Contract - Library Interiors - 1/27/2022 . •w No-cessapps
uS Y!V—t--qCctS OF Tom.LLC LOP"Wriews, D :=e
3S IUM�- Dr M--4
Lwkw*W,TX 78738 Dom 12/Z/2021
vwsdw _« E
9 za TIPS... :�.>,. 0D30 -'_— ,u..._- r� _ & � N-prw s s .-1�2 S r. . ; uid tna < - -
u'g22 -: tM v Lvmh^L 't_M, Y -S.L 5b5 DQ Agav Hfts"ff=r Pmt S=l ,3-7 1:.4 3,.92.1 42 �R' a_C]4 3 2431.29
0, •_o',.,.wwo ; w Uu y .��M%W €w— I Z35',M3 .. -tea -� 2
„_�:-�.,� �`�__ � ,��-�. Wig. .�
- .. .t_
2 ERK a- W W;.- s�p ned='N Q C nwlm 0 CF7�'TaE,=_- ISM Ki 09 3 ?27 RIA
_
- PN 4 E � = Tei` Ow&WiLsO_.et. L Tzb KEW 1=33 38 2?ZW .v.-�.
Q€—.fm aW W WA 4 _ ��_ "�- s.. Agn
:.ter---Rabdnr Teve 620785 Z;4.M. O 3 e-48
QjmmhnQ2%OMPS
3 E.
.TX 79735 OMC 12/2v2021
1WERKIRS 221 E- wST F r-j Rvmk 7X 781564
. _ M- W Wk Nm Ra Wat
200:301 g vR W!mmus _de Su d hmuu_ tx s
:MCI F--s.-=vwu'_='...SW ' m CUSUN -24£2 Agov Do=r, G 41150 —3 M ..1 255!3 510?6
an f-z.. .Mwne-: W—me Dw WWA 2RT BL 2Z'G_W.CC _ _I-em�_ -der•rae .FPe OC 9.176 W. 28% 23g�5 568912
F,, Fog 2 EQTXVvTTQP c4Antq ,-i,.E a0m No Arry"ate 43600 872 355% 27032 t-!06—
T_
0:.,.; .- z €LEI--1 vv-_ va, R W-erped Wm CKH� [Zo' Tab :87 CI'S 38% E 5 SC, F7-22.1
3r - ,.W -. G P 226-2C7 4 kgs` "ate 5,6SS 5 i�, 3,527 50 &198
Lep
_. Aml m susce asmNoC- AM 4W0 3tW1 3 2.032 .=
- a.s,_-08==> c c• 36.._ 0 Ag.C,.3wm. ,� .at4s wV,NAP O mem 1555U M MAW 3% 9%24 ?
03 CERj-SL-242-KLM-NICO Amm s..em:�Meadw e 9D€M) 6973400 38% a'=x,3.2.2. -
a
3�.ua
t� nw* +'_. Oma,-t",o_
1
-a. EGGOW"WRIP OFay �,--�,_Ouluat€_ � - , ���-� --�` � _ v 2 0-� -�: 3-„
, ,� -���' ¢�p Ira=Da Imo-,
`� °�� € - t's .� ��.. �, ��.`-.��� � _ _«moi
3503 WUM ChcwC-..StdR-4
78739 Mnw;2, fav i
Mt M q w P=W RWk one an n.L"
MUMS 20 E SW St Aw4k& AWS4
Rn,%A IX 78661
ftmn , s
Pamns Dad WAt 1 c.- -jaa � ^Zp: Tnia .� _. 5 SR4,DC, 39% 5,524US 3.524,38
Sees -e w m=h o- ¢:
.-d-, RM"CWT te r._v=pwl V*—, .w,_=:GrZ:---v rt '` -mom 38% - ..3; RVie;
-A _.;< Th .mar_ V"w&K wwu 2 I-8 4,4.`-3=F4,".0A. .�:-T,-.: 1 �.. .. .�
71
- �.�... � r
rr EUMMUSEM2P Am. &M.WOF€cap' -nun J368772,00 W27032 540 E
- - -
_ E - 415575
cu Ra.--d w=r ,;: C a w .-.,,t
`m.- 4 :. �. e F.::_..faun_o; �e .-._Tom .T-=6. z,z C 42 ,.-, tib
T - v ldi i.
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of I
Con-q)k.,.1e Pkjs 1-4 and 6 it ihere Arerae�resoad:parues. OFFICE USE ONLY
Cori,qi8ete No! 1,2,3,5,and 6 if Iliea,,,are no imctiesvml panies. CERT11FICATION OF FILING
I Name of business entity filing form,and the city,state anti counoy of the business entity's place Certificate Number:
of business. 2021-834080
Lbwy Interbrs of Texas
Lakeway, TX United Slates Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 12/17/202.1
being filed,
City of Round Rock Date Acknwxdedged,
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,arid provide a
description of the services,goods,or other property to he provided under the contract,
000000- Round R!ock Pubfic Lb
FiXtUres, Furniture& Equipment(FF&E)for ROUTid Rock Public Library
Nature of interest
4 Name of Interested Party City,State,Country(place of busmness) (check applicable)
Controlling Imetmediary
Tayior, Iwkhael Lakeway, TX Unitecl States X
Tay r, Trevor Austin,TX iJmted States X
Taylor, IAoua AUS611,TX United Slazes X
5 Check only if there is NO hitere5ted Party,
6 UNSWORN DECLARATION
my name�s and rny date of b�rP)is
....................................
My addTrF��,jF, �6 lu f 'S ,I
I declare Undu penmy of pequry ihat the foregotng its aue aiisd conect
-7-
Exe,cuTed m County, Stale of oI the T day of
Sir of auifi onzerl agent of r;ontracu,)g business eritizy
(Declwam0
Forms provided by Texas Ethics Commission www ethicsstaleAx.us Versbn V1_1_191b5cdc
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. 2021-834080
Library Interiors of Texas
Lakeway,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is12/17/2021
being filed.
City of Round Rock Date Acknowledged:
01/06/2022
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 otter property to be provided under the contract.
000000-Round Rock Public Lib
Fixtures,Furniture&Equipment(FF&E)for Round Rock Public Library
4 Nature of Interest
Name of Interested Parry City,State,Country(place of business) (check applicable)
Controlling intermediary
Taylor,Michael Lakeway,TX United States X
Taylor,Trevor Austin,TX United States X
Taylor,Moira Austin,TX United States X
5 Check only If there is NO Interested Party. ❑
8 UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (cq) (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 conuaang business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc