Contract No. 11-53-165EVendor Name: GORDONS AUTO REPAIR

AMENDMENT NO. 2

This Amendment modifies Contract No. 11-53-165E, for AUTOMOBILE MAINTENANCE AND REPAIR FOR ZONE 5 by andbetween ths County of Cook, lglnols, herein referred to as "County" and GORDON'S AUTO REPAIR, authorized to do businessIn ths State of illinois hereinafter referred to as "Contractor",

RECITALSWhereas, the County and Contractor have entered into a Contract approved by the County Board on July 10, 2012, (heminafterreferred to as the "Contract"), wherein the Contractor Is to pmvide AUTOMOBILE MAINTENANCE AND REPAIR FOR ZONE 5(hereinafter referred to as the "Services ) from July 15, 2012 through July 14, 2015 with two (2) one (1)year renewal options in anamount not to exceed $312,075.00;and

Whereas, Amendment ¹1 was executed on July 3, 2014 for an increase of $210,000.00; snd

Whereas, the Vendor relocated its business from 11626 South Mayfield Avenue, Alsip, IL 60603 to 10303 South RidgelandAvenue, Chicago Ridge,IL 60415I and

Whereas, the Contract will expire July 14, 2015, and the agreed upon Services are still required; and

Whereas, a renewal is desired for ths continuafion of Services; and

Whereas, an Increase in the amount of $299,000.00 ls required for the continuation of Services; and

Whereas, the County snd Contractor desire to renew the Contract for twelve (12) months beginning on July 15, 2015 throughJuly 14, 2016,

Now therefore, in consideralicn of mutual covenants contained herein, it is agreed by and between the parties to amend theContract as follows:

1. The Contract is renewed through July 14, 201B.

2. The Contract is increased by $299,000,00 and the Total Contract Amount is revised to $621,075.00,

3. The Vendor's location Is changed from 11626 South Mayfleld Avenue, Alsip, IL 60803 to 10303 South RldgslandAvenue, Chicago Ridge, IL 60415.

4, The attached Economic Disclosures Statement form is incorporated and made a part of this Contract,

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

In witness whereof, the County and Contractor have caused Ibis Amendment No. 2 to be executed on the date and year lastwritten below,

County of Cook, illinois

Chief Procurement OBlcer

B,,'.'o/ //o c,'(J'/0/>Slate's Attorney (if applicable)

Gordon's Auto RepairESTATE CF ROY G. GILKISON,

By: ~ V~ /.Signed

Gordon M. GilkisonType or print name

DECEASED

APPROI/EC/ SY BOARD OPCOOK COUIIITY COMMISSIONERS

JUL 0 1 <015

8 LIIJ/Q 2-OIoi

Supervised Administrator ng)V)Title

Date April 9, 2015

Rsv 1/t/15

LETTERSOFOFFICE-DECEDENT'S ESTATE

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOISCOUNTY DEPARTIvKM', PROBATE DIVISION

(Rev. 12/23/03) CCP Q415

Estate of

ROY G. GILKISON

No. 2013 P 007448

..IGI(4':,~ Docket

Deceased Page

LETTERSOFOFFICK - DECEDENT'S ESTATE

GORDON M. GILKISON

Supervised

ROY G. GILKISON

Administrator

who dim Sunday. December 01.2013

estate of the decedent and to do all acts required by law.

has been appointed

of the estate of

deceased

, and is authorized to to take possession of and collect the

wITNEss, December 30.2013

Dorothy BrovruClerk of the Circuit Court

CERTIFICATE

I certi fy that this is a copy of the letters of office now in force in this estate.

DLB

WITNESS, December 30.2013

ClerkgoCourt

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

AMS:dl 45.0013gordon gilidson eststetorder to continue business.doc

Attorneys'ode 90352IN THE CIRCUIT COURT OF COOK COUNTYt ILLINOIS

COUNTY DEPARTMENT, PROBATE DIVISION

ESTATE OF

ROY G. G1LKISON,

Deceased

)))) No. 13 P 007448

)))

ORDER

THIS CAUSE coming on to be heard on the verified petition of GORDON M.GILKISON, Supervised Administrator of the Estate of Roy G. Gilkison, Deceased, to operate thedecedent's business pursuant to F15-1(a) of the Probate Act,

AND the Court being fully advised;

IT IS HEREBY ORDERED:

1. That the Personal Representative is permitted to operate the Decedent's businessknown as Gordon's Auto Repair at both locations in the ordinary course;

2. That the Decedent's business known as Gordon's Auto Repair is permitted tocontinue to service Cook County vehicles under the existing repair contracts at bothlocations;

3. That the Personal Representative is permitted to renew the business license forGordon's Auto Repair with the City of Chicago and to obtain any and all other licenses and

permits as may be required from time to time; and

4. That the requirement is hereby waived for the Personal Representative to filemonthly reports of earnings and expenses. However, so long as the probate estate remains

open, the Personal Representative shall file an annual accounting to report the earnings and

expenses of the decedent's business.

, 2014.

ENTER:

Judge

ouogos Oil orrO 4dreer bco+@ "'tt,

39+a No.

Arnold M schwarrz, Esq.DAVIDSON & SCHWARTZAttorneys for Petitioner db Estate33 N. Dearborn St., Suite 2330Chicago, IL 60602(312)559-0555

CONTRACT NO. 11-53-185E

ECONOIIIC DISCLOSURE STATEhllENTAND EXECUTION DO'CUIIENT

INDEX

Section Descrtpbon Pages

Instnictions Instructions for Completion of EDS

MBE/WBE lNlizstlon Plan

EDS i - ii

EDS 1

Letter of fntent 'DS2

Petition for Reduction/Waivei of M BE/WBE ParticipationGoals EDS 3

6

Certification s

Economic and Other Disclosures,.Affidavit of Child

Support Obligations and Disclosure of Ownership interest

Sole Proprietor Signature Page

EDS4,5

EDS 6 —12

EDS 13s/b/c

Partnership Signature Page EDS 14/s/b/c

10

I.imited Liability Corporation Signature Page

Corporation Signature Page

Cook County Signature Page

EDS 15a/b/c

EDS 16s/b/c

EDS17

1.10.13

. CONTRACT NO. 11-53-185E

Th[e Economic 'Disclosure Statement and Execution Document ("EDS") is to be completed and executed by everyBidde'r on a County contract, every party responding to a Request for Proposals or Request for QuaNications"(Proposei"), and others as required by the Chief Procumment Oflicer. If the Undersigned is awarded a contractPursuant to the procurement process for which this EDS was submitted (the "Contract" ), this Economic DisclosureStatement and Execution Document shall eland as the Undersigned's sxecugon of the Contract.

Deflnigons. Capitalized terms:used in this EDS snd not othsrwiss defined herein shall have ths meanings given tosuch terms in the Instrucgons to Bidders, 'General CondiTions,'equest for Pr'opassls, Request far Qualifications, orother documents, as appgcable.

"AN/iafed EeRy" means a person or entity that, directly or indiisctly: controls the Bidder, iscontrolled by the Bidder, or is; with the Bidder, under Common control of another person or entity.Indicia of control include, without limitation, Interlocking management or ownership; identity ofinterests among family members; shaisd facilities and equipment common usa of employees; sndoiganization of a business entity following the ineligibility of a businegs entity to do business. With

the County under the standards'set forth in the Certifications included in this EDS, usingsubstantially the same management, ownership or principals as ths ineligible entity.

"Bidder," "Pmposer,'" "Undersigned," or "Applicant," is. the person or entity executing this. EDS. Upon award and execution of a Contract by the County, the Bidder, Proposer, Undersigned

or Applicant, as ths case may be, shall become the Contractoi or Contracting Party.

"Proposal," for purposes of this EOS, is the Undersigned's complete response to an RFP/RFQ, orif no RFQ/RFP was issued by the County, .the 'Proposal" is such other proposal, quate or offersubmitted by the Undersigned, and in any event a "Proposal" indudes this'EDS .

"Code" means the Code of Orifinances, Cook County, illinois available through the Cook CountyClerk's Ofgcs website ihtto:/lwww.cookctvclsrk.corn/sub/ordinances.asok This page can also beaccessed by going to www.cookctvclerk.corn,. clicking on'he tsb labeled "County. BoardProceedings," and'then clicking on the link to "Cook County Ordinances."

Contractor" or Contracting Parly" means the Bidder, Proposer or Applicant with whom theCounty has entered into a Contract.

"EDS"means this complete Economic Disclosure Statement and Execution Document, includingsll section[i"listed in'he'Index snd any attachments.

"Lobby" or "lobb)/ing", means to, for compensation, attempt to influence a County official orCounty employee with respect to any County matter.

"Lobbyisf" means any person or entity who lobbies.

"Prohibited Acts" means sny of the actions or occurrences which form the basis for'disqualification under the Cods, or under the Certificatlons hereinafter set forth.

Sections 1 through fk NIBE/WBE Documentation. Sections 1 and 2 must be completed in order ta satisfy therequirements of the County's MBE/WBE Ordinance, as set forth in the Conkact Documents, if applicable. If theUndeisqyied believes a v[aiver is appropriate and necessary, Section 3, the Petition for Waiver of MBE/WBEParticipation must be completed....

Section 4: Ceklflcations. Section 4 sets forth'certlflcations that are required for contracting paitls's under the Cade.E'xe'cution of this EDS constitutes a warranty that all ths statements and certificstions coniained, snd ag the factsstated, in the Certifications are true, correct and complete as of the date of execution.

Section 5: Economic and Other Disclosures Statement. Section 5 is the County's requ'sed Economic and OtherDisclosures Statement form. Execution of this EDS constitutes a warranty that sll the information pmvided in theEDS is tnie, c'orrect and complete es of the'date of execution, and binds,the Undersigned to the warranties,representations, agresmsnts and acknowledgsments contained therelri.

EDS-i1.10.13

COMRACT NO,

1'I-63-166E'ections

8, 7, 8; 9: Execution Forms. The Bidder executes this EDS, and the Contract, by completing and signingthree copies of the appropdate Signature Page. Section 6 is the form for a sole proprietor, Secbon 7 is the form for apartnership or joint venture; Section 8 is the form for a Limited Liability Corporation, and Section 9 is the form for acorporation. Proper execution requires THREE ORIGINALS; therefore, the appropriate Signature Page must be flgbdin, three copies made,.and'ag three copies must bs properly signed, notarized and submitted. Ths forms,msy beprinted and'completed by typing or hand wrigng the information required.

Required Updates. The information provided in this EDS will be kept current, In the event of sny'change in anyinformsgon provided, including but not limited to any change which would render inaccurate or incomplete anycertificafion or statement made in this EDS, the Undersigned will supplement this EDS up to the time the Countytakes action, by filing an amended EDS or such other documentation is is requested.

Additional Information. The County's Governmental Ethics and Campaign Financing Ordinances,'.Impose certainduties and obligaiioiis on persons or en55es seeking County contracts, work, business, or transactions. For furtherinformagon please contact the Director of Ethics at {312)603-4304 {69W. Washingtori St. Suite 3040, Chicago, IL60602) or viiit our web-ske at www.cookcountygov.corn and go to the Ethics Department link. The Bidder mustcomply fully with the applicable ordinances.

EDS-ii

1.10,13

BIDDER/PROPOSER HEREBY STATES that sll MBE/WBE firms Included ln this Plan are ceilitled MBEe/WBEs by at least one of the entitieslisted in the General Conditions.

I. BIDDER/PROPOSER MBE/WBE STATUS: (check the apprapihrie line)

BidderlPrapoeer is a cerliiied MBE ar wBE firm. (If so, aitach copy of appropriate Letter oi cerlilication)

BiddedPmposer is a Joint Venture and one or mare Jalnt Venture parlners are certiiled MBEs or WBEs. (If so,atlach copies of Letter(s) of cerNlcstlon, s copy af Joint venture Agteement c)early describing'the role of the MBE/wBE

llrm(s) snd IM ownership interest In the Joint venhse.and a completed Joint venture AMdaett- available from the GMiceaf Cantrak Compliance)

Bidder/Proposer is not a cergged M BE or WBE finn, nor a Joint Venture wnr M BE/WBE partners, but will utilize MBEand WBEilnns either direclly or indirectly in the perfonnance of the Contract. (If sa, complete Sections II and gl),

II, 'X DlrectPardcipatlon of MME/WBE Firms Indirect Pskiclpstlonof MBE/WBE Firms

where gaals have nat been achieved through dimct participation, Bidder/Prapaser shall include documenlation outlining elforts toachieve Direct Paktcipstian at lhe Rime of Bid/Pmposal submisshm. Indirect Pakicipagon will only be considered aRsr'll efforts toachieve Direct Participation have been exharmhrd. Only after wrinen documentation of Good Faith EBerts is received will IndirectPi'rttclpatlori be consldemd.

MBEs/WBEe that wil perform as subcontractors/suppliers/consultants include the follaning;

MBE/WBE Firm: ALKO, AUTOMOTIVE, INC.

Address:

E-maih

6113 West Roosevelt Road, Cicero, IL 60804

Contact Person; There'sa Mud1er, Pres.

Dollar Amount Perfdpatian; $ al, '580.00

Percent Amount of Pargcipatian:

Phone (708) 863-8050

"Letter of Intent attached?'Letter of Certilication attached?

Yes X No

Yes X . No

MBE/WBEFjrm;. XL TOWING & STORAGE (see seoarate MBE/WBE Utilization Plan attached)Address:

E-msik

Cori tact Person:

Dollar Amount Paigdpatlarr $

Percent Amount of Participation:

'Letter of Intent agached?"tatter of Ceritticritkrn attached?

YesYes

Attach additions) sheets'as needed,

"Additionally, all l.etters of Intent, Letters of Certification and documentation of Good Faith Efforts omitted fiom this:bid/proposal must be submitted to the Office, of Contract Compliance so as to assure receipt by the Contract .Compliance Administrator not later than three (3) business days after ths Bid Opening date.

EDS-11.10.13

'/WBEFam; ALKO AUTOMOTIVE, INC.

'Address: 6113 tr. Rooseve1t Rd.

Ci(y/Static Cicero, Zip 60'804

Phone: (70'8) 863-8050 Fax:

Cook County GovernmentCeillfylngAgency', Office nf Contract Cnmn1ianca

Certification Expiration Date: 12/24/2015

FEIN ¹;

Contact person; Theresa Mud1er

'mail'. Contract¹: 11-53-185E

panicipafkm: [X]Direct [ ] Indirect

Will the Mhh/BE firm bs subccntracgng any. of ths performance of this contract to anvrther firms

[X]No [ ]Yes -Please aaach explanhtlon. Proposed Subcon(rector:

The undsmigned M/WBE is prepared to provide the following Commcdithm/Services for the above named Pro]sct/Contract,

pxovid'e parte as naceeaarv

)ndlcats the Dollar Amount, or percantsne. end ihs Terms of pavment for ths abovslescdbsd Commodities/ Ssrvhes:$ 61.'580.00. nr 1st ~ terms nf navmrntr navmant mnnthtv n'v aa %11'1aa

(ifmore specs is needed fo frwy describe M/WBE Rrm's proposed scope of work anNor psymenl sohedu/e, ellech addi//cna/ sheets)

THE UNDERSIGNED PARTIES AGREE that this Letter of Intent will become s btndhvg Subcontract Agreement condltlensd upon thsBidder/Proposer's receipt of a signed contract from the County of Cook. The 'Undersigned Parties do also certify that they did not aix their

signatures to ibisdocument

ungl all areas under Descdptlon of Service/ Supply end Fse/Cost were completed.

Slgnatum(/WWBE] .,~ / Signature (Pnme Ndder/Proposer]

Gordon M. Gi1kiaonTheresa Mud1er, President Supervised, AdministratorPrint Name Print Name

ALKO AUTOMOTIVE, INO.Firm Name

GORDON'8 AUTO REPAIRFirm Name

March 28 . 2015Date Date

March 28, 2015

Subscribed end sworn befomme

thismdayM MWh] EANotary Public V/~Z

Subscribed and anom before ms

thbr28 day of ~Ma.ra'h ry 15

.:Notary PubdÃ~/p

EDS-'2

OFFICIAL SEADEBRA I..UNKOotary Public - State

Commission Expires

MBBWBE UTILIZATION PLAN ISEC~TION 'I

BIDDEPJPROPOSER HEREBY STATES that afi MBBWBE firms Included in lhls Plan ars cerfified MBEs/WBEs by at least ons of the entitleslicled in Ihe General Ccndilicna

I.. BIDDER/PROPOSER MBBWBESTATUS: (check the appmprlale line)

Siddur/Pmposer is a certified MBE or WBE firm. (If so, attach copy of appmpiiate Letter of Cerglication)

Bidder/Pmposer is a Joint Venture and onb or more Joint Venture partners are cerlified MBEs or WBEs. (If so,afiach copies of Letler(s) of Cerfificnlion, a copy of Joint Venture Agreement clearly describingyne role of the MBE/WBE

hrm(s) and ih ownership interest in the Joint Venbne.and a completed Joint Vdnture Aifidanh-available from the Ogicenf Conlrad Compliance)

X 'idder/Proposer is nota cerMied MBE or WEE finn, nore Joint Ventum with MBBWBE pannnrn. but willufilize MBE'

and WBE'Srmesithei dlrecfiyorindirect/yinthsperformanceoftheContract. (If en, comphdhSedtonsll and SI).

g. g Direct Paracipatlon of MBBWBE Firms Indirect Participation cf MBEWBE Firms

Where goals have not been achieved through direct psitlcipsgon, Bidder/Proposer shall include documentsaon outhnlng efforts toachieve Direct Participation at lhe Sme of Bid/Proposal submisshn. Indirect Psrttdpagon wgi only be considered aReyag efforts toachieve Direct Pargclpatlon have been exhausted. Only alter written documentation of Good Faith Efforts h? received will In directPi/rticlpaaori be considered.

MBEs/WBEs ihatual pwicnn as subcontraciors/suppliers/consufiants include the fofioviing

MSE/WBE Finn; ALKO AUTOMOTIVE, INC.

6113 West Roosevelt Road, Cicero. IL 60804Addlsss'i

E-meit

Contact Pemon: Theresa Nndder, Pres.

Dofisr Amount Psrficipetlon; 3 6 1 .580.00

Percent Amount of parficipalion: 1>X

Phone (708} 863—8050

0/

"Letter of Intent altachwly

'Letter of Cerlificalion afiachsdf

Yes XYes X

No

No

'BBWBEFhm: XL TOWING & STORAGE (see seoerate ffBE/WBE Utilization Plan attached)

Address:

E-mail:

Contact Person:

Dofiar Amount Parfi~ion: 3

Phone;

Percent Amount of Parlicipation

'Letter of Intent attached'/'Lsfierof Cerllfication atlached'I

YesYes

Attach addifiional sheeh'as needed. - .

"Addigormlly, ag I.utters of Intent, I.etters of Certification and documentation of Good Faith Efforts omitted from this: bid/proposal ~mat be submitted to the Office of Contract Compliance so as to assure receipt.by the Contract .

Compliance Administrator not later than three (3) business days after ths Bid Opening date.

EDS-1

CUUK COUN I Y MUVeRNMENI LETTER OF INTENT ISECTI~N2

MhntBE Fimr, ALKO AUTOMOTIVE, INC.

'Address; 6113 W. Roosevelt Rd.

Citylgtats Cicero Nip 60804

Phone; (70'8) 863-8050 Fai

Email

Cook Coirnty GovernmentOffice of Contract Compliance

Csrtigcsticn Expiration Drrie; 12/24/291.5

FEIN ¹ContactPsraon, Theresa Mudi et

Contmct¹: 11-53-185E

Parilcipaian, [X]Direct ( ] Indirect

wig ther triiyfBE llnn be subconlredlng sny of Ihs performance of this contract'to another flan?

(X]No ( ]Yea-Please aNach explanation.. Pmposed Su contractor

The undesigned IvllWBE Is'prepamd to provide the following commoditieslservlcea for the above named pro[acti contract:

provide parts as necessary

indicate the Dollar Amount, or Pereentane. and the Terna of Pavment for the sbovekescribed Comme d8esl Smvices:~61 580.00. or 152. terms of navmeutr unvmeut mnnthlv nv ~a' 1 1~n

/If mors space lc nssdsd lo fulty dsccdhs AffwSE Ffrrntt proposed coops of froth sndror payment schedule, stlach additional sheets)

THE UNDERSIGNED. PARTIES AGREE that this Letter of Intent m11 become a binding Subcontract Agreenwnt oondiilnned upon theBirider/Pmpassfs receipt of a a[pied ccnimct from Ihe County of Cook. The 'Undersigned Parties do also rxugfy that they did not elfin their

signalures tn this docu snt angl all areas under Description of Servicrd Supply ahd Fee/Coat were completed.ESTA„'I~OP ROY 'G. GI ISON, 'DECEASED

Signature (is&BE] / agnnturs (Prime Btddsdpr[porer]

Gordon. M. Gilki.sonTheresa Mud1er, President Supervised AdministratorPrint Name Print Name

ALKO AUTOMOTIVE, INC.Firm Name

March 28. 20150'ate .

GORDON'S'AUTO REPAIRFirm Name

March 28, 2015Date

Snbscribed snd sworn before ihe

this R(bray of ~aturI )%2tt~.

SEAL

'PPICIAL S&LDEBF(A (..L]WKQWSKI

Notary Puhgo - Stars of lllfnolstufy Coinmisston. Expires 11/1 7/8018

Subscribed and sworn before me

ihls28 day'. M r~)2015

..„..EANAYx/z~~-SEAL

EBS-'2

MBBWBEUTILIZATION PLAN /SECTIO~Nt

BIDDER/PROPOSER HEREBY STATES that afi MBBWBE Nrms Indudsd In this Plan sre cerliiled MBEs/WBEs by at least one of the entifieslisted in the General Condifions.

I. BIDDER/PROPOSER MBBWBESTATtls: (check ihe appmpriate line)

Bidder/Pmpcser is a ceriified MBE or WBE firm. (Ifac, aNach copy cf appropriate Letter of Cerfilicaticn)

Bidder/Pmpcser is a Joint Venture snd ona or more Joint Venture partners are cerllfied MBEs or I/I/BEs. (If so,attach ccphs of Letter(s) of Cerfificaticn, s copy of Joint Venture Agmemsnt clearly describing'the role of Ihe MBE/WBE .

firm(s) and its ownership interest in the Joint venture and a completed Joint venture Atfidavtt —available iicm the Cmiceci Conlrad Compliance)

X . BiddedPropcser is not scarified MBE or WBEfirm, nor a Joint Venture with MBE/WBE parlners, but will ufifizs MBE'nd

I/I/BEgrms elthsidirecgy or indirectly In ths pmformance of ths Contract, (If so, complete Secfions N and NI).

N.. -X Direct Parficipafion of MBENNBE Firms lnryrmct Participation of MBBWBE Firms

Where goals have not been achieved through direct parficipagion, Bidder/Proposer shall include dccumentafion cutfining elforts.toachieve Direct Participation at the Nims of Bid/Proposal submisshm. Indirect Parlldpagon vdg only be coimidsred alter'ag etforhi toachieve Direct Participation have been exhausted. Only alter written documsntsNon of Good Faith Ellbrts Is received wig IndirectPiirtlcipatiori be considered.

MBEs/WBEs that s N perform as sub cont/actors/suppliers/consultants include the following:

MBE/WBE Finn; ALKO; AUTOMOTIVE, INC.

Address'.

E-maili

6113 West Roosevelt Road, Cicero, IL 60804

Contact Person: There'ea Nud1ex, Pres.

Dollar Amount Parlicipstion; $~1580.00

Pement Amount of Participafion:

Phone: (7081 863-8050

0/

'Letter of Intent afisched?

*Lefier of CedTicaficn aNached?

Yes XYes X

No

No

'BBWBEFimx XL TOWING & STORAGE (see separate MBE/WBE Utilization PIan attached)

Address:

E-rnaik

Contact Person:

Dollar Amount Parlh!pafcn: $

Percent Amount of Parlicipation;

"Letter of Intent altached'/:"LeNsr of Cerfificaticn attached'I

YesYes

Phone:

Attach addificnal sheets'as needed. - .

"Addgfonalty, all Letters of Intent, Letters of Certification snd documentation of Good Faith Efforts omitted fium thisbid/proposal must be submitted to the Office. of Contract Compliance so as to aisurs receipt by the Contract .

Compliance Administrator not later than three {3)business days after the Bid Opening date.

EDS-11.10.13

I UUK t'OUN I v IsOVENNNEN I LEI TER OF INTENT ISECTION 2I

'ri/VVBEpimc ALKO AUTOMOTIVE, INC.

Addmss b113 W. Roosevelt. Rd.

Ci(y/State: Cd««ZipPhone; {708]863-8050 Fax,

Cook County GovernmentCeritfyingAgency: Office of Contract rnmrtT~

Cergtlcation Expiragon Date; L2/24/2015

FEIN d:

ContactPerson, Theresa Mud1er

Crmtractri: 11-53—185E

Partlcipafion: ( I]Direct [ .]Indirect

Wilt the iri/VVBE,firm be subcontracgng any. of the perfonnance of this contract to arrother firm'/

[X]No ( ]Yes —Please agach explanhtlon.. Proposed Snbcontrarrion

The undersigned IVI/VVBE is prepmed to provide the fogmiiing Commodities/Services for the abave named Project/ Contract:

px'ovidw parts as necessarv

Indicate the gl]tthw ]Btggnn, or percsntace. and the Tenne of pavment for ths abovedescdbed Commodities/ Servhes:~h1,580 ~ 00. nr 152. terms of navment oavment moat'htv nt ac- hvtu alt

(if mom specs ls needed fo fogy describe /I//VyBE Ron's pmposed scope of Work end/or paymsnl schedule, eftech edd/tlonsl sheets]

THE UNDERSIGNED PARTIES AGREE that this Letter of Intent will become a binding Subcontract Agmement conditiened upon theBidder&opcse/s receipt of a skpted contract fram the County of Cook The Undemigned Parlies do also awNy that they did noi agix their

signatures to this docu ent ungt all areas under Description of Service/ Supply ahd Fee/Cost were completed.

r

ES'f Eg7 ROY GQ~IZISOlt ECEASEDBy-

Slgnatws(ltri/yyBE]' .~/ Slgnatum(Prime Bydder'/Proposer)

Gordon M. GilkisonTheresa Mudjer, President Supervised, AdministratorP/int Name Print Name

.ALKO AUTOMOTIVE, INC.Finn Name

March 28 ~ 2015Date

GORDON'S AUTO REPAIRFirm Name

March 28, 2015.Date

Subsmlbed and sworn before me

this 28 day of '.~arch ~Y)

Subscribed and sworn before ms

this28 dsyot Marxvts u'5:Notary Public

EDS'-2

1.10.18

OFFICE OF CONTf!ACT COfvlnt!ANCE

JAC62UEEJtdE GOMEZ

O'REC!OR

!isBi (dark, County (3uilding. Room '020 o Cni agn, Iiitnois 60602 o (si?i 603 5502

TONE PRECKWEFBKLE

Ff'tSIDER'ook

Coonty Board

or Ccenmfssionan

RICHARD R, BDYQN

t District

December 24, 2014

Ms, Theresa Mujder, PresidentAlko Automotive, Inc.

6113West Roosevelt Road

Cicero, R 60604

R(itltnl 5'EFLE

2nd District

IFRRY RUDER

3rd Distrfct

STAIY! I'Y uooltr6<It 0' ct

Annuai Certification Explresl December 24, 2016

Dear Ms. Mujder:

Congratulations on your continued eligibility for Certification as a Women-owned BusinessEnterprise (WBE) by Cook County Government. This certification is valid until December 24, 2019;however, you must re-validate your firms'ertification annuaify,

DIBDI1AH slu5Sslll I)istrirt

)OAN PA'I Rl'A MDRPHY

t ln Disf *it <

lksus 0 < rfl<iA

Ttfl 0 istl'fct

l.u!5 ARROYO ll.6th )ooi<t

PE'rks 6: S'.!YIS!RI

Fir( Drlnltt

BRIDSs CAINFR

"!t.0'tifct

As a condition of continued Certification during this five (6) year term, you must file a oNo ChangeAffidavit" within sixty (60) business days prior to the date of Annual Certification Expiration.Failure to file this Affidavit shall result in the termination of your Certification, You must notil'yCook County Government's Office of Contract Compliance of any change in ownership or controlor any other matters or facts affecting your Brm's eligibility for Certification within fifteen (16)business days of such change.

Cook County Government may commence action to remove your firm as a WBE vendor if you failto notify us of any changes of facts affecting your firm's Certification, or if your firm otherwise failsto cooperate with the County in any inquiry or investigation, Removal of status may also becommenced if your firm is found to be involved in bidding or contractual irregularities.

Your firm's name will be listed in Cook County's Directory of certified firms in the following area(s)of specialty:

-il'. It<rot

..l I. <c Ffl!T.ltEY

's'n kuldnk)IH

(,of'<l(i e<)SI.IIY

1':I'1st't<t

I"(:.'rl) cCHI'li!DFR

is!If oil!tnt

lfFFRFT R. TDBDLEKI

16tn Cdstrict

Regular Dealer: Automotive Parts and Accessories

Your firm'5 partiCiPation on Cook County contracts will be credited toward WBE goals in yourarea(s) of specialty. While your participation on Coo'k County contracts is not limited to yourspecialty, <„redittoward WBE goals will be given only for work performed in the specialty category.

Thank you for your continued interest in Cook County Government's Minority, Women, Veteran,and Service-Disabled Veteran Business Enterprise Programs.

Sincerely,

(Jkr+ur.)tff fs

Contract Comp(lance Director

1/' I foci JG/lar

$ Fiscal Respoftsibility P tnno< alive Eeadershi if @transparency 6< rtccountdbiiltyL< hnpioved s<n<ri< t s

IJ

BIDDER/PROPOSER HEREBY STATES Ihat sg MBE/WBE firms included In this Plan are cediged MBEs/WBEs by at least one of the entitieslisted In lhe General Conditions.

I. BIDDER/PROPOSER MBE/WBE STATUS: (check the appmpriale line)

Bidder/Pmpossr is a cerliTied MBE or WBE firm. (If so, attach copy of appmpri ate Leger of Ceigyication)

Bidder/Pmposer is a Joint Venture snd onh or mom Joint Venture partners are certified MBEs or WBEs. (If so,httach copies of LeNer(s) of Cerggcstlon, s copy of Joint Venture Agreement clesgy describing'the role Of the MBE/WBEfirm(s) and ils ownership Interest h the Joint Venture and a completed Joint Vdnture Affidavit-available from the Office/if Contracl Compliance)

X Bidder/Proposer is not a cerhlied MBE or WBE finn, nor a Joint Venture wilh MBE/WBE partners, but v/ill utilize lvlBEand WBE Nrms egher directly orindiredly in the performance oflhe contract. (If so, complete sections g and Nl).

g.'

Direct Parthipation of MBE/WBE Firms Indbect Participation of MBBWBE Firms

Where goals have not been achieved through direct psitlcipagion, BidderlProposer shag include documentation outlining efforts toachieve Iyirect psrgcipagoa at the time of Bid/proposal submission. Indirect psrticipagon wig only be considered alter'ag efforts toacllleve Direct.Participation have been exhausted. Only sRer wrltlen docurlientstlon of Goad Faith Eftbits ls received wgl Indirect.Ps'dlclpatiori he considered.

hlBEs/WBEs that wll pedorm as subconl/actors/sirppgers/consultants include the fogceing:

MBE/WBEFirmi XL TOWING & STORAGE.

Address: '11 N. Wolcott. 'Chicano. IL 60622

E-mall: , xltcwlnn8sbcnlobal.net

ContactPerson; Sherry DiVito

Dollar Amount Par fktpagorr $ 61,580.00

Pwcent Amount of Parlicipation: 15N

Phone: (773) 434-9731

Yes XYes X

"letter of Intent atiached?'LeNer of CertNcation atlached? No

MBE/WBEFlrm: ALKO AUTOMOTIVE. INC. '(see senarate MBE/WBE Utilization Plan attached)

Address:

Email:

Cmltact Person:.

l}ogsr Amount Parlicipsgon: $

'ercent

Amount of Pmgcipalion:

'LeNer of Intent attached7:'Leger of Csrtlgmitlcn egached7

YesYes

No

, No

I,ANach addlfonal sheelsas needed.

".Additionally, all Letters of Intent, Letters of Certification and documentation of Good Faith Efforts omitted from this:bid/proposal must be subm1tted to the Office. of Contract Compliance so as to assure receipt.by the Contract .Compliance Administrator nol later than three (3) business days after the Bid Opening date.

M/r//SERirni XL TOWING g STORAGE

Address: All N. Wolcott

City/Stela Chi.caco Zip 60622

phone:(773) IS4-gy51 Fax:

Emsgi xihowingesbcgloba1.net

Cook County GovernmentCerllfylngAgency: rt+F< ce nF Cour.rrrrt Cnron~ance

Csrllficatron Exprrabon Date:

FEIN¹;

Contact pe„om Sherry DiVito

Contract¹. 11-53-1858

Partrcrystxxu [Xj Drmct ( j Indsect

Will the M/INBE firm be subcontracting any. of the performance af this contrsot to an'other flimy

[XjNo [ ]Ves-Please attach explanation. -" Proposed Subcontractor:

The undengigned M/WBE is prepared to provide the fralowing Commodiges/Services for the above named Project/ Contract:

. provide .service. and towing as necessary

'ndicate

the holler Amount ar Percentaae, anti the Terms of Pavment for the abovelescdbsd Commodities/ Ssrvlcesi¹61.580.00. or 152, terms of pavinentt payment monthly for services

(//mors specs /s needed fo fuffy describs /r//FFBE F/rmh proposed scope of vtarir end/ar payment sc/rsdu/s, e//ech add///cns/ sheets)

THE UNDERSIGNED. PARTIES AGREE that tms Letter of Intent a¹ll become s binding Subcontract Agreement conditioned upon theBidder/propaser's rscsjpt of a signed contract from the County of Cook. The 'Undersigned parlies do also 'cerfify that they did not affix their

signatur 'cumsnt unfi s nder Descdptlon of Service/Supply and Fee/Desi were completed.ESTATE 07 ROY G; GILKISQN, DECEASEDEyt,~, J~/

Slgnatum(SN/BE) f grgnsture (Prims Bidder/PropossrjGordon M. Gilkison

Sherry DiVito Supervised AdministratorP/int Name Print Name

XL TOWING & STOR'AGE

Firm Name . Firm Name

$'/+8, '2015 '

March 28, 2015

Date . Date

Subscribed and sworn befomme

this ~@dayaf '/

Notary Fubgc

'SEAL

Subscdbsd and swombsfore ms

this 28 day of March,2015

: ll t 1P bli

SEAL

OFFICIAL SEALI sHEILA Jc FEINHANDLER

Notary Public - State ai illinois

My Commission Expires Aug 25, 2018EBS-2

MBBWBE UTILI2ATION PLAN ISECTION 1)

BIDDER/PROPOSER HEREBY STATES that afi MBBWBE Ilrms included h ibis Plan are cerlimied MBEs/WBEs by at least ons of the entitleslisted in ihe General Condition*

I. BIDDER/PROFOSERMBE/WBE STATIC: (check the appropdale line)

Bidder/P eris a ceriifled MBE or WBEfirm. If attach co of i/ate Lelier of Cerfilicatlonlopes ( wz py nppmp )

Bidder/Pmpossr la a Joint Venkus nnd onh or more Joint Venture partnem are carfiiied MBEs or WBEs. (If so,ntlach copies of Lefier(s) of Cerlificslion, a copy of Joint Venture Agreement cleaily describing'he role of the MBE/WBE

'an

fs) and ih ownership interest in the Joint Ventura and a completed Joini Vdnture AffidmQ-avafiable fmm the 0/fice'f Contract Compliance)

X Bidder/Pmpcssr la not a cerfified MBE or WBE firm, nor a Joint VeniumwfihktBE/WBE parlnms, butvrifi Utilize MBE'nd

wBEfinns efihe/d/recfiy or indlmct/y In the perfonnsnis of the contract. (If so, rompleth sadions ll and Ill).

'H. I Direct Pargcipaffon of MBEHHBE Firms Indirect Parlicipatlon sf IHBE/WBE Ffrms

Where goals have not been achieved through direct pamcipation, BidderlPro poser shag include documentahon ougining elforts fio

achieve Direct Participation at the fima of Bid/Proposal. submission. htdlrect Partlrripagon vdg only be consMered ager ag eIforts toachieve Direct Participation have been exhausted. Only after written documentation of Good Faith Egorts h received vail Indirect.Partlcl pafiod be considered.

MBEs/WBEs that will perform as subcont/actors/suppfiers/consultants include tbefofioning:

'MBE/WBEFimz XL TOWING & STORAGE.

Address/ '11 N. Wolcott. 'Chicano. IL 60622

Emaili zltorvinRLasbcnloba1.net

Contact person; Sherry DiVito

Dol(srAmountPwfidpallon:3 61,,580.00

Pmcent Amount of Pariicipafion:~12

Phone: (773) 434-9731

'I»

YesYes X

'Letter of Intent sfische/II

'Letter of Ceitificafion attached7 No

'BE/WBEFlnn: ALKO AUTOMOTIVE.. INC. (see seoarate MBE/WBE Utilization PIan attached)

Address:

E-mail:

Contact Pemoni

Od/sr Amount Pargcipafroic 3

Phonm

Percent Amount of Pmlidpation:

"Letter of Intent sgached'I:'Letter of Csrfificatkm attached'I

YesYes

No

, No

, Attach arkfi/iona) sheds as needed.

"Additiorially, pli Letters of Intent, Letters of Certification and documentagon of Good Faith Efforts omitted fr»om thisbidlproposai ihust be subniltted to the OfHce. of Contract Compliance so as to nisur» receipt. by the Contract .

Compliance Administrator not later than three (3) business days after ths Bid Opening date.

1.10.13'

VVVIt VVV N I Y toVYelcNMEN I LIT TER QF INTENT (SECTION 2)

'/WVBERmx XL TOWING &'TORAGE

Adriress: /ri 1 N. Woicott .

City/State: Chi caco . Zip 60622

phone;(yy3) <3~ 9y31 Fax:

. 'Emait xlt'owinglsbcglobal.net

Coclr. Cobnty Government.Cmlifylng Agency'neet r a nf Cnmtrart Compliance

Certlficagon Expiragon Dam /r/9/15

FEIN ¹:

Contact psmcn, Sherry DiVito

Contmct¹: "53 135E

Pa!Iicipt¹on: [X]Dhect [ .]Indirect

'gl

¹Ie NWBE firm bs subconhsc¹ng Sny. of the psrlbnnencs cf this conhaot'to an'other flan'/

[X[ No [ ]Yes —Please sgach explanation.. Proposed Subconbactor:

The undemlgned M/WBE id prepared to provide the following Commodigss/Services for the above named Project/Contract:

.pttovide service. and towing as necessary

'ndicate

ate Dollar Amount, or percsnlaoe, and the Terms cfpavmsntfor the abovekescdbad Commodltiesl Services;

$61.580.00, or 152, terms. of paymentr payment monthly for services

If/mom specs /s needed lo /My dsscrfbs /rf/I/FSEF/rmb proposed scope of Nod/and/or psymenl schedule, slfach sdd/I/cnsl shee/s]

THE UNDERSIGNED. PARTIES AGREE that this Letter cf Intent will become a binding Subcontract Agnmment conditioned upon theBidder/Pmpcser's receipt of s signed contract from the County of Cook. The 'Undersigned Paties do also 'certify that they did not alrrx their

slgnstu~ms 'cuinent unS all a under ption of Servicel Supply ahd Fse/Cost were completed.ESTATE/ OF ROY G; GIL /ON, DECEASED

By: ~ 'W . . rsdSignature[]¹WBB]

p'... Signature(PilmsBidderlPrcporrel/

Gordon M. Gi1kisonSherry Divito Supervised AdministratorPrint Name Print Name

XL TOWING & STOR'AGEGORDON'S AUTO REPAIR

'irm

Name . FlrmNama

$/I.~,. 2015'

March 28, 2015

Dstd . Date

Sobscdbed snd sworn bsfomrhe

thid+dsy o

Notary Pubgd

SEAL

OFFICIAL SEALI SHEILAMO FEINHANDLER.

. Notary Public - Stsfs oi illinois

My Commission Expires 'Aug 25, 20]S

'ubscribed and swum before ms

s 28 day of March

tery Public MSEAL

EIDSx2

OFFICIAL SEALSHEILA JO FEINHANDLER II

'otary public - State of illinoisMy Commission Expires Aug 25, 2018

1.10.13

MBBWBE UTILI2ATION PLAN ISECTION fli

BIODERIPROPOSER HEREBY STATES that sll MBEIWSE flnns included in this Plan are cerlitisd MBEvIWBEs by at least ane of the entitleslisted in the General Candiflons.

I. BIDDERIPROPOSERNBBWBE STATUS! (check the sppropdahr line)

SiddarIPmpceer is a certified MBE or WBE iirm. (Ifso, attach copy of appropriate Letter of Ce!Slicaflon)

Sld'der/Proposer is s Joint Venture and onh ar mam Jalnt Vsntum partners are cerll fied MBEs or WSEs. (If so,aflach copies of Letler(s) of Cerflflcslion, s copy rd Joint Venture Agrnernent clearly describing'he role of ihe MBEIWBE

Iirm(s) and ih ownership interest in the Joint Vsrdum and a completed Joint Venture Affidavit -available fram Sre CÃice'fCantrarflCampflance)

X Bidder?Pmpossr is nol s cerNled MBE or WBE Iirm, nore Joint Venture with IISBWBE perh!em, but will Utilize MBEand WBE'flrrm sither dirscfly arindinmfly In the pmfonnanus of the Contract. (If so, complete Sedlans 5 and SI).

IL '!X 'Direct Pargcipafion of IIBBWBEFirms . Indhsct Pariicipation of NBBWBE Ffrms

Where goals have not been achieved through direct paiflcipngan, BidderIPropossr shag include dacunumlagon outlining eS'orts toachieve Direct Participation st the Sms of BidlProposal submlsshn. Indirect Padicipagon will only be considered ager'ag efforts toachieve Direct Participation have been exhausted. Only alter wrhten documentation of Good Faith Bfarts is received vdg IndirectPs'rflclpsflori be considered.

MBEsiWSEs that Mfl perform as subcontractors/suppliers/consultants include the following:

'BBWBEFirm: XL TOWING & STORAGE

'ddress: '11 N. Wolcott. 'Chicano. IL 60622

Ewaih xltoarinrtlsbczlobai.net

CmrtactPemaa! Sherry DXVito

Ooflsr Amarrnt Psrflripsflan; $ 61,580, 00

Pecent Amount af Parlicipaiion: 152

Phone: (??5) 434-9?51

Yes XYss X

"Letter of Intent aflached?

'Lslterof Ceiflflcadon atlached'? No

MSEIWBEFlrm: ALKO AUTOMOTIVE. INC ~ '(aee senerete MEE/WBE Utilization Plan attached)

Email:

Contact Psmon!

Ooflsr Amount Psrflrfpaflan: $

Percent Amount sf Padcipalion:

'lafleroflntsnt sflached?'Letter of.Cerflflcathn attached'I

YesYes

Phone:

Attach additional sheets'as needed.

"Additionally, all I.etters of Intent, Letters of Certification snd dacumenhrtion of Good Faith Efforts omitted finm this:. bid/proposal ~mst be submiitsd to the Office of Contract Compliance so as to aisum receipt. by the Contract .

'omplianceAdministrator not inter than three (3) business days after ths Bid opening date.

1.10.13 '

GUUIL GUUN I T rsUVkHNMtNI LEI TER OF INTENT ISEGTION 2I

'it/VIIBERmc Xf. TOWING B STORAGE

Address: ./Ll 1 N. Wolcott .

City/Stetrx Chicago . Zip 60622

Phone:(>>3) 434 gy31 Fax.

,'Emalh xlt'owing8sbcglohal.net

Cook County GovernmentCerllfylngAgancy: of frr a nF Ccntre~t CongLLianoe

Certification ExpiraficnDate; 4/o/I n

Contact Person: Sherry DiVito

11-53-185E

Par5clpatlon: [X]Dimct [ .]Indtrem

WIII the MIFFBE firm be subccnrsdlng sny. of ths perfonnance of this contract to sn'other firmy

[X)No [ ]Yes-Plssseatlachexplsnatlon, . PrcpossdSuteonfractot

The undersigned M/WBE Is'pmpsred to provide the following Commodlgss/Services for the abave named Project/ Conbact.

. Pgovide .servicd and towing as necessary:

indicate the Dollar Amount, or Pemantaoe, and the Terms of Pavment for the abovodescnbed Commodigsal Ssrvkss:$61,580.00, or 152, terms. of payinentr payment monthly for services

f//more specs ls needed fo fuffy describe /rf/8/BE Firm's pmpossd scope cfSudtandibr payment schedule, sdach sdd///cns/shoals)

GORDON'S AUTO REPAIRFthm Name

Firm)arne

'5'/ ~, 2015 March 28, 2015

Date

THE UNDERSIGNED PARTIES AGREE that Wis Letter of Intent wiN become a binding Subccntmct Agmemsnt conditioned upon theBidder/Prnpcser's receipt cf s signed contract from the County of Cook. The Undersigned Parties do also certify that they did not alrix theirsignatums umsntungl all a sunder rlption of Service/Supply and Fae/Ccstwsrecompleted.

ESTATE OF ROY'. GILKISON, DECEASED

Eyr ~Signature(IIPFFBE] f '

Sgnsturs(pdms Bidder/Pmpose/)Gordon M. Gilkison

Sherry DiVito 'Supervii ed AdministratorPrint Name Print Name

XL TOWING & STORAGE

Subscribed and sworn before ms

this~~day o

Notary Pubfd

SEAL

OFFICIAL SEAI„.SHEILA JO FEINHANOLER

Notary Pub'lic - State or illinois

yM Gcmmixxicn Expiree Aug 25, 20I8.

I

EDS-'2

Subscdbsd and swpm twfcm ms

Is 28 day of hfaruh

Notary Public

SEALxo-

OFFIG)AL SEAL

SHEILA JO FEIHHAHDLER

Notary Public'- State cr Illinois

My Commission Expires Aug 25, 20I 8

1.10.13

OFFICE OF CONTRACT COMPUANCE

JACQUELlNE 6ioME2DIRECTOR

116 N. Clads, County Building, Room 1020 6 Chicago, Illinois 60602 ~ (3123 603-5502

TOIEI SJRECIOJVIMKLE

PRESIDENT

Cnoh County Board

otCnmmlssionsrs

EARLEAN COI.LINE

1st District

ROBERT STEELE

Ehd District

JERRY BUTLER

3rd District

STANLEY MOORE

4th District

DEBORAH SIMS

5th District

JOAN PATRICIA MURPHY

6th District

JESUS G. GARCIA

7th District

EDWIN REYES

8th Drstrlct

PETER N. SILVESTRI

9th Dlstl'Ict

BRIDGET GAINER

10th District

JOHhi P. DALEY

11th District

JOHN A FIUTCHEY

12th District

LARRY SUFFBEDIN

13th

Dlstrlst'pril

9, 2014

Ms. Sherry DiVito, PresidentXL Towing 5 Storage„ inc.3555 W. Columbus Avenue

Chicago, IL 80552

Annual Certification Expires: April 9,2015

Dear Ms. DiVito:

Congratulafions on your continued eligibgity for Certiticafion as a WBE by Cook County Governrn'ent.

This WBE Certification is valid until April 9, 2015.

As a condition of continued Certification, you must file a ".Re C'ertlfication Affidavit".within sixty (50)business days prior to the date of eexpiragon. FE5ura to file this Affidavit shall result in the telminadonof your Cer5fication. You must notify Cook County Government's Dffice of Contract Compliance of anychange in ownership or control or any other matters or facts affectihg your firm's eligibiiity forCertificafion.

Cook County Government may commence action to remove your firm aS a WBE vendor if you fail. toridtify us Df any changes of facts affecting your grm's Car5fication, or if your 5rm otherwise falls tocooperate with the county in any inquily or inves5ga5pn. Removal of your status may also becommenced if your firm is found to be involved in bidding or contractual irregularities.

Your firm's name will be listed ill Cook County's Directory of Minority Business Enterprise, Women

Business Enterprise andlor veteran Business Enterprise in the area(s) of'specially:

Transportatiertt Full Service TowinglRecoveryiRosdsids Assistance Company

Your firm's participation on Cook County contracts will be credited toward WBE goals in your area(s) ofspecialty. While your pargcipation on Cook County contracts is not limited to your specialty, credittoward WBE goals will be given only for work done in the specialty category.

Thank you for your confinued interest in Cook County Government's Minor5y, Women arid Veteran

Business Enterprise Programs,

Sincerely,

GREGG GOSI3N

14th District

IIMOTHY O. SCHNEIDER

16th District

JEFFREY R. TOBOLMI

16th District

Jacqueline Gomez

Contract Compliance Dirtmtor

JG/lar

.UZASEI'H ANN GOODY GORMAN

17th District

$ fiscal Responsibility f Innovative Leadership Transparency St Accountability ter Improved Services

PETITION FOR WAIVER OF ilfi BE/WBE PARTICIPATION I SECTION 3I

A. BIDDER/PROPOSER HEREBY REQUESTS'.

FULL MBE WAIVER ..FULL WBE WAIVER

X REDUCTION (PARTIAL MBE and/or WBE PARTICIPATION)

20 % of Reduction for MBE Palfrcipation

10 % of Reduction for WBE Participation

B. REASONFOR FULL/REDUCTIONWAIVERREQUESf

Bidder/Propcser shall check each item applicable to ibr reason fix a waiver requsat. Additlonafiv. suouorfino documenhttion shall

be submitted with this rsouest. If such suoooifino documentation cannot be submitted with bid/omuosai/uuotafion. such

documsnhition shall be submitted directlv to the ONce of Conhact Ccmoliancs no later than three /3) davs from Ihe date ofsubmission date.

(I) Lack of sutfickrnt qualified MBEs and/or VIBEs capable of prbvidlng fiie goods or services required by the contracL(Plea'se explain)

{2) The specificafions and necessary requirements for performing the contract make it impossible or econonfiically

infeasible to diwide the contract kr enable the contractor to utilize MBEs and/or WBEa in accordance with Ihe

applicable psmcipation. (Please explain)

(3) Price(s) quoted by potential MBEs and/or WBEs are above competitive levels and Increase cost of doing business

and would make acceptance of such MBE and/or WBE bid economically impracticable, ialCing into conside'rafion

the percentage of total contract price represented by such MBE and/or WBE bid. {Please explain)

(4) There are other relevant factors making it impossible or economically infea'sible to utilize MBE and/or

WEE firms. (Please explain)

C,'

GOOD FAITH EFFORTS TO OBTAIN MBE/WBE PARTICIPATION

(1) Made timely wnTten solicitation lo identified MBEs and WBEs for utgzaticn of goods and/or services;

and provided MBEs and WBEs Mtli a timely opportunity to review snd obtain relevant specifications,

terms and condiTions of the proposal to enable MBEs and WBEs to prepare an informed response to

solicitation. Please attach)

(2) Followed up iniTial solicitation of MBEs and WBEs to determine if firms are interested in doing

business. (Please attach)

(3) Advertised in a timely manner in one or more daily newspapers and/cr trade publication for MBEs and

WBEs for supply of goods and sendces. (Please attach}

(4) Used the services and assistance of the Office of Contract Compliahce staff. {Please explain)

(5) Engaged MBEs 3 WBEs for indirect participation. (Please explain)

D. OTHER RELEVANT INFORMATION

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

1.10.13

CERTIFICATIONS ISECTION 41

THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE: THE UNDERSIGNED ISCAUTIONED TO CAREFULLY READ THESE CERTIFICATIONS PRIOR TO SIGNING THE SIGNATLIRE PAGE. SIGNINGTHE SIGNATURE PAGE SHAI.L CONSTITUTE A WARRANTY BY THE. UNDERSIGNED THAT ALL THE STATEMENTSCERTIFICATIONS AND INFORMATION SET FORTH WITHIN THESE CERTIFICATIONS ARE TRUE, COIVIPI ETE ANDCORRECT AS OF THE DATE THE SIGNATURE PAGE IS SIGNED. THE'UNDERSIGNED IS NOTIFIED THAT'IF THE

'OUNTYLEARNS THAT ANY OF THE FOI,LOWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACTENTERED INTO WITH T'E UNDERSIGNED SHALL'BE SUBJECT TO TERMINATION.

iL PERSONS AND ENTITIES SUBJECT TO DISQUALIFICATION

No person or business engty shall be awarded s contract or sub-contiact, for a period of gve (5) years from ths date of .conviction er entry of s plea or admission of guilt, civil or criminal, if that person ot business entity:,

')

Has been convicted of an act committed, within the State of Illinois,'f bribery or attempting to bribe an ogiceror employee of a unit of state, federal or load government or school district in the State of Illinois in that,officer's or employee's ofiidial capacity;

2) Has been convicted by federal, state or local government of an act of bid-rigging or attempting to rig bids asdefined in the Sherman Anti-Trust Act and Clayton Act. Act. 15U.S:C.Section 1 ef seqri

3) Has been convicted of bid-riggjng or attempting to rig bids under the lave of federal, state or localgovernment;

4) Has been convicted of an act committed, within the State, of price-fixing or attempting to fix prices as definedby the Sherman Anti-Trust Act and the Clayton Act. 15 U.S.C.Section 1, et seq.;

5)

6)

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

Has been coniricted of defrauding or attempgng to defraud any unit of state or local government or schooldistrict within the State of Illinois;

:7) Has made an adlnission of guilt of such conduct as set forlh in subsections (1) through (6) abave which .

admission is a matter of record, whether or not such person or business entity was subject to prosecution for .the offense or offenses admitted to; or

8) Has entered a'plea of nolo contendere to'hsige cf'bribery, price-'fixing, bid-rigging,'r fraud, as set forth Irisub-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 ollicial, aqsnt oremployee of such business entity committed the Prohibited Act on behalf of the business entity and pumuant to thedirecgon or authorization of an officer, director or other responsible olgcial of the business entity, and such Prohibited .Act occurred within three yearn prior to the award of the contract. In addiTion, a business entiqr shall be disqualified ifan owner, partner or shareholder controlling, directly or indirectly, 20 k or more of the business entity, cr an officer of .the business entity has performed any Pmhibited Act within five years prior tc 'the award of the Contract.

THE UNDERSIGNED HEREBY CER77FIES THAT: The Undersigned has read the provisions of Section A, Personsand Entities Subject to Disqualification, that the Undersigned has not committed any Prohibited Act set forih in SectionA, and that award of the Contract to ths Undersigned would not violate the provisions of such Section or of the Cods

B. BID4BGGING OR BID ROTATING

THE UNDERSIGNED HEREBY'ER77FIES THATQn accordance wiTh 720 iLCS 5/33 E-ff, neither the Undersigned" .nor any Atgisted Entityis barred fiom sward of this Contract as a resuft of a conviction for the vioistion 'of State ldwspmhi&ing bidrigging or bid rotating.

C. 'RUG FREE WORKPLACE ACT

THE UNDERSIGNED HEREBY CERTTFTES THAT: The Undersigned vill provide a drug free workplace, as required byPublic Act 86-1459 (30 ILCS 580/2-11).

EDS-41.10.13

O. DELINQUENCY IN PAYIiiIENT OF TAXES

7'HE uNDERSIGNED HERESY CER77F7ES THATi The Undersigned is not an owner or e Party meParisible for the'eyment of eny tex or fee adminIstered by Cook County by a local municipality, or by the 55nois Department of Revenue,

which such hcr or fee is delinquent, such se ber'ward of e contract or subcontract pursuant to the Cock; Chapter 34,Section 34-129..

'.

HUMAN RIGHTS ORDINANCE

No person who is a party to a contract with Cook Courity ("County" ) shall engage in unlawful discriminagon or sexualharassment against any individual in the terms cr condigons of employment, credit, public accommodations, housing, orpnxrision of County fadliTies, services or progranis (Code Chapter 42, Section 42-30 et seq).

F." ILLINOIS HUMAN RIGHTS ACT

THE UNDERSIGNED HERESY CERTIFIES THATr It is In comPliance wgtr the the illinois Itumen R'ighte Act (776 II CS572'-106), snd egress Io sMde by the rsqubements of the Act es pert of its contractual obligations.

'G. MACSRIDE PRINCIPLES, CODE CHAPTER 34, SECTION 34-132

lf the primary contractor currently conducts business operalions in N'orihem Ireland, or will conduct business during theprojected duration of a County contract, the primary conhaclar shall make ag reasoriable and good faith efforls to conductany such business operations in Norlhsm Ireland in accordance with the MacBride Prindplss for Northern Ireland asdegned in lginols Publh Act 55-1380.

ff. LIVING WAGE ORDINANCE PREFERENCE {COOK COUNTY CODE, CHAPTER 34, SECTION 94 127

:The Code requires thats living wage must be paid ta indhfiduals employed by a Contractor which has a County Contractand by sl( subcontractors of such Conlractor under'a County Cantract, throughout the duraffon of such County Contract„The amount of such Ihfing wage is determined from time ta tkrie by, and is availabls from, the Chief Financial Officer of theCounly.

For purposes of this EDS Secion 4, H, "Contract" means any written agreement whereby ths County ls committed to oidoes expend funds in connection with the agreement or subcontract thereof. The term "Contract" as used in {his'DS,Secffon 4, I, spscificagy excludes contrarris with the following:

1) Not For Profit Organizagons (defined as a corporagon having tsx exempt status under Section 501(C)(3)of theUnited State Internal Revenue Cods and recognized under the. Ignab State not-for +refit law);

2) Community Development Black Grants;

3) Cook County Works Deparlment;

4) 'heriffs Work Alternative Program; and

5) Dsparlment af Correction inmalse.

EDS-51.10.13

REQUIRED DISCLOSURES (SECTION EI

DISCLOSURE OF LOBBYIST CONTACTS

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

Name

N/A

Address

.N/A

2. LOCAL BUSINESS PREFERENCE DISCLOSURE; .CODE, CHAPTER 34, SECTION 34-151(p);

"Local Business'hall mean a person authorbed to transact business in this State and having a bona fide establishment fortransadicg business located wilhin Cook County at which it was actually transacting business on the date when any competitivesolicitatlcn for a public contract is first 'advertised or announced'nd kirther which employs the majority of its regular, full time workforce within Cook County, Induding a foreign corporation duly authorized to transact bijslness in this Stats and which has a bonafide establishment for transacting business located Within Cook County at which it was actually transacting business on the datewhen any- ccmpehtive solicitation kir a public contract is first advergsed or anno'unced snd further which employs the majority ot itsregular, full fime work force within Cook County.

a) ls Bidder a "Local Business" as delined above?

Yes:

b) If yes, list business addresses within Cook County:CORDON'5 ATO RRPATR

- 10903 5.-Rldgeland Ave.

-Chicago Ridge, IL 60415

c) Does Sidderempfoy ths majority of its regular full-fime work(ores within Cook County?

Yes:

3. 'HE CHILD SUPPORT ENFORCEINENT ORDINANCE (PREFERENCE (CODE, CHAPTER 34, SECTION 34-365)

Every Applicant for e counter Privilege shall be in full compliance with any child support order before such Applicant is entitled toreceive or.mnsw s County Privilege, When delinquent, child support exists, ths County shall not issue or renew any CountyPrivilege, and may revoke any County Privilege.

All Applicants are required to. review the Cook County Affidavit of Child Support Obligations attached to this EDS (EDS.8}and complete the following,'based upcn the dehnitions and other information included ln such Affidavit:

EDS-61.10.13

REAL ESTATE OWNERSHIP DISCLOSURES

The Undersigned. must indicate by checking the appropriate prow'sion below and providing sfi required information that eiNe f.

a) The fallowing is a completi list of afi real estate owned by the Undersigned in Cook County:

PERMANENT INDEX NUMBER(S); . N/A

(ATTACH SHEET IF NECESSARY TO LIST ADDIT(ONAL INDEXNUMBERS)

OR:

b) X The Un'dersigned owns no leal estate in Cook Couniy.

tk EXCEPTIONS TO CERTIFICATIONS OR DISCLOSURES.

. If the Undemigned is unable to certil'y to sny of the Cerfifications or any oNer statements contained in this EDS and'not expialnedelsewhere in this EDS, the Undersigned'must exphin belovr.

The undersigned executes these forms as Super'vised Administrator of thes

Estate of Roy G. Gilkison, Deceased (also known as Gordon Gilkison).1

If the letters, NA, the word "None" or "No Response" appears above, or if the space is left blank, it wlfi be conclusively presumedthat the Undersigned certified to afi Cetfificafions and other statemenls contained in this EDS.

*Mrs Gilkison was'the owner of Gordon's Auto Repair, a sole proprietorship.-.Gordon's Auto Repair was the original Bidder/Applicant under this Cook CountyContract tfo. 11-53-185E. Attached hereto is a certified copy of the deathcertificate, certified copy of Letters of Office issued to Gordon H. Gilkison',the decedent's son,.who was 'appointed Supervised Administrator of the ProbateEstate, and an Order entered by the Circuit Court of. Cook County, Illinois,in Case No. 13 P 007448, permitting the Supervised Administrator to continuethe business of Gordon's Auto Repair.

EDS-7'.10.13

COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT

The Cook County Gode of Ordinances (fi2-610 ef seq.) requires that any Applicant for any County Action must disclose illformationconcerning ownership interests in the Applicant. This Disclosure. of Ownership Interest Statement must be completed wi'thinformation current as oi the date this Statement is signed. Furthertnore, 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 stat'ament wll bs maintained in a database'and ln'ade avaiiab! e for public viewing.

If y'ou are asked to list names, but there ala no applicable names to list, you must state NONE: An iriccmplete Statement v/ill bereturned and any action regarding this contract will be delayed. A fafiure to fully comply with the ordinance may result in th'e actiehtaken by the County Board or County Agency being voids'd.

"Applicant" means any Entity or person lnaking an application to the County for any. County Action.

"County Ac//on" 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 or .purchase of real estate:

"Entity" or "Legal:Entity" means'a-sole propriietorship, corporation, partnership, association, business trust, estate, two pr r'norepersons having a joint or common interest, trustee of s land trust, other commercial or legal entity or any beneficiary. or. beneficiaries

. thereof.

This Disclosure of Ownership Interest Statement must be submitted by:

1.An Applicant for County Action and

2 An individual or Legal Entity that holds stock or a beneficial interest in the Applicant and is listed on the Applicant's Statement (a."Holder" ) must file a Statement and.complete ¹1 only under Ownership Interest Declaration.

Please print Cr e responses dearly and legibly. Add additional pages if needed, being careful to idengfy each porfion of the form towhich sech additional page refers.

Th}e Statement is being made by the [ X [Applicant or [ ]Stock/Beneficial Interest Holder

This Statement is an: [. ] Original Statement or [ X ] Amended Statement

Identifyinu Information:ESTATE OP ROY G. GILKISON,

Name DECEASED D/B/A:GORDON'S AUTO REPAIR EIN NO.: 36-3436965

StreetAddressi 10303 S. Ridgeland Ave.

City Chicano Ridae State: IL Zip Code; 60415

Phone No.: (708) 424-2100

Form of Legal Entity: .'[ ] Soki Proprietor [.I Partnership. [ ] Corperatlon .[ ] 'rustee of Land Trust

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

[ ] Other (describe)

1.10.13

Owrtershlp Interest Declaration

List the name(s), address, and per'cent ownership of each individual and each Entity having a legal or beneficialinterest (including ownership) of more than five percent (5%) in the Applicant/Molder.

Name Address Percentage Interest in

Applicant/Holder

N/A'

The Applicant is the ESTATE OF ROY G'. GILKISON, DECEASED, doing business asGordon's Auto Repair..

2. If the interest of sny individual or any Entity listed fn (1) above is held as an agent or agents, or s nominee ornominees, list the name and address'of the principal on whose behalf the Intsrekt la held.

Name of AgentfNominss Name of Principal Principafs Address

N/A

le the Applicant constructively co'ntrolled by another person or Legal Enfity2 [ ]Yes [ ] No

If yes, state the name, address and pementege of beneficial interest of such person or legal entity, and therelabonship under which such cohtrol is being or may be exercised.

Name

N/A

. Address Percentage of,Beneficial Interest

Relationship

Declaration (check the applicable box)

[K] I stale under oath that the Applicant iiss withheld no disclosure as to ownership interest in the Applicant nor eservedany information, date 'or plan as to the intended use or purpose for which the Applicant seeks County Board or otherCounty Agency action.

'

] I state under oath that the Holder has withheld no disdosure as to ownership interest nor reserved any information, required to be disclosed.

ESTATE OF ROY G GILKISON., DECEASEDGORDON ' AUTO -REPAIR

. Name of Authorized AppllcsntlHolder Representative (please print or type)'

P~zsli~Sig'nature Gordon t[. 'Gilkison

. walterlindishsgmailrcomE-mall address

Supervised AdministratorTitle

March 28, 2015Date

(708) 424-2100Phone'Number

Subscriibedthis 28

My commission expires:

Notarv Public SlcnatureNotary Seal

'DS-10.

COOK iCOUKf Y IIOAIID OF ETHICS69W. WASHINGTON STREET, SUITE 3040

CHICAGO, ILLINOIS 60602312/603-4304

312/603-9988 FAX . 312/603-1011 IT/fDD

li'A un II.I4 i.RI/I. AT IONSRIP IIISCI.ASIIRRPRIIVISI4114r

Secffcm 2-582 ofthe Cook County Ethics Ordinarice requh ex any person or'persons doing business vdth Cook County, uponexecution ofa contract with Cook County, to diisclose to the Cook County Board ofEthics the existence 'of familialrelationships they may have with all persons holdiing elective office in the State.of Illinois, the County ofCook, or in anymunicipality withh the County ofCook

The disclosure required by this section shall be filed by January I ofeach calendar year or within thirty (30) days of theexecution ofany contract m'ease. Any'perso'n filing a late disclosure statement afior January 31 shall be assessed a late filingfee of$100.00per day that the disclosure is late. Any person found guilty ofviolating any provision ofthis section orknowingly filing a false, misleading, or incomplete disclosure to the Cook County Board ofEthics shall be prohibited, for aperiod of three (3)years, fiom engaging, direotly or indirectly, in any business with Cook County. Note: Please see Chapter 2Administration, Article VII Ethics, Section 2-582 of the Cock County Code to view the ihll provisions of this section.

Ifyou have questions concerning this disclosure requirement, please call the Cook County Board ofEthics at (312)603-4304.Note: A cuneut list of contractors doing business with Cook County is available via the Cook County Board ofEthics'ebsite at:httpt//wwwseekcouutygcv.cem/taxonomy/ethics/Ltstiugs/cc 'ethics VendcrList;pdf

IIRRIaIITIII14S

'Calendar year" means January I to December 31 ofeach year

"Doing business" for this Ordinance provision means any one or any combination of leases, contracts, or purchases to or withCook County or any Cook County'agency in excess of$25,000 in any calendar year.

is'related to an official or employee as spouse or any ofthe Mowing, whether by"Fantlltal relationship" means a person whoblood, marriage or adoption:~ Parent~ Child~ Brother~ Sister~ Atmte Uncle~ Niece

e Grandparent~ Grandchild .~ Father-in-law~ Mother-in-law~

Son-In-law�'

Daughter-m-law-~ l3rother-in-law'

Sistercinelaw

Stepfather

Stepmother

StepsonStepdaughterStepbrother

Steps'i sterHalf-brotherHalf-sistere Nephew

'SPerson" means any indhddua, ent'ity, Corporation, partnership, finn, association, tmion, trust, estate, as weII as any parent orsubsidiary ofany ofthe foregoing, and whether or not operated for pmfit.

EOS-11

1.10.13

SWORN FAMILIAL RELATIONSHIP DIE CIAO I IRK WARM

pursuant'to Section 2 582 ofthe Cook County Ethics OnHnance, any person* doing business* with<ceja County must discloseto the Cook County Board ofBgdcs, the exisumce offamilial rehmonahips* to any person holding elective office in'}ie State ofIllinois, Cook.County, or in sny municipality within Cook Couidy. Please print your responses.

ESTATE OF ROY. G.Name ofOwner/Employee: GIBKISOII, DECEASED 'itle. Supervised Admirii,strator

Business.BntityName: GORDON S AUTO REPAIR phone (700) 424 2100

BusinessBntityAddress: 10303 S. Ridgeland Ave., Chicago Ridge, IL'0415

. The following familial relationship exists between 'the owner or any employee of the business entity contracted to dq.'business with Cook County and any person holding elective oiBce in the State of Illinois, Cook County, or in any .municipality within Cook County.

Owner/Employee Name:.

N/A

Related to: Relationship:

5.

Ifmore sphce is needed, attach an additional sheet following the above format

There is no familial reladonsldp that exists'between the owner or any employee'of the.business'entitycontracted to do business with Cook County and any person holding elective office in'the State of Illinois; CookCounty, or in any municipality within Cook County.

- To the best of my knowledge and belief, theiaformation provided above is true and complete.ES TE OF ROY Q. GQIKISOII, DECEASED

(n,.~- March 28, 2015Owner/Employee's Signature DateGordon M. Gilkison, Supervised AdministratorSubscribe and sworn before metbiis 28 Day of March 20 '5

County

(SjiiCature) ~'OTARY PUBLIC

SEAL'y Commission expires

Completed forms must be filed'within 30 days ofthe execution ofany contract or lease with Cook County and should be mailedto:

'ook County Board ol'Ethics69 West Washington Street,

Suite 3040Chicago, Illinois 60602

EOS-121.10.13.

SIGNATURE BY A SOLE PROPRIETOR

(SECTION 6)

The Undersigned hereby cerliNes and warranbr that aN of the statements, cerbscssons and representations set forth in this EDSara true, complete and corred; that the Undersigned is in fuil compliance and wiN continue to be in compliance throughout the termof ths Contract or County Pmslsge issued to the Undersigned with as the policies arid requirements set forth in this EDS; and thatag facts snd information provided by tits Undersigned In this EDS are Vue, complete and correct The Urldersigned agrees toinfor'm ihe.Chief'procurement Gfscer in wrisng if any of such statements, cersgcations, representations, facts or information .becomes or is found to b's untrue, incomplete or incorrect during ihe term of the Conhact or County Privilege.

BUSINESS'NAME GORDON'. AUTO REPAIR

BUSINESS ADDRESS 10303 8. Ridgsland Ave., Chicago Ridge, IL 80415

BUSINESS TELEPHONE: (708) 424-2100

FEIN/SSN: 3b-343bgb5

FAX NUMBER; .(708) 424-0100

COOK COUNlY BUSINESS REGISTRATION NUMBER: 105bO

/

SQA ~ PRQPIIIETQRSSIQRATURE. PU IGordon M. Gilkison, Supervised Administrator of the

PRINTNAME . Estate of Rov G. Gilkison. Deceased.

DATE: March 28. 2015

Subscribed to and sworn before me this

,20 15My commission expires:

QFFICIAL SEALNotalv Public Slonaturs I hf ptpid I I ltuk'AWING

Notary Seal Notary Public - State of illinois

)My Commlssiori Expires 11/17/2018 I

EDS-131'.10.13

SIGNATURE BYA PARTNERSHIP /ANO/QR A JOINT VENTUREI

. (SECTION 7)

.The Undersigned hereby cerllhes and warrants: that all of the statements, cerlifications, and representations set forth'in this EDSare true, complete and corrscb that the Undersigned is in full compliance and will con5nue,to be in compliance throughout the tern.

— of the Contract or County P/Iv/1ege issued to the Undersigned with all the policies and requiremenh set forlh in Nis EDS; and thatall of the fade and information provided by the Undersigned in this EDS are true, complete and conscL The Undersigned agrees to

:info'rm the, Chief..P/ocuremsnt Officer in writing if any of 'such statements, csrtiiicatlons, representations, facts or infdrrnaflon. beconies or h found to be untiue, incocl piete or incoriecl during tha term of the Conhact or County Privilege..

.BUSINESS NAME. N/A

BUSINESS ADDRESS:

BUSINESS TELEPHONE:

CONTACT PERSON:

'COOK COUNTY BUSINESS.REGISTRATION NUMBER:

FAX NUMBER:

FEIN/SSN:

SIGNATURE OF PARTNER AUTHORIZED TO EXECUTE CONTRACTS ON BEHALF OF PARTNERSHIP:

"BY:

Date:

Subscribed to and sworn befom me this

day'of ,20.My commission expires:

Nolarv Public SianalureNotary Seal

'* 'ttach hwato a partnemhip resolution or other document authortiing ths Individual signing this Signature pageto so sign on behalf of the Partnership.

EDS-14a1.10.13

SIGNATURE BY A PARTNERSHIP (AND/OR A JOINT VENTUREI

(SECTION 7)

The Undersigned hereby cerfifisi and warrarits: that ail of the statements, csrtifications, snd representations set forth in this EDsare. true, complete and correct; that the Undersigned is in full compliance. and will continue to be in compliance throughout the termof the Contract or County Privilege issued to the Undersigned with'll the policies and requirements set forlh in ibis EDS, and thatall of ths facts and information provided by the Undersigned in this.EDS ars true, complete and correct. The Undersigned agrees toinform the Chief Procursmsnt Officer in wdtfng if any of such statements, csrfificatlons, representations, facts or Informationbecomes or is found t'o be uneue, incomplete orincorrect dui'ing the term of the Contract or County Pmiilsge..

BLISiNESS NAME: '/ABUSINESS ADDRESS:

BUSINESS TELEPHONE FAX NUMBER:

'EIN/SSN:

*COOK COUNTY BUSINESS REGISTRATION NUMBER:

SIGNATURE OF PARTNER AUTHORIZED TO EXECUTE.CONTRACTS ON BEHALF OF PARTNERSHIP:

*BY:

Date:

Subscribed to and sworn before me this

day of ,20'ycommission expires:

X Notarv Public Sionaium

Notary Seal

Atlach hereto a partnership msolugon or other document authorizing the Individual signing this Signature Pageto so sign on behalf of the Partnership.

EDS-14b1.10.13

SIGNA'f URE EY A PARTNERSHIP (AND/OR A JOINT VENTUREI

(SECTION 7)'

The Undprsigned hereby ceriilies and warrants: that all of the statements, certificaftons, and representations sst forth in this EDSare true, complete and correct; that the Undersigried is in full compliance and wiliconlinue to be in compliance throughout the tennof the Contract or County Privilege issued to the Undersigned with all the policies and requirements set forth in this EDS; and thatall of the facts and inforniation'provided by the 'Undersigned in this EDS ars true, complete and corrscL The Undersigned agrees tbinform the Chief Procursmsnt OIIIcsr In writing if any of such statements, certificstions;. representations, facts or Informationbecomes or is found tc be untrue, incomplete or incorrect during the farm of ths Contract or'ounty Privilege..

BUSINESS NAME: N/A

BUSINESS ADDRESS:

BUSINESS TELEPHONE FAX NUMBER:

CONTACT PERSON FEIN/SSN:

"COOK COUNTY BUSINESS REGISTRATION NUMBER:

SIGNATURE OF PARTNER AUTHORIZED TO EXECUTE CONTRACTS ON BEHALF OF PARTNERSHIP:

iBY:

Date:

Subscribed to and sworn befom me this

day oi , 20My commission expires:

Notarv Public Sianalure

Notary Seal

Mach hereto s partnership resolution or other document authorizing the individual signing'this tggnatura Pageto so sign on behalf of the Partnemhip.

EDS-.14c1.10.13

,SIGNATURE BY A LIMITED LIABu ITY CORPORATION

(SECTION 8)

The Undersigned hereby ceriisss snd warrants: that all of the statements, certifications; and repres'notations get forth in:this EDB .are true, complete and correct; that the Uridersigned is in full compliance and will confirice to be in compliance throughou't the term'.

.- of the Contract or. County Privilege issued to the Undersigned with all'ths polides and requirements set forlh in this EDS; anil thatall of the facts snd information provided by the Undersigned in this EDS ars true, complete and conecL The Undersigned agiess toinform ths Procuremsnt Director in writing if any of such statsmenls, certillcations, representations, facts or information becomes orIs found to be untrue, incomplete or Incorrect during ths term of the Contract or County Privilege.

BUSINESS NAME: N/A

BUSINESS ADDRESS

'BUSINESS TELEPHONE: FAX NUMB'ER;

CONTACT PERSON:

'EIN:

MANAGING MEMBER:

*.CORPORATE FILE NUMBER:

MANAGING MEMBER:

SIGNATURE OF MANAGER:

ATTEST:

Subscribed snd sworn tc before me this

day of ', 20

Notary Public Signature Notary Seal

If the LLC is not registered in the Rate of Illinois, a copy of a.current Certificate of Good Standing fromthe state of incorporation must be submitted with this Signature Page.

. -Attach either a certfged copy of the by laws, articles, resolution or other authorization demonstratihgsuch persons to sign tbe'Signature Page on behalf of the LLC:.

EDS-15s1.10.13

SIGNATURE BY A LINIITED LIABn ITY CORPORATION

'lSECTION si

.The Undersigned hereby cerfifies snd warrants: that all of the statements, certifIcslions, and represenmfions set forth in this EDSare true', coroplete and correct; that the Undersigned is in full compliance and will continue to be in compliance throughout the term'of the Contract or County Privilege issued to the Undersigned with afi the policies and requiremenls set forth in this EDS; and thatall of thefarts and infcrmation provided by the Underaigned in this EDS are true, complete snd correcL 'fhe Undersigned agrees toinform the Procurement Director in writing if any of such statements'; cerfificatlons, representafions, facts or information becomes oris'ound to be untrue, Incomplete or incorrect dudng the terni of lhe Contract or County Privilege.

BUSINESS NAME: N/A

BUSINESS ADDRESS

BUSINESS TELEPHONE: FAX NUMBER:

CONTACT PERSON

FEIN *CORPORATE FILE NUMBER

MANAGING MEMBER: MANAGING MEMBER:

SIGNATURE OF MANAGER:

ATTEST:

Subgcribed and swoi'n'o'be%re m's this

dey of

Notary Public Sign'ature Notary Seal

If the LLC is not registered in the State of illinois, a copy of a current Certificate of Good Standing fromthe state of incorporation must be submitted with this Signature Page.

Attach'either a cartittad copy.of the by-laws, artides, resolution or other authorization demonstratihg.such persons to sign the Signature Page on behalf of the LLC.

EDS-15b1.10.13

SIGNATURE BY A LIMITED LIABILITY CORPORATION

(SECTION a}

The Underagned hereby cerfifies and warrants: that afi of the slatements, certificafions, and representations set forth in this EDSare true, complete and correct; that the Undersigned is in tufi compliartce and will continue to be in compliance throughout the termof the Contr'act or County Privilege issued to the Undersigned with afi the Policies and requirements set forth in this EDS; and thatafi of the facts and information pmvided by the Undersigrred In this EDS are true, complete and correct. The Undersigned agrees toinform the Procuremsnt Director in writirig if sny of such stater'nents, certificafions, representations, facts or Informafion becomes oris found to be untrue, incomplete or incorrect dudng the terr'n of the Centract or County Privilege.

BUSINESS NAME: N/A

BUSINESSADDRESS

BUSINESS TELEPHONE . FAX NUMBER:

CONTACT PERSON:

FEIN

MANAGING MEMBER;

*CORPORATE FILE NUMBER:

MANAGING MEMBER:

SIGNATURE OF MANAGER:

ATTEST:

'ubscribed

and sworn to before me this

day of

Notary Public Signature Notary Seal

If the LLC is not registered in the'State of Illinois, a copy of a current'Certificate of Good Standing fromthe state of incorporation must be submitted with this Signature Page.

Attach either a certified copy of the by-laws, articles, resolution or other authorization demonstratingsuch persons te sign the Signature Page on behalf of the LLC.

EDS-15c1.10.13

SIGNATURE BY A CORPORATION

(SECTION 9)

.The Undersigned hereby csr5iies and warrants: that all of the statements, certifications, end representations set forth in this'DSare true, 'complete end correct; fhet the Undemigned is in full compliance and will continue Io be in compliance throughout the tenn .

of the Contract or County Privilege issued tc the Undersigned, with all the policies and requirements sel fcrlh in this EDS; and thatall of the fade and information provided by the Undersigned In this EDS am true; complete and corrscL The Undersigned agrees toinform the Chief Proourement ONcer fn writing if any of such statements,'csrtificsllcns; rhprsssntations, greta or Informationbecomes or is found to be unbue, incomplete or incorrect during the term of the Contract or County privilege.

BLISINESS NAME; '/ABUSINESS ADDRESS:

BUSINESS TELEPHONE:

CONTACT PERSON:

FEIN:

FAX NUMBER:

*IL CORPORATE FILE NUMBER:

LIST THE FOI LOWING CORPORATE OFFICERS:

PRESIDENT: VICE PRES!DENT:

SECRETARY: TREASURER:

SIGNATURE OF.PRESIDENT:

ATTEST: (CORPORATE SECRETARY)

Subscribed and sworn to before me this

day of ,20My commission expires:

Notary Public Signature Notary Seal

* . If the corporation is not registered In the State p(illinois, a copy of the Csrtlficate of Good Standing from the stateof incorporation must be submitted with this Bignabas Page.

in ihe event that this Signature Peg'e is iigned by any persons than ths President and Ssoretary, attach either acertgied c'py of the corporate bPfaws, resolution or other authorization by the corporation, authorizing suchpersons to sign the Signature Page on behalf of the corporatlorI.

EDS-16a1.10.13

SIGNATURE BY A CORPORATION

(SECTION 9}

The Undersigned hereby cedlfles and warrants: that afl of the statements, csrflflcations, and representations set forth in this EOSare true, complete and correct; that the Undersigned is i'n full compliance and will continue to be in compliance throughout the termof the Contract or Courity PrMlsge issued to the Undersigned with all the'olicies and requirements set fcrlh in this EOS; and thatafl of the facts and information provided by the Undersigned in this EDS ars true, complete and corredt The Undersigned agrees tcinform the chief procurement ofllcar In wdtlng if any of such statements, certiflcstioris, representations, facts oi information:becomes or is found tc be unhue, incomplete or incorrect during the term of the Contract or County Prhiilegst

BUSINESS NAME . II/A

BUSINESS ADDRESS',

BUSINESS TELEPHONE:

CONTACT PERSON:

FAX NUMBER:

FEIN: *ILCORPORATE FILE NUMBER:

LIST THE FOLLOWING CORPORATE OFFICERS:

PRESIDENT:

SECRETARY:

~SIGNATURE OF PRESIDENT:

ATTEST:

VICE PRESIDENT

TREASURER:.

(CORPOIKTE SECRETARY}

Subscribed and sworn to befcm me this

day of .20My commission expires:

Notary SealNotary Publh Signature

* If the corporation is not registered in the Stats of glinois, a copy of the CertiBcste of Good Standing from the stats':of incorporation must be submitted with this Signature Page.

In the.event that this Signature Page is signed by any pemons than the President and Sscretiry, attach either acergfted copy of the corporate by-laws, resolution er oth'sr authorization by the corporation, authorlalng such .

persons to sign the Signature Page on behalf of the corporation.

EOS-16h1.10.13

COOK COUNTY SIGNATURE PAGE. (SECTION 10)

.ON BEHALF -OF THE COUNTY OF COOK, A BODY POL!TjC AND CORPORATE OF THE STATE OF ILLINOIS'THISCONTRACT IS HEREBY EXECUTED BY:

COOK COUNTY CHIEF PROCUREMENT OFFICER

DATED AT CHICAGO, ILLINOIS THIS DAY OF

IN THE CASE OF A BID PROPOSAL, THE. COUNTY HEREBY ACCEPTS:

THE FOREGOING BID/PROPOSAL AS IDENTIFIED IN THE'CONTRACT DOCUMENTS FOR CONTRACT NUMBER

ITEM(S), SECTION(S), PART($):

TOTAL AMOUNT OF CONTRACT:

(DOLLARS AND CENTS)

FUND CHARGEABLE:

APPROVED AS TO FORM:

NA

ASSISTANT STATE'S AlTDRNEY{Required on contracts over $1,000,000.00)

EDS-171.10.13

SIGNATURE BYA CORPORATION

(SECTION. 9)

The Undersigned hereby certifies and warrants: that sll of the surtements, 'certificafions, and representations set forth in this EDS - .are'rue, complete and correct; that the Undersigned is in full compliance and will congnue to be in compliance throughout the tennof the Contract or County Privilege issued to Ihe Undersigned with all the policies and requirements set forlh in this EDs; and thatsll of ths facts and information provided b'y the Undersigned In Ibis EDS sre true, complete and correct. The Undersigned agrees toinform'he chief Procursmsnt ONcsr in miting'f any of such statemenls, cerltttcatons, representations, facts or informagonbecdrriss or is found to bs untrue, incomplete or incorrect during Ihe term of the Contract or County Pmslege.

BUSINESS NAME; N/A

BUSINESS ADDRESS:

.. BUSINESS TELEPHONE:

CONTACT PERSON:

FAX NUMBER:

FEIN: "ILCORPORATE FILE NUMBER:

LIST THE FOLLOWING CORPORATE OFFICERS:

PRESIDENT:

SECRETARY:

VICE PRESIDENT:

TREASURER:

~SIGNATURE OF PRESIDENT:

ATTEST: 'CORPORATE'SECRETARY)

Subscribed and sworn to before me this

dsy of ,20My commission expires:

Notary SealNotary Public Signature

*; " If the corporation Is not registered in the State of illinois„a copy of(he Certificate of Good Standing from the state .

of inborporation must be submitted with this Signatum Page.

In the event that this Signature Page is signed by any persons than the President and Secretary, attach either.acergged copy of the corporate bydaws, msolutlon or other authorimtlon )ty the corporation, authortslng suchpemons to sign the Slghaturs Page on behalf of ths corporation.

EDS-16c1.10.13

AC CPRL7 CERTIFICATE OF LIABILITY INSURANCEDATE (MM 0DlYYYN

03/16/201 6

CONTICTNmfs:Pmnons 773mq38 2886E-MNLM/DRESS:

THIS CERTtRCATE 8 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTB UPON THE CERTIFICATE HOLDER, THISCERTIRCATE DOES NOT AFRRMAT(VELY OR NEGAT(VELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POUCIESBELOW. THIS CERT(AGATE OF IN 8URANCE DOES NOT CONSTITUTE A CONTRACT BEIWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIR CATE HOLDER

IMPORTANT: If the certificate holder ls an ADDITIONAL INSURED the Policy(les) must be endorsed. If SUBROGATION 18 WAIVED subject tothe terms and condgions of the pogcy certain policies may require an endorsemenL A statement on mis certificate does nol confer rights to thecergf (cate holder in Eeu oi euoh endorsement(s).

PRODUCER

Insurance Brokers Inc 773-338-31657547 N Rogers Ave

ChicagoINSURED

Gordon'8 Auto Repair10303 Ridge)and Ave

Chicago Ridge

IL 60626

IL 60415

INBURER/01 AFFCRDINS covE/MGE

fnsunpn A Travelers Indemnity CoD/SURER a:INSURER C:INSURER 0

.'NSURERE:ImauRER F:

NNC 025668

LIMITS

EACH OCCURRENCE0/UGIGE lo flENTEDPREMISES IE occurfeuc I

hMD E/0 (Ahr olla uafsccl

680-SE627710PERSONAL 0 ADV INJURY

PRODUCTS - COMI /OP AGG

CONNNEG SINGLE LIMITIE ld tl

BODILY INJURY (P f person

680-SE527710 BODILY INJURY (P\f accldaaq

PROPERTV DAMAGEIPef a Id tl

AGGREGATE

Ql sratum I I m

E.L DINMASE ~ EA EMPLDYEE

E.L DISEASE ~ POLICY LIMIT

COVERAGES CERTIRCATE NUMBER: HENS ION NUM 8ER:THB 8 TO CERTIFY IHAT THE FOL IDES OF NSURANCE LBTED BBOW HAVE BEEN ISSUE/ TO THE INSURED NAMED ABOVE FOR THE POLICY FERICDINDICA TED. NCTWQHSTAHDING ANY REOUREugdT TERM OR CO/EXRON OF ANY CONTRACT OR OTHER DOCUMENT WQH RB/PECT TO WHCH THSCERTIF/CATE M/I Y BEBSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HERBN IS SUBJECT TO ALL THE1ERMS,EXCLUSIONS AND CCNDIRCNB OF SUCH PCLICEB. LIMfTS SHOWN MAY HAVE BEEN RED(/CED BY PAID CLAIMS.

INSR cPDL IUSK POLICYBFF POLICYEXPLnl TYPE OP INSIIRIWCE torch wu POLICY NUMBER NIIM/DD/YYYYI IMMGO/YWYI

Q COMMEaC//LGENERALLIABILQY

V CLAIMMNDE OCCUR

Tfs(2014 T/0/2010

QEN'L AGGREGATE LIMIT APPLIES PER:lPll Pno.POLICY~~ /per ~Q LOC

OTHER:

mt TO MOBILE LIASILNY

ANY AUTO

A ALL OWNED SCHEDULED T/SMO14 TedcteAUTOS AUTOS

I2 NON.OWNEDHIRED AUTOS AUTOS

OCCURQ UMBRELLAL/ABFACN OCCURRENCE

Q EXCESS Llm CLAIMS INDE

Q DED I I RE/ENTION 0WORKERS COMPENSNIONANO EMPLOYPRIF LIMNLDYANY P/IOPRIRTOR/PARTNER/EXECUTIVE E.L EACH ACGI DENTOFF(GER/MEMBER EXGLUDEDI N/A(Mead>terr ln NHIIf Yos, doscrlhe underDESCRIPTION OF OPERATIONS h low

0 1„000,0000 300,0000 6,000

1toootooo0 2,000,0000 2,000,00D

s 1,000,000

Garage Keepers Legal680-8E527710 T/0/2014 T/0/201 0

DEscRlpTIQN OF cpERARGNB I LocATIGNB I vENIGLEB (AGDRD lct, nldnloual Remafh4 schedule, mav 0~ attached It more spmo fa fequlradl

Auto repair garage located at: 10303 Ridge)and Ave; Chicago Ridge IL 60416

CERTIFICATE HOLDER CANCELLATION

Cook County118N Clark StChicago IL 60602

ACORD 20 (2014/01)

SHOULD ANY OF THE A BOY E DES C RIBED POLICIES BECANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED INACCORDANCE WITH THE POLICY PRCVIMONS.

NIMQRIZRO REPRESENTATIVE H,~Cl 10002014ADO RD CORPORATION. AE rig Ms reserved.

The ACORD name and logo are reghtered marks of ACORD