Contract - Odessa Pumps - 11/26/2019 ODESSA PUMPS - BOERNE QUOTE
': ` ` ` 830) 755-5160
0BOE NE TX 78006-9102 Number 226219
`PUIN4P S Date 10/03/2019
A DISTRIBUTIONIAq OWN COMPANY Page 1
Bill-to: 2415 Ship-to: 03
CITY OF ROUND ROCK CITY OF ROUND ROCK
221 E MAIN ST 3939 E PALM VALLEY BLVD
ROUND ROCK TX 78664-5271 ROUND ROCK TX 78665-9443
Reference# S/sp Terms Whse Freight Ship Via
ROUND ROCK 5435MV QUOTE 406 NET 30 DAY 04 PRE/ADD DELIVER
Quoted By: EJS Quoted Ta:'BRANDON PRITCHETT Effective: 09/18/2019 Expires: 10/31/2019
Item Description Ordered um Price UM Extension
***BUY BOARD 589-19***
PENTAIR/LABOR PRICING
WE OFFER THE FOLLOWING:
RATED FOR 3875 GPM @ 80'TDH
101ID5435MV FAIRBANKS PUMP 1 EA 105600.00 EA 105600.00
22 WEEK LEAD TIME
FREIGHT PREPAID
SEE BELOW FOR PUMP SPECS
Merchandise Tai Total
105600.00 .00 $105600.00
WE WOULD APPRECIATE YOUR BUSINESS!!
Customer Copy ... Last Page
CERTIFICATE OF INTERESTED PARTIES FORM1295
loll
Complete Nos.I-4 and 6 if there are Interested parties, OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 it there are no interested parties, CERTIFICATION OF FILING
I Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2019-559023
Odessa Pumps&Equipment, Inc
Boerne,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 11106/2019
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
Industrial Pumps, Parts&Service
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,
6 UNSWORN DECLARATION
Mynameis kim �&,-kkr
and my date of birth is
My address is 55 1 o VJ —T-V
(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,&��ay ort -Vi2!Efft-tke,�019--
(month) (Year)
Signeure of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.musa
Version V1,1.3a6af7d
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. 2019-559023
Odessa Pumps&Equipment, Inc
Boerne,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 11/06/2019
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
Industrial Pumps, Parts&Service
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