Contract - Chastang Ford - 1/24/2019 (2) t'P + 'L LJ/(/ t!'. �y'�) •,f`J �— (t�ir1,jj , f llx;1 r(.. J_t 3q
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CONTRACT PRICING WORKS.T ET Contract TDate
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T06-18 ! 11/8/2018
or tVC�t UR S'IFIICL�S Only Prepared:
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A�cnc�:Buyllig
1GITY OF ROUND ROCK Contractor: =CHASTANG FORD
Contact 1:MARSHALL REYNOLDS '
Person: ' E repand IED MILLER
Fly; E
Phone; s Phone: 1713-675-5007
r"" rax: 1713-678-5001
Email: _ Email: Iemillcr@chastangford.com
Product s
,Code: F B4 nrscription: 12019 FORD F550 DIESEL
;4 'ruditct:Ifem.B2s'e: >irt i t; k'er Col triicfor!s'13�G: :l bii t itcfl
:I 33,749
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Description Cost Description F
; Cost
1651VrB-165"WB/84"CA 174
512-SPARE TIREAVH EEL 350 VST-40-1 ?
' 7.456
6814-19500 GVWR 1155 DOT4-STROBE LIGHT KIT 675
X81--4,88 LIMITED SLIP AXLE f 360 DOT-SAFETY KI7'-FIRE L-XTINGUISHER.AND REFL 1 i95
90L-POWER EQUIP GROUP 9 i5 S'1'ROBE W/SB AND-SINGLE MOUNT STROBES X2 F 990
62R-PTO PROVISION 280 DF138-COMBO PTNTLE HITCH AND 2"BALL ; 37S
CV 1-ENGINEERING CHASSIS LAYOUT AND DESIGN 998 7PRONGF-7 PRONG LIGHT PLUG 1 INCL
585-AMIi;tiI/14P3/SYNV 1 550 STROBE KIT DOT3
878
67P 7500 LB FRONT AXLE = 255
FLRI-FLOOR PLAIN INTEREST 1.4X210 2940 _
IN i-LOT INSURANCE 7 X?10 ' 1470 Subtotal Froin Additionnl,Sl,ect(s):
I SA-UPFITTER INTERFACE MODULE 295 Subtotal B:: 8734I
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Description Cost Descriptioni Cost
FURNISH AND INSTALL ARROWSTICK I 795 JUPGRADE TO VST7 y1H[ 1 22846
REAR SPRING UPGRADE 1 1178 ��
2400 W INVERTER 1 1087Subtotal W.1087 '759-(1)
Check:Total cost of Unpublished Options(C)cannot exceed 25%of the total ofthe Base Unit 1
Price plus Published Options(A+T3), I For this transaction Cllr percerttnbe is: 210%
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13:T'filI CostQtlici�A7 6:'�a _
.pP.. 1.15 tcrYs�i T7u�attuts;( F7i FC):;:''':
Quaitt1ty Ordered: Z X Subtotal of A+13+C: 146996 = .,�. Subtotal D:_
146996
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b• 9..(. 3�::' Subtotal E:; 1000
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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. 2018-433723
Chastang Ford
H,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 12/13/2018
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.
REQ#190570
FORD F550 WITH VERSALIFT AREIAL
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 �af'Ye--t.L� f " ' 1l /
'J � , and my date of birth is 7-2 T
My address is 7 l � _Z ,� � 7l Jl(�� _� �t'ltt,2,, / �s?
(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)
Si?
alu uthorized agent of contracting business entity
c'°" (Declarant)
Forms provided by Texas Ethics Commission www.ethics.st .us Version V1.0.6711
CERTIFICATE OF INTERESTED PARTIES FORM 3.295
1 of 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. 2018-433723
Chastang Ford
H,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 12/13/2018
being filed.
CITY OF ROUND ROCK Date Acknowledged:
01/24/2019
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.
REQ#190570
FORD F550 WITH VERSALIFT AREIAL
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 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