request N inquiry, pre~;cm tlfr;

.. : ""

1 hereby certify that the foregoing instument is a true and correct copy of the Ori~~nal C Y:A ✓"- --~ Filed in this office 12\df v \ '$ , 20-e1

IN TESTIMONY WHERE , I have hereunto set my

hand and seal of this office this -~ 'JI \ S, 20J{i CRYSTAL TAYLOR, Faulkner Co nty, Arkansas

Circuit County Clerk

~ -~ , Deputy Clerk

IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL DISTRICT OF ARKANSAS

ORDER

Under the provisions of Rule 4(c) of the Arkansas Rules of Civil Procedure, the following individuals are

appointed and authorized by this Court to serve civil process- including writs of garnishment and subpoenas issued

by the clerks of the Sixth Judicial District and orders of the courts- until fu11her order of this Court:

Kym Armstrong Paul Hickman Timothy Porchia Crystal Bastion Les W. 1-lolt Donald Quinn John P. Brown James C. Johnson Rachel Quinn Hester "Ray" Bryant Jane Kauffman Kandis Rikard Studdard Deborah Buckels Mark Keesee Sammie Robinson John Allen Burns Monica L. Keesee Timothy Sibert Arnett Charles Charles Louis Keller, Jr. Natasha Sims Kimberlee Cheesman Jeremy D. Kurek David Singer Victor Coleman Robert K. Lane Robin Slate Janette Covington Artenis Lewis Elaine Smith Ken Cross Danny Lewis Kelly Smith Robert Glenn Davis Sarah Lorenz Sherry A. Smith Larry Davis Daniel Maglothin Brandon C. Stephens Myrtle J. Davis Jim "Butch" Martin Joe C. Stewart Marissa Doan Elisha Martin Keith Sti les Harold Edmonson David G. McCreery Solomon Tobi Jimmy Ellington Newell McManus Gary Tramel James Everett Kathryn Melnick Steven D. Turnage Rick Tony Fields Najiba Moyer Lisa TwoRivers James Franklin Andrew Myers Jennifer Waleryszak Raymond Frazier Fred Myers Doris Walker Richard A. Freeman Stephanie Myers Samoan Watkins Sheldon Gately Eric Nathaniel Karl Wawak James Gooch Heath Nelson Craig Webb DeWayne Hall Will Oliver James Whitaker Darrius Handy Donna Parker Rebecca Whitaker Carl Lee Harrod Marian Ashley Payne Juanita White Walter Hedrick Kendric Perry Leslie Winem iller Jamie Heflin Tiffany Perry Abel Woodruff

1

I

Service of such process shall be in accordance with the Arkansas Rules of Civil Procedure, Arkansas Code

Annotated, and the Constitution of the State of Arkansas. When serving process, these appointed process servers

shall carry a certified copy of this order of appointment and a valid driver's license and will, upon request or inquiry,

present this identification at the time service is made.

Each process server is ordered to notify the Court in writing in the event that he or she is convicted of a

crime punishable by imprisonment for more than one year or a crime involving dishonesty or false statement,

regardless of the punishment. Each process server is also ordered to notify the Court in writing in the event that he

or she no longer holds a valid driver's license. The occurrence of any of these events will result in the immediate

revocation ofa process server's appointment.

If an individual lets his or her renewal lapse for one year or more, he or she will be required to submit an

application for a new process server and will be required to pay the new application fees. The individuals listed in

this order are to submit all applications for renewal or new licensing by Friday, January 29, 2021 at 4:30 p.m.

and all process licenses issued in January 2020 are valid until February 28, 202 1, unless an individual's appointment

to serve process is revoked prior to that date for cause. Th is order revokes any prior orders of appointment.

IT IS SO ORDERED.

February I 1, 2020 Date

A TRUE C.OPY CERTIFIED THIS FEB l !2020

Print Form

r/o15fr1J1 f -t I

IN TBE CIRCIDT COURT OF (f,,-.A'l CO~"'TY, ARKANSAS ELECTRONICALL'-' Fll..£0

-- _ 2 B 2~ . • "=· >i : tr: ll•• .... -~ --- --

C,;.a.£ • : .... '\, : __ . • . -, IN THE MATTER OF THE APPOINTl'vIENT OF {2..Jl(,,Jc,._ vt? P fl~ / f TO SERVE LEGAL PROCESS ---'-~-'--'---'-.,_,/ ,_~-----'~ ---

ORDER OF APPOINTME1'1 AS PROCESS SERVER

Pursuant to Rule 4 (c)(2), Arkansas Rules of Civil Procedure, and Adrnini~tive Order

Number 20, after reviewing the application, affidavit, and other infOIT!lation submrtte&by Applicant f/c; /- j:J_r'" 1 h}_ ) .

for appointment to serve legal process in ([ ,~/\ f -t Courtt[y][iesl, A.rkarisas, the court

finds as follows:

That the application should be, and hereby is, approved; ~is appointment i~ effective for

_ _ _ ] ___ years, until 12:00 Midnight,

co urt order.

Name of Process Server:

Address:

Count[y)[i i=s} in which authorized to serve process:

J.A}? ~X , 2 d:i.P , unless tenninated earlier by I

Dewayne Hall Legal Process Server P .O . Box 1262 Co11way, AR 72033 501 -733-9966

This appointment is effective for every division of circuit court anq for every district• court in

said count[y)[ics].

The circuit clerk shall file this order and provide a certified copy of it to

the process server, and the circuit clerk and sheriff of each county of this judicial circuit

qualified process servers that it maintain:; and posts.

The process server shall carry a certified copy of this order of appointment and a

valid driver 's license, when serving process and shall, upon request or inquiry, present this

identification at the time service is made.

Circuit Judge

Print Forn

IN THE CIRCUIT COURT OF Lt 11~ t(C~UNTY, AR.KANS~

NUMBER ifJL5- tt-5 D ·J ? C 3 znn J1i!' 1 s , 1i ._: "'

ORDER OF APPOINTMENT AS PROCESS SERVER

Pursuant to Rule 4 (c)(2), Arkansas Rules of Civil Procedure, and Admini~trative Order

Number 20 , after reviewing the application, affidavit., and other information submitted]by Applicant

ror appointment to serve 1cgiu process in Lallo KC Cpunt{y)[ies], Ark~sas, the court

finds as follows: '

That the application ~bould be, and hereby is, approved; ~his appointment i~ effective for . .

_ _ _,_c_,):;..__years, until 1_2:00 Midnight~J,/)1.() l5 court order.

, 2~ unless termin~ted earlier by


Address:

Count[y)[ies] in which authorized to serve process:

D ewayne Hall Legal Process Server po. B ox 1262 C o nway, AR 7 2033 501-733-9966

This appointment is effective for every division of cirtuit court an9 for every distric~ court in

said count[y][ics].


the process server, and the circuit clerk and sheriff of each county of this judicial circuit

wherein approval has been gr~ted. The circuit clerk(s) shall add tpe Applicant to the list of

This appointment is effective for every division of circuit court and for every district court

in said count[y ][ies].

T he circuit clerk shall file this order and provide a certified copy of it to

the process server, and the circuit clerk ·and sheriff of each county of this judicial circuit

wherein approval has been granted. The circuit clerk(s) shall add the Applicant to the list

of qualified process servers that it maintains and posts.


valid driver's license, when serving process and shall, upon request or inquiry, present this


Entered this ~ 5? day of~ .,. , 2 0 ( g .

GW@id~J Circuit Judge

I, Myka Sample, cerliiy this instrume~t 1s a true Copy of the C) r~c o ~ AP f'o,1'-"- fW.."--+-O.§ Pru~~~ ~r--ve-r

on file in this office, dated q · 2 fs 1 ~ Book _____ at page ___ _ __ _

IN THE CIRCUIT COURT OF fa. I I It (COUNTY, ARKANSAS

NUMBER(@cv- : n ·- Is- s-=-y

201 8 SEP 28 PM 3: 02

J '{:_ ~---- --

IN THE MATTER OF THE APPOINTMENT OF ;;J-tA,/ V'I/J n ..( /ti~ ( f TO SERVE LEGAL PROCESS ----=--/-I'-------..__ __

ORDER OF APPOINTMENT AS PROCESS SERVER

Pursuant to Rule 4 (c)(2), Arkansas Rules of Civil Procedure, and Administrative

Order Number 20, after reviewing the application, affidavit, and other information

submitted by Applicant for appointment to serve legal process m

--=_5_11--'-/_,)1_.,( ___ Count[y][ies], Arkansas, the court finds as follows:

for

Tha~ the application should be, and hereby is, approved; this appointment is effective

3 years, until 12:00 Midnight,StrYt. d? ' 2M, unless

terminated earlier by court order.


Address:

Count[y ][ies] in which authorized to serve process:

Dewayne Hall Legal Process Server P.O. Bex ~262 Conway, AR 72033 501-733-9966

qualified process servers that it maintain~ and posts.

The process server shall carry a ceitified copy of tbis order of appointment and a

valid driver's license, when serving process and shall, upon request or inquiry, present this


Entered this _\.2_ day of p(Afy\Q ,2 D\[.

~l~~))Q Circuit Judge

- -

l'i TH£ CIRCUT COrnT OF (raYl~,;;tln. ARK.-\.~:A~ ~C\IB[R ~i.s "J r-1]·

l'i THE ~l~TTER Of THE APPOl'iDIE'iT Of # _.e wy /1e:_ TO SERVE LEGAL PROCESS

ORDER OF . .\.PPOI~L\lE~T .-\S PROCESS SER\l::R

Order :(umber 20, afi.e:- re\ ie\\ ing "I •• • ,.._. •

tr.c 2pp~:c2r:c::. a:::Ga\"::.

:.ubn::~~~-:: '.:;~ .-\ppiican: f0r a.pr:-0:n::1~~:·:. · ' se:-, ~- :ega'.

{rl)./ {Q.n J _ co,:r.t~y][ies 1- .-\:-i<ansas. ::-::: .:2:.:::-: ::r:ds 2s f.::: ::'-'''- s:

for J

:--:ame of Process Sen·er:

. ..\ddress:

Count(::- ][ies] in \\ hich a-ithorized t.o scn·e process:

_, _, -- ....

Jtq//

in sa:-:: count[: Hies].

:he process sen·er, and tne circuit clerk anc sherif:· ... ~:· ~a.:::1 couo:;. ..... ,.. ... , .. . ..... .. ... , ... ~ ..

\, herein approYa! has b.:·en granted.

identifica:i0r: a, the time Se!"\ ice is na•.::e.

ORDER OF-APPOINTMENT AS PROCESS SERVER

Pursuant to Rule 4 (c)(2), Arkansas Rules of Civil Procedure, and Administrative Order

Number 20, after reviewing the application, affidavit, and other informatio9 submitted by Applicant (... unw1 U.J"'" ,1(,.v+1 Yr t I

for appointment to serve legal process in -+--______ _ Count[y][ies], Arkansas, tbe court •

finds as follows:

That the application shoulo 6e;· ana·hereby is, approved; this appointment is effective for

years, until 12:00Midnight, /'1/JV /I) ------ J

,2o.::<o, unless terminated earlier by FIL-ED

court order.

Name "of Process Server:

Address:

Count[y)[ies] in which authorized to serve process:

DARLENE MASSINGILL CIRCUIT CLER~ CONWAY COUN .Y,

D ewayne Hall ----e-----.---=----=-,c-p,=~=------:----+,I U )i\j O G 2 : ·., Legal Proces~ Seryer ~ v .

P.O. Box· 1262 AM '

~;,.f._~;¥:9~:6 72033 .118 l 9110!1111211121314151 ~

-----~

This appointment is effective for every division of circuit court and for every district court in

said count[y][ies].


A True Copy I Certi~ · This Day - / ::> 20 ( 7 Time __ l I : r=J5 A;;y; -Sharon Barnett, Clerk ~ By !) '"rJY\0 Q/@•v?t't~,ct1'.:f

qualified process servers that it maintains and posts ..

The process server shall carry a certified copy ot"this order of appointment and a

valid driver's license, when serving p rocess and shall, upon request or inquiry, present this


En tered this -1!._ day of_,_h.:...;.1/f~Y __ _ I

Circuit Judge

CV2017- 001.974

NUMBER 73CV-2008-735

IN THE MATIER OF DIE APPOINTMENT OF DEWAYNE HALL

TO SERVE LEGAL PROCESS :

ORDER OF APPOINTMENT AS PROCES.,', SERVER.

Pursuant to Rule 4 (cX2), Arkansas Rules of Civil Pro~ure, and Administrative Order

Number 20, after reviewing the application, affidavit, and other infopnation submitted by Applicant

for appointment to serve legal process in -ll.:4-·lb~i t~e ____ Count(y ][i~). Arlcansas, the court

finds as follows:

That the application should be, and hereby is, approved; tljis appointment is effective for

---=3)'---_years, until 12:00 t.iidnight, \ ~ / /~ 20 lo. unless terminated earlier by :

court order.


Address:

Count{y][ies] in which authorized to serve process:

oe,-1ayr.e P.aJ.l

P . o . box :i.. 262

Comm'-' l\i3 7;>QJ3

Whit.e

This appointment is effective for every division of circuit court and for every district court in

said count(y](ies}.

The ci.ratlt clerk s~ file this order and provide a certified copy of it to

the process server, and the circuit clerk and sheriff of each county of ~is judicial circuit

wherein approval has been granted. The circuit derk(s) shall add \he ~licant to lhe list of

CV2017- o01.97s

qualified procc.5s servers that it majntains an~ posts.

The process server shall capy a certified aipy of this ordet of appointment and a

valid driver's license, when servini process and shall. upon request or inquiry, present this

identification at the time service is ·made.

Eotered this ll_ day of

Circuit Judge

PROCESS SERVER INFORMATION FORM

• Complete all information for the Process Servers who will provide services under a resulting contract. • List §.I! Judicial Districts, corresponding counties, and Regions in which the Process Server is qualified to serve

process. • Provide this information even if your company is not submitting a bid response for all Regions in which the Process

Server is qualified to serve.

Phone Judicial Regions Process Server Name Email Number District(s) Counties Serviced Serviced Serviced

5'ul -,33 "'"'- 5 f~""' '1l 1' '1

lo /) t. t../ fA V 11 t, /fa If dh r,4// 5~ w,r,J <fr·o,.,_ hef ~, d"v!~}~., I "1

I ,

f,._t1lk11er -{~rcy 7 ;i.<> t/6't'I IJ ,,.,.,,., J1 w'i/+~ t ,-3 - /_,Oholfe

~ ·v

,5' 1-.-0J"- ... Vetl

I!) .< u If ('J/'1 Wtt-Y (p Pvla-5'11 . /Jer"'Y If ,!}-~ <'al, .h(

{'1 6-~,,--1 ,.., d G-nt", .. ii~, I[)... ,re, Jlot JJ?/1hfi

V '7

Bid Response Packet SP-19-0050 Page 6 of6

EQUAL OPPORTUNITY POLICY

DEWAYNE HALL PROCESS SERVICE HAS NO EMPLOYES AT THIS TIME

IF AT ANYTIME IN THE FUTURE I DO HIRE SOMEONE I WILL NOT DISCRIMINATE

AG INST ANY PERSON FOR ANY REASON

DEWAYNE HALL

CONTRACT AND GRANT DISCLOSURE AND CERTIFICATION FORM Failure to complete all cl the following information may result in a delay in obtaining a contract, lease, pur$se agreement, or grant award with any Arkansas State Agency. SU8CONTAAC10R: SUBCOHTRACTOR NAME.:

D Yes 12!fJo

f-t I ISTHIS FOR:

TAXPAYER 10 NAME: 0 Goods? Both?

YOUR LAST NAME: FIRST NAME: M.I.: l-ADORES$: l- t1 CITY: STATE: ;,rt/ ZIP CODE: '7ci1.. if11 COUNTRY:

AS A CONDITION OF OBTAJNIN EXTENDING AMENDING OR RENEWING A CONTRACT LEASE PURCHASE AGREEMENT OR GRANT AWARD WITH ANY RKANSAS STATE AGENCY1 THE FOLLOWING INFORMATION MUST BE DISCLOSED:

11 F O R I N D I VI D U A L S * Indicate below ~: you, your spouse or the brother, sister, parent, or child of you or your spouse is a current or former: meml>er of I.he General Assembly, Consrnvtionat Officer. State Board or Commission Member, or State Emolovee:

Marl< (,1) Name of Position of Job Held For How Long? W'lat is I.he persoo(s} name and how are they related to you?

Position Held [senator, representative, name of [i.e., Jane Q . Public. spouse, Jom Q . Public. Jr., child, etc.]

un-ent Former board/ conmission, data entry, etc.) From To Person's Name{s} Relation MM/VY MM/VY

General Assembly

Constitutional Officer

State Board o, Commission Member

Sta~ployee

9'f None of the above applies

I FOR AN ENTITY (BUSINESS) * Indicate below~ eny of I.he foUOWIOQ persons, current or former, hold any position o f control or hold any ownership interest of 10% or greeter If\ I.he entity: member of I.he General Assembly, Const1tut1onal Officer, State Board o, Commission Member, State Employee, o, the spouse, brolh<lr, sister, paren~ or child of a member of I.he General Assembly. Conslitutional Olfocer. State Board or Comm1ss,on Member, or Slate Emolo~. Position of control means the ~r to direcl the ourchasino oolicies o, influence th8 manaoement of the ent~v.

Mark(~) Name of Position of Job Held For How Long? 'M1at is the persoo(s) name and what is his/her% of ownership interest and/or

what is his/her oosition of control? Position Held fM,nator, represe.ntative, name of Ownership Position of

Current Former bOard/cornnission. data entry. etc.I From j To Person's Name(s) MM/YY MM/YY Interest f% \ Control

General Assembly ! Constitutional Officer ! State Board or Commission Member

St,ieEmployee ' ! rJ None of the above applies

I

Contract and Grant Disclosure and Certification Form

Failure to make a11v disclosure requireLI bv Governor's £i:ecutive Order 98-04, or any violation ofa,1v rule. regulation, or policy at/opted pur.ma,11 to that Order, shall be a material breach o[the terms o[this contract. A11v contractor, whether 011 intlivitlual or e11titv, who fails to make the require<! disclosure or wl,o violates a11v rule, regulatio11, or policy shall be subiect to all legal remedies available to the agency.

As an addit ional condition of obtaining, extending, amending, or renewing a contract with a state agency I agree as follows:

1. Prior to entering into any agreement with any subcontractor, prior or subsequent to the contract date, I will require the subcontractor to complete a CONTRACT AND GRANT DISCLOSURE AND CERTIFICATION FORM, Subcontractor shall mean any person or entity with whom I enter an agreement whereby I assign or otherwise delegate to the person or entity, for consideration. all, or any part, of the perfom,ance required of me under the temis of my contract with the state agency.

2. I will include the following language as a part of any agreement with a subcontractor:

Failure to make any disclosure required by Governor ·s Executive Order 98-04, or any violation of any rule, regulation, or policy adopted pursuant to that Order, shall be a material breach of 1he terms of this subcon/ract. The party who fails to make the required disclosure or who violates any rule, regulalion, or policy shall be subject to al/ legal remedies available to the contractor.

3. No later than ten (10) days after entering into any agreement with a subcontractor, whether prior or subsequent to the contract date, I will mail a copy of the CONTRACT AND GRANT DISCLOSURE AND C ERTIFICATION FORM completed by the subcontractor and a statement containing the dollar amount of the subcontract to the state aaency.

I certify under penalty of periurv, to the best of my knowledge and belief, all of the above information is true and correct and that I agree to the subcontractor disclosure conditions stated herein.

Signatuce -~ .._., If,,_),{ Title. ___ tJ_w_n_ (_.,,.,. _____ Date If ... If..~(}

Vendor Contact P:on/7.P,.h " ,.,., /-/t, {( Title __ ---"-//_.,.w_ r._.-f_/ _____ Phone No. ,{o f - '7,J.J -q9 /

Agency use only Agency Agency Agency Contact Contract Number ___ Name _________ Contact Person. ________ Phone No. _____ or Grant No. __

PROPOSED SUBCONTRACTORS FORM

• Do not include additional information relating to subcontractors on this form or as an attachment to this form.

PROSPECTIVE CONTRACTOR PROPOSES TO USE THE FOLLOWING SUBCONTRACTOR(S) TO PROVIDE SERVICES.

ype or rm e o owma m orma ion T P . t th fi II . . fi

Subcontractor's Company Name Street Address City, State, ZIP

Ronne,/ f/en,-;,,..,.fd., I,, 'f 11.,yfl,{u,l(e_ tJ, I' ti,, w'" ,,, Jdylf ( / 7

□ PROSPECTIVE CONTRACTOR DOES NOT PROPOSE TO USE SUBCONTRACTORS TO PERFORM SERVICES.

Bid Response Packet SP-19-0050

7g..or;...

Page 4 of6

Thank vou. Your oavment is comolete. :;ur account will be charqed by Arkansas GovPav - Arl(ansas GovernmP.nt SPrviN •c

Thank you for registering as a vendor with the State of Arkansas.

You will soon receive a copy of the information you submitted via e-mail. You may change your information by returning to this site and accessing the "My Business Information'' section.

This application must first be reviewed and approved by the Office of State Procurement Changes will not be immediately available. You will be notified upon approval or rejection of application via email. For questions regarding the approval of your application, please contact the Office of State Procurement at (501 )324-9316.

You will be notified by the Office of State Procurement when bidding opportunities for the goods you selected are available. 'The Office of State Procurement is unable to guarantee that you will receive copies of all bids for the commodities listed on your vendor registration form. To ensure that you are aware of those bids we strongly encourage you to view the vendor bid information at

. If you have any questions about your vendor registration, please contact~ Ve II ~ e / Payment Summary ~.#, () I{) o / ~~ 6 2 r

Amount Paid: $25.00

Arkansas.gov Total: $25.00

Payment Status: Complete

Order Datemme: 04/13/2020 10:52 AM

Conflrma\ion Number (Order Id): 20200413104143286

Name on card: Dewayne Hall

Email Address: dhal/5@windscream. nee

Phone Number: 5017339966

Billing Address: 22 BUD CHUCK LANE CONWAY, AR 72033, UN\iED STATES

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ORDER OF AJ.>POINTMENT AS PROCESS SERVER

Pursuant to Rule 4 (c)(2). Arkansas Rules of Civil Procedure, and Admini$rative Ordcr

Number 20, after reviewingthc application, affidavit, and other information submittedby Applicaru:

for appointment to serve le~ process ft,"t'H-.u ( \)~ ~~r )t~~][ies), ~. the court . :

fmds as follows:

Print Form

That the application should be, and hereby is, approved; ¥ns appointment i~ effective for

) years,until12:00Midnight, Y--tz f 1 ,2 o,10 unlesstennin~edearlierby J ;

court order.


Address:

Co unt[y)[ies) in which

authorized to serve process:

I

f,'.U,.\b1 VM f!>.re,,, 1 ~

This appointment is effective for every division of circuit court anq for every district:court in

said count[y)[tcs].

The circuit clerk shall tile this order and provide a certified copy of it to

the process server, and the ci..rcuit clerk and sheriff of each county of this judicial circuit

wherein approval has been granted. Toe circuit clerk:(s} shall add tj"te App1icantto the list of

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qualified process servers that it maintains ano posts.


valid driver's license, when servirm process and shall, upon request or inquiry, present this


Entered this f 7 day of_~_, _;/0:..,..'---- 2 cl r . -- T

Circuit Judge

IN THE CI RCUIT COURT OF FAULKNER COUNTY, ARKANSAS

CIRCUIT

20TH CIRCUIT

23LS-18-10

RONNEY HERRINGTON

CLERK' S CERTIFICATE

I, CRYSTAL TAYLOR, CIRCUIT CLERK, Cle rk of the Ci rcuit Court of

FAULKNER County , Arkansas , do hereby certify that the for egoin g are

true and corre ct photocopies of the attached plead i ngs o f s a id Court

as the s ame appea rs of record in this o f fice .

WI TNESS my hand a nd o fficial Cour t Seal this 18-MAY- 2018 .

CRYSTAL TAYLOR, CIRCUIT CLERK

BY: 0011Q~5Efo.c.

BID RESPONSE PACKET SP-19-0050

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