Fill - Free fillable Office of the Illinois State Treasurer Michael W. (Illinois State Treasurer's Office) PDF form

Office of the Illinois State Treasurer

Michael W. Frerichs

Request for Proposals

E-Pay Accounts

Proposals due June 25, 2015 by 2 pm CT.

May 27, 2015

Jim Underwood

Chief Procurement Officer

400 West Monroe Street, Suite 401

Springfield, IL 62704

Office of the Illinois State Treasurer

Request for Proposals

E-Pay Accounts

Table of Contents

I. Overview ............................................................................................................................. 3

II. Background ......................................................................................................................... 3

III. Scope of Work .................................................................................................................... 4

IV. Proposal............................................................................................................................... 6

V. RFP Schedule and Process .................................................................................................. 8

VI. Evaluation Process and Criteria ........................................................................................ 11

VII. Contract Terms and Conditions ........................................................................................ 13

Appendix A ................................................................................................................................... 18

Appendix B ................................................................................................................................... 28

Appendix C ................................................................................................................................... 31

Appendix A Illinois State Treasurer Certifications

Appendix B Disclosures Financial Interest and Potential Conflicts of Interest (Disclosure

Form A)

Appendix C Disclosures Other Contract and Procurement Related Information (Disclosure Form B)

I. Overview

This is a Request for Proposal (“RFP”) regarding the Office of the Illinois State Treasurer’s

(“Treasurer”) electronic payment processing program (“E-Pay”) and the bank accounts affiliated

thereto. Due to the planned custodial transition of the public treasurer’s investment pool

(“Illinois Funds”), the E-Pay accounts must also be transitioned to a new custodial bank. This

RFP seeks a financial institution that can 1) provide E-Pay accounts where the funding of

electronic payments can settle and 2) assign such accounts the current E-Pay routing number and

account numbers (collectively, the “Project”). The Treasurer does not seek an electronic

payment processor at this time.

Financial institutions that submit responses (“Respondents”) shall submit their responses to this

RFP (“Proposals”) by 2 pm on June 25, 2015. The winning Respondent (“Contractor”) shall

enter into a contract with the Treasurer (“Agreement”) for an initial term of four (4) years. Upon

expiration of this term, the Treasurer shall have the option to renew the Agreement for additional

periods, not to exceed a total of ten (10) years, including the initial four (4) years.

II. Background

This Section provides an explanation of the E-Pay program and the changes it will be

undergoing.

A. What is E-Pay?

Authorized by Section 17 of the State Treasurer Act, 15 ILCS 505/17, the Treasurer administers

a public treasurers’ investment pool (“Illinois Funds”) and, as a corollary, E-Pay. E-Pay is an

electronic payment processing service made available only to units of Illinois government that

invest in the Illinois Funds. Participants include, but are not limited to, county treasurers, circuit

clerks, municipalities, colleges, and universities.

E-Pay provides Participants a safe and secure electronic payment program that allows a

Participant’s customers (“Customers”) the ability to pay bills 24 hours a day, seven days a week.

Participants may accept credit cards, bank cards, and electronic checks via the internet, over-the-

phone through a telephone system (“IVR”) and over-the-counter (“OTC”). The Treasurer has

approximately 800 State and local Participants with over 5,000 operating merchant identification

numbers.

B. Current account structure

All E-Pay accounts are Illinois Funds accounts, making them investment accounts within the

Illinois Funds. Currently, these accounts are allowed to initiate transactions via wire, automated

clearing house (“ACH”), and check. However, the Treasurer is in the process of removing check

writing capabilities from the E-Pay accounts and will be completed prior to the transition to the

Contractor. As these accounts are currently Illinois Funds accounts, Participants do not receive

direct charges for the services. The costs are part of the overall custodian fee charged against the

earnings of the Illinois Funds.

The average total balance of all E-Pay accounts over the past 18 months is nearly

$739,000,000.00. The total program processing volume funded to E-Pay accounts is

approximately $150,000,000.00 per month. During 2014, the monthly average chargeback

volume against all accounts was approximately $23,333 per month, and for 2015 year to date the

average has been approximately $37,750. There is an average of 5 overdraft accounts per month

with no more than 12 per month over the past 12 months. Currently, there is no charge for

overdrafts.

C. Transition of E-Pay

The Treasurer is currently coordinating a transition between custodians for the Illinois Funds.

As a result of the transition, E-Pay will also require a new custodial bank. Currently, the E-Pay

accounts are held on a Hogan platform. After the transition to a new bank custodian, the E-Pay

accounts will be “transaction” accounts.

In order to provide Participants with an efficient transition, Participants must retain the current

E-Pay American Bank Association (“ABA”) routing transit number and their current account

numbers (“Account Numbers”). All E-Pay accounts currently have the same ABA routing

transit number, which is 081225707 (“ABA Number”). At this time, only the Illinois Funds and

E-Pay accounts utilize the ABA Number. However, after the transition to the Contractor, only

E-Pay accounts will utilize the ABA Number.

E-Pay account numbers currently have a 10 or 12 digit format. The current Account Number

structure is as follows:

E-Pay Account Numbers: 71391xxxxx, 15160xxxxxxx

43486xxxxx, 25160xxxxxxx

III. Scope of Work

With this RFP, the Treasurer seeks a Contractor that will obtain the ABA Number; provide

Participants with E-Pay accounts bearing the ABA Number and Account Numbers; and, at the

expiration of the Agreement, transfer the ABA Number and Account Numbers to a successor

bank, selected by the Treasurer. Sections III.A through III.C are hereinafter referred to

collectively as the “Work.”

A. Transition

The Contractor shall perform the following:

1. Obtain the ABA Number for the sole benefit of E-Pay;

2. Coordinate with the current E-Pay custodial bank and the Treasurer for a smooth transition of

the E-Pay accounts;

3. Supply the current custodian with an image cash letter (ICL) or some other agreed upon

settlement process for the Illinois Funds accounts for a specified period of time after the

transition date; and

4. Upon termination of the Agreement, transfer the ABA Number and Account Numbers to a

successor financial institution, selected by the Treasurer.

B. Accounts

The Contractor shall perform the following:

1. Provide Participants with E-Pay accounts, bearing the ABA Number and Account Numbers;

2. Provide adequate personnel to accommodate telephone inquiries, requests and technical

issues from Participants and the Treasurer;

3. Provide a toll-free line for the exclusive use of Participants;

4. Send Participants deposit notifications by e-mail or facsimile on the day such deposit is

made. Each notification will report the amount deposited, the account credited, the date

of credit, and the date the funds are available;

5. Provide Participants electronic access to account information, specifically current and

historical account detail with addenda information, the ability to print and export current

and previous daily statements and monthly statements, and any other services Respondent

can provide;

6. For E-Pay account balances over the FDIC limit,

a. pledge securities, acceptable to the Treasurer and held in a manner acceptable to the

Participant, to ensure accounts are collateralized or

b. provide mutually acceptable sweep investment opportunities for end of day balances;

7. Give Participants the option to have fees invoiced or debited from the E-Pay account; and

8. Provide ACH Fraud Filters to protect the E-Pay accounts from unauthorized transactions.

C. Add-ons

The Contractor may perform the following:

1. Automatically transfer E-Pay account funds over a predetermined amount to an Illinois Funds

account at U.S. Bank Fund Services every business day by 10:30 a.m. CT via a daily

purchase through a TIP file to U.S. Bank Funds Services in conjunction with a single

wire transfer of funds associated with the TIP file;

2. Provide Participants an earnings credit in their billing statement or account analysis, based

on the average monthly collected balance in a Participant’s account and offset the fees related

to the account with such credit;

3. Charge Participants an administrative fee on behalf of the Treasurer and transfer the

payments to the Treasurer;

4. Limit a Participant’s E-Pay account to only receive credits and debits from the

established credit card processors or such Participant’s Illinois Funds account; and

5. Provide bank defined templates for wire transfer and ACH transactions from a

Participant’s E-Pay account to its respective Illinois Funds account.

IV. Proposal

This Section provides the required elements for Respondent’s Proposal.

A. Proposal format

The Respondent’s Proposal shall contain the following:

1. Cover page – The cover page shall provide the name, physical address, e-mail address,

and telephone number of the person(s) available for contact regarding the Proposal. Such

person(s) must be authorized to make representations on behalf of the Respondent.

2. Section I – In Section I, Respondent shall provide a brief two-page narrative, describing

the general conceptual approach Respondent would take to perform the Project and any

other information Respondent believes is relevant. Emphasis should be on clarity,

brevity and completeness of response.

3. Section II – In Section II, Respondent shall list all of the Work set forth in Section III of

this RFP and confirm or deny whether it can perform each item. Respondent’s answers

must including the headings (e.g. “Transition”) and be numbered in the order provided in

Section III of this RFP.

4. Section III – Section III shall contain Respondent’s answers to the questions presented in

Section IV.B of this RFP. Respondent must respond to all of the questions.

Respondent’s answers must include the headings (e.g. “E-Pay Accounts”) and be

numbered in the order provided in Section IV.B.

5. Section IV – Section IV shall provide a list of the subcontractor(s) Respondent will use

for this Project, if any, and the general type of work to be performed by each

subcontractor.

6. Section V - Respondent and any subcontractor(s) must submit the following three (3)

fully executed documents: Illinois State Treasurer Certifications, Disclosures Financial

Interest and Potential Conflicts of Interest (Disclosure Form A), and the Disclosures

Other Contract and Procurement Related Information (Disclosure Form B).

7. Section VI – Section V shall provide Respondent’s price (“Cost Proposal”) in a

separately sealed envelope and on a separate electronic storage device. The required

elements of the Cost Proposal are provided in Section IV.C of this RFP.

Proposals must be submitted in a sealed envelope or package bearing the title “State Treasurer

Request for Proposal for E-Pay Accounts” and the Respondent’s name and address. The package

must include one (1) original and four (4) copies of the Proposal. A separate envelope must

contain one (1) original and four (4) copies of the Cost Proposal. In addition, please provide

three (3) electronic copies of the Proposal and three (3) separate electronic copies of the Cost

Proposal. Each electronic Proposal copy and each electronic Cost Proposal copy shall be on a

separate electronic storage device, such as a CD or thumb drive.

B. Questions to be addressed in the Proposal

E-Pay Accounts

1. If possible, how would Respondent limit a Participant’s E-Pay account to only receive

credits and debits from the established credit card processors or such Participant’s Illinois

Funds account?

2. Discuss the ACH Fraud Filters Respondent would provide Participants, including

notification formats, and the timeframe in which Participants would be required to

respond to such notifications;

3. If possible, how would Respondent charge Participants administration fees on behalf of the

Treasurer and transfer the payments to the Treasurer;

4. How will Federal Deposit Insurance Corporation (“FDIC”) charges be handled, meaning will

such charges be passed through to the Participants, covered by Respondent, etc.?

5. Discuss how Respondent intends to provide customer service to the Treasurer and

Participants.

6. Please discuss the account information and account services Respondent can

electronically provide Participants.

7. Provide a complete list of banking services Respondent can provide Participants.

Diversity

8. Please provide the percentage of Respondent’s staff who are female, minority, persons

with disabilities, or military veterans.

9. Is the Respondent or its affiliates female, minority, persons with disabilities, or veteran

owned or managed? For purposes of this RFP, “female, minority, persons with

disabilities, or veteran owned or managed” shall mean being owned or managed by 51%

or more of a combination of female, minority, persons with disabilities, or military

veteran.

10. Using the definition provided above, what is the percentage of Respondent’s

subcontractors for this Project, if any, that are female, minority, persons with disabilities,

or veteran owned or managed?

Illinois Presence

11. Please describe what presence the Respondent has in the State of Illinois. Such

“presence” can be demonstrated by the percentage of Respondent’s full-time employees

or employees who spend more than half their time in Illinois and having physical offices

or a principal place of business located in Illinois.

12. Using the definition provided above, what is the percentage of Respondent’s

subcontractors for this Project, if any, that have an Illinois presence?

C. Cost Proposal

For the Cost Proposal, Respondent shall provide a list of proposed banking services and the cost for

each service. Pricing should not be provided in a bundled format.

V. RFP Schedule and Process

This Section provides the process and schedule for this RFP.

A. RFP Schedule

The following is the schedule for this RFP:

Date

Event

May 27, 2015

RFP published on the Treasurer’s website.

June 2, 2015

Notice of intent to participate in the Bidder’s Conference due by

2 pm CT.

June 3, 2015

Mandatory Bidder’s Conference at 2 pm CT.

June 10, 2015

All Respondent questions due to the Chief Procurement Officer

by 2 pm CT.

June 16, 2015

Responses to all Respondent questions posted on the

Treasurer’s website by 4 pm CT.

June 25, 2015

Proposals due by 2 pm CT.

July 1, 2015

Interviews, if any, with final candidates.

July 21, 2015

If applicable, best and final offer due by 2 pm CT.

July 23, 2015

Notification of award and begin negotiation of Agreement.

These dates are subject to change at the Treasurer’s discretion.

B. Contact Information

The Treasurer’s Chief Procurement Officer (“CPO”) is the sole point of contact concerning this

RFP.

Respondents should submit questions about the intent or content of this RFP and request

clarification of any and all procedures used for this RFP prior to the submission of a Proposal.

Respondents must submit their questions in writing by e-mail to the CPO by 2pm CT on June 10,

2015.

Jim Underwood

Chief Procurement Officer

Office of the Illinois State Treasurer

400 W. Monroe St., Suite 401

Springfield, IL 62704

Phone: 217.782.1708

Fax: 217.524.3822

junderwood@illinoistreasurer.gov

C. Mandatory Bidder’s Conference

If a Respondent intends to participate in the Bidder’s Conference, Respondent must e-mail the

CPO notice of intent to participate by 2 pm CT on June 2, 2015. Participation by phone is

acceptable. The Bidder’s Conference shall be on June 3, 2015 at 2 pm CT at the following

address:

400 W. Monroe St., Suite 401

Springfield, IL 62704

For Respondents who wish to participate in the Bidder’s Conference by phone, the dial-in

information is as follows:

Phone number: 888.494.4032

Password: 7753017055

D. Proposal Submission

All Proposals must be received by mail or messenger no later than 2 pm CT on June 25, 2015.

Proposals should be mailed or messengered to

Jim Underwood

Office of the Illinois State Treasurer

400 W. Monroe St., Suite 401

Springfield, IL 62704

E. RFP Process

1. RFP amendments

If it is necessary to amend this RFP, the Treasurer will post any amendment to its website at

www.illinoistreasurer.gov.

2. CPO may cancel the RFP

If the CPO determines it is in the State’s best interest, he reserves the right to do any of the

following:

a. cancel this RFP;

b. modify this RFP as needed; or

c. reject any or all Proposals received in response to this RFP.

3. Respondents’ costs

The cost of developing a Proposal is each Respondent’s responsibility and may not be charged to

the Treasurer.

4. Withdrawal of Proposal

Respondent may withdraw its Proposal at any time prior to the deadline for receipt of Proposals.

The Respondent must submit a written withdrawal request, addressed to the CPO and signed by

the Respondent’s duly authorized representative.

5. Modification of Proposal

A Respondent may submit an amended Proposal before the deadline for receipt of Proposal.

Such amended Proposal must be a complete replacement for the previously submitted Proposal

and must be clearly identified as such in the transmittal letter to the CPO.

6. Proposal is State property

On the Proposal due date, all Proposal and related material submitted in response to this RFP

become the property of the State of Illinois.

7. Proposal is a firm offer

A Proposal submitted in response to this RFP is a firm and binding offer, valid for 180 days after

the due date for Proposals or the due date for the receipt of a best and final offer, whichever falls

later.

8. Verbal communications

Any verbal communication from the Treasurer’s employees or its contractors concerning this

RFP is not binding on the State, and shall in no way alter a specification, term or condition of

this RFP.

VI. Evaluation Process and Criteria

This Section explains how the Treasurer will evaluate the Proposals.

A. Mandatory requirements

Failure to perform any of the following shall lead to Respondent’s automatic disqualification:

1. Submit Proposal and accompanying Cost Proposal by 2 pm on June 25, 2015;

2. In Respondent’s Proposal, provide all of the sections and the information required for

each section as set forth in Section IV.A of this RFP;

3. Be able to assign Participants’ current Account Numbers to the new E-Pay accounts; and

4. Provide the Cost Proposal in a separately sealed envelope and on a separate electronic

storage device.

B. Scoring

Evaluation Factor

Maximum Number

of Points Possible

Ability to perform the Work

Work plan

Diversity

Illinois presence

Cost Proposal

TOTAL

100

C. Determining scores

The Treasurer’s employees will comprise the evaluation team (“Evaluation Team”). Each

Evaluation Team member will independently review and score the Proposals. The scores will

then be compiled and analyzed. The Evaluation Team reserves the right to waive minor

technical irregularities.

1. Ability to perform the Work score

The Evaluation Team will evaluate the Respondent’s ability to perform the Work, based upon

the answers Respondent provides in Section II of its Proposal. A Respondent will either receive

50 or 0 points, depending upon whether it can perform all of the mandatory items listed in

Sections III.A through III.B of this RFP. A Respondent can receive up to 10 points for its ability

to provide the preferred items listed in Section III.C of this RFP.

2. Work plan score

The Evaluation Team shall score the Respondent’s Work plan, based upon the narrative

Respondent provides in Section I of its Proposal and the responses in Section III of its Proposal

(responses to Section IV.B of this RFP). Higher scores will be awarded to the Respondents that

best fit the needs of the E-Pay program.

3. Diversity score

Respondent’s diversity score will be scored based on the answers Respondent provides to the

diversity questions in Section IV.B of this RFP. The Evaluation Team shall award a higher

diversity score to Respondents that are female, minority, person with disabilities, or veteran

owned or managed. Having a higher percentage of subcontractors that are female, minority,

person with disabilities, or veteran owned or managed shall also result in higher scores.

4. Illinois presence score

Respondent’s Illinois presence shall be scored based on the answers Respondent provides to the

Illinois presence questions in Section IV.B of this RFP. Respondents with a principal place in

Illinois and a higher percentage of employees in Illinois shall receive higher scores.

5. Cost Proposal score

The Evaluation Team shall evaluate the cost-effectiveness of Respondent’s Cost Proposal in

order to determine the Cost Proposal score.

VII. Contract Terms and Conditions

The Contractor shall agree to each contractual provision set forth in this Section.

A. Contractual responsibility

Contractor will be contractually responsible for all services provided. By responding to the RFP,

Contractor expressly agrees to the Contractual Requirements herein. Contractor shall at all times

provide services in a commercially reasonable manner.

B. Governing law

The Agreement shall be governed in all respects by the laws of the State of Illinois.

C. Record retention and audit

Contractor agrees to maintain books and records related to the performance of the contract and

necessary to support amounts charged to the State under the contract for a minimum of three

years from the last action on the contract or after termination of the Agreement, whichever is

longer. Contractor further agrees to cooperate fully with any audit and to make the books and

records available for review and audit by the Auditor General, chief procurement officers,

internal auditor and the Treasurer; Contractor agrees to cooperate fully with any audit conducted

by the Auditor General or the Treasurer and to provide full access to all relevant materials. The

three-(3)-year period shall be extended for the duration of any audit in progress during the term.

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

this Agreement for which adequate books, records, and supporting documentation are not

available to support their purported disbursement.

D. Term of Agreement

The Agreement shall have a four (4) year term, unless terminated in accordance with the terms of

the Agreement. The Treasurer shall have the option to renew the Agreement for additional

periods, not to exceed a total term of ten (10) years, including the initial four (4) years.

E. Termination

1. Termination without cause

The Treasurer may elect to terminate the Agreement any time upon five (5) days’ notice. Upon

termination, the Treasurer will pay for work satisfactorily completed prior to the date of

termination as determined in a reasonable manner.

2. Termination for cause

Notwithstanding any language to the contrary, the Agreement may be terminated by the

Treasurer under any of the following circumstances:

a. Contractor fails to furnish a satisfactory performance within the time specified;

b. Contractor fails to perform any of the provisions of this Agreement, or so fails to make

progress as to endanger performance of this Agreement in accordance with its terms;

c. Any services provided under the Agreement are rejected and are not promptly corrected

by Contractor, or repeatedly rejected even though Contractor offers to correct services

promptly;

d. There is sufficient evidence to show that fraud, collusion, conspiracy, or other unlawful

means obtained the Agreement;

e. Contractor is guilty of misrepresentation in connection with another contract for services

to the State;

f. Contractor is adjudged bankrupt or enters into a general assignment for the benefit of

their creditors or receivership due to insolvency;

g. Contractor disregards laws and ordinances, rules, or instructions of a contracting officer

or acts in violation of any provision of the Agreement or this part, or the Agreement

conflicts with any statutory or constitutional provision of the State of Illinois or of the

United States; and

h. Any other breach of contract or other unlawful act by Contractor occurs.

Prior to terminating the Agreement for cause, the Treasurer shall issue a written warning that

outlines the remedial action necessary to bring the Contractor into conformance with the

Agreement. If such remedial action is not completed to the satisfaction of the Treasurer within

thirty (30) business days, a second written warning may be issued. If satisfactory action is not

taken by Contractor within five (5) business days of the date of the second written warning, the

Agreement may be cancelled and the Treasurer may recover any and all damages involved with

the transition to a new vendor including incidental and consequential damages. Failure by the

Treasurer to issue a warning or cancel this Agreement does not waive any of the Treasurer’s

rights to issue subsequent warnings.

In addition, the Treasurer reserves the right to reduce the fee paid to Contractor as compensation

for services under the Agreement during any period Contractor fails to perform with reasonable

care any of its obligations under the Agreement.

F. Confidentiality and security requirements

1. Confidential Information

All Confidential Information, as defined below, shall be held in strict confidence by the

Contractor and shall not be disclosed to any third party. Confidential Information includes all

information but the following: (i) information already known or independently developed by the

recipient; (ii) information required to be released by law; (iii) information in the public domain

through no wrongful act of the recipient; and (iv) information received by the recipient from a

third party who was free to disclose it (“Confidential Information”).

Any disclosure required to be made by applicable law shall not be made sooner (unless otherwise

compelled or required by law or judicial process) than five (5) business days immediately

following receipt by the Treasurer from the Contractor of written notice of such order, and such

notice will include a copy of any relevant court or other order. In the event the Contractor is

ordered to disclose Confidential Information, the Contractor shall afford the Treasurer a

reasonable opportunity to participate and object to any such disclosure.

2. Use of Confidential Information by Employees and Agents of Contractor

The requirement of confidentiality under this Agreement also applies to the employees and

agents of the Contractor. The Contractor shall use its best efforts to ensure that its employees

and agents adhere to the confidentiality requirements set forth herein. Use by and disclosure to

employees and agents of Confidential Information to the extent necessary to carry out the terms

and purposes of this Agreement is acceptable.

3. Protection of Confidential Information

The Contractor represents, warrants, and covenants that it has implemented and will maintain an

information security program reasonably designed to protect Confidential Information, including

customer information, which program includes administrative, technical, and physical safeguards

to ensure the security and confidentiality of all customer information, to protect against

anticipated threats or hazards to the security or integrity of such customer information, and to

protect against unauthorized access to or use of such customer information.

4. Privacy Policy

Contractor will comply with any applicable federal or state laws or regulations, as well as any

comply with a privacy policy with respect to the Project that meets the requirements of

applicable law.

5. Program Lists

The Contractor specifically agrees that it shall not, and shall cause its subcontractors and

affiliates not to, sell, provide, or otherwise disclose information from, any program list to any

third party, unless otherwise directed to or approved by the Treasurer or required by applicable

law.

G. Liability of Contractor

Contractor shall be liable to the Treasurer for actual and compensatory damages that are

available to the Treasurer in law or remedies in equity.

H. Indemnification

The Contractor shall indemnify, defend and hold Treasurer, its officers, agent and employees,

harmless from and against any and all liabilities, demands, claims, lawsuits, losses, damages,

causes of action, fines, or judgments, including costs, attorneys’ and witnesses’ fees and

expenses incident thereto, for all injuries, including but not limited to injuries to person and for

loss of, damage to, or destruction of property due to the Contractor’s negligent acts or omissions

or willful misconduct of Contractor, its employees or its agents in connection with this RFP and

subsequent Agreement.

I. Subcontractors

The Contractor must state whether the services of a subcontractor will be used. The contract

must include the names and addresses of all subcontractors and the expected amount of money

each will receive under the contract. The Contractor will be required to obtain written approval

from the Treasurer prior to adding or changing subcontractors. Subcontractors will be required

to complete the attached State Certifications and Disclosure Forms, found at as Appendices A, B,

and C.

Contractor has a duty to select, with due diligence, all other entities that shall be necessary to

implement the Agreement. Contractor shall establish and enforce reasonable procedures to

assure the Treasurer of the performance by all other entities of the services necessary to

implement this Agreement.

J. Review

Treasurer’s staff will conduct periodic performance reviews of the Contractor, during which its

compliance with all aspects of the Agreement with the Treasurer will be reviewed and assessed.

K. Work Product

1. Ownership of work product.

Except as otherwise agreed to in writing, all work product, including, but not limited to,

documents, reports, data, information, designs, code, and ideas specially produced, developed, or

“Work Product”) will become and remain the property of the Treasurer, including any copyright

or service marks developed by the Contractor on behalf of the Treasurer. The Treasurer shall

have the right to use all such work product without restriction or limitation and without further

compensation to the Contractor.

2. Return of Work Product

Within thirty (30) days after expiration or termination of the Agreement, the Contractor shall

deliver to Treasurer, or to a third party, if so instructed by the Treasurer, all Work Product in

Contractor’s possession in the performance of the Agreement. If requested by the Treasurer, the

Contractor shall certify in writing that all such Work Product has been delivered to the Treasurer.

L. Services

Contractor shall not modify any service or the manner of providing such service under this

Agreement without the prior written authorization of the Treasurer. Modification means any

change to an existing service or the addition of a new service.

M. Access to information

Upon request, the selected Contractor shall provide the Treasurer access to all files, records,

participant email addresses, documents, and data pertaining to the Program that are in its

possession and control regardless of how that information is stored. The information shall be

provided in a form acceptable to the Treasurer.

N. Assignment

Each term and provision of the Agreement is binding and enforceable against and inures to the

benefit of any successors of the Treasurer and any successors of Contractor, but neither this

Agreement nor any of the rights, interests, or obligations is assignable without the prior written

consent of the other party. Any attempt by Contractor to transfer or assign any rights or

obligations related to the provision of services under this Agreement, without the prior written

consent of the Treasurer, shall render this Agreement voidable by the Treasurer. The Treasurer

may unilaterally bind any successor of the provider to the terms and conditions of any

Agreement between the parties.

O. State Certifications/Disclosures

The Agreement will incorporate Contractor’s fully executed State Certifications and Disclosure

Forms, a copy of which is attached hereto as Appendices A, B, and C.

Appendix A

ILLINOIS STATE TREASURER CERTIFICATIONS

______________________________________________ (“CONTRACTOR”) makes the

following certifications:

1.0 ANTI-BRIBERY.

CONTRACTOR certifies that it is not barred from being awarded a contract or

subcontract under Section 50-5 of the Illinois Procurement Code (30 ILCS 500/50-5). Section

50-5 prohibits a contractor from entering into a contract with a State agency if the contractor has

been convicted of bribery or attempting to bribe an officer or employee of the State of Illinois, or

if the contractor has made an admission of guilt of such conduct with is a matter of record. The

contractor further acknowledges that the chief procurement officer may declare the related

contract void if this certification is false.

2.0 BID-RIGGING/BID-ROTATING.

CONTRACTOR certifies that it has not been barred from contracting with a unit of State

or local government as a result of a violation of Section 33E-3 or 33E-4 of the Criminal Code of

1961 (720 ILCS 5/33E-3, 33E-4).

3.0 DRUG FREE WORKPLACE.

This certification is required by Section 3 of the Drug Free Workplace Act

(30 ILCS 580/3). The Drug Free Workplace Act, effective January 1, 1992, requires that

CONTRACTOR shall not be considered for the purposes of being awarded a contract for the

procurement of any services from the State unless CONTRACTOR has certified to the State that

CONTRACTOR will provide a drug free workplace. False certification or violation of the

certification may result in sanctions including, but not limited to, suspension of contract

payments, termination of the contract and debarment of contracting opportunities with the State

for at least one (1) year but not more than five (5) years.

CONTRACTOR certifies and agrees that it will provide a drug free workplace by:

a. Publishing a statement:

i. Notifying employees that the unlawful manufacture, distribution, dispensation,

possession or use of a controlled substance, including cannabis, is prohibited in

the grantee’s or contractor’s workplace.

ii. Specifying the actions that will be taken against employees for violation of such

prohibition.

iii. Notifying the employee that, as a condition of employment on such contract or

grant, the employee will:

a. abide by the terms of the statement; and

b. notify the employer of any criminal drug statute conviction for a violation

occurring in the workplace no later than five (5) days after such

conviction.

b. Establishing a drug free awareness program to inform employees about:

i. the dangers of drug abuse in the workplace;

ii. CONTRACTOR’s policy of maintaining a drug free workplace;

iii. any available drug counseling, rehabilitation, and employee assistance programs;

and

iv. the penalties that may be imposed upon an employee for drug violations.

c. Providing a copy of the statement required by Section (a) to each employee engaging in

the performance of the contract or grant and to post the statement in a prominent place in

the workplace.

d. Notifying the Treasurer’s Office within ten (10) days after receiving notice under part (b)

of paragraph (iii) of Section (a) above from an employee or otherwise receiving actual

notice of such conviction.

e. Imposing a sanction on, or requiring the satisfactory participation in drug abuse

assistance or rehabilitation program by, an employee who is so convicted, as required by

Section 5 of the Drug Free Workplace Act.

f. Assisting employees in selecting a course of action in the event of drug counseling,

treatment, and rehabilitation is required and indicating that a trained referral team is in

place.

g. Making a good faith effort to continue to maintain a drug free workplace through

implementation of the Drug Free Workplace Act.

4.0 U.S. EXPORT ACT.

CONTRACTOR certifies that neither CONTRACTOR nor any substantial-owned

affiliated company is participating or shall participate in an international boycott in violation of

the provisions of the U.S. Export Administration Act of 1979 (50 U.S.C.A. App. § 2401 et seq.)

or the regulations of the U.S. Department of Commerce promulgated under that Act.

5.0 NON-DISCRIMINATION.

CONTRACTOR certifies that it is in compliance with the State and Federal

Constitutions, the U.S. Civil Rights Act, Section 504 of the Federal Rehabilitation Act, and all

applicable rules that prohibit unlawful discrimination in performance of this Agreement and all

other activities, including employment and other contracts. As a condition of receiving the

Agreement, CONTRACTOR represents or certifies that services, programs and activities

provided under the Agreement are and will continue to be in compliance with State and Federal

Constitutions, the U.S. Civil Rights Act, Section 504 of the Federal Rehabilitation Act, and all

applicable laws that prohibit unlawful discrimination.

6.0 AMERICANS WITH DISABILITIES ACT.

CONTRACTOR certifies that it is in compliance with the Americans with Disabilities

Act (“ADA”) (42 U.S.C. 12101 et seq.) and the regulations thereunder (28 CFR 35.130) prohibit

discrimination against persons with disabilities by the Treasurer, whether directly or through

contractual arrangements, in the provision of any aid, benefit or service. As a condition of

receiving the Agreement, CONTRACTOR represents or certifies that services, programs and

activities provided under the Agreement are and will continue to be in compliance with the

ADA.

7.0 ILLINOIS HUMAN RIGHTS ACT.

CONTRACTOR certifies that it is presently in compliance with all of the terms,

conditions and provisions of Section 5/2-105 of the Illinois Human Rights Act (775 ILCS 5/2-

105), together with all rules and regulations promulgated and adopted pursuant thereto.

8.0 FELONY.

CONTRACTOR certifies that it has not been barred from being awarded a contract under

Section 50-10 of the Illinois Procurement Code (30 ILCS 500/50-10). Section 50-10 prohibits a

contractor from entering into a contract with a State agency if the contractor has been convicted

of a felony and 5 years have not passed from the completion of the sentence for that felony. The

contractor further acknowledges that the chief procurement officer may declare the related

contract void if this certification is false.

9.0 FORMER EMPLOYMENT.

CONTRACTOR has informed the Treasurer’s Office in writing if CONTRACTOR was

formerly employed by the Treasurer’s Office and has received an early retirement incentive

under Section 14-108.3 or 16-133.3 of the Illinois Pension Code (30 ILCS 105/15a).

10.0 INDUCEMENT.

CONTRACTOR has not paid any money or valuable thing to induce any person to

refrain from bidding on a State contract, nor has CONTRACTOR accepted any money or other

valuable thing, or acted upon the promise of same, for not bidding on a State contract (30 ILCS

500/50-25).

11.0 REVOLVING DOOR PROHIBITION.

CONTRACTOR certifies that neither it nor its employees and agents are in violation of

section 50-30 of the Illinois Procurement Code (30 ILCS 500/50-30). Section 50-30 prohibits

for a period of (2) years after terminating an affected position certain State employees and their

designees from engaging in any procurement activity relating to the State agency most recently

employing them for a specified period of time.

12.0 REPORTING ANTICOMPETITIVE PRACTICES.

CONTRACTOR shall report to the Illinois Attorney General and the Chief Procurement

Officer any suspected collusion or other anticompetitive practice among any bidders, offerors,

contractors, proposers or employees of the State (30 ILCS 500/50-40, /50-45, /50-50).

13.0 DISCRIMINATORY CLUB.

CONTRACTOR agrees not to pay any dues or fees on behalf of its employees or agents

or subsidize or otherwise reimburse them for payments of any dues or fees to a discriminating

club as prohibited by Section 2 of the Discriminatory Club Act (775 ILCS 25/2).

14.0 TAXPAYER IDENTIFICATION NUMBER AND LEGAL STATUS OF CONTRACTOR.

CONTRACTOR shall be in compliance with applicable tax requirements and shall be

current payment of such taxes. Under penalty of perjury, CONTRACTOR certifies that #

is its correct Taxpayer Identification Number and that it is doing business as a (please

check one):

_____ Individual _____ Government Entity

_____ Sole Proprietor _____ Nonresident alien

_____Partnership/Legal Corporation _____ Estate or trust

_____ Tax Exempt _____ Pharmacy (Non-Corp.)

_____ Corporation providing or billing _____ Pharmacy/Funeral

Home/Cemetery

medical and/or health care services (Corp.)

_____ Corporation NOT providing or billing _____ Limited Liability Company

(select

medical and/or health care services applicable tax classification.)

_____ Other: □ C = corporation

□ P = partnership

15.0 LICENSE; AUTHORIZED BIDDER OR OFFEROR.

CONTRACTOR, directly or through its employees, shall have and maintain any license

required by this Agreement. CONTRACTOR further certifies that it is a legal entity authorized

to do business in Illinois prior to the submission of the bid, offer, or proposal pursuant to section

20-43 of the Illinois Procurement Code (30 ILCS 500/20-43).

16.0 APPROPRIATION.

This Agreement is subject to termination and cancellation in any year for which the

General Assembly fails to make an appropriation for payments under the terms of the contract.

17.0 RECORDS RETENTION; RIGHT TO AUDIT.

CONTRACTOR agrees to maintain books and records related to the performance of the

contract and necessary to support amounts charged to the State under the contract for a minimum

of three years from the last action on the contract or after termination of the Agreement,

whichever is longer. Contractor further agrees to cooperate fully with any audit and to make the

books and records available for review and audit by the Auditor General, chief procurement

officers, internal auditor and the Treasurer; CONTRACTOR agrees to cooperate fully with any

audit conducted by the Auditor General or the Treasurer and to provide full access to all relevant

materials. The three-(3)-year period shall be extended for the duration of any audit in progress

during the term. 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 this Agreement for which adequate books, records, and supporting

documentation are not available to support their purported disbursement.

18.0 CONFLICTS OF INTEREST.

CONTRACTOR has disclosed, and agrees that it is under a continuing obligation to

disclose, to the Treasurer financial or other interests (public or private, direct or indirect) that

may be a potential conflict of interest that would prohibit CONTRACTOR from entering into or

performing the Agreement. Conflicts of interest include, but are not limited to, conflicts under

Section 1400.5020 of the Treasurer’s Procurement Rules (44 Ill. Adm. Code 1400.5020) and

Sections 50-13, 50-20, and 50-35 of the Illinois Procurement Code (30 ILCS 500/50).

19.0 LATE PAYMENTS.

Late payment charges, if any, shall not exceed the formula established in the Illinois

Prompt Payment Act (30 ILCS 540/1) and the Illinois Administrative Code (74 Ill. Adm. Code

900).

20.0 LIABILITY.

The State’s liability for damages is expressly limited by and subject to the provisions of

the Illinois Court of Claims Act (705 ILCS 505/1) and to the availability of suitable

appropriations.

21.0 DEBT DELINQUENCY.

CONTRACTOR certifies that it, or any affiliate, is not barred from being awarded a

contract or subcontract under section 50-11 of the Illinois Procurement Code (30 ILCS 500/50-

11). Section 50-11 prohibits a contractor from entering into a contract with the Treasurer’s

Office if it knows or should know that it, or any affiliate, is delinquent in the payment of any

debt to the State as defined by the Debt Collection Board. CONTRACTOR further

acknowledges that the Treasurer’s Office may declare the Agreement void if this certification is

false or if CONTRACTOR or any affiliate is determined to be delinquent in payment of any debt

during the term of the Agreement.

22.0 EDUCATIONAL LOAN DEFAULT.

CONTRACTOR certifies that it is not barred from being awarded a contract under the

Educational Loan Default Act (5 ILCS 385). Section 3 of the Educational Loan Default Act

prohibits an individual from entering into a contract with the Treasurer’s Office if that individual

is in default of an educational loan. CONTRACTOR further acknowledges that the Treasurer’s

Office may declare the Agreement void if this certification is false or if CONTRACTOR is

determined to be in default of an educational loan during the term of the Agreement.

23.0 FORCE MAJEURE.

Failure by either party to perform its duties and obligations shall be excused by

unforeseeable circumstances beyond its reasonable control, including acts of nature, acts of the

public enemy, riots, labor or material shortages, labor disputes, fire, flood, explosion, legislation,

and governmental regulation.

24.0 ANTITRUST ASSIGNMENT.

CONTRACTOR hereby assigns, sells and transfers to the State of Illinois all right, title

and interest in and to any claims and causes of action arising under antitrust laws of Illinois or

the United States relating to the subject matter of the Agreement.

25.0 PROHIBITION OF GOODS FROM FORCED LABOR.

CONTRACTOR certifies that it is not barred from being awarded a contract under the

State Prohibition of Goods from Forced Labor Act (30 ILCS 583). Section 10 of the State

Prohibition of Goods from Forced Labor Act prohibits a contractor from entering into a contract

with the Treasurer’s Office if that contractor knew that the foreign-made equipment, materials,

or supplies furnished to the State were produced in whole or part by forced labor, convict labor,

or indentured labor under penal sanction. CONTRACTOR further acknowledges that the

Treasurer’s Office may declare the Agreement void if this certification is false or if

CONTRACTOR is determined to have known that the foreign-made equipment, materials, or

supplies furnished to the State during the term of the Agreement were produced in whole or part

by forced labor, convict labor, or indentured labor under penal sanction.

26.0 PROHIBITION OF GOODS FROM CHILD LABOR.

CONTRACTOR certifies in accordance with Public Act 94-0264 that no foreign-made

equipment, materials, or supplies furnished to the State under the contract have been produced in

whole or in part by the labor of any child under the age of 12.

27.0 SARBANES-OXLEY ACT AND ILLINOIS SECURITIES LAW.

CONTRACTOR certifies that it is not barred from being awarded a contract or

subcontract under section 50-10.5 of the Illinois Procurement Code (30 ILCS 500). Section 50-

10.5, amongst other things, prohibits a contractor from bidding or entering into a contract or

subcontract with the Treasurer’s Office if the contractor or any officer, director, partner, or other

managerial agent of the contractor has been convicted in the last 5 years of a felony under the

Sarbanes-Oxley Act of 2002 or a Class 3 or Class 2 felony under the Illinois Securities Law of

1953 or if the contractor is in violation of Subsection (e). CONTRACTOR further acknowledges

that the Treasurer’s Office may declare the agreement void if this certification is false or if

CONTRACTOR is determined to have been convicted of a felony under the Illinois Sarbanes-

Oxley Act of 2002 or a Class 3 or Class 2 felony under the Illinois Securities Law of 1953 during

the term of the agreement.

28.0 DISPUTES.

Any claim against the State arising out of this Agreement must be filed exclusively with

the Illinois Court of Claims (705 ILCS 505/1). The State shall not enter into binding arbitration

to resolve any agreement dispute. The State of Illinois does not waive sovereign immunity by

entering into this Agreement. Any provision containing a citation to an Illinois statute (cited

“ILCS”) may not contain the complete statutory language. The official text, which is

incorporated by reference, may be found in the appropriate chapter and section of the Illinois

Compiled Statutes. An unofficial version may be viewed at www.ilga.gov.

29.0 THIRD PARTY PAYMENTS.

CONTRACTOR certifies that no fee was paid to a third-party in expectation of being awarded a

contract by the Treasurer.

30.0 MOST FAVORABLE TERMS.

If more favorable terms are granted by the CONTRACTOR to any similar governmental

agency in any state in a contemporaneous agreement let under the same or similar financial terms

and circumstances for comparable supplies or services, the more favorable terms will be

applicable under the Agreement between the Treasurer’s Office and the CONTRACTOR.

31.0 BOARD OF ELECTIONS REGISTRATION.

____ The CONTRACTOR certifies that they are not required to register as a business entity

with the State Board of Elections pursuant to the Illinois Procurement Code (30 ILCS 500/20-

160). Further, the CONTRACTOR acknowledges that all contracts or subcontracts between

State agencies and a business entity that do not comply with this Section shall be voidable under

Section 50-60 of the Illinois Procurement Code (30 ILCS 500/50-60).

(or)

____ The CONTRACTOR certifies that they have registered as a business entity with the

State Board of Elections and acknowledges a continuing duty to update the registration pursuant

to the Illinois Procurement Code (30 ILCS 500/20-160). Further, the CONTRACTOR

acknowledges that all contracts or subcontracts between State agencies and a business entity that

do not comply with this Section shall be voidable under Section 50-60 of the Illinois

Procurement Code (30 ILCS 500/50-60).

32.0 COLLECTION AND REMITTANCE OF ILLINOIS USE TAX.

The CONTRACTOR certifies that it is not barred from being awarded a contract under

section 50-12 of the Illinois Procurement Code (30 ILCS 500/50-12). Section 50-12 prohibits a

contractor from entering into a contract or subcontract with a State agency if the

CONTRACTOR or affiliate has failed to collect and remit Illinois Use Tax on all sales of

tangible personal property into the State of Illinois in accordance with the provisions of the

Illinois Use Tax Act. The CONTRACTOR further acknowledges that the contract or subcontract

may be voided if this certification is false.

33.0 ENVIRONMENTAL PROTECTION ACT VIOLATIONS.

The CONTRACTOR certifies that it is not barred from being awarded a contract or

subcontract under section 50-14 of the Illinois Procurement Code (30 ILCS 500/50-14). Section

50-14 prohibits a CONTRACTOR from entering into a contract or subcontract with a State

agency if the CONTRACTOR has been found by a court or the Pollution Control Board to have

committed a willful or knowing violation of the Environmental Protection Act within the last (5)

years. The CONTRACTOR further acknowledges that the contracting State agency may declare

the related contract or subcontract void if this certification is false.

34.0 LEAD POISONING PREVENTION ACT VIOLATIONS.

The CONTRACTOR certifies that it is not barred from entering into a contract or

subcontract under section 50-14.5 of the Illinois Procurement Code (30 ILCS 500/50-14.5).

Section 50-14.5 prohibits a CONTRACTOR from entering into a contract or subcontract with the

State of Illinois or a State agency if the CONTRACTOR, while the owner of a residential

building, committed a willful or knowing violation of the Lead Poisoning Prevention Act. The

CONTRACTOR further acknowledges that the Treasurer may declare the related contract or

subcontract void if this certification is false.

35.0 BOND ISSUANCES.

The CONTRACTOR certifies that it is not barred from being awarded a contract or

subcontract under section 50-21 of the Illinois Procurement Code (30 ILCS 500/50-21). Section

50-21 prohibits State agencies from entering into contracts or subcontracts with respect to the

issuances of bonds or other securities by the State or a State agency with any entity that uses an

“independent consultant” as defined in section 50-21.

36.0 POLITICAL CONTRIBUTIONS.

The CONTRACTOR certifies that it is not barred from being awarded a contract or

subcontract under section 50-37 of the Illinois Procurement Code (30 ILCS 500/50-37). Section

50-37 prohibits business entities whose contracts with State agencies, in the aggregate, annually

total more than $50,000, or whose aggregate pending bids and proposals on State contracts total

more than $50,000, and any affiliated entities or affiliated persons of such business entity, from

making any contributions to any political committee established to promote the candidacy of the

office holder responsible for awarding the contract on which the business entity has submitted a

bid or proposal during the period beginning on the date the invitation for bids or request for

proposals are issued and ending on the day after the date the contract is awarded.

37.0 LOBBYING RESTRICTIONS.

The CONTRACTOR certifies that it is not barred from being awarded a contract or

subcontract under section 50-38 of the Illinois Procurement Code (30 ILCS 500/50-38). Section

50-38 prohibits a CONTRACTOR from billing the State for any lobbying costs, fees,

compensation, reimbursements, or other remuneration provided to any lobbyist who assisted the

CONTRACTOR in obtaining the contract or subcontract.

38.0 DISCLOSURE OF BUSINESS OPERATIONS WITH IRAN (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:

(1) 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; or

(2) 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.

You must check one of the following items and if item 2 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:

___________________________________________

CONTRACTOR

By:

Signature

Name

Title

Date

Appendix B

DISCLOSURES

FINANCIAL INTEREST AND POTENTIAL CONFLICTS OF INTEREST

(Disclosure Form A)

The Treasurer’s Procurement Regulations (44 Ill. Adm. Code 1400.5035) require that

contractors/offerors desiring to enter into certain contracts with the State of Illinois must

disclose the financial and potential conflicts of interest information as specified below.

Contractor/offeror shall disclose the financial interest and potential conflicts of interest

information identified in Sections 1 and 2 below as a condition of receiving an award or

contract. Submit this information along with your bid, proposal or offer.

This requirement applies to contracts with an annual value exceeding $10,000.

A publicly traded entity may submit its 10K disclosure in satisfaction of the disclosure

requirements set forth in both Sections 1 and 2 below.

Sec. 1. Disclosure of Financial Interest in the Contractor/Offeror

a. If any individuals have one of the following financial interests in the

contractor/offeror (or its parent), please check all that apply and show their name

and address:

Ownership exceeding 5% (_____)

Ownership value exceeding $106,447.20 (_____)

Distributive Income Share exceeding 5% (_____)

Distributive Income Share exceeding $106,447.20 (_____)

Name: ____________________________________________________

Address: ____________________________________________________

b. For each individual named above, show the type of ownership/distributable income

share: sole proprietorship _____ stock _____ partnership _____ other (explain)

______________________________________________________.

c. For each individual named above, show the dollar value or proportionate share of

the ownership interest in the contractor/offeror (or its parent) as follows:

If the proportionate share of the named individual(s) in the ownership of the

contractor/offeror (or its parent) is 5% or less, and if the value of the ownership

interest of the named individual(s) is $106,447.20 or less, check here (_____)

If the proportionate share of ownership exceeds 5% or the value of the ownership

interest exceeds $106,447.20, show either.

The percent of ownership __________%

The value of the ownership interest $___________

Sec. 2. Disclosure of Potential Conflicts of Interest. For each of the individuals having the level of

financial interest identified in Section 1 above, check “Yes” or “No” to indicate which, if

any, of the following potential conflicts of interest relationships apply. If “Yes,” please

describe (use space under applicable section to explain your answers – attach additional

pages as necessary).

a. State employment, currently or in the previous 3 Yes No

years, including contractual employment of services _____ _____

b. State employment for spouse, father, mother, son, or Yes No

daughter, including contractual employment for _____ _____

services in the previous 2 years.

c. Elective status; the holding of elective office of the Yes No

State of 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 Yes No

currently or in the previous 2 years; spouse, father, _____ _____

mother, son, or daughter.

e. Appointive office; the holding of any appointive Yes No

government 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 Yes No

currently or in the previous 2 years; spouse, father, _____ _____

mother, son, or daughter.

g. Employment, currently or in the previous 3 years, as Yes No

or by any registered lobbyist of the State _____ _____

government.

h. Relationship to anyone who is or was a registered Yes No

lobbyist in the previous 2 years; spouse, father, _____ _____

mother, son, or daughter.

i. Compensated employment, currently or in the Yes No

previous 3 years, 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 with either

the Secretary of State or the Federal Board of

Elections.

j. Relationship to anyone; spouse, father, mother, son, Yes No

or daughter, who is or was a compensated employee _____ _____

in the last 2 years of 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.

This disclosure is submitted on behalf of

_______________________________________________

(Name of Contractor/Offeror)

Official authorized to sign on behalf of Contractor/Offeror:

Name (printed) ____________________________________Title ________________________

Signature ________________________________________ Date _______________________

Appendix C

DISCLOSURES

OTHER CONTRACT AND PROCUREMENT RELATED INFORMATION

(Disclosure Form B)

The Treasurer’s Procurement Regulations (44 Ill. Adm. Code 1400.5035) require that contractors/offerors

desiring to enter into certain contracts with the State of Illinois must disclose the information as specified

below.

Contractor/offeror shall disclose the information identified below as a condition of receiving an award or

contract.

This requirement is applicable to only those contracts with an annual value exceeding $10,000.

You must submit this information along with your bid, proposal or offer.

a. Contractor/offeror shall identify whether it has current contracts (including leases) with other

units of State of Illinois government by checking “Yes”_____ or “No” _____.

If “Yes” is checked, identify each contract by showing agency name and other descriptive

information such as purchase order or contract reference number (attach additional pages as

necessary).

b. Contractor/offeror shall identify whether it has pending contracts (including leases), bids,

proposals, or other ongoing procurement relationships with other units of State of Illinois

government by checking “Yes” _____ or “No” _____.

If “Yes” is checked, identify each such relationship by showing agency name and other

descriptive information such as bid or project number (attach additional pages as necessary).

This disclosure is submitted on behalf of ____________________________________________

(Name of Contractor/Offeror)

Official authorized to sign on behalf of Contractor/Offeror:

Name (printed) ____________________________________ Title _______________________

Signature ________________________________________ Date_______________________

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