Loading...
Contract - Southern Tire Mart - 10/14/2021CITY OF ROUND ROCK AGREEMENT FOR THE PURCHASE OF TIRE, TUBES, SUPPLIES AND EQUIPMENT WITH SOUTHERN TIRE MART, LLC THE STATE OF TEXAS § CITY OF ROUND ROCK § COUNTY OF WILLIAMSON § COUNTY OF TRAVIS § KNOW ALL BY THESE PRESENTS: THAT THIS Agreement for the purchase of tire, tubes, supplies and equipment needed to maintain City of Round Rock owned vehicles (referred to herein as the "Agreement"), is made and entered into on this the 144'S dayof the month of &,A'4w'VX1L ,2021, b and between y the CITY OF ROUND ROCK, TEXAS, a home -rule municipality whose offices are located at 221 East Main Street, Round Rock, Texas 78664 (referred to herein as the "City") and SOUTHERN TIRE MART, LLC, whose offices are located at 800 Highway 98, Columbia, MS 39429 (referred to herein as the "Vendor"). RECITALS: WHEREAS, City desires to purchase tires, tubes, supplies and equipment and related services needed for the maintenance of City owned vehicles; and WHEREAS, City is a member of BuyBoard Cooperative and Vendor is an approved BuyBoard vendor; and WHEREAS, the City desires to purchase certain goods and services from Vendor through BuyBoard Cooperative Contract No. 636-21 to receive pricing and services as set forth herein; and WHEREAS, the parties desire to enter into this Agreement to set forth in writing their respective rights, duties, and obligations; NOW, THEREFORE, WITNESSETH: That for and in consideration of the mutual promises contained herein and other good and valuable consideration, sufficiency and receipt of which are hereby acknowledged, it is mutually agreed between the parties as follows: 1.01 DEFINITIONS A. Agreement means the binding legal contract between City and Vendor whereby City agrees to buy specified goods and/or services and Vendor is obligated to provide said 00481506/ss2 '� 2v21 .2�� goods/seryices. The Agreement includes any exhibits, addenda, and/or amendments thereto. Be City means the City of Round Rock, Williamson and Travis Counties, Texas. co Effective Date means the date upon which the binding signatures of both parties to this Agreement are affixed. D. Force Maj*eure means acts of God, strikes, lockouts, or other industrial disturbances, acts of the public enemy, orders of any kind from the govel-l"no-nent of the United States or the State of Texas or any civil or me litary authority, insurrections, riots, epidemics, landslides, lightning, earthquakes, fires, hurricanes, storms, floods, restraint of the government and the people, civil disturbances, explosions, or other causes not reasonably within the control of the party claiming such inability. E. Goods and services mean the spec40 ified services, supplies, materials, commodities, or equipment. 2.01 EFFECTIVE DATE AND TERM A. This Agreement shall be effective on the date i*t has been signed by both parties hereto, and shall remain in full force and effect, unless and until i*t expires by operation of the term stated herein, or until terminated as provided herein. Be The term of this Agreement shall be from the effective date of the Agreement until February 29, 20240 City reserves the right to review the relationship at any time, and may 41 elect to terminate this Agreement, with or without cause, or may elect to continue. 3.01 CONTRACT DOCUMENTS AND EXHIBITS City selected Vendor to supply the goods and services as outlined len Exhibit "A," attached hereto and incorporated herein by reference. The goods and services which are the subject of this Agreement are described in Exhibit "A" and, together with this Agreement, comprise the total Agreement and they are fully a part of this Agreement as if repeated herein in full. 4.01 ITEMS AWARDED AND SCOPE OF WORK When taken together with the appended exhibit, this Agreement shall evidence the entire understanding and agreement between the parties and shall supersede any prior proposals, correspondence or discussions. Vendor shall satisfactorily provide all goods and services described under the attached Exhibit "A" at the sole request of the City. Vendor provide goods md services in accordance with this Agreement, in accordance with the appended exhibits, in accordance with due care, and in accordance with prevailing industry standards for comparable services. 2 5.01 COSTS A. City agrees to pay for goods during the term of this Agreement at the pricing set forth I*n Exhibit "A." Be The City is authorized to pay the Vendor an amount not -to -exceed Sixty -Five Thousand and No/100 Dollars ($65 000.00) for the term of this Agreement. 6.01 INVOICES All invoices shall include, at a minimum, the following information: A. Name and address of Vendor; Be Purchase Order Numbers C. Description and quantity of items received or services provided; and A. Delivery or performance dates. 7.01 NON -APPROPRIATION AND FISCAL FUNDING This Agreement is a coloilli-itment of City's current revenues only. It is understood and agreed that City shall have the right to terminate this Agreement at the end of any City fiscal year if the governing body of City does not appropriate funds sufficient to purchase the services as determined by City's budget for the fiscal year in question. City may effect such termination by giving Vendor a written notice of termination at the end of its then current fiscal year. 8.01 PROMPT PAYMENT POLICY In accordance with Chapter 2251, V.T.C.A., Texas Government Code, payment to Vendor will be made within thirty (30) days of the day on which City receives the performance, supplies, materials, equipment, and/or deliverables, or within thirty (30) days of the day on which the performance of services was complete, or within thirty (30) days of the day on which Is City receives a correct invoice for the performance and/or deliverables or services, whichever is later. Vendor may charge interest on an overdue payment at the "rate i*n effect" on September 1 of the fiscal year i*n which the payment becomes overdue, i*n accordance with V.T.C.A., Texas Government Code, Section 2251025(b); however, this Policy does not apply to payments made by City in the event: A. There i*s a bona fide dispute between City and Vendor, a contractor, a subcontractor or supplier about the goods delivered or the service performed that cause the payment to be late; or 3 B. The terms of a federal contract, grant, regulation, or statute prevent City from making a timely payment with federal funds; or C. There is a bona fide dispute between Vendor and a subcontractor or between a subcontractor and its supplier about the goods delivered or the service performed that causes the payment to be late; or B. Invoices are not mailed to City in strict accordance with instructions, if any, on the purchase order or the Agreement or other such contractual agreement. 9.01 GRATUITIES AND BRIBES City may, by written notice to Service Provider, cancel this Agreement without liability to Vendor if it is determined by City that gratuities or bribes in the form of entertainment, gifts, or otherwise were offered or given by Vendor or its agents or representatives to any City officer, employee or elected representative with respect to the performance of this Agreement. In addition, Vendor may be subject to penalties stated in Title 8 of the Texas Penal Code. 10.01 TAXES City is exempt from Federal Excise and State Sales Tax; therefore, tax shall not be included in Service Provider's charges. 11.01 ORDERS PLACED WITH ALTERNATE SERVICE PROVIDERS If Vendor cannot provide the goods as specified, City reserves the right and option to obtain the products or services from another supplier or suppliers. 12.01 INSURANCE Vendor shall meet all requirements required by the City as set forth in Exhibit "B," attached hereto and incorporated herein by reference for all purposes. 13.01 CITY' S REPRESENTATIVE City hereby designates the following representatives authorized to act in its behalf with regard to this Agreement: Chad McDowell Director of General Services 220 Commerce Cove Round Rock, Texas 78664 (512) 341-3191 cmcdowell(a,roundrocktexas.yov � r 4 14.01 RIGHT TO ASSURANCE Whenever either party to this Agreement, Is in good faith, has reason to question the other party 19 s intent to perform hereunder, then demand may be made to the other party for written In assurance of the intent to perform. In the event that no written assurance is given within the reasonable time specified when demand i*s made, then and i*n that event the demanding party may 40 40 treat such failure as an anticipatory repudiation of this Agreement. 15.01 DEFAULT If Vendor abandons or defaults under this Agreement and is a cause of City purchasing the specifiedied goods elsewhere, Vendor agrees that t may be charged the difference in cost, if any, and that it will not be considered i*n the re -advertisement of the service and that i*t may not ID be considered in future bids for the same type of work unless the scope of work is significantly changed. Vendor shall be declared in default of this Agreement if it does any of the following0 : A. Fails to make any payment in full when due; Be Fails to fully, timely and faithfully perform any of its material oblIs igations under this Agreement; Co Fails to provide adequate assurance of performance under the "Right to Assurance" section herein; or D. Becomes insolvent or seeks relief under the bankruptcy laws of the United States. 16.01 TERMINATION AND SUSPENSION A. City has the right to terminate this Agreement, in whole or in part, for convenience and without cause, at any time upon thirty (30) days ' written notice to Vendor. Be In the event of any default by Vendor, City has the right to terminate this Agreement for cause, upon ten (10) days' written notice to Vendor. C. Vendor has the right to terminate this Agreement only for cause, that being in the event of a material and substantial breach by City or by mutual agreement to terminate evidenced in writing by and between the parties. D. In the event City terminates under subsections (A) or (B) of this section, the following shall apply: Upon City's delivery of the referenced notice to Vendor, Vendor shall discontinue all services in connection with the performance of this Agreement and shall proceed to cancel promptly all existing orders and contracts insofar as such orders and contracts are chargeable to this Agreement. Within thirty (30) days after such notice of termination, Vendor 5 shall submit a statement showing in detail the goods and/or services satisfactorily performed 40 under this Agreement to the date of termination. City shall then pay Vendor that portion of the charges, if undisputed. The parties agree that Vendor is not entitled to compensation for services it would have performed under the remaining term of the Agreement except as provided herein. 17.01 INDEMNIFICATION Vendor shall defend (at the option of City), indemnify, and hold City, its successors, assigns, officers, employees and elected officials harmless from and against all suits, actions, legal proceedings, claims, demands, damages, costs, expenses, attorneys fees, and any and all other costs or fees arising out of, or incident to,, concerning or resulting from the fault of Service Provider, or Service Provider's agents, employees r subcontractors, in the performance of Vendor's obligations under this Agreement, no matter how, or to whom, such loss may occur. Nothing herein shall be deemed to limit the rights of City or Vendor (including, but not limited to the right to seek contribution) against any third party who may be liable for an indemnified Claim,, 18.01 COMPLIANCE WITH LAWS, CHARTER AND ORDINANCES A. Vendor, its agents, employees and subcontractors shall use best efforts to comply with all applicable federal and state laws, the Charter and Ordinances of the City of Round Rock, as amended, and with all applicable rules and regulations promulgated by local, state and national boards, bureaus and agencies. B. In accordance with Chapter 2271, Texas Government Code, a governmental entity may not enter into a contract with a company for goods and services unless the contract contains written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. The signatory executing this Agreement on behalf of Vendor verifies Vendor does not boycott Israel and will not boycott Israel at any time during the term of this Agreement. 19.01 ASSIGNMENT AND DELEGATION The parties each hereby bind themselves, their successors, assigns and legal representatives to each other with respect to the terms of this Agreement. Neither party shall assign, sublet or transfer anyy interest in this Agreement without prior written authorization of the other party,, 20.01 NOTICES All notices and other communications in connection with this Agreement shall be 1'*n writing and shall be considered given as follows: 1. When delivered personally to the recipient's address as stated in this Agreement; or l$I 2. Three (3) days after being deposited i*n the United States mail, with postage prepaid to the recipient's address as stated in this Agreement. Notice to Vendor: Southern Tire Mart, LLC 800 Highway 98 Columbia, MS 39429 Notice to City: City Manager Stephen L. Sheets, City Attorney 221 East Main Street AND TO: 309 East Main Street Round Rock, TX 78664 Round Rock, TX 78664 Nothing contained herein shall be construed to restrict the transmission of routine communications between representatives of City and Vendor. 21.01 APPLICABLE LAW; ENFORCEMENT AND VENUE This Agreement shall be enforceable in Round Rock, Texas, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for same shall lie in Williamson County, Texas. This Agreement shall be governed by and construed in accordance with the laws and court decisions of the State of Texas. 22.01 EXCLUSIVE AGREEMENT This document, and all appended documents, constitutes the entire Agreement between Vendor and City. This Agreement may only be amended or supplemented by mutual agreement 40 of the parties hereto in writing, duly authorized by action of the City Manager or City Council. 23.01 DISPUTE RESOLUTION City and Vendor hereby expressly agree that no claims or disputes between the parties In arising out of or relating to this Agreement or a breach thereof shall be decided by any arbitration proceeding, including without limitation, any proceeding under the Federal Arbitration Act (9 USC Section 1-14) or any applicable state arbitration statute. 24.01 SEVERABILITY The invalidity,invalidity,illegality,41 or unenflorceability of any provision of this Agreement or the occurrence of any event rendering any portion or provision of this Agreement void shall in no Is way affect the validity or enforceability of any other portion or provision of this Agreement. Any void provision shall be deemed severed from this Agreement, and the balance of this Agreement shall be construed and enforced as if this Agreement did not contain the particular portion or 7 provision held to be void. The parties further agree to amend this Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. The provisions of this section shall not prevent this entire Agreement from being void should a provision which is of the essence of this Agreement be determined void. 25.01 MISCELLANEOUS PROVISIONS Standard of Care. Vendor represents that it employs trained, experienced and competent persons to perform all of the services, responsibilities and duties specified herein and that such services, responsibilities and duties shall be performed i*n a manner according to generally accepted industry practices. Tiis of the Essence. Vendor understands and agrees that time imes of the essence and that any failure of Vendor to fulfill obligations for each portion of this Agreement within the agreed ti*meframes will constitute a material breach of this Agreement. Vendor shall be fully responsible for its delays or for failures to use best efforts in accordance with the terms of this Agreement. Where damage is caused to City due to Service Provider's failure to perform in these circumstances, City may pursue any remedy available without waiver of any of City s additional legal rights or remedies. Force Majeure, Neither City nor Vendor shall be deemed in violation of this Agreement if it is prevented from performing any of its obligations hereunder by reasons for which it is not responsible as defined herein,, However, notice of such impediment or delay i*n performance must be timely given, and all reasonable efforts undertaken to mitigate lets effects,, Multiple Counterparts,, This Agreement may be executed in multiple counterparts, any one of which shall be considered an original of this document; and all of which, when taken together, shall constitute one and the same instrument,, [Signatures on the following page.] 8 IN WITNESS WHEREOF, City and Vendor have executed this Agreement on the dates indicated. City of Round Rock, Texas By: Printed Name: Title: MA Date Signed: _ Attest: By: ff)k U Sara White, City Clerk For City, roved as to Form: By: Stepha L. Sheets, City Attorney Southern Ti h Printed Name: Richard Conwill Title: Director of Government Sales Date Signed: 9/16/2021 9 LXnllDlt "A" Board' nNUMMMA - mom Proposal No. 636-21 for Tires,, Tubes, Supplies and Equipment EVALUATION ITEMS (As Specified) EVALUATION ITEMS; The requested pricing information will only be used for purposes of assisting with the evaluation of a Vendor's price competitiveness as it pertains to this proposal invitation. These items will not be individually awarded. THE FOLLOWING EVALUATION ITEMS MUST BE COMPLETED FOR EITHER THE AS SPECIFIED OR ALTERNATE PRODUCT. Equal alternates may be submitted on the separate EVALUATIONS ITEMS (Alternates) form only if you do not sell the specific product listed. This form must be fully completed and returned or PROPOSAL RESPONSE WILL NOT BE CONSIDERED. Vendors that do not offer any of the evaluation or alternate items listed below shall slibmit M wn-ilLen IMCE DEgvidina eX121griation Mgugafinq_ exemgWon from this ECqUitgme The Cooperative may determine., in its sole discretion, whether or not to exempt a vendor from this requirement based on all information provided with the proposal response. AS SPECIFIED Calculated Buyboard AS SPECIFIED Price Indicate Discount i� (catalog/pricelist price less Item Specified I 1� (as stated company s discount proposed N 0. Brand Model Size Description Qty. - proposal response) Buyboard Price) 223.97 45 124e40 Firestone FRHWK GT V PRST P265/60R17 Pursuit 1$-- $ 191.49 42 111.70 2 Firestone FRHWK GT Z PRST 235/55R17 Pursuit 1 $ P/0 $ 235.37 48 122_.66 3 Firestone DES7LE2 P265/70R17 Passenger 1 $ % $ _ 6_ 1 2 4 31 112. 0 0 4 Firestone TRAN HT LT245/75R16 Light Truck $ -, ,_. -7 - - - - 160 1--5 114.50 5, Firestone TRAM HT LT225/75R16 Light Truck $ -, ." 830.55 43 474.57 6 Firestone SSG RB TG 14.00-24 Off The Road 1 0/0 Page 40 of 68 EVALUATION ITEMS txnibit AFLoqrdImm6w Proposal No. 636-21 for Tires, Tubes, Supplies and Equipment EVALUATION ITEMS (As Specified) AS SPECIFIED calculated Buyboard AS • , AS • , Price PriceUnit Indicate Discount (catalog/pricelistprice less Item Specified (as stated in proposed • • company's discount proposed No. Brand Model Size Description Qty. • • proposal r- • • -) Buyboard Price) 814.62 56 362.00 Medium 7 Bridgestone R268 ECaPIA 11R24.5 Truck/School School Bus 1 � �-���M-����.�...,.�.��.�.._ .� °f� $ .b._ . ....._ Medium 1 132.3 1 52 550.00 8, Bridgestone g M860A 315/80R22.5 Truck/School Bus 1 $ ' ..__ _ _ _�_� Goodyear EAG RSA VSB 265/60R17 Pursuit 1 ALTERNATE $ _ $�_ ALTERNATE 0 Goodyear INTEGRITY B03 225 60R 16 97S Passenger 1 $ I Goodyear WRL SRA 265/65R18 Light Truck 1 ALTERNATE $ $ 112TS B L . _ ..,� . _�... 12 Goodyear WRL SRA 265/75R16 OWL Light True _�_ ALTERNATE $ � _�`�� $ 10 . . „.,. ALTERNATE 3 Goodyear G661 HAS 12R22.5 TL 16 Medium Truck 1 $ �.�...� o to $ 291.00 50„_ 145,50 14 Michelin LTX A,j� LT245/75R16 � Light Truck � ..... ..,___... r....� ���� $ �_,.. ALTERNATE 15 Michelin XPS RIB LT245/75R 16 Light Truck $ Page 41 of 68 EVALUATION ITEMS LXMIDIt "A" s PWLoqrd a" 6mal Proposal No. 636-21 for Tires, Tubes, Supplies and Equipment EVALUATION ITEMS (As Specified) SPECIFIED CalculatedAS Buyboard SPECIFIED SPECIFIEDAS AS Price IndicateUnit •(catalog/ price I ist price Item Specified (as stated in proposed -• • •. discount proposed No. Brand Model Size Description cata • • 301.19 proposal 50 res• • • •. • ' • 150.59 16 Michelin DEFENDER LT}C M/S P275/55R20 Light Truck 1 $ M ................. % $ COMMERCIAL TEA 262.28 50 131,14 17 BF Goodrich ALL SEASON 2 112R LT225/75R16 Light Truck 1 ° COMMERCIAL TEA 274,92 50 137.46 1 BF Goodrich ALL SEASON 2 12OR 'LT255/75R16 Light True � $ _._�..� � �._ _.'�%p $ . _ ..... ..m..,,,rv._..... LONG TRAIL T/A 284.40 50 142.20 1 BF Goodrich TOUR 114T P275/6OR20 Light Truck 1 $ $ LONG TRAIL T/A 175.38 50 87-69 20 BF Goodrich JL TOUR XL 108T LT235/75R15 Light Truck 1 $ % $ Page 42 of 68 EVA LL.JATI O N T E M S Exr1lbit "All Board'Imom Proposal No. 636-21 for Tires,, Tubes,, Supplies and Equipment EVALUATION ITEMS (Alternates) EVALUATION ITEME: The requested pricing information will only be used for purposes of assisting with the evaluation of a Vendor's price competitiveness as it pertains to this proposal invitation. These items will not be individually awarded. THE FOLLOWING EVALUATION ITEMS MUST BE COMPLETED FOR EITHER THE AS SPECIFIED OR ALTERNATE PRODUCT, Equal alternates may be submitted on the separate EVALUATIONS ITEMS (Alternates) form only if you do not sell the specific product listed. This form must be fully completed and returned or PROPOSAL RESPONSE WILL NOT BE CONSIDERED, Vendors that do not offer any of the evaluation or alternate items listed below shall submit a wr:i=n I jDrovidina exDLqnajjoq reqyesbna. exem2li:on f m this reauirement. The Cooperative may determine,, in its sole discretion, whether or not to exempt a vendor from this requirement based on all information provided with the proposal response. EQUAL ALTERNATE EQUAL EQUAL EQUAL Calculated ALTERNATE ALTERNATE ALTERNATE Buyboard Price Indicate Brand Indicate Unit Price Indicate Discount (catalog/pricelist and Model as stated in your (as stated in your price less discount 'Item Specified Number and company's company's proposal proposed No. Brand Model Size Description Qty. Catalog Paae No. catalog/ pricelist response) Buyboard Price) 1 Firestone FRHWK GT V PRST P265/60R17 Pursuit $ $ 2 Firestone FRHWK GT Z PRST 235/55RI7 Pursuit 1 $ % $ 3 Firestone DES-rLE2 P265/701117 Passenger 1 $ % $ 4 Firestone TRAN HT LT245/75R16 Light Truck 1 ............................ $ 5 Firestone TRAN HT LT225/75R16 Light Truck 1. . . . . . . . . . . . . . . . . $ $ 6 Firestone SSG RB TG 14.00-24 Off The Road 1 $ % $ Page 43 of 68 EVALUATION ITEMS Exnibit "H" Board' Proposal No. 636-21 for Tires, Tubes, Supplies and Equipment EVALUATION ITEMS (Alternates) g EQUAL ALTERNATE EQUAL EQUAL EQUAL Calculated ALTERNATE ALTERNATE ALTERNATE Buyboard Price Indicate Brand Indicate Unit Price Indicate Discount (catalog/ pricel ist and Model as stated in your (as stated in your price less discount m Specified Number and company's company's proposal proposed = o. Brand Model Size Description Cata�o4 Page No. catalog/ r�celist r��r�se) BLy�rd Price) I --- I-- I 7 Bridgestone R268 ECOPIA 11 R24.5 Medium Truck/School $�� % $ Bus 8 Bridgestone M860A 315/80R22.5 Medium Truck/School 1 $ o ......�w..�.�.�.�..,.r..� f� $ ... u.. ,_ . Bus Goodyear EAG RSA VSB 265/60R17 08V Pursuit 1 Fir"tone Firehawk GTV ���� #02���9 223.97 46 �9 124.40 $ Fi�tone Catalog $/� Page 1 Firestone cnamglor, Fuel 100.74 20 80.60 10 Goodyear INTEGRITY B03 225/60R16 97S Passenger 1Fightw0°'�7$W Firestone Catalog Page 8 � W W �� I� Goodyear WRL 5RA 265/65R18 112T Light Truck Firestone Destination �.�3 #�itJ�389Firestone� 244.23 $/c� 208 � 4•11 $ BSL Catalog Page 4 12 Goodyear WRL 5RA 265/75R16 OWL Truck 1 � . � �� �� PAW� 176.96 $$ 2 o '�3,9? 10Light ,�„ E Firestone FS561 #248494 Firestone 686.20 36 �, 347 13 Goodyear G661 HAS 12R22.5 TL 16 Medium Truck $ ,�, $ Catalog Page 14 14 Michelin LTX A/'T'2 LT245/75R16 Light Truck 1 $r°l� $ 15 Michelin XPS RIB LT245/75R16 Li ht Truck 1 Mdgeg#Dne V-SWel Rib 265 #003489 190,79 2O °Ire 1 3 Bridgestone Catalog Page 9 Page 44 of 68 EVALUATION ITEMS Exn i bit "till oar ,Owe Proposal No. 636-21 for Tires, Tubes, Supplies and Equipment EVALUATION ITEMS (Alternates) EQUAL ALTERNATE EQUAL EQUAL EQUAL Calculated ALTERNATE ALTERNATE ALTERNATE Buyboard Price Indicate Brand Indicate Unit Price Indicate Discount (catalog/ pricelist and Model as stated in your (as stated in your price less discount Item Specified Number and company's company's proposal proposed = No. Brand Model Sire Description Qty, Catalog Pale No. catal / ricelist response) Buyboard Price 16 Michelin DEFENDER LTX M/S P275/55R20 Light Truck $ ___ __ % $ COMMERCIAL T/A 17 BF Goodrich ALL SEASON 2 LT225/75R16 Light Truck $ °Yo $ 112R COMMERCIAL T/A 18 BF Goodrich ALL SEASON 2 LT265/75R16 Light Truck 1 $ % $ 12BR 19 BF Goodrich LONG TRAIL T/A P275/60R20 Light Truck°/�o $ TOUR 114T _ 20 BF Goodrich LONG TRAIL T/ALT235/75R15 Light Truck $ % $ TOUR XL 108T Page 45 of 68 EVALUATION ITEMS CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 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 Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2021-803162 Southern Tire Mart, LLC Columbia, MS United States Date Filed: 09/17/2021 2 Name of governmental entity or state agency that is a party to the contract for which the form is 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. 000000 Tires 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Duff, James Columbia, MS United States X Duff, Thomas Columbia, MS United States X 5 Check only if there is NO Interested Party. 6 UNSWORN DECLARATION My name is Richard Conwill , and my date of birth is My address is 800 Highway 98 Columbia MS 39429 USA (street) (city) (state) (zip code) (country) declare under penalty of perjury that the foregoing is true and correct. Executed in Marion County, State of MS , on the 17 day of Sept. , 20 2 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191bbcdc CERTIFICATE OF INTERESTED PARTIES FORm 1295 10fi 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 Certificate Number: i Name of business entity filing form, and the city, state and country of the business entity's place of business. 2021-803162 Southern Tire Mart, LLC Columbia, MS United States Date Filed: 09/17/2021 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Round Rock Date Acknowledged: 09/28/2021 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. 000000 Tires 4 Nature of interest Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary Duff, James Columbia, MS United States X Duff, Thomas Columbia, MS 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 , (street) (city) (state) (zip code) (country) 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 contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1,191b5cdc