Contract - L3 Mobile-Vision Inc. - 8/24/2017 li ;3 r
— Mobile-Vision, Inc. Vir
Number 207537868
400 Commons Way.Rockaway.NJ 07866
E T 073-453-8567. F,973-257-3024 Date July 07,2017
`Sold To Ship To
Round Rock Police Department Round Rock Police Department
Rick Joubert Rick Joubert
2701 N.Mays 2701 N.Mays
Round Rock,TX 78665 Round Rock,TX 78665
Phone 512-218-5521 Phone 512-218-5521
Fax 512-218-6681 Fax 512-218-6681
Salesperson P.O.Number Ship Via Terms
Valerie McKenna None
Line':, Qty SKU Description_......._.._... ; Unit Pricei Ext.Price I Comments
I 28 FBHKUA32Z-14 FiashbackHD Upgrade Kit,DVR,Optical 52,612.00 $78,730.00
Zoom Cam,32OBSD,14'camera cable.
For customers with Flashbackl,
Flashback2 or Flashback3 systems.
Only new equipment is warranted.
i 2 28 MVO-FB-EMA-1Y Flashback,In-Car Video System,1 Year $299.00 S0.00
•
Warranty
Note:Has R772
Note:Promo Pricing•Order must be placed by 12-29-17
Nolo:Includes FBHD DVR Only and Camera with Cable(This is not a complete FlashbaekHD Digital In Car Video System) - -
Signing below is in lieu of a formai Purchase Order. '
i SubTotai 78,738.001
Your
Your signature will authorize acceptance of both pricing and product: Tax TBD`
S& l1560.00
Signed: Dated: l_._.._. ..._w,__.......,._-........----.--_...._.._—._.�
Total 79,296.pt3'
L-3 Shipping Terms are FOB Rockaway,NJ,By signing below you agree to
waive your shipping terms and ship this order FOB Rockaway,NJ.
Signed: Dated:
•
Quotation is valid for 60 doys from data issued.The technology described herein Is controlled under the Export Administration Regulation
TEAR)and may not be exported without proper authorization by the U.S Department of Commerce.Stale,Local Fees and Taxes are not
included
07/07/2017 3:68 pm Page 1 of 1
is
Justification Form
Instructions:Complete this form for all Proprietary Purchases that will exceed$3,000.00,where competition is not being considered
and submit the document to the Purchasing Department.
Request No.: 172541 Cost: $79,296.00 Data: 07/10/2017
Commodity Code: 055'12 Briefly describe Goods/Services being purchased:
upgrade on existing equipment to police cruiser camera
Proposed Vendor: L3 Vendor No.:
I. The requested goods/services are proprietary due to(check all that apply):
COMPATIBILITY-Must fit and function without modification on existing piece of equipment.List existing piece of
equipment:
aREPLACEMENT/MAINTENANCE-Repair or maintenance from other than original manufacturer or manufacturer
authorized service providor would void warranty.List existing piece of equipment:
EISOLE SOURCE/ONLY KNOWN SOURCE-Available from only one vendor or source.Name of source:
CITY STANDARD(Standards list on file). Standards list provided to Purchaser: Y or ON
EOTHER-Explanation Required:
II. Provide full explanation,complete descriptions,relevant reasons,and documentation supporting this request.
III. Submit documentation and detailed explanation regarding other providers whose products or services have been evaluated and
the reasons why those products or services do not meet requirements.
IV. By submitting this request,I certify that the above justification is accurate and complete to the best(Amy knowledge and that I
have no financial or other interest in selecting the vendor to provide the goods or services indicated.
zeie.,__2,27„,
d.4
‘83629 7 -fr)
Requestor ept. Phone Date
ifia...4e-e( /c7-/7
Dept.Approv Supervisor/Manager) Date
**TO BE COMPLETED BY PURCHASING**
V. Based on the above and(any)attached document(s),I concur/ do not concur with this justification.
Purchaser/Buyer Date P.O.#
VI. APPROVED: YES NO
Purchasing Supervisor/Manager Date
REVISED:08/2011
CERTIFICATE OF INTERESTED PARTIES FORM 1295
101`1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-235645
L3 Mobile-Vision, Inc.
Rockaway,NJ United States Date Piled:
2 Narne of governmental entity or state agency that is a party to the contract for which the form is 07/12/2017
being filed.
City of Round Rock Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract,
Quote#207537868
FSHD Upgrades
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party. ❑
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that t eTiscsu true and correct.
i John Powers
} VP of Sales and Marketin
Signature of authorized agent f co cting bus' s entity
APF1X NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said John Powers this the 12 day of JUIN[ ,
20 17 to certify which,witness my hand and seal of office.
J.
l 1`
Ryan Hourihan Proposal Writer
ig ture of officer adminNAAMame of officer administering oath Title of officer administering oath
NOTARY P IC OF NEW
Forms provided by Texas Eth 1 www.ethics.stateAx.us Version V1.0.883
VV Camtn ss 0111x res Q1 1
CERTIFICATE OF INTERESTED PARTIES FORM 3.295
10f1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-235645
L3 Mobile-Vision, Inc.
Rockaway, NJ United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 07/12/2017
being filed.
City of Round Rock Date Acknowledged:
07/17/2017
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
Quote#207537868
FBHD Upgrades
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said this the day of
20 ,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883