Contract - Vermeer Texas-Louisiana - 11/14/2019 �, Vermeer Texas-Louisiana Please remit to:
Vermeer 1945 Louis Henna Blvd Vermeer Texas-Louisiana
Round Rock, TX 78664 Dept#41351 - PO Box 650823
Texas-Louisiana Ph: (512) 244-0505 Dallas, TX 75265-0823
vermeertexas.com
Branch
Ship To: IN STORE PICKUP 04 - ROUND ROCK
Date Time Page
09/20/2019 10:42:32 (0) 1
Account No Phone No Est No 03
ROUND001 5128012972 Q00390
Ship Via Purchase Order
Invoice To: CITY OF ROUND ROCK FORESTRY
301 WEST BAGDAD STE 250 Tax ID No
ROUND ROCK TX 78664
Salesperson
TERRY HALL 947
EQUIPMENT QUOTE - NOT AN INVOICE
Description ** Q U 0 T E ** EXPIRY DATE: 11/30/2019 Amount
New VERMEER BC1800XL WITH 130HP CUMMINS TIER 4 FINAL 71408 .00
****INCLUDING THE FOLLOWING OPTIONS****
BC1800XL091 WINCH OPTION
ONE YEAR OR 1000 HR VERMEER LIMITED STANDARD WARRANTY
CUMMINS 2 YEAR OR 2000 HR STANDARD WARRANTY
BUY BOARD 4515-16
QUOTE INCLUDES FREIGHT AND PREP
Subtotal: 71408.00
Authorization: Quote Total: 71408.00
Good for thirty(30)days from date of quote. Thank You For Your Business!
CERTIFICATE OF INTERESTED PARTIES
FORM ..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.
Vermeer Texas-Louisiana 2019-557497
Round Rock,TX United States Date Piled:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 11/01/2019
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
BC1800XL
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 / 'S" ���c f .w-,r`, /..�1�'�� 1 �u�� ,C lt� 1 ,-V
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in
(month) (year)
Signature of aft{ori ed agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state,tx.us Version V1.1.3a6aaf7d
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. 2019-557497
Vermeer Texas-Louisiana
Round Rock,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 11/01/2019
being filed.
City of Round Rock Date Acknowledged:
11/07/2019
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.
000000
BC1800XL
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 V1.1.3a6aaf7d