Contract - US Bancorp Government Leasing & Finance - 8/28/2014 i
DOCUMENT CHECKLIST
PLEASE EXECUTE TWO(2)ORIGINALS OF ALL DOCUMENTS
i
RETURN ALL ORIGINALS TO:
U.S. BANCORP GOVERNMENT LEASING AND FINANCE, INC.
MYRA AKSAMIT
95017 TH STREET,7r"FLOOR
DENVER,CO 80202
303-585-4054
➢ Property Schedule No. 2-This document must be executed in the presence of a witness/attestor. The attesting
witness does not have to be a notary,just present at the time of execution.
➢ Property Description and Payment Schedule-Exhibit 1
i
D Lessee's Counsel's Opinion - Exhibit 2. This exhibit will need to be executed by your attorney, dated and
placed on their letterhead.Your attorney will likelywant to review the agreement prior to executing this opinion.
➢ Lessee's Certificate-Exhibit 3. 1) Please fill in the person's title who will be executing the certificate in the first .II
paragraph (note: the person who signs this exhibit cannot be the same person as the executing official(s) for all
other documents); 2) Please fill in the date that the governing body met in Line 1; 3) In the middle set of boxes,
please print the name of the executing official(s) in the far left box,print their title(s) in the middle box and have the
executing officials) sign the line in the far right hand box; 4) Include in your return package a copy of the board
minutes or resolution for our files; and 5) The exhibit should be executed by someone other than the executing
official(s) named in the center box.
➢ Payment of Proceeds Instructions - Exhibit 4. This is for the vendor payment information. If more than one
vendor is being paid please make copies of this exhibit and fill out as many as are needed.
➢ Acceptance Certificate-Exhibit 5. The date that all equipment is delivered, installed and accepted is the date
that should be placed on the "DATE' line. If moneys are being deposited into escrow this exhibit should be held
and returned with the final disbursement from the escrow account.
➢ Bank Qualification and Arbitrage Rebate-Exhibit 6.
Y Insurance Authorization and Verification-To be filled out by the Lessee and sent to your insurance carrier. A,
valid insurance certificate,or self-insurance letter if the Lessee self-insures,is required prior to funding.
➢ Notification of Tax Treatment-Please provide your State of SalesNse tax Exemption Certificate.
D Form 8038-G-Blank form provided to Lessee.Please consult your local legal/bond counsel to fill out.
➢ Affidavit
R-2014-1712
Property Schedule No.
Master Tax-Exempt Lease/Purchase Agreement
This Property Schedule No. 2 is entered into as of the Commencement Date set forth below, pursuant to that certain Master Tax-
Exempt Lease/Purchase Agreement(the'Master Agreement'), dated as of September 24, 2013, between U.S. Bancorp Government
Leasing and Finance,Inc.,and City of Round Rock,Texas.
L Interpretation. The terms and conditions of the Master Agreement are incorporated herein by reference as if fully set forth herein.
Reference is made to the Master Agreement total[representations,covenants and warranties made by Lessee in the execution of this
Property Schedule, unless specifice0y set forth herein. In the event of a conflict between the provisions of the Master Agreement and
the provisions of this Property Schedule,the provisions of this Property Schedule shall control. All capitalized temis not otherwise
defined herein shall have the meanings Provided in the Master Agreement
2. Commencement Date. The Commencement Date for this Property Schedule is August 28,2014. '..
3. Property Desiontritiort and Paymant Schedule,The Property subject to this Property Schedule is described in Exhibit 1 hereto. Lessee
shall not remove such property from the locations set forth therein without giving prior written notice to Lessor. The Lease Payment
Schedule for this Property Schedule is set forth in Exhibit 1.
4. Opinion. The Opinion of Lessee's Counsel is attached as Exhibit 2.
5. Lessee's Certificate. The Lessee's Conificate is attached as Exhibit 3.
6, Proceeds. Lessor shall disburse the proceeds of this Property Schedule in accordance with the instructions attached hereto as Exhibit
4
Z Acceptance Certificate. The form of Acceptance Certificate is attached as Exhibit 5.
8, Additional Purchase Option Provisions. In addition to the Purchase Option provisions set forth in the Master Agreement, Lease
Payments payable under this Property Schedule shall be subject to prepayment in whole at any time by payment of the applicable
Termination Amount set forth in Exhibit 1 (Payment Schedule) and payment of all accrued and unpaid interest through the data of
prepayment.
9. Bank Qualification and Arbil Rebate. Attached as Etilbit 6,
10. Expiration. Lessor, at its sole determination,may choose not to accept this Property Schedule if the fully executed, original Master
Agreement (including this Property Schedule and all ancillary documents) is not received by Lessor at its place of business by
September 21,2014.
IN WITNESS WHEREOF, Lessor and Lessee have caused this Property Schedule to be executed in their names by their duly authorized
representatives as of the Commencement Date above
Lessor: U.S. Bancorp Government Leasing and Lessee:City of Round Rock,Texas
Finance,Inc.
B : B :
Name: Myra A Name'Alan McGraw
Documentation Supervisor
Title: Title: Mayor
At
By qfwz JA
Name: Sara White
Title: City Cierk
EXHIBIT 1
Pro ert Description and Pa ment Schedule
Re. Property Schedule No.2 to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government
Leasing and Finance, Inc.and City of Round Rock,Texas.
THE PROPERTY IS AS FOLLOWS: The Property as more fully described in Exhibit A incorporated herein by reference
and attached hereto. It includes all replacements, parts, repairs, additions,accessions and accessories incorporated
therein or affixed or attached thereto and any and all proceeds of the foregoing, including,without limitation, insurance
recoveries.
PROPERTY LOCATION. 221 East Main Street
Address
Round Rock,TX 78681 !.
city,Slate Zip Cade
USE: Various Vehicles - This use is essential to the proper, efficient and economic functioning of Lessee or to the
services that Lessee provides,and Lessee has immediate need for and expects to make immediate use of substantially all
of the Property,which need is not temporary or expected to diminish in the foreseeable future.
Lease Payment Schedule '...
Total Principal Amount: $1,450,000.00
Lease Principal Interest Termination
Payment No. Due Date Payment Portion Portion Amount
(After Making Paymont
for eaid Due Date
1 1-Mar-2015 151 174.67 139,676.34 11,298.33 1 349,427.37
2 1-Sep-2015 151174.67 141,186.15 9,988.52 1,204,005.64
3 1-Mar-2016 151,174.67 142,262.56 8,912.11 1,057,475.20
4 1-Se -2016 151,174.67 143347.19 7827.48 909,827.59
5 1-Mar-2017 151174.67 144440.08 6,734.59 761054.31
6 1-Se -2017 151,174.67 145,541.31 5633.36 611,146.76
7 1-Mar-2018 151,174.67 146,650.93 4,523.74 460,096.30
8 1-Se -2018 1 151,174.67147,769.02 3405.65 307,894.21
9 1-Mar-2019 _151,174.67 148,895.62 2,279.05 154531.72
10 1-Se -2019 151174.67 150030.80 1143.87 1 0.00
TOTALS: 1 1511,746.70 1450,000.00 61746.70 1 '..
Interest Rate: 1.520%
Lessee:City of Round Rock,Texas
B :
Name:Alan McGraw
Title: Mayor
EXHIBIT I
lPropertyDescri tion
2014 Lease/Purchase Equipment List
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TOUT: 31529453.75
EXHIBIT
Lessee's Counsel's O inion
Sheets & Crossfield, P.c.
ATTORNEYS AT LAW
309 Fast Main Street.Round Rock,TX 78664-5246
Phone 512-255-8877.fax 512-255-8986
w sheetscrosefield mm
August 28, 2014
U.S. Bancorp Government Leasing and Finance, Inc.
13010 SW 68"Parkway, Suite 100
Portland, OR 97223
Re: Master Tax-Exempt Lease/Purchase Agreement dated as September 24, 2013
(the"Master Agreement")by and between the CITY OF ROUND ROCK,TEXAS
("Lessee") and U.S.Bancorp Government Leasing and Finance,Inc. ("Lessor")
Dear Sir or Madam:
I have acted as counsel to Lessee with respect to the Master Agreement described above and
various related matters, and in this capacity have reviewed a duplicate original or certified copy
thereof and Property Schedule No. 02 executed pursuant thereto (together with the Agreement, the
"Lease"). I have examined the law and such certified proceedings and other papers as we deem
necessary to render this opinion.
All capitalized terms not otherwise defined herein shall have the meanings provided in
the Master Agreement and Property Schedule.
As to questions of fact material to my opinion, I have relied upon the representations of
the Lessee in the Master Agreement and the Property Schedules and in the certified proceedings
and other certifications of public officials furnished to us without undertaking to verify the same
by independent investigation.
Based upon the foregoing, I am of the opinion that, under the existing law:
1. Lessee is a public body corporate and politic, duly organized and existing under the laws
of the State of Texas, and has a substantial amount of one or more of the following
sovereign powers: (a) the power to tax, (b) the power of eminent domain, and (c) the
police power.
2. Lessee has all requisite power and authority to enter into the Master Agreement and
Property Schedules and to perform its obligations thereunder.
3. The execution, delivery and performance of the Master Agreement and the Property
Schedules by Lessee has been duly authorized by all necessary action on the part of the
Lessee.
Page 1— Opinion Letter
4. All proceedings of the Lessee and its governing body relating to the authorization and
approval of the Master Agreement and the Property Schedules, the execution thereof and
all transactions contemplated thereby have been conducted in accordance with all
applicable open meeting laws and all other applicable state and federal laws.
5. Lessee has acquired or has arranged for the acquisition of the Property subject to the
Property Schedules, and has entered into the Master Agreement and the Property
Schedules, in compliance with all applicable public bidding laws.
6. Lessee has obtained all consents and approvals of other governmental authorities or
agencies which may be required for the execution, delivery and performance by Lessee of
the Master Agreement and the Property Schedule, in compliance with all applicable
public bidding laws.
7. The Master Agreement and the Property Schedules have been duly executed and
delivered by Lessee and constitute legal, valid and binding obligations of Lessee,
enforceable against Lessee in accordance with the terms thereof, except insofar as the
enforcement thereof may be limited by any applicable bankruptcy, insolvency,
moratorium, reorganization or other laws of equitable principles or general application, or
of application to municipalities or political subdivisions such as the Lessee, affecting
remedies or creditors' rights generally, and to the exercise of judicial discretion in
appropriate cases.
8. As of the date hereof, based on such inquiry and investigation as we have deemed
sufficient, no litigation is pending, (or, to our knowledge, threatened) against Lessee in
any court (a) seeding to restrain or enjoin the delivery of the Master Agreement or the
Property Schedules or of other agreements similar to the Master Agreement; (b)
questioning authority of Lessee to execute the Master Agreement or the Property
Schedules, or the payment of principal or interest on, the Property Schedules; (c)
questioning the constitutionality of any statute, or the validity of any proceedings,
authorizing the execution of the Master Agreement and the Property Schedules; or (d)
affecting the provisions made for the payment of or security for the Master Agreement
and the Property Schedules.
This opinion may be relied upon by the Lessor, its successors and assigns, and any other
legal counsel who provides an opinion with respect to the Property Schedule.
Very yYour
Stephan . Sheets
City Att mey
EXHIBIT 3
Lessee's Certificate
Re: Property Schedule No. 2 to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government
Leasing and Finance,Inc.and City of Round Rock,Texas.
The undersigned, being the duly elected, qualified and acting Mayor of the City of Round Rock("Lessee") does hereby certify,
as of August 28,2014,as follows:
1. Lessee did, at a meeting of the governing body of the Lessee held August 28,2014 by resolution or
ordinance duly enacted, in accordance with all requirements of law, approve and authorize the execution and delivery of
the above-referenced Property Schedule (the "Property Schedule") and the Master Tax-Exempt Lease/Purchase
Agreement(the"Master Agreement') by the following named representative of Lessee,to wit:
NAME TITLE SIGNATURE
OF EXECUTING OFFICIAL OF EXECUTING OFFICIAL OF EXECUTING OFFICIAL
Alan McGraw Mayor
a dr Or
2. The above-named representative of the Lessee held at the time of such authorization and holds at the
present time the office set forth above.
3. The meetings) of the governing body of the Lessee at which the Master Agreement and the Property
Schedule were approved and authorized to be executed was duly called, regularly convened and attended throughout by
the requisite quorum of the members thereof, and the enactment approving the Master Agreement and the Property
Schedule and authorizing the execution thereof has not been altered or rescinded. All meetings of the governing body of
Lessee relating to the authorization and delivery of Master Agreement and the Property Schedule have been: (a) held
within the geographic boundaries of the Lessee; (b) open to the public, allowing all people to attend; (c) conducted in
accordance with internal procedures of the governing body, and (d) conducted in accordance with the charter of the
Lessee, if any,and the laws of the Slate.
4. No event or condition that constitutes, or with the giving of notice or the lapse of time or both would
constitute, an Event of Default(as such terms are defined in the Master Agreement)exists at the date hereof with respect
to this Property Schedule or any other Property Schedules under the Master Agreement.
5. The acquisition of all of the Property under the Property Schedule has been duly authorized by the
governing body of Lessee.
6. As of the date hereof, no litigation is pending, (or, to my knowledge, threatened) against Lessee in any
court (a) seeking to restrain or enjoin the delivery of the Master Agreement or the Property Schedule or of other
agreements similar to the Master Agreement; (b)questioning the authority of Lessee to execute the Master Agreement or
the Property Schedule, or the validity of the Master Agreement or the Property Schedule, or the payment of principal of or
interest on, the Property Schedule; (c) questioning the constitutionality of any statute, or the validity of any proceedings,
authorizing the execution of the Master Agreement and the Property Schedule;or(d) affecting the provisions made for the
payment of or security for the Master Agreement and the Property Schedule.
City of Round Rock,Texas
By: (40
Title: City Clerk
SIGNER MUST NOT BE THE SAME AS THE EXECUTING OFFICIALS SHOWN ABOVE.
EXHIBIT 4
Payment of Proceeds Instruction
i
U.S. Bancorp Government Leasing and Finance,Inc.
13010 SW 68th Parkway, Suite 100
Portland,OR 97223
Re: Property Schedule No. 2 (the "Property Schedule") to Master Tax-Exempt Lease/Purchase Agreement
between U.S. Bancorp Government Leasing and Finance, Inc. ("Lessot� and City of Round Rock,Texas
("Lessee").
Ladies and Gentlemen:
The undersigned, an Authorized Representative of the Lessee hereby requests and authorizes Lessor to disburse the net
proceeds of the Property Schedule as follows:
City of Round Rock
Name of Payee:
XXX
By check_ By wire transfer_
If by check, Payee's address:
If by wire transfer, instructions as follows:
JPMorgan Chase Bank
Pay to Bank Name: ',.
221 W. Sixth Street, Floor 2 Austin,TX 78701
Bank Address:
512479-2720
Bank Phone q:
City of Round ROGc Operating Acct i
For Account of
456891386
Account No.:
021000021
ABA No.
Lessee: City of Round Rock.Texas
Name:Alan McGraw
Title: Mayor
EXHIBIT 5
cce tance Certificate
U.S. Bancorp Government Leasing and Finance,Inc.
13010 SW 68th Parkway, Suite 100
Portland,OR 97223 !i
Re. Property Schedule No.2 to Master Tax-Exempt Lease/Purchase Agreement between U.S.Bancorp Government !
Leasing and Finance, Inc,and City of Round Rock,Texas
Ladies and Gentlemen:
In accordance with the above-referenced Master Tax-Exempt Lease/Purchase Agreement (the"Master Agreement"), the
undersigned ("Lessee") hereby certifies and represents to, and agrees with, U.S. Bancorp Government Leasing and
Finance, Inc. ("Lessor'), as follows:
(1) The Property, as such terms are defined in the above-referenced Property Schedule, has been acquired,
made,delivered, installed and accepted on the date indicated below.
(2) Lessee has conducted such inspection and/or testing of the Property as it deems necessary and appropriate
and hereby acknowledges that it accepts the Property for all purposes.
(3) No event or condition that constitutes, or with notice or lapse of time,or both, would constitute, an Event of
Defaults(as sury/ch,terms are defined in the Master Agreement)exists at the date hereof.
Acceptance Date:
Lessee:City of-Round Rock,Texas
By:
Name:Alan McGraw
Title:Mayor
EXHIBIT
Bank Qualification And Arbitra e Rebat
U.S. Bancorp Government Leasing and Finance, Inc.
13010 SW 68th Parkway,Suite 100
Portland, OR 97223
Re: Properly Schedule No.2 to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government
Leasing and Finance,Inc.and City of Round Rock,Texas
Bank Qualified Tax-Exempt Obllgatlon under Section 265 I'
Lessee hereby designates this Property Schedule as a "qualified tax-exempt obligation" as defined in Section
265(b)(3)(B) of the Code. Lessee reasonably anticipates issuing tax-exempt obligations (excluding private activity bonds
other than qualified 501(c)(3) bonds and including all tax-exempt obligations of subordinate entities of the Lessee)during the
calendar year in which the Commencement Date of this Properly Schedule falls,in an amount not exceeding$10,000,000.
Arbitrage Rebate
Small Issuer Exception:
(a)Lessee is a governmental unit under the law of the State with general taxing powers, (b)this Property Schedule
is not a private activity bond as defined in Section 141 of the Code, (c) 95% or more of the net proceeds of this Property
Schedule will be used for local government activities of Lessee, and (d) the aggregate face amount of all tax-exempt
obligations (other than private activity bonds) issued by Lessee (and all subordinate entities thereof) during the calendar
year in which the Commencement Date of this Property Schedule falls is not reasonably expected to exceed $5,000,000
(plus any additional amounts, not to exceed $10,000,000 which are for the construction, reconstruction or rehabilitation of
public school facilities).
Lessee: City of Round Rock,Texas
B :
Name:Alan McGraw
Title: Mayor
TML
Certificate of Coverage
TMLIRP Contract Number 13127
Member: Company Affording Coverage:
Round fleck Texas Municipal League Intergovernmental Risk Pool(TMLIRP)
Mr.Michael Bennett PO Box 149194
Risk Manager Austin,TX 78714-9194
221 E Main Ave She 100 (512)491-2300 or(800)537-6655
Round Rock-roxas 78664 Fax:(512)491-2404
Certificate Holder:
U.S. Bancorp Government Leasing and Finance, Inc.
13010 SW 68th Parkway,Suite 100
Portland, OR 97223
This is to certlty that the coverages listed below have been provided to the member and are in effect at this time. Notwithstanding any requirements,
terms,or conditions of any other..,,(rant or agreement with respect to which this criminate may be Issued or may pertain,the coverage afforded by
TMLIRP described heroin is subject only to the terms,exclusions and additions of TMLIRPa coverage contracts between TMLIRP and Its member(s).
Coverage is continuous until canceled,
General Liability Effective Dale: 10MI2013 Real&Personal Property Effective Date: 10/12013
Anniversary Date: 1WI12014 Anniversary Date: 10/1/2014
Limits of Liability(Each Ocwrmnce): $1,OOi Limits of Coverage: $222,508,631
Sudden Events Involving Pollution
(Each Occurrence): $1,000,000 Deductible per Occurrence: $2,500
Annual Aggregate: $2,000,000 Mobile Equipment Effective Dale'. 10/12013
Deductible per Occurrence: $2,500 Anniversary Date', 10/la014
Law Enforcement Liability Effective Data Limits of Coverage: $5.495.105
Anniversary Data: Deductible per Occurrence: 52,500
Limits of Liability(Each Occurrence): Holler&Machinery-Broad Farm Effective Date: 1011x013
Annual Aggregate: Anniversary Date: Kirla014
Deductible per Occurrence: Per Accident LimlC $18,500,000
Errors and Omissions Liability Effective Dater Deductible per Occurrence. $2,500
Anniversary Date: Yes No
Limits of Liabildy(Each Wrongful Act): Mortgagee X
Annual Aggregate: Loss Payee X
Deductible per Occurrence: Loan Number:
Auto Liability Effective Data Yearur akelhlodel VIN Value
Anniversary Dale:
Limits of Liabllily(Each Occurrence):
Deductible per Decormnce:
Auto Physical Damage Effective Dale'.
Anniversary Date.
Limits of Liability:
Collision Deductible:
Comprehensive Deductible:
Yes No
Loss Payee: Loan Number
DESCRIPTION:
Evidence of Coverage
Cencetlegon: Should any of the above described coverages be canceled before the anniversary dale thereof.TMLIRP will endeavor to mail
30 days written notice to Inc above named papillose,holder,but failure to mail such notice shall impose no obligation or liability of any kind
upon TMLIRP.
AuthorizenddRRep�resentatju¢ Date Issued
/'�✓+./A_` )� W2014 X102
10/15100
I
Notification of Tax Treatment to Tax-Exempt Lease/Purchase Agreement
II
This Notification of Tax Treatment is pursuant to Property Schedule No. 2 to the Master Tax-Exempt Lease/Purchase Agreement
dated as of September 24,2013 and the related Property Schedule,between Lessor and Lessee(the"Agreement').
Lessee agrees that this Property Schedule SHOULD be subject to sales/use taxes
X Lessee agrees that this Property Schedule should NOT be subject to saies/use taxes and Lessee has previously
provided our tax-exemption cerfificate to Lessor
Lessee agrees that this Property Schedule should NOT be subject to sales/use taxes and no tax-exemption certificate is
issued to us by the State
Lessee agrees that this Property Schedule is a taxable transaction and subject to any/all taxes
Lessee agrees that this Property Schedule is subject to sales/use taxes and will pay those taxes directly to the Stale or
Vendor
IN WITNESS WHEREOF,Lessee has caused this Notification of Tax Treatment to be executed by their duly authorized representative.
Lessee: Cily of Round Rock,Texas
i-Y
6 ' '
Name:Alan McGraw
Title: Mayor
it
TML
Certificate of Coverage
aronerearrosissuri
TMLIRP Contract Number 13127
Member: Company Affording Coverage:
Round Rack Texas Municipal League Intergovernmental Risk Pool(TMLIRP)
Mr.Michael Bennett PO Box 149194
Risk Manager Austin,TX 78714-9194
221 E Main Ave Ste 100 (512)491-2300 or(800)537-6655
Round Rock,Texas 78664 Fax: (512)491-2404
Certificate Holder;
U.S. Bancorp Government Leasing and Finance. Inc.
13010 SW 68th Parkway, Suite 100
Portland, OR 97223
This is to certify that the coverages listed below have been provided to the member and are in effect at this time. Notwithstanding any requirements,
terms,or conditions of any other contract or agreement with respect to which this certificate may be issued or may pertain,the coverage afforded by
TMLIRP described herein is subject only to the terms,exclusions and additions of TMLIRP'a coverage contracts between TMLIRP and Its mamber(s).
Coverage Is continuous until canceled.
General Liability Effective Dale: 10/1/2013 Real&Personal Property Effective Date: 10!1/2013
Anniversary Date: 10/1/2014 Anniversary Date: 10/1/2014
Limits of Liability(Each Occurrence): $1,000,000 Limits of Coverage: $222,508,631
Sudden Events Involving Pollution
(Each Occurrence): $1,000,000 Deductible per Occurrence: $2,500
Annual Aggregate: $2,000,000 Mobile Equipment Effective Date: 10/1/2013
Deductible per Occurrence: $2,500 Anniversary Date: 10/1/2014
Law Enforcement Liability Effective Data Limits of Coverage: $5495,105
Anniversary DateDeductible per Occurrence: $2,500
Limits of Liability(Each Occurrence): Boiler&Machinery-Broad Form Effective Date' 10/1/2013
Annual Aggregate: Anniversary Date: 101112014
Deductible per Occurrence, Per Accident Limit: $18,500,000
Errors and Dimensions Liability Effective Date: Deductible per Occurrence: $2,500
Anniversary Date. Yes No
Limits of Liability(Each Wrongful Act: Mortgagee X
Annual Aggregate: Loss Payee X
Deductible par Occurrence: Loan Number:
Auto Liability Effective Date. YearlMakelModel VIN Value
Anniversary Date:
Limits of Liability(Each Occurrence):
Deductible per Occurrence:
Auto Physical Damage Effective Date:
Anniversary Date:
Limits of Liability.
Collision Deductible:
Comprehensive Deductible:
Yes No
Loss Payee: Loan Number
DESCRIPTION:
Evidence of Coverage
Cancellation: Should any of the above described coverages be canceled before the anniversary dale thereof.TMLIRP will endeavor to mad
30 days written notice to the above named cedificate holder,but failure to mail such notice shall impose no obligation or liability of any kind
upon TMLIRP.
Authorispial�Represent ad Date Issued
8/6/2014 X102
10/15/08
n 3.I..)
laa.nxoaal
TEXAS SALES AND USE TAX EXEMPTION CERTIFICATION
Name of purchaser,firm or agency
City of Round Rock
Addrese(street x number,P.Box or Route number) Phone(Ree cava and number)
221 East Main St. 5t2-218-5400
City,Slate,ZIP code
Round Rock,Texas 78664
I, the purchaser named above, claim an exemption from payment of sales and use taxes (for the purchase of taxable
items described below or on the attached order or invoice)from:
Seller: Q SAroLor, P Goful�Ei'Kyfv r paths 7i FiNNkXf � tti�
Street address: 13010 SIA li Ip"Ikliki S6 ITS 100 City,State,ZIP code: eJi-ri-d i C, 77Z3
Description of items to be purchased or on the attached order or invoice:
N`ai 1 A y,-CXEMeC L-ii / Pj&-i Alf riszloiy 1
Purchaser claims this exemption for the following reason:
The City of Round Rock,Texas is a tax-exempt municipality.
Tax ID#74-6017485
1 understand that I will be liable for payment of sales or use taxes which may become due for failure to comply with the provisions of the
Tax Code:Limited Sales,Excise,and Use Tax Act;Municipal Sales and Use Tax Act;Sales and Use Taxes for Special Purpose Taxing
Authorities;County Sales and Use Tax Act;County Health Services Sales and Use Tax;The Texas Health and Safety Code;Special
Provisions Relating to Hospital Districts,Emergency Services Districts,and Emergency Services Districts in counties with a population
of 125,000 or less.
I understand that it is a criminal offense to give an exemption certificate to the seller for taxable items that I know,at the time ofpurchase,
will be usedin a manner other than that expressed in this certificate and,depending on the amount oftax evaded,the offense may range
from a Class C misdemeanor to a felony of the second degree.
Porch a nue Dace
Sign 0 For the City of Round Rock
NOTE: This certificate cannot be issued far the purchase,lease,or rental of a motor vehicle.
THIS CERTIFICATE DOES NOT REQUIRE A NUMBER TORE VALID.
Sales and Use Tax"Exemption Numbers'or"Tax Exempt'Numbers do not exist.
This certificate should be furnished to the supplier. Do not send the completed certificate to the Comptroller of Public Accounts.
5-1
,741161 Departmentof ethe Treasury
Instructions for Form
`L�I Internal Revenue Service
8038-G
(Rev. September 2011 )
Information Return for Tax-Exempt Governmental Obligations
Section references are to the Internal indenture or other bond documents. See Rounding to Whole Dollars
Revenue Code unless otherwise noted. Where To File next. You may show amounts on Nis return as
General InstructionsWhere TO File whole dollars.To do so,drop amounts
less than 50 cents and increase amounts
Purpose Of Form File Form 8038-G, and any attachments, from 50 cents through 99 cents to the
Form 80381 is used b of with the Department of the Treasury, next higher dollar.
y issuers
Internal Revenue Service Center,Ogden,
tax-exempt governmental obligations to UT 64201. Questions on Filing Form
provide the IRS with the information 8038-G
required by section 149(e)and to monitor private delivery services. You can use For specific questions on how to file Form j
the requirements of sections 141 through certain private delivery services 8038-G send an email to the IRS at
150, designated by the IRS to meet the'timely TaxEXemptBOndouesnonS®Irs.gov
Who Must File mailing as timely filing/paying'rule for tax and put'Form 8038-G Question'in the
returns and payments.These private subject line. In the email include a
IF the Issue Ice THEN,for tax<xem t delivery services include only the description of your question,a return
Pr P following: email address,the name of a contact
(line 21,column(b)) governmental • DHL Express(DHL): DHL Same Day person, and a telephone number.
Is... obligations Issued Service.
after accounts,31, • Federal Express(FedEx) FedEx Definitions
1986,leavers moat
Priority Overnight, FedEx Standard
file... y g Tax-exempt obligation. This is any
Overnight,FedEx 2Day,FedEx obligation,including a bond,installment
$100.000 or more Amparata Form International Priority, and FedEx purchase agreement,or financial lease,
883&G for each Issue International First on which the interest Is excluded from
Less Nan$100,000 Fort 8038-GC, • United Parcel Service(UPS):UPS Next income under section 103.
Information Return far Day Air,UPS Next Day Air Saver,UPS Tax-exempt governmental obligation.
Small Tax-Exempt 2nd Day Air,UPS 2nd Day Air A.M., UPS Atex-exempt obligation that is not a
Governmental Bono Wbridwde Express Plus,and UPS pdvafe activity bond(see below)is a
Issues,Leases,and Worldwide Express. tax-exempt governmental obligation.This
Installment Sales The private delivery service can tell includes a bond issued by a qualified
you how to get written proof of the mailing volunteer fire department under section
For date. 150(e).
recovery
build America hoods and
13 mcovope-em economic Other Forms That May Be obligation
activity bond. This includes an
development bonds use Form obligation issued as part of an issue in
8038-8, information and Refum for one Required which:
Entente Bonds and RecoveryZone penalty i rebating arbitrage(pr paying a • More than 10%of the proceeds are to
Economic Development Bonds.For tax Penalty in lieu of arbitrage rebate)to the be used for any private activity business !l
credit bonds and specifiedC,lax credit Federal government,use Form on and, use,and
bends use Form 8 ail Bon,s and Information Arbitrage Rebate,Yield Reduction and • More than 10%rest the payment of
either Return for Tax Credit Bonds end Penalty in Lieu of Arbitrage Rebate. principalor edinterestof tethe!me
priseither
Specified Tax Credit Bonds. be severed by an interest in property to
For private activity bonds,use Form be used fora private business use far
When TO FII¢ 8038,Information Return For Tax-Exempt payments for such property)or(b)to be
File Form 8038-G on or before the 15th Private Activity Bond Issues. derived from payments for property(or
day of the 2nd calendar month after the For build America bands(Direct Pay), borrowed money)used for a private
dose of the calendar quarter in which the business use.
bond is issued.Farm 8038-G may not be build America bonds(Tax Credit),and It also includes a bond,the proceeds '..
filed before the issue dale and must be recovery zone economic development of which(a)are to be used directly or
completed based an the facts as of the bonds,complete Farm 80381
Information Return for Build America indirectly to make or finance loans(other
issue date, than loans described in section 141(c)(2p
Bends and Recovery Zone Economic to persons other than governmental units
extension of time la fie Form 8038-G and( )
Late filing. An issuer may be granted an Development Bonds. b exceeds the lesser of 5%of the
o
under Section 3 of Rev.s determined t For qualified forestry conservation proceeds or$5
million
2002-37 efailure
LR.B 5tim if its determined that bonds,new clean renewable energy Issue Price. The issue price of
in
thefailureto floe print is etduetowillful bonds,qualified energy conservation obligationsisgenerally determinedunder
neglect Type or pantie the lop of the bonds,qualified zone academy bands, Regulations section ,the issue Thus,
forte'Request for Relief and
attach
a le 3 qualified school y bonds,Mi bonds,dean when issued for cash,the issue price is
of Rev.Prow.y Form
and attach n letter renewable energy bonds, Midwestern lax the first of the
at which a substantial
explaining why Forth 8038-G was not credit bonds,and all other qualified tax amount of lite obligations are sold to the li
submittedto hethe IRS ontime.issue
Also bends bonds(except build America public.To determine the issue price of an
indicate whether the bond issue t bonds), file Form edit Bond Information obligation issued for property,see
question is under examination trust
the IRS. Return for Tar Credit Bonds and sections 1273 and 1274 and the related
Do not submit copies of the trust Specified Tax Credit Bonds. regulations.
Sep 20,2011 Cat.Na.63774D
Issue. Genemlly,obligationseretreated return for the same dale of issue.if you exchanges the bonds that are part of the
as part of the same issue if they are are filing to correct errors or change a issue for the underwriter's(or other
issued by the same Issuer,on the same previously filed return,check the purchasers)funds. For a lease or j
date,and in a single transaction,or a Amended Return box in the heading of installment sale,enter the date interest
series of related transactions.However, the form. starts to accrue in a MMIDDIYYYY .I
obligations issued during the same The amended return must provide all format.
calendar year(a)under a loan agreement the information reported on the original Line B. Ifthere is no name of the issue,
under which amounts are to be advanced return,in addition to the new or corrected please provide other identification of the
periodically(a"draw-down loan)or(b) information.Attach an explanation of the issue.
with a tens not exceeding 270 days,may reason for the amended return and write
be treated as part ofthe same issue if the across the top."Amended Return Lines. Enter the CUSIP(Committee on
obligations are equally and ratably Exploration.*Failure to attach an Uniform Securities Identification
secured under single indenture or loan explanation may result in a delay in Procedures)number of the bond with the
agreement and are issued under a processing the ton. latest maturity.If the issue does not have
common financing arrangement(for a CU SIP number,write`None.'
example, under the same official Line 1. The issuer's name is the name of
statement periodically updated to reflect the entity issuing the obligations,not the Line 10a. Enter the name and title of the
changing factual circumstances).Also,for name of the entity receiving the benefit of officer or other employee of the Issuer
obligations issued under a draw-down the financing, For a lease or installment whom the IRS may call for more
loan that meet the requirements of the sale,the issuer is the lessee or the information.If the issuer wishes to
preceding sentence,obligations issued purchaser. designate a person other than an officer
during different calendar years may be Line 2. An issuer that does not have an or other employee of the issuer(including
treated as part of the same issue if all of employer identification number(EIN) a legal representative or paid prepamr)
the amounts to be advanced under the should apply for one on Form SS4, whom the IRS may call for more
draw-down loan are reasonably expected Application for Employer Identification information about the return,enter the
to be advanced within 3 years of the date Number.You can get this form on the IRS name,title,and telephone number of
of issue of the first obligation.Likewise, website at IRS.gov or by calling such person on lines 3a and 3b.
obligations(other than private activity 1-800-TAX-FORM(1-800-8291 You Complete lines Ilia and 106 even
bonds)issued under a single agreement may receive an FIN by telephone by if you complete lines 3a and 3b.
that is in the form of a lease or installment following the instructions for Form SS4.
sale may be treated as part of the Same Llne 3a. It the issuer wishes to authorize
issue if all of the property covered by that a person other than an officer or other Part II—Type of Issue
agreement is reasonably expected to be employee of the issuer(including a legal
delivered within 3 years of the date of representative or paid preparer)to Elections referred to in Pad If are
issue of the first obligation. communicate with the IRS and whom the I made on the original bond
Arbitrage rebate. Generally, interest on IRS may contact about this retum 13 documents,not on this fano.
a state or local bond is not tax-exempt (Including in writing or by telephone),
unless the issuer of the bond rebates to enter the name of such person here.The Identify the type of obligations issued
the United States arbitrage profits earned person listed in line the must be an by entering the corresponding issue price
from investing proceeds of the bond in individual, Do not enter the name and tide (see Issue price under Definitions earlier).
higher yielding nonpurpose investments. of an officer or other employee of the Attach a schedule listingnames and EINs
See section 148(f). issuer hem(use line 10n for that of organizations that are to use proceeds
Construction Issue. This is an issue of purpose). of these obligations,if different from those
taxexempl bonds that meets bath of the Note. By authorizing a person other than of the issuer, include a brief summary of
following conditions'. an authorized officer or other employee of the use and indicate whether or not such
1. At least 75%of the available the issuer to communicate with the IRS user is a governmental or
construction proceeds are to be used for and whom the IRS may contact about this nongovernmental entity.
construction expenditures with respect to return,the issuer authorizes the IRS to Line 18. Enter a description of the issue
property to be owned by a governmental communicate directly with the individual in the space provided
unit or a section 501(c)(3)organization, entered on line 3a and consents to
and disclose the issuer's return information to Llne 1s. If the obligations are short-tens
2. All the bands that are pad of the that individual,as necessary,to process tax anticipation notes or warrents(TANS)
issue are qualified 501(c)(3)bands, this return. or short-term revenue anticipation notes
bonds that are not private activity bonds, Lines 4 and 6. If you listed an individual or warrants(RANs),check box iga. If the
or private activity bonds issued to finance on line 3a to communicate with the IRS obligations are short-term bond
property to be owned by a governmental and whom the IRS may contact about this anticipation notes ,issued with the
unit or a section 501(c)(3)organization. return,enter the number and street(or expectation that theeyy wwi1l1 l be refunded with
P.O.box if mail is not delivered to street fproceeds of long-term bonds at some
In lieu of rebating any arcuates that address),city,town,or post office,state, future date,check box 19b.Do not check
may be owed to the United States,the and ZIP code of that person.Otherwise, born boxes
issuer of a construction issue may make enter the issuer's number and street(or Line 20. Check this box if property other
an irrevocable election to pay a penalty. P.O.box if mail is not delivered to street than cash is exchanged for the obligation.
The penalty is equal to 19z%of the address),city,town,or post office,state, for example,acquiring a police car, a fire
ameunt of construction proceeds that do and ZIP code. truck,or telephone equipment through a
not meet certain spending requirements, series of month) payments.(This type of !
Sae section 148(f)(4)(C)and the Note. The address entered on lines 4 Y P Y as
Instructions for I'd.8038-T. and 6 is the address the IRS will use for obligation is sometimes rate ned to as a
all written communications regarding the "municipal lease.')Also check this box if j
Specific Instructions processing of this return,including any real property Is directly acquired in
p notices. exchange for an obligation to make
Part I—Reporting Authority Line S. This line is for IRS use only. De periodic payments of interest and
not make any entries in this box. principal. Do not check this box if the
Amended return. An issuer may file an proceeds of the obligation are received in
amended return to change or add to the Line 7. The date of issue is generally the the form of cash,even if the term"lease"
information reported on a previously filed date on which the issuer physically is used in the We of the issue. ,
-2-
Part III—Description of principal,interest,or call premium on any the conditions of the private business
Obligations other issue of bands after 90 days of the tests or the private loan financing test th
date of issue,including proceeds that will be met,then such issue is also an issue
Line 21. For column(a),the final be used to fund an escrow account fair of private activity bonds. Regulations
maturity date is the last date the issuer this purpose. section 1.141-2(dH3)defines a deliberate
must redeem the entire Issue. action as any action taken by the issuer
Part V—Description of that is within its control regardless of
For column earlier.
see Issue price under d
Definitions eadiec Relund¢d Bonds whether there is intent to trolale such
Far column(c),the stated redemption Complete this part only if the bonds are to fesis.Regulations section 1.141-12
Price at maturity of the entire issue is the be used to refund a prior issue of explains the conditions to taking remedial
sum of the staled redemption prices at tax-exempt bands.For a lease or action that prevent an action that causes
maturity of each bond issued as part of installment sale,write-N/A"in Ne space an issue to meet the private business
the issue.For a lease an installment sale, to the right of the title for Part V. tests or private loan financing test from
write'NIA'in column(c). Lines 31 and 32. The remaining being treated as a deliberate action.
For column tl ,ihe wet hted avers a weighted average maturity is determined Check the box if the Issuer has
O v g of m without regard to the refuntling.The established written procedures to ensure
maturity is sum the products of the weighted average maturity is determined timely remedial action for all nonqualified
issue price of each maturity and the in the same manner as on line 21,column bonds according to Regulations section
number of years to maturity(determined (d) 1.141-12 or other remedial actions
separately for each maturity and by taking authorized by the Commissioner under
into account mandatory redemptions), Line 34. If more than a single issue of Regulations section 7.141-12 h
divided by the issue once of the entire bonds will be refunded.enter the date of Line 44. Check the box if the suer has
issue(from line 21,column(b)).For a issue of each issue.Enter the date in an
lease or installment sale,enter instead MM/DD/YYYY formatestablished written procedures to monitor
the total number of years the lease orpaft Vl—MISC¢Ilan¢OU6 compliance with the arbitrage,yield
installment sale will be outstanding. restriction, and rebate requirements of
For column(e),the yield,as defined in Line 35. An allocation of volume cap is section 148.
section 148(h),is the discount rate that, required if the nonqualified amount for the Line 45a, Check the box if some partof
when used to compute the present value issue is more than$15 million but is not the proceeds was used to reimburse !i
of all payments of principal and interest tomore than the amount that would cause expenditures.Figure and then enter the
be paid on the obligation,produces an the issue to be private actraty bonds. amount of proceeds that are used to
amount equal to the purchase price, Line 36. If any portion of the gross reimburse the issuer for amounts paid for
including accrued interest.See proceeds of the issue is or will be a qualified purpose prior to the issuance
Regulations section 1.1484 for specific Invested in a guaranteed Investment of the bonds.See Regulations section
rules to compute the yield on an issue. If contract(GIC),as defined In Regulations 1.150.2.
the issue is a variable rate issue,write section 1.148-1(b),enterthe amount of Line 45b. An issuer must adopt an
'VR'as the yield of the issue.For other the gross proceeds so invested,as well official intent to reimburse itself for
Nan variable rale issues,carry the yield as the final maturity date of the GIC and preissuance expenditures within 60 days
out to four decimal places(far example, the name of the provider of such contract. after payment of the original expenditure
5.3125%). If the issue is a lease or Line 37. Enter the amounl of the unless excepted by Regulations section
installment sale,enter Ne effective rale of proceeds of this issue used to make a 1.150-2(f).Enter the date the official
interest being paid. loan to another governmental unit,the intent was adopted.See Regulations
Part IV—Uses of Proceeds of
interest of which is taxexempl. section 1.150-2(e)for more information
Bond I6aU¢ Line 38. If the issue is a loan of about official intent.
For a lease or installment sale,write'NW proceeds from another tax-exempt issue, Signature and Consent
In the space to the right of the title for Pad EIN,check the box and enter the date of issue, An authorized representative of the issuer
IV pool and name of issuer of the master must sign Form 8038-G and any
pool obligation. applicable certification.Also print the
Line 22. Enter the amount of proceeds Line 40. Check this box if the issue is a
that will be used to pay interest from the construction issue and an irrevocable name and title of the person signing Form
date the bonds are rated to the dale of election to a a penalty In lieu of 8038-G.The authonzetl representative of
issue. pay p y the issuer signing this form must have the
arbitrage rebate has been made on or authority to consent to the disclosure of
Line 24. Enter the amount of the before the date the bonds were issued the issuers return information,as
proceeds that will be used to pay bond The penally is payable with a Form necessary to process this return,to the '..
issuance costs,including fees for trustees 6038-T for each 6-month period after the persons)that have been designated in
and hand counsel. If no bond proceeds date the bonds are issued.Do not make Form 8038-G.
will be used to pay bond Issuance costs, any payment of penalty in lieu of arbitrage No[e. IF the issuer in Part 1,lines 3a and
enter zero. Do not leave this line blank. rebate with this form.See Rev.Prom.
Llmi Enter the amount of the 92-22,1992A C.B.736 for rules 3b authorizes the IRS to communicate
proceeds that will be used to pay fees for regarding the"election document.' (including in writing and by telephone)
credit enhancement that are taken into LIne41e. Check this boxif the issuer with a person other than an officer or
account in determining the yield on the has identified a hedge on its books and other employee of the issuer, by signing
issue for purposes of section 148(h)(for records according to Regulations sections this forth,the issuers authorized
example,bond insurance premiums and 1.1484(h)(2)(viii)and 1.1484(h)(5)that representative consents to the as sure
certain fees for letters of credit). permit an issuer of tax-exempt bonds to of the issuers realm information,
Line 26. Enter the amount of proceeds identify a hedge for it to be included In necessary to process this return,too
such
that will be allocated to such a fund. Neld calculations for computing arbitrage. person.
Une27. Enter the amount of the LIne42. In determining if the issuer has Paid Preparer
proceeds that will be used to pay super-integrated a hedge,apply the rules If an authorized officer of the issuer filled
principal,interest,or call premium on any of Regulations section 1.148-4(h)(4) If in this return,the paid preparer's space
other issue of bonds within 90 days of the the hedge is super-integrated,check the should remain blank.Anyone who
date of issuebox. prepares the return but does not charge
LIne28. Enter the amount of the LIne43. If the issuer takes a'deliberate the organization should not sign the
proceeds that will be used to pay action"after the issue date that causes return. Certain others who prepare the
.3.
I
return should not sign. For example,a the infomtation.M need it to ensure that Learning about the law or 2 hr.,41 min. II
regular,full employee of the issuer, you are complying with these laws the farm . . .. .. . .. . .
such as a dark,secretary,etc.,should You are not required to provide the Preparing,copying, 3 hr.,3 min. j
net signinformation requested on a form that is aasemblimg,and sending
Generally,anyone who is paid subject the Paperwork Reduction Act
the form to the IHS. .. . .
aret
prepare a return mus[sign it and fill11 in the unless the form displays a valid OMB If you have comments concerning the
other blanks in the um. Preparer Use control number.Books or records relating accuracy of these time estimates or
Only area of the are m. to a form or its instructions must be suggestions for making this form simpler,
The the preparer must retained as long as their contents may we would be happy to hear from Se You
• Sign the return in the space facsimile
become material in the administration of can write to the Internal Revenue Service,
for the preparar's cce signature(a facsimile any internal Revenue law.Generally,tax Tax Products P-T:M.ina111 Committee,
signature is acceptable). returns and realm information are Ave.N .R: 6526,,W 1111 Constitution
• Enter the preparer information,and confidential,needed
required by section and
Ave.NW.D I not
Washington,DC
• Give a copy of the return to the issuer. The time needed to complete antl file 20224. Do not send the farm to this
this forth varies dependingonindividual office.Instead,see Where To File
Paperwork Reduction Act Notice. We circumstances.The estimated average
carr for the information an this form to time Is
tarty out the Internal Revenue dews the
United States.You are required to give us
-4
Fprm$03$4 1 Information Return for Tax-Exempt Governmental Obligations
(Rev.September 2011) ►Under Internal Revenue Code section full OMB No,1545-0720
Deparhner0 of 0.¢heasury ►Bee separate Instructions.
mtemal Revenue service Caution:If the issue price is under$100,000,use Fon,8038-GC.
Reportin Authority It Amended Return,check here Pi El-1 Issu¢(s wma 2 Issuersemployer Identification number(EIN)
GrT of t�+4u1 12oc� 7`1-601 $S
SoName of pawn(othermen issuep wnh whom the IRS may communicate abouuhis return lane refrucransl 3b Telephone number of Other person shown on so
S f1 G — S`13Z
4 Number antl s(reel(O/P.O.box if mail is ttlellveretl LO street address) Rmm/suite 5 RsddrtmmberyFm IFSOse Onlyf
a I c��T MA S s
a ctown,or postoa state,antl ZIP nada 7 Date of issue
a Namedissue 9 CUSIPnumber
"S-Vol Nar
100 Name and title of of Mer or other employee of the Issuer whom the IRs may call for more informati clad 101, TelepM1onenumber of officer w other
inotmotione) amPlOyee Shown on 10a
SIL—ZI i SYY
Type of Issue enter the Issue price).See the instructions and attach schedule.
11 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Health and hospital . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Transportation . . . . . . . . . . . . . . . . . . 13
14 Public safety . . . . . . . . . . . . . . . . . . . . . 14
15 Environment(including sewage bonds) . . . . . . . . . . . . . . . . . . 15
16 Housing . . . . . . . . . . . . . . . . . 16
17 Utilities . . . . . . . . . . . . . 17
18 Other. Describe ► 18
19 If obligations are TANS or RANs, check only box 19a . . . . . . . . . ► ❑
If obligations are BANS,check only box 191b . . . . . . . . . . . . . . . . ► ❑
20 If obligations are in the form of a lease or installment sale, check box . . . . . . . . ► ❑
Wri Description of Obli ations. Com late for the entire issue for which this form is being filed.
Ia)Final malunty data (b)l.c., I Ic)Steted retl¢mption (m Weightetl let Yield
price at maWhty erage mMwity
21 Fl- —.1oI ),iiiI Wxz / .28 ears 1 9 2-- %
Uses of Proceeds of Bon Issue(includin underwr' ars'discount
22 Proceeds used for accrued interest . . . . . . . . . . . . . . . . . . . . . 22
23 Issue price of entire issue(enter amount from line 21, column(Idi . . . . 23
24 Proceeds used for bond issuance costs(including underwriters'discount). 24
25 Proceeds used for credit enhancement . . . . . . . . . . . 25
25 Proceeds allocated to reasonably required reserve or replacement fund . 26
27 Proceeds used to currently refund prior issues . . . . . . . . . 27
28 Proceeds used to advance refund prior issues . . . . . . . . . 28
29 Total(add lines 24 through 28) . . . . . . 29
30 Nonrefunding proceeds of the issue(subtract line 29 from line 23 and enter amount here) 30
Descri tion of Refunded Bonds.Complete this part only for refunding bonds.
31 Enter the remaining weighted average maturity of the bonds to be currently refunded . . . . ► IJ1A years
32 Enter the remaining weighted average maturity of the bonds to be advance refunded . . . . P. Q A years
33 Enter the last date on which the refunded bonds will be called(MMl . . . . . . ►
34 Enter the date(s)the refunded bonds were issued II(MMMONYYY)
For Paperwork Reduction Act Notice,see separate instructions. Cat.No,63773S Foran 8038-G(Rev.9-setd
Forth a02e-a(Rev.92011) Page 2
FURVA Miscellaneous
35 Enter the amount of the state volume cap allocated to the issue under section 141(b)(5) 35
36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
(GIC)(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . 36a
b Enter the final maturity date of the GIC 1-
e
c Enter the name of the GIC provider III
37 Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans
to other governmental units . . . . . . . . . . . . . . . . . . . . . . . . 37
38a If this issue is a loan made from the proceeds of another tax-exempt issue,check box► ❑and enter the following information:
If Enter the date of the master pool obligation to
C Enter the EIN of the issuer of the master pool obligation►
d Enter the name of the issuer of the master pool obligation►
39 If the issuer has designated the issue under section 265(b)(3)(B)h)(III)(small issuer exception),check box ► ❑
40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate,check box . . . . . . . . . . . . . ► ❑
41a If the issuer has identified a hedge,check here► ❑ and enter the following information:
b Name of hedge provider III
c Type of hedge►
d Term of hedge I-
42
42 If the issuer has superintegrated the hedge,check box . . . . . . . ► ❑
43 If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated
according to the requirements under the Code and Regulations(see instructions),check box . . . . . . . . ► ❑
44 If the issuer has established written procedures to monitor the requirements of section 148,check box . . . . . ► ❑
45a If some portion of the proceeds was used to reimburse expenditures,check here► ❑ and enter the amount
of reimbursement . . . . . . . . . 10-
Is
b Enter the date the official intent was adopted►
Under penalties of perjury,I declare that I have examined this return and accompanying schedules and statemeni and to the best of my knowll
Signature and be;lec they are time,correct,and complete.I further declare that I consent to the IRS's disclosure of the issuer's humid information,as necessary to
and studies this
""Mum,to the pe that I have a dhor¢ed above.
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signawre or Iso s amn ized repres mire Data rypa or pant name and ane
Paid Pnn✓Iype preparers name Preparefs signature Data crack E] n PTIN
self-employed
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Form 8038-6(Rev.8-2011)
AFFIDAVIT
STATE OF TEXAS §
§
§ KNOW ALL MEN BY THESE PRESENTS:
COUNTIES OF WILLIAMSON §
&TRAVIS §
BEFORE ME, the undersigned authority, on this day personally appeared Alan McGraw,
known to me to be the person whose name is subscribed to the following instrument, and who,
being duly sworn upon his oath, deposed and stated as follows:
L "My name is Alan McGraw. I am the duly elected, qualified, and acting Mayor of the
City of Round Rock, Texas ("City"). I am over eighteen years of age, of sound mind, and
capable of making this affidavit. I have personal knowledge of the facts recited herein, and
competent to testify to all facts recited herein,and all such facts are true and correct."
2. "The City is the sole owner of the Property identified in Properly Schedule No. 2
("Property') of the Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp
Government Leasing and Finance, Inc. and the City of Round Rock and attached hereto as
Attachment A."
3. "Copies of the original titles in possession of the City have been attached hereto as
Attachment B."
4. "The City is in sole possession of the Property and has full rights and power to enter into
a Master Tax-Exempt Lease/Purchase Agreement for said Property." 'I
5. "The Property has all been acquired and is located in Round Rock,Texas."
6. "There are no pending suits or judgments, executions, attachments in any court other
forum with regard to the Property of any other legal obligations which may be enforced against
00309696/w2
the Property."
7. "The City has created a special Interest and Sinking Fund (the "Interest and Sinking
Fund") solely for the benefit of the Master Tax-Exempt Lease/Purchase Agreement for said
Property. The Interest and Sinking Fund shall be kept separate and apart from all other funds
and accounts of the City, and shall be used only for paying interest and principal in accordance
with Exhibit 1, Property Description and Payment Schedule, of the Master 'fax-Exempt
Lease/Purchase Agreement. All ad valorem taxes levied and collected for and on account of the
Master Tax-Exempt Lease/Purchase Agreement shall be deposited, as collected, to the credit of
the Interest and Sinking Fund. During each year while the principal and or interest thereon are
outstanding and unpaid, the governing body of the City shall compute and ascertain a rate and '.....
amount of ad valorem tax money required to pay the interest pursuant to Exhibit 1, Property
Description and Payment Schedule, of the Master Tax-Exempt Lease/Purchase Agreement as
such interest comes due, and to provide and maintain an Interest and Sinking Fund adequate to
pay the principal pursuant to Exhibit I, Property Description and Payment Schedule, of the
Master Tax-Exempt Lease/Purchase Agreement as such principal becomes due (but never less
than 2% each year), and said tax shall be based on the last approved tax rolls of the City, with
full allowance made for tax delinquencies and the cost of tax collection.
7. "The City designates Property Schedule No. 2 as "qualified tax-exempt obligation" as
defined in Section 265(b)(3)(B) of the Code. The City does not reasonably anticipate issuing
tax-exempt obligations in calendar year 2013 in an amount exceeding$10,000.00.
0 �/ V
Affiant
2
'i
STATE OF TEXAS § ill'
§ I
COUNTIES OF WILLIAMSON AND §
TRAVIS §
i
SUBSCRIBED AND SWORN TO ME BEFORE, on this the day of August,
2014,by Alan McGraw, to certify which witness my hand and seal of office.
VllqAU
NOTARY PUBLIC, STATE OF TEXAS
�SArk Lti,)(.1 UJW4C
PRINTED NAM F NES OTARY
MY COMMISSION EXPIRES:
"'!a"'Y SARA LEIGH7EXPI]RES
COMMISSIO
,Pr: JWy 11,
3