Contract - BSN Sports - 5/25/2017 Quote
Quote M 20882560
Purchase Order#: Soccer Goals
4 Cart Name:
135N SPORTS Quote Date: 02/22/2017
Quote Valid-to: 04/28/2017
1901 Diplomat Dr Payment Terms: NT30
FARMERS BRANCH,TX 75234
Tel:1-877-645-3050 Fax:1-800-899-0149 Ship Via:
Visit us at www.bsnsports.com Ordered By: Johnnie
Contact Your Rep
Nathan Hills Email:nhille@bsnsports.com I Phone:512-696-3295
Sold to Ship To Payer
1093467 1333969 1093467
CITY OF ROUND ROCK OLD SETTLERS PARK CITY OF ROUND ROCK
Attn: Accounts Payable ROUND ROCK PARK AND REC Attn: Accounts Payable
221 East Main St. 3300 PALM VALLEY BLVD 221 East Main St.
ROUND ROCK TX 78664 ROUND ROCK TX 78664 ROUND ROCK TX 78664
Item Descripllon Qlv Unit Price Total
3" Classic Alumagoal 8'X 24'WHITE 5 PR $ 1,885.99 $ 9,429.95
Item#-SGA300
3" Classic Alumagoal 6.5'X 18.5'WHITE 14 PR $ 1,639.99 $ 22,959.86
Item#-SGA302
SPRING BASIC FOUR CORNER SET 19 SET $ 139.39 $ 2,648.41
Item#-MK4X4S
Subtotal: $35,038.22
Other: $0.00
TEXAS BUY BOARD Freight: $0.00
44012(502.16) Sales Tax: $0.00
Order Total: $35,038.22
THANK YOUI Payment/Credit Applied: $0.00
Order Total: $35,038.22
Check your quote at www.bsnsports.com/1&ProgramlD=20882560&zip=78664
Page:1 of 1
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1041
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. 2017-195757
BSN Sports LLC
Dallas,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 04/20/2017
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 services,goods,or other property to be provided under the contract.
for soccer complex
multi purpose soccer goals
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.
1.41
6 AFFIDAVIT I swear,or affirm,under penalty o/perjury, he above disclosure Is true and correct.
SHERRYIQBAL CHRIS BL
MY COMMISSION EXPIRES OOMFIEL D
September 15,2017 � National Bid Director
Sign atur f authork4d agent of 96ntraA&N L)&AW0r'ts.com
AFFIX NOTARY STAMP/SEAL ABOVE q
Sworn to and subscribed before me,by the said t ( SG / �CZ t'7 this the Gy r1' day of ,
20__L7 ,to certify which,witness my hand and seal of office.
Signature of o er admi s6'Fng oath Printed na a of officer administering oath Title of office administering oath
Forms provided b�Texas Ethics/C/ommission www.ethics.state.tx.us Version V1.0.883
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 1
7-7
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. 2017-195757
BSN Sports LLC
Dallas,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 04/20/2017
being filed.
City of Round Rock Date Acknowledged:
04/25/2017
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.
for soccer complex
multi purpose soccer goals
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party.
X
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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883