FY27 AG Office Supplies - IFB~4.pdf

STATE OF ILLINOIS

SOLICITATION DOCUMENT

’27 AG Office Supplies

(BID # 27-340IAGO-IAGO3-B-51976)

The Office of the Attorney General is inviting responsible vendors to submit bids to meet their needs.

Below is a brief description of our needs with detailed requirements in Section 3 of this Invitation for Bids (hereinafter, “IFB”). If you are interested and able to meet these requirements, please submit an Offer.

The Office of the Attorney General shall make all procurements in the most economical, expeditious and commercially reasonable manner that is in accordance with law. The Office of the Attorney General shall procure its needs in accordance with the Attorney General’s Procurement Rules (44 Ill. Adm.

Code Part 1300) and in a manner substantially in accordance with Articles 1, 15, 20, 25, 35, 35, 40, 50, and 53 of the Illinois Procurement Code (30 ILCS 500/Arts. 1, 15, 20, 25, 35, 40, 45, 50 and 53). Where required by law, the Office of the Attorney General will utilize the IFB process outlined herein. Please read the IFB, sample Contract form, and submit your Bid in accordance with the Instructions. The instructions for submitting Bids to respond to this IFB follow in Part A, Section 1, “INSTRUCTIONS, DATES, RESERVATIONS AND OTHER GENERAL INFORMATION.”

We are issuing this solicitation in the following form, and you must take that into account when reading and responding:

Invitation for Bids

Brief Description: The Office of Attorney General is seeking cost information for general office supplies to replenish our stockroom as needed and to be delivered to various office locations throughout the State of Illinois.

The solicitation package consists of two parts:

Part A INSTRUCTIONS FOR SUBMITTING AND EVALUATING BIDS AND PROPOSALS: Part A consists of the following sections:

SECTION 1 INSTRUCTIONS, DATES, RESERVATIONS AND OTHER GENERAL

INFORMATION

SECTION 2 HOW WE WILL EVALUATE OFFERS

SECTION 3 SPECIFICATIONS / QUALIFICATIONS / STATEMENT OF WORK

These sections provide information necessary for submitting an Offer (a bid or proposal); set forth the basic legal and policy requirements associated with this solicitation and tell how we will evaluate Offers.

Part B OFFER RESPONSE FORMS: Part B consists of the following sections:

SECTION 4 OFFER TO STATE OF ILLINOIS, ATTORNEY GENERAL

SECTION 5 RESPONSIBILITY FORMS

SECTION 6 RESPONSIVENESS

SECTION 7 PRICE

SECTION 8 SAMPLE CONTRACT

Your response to Part B will constitute your Offer to the Office of Attorney General and will provide us with information about you, what you will provide, your ability to perform and your price. We will evaluate this information as well as compliance with the Instructions.

In this document, the Office of Attorney General will be referred to as “State”, “OAG”, “we” or “us”. The person submitting an Offer will be referred to as “Vendor”, “Contractor” or “You”. “We” is used appropriate to the context.

Please read the entire solicitation package and submit your Offer for evaluation in accordance with all instructions.

Public Act 95 -971 contains registration requirements regarding bids and proposals submitted by vendors. You must read and comply with the requirements. See www.purchase.state.il.us for additional information.

NON-DISCRIMINATION POLICY In compliance with the State and Federal Constitutions, the Illinois Human Rights Act, the U.S. Civil Rights Act, and Section 504 of the Federal Rehabilitation Act, the State of Illinois does not discriminate in employment, contracts, or any other activity.

PART A – INSTRUCTIONS FOR SUBMITTING AND EVALUATING BIDS AND PROPOSALS

SECTION 1 - INSTRUCTIONS, DATES, RESERVATIONS AND OTHER

GENERAL INFORMATION

1.1 PROJECT CONTACT:

If you have a question or suspect an error, you must immediately notify the OAG Project Contact identified in this section. Do not discuss the solicitation or your Offer, directly or indirectly, with any OAG employee other than the OAG Project Contact. Only written answers to questions shall be binding on the State.

Jacquelyn Charleston Phone: 312-814-2424 Office of the Illinois Attorney General Email: jacquelyn.charleston@ilag.gov 115 S. LaSalle St, 23rd Floor Chicago, IL 60603

1.2 VENDOR CONFERENCE / SITE VISIT

Vendor Conference / Site Visit Required: Yes X No

Mandatory Attendance Required: Yes X No

We will provide written responses to questions and only those written responses shall be binding. If attendance is mandatory, you will be disqualified if you (incumbents included) do not attend, are not on time, leave early or fail to sign the attendance sheet. You must allow adequate time to accommodate security screenings at the site.

1.3 OFFER DUE DATE, TIME AND SUBMISSION PROCESS:

Offer Due Date/Time: May 5, 2026 / Time: 10am

SUBMISSION PROCESS:

Please do not send electronic submissions via the BidBuy website.

The OAG is accepting responses to this IFB as follows:

ELECTRONIC SUBMISSION

1) Attach a PDF version of your bid response and send via email to the following email address:

ProcurementBids@ilag.gov

2) Please include in the SUBJECT FIELD of your email, IFB Title: ’27 AG Office Supplies and the Due Date: May 5, 2026

We will not consider Offers, modifications or withdrawals submitted after the due date and time. All times are Central Standard Time.

1.4 OFFER FIRM TIME: Your Offer must remain firm for 160 days from opening.

1.5 PROTEST REVIEW OFFICE:

OFFICE OF ATTORNEY GENERAL Ph: 312-814-3667 Attn: Eileen Pratt Fax: 312-814-5620 115 S. LaSalle Street, Floor 23 TDD: 312-814-3374

CHICAGO, IL 60603

You may submit a written protest of our actions to the PROTEST REVIEW OFFICE following the requirements of the Standard Procurement Rules (44 Ill. Adm. Code 1.5550). We must physically receive the protest by noon of the seventh calendar day after you knew or should have known of the facts giving rise to the protest.

1.6 PUBLIC CONTRACTS NUMBER: (775 ILCS 5/2-105) If you do not have a Department of Human Rights’ (DHR) Public Contracts Number or have not submitted a completed application to DHR for one before opening we may not be able to consider your Offer. Please contact DHR at 312-814-2431 or visit http://www.state.il.us/dhr/index.htm for forms and details.

1.7 OUT OF STATE COMPANIES: Please contact the Illinois Secretary of State (217) 782-1834) regarding a Certificate of Authority.

To transact Business in Illinois. Application Form BCA 13.15 may be downloaded from http://www.cyberdriveillinois.com/departments/business_services/publications_and-forms/bca.html. If you are a foreign limited liability company or other legal entity, you will need to submit the appropriate documentation. It is entirely the Vendor's responsibility to determine whether the Vendor is required to obtain a Certificate of Authority to transact Business in Illinois, and if so, to obtain that Certificate via the filing of the required form and payment of any required fees and taxes.

1.8 AWARD: We will post a notice to BidBuy identifying the apparent awardee. The notice extends the Offer Firm Time until we sign a contract or determine not to sign a contract. We may accept or reject your Offer as submitted, or may require contract negotiations. If negotiations do not result in an acceptable agreement, we may reject your Offer and begin negotiations with another Vendor. Protested awards are not final and are subject to resolution of the protest.

1.9 PUBLIC RECORDS AND REQUESTS FOR CONFIDENTIAL TREATMENT: Offers become the property of the OAG and these and late submissions will not be returned. Your Offer will be open to the public under the FOIA and other applicable laws and rules, unless you request in your Offer that we treat certain information as exempt. A request for confidential treatment will not supersede the OAG’s legal obligations under FOIA. We will not honor requests to exempt entire Offers. You must show the specific grounds in FOIA or other law or rule that support exempt treatment. Regardless, we will disclose the successful Vendor’s name, the substance of the Offer, and the price. If you request exempt treatment, you must submit an additional copy of the Offer with exempt information deleted. This copy must tell the general nature of the material removed and shall retain as much of the Offer as possible. You will be responsible for any costs or damages associated with our defending your request for exempt treatment.

You agree the OAG may copy the Offer to facilitate evaluation, or to respond to requests for public records. You warrant that such copying will not violate the rights of any third party.

1.10 RESERVATIONS: You must read and understand the solicitation and tailor your Offer and activities to ensure compliance. We reserve the right to amend the solicitation; reject any or all Offers; to award by item, group of items, or grand total; and to waive minor defects. We may request a clarification; inspect your premises; interview staff; request a presentation; or otherwise verify the contents of the Offer, including information about subcontractors and suppliers. We may request Best & Final Offers when appropriate. We will make all decisions on compliance, evaluation, terms and conditions, and shall make decisions solely in the best interests of the OAG. This competitive process requires that you provide additional information and otherwise cooperate with us. If you do not comply with requests for information and cooperate, we may reject your Offer. You have no right to an award by submitting an Offer, nor do you have the right to a contract based on our posting your name in a Bidbuy notice. We are not responsible for and will not pay any costs associated with the preparation and submission of your Offer.

If you are the awardee, you shall not commence, and will not be paid for any billable work prior to the date all parties execute the contract, unless approved in writing in advance by the State Purchasing Officer or the Chief Procurement Officer (or the CPO’s designee).

1.11 GOVERNING LAW AND FORUM: Illinois law and rule govern this solicitation and any resulting contract. You must bring any action relating to this solicitation or any resulting contract in the appropriate court in Illinois. We do not allow binding arbitration. This document contains statutory references designated with “ILCS”. You may view the full text at http://www.ilga.gov/legislation/ilcs/ilcs.asp. The Illinois Procurement Code (30 ILCS 500/1-1 et seq.) and the Attorney General’s Procurement Rules (44 Ill. Adm. Code 1300) are applicable to this solicitation and may be viewed by users registered for Illinois Bidbuy at https://www.bidbuy.illinois.gov/bso/.

SECTION 2 - HOW WE WILL EVALUATE OFFERS

2.1 OFFER RESPONSE FORMS: We will evaluate the information you provide in the Offer Response Forms. You will find these forms in later sections of this solicitation.

2.2 EVALUATION CATEGORIES: We evaluate four categories of information: Administrative Compliance, Responsibility, Responsiveness, and Price. We will consider the information you supply or do not supply, and the quality of that information when evaluating your Offer. If we find a failure or deficiency, we may have to reject the Offer or reflect that in the evaluation.

2.2.1 ADMINISTRATIVE COMPLIANCE: We will determine whether your Offer complied with the Instructions for Submitting Offers. Except for late submissions, we may require that a Vendor corrects all deficiencies as a condition of further evaluation.

2.2.2 RESPONSIBILITY: We will determine whether you are a “Responsible” Vendor; a Vendor with whom we can or should do business.

i. A “Responsible” vendor must exist as a legal entity and must comply with all provisions of the

Illinois Procurement Code (30 ILCS 500/1-1 et seq.), including section 20-43 (30 ILCS 500/20- 43), which requires that vendors be authorized to do business in Illinois at the time a bid or proposal is submitted for an OAG contract. Evidence of good standing can include Certificate of Good Standing, copy of assumed name certificate from home county, etc., dated within the sixty days from the date of your Offer.

ii. Section 50-10.5 of the Procurement Code (30 ILCS 500/50-10.5) prohibits a person or business from bidding or entering into a contract under the Code if the person or business

(a) assisted the OAG in determining whether there was a need for the contract except as part of a response to a publicly issued request for information (RFI) or

(b) assisted the OAG by reviewing, drafting or preparing a request for proposals, request for information, or provided similar assistance. See certifications section of the Contract for the required certifications prior to entering into a contract with the OAG.

iii. Other factors that we may evaluate to determine Responsibility include, but are not limited to:

certifications, conflict of interest, financial disclosures, taxpayer identification number, past performance, references (including those found outside the Offer), and compliance with applicable laws, financial stability and the perceived ability to perform completely as specified.

Every bid submitted to and contract executed by the OAG and every subcontract subject to Section 20-120 of the Procurement Code shall contain a certification by the bidder, contractor, or subcontractor, respectively, that the bidder, contractor, or subcontractor is not barred from being awarded a contract or subcontract under this Section and acknowledges that the chief procurement officer shall declare the related contract void if any of the certifications are false.

You must at all times have financial resources sufficient, in the opinion of the OAG, to ensure performance of the contract and must provide proof upon request. The OAG may terminate the Contract, consistent with the termination for cause provision of this Contract, if the Vendor lacks the financial resources to perform under the Contract. We may require that a Vendor correct any deficiencies as a condition of further evaluation.

2.2.3 RESPONSIVENESS: We will determine whether the Offer meets the stated requirements.

Minor differences or deviations that have negligible impact on the price or suitability of the supply or service to meet the OAG’s needs may be accepted or corrections allowed. If no administratively compliant and responsible Vendor meets a particular requirement, we may waive that requirement.

When the specification calls for “Brand Name or Equal”, equal products will be considered with proof the other product meets stated specifications and is equivalent to the brand product in terms of quality, performance, and desired characteristics.

In accordance with Public Act 95-971, if you are required to submit the State Board of Elections Registration Certificate and fail to do so, your bid / proposal will be disqualified.

2.2.4 PRICE: We will identify the lowest priced Offer(s) that meets Administrative, Responsibility and Responsiveness Requirements. We will rank Offer(s) in order of Price when appropriate.

2.3 AWARD: Award(s) will be made to the Responsible Vendor(s) whose Offer(s) passes Administrative review, is Responsive, and who submits the lowest Price as identified in Exhibit A. If a bidder does not bid on every item, the bidder will not be considered for award.

SECTION 3 - SPECIFICATIONS / QUALIFICATIONS / STATEMENT OF WORK

3.1 SUPPLIES AND/OR SERVICES REQUIRED

The OAG is seeking to secure a contract for general office supplies for our upcoming FY27 fiscal year as listed in Exhibit A. Quantities shown in the exhibit are estimates based on previous usage; amounts ordered throughout the year may vary. Equivalent, recycled, or refurbished products are not acceptable. The vendor must provide cost information for each item they are responding to on the attached spreadsheet title ‘EXHIBIT A’ for each respective fiscal year.

3.2 DELIVERABLES

The Attorney General’s Office requires timely delivery of the items listed in Exhibit A. The vendor must contact the OAG prior to delivery to confirm information and provide an ETA. In some cases, dock access may be required.

Delivery will be expected within 3-7 days after the order is placed. However, due to nationwide supply chain issues, we will be flexible on the time frame at this time. We are requesting that the awarded vendor provide real-time delivery updates regarding delivery time frames (including shipping delays/backorders).

Repeated failure of an awarded vendor to meet these servicing guidelines shall constitute a breach of contract, and the OAG shall seek other remedies up to and/or including termination of the contract.

3.3 REPORTING, STATUS AND MONITORING

3.3.1 At the OAG’s option the Parties will work together to monitor performance during the contract and any warranty term. This may include use of a performance scorecard with conditions, milestones, requirements, or timetables that must be met before additional steps may be taken, or payment is due. The scorecard may also record matters related to price, service, quality and other factors deemed important.

3.3.2 Vendor shall cooperate with the OAG in this monitoring activity, which may require that Vendor report progress and problems (with proposed resolutions), provide records of its performance, allow random inspections of its facilities, participate in scheduled meetings and provide management reports as requested by the OAG.

3.4 VENDOR AND STAFF REQUIREMENTS

3.4.1 Subcontractor Disclosure. Will you be using any subcontractors? Yes No If yes, you must identify in Section 8.7 the names and addresses of all subcontractors you will be entering into a contractual agreement with for a total value of $25,000 or more in the performance of this Contract, together with a description of the work to be performed by the subcontractor and the anticipated amount of money, to the extent the information is known, that each subcontractor is expected to receive pursuant to the Contract. For purposes of this section, subcontractors are those specifically hired to provide to the Vendor some or all of the goods, services, property, remuneration, or other forms of consideration that are the subject of this Contract, including sub-lessees from a lessee of a State agency. A copy of each subcontract issued pursuant to the Contract shall be provided to the State Purchasing Officer or Chief Procurement Officer within 20 days after the execution of the Contract or after execution of the subcontract, whichever is later. If at any time during the term of the Contract, Vendor adds or changes any subcontractors, Vendor will be required to promptly notify, by written amendment to the Contract, the State Purchasing Officer or the Chief Procurement Officer of the names and addresses and the expected amount of money that each new or replaced subcontractor will receive pursuant to the Contract. Any subcontracts entered into prior to award of the Contract are done at the Vendor’s and subcontractor’s risk. All subcontracts must include the Subcontractor Standard Certifications and the Disclosures and Conflicts of Interest, completed and signed by the subcontractor.

3.4.2 References: We may request references from companies you have done business with in the past providing the same products and/or services.

3.5 WHERE SUPPLIES ARE TO BE DELIVERED

3.5.1 The awarded vendor will be required to make inside deliveries at our main offices: 115 S.

LaSalle Street, 23rd Floor, Chicago, IL, 60603 and 500 S. 2nd St., Springfield, IL, 62701.

However, there may be instances where deliveries may be required to our various satellite and regional offices. The freight elevators at all OAG facilities can only accommodate half pallets.

3.6 OTHER SPECIFICATIONS

3.6.1 Preferences (check all that apply): The Illinois Procurement Code (See 30 ILCS 575, 30 ILCS 500/45-45, 30 ILCS 500/45-90, 30 ILCS 500/45-95) and the Attorney General’s Procurement Rules (See Ill. Adm. Rule 1300.4500) provide for various preferences to promote procurement opportunities in Illinois. Does the Respondent make any claim with respect to the preferences listed below? The OAG reserves the right to determine whether the preference indicated applies to the Respondent. Is your company at least 51% owned and controlled by individuals in one of the following categories? If “Yes,” please check the category that applies:

A Minority Owned Business Enterprise (30 ILCS 575/2(A)(1) & (3))

A Women Owned Business Enterprise (30 ILCS 575/2(A)(2) & (4))

A Persons with Disabilities Owned Business Enterprise (30 ILCS 575/2(A) (2.05) & (2.1))

A Qualified Small Business Enterprise

A Qualified HUB Zone Business Enterprise (30 ILCS 500/45-95)

Other - Please specify here:

3.6.2 As required by Illinois Public Act 95-307, all information technology, including electronic information, software, systems, and equipment, developed or provided under this contract must comply with the applicable requirements of the Illinois Information Technology Accessibility Act Standards as posted at http://www.dhs.state.il.us/iitaa.

3.6.3 As required by Executive Order 12549, Debarment and Suspension, 28 CFR Part 67.510, the Vendor certifies that neither the Vendor nor the Vendor’s principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this procurement by any Federal department or agency.

3.6.4 The current Vendor’s employees who perform the services under the current contract are covered by a collective bargaining contract. In accordance with Illinois law (30 ILCS 500/25-80), in order to be considered a responsible bidder and eligible for award you must

(a) offer to assume the collective bargaining obligations of the prior employer, including any existing collective bargaining agreement with the bargaining representative of any existing collective bargaining unit or units performing substantially similar work to the services covered by the contract subject to its bid or Offer, and (b) offer employment to all employees currently employed in any existing bargaining unit performing substantially similar work that will be performed under this contract. By submitting a bid or Offer to us, you are certifying you will comply with this law.

3.7 TERM OF CONTRACT

The term of the contract will be a minimum of a one-year term, commencing July 1, 2026 through June 30, 2027 with two one-year renewal options as outlined in section 3.8.

The optional renewal period dates consist of: July 1, 2027 through June 30, 2028, and/or July 1, 2028 through June 30, 2029.

3.8 RENEWAL

The resulting Contract may not be renewed unless the renewal period(s) and any applicable conditions are shown below. The renewal shall be subject to the same terms and conditions as the original Contract unless otherwise stated below. However, the Contract may not renew automatically, nor may the Contract renew solely at the Vendor’s option.

The OAG reserves the right to renew for a total of 3 years in one of the following manners:

a) One renewal covering the entire renewal allowance,

b) Individual one-year renewals up to and including the entire renewal allowance, or

c) Any combination of full or partial-year renewals up to and including the entire renewal allowance.

End of Instructions

PART B – OFFER RESPONSE FORMS

SECTION 4 - OFFER TO STATE OF ILLINOIS, ATTORNEY GENERAL

Project Title / Reference #: ’27 AG Office Supplies (BID # 27-340IAGO-IAGO3-B-51976)

The undersigned authorized representative of the identified Vendor does hereby submit this Offer to perform in full compliance with the subject solicitation. By completing and signing this Form, we are making an Offer to the State of Illinois, Office of the Attorney General, for its review and possible acceptance. We are also certifying compliance with the various requirements of the solicitation and the documents contained in the solicitation.

Offeror hereby certifies that no person or entity representing their offer has retained a person or entity to attempt to influence the outcome of a procurement decision made under the Illinois Procurement Code for compensation contingent in whole or in part upon the decision or procurement. Any person who violates this subsection is guilty of a business offense and shall be fined.

We have marked each blank below as appropriate and have used N/A when a section is not applicable to this solicitation. We understand that failure to meet all requirements is cause for disqualification.

Check appropriate boxes below for each section:

We have:

Reviewed the Offer Form, including all referenced documents as well as the solicitation instructions, filled in all relevant blanks, provided any requested information, and

Signed on the space(s) provided

Acknowledgment of Amendments

We acknowledge receipt of any and all addendums to the solicitation and have taken those into account in making this Offer.

Offer Response Forms: Accompanying and as part of this Offer you will find:

(check appropriate boxes below):

For all Offers:

Bid Security, if required

Completed Responsibility Forms packet

Business and Directory Information

Disclosures and Conflicts of Interest

Completed and Signed Taxpayer Identification Number form

References, if required

Political Contributions Form

We have made the certification required by Public Act 95-971 & attached the State Board of Elections certificate of registration.

Exceptions: In preparing the Offer we have taken (check appropriate boxes below)

No Exceptions

Exceptions to the OAG’s language or requirements in the following sections of the Offer:

Contract

Responsibility forms

Details of the exceptions are shown (check one) in the text of each section of the Offer on a separate labeled attachment

Details of the exceptions are shown (check one) In the text of each section of the Offer

On a separate labeled attachment

Domestic Products (check the appropriate boxes below)

We are not making a claim for preference under the Procurement of Domestic Products Act (30

ILCS 517).

We are making a claim for preference under the Procurement of Domestic Products Act

(30

ILCS 517).

After reading the Act we certify we are eligible and that the following product or products bid or proposed in response to this solicitation meets the requirements of the Act. Check and complete as applicable:

All products

The following individual products (show line item if applicable)

Request for Confidential Treatment (check appropriate boxes below)

We are not requesting confidential treatment for this Offer.

We are seeking confidential treatment for portions of this Offer. We have supplied, as an attachment to this Offer, a listing of the provisions identified by section number for which we seek confidential treatment along with the statutory basis under Illinois law for exempting that information from public disclosure. We are including a detailed justification to support the statutory basis under Illinois law for exempting that information from public disclosure. We have supplied an additional copy of the Offer with confidential information deleted. In the event the designation of confidentiality of this information is challenged, the undersigned hereby agrees to provide legal counsel or other necessary assistance to defend the designation of confidentiality and agrees to hold the OAG harmless for any costs or damages arising out of the OAG agreeing to withhold the materials based on Vendor’s request.

Protests and Negotiations

If we are selected for award, we understand that does not entitle us to a contract. We further understand the award is conditioned on favorable resolution of any protests and to successful negotiation of terms and conditions including but not limited to price and any exceptions requested.

Vendor Contact Person:

The contact person for purposes of responding to any questions the OAG may have is:

Printed Name: Title:

Address:

Phone: Fax:

Email:

(Vendor name and DBA)

(Signature of party authorized to bind the named Vendor)

Printed Name Title

Address

Phone Number Fax

E-mail

SECTION 5 - RESPONSIBILITY FORMS

We have identified various information we need in order to determine if you are eligible to contract with the OAG and can be considered a ”Responsible” Vendor.

You will need to review each of the Responsibility forms

a. Fill in all relevant blanks and provide any requested information.

i. Business and Directory Information

ii. Disclosures and Conflicts of Interest

iii. Political Contributions

b. Complete and sign:

i. Taxpayer Identification Form

c. Attach references, if required

You must include all of this as part of your Offer or risk disqualification.

BUSINESS AND DIRECTORY INFORMATION

(a) Name of Business (Official Name and D/B/A)

(b) Business Headquarters (include Address, Telephone and Facsimile)

(c) If a Division or Subsidiary of another organization provide the name and address of the parent

(d) Billing Address

(e) Name of Chief Executive Officer

(f) Customer Contact (include Name, Title, Address, Telephone, Toll-Free Number, Facsimile and E-mail)

(g) Company Web Site

(h) Type of Organization (i.e., Sole Proprietor, Corporation, Partnership, etc. -- should be the same as on the Taxpayer ID form below)

(i) Length of Time in Business

(j) Annual Sales (for most recently completed Fiscal Year)

(k) Number of Full-Time Employees (average from most recent Fiscal Year)

(l) Type of and description of business

(m) State of incorporation, state of formation or state of organization

(n) Identify and specify the location(s) and telephone numbers of the major offices and other facilities that relate to the Vendor’s performance under the terms of this solicitation.

(o) Department of Human Rights (DHR) Public Contract Number

If Vendor has employed fifteen (15) or more full-time employees at any time during the 365-day period immediately preceding the publication of this solicitation in the Illinois Bidbuy (or issuance date if not published), then Vendor must have a current Public Contract Number or have proof of having submitted a completed application for one prior to the Solicitation opening date. (44 Ill.

Adm. Code 750.210(a)) For application information, call the DHR Public Contracts unit at (312) 814-2431.

Show # or attach proof of application.

DISCLOSURES AND CONFLICTS OF INTEREST

Instructions: Vendor shall disclose financial interests, potential conflicts of interest, debarment/legal proceedings, business operations with Iran, contract information and lobbyist information identified in Sections 1 through 6 below as a condition of receiving an award or contract (30 ILCS 500/50-13, 50-35 and 50-36). Failure to fully disclose shall render the contract, bid, proposal, subcontract, or relationship voidable by the chief procurement officer if s/he deems it in the best interest of the State of Illinois and may be cause for barring from future contracts, bids, proposals, subcontracts, or relationships with the State.

There are six sections to this form and each must be completed to meet full disclosure requirements.

Note: The requested disclosures are a continuing obligation and must be promptly supplemented for accuracy throughout the process and throughout the term of the resultant contract if the bid/offer is awarded. As required by 30 ILCS 500/50-2, for multi-year contracts Vendors must submit these disclosures on an annual basis.

A publicly traded entity may submit its 10K disclosure in satisfaction of the disclosure requirements set forth in Section 1 below.

HOWEVER, if a Vendor submits a 10K, they must still must complete Sections 2, 3, 4, 5 and 6 and submit the disclosure form.

If the Vendor is a wholly owned subsidiary of a parent organization, separate disclosures must be made by the Vendor and the parent. For purposes of this form, a parent organization is any entity that owns 100% of the Vendor.

This disclosure information is submitted on behalf of (show official name of Vendor, and if applicable, D/B/A and parent):

Name of Vendor: _________________________________________________

D/B/A (if used): ___________________________________________________

Name of any Parent Organization: _____________________________________

Section 5.1: Section 50-35 Disclosure of Financial Interest in the Vendor.

(All Vendors must complete this section)

Vendors must complete subsection (a), (b) or (c) below. Please read the following subsections and complete the information requested.

a. If Vendor is a Publicly traded corporation subject to SEC reporting requirements

i. Vendor shall submit their 10K disclosure (include proxy if referenced in 10k) in satisfaction of the financial and conflict of interest disclosure requirements set forth in subsections 50-35 (a) and (b) of the Procurement Code. The SEC 20f or 40f, supplemented with the names of those owning in excess of 5% and up to the ownership percentages disclosed in those submissions, may be accepted as being substantially equivalent to 10K.

Check here if submitting a:

10k 20f 40f

OR

b. If Vendor is a privately held corporation with more than 200 shareholders

i. These Vendors may submit the information identified in 17 CFR 229.401 and list the names of any person or entity holding any ownership share in excess of 5% in satisfaction of the financial and conflict of interest disclosure requirements set forth in subsections 50-35 a and b of the Illinois Procurement Code.

c. If Vendor is an individual, sole proprietorship, partnership or any other not qualified to use subsections (a) or (b), complete (i) and (ii) below as appropriate.

i. For each individual having any of the following financial interests in the Vendor (or its parent), please mark each that apply and show the applicable name and address. Use a separate form for each individual.

1. Do you have an ownership share of greater than 5% of the offering entity or parent entity?

Yes No

2. Do you have an ownership share of less than 5%, but which has a value greater than $106,447.20?

3. Do you receive more than $106,447.20 of the offering entity’s or parent entity’s distributive income? (Note: Distributive income is, for these purposes, any type of distribution of profits. An annual salary is not distributive income.)

4. Do you receive greater than 5% of the offering entity’s or parent entity’s total distributive income, but which is less than $106,447.20?

5. If you responded yes to any of questions 1-4 above, please provide either the percentage or dollar amount of your ownership or distributive shar of income: __________________. For partnerships with more than 50 partners, the percentage share of ownership of each individual identified above may be shown in the following ranges (dollar value fields must also be completed when applicable):

0.5% or less >0.5 to 1.0% >1.0 to 2.0% >2.0 to 3.0 %

> 3.0 to 4.0% >4.0 to 5.0% and in additional 1% increments as appropriate %

6. If you responded yes to any of the questions 1-4 above, please check the appropriate type of ownership/distributable income share:

Sole Proprietorship Stock Partnership Other (Explain)

Name:

7. In relation to individuals identified above, indicate whether any of the following potential conflicts of interest relationships apply. If "Yes," please describe each situation (label with appropriate letter) using the space at the end of this Section (attach additional pages as necessary). If no individual has been identified above, mark not applicable (N/A) here ________.

(a) State employment, currently or in the previous 3 years, Yes No including contractual employment of services directly with the individuals identified in Section 1 in their individual capacity unrelated to the Vendor's contract.

(b) State employment of spouse, father, mother, son, or daughter, Yes No including contractual employment for services in the previous 2 years.

(c) Elective status; the holding of elective office of the State of Yes No Illinois, the government of the United States, any unit of local government authorized by the Constitution of the State of Illinois or the statutes of the State of Illinois currently or in the previous 3 years.

(d) Relationship to anyone holding elective office currently or in the Yes No previous 2 years; spouse, father, mother, son, or daughter.

(e) Appointive office; the holding of any appointive government Yes No office of the State of Illinois, the United States of America, or any unit of local government authorized by the Constitution of the State of Illinois or the statutes of the State of Illinois, which office entitles the holder to compensation in excess of expenses incurred in the discharge of that office currently or in the previous 3 years.

(f) Relationship to anyone holding appointive office currently or in Yes No the previous 2 years; spouse, father, mother, son, or daughter.

(g) Employment, currently or in the previous 3 years, as or by any Yes No registered lobbyist of the State government.

(h) Relationship to anyone who is or was a registered lobbyist in Yes No the previous 2 years; spouse, father, mother, son, or daughter.

(i) Compensated employment, currently or in the previous 3 years, Yes No by any registered election or re-election committee registered with the Secretary of State or any county clerk in the State of Illinois, or any political action committee registered with either the Secretary of State or the Federal Board of Elections.

(j) Relationship to anyone; spouse, father, mother, son, or Yes No daughter; who is or was a compensated employee in the last 2 years of any registered election or reelection committee registered with the Secretary of State or any county clerk in the State of Illinois, or any political action committee registered with either the Secretary of State or the Federal Board of Elections.

Section 5.2: Section 50-13 Conflicts of Interest

Prohibition. It is unlawful for any person holding an elective office in this State, holding a seat in the General Assembly, or appointed to or employed in any of the offices or agencies of State government and who receives compensation for such employment in excess of 60% of the salary of the Governor of the State of Illinois [$106,447.20], or who is an officer or employee of the Capital Development Board or the Illinois Toll Highway Authority, or who is the spouse or minor child of any such person to have or acquire any contract, or any direct pecuniary interest in any contract therein, whether for stationery, printing, paper, or any services, materials, or supplies, that will be wholly or partially satisfied by the payment of funds appropriated by the General Assembly of the State of Illinois or in any contract of the Capital Development Board or the Illinois Toll Highway Authority.

Interests. It is unlawful for any firm, partnership, association, or corporation, in which any person listed in subsection (a) is entitled to receive (i) more than 7 1/2% of the total distributable income or (ii) an amount in excess of the salary of the Governor ($177,412.00], to have or acquire any such contract or direct pecuniary interest therein.

Combined interests. It is unlawful for any firm, partnership, association, or corporation, in which any person listed in subsection (a) together with his or her spouse or minor children is entitled to receive (i) more than 15%, in the aggregate, of the total distributable income or (ii) an amount in excess of 2 times the salary of the Governor [$354,824.00], to have or acquire any such contract or direct pecuniary interest therein.

(Check One):

No Conflicts of Interest

Potential Conflict of Interest (If checked, name each conflicted individual, the nature of the conflict and the name of the State agency that is associated directly or indirectly with the conflicted individual.)

Section 5.3: Debarment/Legal Proceeding Disclosure

Each of the persons identified in Sections 1 and 2 must each identify any of the following that occurred within the previous 10 years:

If any of the above is checked yes, please identify with descriptive information the nature of the debarment and legal proceeding. The State reserves the right to request more information, should the information need further clarification.

Section 5.4: Disclosure of Business Operations with Iran (All Vendors must complete this section).

In accordance with 30 ILCS 500/50-36, each bid, offer, or proposal submitted for a State contract, other than a small purchase defined in Section 20-20 [of the Illinois Procurement Code], shall include a disclosure of whether or not the bidder, offeror, or proposing entity, or any of its corporate parents or subsidiaries, within the 24 months before submission of the bid, offer, or proposal had business operations that involved contracts with or provision of supplies or services to the Government of Iran, companies in which the Government of Iran has any direct or indirect equity share, consortiums or projects commissioned by the Government of Iran and:

more than 10% of the company’s revenues produced in or assets located in Iran involve oil-related activities or mineral-extraction activities; less than 75% of the company’s revenues produced in or assets located in Iran involve contracts with or provision of oil-related or mineral – extraction products or services to the Government of Iran or a project or consortium created exclusively by that Government; and the company has failed to take substantial action;

The company has, on or after August 5, 1996, made an investment of $20 million or more, or any combination of investments of at least $10 million each that in the aggregate equals or exceeds $20 million in any 12- month period that directly or significantly contributes to the enhancement of Iran’s ability to develop petroleum resources of Iran.

Debarment from contracting with any governmental entity Yes No

Professional licensure discipline Yes No

Bankruptcies Yes No

Adverse civil judgments and administrative findings Yes No

Criminal felony convictions Yes No

A bid, offer, or proposal that does not include this disclosure shall not be considered responsive. We may consider this disclosure when evaluating the bid, offer, or proposal or awarding the contract.

You must check one of the following items and if the second box is checked, you must also make the necessary disclosure:

There are no business operations that must be disclosed to comply with the above cited law.

The following business operations are disclosed to comply with the above cited law:

Section 5.5: Current and Pending Contracts

Does the Vendor have any contracts pending contracts, bids, proposals or other Yes No ongoing procurement relationships with units of State of Illinois government?

If yes, please identify each contract, pending contract, bid, proposal and other ongoing procurement relationship it has with units of State of Illinois government by showing agency name and other descriptive information such as bid number, project title, purchase order number or contract reference number.

Section 5.6: Representative Lobbyist/Other Agent (All Vendors must complete this section).

Is the Vendor represented by or employing a lobbyist required to register under the Yes No Lobbyist Registration Act or other agent who is not identified under Sections 1 and 2 and who has communicated, is communicating, or may communicate with any State officer or employee concerning the bid, offer or contract?

If yes, please identify each agent / lobbyist, including name and address.

Costs/Fees/Compensation/Reimbursements related to assistance to obtain contract (describe):

Vendor certifies that none of these costs will be billed to the State in the event of contract award.

Vendor must file this information with the Secretary of State.

This Disclosure is signed and made under penalty of perjury pursuant to Sections 500/50-13 and 500/50-35(a) of the Illinois Procurement Code.

This disclosure information is submitted on behalf of: _________________________________

(Vendor/Subcontractor Name)

Name of Authorized Representative:

Title of Authorized Representative:

Signature of Authorized Representative:

Date:

Political Contributions

Every bid submitted to the OAG after January 1, 2009 (the effective date of Public act 95- 971), must contain a certification by the bidder that either the bidder is not required to register as a business entity with the State Board of Elections pursuant to section 20-160 of the Illinois Procurement Code (30 ILCS 500/20-160) or the bidder has registered as a business entity with the State Board of Elections and acknowledges a continuing duty to update the registration. More information about the registration requirements can be found on the Board of Elections website, www.elections.il.gov.

By submission of an Offer, you acknowledge and certify that you have read, understand and will comply with section 9-35 of the Illinois Election Code (10 ILCS 5/9-35) and section 20-160 of the Illinois Procurement Code, including but not limited to, all provisions relating to reporting and making contributions to state officeholders, declared candidates for State offices and covered political organizations that promote the candidacy of an officeholder or declared candidate for office. Vendor acknowledges that the OAG may declare any resultant contract void if this certification is false or if section 20-160 of the Illinois Procurement Code is violated.

In compliance with the Illinois Procurement Code, please check the following certification that applies to you:

Vendor is not required to register as a business entity with the State Board of Elections.

Vendor has registered as a business entity with the State Board of Elections. As a registered business entity, Vendor acknowledges a continuing duty to update the registration as required by the Act.

TAXPAYER IDENTIFICATION NUMBER

I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3. 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’s name on the name line and the d/b/a on the business name line and enter the owner’s SSN or EIN.

If the LLC is a corporation or partnership, enter the entity’s business name and EIN and for corporations, 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: _______________________________________________________________

Business Name: ______________________________________________________

Taxpayer Identification Number: _________________________________________

Social Security Number: _________________________________________

Employer Identification Number: ____________________________________

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 (select Medical and/or Healthcare services Applicable tax classification)

Corporation NOT providing or billing Medical and/or health C = Corporation care services P = Partnership

Signature: ________________________________ Date: ____________________

SECTION 6 - RESPONSIVENESS

For this solicitation, you will need to respond to each of the points identified in Section 3 of the Solicitation.

You must follow any format shown or referenced below. If none, you may respond freeform provided you address all the points, numbering each point as found in Section 3 and addressing them in the order they appear.

SECTION 7 - PRICE

7.0 PRICE SUBMISSION: The Vendor will provide its Price Proposal in accordance with the services specified in this document. Required pricing details are shown below:

7.1 METHOD AND RATE OF COMPENSATION: Identify the method of and provide the rate or price for each type of supply or service. Pricing shall be in accordance with the unit of measure specified and unit price shall be quoted per item unless specifically provided below. All extensions and totals requested shall be shown. Prices quoted must be net after deducting all trade or quantity discounts and any other available allowances. Prices must be F.O.B. DESTINATION with all transportation and handling included and paid by the Vendor.

Hourly

Monthly

Annually

Project

X Item (show unit of measure and rate)

7.2 MAXIMUM COMPENSATION FOR SUPPLIES AND SERVICES: Show price in checked category only:

X Firm Price:

Estimated Price

7.3 EXPENSES: Unless otherwise specified, this contract does not allow for reimbursement of any expense incurred by Vendor, including but not limited to telephone or other communications devices, postage, copying, travel, transportation, lodging, food and per diem.

7.4 PAYMENT TERMS AND CONDITIONS (including when paid, frequency and retainage): Payment will be made after completion of the Contract unless otherwise specified below. 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. Invoices for supplies purchased, services performed and expenses incurred through June 30 of any year must be submitted to the State no later than July 31 of that year; otherwise Vendor may have to seek payment through the Illinois Court of Claims (30 ILCS 105/25). All invoices are subject to statutory offset (30 ILCS 210).

7.5 DISCOUNTS: ____% discount for payment within ____ days of delivery. This discount will not be a factor in making the award.

7.6 TAX EXEMPTIONS: State and Federal tax exemption information is available upon…