R-2016-3184 - 1/28/2016 RESOLUTION NO. R-2016-3184
WHEREAS, the City of Round Rock ("City") desires to purchase a vehicle for the Fire
Department, and
WHEREAS, the City is a member of the Texas Government Statewide Purchasing
Cooperative ("Buy Board"), and
WHEREAS, Silsbee Ford is an approved vendor of the Buy Board, and
WHEREAS, the City wishes to issue a purchase order to Silsbee Ford, Now Therefore
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS,
That the City Manager is hereby authorized and directed to issue a purchase order to Silsbee
Ford for the purchase of a vehicle for the Fire Department.
The City Council hereby finds and declares that written notice of the date, hour, place and
subject of the meeting at which this Resolution was adopted was posted and that such meeting was
open to the public as required by law at all times during which this Resolution and the subject matter
hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act,
Chapter 551, Texas Government Code, as amended.
RESOLVED this 28th day of January, 2016.
ALAN MCGRAW, Mayor
City of Round Rock, Texas
ATTEST:
— slmm,�� - �44
SARA L. WHITE, City Clerk
0112.1604;00349974
CERTIFICATE OF INTERESTED PARTIES
FORM 129rJ
lofl
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. 2016-2909
Silsbee Ford Inc.
Silsbee,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 01/13/2016
being filed.
City of Round Rock Date Acknowledged:
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 goods or services to be provided under the contract.
000000
automobiles
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
Donalson, Drew Silsbee,TX United States X
5 Check only if there is NO Interested Party.
6 AFFIDAVIT I swear,or affirm,under penalty p rju ,that the above disclosure is true and correct.
t�t�Y pl-4�
SHIRLEY IRENE PAYNE
My Commission Expires
April 16,2019
Sr�FF OF ISE��g
Signatur of authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE `� 1 L' (��/�
Swo n(to,,and subscribed before me,by the said '' 1gl•� '7 y A/' this the day of71 1 I )
20 V/ ,to certify which,witness my hand and seal of office.
'S. If
Sign& re icer administering oath Printed name of offi r admini to ing oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.34032
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
10f1
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. 2016-2909
Silsbee Ford Inc.
Silsbee,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 01/13/2016
being filed.
City of Round Rock Date Acknowledged:
01/19/2016
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 goods or services to be provided under the contract.
000000
automobiles
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
Donalson, Drew Silsbee,TX United States X
5 Check only if there is NO Interested Parry.
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said this the day of
20 ,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Cnrmc nrmArlori by Tavnc Fthirc r•nmmiccinn MAMA/athirc ctnta tx nc VprSlOn V1.0.34032