W.W. Grainger Contract Amendment 03172020.pdf

STATE OF ILLINOIS

CONTRACT AMENDMENT

State of Illinois Chief Procurement Office 1 Contract Amendment with Certifications (< $50K) V.15.2

The undersigned Agency and Vendor, W.W. Grainger, (the Parties) agree that the following shall amend the Contract referenced herein. All terms and conditions set forth in the original Contract, not amended herein, shall remain in full force and effect as written. In the event of conflict, the terms of this Amendment shall prevail.

IN WITNESS WHEREOF, the Agency and the Vendor cause this Amendment to be executed on the dates shown below by representatives authorized to bind the respective PARTIES.

VENDOR

Vendor Name: W.W. Grianger Inc. Address: 100 Grainger Parkway Lake Forest, IL . 60045

Signature: Phone: 513-505-0141

Printed Name: Michelle Hammer Fax:

Title: Sr. Government Sales Manager Email: michelle.hammer@grainger.com

Date: 3/30/2020

STATE OF ILLINOIS

Procuring Agency: Central Management Services Phone: 1-866-455-2897

Street Address: 1000 E Converse St. Fax:

City, State ZIP: Springfield, IL 62702

Official Signature: Date:

Printed Name:

Official’s Title:

Legal Signature: Date:

Legal Printed Name:

Legal’s Title:

Fiscal Signature: Date:

Fiscal’s Printed Name:

Fiscal’s Title:

State of Illinois Chief Procurement Office 2 Contract Amendment with Certifications (< $50K) V.15.2

STATE USE ONLY NOT PART OF CONTRACTUAL PROVISIONS

PBC# 12-71645 Project Title PSD MAINTENCE, REPAIR, AND OPERATIONS

Contract # PSD4018035 Procurement Method (IFB, RFP, Small, etc): IFB

IPB Ref. # 227234 IPB Publication Date: 3/10/2014 Award Code: A

Subcontractor Utilization? Yes X No Subcontractor Disclosure? Yes No

Funding Source Obligation #

CPO 33 – General Counsel Approval:

Signature Printed Name Date

State of Illinois Chief Procurement Office 3 Contract Amendment V.15.2

1. CONTRACT DESCRIPTION (including Original Purchase Order or Contract Number): PSD MAINTENCE, REPAIR, AND OPERATIONS (PSD4018035).

2. CHANGE ORDER: Is this amendment a change order as defined in 30 ILCS 500/1-15.12 and 720 ILCS

5/33E?

Yes No

3. DESCRIPTION OF AMENDMENT (Check all that apply, complete blanks and explain as necessary):

3.1. The completion date will be extended.

3.1.1. Original completion date: 04/30/2020.

3.1.2. Revised completion date: 10/31/2020.

3.2. The method of determining compensation (e.g., hourly rate, fixed fee, etc.) will stay the same.

3.3. The cost will be increased.

3.3.1. Original cost: $100,000,000.

3.3.2. Amount of change: $10,000,000.

3.3.3. Revised cost: $110,000,000.

3.4. The supplies or services to be provided will stay the same.

3.5. Subcontractors are being added, deleted, or remain the same?

• Subcontractor Name:

added deleted

Amount to be paid:

Address:

Description of work:

• Subcontractor Name:

added deleted

Amount to be paid:

Address:

State of Illinois Chief Procurement Office 4 Contract Amendment V.15.2

Description of work:

3.5.1. All contracts with the subcontractors identified above must include the Standard Certifications and Financial Disclosures and Conflicts of Interest completed and signed by the subcontractor.

3.5.2. If the annual value of any of the subcontracts is more than $50,000, then the Vendor must provide to the State the Financial Disclosures and Conflicts of Interest for that subcontractor.

3.5.3. If the subcontractor is registered in the Illinois Procurement Gateway (IPG) and the Vendor is using the subcontractor’s Standard Certifications or Financial Disclosures and Conflicts of

Interest from the IPG, then the Vendor must also provide a completed Forms B for the subcontractor.

3.5.4. If at any time during the term of the Contract, Vendor adds or changes any subcontractors, Vendor will be required to promptly notify, in writing, 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.

4. EFFECTIVE DATE OF AMENDMENT: Upon execution date.

STATE OF ILLINOIS

TAXPAYER IDENTIFICATION NUMBER

State of Illinois Chief Procurement Office 5 Taxpayer Identification Number V.15.2

I certify that:

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

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

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: W.W. Grainger Inc.

Business Name: Grainger

Taxpayer Identification Number:

Social Security Number:

or

Employer Identification Number : 36-1150280

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)

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

Signature of Authorized Representative:

Date: 3/30/2020