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Contract - Casco Industries, Inc. - 8/22/2019 CITY OF ROUND ROCK AGREEMENT FOR PURCHASE OF PUBLIC SAFETY AND FIREHOUSE SUPPLIES AND EQUIPMENT WITH CASCO INDUSTRIES,INC. THE STATE OF TEXAS § CITY OF ROUND ROCK § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § COUNTY OF TRAVIS § This Agreement is for the purchase of public safety and firehouse supplies and equipment, and is referred to herein as the "Agreement." This Agreement is made and entered into on this the 22A-day of the month of + , 2019, by and between the CITY OF ROUND ROCK, TEXAS, a home-rule municipal y whose offices are located at 221 East Main Street, Round Rock, Texas 78664, referred to herein as the "City," and CASCO INDUSTRIES, INC., whose offices are located at 607 West 62 Street, Shreveport, Louisiana 71108, referred to herein as "Vendor." This Agreement supersedes and replaces any previous agreement between the named parties, whether oral or written, and whether or not established by custom and practice. RECITALS: WHEREAS, City desires to purchase public safety and firehouse supplies and equipment, and City desires to obtain said goods from Vendor; and WHEREAS, City is a member of the Buy Board Cooperative Purchasing Program ("Buy Board") and Vendor is an approved Buy Board vendor through Buy Board Contract # 524-17; and WHEREAS, City desires to purchase certain goods and services from Vendor through Buy Board as set forth herein; and WHEREAS, the parties desire to enter into this Agreement to set forth in writing their respective rights, duties, and obligations; NOW,THEREFORE, WITNESSETH: That for and in consideration of the mutual promises contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged,the parties mutually agree as follows: 00427269/ss2 1 1.0 DEFINITIONS A. Agreement means the binding legal contract between City and Vendor whereby City agrees to obtain specified goods and Vendor is obligated to provide specified goods. This Agreement includes any exhibits, addenda, and/or amendments thereto. B. City means the City of Round Rock, Williamson and Travis Counties, Texas. C. Effective Date means the date upon which the binding signatures of both parties to this Agreement are affixed. D. Goods mean the specified supplies, materials, commodities, or equipment. E. Vendor means Casco Industries, Inc., or any successors or assigns. 2.0 EFFECTIVE DATE; INITIAL TERM; ALLOWABLE RENEWALS A. This Agreement shall be effective on the date it has been signed by both parties hereto, and shall remain in full force and effect unless and until it expires by operation of the term stated herein, or until terminated or extended as provided herein. B. This Agreement shall expire on March 31, 2020. 3.0 SCOPE OF WORK A. The goods and related services which are the subject matter of this Agreement are described generally in the attached Exhibit"A." B. This Agreement shall evidence the entire understanding and agreement between the parties and shall supersede any prior proposals, correspondence or discussions. C. Vendor shall satisfactorily provide all deliverables and services described in Exhibit"A"within the contract term specified. A change in the Scope of Services or any term of this Agreement, including bonding requirements, must be negotiated and agreed to in all relevant details, and must be embodied in a valid Supplemental Agreement as described herein. 4.0 COSTS A. City agrees to pay for goods and related services during the term of this Agreement at the pricing set forth in Exhibit"A." B. The City shall is authorized to pay the Services Provider an amount not-to- exceed Two Hundred Thousand and No/100 Dollars ($200,000.00) for the term of this Agreement. 2 5.0 INVOICES All invoices shall include, at a minimum,the following information: 1. Name and address of Vendor; 2. Purchase Order Number; 3. Description and quantity of items received; and 4. Delivery dates. 6.0 NON-APPROPRIATION AND FISCAL FUNDING This Agreement is a commitment of City's current revenues only. It is understood and agreed that City shall have the right to terminate this Agreement at the end of any City fiscal year if the governing body of City does not appropriate funds sufficient to purchase the services as determined by City's budget for the fiscal year in question. City may effect such termination by giving Vendor a written notice of termination at the end of its then-current fiscal year. 7.0 PROMPT PAYMENT POLICY Prompt Payment Act. In accordance with Chapter 2251, V.T.C.A., Texas Government Code, any payment to be made by City to Vendor will be made within thirty (30) days of the date City receives goods under this Agreement, the date the performance of the services under this Agreement are completed, or the date City receives a correct invoice for the goods or services, whichever is later. Vendor may charge interest on an overdue payment at the "rate in effect" on September 1 of the fiscal year in which the payment becomes overdue, in accordance with V.T.C.A., Texas Government Code, Section 2251.025(b). This Prompt Payment Policy does not apply to payments made by City in the event: 1. There is a bona fide dispute between City and Vendor, a contractor, subcontractor, or supplier about the goods delivered or the service performed that cause the payment to be late; or 2. There is a bona fide dispute between Vendor and a subcontractor or between a subcontractor and its supplier about the goods delivered or the service performed that causes the payment to be late; or 3. The terms of a federal contract, grant, regulation, or statute prevent City from making a timely payment with federal funds; or 4. The invoice is not mailed to City in strict accordance with any instruction on the purchase order relating to the payment. 8.0 GRATUITIES AND BRIBES City may, by written notice to Vendor, cancel this Agreement without liability to Vendor if it is determined by City that gratuities or bribes in the form of entertainment, gifts, or otherwise were offered or given by Vendor or its agents or representatives to any City officer, employee or elected representative with respect to the performance of this Agreement. In addition, Vendor may be subject to penalties stated in Title 8 of the Texas Penal Code. 9.0 TAXES City is exempt from Federal Excise and State Sales Tax; therefore, tax shall not be included in Vendor's charges. 10.0 INSURANCE Vendor shall meet all City of Round Rock insurance requirements set forth at: http:f/NN,-N`�v.roundrocktexas.gov/,,vp-content/uploads/2014/1?/corr insurance 07 ?011? pdf. 11.0 CITY'S REPRESENTATIVE City hereby designates the following representative authorized to act in its behalf with regard to this Agreement: Chief Robert Isbell Fire Department 203 Commerce Boulevard Round Rock, TX 78665 (512)218-6630 risbell(cc,roundrocktexas.gov 12.0 DEFAULT If Vendor abandons or defaults under this Agreement and is a cause of City acquiring the specified goods elsewhere. Vendor shall be declared in default of this Agreement if it does any of the following and fails to cure the issue within thirty (30)days of receipt of written notice: A. Fails to fully, timely and faithfully perform any of its material obligations under this Agreement; B. Becomes insolvent or seeks relief under the bankruptcy laws of the United States, and is unable to perform its material obligations under the Agreement. 4 13.0 TERMINATION AND SUSPENSION A. In the event of any uncured default by either party, the non-defaulting party has the right to terminate the affected portions of this Agreement for cause, upon ten (10) days' written notice to the defaulting party following the cure period. B.' In the event City terminates under this section, the following shall apply: Upon the effective date of the termination, Vendor shall discontinue performance of the affected Services and will schedule the removal of the affected Equipment. The City will be responsible only for amounts due and owing for the terminated affected Services and affected Equipment up through the date of termination. 14.0 COMPLIANCE WITH LAWS, CHARTER AND ORDINANCES A. Vendor, its agents, employees and subcontractors shall use best efforts to comply with all applicable federal and state laws, the Charter and Ordinances of the City of Round Rock, as amended, and with all applicable rules and regulations promulgated by local, state and national boards, bureaus and agencies. B. In accordance with Chapter 2270, Texas Government Code, a governmental entity may not enter into a contract with a company for goods or services unless the contract contains written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel and will not boycott Israel during the term of this contract. The signatory executing this Agreement on behalf of Vendor verifies Vendor does not boycott Israel and will not boycott Israel during the term of this Agreement. 15.0 ASSIGNMENT AND DELEGATION The parties hereby bind themselves, their successors, assigns and legal representatives to each other with respect to the terms of this Agreement. Neither party shall assign, sublet or transfer any interest in this Agreement without prior written authorization of the other party. 16.0 NOTICES A. All notices and other communications in connection with this Agreement shall be in writing and shall be considered given as follows: 1. When delivered personally to recipient's address as stated in this Agreement; or 2. Three (3) days after being deposited in the United States mail, with postage prepaid to the recipient's address as stated in this Agreement. 5 Notice to Vendor: Casco Industries, Inc. 607 West 62 Street Shreveport, Louisiana 71108 Notice to City: City Manager Stephan L. Sheets, City Attorney 221 East Main Street AND TO: 309 East Main Street Round Rock, TX 78664 Round Rock, TX 78664 B. Nothing contained herein shall be construed to restrict the transmission of routine communications between representatives of City and Vendor. 17.0 APPLICABLE LAW; ENFORCEMENT AND VENUE This Agreement shall be enforceable in Round Rock, Texas, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for same shall lie in Williamson County, Texas. This Agreement shall be governed by and construed in accordance with the laws and court decisions of the State of Texas. 18.0 EXCLUSIVE AGREEMENT This document, and all appended documents, constitutes the entire Agreement between Vendor and City. This Agreement may only be amended or supplemented by mutual agreement of the parties hereto in writing. 19.0 DISPUTE RESOLUTION City and Vendor hereby expressly agree that no claims or disputes between the parties arising out of or relating to this Agreement or a breach thereof shall be decided by any arbitration proceeding, including without limitation, any proceeding under the Federal Arbitration Act (9 USC Section 1-14) or any applicable state arbitration statute. 20.0 SEVERABILITY The invalidity, illegality, or unenforceability of any provision of this Agreement or the occurrence of any event rendering any portion or provision of this Agreement void shall in no way affect the validity or enforceability of any other portion or provision of this Agreement. Any void provision shall be deemed severed from this Agreement, and the balance of this Agreement shall be construed and enforced as if this Agreement did not contain the particular portion or provision held to be void. The parties further agree to amend this Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. The provisions of this section shall not prevent this entire Agreement from being void should a provision which is of the essence of this Agreement be determined void. 6 21.0 MISCELLANEOUS PROVISIONS A. Standard of Care. Vendor represents that it employs trained, experienced and competent persons to perform all of the services, responsibilities and duties specified herein and that such services, responsibilities and duties shall be performed in a manner according to generally accepted industry practices. B. Time is of the Essence. The parties agree that, from time to time, certain unique transactions may have special requirements relative to timing and, accordingly, the parties will identify those transactions and exercise best efforts to accomplish those transactions within the stated timeframe. Other timing requirements will be met in a commercially reasonable manner. Where damage is caused to City due to Vendor's failure to perform in the special timing requirement circumstances, and subject to the Limitation of Liability provision in the Exhibit "A" (SSA), City may pursue any remedy available without waiver of any of City's additional legal rights or remedies. C. Binding Agreement. This Agreement shall extend to and be binding upon and inure to the benefit of the parties' respective heirs, executors, administrators, successors and assigns. D. Multiple Counterparts. This Agreement may be executed in multiple counterparts, any one of which shall be considered an original of this document; and all of which, when taken together, shall constitute one and the same instrument. [Signatures on the following page.] 7 IN WITNESS WHEREOF, City and Vendor have executed this Agreement on the dates indicated. Casco Industries, Inc. By: G'l anew &Zz&4 Printed Name: Chancy B i z z e l l Title: Central Texas Sales Rep Date Signed: July 7 , 2019 City of Round TIck,Texas By: A M / Printed Name: I 6fM IBJ Title: a Date Signed: •2�. For City,Attest: By: SWAZ, Sara L. White, City Clerk For City,tp roved as to orm: . BY (X�1� Stephan . Sheets, City Attorney 8 3/1/2019 Index Phone: 800.695.2919 a Email: � info@buybocrd.com Coapercllre Parchasing ..,�. _ 1�lel"c�me Cliery�_j-Cog y +nistration RFQ Purchase Order Reports Shopping Cart Help Clff Vendor Contract Information Back Searches: Vendor Name: Casco Industries,Inc. Search by Vendor Address: 607 West 62 Street Browse Contracts Shreveport,LA 71106 Phone Number: (903)235-3127 Alternate Phone Number (318)865-5107 Search: Email: david@cascoindustries.com 524-17 Website: http://www.cascoindustries.com All Federal ID: 72-0698936 Vendor Discounts Only Contact: David Stewart �-� Catalog Pricing Only Accepts RFQs: Yes Refine Your Search: Minority Owned: No Women Owned: No Vendors Service-Disabled Veteran Owned: No None Selected EDGAR Forms Received: Yes Price Ran9e Show all prices No Israel Boycott Certificate: No Cate9. No Excluded Foreign Terrorist Orgs: No None Selected Contract Name: Public Safety and Firehouse Supplies and Equipment Contract Contract#: 524-17 None selected Effective Date: 04/01/2017 Expiration Date: 03/31/2020 Payment Terms: Net 30 days Delivery Days: 60 Shipping Terms: Pre-paid and added to invoice Additional Resources Freight Terms: FOB Destination Ship Via: Common Carrier Region Served: All Texas Regions States Served: Arkansas,Colorado,Kansas,Louisiana,Missouri,New Mexico,Oklahoma,T Additional Info: EDGAR Vendor Certification Form(relating to 2 CFR Part 200&Appendix II) Vendor response document,and can be found in the Vendor Proposal File lin page. Quote Reference Number: 524-17 Return Policy: Must call for RGA number within 10 working days of receipt of order Contract Documents EDGAR Notice: Click to view EDGAR Notice Proposal Documents: Click to view BuyBoard Proposal Documents Regulatory Notice: Click to view Bonding Regulatory Notice Proposal Files: Click to view Vendor Proposal Files Documents Renewal Notice/Letter: Click to view Vendor Renewal Notice/Letter Documents Contact us 800.695.2919 https://app.buyboard.com/Search/Index?SearchTerm=524-17&DiscountProductld=-1 1/1 V 4 , 1BY RM0 The Safety Company January 15, 2019 To Whom It May Concern, This letter is to confirm that Casco Industries, Inc. is the exclusive authorized distributor for all Globe products in Texas, Oklahoma, Louisiana and Arkansas. GLOBE MANUFACTURING COMPANY is a 132-year old business engaged in the manufacture of turnout clothing for the fire and rescue industry. We take great pride in the design and construction of our garments and strive to continue to make the best products available in today's marketplace. We do business as Globe Firefighter Suits and Globe FootGear, servicing a variety of needs. In addition,we offer care &cleaning services and training. Casco Industries, Inc. and Globe Manufacturing Company, LLC have been strong partners for many years. By working together,we provide the high quality service that all of our customers expect and deserve. We appreciate your interest in Globe Manufacturing Company products. Sincerely, GLOBE MANUFACTURING COMPANY, LLC Ataik Da&n Mark Dolim Customer Support Services Manager MD/nms Globe Manufacturing Company,LLC 137 Loudon Road,Pittsfield,NH 032631 T.800.232.8323 I T.603.435.8323 globeturnoutgear.com The Safety Company April 12, 2019 MSA Corporate Center 1000 Cranberry Woods Drive Cranberry Township,PA 16066 Round Rock Fire Department 800.MSA.2222 203 Commerce Blvd www.MSAnet.com Round Rock, TX 78664 To Whom It May Concern: Thank you, Round Rock Fire Department for your interest in the MSA product line. This letter confirms that Casco Industries Inc is the sole authorized distributor of MSA SCBA and SCBA accessories for the Municipal Fire Service Market in the State of Texas. By way of background, in the fire service/first responder markets, MSA imposes specific requirements upon our distributors, which can result in a small number of distributors authorized to call upon a particular region.We impose these requirements because the equipment we manufacture and sell requires the involvement of partners with special knowledge, training and experience. Accordingly, MSA's distributors are obligated to acquire and maintain extensive knowledge,training, and experience necessary to properly educate, assist and service our end user customers before, during and after the sale. MSA's fire service/ first responder distributor qualification requirements are likewise intended to ensure the highest possible end user customer experience. If you desire additional information about MSA, its product lines, or channel partners, please do not hesitate to contact me. Thank you for your interest in our products. Sincerely, e. Scott McGuire North American Sales Channels Specialist Phone: 724-742-8028 Email: scott.mcguire@MSAsafety.com DEBARRED VENDOR LIST The following vendors shown below are debarred from doing business with the State of Texas, effective from the date of debarment for the length of time indicated. Whether they are listed below or not, the debarred vendors include the vendors' successors in interest as defined in Rule §20.102(b)(4). Last updated: 2/28/18 Vendor ID Number Vendor Name/Address Date of Debarment Length of Debarment 1562456928900 Smith Housewares and Restaurant November 12,2014 5 Years Supplies 500 Erie Blvd. Syracuse, NY 13202 1760677671800 Texas Code Blue October 24,2016 5 Years 5550 Eastex Fwy,Suite#L Beaumont,TX 77708-5300 Texas Comptroller of Public Accounts Statewide Procurement Division SAM Search Results List of records matching your search for Functional Area: Performance Information Entity Name: Casco Industries Classification: Individual,Firm,Special Entity Designation,Vessel Record Status:Active No Search Results April 18.2019 11:39 AM hftps://www.sam.gov Page 1 of 1 Exhibit "A" City of Round Rock,Texas Price Sheet Casco Industries,Inc. BuyBoard Contract S24-17 The City of Round Rock would like to enter into a contract with Casco Industries per the terms of Buy Board Contract 524-17.The City intends to purchase from this contract public safety and firehouse supplies and equipment in an amount not to exceed$200,000. Contract Term:Effective from date of execution and will expire on 03/31/2020,per the terms of BuyBoard Contract No. 524-17. Special Line# Product Description Unit of Measure Unit Cost(per Buy Board) Section 1. Public Safety Supplies and Equipment 1 Streamlight SL-90 Flashlight,LED-C4,model 90500 Orange ea $85.00 2 Streamlight SL-20 Flashlight,LED,SL-20LP-PN2S310,w/out charger ea $73.89 3 Streamlight LiteBox Flashlight-model 45127,Orange,w/charger ea $145.86 4 Streamlight Vulcan Flashlight-model 44411,Duel LEDS,Orange,Wout charger ea $93.76 5 Streamlight Scene Light-45670 ea $667.75 6 MSA Breathing Airpacks,G1-444MA2Q6LGR ea $10,190.65 7 MSA 4500 psi/45minute cylinders,G1-10175708,W/QC Adapter ea $1,352.35 8 MSA Repair Parts for Airpacks,G1-Attached parts listing-SEE UST PRICE ea $0.10 9 MSA Accessories for Airpacks,G1-Attaching a list-SEE LIST PRICE ea $0.15 10 MSA/Cairns Fire Helmet 1044-1044 Deluxe PN 71M43123100 ea $304.20 11 Globe Turnout Gear Coat,Ultra Xtreme-PBI MAX new spec ea $1,941.37 12 Globe Turnout Gear Trousers,Ultra Gxcel-PBI MAX new spec ea $1,423.10 13 Globe Shadow 1301400 Structure Boot-Shadow pair $435.00 16 Tempest PPV Fan,Gas-910-110016" ea $2,111.48 17 Tempest PPV Fan,Electric-VS1 Deluxe ea $4,098.75 Exhibit "A" INFORMATION ONLY BELOW Contract State%of Line Item Description discount off %Off Catalog Catalog catalog/pricellst Discount(%)Off Please state the(%) CataloglPrtcelist for off catalog/pricelist for Thermal Imaging Thermal Equipment Imaging Equipment. Catalog/Pricelist 8 MUST be included or 26% MSA proposal will not be considered. Discount(%)Off Please state the(%) Catalog/Pricelist for off cataloglpdoelist for Flashlights,Batteries, Flashlights,Batteries, and related Items and related items. Catalog/Pricellst MUST be 9 included or proposal 48% Streamlight will not be considered. Discount(%)Off Please state the(%) Catalog/Pricelist for Uniforms,Rainwear,Jackets,Footwear and Accessories off catalog/pricelist for Uniforms, Rainwear,Jackets, Footwear and Accessories. 17 CataloglPricelist 30% IJon MUST be included or proposal will not be considered. Discount(%)Off Please state the(%) Catalog/Pricelist for off catalog/pricelist for Breathing Apparatus Breathing Apparatus. Catalog/Pricelist MUST be included or proposal 18 will not be considered 15% MSA Discount(%)Off Please state the(%) Catalog/Priceilst for Protective Clothing and Rescue Gear including Protective Boots, off catalog/pricelist for Helmets and Gear Bags Protective Clothing and Rescue Gear Including Protective Boots, Helmets and Gear Bags.Catalog/Pricellst 19 MUST be 25% GLOBE Included or proposal will not be considered Exhibit "A" Discount(%)Off Please state the(%) Catalog/Pdcalist for Protective Clothing and Rescue Gearincluding Protective Boots, off catalog/pricelist for Helmets and Gear Bags Protective Clothing and Rescue Gear Including Protective Boots, Helmets and Gear Bags.Catalog/Pdcelist MUST be 19 included or proposal 35% MSA-Caims will not be considered Discount(%)Off Please state the(%) Catalog/Pdcelist for off catalog/pricelist for Turnout Gear Turnout Gear. Catalog/Pdcellst 20 MUST be included or 25% GLOBE proposal will not be considered. Discount(%)Off Please state the(%) Catalog/Pdcelist for off catalog/pdcelist for Portable Lighting Portable Lighting Equipment Equipment. Catalog/Pricellst MUST be Included or 21 proposal will not be 48°r6 Streamlight considered Discount(%)Off Please state the(%) Catalog/Pricelist for Uniforms,Rainwear,Jackets,Footwear and Accessories off catalog/pricellst for Uniforms,Rainwear, Jackets,Footwear and Accessories, Catalog/Pricelist 22 MUST be included or 30% Lion proposal will not be considered. Discount(%)Off Please state the(%) Catalog/Pricelist for Gas Detection Devices off catalog/pdcelist for Gas Detection Devices. Catalog/Pricelist 23 MUST be Included or 22% MSA proposal will not be considered. Discount(%)Off Please state the(%) Catalog/Pricelist for Fire Hose and Nozzles off catalog/pricelist for Fire Hose and Nozzles. CataloglPricellst 36 MUST be included or 40% Elkhart&Akron proposal will not be considered. Exhibit "A" Discount(%)Off Please state the(%) Catalog/Pricelist for Fire Hose and Nozzles off catalog/pricelist for Fire Hose and Nozzles. Catalog/Pricellst 36 MUST be Included or 35% North American Hose proposal wIl not be considered. Discount(%)Off Please state the(%) Catalog/Pricellst for off catalog/pdoelist for Other Fire House All Other Fire House Equipment and Supplies Equipment and Supplies. Catalog/Pricelist 25 MUST 12% Zico be Included or proposal will not be considered Discount(%)Off Please state the(%) Catalog/Pricelist for off catalog/priceilst for Other Fire House All Other Fire House Equipment and Supplies Equipment and Supplies. Catalog/Prlcellst 25 MUST 11% Ready Rack be included or proposal will not be considered Discount(%)Off Please state the(%) Catalog/Pricelist for off catalog/pricelist for Other Fire House All Other Fire House Equipment and Supplies Equipment and Supplies. Catalog/Pricellst 25 MUST 25% TEMPEST be Included or proposal will not be considered Discount(%)Off Please state the(%) Catalog/Pricellst for Fire House Equipment Repair Parts off catalog/pricellst for Fire House Equipment Repair Parts. Catalog/Pdceflst 26 MUST be Included or proposal will not be ��% MSA considered Exhibit "A" Not to Exceed Detailed lnforfnadon Installation and Repair Service Hourly on Hourly labor Rata Labor Rate Not to Exceed Hourly Labor Rate for Installation/Repair Service of Public Safety Hourly Labor Rate for Equipment and Products Installation/Repair Service of Public Safety Equipment and Products—State the Not to Exceed hourly labor rate for Installation/Repair Service of Public 27 Safety Equipment and $95hr CASCO Products. Not to Exceed Hourly Labor Rate for Installation/Repair Service of Firehouse Hourly Labor Rate for Equipment and Products Installation/Repair Service of Firehouse Equipment and Products-State the Not to Exceed hourly labor rate for Installation/Repair 28 Service of Firehouse $95 hr CASCO Equipment and Products Information Only: The City of Round Rock reserves the right to order other products from the attached MSRP Sheet per the discounts quoted in the BuyBoard Contract#524-17 Signature of Authorized Representative:— Printed Name; Chancy Bizzell Phone Number: 512-848-9971 Email Address: cbizzell@cascoindustries.com f! 1 I CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft 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. 12019-514517 Casco Industries,Incorporated Grand Prairie,TX United States pate Flied: 2 Name of governmental entity or state agency that Is a party to the contract for which the form Is 07/1012019 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. 524-17 Public Safety and Firehouse Supplies and Equipment 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling intermediary i I I i I I I I ! 5 Check only If there Is NO Interested Party. X 6 UNSWORN DECLARATION My name is exam, and my date of birth Is_ ` My address is 7J-1-J N4 ,p, < 7 75-71 (� (street) (city) (state) (zip code) (country) I declare under penlalty/of perjury that the foregoing is true and correct. Executed in County, State of SAS ,on the-b-4day of ,20 i . (� (year) Signature of authorized agent of contracting business entity (Declarant) Li Forms provided by Texas 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 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2019-514517 Casco Industries, Incorporated Grand Prairie, 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 07/10/2019 being filed. City of Round Rock Date Acknowledged: 08/07/2019 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. 524-17 Public Safety and Firehouse Supplies and Equipment 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 V1.1.39f8039c