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HomeMy WebLinkAboutPO 6874: CONTRACT WITH RENE BATES AUCTIONEERS, INC. e 1 City of :1 rthur Texas INTEROFFICE MEMORANDUM Office of the Finance Department Date: June 12, 2020 To: Ron Burton, City Manager From: Clifton Williams, Purchasing Manager RE: Proposed Ordinance Number 6874 Nature of the request: Purchasing Division is requesting the sale of Surplus Furniture/Equipment, Minor Equipment, Vehicles, and Heavy Equipment Staffing Analysis, Considerations: None Recommendation: Purchasing is requesting that City Council approve PO No. 6874 authorizing the sale of Surplus using online auction through Renee Bates Auctioneers, Inc. Budget Consideration: N one P. O.No. 6874 06/08/20 CR Page 1 ORDINANCE NO. AN ORDINANCE AUTHORIZING THE SALE OF SURPLUS FURNITURE/MINOR EQUIPMENT, VEHICLES, EQUIPMENT, OR HEAVY EQUIPMENT BY A PUBLIC ONLINE AUCTION THROUGH RENE BATES AUCTIONEERS, INC. WHEREAS, the City of Port Arthur has surplus property as described in Exhibit "A" to wit; assorted furniture/minor equipment, vehicles, equipment, or heavy equipment surplus which has become obsolete and/or non-functional; and WHEREAS, it has been determined that it would be in the best interest of the City to sell said property at an online auction to obtain the best possible price. NOW,THEREFORE BE IT ORDAINED BY THE CITY OF PORT ARTHUR: Section 1. That the City Council authorizes the City Manager, together with the Purchasing Manager, pursuant to Article XIV, Section 7 of the Charter of the City of Port Arthur, to sell the above named surplus property at an auction, said property attached hereto and made a part hereof as Exhibit"A". Section 2. That the City Manager, together with the Purchasing Manager are hereby authorized and empowered to execute and deliver bills of sale or other instruments necessary to transfer title to said items at the price bid. Section 3. That this being an Ordinance not requiring publication the same shall take effect and be in force immediately from and after its passage. Section 4. That a copy of the caption of this Ordinance be spread upon the Minutes of the City Council. P 0 6874 P. O. No. 6874 06/08/20 CR Page 2 READ, ADOPTED, AND APPROVED, this day of June, AD, 2020, at a Regular Meeting of the City Council of the City of Port Arthur, Texas, by the following vote: AYES: Mayor: Councilmembers: NOES: Thurman Bartie, Mayor ATTEST/ ArP40 AP She• ' Be AIMPATcretary iAPP OVED AS TO FORM: ()A-f_a-P 0-,t—i)-e-A al cyri Val Tizen , ity Attorney APPRO 064., ADMINISTRATION: .$4 Ron Burton, Cit,Wanager ar Clifton illiams, CPPB, Purchasing Manager P 0 6874 P. 0. 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O O -P 00 N J Q1 O ,--• "._, 00 � Q.) --' � N ,..0ON N 00 ONTO Q\ O, rn x s G� CD CD 0-1w C17 C o CD CD z CD N m a- Gl Exhibit F Surplus Property Disposition e-mail to Clifton.williams@portarthurtx.gov or fax to 409.983.8291 Name: Al Gillen Date: 6-9-2020 Dept: Police Phone: Email: For Office Use Description Make/Model Serial No. Only 2 Gray Office Chairs 1 Blue Office Chair a Black Office Chair 1 Floor Buffing Machine 258171 2 drawer Black Filing Cabinet 1 Police Light Bar Whelen SX8BBRR 144334 Air Clean System Sirchie CA530 ACCAS30-031 5 Boxes of Books 1 Light Bar Whelen SW8DRR 183585 1 Light Bar Whelen GB 2SP3J 5645 2 Light Bars Whelen N/A 8 Sets of Rear 2016 or 2017 Ford Taurus Seats 3 Back 2016 or 2017 Ford Taurus For Office Use Only Date Received Received By Appointment Date Appointment Time Exhibit F Surplus Property Disposition e-mail to Charmaine.robersonrie.portarthurtx.gov or fax to 409.983.8291 Kenyatta Lee October 13. 2019 Name: Date: Development Services 409-983-8535 Dept: Phone: kenyatta.leeca?portarthurtx.gov Email: For Office Use Description Make/Model Serial No. Only Deep Chest Freezer(White) General Electric MZFCM7SKAWW 4 i Mahogny Desk HON Mahogny Desk HON Computer Monitor Dell CNOV7JPS-QDC00-85H- OLRBA00 Keyboard and Mouse Dell/KB216D CN-OG4D2W-M6D00-86H- 0570-A00 Computer Monitor Dell CN-0668VC-QDC00-7B0- 4YDB-A02 Keyboard and Mouse Dell CN-0644G3-L0300-7A4- 11J2-A03 Computer Monitor Dell CN-0668VC-QDC00-7BO- 4 Y 1 B-A02 Keyboard Dell CN-064463-LO300-7A4- ITJ2-A03 f.:(pip Make Model Year VIN f For Office Use Only { Date Received Received By Appointment Date A. .ointment Time Exhibit F TW Surplus Property Disposition e-mail to Clifton.williams@portarthurtx.gov or fax to 409.983.8291 Name: I9(1j e 4e iJ us Date: - ', �;; 6 Dept: _1 ) Phone: Email:-J g19PlJ sc) 227 Aoki For Office U--e.-11 Description Make/Model Serial No. Only • For Office Use Only Date Received Received By Appointment Date Appointment Time PAPD May 2020 Auction List— IT Equipment Type Brand Model SN Computer Compaq D510c V229KN8ZA017 Computer Compaq D512C W249KN8ZB143 Computer Dell OptiPlex 745 HV95GD1 Computer Dell OptiPlex 745 99MNDC1 Computer Dell OptiPlex 745 BGT7QD1 Computer Dell OptiPlex 745 50VFFC1 Computer Dell OptiPlex 760 H7WZBK1 Computer Dell OptiPlex 9010 A10 JL6ZFX1 Computer Dell OptiPlex 960 H8TKLM1 Computer Dell OptiPlex 960 DDWOPL1 Computer Dell OptiPlex 960 H8WKLM1 Computer Dell OptiPlex 960 D3QSNM1 Computer Dell OptiPlex 960 D3NSNM1 Computer Dell OptiPlex 960 D3RQNM1 Computer Dell OptiPlex 960 91F8LM1 Computer Dell OptiPlex 960 D3PRNM1 Computer Dell OptiPlex 960 1CC8PL1 Computer Dell OptiPlex 960 H8VKLM1 Computer Dell OptiPlex 960 91FBLM1 Computer Dell OptiPlex 980 FH9YNM1 Computer Dell OptiPlex GX270 GOWBY41 Computer Dell Precision T3400 DQNXTH1 Computer Dell Precision T3400 F0281G1 Computer Dell Vostro 200 BKGYQF1 Monitor Dell 1907FPVT CNOC-AA36 Monitor Dell E173FPC CNOF-34ZS Monitor Hanns-G JC199D G51G-8547 Monitor Dell P2311HB CNOW-1H7L Monitor Dell P2311HB CNOW-1K7L Monitor Dell P2311HB CNOW-1PWL Monitor Dell P2311HB CNOW-04NL Printer HP CU 2600n CNHC6CF2L0 Printer HP CU CP4525 JPBCC3FO6K Printer HP CU CP4525 JPBCC3F083 Printer Brother HL-4150cdn U62499D3J350260 Printer HP U 4050 USQF041488 Printer HP U 4240n JPGGL17259 Printer HP U P1102w VND3J17776 Printer HP OJ 5610 A10 CN814F5OVH Printer HP OJP 8100 CN46AFV3WY Printer Dell P513w 7TOD9J1 Printer Canon Pixma IP100 ABCF85519 Server IBM Netfinity 3000 23R1302 UPS APC SMC1500 351711X03819 C) , Exhibit F Surplus Property Disposition e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: l ej ♦ _ • C,1 s Date: (0 — - /f� Q Dept: (onrn U to 1 `t-&' S7cPtOpcflfPhone: 'q q 38d od 3 Email: $ 1 mQWILI.e�Sex �( . t11 IQY`t'hUi qc 1f For Office Use Description Make/Model Serial No. Only cz n o n Pcxr1-t Shebf con (iry v'ct 1. 13 - 3e7a.-SEI P`^ 1051 r 'I L ---Di nc L_ ofDVOt 60'09 Mk Set tagGo-5 E1ec i L II o 1 l . 01 e) (e3 ' c�-�'+ c� 9e(x�a is ► :- i v r �� �� Le tAors( Vn c ) n ' C'-rt‘ I J 61 bran � L-fr(G •4s 4 rpt r 'fl - 5 C (Q 1'dersX onNv 0.16 (3305- 1 , , LLt+1:1U4 �� K t a5 ;- 1(-1(/' q3 g i c.vus For Office Use Only Date Received Received By Appointment Date Appointment Time 0 Exhibit F Surplus Property Disposition e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: ma ( 9 9 C 5 Se X &a n s Date: 6._ q - „..30 Dept: ( ominvnhj Ic/`eN lOpnyat Phone: 49 q - q ggods) Email: mar 9, (:)SS'fy Q _id (40or+g, g01f For Office Use Description Make/Model Serial No. Only Ee(- cic R no I Shakr ► y- d / L+ HP r nc rr Co r+D t 0 CCN 33c-AVo i X 41Tect _Shre6kAloc mi onoi - V-`can La Ko f i^ mrfnio_ r) rwk - *Iwo s I--I 6114 3(0G' 1 j r� .Aa To c L1 Qitt r,{-te. Z I. Caf-i- (261,C tL_ Beouhl ( We cp T 1494 -q l )cow T S-zo7 n�s2:L ?OC.c" 1-1 .4 oc�r c& o Le r �� — ibI UE? E 1-77-- a r 13poc c 11t4octiple‘G T n,er 1<i1--. ji 1, 1-1( B1o? - 0G-0ci / 3ooc i-e_silocev-U • a , i + - 7' c i t 3a)c i Sklar , CCOu Viktor- eL/ a 1(0.P 1 Ulg1'� ckcs o4 ) S ,Eon. --IQ �riG �y ►k�Y�9 once .inti- ()ono-- /Qg ')-(0 icy, 3 9 o,p, et- `)c 4 Yl Yl 'E'r 5C j( -1-I-(0 a 3 F-- NLVirV— Coc l`ectiOklb .3cc( Gi7Lfst- l�-to(v1 For Office Use Only Date Received Received By Appointment Date Appointment Time 0) ' Exhibit F Surplus Property Disposition e-mail to Clifton.williams@portarthurtx.gov or fax to 409.983.8291 Name: Bella Leblanc Date: 11/1/2019 Dept: Finance/Accounting Phone: 409-983-8271 Email: Bella.Leblanc@portarthurtx.gov For Office Use Description Make/Model Serial No. Only Printer Hewlett Packard JPFC65K009 Brown Wood Desk N/A N/A Storage Cabinet 2 Drawer 2 Chairs Black and wood For Office Use Only Date Received Received By Appointment Date Appointment Time 0 Exhibit F Surplus Property Disposition e-mail to Shawna.Tubbs@portarthurtx.gov or fax to 409.983.8291 Name: Chief Larry Richard Date: 6/9/2020 Dept: Fire Phone: 409-983-9738 Email: larry.richard@portarthurtx.gov For Office Use Description Make/Model Serial No. Only (1) 1 inch rubber hose Damaged n/a (2) hard suction hoses Damaged n/a (24) 1.75 inch hose Damaged n/a (25) 5 inch supply hose Damaged n/a (1) Coke Machine not working • (1) Water Machine not working 900178 01-090525323860 (1) Refrigerator not working Frigidaire 4811013348 (1) Refrigerator not working Samsung 314717 JKJ44BBK 101981 R (1) Refrigerator not working General Electric GDSL3KCYCRLS For Office Use Only Date Received Received By Appointment Date Appointment Time 0 Exhibit F Surplus Property Disposition V v e-mail to Clifton.williams(portarthurtx.govor fax to 409.983.8291 Name: /' IJ� ( 4 Date: t (91)01 Dept: Li Phone: 11 S1- (7 tp Email: a/ yl vv—V V For Office Use Description Make/Model f Serial No. Only (2) Toshiba T-4530 Toner PS-ZT4530 n/a HP Ink 902XL (black) HP Ink 902XL (magenta) (2) HP Ink 902XL (cyan) HP Ink 902XL (yellow) Canon Pixma Ink BCI-15 (black) Canon Pixma Ink BCI-16 (color) Imagistics Printpowder Toner (Oce)461-3 (3)Nukote Laser Toner Oki (black) replaces #52107201 Dell Keyboard L100 CNORH6597357I84LO7JH Dell Keyboard L100 CNORH6597357195F001Q Dell Keyboard L100 CNORJI6597357181L06RX Dell Keyboard KB212-B CN04G4817161646EOCNCA00 Acco Stapler Acco 41 Swingline Stapler Speed stapler 4 Dell Mouse 0c8649 528079462 (2) Casio Printing Calculator HR-100TE Plus-W Kensington Guardian Swabs 20 swabs Swingline Heavy Duty Stapler 10081 Bates Power Arm Stapers 224XHD Desk lamp 16486-002 E78751 Toshiba e-Studio 453 Copier CP-4540 CIB952738 Dell mouse Odj30l Hc6330a24eq Exhibit F Surplus Property Disposition r•W e-mail to Clifton.williams@portarthurtx.gov or fax to 409.983.8291 Roland Ozane 8/29/19 Name: Date: Dept: Health Phone: 409-983-8864 Email: For Office Use Description Make/Model Serial No. Only Computer Dell MX-d4D 133-47741 Laser Jet Printer HP CC378A CND0203289 Copier Qhb 9603275 39579 Desk Jet Printer D4360 TH8C2130QB Printer Lexmark S025-410 94687W4 3 Toners Minolta 102A Computer Monitor LG 705NDQA22604 Computer Monitor Dell 0CN078728784P Computer Monitor Acer ET687000447160 Refrigerator Haier BL007001 GOOTAA4K Refrigerator Haier BL007001 GOOTAA5K Refrigerator HotPoint 200000831246 34 Chairs Printer Epson G8dy355431 Copier HP CN 1 C 143472 Fax Brother U6132SM0n679463 14 Toners For Office Use Only Date Received Received By Appointment Date Appointment Time Exhibit F , ,.` Surplus Property Disposition e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: Sherrell Rankins Date: 11-7-19 Dept: Environmental Health Phone: (409) 983-8209 Email: For Office Use Description Make/Model Serial No. Only Lift-off Correction Tape IBM Wheelwriter #11412 (6) Correction Ribbon IBM Wheelwriter #11413 (18) • LiftOoff Correction Tape IBM by LEXMARK #1337765 (8) For Office Use Only Date Received Received By Appointment Date Appointment Time 0 Exhibit F N j Surplus Property Disposition e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: Sherrell Rankins Date: 11-7-19 Dept: Environmental Health Phone: (409) 983-8209 Email: For Office Use Description Make/Model Serial No. Only Lift-off Correction Tape IBM Wheelwriter #11412 (6) Correction Ribbon IBM Wheelwriter #11413 (18) LiftOoff Correction Tape IBM by LEXMARK #1337765 (8) For Office Use Only Date Received Received By Appointment Date Appointment Time Exhibit F e�' y Surplus Property Disposition e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: P-bb..) 11 P ; Date: VI-19 Dept: Fr,._.) ,„ ►.. o—i ir1e-la-0--N+- Phone: 1--.{c -q.e)3-Bail9 Email: -h( For Office Use Description Make/Model Serial No. Only pv- payee c5w$6.Ci mt 1 14 31b Li xlp i tar 954-34%-1 'DO sY�t z * beta 1S Qom' pepee- CG 9 a 5 -ta.000 3 can ti J3f)5 CG 813-- 120W2 Q -1 pt c paP n CS--10a -Loccla3 1 pin apce- Com.-tom -- u2cx y G, 1 `t r\NL Ivc.,4- CC U:H(41-(x-) Gad 1 pi papc2 C.¢_1 Da --Le.ocoy ) k p c -�oa r ti20030 pine.)+t: pape.. 41Q Dc,Pt- Q q33,x t_ stow ca it t Mn o csL'Iek- ? x c,L\5 hp Cid -*L.% -e610 -. 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For Office Use Only Date Received Received By Appointment Date Appointment Time Exhibit F Surplus Property Disposition e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: x G�11-c�,pi� Date: I---1-k9 Dept: Qx)n,r-1- e._9tc_.1 uL2c.. 1 Phone: 'Oct - CVEYb-8c"?LI Ct Email: (z)3b,),Cy 11-C.S For Office Use Description Make/Model Serial No. Only hp a3 L.n. �P C___\60,31) aa-k..) h,P S(p % (901a ) 09 &. 1 hp £(Dy c c\Lp lip G a, h� Pis A 5a c..v 'S- at8 LOOFC 1 For Office Use Only Date Received Received By Appointment Date Appointment Time • ! i G - Exhibit F Surplus Property Disposition e-mail to Clifton.Willianis ri portarthurtx.gov or fax to 409.983.8291 Name: Victoria Hernandez Date: 11/13/2019 Dept: Demolition Phone: 409-983-8209 Email: victoria.hernandez@portarthurtx.gov For Office Use Description Make/Model Serial No. Only TDK VHS-C premium tapes 30 minutes Qty-26 tapes TKD VHS-C superior high gra$30 minutes Qty-12 tapes TKD VHS-C superior D90 90 minutes Qty-7 tapes Imation Diskettes 2HD 1.44 MB Qty-8 disks TDK High Density Floppy Dish 1.4 MB Qty-7 disks Office Depot diskettes rainbow 676-621 (50) pack Qty-1 Presaply file folder labels 43-800 Qty-2 Print/Write Green File folder labels 05203 Qty-1 File Folder Labels dark Blue 05200 Qty-1 File Folder Labels Assorted 05215 Qty-1 Office Depot file folder labels red 612-651 Qty-2 Rolodex Refill Cards 100 ct D67553AS Qty-1 Desk top organizer black (11) compartments Qty-1 IBM Easystrike correctable ribbon 1380999 Qty-2 Kores ',Vheelwriter Ribbon KOR192L Oty-2 Porelon Correctable Ribbon 11413 Qty-2 Swingline Stapler 444 Oty-1 For Office Use Only Date Received Received By Appointment Date Appointment Time 0 Exhibit F Surplus Property Disposition e-mail to Clifton.Williarns@portarthurtx.gov or fax to 409.983.8291 Name: Victoria Hernandez Date: 11/13/2019 Dept: Demolition Phone: 409-983-8209 Email: victoria.hernandez@portarthurtx.gov For Office Use Description Make/Model Serial No. Only Staples-copier 5AX82010 Qty-2 Staples-copier 472-3 Qty-2 Staples-copier 794-4 Qty-1 Corporate Express Ink CartridaCEBIJ29R-Black Qty-2 Oce Toner-Magenta 493-3 Qty-6 Oce Toner-Cyan 493-4 Qty-6 Oce Toner-Yellow 493-2 Qty-6 Brother Printing Cartridge PC-201 Qty-7 Oce Toner-Black 493-1 Qty-2 Office Depot photo paper 937-389 Qty-1 Lexmark Toner Cartridge E260A11 A Oty-1 Office Depot Toner Cartridge 784-338 Oty-2 Oce Copier SR27A Qty-1 Kyocera Toner Black TK-827M Qty-1 Waste Toner Bottle 4049-111 OW-1 Kyocera Toner Kit TK-657 Qty-1 Dell computer speakers A215 Qty-1 For Office Use Only Date Received Received By Appointment Date Appointment Time 1 a , Exhibit F Surplus Property Disposition e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: Victoria Hernandez Date: 11/27/2019 Dept: Demolition Phone: 409-983-8209 Email: victoria.hernandez@portarthurtx.gov For Office Use Description Make/Model Serial No. Only hp laserjet cartridge Yellow Q6002A Qty-1 hp laserjet cartridge Cyan Q6001A Qty-2 hp laserjet cartridge Black Q6000A Qty-9 Dell black toner cartridge 2330d/dn & 2350d/dn Qty-2 Dell black toner cartridge 330-2666 Qty-1 Kyocera Magenta Toner Kit TK-867M Qty-2 Oce Imaging Unit Yellow 493-6 Qty-1 Oce Imaging Unit Magenta 493-7 Qty-1 Oce Imaging Unit Noir 493-9 Qty-1 Oce Imaging Unit Cyan 493-8 Qty-1 For Office Use Only Date Received Received By Appointment Date Appointment Time Exhibit F Surplus Property Disposition e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: Rochelle Mitchell Date: 5/7/2020 Dept: Meter Services Phone: 409 983-8223 Email: Rochelle.Mitchell©portarthurtx.gov For Office Use Description Make/Model Serial No. Only Water Pump Honda GCBNT-1234707 Water Pump Honda GCAAT-2023406 Water Pump Honda GCAAT-1433007 Water Pump Honda GCBNT-1234708 Water Pump Honda GCBNT-1024799 For Office Use Only Date Received Received By Appointment Date Appointment Time • 0 Exhibit F A - Surplus Property Disposition `'/ e-mail to Clifton.Williams@portarthurtx.gov or fax to 409.983.8291 Name: Rochelle Mitchell Date: 5/7/2020 Dept: Meter Services Phone: (409) 983-8223 Email: Rochelle.Mitchell@portarthurtx.gov For Office Use Description Make/Model Serial No. Only Studio 455 Copier Toshiba CQJ914921 Kyocera Copier Ecosys E52FA01 B2LXK00 For Office Use Only Date Received Received By Appointment Date Appointment Time Exhibit F Surplus Property Disposition e-mail to bella.leblanciportarthur.net or fax to 409.983.8291 Kenyatta Lee January 21, 2020 Name: Date: Equipment Services 409- 983-8535 Dept: Phone: Kenyatta.lee@portarthurtx.gov Email: For Office Use Description Make/Model Serial No. Only Tractor Tire 13.6L-28 Tractor Tire 13.6L-28 Tractor Tire 17.5L-24 Tractor Tire 14.00-24"1 Tractor Tire 18.4-30 Inner Tube (9) 13.6/14.9 Tire 9R22.5 Tire 8R19.5 Fleece Charger 6006 Battery Charger For Office Use Equip # Make Model Year VIN Only For Office Use Only Date Received Received By Appointment Date Appointment Time Exhibit F Surplus Property Disposition e-mail to bella.leblanceportarthur.net or fax to 409.983.8291 Kenyatta Lee January 21, 2020 Name: Date: Equipment Services 409- 983-8535 Dept: Phone: Kenyatta.lee@portarthurtx.gov Email: For Office Use Description Make/Model Serial No. Only TP87 Turbine Sand Blaster Predator 6,500 Portable Generator Mobil Master Cooler Cooling Fans (2) Snap-On WB 250 Balance Machine MB 250 For Office Use Equip # Make Model Year VIN Only For Office Use Only Date Received Received By Appointment Date Appointment Time — Zvv, , a W — = 45. 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CD na nC a = , 06e . . n_ T_ m En . s O & 4t O Gl 00 r. rii O0 7� c It k((''.._. — —. 0 - CD , N ,--` ,-` 4D Cl > > va 00 5 d w CD Crl -0 to .�1 A — 0 ~• I� 5• ' ,_ CT; �D CA O r �s ...• z CD 5 SID 7 O I.0 O 1. n PI aii. 0 • fD y' d N - - O col rn -1. O H = v, .0 = 1 n r_ z ° C7 cm co co • N CN i CS —. C., et 00 8 O 1. d 't CD N WI O totv k O C Z z z z x4t scM a a a �= l'.04 coii CcoCC coCD O �+ v� v) v� cn R c4 ►t n nR. CCD 0 CCD CCD n C T eD ( � w CD• ►.. Cd •] Cn n X It O Gl • Exhibit F Surplus Property Disposition e-mail to purchasing(& portarthur.net or fax to 409.983.8291 Name: Larry Richard Date: April 12, 2018 Dept: Fire Department Phone: 983-8738 Email: lrichard@portarthur.com For Office Use Description Make/Model Serial No. Only #1638 Year 2007 Ford Crown Victoria 2FAFP71W97X155956 #1464 Year 2002 Ford Crown Victoria 2FAFP71W22X154687 For Office Use Only Date Received Received By Appointment Date Appointment Time