Contract - Youngblood Auto & Tire, LLC - 2/13/2020 CITY OF ROUND ROCK
AGREEMENT FOR THE PURCHASE OF
TIRES, TUBES, EQUIPMENT AND SERVICES
WITH
YOUNGBLOOD AUTO & TIRE,LLC
THE STATE OF TEXAS §
CITY OF ROUND ROCK § KNOW ALL BY THESE PRESENTS:
COUNTY OF WILLIAMSON §
COUNTY OF TRAVIS §
THAT THIS Agreement for the purchase of tires, tubes, equipment and services needed
to maintain City of Round Rock owned vehicles (referred to herein as the "Agreement"), is made
and entered into on this the`�day of the month of4t6A4AjZJA , 2020, by and between
the CITY OF ROUND ROCK, TEXAS, a home-rule municipality w ose offices are located at
221 East Main Street, Round Rock, Texas 78664 (referred to herein as the "City") and
YOUNGBLOOD AUTO & TIRE, LLC, whose offices are located at 375 Louis Henna West,
Austin, Texas 78728 (referred to herein as the"Vendor").
RECITALS:
WHEREAS, City desires to purchase tires, tubes, equipment and related services needed
for the maintenance of City owned vehicles; and
WHEREAS, City is a member of BuyBoard Cooperative and Vendor is an approved
BuyBoard vendor; and
WHEREAS,the City desires to purchase certain goods and services from Vendor through
BuyBoard Cooperative Contract No. 553-18 to receive pricing and services 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, sufficiency and receipt of which are hereby acknowledged, it is mutually
agreed between the parties as follows:
1.01 DEFINITIONS
A. Agreement means the binding legal contract between City and Vendor whereby
City agrees to buy specified goods and/or services and Vendor is obligated to provide said
00436851/ss2
i
goods/services. The 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. Force Majeure means acts of God, strikes, lockouts, or other industrial
disturbances, acts of the public enemy, orders of any kind from the government of the United
States or the State of Texas or any civil or military authority, insurrections, riots, epidemics,
landslides, lightning, earthquakes, fires, hurricanes, storms, floods, restraint of the government
and the people, civil disturbances, explosions, or other causes not reasonably within the control
of the party claiming such inability.
E. Goods and services mean the specified services, supplies, materials,
commodities, or equipment.
2.01 EFFECTIVE DATE; TERM
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 as provided herein.
B. The term of this Agreement shall be from the effective date of the Agreement
until February 28, 2021. City reserves the right to review the relationship at any time, and may
elect to terminate this Agreement, with or without cause, or may elect to continue.
3.01 CONTRACT DOCUMENTS AND EXHIBITS
City selected Vendor to supply the goods and services as outlined in Exhibit "A,"
attached hereto and incorporated herein by reference.
The goods and services which are the subject of this Agreement are described in Exhibit
"A" and, together with this Agreement, comprise the total Agreement and they are fully a part of
this Agreement as if repeated herein in full.
4.01 ITEMS AWARDED; SCOPE OF WORK
When taken together with the appended exhibit, this Agreement shall evidence the entire
understanding and agreement between the parties and shall supersede any prior proposals,
correspondence or discussions. Vendor shall satisfactorily provide all goods and services
described under the attached Exhibit "A" at the sole request of the City. Vendor provide goods
and services in accordance with this Agreement, in accordance with the appended exhibits, in
accordance with due care, and in accordance with prevailing industry standards for comparable
services.
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5.01 COSTS
A. City agrees to pay for goods 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 Four Hundred Thousand and No/100 Dollars ($400,000.00) for the term of this
Agreement.
6.01 INVOICES
All invoices shall include, at a minimum, the following information:
A. Name and address of Vendor;
B. Purchase Order Number;
C. Description and quantity of items received or services provided; and
A. Delivery or performance dates.
7.01 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.
8.01 PROMPT PAYMENT POLICY
In accordance with Chapter 2251, V.T.C.A., Texas Government Code, payment to
Vendor will be made within thirty (30) days of the day on which City receives the performance,
supplies, materials, equipment, and/or deliverables, or within thirty (30) days of the day on
which the performance of services was complete, or within thirty (30) days of the day on which
City receives a correct invoice for the performance and/or deliverables 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); however, this Policy does not apply to payments made
by City in the event:
A. There is a bona fide dispute between City and Vendor, a contractor, a
subcontractor or supplier about the goods delivered or the service performed that
cause the payment to be late; or
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B. The terms of a federal contract, grant, regulation, or statute prevent City from
making a timely payment with federal funds; or
C. 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
B. Invoices are not mailed to City in strict accordance with instructions, if any, on
the purchase order or the Agreement or other such contractual agreement.
9.01 GRATUITIES AND BRIBES
City may, by written notice to Service Provider, 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.
10.01 TAXES
City is exempt from Federal Excise and State Sales Tax; therefore, tax shall not be
included in Service Provider's charges.
11.01 ORDERS PLACED WITH ALTERNATE SERVICE PROVIDERS
If Vendor cannot provide the goods as specified, City reserves the right and option to
obtain the products or services from another supplier or suppliers.
12.01 INSURANCE
Vendor shall meet all requirements required by the City as set forth in Exhibit `B,"
attached hereto and incorporated herein for all purposes.
13.01 CITY'S REPRESENTATIVE
City hereby designates the following representatives authorized to act in its behalf with
regard to this Agreement:
Chad McDowell
Director of General Services
220 Commerce Cove
Round Rock, Texas 78664
(512) 341-3191
cmcdoAvellLd,roundrocktexas.gov
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14.01 RIGHT TO ASSURANCE
Whenever either party to this Agreement, in good faith, has reason to question the other
party's intent to perform hereunder, then demand may be made to the other party for written
assurance of the intent to perform. In the event that no written assurance is given within the
reasonable time specified when demand is made, then and in that event the demanding party may
treat such failure as an anticipatory repudiation of this Agreement.
15.01 DEFAULT
If Vendor abandons or defaults under this Agreement and is a cause of City purchasing
the specified goods elsewhere, Vendor agrees that it may be charged the difference in cost, if
any, and that it will not be considered in the re-advertisement of the service and that it may not
be considered in future bids for the same type of work unless the scope of work is significantly
changed.
Vendor shall be declared in default of this Agreement if it does any of the following:
A. Fails to make any payment in full when due;
B. Fails to fully, timely and faithfully perform any of its material obligations under
this Agreement;
C. Fails to provide adequate assurance of performance under the "Right to
Assurance" section herein; or
D. Becomes insolvent or seeks relief under the bankruptcy laws of the United States.
16.01 TERMINATION AND SUSPENSION
A. City has the right to terminate this Agreement, in whole or in part, for
convenience and without cause, at any time upon thirty (30) days' written notice to Vendor.
B. In the event of any default by Vendor, City has the right to terminate this
Agreement for cause, upon ten (10) days' written notice to Vendor.
C. Vendor has the right to terminate this Agreement only for cause, that being in the
event of a material and substantial breach by City or by mutual agreement to terminate evidenced
in writing by and between the parties.
D. In the event City terminates under subsections (A) or (B) of this section, the
following shall apply: Upon City's delivery of the referenced notice to Vendor, Vendor shall
discontinue all services in connection with the performance of this Agreement and shall proceed
to cancel promptly all existing orders and contracts insofar as such orders and contracts are
chargeable to this Agreement. Within thirty (30) days after such notice of termination, Vendor
5
shall submit a statement showing in detail the goods and/or services satisfactorily performed
under this Agreement to the date of termination. City shall then pay Vendor that portion of the
charges, if undisputed. The parties agree that Vendor is not entitled to compensation for services
it would have performed under the remaining term of the Agreement except as provided herein.
17.01 INDEMNIFICATION
Vendor shall defend (at the option of City), indemnify, and hold City, its successors,
assigns, officers, employees and elected officials harmless from and against all suits, actions,
legal proceedings, claims, demands, damages, costs, expenses, attorney's fees, and any and all
other costs or fees arising out of, or incident to, concerning or resulting from the fault of Service
Provider, or Service Provider's agents, employees or subcontractors, in the performance of
Vendor's obligations under this Agreement, no matter how, or to whom, such loss may occur.
Nothing herein shall be deemed to limit the rights of City or Vendor (including, but not limited
to the right to seek contribution) against any third party who may be liable for an indemnified
claim.
18.01 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 and services unless the contract contains
written verification from the company that it: (1) does not boycott Israel; and (2)will not boycott
Israel during the term of the contract. The signatory executing this Agreement on behalf of
Vendor verifies Vendor does not boycott Israel and will not boycott Israel at any time during the
term of this Agreement.
19.01 ASSIGNMENT AND DELEGATION
The parties each 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.
20.01 NOTICES
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 the recipient's address as stated in this Agreement;
or
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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.
Notice to Vendor:
Youngblood Auto & Tire, LLC
375 Louis Henna West
Austin, Texas 78728
Notice to City:
City Manager Stephen L. Sheets, City Attorney
221 East Main Street AND TO: 309 East Main Street
Round Rock, TX 78664 Round Rock, TX 78664
Nothing contained herein shall be construed to restrict the transmission of routine
communications between representatives of City and Vendor.
21.01 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.
22.01 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, duly authorized by action of the City Manager or City Council.
23.01 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.
24.01 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
7
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.
25.01 MISCELLANEOUS PROVISIONS
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.
Time is of the Essence. Vendor understands and agrees that time is of the essence and
that any failure of Vendor to fulfill obligations for each portion of this Agreement within the
agreed timeframes will constitute a material breach of this Agreement. Vendor shall be fully
responsible for its delays or for failures to use best efforts in accordance with the terms of this
Agreement. Where damage is caused to City due to Service Provider's failure to perform in
these circumstances, City may pursue any remedy available without waiver of any of City's
additional legal rights or remedies.
Force Majeure. Neither City nor Vendor shall be deemed in violation of this Agreement
if it is prevented from performing any of its obligations hereunder by reasons for which it is not
responsible as defined herein. However, notice of such impediment or delay in performance
must be timely given, and all reasonable efforts undertaken to mitigate its effects.
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.]
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IN WITNESS WHEREOF, City and Vendor have executed this Agreement on the dates
indicated.
City of Round Rock,Texas Youngblo d Auto & ire,LLC
r �-
By: By:
Printed Nam Printed ame: j�--�Gc,r•
Title: Title: '� �DateSigned: J 3• V Date Signed: ! 13 i i
Attest:
By:
Sara White, City Clerk
For City,A p oved as to Fo m:
By:
Stephan . Sheets, City Attorney
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Exhibit"A"
City of Round Rock, Texas
Price Sheet
Youngblood Auto&Tire, LLC
BuyBoard Contract 553-18
The City of Round Rock would like to enter into a contract with Youngblood Auto&Tires,LLC per the terms of Buy Board Contract 553-18.The City intends to
purchase from this contract tires,tubes,supplies and equipment in an amount not to exceed$400,OOd.
Contract Term:Effective from date of execution and will expire on 02/28/2021,per the terms of BuyBoard Contract No.553-18.
Special Instructions:Complete pricing below and submit copy of price list or catalog.
State Percent(%)of
Item No. Short Description Full Description Discount off State Name of Exceptions to
Catalo !Pricelist CataloglPricelist Discount
Section): Tire Products and Supplies
Discount(%)Off Please state the discount(%)off catalog/pricelist CS°/a ;r}¢.(;n 3t~(a dal .-:d
Catalog/Pricelist for for Tires and Tubes.(Ail types of Cars,Suvs, #ass�� ; 11-1'T;-k F'
1 Tires and Tubes Trucks and Related Vehicles) Catalog/Pricelist % d ek
.. ' S�-e- .� �- MUST be Medi vv.--Tr1
coincluded or proposal will not be considered. 0% "v.. Jig, L1.
Discount(%)off Please state the discount(%)off catalog/pricelistp'fe, ;�.t�.e ;n om �• ��
catalog/pricelist for Off-the-road for Off the Road(OTR,Earthmover)Tires and
2 (OTR Earthmover)Tires and Tubes. Catalog/Price llist MUST be included or d2 % � ;M i
Tubes proposal will not be considered.
Discount(%)(%)Off Please state the(%)off cataloglpricelist for
Catalog/Pricelist for Retread Tires and Tubes(All types of Cars,
3 Retread Tires and Tubes Suvs,Trucks and Related Vehicles). -o % ivu,CLA,
Catalog/Pricelist MUST be included or proposal
will not be considered.
Discount(%)Off Please state the(%)off catalog/pricelist for All
CataloglPricelist for All Other other tires and related products.
4 Tires and Related Products Catalog/Pricelist MUST be C) % ma
included or proposal will not be considered.
t t _
Exhibit"A"
5ft-flon III.tire Service
Discount{°!o)Off Please state the(°lo}off catalog/pricelist for Tire
Catalog/Pricelist for mounting,Dismounting,Road Hazard,and
Tire mounting,Dismounting, Flat Repair Service(All Types of Cars,Suvs,
5 Road Hazard and Flat Repair Trucks,School Buses and Related Vehicles). i °fo g C—
Services Catalog/Price list MUST be included or proposal .i_ r--
will not be considered '
Discount(%)Off Please state the(%)off catalog/pricelist for Tire
Catalog/Pricelist forTire Valve Valve Stems(All types of Cars,Suvs,Trucks,
stems School Buses and Related Vehicles). yo V n W
6 Catalog/Pricelist MUST be included or proposal °lo `��-
will not be considered
Discount(%)Off Please state the(%)off catalog/pricelist for Tire
Catalog/Pricelist for Balancing Services(All types of Cars,Suvs,
Tire
L°'
Tire Balancing Services Trucks,School Buses and Related Vehicles).
7 Catalog/Pricelist MUST be included or proposal °I° �•�
will not be considered i
Discount(%)Off Please state the(%)off cata log/price list for Tire / t
Catalog/Pricelist for Alignment Services(All types of Cars,Suvs, "�`� ` �"`
$ Tire Alignment Services Trucks,School Buses and Related Vehicles). °/° +e
Catalog/Pricelist MUST be included or proposal
will
not be considered
Discount(%)Off Please state the(%)off cata log/price list for Tire � v
Catalog/Pricelist for Disposal and Recycling Services(All types of
Tire Disposal and Recycling Cars,Suvs,Trucks,School Buses and +
9 Service Related Vehicles).Catalog/Pricelist MUST be °/05 --
included or proposal will not be considered
Not To Exceed Detailed
s t�Ill. ttr� itrr600 and RoOkI l rvi l Hourly Information Exceptions to
Labor Rate on Hourly Labor Hourly Labor Rate
Rate
Exhibit"A"
Not to exceed Hourly Labor Hourly Labor Rate for Installation/Repair
Rate for Installation/Repair Service of Tire Related Equipment and4w�b��+�'
Service of Tire Related Products—State the Not to Exceed hourly labor
10 Equpment and products. rate for Installation/Repair Service of Tire Related %
Equipment and Products.
Information Only: The City of Round Rock reserves the right to order other products from the Youngblood Auto&Tire,LLC per the discounts
quoted in the BuyBoard Contract#553-18.
Company Name: Youngblood Auto&Tire,LLC.
BuyBoard Contract#553-18.
Signature of Authorized Representative:
Printed Name:. ,~�gyp`
Phone Number: `� l
Email Address: 4x,' ca
Exhibit "A"
Account Information:
Company Name City of Round Rock
.:.:... ...
Address 901 Luther Peterson Lane
Phone Numbers 512-516-9011
Contact Oscar Wise
Bid Rate: Valid thru 2020
Service Rate
Service Call Rate $45.00
After Hour Service Rate $75.00
OTR Service Rate $85.00
After Hours Service Rate $125.00
Bid Rate: Valid thru 2020
Mount/Dismount-Flat Repair Rate
11 R22.5 $25.00
11 R24.5 $25.00
13.00-24 $45.00
14.00-24 $45.00
17.5-25 $75.00 [
20.5-25 $85.00 ;
23.5-25 $85.00
26.5-25 $95.00
29.5-25 $125.00
18.00-33 $125.00
Bid Rate: Valid thru 2020
Small OTR Rate
-11L16 $27.50
10.00-16.5 $27.50
12.00-16.5 - $27.50
19.5-24 $45:00
Youngblood Auto and Tire, LLC 512.719.5700
375 Louis Henna Blvd
Austin, TX 78728
Exhibit "A"
Account Information.
Company Name City of Round Rock
Address 901 Luther Peterson Lane
Phone Numbers 512-516-9011
Contact _ _ Oscar Wise
Bid Rate: Valid thru 2020
Passen er Valve Stem 2.50
Light/Medium Truck Valve Stem 3.50
OTR Valve Stem 15.00 i
Passenger/r.i.ght Truck Spin Balance 10.00
Medium Truck Spin Balance 15.00
Passenger/Light Truck 2-wheel Alignment 60.00
Medium Truck Alignment(per axle) 100.00
Passenger%Light Truck Disposal 5.00
Medium Truck Disposal 10.04
$85 HOURLY LABOR RATE ON ALL OTHER MECHANICAL SERVICES
Youngblood Auto and Tire, LLC 512.719.5700
375 Louis Henna Blvri
Austin,TX 78728
Effective:4/1/2019 STATE OF TEXAS AND LOCAL GOVERNMENT AGENCIES Page 1 of 1
PROGRAM INFORMATION APPROVAL NUMBERS
Program:Federal Open Market
Effective Date:4/1/2019 Approval Type Approval N Billing Type
Expiration Date:3/31/2020
State anal Local Government Agencies G0006566 Local Billing(Type B—Dealer/Store invoice)
Price Book Date:7/1/2018 -
PROGRAM OVERVIEW State Agencies using Voyager Card 60006567 Akron Billing(Type D on Tire-HQ or TC-73
on GBMS)
There is no formal contract in the State
of Texas. Pricing has been established "
based off the 7-1-18 Federal Open
Market&Net State Price Book.USE Loca!i3iliinp,Instructions T e B—Dealer/StorP Invoice)
60006567 WHEN BILLING THRU THE Akron Billing instroctitIns I —Type G TC73
VOYAGER PROGRAM.
SPECIFIC REQUIREMENTS OFF-FACTORS
MDSE Group Off Factor
7905 Police Auto 0.5000D
7925 Auto Radial 0.45000
7941 LT Truck Radial 0.45000
1170 Unisteel RLT—16"to 19.5"Diameter 0.60000
7955 MED Commercial Radial 0.60000
7961 Off Road Truck Bias 0.24000
7962 Off Road Truck Radial 0.74000
ADDITIONAL INFORMATION
Government Billing Instructions
This sales program can be changed,modified,or canceled at any time at Goodyear's discretion,with or without advanced notice.
Please view file for state specific dining instructions.
Voyager Card Requirements
Goodyear can accept the Voyager Card for Government tires for ali State of Texas agencies. Dealers can quote government pricing using Tire-HCl,Gov't Sales,State of e
Texas Price Book(attached).
When entering a Voyager Card(call Voyager for approval using 800,987-6589)PUtOsdse for a state agency,Supply Point would use the toiiowing transaction and
information:GBMS Transaction-TC73,Tire-HQ Doc Type—D,Acct Number- #9342,Non-Sig Number-#72292,Gov't Approval-#G0006567.
RELEVANT DOCUMENTATION—SEE ATTACHMENTS
N
State Price Book State Price Book Government Billing
**See Attachment on left*° (PDF) Instructions(PDF)
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
0f 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.
Youngblood Auto&Tire
2019-569784
Austin,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 12/13/2019
being filed.
City of Round Rock Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track br identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
000000
Tires,Tubes,and Services
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling intermediary
Dear, Brian Austin,TX United States X
5 Check only if there is NO Interested Party. F1
6 UNSWORN DECLARATION
My name is t F"`ty1 -Q ''� and my date of birth is
My address is p G�VY SU vi �vr , '"j. 7Yj ,- D 5
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
jj
Executed in___ _ —T,"y i County, State of CfS_,on the day of k20R
(month) (year)
so
Signatur of authorized a ent 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. 2019-569784
Youngblood Auto&Tire
Austin,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 12/13/2019
being filed.
City of Round Rock Date Acknowledged:
12/13/2019
g 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
Tires,Tubes,and Services
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Dear, Brian Austin,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)
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