Contract - The Playwell Group, Inc. - 9/13/2018 www.playwel{ roup.com QUOTATION
800-726-1816 QUOTE# 7/30/2018
Playly
ywell Group,Inc. 505-296-8900(fax) 11072
Athletic,Park,and Playground EgUiptnent
Serving Texas,New Mexico,Oklahoma,and Arkansas since 1988
BILL TO: SHIP TO:
City of Round Rock City of Round Rock-OSP Adult Complex
Accounts Payable Katie Baker
221 East Main Street 660 North Red Bud Lane
Round Rock,TX 78664 Round Rock,TX 78665
Phone: (512)341-3355 Phone: (512)341-3355
COST.PO# TERMS SALES REP COUNTY QUOTE EXPIRATION
NET 30 CES WILLIAMSON 8/30/2018
ITEM DESCRIPTION QTY LIST PRICE DISC.PRICE TOTAL
BUYBOARD#512-16 BUYBOARD CONTRACT#512-16 EXPIRES 1 0.00 0.00 0.00
9/30/2018
ICON
MC14x24M-P2 CANTILEVER MONOSLOPE ICON SHELTER WITH 6 17382.00 16,512.90 99,077.40
24GA PRECUT MULTI-RIB METAL ROOF,ALL
FASTENERS,ANCHOR BOLTS,E-COAT AND
POWDER COATING
SED ICON SEALED ENGINEERED DRAWINGS 1 334.00 317.30 317.30
SHIP-ICON SHIPPING AND HANDLING 1 6028.60 6,028.60 6,028.60
ICON SHELTER SYSTEMS,INC.-Deliveries
require special or additional care or attention.If
Playworks is not contracted for installation,
product must be off loaded by customer,fork lift
required.Please refer to the WARNING LABEL
upon delivery.
PERMITS PERMITTING .00 0.00 0.00
No permitting or windstorm engineering for
permitting is included unless specifically noted.
QUOTE VALID FOR 30 DAYS. Product will be ordered upon receipt of written
approvals and/or deposit. Please email or fax all pages. SUBTOTAL
PLEASE REMIT YOUR DEPOSIT TO: $105,423.30
THE PLAYWELL GROUP,INC.
9430 SAN MATEO BLVD., NE, UNIT G SALES TAX (0.0%) $0.00
ALBUQUERQUE, NM 87113
Date Signature TOTAL $105,423.30
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. 2018-396467
The PlayWell Group, Inc.
Dallas,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 08/24/2018
being filed.
City of Round Rock Date Acknowledged:
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.
Old Settlers Park Adult Comple
Cantilever Monoslope Icon Shelter Purchase
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
The PlayWell Group, Inc. Dallas,TX United States X
5 Check only if there is NO Interested Party.
6 UNSWORN DECLARATION
My name is I 5 J171 and my date of birth is r
1<71
My address is .l 1
rS
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Lty . y /'Executed in /I�i Coun , State of C/ on the da of - 'i ' ,20/�.
onth) (year)
X1,7
Signature of authorized agenof contracting business entity
(Declara t)
Forms provided by Texas Ethics Commission www.ethics.state,tx.us Version V1.0.6711
CERTIFICATE OF INTERESTED PARTIES
FORM 1Z9rJ
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. 2018-396467
The PlayWell Group, Inc.
Dallas,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 08/24/2018
being filed.
City of Round Rock Date Acknowledged:
08/31/2018
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.
Old Settlers Park Adult Comple
Cantilever Monoslope Icon Shelter Purchase
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
The PlayWell Group, Inc. Dallas,TX United States X
5 Check only if there is NO Interested Party. ❑
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 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711