Contract - Safeware - 6/13/2019Sol �&IA/q�0
QUOTATION
10750 Irma Drive
Unit 13
Northglenn, CO 80233
303-322-3577
www.safewareinc.com
Bill To: Customer ID: 47738
City of Round Rock
Accounts Payable
221 E Main Street
Round Rock, TX 78664
USA
512-218-5524
Order Number
1510010
Order Date
Page
2/22/2019 00:00:00
1 of 2
Quote Expires On 5/31/2019
Ship To:
City of Round Rock
Police Administration
2701 N Mays Street
Round Rock, TX 78665
USA
Reauested Bv: Ms_ Damaris Mnralec
PO Number
Taker
Email
MICH/MIL Helmet
Diana Mularky
dmularky@safewareinc.com
Freight Terms
Phone
Fax
Freight Paid
303-322-3577
303-322-1992
Quantities
Pricing
Item ID
Item Description
UOM
Unit
Price
Extended
Price
Ordered
Allocated
Remaining
UOMUni!
y
Size
O
UnitSize
105.00 0.00 105.00 EA USI ACH-MICH-MIL-IIIA-MDBLK-DK6S EA 415.58 43,635.90
List Price. 755.01 USC Discount: 41 % Your Discount: 44.96%
1.0 ACH-MICH-MIL Level IIIA Helmet 1.0
With US Mil Spec 7 pad system, DK6 H.150s 6"
Faceshield NIJ 0104.02 rated, Medium, Black
10.00 0.00 10.00 EA USI ACH-MICH-MIL-IIIA-SMBLK-DK6S EA 415.58 4,155.80
List Price. 755.01 USC Discount: 41 % Your Discount. 44.96%
1.0 ACH-MICH-MIL Level IIIA Helmet 1.0
With US Mil Spec 7 pad system, DK6 H.150s 6"
Faceshield NIJ 0104.02 rated, Small, Black
45.00 0.00 45.00 EA
USI ACH-MICH-MIL-ILIA-LGBLK-DK6S
EA
415.58 18,701.10
List Price.
755.01 USC Discount: 41 %
Your Discount:
44.96%
1.0
ACH-MICH-MIL Level IIIA Helmet
1.0
With US Mil Spec 7 pad system, DK6 H.150s 6"
Faceshield NIJ 0104.02 rated, Large, Black
26.00 0.00 26.00 EA
USI ACH-MICH-MIL-ILIA-XLBLK-DK6S
EA
415.58 10,805.08
List Price.
810.04 USC Discount. 41 %
Your Discount:
48.70%
1.0
ACH-MICH-MIL Level IIIA Helmet
1.0
With US Mil Spec 7 pad system, DK6 H.150s 6"
Faceshield NIJ 0104.02 rated,X-Large, Black
186.00 0.00 186.00 EA
USI H-BAG
EA
38.96 7,246.56
List Price:
66.04 USC Discount. 41 %
Your Discount:
41.01 %
1.0
Helmet Bag
1.0
1.00 0.00
1.00 EA USC
1.0 U.S. Communities Contract #4400008468
EA 0.00 0.00
1.0
QUOTATION
107501rma Drive
Unit 13
Northglenn, CO 80233
303-322-3577
www.safewareinc.com
Order Number
1510010
Order Date
Page
2/22/2019 00:00:00
2 of 2
Quote Expires On 5/31/2019
Quantities
Pricing
Item ID
Item Description
UOM
Unit
Price
Extended
Price
Ordered
Allocated
Renwining
UOM
Unit Size
C
Unit Size
Total Lines: 6
Public Safety and Emergency Preparedness
Standard freight within continental US is paid, all
HAZMAT or expedited freight will be billed.
*Agency must be registered with U.S.
Communities at www,uscommunities.org
SUB —TOTAL: 84,544.44
TAX.- 0.00
AMOUNT DUE: 84,544.44
Actual freight added per freight terms
CERTIFICATE OF INTERESTED PARTIES FORM 1.295
loll
complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2Q19.486340
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Safeware Inc
Lanham, MD United States
Date Filed:
05/04/2019
2 Name of governmental entity or state agency ffint is a party to the contract for which the forms
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,
000000
Purchase of Ballistic Helmets and Helmets Bags
4
Name of Interested Party
City, State, Country (place of business)
Nature oflnterest
(check applicable)
Controlling
Intermediary
5 Check only if there is NO Interested Party. ❑
X
6 UNSWORN DECLARATION
My name Is ?r1r ,and my date of birth Is '
My address is 91163 fc rlrn.shlot / H` Ayi M An,�(�S A
c sdeh�
(street) (City) (state) -- (zip ccode)--� (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in he- PAC Y,OJ7 DE� County, State of Y on the ,Z� d y of 20/.
(mo ) (year)
oaSignature
r
of authorize�dayentof contracting business entity
16, (Dedarant)
... •..., p,... ,..w -Y , -- a- 11-0 vvnurnoaIun WWW.C[11I1;5.5We.D(.us Version V1.1.39f8039c
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
Certificate Number:
2019-486340
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Safeware Inc
Lanham, MD United States
Date Filed:
05/04/2019
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:
05/23/2019
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.
000000
Purchase of Ballistic Helmets and Helmets Bags
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(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)
t-orms provlaea oy Texas Ethics Commission www.ethlcs.state.tx.us Version V1.1.39f8039c