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Contract - Chastang Ford - 2/14/2019 CONTRACT PRICING WORKSHEET :Contract BU AM10-18 Date For MOTOR VEHICLES Only N'o.: Prepared: 12/3/2013 This Worksheet is prepared by Contractor and given to End User. If a PO is issued,both documents MUST be faxed to H-GAC @ 713-993-4548. Therefore please type or print legibly. anticsCITY OF ROUND ROCK Agency: Contractor; CHASTANG FORD Co nton: PeSCOT TPARKER Prepared Pcnon: ED MILLER Phone: Phone: 713-678-5007 Fax: Fan 713-678-5001 Emu: SPARKER@ROUNDROCKTEXAS.GOV EmaIt: EMILLER@CHASTANGFRD.COM ProduCode: Ah118JC14 nexripuan: 2019 FORD TRANSIT RESPONSE UNIT A.Product Item Base Unit Price Per Contractor's H-GAC Contract: 33988 B.Published Options-Itemize below-Attuch additional sheet(s)if necessary-Include Option Code in description if applicable. (Note:Publishcd Options arc options which were submiucd and priced in Contractors bid.) Description Cost Description Cost AUTU` V6Description INCL 7V10-LED FLASHING E•MERG LIGHTPKG 2375 AINCL AV121800WINVE•RTER 2275 544-LONG ARM POWER HEATED MIRRORS 220 AV I 1 RES-AR SEAT BELTS 8 X 575 4600 43R-REVERSE SENSING 295 BSU03-LOWER AND UPPER CABINETS 4475 F4X-T-350 DRW UPGRADE 10995 96B-INTERIOR UPGRADE 1495 HD ALTERNATOR INCL 86F-2 EXTR KEYS 125 R3U-EXTENDED LENGTH 7995 NGT UNIT 90C-POWER INVERTER 100 DUAL BATTERIES INCL Subtotal From Additional Sheet(s): Subtotal B: 34950 C.Unpublished Options-Itemize below/attach additional sheets)If necessary. (Note:Unpublished options are items which were not submitted and priced in Contractors bid.) Description Cost Description Cost FLOOR PLAN INTEREST 150 X 12 1800 IN 1-LOT INSURANCE 150X6 900 200W-UPGRADE TO 20OW INVERTER 995 REAR DOOR GLASS 250 PRO AIR 585/110 A/C AND HEAT 9995 Subtotal C: 13940 Check:Total cost of Unpublished Options(C)cannot exceed 25%of the total of the Base Unit Price plus Published Options(A+B). For this transaction the percentage is: 20% D.Total Cost Before Any Applicable Trade-In/Other Allowances/Discounts(A+B+C) Quantity Ordered: 1 X Subtotal ofA+B+C; 82878 Subtotal D: 52878 E.H-GAC Order Processing Charge(Amount Per Current Policy) Subtotal E: 1000 F.Trade-Ins/Special Discounts/Other Allowances/Freight/Installation/Miscellaneous Charges Description Cost Description Cost TITLE AND LICENSE 200 DELIVER TO ROUND ROCK INCL DISCOUNT -314 Subtotal F: -114 Delivery Date: 32-36 WEEKS ARO G.Total Purchase Price(D+E+F): 837W �2�(�-tea IAF -�;� 1908W APL*Aq(o- a9 tn' B� CONTRACT PRICING WORKSHEET Contract Date ffMCFor MOTOR VEHICLES Only No.: AN"'48 Prepared: 12/3/2018 This Worksheet is prepared by Contractor and given to End User. If a PO is issued,both documents MUST be faxed to H-GAC @ 713-993-4548. Therefore please type or print legibly. ag)tnr. CITY OF ROUND ROCK n enc. Contractor: CHASTANG FORD Contact SCOTTPARKER Prepared Person: 11y. ED MILLER Phone: Phone: 713-678-5007 ra:t Pax: 713-678-5001 Email: SPARKER@ROUNDROCKTEXAS.GOV Email: EMILLER@CHASTANGFRD.COM Prod C deet AN118JC14 I uereription: 2019 FORD TRANSIT RESPONSE UNIT A.Product Item Base Unit Price Per Contractor's H-GAC Contract: 33988 B.Published Options-Itemize below-Attach additional shcet(s)if necessary-Include Option Code in description if applicable. (Note:Published Options are options which were submitted and priced in Contructor's bid.) Description Cost Description Cost 3.7L V6 INCL AV10-LED FLASHING EMERG LIGHTPKG 2375 AUTOMATIC INCL AV)2 1800 W INVERTER 2275 544-LONG ARM POWER HEATED MIRRORS 220 AV I 1 RES=AR SEAT BELTS 8 X 575 4600 43R-REVERSE SENSING 295 BSU03-LOWER AND UPPER CABINETS 4475 F4X-T-350 DRW UPGRADE 10995 968-INTERIOR UPGRADE 1495 HD ALTERNATOR INCL 86F-2 EXTR KEYS 125 R3U-EXTENDED LENGTH 7995 DPLY UNIT PER SPECS 90C-POWER INVERTER 100 DUAL BATTERIES INCL Subtotal From Additional Shect(s): Subtotal B: 34950 C.Unpublished Options-Itemize below/attach additional sheet(s)if necessary. (Note:Unpublished options are items which were not submitted and priced in Contractor's bid.) Description Cost Description Cost FLOOR PLAN INTEREST 150 X12 1800 [NI-LOT INSURANCE 150X6 900 20OW-UPGRADE TO 200W INVERTER 995 REAR DOOR GLASS 750 PRO AIR 585/110 A/C AND HEAT 9995 Subtotal C: 13940 Check:Total cost of Unpublished Options(C)cannot exceed 25%of the total ofdtc Base For this trnnsactlon the percentage Unit Price plus Published Options(A+B). p ge is: 20% D.Total Cast Before Any Applicable Trade-In/Other Allowances/Discounts(A+B+C) Quantity Ordered: I X Subtotal of A+B+C: 82878 = Subtotal D: 82878 E.H-GAC Order Processing Charge(Amount Per Current Policy) Subtotal E: 1000 F.Trade-Ins/Special Discounts/Other Allowances/Freight/Installation/Miscellaneous Charges Description Cost Description Cost TITLE AND LICENSE 200 DELIVER TO ROUND ROCK INCL Subtotal F: 200 Delivery Date: 32-36 WEEKS ARO G.Total Purchase Price(D+E+F) s4o78 CERTIFICATE OF INTERESTED PARTIES FORM 1295 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 fort,and the city,state and country of the business entitys place of Certificate Number. business. 2019-439548 Chastang Ford HOUSTON,TX United States Date Rled: 2 Name of govemmental entity or state agency that Is a party to the contract for which the form is being 01/09/2019 filed. CITY OF ROUND ROCK Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identity the contract,and provide a description of the services,goods,or other property to be provided under the contract. am 10-18 swat vans purchase 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary 5 Check only 0 there is NO Interested Party. ❑ X 6 UNSWORN DECLARATION MY name is ^Gr �—� l t t ` I�� and my date of birth is — �?e e /��- GSkrte, 7-7�8 3 s My address is G , (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) ignature uthorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission ethics.state. s Version V1.1.28ab6150 CERTIFICATE OF INTERESTED PARTIES FORM 1.295 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. 2019-439548 Chastang Ford HOUSTON,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 01/09/2019 being filed. CITY OF ROUND ROCK Date Acknowledged: 01/31/2019 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. am10-18 swat vans purchase 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 V1.1.28ab6150