ORDERING INFORMATION

Item Description

(manufacturer, model, serial number, feature, etc.) Qty One Time Charge

Unit Extension

1.

4 ounce RX Destroyer

$19.00

Page Total:$ 95.00

BOA Total (if multiple pages):$

State of Illinois Chief Procurement Office General Services 1 BOA under $50,000 V.23.2

ADDITIONAL INFORMATION / REFERENCES / ATTACHMENTS

1. Bids Due: by 11:00 am CST on 04/02/2026.

2. Bids must be submitted through BidBuy or email to the solicitation contact on page one. Only electronic submission will be accepted.

3. VENDOR: All the requested items must be delivered within 30 days of Vendor being awarded contract unless another timeframe is agreed upon between

Vendor and Agency designee.

4. Pricing for all commodities and/or equipment shall be in accordance with the unit of measure specified in the Pricing Section and only one unit price shall be quoted per item unless otherwise stated. All extensions and totals requested shall be shown. Prices quoted must be net after deducting all trade or quantity discounts.

5. Agency reserves the right to award bid in whole or in part.

6. Signed BOA with bid information needs to be submitted through BidBuy. Agency must have fully executed BOA, signed, and dated by both parties, prior to product being sent to the Agency by Vendor.

7. The vendor will be responsible for shipping or delivery of the parts to the Agency. Prices must be F.O.B. DESTINATION with all transportation and handling included and paid by the Contractor. Deliveries are accepted Monday through Friday, 8:00 a.m. to 1:30 p.m., excluding state holidays. Delivery to be made to the facility’s warehouse receiving dock.

8. The use of a brand name is for the purpose of describing the standard of quality, performance, and characteristics desired and is not intended to limit or restrict competition. "Or equal" submissions will not be rejected because of minor differences in design, construction or features that do not affect the suitability of the product for its intended use. Burden of proof that the product is equal is on the bidder.

State of Illinois Chief Procurement Office General Services 2

SIGNATURES The undersigned parties agree to theseterms and conditions.

Vendor State of Illinois

Signature:

State Agency:

Printed Name: Ethan Miller Signature agency representative:

Title: Member Printed Name:

Date: 4/3/26 Title:

Date:

State of Illinois State of Illinois

Signature agency representative: Signature agency representative:

Printed Name: Printed Name:

Title: Title:

Date: Date:

State of Illinois Chief Procurement Office General Services 3 BOA under $50,000 V.23.2

Levorne Clemons/MSE

Center Supervisor

04/03/2026

STATE OF ILLINOIS

STANDARD TERMS AND CONDITIONS

1. PAYMENT TERMS AND CONDITIONS:

1.1. Late Payment: Payments, including late payment charges, will be paid in accordance with the State

Prompt Payment Act and rules when applicable. 30 ILCS 540; 74 III. Adm. Code 900. This shall be

Vendor’s sole remedy for late payments by the State. PaymenttermscontainedonVendor’sinvoices shall have no force and effect.

1.2. Minority Contractor Initiative: Any Vendor awarded a contract under Section 20-10, 20-15, 20-25 or

20-30oftheIllinoisProcurementCode(30ILCS500)of$1,000ormoreisrequiredtopayafeeof$15.

The Comptroller shall deductthefeefromthefirstcheckissuedtotheVendorunderthecontractand deposit the fee in the Comptroller’s Administrative Fund. 15 ILCS 405/23.9.

1.3. Expenses: TheStatewillnotpayforsuppliesprovidedorservicesrendered,includingrelatedexpenses, incurredpriortotheexecutionofthiscontractbythePartieseveniftheeffectivedateofthecontractis prior to execution.

1.4. Prevailing Wage: As a condition of receiving payment Vendor must (i) be in compliance with the contract, (ii) pay its employees prevailing wages when required by law, (iii) pay its suppliers and subcontractorsaccordingtothetermsoftheirrespectivecontracts,and(iv)providelienwaiverstothe

State upon request. Examples of prevailing wage categoriesincludepublicworks,printing,janitorial, window washing, building and grounds services, site technician services, natural resource services, securityguardandfoodservices. TheprevailingwagesarerevisedbytheDepartmentofLaborandare available on the Department’s official website, which shall be deemed proper notification ofanyrate changesunderthissubsection. VendorisresponsibleforcontactingtheIllinoisDepartmentofLaborto ensure understanding of prevailing wage requirements at 217-782-6206 or (https://labor.illinois.gov/).

1.5. FederalFunding: ThiscontractmaybepartiallyortotallyfundedwithFederalfunds. Iffederalfundsare expected to be used, then the percentage of the good/service paid using Federal fundsandthetotal

Federal funds expected to be used will be provided in the award notice.

1.6. Invoicing: By submitting an invoice, Vendor certifies that the supplies or services provided meet all requirements of the contract, and the amount billed, and expenses incurred are as allowed in the contract. Invoicesforsuppliespurchased,servicesperformed,andexpensesincurredthroughJune30of anyyearmustbesubmittedtotheStatenolaterthanJuly31ofthatyear;otherwiseVendormayhave to seek payment through the Illinois Court of Claims. 30 ILCS 105/25. All invoices are subject to statutory offset. 30 ILCS 210.

1.6.1. Vendor shall notbillforanytaxesunlessaccompaniedbyproofthattheStateissubjecttothe tax. If necessary, Vendor may request the applicable Agency/University state tax exemption number and federal tax exemption information.

State of Illinois Chief Procurement Office General Services 4 BOA under $50,000 https://labor.illinois.gov/

1.6.2. Vendorshallinvoiceatthecompletionofthecontractunlessinvoicingistiedinthecontractto milestones, deliverables, or other invoicing requirements agreed to in the contract.

2. ASSIGNMENT: This contractmaynotbeassigned,transferredinwholeorinpartbyVendorwithouttheprior written consent of the State.

3. SUBCONTRACTING: Forpurposesofthissection,subcontractorsarethosewithcontractswithanannualvalue exceeding $100,000 and who are specifically hiredtoperformallorpartoftheworkcoveredbythecontract.

Vendormustreceivepriorwrittenapprovalbeforeuseofanysubcontractorsintheperformanceofthiscontract.

Vendor shall describe, in an attachment if not already provided, the names and addresses of all authorized subcontractors to be utilizedbyVendorintheperformanceofthiscontract,togetherwithadescriptionofthe work to be performed by the subcontractor and the anticipated amountofmoneythateachsubcontractoris expectedtoreceivepursuanttothiscontract. Ifrequired,Vendorshallprovideacopyofanysubcontractswithin fifteen (15) days after execution of this contract. All subcontracts must include the same certifications that

Vendormustmakeasaconditionofthiscontract. VendorshallincludeineachsubcontracttheStandardIllinois

Certification form available from the State. If at any time during the term of the Contract, Vendor adds or changes any subcontractors, then Vendor must promptly notify, by written amendment to the Contract, the

StatePurchasingOfficerortheChiefProcurementOfficerofthenamesandaddresses,theexpectedamountof moneythateachneworreplacedsubcontractorwillreceivepursuanttotheContract,andthegeneraltypeof work to be performed. 30 ILCS 500/20-120.

4. AUDIT/RETENTIONOFRECORDS: Vendoranditssubcontractorsshallmaintainbooksandrecordsrelatingtothe performanceofthecontractorsubcontractandnecessarytosupportamountschargedtotheStatepursuantthe contract or subcontract. Books and records, including information stored in databases or other computer systems, shall be maintained by the Vendor for a period of three (3) years from thelaterofthedateoffinal payment under the contract or completion of the contract,andbythesubcontractorforaperiodofthree(3) yearsfromthelateroffinalpaymentunderthetermorcompletionofthesubcontract. IfFederalfundsareused to pay contract costs, the Vendoranditssubcontractorsmustretaintheirrespectiverecordsforfive(5)years.

Books and records required to be maintained under this section shall be available for review or audit by representatives of the procuring Agency, the Auditor General, the Executive Inspector General, the Chief

ProcurementOfficer,StateofIllinoisinternalauditorsorothergovernmentalentitieswithmonitoringauthority, uponreasonablenoticeandduringnormalbusinesshours. Vendoranditssubcontractorsshallcooperatefully withanysuchauditandwithanyinvestigationconductedbyanyoftheseentities. Failuretomaintainbooksand recordsrequiredbythissectionshallestablishapresumptioninfavoroftheStatefortherecoveryofanyfunds paidbytheStateunderthiscontractoranysubcontractforwhichadequatebooksandrecordsarenotavailable to support the purported disbursement. The Vendor or subcontractors shall not impose achargeforauditor examination of the Vendor’s or subcontractor’s books and records. 30 ILCS 500/20-65.

5. TIMEISOFTHEESSENCE: TimeisoftheessencewithrespecttoVendor’sperformanceofthiscontract. Vendor shall continue to perform its obligations while any dispute concerning the contract is being resolved unless otherwise directed by the State.

State of Illinois Chief Procurement Office General Services 5

6. NOWAIVEROFRIGHTS: Exceptasspecificallywaivedinwriting,failurebyaPartytoexerciseorenforcearight does not waive that Party’s right to exercise or enforce that or other rights in the future.

7. FORCEMAJEURE: FailurebyeitherPartytoperformitsdutiesandobligationswillbeexcusedbyunforeseeable circumstances beyond its reasonable control and not due to its negligence, including acts of nature, acts of terrorism, riots, labor disputes, fire, flood, explosion, and governmental prohibition. The non-declaringParty may cancel the contract without penalty if performance does not resume within thirty (30) days of the declaration.

8. CONFIDENTIALINFORMATION: EachParty,includingitsagentsandsubcontractors,tothiscontractmayhaveor gainaccesstoconfidentialdataorinformationownedormaintainedbytheotherPartyinthecourseofcarrying out its responsibilities underthiscontract. VendorshallpresumeallinformationreceivedfromtheStateorto which it gains access pursuant to this contract is confidential. Vendor information, unless clearly marked as confidential and exempt from disclosure under the Illinois Freedom of Information Act, shall be considered public. Noconfidentialdatacollected,maintained,orusedinthecourseofperformanceofthecontractshallbe disseminatedexceptasauthorizedbylawandwiththewrittenconsentofthedisclosingParty,eitherduringthe period of the contract or thereafter. The receiving Party must return any and all data collected,maintained, createdorusedinthecourseoftheperformanceofthecontract,inwhateverformitismaintained,promptlyat theendofthecontract,orearlierattherequestofthedisclosingParty,ornotifythedisclosingPartyinwritingof its destruction. The foregoing obligations shall not apply to confidential data or information lawfully in the receivingParty’spossessionpriortoitsacquisitionfromthedisclosingParty;receivedingoodfaithfromathird

PartynotsubjecttoanyconfidentialityobligationtothedisclosingParty;nowisorlaterbecomespubliclyknown through no breach of confidentiality obligation by the receiving Party; or is independently developed by the receiving Party without the use or benefit of the disclosing Party’s confidential information.

9. USEANDOWNERSHIP: Allworkperformed,orsuppliescreatedbyVendorunderthiscontract,whetherwritten documentsordata,goodsordeliverablesofanykind,shallbedeemedworkforhireundercopyrightlawandall intellectualpropertyandotherlaws,andtheStateofIllinoisisgrantedsoleandexclusiveownershiptoallsuch work,unlessotherwiseagreedinwriting. VendorherebyassignstotheStateallright,title,andinterestinandto such work including any relatedintellectualpropertyrights,and/orwaivesanyandallclaimsthatVendormay havetosuchworkincludinganyso-called"moralrights"inconnectionwiththework. Vendoracknowledgesthe

Statemayusetheworkproductforanypurpose. Confidentialdataorinformationcontainedinsuchworkshall be subject to confidentiality provisions of this contract.

10. INDEMNIFICATION AND LIABILITY: The Vendor shall indemnify and hold harmless the State of Illinois, its agencies,officers,employees,agentsandvolunteersfromanyandallcosts,demands,expenses,losses,claims, damages,liabilities,settlementsandjudgments,includingin-houseandcontractedattorneys’feesandexpenses, arising out of: (a) any breach or violation by Vendor of any of its certifications, representations, warranties, covenantsoragreements;(b)anyactualorallegeddeathorinjurytoanyperson,damagetoanyrealorpersonal property,oranyotherdamageorlossclaimedtoresultinwholeorinpartfromVendor’snegligentperformance;

(c)anyact,activityoromissionofVendororanyofitsemployees,representatives,subcontractorsoragents;or

State of Illinois Chief Procurement Office General Services 6

(d)anyactualorallegedclaimthattheservicesorgoodsprovidedunderthiscontractinfringe,misappropriate, or otherwise violate any intellectual property (patent, copyright, trade secret, or trademark) rights of a third party. InaccordancewithArticleVIII,Section1(a),(b)oftheConstitutionoftheStateofIllinoisand1973Illinois

Attorney General Opinion 78, the State may not indemnify private parties absent express statutory authority permitting the indemnification. Neither Party shall be liable forincidental,special,consequential,orpunitive damages.

11. INSURANCE: Vendorshall,atalltimesduringthetermandanyrenewalsmaintainandprovideaCertificateof

InsurancenamingtheStateasadditionallyinsuredforallrequiredbondsandinsurance. Certificatesmaynotbe modifiedorcanceleduntilatleastthirty(30)days’noticehasbeenprovidedtotheState. Vendorshallprovide:

(a) General Commercial Liability occurrence form in amount of $1,000,000 per occurrence (Combined Single

Limit Bodily Injury and Property Damage) and $2,000,000AnnualAggregate;(b)AutoLiability,includingHired

AutoandNon-ownedAuto,(CombinedSingleLimitBodilyInjuryandPropertyDamage)inamountof$1,000,000 peroccurrence;and(c)Worker’sCompensationInsuranceinamountrequiredbylaw. Insuranceshallnotlimit

Vendor’s obligation to indemnify, defend, or settle any claims.

12. INDEPENDENTCONTRACTOR: Vendorshallactasanindependentcontractorandnotanagentoremployeeof, or joint venture with the State. All payments by the State shall be made on that basis.

13. SOLICITATIONANDEMPLOYMENT: VendorshallnotemployanypersonemployedbytheStateduringtheterm ofthiscontracttoperformanyworkunderthiscontract. VendorshallgivenoticeimmediatelytotheAgency’s director if Vendor solicits or intends to solicit State employees to perform any work under this contract.

14. COMPLIANCE WITH THE LAW: The Vendor, its employees, agents, and subcontractors shall comply with all applicable federal, state, and local laws, rules, ordinances, regulations, orders, federalcircularsandalllicense andpermitrequirementsintheperformanceofthiscontract. Vendorshallbeincompliancewithapplicabletax requirementsandshallbecurrentinpaymentofsuchtaxes. Vendorshallobtainatitsownexpense,alllicenses and permissions necessary for the performance of this contract.

15. BACKGROUND CHECK: WhenevertheStatedeemsitreasonablynecessaryforsecurityreasons,theStatemay conduct,atitsexpense,criminalanddriverhistorybackgroundchecksofVendor’sandsubcontractor’sofficers, employees or agents. Vendor or subcontractor shall reassign immediately any such individual who, in the opinion of the State, does not pass the background check.

16. APPLICABLE LAW:

16.1. PREVAILING LAW: This contract shall be construed in accordancewithandissubjecttothelawsand rules of the State of Illinois.

16.2. EQUAL OPPORTUNITY: The Department of Human Rights’ Equal Opportunity requirements are incorporated by reference. 44ILL. ADM. CODE 750.

State of Illinois Chief Procurement Office General Services 7

16.3. COURT OF CLAIMS; ARBITRATION; SOVEREIGN IMMUNITY: AnyclaimagainsttheStatearisingoutof thiscontractmustbefiledexclusivelywiththeIllinoisCourtofClaims. 705ILCS505/1. TheStateshall notenterintobindingarbitrationtoresolveanydisputearisingoutofthiscontract. TheStateofIllinois does not waive sovereign immunity by entering into this contract.

16.4. OFFICIAL TEXT: The officialtextofthestatutescitedhereinisincorporatedbyreference.Anunofficial version can be viewed at (www.ilga.gov/legislation/ilcs/ilcs.asp).

17. ANTI-TRUSTASSIGNMENT: IfVendordoesnotpursueanyclaimorcauseofactionithasarisingunderfederalor state antitrust laws relating to the subject matter of the contract, then upon request of the Illinois Attorney

General, Vendor shall assign to the State rights, title and interest in and to the claim or cause of action.

18. CONTRACTUAL AUTHORITY: The Agency that signs for the State of Illinois shall be the only State entity responsible for performance and payment under the contract. When the Chief Procurement Officer or authorizeddesigneesignsinadditiontoanAgency,theydosoasapprovingofficerandshallhavenoliabilityto

Vendor. WhentheChiefProcurementOfficerorauthorizeddesignee,orStatePurchasingOfficersignsamaster contractonbehalfofStateagencies,onlytheAgencythatplacesanorderwiththeVendorshallhaveanyliability to Vendor for that order.

19. EXPATRIATEDENTITIES: Exceptinlimitedcircumstances,nobusinessormemberofaunitarybusinessgroup,as defined in theIllinoisIncomeTaxAct,shallsubmitabidfororenterintoacontractwithaStateagencyifthat business or any member of the unitary business group is an expatriated entity.

20. NOTICES: Notices and other communications provided for herein shall be given inwritingviaelectronicmail whenever possible. If transmissionviaelectronicmailisnotpossible,thennoticesandothercommunications shallbegiveninwritingviaregisteredorcertifiedmailwithreturnreceiptrequested,viareceiptedhanddelivery, viacourier(UPS,FederalExpressorothersimilarandreliablecarrier),orviafacsimileshowingthedateandtime of successful receipt. Notices shall be sent to the individuals who signed this contract using the contact informationfollowingthesignatures. Eachsuchnoticeshallbedeemedtohavebeenprovidedatthetimeitis actually received. By giving notice, either Party may change its contact information.

21. MODIFICATIONS AND SURVIVAL: Amendments, modifications and waivers must be in writing and signed by authorizedrepresentativesoftheParties. Anyprovisionofthiscontractofficiallydeclaredvoid,unenforceable, oragainstpublicpolicy,shallbeignoredandtheremainingprovisionsshallbeinterpreted,asfaraspossible,to giveeffecttotheParties’intent. Allprovisionsthatbytheirnaturewouldbeexpectedtosurvive,shallsurvive termination.IntheeventofaconflictbetweentheState’sandtheVendor’sterms,conditionsandattachments, the State’s terms, conditions and attachments shall prevail.

22. PERFORMANCERECORD/SUSPENSION: UponrequestoftheState,Vendorshallmeettodiscussperformance or provide contract performance updates to help ensure proper performance of thecontract. TheStatemay considerVendor’sperformanceunderthiscontractandcompliancewithlawandruletodeterminewhetherto

State of Illinois Chief Procurement Office General Services 8 BOA under $50,000 http://www.ilga.gov/legislation/ilcs/ilcs.asp continuethecontract,suspendVendorfromdoingfuturebusinesswiththeStateforaspecifiedperiodoftime, or whether Vendor can be considered responsible on specific future contract opportunities.

23. FREEDOM OF INFORMATION ACT: This contract and all related public records maintained by,providedtoor requiredtobeprovidedtotheStatearesubjecttotheIllinoisFreedomofInformationAct(FOIA)(50ILCS140) notwithstanding any provision to the contrary that may be found in this contract.

24. SCHEDULEOFWORK: AnyworkperformedonStatepremisesshallbedoneduringthehoursdesignatedbythe

State and performed in a manner that does not interfere with the State and its personnel.

25. WARRANTIES FOR SUPPLIES AND SERVICES:

25.1. Vendor warrants that the supplies furnished under this contract will: (a) conform to the standards, specifications, drawing, samples ordescriptionsfurnishedbytheStateorfurnishedbytheVendorand agreedtobytheState,includingbutnotlimitedtoallspecificationsattachedasexhibitshereto;(b)be merchantable,ofgoodqualityandworkmanship,andfreefromdefectsforaperiodoftwelvemonthsor longerifsospecifiedinwriting,andfitandsufficientfortheintendeduse;(c)complywithallfederaland state laws, regulations and ordinances pertaining to the manufacturing, packing, labeling, sale and deliveryofthesupplies;(d)beofgoodtitleandbefreeandclearofallliensandencumbrancesand;(e) notinfringeanypatent,copyrightorotherintellectualpropertyrightsofanythirdparty. Vendoragrees to reimburse the State for any losses, costs, damages or expenses, including without limitations, reasonable attorney’s fees and expenses, arising from failure of the supplies to meet such warranties.

25.2. Vendor shall insure that all manufacturers’ warranties are transferred totheStateandshallprovidea copy ofthewarranty. Thesewarrantiesshallbeinadditiontoallotherwarranties,express,impliedor statutory, and shall survive the State’s payment, acceptance, inspection or failure to inspect the supplies.

25.3. Vendor warrants that all services will be performed to meet the requirements of the contract in an efficientandeffectivemannerbytrainedandcompetentpersonnel. Vendorshallmonitorperformances of each individual and shall reassign immediately any individual who is not performinginaccordance with the contract, who is disruptive or not respectful of others in the workplace, or who in any way violates the contract or State policies.

26. REPORTING, STATUS AND MONITORING SPECIFICATIONS: Vendor shall immediately notify the State of any event that may have a material impact on Vendor’s ability to perform the contract.

27. EMPLOYMENTTAXCREDIT: Vendorswhohirequalifiedveteransandcertainex-offendersmaybeeligiblefortax credits. 35ILCS5/216,5/217. PleasecontacttheIllinoisDepartmentofRevenue(telephone#:217-524-4772) for information about tax credits.

28. TERMINATIONFORCAUSE: TheStatemayterminatethiscontract,inwholeorinpart,immediatelyuponnotice to the Vendor if:(a)theStatedeterminesthattheactionsorinactionsoftheVendor,itsagents,employeesor

State of Illinois Chief Procurement Office General Services 9 subcontractorshavecaused,orreasonablycouldcause,jeopardytohealth,safety,orproperty,or(b)theVendor has notified the State that it is unable or unwilling to perform the contract.

28.1. If Vendor fails to perform to the State’s satisfaction any material requirement of this contract, is in violation of a material provision of this contract, or the State determines that the Vendor lacks the financialresourcestoperformthecontract,theStateshallprovidewrittennoticetotheVendortocure the problem identified withintheperiodoftimespecifiedintheState’swrittennotice.Ifnotcuredby thatdatetheStatemayeither:(a)immediatelyterminatethecontractwithoutadditionalwrittennotice or (b) enforce the terms and conditions of the contract.

28.2. ForterminationduetoanyofthecausescontainedinthisSection,theStateretainsitsrightstoseekany available legal or equitable remedies and damages.

29. TERMINATION FOR CONVENIENCE: The State may, for itsconvenienceandwiththirty(30)dayspriorwritten noticetoVendor,terminatethiscontractinwholeorinpartandwithoutpaymentofanypenaltyorincurringany further obligation to the Vendor.

29.1. The Vendor shall be entitled to compensation upon submission of invoices and proof of claim for supplies and services provided in compliance with this contract up to and including the date of termination.

30. AVAILABILITYOFAPPROPRIATION: Thiscontractiscontingentuponandsubjecttotheavailabilityoffunds. The

State,atitssoleoption,mayterminateorsuspendthiscontract,inwholeorinpart,withoutpenaltyorfurther payment being required, if (1) the Illinois General Assembly or the federal funding source fails to make an appropriation sufficient to pay such obligation, or if funds needed are insufficient for any reason (30 ILCS

500/20-60),(2)theGovernordecreasestheDepartment’sfundingbyreservingsomeoralloftheDepartment’s appropriation(s) pursuant to power delegated to the Governor by the Illinois General Assembly, or (3) the

Department determines, in its sole discretion or as directedbytheOfficeoftheGovernor,thatareductionis necessaryoradvisablebaseduponactualorprojectedbudgetaryconsiderations. Contractorwillbenotifiedin writing of the failure of appropriation or of a reduction or decrease.

State of Illinois Chief Procurement Office General Services 10

TAXPAYER IDENTIFICATION NUMBER

I certify that:

Thenumbershownonthisformismycorrecttaxpayeridentificationnumber(orIamwaitingforanumbertobeissued to me), and

I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notifiedbytheInternalRevenueService(IRS)thatIamsubjecttobackupwithholdingasaresultofafailuretoreportall interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

I am a U.S. person (including a U.S. resident alien).

● If you are an individual, enter your name and SSN as it appears on your Social Security Card.

● If you are a sole proprietor, enter the owner’s name on the name line followed by the name of the business and the owner’s SSN or EIN.

● If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’snameonthenamelineandtheD/B/Aonthebusinessnamelineandentertheowner’sSSNor

EIN.

● IftheLLCisacorporationorpartnership,entertheentity’sbusinessnameandEINandforcorporations, attach IRS acceptance letter (CP261 or CP277).

● For all other entities, enter the name of the entity as used to apply for the entity’s EIN and the EIN.

Name: Ethan Miller

Business Name: E&N Services Company

Taxpayer Identification Number:

Social Security Number:

or

Employer Identification Number: 922046429

Legal Status (check one):

☐ Individual ☐ Governmental

☐ Sole Proprietor ☐ Nonresident alien

☐ Partnership ☐ Estate or trust

☐ Legal Services Corporation ☐ Pharmacy (Non-Corp.)

☐ Tax-exempt ☐ Pharmacy/Funeral Home/Cemetery (Corp.)

☐ Corporation providing or billing ☐ Limited Liability Company medical and/or health care services (select applicable tax classification)

X Corporation NOT providing or billing ☐ C = corporation medical and/or health care services ☐ P = partnership

Signature of Authorized Representative:

Date: 4/3/26

State of Illinois Chief Procurement Office General Services 11 Taxpayer Identification Number