Contract - Siddons-Martin - 10/13/2016�ytx ��'� QT "3'0.64.•
„ t -ding the Southwest
January 11, 2016
Round Rock Fire Department
203 Commerce
Round Rock TX 76645
3500 Shelby Lane
Denton, Texas 76207
GDN P115891
TXDOT MVD No. A115890
EIN 27-4333590
RE: Proposal for 100' PAP
Siddons-Martin Emergency Group, LLC is pleased to provide the following proposal to Round Rock Fire Department. Unit will
comply with all specifications attached and made a part of this proposal. Total price includes delivery FOB Round Rock Fire
Department and training on operation and use of the apparatus.
Amount
Description
EP804488-395 Dash CF 100' Aluminum Platform
Pierce, Dash CF, Aerial, Platform - Alum, DD13 500hp, 300 gal, PUC 1500
Price guaranteed for 30 days. Delivery within 8 9 months of order date. A Vehicle Price $ 1,264,537.00
warranty term of 12 months is included. E uipment $ 26,588.00
q
SUB TOTAL $ 1,291,125.00
BuyBoard 399-12 $ 1,500.00
TOTAL $ 1,292,625.00
Additional. Total price includes 2 factory trips for 6 persons each.
Taxes. Tax is not included in this proposal. In the event that the purchasing organization is not exempt from sales tax or any
other applicable taxes and/or the proposed apparatus does not qualify for exempt status, it is the duty of the purchasing
organization to pay any and all taxes due. Balance of sale price is due upon acceptance of the apparatus at the factory.
Late Fee. A late fee of .033% of the sale price will be charged per day for overdue payments beginning ten (10) days after the
payment is due for the first 30 days. The late fee increases to .044% per day until the payment is received. In the event a
prepayment is received after the due date, the discount will be reduced by the same percentages above increasing the cost of
the apparatus.
Acceptance. In an effort to ensure the above stated terms and conditions are understood and adhered to, Siddons-Martin
Emergency Group requires an authorized individual from the purchasing organization sign and date this proposal and include it
with any purchase order. Upon signing of this proposal, the terms and conditions stated herein will be considered binding and
accepted by the Customer. The terms and acceptance of this proposal will be governed by the laws of the state of TX. No
additional terms or conditions will be binding upon Siddons-Martin Emergency Group unless agreed to in writing and signed by
a duly authorized officer of Siddons-Martin Emergency Group.
Sincerely,
Travis Walden
Siddons-Martin Emergency Group, LLC
01-11-2016
proposal 300062.7
1/I
Farms provided by Texas Ethics Commission www.ethics.state.tx.us version v:L.u.zi i
CERTIFICATE OF INTERESTED PARTIES
FORM 3.295
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
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2016-105515
Siddons Martin Emergency Group, LLC
Houston, TX United States
Date Filed:
08/29/2016
2 fame of govemmental 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
description of the services, goods, or other property to be provided under the contract
the contract, and provide a
Fire Truck
100' Aluminum Platform Fire Truck
4
Name of Interested Party
City, State, Country (place of business)(check
Nature of interest
applicable)
Controlling
intermediary
Martin, Jr., Leon
Houston, TX United States
X
Sid Ions, Patrick
Houston, TX United States
X
5
Check only if there is NO Interested Party. ❑
6
AFFIDAVIT I swear, or affirm, under penalty of perjury, that the
above disclosure is true and correct
CINDY L. HUMPHRIES
Notary Public. State of Texas
P �1=J My Commission Expires
April 26, 2017
�,.
Sfgnaty of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said 11 a tkrWl (0 111f this the f� r t day of
0 r , to certify which, witness my hand and seal of office.
(101d—i 111L'" " -" �61& L'� ALIQ's
Signatu e of officer adniini tering oath Printed n me of officer administering oath Title of offic r administering oath
Farms provided by Texas Ethics Commission www.ethics.state.tx.us version v:L.u.zi i
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
10f1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2016-105515
Date Filed:
08/29/2016
Date Acknowledged:
08/31/2016
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Siddons Martin Emergency Group, LLC
Houston, TX United States
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
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.
Fire Truck
100' Aluminum Platform Fire Truck
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
Martin, Jr., Leon
Houston, TX United States
X
Siddons, Patrick
Houston, 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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277