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TRANSCRIPT
Contract No. 08-45-256Vendor Name: SECURUS TECHNOLOGIES, INC
SIXTH AMENDMENT TO CONTRACT 08.45-256BETWEEN COOK COUNTY, ILLINOIS AND SECURUS TECHNOI.OGIES, INC,
This SIXTH AMENDMENT ("Sixth Amendment" ) is effective September 16, 2016 ("Sixth Amendment
Effective Date" ) and amends and supplements contract number 08-45-256 ("Contract" ) between Cook
County, illinois ("County" ) and Securus Technologies, Inc. ("Contractor" ) accepted by the parties on May
29, 2008, as subsequently amended on June 8, 2011, April 12, 2012, December 18, 2012, April 9, 2014,and September 9, 201S.
WHEREAS, the County desires to continue to receive services under the Contract; and
WHEREAS, the parties desire and agree to enter into this Sixth Amendment to extend the Term of the
Contract by six (6) months;
NOW, THEREFORE, as of the Sixth Amendment Effective Date and in consideration of the mutual
promises and covenants contained herein, which the parties agree are adequate and sufficient, the
parties agree as follows:
1. LEE., Under paragraph III of Part I of the Contract, the term shall commence on the date the
System is installed and operating. The first call placed on the System occurred September 15,2008, and the parties previously extended the Contract for each of the two (2) one-year renewal
periods, the second of which commenced on September 15, 2012. Next, the parties agreed In
the Third Amendment to the Contract to extend the term by fifteen (15) months from
September 1S, 2013, resulting In a modified end date of December 15, 2014. Next, the parties
agreed in the Fourth Amendment to extend the term of the Contract by twelve (12) months
from December 15, 2014, resulting in a modified end date of December 15, 2015. Further, the
parties agreed in the Fifth Amendment to extend the term of the Contract by nine (9) months
from December 15, 2015, resulting in a modified end date of September 15, 2016. By
agreement of the parties pursuant to the terms of this Sixth Amendment, the Term of the
Contract is extended by six (6) months from September 16, 2016, resulting in a modified end
date of March 15, 2017. The effective date of this Sixth Amendment shall be September 16,2016, subject to Cook County Board authorization.
2. GROSS REVENUES: The parties agree that for the period from the Sixth Amendment Effective
Date until the modified end date of March 15, 2017, the term "Gross Revenues" as that term Is
used in the Contract shall remain defined by section 5 of the Fifth Amendment.
3. TRANSITION: The parties reaffirm section 8(e) of the Fourth Amendment, which states that the
Contractor agrees to continue providing all of the services in accordance with the terms and
conditions, requirements and specifications of this Contract for a period not to exceed 90calendar days after the expiration, terminadon or cancellation date.
All terms and conditions of the Contract not modified by this Sixth Amendment remain in full force and
effect.
All capitalized terms used but not define herein shall have the meaning set forth in the Contract.
Contract No. 08-45-256Vendor Name: SECURUS TECHNOLOGIES, INC
Exhibits:
1. Economic Disclosure Statement
2. MBE/WBE Utillzatlon Plan
3. Identification of Sub-Contractors/Suppliers/Sub-Consultant
IN WITNESS WHEREOF, the parties have executed this Sixth Amendment as of the Sixth Amendment
Effective Date by duly authorized representatives.
Execution of the Sixth Amendment shall be evidenced by the signature of the parties'epresentatives as
set forth below. Contractor represents that it remains a corporation in good standing authorized toconduct business within the State of illinois and agrees that the signature of its representatives below
constitutes a Certification as to each of the matters set forth in the County's Execution Forms, which are
attached to the Contract.
County of Cook, illinois
Chief Procurement Officer
r
State's Attorneygffice (if app~fica )
Securus Technologies, Inc.
Signed
Robert Pickens
Type or print name
President
Title
EXHIBIT 2
MBE/WBE Utilization Plan
hffEE/WEE UTILIZATION PLAN ~ PONE( 1
BIDDER/psopoBER HEREBY 8TATEs ihai ail MBE/n!BE iiimr included in dru plan aie certiFied MBEs/wBEc by at!anat one of ina cniiiiaa tinted h ina General
Cond{liana-Baciicn lg.
BIDDER/PROPOSER I/ISB/WSE STATICS: (chacii the approprisia line)
Bidder/ piapcasr is s cariiTiad MBE cr wBE firm. Bfac, attach copy of currant Leam cf caifiiir arian)
Bidder/Pmpeam iv a Joint venlum and ons or mare Joint ventura perinea am carbTiad MBEa or wBEs. {Ifao, effach ccfdoa of Loller(a) oiCaiiiiioaffan, a copy ci Jdni Venwm Agraamani dearly darrubtrd the role of Ihe MBBWBE lirm(a) anil lla mvnarehip Inlsraai In Iha JoinlVanture acri acomplalad JointVanluisAffidavil-avaffableonlineairrrnvrarnccunrv'iccv/ccniiacicnmciiaccai
BMdar/Pmpoaer h noi s rbrfffmd MBE or WSE ffrm, nor s Joint Vapwrs vdthhIBWBE psgnwa, bul nfl uiiliae MSE and wsg Arm's eitherdlraaiiy mlncffmclly In the padormsmn of the Coclraci. gfac, compbts Sscffans II balci sndihe Lelli rtat elinlani- Form 2)
IL ~ Olraat aagcaiPaffan Of MSE/WBE Pi/ma ~ lndlnint PardalPSBan Of MSBAWBE lrhnm
NDTE: tfgbrue goals tuws «at been achieved tbraogh dlnmt pargtffgrrgon, Stddedpropooer shell Include deoumsnlegen outlining efforts tosehleve Direst psigolpsgsn at Iho sins of sldgrropossl submission. Indlreot pdrtialpNlon will ontg be oonsfdprod hflor sg of(orle tosehhnra Dgtwt Pdrgefftstten hove seen exhausted, Dihlg oflsr written deownsnlsgon ef Eood Pollh Efhrrto Io rooolvod tdg Ihdllool
Psigetpogrnv bs oorr Mddrad,
hffggsfptggs that vdg psrform aa auhcontrsdora/auppffers/consultants include Ihe fegowlng:
MBE/WBE Fimc Inforrnltg Nstwork Ltdmevv Auaross: BXPUIFi&gon Avenue
ruhw, 781 N tgdnytlriron St rg BDQ Qhtatago II 8108chg Suho 'IBBO
p,~d ~WNIUIOQIIHMevrllevetk.oaleChtbngo IL 6080i
Edita Ararnbtrlo, Prsotdant Phone, B12-ggff dhg24
oolierAmounl prugdpsiion s 01s 000/onnusgY, pnynbio monthtg For duration of contraot nor sarms of Amondmnni 4
parasol Amount of pmfblprnloic
"Lrhm Of Intent sgmhmi'r Yea~'Cuuant Lrdbrof Carfflirmthn slachsdy Yea~ No
No
NSE/WBE Plan:
Add!ard!
Ccntsdparsom
Belier Amount Periisipslibs! ff
Pmcant Amomu el Psnicipalicn;
'Loiter of Inhmt nttached7 Yac'currani LettmnfcaNTicsrlcn aiischmiy Ysr .
Nc„NO
Aimch ~ahaarsee naaired
'Letter(oj of Intent snd ourrord Lolters of cerENNlon ffgffd beau~ at tho thus of bid,
hc/VVSE ifdgasdon Plan ~ Form 1 Rsvlaoch Otlggfgols
BBEABSELETTER DF INTENT ~ FGRSI 2
hfwvsE Firm: Informity Network Ltd
Contact person: Edits ArambuloNew Address; M3 N. Michigan Avenue
Address; F31N Sangamon, ff BDO
New Zip:60%1Chicngcr, IL 2ip 60642
Csrrifying Agency: Cook County~NI II A%I ttfAAfllltllllCsrtillcafcn Expirslicn Dale. Rs"C~m~u "Ps" Ing
EthnicityAsian Pacilic islander
SkyprcpcaarjDoniract d:
phonm 312-36141624 Fax 312-381A8520 FSN 8 41-2078226
Parthipatforr (yt) BimB ( ) Indirect
Nll grs IdjyVBE firm be scbccntractng aay of the geode or services of this contract to rmolhsr linn'I
IXI No ( }Yea- Plsass sgaclrexphnation, Pmpsaed Subcontractor(s): Nona
Ths undsmignsd kgtRBE IB prepared tn prmdds the hllcwhg GsmmcditssfSarvtcrs br the above named Pro}scy Contract prmcw sures jr rreeded Isatr jrrjsrcrjjrs tauEE Hrmb jrrcjxusrr cstars sr wars arvrjcr aapauwr adrrtdvjrt, aljara addwvtar shvcbj
Onsits Pro)sot hdatnagsmnrtL Help Ossk Adrntn Support, snd fdsfntsnancs Aotbr@ss by ISKVV Tsohrdcharrs
for the ceok Courny Inmate Phone Byatsrn el Docik County Department of Corrpctlons Jell Paollity, 8 hours
psr day Monday Thru Friday Encspt Holidays.
Inrgcate Ihe Degar Amount, psraantans, and Ihe Terms nppsumsnt for the sbowvdsacdbsd commodsleaj services.snvaafsaracs,dvtxar sar moain aaa.athntnscdmsnt
'NE
UNBERBISltIED PARTIEB ABREE thol Ihia Loiter of Irdanl viill become a bbtrgng Snbccnlract Agresmenl for the stpnswork, ccndBdnad uprm (1} the sdd~srs rmmBI of a signed ctntmrd from lhe county of olahI'(2) Undamlgned
fhrbssntrsctor ~compilers vdth as whnnpt selsnthde, codes, ordlntmtms end alahmm nntutrtm by conharaor, Dockcounty, wl se Bhds lo~as a BIBBBIIBEgrm fsr Ihe above work, The Undersigned Paihrs do also oersfy that they
dht nctagix ihrdrsiywlye lolbladccwnentongl allsmes under Dsswlpllsn of seeker Supply and pesfthnd wsra completed.
WA~+ IM~I~Wm (jidttyBI) sgnature (prjms Bhhbcprcpcasr)
Edits jpnrnbuto, president ftobsrt PlcksnaPdnfbire Print Name
informity Nshvork Ltd. Saaurus Tsohrrotogiss
Fhm Name Fhm Name
fjst/I+I / ~Osis Dots
Sdmwlbad end sworn bshm ms subscribed snd swrun befom nls
Ifda5 dsyof MKl s „gg~,NolmyP lilic (,E~ )ff~
l
usrarvpsrnni,imtpfrrsgssbbiviv Ddrbnrtssiod Bnntvds
trcvhmbsr.aa, Sbta
fff, ~ 7 llvlllflt FWII Follrrx
I'/ t@I 7wf"Afrt,7g~".iffl'..„',.l,iljlt'7 ~)rjrr
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Dgsglg is BRABT
Sly Bemmhmhm EaahasBovialbsrg. Satg
svlaed xfgglx4
i OFRCE OF CON1RAC1 COMPI.IANCF
I JAct2IJaktnta GcFssaz
DIRECTOR
,1.18N Qark, Cauntf Building, Rnnm MEB e Ctecagn, glinnis 66620 e PLS) BDS-FSCS
YOrgl IsttacittRJINIELS
PRESIDENT
Purnk CmrneJ emne
oi Cnmmissinnms
IIICHARD R, SOYKIN
1st Dfstrict
July 14, 2015
MB. Edits Arambulo
lnformity Nebvcrk, Ltd.
721 North Sangamon Rite frt00
Chicago, 5.50622
Dear Ms, Arsmbulo
Nn Change Affidemt Buhmitled YII3/NOI6
Ien.certfrleetrfnn Pendfng
Nevr Address Change Prmdinq:
333 hl. Michigan Ave,suite 'IBS(l
Chicago IL Bcegt
Annual Cardgcadon Expires: July 14, 25'la
ROSEIYI STfELE
2nd oetrln
JERRY BLDLDI
3rd District
STANLEY MOORE
4th Dfstdet
DESOI4LN SIMS
Sth Ofstrkt
JDAH PATRIQA MURPIIY
6th Distrid
JESL6 6. CrARQA
Tth Dletdel
leTI Ri Ie. SILYESTRI
6th DIN)et
JOHN P. DALEY
11th Dettlet
AJHN A FRITCHFY
11th Oterin
LARRY SOFFREDIN
11th District
Contpatulsdons on your condnugd etigklgy for CeitScstion ss s Minority snd Vyomen Busktess
Enterpdse (MSEIWSEj by Cook County Government, This WISEIWSE CerNlcetion is vagd until
Julv 14.2525,
AS S COndNOn Of Ccngnued Cerdgoagcn.during this 5Ve (5) year perlcd, yOu muet file a ~n
.chasse AIEdsvttn within sixty (55I days prior to the dfds of annual egptredon. Fsttufe to%6this Afgdsvtt shall fastfS in the terminagtm of your cei5licaggn, You must nogfy.Cook countyGovemmenfs Ofgcs of Contract Cornpgance of sny change ln ownership or conliol or any othermsgeis or fists alfscdng your firm's eligibility for Ceitlgcsgon whhln tflbgen (15)business days ofsuch changes.
Cook Getty Govemmwt may commerce action to famous your finn as a SlSEIWSE vendor if
you fiil to no5fy us ef any changes ef facts agecgng your 5rm's cettgcatlon, or lf your gun
otherwise fillts N cooperate with.the County in any inquity or inves55atlon, Removal of status
msy else be commenced if your grm is hund to be involved in bidding or contractual iiiagutsrlgeg.
Your Sm'3 name wgl betlsled in cook county's Directory sf Minority Business Entsiprlss, woman
Business Enteipdge sndf or vetsmn Sushuiss Enterpdse infhe siss(s~ of specialty;
COItSULTING SSNVICESI TELECOMMUNICATIONS PSOJSCT ldrfUIAGSNISNTI NSTyyORK
OSSIGN AN5I INSTALLATION; NSGUL5IS OSfkLSItl TELEPHONE SgtUIPISENT 8 SUPPLIES
Your 5im's psrddpsgsn sn county contracts wgl be credited towerdIIE or mIIE goals in your
ares(aj ufspeciaky. Whgs your pa~ on Cook County contiscfs ls rtct gmtted to your
specialty, Dredk tcwsid Qg or gg goals will be ghlsn orily fol work~ln ths specialty
category,
Thank you for your congnued interest in Cook County Government'6 Minority, Women snd
Veteran Suginegg E~Progmmg.
Sincerely,
6RI!666OSIJN
14th Ofsefst
TINIOTHY O. SCHNBDER
11th District
Contract Compliance Director
JEFFREY R. TOBOLSIB
16th District
lilcfgefh ANN OOODY SOIIIJAN
11th District
IS Fiscsl ftespcftsibitlty 'f lnnovetlve Leedetshtc Trettspe Tettcy st Accounkebllity Q improved services
r. Ni i
IACOLrfiortta ICnOfit/iilfcZ
O'JRI CTOR
116 N. Clark, Couiriy Building, Room 1020 r Chicago, illinois 60602 c l312i 603-5502L....September y, 20 i fi
TCJirrt IorEECKVLJllIIIKLS
PR ES ID E NT
Cook County Beers
or Corner issroners
RICHARD R BOYRIN
1st District
ROBERT STEELE
2nd District
It/ts. Shannon E. Andrews
Chief Procurement Officer
118N. Clark Street
County Buikfing-Room 1018
Chicago, IL 60602
JERRY BUTLER
3rd District
STANLEY MOORE
4th District
Re: Securus Technologies, Inc.
Contract No.08-45-256 (Amendment No. 6)
Coinless inmate and Public Pay Phones
Bureau of Technology
DEBORAH SINS
5th DistnctDear Ms. Andrews:
JOAN PATRICIA MURPHY
6th District
IESUS G. GARCIA
7th District
The Office of Contract Compliance is in receipt of the above-referenced contract amendment and hasreviewed this contract for compliance with the Minodity- and Women- owned Business Enterprises (MBE/WBE)
Ordinance. After careful review of our records as reported by the vendor, it has been determined the vendor ia
in compliance with the MBE/WBE Ordinance.
LUIS ARROYO, JR
8th District
PETER N. SILVESTRI
9th Distnct
Sincerely,
r"CN AC
BRIDGET GAINER
10th District
JOHN P DALEY
11th District
Jacquefine Gomez
Contract Compliance Director
JG/ate
JOHN A. FRITCHEY
12th District
lARRY SUFFREDIN
13th District
Cc; Tangela Malloy, OCPO
William Campbell-Bezat, BOT
GREGG GOSUN
14th DiStrict
TIMOTHY 0 SCHNEIDER
15th District
JEFFREY R. TOBOLSRI
16th District
SEAN N. MORRISON
17th District
$ Fisca! Responsibility f innovative Leadership Transparency EJI Accountability@improved services
EXHIBIT 1
Economic Disclosure Statement (EDS)
CONTRACT NO.
COOK COUNTYECONOMIC DISCLOSURE STATEMENT
AND EXECUTION DOCUMENTINDEX
Section Description Pages
Instructions for Completion of EDS EDS i-ii
Certiffcations
Economic and Other Disclosures, Affidavit of ChildSupportObligations, Disclosure of Ownership Interest
and Familial Relationship Disclosure Form
Cook County Affidavit for Wage TheR Ordinance
EDS 1—2
EDS 3-12
EDS 13-14
Contract and EDS Execution Page
Cook County Signature Page
EDS 15-17
EDS 18
CONTRACT NO.SECTION 1
INSTRUCTIONS FOR COMPLETION OFECONOMIC DISCLOSURE STATENIENT AND EXECUTION DOCVIIIIENT
This Economic Disclosure Statement and Execution Document ("EDS") is to be completed and executedby every Bidder on a County contract, every Proposer responding to a Request for Proposals, and everyRespondent responding to a Request for Qualifications, and others as required by the Chief ProcurementOfficer. The execution of the EDS shall serve as the execution of a contract awarded by the County. TheChief Procurement Officer reserves the right to request that the Bidder or Proposer, or Respondentprovide an updated EDS on an annual basis.
Definitions. Terms used in this EDS and not otherwise defined herein shall have the meanings given tosuch terms in the Instructions to Bidders, General Conditions, Request for Proposals, Request forQualifications, as applicable.
Affiliate means a person that directly or indirectly through one or more intermediaries, Controls isControlled by, or is under common Control with the Person specified.
Applicant means a person who executes this EDS.
Bidder means any person who submits a Bid.
Code means the Code of Ordinances, Cook County, illinois available on municode.corn.
Contract shall include any written document to make Procurements by or on behalf ofCook County.
Contractor or Contracting Parly means a person that enters into a Contract with theCounty.
Control means the unfettered authority to directly or indirectly manage governance,administration, work, and all other aspects of a business.
EDS means this complete Economic Disclosure Statement and Execution Document,including all sections listed in the Index and any attachments.
Joint Venture means an association of two or more Persons proposing to perform a for-profit business enterprise. Joint Ventures must have an agreement in writing specifyingthe terms and conditions of the relationship between the partners and their relationshipand respective responsibility for the Contract
Lobby or lobbying means to, for compensation, attempt to influence a County official orCounty employee with respect to any County matter.
Lobbyist means any person who lobbies.
Person or Persons means any individual, corporation, partnership, Joint Venture, trust,association, Limited LiabiTity Company, sole propdietorship or other legal entity.
Prohibited Acts means any of the actions or occurrences which form the basis fordisqualification under the Code, or under the Certifications hereinafter set forth.
Proposal means a response to an RFP.
Proposer means a person submitting a Proposal.
Response means response to an RFQ.
Respondent means a person responding to an RFQ.
RFP means a Request for Proposals issued pursuant to this Procurement Code.
RFQ means a Request for Qualifications issued to obtain the qualifications of interested parties.
EDS-i 8/2015
CONTRACT NO.
INSTRUCTIONS FOR COIIIIPLETION OFECONOhllIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT
Section 1:instructions. Section 1 sets forth the instructions for completing and executing this EDS.
Section 2: Certlficatlons. Section 2 sets forth certifications that are required for contracting parties underthe Code and other applicable laws. Execution of this EDS constitutes a warranty that all the statementsand certifications contained, and all the facts stated, in the Certigcations are true, correct and complete asof the date of execution.
Section 3: Economic and Other Disclosures Statement. Section 3 is the County's required Economicand Other Disclosures Statement form. Execution of this EDS constitutes a warranty that all theinformation provided in the EDS is due, correct and complete as of the date of execution, and binds theApplicant to the warranties, representations, agreements and acknowledgements contained therein.
Required Updates. The Applicant is required to keep all information provided in this EDS current andaccurate. In the event of any change in the informahon provided, including but not limited to any changewhich would render inaccurate or incomplete any certification or statement made in this EDS, theApplicant shall supplement this EDS up to the time the County takes action, by filing an amended EDS orsuch other documentation as is required.
Additional Information. The County's Governmental Ethics and Campaign Financing Onlinancesimpose certain duties and obligations on persons or entities seeking County contracts, work, business, ortransactions, and the Applicant is expected to comply fully with these ordinances. For further informationplease contact the Director of Ethics at (312}603Q304 (69 W. Washington St. Suite 3040, Chicago, IL60602) or visit the weMite at cookcountyil.gov/ethics-boardwf.
Authorized Signers of Contract and EDS Execution Page. If the Applicant is a corporation, thePresident and Secretary must execute the EDS. In gie event that this EDS is executed by someone otherthan the President, attach hereto a certified copy of that section of the Corporate By-Laws or otherauthorization by the Corporation, satisfactory to the County that permits the person to execute EDS forsaid corporation. If the corporation is not registered in the State of illinois, a copy of the Certificate ofGood Standing from the state of incorporation must be submitted with this Signature Page.
If the Applicant is a partnership or joint venture, all partners or joint venturers must execute the EDS,unless one partner or joint venture has been authorized to sign for the partnership or joint venture, in
which case, the partnership agreement, resolution or evidence of such authority satisfactory to the Officeof the Chief Procurement Officer must be submitted with this Signature Page.
If the Applicant is a member-managed LLC all members must execute the EDS, unless otherwiseprovided in the operating agreement, resolution or other corporate documents. If the Applicant is amanager-managed LLC, the manager(s) must execute the EDS. The Applicant must attach either acertified copy of the operating agreement, resolution or other authorization, satisfactory to the County,demonstrating such person has the authority to execute the EDS on behalf of the LLC. If the LLC is notregistered in the &ah of illinois, a copy of a current Certificate of Good Standing from the state ofincorporation must be submitted with this Signature Page.
If the Applicant is a Sole Proprietorship, the sole proprietor must execute the EDS.
A "Partnership" "Joint Venture" or "Sole Proprietorship" operating under an Assumed Name must beregistered with the glinois county in which it is located, as provided in 605 ILCS 405 (2012), anddocumentation evidencing registration must be submitted with the EDS.
EDS-ii 8/2015
SECTION 2
CERTIFICATIONS
CONTRACT NO.;
THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE. THE APPLICANT IS CAUTIONEDTO CAREFULLY READ THESE CERTIFICATIONS PRIOR TO SIGNING THE SIGNATURE PAGE SIGNING THE SIGNATUREPAGE SHALL CONSTITUTE A WARRANTY BY THE APPLICANT THAT ALL THE STATEMENTS, CERTIFICATIONS ANDINFORMATION SET FORTH WITHIN THESE CERTIFICATIONS ARE TRUE, COMPLETE AND CORRECT AS OF THE DATE THESIGNATURE PAGE IS SIGNED. THE APPLICANT IS NOTIFIED THAT IF THE COUNTY LEARNS THAT ANY OF 77-IEFOLLOWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACT ENTERED INTO WITH 'THE APPLICANT SHALLBE SUBJECT TO TERMINATION.
B.
PERSONS AND ENTITIES SUBJECT TO DISQUALIFICATION
No person or business entity shall be awarded a contract or sub-contract, for a period of five (5) years from the date ofconviction or entry of a plea or admission of guilt, civil or criminal, if that person or business entity:
1) Has been convicted of an act committed, within the State of glinois, of bribery or attempting to bribe an officer oremployee of e unit of state, federal or local government or school district in the State of illinois in that officers oremployee's otgcial capacity;
2) Has been convicted by federal. state or local government of an act of bid-rigging or attempting to rig bids as definedin the Sherman Anti-Trust Act and Clayton AcL Acl. 15 U.S.C.Section 1 et seq 4
Has been convicted of bid-rigging or attempting to riig bids under the laws of federal, state or local government;
Has been convicted of an act committed, within the State, of price-gxing or attempting to fix prices as defined by theSherman Anb-Trust Act and the Clayton Act. 15 U.S.C.Section 1, et seq 4
Hss been convicted of price-gxing or attempting to fix prices under the laws the State;
Has been convicted of defrauding or attempting to defraud any unit of state or local government or school districtwithin the Slate of illinois;
3)
4)
7) Has made an admission of guilt of such conduct as set forth in subsections (1) through (6) above which admission isa matter of record, whether or not such person or business entity wes subject to prosecution for the offense oroffenses admitted to; or
8) Has entered a plea of nolo contendere to charge of bribery, price-fixing, bid-rigging, or fraud, as set forth in sub-paragraphs (1) through (6) above.
In the case of bribery or attempting to bribe, a business entity may not be awarded a contmct if an official, agent or employeeof such business engty committed ths Prohibited Act on behalf of the business entity snd pursuant to lhe direction orauthorization of an oflicer, director or other responsible ofgcial of the business entity, and such Prohibited Act occurred within
three years prior to the award of the contract. In addigon, a business entity shall be disqualified if sn owner, partner orshareholder controlling, directly or indirectly, 20% or mors of the business entity, or an ofgcer of the business entity hasperformed any Prohibited Act within five years prior to the award of theConhact.
THE APPLICANT HEREBY CER77FIES THAT: The Applicant has read the provisions of Section A, Persons and EntitiesSubject to Disqualification, that the Applicant has not committed any Prohibited Act set forth in Section A, and that award ofthe Contract to the Applicant would not violate the provisions of such Secgon or of the Code.
BID-RIGGING OR BID ROTATING
THE APPLICANT HEREBY CERTIFIES THAT: In arxxxdance with 720 ILCS 5/33 E-11, neither the Applicant nor anyAigliated Entity is Oaned fiom award of gris Contract as a result of a conviction for the vfolagon of State laws prohibiting birf-
nggfng or bid rotating.
DRUG FREE WORKPLACE ACT
THE APPLICANT HEREBY CERTIFIES THAT: The Applicant will provide a drug free workplace, as required by (30 ILCS 580/3).
EDS-1 8/2015
CONTRACT NO.DELINQUENCY IN PAYMENT OF TAXES
THE APPVCANTHEREBY CERTIFIES THAT: The Appficantis not an owner or a party responsible for the payment of any taxor fee administered by Cook County, by a local manic(pality, or by the IEnois Oepartment of Revenue, which such tax or fee isdelinquent, such as bar award of a contract or subcontract pursuant to the Code, Chapter 34, Section 34 171.
HUMAN RIGHTSORDINANCE
No person who is a parly to a contract vrith Cook County ("Count)I') shall engage in unlawful discriminatio or sexual harassmentagainst any individual in the terms or conditions of employment, credit, public accommodations, housing, or provision of CountyfadliTies, services or programs (Code Chapter 42, Section 42-30 st seq.}.
ILLINOIS HUMAN RIGHTS ACT
THE APPLICANT HEREBY CERTIFIES THATr Itis in compliance with the Illinois Human Nghts Act (775 It.CS Sr2-105), andagrees to abide by the requirements of the Act as part ofits contractual obfigations.
INSPECTOR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTION 34-174 and Section 34-250)
The Applicant has not willfully failed to cooperate in an investigation by the Cook County independent inspector General or toreport to the Independent Inspector General eny and all in(conation concerning conduct which they know to involve corruption, orother criminal activity, by another county employee or otfefial, which concerns his or her oflice of employment or County relatedtransaction.
The Applicant has reported directly and without any undue delay any suspected or known fraudulent acfivity in the County*s
Procurement process to the Office of the Cook County Inspector General.
CAMPAIGN CONTRIBUTIONS (COOK COUNTY CODE, CHAPTER 2, SECTION 24I88)
THE APPLICANT CERTIFIES THAT: lt has read and shall comply with the Cook County's Ordinance concerning campaign
contributions, which is codified at Chapter 2, Division 2, Subdivision II, Section 585, and can be read in its entirety atwww.mon icode.
corn.
GIFT BAN, (COOK COUNTY CODE, CHAPTER 2, SECTION 2474)
THE APPLICANT CERTIFIES THAT: It hss read snd shall comply with the Cook County's Ordinance concerning receiving andsolicibng gifts and favors, which is codified at Chapter 2, Division 2, Subdivision II, Section 574, and can be read in its entirety atwww.municode.corn.
LIVING WAGE ORDINANCE PREFERENCE (COOK COUNTY CODE, CHAPTER 34, SECTION 34-180;
Unless expressly waived by the Cook County Board of Commissioners, the Cods requires that a living wage must be paid toindhriduals employed by a Contractor which has a County Contract and by afi subconlractors of such Contractor under a County
Contract, throughout the duration of such County Contract The amount of such living wage is annually by the Chief Financial
Oificer of the County, and shall be posted on the Chief Procurement Otfiosfs website.
The tenn "Contract" as used in Section 4, I, of this EDS, specifically excludes contracts with the following:
1) Not For Profit Organizations (defined as s corporation having tax exempt status under Section 501(C)(3)of the United
State Internal Revenue Code and mcognized under the illinois Stats not-for-profit ksv);
2) Community Development Block Grants;
3) Cook County Works Department;
4) Sheriffs Work Alternative Program; and
5) Department of Correction inmates.
8/2015
CONTRACT NO.
SECTION 3
REOUIRED DISCLOSURES
1. DISCLOSURE QF LOBBYIST CONTACTS
List all persons that have made lobbying contacts on your behalf with respect to this contract:
Name Address
2. LOCAL BUSINESS PREFERENCE STATEMENT (CODE, CHAPTER 34, SECTION 34-230)
Local business means s Person, including s foreign corporation authorized to transact business in Illinois, having a bona fide
establishment located within the County at which it is transacting business on the date when s Bid is submitted to the County, andwhich employs the majority of its regular, full-time work force within the County. A Joint Venture shall constitute a Locai Business if oneor more Persons that qualify as a "Local Business" hold interests totaling over 50 percent in the Joint Venture, even if the Joint Venture
does not, at the time of the Bid submittal, have such a bona fide establishment within the County.
s) IsApplicsnta "Local Businsss" as defined abcveg
XYes: No:
b) If yes, list business addresseswithin Cook County:
c) Does Applicant employ the majority of its regular full-time workforce within Cook County7
XYes: No:
3. THE CHILD SUPPORT ENFORCEMENT ORDINANCE (CODE, CHAPTER 34, SECTION34-172)
Every Applicant for a County Privilege shall be in full compliance with any child support order before such Applicant is enlilled to receive orrenew a County Privilege. When delinquent child support exists, the County shall not issue or renew any County Privilege, and may
revoke any County Privilege.
All Applicants are required to review the Cook County Affidavit of Child Support Obligations attached to thar EDS (EDS-5) sndcomplete the Affidavit, based on the instrucgons in the Affidavit
EDS-3 5/20(5
CONTRACT NO.4. REAL ESTATE OWNERSHIP DISCLOSURES.
The Applicant must indicate by checking the appropriate provision below and providing all required information that either:
a) The following is a complete list of all real estate owned by the Applicant in Cook County:
PERMANENT INDEX NUMBER(S):
(ATTACH SHEET IF NECESSARY TO LIST ADDITIONAL INDEX
NUMSERS)
OR:
b) The Applicant owns no real estate in Cook Couniy.
tk EXCEPTIONS TO CERTIFICATIONS OR DISCLOSURES.
If the Applicant is unable to cerfify to any of the Cerggcations or any other statements contained in this EDS and not explained elsewhere in
this EDS, the Applicant must explain below:
If the letters, NA", the word "None" or "No Response" appears above, or if the space is leR blank, it will be conclusively presumed that the
Applicant cergged to all Certiiicagons and other statements contained in this EDS.
EDS-4 8I2015
CONTRACT NO.
COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEfifiENT
The Cook County Code of Ordinances ([2-610 et see.) requires that any Applicant for any County Action must disdose informationconcerning ownership interests in the Applicant. This Disclosure of Ownership Interest Statement must be completed with sfiinformation current as of the date this Statement is signed. Furlhermore, this Statement must be kept current, by filing an amendedStatement, until such time as the County Board or County Agency shall take action on the application. The informafion contained in
this Statement will be maintained in a database and made available for public viewing.
If you are asked to list names, but there are no applicable names to list, you must slate NONE. An incomplete Statement will bereturned and any action regarding this contract will be delayed. A failure to fully comply with the ordinance may result in the actiontaken by the County Board or County Agency being voided.
"App//canp means any Entity or person making an application to the County for any County Action.
County Ac/ion" means any action by a County Agency, a County Department, or the County Board regarding an ordinance orordinance amendment, a County Board approval, or other County agency approval, with respect to contracts, leases, or sale orpurchase of real estate.
Person" "EnNy" or "Legs/ EnNy" means a sole proprietorship, corporation, partnership, association, business trust, estate, two ormore persons having a Joint or common interest, trustee of s land trust, other commercial or legal entity or any beneficiary orbeneficisries thereof.
This Disclosure of Ownership Interest Statement must be submitted by:
1.An Applicant for County Action and
!
2. A Person that holds stock or a beneficia( interest in the Applicant gng is listed on ths Applicant's Statement (a "Holder" ) must fils aStatement snd complete ¹I only under Ownership Interest Declaration.
Please print or type responses dearly and legibly. Add additional pages if needed, being careful to identify each portion of the form towhich each additional page refers.
This Statement is being made by the [ X ]Applicant or [ ] Stock/Beneficial Interest Holder
This Statement ls an:
Identifying Information:
Name; Securus Technoloaies. Inc.
D/8/A:
Street Address:
City: Dafias
Phone No.: 972-277-0300
[ X ) Original Ststementor [ J Amended Statement
FEIN NO.: 75-2722144
14651 Dsfiss Psrkwav. Sixth Floor
State: Zip Code: 75254
Fax Number: 972-277-0699 Email: boickensfibsecurustechnolooies.corn
Cook County Business Registration Number:(Sole Proprietor, Joint Venture Partnership)
Corporate File Number (ifapplicable):
Form of Legal Entityi
[ I Sole Proprietor [ [ Partnership [X ) Corporation [ ] Trustee of Land Trust
[ ] Business Trust [ [ Estate [ ] Association [ ] Joint Venhas
[ ] Other (describe)
EDS-6 8/2015
CONTRACT NO.
Ownership Interest Declaration:
1. List the name(s), address, and percent ownership of each Person having a legal or benescial interest (induding ownership) otmore than five percent (5%) in the Applicant/Holder.
Name Address Percentage Interest in
Applicant/HolderSecurus Technologies Holdings, Inc. 14651 Dallas Parkway, Sixth Floor, Dallas, TX 75254 100%
if the interest of any Person listed in (1)above is held ss sn agent or agents, or a nominee or nominees, list the name andaddress of the principal on whose behalf the interest is held.
Name of Agent/Nominee
a //I).Name of Principal Principal's Address
Is the Applicant consbuctively controlled by another person or Legal Entit)/7 [ ]Ves [ X ]No
If yes, state the name, address and percentage of beneficial interest of such person, and the relationship under which suchcontrol is being or may be exercised.
Name Address Pementage ofBeneficial Interest
Relationship
Corporate Officers, iilembsis and Partners Information:
For all corporafions, list the names, addresses, and terms for all corporate oNcers. For all limited liability companies, list the names,addresses for all members. For sll partnerships and joint ventures, list the names, addresses, for each partner or joint venture,
Name Address
Richard A. Smilh 14651 Dallas Pkwsy, 6s Fl, Dallas, TX 75254
Robert Pickens 14651 Dallas Pkway, 6'" Fl, Dallas, TX 75254
Geoffrey Boyd 14651 Dallas Pkway, 6 Fl, Dallas, TX 75254
Dennis Reinhold 14651 Dallas Pkway, ae Fl, Dallas, TX 75254
Title (specify title ofONce, or whether manageror partner/joint venture)Chief Executive Olticer
President
Term of ONics
7/1/2008 to present
05/01/2014 to present
Chief Financial OIIIcsr 10/1 5/2013 to present
VP, General Counsel snd Secretary 8/17/2005 to present
Declaration (check the applicable box):
[X ] I state under oath that the Applicant has withheld no disdosure as to ownership interest in the Applicant nor reservedany information, data or plan as to the intended use or purpose for which lhe Applicant seeks County Board or other County
Agency action.
[ ] I state under oath that the Holder has withheld no disclosure as to ownership interest nor reserved any informsfion required tobe disclosed.
EDS-7 8/2015
CONTRACT NO.
COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEIMENT SIGNATURE PAGERobert Pickens President
Name of Authodzed Applicant/Holder Representasve (please printor type)
E-mail address
Date972-277-0300
Phone Number
Mv- '-.P .: g /-=Er/(7DIMDY A CAREY
MY COMMISSION EXPIRESe ~~ .e nhiv—r--—
EDS-8 8/2015
CONTRACT NO.
COOK COUNTY BOARD OF ETHICS69 W. WASHINGTON STREET, SUITE 3040
CHICAGO, ILLINOIS 60602312/603-4304 Office 312/603-998$ Fax
FAMILIAL RELATIONSHIP DISCLOSURE PROVISION
Nenotism Disdosure Reauirement:
Doing a sigoificant amount of business with the County requires that you disclose to the Board of Ethics the existence of any familialrelationships with any County employee or any person holding elective office in the State of Illinois, the County, or in anymunicipality within the County. The Ethics Ordinance defines a significant amount of business for the purpose of this disclosurerequirement as more than $25,000 in aggregate County leases, contracts, purchases or sales in any calendar year.
If you are unsure of whether the business you do with the County or a County agency will cross this threshold, err on the side ofcaution by completing the attached familial disclosure form because, among other potential penalties, any person found guilty offailing to make a required disclosure or knowingly filing a false, misleading, or incomplete disclosure will be prohibited fiom doingany business with the County for a period of three years. The required disclosure should be filed with the Board of Ethics by January1 of each calendar year in which you are domg business with the County and again with each bid/proposaVquotation to do businesswith Cook County. The Board ofEthics may assess a late filing fee of $100 per day after an initial 30-day grace period,
The person that is doing business with the County must disclose his or her familial relationships. If the person on the County lease orcontract or pmchasing I'rom or selling to the County is a business entity, then the business entity must disclose the familialrelationships of the individuals who are and, during the year prior to doing business with the County, were:
~ its board of directors,~ its oificers,~ its employees or independent contractors responsible for the general administration of the entity,~ its agents authorized to execute documents on behalf ofthe entity, and~ its employees who directly engage or engaged in doing work with the Countyon behalf of the entity.
Do not hesitate to contact the Board of Ethics at (312) 603-4304 for assistance in determining tbe scope of any required fiuuilialrelationship disclosure.
Additional Defmitionsi
"Familial relationship" means a person who is a spouse, domestic partner or civil union partner of a County employee or State,County or municipal official, or any person who is related to such an employee or official, whether by blood, maniage or adoption, asa:
0 Parent0 Child0 Brother
Sister0 Aunt0 Uncle0 Niece
0 Nephew
0 Grandparent0 Grandchild
0 Father-in-law0 Mother-in-law0 Son-in-law0 Daughter-in-law0 Brother in law
0 Sister-in-law
0 Stepfather0 Stepmother0 Stepson~ Stepdaughter0 Stepbrother0 Stepsister
0 Half-brother0 Half-sister
EDS-0 8/2015
COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM
CONTRACT NO.
PERSON DOING OR SEEKING TO DO BUSINESS WITH THE COUNTY
Name of Person Doing Business with the County: Securus Technoloaies. Inc.
Address ofPerson Doing Business with the County: l4651 Dallas Parkwav. Sixth Floor. Dallas. TX 75254
Phone number of Person Doing Business with the County: 972-277-0300
Email address of Person Doing Business with the County: boickensSsecurustechnoloaies.corn
IfPerson Doing Business with the County is a Business Entity, provide the name, title and contact information for theindividual completing this disclosure on behalf of the Person Doing Business with the Couaty:
Robert Pickens, President, bnickensCdsecurustechnoloaies.corn, 972-277-0300
B. DESCRIPTION OF BUSINESS WITH THE COUNTYAppend additional pages as needed and for each County lease, contract purchase or sale sought and or obtainedduring the calendar year ofthis disclosure (or the proceeding calendar year ifdisclosure ls made on January /),idenufyt
The lease number, contract number, purchase order number, request for proposal number and/or request for qualificationnumber associated with the business you are doing or seeking to do with the County:
Contract No. 08-45-256
The aggregate dollar value of the business you are doing or seeking to do with the County: 8
The name, title and contact information for the County ofBcial(s) or employee(s) involved in negotiating the business you aredoing or seeking to do with the County:
Darrin Hays, Major Account Manager, 480-286-4758; Joshua Conklin, Vice President of Sales, 972-277-0300
The name, title aud contact information for the County official(s) or employee(s) involved m managing the business you are
doing or seeking to do with the County:
C. DISCLOSURE OF FAMILIAL RELATIONSHIPS WITH COUNTY EMPLOYEES OR STATE. COUNTY ORMUNICIPAL ELECTED OFFICIALS
Cheek the box that applies and provide related information where needed
t3 The Person Doing Business with the County is an individual snd there is uo familial relationship between this individual
aud any Cook County employee or any person holding elective oflice in the State of Illinois, Cook County, or anymunicipality within Cook County.
The Person Doing Busmess with the County is a business entity and them is no familial relationship between any member
of this business entity's board of directors, officers, persons responsible for general administration of the business entity,
agents authorized to execute documents on behalf of the business entity or employees directly engaged in contractual workwith the County on behalf of the business entity, and any Cook County employee or any person holding elective office in the
State of illinois, Cook County, or any municipality within Cook County.
EDS-10 8/2015
COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM
CONTRACT NO.
Ij The Person Doing Business with the County is an individual and there is s familial relationship between this individualand at least one Cook County employee and/or a person or persons holding elective office in the State of Illinois, CookCounty, and/or any municipality within Cook County. The familial relationships are as follows:
Name of Individual DoingBusiness with the County
Name ofRelated County Title and Position ofRelated Nature ofFamilialEmployee or State, County or County Employee or State, County Reladonsbip*Municipal Elected Otftctal or Municipal Elected Otffclal
Ifmore space is needed, attach an additional sheet following the above format.
The Person Doing Business with the County ls s business entity and there is a familial relationship between at least onemember of this business entity's board ofdirectors, officers, persons responsible for general administration of the businessentity, agents authorized to execute documents on behalf of the business entity and/or employees directly engaged incontractual work with the County on behalf of the business entity, on the one hand, and at least one Cook County employeeand/or a person holding elective office in the State of Illinois, Cook County, and/or any municipality within Cook County, onthe other. The familial relationships are as follows:
Name ofMember of BoardofDirector for BusinessEntity Doing Business withthe County
Name of Related County Title and Position of Related Nature ofFamilialEmployee or State, County or County Employee or State, County Relauonship*Municipal Elected Olftcial or Municipal Elected OIEciat
Name of Officcr for Business Name ofRelated County Title and Position ofRelatedEntity Doing Business with Employee or State, County or County Employee or State, Countythe County Municipal Elected OIEcial or Municipal Elected Otgcial
Nature ofFamilialRelationship
EDS-11 8/2015
Name of Person Responsiblefor the GeneralAdministradon of tbeBusiness Entity DoingBusiness with the County
CONTRACT NO.Name of Related County Title and Position ofRelated Nature ofFamilialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected Olficisl or Municipal Elected 0%cia)
Name ofAgent Authorizedto Execute Documents forBusiness Entiiy DoingBusiness with the County
Name ofRelated County Title and Position of Related 'Nature of FamilialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected OKcisl or Municipal Elected Ofiicial
Name of Employee ofBusiness Entity DirectlyEngaged in Doing Businesswith the Couoty
u/e
Name ofRelated Couaty Title and Position ofRelated Nature ofFamilialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected Official or Municipal Elected OBicial
Ifmore space is needed, attach an additional sheet following the above format.
VERIFICATION: To the best of my knowledge, the information I have provided on this disclosure form is accurate and complete. Iacknowledge that an inaccurate or incomplete disclosure is punishable by law, including but not limited to fines and debarment.
4>A~Signature ofRecipient Date
SUBMIT COMPLETED FORM TO: Cook County Board ofEthics69 West Washington Street, Suite 3040, Chicago, Illinois 60602Office (312)603-4304 —Fax (312)603-9988CookCounty. Ethicscooke ountyil.gov
Spouse, domestic partner, civil union partner or parent, child, sibling, aunt, uncle, niece, nephew, grandparent or grandchild
by blood, mamage (l.e. in laws and step relations) or adoption.
EDS-12 8/201 5
CONTRACT NO.SECTION 4
COOK COUNTY AFFIDAVIT FOR WAGE THEFT ORDINANCE
Effective May I, 2015, every person, /nc/udlna Subsesnt/a/ Owners, seeking a Contract wilh Cook County must comply with the Cook County Wage Theft j
Ordinance set forth in Chapter 34, Article IV, Section 179. Any Person/Substantial Owner, who fails to comply with Cook County Wage Theft Ordinance,msy request that the Chief Procurement Oitlcer grant s reduction or waiver in accordance with Section 34-179(d).
"Contract" means any wditten document to make Procummsnts by or on behalf of Cook County.
"person" means any individual, corporation, partnership, Joint Venture, trust, association, limited liability company, sole proprietorship or other legal coaly
"Procurement" means obtaining supplies, equipment, goods, or services of any kind.
"Substsntie/ Owner" means sny person or persons who own or hold s twenty-five percent (25%) or more percentage of Interest in any business entityseeking s County Privilege, including those shareholders, general or limited partners, beneficiaries and principals; except where s business entity is anindividual or sole proprietorship, Substantial Owner means that individual or sole proprietor.
All Persons/Substantial Owners are required to complete this affidavit and comply with the Cook County Wage Theft Ordinance before any Contract isawarded. Signature of this form constfiutes a certiTication ihe information provided below is correct and complete, end that the individual(s) signing this formhas/hsve personal knowledue of such information.
I. Contract Information:
Contract Number:08~-256
County Using Agency (requesting Procurement): Cook Countv
II. Pemon/Substantial Owner InformagomSecurus Technologies, Inc.
Person (Corporate Entity Name):
Substantial Owner Complete Name:
FEIN¹ 75-2722144
Date of Birth:
Street Address:
E-mail address:
14651 Dallas Parkwav. Sixth Floor
boickansitbsecurustechnolooien.corn
City: Dallas
Home Phone: ( 972) 277-0300
III. Compliance with Wage Laws:
State: Texas
Driver's Lkmnse No;
Ztp: 75254
Within the past five years has the Person/Substantial Owner, in any judicial or administrative proceeding, been convicted of, entered aplea, made an admission of guilt or liability, or had an administrative finding made for committing a repeated or willful violation of any ofthe following laws:
YESo NO///ino/s Wage Paymenf and Collection Act 820 /LCS 115/1 el seq.,
////no/s Minimum Wage Act, 820 /LCS 105/l et seq., YES or QO
///inois Worker Adjusbnanf and Retraining Notification Acf, 820 /LCS 65/f ef asq., YES o NO
Emp/oyee C/ass/ficalion Acf, 820 /LCS 185/1 etseq., YES o NO
Fa/r Labor Standards Act of1938, 29 L.S.C.201, atsaq., YES o NO
Any cumparab/e state slafute or regu/al/on of any state, which governs the paymentof wages YES o
If the Person/Substantial Owner answered "Yes" to any of the questions above, it is ineligible to enter into a Contract with CookCounty, but can request 9 reduchon or waiver under Sectlon IV.
EDS-13 8/2015
CONTRACT NO.
IV. Request for Waiver or Reduction
If person/Substantial Owner answered 'yes" to any of the questions above, it may request a reduction or waiver inaccordance with Section 34-179(d), provided that the request for reduction of waiver is made on the basis of one or more otthe following actions that have taken place:
These ~been s bona fide change in ownership or Control of the ineligible Person or Substantial OwnerYESo 0
Oisciplinyqr, action has been taken against the individual(s) responsible for the acts giving rise to the vioiadonYES or~0
Remed~ls 'on has been taken lo prevent s iscunencs of the acts giving rise to the disqueiilicetion or defaultYESo 0Other f(rfttrdhat the Person or Substsnbai Owner believe are relevant.YES NO
The Person/Substantial Owner must submit documenieiion to suooorl the basis ofits reouesi for e reduction or waiver. The ChiefProcurement Officer reserves the noht to make additional inouiries end mcuest additional riocumsntaticn.
V. AffirmationThe Person/Substantial Owner affirrrs that all statements contained in the Aitidavit are true, accurate and complete.
Signature: Date: 8 4& 4C
Name of Person signing (Print): Robert Pickens
S scribed and swyljlto+remethis t~ dayof
xRt(~ Pull)re Sitp(store~
Note: The abq)rt( information is subjp to variffcstion prior to tbe award
Title: President
,20 (tv
EDS-14 8/2015
SECTION 5CONTRACT NO.
CONTRACT AND EDS EXECUTION PAGEPLEASE EI/ECUTE THREE ORIGINAL PAGES OF EDS
The Applicant hereby certifies and warrants that all of the statements, certiffcations and represenlaffons set forth in this EDS are true,complete and correct; that the Applicant ls in full compliance and will continue to be in compliance throughout the term of the Contract orCounty Privilege issued to the Applicant with all the policies and requirements set forth in this EDS; and that sll fade snd informationprovided by the Applicant in this EDS are true, complete and correct. The Applicant agrees to inform the Chief Procumment Officer inwriting if any of such statemenls, certiffcations, mpresentations, facts or informafion becomes or is found to be untrue, incomplete orincorrect during the term of the Contract or County Privilege.
Execution by Corporation
Secures Technologies, Inc.
Corporation's Name
Robek Plckens
President's Printed Name and Signature
972-277-0300
Telephone
Secretary Signature
JfE/ADate
Execution by LLC
LLC Name "Member/Manager Printed Name snd Signature
Date Telephone and Email
Execution by Partnership/Joint Venture
Partnership/Joint Venture Name *Partner/Joint Venturer Printed Name and Signature
Date Telephone and Email
Execution by Sole Proprietorship
Priinted Name Signature Assumed Name (ifapplicable)
Date Telephone and Email
Su cribed and sworn befo is924/n dayof Al(P20
My commission expires:
@a~(~Jjgrljjh, CINDYL CARET
fbi+'~) My COMMISSION EXPIRES
Sepffrmber 7.2017
~AefP.bjl4i/ Notary Seal
*Ifthe opersffng agreement, partnsgjip agreement or governing documents requiring execution by multiple membem, managers,partners, or joint venturers, please complete and execute additional Contract and EDS Execution Pages
EDS-15 8/2015
EXHIBIT 3
Identification of Sub-Contractors/Suppliers/Sub-Consultant
CONTRACT NO. 11-41-05
Cook CountyOffice of the Chief Procurement Officer
Identification of Subcontractor/Supplier/Subconsultant Foun
OCPO OMLYi
Q Oieaueliricetion
Q Check Comoiete
The Bidder/Proposer/Respondent ("the Contractor") will fully complete and execute and submit an IdenlNcation ofSubcontractor/SuppkerlSubconsuitant Form ("ISF")with each Bid, Request far Proposal, and Request forQualification. The Contractor must complete the ISF for each Subcontractor, Supplier or Subconsufiant whichshall be used on the Contract. In the event that there are any changes in the utilization of Subcontractors,Suppliers or Subconsultants, the Contractor must tile an updated ISF.
Bid/RFP/RFQ No.: 80060012
Total Bid or Proposal Amount:
Contractor. Securue Technologies, inc.
Authorized Contactfor Contractor: Robert Pickens
Email Address(Contractor): [email protected]
Company Address(Contractor): 14651 Dallas Parkway, Sixth Floor
I Date:
Contract Title:
Subcontractor/Supplier/Subconsultant to beadded or substitute: Informity Network, Ltd.Authodized Contact forSubcontractor/Supplier/Subconsukant: Edita ArmabuloEmail Address(Subcontractor): [email protected]
Company Address(Subcontractor): 731 N. Sangamon, Suite 300
City, State andZip (Contractor): Dalkre, TX 75254Tekqihane and Fax 972-277-0300(Contractor)Estimated Start andCompkition Dates g/16/2016-3/15I2017(Contractor)
City, State and Zip(Subcontractor): Chicano, IL 60642Telephone and Fax(Subcontractor) 312-361-6524Estimated Start andCompletion Dates 9/1 6/2016- 3/1 5/2017(Subcontractor)
Note: Upon request, a copy of all written subcontractor agmements must be provided to the OCPO.
Total Pdce ofDescrlotion af Services or Suoolies Subconhact far
Senilces or SuoollesOneite Project Management, Help Desk Administration support, maintenance activities $515,000Annual
The subcontract documents will incorporate sll requirements of the Contract awarded to the Contractor ae applicable.The subcontract will in no way hinder the Subcontractor/Supplier/SubconsuNant from maintaining its pragrees an anyother contract on which it is either s Subcontractor/Supplier/Subconsultant or pdncipsl contractor. This disckxture lsmade with the understanding that the Contractor Is not under any circumstances relieved of its abiNies andobligations, snd is responsible for the organization, performance, end quality of work. This form does not approveany proposed changes, revisions or modifications to the contract «ppiaved fiiBE/WBE Utilization Plan. Anychanges to the contract's approved NBE/yyBE/Ufifizstion Plan must be submitted to the Office of theContxact Compliance.
Securus Technologies, Inc.
Name g Robert Pickene
TitlePresident
Prime Contractor Signature
ar -/2-i(aDate