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Contract - Silsbee Ford - 4/11/2019m mu sell PRODUCT PRICING SUMMARY GOODBUY 19 - 8F000 VEHICLES VENDOR --Silsbee Ford,1211 Hwy % N., Silsbee TX 77656 End User: CRY OF ROUND ROCK Prepared by, GLEN ANOEME Contact: SCOTT PARKER Phone: 409-880-9191 Email: Finan: 1lalzcei1e. o fflo dlnman.©om Product Description: 2020 FORD DJIERCEPTOR UTDJTY AWD Date: Ja!m 16, 2019 A. Bid Item A. Base Priced S 34,964.00 R V00t.-v nnHnnm Code I options Bid Price Code Options Bid Price 99B EMERGENCY EQUU MFNT S 25,790.28 EXT BLACK 17A REAR AIC S 610.00 WT CLOTH BUCKETS/REAR VDM SIS DUAL LED SPOTLIGHTS S 620.00 SYNC UIAND FREE) 60A GRD.L WIRING S 30.00 4 KEYS 86T RR TAMI AMP HSO. S 60.00 CRUISE SYNC 331. V6 S 4.1%.42 PRE DRILLED HEADLAMP HOUSING POWER WWDOWSA.00KS AMMMNCD/ REAR CAMERA Total of B. Published Options:) S 22,03.86A Published Option Discount (5%)l 3 142.82 C. Additional Options loot to exceed 25%1 0.0% O tions BW Price Options Bid Price Total of G Unpublished Options: S D, Floor Pian Interest (for Instock and/or equipped vehicles): E. Lot Insurance (for b"tock and/or equipped vehicles): F. Contract Price adjustment: 2 YR REO 8t DOC FEE G. Additional Delivery Charge: 0 miles H. Subtotal: L Quantity Ordered 2 x K J. Trade In: K. GOODBUY Administrative Fee (5300 per purchase order) 4 TOTAL PURCHASE PRICE INCLUDING GOODBUY FEE S S 90.1 3 166.73 Is S 58,117.28 S 11 3456 Is 300.00 S 116,53456 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.39f8039c CERTIFICATE OF INTERESTED PARTIES FORM 3.295 loll Complete Nos. 1 - 4 and 6 If there are interested patties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2019-465686 silsbee ford SILSBEE, TX United States Date Filed: 03120/2019 2 Name of governmental entity or state agency that is a party to the contract for which the form Is 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. GOODBUY 19-8FOOD TWO 2020 FORD INTERCEPTORS 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary DONALSON, DREW SILSBEE, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DE ARATION My name is J� v\ and my date of birth is My address is C Le ''e ' /\ , �� L,5(" (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. '— Executed in 1 u� County, State of on the f� l od'y of S 20� (month) (year) Signature of authorized agent of contractin usiness en ity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.39f8039c corms proviciea by I exas Ethics commission www. ethics. state. tx.us Version V1.1.39f8039c 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 Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2019-465686 silsbee ford SILSBEE, TX United States Date Filed: 03/20/2019 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. CITY OF ROUND ROCK Date Acknowledged: 04/04/2019 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. GOODBUY 19-817000 TWO 2020 FORD INTERCEPTORS 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary DONALSON, DREW SILSBEE, 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) corms proviciea by I exas Ethics commission www. ethics. state. tx.us Version V1.1.39f8039c