Contract - Chastang Enterprises, Inc. - 5/27/2021CHASTANG ENTERPRISES HOUSTON LLC / DBA CHASTANG FORD
BUYBOARD WORK,SHEET
End User: CITY OF ROUND ROCK
Contact: MARSHALL REYNOLDS
Phone/email:
Product Description: 2022 F550
A. Bid Series: ITEM 130
10 n..1%1:e16s.i
4STANG REP ED MILLER
Phone/fax: 713-478-500 7
- c w vies
Date: Wednesday, May 5, 2021
email: emiller@chastanaford.com
A. Base Price: $ 28,978.00
Code
Options
Bid Price
Code
Options
Bid Price
99T
6.71, POWERSTROKE DIESEL
S 99325.00
512
SPARE TIRE/WHEEL
S 350.00
X8L
4.88 LIMITED SLIP
S 360.00
52B
BRAKE CONTROLLER
$ 270.00
90L
POWER E UIP GROUP
$ 865.00
T2-1 I
MECHANICS BODY WITH CRANE
$ 729995.00
SC 1
SUPERCAB UPGRADE
S 3,895.00
FLR 1
FLOOR PLAN INTEREST 14X 180
$ 29520.00
84CA
84" CA UPGRADE
S 375.00
M 1
LOT INSURANCE 7 X 180
S 1,260.00
F4H
4WD UPGRADE
S 3,995.00
67B
DUAL ALTERNATORS
$ 115.00
872
BACKUP CAMERA
$ 475.00
67X
HD FRONT SUSP
$ 125.00
68M
19500 PAYLOAD UPGRADE
S 1,155.00
18B
PLATFORM RUNNING BOARDS
$ 445.00
43C
110V/40OW OUTLET
S 175.00
Total of B. Published Options:I S 981,700.Qa
r.
saoh "Ift% . mmk ♦th aLwoo A 7A%..I V= R 4 %
options
Bid Prise
Options
Bid Price
AIR N ARC 250 COMPRESSOR / GENERATOR I
S 10,384.00
BUMPER REPLACEMENT
INCL
AND WELDER
SPRAY LINER
INCL
WORK LIGHTS
INCL
BACKUP ALARM
INCL
STROBES
INCL
WINDOW TINT
S 295.00
INSTALL OEM CAMERA
INCL
Total of C. Unpublished Options:I S 10,679.001
D.
Pre -delivery Inspection:
Is -
E.
Texas State Inspection;
Is-
F.
Manufacturer Destination/Delivery:
_J
1.
Contract Price Adjustment:
$ -
J.
Additional Delivery Charge: 0 miles
S -
K.
Subtotal:
$ 138447.00
L.
Quantity Ordered 1 x K =
$ 1389247.00
M.
Trade in:
$ 400.00
N.
BUYBOARD FEE
O.
TOTAL PURCHASE PRICE
S 138,647.00
R-2vzl - I� l
CERTIFICATE QF I-NTERESTEt7► PARTIES FORM'....295
1of1
---------- - ---- --
Complete.Nos.-1- 4 and 6., if there are Interested Parties. OFFICE USE ONLY
Complete Nos. 1j. 213..j. S. and 6 iF`there are no interested parties CERTIFICATION QF FILING
1
Name o*f,bus(rtess entity fllfag #orm, and the city, state. and count- -----------
ry of the business entity's. place Cortificate.Number;
of business.. 2021 738502
chasitang enterprises
houston, TX United.S-Rates Date Ftied:
2
Name o govemmen en ty or state agencYL.t of J.S. party tothe contract r w � t e orm is 04/14/2021
beinvAle.d.
CIN OP.ROUND ROCK Date Acknowledged:
3Provide
the<iderrtification r�um6er usedbylhe: governmental entity or state agencarto track or identify the �ontFact, and provide a
deiscrlptw-rt of the ssrviwes. goods, or other, property to pe provided under the contract.
2022 F550
PURCHASE OF 2022FORD F550:
4
www- - ------- ---------- --Nat.ure oUnaerest
Name of I nterested Party City, State, Country (place of business) (check applicable}
NN 016ntrnlling Inte,media
- --------- W-10----- -------------
--------
------
- ---------------------------------- ------ -- --
-------------
5
Check only if there is..*NOinterested Pally. o
X
6
UNSWORN DECLARATION.'
My Warne is _ ��4J � �G+C'f ! " ► / �'I � + ��° �" ,and my dale of birthA's J./419
My. address i� 27(a 7� � a�1 �f (Ft�.��b�� � �r'`/N A�f _, / !
T�
(street) (City) (state) (zip code) (country}
declare under penalty of pe.rJury'that the foregoing is,true and correct.
Executed in i�� � � �.� K COunty, StWs of , on the day of 20�.
(month) (year)
ere ofautoeacctnbt antity
(Declarant)..---
Forms provided by Texas Ethics Commission ethit'�te.tx:us Version vi.l.cettti9sa
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
10fl
Complete Nos. 1,, 4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos, 1, 21 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:
0
of business. 2021-738502
chastang enterprises
houston, 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 04/14/2021
being filed.
CITY OF ROUND ROCK Date Acknowledged:
04/19/2021
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.
2022 F550
PURCHASE OF 2022 FORD F550
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
5
Check only if there is NO Interested Party.
MX
6
UNSWORN DECLARATION
My name is ,and my date of birth is
My address is -1
(street) (city) (state) (zip code) (country)
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 wwwethics.statetx,us Version viacettaq8a