Contract - Kinloch Equipment & Supply, Inc. - 2/13/2020 SERVICE ESTIMATE
Kin-loch
S�s EquiIP ment& Supply,Inc.
3320 Pasadena Blvd. Pasadena,TX 77503
www.ktnlochequip.com Voice:713-473-6213
Fax:713-473-7858
SOLD TO SHIP TO
ROUNOO CITY OF ROUND ROCK CITY OF ROUND ROCK
ATTN: ACCT PAY
221 FAST MAIN STREET 910 LUTHER PETERSON
ROUND ROCK, TX 78664 ATTN: WATER UTILITIE
ROUND ROCK., TX 78664
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Rim
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-pi# 41 m1f
201-1-1-1
Tax D Qty Description Price Amount
Gro' '*01'
ESTIMATED LAbOjR'
5' TALLATION LABOR-' --6500.1w,100
6 t�TWS
MISC PART
E '?A1NTED ,WNT-` -'60
.-,1 ,bEBR1S BODY -INSTALLf 42967.'10 '42967;
1Q0NSUMA5L&S .
E - CONSUIA"LZSOD'
FREIGHT INC
E
'FREIGHT 00
SUBTOTAL 53317.60
x Charge Sale
fv"
PAY THIS
-it
k, xslAMOUNT $53317.601
N.
THIS IS AN ESTIMATE ONLY AND MAY NOT
INCLUDE ANY FRIT IGHT CHARGES
-207-P—bv3S
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
loft
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
1 Name of business entity filing form,and the city,state and country of the business entity's place ertiRia eIN mb r: OF FILING
of business.
Kinloch Equipment&Supply, Inc 2020-577958
Pasadena,TX United States
2 Name of governmental entity or state agecDate Filed:
being filed.
01/16/2020
City of Round Rock
Date Acknowledged;
3 Provide the identification number used by the govemmental 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.
0000
Vactor Debris Body Installed
4
Name of Interested Parry Nature of Interest
City,State,Country{place of business
(check applicable)
Controlling Intermediary
rUNSWORN
ly if there is NO Interested Party. �}
L^J
DECLARATION
__�`;�'t.'�,-
and m date of birth. :
Y is
My address is G ,• :}�, /� W' /� ,� _
(city) (state) (zip code)
(country)
I declare under penalty of perjury that(lie foregoing is true and correct
Executed in '"��"``
County, State of i f r� �� on the & day of �/�,;✓Gifr,� p z
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission
wwvv.ethics.state.tx.us Version 71.1.3a6aaf7d
,,:;:: ..:.....,-H...........,....,...�. ........:...... ,................».34!9Y':::Y.SrMMwurw.ww..w...........:..:... .:::::
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. 2020-577958
Kinloch Equipment&Supply, Inc
Pasadena,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 01/16/2020
being filed.
City of Round Rock Date Acknowledged:
01/27/2020
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.
0000
Vactor Debris Body Installed
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