ILLINOIS SECRETARY OF STATE
LOBBYIST REPORTING FORM FOR
VERBAL PROCUREMENT COMMUNICATIONS
*Submission of this form is required only by registered lobbyists after oral communications to a Secretary of State employee about
a procurement on behalf of a vendor/client, according to Section 50-39 of the Illinois Procurement Code, 30 ILCS 500/50-39.
*This form need not be submitted for (i) statements by a person publicly made in a public forum; (ii) statements regarding matters
of procedure and practice, such as format, the number of copies required, the manner of filing, and the status of a matter; or (iii)
communications regarding the administration and implementation of an existing contract.
LOBBYIST NAME AND REGISTRATION NUMBER:
LOBBYIST TELEPHONE NUMBER/EMAIL ADDRESS:
CLIENT/VENDOR NAME:
Type of VERBAL Contact (Select One):
n
In Person
n
Telephone
n
Other (list):
Name and Job Title of Secretary of State Employee Contacted:
Secretary of State Employee Telephone Number (if known) or Name of Secretary of State Department Contacted:
Date, Time and Duration of Contact:
Location of the Verbal Communication:
Action Requested/Recommended by Lobbyist on behalf of Vendor:
Summary of Communication and Pertinent Information:
Names and Telephone numbers of any other Participants:
Date this Form Submitted to the Secretary of State:
Submit this form to: Secretary of State, Inspector General’s Office, C/O Procurement Compliance Monitor,
324 W. Monroe St., Springfield, Il 62704
Printed by authority of the State of Illinois. August 2011 — 1 — SOS IG 17
