cook county governmentopendocs.cookcountyil.gov/procurement/contracts/1845-17647.pdfcook county...

BIDDER: G & 0 Thermal Supply Company

COOK COUNTY GOVERNMENTOffice of the Chief Procurement Officer

PURCHASES (($25,000) CONTRACT FOR SUPPLIES

DOCUMENT NO. 1845-1 7647(PURCHASE ORDER NO. 70000096196)

INDUSTRIAL STEAM MULTI-STAGE CENTRIFUGAL PUMPFOR

COOK COUNTY DEPARTMENT OF FACILITIES MANAGEMENT

BIDS TO BE EXECUTED IN TRIPLICATEBID OPENING WILL BE ONFRIDAY, JANUARY 11, 2019 AT 10:00 A.M. CENTRA'L STANDARD TIIIELATE BIDS WILL NOT BE CONSIDEREDDELIVER BIDS TO 118 N. CLARK ST., ROOM 1018, CHICAGO, IL 60602

Questions regarding this Bid should be directed to:DANIEL GIZZI, SPECIFICATIONS ENGINEER III

EMAIL: [email protected]: (312) 603-6825

Toni PreckwinkieCook County Board President

Raffi SarrafianChief Procurement Officer

TABLE OF CONTENTS

Section

Instructions to Bidders .

Parle

General Conditions .

Special Conditions 13

Specifications 15

Site Inspection Certificate 17

Proposal .

Exhibits

Exhibit I:

Section 1

Section 2

Section 3

Electronic Payables Program Form

Instructions for Completion of EDS.

Certifications.

Economic and Other Disclosures, Affidavit of Child Support Obligations, .......Disclosure of Ownership Interest and Familial Relationship Disclosure Form

Paoe

EDS i

EDS 1 -2

EDS 3-12

Section 4

Section 5

Section 6

Cook County Affidavit of Wage Theft Ordinance....

Contract and EDS Execution Page

Cook County Signature Page...

EDS 13 — 14

EDS 15 — 17

EDS 18

Fillable PDF Links for all Exhibits Available at: httos:I/www.cookcountvil.aov/serviceldotna4rusiness-cook-~coun

SB — July 2017

CONTRACT ND 1845-17647

INSTRUCTIONS TO BIDDERSINDEX

Section

IB-01

IS-02

IB-03

IB-04

IB-05

I B-06

I B-07

IB-08

IB-09

IB-10

IB-11

IB-12

IB-13

IB-14

IB-15

IB-16

IB-17

IB-18

IB-19

IB-20

I B-21

I B-22

S~ub ect

Detinitions

Site Inspection Certificate

Exceptions and Addendum

Bidder Representations and Warranties

Submission of Bid Proposals

Bid Proposals to Conform to Contract Documents

Competency of Bidder

Local Business Preference

Consideration of Bid Proposals

Withdrawal of Bid Proposals

Notice of Award

Bid Disputes

Prices Firm

Cash Billing Discounts

Catalogs

Authorized Dealer/Distributor

Trade Names

Samples

Notices

Compliance with Laws - Public Contracts

Cook County Recycled Product Procurement Policy

Estimated Quantities

Pacae

SB — July 2017

INSTRUCTIONS TO BIDDERSCONTRACT NO. 1845-17647

IB-01 DEFINITIONS

A. BIDDER shall mean any Person who submits a Bid.

BID COVER PAGE shall mean the general description of the required services, goods, equipment, orsuppkes, the contact information of the assigned Contract Negotiator or Specification Engineer in the Office ofthe Chief Procurement Officer, and shall include the date, time and place for both the submission of BidProposals and the opening of the Bid Proposals.

BID or BID PROPOSAL shall mean a response to the Bid Notice containing all Bid Documents and any otherdocuments or information the Bidder is required to provide.

D. BID DOCUMENTS means the documents, specifications, forms and other information necessary and requiredfor a Bid.

BID NOTICE means the notice from the CPO regarding a Procurement which shall include: a generaldescription of the Procurement; information necessary to obtain the Bid Documents, and the date, time andplace for both the submission of Bids and the opening of the Bids.

F. CONTRACT shall mean any written document to make Procurements by or on behalf of Cook County.

CONTRACT DOCUMENTS shall mean collectwely the Bid Cover Page, Bid Notice, Bid Documents, and anyother document required by the Chief Procurement Officer. The above documents shall be considered as oneintegrated document setting forth the obligations of the parties.

H. CONTRACTOR shall mean the Person that enters into a Contract with the County.

COUNTY shall mean the County of Cook, a body politic and'corporate of the State of illinois.

DIRECTOR shall mean the person or persons authorized by the County to act in connection with this Contract.Such authorization shall not include any power to change the scope of the Contract or to obligate the County topay additional sums beyond the amount of the Contract awarded by the Cook County Board of Commissionersor the Chief Procurement Officer.

K. CHIEF PROCUREMENT OFFICER or CPO shall mean the Chief Procurement Officer of the County of Cookwhose duties and responsibilities are more particularly described in the Cook County Procurement Code,Chapter34, Article IV, Division I.

L OCPO shall mean the Office of the Chief Procurement Officer of Cook County.

PERSON shall mean any individual, corporation, partnership, Joint Venture, trust association, LimitedLiability Company, sole proprietorship or legal entity.

N. PROCUREMENT shall mean obtaining supplies, equipment, goods or services of any kind

SPECIFICATIONS shall mean the description of the services, work, goods, equipment, personnel, volume anduse statistics and all requirements for the scope of work set forth in the Contract Documents.

LISING AGENCY shall mean the departments or agencies within Cook County government induding electedofficials.

SB — July 2017


IB-02 SITE INSPECTION CERTIFICATE

The Bidder shall inspect the job-site to become familiar with the conditions related to the work or services and therequirements set forth in the Bid Documents. Failure of the Bidder to visit the Site shall not relieve or alter the Bidder'sresponsibility for completing the work or services as required by the Contract Documents.

When required as mandatory in the Contract Documents, the Bidder shall visit the job-site and shall carefully examineand become familiar with all conditions which may in any way affect the performance of the Contract and shall submitcertification of such mspection along with the Bid Proposal. The dates and conditions of the site inspection aredetermined by the County. If the Contract Documents provide that inspection of the site is mandatory, a Bidder'sfailure to attend all of the required site inspections shall render the Bid Proposal non-responsive.IB-03 EXCEPTIONS AND ADDENDUM

The County will not provide oral answers to questions concerning Bid Documents before or subsequent to the award ofa Contract. If an interpretation or clanfication of the Bid Document is desired by the Bidder or if the Bidder intends torequest s deviation to the Specifications, the Bidder shall submit questions or request for the deviation to theSpecifications to the Chief Procurement Officer prior to the date for inquiries set forth in the Special Conditions TheChief Procurement Officer will answer questions or requests for deviations to the Specifications by issuing an Addendumwhich shall be available to all Bidders submitting a Bid Proposal. If no Addendum is issued by the Chief ProcurementOfficer, then such deviation or exception to the Specification shall be deemed reiected. The Chief Procurement Officershall reject any Bid containing deviations or exceptions to the Specifications not previously accepted through a writtenAddendum. Bidder shall acknowledge receipt of each Addendum issued in the space provided on the proposal form.The Bidder's failure to acknowledge in writing any issued addenda may result in the CPO finding the Bid non-responsiveand rejecting the Bid The OCPO shall not allow any Bidder to acknowledge any such addenda, in wnting or orally, afterthe Bid Opening.

All written requests for ciarifications, deviations or exceptions shall be addressed to the Specification Engineer orContract Negotiator listed on the Bid Cover Page

If the apparent lowest Bidder takes exceptions or deviations to the General Conditions, which are submitted with the Bid,the CPO shall reject the Bid as non-responsive in the event that the Chief Procurement Officer, in his or her sole opinion,determines such exceptions or deviations to be material.

IB-04 BIDDER REPRESENTATIONS AND WARRANTIES

The submission of a Bid shall constitute a representation and warranty that: (i) Bidder has carefully and thoroughlyreviewed the Contract Documents and has found them complete and free from ambiguities and sufficient to describe therequired goods, equipment, supplies or services; (ii) Bidder and all laborers, employees or subconbtractois it intends touse in the performance of this Contract are skilled and experienced in the type of work or services called for by theContract Documents; and (iii) neither the Bidder nor any of its employees, agents, suppliers or subcontractors haverelied on any verbal representations from the County, or any of the County's employees, agents, or consultants, inpreparing the Bid.

IB.05 SUBMISSION OF BID PROPOSALS

All Bidders shall submit the bound copy of the Bid in a sealed envelope and shall cause the Bid to be dehvered to TheOffice of the Chief Procurement Officer, Room 1018, County Building, 118 North Clark Street, Chicago, illinois 60602 bythe date and hour for the Bid Opening as shown in the Bid The sealed envelope submitted by the Bidder shall have theBid label, set forth herein, or shall have the following information on the face of the envelope Bidder's name, address,subject matter of Bid, Bid or Contract number, advertised date of Bid Opening and the hour designated for Bid Openingas shown in the Contract Documents.

IB-08 BID PROPOSALS TO CONFORM TO BID DOCUMENTS

The County will not entertain or consider any Bids (i) received after the exact time specified in the Bid; (ii) notaccompanied by the required bid deposit; or (ki) in any other way failing to comply fully with the conditions stated in theBid.

IB-07 COMPETENCY OF BIDDER

No Contract shall be awarded to a Bidder that is in arrears or is in default to the County upon any debt or Contract, orthat is a defaulter, as surety or otherwise upon any obligation to said County, or has failed to perform faithfully anyprevious contract with the County.

SB — July 2017


IB-08 LOCAL BUSINESS PREFERENCE

The Chief Procurement Officer shall, for all Procurements funded solely with County dollars by competitive sealedbidding, accept the lowest bid price or lowest evaluated bid price from a responsive or responsible local business,provided that the Bid does not exceed the lowest bid price or lowest evaluated bid price from a responsive andresponsible non-local business by more than five percent (5'lo)."Local business" shall mean a Person, including a foreign corporation authorized to transact business in illinois, havinga bona fide establishment located within the County at which it is transacting business on the date when a Bid issubmitted to the County, and which employs the majority of its regular, full-time work force within the County. A JointVenture shall cons0tute a Local Business if one or more Persons that qualify as a "Local Business" hold interests totalingover 50 percent in the Joint Venture, even if the Joint Venture does not, at the time of the Bid submittal, have such abona fide establishment within the County.

IB-09 CONSIDERATION OF BID PROPOSALS

The County reserves the right to reject or accept any or all Bid Proposals, to extend the bidding period, to wawetechnicalities in the Bid and/or to withdraw or cancel the Bid or to issue a new Bid, i.e., "rebid'rior to award of theContract

After Bid Proposals are opened and read aloud, they will be evaluated based on the price, conformance withSpecifications, the responsibility of the various Bidders taking into consideration factors including, but not limited to,those noted in IB-09, IB-10 and responsiveness to the County's Minority and Female Owned Business Ordinance.The Chief Procurement Officer reserves the right to make corrections, after recewing the Bids, to any clerical errorapparent on the face of the Bid, including but not limited to obviously incorrect units or misplaced decimal points, orarithmetic errors. In the event that companson of the Bidder's "Unit Price" and "Total Price" submitted for any hne itemsreveals a calculation error, the Unit Price will prevail.

The Chief Procurement Officer reserves the right to reject any Bid that, in his or her discretion and authority isdeemed materially unbalanced.

IB-10 WITHDRAWAL OF BID PROPOSALS

Bidders may withdraw their Bid Proposals at any time prior to the time specified in the Bid as the date and hour setfor the Bid Opening, However, no Bidder shall withdraw, cancel or modify its Bid Proposal for a period of ninety (90)calendar days affer said advertised Bid Opening.

IB-11 NOTICE OF AWARD

The Chief Procurement Oflicer shall notify the successful Bidder, in writing, of award of the Contract by the Countywithin ninety (90) days from the Bid Opening date. Upon receipt of the Notice of Award, the Contractor shall promptlysecure, execute and deliver to the Chief Procurement Officer any documents required hereinIB-12 BID DISPUTES

Section 34-136 of the Cook County Procurement Code permits Bidders to tile protests. Any Bidder who reasonablybelieves that the recommended Bidder is not the lowest Responsive and Responsible Bidder, or has a complaint aboutthe bid process, may submit a bid protest, in writing, and directed to the CPO, within three business days after the dateupon which the CPO posts the recommended Bid for award or execution on the County's website. The bid protest mustspecify why the protester behaves the recommended Bidder is not the lowest Responsive and Responsible Bidder, orwhy the protestor believes the bid procedure was unfair, including a statement of how the alleged unfairness prejudicedthe protesting Bidder and the action requested of the CPO. A bid protest based on an issue which could have beenclarified through a request for clarification or information pursuant to Section 34-136(d), and IS-05, Communications withthe County regarding competitive bidding process, will not be considered if the protesting Bidder failed to make suchrequest. When a bid protest has been submitted, no further action shall be taken on the Procurement until the CPOmakes a decision concerning the bid protest, unless the Using Agency responds in writing and sufficientty demonstratesthat (i) the item to be procured is urgently required and (ii) failure to make the award promptly will unduly delay dehveryor performance or cause other undue harm.

The CPO shall issue a written deasion on the bid protest to the protesting Bidder and to any other Bidder affected bysuch decision as soon as reasonably practicable. If the bid protest is upheld based on a lack of fairness in the bidprocedure, the CPO shall re-bid the procurement. If the CPO determines that the recommended Bidder was notResponsive and Responsible, that Bidder shall be disqualified and the CPO may either recommend the lowestResponsive and Responsible Bidder or re-bid. Any CPO decision concerning bid protests shall be final.

I B-1 3 PRICES FIRM

All prices quoted in the Bid Proposal shall be firm and will not be subject to increase during the term of the Contract,except as otherwise provided in these Contract Documents

SB — July 2017


IB-14 CASH BILLING DISCOUNTS

Cash billing or percentage discounts for payment will not be considered in evaluating Bid Proposals.IB-15 CATALOGS

Each Bidder shall submit in TRIPLICATE, where necessary or when requested catalogs, descriptive literature, anddetailed drawings, fully detailing features, designs, construction, appointment and finishes not covered in theSpemfications but necessary to fully describe the goods, equipment, suppkes or services.IB-16 AUTHORIZED DEALER/DISTRIBUTOR

For goods, equipment and supplies, the Bidder must be one of the following: (i) the manufacturer, (ii) an authorizeddealer/distributor; or (iii) able to promptly secure the necessary genuine parts, assemblies and/or accessories assupplied by the original equipment manufacturer (O.E.M.), along with any necessary schematics or drawings to fulfillthe contractual obligations. With respect to the purchase of vehicles, or services related to vehicles, theSpecifications or Special Conditions may require that the Bidder be an authorized dealership of the manufacturer.The Bidder must be able to furnish original product warranty and manufacturer's related services such as productinformation, product re-call notices, etc. Proof of ability to transfer product warranty to the County is to be submittedwith the Bid Proposal.

IB-17 TRADE NAMES

In cases where an item is identified by a manufacturer's name, brand name, trade name, catalog number, orreference, it is understood that the Bidder proposes to furnish the item identified and does not propose to furnish analternate but equivalent item, unless the Bidder has proposed and the County has accepted the alternate butequivalent item.

Unless the Bid states that no substitute shall be allowed, the reference to a manufacturer's name, brand name, tradename, catalog number, or reference is intended to be descriptive and not restrictive and to indicate to prospectiveBidders articles that shall be satisfactory. Bid Proposals for other manufacturer names, brand names, trade names,catalog numbers or references shall be considered, provided each Bidder states on the face of the Bid Proposal whatalternate, but equivalent items are being proposed.

If the Bidder proposes alternate, but equivalent, items, the Bidder must provide the following: (i) product identification,including manufacturer's name and address; (ii) manufacturer's literature identifying the product description,reference standards and performance and test data; (iii) samples, as applicable; and (iv) itemized comparisons of theproposed alternate items listing significant variations If a Bidder proposes alternate items, it warrants and representsthat in making a formal request for substitution that (i) the proposed alternate item is equivalent to or supedior in allrespects to the item specified in the Bid; and (ii) that the same warranties and guarantees will be provided for theproposed alternate items as those specified in the Bid. The CPO may, in his or her sole discretion accept analternate item for a specified item, provided the alternate items so bid is, in the CPO's sole opinion the equivalent ofthe item specified in the Bid. An alternate item that the CPO determines not to be equivalent to the specified itemshall render the bid non-responsive and the CPO shall reject the Bid.

IB-18 SAMPLES

Bidders may be asked upon request of the Chief Procurement Officer, including subsequent to the Bid Opening, tofurnish and deliver a representative sample sufficient to effectively evaluate each item listed in the Bid Proposal. Allsamples must be delivered F.O.B. DESTINATION, FREIGHT PREPAID to an identified delivery location within five(5) business days of the request. Samples submitted must be identical to those specified in the Bid Proposal.Submission of other than the samples reflected in the Bid Proposal or failure to furnish samples within the requiredtime period shall be cause for rejection of the Bid Proposal. All samples are subject to mutilation and will not bereturned. Bidders shall bear the cost of any samples and shipping or delivery costs related thereto

IB-19 NOTICES

All communications and notices between the County and Bidders regarding the Bid Documents shall be in writing andhand delivered or delivered via first class United States mail, postage prepaid, or via e-mail Notices to the Biddersshall be addressed to the name and address provided by the Bidders, notices to the Chief Procurement Officer shallbe addressed to Room 1018, County Building, 118 North Clark Street, Chicago, illinois 60602.

SB — July 2017


IB-20 COMPLIANCE WITH LAWS - PUBLIC CONTRACTS

This is a competitive Bid of Cook County government subject to laws and ordinances governing public bids andcontracts. The Bidder shall at all times observe and comply with all laws, ordinances, regulations and codes of theFederal, State, County and other local government agencies which may in any manner effect the preparation of theBid Proposal or the performance of the Contract. If the Bidder observes that any of the Bid Documents are atvariance with any laws, ordinances, regulations or codes, it shall promptly notify the Chief Procurement Officer inwriting and if necessaiy an addendum shall be issued by the Chief Procurement Officer.

IB-21 COOK COUNTY RECYCLED PRODUCT PROCUREMENT POLICY

Cook County has adopted the Cook County Recycled Product Procurement Policy. In accordance with the Policy,Cook County encourages the use of recycled paper and paper products, whenever practicable. The Bidder shall userecycled paper, except where the specialized nature of certain materials (such as photographs) requires otherwise,and all documents shall be printed two-sided unless two-sided printing is not practicable

IB-22 ESTIMATED QUANTITIES

Unless expressly stated in the Specifications, Special Conditions, or Proposal page(s) any quantities stated in this Bidrepresent estimated usage and as such are for bid canvassing purposes only. The County reserves the right toincrease or decrease quantities ordered. Nothing herein will be construed as an intent or obkgation on the part of theCounty to purchase any goods, equipment, supplies or services beyond those determined by the County to benecessary to meet its needs

END OF SECTION

SB — July 2017

CONTRACT NO 1845-17647

GENERAL CONDITIONSBID CONTRACTS

INDEX

Section

GC-01

GC-02

GC-03

GC-04

GC-05

GC-06

GC-07

GC-08

GC-OS

GC-10

GC-11

GC-12

GC-13

GC-14

GC-15

GC-16

GC-17

GC-18

GC-19

S~ub'ect

Subcontracting or Assignment of Contract or Contract Funds

Indemnification

Inspection and Responsibility

Payment to Contractors and Subcontractors

Insurance

Disputes

Default

County's Remedies

Patents, Copyrights and Licenses

Compliance with Laws

Delivery

Material Data Safety Sheet

Termination for Convenience

Guarantees and Warranties

Confidentiality and Ownership of Documents

Audit; Examination of Records

Governing Law

Cooperation with Inspector General

M/WBE Commitment

Parte

10

10

10

12

12

12

12

12

13

13

13

13

14

14

14

SB — July 2017

CONTRACT NO. 1845-17647

GENERAL CONDITIONS

GC-01 SUBCONTRACTING OR ASSIGNMENT OF CONTRACT OR CONTRACT FUNDSOnce awarded, this Contract shall not be subcontracted or any part thereof assigned without the express writtenapproval of the County Chief Procurement Officer (" Chief Procurement Officer"). In no case, however, shall suchapproval relieve the Contractor from his obligations or change the terms of the Contract. The Contractor shall nottransfer or assign any Contract funds or claims due or to become due without the advance written approval of theChief Procurement Officer. The unauthorized subcontracting or assignment of the Contract, in whole or m part, or theunauthonzed transfer or assignment of any Contract funds, either in whole or in part, or any interest therein, whichshall be due or are to become due the Contractor shall have no effect on the County and are null and void.

The Contractor shall identify any and all contractors and subcontractors it intends to use in the performance of theContract by completing the Identification of Subcontractor/Supplier/Subconsultant Form ("ISF"). All such personsshall be subject to the prior approval of the County. The Contractor will only subcontract with competent andresponsible Subcontractors The Chief Procurement Officer may require in his or her sole discretion, that theContractor provide copies of all contracts with subcontractors.

The Contractor and its employees, contractors, subcontractors, agents and representatives are, for all purposesarising out of this Contract, independent contractors and are not employees of the County. It is expressly understoodand agreed that the Contractor and its employees, contractors, subcontractors, agents and representatives shall in noevent as a result of a contract be entitled to any benefit to which County employees are entitled, including, but notlimited to, overtime, retirement benefits, worker's compensation benefits and injury leave or other leave benefits

GC-02 INDEMNIFICATIONThe Contractor covenants and agrees to indemnify and save harmless the County and its commissioners, officials,employees, agents and representatives, and their respective heirs, successors and assigns, from and against anyand all costs, expenses, attorney's fees, losses, damages and liabilities incurred or suffered directly or indirectly fromor attributable to any claims arising out of or incident to the performance or nonperformance of the Contract by theContractor, or the acts or omissions of the officers, agents, employees, contractors, subcontractors, licensees orinvitees of the Contractor. The Contractor expressly understands and agrees that any Performance Bond orinsurance protection required of the Contractor, or otherwise provided by the Contractor, shall in no way limit theresponsibility to indemnify the County as hereinabove provided.

GC-03 INSPECTION AND RESPONSIBILITYThe County shall have a right to inspect and approve any Contract goods, equipment, supplies or services used incarrying out this Contract and shall approve the quality and standards of all materials or completed work furnished underthis Contract Contract goods, equipment, supplies or services not complying herewith may be rejected by the ChiefProcurement Officer and/or the Using Agency and shall be replaced and/or re-performed by the Contractor at no cost tothe County. Any Contract goods, equipment or supplies rejected shall be removed within a reasonable time from thepremises of the County at the entire expense of the Contractor, after notice has been given by the County to theContractor that such Contract goods, equipment or supplies have been rejected.

10SB — July 2017


GENERAL CONDITIONS

GC-04 PAYMENT TO CONTRACTORSAll invoices submitted by the Contractor shall be in accordance with the cost provisions contained in the ContractDocuments and shall contain a detailed description of the Deliverables (i.e, the goods, equipment, supplies or services)including the quantity of the Deliverables, for which payment is requested. All invoices for services shall include itemizedentries indicating the date or time period in which the services were provided, the amount of time spent performing theservices, and a detailed description of the services provided dunng the period of the invoice. All Contracts for servicesthat are procured as Sole Source must also contain a provision requiring the Contractor to submit itemized recordsindicating the dates that services were provided, a detailed description of the work performed on each such date, andthe amount of time spent performing work on each such date. All Contracts for services that are procured as SoleSource must also contain a provision requiring the Contractor to submit itemized records indicating ihe dates thatservices were provided, a detailed description of the work performed on each such date, and the amount of time spentperforming work on each such date. All invoices shall reflect the amounts invoiced by and the amounts paid to theContractor as of the date of ffie invoice. Invoices for new charges shall not include "past due" amounts if any, whichamounts must be set forth on a separate invoice Contractor shall not be entitled to invoice the County for any late feesor other penalties.

In accordance with Section 34-177 of the Cook County Procurement Code, the County shall have a right to set off andsubtract from any invoice(s) or Contract price, a sum equal to any fines and penalties, including interest, for any tax orfee delinquency and any debt or obligation owed by the Contractor to the County.

The Contractor acknowledges its duty to ensure the accuracy of all invoices submitted to the County for payment. Bysubmitting the invoices, the Contractor certifies that all itemized entries set forth in the invoices are true and correct. TheContractor acknowledges that by submitting the invoices, it certifies that it has delivered the Deliverables, i.e., the goods,supplies or equipment set forth in the Contract to the Using Agency, or that it has properly performed the services setforth in the Contract The invoice must also retiect the dates and amount of time expended in the provision of servicesunder the Contract. The Contractor acknowledges that any inaccurate statements or negligent or intentionalmisrepresentations in the invoices shall result in the County exercising all remedies available to it in law and equityincluding, but not limited to, a delay in payment or non-payment to the Contractor, and reporling the rnatter to the CookCounty Office of the Independent Inspector General.

GC-05 INSURANCEContractor shall purchase and maintain during the term of this Contract insurance coverage which will satisfactorilyinsure Contractor and the County against claims and liabilities which could arise because of performance of theContract.

GC-06 DISPUTESAny dispute arising under the Contract between the County and Contractor shall be decided by the Chief ProcurementOfficer. The complaining party shall submit a written statement detailing the dispute and specifying the specitic relevantContract provision(s) to the Chief Procurement Officer. Upon request of the Chief Procurement Officer, the partycomplained against shall respond to the complaint in writing within five days of such request. The Chief ProcurementOfficer will reduce hisiher decision to writing and mail or otherwise furnish a copy thereof to the Contractor and UsingAgency Dispute resolution as provided herein shall be a condition precedent to any other action at faw or in equityNotwithstanding a dispute, Contractor shall continue to discharge all its obligations, duties and responsibilities set forth inthe Contract during any dispute resolution proceeding unless otherwise agreed to by the County in writing.

SB — July 2017

CONTRACT NO 1845-17647

GENERAL CONDITIONS

GC-07 DEFAULTContractor shall be in default hereunder in the event of a material breach by Contractor of any term or condition of thisContract where Contractor has failed to cure such breach within ten (1 0) days after written notice of breach is given toContractor by the County, setting forth the nature of such breach.A material breach of the contract by the Contractor includes but is not limited to the following:1. Failure to begin performance under the Contract within the specified time,2. Failure to perform under the Contract with sufficient personnel, equipment, or materials to ensure completion

of said performance within the specified time or failure to assign qualified personnel to ensure completionwithin the specified time;

3. Performance of the Contract in an unsatisfactory manner;4. Refusal to perform services deemed to be defective or unsuitable,5. Discontinuance of performance of Contractor's obligations under the Contract or the impairment or the

reasonable progress of performance;6. Becoming insolvent, being declared bankrupt or committing any act of bankruptcy or insolvency;7. Any aswgnrnent of the Contract for the benefit of creditors;8 Any cause whatsoever which impairs performance in an acceptable manner; or9. Any other material breach of any term or condition of the Contract.

County shall be in default hereunder if any material breach of the Contract by the County occurs which is notcured by the County within forty-five (45) days affer written notice of breach has been given by Contractor tothe County, setting forth the nature of such breach.

GC-08 COUNTY'S REMEDIESIf the Contractor fails to remedy a matenal breach during the ten (10) day cure period pursuant to General Condition GC-05, Default, the County shall have the right to terminate the Contract provided, however, that the County shall giveContractor prior vmtten notice of its intent to terminate. Following notice of breach to Contractor, the County reservesthe right to withhold payments owed to Contractor until such time as Contractor has cured the breach which is thesubiect matter of the notice In addition, the County shall have the right to pursue all remedies in law or equity.

GC-09 PATENTS. COPYRIGHTS AND LICENSESContractor agrees to hold harmless and indemnify the County, its officials, agents, employees and affiliates from anddefend, as permitted by illinois law, at its own expense (including reasonable attorneys', accountants'ndconsultants'ees),

any suit or proceeding brought against the County based upon a claim that the ownership and/or use ofequipment, hardware and solbvare or any part thereof utilized in performing Contractor's services constitutes aninfringement of any patent, copyright or license or any other intellectual property nght. In the event the use of anyequipment, hardware or soibvare or any part thereof is enjoined, Contractor with all reasonable speed and due diligenceshall provide or otherwise secure for County, at the Contractor's election, one of the following: the right to continue useof the equipment, hardware or software; an equivalent system having the Specifications as provided in this Contract; orto modify the system or its component parts so that it becomes non-infrtinging while performing in a substantially similarmanner to the original system, meeting the Specifications of this Contract.

GC-10 COMPLIANCE WITH LAWSThe Contractor shall observe and comply with the laws, ordinances, regulations and codes of the Federal, State, Countyand other local government agencies which may in any manner affect the performance of the Contract, including but notlimited to those County Ordinances set forth in the Certifications, Affidavits or EDS attached hereto and incorporatedherein. Assurance of compliance with this requirement by the Contractor's employees, agents or subcontractors shallbe the responsibility of the Contractor. The Contractor shall secure and pay for all federal, state and local licenses,permits and fees required in order to perform this Contract.

GC-11 DELIVERYAll Contract goods, equipment or supplies shipped to the County shall be shipped F.O.B., DESTINATION, FREIGHTPREPAID. Arrangements shall be made in advance by the Contractor in order that the County may arrange for receipt ofthe materials. The County reserves the right to add new deliveiy locations or delete previously sated delivery locationsas required during the Contract period. The only restriction regarding the County's right to add new delivery locationsshall be that any new or additional location shall be within the geographical boundaries of the County of Cook.

GC-12 MATERIAL DATA SAFETY SHEETWhere required under the liknois "Toxic Substance Disclosure to Employees Act", illinois Compiled Statutes, 820 ILCS255/1, Contractor shall submit with each delivery of Contract goods, equipment or supplies a Material Safety DataSheet.

12SB — July 2017


GENERAL CONDITIONS

GC-13 TERMINATION FOR CONVENIENCEThe County may terminate this Contract, or any portion, at any time by notice in writing from the County to theContractor. Unless otherwise stated in the notice, the effective date of such termination shall be three business daysaffer the date the notice of termination is mailed by the County If the County elects to terminate the Contract in full,unless otherwise specified in the notice of termination, the Contractor shall immediately cease performance and shallpromptly tender to the County all work products, reviews, recommendations, reports, documents and analyses, whethercompleted or in process. If the County elects to terminate the Contract in part, unless otherwise specified in the notice ofpartial terminafion, the Contractor shall immediately cease performance of those portions of the Contract which areterminated and shall promptly tender to the County all work products, reviews, recommendations, reports, documentsand analyses relating to said portions of the Contract, whether completed or in process Contractor shall refrain fromincurnng any further costs wiih respect to portions of the Contract which are terminated except as specifically approvedby the Chief Procurement Officer. The Contractor shall not invoice the County for any goods, equipment, suppkes orservices provided after the effective date of termination.

GC-14 GUARANTEES AND WARRANTIESUnless otherwise stated herein, all guarantees and warranties required shall be furnished by the Contractor and shall bedelivered to the Department before final payment on the Contract is issued. The Contractor agrees that the Contractgoods, equipment, supplies or services to be furnished shall be covered by the most favorable commercial warrantiesthe Contractor gwes to any customer for the same or substantially similar Contract goods, equipment, supplies orservices and that the rights and remedies so provided are in addition to and do not limit any nghts afforded to County.

GC-15 CONFIDENTIALITY AND OWNERSHIP OF DOCUMENTSContractor acknowledges and agrees that information regarding this Contract is confidential and shall not be disclosed,directly, indirectly or by implication, or be used by Contractor in any way, whether during the terin of this Contract or atany time thereafter, except solely as required in the course of Contractor's performance of the Contract Contractor shallcomply with the applicable privacy laws and regulations aifecting the County and will not disclose any of County'srecords, materials, or other data to any third party. Contractor shall not have the right to compile and distribute statisticalanalyses and reports utilizing data derived from information or data obtained from County without the prior writtenapproval of County, In the event such approval is given, any such reports published and distributed by Contractor shallbe furnished to County without charge.

All documents, data, studies, reports, work product or product created as a result of the performance of this Contractshall be the property of the County of Cook It shall be a breach of this Contract for the Contractor to reproduce or use,any documents, data, studies, report, work product or product obtained from the County of Cook or created hereby for itsown purposes or to be copied and used by any third party. Duriing the performance of the services herein provided for,the Contractor shall be responsible of any loss or damage to the County's documents while they are in the Contractorspossession, and any such document lost or damaged shall be restored at the expense of the Contractor

GC-16 AUDIT: EXAMINATION OF RECORDSThe Contractor agrees that the Cook County Auditor or any of its duly authorized representatwes shall, until expiration ofthree (3) years after the final payment under the Contract, have access and the right to examine any books, documents,papers, canceled checks, bank statements, purveyor's and other invoices, and records of the Contractor related to theContract, or to Contractor's compliance with any term, condition or provision thereof. The Contractor shall beresponsible for establishing and maintaining records sufficient to document the costs associated with performance underthe terms of this Contract.

The Contractor further agrees that it shall include in all of its subcontracts hereunder a provision to the effect that thesubcontractor agrees that the Cook County Auditor or any of its duly authorized representatives shall, until expiration ofthree (3) years affer final payment under the subcontract, have access and the right to examine any books, documents,papers, canceled checks, bank statements, purveyor's and other invoices and records of such subcontractor involvingtransactions relating to the subcontract, or to such subcontractor's compliance with any term, condition or provisionthereunder or under the Contract.

In the event the Contractor receives payment under the Contract, reimbursement for which is later disallowed by theCounty, the Contractor shall promptly refund the disallowed amount to the County on request, or at the County's option,the County may credit the amount disallowed from the next payment due or to become due to the Contractor under anycontract with the County.

13SB — July 2017

CONTRACT NO. 1 845-17647

GENERAL CONDITIONS

GC-1 7 GOVERNING LAWThis Contract shall be governed by and construed under the laws of the State of illinois The Contractor irrevocablyagrees that, subject to the County's sole and absolute election, any action or proceeding in any way, manner or respectarising out of the Contract, or arising from any dispute or controversy in connection with or related to the Contract, shallbe litigated only in courts within the Circuit Court of Cook County, State of lginois, and the Contractor consents andsubmits to the jurisdiction thereof. In accordance with these provisions, Contractor waives any right it may have totransfer or change the venue of any litigation brought against it by the County pursuant to this Contract.

GC-18 COOPERATION WITH INSPECTOR GENERALContractors, subcontractors, licensees, grantees or persons or businesses who have a County contract, grant, license,or certification of eligibility for County contracts shall abide by all of the applicable provisions of the Office of theIndependent Inspector General Ordinance (Section 2-281 et. seq. of the Cook County Code of Ordinances). Failure tocooperate as required may result in monetary and/or other penalties

GC-19 MINORITY AND WOMEN OWNED BUSINESS ENTERPRISES COMMITMENTIn the performance of this Contract, including the procurement and lease of materials or equipment, Contractor mustabide by the minority and women's business enterprise commitment requirements of the Cook County Ordinance forall contracts which have an amount of $25,000 or more, (Article IV, Section 34-267 through 272) except to the extentwaived by the Compliance Director

14SB — July 2017


SPECIFICIATIONS

SC-01 SCOPEThe Bidder shall furnish an Industrial Steam Multi-Stage Centrifugal Pump for the Cook County Department of FacilitiesManagement, all in accordance with the Contract Documents, Specifications and Proposai herein. This bid documentis specific to the manufacturer Industrial Steam. No other manufacturers are solicited nor will they be considered foraward.

SC-02 CONTRACT PERIODThis contract shall be effecbve February 20, 2019 through February 19, 2020 after award by the Chief ProcurementOfficer and after proper execution of the Contract Documents.

SC-03 AWARD OF CONTRACTThe Contract shall be awarded to the lowest, responsible and responsive Bidder whose bid meets the requirementsand criteria set forth in the Bid Documents. All items, unless otherwise stated, will be assumed to meet all specificationsand requirements as set forth in the Bid Documents. Ambiguous bids which are uncertain as tc terms, delivery, quantity,or compliance with specifications may be declared non-responsive and rejected The County shall be sole determinantof the relevant and appropriate cost factors used in evaluating any Base, Options and/or Alternate bids. Bidders mustquote all lines for consideration. It is the intent of the County to award this bid in whole and not in part. Only one awardwill result from this bid.

SC.04 DELIVERYInside delwery shall be made within 5 (five) business days of an order to the location usted below The Vendor shallmake delivery within five business days between the hours of 8:00 a.m. and 1.30 p.m., Monday through Friday, exceptthe following holidays: Columbus Day, Veteran's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day,Christmas Day, New Year's Day, Martin I uther King, Jr. Day, Casmir Pulaski Day, Lincoln's Birthday and Washington'sBirthday. Delivery will not be accepted affer the time speciTied. Freight and delivery charges shall be included in theVendor's bid. The Purchase Order Number must appear on the dock receipt when goods are delivered. The Contactperson for the delivery locations is: Brian Barron, Operations Engineer III, who can be contacted at (773) 674-6268.

Brian Barren, Operations Engineer III

Cook County Department of Facilities ManagementCook County Powerhouse3045 S. Sacramento AvenueChicago, IL 60608

SC-05 INQUIRIESA copy of any written request for interpretation of documents shall be provided to the Office of the Chief ProcurementOfficer at the address set forth below.

Inquiries about the interpretation of the Spemfications must be made only in writing and shall be directed to the ChiefProcurement Officer. Inquiries will be answered in writing, if deemed necessary, by means of an Addendum issued bythe Office of the Chief Procurement Officer. (Reference Instructions to Bidders, Section IB-05 "Exceptions andAddendum", Page IB-3). Inquiries must be received no later than 12:00 p.m. on Wednesday, January 2, 2019.

During the bid process, ail inquines must be directed, in writing, only to the Office of the Cook County Chief ProcurementOfficer as follows:

Raffi SarrsfianCook County Chief Procurement Officerc/o Daniel Gizzi, Specifications Engineer III

118 N. Clark Street, Room 101 8Chicago, IL 6060"

Contact Info for Specifications Engineer III

Carolynn Jones. (312} 603-6825 or dan [email protected]

155SB — July 2017

CONTRACT NO. 1845-1 7647

SPECIAL CONDITIONS

SC-06 REJECTED PRODUCTAll Industnal Steam Multi-Stage Centrifugal Pump will be inspected upon delivery Any product that does not meet theagreed specifications shall be rejected. The Vendor will have five (5) business days to replace the reiected IndustrialSteam Multi-Stage Centrifugal Pump If the Industrial Steam Multi-Stage Centrifugal Pump is not replaced with in five(5) business days, the vendor will be held responsible for any additional costs should Cook County need to obtain theIndustrial Steam Multi-Stage Centrifugal Pump from another vendor.

SC-07 WARRANTY

The Vendor shall provide manufacturer warranty

SC-08 NOTIFICATION

Do not begin performance on the Contract until notified by the Using Agency.

16SB — July 2017

SPECIFICIATIONS

CONTRACT NO. 1845.-17647

ITEM.NO. 01 Industrial Steam Multi-Staae.Centdfuasl Puma

ManufacturerModel NumberMotorSpsdficstionHorsepowerVoltsAmpsRevelations per Minute (RPM)HehzPhaseEnclosureFromSar)al Number

2VC-1 30-7-2L85800027101841y27118.7 kilo watts 1P54200/40068I34292048. 3Total Endosure Fan Cooled (Tefc)286t5c2CB10107{N42

17ASB- July2017

SITE INSPECTION CERTIFICATE

(NOT APPLICABLE)


This is to verify that Bidder has, this date, participated in the Mandatory Site Inspection as required in this Bid. Bidderhas inspected the site and related Bid Documents snd fully familiarized itselfwith all conditions and matters whish mightin any way affect the Deliverables, induding costs and scheduling.

@LVh E. Et=-aznfkkNAME (PRINTED/TYPED AND SIGNATURE)

y'h~XWAL Jt//Q 4/ /rfa/P'OMPANY

/(I'JfJAe'z-J(-

OFFICIAL CAPACITY

-p, S'- gz&-ck oTELEPHONE NUMBER (Ama Code)

NOTE: This form must be lllled in completely and returned with Bid Proposal

INSPECTION CONFIRMED BY:

DATE:

Z/J8- Qo/g

1888 — July 2017


PROPOSAL

BIDDER. 6 ~ ~ $86 AIQL ~&//LP'PPSV/

The Bidder dedares that it has carefully examined the Proposal Form, General snd Speaal Condldons andSpecifications idenfNed es Contract Document Number 1845-17647 for an Industrial Steam Muki-Stage CentrifugaPump for the Cook County Department of Facilifies Management,,as pmpsrsd.by Cook County, snd that they havefsnNiarized themselves with all of the conditions under which it must be carried out end understand that In making thisProposal they waive sll rights to plead any misunderstanding regarding the same.

In the event that there is a mathematical en or between the Unit price" and 'Extended price", the Unii pries will prevail.This Proposal Page should be completed snd submrihrd ss a paper copy with the bid. Failure to submit the ProposalPage will be cause for disqualilicegon.

All shipping end delwsry charges for inside delivery must be induded in the Unit Price.

ITEM NO. UNIT OF MEASURE

EACH

DESCRIPTION

INDUSTRIAL STEAM MULTI-STAGECENTRIFUGAL PUMP AS PERSPECIFICATIONS HEREIN.

IEACH

$ /dr JP ~~ 'OTAL

DELIVERY DATE:(NUMBER OF CALENDAR DAYS AFTER AWARD OF CONTRACT)

The receipt of ps fogowing addenda to the Speclgcstions is acknowledged:

Addendum No. / 48~7~+4 Date~Addendum No, ~ ~I c0~~ 7 ~ ~~ Date: / E a7crl 9

Addendum No.

SIGNATURE

Date:

D,«:

19SS — July 2017

EXHIBIT I

OFFICE OF THE COOK COUNTY COMPTROLLERELECTRONIC PAYABLES PROGRAM luE-PAYABLESnl,

FOR INFORINA TION PURPOSES ONLYThis document describes the ONce of the Caolr Cauntv Comotralfm's Electronic Psvsblss Pzoamm ("E-Psvsblsseblf vou wish to nsrtfckurte in E-Psvsbles. oissss contact the Cook Countv Camntroser's Ofdce. AccountsPsvsbie. 116 N. Clark Sheet. Room 500. Chicsao. iL 60602.

DESCRIPTIONTo increase payment sificiency and timeliness, we have intraduced E-Payablss program, e new payment iriiliefivs toaur accounts payable model. This new iniTiativs utilizes a Visa purchsring card and operates through the Visa paymentnetwork. This is County's preferred method af payment snd your 'participation in aur Visa purchasing card programwill provide mutual benefits both to your organization and ours.

As s vendor, you msy experienc the following benefits by accepting this new payment type:

tmproved cash fiaw snd accelerated paymentReduced paperwork snd a more streamlined sccaunts recskrsbte processEfimyisdon of stop payment issuesReduced payment delaysReduced costs for handling paper checksPayments ssltled direcfiy to your merchant account

There sre twa opgons within this inifiative:

1. Dedicated Credit Card - "PULL" SettlementFor this option, you wfil have an assigned dedicated credit card to be used for sech payment. You will provide s pointof cantsct within your organization who wiN keep credit card information on Ills. Each time s payment is insde, you wfilreceive s remittance advice vis email detailing the invoices being paid. Each time you receive a remittance advice, youwill pracess payments in the same manner you process credit card trsnsacfiions today.

2. One-Ttme Use Credit Card - "SUGA" SettlementFor this option, yau will provide s paint of contact whhin your organization who will receive sn email notEcstionauthorizing yau to process psymenls in the same manner you process credit card transactions today. Each timepayment is made, you will receive a remittance advice, via email, detailing the invaices being paid. Also, each time youreceive s mmillsncs advice, you wfil receive s new, unique credit card number. This opfion is ideal for suppliers whoare unable to keep credit card account information on file.

REMAINDER QF PAGE INTENTIONALLY LEI'T BLANK

SB — July 2017

CONTRACT a: 1845-1 764?

COOK COUNTYECONOMIC DISCLOSURE STATEINENT

AND EXECUTION DOCUMENTINDEX

Secdon

5

Description

Instructions for Completion of EDS

Certification s

Economic and Other Disclosures, Affidavit of ChildSupport Obligations, Disclosure of Ownership Interest

and Familial Relationship Disclosure Form

Cook County ANdavit forWage Theft Ordinance

Contract and EDS Execution Page

Cook County Signature Page

Pages

EDSi-li

EDS 1-2

EDS 3-12

EDS 13-14

EDS 15-17

EDS 18

CONTRACT g: 1845-17647

SECTION 1

INSTRUCTIONS FOR COMPLETION OFECONOIIIIIC DISCLOSURE STATEIIIIENT ANO EXECLITION DOCUIIIIENT

This Economic Disciosure 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 Procuram'entOfficer. 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 Respondent

, provide an updated EDS on an annual basis.

Definitions. Terms used in this EDS and not otherwise defined herein shall have the ineanings given tcsuch terms in the instructions to Bidders, General Conditions, 'Request for Proposais, Request forQualifications, as applicable.

AKilafe 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 Procuremenls by or on behalf ofCook County,

Contractor or Contracting Party 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,induding all sections listed in the index and any attachments.

Joint Venture means an association of two or more Persons proposing to perform a for-proht business enterprise, Joint Ventures must have an agreement in writing specifyingthe tenne and conditions of the relationsh'ip 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 Liability Company, sole proprietorship or other iegel entity.

Prohibited Acts means any of the actions or occurrences which form the basis fordisquaiiTication under the Code, or under the Certificabons 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.

FfFP 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.

Eos-i

CONTRACT ff: 1845-17647

INSTRUCTIONS FOR COIiiIPLETION OFECONOIIIIIC DISCLOSURE STATEIIIIENT AND EXECUTION DOCUNIENT

Section 1: Instructions. Section 1 sets forth the instructions for completing and executing this EDS.

Section 2: Cerbfications. 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 Certifications 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 true, 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 information provided, including but not limited to any changewhich would render inaccurate or incomplete any certification or statement made in this EDS, theApplicant shalt 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 Ordinancesimpose 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) 603-4304 (69 W. Washington St. Suite 3040, Chicago, IL60602) or visit the web-site at cookcountyiLgov/ethics-boards.

Authorized Signers of Contract and EDS Execution Page, If the Applicant is s corporation, thePresident ancf Secretary must execute the EDS, In the 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 Cergffcate 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 cr joint venturers must execute the EDS,unless one partner or joint venture has been authorized to sign for the partnership or joint venture, inwhich case, the partnership agreement, resolution or,evidence of 'such authority satisfactor'y 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 acerdfisd 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 State of illinois, a copy of a current Certificate of Good Standidg 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 illinois county in which it is located, as provided in 805 ILCS 405 (2012}, anddocumentation evidencing registration must be submitted with the EDS.

Effective October 1, 2016 all foreign corporations and LLCs must be registered with the illinoisSecretary of State's Office unless a statutory exemption applies to the applicant. Applicants who areexempt from registering must provide a written statement explaining why they are exempt fromregistering as a foreign entity with the Illinois Secretary of State's Offfce.

EDS-ii

CONTRACT B: 1645-17647

SECTION 2

CERTIFICATIONS

THE FOLLOWING CERTlFICATIONS 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 SHrd L 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 THEFOLLOWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACT ENTERED INTO WITH THE APPLICANT SHALLBE SUBJECT TO TERMINATION.

A. PERSONS AND ENTITIES SUBJECT TO DISQUALIFICATION

No psmon 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 pemon or business entity:

1) Hss been convicted of an act committed, uiithin the State of illinois, of bribery or attempting to bribe an officer oremployee of a unit of state, federal or local government or school district in the State of illinois in that officei"s oremployee's otficial capacity;

2) Hss been convicted by federal, state or local government of an act of bid-rigging or attempting to iig bids as definedin the Sherman Anti-Trust Act and Clayton Act, Act, 16 U.S.C. Section 1 et seqz

Hss been convicted of bid-rigging or attempting to rig bids under the laws of federal, state or local government;Has been convicted of an act committed, within the State„of price-fixlng or attempting to fix pncss as defined by theSherman Anti-Trust Aot and the Clayton Act. 15 U.S.C. Section 1, et seq.l

Hss been convicted of price-fixing or attempting to fix prices under the laws the Stats;

Hss been convicted of defrauding or attempting to defraud any unit of state or local government or school districtwithin the State of illinois;

5)

6)

Hss 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 en'fity was 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-psragraphs (1) through (6) above.

In the case of bribery or attempting to bribs, a business entity may not bs awarded a contract if an official, agent or employeeof such bu~iness entity committed the Prohibited Act on behalf of the business entity and pursuant to the direction orauthorization of sn otficer, director or other responsible otficiai of the buiinsss entity, and such Prohibited Act occurred withinthree years prior to the award of the contract. In addition, a business enfity shall be disquafilisd if an owner, partner orshareholder controlling, directly or indirecfiy, 20% or more of the business entity, or an otficer of the business entity hssperformed any Prohibited Act within five years prior to the award of the Contract.

THE APPLICANT HEREBY CERTIFIES THAT: The Applicant has read the proyisions of Section A, Persons and EntitiesSubjed to Disqualificalion, that the Applicant has not committed any Prohibited Act set forth in Section A, and that award ofthe Contract to Ihe Applicant would not violate the provisions of such Sscfion or of the Code.

B. " BID-RIGGING OR BID ROTATING

THE APPUCANT HEREBY CERTIFIES THAT: In accordance wftb 720 ILCS 5733 E-11, neither tbs Applicant nor anyAt%listed EnNy is barred from award of this Contract as a result of e conviction for the victatrbn of State laws prohibiting bld-ngglng or bid rotaflng,

DRUG FREE WORKPLACE ACT

THE APPL!CAAtT HEREBY CERTIFIES THAT The Applicant will provide a dmg free workplace, as required by (30 ILCS 580/3).

EDS-1

CONTRACT ff: 1845-17647

D. DELINQUENCY IN PAYMENT OF TAXES

THE APPL/CANT HEREBY CERTIFlES THAT: The Applicant is nal an owner or s party responsible for tbs payment of anylsx or fee sdmlnislsred by Cook Counly, such as bsr award af e contract or subcontract pursuant to the Code, Chapter 34,Sscfcw 34 171.

E. HUMAN RIGHTS ORDINANCE

Na person wha is a party to a contract with Cook County ("County") shall engage in unlawful discrimination or sexual harassmentagainst any individual in the terms or candTiions of empioymsnt, credit, public accommodations, housing, or prevision of Countyfacilibes, services or programs (Code Chapter 42, Sectian 42-30 et seq.).

F.

H.

ILLINOIS HUINAN RIGHTS ACT

THE APPLICAIVT HEREBY CERTIFIES TMATr It is in compliance with the illinois Human Rights Act {7 75 ILCS '5rg 105), sndagrees lo abide by the requirements ofthe Acl aspart of its contractual obligations.

INSPECTOR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTION 34-174 and Secgon 34-2%)

The Applicant has not viiilfully failed to cooperate in an investigation by ths Cook County Independent Inspector General or toreport to the Independent inspector General any and all infarmation concerning conduct which they know to involve corrupbon, orother cdminsl activity, by another county employee or otficial, which cancems his or her algae of empfaymsnt or County relatedtransaction.

The Applicant has reparied directly and without any undue delay any suspected or known fraudulent sdivity in the County'sProcurement process to Ihs Oflice of the Cook Caunty Inspectar Gsnerat

CAlylPAIGN CONTRIBUTIONS (COOK COUNTY CODE, CHAPTER 2, SECTION 2-585)

THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Coak County's Ordinance concerning campaigncontributions, which is codNed at Chapter 2, Division 2, Subdivision II, Section 585, and can be read in its entiretyat www.municode.corn.

I. GIFT BAI4, (COOK COUNTY CODE, CHAPTER 2, SECTION 24I74)

THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County's Ordinance concerning receiving andsolicNng gifts and favors, which is codified at Chapter 2, Division 2, Subdivision II, Section 574, and csn bs read in its entirelyat www.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 Cade requires that a living wage must be paid toindividuals employed by a Contractor which has a County Contract and by all subcontractors of such Conirador under a CouniyContrad, throughout the duration of such County Contract. The amaunt af such living wage is annually by the Chief FinancialOfficer of the County, and shall be posted on the Chief Procurement Officer's website.

The term "Contract" as used in Section 4, I, of this EDS, speciTically excludes contracts with the foilowkrg

1) Nat-Far Profit Organizations (detined as a corporation having tax exempt status under Section 501{0)(3) of the UnitedState Internal Revenue Cade and recognized under the illinois State not-far -profit law);

2) Camrnunily Development Block Grants;

3) Cack County Works Departrrisnt;

4) Sheritfs Work Alternative Program; and

5) Department of Correction inmates.

Eos-2

CONTRACT ty: 1846-1 7647

SECTION 3

REQUIRED DISCLOSURES

1. DISCLOSURE OF LOBBYIST CONTACTS

List all persons that have roads lobbying contacts on your behalf with respect to this contracb

Address

2 LOCAL BUSINESS PREFERENCE STATEMENT (CODE) CHAPTER 34 SECTION 34 235)

Local business means a Person, induding a foreign corporation euthorizsd 'to 'transact business in lfiinois, having a bona fideestablishment located within the County st which it is transacfing business on ths date when a Bid is submitted tc the County, andwhich employs the majority of its regular, full-time work force within ths County. A Joint Venture shall constitute s Local 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 Venturedoes not, at the time of the Bid submittal, have such a bona fids establishment within the County.

a) ls Applicant a "Local Business" as dsfiined sbovey

No:

b) If yss, list business addresses within Cook County

Spa& & Pun~~&;6/lida4)'42 //,

c) Does Applicant employ the majority of fis regular full-time workforcs within Cook County?

es: W No:

THE CHILD SUPPORT ENFORCEMENT ORDINANCE (CODE, CHAPTER 34, SECTION 34-172)

Every Applicant for a County Privllege shall be in full compliance with any child support order before such Applicant is entitled to receive orrenew a County Privilege. When delinquent child support exists, the County shall hot issue or renew any County Privilege, and mayrevoke any County Privilege.

All Applicants are requimd to review the Cook County Affirdavit of Child Support Obligations attached to this EDS (EDS-5) andcomplete the Affidavit, based on the Instructions in the Affidavit

EDS-3

REAL ESTATE OWNERSHIP DISCLOSt'he

Applicant must indicate by checking the appropriate e.ovidon below and providing afi required information that either.

a) The fcficwing is a compkrte list of afi real estate owned by the Applicant in Cook County:

PERfifiANENT INDEX NVfifiBER{S):

(ATTACH SHEET IF NECESSARy TO LIST ADDITIONAL INDEX

NUfifiSERS)

b) 'heApplicant owns no real estate in Cook County.

a. EXCEPTIONS TO CERTIF)CATIDNS OR DisCLDSVRES.

If the Applicant is unable to cerfify to any of the Certifications or any other statements contained in this EDS and not explained ehewhere in

this EDS, the Applicant must explain beknrr

If the letters, "HA", the word "None or 'No Response appears above,'r if the space is lefi 5ank, it will be conrfiusively presumed that the

Applicant certilied to sil Cerlificafions and ofiwr statements contained in this EDS.

EDS-4

CONTRACT ¹: 1845-17647

COOK COUNTy DISCLOSURE OF OWNERSHIP INTEREST STATEMENT

The Cook County Code of Didinances (i]2-610 ei seq.) requires that any Applicant for any County Acbon must discloseinformation concerning ownership interests'in the Applicant. This Disdosure of Ownership Interest Statement must be completedwith all information current as of the date this Statement is signed. Furthermore, this Statement must be kept cu'rrent, by filing anamended Statement, until such time as the County Board or County Agency shall take action on the application. Theinformation contained in this Statement will be maintained in a database and made available for public viewing. Countyreserves the right to request additional infarmation to verify veracity of information contsintsd in this statement.

If you are asked to list names, but there are no applicable names to list, you must state NONE. An incomplete Statement willbe returned and any action regarding this contract will be delayed. A'ailure to fully comply with the ardinancs may result in theaction taken by the County Board ar County Agency being voided.

'Appiicenf'eans any Entity or person making an application to the County for any County Acdon.

"County Action means any adion by a County Agency, a County Department, or the County Board regarding an ordinance arordinance amendment, a County Board approval, or other Counly agency approvai, with respect to contracts, leases, or sale orpurchase of real estate.

"Person" Entriy or "Legal Entify means a sole proprietorship, corporation, partnership, assodatian, business trust, estate, two ormore persons having a joint or common interest, trustee of a land trust, other commercial or legal entity ar any beneAciaiy orbeneticiaries thereof.

This Disclosure of Ownership Interest Statement must be submitted by:1. An Applicant for County Acfion and

2. A Person that holds stock or a beneficial interest in the Applicant and is listed on the Applicant's Statement (a 'Holder") mustfile a Statement and complete ¹I only under Ownership Interest Dtrclamtton.

Please print or type responses dearly and legibly. Add additional pages if needed, being careful to identify each portion of the formta which each additional page refers.

This Statement is being made hy the [ g ] Applicant or [ ] Stackigenegcial interest Halder

Zip Code:

Fmaii g4 e v/Q~Q~QZ

This Statement ia an: [ p ] Original Statement or [ ] Amended Statement

Identifying Information:

7E&XMC ~~//i ]r &mApPDiBiA;6 ¹8 7%%Sf/ +if//LP'pirr@Aii/ FEIN ¹ Only: A o7/rr/s +3$~street Address: ~135 s Alan'Lk PA/Faddy'ity.

CEPI&sfdd S~a~e: ////s/» ~

Phone No:7OP W&-dsldiy FsxNumber. /8 ~ ri/~8" ~/C

Cook County Business Registration Number.(Sole Praprietor, Joint Venture Partnership)

Corporate File Number {if applicable):

Form of Legal Entity:

[ ] Sale Proprietor [ ] Partnership Corporatian [ ] Trustee of Land Trust

] Business Trust [ ] Estate [ ] Association [ ] Joint Venture

[ ] Other (describs)

CONTRACT dt 1845-17647

Ownership Interest Declaration:

1. List the nams(s), address, and percent ownership of each Person having a legal or beneficial interest (including ownership) ofmore than five percent (B /) in the Applicant/Holder.

Name Address

klddhtvf/t 88 -"Afoot daAA//i/j PM'~/ ~

Percentage Interest inApplicant/Holder

If the interest of any.Person listed in (1) above is held as an 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

8/8Name of Principal Principal's Address

Is the Applicant constructively controlled by another pemon or Legal Entity7 [ ] Yes [ ] 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.

Address Percentage ofBeneficial Interest

Relationship

Corporate ONicers, Nlembem and Paitnem information:

For all corporations, list the names, addresses, and terms for all corporate oflicers. For all limited liability companies, list the names,addresses for all members. For all partnerehips and joint ventures, list the names, addresses, for each partner or joint venture.

Name Address Title (specil'y title ofOffice, or whether manageror partner/joint venture)

Term of Office

Declaration (chsck the applicable box):

I state under oath that the Applicant has withheld no disclosure as to ownership interest in the Applicant nor reservedany informagcn, data or plan as to the intended use or purpose for which the Applicant seeks County Board or other CountyAgency action.

[ ] I state under oalh that the Holder has withheld nc disdosure as to ownership interest nor reserved any information required tobe disdosed.

Ebs-7

CONTRACT ¹: 1845-17647

COOK COUNTy DISCLOSURE OF OWNERSHIP INTEREST STATEIIENT SIGNATURE PAGE

Ayflry xi E- jtnfgJuaZNam~of Authorized AppticantfHolder Representative (please print or type) Title i-8 ~nilSignature Date

/gurdyJrzad+ SD?ya~C, C~ g, I.@Z&-fr,&F2

E-mail address Phone Number

Subscribed to and sworn before methis ¹ day of uVIN, 201$.

x+ ~~ ~el~Notary Public Signature

My commission expires:

OFFICIAL SEAL

gggtggg DWORAK MEEKSatftftvpueDc STATSIF ILLINDISMY COMMiSSION 2XPIRESCSI22/20

,,~/,AAAr,

EDS-s

CONTRACT g: 1 845-17647

COOK COUNTY BOARD OP ETHICS69 W. WASHINGTON STREET, SUITE 3040

CHICAGO, ILLINOIS 60602312/603-4304 OIEce 3 12/603-9988 Fax

FAMILIALRELATIONSHIP DISCLOSURE PROVISION

Nenntism Dinclnnnre'Renuirement.

Dohg a signi6csnt mnount ofbusiness with the County requires that you disclose to the Board of Ethics the existence of any gunilialrelationships with any County employee or any person holding elective ofgce in the State of Illinois, the County, or in anymunicipality within the County. The Ethics Ordinance de6nes a signi6cant amount of business for tbe purpose of this disclosurerequirement as more than $2S,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 gunilial disclosure form because, among other potential penalties, any person found guiltyof'ing

to make s required disclosure or knowingly 61ing a false, misleading, or incomplete disclosure will be prohibited 6 om doingany business with the County for a period of three years. The required disclosure should be 61ed with the Board ofEthics by JanuaryI of each calendar year in which you are doing business with the County and again with each bid/proposal/quotation to do businesswith Cook County. The Board ofEthics may assess a late 6ling fee of$ 100 per day ager an initial 30-day grace period.

The person that is doing busmess with the County must disclose his or her famiTial relationships. If the person on the County lease orcontraot or purchasing from or selling to the County is a business entity, then the business entity must disclose the famiTialrelationships ofthe individuals who are and, during the year prior to doing business with the County, were:

its board ofdirectors,Its of6cers,

~ its employees or independent contractors responsible for the general administration ofthe entity,its agents authorized to execute documents on behalfoFthe entity, andits employees who directly engage or engaged in doing work with the Comty on behalfoFthe entity.

Do not hesitate to contact the Board of Ethics at (312) 603-4304 for assistance in determining the scope of any required Sunilialrelationship disclosure.

Additinnnl Defmitinnm

"Familial relationship" means a person who is a spouse, domestic partner or civil union partner of a County employee or State,County or municipal o15cial, or any person who is related to such an employee or of6cial, whether by blood, mamage or adoption, as

ParentChildBrotherSisterAuntUncleNieceNephew

GrandparentGrandchildFatherin-lawMotherin-lawSonin-lawDaughter in-lawBrotherin-lawSrster-m-law

StepfatherStepmotherStepsonStepdaughterStepbrotherStepsisterHa1$brotherHalfsister

EDS-9

CONTRACT g: 1845-17647COOK COUNTY BOARD OF ETHICS

FAMILIAL RELATIONSHIP DISCLOSURE FORM

PERSON DOINr nR SEEKINr To DnRUSrwusg wrrH THE COUNTY

Name ofPerson Doing Business with the County: tpr r dy t f+ewtf~ Jtr r +@mal'~P

Adds'ass ofPerson Dohg Business withthe County; . W5 cSW g&/f r A ect~~ai frag, c P/Waist fZ

Phone number ofPerson Doing Business with the County: 778 7d ~ f3to et

EmailsddressofPersonDoingBusinesswiththeCounty: Adaryr~ P 6D yfye~PL +one

If Person Doing Business with the County is a Business Entity, provide the name, title and contact information for theindividual completing this disclosure on behalfofthe Person Doing Business with the County:

s/)/It/J t(I Emma-W -Mnn Ared(

B. DgscRIPTloN oF BUslNEss wfTH THE cnUNTYAppendadditionalpages as needed andfor each County lease, contract, pure/tare or sale sought and/or obtainedduring the caiendaryear ofthis disclosure (or iheproceeding caLendaryear ifdisclosure is made on January 1),identify:

The lease number, contract number, purchase order number, request for proposal number and/or request for qualificationnumber associated withthebusinessyouare doingor seeking to do withthe County: ff @4" yr d f &

The aggregate dollar value ofthe business you are doing or seeking to do with the County: S

The name, title and contact information for the County otfictql(s) or employee(s) involved in negotiating the business you aredoing or seeking to do with the County; d/

BJ~ -Aoz- d~mThe name, title and contact information for the County official(s) or employee(s) iavolved in mansghtg the business you aredomg or seeking to do with the County; tt" 4: 78~ 6&it rr" A . Ca&r~a.f-d

rQi a - fo o Z - 3/7~

Dhscfdxsr/RE nF F/tMII IAL REIATinNSIm S wITII cnnNTY EtvtPLnYEFs OR STATE. COUNTY oRtvtl/NtrIPALEI.ECTED nFFIriALS

Check the box tttat applies andprovide relatedinformation where needed

The Person Doing Business with the County is an individual and there is no familial relationship between this individualand suy Cook County employee or any person holdmg elective o%ce m the State ofillinois, Cook Couruy, or anymunicipality within Cook County.

The Person Doing Business with the County is a business entity and there is no familial relationship between any memberof this business entity*s board ofdirectors, ofgcers, persons responsible for general administration ofthe business entity,agents authorized to execute documents on behalf of the business entity or employees directly engaged in contractual workwith the County on behalfof the business entity, and any Cook County employee or any person holding elective ofhce in theState of IllinOi, Cook County, or any municipality within Cook County.

EDS-1O

CONTRACT 4: 1645-17647

COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM

D The Person Doing Business withthe Courny is an individual snd there is a familial relationship between this individualsnd at least one Cook County employee and/or a person or persons holding elective offfce in the State ofiginois, CookCounty, and/or any mmucipality within Cook County. The famgial relationships are as follows:

Name ofIndividual Domg Name ofRelated County Title snd Position cfRelatedBusiness with the County Employee or State, County or County Employee or State, County

Municipal Elected Official or Municipal Elected Oigcisl

Nature cfFamilialRelationship

ffmore space is needed attach mi additional sheetfollowing the aboveformat.

D The Person Doing Business with the County is a business entity and there R a familial relationship between at least onemember ofthis business entity's board ofdirectors, offfcers, persons responsible for general administration of the businessentity, agents authorized to execute documents on behalfofthe business entity snd/or employees directly engaged incootractual work with the County on behalfofthe business entity, on the one hand, and at least one Cook County employeeand/or a person holding elective ofgce in the State ofBBnois, Cook Cotmty, snd/or any municipality within Cook County, onthe other. The familial relationships are as follows:

Name ofMember ofBoardofDirector Sr BusinessEntity Doing Business withthe County

Kame ofRelated County Title aud Position ofRelated Nature ofFsmiTial

Employee or State, County or Ccunty Employee or State, County RelationshipMunicipal Elected Ofgctal or Municipal Elected 0$ciat

Natne ofOtftcer for BusinessEntity Doing Business withthe County

Name ofRelated County Title snd Position ofRelated Nature ofFamiTialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected Offtcial or MunicipalElected Oificisl

.EOS-1 1

CONTRACT S, 1845-17647COOK COUNTY BOARD OF ETHICS

FAMILIALRELATIONSHIP DISCLOSURE FORM

Name ofPerson Respaasihlefor the GeneralAdministration oftheBusiness Entity DoingBusiness with the Cauaty

Kame ofRelated County Title snd Position ofRelatedEmployee or State, County ar County Employee or State, CountyMunicipal Elected Ofdcisl or Municipal Elected Ofdcial

Nature afFsmiTialRelationship

Name sfAgeat Authoiizsdta Execute Documents farBusiness Entity DoingBusiness with the County

¹me ofRelated County Title snd Position ofRelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Ofgcisl or Municipal Elected Ofdcial

Nature ofFamilialRelationship

Name ofEmployee ofBusiness Entity DhectlyEngaged in Doing Businesswith the County

Name ofRelated County Title and Position afRelatedEmployee or State, County or Cauuty Employee or State, CountyMunicipal Elected Official or Municipal Elected OIEchl

Nature ofFamilialRelationship

ffmore space is needea', attach an additional sheetfollowing the abovefortnat.

VERIFICATION: To the best ofmy knowledge, the information I have provided on this disclosure form is accurate and complete. I

acknowledgethat an inacc ate or mcomplete disclosure is punishable bylaw, including but not limitedto Snes and debarment.

y-Z-~ufy'ignature

ofRecipient Date

SUBMIT COMPLETED FORM TO: Cook County Board ofEthics69 West Washington Street, Suite 3040, Chicago, lllmois 60602Oflice (312) 603-4304- Fax (312) 603-9988CookCotmly.Etidcs@cookcountyihgov

Spouse, domestic partner, civil union partner or parent, child, sibling, aunt, uncle, niece, nephew, grandparent or grandchildby blood, marriage (i e. in laws snd step relations) or adoption.

EDS-12

CONTRACT S: 1846-1?64?

SECTION 4

COOK COT INTY AppfOAFIT FOR WAGE TITFFT 0RMhIAhICK

Effsdive Illlay 1, 2015, every person, Includino subsisndel ownem, seeking a contract with cook county must comply vtth the Gook county Wage TheftOrdinance set forth in Chapter 34, Arfide IV, Sscfion 179. Any PersonISubstantial Owner, who fails to comply with Cook County Wage Thea Ordinance,may request that the Chief procuement Oitcer.grant s reduction or waiver in accordance with Secdon 34-179(d).

"Contract" mesne any written document to make Procurements by or on behalf of Cook County.

"Persod'eans any individual, corporation, partnership, Joint Venture, trust, association, limited lisbiTky company, sole proprietorship or other legal entity.

"Pmcuremsnl" means obtaining supplies, equipment, goods, or services of any kind.

"Substantial Owner" means any person or persons who own or hold s twenty-five percent (25'Ya) or more percentage of interest in sny business ensbiseeking a County Prigiege, including those shareholders, general or limited partners, bsnsiicisdes snd principah; sxospt where a business entity is anindiVidual or sole proprietorship, Substantial Owner means that indMdual or sole. proprietor.

All personslsubstsntisl owners are requimd to complete this airidswt snd comply with the cook county wage Theft ordinance before any Contract.isswaideit Signature of this form constitutes a certiTicaiion the information provided below is correct and complete, and that the individual(s) signing this formhaslhave personal knowledge oi such information. County reserves the right to request additional information to vsrify veracity of Informationcontained in this Aflidavtt

I. Contract Information:

Contract Number: ' A //5o Y7County Using Agency (requesting Procurement): /4/n cU

ll. PersonlSubstantial Owner Information

Person(Corporate Entity Name): +/ 8 /d~AP4c

substantial owner complete Name: dli(.t/dfvh 58iYl/8/ISc ~+ Av ) 3/t)/rrdr Wtw/ AsFEINP

E-mail address; DXEN/4)ju~ C. ddtf )tp/~/I/.

Street Address: +g W ~ ArrrAFAJk/~/ h/4/)yr/4"

Chy: C-'h/dA'00 State: /CA(dv'-I Zip.

Home Phone:

gt. Compliance with Wage Laws:

Illinois W~ayment snd Collection Acl, 820 ILCS 118/1 et seq.,YES or~0

Illinois ittf Wage Act, 820ILCS 108/I etseq.,YES

Illinois y/o djustment and Refraining Notigcagon Act, 820 ILCS 68/1 et seq.,YES

Employ III

YESFairLs dards Act of 1938, 29 U 8 C. 201, et seq.,

YESAny corn state statute or regulation ofsny state, which governs the psymenl of wages

YES

cation Act, 820 ILCS 186/f et ssq

Within the past five years has the PersonISubstantial 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 sny ofthe following laws:

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 a reduction or waiver under Section IV.

EDS-1 3

CONTRACT ff: 18r(5-17647

IV. Request for Waiver or Reduction

If Person/Substantial Owner answered "Yes" to any of the questions above, it may request s reduction or waiver in

accordance viith Section 34-179(d), provided that the request for reduction of waiver is made on the basis of one or more ofthe follcviing actions that have taken piece:

There as een a bone fide change in ownership or Control of the ineligible Person or Svbslanlisl OwnerYESo 0Discipl'tion has been taken against the individual(s) responsible for the acts giving n'se to the violation

YES o

RsmeYES o

has been taken to prevent e recunsnce of the acts giving rise to ths disqualilicslion or default

Other f that lhs Person or Substantial Owner believe sre mlsvsnt.YESo 0

th p r rt b pr sp t ~bi foal ts ~ i . Tl ~GMtProcurement Officer reserves fhenrht tg muzaka~on I ui 'es n uest rifonsl oc mental(

V. AffirmationThe Personlgubstantisj Owner ahirms t all statements contained in the Affidavit are true, accurate and complete.

Signature: o~'.~44~ ryName of Person signing (Print): 9 ytpyO + ~iitr4Tws=+ Title:

Subscdbed and sworn tc before me this 'A~ day of , xnx M~~~

Notary Public Signaturehloter Ths shove information is subject to verltfcstfon prfor to ths

aw,'DS-1

4

CONTRACT. fv. 1 846-17647

SECTION 4

f.nnyf L.OLINTY APPmAVrr POR WAr.R TTTRRTORiyfNANCRI

Etfective Msy 1, 2015, every pemon, lncfudina suhsfsnsef owners, seeking a contract with cook county must crvnpb¹ vfth the cook counqr wage Theftordinance set forth in chapter 34, Arfcki Iv, sechon 178. Any person/Substantial owner, who fails ki comply wfih Cook County Wale Theh Ordinance, .

msy request that the Chief Procummsnt Mcer grants reduction or waiver in accordance with Sedlon 34 179(d).

¹Donhscr means any vmtlen document lo 'make procummenta by or on behalf of cock county."person" means any Individual, corporaficn, partnemhip, uoint Venture, trust assoaafion, limited ilshfity company arse proprietorship cr other legal enfibr.'P~'eans obtsrrdng supplies, equipment goads, or sewlces of any kind.

"Substantial Ownw" means any pwson cr psmons who own or hold s twenbr-five percent (25%) or more percentage cf interest in scy business snfilyseeking e County Privilege, inducing those shareholders, general or limited parlners, beneficiaries and principals; mcspt wham s business snfiiy is anindhiidual or sole pmprletcrship, Suhstacfisl Owner means that indivktual or sole proprietor,

Afi Peisonsigubstsctial Owners are required to complete this aflidsvit snd comply with the Cock County Wage Thelt Ordinance before any Contract leswanled. Signstum of Ihh form constilules a certificsfion the information provided below ls cosset wtd complete, snd that hw individual(s) signing this fccnhsslhsve personal knowhdgs of such information. County mssrvae the right to mquest mlditionsl Infomwdon to vertfy vsmctty of Information«ontalned in this Afgdsvit.

I. Contract Information:

Contract Number: ' ~ / Y¹y

r t¹u i ¹A¹ w{~ ~¹¹ t): /Arran/¹J ¹wus~k&ll'I.

Personfgtrbsbrntksi Owner information:

Person (Corporate Enilqi Name):

Substantial Owner Compiete Name:

FEIN¹ 3~ ¹cf y r~E-mailaddrsss: DAZE/ih4¹k¹E 8 esty 22r~.Street Address. W$ ¹7d ~ 4s~P~ Pi ¹fLi@AY

Chy: CEfiddkn

Home Phone:

SI,„. '/Cod&

F/¹/v¹s Jj

«/So

III. Compliance with Wage Laws:

fili)oois WagfhE¹ey rmrrf snd Coilsciion Act, 820 ILCS 1 1Srf st ssg„YES or~0

ifinois INn Wage Acf, 820 ILCS I0f¹rf st ssg.,YES

illinois

YES

EmployYES

Fair Ls s Acf of 1938, 29 U.S.C. 201, et sag¹YES

Any corri fs sfsfufs or rsgrdsffon ofshy sfsfs, which governs the payment of wagesYES

fment snd Retraining Noggcsffon Acf, 820 ILCS 8&'1 sf ssg

fion Acf, 820 ILCS 585rf et seg

Mfithin the past five years has the Person/Substanfial Owner, in sny judicial or administrative proceeding, been convicted of, entered aplea, made an admission of guilt or liabifdy, or had an administrative finding made for ccmmNing a repeated or wlgful violation of any ofthe following laws:

If tile Person/Substanfird Owner answered "Yes" to any of the questions above, it is ineligible to enter into a Contract with CookCounty, but can request a reduction or waiver under Section IV.

ED8-13

CONTRACT ¹: 1846-17647

IV. Request foi Waiver or Reduction

11 Person/Substantial Owner answered "Yes" to any of the questions above, it may request a reduction or waiver inaccordance with Secfion 34-179(d), provided that the request for reduction of waiver is made on the basis ot one or more ofthe following actions that have taken place:

There been a bona fide change in ownership or Control of ths ineiigible Person or Substantial OwnerYES o( 0

Dis ''on has been taken against the individual(sj responsible for the acts gr'ving n'ss to ihs viols¹onYE

ReYE

has been taken fo prevent a rscunsnce of ths acts giving rise to the disquamication or default

Other f that the Person or Substantial Ownerbelieve ais relevant.YES NO

~The rson/Substantial Owner must submit documsrdetion to suoooff ths basis of iis ie usst for a reduction or w 'v r. The hlefProcurement Officer reserves ihs n'oht to mmes ditionsl inouiries and isousst sdddiona( documsnfstkvr.

V. AfhrmstionThe Person/Substanffal Own@ aiiirms that statements contained in the

Affidavitare

tru, accurate and complete.

ii¹;i.„::~P~ W D,i,,~tlat nM,„,„p,,„~„~(ir„,), gill e dd~alr ii ~i,,~ger,a~r ,'beb&

d tri iM l(f dy f 4~~,20 tl

Note".The above information is subject fo verfficatlon prfor to the award of e ConCONOTARY PUBLIC

MY OOMMISSIO

EDS44

CONTRACT lb. 1645-17647

SECTION 4

CAAft COiTNTV'FFfftAVlf FAR WAIF. TFIFFF fyRDKNAWCR

Ebective Msy 1, 2015, every peman, incfudina subcranial ownenr, seeking e contrast with cook County must comply with ihe Cook CountY Wage TheftOrdinance set forth in Chapter 34, Aryde IV, Secgon 179. Any persanrsubsbmiial Owner, who fails ta camply with Cack County Wage Thslt Oniinsncs.may request that the Chief pracu anent Ollicer grant a redudlon orwaiver in accordance with Sedion 34 179(d).

"Confmcf means nny written document ta inake Precvmmenls by or on behalf of Cook County.

"Pemon" means any individusi, carpamtion,.partnership, Joint Venture, trust, essocis5on, limited linbiTty company, sale prapdstorship ar other isaal enbbi.

"Prccummenf means abieining supplies, equipment, gaacis, or services af any kind.

"Scbslenliel Owns" means eny person or pemons who awn or hold e twenty-five percent (25%) or more percentage af interest in any business entityseeking s county piivtsge, including ihose shareholdem, general ar limited pariners, benelicinries snd principals; encept where s budiness entity is snindividual oracle praprietorship, Substantial Owner means that individual or sole proprietor.

All PersonslSubstsntisl Owners are mquired to complete ibis algdsv(t and campiy with the cask Counly Wage Their Onsnance before sny Contract isawarded. Signature af ibis form constitutes n certification the information provided below is correct snd complete, and that the individual(s) signing this formhss/have personal knowledge of such infarmation. Oounbi mserves the right to request additional Informssan to verify vemaity of informationcontained in this Affidavit.

I. Contract Informagon:

Contract Number. '/f~ /N rr 7County Using Agency {iequesling Procurement): ~/f4'&laJ AAf~tXEnli

II. PersonlSubslsntial Owner Inforruatloim

Person (Corporate Entity Name): +I i«l ~~ +PI COAIAAP

8 b t qi ia c pl@ tl ~8/Lfl w iiirnaerJr iug/ BAt/8 MVP/4t rur QJFEINff 3 (p

E-mail address: D&A1it)yeda g dlcr lpga~ ruince

street Address: +K~ ~ AlrrA2yvgrcdp Pi'4A/4c'e: err«/A svv: Ilc««-r ~z;p,

Home Phone:

lit. Campliancs with Wage Laws'.

Within the past five years has the Person/Substantial Owner, in any judicial or administrative proceeding, been convicted of, entered splea, made an admission of guilt or liability, or had an administrative gnding made for cammdgng s repeated or wglfrd violation of any ofthe following lawrn

Illinois

Illinois

YESlllinodr

YESEmplo

YESFairLs

YESAny c

YES

ment and Cogscfion Acl, 820 ILCS 15Pf et seq.,

sgeAcl,820ILCS 105rf stssg.,

ustment and Retraining Noflgcsgan Acf, 820 ILCS 6S'1 ef seq,,

allan Acl, 820 ILCS 18$'I etseq.,

nlsAct of 1888, 29 U.S.C. 201, sl ssg.,

statute or regulalion of sny state, which governs the payment of wages

If the Person/Substantial Owner answered "Yes" to any of the questians above, it is Insiigibte ta enter into a Contract with CookCounty, but can request a reduction or waiver under Section IV.

EDS-1 3

CQNTRACT fk 1846-17647

iv. Request for Waiver or Reduction

If psrsonfSubstantiai Ovmsr answemd "Yes" to any of the questions above, it may request a reduction or waiver in

accordance with Ssrbon 34-179(d), provided that the request for reduction of waiver ls made on the basis of one or moreof'he

following acfions that have taken place:

There h~sen a bona fide change in ownership or Control of the insiigible Person or Substantial Owner

YES or 6

Disciptin~actfon has been taken against the inrgviduat(s) responsible fbr the sots givmg rise io tbe violation

YES or ~O

Rernediftfvfctfon has been taken to pmvent a recunence of the acts giving rise to the disquaNicatfon or default

YES o+M

Other fsffftatr that the Peaon or Substanl'ial Owner believe sre mlevant.YES or+0

~The Pe onlSubstentfst Owner m st submit ocu nis' to o e basis of its reousst for a rsdggtiop or waiver. ~he ief

Procursment OlÃcer reserves iherioht to make d'

al i 'n t addNonal documentation.

V. AffirmationThe Person/Substantial Owner affirms that statements cont 'ned in the Afildavit are true, accurate and complete.

Signature: I MW - Oats: l1 I(t jl l

Name of Person signing (Print): A"r8 ds~~d4a4 Tttte; t!I M~ /A@$ rid&AF'

b~& & I r f thi lv d r f ~U/~,RII~IX C&~O I 5~ &~

Notary Public SignatureNote: The above information is subject to verification prior to

EDSn4

CONTRACT ¹: 1845-17647

SECTION 5

CONTRACT AND EDS EXECUTION PAGEPLEASE EXECI/TE THREE ORIGINAL PA GES OF EDS

The Applicant hereby ceritfies and, warrants that all of the statements, certifications and representations set forth in this EDS are true,complete and correct; ihat the Applicant is in full compliance and will continue to be in compliance throughout the term of ths Contract orCounty Privilege issued to the Applicant with afi the policies and requirements set forth in this EDS; and that afi fade and information

provided by the Applicant in this EDS are true, complete and correct. The Applicant agrees to inform the Chief Procurement Oflicer in

writing if any of such statements, certifications, representations, facts or information becomes or is found tc be untrue, incomplete or

incorrect during the term of the Contract or County Privilege

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A//lP'orporation'sName

773 7d ~ /'~&+

Execution by Corporation

/ll/'//Af Jfitf. g A/AE/DmPresident's Printed Name and Signature

g/f/~/J//WE/J&p g~ /r//W,NAIHr/,

Email

Secretary Signature Date

Execution by LLC

LLC Name "Member/Manager Printed Name and Signature

Date Telephone and Email

Execution by Partnership/Joint Venture

Partnershtp/Joint Venture Name "Partner/Joint Venturer Printed Name and Signature


Execution by Sole Proprietorship

Printed Name Signature Assumed Name (if applicable)


Subscribed and sworn to before me thisdsy of ~N///rr/', 20 / P,

My commission

Notary Public Signature Notary Seal

*If the operating agreerneni, partnership agreement or governing documents reqpartners, or joint venturers, please complete and execute additional Contract and

nagara,

505-15


SECTION 6COOK COUNTY SIGNATURE PAGE

ON BEHALF OF THE COUNTY OF COOK, A BODY POLITIC AND CORPORATE OF THE STATE OF ILLINOIS, THISCONTRACT IS HEREBY EXECLITED BY:

COOKCQI|IITCHIEF~RQ OREMENTQFFICER)

DATED AT CHICAGO, ILLINOIS THIS ~ DAY OF l~&ldr~~/APPROVED AS TO FORM:

NIAASSISTANT STATES ATTORNEY(Required on contracts over $1,000,000,00)

CONTRACT TERM & AMOUNT

1845-17647CONTRACT ¹

Februarv 20. 2019 throuoh Februarv 19. 2020ORIGINAL CONTRACT TERM

$16.688.75CONTRACT AMOUNT

NIACOOK COUNTY BOARD APPROVAL DATE (Ii Applicable)

RENE)h(AL OPTIONS (if Applicable)

EDS-19 March/2017