EBF Christmas Gifts.doc

IL 401-0105

State of Illinois September 23, 2020

Order for Delivery Agency OFD # 96210270

Vendor

Ship To (Transportation Charges to be Prepaid)

VIENNA CORRECTIONAL CENTER

6695 State Rt 146 East Vienna, Il 62995

Bill To

VIENNA CORRECTIONAL CENTER

6695 State Rt 146 East Vienna, Il 62995

Object Code

Agency Phone Number and ext.

618-658-8371, x515

1.

FORMCHECKBOX

New

2.

FORMCHECKBOX

Change

3.

FORMCHECKBOX

Delete (Do Not Use)

(Do Not Use)

From To

Month/Day/Year Month/Day/Year (Do Not Use)

$0.00

Measure Unit

Price Total

Price

4830 FORMTEXT

$4,830.00

0.00

0.0 FORMTEXT

$0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0 FORMTEXT

TOTAL

4830 FORMTEXT

$4,830.00

Date – Checked Against Inventory

(If Multiple Rates, Specify)

Per

(Rate) (Time)

1.

FORMCHECKBOX

Bids Required

2.

FORMCHECKBOX

Exempt From Bid

3.

FORMCHECKBOX

Exempt / Bids

Obtained

4.

Emergency

Delivery:

Complete

FORMCHECKBOX

Incomplete Invoice No.

The Merchandise or Service Billed Above Has Been Received

And Complies With Our Specifications or Request:

Requested By Debra Moore

Approved By

P.O. or Authorization No.

Certification for Qualified Vendors are on File That:

(A) The vendor is not barred from receiving state contracts as a result of bribery, attempting to bribe or admitting to bribing an officer or employee of the State of Illinois, (Section 10.1 of the Illinois Purchasing Act see ILL. Statutes 30 ILCS 505/10.1), and

(B) That if the vendor has been convicted of a felony, at least one year has passed since completion of the sentence as of the date for opening of bids or proposals, or the date of the contract if there is no opening date schedule, and

(C) The vendor is not a person barred from bidding on or receiving state or local government unit contracts as a result of illegal bid rigging or bid rotating as defined in the criminal code, and

(D) If this contract is with an individual or individuals, that such individual or individuals are not barred from receiving state contracts as a result of default on any education loan, and

(E) The vendor certifies that is the vendor’s correct Federal Taxpayer Identification number. The vendor is doing business as a (please check one):

Individual

Corporation

Partnership

Sale Proprietorship

Not-for-Profit Corporation

Trust or Estate

Real Estate Agent

Governmental Entity

Tax Exempt Organization

Medical and Health Care

(IRC 501 (a) only)

Services Provider Group

(F) Vendor certifies that it has read and is, or will be, in compliance with the drug free workplace act (ILL. Statues 30 ILCS 580/1) on the effective date of this contract or January 1, 1992, whichever is later. If this contract is with an individual, or an individual doing business in the form of a sole proprietorship, the individual will not engage in the unlawful manufacture, distribution, dispensation, possession or use of a controlled substance in performance of the contract, and

(G) Is compliant with all applicable provisions of the Illinois Human Rights Act, the Public Works Employment Discrimination Act, the U.S. Civil Rights Act and Section 504 of the Federal Rehabilitation Act, and Americans with Disabilities Act, as well as all applicable regulation, and

(H) Has established written sexual harassment policies in compliance with Illinois State Statues.

(I) Vendor Certifies he/she has informed the director of the agency in writing if he/she was formerly employed by that agency and has received an early retirement incentive under Section 14-108.3 or 16-133.3 of the Illinois Pension Code. Vendor acknowledges and agrees that if such early retirement incentive was received, this contract is not valid unless the official executing the contract has made the appropriate filing with the Auditor General prior to execution.

Retention of Records

Vendor shall maintain, for a minimum of five years after completion of the contract, adequate books, records and supporting documents to verify the amounts, recipients and uses of all contracts; that the contract and all books, records and supporting documents related to the contract shall be available for review and audit by the Auditor General; and that the contractor agrees to cooperate fully with any audit conducted by the Auditor General and to provide full access to all relevant materials. Failure to maintain the books, records and supporting documents required by this Section shall establish a presumption in favor of the State for the recovery of any funds paid by the State under the contract for which adequate books, records, and supporting documentation are not available to support their purported disbursement.

See Certification Compliance on Back of Form