R-2018-5362 - 4/12/2018 RESOLUTION NO. R-2018-5362
WHEREAS, the City of Round Rock ("City") desires to purchase Opioid kits for the Opioid
Emergency Response Pilot, and
WHEREAS, the City is a member of the Texas Government Statewide Purchasing
Cooperative ("Buy Board"), and
WHEREAS, Bound Tree is an approved vendor of the Buy Board, and
WHEREAS, the City wishes to issue a purchase order to Bound Tree,Now Therefore
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS,
That the City Manager is hereby authorized and directed to issue a purchase order to Bound
Tree for the purchase of Opioid kits for the Opioid Emergency Response Pilot.
The City Council hereby finds and declares that written notice of the date, hour, place and
subject of the meeting at which this Resolution was adopted was posted and that such meeting was
open to the public as required by law at all times during which this Resolution and the subject matter
hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act,
Chapter 551, Texas Government Code, as amended.
RESOLVED this 12th day of April, 2018.
CRAIG OR0,1
ayor
City of ound Texas
ATTEST:
L .
SARA L. WHITE, City Clerk
0112.1804;00398626
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1of1
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. 2018-332520
Bound Tree Medical, LLC
Dublin,OH United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/30/2018
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.
530-17
EMS Medical Supplies
4 Nature of Interest
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 UNSWORN DECLARATION
My name is Tim Jamison and my date of birth is April 5th, 1987
My address is 5000 Tuttle Crossing Blvd. Dublin , Ohio 43016 Franklin
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in Franklin County, State of Ohio -,on the 30thday of March ,2017.
(month) (year)
,,_ rgnat ut iorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.5523
CERTIFICATE OF INTERESTED PARTIES FORM 1.295
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. 2018-332520
Bound Tree Medical, LLC
Dublin, OH United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/30/2018
being filed.
City of Round Rock Date Acknowledged:
04/04/2018
g 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.
530-17
EMS Medical Supplies
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 UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of .120
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.5523