Contract No. 10-50-1087CVendor Name: O'ONNOR LAW OFFICES, LLC

AMENDMENT NO. 3

This Amendment modifies Contract No. 10-50'-1087C for Instructional Services by and between theCounty of Cook, illinois, herein refened to as "County" and O'onnor Law Offices, LLC, authorized to dobusiness in the State of illinois hereinafter referred to as "Contractor:

RECITALS

Whereas, the County and Contractor have entered into a Contract approved by the County Board on April20, 2011, (hereinafter referred to as the "Contract" ), wherein the Contractor is to provide instructionalservices (hereinafter referred to as the "Services" ) fnxn August 1, 2011 through July 31, 2014, with two,one-year renewal options, in an amount not to exceed $215,100.00;and

Whereas, Amendment No. 1 was executed on August 1, 2014 for a renewal period of one year fromAugust 1, 2014 through July 31, 2015; and

Whereas, Amendment No. 2 was executed on June 18, 2015 for a renewal period of one year fromAugust 1, 2015 through July 31, 2016 and increased in the amount of $14,000.00; and

Whereas, the Contract will expire July 31, 2016 and the agreed upon Services are still required; and

Whereas, the County and Contractor desire to extend the Contract for four (4) months beginning onAugust 1, 2016 through December 2, 2016.

Now therefore, in consideration of mutual covenants contained herein, it is agreed by and between theparties to amend the Contract as follows:

1. The Contract is extended through December 2, 2018.

2. GC-06 of the Agreement is deleted in its entirety and is revised as follows:

All invoices submitted by the Contractor shall be in accordance with the cost provisions contained

in the Contract Documents and shall contain a detailed description of the Deliverables (i.e., thegoods, equipment, supplies or services) including the quantity of the Deliverables, for which

payment is requested. All invoices for services shall include itemized entries indicating the dateor time period in which the services were provided, the amount of time spent performing theservices, and a detailed description of the services provided during the period of the invoice. All

invoices shall reflect the amounts invoiced by and the amounts paid to the Contractor as of thedate of the invoice. Invoices for new charges shall not include "past due" amounts, if any, which

amounts must be set forth on a separate invoice. Contractor shall not be entitled to invoice theCounty for any late fees or other penalties.

In accordance with Section 34-177 of the Cook County Procurement Code, the County shall have

a right to set off and subtract from any invoice(s) or Contract price, a sum equal to any fines and

penalties, including interest, for any tax or fee delinquency and any debt or obligation owed by theContractor to the County.

Rev t////5

Contract No. 10-50-1087CVendor Name: O'ONNOR LAW OFFICES, LLC

The Contractor acknowledges its duty to ensure the accuracy of all invoices submitted to theCounty for payment. By submitting the invoices, the Contractor certifies that all itemized entriesset forth in the invoices are true and correct. The Contractor acknowledges that by submitting theinvoices, it certifies that it has delivered the Deliverables, i.e., the goods, supplies or equipmentset forth in the Contract to the Using Agency, or that it has properly performed the services setforth in the Contract. The invoice must also reflect the dates and amount of time expended in theprovision of services under the Contract. The Contractor acknowledges that any inaccuratestatements or negligent or intentional misrepresentations in the invoices shall result in the Countyexercising all remedies available to it in law and equity including, but not limited to, a delay in

payment or non-payment to the Contractor, and reporting the matter to the Cook County Office ofthe Independent Inspector General.

When a Contractor receives any payment from the County for any supplies, equipment, goods, orservices, it has provided to the County pursuant to its Contract, the Contractor must makepayment to its subcontractors within 15 days after receipt of payment from the County, providedthat such subcontractor has satisfactorily provided the supplies, equipment, goods or services in

accordance with the Contract and provided the Contractor with all of the documents andinformation required of the Contractor. The Contractor may delay or postpone payment to asubcontractor when the subcontractor's supplies, equipment, goods, or services do not complywith the requirements of the Contract, the Contractor is acting in good faith, and not in retaliation

for a subcontractor exercising legal or contractual dghts.

3. The attached Identification of Subcontractor/Supplier/Subconsultant, Minority-Owned BusinessEnterprise and Women-Owned Business Enterprise Utilization Plan, and Economic DisclosuresStatement forms are incorporated and made a part of this Contract.

4. All other terms and conditions remain as stated in the Contract.

In witness whereof, the County and Contractor have caused this Amendment No. 3 to be executed on thedate and year last written below.

County of Cook, illinois

~, % LIIL-Chiet Procurement Officer

By:Qate's Attorney (if applicable)

Qiiled

AAb~A I 7. l2/mwMa/Type or print name

Dat: ~~ AlV'Gl 0Title

Date: W~ / l 7. 7~1Li

xev t/t/ts

ATTACHMENTS

Identification of Subcontractor/Supplier/Subconsultant Form

Minority-Owned Business Enterprise and Women-Owned Business Enterprise Utilization Plan

Economic Disclosure Statements

Identification of Subcontractor/Supplier/Subconsultant Form

Cook CountyOffice of the Chief Pmcurement Oflicer

Identification of Subcontractor/Supplier/Subconsultant Form

OCPO ONLY:A Diecuelific~iCl Check Ccmoiete

Ths Bidder/Proposer/Respondent ("the Contractoi"') will fully complete and execute and submit an Identification ofSubcontractor/Supplier/Subconsultant Form ("ISF")with each Sid, Request for Proposal, and Request forQualification The Contractor must complete the ISF for each Subcontractor, Supplier or Subconsultant whichshall be used on the Contract. In the event that there are any changes in the utilization of Subcontractors,Suppliers or Subconsultants, the Contractor must file an updated ISF

re»Frrr~drFT N 70Bid/RFP/RFQNo.: l0-KC7-ralp'l8 ' I'7-lkTotal Bid or Proposal Amount: \ 4i BfyB .. a Adrr Qr/sf'rrrFm&CJ'AketrrrdFaevi-™~ I Subcontractor/Supplier/Contractor'8~P'~ ~I/~/(/ii)', CK Subconsultant to be

d .BMOC / r'T8/nasnp added or substitute: r//3Authorized Contact for

Authorized contact ~ref vy t/ededrFrFDd(r subcontractor/supplier/Subconsultant: ry re

Email Address / I nn Email Address(Contractor). F@%' fldfar/r/drk&dy'FrFi/(i. Cfrur (Subcontractor):

OCUL~ &» ~zM OCcCompany Address <++>~ Bn ~~~~> g Company Address(Contractor): r~ ~ +~ ~ +dr/ (Subcontractor); ~/~dec/deCity, State and City, State and ZipZip (COntraCtar) &VIA fi446f. Zi I/elf M4 7 (SubCOntraCtOr): CYfPTelephone and Fax Telephone and Fax(Contractor) Ng g ) 4L/o lri JX+J (Subcontractor) ~//Estimated Start and p ~ ~~ ~~.me Estimated Start andCompletion Dates Completion Dates ~/y(Contractor) rg. Z- 4 (Subcontractor)

Note: Upon request, a copy of all written subcontractor agreements must be provided to the OCPO.

Oescrlotlon of Services or Suonllee

/nfer/vcP7W

Total Price ofSubcontract for

Services or Suooliss

The subcontract documents will incorporate all requirements of the Contract awarded to the Contractor as applicable.The subcontract will in no way hinder the Subcontractor/Supplier/Subconsultant from maintaining its progress on anyother contract on which it is either a Subcontractor/Supplier/Subconsultant or prinapal contractor. This disclosure ismade with ths understanding that the Contractor is not under any circumstances relieved of its abilities andobligations, and is responsible for the organization, performance, snd quality of work. This form does not approveany proposed changes, revisions or modifications to the contract approved MBE/WBE Utilization Plan. Anychanges to the contract's approved MBEIWBEIUtilizaffion Plan must be submitted to the Office of theContract Compliance.

Contractor gg~~~g ~g~~~@Vie ~ OVewrroEW~Mi~ ~irJge< g/~z Jgg

Prime Contractor Signature (ykte

yF ~ J~~orT~Cr@8S KHZ dE (x/d58y ~re Q~~,

Minority-Owned Business Enterprise and Women-Owned Business Enterprise Utilization Plan

OFFICE OF CONTIESFRQOMPLIANCE

DIRECTOR

118 N. CIRGS County Buildimh Room 1020 ~ Chintga, Vlinois 60602 e f312)603-5502

TEINI PnaCKvvIRIKLa

PM5IOENT

Cook Coontir Brood

of Commissiomos

RICHARD Rr BOYtGN

1st District

ROBERT STSELs

2nd Oistnct

JFJIRY BUTLER

3 rd Dlstrkf

STANI.EY MOORE

sth oistrin

OEBORAH SiMS

5tlt Dlsklft

MB, Shannon E, Andrews

Chief Procurement Officer

118hL Clark Street

Counbl Building-Room1016

Chicago, IL 60602

Re: Contract hfo. 1040-tfITC, Amendment tfo. 6

hwbuctiohsl Services (O'onnor Law Offices, LLC)

Sheriffs Office

JOAN FATRJCiA MURPHY

6th District

JE5US Ci. GARCIA

7th District

LUIS ARROYO, JR

8th District

The Olce of Contract Compifance is in receipt of the above-referenced contract amendment and hss

reVieWed thiS COntraCt fOr COmplianee With the MinOriiy- and WOmen-OWned BusfnesaEntaiprisea (MBErrWQE)

Ordiriance. Afb3r Careful review of our records as reported by the vendor, it has been detenrilned the vendor ls

in copliance with the MBEfWBE Ordinance.

PETER N, SRVE5TRI

9th District

BRIDGET GAINER

10th 0Istrlct

ctt omex

Contract Compliance Qirector

JOHN P, DALEY

tltll District

JDHlf A. FRITCHEY

12th Distiict

LARRY SUFFRFOIN

13th Oistirct

Cc: Colleen Chambem, Procmement Buyer

Sherilys Oface

GREGG BOSON

lrkir District

TIMOTHY O. SCHNGOER

15th District

JEFFRE'i IL TOBOISKI

tstll DirtriCt

GAIJ N LIORRGGN

17th District

$ Fiscal Responsibility f Innnvative Ltnsdersttrp Ttansparency at Accountability Q>, Irnproved services

PETITION FOR WAIVER OF MBE/WBE PARTICIPATION - FORM 3

FULL WBE WAIVER

3E of Reduction for MBE Participation'/s of Reduction for WBE Participation

B.REASON FOR FULUREDUCTION WAIVER REQUEST

A. BIDDER/PROPOSER HEREBY REQUESTS:

IRl FULL MBE WAIVER

REDUCTION (PARTIAL MBE and/or WBE PARTICIPATION)

Bidder/Proposer shall check each item applicable to its reason for a waiver request. Additionally, supportingdocumentationshallbesubmittedwiththisrequest.y +g~~psO 4/~

OF'1)

Lack of sufficient qualified MBEs and/or WBEs capable of providing the goods or services requiredby the contract. (Please explain)

(2) The specifications and necessary requirements for performing the contract make it impossible oreconomically infeasible to divide the contract to enable the contractor to utilize MBEs and/or WBEs in

accordance with the applicable participation, (Please explain)

(3) Price(s) quoted by potential MBEs and/or WBEs are above competitive levels and increase cost ofdoing business and would make acceptance of such MBE and/or WBE bid economically impracticable,taking into consideration the percentage of total contract price represented by such MBE and/or WBEbid. (Please explain)

(4) There are other relevant factors making it impossible or economically infeasible to utilize MBE and/orWBE firms. (Please explain)

C. GOOD FAITH EFFORTS TO OBTAIN MBE/WBE PARTICIPATION

(I) Made timely written solicitation to identified MBEs and WBEs for utilization of goods and/or services;and provided MBEs and WBEs with a timely opportunity to review and obtain relevant specifications,terms and conditions of the proposal to enable MBEs and WBEs to prepare an informed response tosolicitation. (Attach of copy written solicitations made)

(2) Used the services and assistance of the Office of Contract Compliance staff. (Please explain)

(3) Timely notified and used Ihe services and assistance of community, minority and women businessorganizations. (Attach of copy written solicitations made)

(4) Followed up on initial solicitation of MBEs and WBEs to determine if firms are interested in doingbusiness. (Attach supporting documentation)

(5) Engaged MBEs S WBEs for direct/indirect participation. (Please explain)

D. OTHER RELEVANT INFORMATION+

Attach any other documentation relative to Good Faith Efforts in complying with MBE/WBE participation.

M/VVBE Utilization Plan - Form 3 Revised: 01/29/14

O'ONNOR LAW OFFICES, LLC10751 W. 165r" STREET, SUITE 101

ORLAND PARK, IL 60467-8702TELEPHONE: (708) 460-8888 / FACSIMILE: (708) 460-8887

www.doconnorlawoffices.corn

June 17, 2016

Cook County Procurement OfficeMs. Colleen Chambers118 N. Clark St.—Room 1018Chicago, IL 60602

In Re: Petition for Waiver of MBE/WBE Participationfor 10-50-1087 CSherifFs Training Institute

Dear Ms. Chambers:

As provided in documentation previously submitted pursuant to this contract, O'onnorLaw Offices, LLC is comprised of my wife, Mons L. O'onnor, an attorney and partnerat O'onnor Law Offices, LLC and myself as the Managing Member of the LimitedLiability Company. We have two other attorneys who are "ofcounsel" to the firm.Notwithstanding that one-half of the firm is comprised of female attorneys, our firm isnot presently recognized or defined as a Minority Business Enterprise or Women-OwnedBusiness Enterprise. More specifically, due to the fact that the services under thiscontract are highly unique to the knowledge, training, and experience of the Contractor,the Contractor requests a Full Waiver of MBE/WBE participation. The Contractorcomplies with all other requirements and mandates as defined in the aforementionedcontract.

Should there be any questions or concerns, feel free to contact the undersigned or MonsO'onnor at 708-460-8888.

Very Truly Yours,O'C Law Offices, LLC

David J. O'onnor

DOC/ed

Economic Disclosure Statements

COOK COUNTVECONOMIC DISCLOSURE STATEMENT

AND EXECUTION DOCUMENTINDEX

Section

1

Description

Instructions for Completion of EDS

Pages

EDS i-ii

CertiTtcations

Economic and Other Disclosures, Affidavit of Child

Support Obligations, Disclosure of Ownership Interestand Familial Relationship Disclosure Form

Cook County Affidavit for Wage Theft Ordinance

EDS 1-2

EDS 3 —12

EDS 13-14

Contract and EDS Execution Page

Cook County Signature Page

EDS 15-17

EDS 15

SECTION 1

INSTRUCTIONS FOR COMPLETION OFECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT

This Economic Disclosure Statement and Execution Document ("EDS") is to be completed and executedby every Bidder on a County contract, every Proposer responding to a Request for Proposals, and everyRespondent responding to a Request for Qualifications, and others as required by the Chief ProcurementOfticer. The execution of the EDS shall serve as the execution of a contract awarded by the County. TheChief Procurement Officer reserves the right to request that the Bidder or Proposer, or Respondentprovide an updated EDS on an annual basis.

Definitions. Terms used in this EDS and not otherwise defined herein shall have the meanings given tosuch terms in the Instructions to Bidders, General Conditions, Request for Proposals, Request forQual1Tications, as applicable.

Affiliate means a person that directly or indirectly through one or more intermediaries, Controls isControlled by, or is under common Control with the Person specified.

Applicant means a person who executes this EDS.

Bidder means any person who submits a Bid.

Code means the Code of Ordinances, Cook County, illinois available on municode.corn.

Contract shall include any written document to make Procurements by or on behalf ofCook County.

Contractor or Contracting 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,including all sections listed in the Index and any attachments,

Joint Venture means an association of two or more Persons proposing to perform a for-profit business enterprise. Joint Ventures must have an agreement in writing specifyingthe terms and conditions of the relationship between the partners and their relationshipand respective responsibility for the Contract

Lobby or lobbying means to, for compensation, attempt to influence a County official orCounty employee with respect to any County matter.

Lobbyist means any person who lobbies.

Person or Persons means any individual, corporation, partnership, Joint Venture, trust,association, Limited Liability Company, sole proprietorship or other legal entity.

Prohibited Acts means any of the actions or occurrences which form the basis fordisqualification under the Code. or under the Cerlifications hereinafter set forth.

Proposal means a response to an RFP.

Proposer means a person submitting a Proposal.

Response means response to an RFQ.

Respondent means a person responding to an RFQ.

RFP means a Request for Proposals issued pursuant to this Procurement Code.

RFQ means a Request for Qualifications issued to obtain the qualifications of interested parties.

EDS-i N2015

INSTRUCTIONS FOR COMPLETION OFECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT

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

Section 2: Certifications. Section 2 sets forth certiTications 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 shell supplement this EDS up to the time the County takes action, by filing an amended EDS orsuch other documentation as is required.

Addigonal 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, IL

60602) or visit the web-site at cookcountyil.gov/ethics-board-of.

Authorized Signers of Contract and EDS Execution Page. If the Applicant is a corporation, thePresident and 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 Certificate ofGood Standing from the state of incorporation must be submitted with this Signature Page.

If the Applicant is a partnership or joint venture, all partners or joint venturers must execute the EDS,unless one partner or joint venture has been authorized to sign for the partnership or joint venture, in

which case, the partnership agreement, resolution or evidence of such authority satisfactory to the Officeof the Chief Procurement Officer must be submitted with this Signature Page.

If the Applicant is a member-managed LLC all members must execute the EDS, unless otherwiseprovided in the operating agreement, resolution or other corporate documents. If the Applicant is amanager-managed LLC, the manager(s) must execute the EDS. The Applicant must attach either acertified copy of the operating agreement, resolution or other authorization, satisfactory to the County,demonstrating such person has the authority to execute the EDS on behalf of the LLC. If the LLC is notregistered in the State of illinois, a copy of a current Certificate of Good Standing from the state ofincorporation must be submitted with this Signature Page.

If the Applicant is a Sole Proprietorship, the sole proprietor must execute the EDS.

A "Partnership" "Joint Venture" or "Sole Proprietorship'perating under an Assumed Name must beregistered with the illinois county in which it is located, as provided in 605 ILCS 405 (2012), anddocumentation evidencing registration must be submitted with the EDS.

EDS-ii 8/2015

SECTION 2

CERTIFICATIONS

THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE. THE APPLICANT IS CAUTIONEDTO CAREFULLY READ THESE CERTIFICATIONS PRIOR TO SIGNING THE SIGNATURE PAGE. SIGNING THE SIGNATUREPAGE SHALL CONSTITUTE A WARRANTY BY THE APPLICANT THAT ALL THE STATEMENTS, CERTIFICATIONS ANDINFORMATION SET FORTH WITHIN THESE CERTIFICATIONS ARE TRUE, COMPLETE AND CORRECT AS OF THE DATE THESIGNATURE PAGE IS SIGNED. THE APPLICANT IS NOTIFIED THAT IF THE COUNTY LEARNS THAT ANY OF THEFOLLOWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACT ENTERED INTO WITH THE APPUCANT SHALLBE SUBJECT TO TERMINAllON.

PERSONS AND ENTITIES SUBJECT TO DISQUALIFICATION

No person or business entity shall be awarded a contract or sub-contract, for a period of five (5) years from the date ofconviction or entry of a plea or admission of guilt, civil or criminal, if that person or business entity:

1) Has been convicted of an act committed, within the State of illinois, of bribery or attempting to bribe an officer oremployee of a unit of stats, federal or local government or school district in ths State of illinois in that officer's oremployee's official capacity;

2) Has been convicted by federal, state or local government of an act of bid-rigging or attempting to ng bids as definedin the Sherman AntiTrust Act and Clayton Act Act 15 USC. Section 1 eiseqri

Has 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-fixing or attempting to fix prices as defined by thsSherman AntiTrust Act and ths Clayton Act. 15 USC. Section 1, et seqri

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

3)

4)

5)

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

T) Has made an admission of guilt of such conduct as set forth in subsections (1) through (6) above which admission isa matter of record, whether or not such person or business entity was subject to prosecution for the offense oroffenses admitted to; or

BIO4IIGGING OR BID ROTATING

THE APPLICANT HEREBY CERTIFIES THAT: in accordance with 720 ILCS 5/33 E-11, neither the Applicant nor anyAFiiiafed Entity is bansd from award of this Contract as a msuit of a conviction for the violation of State laws prohibiting bid-

rigging or bid rotating.

8) Has entered a plea of nolo contendere to charge of bribery, price-fixing, bid-rigging, or fraud, as set forth in sub-paragraphs (1) through (6) above.

In the case of bribery or attempting to bribe, a business entity may not be awarded a contract if an official, agent or employeeof such business entity committed the Prohibited Act on behalf of the business entity and pursuant to the direction orauthorization of an officer, director or other responsible official of the business entity, and such Prohibited Act occurred within

three years prior to the sward of ths contract. In addition, s business entity shall be disqualifie if an owner, partner orshareholder controlling, directly or indirectly, 20% or more of the business entity, or an officer of the business entity hasperformed any Prohibited Act within five years prior to the award of the Contract.

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

DRUG FREE WORKPLACE ACT

THE APPUCANT HEREBY CERTIFIES THAI; The Applicant will provide a drug free workplace, as required by (30 ILCS 58013).

EDS-1 8/2015

D. DELINQUENCY IN PAYMENT OF TAXES

THE APPLICANT HEREBY CERTIFIES 7NAT: The Applicant is not an owner or a party responsible for the payment of any taxor fee administered by Cook County, by a local municipality, or by the illinois Department of Revenue, which such tax or fee isdelinquent such as bsr award of e contract or subcontract pursuant to the Code, Chapter 34, Section 34171.

E. HUMAN RIGHTS ORDINANCE

No person who is a parly to a contract with Cook County ("County" ) shall engage in unlawful discdmination or sexual harassmentagainst any individual in the terms or condibons of employment, credit, public accommodations, housing, or provision of Countyfacilifies, services or programs (Cods Chapter 42, Section 42-30 et seq.).

F. ILLINOIS HUMAN RIGHTS ACT

THE APPLICANT HEREBY CERTIFIES THAT: It is in compliance with the illinois Human Rights Act (775 ILCS 5rg-t05), andagrees to abide by the requirements of the Act as part of its contractual obll gafions.

INSPECTOR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTION 34-174 and Section 34 260)

The Applicant has not willfully failed to cooperate in sn investigation by the Cook County Independent Inspector General or toreport to ths Independent Inspector General any and afi information concerning conduct which they know to involve corruption, orother criminal activity, by another county employee or oflicial, which concerns his or her office of employment or County relatedtransacbon.

The Applicant has mported directly and without any undue delay any suspected or known fraudulent activity in the County'sProcurement process to the Office of the Cook County Inspector General.

H. CAMPAIGN CONTRIBUTIONS (COOK COUNTY CODE, CHAPTER 2, SECTION 24)86)

THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County's Ordinance concerning campaignconiributions, which is codified at Chapter 2, Division 2, Subdivision 6, Section 585, and can be read in ils entirety atwww.municode.corn.

GIFT BAN, (COOK COUNTY CODE, CHAPTER 2, SECTION 24)74)

THE APPLICANT CERTIFIEB THAT: It has reed and shall comply with the Cook County's Ordinance concerning receiving andsoliciting gifts and favors, which is codNed at Chapter 2, Division 2, Subdivision II, Section 574, and can be read in its entirety atwww.municode.corn.

LIVING WAGE ORDINANCE PREFERENCE (COOK COUNTY CODE, CHAPTER 34, SECTION 34-160;

Unkrss expressly waived by the Cook County Board of Commissioners, the Cods requires that a living wage must be paid toindividuals employed by s Contractor which has s County Contract and by afi subcontractors of such Contractor under a CountyContract, throughout the duration of such County Contract. The amount of such living wage is annually by the Chief FinancialOfficer of the County, and shall be posted on the Chief Procurement Officefs website.

The term "Contract" as used in Section 4, I, of this EDS, specifically excludes contracts with the following:

1) Not-For Profit Organizations (defined as a corporation having tax exempt status under Section 501(C)(3)of the UnitedState Internal Revenue Code and mcognized under the illinois State not-for -profit law);

2) Community Development Block Grants;

3) Cook County Works Department;

4) Sheriffs WorkAlternative Program; and

5) Department of Correction inmates.

EDS-2 8/2015

SECTION 3

REQUIRED DISCLOSURES

1. DISCLOSURE OF LOBBTIST CONTACTS

List all persons that have made lobbying contacts on your behalf with respect to this contract:

Address

2. LOCAL BUSINESS PREFERENCE STATEMENT (CODE, CHAPTER 34, SECfION 34-230)

Local business means a Person, including a foreign corporation authorized to transact business in illinois, having a bona fide

establishment located within the County at which it is transacting business on the date when a Bid is submitted to the County, and

which employs the majority of its regular, full-time work force within the County. A Joint Venture shall constitute a 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 Venture

does not, at the Sme of the Bid submittal, have such a bona fide establishment within the County

a) Is Applicant a "Local Business" as defined above?

No

b) If yes, list business addresses within Cook County: ~ w

iO~J-l WZ~~<P.- Zzr~ 201pgizwg AAcA. wz 4ov4/

c) Does Applicant employ the majority of its regular full-time workforce within Cook Count)rf

v..: A'o;3. THE CHILD SUPPORT ENFORCEMENT ORDINANCE (CODE, CHAPTER 34, SECTION 34-172)

Every Applicant for a County Privilege shall be in full comphance with any child support oaler before such Applicant is entitled to receive orrenew a County Privilege. When delinquent child support exists, the County shall not issue or renew any County Privilege, and may

revoke any County Privilege,

All Applicants are required to review the Cook County Affidavit of Child Support Obligations athrched to this EDS (EDS-5) andcomplete the AISdavit, based on the instructions in the Affidavit

EDS-3 8/2015

4. REAL ESTATE OWNERSHIP DISCLOSURES.

The Applicant must indicate by checking the appropriate provision below and providing afi required information that either:

a) The following is a complete listof afi real estate owned by the Applicant in Cook County:

PERMANENT INDEX NUMBER(S): P 7 R 9 7/3 7 QOZ (3886av- a5- Mod-w.s -zoom

(ATTACH SHEET IF NECESSARY TO LIST ADDfTIONAL INDEX

NUMBERS)

OR:

b) The Applicant owns no real estate in Cook County.

6. EXCEPTIONS TO CERTIFICATIONS OR DISCLOSURES.

If the Applicant is unable to certify lo any of the Cemfications or any other statements contained in this EDS and not explained elsewhere in

this EDS, the Applicant must explain below.

If the letters, "NA", the word "None or "No Response appears above, or if the space is lefi blank, it will be conclusively presumed that theApplicant cerfified to afi Certifications and other statements contained in this EDS.

EDS-4 8/2015

COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT

The Cook County Code of Ordinances (I)2-610 et serf.) requires that any Applicant for any County Action must disclose informationconcerning ownership interests in the Applicant. This Disclosure of Ownership Interest Statement must be completed with allinformation current as of the date this Statement is signed. Furthermore, this Statement must be kept current, by filing an amendedStatement, until such time as the County Board or County Agency shall take action on the application. The information contained inthis Statement will be maintained in a database and made available for public viewing.

It you are asked to list names, but there ars no applicable names to list, you must slate NONE An incomplete Statement will bereturned and any ection regarding this contract will be delayed. A failure to fully comply with ths ordinance may result in the actiontaken by the County Board or County Agency being voided.

"App/icant" means any Entity or person making an application to the County for any County Action

County Action means any action by a County Agency, a County Department, or the County Board regarding an ordinance orordinance amendment, a County Board approval, or other County agency approval, with respect to contracts, leases, or sale orpurchase of real estate

"person" "Entity" or "Legal En///y" means a sole proprietorship, corporation, partnership, association, business trust, estate, two ormore persons having a joint or common interest, trustee of a land trust, other commercial or legal entity or any bensficiary orbeneficiaries thereof.

This Disclosure of Ownership Interest Statement must be submitted by:

1. An Applicant for County Action and

2. A person that holds stock or a beneficial interest in the Applicant ~nis listed on the Applicant's Statement (s "Holder") must file aStatement and complete Srt only under Ownership Interest Declaration.

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

This Statement is being made by the [~)Applicant or [ [ Stock/Beneficial Interest Holder

This Statement is an: [~Original Statement or [ ] Amended Statement

Identifying Information:

Name 8I.FJyYWIJA ~f)i%LA, LL C

D/B/A. FEIN ND.: 20 S 0/'7JJ 7StreetAddress;XfVQ / A/. /~ ~ —sjhl~ l l7 Icity /3ELinPB AAf A'tatePhone No.: 1&83 P80"rSJS Fax Number: &f)f')uÃfj -red 7

zip cod d0 0 P/rr

Ea i: M /0 der Pguogjpg

Cook County Business Registration Number: ii//A(Sole Proprietor, Joint Venture Partnership)

Corporate File Number(if applicable): WL r JECyr F~a rOm' AApyx / yCrr- r[ /7JK9.79'/9Form of Legal Entity:

[ ) Sole Proprietor [ ) Partnership [ [ Corporation [ ) Trustee of Land Trust

[ ) Business Trust [ ) Estate [ ) Association [ ) Joint Venture

[g Other (describe) ZIA1/~A

&/CS/EJECT/

ry./9~PA&P k

EDS-6 8/2015

Ownership Interest Declaration:

List the name(s), address, and percent ownership of each Person having a legal or beneficial interest (including ownership) ofmore than five percent (5%) in the Applicant/Holder.

Name Address Percentage Interest in

Applicant/Holder~ed Z 6/m~mnP ZWZ9 tu F~D~C. fJeC~dd~e7F '/n Yi~ l r'ugly

If the interest of any Person listed in (1) above is held as an agent or agenkr, or a nominee or nominees, list the name andaddress of the principal on whose behalf the interest is held.

Name of Agent/Nominee Name of Prinmpal Principal's Address

3. Is the Applicant constructively controlled by another person or Legal Entity? [ ] Yes [ X ] No

If yes, stats the name, address and pena/stage of benelicial interest of such person, and the relationship under which suchcontrol is being or may be exercised.

Name Percentage ofBeneficial Interest

Relationship

w/A'orporate

Officers, Members and Partners Information:

For all corporations, list the names, addresses, and terms for all corporate officers. For afi limited liability companies, list the names,addresses for afi members. For afi partnerships and joint ventures, list ths names, addresses, for each partner or joint venture,

Name Address Title (specify title ofOifice, or whether manager

Term of Office

or parlner/joint venture)

~~AWDl~~~z i'.lirm~ PkwadrW P~~~~nPAef ~

df)NF~Declaration (check the applicable box):

I stats under oath that the Applicant has withheld no disclosure as to ownership interest in the Applicant nor reservedsny information, data or plan as to the intended use or purpose for which the Applicant seeks County Board or other County

Agency action.

[ ] I state under oath that the Holder has withheld no disclosure as to ownership interest nor reserved any informafion required tobe disclosed

EDS-7 8/2015

COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT SIGNATURE PAGE

17 OY~~~AName of Authori ed Appl~ic 5Pplder Representative (please print or type) Title

ref~~ a Jr7 JrsSi~na re

nfaaa A Joconna/l~nAA 'cpJ'. co~ (1~~) Yfo-SXZZE-mail address Phone Number

Subsp~r'I to and sworn before.tnethis g~'ay of~U.tk,

20'/Ilri

Gill I/I/M

My commission expires:

OFHQAL SEALERIfS GELEGPN

NOTARY FURLS: -STATS OF ILLINOIS

Nottf iy Self COMMISSION EXPIRES:07/17/ts,I

EDS-8 8/2015

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

CHICAGO, ILLINOIS 60602312/603-4304 Office 312/603-9988 Fax

FAMILIAL RELATIONSHIP DISCLOSURE PROVISION

Nenotism DtseIasure Reouirement:

Doing a significant amount of business with the County requires that you disclose to the Board of Ethics the existence of any familialrelationships with any County employee or any person holding elective office in the State of Illinois, the County, or in anymunicipality within the County. The Ethics Ordinance defines a significant amount of business for the purpose of this disclosurerequirement as more than $25,000 in aggregate County leases, contracts, purchases or sales in any calendar year.

If you are unsure of whether the business you do with the County or a County agency will cross this threshold, err on the side ofcaution by completing the attached familial disclosure form because, among other potential penalties, any person found guilty offailing to make a required disclosure or knowingly filing a false, misleading, or incomplete disclosure will be prohibited from doingany business with the County for a period of three years. The required disclosure should be filed with the Board of Ethics by January1 of each calendar year in which you are doing business with the County and again with each bid/proposal/quotation to do businesswith Cook County. The Board ofEthics may assess a late filing fee of $100 per day after an initial 30-day grace period.

The person that is doing business with the County must disclose his or her familial relationships. If the person on the County lease orcontract or purchasing &om or selling to the County is a business entity, then the business entity must disclose the familialrelationships of the individuals who are and, during the year prior to doing business with the County, were:

~ its board of directors,~ its officers,~ its employees or independent contractors responsible for the general administration of the entity,~ its agents authorized to execute documents on behalf of the entity, and~ its employees who directly engage or engaged in doing work with the County on behalf of the entity.

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

Additional Definitions:

"Familta! re/u/ions/tip" means a person who is a spouse, domestic partner or civil union partner of a County employee or State,County or municipal official, or any person who is related to such an employee or official, whether by blood, marriage or adoption, asa:

Parent0 Child

BrotherSisterAuntUncleNieceNephew

0 Grandparent0 Grandchild

Father-in-lawMother-in-law

Dl Son-in-lawDaughter-in-lawBrother-in-lawSister-in-law

0 Stepfather0 Stepmother0 Stepson0 Stepdaughter0 Stepbrother0 Stepsister0 Half-brother0 Half-sister

EDS-9 8/2015

COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM

Name of Person Doing Business with the County

PERSON DOING OR SEEKING TO DO BUSINESS WITH THK COUNTY

~~~~7. OkW~cZf/dew~~ f~>i

Address ofPerson Doing Business with the County: JO ZW/ Af. ldM~r/+ el''WlGJ WL tpd) g/V

Phone number ofPerson Doing Business with the County; /70K ) N 0 —ZiPIPcP

Email address ofPerson Doing Business with the County: fJ 9 VS P dZCOnmrl~aA'Ce". gtgrip

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

fJgrerce JAvrdhprciz 8/-0 —vtfrsr~r/.T /7l~nra rr/'ttrvesrwpne Csae

DESCRIPTION OF BUSINESS WITH THE COUNTYAppend additional pages as needed and for each County lease, contract, purchase or sale sought and/or obtainedduring the calendar year of this disclosure /or the proceeding calendar year ifdisclosure is made on January /),identify:

The lease number, contract number, purchase order number, request for proposal number and/or request for qualificationnumber associated with the business you are doing or seeking to do with the County: A'fl -MID - yOg 7Q

(/umAJFJc~ An Z)aar

The aggregate dollar value of the business you are doing or seeking to do with the County: fA . /I//f/.(at Zgp, tytyo. ~

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

AC~/.f~df~AJ'. U4AFFP JlPPE AOCt/~rriP~ZVuCM ifrZ-SOS- d;99/)The name, title and contact information for the County official(s) or employee(s) involved in managing the business you aredoing or seeking to do with the County:

Nip& AERY. /ZvcCfrf'I/f,'/Juan(r W(SP fiys-t)ICE-S/Z9)

C. DISCLOSURE OF FAMILIAL RELATIONSHIPS WITH COUNTY EMPLOYEES OR STATE. COUNTY ORMUNICIPAL ELECTED OFFICIALS

Check the box that applies and provide related information where needed

The Person Doing Business with the County is an individual and there is no familial relationship between this individualand any Cook County employee or any person holding elective office in the State of Illinois, Cook County, 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 of directors, officers, persons responsible for general administration of the business entity,agents authorized to execute documents on behalf of the business entity or employees directly engaged in contractual workwith the County on behalf of the business entity, and any Cook County employee or any person holding elective office in theState of Illinois, Cook County, or any municipality within Cook County.

EDS-10 8/2015

COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM

Ct The Person Doing Business with the County is an individual and there is a familial relationship between this individualand at least one Cook County employee and/or a person or persons holding elective office in the State of Illinois, CookCounty, and/or any municipality within Cook County, The familial relationships are as follows:

Name of Individual DoingBusiness with the County

Name ofRelated County Title and Position of Related Nature ofFamilialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected OAicial or Municipal Elected OAicial

ffmore space is needed, aaach an additional sheet following the above format.

The Person Doing Business with the County is a business entity and there is a familial relationship between at least onemember of this business entity's board ofdirectors, officers, persons responsible for general administration of the businessentity, agents authorized to execute documents on behalf of the business entity and/or employees directly engaged incontractual work with the County on behalf of the business entity, on the one hand, and at least one Cook County employeeand/or a person holding elective office in the State of Illinois, Cook County, and/or any municipality within Cook County, onthe other. The familial relationships are as follows:

Name of Member of Boardof Director for BusinessEntity Doing Business withthe County

Name of Related County Title and Position of Related Nature ofFamilialEmployee or State, County or Couniy Employee or Stale, County RelationshipMunicipal Elected OIAcial or Municipal Elected Ofgicial

Name of OAicer for Business Name of Related County Title and Position of RelatedEntity Doing Business with Employee or State, County or County Employee or State, Countythe County Municipal Elected OAlcial or Municipal Elected OfAcial

Nature ofPamilialRelationship

EDS-11 8/2015

Name of Person Responsiblefor the GeneralAdministration of theBusiness Entity DoingBusiness with the County

Name ofRelated CountyEmployee or State, County orMunicipal Elected Olflcial

Title and Position of RelaaxtCounty Employee or State, Countyor Municipal Elected Oflicial

Nature ofFamilialRelattonshrp

Name of Agent Authorizedto Execute Documents forBusiness Entity DoingBusiness with the County

Name of Related County Title and Position ofRelated Nature ofFamilialEmployee or State, County or County Employee or State, County Relationship*Municipal Elected Oflicial or Municipal Elected Ofllcial

Name of Employee ofBusiness Entity DirectlyEngaged in Doing Businesswith the County

Name of Related County Title and Position ofRelated Nature ofFamilialEmployee or State, County or County Employee or State, County Relationship*Municipal Elected Offitcial or Municipal Elected Official

Ifmore space is needed, attach an additional sheet following the above farmed.

VERIFICATION: To the best of my knowledge, the information I have provided on this disclosure form is accurate and complete. Iacknowledge that an inaccurate or incomplete disclosure is punishable by law, including but not limited to fines and debarment.~. iV rorySt~ore of Redfpient Date

tv'UBMIT

COMPLETED FORM TO: Cook County Board of Ethics69 West Washington Street, Suite 3040, Chicago, Illinois 60602Office (312) 603-4304 —Fax (312) 603-9988CookCounty.Ethics@cookcountyiLgov

'pouse, domestic partner, civil union partner or parent, child, sibling, aunt, uncle, niece, nephew, grandparent or grandchildby blood, marriage (l.e. in laws and step relations) or adoption.

EDS-12 8/2015

SECTION 4

COOK COI/NTY AFFIDAVIT FOR WAGE THEFT ORDINANCE

Effective May 1, 2015, every person, inc/ud/na subsfsnder ownem, seeking s contract wilh cook county must comply with the cook county wage ThefiOrdinance set forth in Chapter 34, Article IV, Section 179. Any Person/Substantial Owner, who falls to comply with Cook County Wage Theft Ordinance,msy request that the Chief Procumment ONcer grant a reduction or waiver in accordance with Secfion 34-179(d).

"Contract" means any wntten document ta make Pracurements by or on behalf af Cook County.

"Person" means any individual, corporation, partnership, Joint Venture, trust, association, limited liability company, sole proprietorship or other legal entity

"Procuremenf'eans obtaining supplies, equipment, goods, or services of any kind.

"Substsnt/sl Owner" means any person or persons who own or hold s twenty-five percent (25%) or mors percentage of Interest in sny business sadlyseeking s County pdivilege, including those shareholders, general or limited partners, benelldarles and principals; except where a business entity is anindividual or sale proprietorship, Substantial Owner means that individual or sole proprietor.

Afi persons/Substantial Owners are required to complete this affidavit and comply with the Cook County Wage Theft Ordinsnm before any Contract isawarded. Signature of this form constitutes a certification the information provided below is correct and complete, and that the individual(s) signing this formhas/have personal knowledce of such information.

I. Contract Information:

Contract Number. Zn-WO -Po &VClCounty Using Agency (requesting procurement): / rIOvtf PWu~ l/4.&rruiII. Person/Substantial Owner Information:

y r)Person(Corporate Entity Name): / J l~rI/~f7& Z Jtrq~ ~/i~Substantial Owner Complete Name: Z~r2 I 7. f) /~r)yr'F/5A 4flA IVAN//V8

FEIN¹ 20- Al 7II '7Date of Birth: E-mail address: f Jjfiyptp p DI4ownyfr/~dggdrff'f/yyy

Street Addreea: PEA X vrq r'hr jvfprtr ArF~city: OWL'@MA A~Home Phone: (gdd ZM9 79'

zip: 60&'9'7State:

Driver's License No:

III. Com pgance with Wage Laws:

Within the pastfive years hasthe Person/Substanfiial Owner, in any judicial or administrative proceeding, been convicted of, entered aplea, made an admission of guilt or liabikty, or had an administrative finding made for committing a repeated or willful violation of any ofthe following laws:

illinois Wage Payment and Collection Acl, 820 ILCS 115/1 et seq., YES oNO

/Iiinois Minimum Wage Acl, 820 ILCS 105/1 el seq., YES oQNO

/llinois Worker Ad/us/men/ and Retraining Notification Acl, 820 ILCS 65/1 el seq., YES oQNO

Employee C/assificalion Act, 820 ILCS 185/1 el seq., YES osQNO

Fair Labor 8/andards Acl of 1938, 29 U.S.C. 201, el seq., YES orlQO

Any comparable state slalu/e or regulation of any state, which governs the payment of wages YES orQO

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 waver under Section IV.

EDS-13 8/2015

IV. Rq f INi Rd u ry/nrIf Person/Substantial Owner answered "Yes" to any of the questions above, it may request a reduction or waiver inaccordance with Section 34-179(d), provided that the request for reduction of waiver is made on the basis of one or more otthe following actions that have taken place:

There has been a bona fide change in ownership or Control of the ineligible Person or Substantial OwnerYES or HO

Disciplinary action has been taken against the individual(s) responsible for the acts giving rise to the violationYES or NO

Remedial action has been taken to prevent a recurrence of the acts giving rise to the disqualification or defaultYES or NO

Other factors that the Person or Substantial Owner believe are relevant.YES or NO

The personrSubstsntial Owner must submit documentation to suooort the basis of its reouest for a reduction or waiver. The ChiefPmcurement Officer reserves the rioht to make additional inouiries and raouest additional documentation.

V. AffirmationThe PersoniSubstanfial Owner aff ms that all

sbutmentscontained in the Affidavit are true, accurate and complete.

Signature: . if&~JM Date: (PZ/7/P6'UName of Person signing (Print): XIAV/8 ~ /. f2/~W/YP)r(2 Title: AdAAA&vi/)r fP&/PIPE~Sub d q(id sworn to before me this I T day of (AU.AC/ ,20 lQ

GAL)<L <~Cia/ Notary ubl Signature Notary Sea I

Hotfrr The above info met n is subject to verification prior to the award of the Contract.

EDS-14 8)2015

SECTION 5

CONTRACT AND EDS EXECUTION PAGEPLEASE EXECUTE THREE ORIGINAL PAGES OF EDS

The Applicant hereby certifie and warrants that afi of ths statements, certifications and representations set forth in this EDS sre true,complete and correct; that the Applicant is in full compliance and will continue to bs in compliance throughout ths term of the Contract orCounty Privilege issued to the Applicant with afi the policies and requirements set forth in this EDS; and that all facts and informationprovided by the Applicant in this EDS are true, complete and consct. The Applicant agrees to inform the Chief Procurement Office inwriting if any of such statements, csrbfications, representations, facts or information becomes or is found to be untrue, incomplete orincorrect during the term of the Contract or County Privilege.

Execution by Corporation

Corporation's Name President's Printed Name and Signature

Telephone Email

Secretary Signature Date

8i.e~/~PS~/)McFJ'. i/P.LLC Name

M~ J'7. R're/riDate&

Execution by LLC

V47 WgP~ ~~~/ngF ~yegg~*Member/Manager Printed Name and Signature

PQ') NG-AV~ —OFF H d/nC/baFOngwszg4LEj'.Telephone and Email

Execution by Partnership/Joint Venture

Partnership/Joint Venture Name *Partner/Joint Venturer Printed Name and Signature

Date Telephone and Email

Execution by Sole Proprietorship

Printed Name Signature Assumed Name (if applicable)

Date Telephone and Email

Su~led and swage bEfore mq jhlsI P'< dayofi IlkÃ,20~.

4/ Tl 'l3AUL/jrILTIMy commission expires:

OFFICIAL SEAL

NOTARY PUBLIC STATE OF ILLINOISMY COMMISSION EXPIRES 07/17/lg

Nbtkry Public Signature ( )Notary Seal

*If the operating agresmen, partnership agreement or governing documents requiring execution by multiple members, managers,partners, or joint vsnturers, please complete and execute additional Contract and EDS Execution Pages.

EDS-15 8/2015