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Contract - Freightliner of Austin - 10/14/2021FREIGHTLINER O 1-rol, Soft FM. it". U0 so-) &W. 5U-M� Austa. Toms 78721 FAX: 512-389-2663 Wets.* I-SM3W2005 CITY OF ROUND ROCK 4001"NS 221 E. MAIN ST 2023 FREIGHTLINER " M2106 L A docufftntary fee Ls not an olwal fee, a docunw1ary fee is not required by law but OW be charged to buyers (or handUng, documents and Worming se(vices retatft to the the closing of a sale. Buyers wary avoid payment of the fee 1 to the selW by handMg the documeM and performing ft se vices relating to the dosing of "sale. A documentary fee may riot exceed $50.00. Thft notice Is required by law. El oofxv docunvntal no es un cotwo 017cfel. ET coft docuinentW no es un requisito belo to ley,, pero se to puede cobtar. Al cwpf;odcw por el rendimlento de 16$ servkW refeclonados con la completadon de la vente y Por comp1mr los docomentos. FJ comprador puede evitar el pogo at vendedor do este costo V el compmW mis" se encarga de mandejer los dwumentos y do los ser&ks necesarlos pars 1A completaclw do to vents. El co documental no puede sobmpasar Jos $50.00 (U.S.) Este aWso es requefido balo la ley. �-MMMMMMMMMM I Disclaimer of Warranties Any warranties on the prod" sold hem" aie those made by the factory. The SeNer,PeAghfter of AusAn, hereby expres* disclaims all wsrmnties, ewer twessed or implied Including any JmplW warmnty of merchantability or ARAM for a particular purpose, and FMAWner of Awfin. neither assumes not authatizes any other person to assume 1cm It iary flability in connection with ft We of this vehicie. ROUND ROCK (2) STORSE LIGHTS RECESSEDIN CMOMER SIGNMME MGM SIGNATURE KEVIN KRIEG **Wow Wo forth v0 f� SO )4 tz AS3 �S`1 Si2-2i&557i STAN cCQE TX f78664 ME" LM 70YAL ---- -- ---- '%*4t4U:).ZV PAYOFF TO; 7nWo #Vky*ar= N/A ADORES& N/A TELEPWNE- FAX Solos Tax N/A GOOD UNITIL- vehicte If*&" TeX WA QUOTED BY: License Fee N/A WOW U94 TO: Body Tom. Docunumtsty Fee N/A ADDRESS: U=46 WL t Faftef Excise Toz N/A sum kw.: ----- ---------- TOTAL SALE PRIME 4541,405-20 MATED; UEN AMOtOFT S "If on Tiede DRAFT FOR S Adf*eM*M DRAFT IMU.- TratWer. Len DeMalt ADDRUS-, Total ealanvi Oita 4 AM fat 0000wo 00ownd ►I low 1 ***A~ or, the Cams~ 0"*M" Aa AW W* &"M two~ 00" coft we 1* 4"a FM Is OWOAWN~ of 8 M wo lion MM64"M WIN!** 1163*06famellso W4 so~ er of a" how,, VOW W%ft#*WAdft ow Or 61 oft WAW'km- of no *a 16618MM" a to 1 0 � 14 so, 0 SM WO PW*%NW SW*Mft T# OOK Oft 4W WftOW 0% Of 0 00 IP 00" 111AM%ftft-0 ?BONN~ WO MIke WA ft*p%w* rodIft C" kv &MMAMM" if-ft. .100 PM - -0. a ill ft % 10 am"O Now w4wowd 004A&MMOMM A#MwvQftMft4M-jrVW 166"M I a boof V"fevw pt*sgism how tv ftaow a 8 dMko) a 6(Art Mfi*ft*"%* Of #AMU". UWA$ R-Zpy1 �Z�S CERTt�ICATE QF II�TERES1`EC� ---------------e------------------ -- ----.-.I -- .- ------ 11 i -.- � --. - - ------ -----.------------ ---- -- PARTIES FoRM �.95 ----------- -- - -- 1of7 ----*- Camplete:Nod.1-4----- a- - -------------------- --- ---------------- ---------------- —0 i A'A i ------ --------- 'ndll.'..f.. them---. N- . -.. a-.-.N.--. r-..-.U-.. e in. @. so terested parties. 0FFtCE U. .....SA t3NLY OMplete Nos,1, 2-t , 3, 5. and 8 if theVno'inierepiare sted rties... GEftTiFiG�tiT1.t,�N O� FIL.... 11V�, --:--------- ------------ ,- ­ ------ -------- --- ------------ .- M. . - - .N.. - ......-.-.-.-.--.-. --------- ----- -------------------- ------------ --- — - ------------------------- ------------- -------- ---W ----�----.---- ------ .. 1 Namevf business eniity tilinglormdherv, an , state and'06htysofthe L usiness entity's pJacerCe of husit►ess: �021-79751 Freigh�ner of n AutJn,"X Utes. Cate Fited 2 amen government enYor state agency t is a party tot e contrast' ar w �c e #arm is 09101/2021 ....... ..... being filed. City 0fKOUnd Rack Daxe w 3Wld- -------------- — ----- ------ --------------- -------------- ----------------- -- - ------------ ------ -------- — ----------- ---------- ------- ------ ged. Provide tho identification number used-b y the governrne»tal entity or state agency to track +ar ider�tifiy the.canttact, and provide a CERTIFICATE OF INTERESTED PARTIES FORM 1295 10fl 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. 2021-797513 Freightliner of Austin Austin, 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 09/01/2021 being filed. City of Round Rock Date Acknowledged: 09/02/2021 g Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract. 000000 Dump Trucks 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Hempel, Carlton Austin, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is ,and my date of birth is My address is I It (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed i n 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 www,eth ics state Ax. us Version V1.1,191b5cdc