Contract - Metro Fire Apparatus Specialists, Inc. - 6/13/2019METRO FIRE
APPARATUS SPECIALISTS. IMO.
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17360 State Hwy 249
Mansfield
625 S Wisteria St Ste 121
Suite 250
ManaReld TX 76063-26U
Houston TX 77064-1142
(817) 467-0911 Phone
(713) 692.0911 Phone
(817) 376-1775 Fax
(713) 892-1591 Fax
Bill to: ROUND ROCK FIRE DEPARTil M
ROUND ROCK FIRE DEPARTbENT
203 CObMRC8
ROUND ROCK, TX 78664
South Houston
614 MtchIgan St
South Houston TX 77687-3221
(713) 476-2411 Phone
1713) 475-2428 Fax
QUOTE
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Ship to: ROUND ROCK FIRE DEPARTMENT
3300 GATTIS SCHOOL ROAD
ROUND ROCK, TX 78664
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SubTotal
4499.001 50487.
Total k .:
QUOTE GOOD FOR 45 DAYS
58,487.
CERTIFICATE OF INTERESTED PARTIES FORM 1295
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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:
2019-488119
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Metro Fire Apparatus Specialists, Inc.
Houston, TX United States
Date Filed:
05/08/2019
2 Name of governmental entity or state agency that is a party tot the contract for w c t form is
being filed.
City of Round Rock
71
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.
Buy Board COOP Contract 524-17 !
Bullard thermal imager QXT
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
RUSSELL, CRAIG
HOUSTON, TX United States
X
I
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DE RATION
My name is _ N and my date of birth is ' `
??
My address is � j 5 0 SA 21.1 \ S��. G. So
(street) (city) (state) (zip code) (country)
I declare under penaltyof perjury that the foregoing is true and correct.
�� q Q
Executed in-�-tf�iGKl s County, State f l /� , on the p day of, 20 i �.
(month) (year)
Signature of orized ag n f contracu usiness entity
(Declarant)
v!"IQ Nruviucu uy i cnaa cunw %..Vnnmaaiun Www.elrlics.stale.Mus version v1.1.391`8039c
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.
2019-488119
Metro Fire Apparatus Specialists, Inc.
Houston, TX United States
Date Filed:
05/08/2019
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.
Buy Board COOP Contract 524-17
Bullard thermal imager QXT
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
RUSSELL, CRAIG
HOUSTON, 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)
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 V1.1.39f8039c