Contract No. 1430-14166Vendor Name: INTERIOR INVESTMENTS, LLC

AMENDMENT NO. 1

This Amendment modifies Contract No. 1430-14165, for Office Furniture by and between the County ofCook, illinois, herein referred to as "County" and Interior Investments, LLC, authorized to do business in theState of illinois hereinafter referred to as "Contractor":

RECITALS

Whereas, the County and Contractor have entered into a Contract approved by the County Board on

January 21, 2015, (hereinafter referred to as the "Contract" ), wherein the Contractor is to provide OfficeFurniture (hereinafter referred to as the "Supplies"") from February 1, 2015 through September 30, 2016,with ihree (3) one (1)year renewal options, in an amount not to exceed $1,500,000.00;and

Whemas, the Contract will expire September 30, 2016, and the agreed upon Supplies are still required; and

Whereas, a renewal is desired for the continuation of Supplies; and

Whereas, an increase in the amount of $1,500,000.00 is required for the continuation of Supplies; and

Whereas, the County and Contractor desire to renew the Contract for one year beginning on October 1,2016 through September 30, 2017; and

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 renewed through September 30, 2017.

2. The Contract is increased by $1,500,000.00 and the Total Contract Amount is revised to

$3,000,000.00.

3. The attached Identification of Subcontractor/Supplier/Subconsultant Form, MBE/WBE Utilization

Plan forms, and Economic Disclosures Statement and Execution Document and are incorporatedand made a part of this Contract.

4. GC-06 Pavment of the Contract is deleted in its entirety and is revised by adding the following

provision as subsection:

All invoices submitted by the Consultant shall be in accordance with the cost provisions containedin the Agreement and shall contain a detailed description of the Deliverables, including the quantityof the Deliverables, for which payment is requested. All invoices for services shall include itemizedentries indicating the date or time period in which the services were provided, the amount of time

spent performing the services, and a detailed description of the services provided during the periodof the invoice. All invoices shall reflect the amounts invoiced by and the amounts paid to theConsultant as of the date 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. Consultant shall not beentitled to invoice the County for any late fees or other penalties.

Contract No. 1430-14166Vendor Name: INTERIOR INVESTMENTS, LLC

In accordance with Section 34-177 of the Cook County Procurement Code, the County shall have aright to set off and subtract fram 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 theConsultant to the County.

The Consultant acknowledges its duty to ensure the accuracy of all invoices submitted to theCounty for payment. By submitting the invoices, the Consultant certifies that all itemized entdiesset forth in the invoices are true and correct. The Consultant acknowledges that by submitting theinvoices, it certifies that it hss delivered the Deliversbles, i.e., the goods, supplies, seniices orequipment set forth in the Agreement to the Using Agency, or that it has properly performed theservices set forth in the Agreement. The invoice must also reflect the dates and amount of timeexpended in the provision of services under the Agreement. The Consultant acknowledges that

any inaccurate statements or negligent or intentional misrepresentations in the invoices shall resultin the County exercising ail remedies available to it in law and equity including, but not limited to, adelay in payment or nonpayment to the Consultant, end reporting the matter to the Cook CountyONce of the Independent Inspector GeneraL

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

In witness whereof, the County and Contractor have caused this Amendment No. 1 to be executed on thedate and year last written below.

County of Cook, Illinois Interior Investments, LLC

Officer

~appfi

~ W/

Signed

Isaac~ lb'. %~i'4~Type or print name

6av f kr Z M.terTitle

Pate. 0 /T Sarltl

Contract No. 1430-141SSVendor Name: INTERIOR INVESTMEMTS, LLC

ATTACHMENTS

l Intelial'nvestments~

Creating linsnctelltr responsive otgce environments

550 Bond StreetLincolnshire, IL 60069P: 847.325.1000F:847.325.1001www.interiorinvestments.corn

To: Cook County ProcurementRE: Corporate Resolution on Contracts

In the matters of government contracting, George Maniatis is an authorized signatory forInteri C

Sig

DonOwner

Steve RiceCOO

gjoi 'z~ Zot6STEVEN 6 IEOEOFRCIAL SEAL

Naasv Fablfc - sass aneealeNv co~eeaa Eos

ass sr. SetT

LSIIE C n~pg&L.

I-'i le Number 0010353-5

To all to whom these Presents Sha11 Come, Greeting:

I, Jesse White, Secretary of State of the State of I//inois, do hereby

certify that I am the keeper of the records of the Department ofBusiness Services. I certify thatINTERIOR INVESTMENTS, L.L.C.,HAVING ORGANIZED IN THE STATE OF ILLINOIS ONFEBRUARY 10, 1997,APPEARS TO HAVE COMPLIED WITH ALL PROVISIONS OF THELIMITED LIABILITY COMPANY ACT OF THIS STATE, AND AS OF THIS DATE IS IN GOODSTANDING AS A DOMESTIC LIMITED LIABILITY COMPANY IN THE STATE OF ILLINOIS.

In TeStimOny WhereOf, I hereto set

my hand and cause to be affixed the Great Seal ofthe State of Illinois, this 21ST

day of APRIL A.D. 2016

AuthenUcaaon tl: 101 1201 138 verifiable until 04/21/201 7

Authenticate at: htlp://www.cyberdriveihinoie corn

CONTRACT NO.1430-14166

Cook County OCPO ONLY:

Oflice of the Chief Procurement OIBcer O Oisauaiificetion

IdentiTication of Subcontractor/Supplier/Subconsultant Form

The Bidder/Proposer/Respondent ("the Contractor") will fully complete and execute and submit an Identification ofSubcontractorlSupplisr/Subconsultant Form ("ISF")with each Bid, 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.

Bid/RFP/RFQ Nou

Total Bid or Proposal Amount. 4

Contractor.

Authorized Contact

~

far Contractor; (s~ //~ra/rfess): Je«««fc/f48 i«4-/«r i«vcifr«wl ~

c«nS'ZS /B«4 6fr««F

)Zl*cgn rA:rc TL ii o O(i 4

City, State andZip(Contract~or: i"4~ Inc) )rc, tL CsebfTelephone and Fax(Contractor) e ~ i(f/Vf)

PALS

leos Ii irf laelEstimated Start andCompletion Dates(Contractor)

be/b - cost

Date: /c\ ck

ContractTitle: II rv>o iV l trfSubcontractor/Supplier/Subconsuitsnt to be C F 5 f I f( fv~added or subsfituts:Authorized Contact forSubcontractor/Supplier/Subconsultant: G«« I)vce

Email Address(Subcontractor): i(ceo E iv) A. rc~

Company Address(Subcontramar):

City, State and Zip~ c«t«< bale(a

Telephone and Fax(Subcontractor) I'. (yrc) ""I Vise P: xt'fiefEstimated Start andCompletion Dates(Subcontractor) "(' yrr - V I/ /fca I

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

Descriotion of Services or Suoolies

~«r«(IlrC i ~vf«l 5vv«J)cs c«t( Scr/N «3

Total Price ofSubcontract for

Services or Suoutles

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 anyoiher contract on which it is either a Subcontractor/Supplier/Subconsultant or principal contractor. This disdosure ismade with the understanding that the Contractor is not under any circumstances relieved af its abilities andobligations, and is responsible for the organization, perfonnance, and quality of work. This form does not approveany pmposed changes, revisions or modifications to the contract approved IyIBE/WBE Utglzstlon Plan. Anychanges to the contract's approved INBE/WBE/Utfgzation Plan must be submitted to the Office of theContract Compliance.

Contractor e"u i w 7~v«, I.~c«44

lc««,c uqAL«ts('t<Title

4rc«mr«c«/+ 4ccc««F /4trPrime Contractor Signature

'Phe i/ Zr/ODate

OFFICE OF CONTRACT COMPUANCE

JACQUELINE GOMEZ

DIRECTOR

118 N. Clark, County Building, Room 1020 B Chicago, Illinois 60602 ~ (312) 603-5502

Msy 31,2016

TONI PRECKWINKLE

PRESIDENT

Cook County Board

or Commimianns

RICHARD R, BOYKIN

1st District

ROBERT STEFLE

2nd District

Ms. Shannon E. Andrews

Chief Pmcurement Of/xxu

115N. Chsk Street

Counk/ Building-Room 1016

Chicago, IL 60602

Re: Contmct No. 1430-14165 (Amendment No. 1)

OBcs Furniture

Olfice of Capital Ranning snd Policy

JERRY BUTLER

3rd District

STANLEY MOORE

4th District

DEBORAH SBAS

5th Dlstrict

JOAN PATRICIA MURPHY

6th District

JESUS G. GARCIA

7th District

LUIS ARROYO, JR

8th District

PETER.N~——

9th District

BRIDGET GAINER

10th Distdict

JOHN P. DALEY

11th District

JOHN A FRITCHEY

12th District

LARRY SUFFREDIN

13th District

MBSWBE

CFS 'nslallagons, Inc.

ShtusMBE (6)

Cerhfvha Assn cv

City cfCNcsgo

Commitment

17.5%(Direct)

Pascal MBE and Full WBE Waiver Granted: Due to the specMcallon and necsssmy mqulremsnts for performing Steulntract make It Impossgde oreconomicaly infeasible to divide Ste contract to enable the vendor to uglize MBEB end/or

WBEs in accordance with ths applicable pargcipation.

Revised MBE/WBE forms were used in the dehtrmination of gte responsiveness of ttds contraot.

Slncemly,~

omsz

Contract Compliance Duector

JG/ats

0esr Ms. Andmws

e is in reipt of the abave-reference contract smsndm t

coinpBmcs with the Minmgy. snd Women- owned Business Enterprises (MBE/WBE) Ordinance. ASsr careful retdetu, ithas been determined this amendment is responsive to the Ordinance.

Bldderi htterlor investments, LLC

Orlghssl Contract Vahmi $1,500,000.00

Incmased Contract Vahux $1,500,000.00(Amendment No. 1)New Contract Value: $5,000,000.00

Contnmt Extension: 12 months

New Contract Term: Ock2bsr1, 2016 thmugh September 30, 201T

Conhact Bosh 25% llilBE end 10%WEE

GREGG GOSUN

14th District

Cc: Nkmle Large, OCPO

Sesmesh Lloyd, OCPP

nMOTHY O. SCHNHDER

15th District

JEFFREY R. TOBOLSKl

16th Distdict

SEAN N MORiiiron

17th District $ Fiscal Responsibilhy f Innovative Leadership Trerisperency st Accountability Ir Improved senrices

M BE/WBE LETTER OF INTENT - FORM I

M/WBE Firm: t F5 //dMCE 47k& CPCCertifying Agency: (/')sM /j/C 4//

Contact Person; Qkdk 8ASO Certification Esp)ratios Deto: 0/p/LPGA'fI

Ethnicity: S))r))dd-Add„.:W )A) HA@uSM

Gty/state: PLL4QQ 4~ Ehc ~0tpl ~ Bid/propossi/contracts:I/

Phone: RI2 f4~ f/EBEP Fax:3Qf/Ijnjr g/6'/ FEIN ih z 7- I/I'I ')zrc

Email: /A/W ffsT. Co j/7Ãp5Participation: s/ Direct v/ Indirect

Wgl the M/WBE Rnn be subcontracting any of the goods or services of this contract to another firm)

d No s/ Yas -Please attach evplsnathn. Proposed Subcontractor)a):

The undersigned M/WBE is prepared to provide the fogowing Commodious/Services for the abave named

Project/ Contract: (If more space is nemled ta fully describe M/WBE Finn's pmpased scope of work and/ar

payment schedule, attach additional sheets)

dll LA4r ru res/c~ . sfalarer. /~rArj. c/srnrus. nwo/ r avA o Csp clad'3

f .n.r~:Fmjiar WWmbt, gQ

Indicate the Dolbr Amount, Percentage snd the Terms of Payment for the shmte4escribed Commodities/

Services:

/755

THE UNDEI5IGHED PARTIES AGREE that this Letter of Intent'ig become a bindkrg Subasntrect Agreement for

the above work, aandhlaned upon (1)the Bidder/Proposer's receipt of s signed contract fram the County of

Cooir: )Z) Lindersigned Subcontractor remaining compliant with sll relevant credentials, codes, onlinances snd

statutes requimd by Contractor, Cook County, and the State to participate as s M BE/WBE h'rm for the above

~~deadgaedirsrties-da~eerttfythat~ysgsfnotsrfhxthal~ur~es o thTs document until sll

areas up/or D)rscripgpfrof Service/ Supply and Fee/Cost were completwl.

4/5jn'afore )MAYBE) Signature )prime Nddor/propaser)

Al//8/6///Q rV. AA,'.ArPrint&sme Print. Name

I'FC WSQu./ET/ad. ~ CLFsrr w 4 vv< FvuoH/S

Firm Name Finn Name

3-lf-IF'ate

r//av/ Zero

Date

Suimcribed and sworn before nse

thb +d.y.f itur~,2D~.sins PublicPX//~/:X

ALEfrrhaa 'EALOFsrCIAL 66AL

no>o>r porno, Smoor nornsMr Commissian avsiros

Anni ss> sara

Subscribed and nvorn before me

OPWtfAI. SE)LE.ANTH(Q@gggrt)E)INSTDN

EDBAI

thhmdayM ~I,ZO/'/.Nomry Public

/

Cook County GevernmentM/%BE Reciprocal Certification Affidavit

C(I'-5 /48~47isk. ran.Add -9d'~l (A) 4kÃ/MnJ Chy AA+uC-.ty State Zip kata/2

Phone(P(2. ) 9&5 Vf DD Ennui le (g todg'yd/ S.~~1 4VCM A~, /AM

(/1 rraroraed Repreeenraran) irdin/ Tirie)

of PP9 I+c978~W/d&ll /eg/8 do hereby affirrm/Name af Firm) d

1) ~ I+S7ALLR ~/im)/A dertfC. is a Minority asd/or Women Business Enterprise(Na/ne ofFirm)

currently certifie by the City ofChicago as: [ j Black- (yd) Hispanic- ( ) Asian- [ ) Womatvownedbusiness.

2) With respect to PFS A1SNLCA~lItf//IA(I5/cprssonal net worthofthe qualifying(Name ofFirm)

(51%)individual(s) does not exceed $2,210,847, excluding the individual's ownership interest in theM/WBB finn and t)te equity of the owner's primary residence, and otherwise meets the requirements

of Chapter 34, Article IV of the Cook County Procumment Code, (As per Section 34-263 of theCook County Procurement Code, an individual's personal net worth irdcludes only his or her ownShare of assets held jointly or as community/marnal property with tbe individual's spouse.)

—--a)- -Thexver@rmmmt gross receipts ol PFS l~vA&8 ~iJ d/eq/5

(Name ofFr/err)

as derived from tax filings over the five most recent years, does not.exceed the Small Business SizeStandards published by the U.S.Small Business Aihninistration found in Title 13, Code of Federal

Regu)ations, Part 121.(httn://www.sbadzov/content/smail-businerswzc-standards)

Upon penalty of perjury, I AJ46L +d~ atfirm that,

tother

best of my(/trr/rrae(ee/f ttepre rnnrarlrn)

knowledge an4 belier, the infirnstion hemin is true ra& accurate.

dd ~l / r/d dern I4f' r Qtsk///d

(r d d u r r rn/dt& dr /46L //10//I

ri < ~ Notary's Seal

IMv Coarnaeaien axpiraa

4'sra ts, tet a

DoPARTRRlIT or PaocnanmouT SRBTIcss

CITY OP CRICAOO

'eNuost Normen

CFS InslalWion, lnc.3021 YY. Hwloon 8I.Ch~o, IL eN12

We oln Idusoad io hdonn you4wt CFS I::":=.>hi. has bwn oedNad ae o INnodty.Os«ad „4 — —

f%5NP) byiie ~at Chio@go f~..'nd~:~oeltNoathul IovsN u«N ININANW IusoNer ywr Ill«Pe

—~ nNN hu a=:- anltui4. In Iheluut. Ne Clly hae,luuohhsd yseu wwh an nbiiw'ilthdtar eon5oaho year oelehoNen: ouob hdbaeuN no hulgar-he laswd. Ae a eel~waco, m ooqulle yoo io be oen uwe diligent ln Nnoyour annwl Ne4hb«No ANhtaok N daynhiihna your anwal onnbensuy dots.

It Is tunr your awlulaaNNy to obwdl Ihe ca/0 ~~w 4eahuy wd YRNy'jour ooNI«asonAe a.==:=.,saf~~~s'iNohtNIheNnr yaartradad OQSH ebooets you

aoeat ~an ~.%eC~~.Yata--It«slee anneN u'~ AN4aylt IO due by~s ~efs and~~ds Rance, yw base onh ss ssts .. = ss ~ stsr st Ns:~ st

s~~lgo ~~ s~r s~hrthe oaalwuellll 4r tuse on QfStst s

Your Ilrm'e Iluo.year eer&ealon wN esFhot on WÃ4011. You faro en aNnuaSre duly IRNefor roon ~~4$ daye later to Ibe dabr af Ibe Ibn year Onsbnusely data Theiihtu, youmuat Ne Ilsr ~~hy NNa~L

Rage «ale-~4e ~ln base hnd youl ~~ Iayee andnN be belhhdo lo~o «~4yw%thr.

CFS InshRsfm, Inc. Paye2of 2

~ Flu your annual ~Ne A%da4wuhln ths»qsiod Nms psdcd;~ Pevtde NnanoHI or oNer recants roqusstsd punnsnd to an aw«t w«hln the ntquhed

time perlnd;o Ncdly tho CNy of sny changes a«beds« your Srnrs csr«Nca«on w«hln 10 day» cf such

chan«s> or~ FNs your focsr«iles«sn w«hln ths nutshsd «mo psdsd.

Rsase bs wnHdsd of your ocnhncfual ~n to soapsuds w«h the CNy wNh respect ts anynWhcua, audNS Of Int + % Of Na Cunhacb end essenaselO ae«on lnn«lama. We Shun«lyoncouru«s ycu to assHI us H mnHtelnhqf «» InHtp«y or sur prc«wns hy»por«n« h»hmooeor sucplchns of «aud or abuse to «» CNy'a ~ thaneeal atchhnqpd.-~r«sneeslAnL or 00«dlN.TOLD f 'N).

Bs sdshed thtd If you or youl Nrm H Sund to be lmsdssd In cerNeNan, bhh«ng acdlorocnhnalual Nuud or abuse, ths CNy wlN p»sua deus,~i and ~»M. In aNIon to~ny c«»r psneNy inposed by Iaw, any person who knsnHNly obhdns, or hnowH«ly essHlssno«»r H chteNdn« a contend wNh «» Qly by Ibh»ty ~~ Ihe Hdtrihud or enNy, orihe indkdd»l ar-etNNy aadctsd ls «ulNy of a mHdemo»w, luudshahlo hy Hcan- ', H Ihocounly Q fcr a pe«ed not to osoesd slumoNe, or a 0» of not loss 0»n 00,00«and not nuns«lan 0%0,000 or bc«L

Your Nnn's name,wIN'bo NeHd In ihe CNy's Choctaw of NfhunNy and yucrn~wnod sushsssEnlerpdses H ths spacHftf a»a(CI of:

fhtft«CaAgQNNNN'Nti IAepufntttnn, Naltdur Oyelem, InetnllnSond«NNNtt- Tntahhqf Musd tt- —"~,Otthro, or Inu«tu«eatduunnturo ind Rqulpmsrd

Your Ihm's pndhllru«on on CNy contnnds wlN be cnn«Hd only teased INneritpdhNned

..,,onnNI tuna@I «oahnNfhe «harn coty«uunnh N»l ls aaNK

perfsniied aad pnndtllng a oonunendu«y useful thtudhm that b dana H 0» appnned cpscH«y

Thank you fsr your idoreut H the CNy's N«norNy and lNwnen-Owned Business EntsqnbegdSENIOE) pnupnrn.

~g NN:War1'I I IP»comment Ol«csr

PETITION FOR WAIVER OF IISSWSE PARTICIPATION - FORM 3

A. SIDDE PROPOSER HERESYREOUESTS:

RILL NSE WAIVER RILL WSE WAIVER

p RENICTIOR (PARIIAL MSE andlor WEE PARTICIPATOR)

5( ofReducfionhrMBEPerficipsfhn»I ti»il»»4»»», I» n»»»v~3 t» T~tptll Ytwy»rt% of Reducfianhr WBE Perfidpe5on g n.zf ~a i 3 cF3

B.REASON FOR FULUREOUCTENI WAIVER REOUEBT

Bidder/Proposer shell check each Ism spplicsbls h fis nmson for a waiver request. Additionally, suppargngdccumenle5an shdlbe submitted Wfih INs request.

(1) Lack of suNdent qualSsd MBEs and/or WBEs capable of pravkfing Ihe goods or ssnrices required

bythscontiaaL (Please explain)

2 (2) Ths spetBcafions and necessary requiremerds for performing Im contract male it impossible orecanomhefiy infeesibhlo dvide fire connect h enable the connector to ufilizs hERs and/or WBEs In

accwdam vrith the sppficrhte parbcipsiian. phase explain)

(3) Pric(s) qualed by patsntbd MBEs andlor WBEs are above campefitlvs levels and Increase cost ofdoing business and would make accsphmco of such MBE andfcr WBE bid.ecanamhsfiy impracficabh,

hNng inh cansiderafion fim percentage afhhi contract price represented by such MBE and/or WBEbid. (Phmse sxpltdn)

(4) Thwe sre olher relevant fedora maldng It bnpossibls or economhafiy infeasible h ufilhe MBE sndiarWEE limo, (Phase uuphh)

C.BOOB FAITH EFFORTS TOOBVASI 55BEIWSEPA555ICIPATION

(1) Made fimsiy wrfihm ~to iden5fied NKs snd WBEs for ufilizafion of goads and/or seniioes;— -endpnnided-MSEemtdWBEswlth stiaudyopporlunitylotmriew and otriain rehnmhf dpedfiiidhns,

terna and comliiians tdtw proposal to snabh MBEaahd WBEs ta pmpms en infmmsd response toacficgafion, (ANach ofcopy wrINnn sogcSrdhns made)

(2) Used gw services end smdshmce af the Oghe of Canirsct Compksnce shff. (Phase exphin)

(3) Timely nafilieil and used gw seNlces snd eashlanoe of commungy, mlnorfiy snd women business

orgarrizsfiorm. (ASaoh of eopywrISen eoStdtaEans made)

(4) Fofiawedup on infihl sofidhBon cfMBEs and WBEs to eeteimine if firms are interested in doing

business. (Athmh suppeNng dacunssdnfihm)

(5) Engaged MBEs A WBEs for direcgindimct perficipefian. (Phase exphln)

O. OTHER INIUINAMT INFORMAWBM

Attach any othsr documsahganrsistive to Good Faith Efhrts in complying vrith MSEIWBE pai5cipafian.

O»t.w~ »k»,ta;tt~ (v~g f„~ Eggvt, fi»)IN,t

rvVvvsE Utluzatian prsn - Form 3 nevlted: 01/zsy14

In the process of delivering best value services to Cook County Interior Investments'ood Faith Effort

to subcontract as much work as possible to MBE Ik WBE vendors can be seen as fogows:

when providing contract furniture to Cook County the areas of performance are as follows:

~ Furnltura Actual product, procured for Cook County by interior Investments via select local

government contracts: "USCommunities", TCPN, and NAIPA for maximum value. This is thecomponent that Intedor Irwestments handles as the regisiured dealer of the applicable

manfacturars.

v Installation BRelated Labor. To be provided by MBE subcontractor CFS installations. Roughly

17.5%ofany given project.

~ Design Services: InterIor Investments "could" subcontract this out, to increase either MBE/wBE

participadon, however, as Interior Investments considers this service integral to good customer

service, we already pnwide this for free via internal staff, so if we subcontracted it out, we

would be increasing costs to the county without adding value.

~ project Management Servkes: Once again, like design, Interior Investments 'could" subcontract

this out, to increase either MBE/WBE participation, however, as Interior Investments considers

this senrice integral to good customer service, we already pmvide this for free via internal staff,

so if we subcontracted it out, we would be increasing costs to the county without adding value.

~ MISC: any additional servkes ie: warehousing, mockups, education will already be provided by

Interior irwestments as standard service free of charge, or if in the case of Iong term storage,

wouldhe haridled by the already subcontracted CFS.

In summation, we believe that saving the county as much as 20% of costs on any given job is a

considerable savings and not one to be thrown away, and thus request the waiver of the remaining

MBE/WBE partidpation percentages.

CONTRACT NO.'l430-14165

COOK COUNT%ECGNGNIIC DISCLOSURE STATEfifiENT

AND EXECUTtGN DOCUMENTINDEX

Section Description

Instructions for Completion of EDS

Certifications

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 i- ii

EDS 1-2

EDS 3 —12

EDS 13-14

Contract and EDS Execution Page

Cook County Signature Page

EDS 15-17

EDS 18

CONTRACT NO J430-14165

SECTION 1IMSTRUCTIIGNS FGR COMPILE'll'IGM GF

ECOMOIIIIIC DISCLOSURE STATEMENT ANQ EXECUTION DQCUMIENT

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

Definitions. Terms used in this EDS and not otherwise defined herein shall have the meanings given tosuch terms in the Instructions to Bidders, General Conditions, Request for Proposals, Request forQualiTications, 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 s 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 llenlure 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 Certifications hereinafter set forth.

Proposal means a response to an RFP.

Proposer means a person submitting a Proposal.

Response means response to an RFQ.

Respondent means a person responding to an RFQ.

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

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

EDS-i 8/2015

CONTRACT NO.1430-14185

IlNSTRUCTIGNS FGR COIVIPLETIGN GFECQNGIIIC li>ISCLQSURE STATENIENT AND EXECUTION DGCUINENT

Section 1: instructions. Section 1 sets forth the instructions for completing and executing this EDS.Section 2: Csrtlffcations. Section 2 sets forth certifications that are required for contracting parties underthe Code and other applicable laws. Execution of this EDS constitutes a warranty that all the statementsand certifications contained, and all the facts stated, in the Certifications are true, correct and complete asof the date of execution.

Section 3: Economic and Other Disclosures Statement. Section 3 is the County's required Economicand Other Disclosures Statement form. Execution of this EDS constitutes a warranty that all theinformation provided in the EDS is true, correct and complete as of the date of execution, and binds theApplicant to the warranties, representations, agreements and acknowledgements contained therein.

Required Updates. The Applicant is required to keep all information provided in this EDS current andaccurate. In the event of any change in the information provided, including but not limited to any changewhich would render inaccurate or incomplete any certification or statement made in this EDS, theApplicant shall supplement this EDS up to the time the County takes action, by filing an amended EDS orsuch other documentation as is required.

Additional Information. The County's Governmental Ethics and Campaign Financing Ordinancesimpose certain duties and obligations on persons or entities seeking County contracts, work, business, ortransactions, and the Applicant is expected to comply fully with these ordinances. For further informationplease contact the Director of Ethics at (312) 603-4304 (69 W. Washington St. Suite 3040, Chicago, IL60602) or visit the web-site at cookcountyil.gov/ethics-board-ot'.

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, inwhich 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 acertiTied 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" operating 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.

6DS-ii 8/2015

SECTION 2

CERTIFICATIOMS

CONTRACT NO,1430 14165

THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE. THE APPLICANT IS CAIJTIONEDTO CAREFULLY READ THESE CERTIFICATIONS PRIOR TO SIGNING THE SIGNATURE PAGE. SIGNING THE SIGNATLIREPAGE 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 QF THEPOLI OWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACT ENTERED INTO WITH THE APPLICANT SHALLBE SUBJECT TO TERMINATION.

PERSONS AMD ENTITIES SUBJECT TO DISQUALIFICATION

No person or business entity shall be awarded a contract or sub-contract, for a period of five (5) years fnxn 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 lfilnois, of bribery or attempting to bribe an ofticer oremployee of a unit of stats, federal or local government or school district in the State of lfilnois 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 rig bids as definedin the Sherman Anti-Trust Act and Clayton Act. Act. 15 U.S.C. Section 1 ef seq.;

3) Has been convicted of bid-rigging or attempting to rig bids under the laws of federal, slate or local government;

4) Has been convicted of an act committed, within the State, of price fixing or attempting to fix prices as defined by theSherman Anti-Trust Act and the Clayton Act. 15 U.S.C. Section 1, el sag 3

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

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

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

8) Has entered a plea of nolo conlendere to charge of briibery, 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 enfily committed the Prohibited Act on behalf of the business entity and pursuant to the direction

or'uthorizationof an officer, director or other responsible official of the business entity, and such Prohibited Act occurred withinthree years prior to the award of the contract. In addition, a business entity shall bs disqualified if an owner, partner orshareholder controlling, directly or indirectly, 20% or more of the business entity, or an offlcer of the business entity hasperformed any Prohibited Act within five years prior to the award of the Contract.

THEAPPLICANT 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 the provisions of such Section or of the Code.

BID-RIGGING OR BID ROTATING

)HE APPLICANT HEREBY CERTIFIES THAI r in accordance with 720 ILCS 5/33 E-lf, neither the Applicant nor anyAlfilialed Entity is barred from sward of this Contract as a resull ol a conviction for the violation of State laws prohibii'ing bid-rigging or bid rotating.

DRUG FREE WORKPLACE ACT

'THE APPLICANT HEREBY CERTIFIES THAT: The Applicant will Provide a drug free workPlace, as required by (30 ILCS 580/3).

EDS-fi 8/2015

CONTRACT hi0.1430-14165

DELiNQUEMCY IM PAYMEMT QF TAXES

TIIE APPLICAIIIT HEREBY CERI IFIES THAI: The Applicant is nol an owner or s party responsible Ior the payment of any tsxor fee administered by Cool; County, by a local municipality, or by the llfinois Depaifment of Revenue, which such tax or fise isdelinquent, such es bsr sward of s contract or subcontract pursuant to ths Code, Chapter 34, Section 34-171.

HU66AM RIGHTS ORDINANCE

Mo person whc is a party to a contract with Cook County ("County" ) shall engage in unlawful discrimination or sexual harassmentagainst any individual in the terms or conditions of employment, credit, public accommodations, housing, or provision of Countyfacilities, services or programs (Code Chapter 42, Section 42-30 et seq.).

ILLINOIS HUMAN RIGHTS ACT

THE APPLICANT HERES 7 CERTIFIES 7HATr ll is in comPliance with ttre Illinois Human Rights Act (775 ILCS fir2 105) sndagrees to abide by the requirements of ttie Act as part of its contractual obligations.

IIMSPECTQR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTION 34-'I74 and Section 34-250)

The Applicant hss not willfully failed to cooperate in an investigation by ths Cook County Independent Inspector General or toreport to the Independent Inspector Geneml any and all information concerning conduct which they know to involve corruption, orother criminal activity. by another county employee or official, which concerns his or her office of employment or County relatedtransaction.

The APPlicant bas reported directlY and without any undue delay any suspected or known frauduient activit„ in the C untProcurement process to the Office of the Cook County Inspector General.

CAMPAIGN CQMTRISUTIQNS (CQQK COUNTY CODE, CHAPTER 2, SECTION 2-565)

THE APPLICANT CERTIFIES THAT: lt has read and shall comply with the Cook County's Ordinance concerning campaigncontributions, which is codified at Chapter 2, Division 2, Subdivision 6, Section 585, and can be read in its entirety atwwiv.> uriicods. om.

GIFT SAN, (CQQK COUNTY CODE, CHAPTER 2, SECTiON 2-574)

THE APPLICANT CERTIF656 THAT: It has read and shall comply with the Cook County's Ordinance concerning receiving andsoliciting gifts and favors, which is codified at Chapter 2, Division 2, Subdivision II, Section 574, and can be read in its entirety at~mvw.musico 'c.con ..

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

Unless expressly waived by the Cook County Board of Commissioners, ths Cods requires that a living wage must be paid toindividuals employed by a Contractor which has a County Contract and by afi subcontractors of such Contractor under a CountyContract, throughout the duration of such County Contrack The amount of such living wage is annually by the Chief FinancialOfficer of the County, and shall be posted on the Chief Procurement Otticsr's 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 recognized under the lfiinois State not-for -profit law);

2) Community Development Block Grants;

3) Cook County Works Department;

4) Sheriff's Work Alternative Program; and

5) Department of Correction inmates.

8/2015

CONTRACT NO,1430-14165

SECTION 3

RECIUIRED GISCILQSURES

DISCLOSURE OF LOBBYIST COMl ACTS

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

Name Address

2, LOCAL BUSINESS PREFERENCE STATEIIENT (CODE, CHAPTER 34, SECTION 34.230)

Local business means a Person, including a foreign corporation authorized to transact business in illinois, having a bona fideestablishment located within the County at which it is transacting business on the date when a Bid is submitted to the County, andwhich employs the majority of its regular, full-time work force within the County. A Joint Venture shall constitute a Local Business it oneor more Pemons that qualify as a "Local Business" hold interests totaling over 50 percent in the Joint Venture, even if the Joint Venturedoes not, at the time of ths Bid submittal, have such a bona fide establishment within the County.

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

Y-: No:

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

7 e 5" iuvte V Q~~LX~c tkivs, 5~;tc I>46

Ckr~wes. 7L iLdtta Ojr

c) Does Applicant employ ths majority of its regular full-time workforce within Cook County?

Yes: No:

3. THE CHILD SUPPORT EMFORCEINENT ORDINANCE (CODE, CHAPTER 34, SECTIOM 34 172)

Every Applicant for a County Privilege shall be In full compliance with any child support order before such Applicant is entitled to receive orrenew a County Privilege, When delinquent child support exists, the County shall not issue or renew any County Privilege, and mayrevoke any County Privilege.

All Applicants are inquired to review the Cook County Affidavit of Child Support Obligations attached to this EDS (EDS.5) andcomplete the Affidavit, based on llhe Instructions in lihe Affidavit.

EDS-3 5/2015

CONTRACT NO 1430-14165

4, REAL ESTATE OWNERSHIP DISCLOSURES.

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

a) The following is a complete list of all reel estate owned by the Applicant in Cook County:

PERMAMEMT INDEX NUMBER(S):

(ATTACH SHEET IF NECESSARY TQ LIST ADDITIQNAL INDEXNUMBERS)

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

EXCEPTIONS TO CERTIFICATIOMS OR DISCLOSURES.

lf the Applicant is unable to cerlify to any of the Certifications or any other statements contained in this EDS and not explained elsewhere jnthis EDS, the Applicant must explain below:

lf the letters, "NA", the word "None" or "No Response" appears above, or if the space is left blank, it will be conclusively presumed that theApplicant cerbTied to all Certifications snd other statements contained in this EDS.

EDS-4 8/2015

CONTRACT hi0,1430-14165

The Cook County Code of Ordinances (62-610 el seq.) 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 in

Statement will be maintained in a database and made available for public viewing.

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

"App//canl" 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 "Legs/ Entily" means a sole proprietorship, corporation, partnership, association, business trust, estate, two ormore persons having a Joint or common interest, trustee of s land trust, other commercial or legal entity or any beneficiary 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 and is listed on the Applicant's Statement (a "Holder") must file aStatement and complete ¹t only under Ownership Interest Declaration.

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

This Statement Is being made by the [ vt ] Applicant or [ ] Stock/Beneficial Interest Holder

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

Idlen'dfying Informstiion:

Name +~ (amex

D/B/A: X f.s ]we 7~vvr Fmvn4

Street Address: y 5 e Puo~vt, 9 ).rsr,¹

City: LtmLv( n 1L(xs

Phone No: [, f/%1 ) 3K'' /seeState:

Fax Number:

FEIN NO, Bbg //0

Zip Code: gf Ou 5

Email: sva~rvsfry (@~n/vrv'ovr'nvfrMr~/F seer<

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

Corporate File Number (if applicable):

l=orm of I egal Entity:

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

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

[ ] Other (describe)

EDS-6 8/2015

CONTRACT NO.1430-14165

Ownership Interest Declaration:

List the name(s), address, and percent ownership of sech Person having s legal or beneficial interest (including ownership) ofmore then five percent (5%) ln the Applicant/Holder.

Name Address

$ )d j],n[ Sl-wr.i-, j'...(,],frr.7Z

Percentage Interest in

Applicant/Holder

'//fy.

zc i„

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

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

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

If yes, state ths name, address and percentage of beneficial interest of such person, and the relationship under which suchcontrol is being or msy be exercised.

Name Address Percentage ofBeneficial Interest

Relationship

Corporate Officers, Members and Partners Information:

For all corporations, list the names, addresses, and terms for all corporate officer. For all limited lisbllily companies, list the names,addresses for sll members. For sll partnerships snd joint ventures, list the names, addresses, for each partner or joint venture.

Name Address Title (specify title ofOffice, or whether manageror partner/joint venture)

Term of Office

Declaration (check the applicable box):

[ v ] I state under oath thai ths Applicant hss withheld no disclosure as to ownership interest in the Applicant nor reservedany information, data or plan ss to the intended use or purpose for which the Applicant seeks County Board or other County

Agency action.

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

EDS-7 8/2015

CONTRACT bio,f430

COOK COUNT% DISCLOSURE GF Ot/I/MERSHllts IIMTEREST STATEIIIIEMT SIGMATUIRE PAGE

6s.s r ~r. /A snl s9dk 4 I scfma+ Aosf,Name of Authorized APPlicant/Holder Regresentative (Please Print or tyPe) Title

siss flldtll,

Signature Date

e/~aors.f ts P) r wknsr rnvss(-rnynQ ps~ Cvetr3 ') Sf - WyoE-mfil address Phone Number

Subscribed to and sv/orn before me

this ", 'ay of '"', 20,'.

:: ='/'iP@<Nofary Public Signature

II/Iy co

Notary Seal

EDS-8 8/2015

CONTRACT NO.1430-14185

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

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

N~eotiism Disclosure Requirement:

13oing a significant amount of business with the County requires that you disclose to the Board of Ethics the existence of arty fariiiiialrelationships 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 completiug the attached familial disclosure form because, among other potential penalties, any person found guilty offailing to make a required disclosure or luiowingly filing a false, misleading, or incomplete disclosure will be prohibited front doingany business with the County for a period of three years. The required disclosure should be filed with the Board of Ethics by JanuaryI of each calendar year in which you are doing business with the County and again with each bid/proposal/quotation to do businesswith Cook County. The Board of Ethics 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 fiom 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:

a its board of directors,o its officers,

its employees or independent contractors respousible for the general administratimi of the entity,o 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.

Adldliitiional Definitions:

"Fanriiia) relationship" means a person who is a spouse, domeslic 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 oAicial, whether by blood, marriage or adoption, asrc

0 Parent

0 ChildBrotherSisterAunt

UncleNiece

0 Nephew

GrandparentGrandchildFather-ui-lawhdotherin-lawSon.in-lawDaughter-in-lawBrother-in-lawSister-in-law

Stepfather

0 Stepmother

0 StepsonStepdaughterStepbrother

0 StepsisterP Haifbrother

0 Haifsister

EDS-8 8/2015

CONTRACT NOA430-14185

COOK CGUNTV BOARD OP ETHICSPAMILEAU RELATkONSIHP BISCILOSURE PGRM

PERSON DOING GR SEEICING TG BG BIUSINESS eh>ITH THE CQIUNTV

Name of Person Doing Business with the County: Gee>ac h ic.ka4i ah.a>et at.t i

Address of Person Doing Business with the County; 101$( M Bv> * Ci>c(c, (I eh )hti(si

Phone number of Person Doing Business with the County; ())6'g ) 7 tl hq90

Email address of Person Doing Business with the County: < >sean 'a kin « Ie>re >r»>i»>s brr>eo >S, <~If Person Doing Business with the County is s Business Entity, provide the name, title and contact informatioii for theindividual completing this disclosure on behalf of the Person Doing Business with the County:

DESCRIPTION OP BUSINESS WITH THE COUNTVAppend additional pages as needed andfor each County lease, contract purchase or sale sought andyor obtainedduring the calendar year of this disclosure (or the proceeding calendar year ifdisclosure is made on January I),Ide>itlfyi

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:

4&~d'q'hl> ~ I ql ta 6

The aggregate dollar value of the business you are doing or seeking to do with the County: $ I>frsp> wpa" $>~g~f hy

ae>$

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

N)itcsl e Iu~er ka>hu C.oa>~J. fr)stat>afar'he

name, title and contact infoimation for the County official(s) or employee(s) involved in managing the business you aredoing or seeking to do with the County:

5k> >)e >h'kl>r ra pi > >>>f Dt r > vfc> @tare>e>e 0 Aswl yqh >>ef

C. DISCLOSURE GF PAMII.IAIL REILATIONSHIPS WITH COUNTY EMPI,GVEES OR STATE. CQUNTV QRMUNICllPAI, EILECTEIU OPPICIAILS

Check the box that applies and provide related information where needed

The Person Doing Business with the County iis an indiividual and there is no farmiilial i ellationsliiip 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 emtity and there is no familial ielationshilp 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 eleciive office in theState of Illinois, Cook County, or any municipality within Cook County.

EDS-10 8/2015

CONTRACT MOAASII th185

COOK CQIJXTV BOARD QP KTIIICSPAhiII,IAL RREATIONSEP DISCI QSIIRIg PQRWii

Ij The Person Doiug Business with the County is an iindlividual and tires e is a familiial i eiatfionsliip 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 famiillial i elatlonships ai e as follows:

Name of individual Doing

Business with the County

Name of Related County Title and Position of RelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Official or Municipal Elected Officia

Nature of FamilialRelationship

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

The Person Doing Business with the County is a business entity snd there is a famihal relationslhip between at least onemember of this business entity's board of directors, 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 inconnnctual 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 reiationshdps are as foffews;

Name cfMember ofBoaidof Director for BusinessEntity Doing Business with

the County

Name of RelatedCounty Title snd Position of RelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Official or Municipal Elected Officia

Nature ofFamilialRelationship

Name ofOfficer for Business Name of Related County Title aud Position of Related Nature of FamilialEntity Doing Business with Employee or State, County or County Employee or State, County Relauonship*the County Municipal Elected Officia or Municipal Elected Ofgcial

EDS-11 8/2015

CONTRACT 6!O,1480 14 ~ 85

Name of Person Responsible

for the GeneralAdministration of theBusiness Entity DoingBusiness with the County

Name of Related County Title aud Position of RelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Ofiicial or Municipal Elected Official

Nature of FamilialRelationship

Name of Agent Authorized

to Execute Documents forBusiness Entity DoingBusiness with the County

Name of Related County

Eaiployee or State, County orMunicipal Elected Official

Title and Position of Related Nature of FamilialCounty Employee or State, County Relationshipor Municipal Elected Otficiat

Name of Employee ofBusiness Entity DirectlyEugaged in Doing Businesswith the County

Name of Related County Title and Position ofRelatedEmployee or State, Couniy or County Employee or State, CountyMunicipal Elected Ofiicial or Municipal Elected Official

Nature of FamilialRelationship*

Ifmore space is needed, attach an addiiianal sheer following the abovefonnat.

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

~ nn tstva='P

Signature ofRecipient Date

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

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

EDS-12 8/2015

CONTRACT NO.1430-14165

Effsctlve ktsy 1 2015 every Person Includlna Substsnual Owners seeking a Contract with Cook County must comply with the Cook County Wage Th ffOrdinance set forth In Chapter 34, Article IV, Seclion 179. Any Person/Substantial Owner, who fallk to comply with Cook County Wage Then Ordjnance,may request that the Chief Procurement Officer grant s reduction or waiver in accordance with Section 34-179(d).

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

"person" means any individual, corporation, partnership, Joint Venture, trust, association, limited liability company, sole prapnetarship or other legai entity

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

"substantial owner" means any person or persons who own or hold a twenty-five percent (25%) or more percentage of Interest in any business antsyseeking a County Privilege, including those shareholders, general or limited partners, benelicianes and principals; except where a business entiiy is anindividual or sole proprietorship, Substantial Owner means that individual or sole proprietor.

Ag persons/Substantial Owners are required to complete this affidavit and comply with the Cook County Wage Theft Ordinance befare any Contract isaurarrled Signature of this form constitutes a certification the information provided below is correct and complete, snd that the individual(s) signing this formhas/have personal knowledae of such Information.

I. Corttract Information:

Contract Number: Iur30 "llqibg'ounty

Using Agency (requesting Procurement).

III. Person/Substantial Owner Information:

Person (Corporate Entity Name): Lnfxrrsr %nues) see IS I Z 5 Inner T~c )

Substantial Owner Complete Name: )-ran Gfnair non

FEINtf >trN Ile esty

Date of Birth:

Street Address: q2 /j @Fib

Email address: LS(snnen fb)nferrw rnurrs I~enface~

City: Lrrnv (4 seve

Home Phone: (~8'I ) )IS b - I 1ee

State:

Driver's License No

Ztp: (ee'Sgrr

gi. Compliance with Wage ILaws:

Within the past five years has the Person/Substantial Owner, in any judicial or administrative proceeding, been convicted of, entered aplea, made an admission of guilt or hability, or had an administrrative finding made for committing a repeated or willful violation of any ofthe following laws:

illinois yyege Peymeni and Collection Act. 820 ILCS 115/1 et seq., YES or QQ

illinois Minimum I4/age Act, 820 ILCS 105/1 et seq., YES or IQ

illinois lrirorker Adjustment end Retre/ning Notrfrcetion Act, 820 ILC3 65/1 et seq., YES or

Employee Classification Act, 820 ILCS 185/1 et seq., YES or gPFair Labor Standards Act of 1938, 29 0 3 C. 201, ei seq., YES or(t)Dy

Any comparable state statute or regulation of any state, which governs the payment of wages YES orQ

lf the person/Substantial Owner answered "Yes" to any of the questions above, it is Ineligible to enter into a Contract wtth CookCounty, but can request a reduction or waiver under Section IV.

EDS-13 8/2015

CONTRACT Iqr0.1430 141SS

IV, Request for Waiver or Reduction,

If person/Substantial Owner answered "Yes" to any of the questions above, it may request a reduction oi waiveraccordance with Section 34-179(d), provided that the request for reduction of waiver is made on the basis of one or more ofthe following actions that have taken place;

There has been s bona fide change in ownership or Control of the ineligible Person or Substantial OwnerYES or NO

Disc/pl/nary ection has been taken against the individual(s) responsible for the acts giving rise to the vlo/ation

YIES or NO

Remedial ection hss been taken to Prevent s recunencs of the acts giving rise to the disquslif'icado

YES or NO

Other factors that the Person or Substantial Owner believe are relevant.

YES or NO

II statements contained in the Affidavit are true, accurate and complete

Date/v-:,".!':l.-.

4Signature:

Name of person signing (Print); i'.,r:-4 ' I"','i 'vi:-'':r'itle:4

Su6scribed and swatnfo trefore me this, day of

Notary Public Signature Nol((ry SealNoter The above information is subject to verification prior to the sward of the pntracl(t

20

The personrSubstant/a/ Owner must submit documentation to suooort the basis of its reauest for a reduction or waiver. The Chiefprocurement Off/cer reserves fhe ri aht to make additional inaui ries and reauest additional documentation.

V. AfSrmationThe Person/Substantial Owner a

EDS-14 II/201 5

CONTRACT NO.1430-14165

SECTION 5

CONTRACT AND EDS EXECUTION PAGEPLEASE EXECUTE THREE ORIGINAL PAGES OF EDS

The Applicant hereby certifies and warrants that all of the statements, csrtlflcations and representations set forth in this EDS are true,complete and correct; that the Applicant is in full compliance and wilt continue to be in compliance througtiut the term of the Contract orCounty Priivilege issued to the Applicant with all the policies and requirements set forth in this EDS; and that all facts and information

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

writing if any of such statements, certiftcations, representations, facb or information becomes or is found to be untrue, incomplete orIncorrect during the term of ths Contract or County Privilege.

J J ('~ap'XleCorporation's Name

Execution by Corporation

VISJt grrrtretrv Nvsejeeferr jvr Qen S4anrrssePresident's Printed Name and Signature

(ffet73 Sl 5- lssoTelephone

klsjrassmre &> lrrprsrer I rrvas jvetsrJl . terre

Email

Secretary Signature

5/sl (z fl,Date

Execution by LLC

LLC Name *Member/Manager Printed Name and Signature

Date Telephone and Email

Execution by Partnership/Joint Venture

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

Date Telephone and Email

Execution by Sole Proprietorship

Printed Name Signature Assumed Name (If applicable)

Date Telephone and Email

Subsstjt jed and

Notary Public Kgnafure

My commission expires:

Notary Seal

syattaif F.arcsOFFICIAL SEAL

Notary psbtto - stele ot illinoisuy Comm@eton Srrolme

osrossr sr, esty

"If the opersfing agreemsnt, partnership agreement or governing documents requiring execution by multiple members, managers,partners, or joint venturers, please complete and execute additional Contract and EDS Execution Pages.

EDS-15 8/2015

l InteriorInvestments„.C res ling Hnsncisrrr responsive swee environments

550 Bond StreetLincolnshire IL 60060Fo 847.325.1000F:847.325.1001www interiorinvestments corn

To: Cook County ProcurementRE: Corporate Resolution on Contracts

In the matters of government contracting, George Maniatis is an authorized signatory forInten C

Sign

Don

j%el. ~g) ZO)4

Steve Rice

OFRCIAL SEALtartary pablfo - slate el enate

trv Commttwonistgae

7.otic C my~>

File Number 0010353-5

atmwaaaa ~

To all to aohom these Presents Shall Come, Greeting:

I, Jesse White, Secretary of State of the State of IllirIois, do hereby

certify that I am the keeper of the records of the Deparhnent ofBusiness Services. I certify thatINTERIOR INVESTMENTS, L.L.C.,HAVING ORGANIZED IN THE STATE OF ILLINOIS ONFEBRUARY 10, 1997,APPEARS TO HAVE COMPLIED WITH ALL PROVISIONS OF THELIMITED LIABILITY COMPANY ACT OF THIS STATE, AND AS OF THIS DATE IS IN GOODSTANDING AS A DOMESTIC LIMITED LIABILITY COMPANY IN THE STATE OF ILLINOIS.

In Testimony 8%ereof, I hereto set

nIy hand and cause to be affixed the Great Seal ofthe State of Illinois, this 21ST

day of APRIL A.D. 2016

Authentication B. 1Bt 1201138veritable until 04/21/201 7

Authenticate at. hhp://www.ct/bentnveitttnoie.corn

CERTIFICATE OF LIABILITY INSURANCEDATE (MM/OD/YYYY)

I 6/1/2016THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAllVELY AN)END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACf BETWEEN THE E)SUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIRCATE HOLDER.

IMPORTANT: If the certificate holder Is an ADD)llONAL INSURED, the Pogcy(les) must be endorsed. If SUBROGATION IS WAIVED, sub)sct tothe terms end conditions of the poBcy, certsln pogclss may require sn endorsement. A smtement on this cmtiacats doss not confer rights to thecertificate holder in Beu of such endomementlsL

PRODUCER Unfed": Heather VoceATB)ur J. Gallagher Risk Management Servfces, Inc.

630-28Two Pierce Place lair.'f uwt fsff: u*t. 630-285-4006Itasca IL 60143-3141 ~~„'ee. heather voceajg.corn

INSURED

Interior Investments, LLC550 Bond StLincolnshire, IL 60069-4207

SSURER(S) AFFORDING COVERAGE

WSURER A:LM Insurance Corooration

INSURER e:Libertv Mutual Fire Insurance ComoassuRER c:LibertV Insurance Corporation

BMURER D:Emplovers Insurance Company of WausEISURER E:

NAIC S

33600230354240421458

GEN'L AGGREGATE UMIT APPLIES PER:

POLICY ~X JFCT ~X LCC~ PRC-

OTHER'

AUTOMOBILE LMBIUTY A52-Z91-456932-026

X ANY AUTO

x ALL HIINED gc()22ULEDI)I(NJyWNEDX HIRED AUTOS AUTOS

C X UMBRELLA LMB ~X OGGUR THY-Z91-456932-045

Excess uneI I cUVMSMADE

DED IX

I RETENTION $ 1D.000

D WORKERS CONIFENSARONAND EMPLOYERS'ASILD Y TINANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/blEMSER EXCLUDED7(Mandatory In NN)If res, descrfbe underDESCRIPTION OF OPERATIONS below

5/15/2016 5/15/2017 EACH OCCURRENCE $15,00D,000

$15,00D,000AGGREGATE

5

X I ST/LTUTE I ER

E.L.EACHACCIDENT $1,000,000

WCC-Z91H659S2-016 6/16/2016 5/15/2D17

E L. OMEASE - EA EMPLOYEE $1,000,000

E L DISEASE - POLICY LIMIT $1,000,000

WSURER F:COVERAGES CERTIFICATE NUMBER: 985014400 REVMION NUIBBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTVSTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. Lal)TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS

MSR ItUUL uufsn POLICY EFF POUCY EXPLTR IYPE OF INSURANCE fNnD WVD POLICY NUMBER /MM/DOIYYVYI fetM/DD/YYYYt UMRS

A X COMMERCIALGENERALLIABIUIY Y TB5-Z91-456932-066 5/1 5/2016 5/1 5/2017 EACN OCCURRENCE $1 000 000DAMAGE To RENTEOCLAIMSalADE X OCCUR PREMISES fE I $500,000

MED EXP (Any one bereonl $10,000

PER!!ONALILADV INJURY $1,000000GENERAL AGGREGATE $2,0D0,000

PRODUCTS - COMP/OP AGG $2,000,0006

5/15/2016 5/15/2017 UUMUNvuufNt'LULfMff(Ea acddsntl 1,000,000eooILY INJURY (Per person)

BODILY INJURY(Perecdden$ $VNUVanr T DAMAGElPeracddentl

6

DEBORIp TIDN 0F 0FERRY)ONE I LocATI0Ns f vsdcLee (AODRD 1$1,Adadional Rema/be Ssbeduls. may bs aNaobed Nmwe spaos fs rebut fuel

RE: Contract ¹:1430-14165Cook County, its othe)a)6, employees and agents are shown as additional insured with respect to General Liability as evidenced herein on aprimary/non-contributory basis and Auto Liability coverage as required by written contract with respect to the work performed by the namedinsured. Umbrella Liability follows form.

CERTIFICATE HOLDER CANCELLATION

Cook County Criminal Courts Administration Building2650 South California Avenue, Room 526Chicago)L 60608USA

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORETHE EXPIRATMN DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROWSIONS.

A~UDRlzec INPRMENTATR/E

ACORD 25 (2014/01)09 $000-2014 ACORD CORPORATION. AB rights reserved.

The ACORD name and logo BFD registered msdm of ACORD