Fill - Free fillable form to IDHR Fiscal Unit, 100 W Randolph (Illinois) PDF form

IDHR Employer Location(s) Report Form (PC-1A)

State of Illinois

Illinois Department of Human Rights

Legal Division, Public Contracts Unit

Submit this form via Email to: IDHR.PublicContracts@Illinois.gov

Or via mail to:

IDHR - PUBLIC CONTRACTS UNIT

100 W. RANDOLPH ST - SUITE 10-100

CHICAGO, IL 60601

Note: If the Illinois location has a different FEIN from the corporate office, do not complete this form.

Proceed to the Vendor On-Line Registration Page to apply for an IDHR Eligibility Number and pay

the $75.00 registration fee using a credit card. To pay via mail, submit a properly completed, signed

form to IDHR Fiscal Unit, 100 W Randolph St., Suite 10-100, Chicago, IL 60601 accompanied by a

certified check, money order, or cashier's check for $75 payable to the Illinois Department of Human

Rights.

Instructions: This form is to be used by an entity to add or renew an Illinois Location to an existing

IDHR Eligibility Number (out-of-state locations cannot register). If your entity has multiple Illinois

locations that all have the same Federal Employer Identification Number (FEIN), you are not

obligated to pay an additional fee to receive an IDHR number for any locations having the same

FEIN and wishing to be eligible to bid on business with the State of Illinois. IDHR Location Eligibility

Numbers expire five years after the date of issue and may be renewed at the same time that the

corporate entity IDHR number is renewed for a $75 fee. No additional fee is required to add

locations. Forms received with the employment data omitted will not be processed. The information

is necessary to comply with the statutory provisions set forth in 775 ILCS 5/1-101 et seq. Disclosure

of this information is REQUIRED. The gathering and retention of employee race/ethnicity and

gender data is permitted by State and federal law so long as such data is kept separate from other

personnel information and is not used for the purpose of engaging in unlawful discrimination. For

administrative details, review 44 Il Admin code, Section 750.210(a).

You must have an IDHR Eligibility Number if your company wants to be eligible to bid on State

contracts and any one of the following applies:

1) your company employs 15 or more persons at the time of application for a public contract;

2) your company has employed 15 or more persons at any time during the 365 day period prior to the

date of your applying for the public contract;

3) you are directed to file by a contracting agency of the State of Illinois, any political subdivision, or

municipal corporation.

A form is deemed filed when it is received by the IDHR Public Contracts Unit - Chicago Office,

PROPERLY completed and signed. An IDHR PC-1A form must be completed for EACH additional

location applying to do business with the State. No additional fee is required to add locations. This

form must be filed prior to bid opening.

The FEIN must be provided.

If your entity does not have an eligible IDHR number, please visit www.illinois.gov/dhr/publiccontracts

to obtain a PC-1 Form or visit the Vendor On-Line Registration page.

IDHR EMPLOYER LOCATION(S) REPORT FORM 6/1/2016 Employer Report Form - Submit to IDHR Public Contracts Unit

Note: An Employer IDHR Eligibility Number Expires 5 years from the date of issue/renewal

IDHR Employer Location(s) Report Form (PC-1A)

State of Illinois

Illinois Department of Human Rights

Legal Division, Public Contracts Unit

Submit this form via Email to: IDHR.PublicContracts@Illinois.gov

Or via mail to:

IDHR - PUBLIC CONTRACTS UNIT

100 W. RANDOLPH ST - SUITE 10-100

CHIAGO, IL 60601

Adding a location to a new or existing IDHR Number.

Renewing a location to a new or existing IDHR Number.

IDHR Number (If renewing or adding location): FEIN (required):

Name of Applying Company:

Address:

City: State: ZIP: County:

Country:

Contact Name: Contact Phone: E-mail:

Does the company have a current, written sexual harassment policy?

Yes No

Within the past three years, has the company been declared ineligible for any public contract based

on a finding of employment discrimination? If yes, attach a separate sheet fully explaining the

situation.

Yes

In the chart below, enter the racial and gender breakdown of the employees of the company, or the branch/location of the

company/organization applying to be eligible to bid on contracts for the State of Illinois.

White Black Hispanic

Asian/Pacific

Islander

American Indian Totals

Male

Female

Total

By checking this box, I certify that the information provided in this report, and in any attachments thereto, is

true and accurate to the best of my knowledge and belief. The employer filing this report agrees to

conform with the requirements set forth in the Illinois Human Rights Act, 775 ILCS 5/1-101 et seq., and the

rules and regulations of the Department of Human Rights. I am authorized to submit this form on behalf of

the employer.

Typed Name / Title of the person completing this form

Date this form was completed

IDHR EMPLOYER LOCATION(S) REPORT FORM 6/1/2016 Employer Report Form - Submit to IDHR Public Contracts Unit

Note: An Employer IDHR Eligibility Number Expires 5 years from the date of issue/renewal

State of Illinois

Illinois Department of Human Rights

Legal Division, Public Contracts Unit

Definitions, Clauses and Policies

Applicable to the IDHR Employer Report Form

Keep for your Records

Definition of employee - For purposes of this form, an “employee” is an individual performing services for remuneration for the employer. All full-time and

permanent part-time employees are to be reported. Forms received containing mathematic errors will not be processed.

Description of Race/Ethnic -

Race/ethnic designations as used by the Department do not denote scientific definitions of anthropological origins. For the

purposes of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as

belonging. However, no person should be counted in more than one race/ethnic group. They are:

“White (Not of Hispanic Origin)”

All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

“Black or African-American”

(Not of Hispanic Origin). All persons having origins in any of the Black racial groups of Africa.

“Hispanic or Latino”

All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

“Asian or Pacific Islander”

All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific

Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa.

“American Indian or Alaskan Native”

All persons having origins in any of the original peoples of North America, and who maintain cultural identification

through tribal affiliation or community recognition.

Definition of categories - Each employee should be counted in only one job category. Select the category containing the jobs most similar to that performed

by the employee. The jobs listed in each category are intended to provide examples, not a complete list, of all job titles falling into that category.

“Executive Senior Level Officials”

Individuals who plan, direct and formulate policies, set strategy and provide the overall direction of enterprises/

organizations for the development and delivery of products or services, within the parameters approved by boards of directors or other governing bodies.

Examples include: chief executive officers, chief operating officers, chief financial officers, line of functional areas or operating groups, chief information

officers, chief marketing officers, chief legal officers, management directors and managing partners.

“First/Mid Level Officials and Managers”

Individuals who typically lead major business units. They implement policies, programs and directives of

executive/senior management through subordinate managers and within the parameters set by Executives/Senior Level management. Examples of these

kinds of managers are: first-line managers, team managers, unit managers, administrative services managers, purchasing and transportation managers, call

center or customer service managers, technical support managers, and brand of product managers.

“Professionals”

Occupations requiring either college graduation or experience of such kind and amount as to provide a comparable background. Includes:

accountants and auditors, airplane pilots and navigators, architects, artists, scientists, designers, dietitians, editors, engineers, lawyers, librarians,

mathematicians, registered professional nurses, personnel and labor relations specialists, physicians, social scientists, teachers, surveyors etc.

“Technicians”

Occupations requiring a combination of basic scientific knowledge and manual skill which can be obtained through 2 years of post high school

education, such as is offered in many technical institutes and union colleges, or through equivalent on-the-job training. Includes: computer programmers,

drafters, engineering/mathematical/scientific aides, licensed/practical/vocational nurses, photographers, radio operators, technical illustrators, medical/dental/

electronic/scientific technicians, etc.

“Sales Workers”

Occupations engaging wholly or primarily in direct selling. Includes: advertising agents and sates workers, insurance agents and brokers,

real estate agents and brokers, stock and bond sales workers, demonstrators, sales workers and sales clerks, grocery clerks, and cashiers/checkers, etc.

“Administrative Support Workers”

Includes all clerical-type work regardless of level of difficulty, where the activities are predominantly non-manual though

some manual work not directly involved with altering or transporting the products is included. Includes: bookkeepers, collectors (bills and accounts),

messengers and office helpers, office machine operators (including computer), shipping and receiving clerks, stenographers, typists and secretaries,

telegraph and telephone operators, legal assistants, etc.

“Craft Workers (skilled)”

Manual workers of relatively high skill level having a thorough and comprehensive knowledge of the processes involved in their

work. Exercise considerable independent judgment and usually receive an extensive period of training. Includes: the building trades, hourly paid

supervisors/lead operators not members of management, mechanics, skilled machinists, electricians, compositors/typesetters/engravers, pattern/model

makers, stationary engineers, motion picture projectionists, painters (construction/maintenance), tailors/tailoresses, arts/decorating occupations,

handpainters, coaters, bakers, etc.

“Operatives (semiskilled)”

Workers who operate machine or processing equipment or perform other factory-type duties of intermediate skill level which can

be mastered in a few weeks and require only limited training. Includes: apprentices (auto/plumbing/bricklaying/carpentry/electrical/machinist/mechanical/

building trade/metalworking/printing trades, etc.), attendants (auto service/parking), blasters, chauffeurs, delivery workers, sewers/stitchers, dryers, furnace

workers, heaters, laundry/dry cleaning, milliners, mine laborers, motor operators, oilers/greasers (except auto), painters (manufactured articles),

photographic processors, truck/tractor drivers, welders/flame cutters, electronic equipment assemblers, butchers/meatcutters, inspectors/testers/graders,

handpackers/packagers, knitting/looping/taping/weaving machine operators, etc.

“Laborers & Helpers”

Workers in manual occupations which generally require no special training who perform elementary duties that may be learned in a few

days and require the application of little or no independent judgment. Includes: garage laborers, car washers/greasers, gardeners, farm workers,

stevedores, wood choppers, lifting/digging/mixing/loading/pulling laborers, etc.

“Service Workers”

Workers in both protective and non-protective service occupations. Includes: attendants (hospital/other institutions, professional/personal

service, nurses aides/orderlies), barbers, char workers/cleaners, cooks, counter/fountain workers, elevator operators, firefighters/fire protection, guards,

doorkeepers, stewards, janitors, police officers/detectives, porters, waiters/waitresses, amusement/recreation facilities attendants, guides, ushers, public

transportation attendants, etc.

(IDHR EMPLOYER REPORT FORM 1/30/2015) Definitions, Clauses and Policies - Keep for your records

State of Illinois

Illinois Department of Human Rights

Legal Division, Public Contracts Unit

Definitions, Clauses and Policies

Applicable to the IDHR Employer Report Form

Keep for your Records

ILLINOIS ADMINISTRATIVE CODE

EQUAL EMPLOYMENT OPPORTUNITY CLAUSE

44 Ill. Admin. Code, Section 750. APPENDIX A. Equal Employment

Opportunity Clause

EQUAL EMPLOYMENT OPPORTUNITY

In the event of the contractor's non-compliance with the provisions of this

Equal Employment Opportunity Clause, the Illinois Human Rights Act or the

Rules and Regulations of the Illinois Department of Human Rights

("Department"), the contractor may be declared ineligible for future contracts

or subcontracts with the State of Illinois or any of its political subdivisions or

municipal corporations, and the contract may be canceled or voided in whole

or in part, and such other sanctions or penalties may be imposed or remedies

invoked as provided by statute or regulation. During the performance of this

contract, the contractor agrees as follows:

1) That it will not discriminate against any employee or applicant for

employment because of race, color, religion, sex, marital status, national

origin or ancestry, age, physical or mental handicap unrelated to ability, or an

unfavorable discharge from military service; and further that it will examine all

job classifications to determine if minority persons or women are underutilized

and will take appropriate affirmative action to rectify any such underutilization.

2) That, if it hires additional employees in order to perform this

contract or any portion thereof, it will determine the availability (in accordance

with the Department's Rules) of minorities and women in the area(s) from

which it may reasonably recruit and it will hire for each job classification for

which employees are hired in such a way that minorities and women are not

underutilized.

3) That, in all solicitations or advertisements for employees placed

by it or on its behalf, it will state that all applicants will be afforded equal

opportunity without discrimination because of race, color, religion, sex, marital

status, national origin or ancestry, age, physical or mental handicap unrelated

to ability, or an unfavorable discharge from military service.

4) That it will send to each labor organization or representative of

workers with which it has or is bound by a collective bargaining or other

agreement or understanding, a notice advising such labor organization or

representative of the contractor's obligations under the Illinois Human Rights

Act and the Department's Rules. If any such labor organization or

representative fails or refuses to cooperate with the contractor in its efforts to

comply with such Act and Rules, the contractor will promptly so notify the

Department and the contracting agency and will recruit employees from other

sources when necessary to fulfill its obligations thereunder.

5) That it will submit reports as required by the Department's Rules,

furnish all relevant information as may from time to time be requested by the

Department or the contracting agency, and in all respects comply with the

Illinois Human Rights Act and the Department's Rules.

6) That it will permit access to all relevant books, records, accounts

and work sites by personnel of the contracting agency and the Department for

purposes of investigation to ascertain compliance with the Illinois Human

Rights Act and the Department's Rules.

7) That it will include verbatim or by reference the provisions of this

clause in every subcontract it awards under which any portion of the contract

obligations are undertaken or assumed, so that such provisions will be

binding upon such subcontractor. In the same manner as with other

provisions of this contract, the contractor will be liable for compliance with

applicable provisions of this clause by such subcontractors; and further it will

promptly notify the contracting agency and the Department in the event any

subcontractor fails or refuses to comply therewith. In addition, the contractor

will not utilize any subcontractor declared by the Illinois Human Rights

Commission to be ineligible for contracts or subcontracts with the State of

Illinois or any of its political subdivisions or municipal corporations.

FEDERAL EXECUTIVE ORDER 11246

The Executive Order 11246 (E.O 11246) prohibits federal contractors and

subcontractors and federally-assisted construction contractors and

subcontractors that generally have contracts that exceed $10,000 from

discriminating in employment decisions on the basis of race, color, religion,

sex, or national origin. It also requires covered contractors to take affirmative

action to ensure that equal opportunity is provided in all aspects of their

employment.

The E.O. 11246 is administered by the Employment Standards

Administration's Office of Federal Contract Compliance Programs (OFCCP)

within the U.S. Department of Labor.

WRITTEN SEXUAL HARASSMENT POLICY REQUIRED

Illinois law requires all parties to a public contract and all eligible bidders to

have a written sexual harassment policy covering their employees and

applicants for employment. This requirement applies regardless of the

number of persons employed or the dollar value of any public contract.

This requirement is found at 775 ILCS 5/2-105(A)(4). Each sexual

harassment policy must contain the following elements:

1. A statement that sexual harassment is illegal.

2. The definition of sexual harassment under the Illinois Human Rights

Act.

3. A description of the acts that constitutes sexual harassment, with

examples.

4. The vendor's internal complaint procedure, including penalties.

5. The legal recourse, investigative, and complaint process available

through the Illinois Department of Human Rights and the Illinois Human

Rights Commission.

6. Information as to how a person can contact the Department and the

Commission.

7. Information regarding the protection against retaliation under

Section 6-101 of the Human Rights Act.

A copy of the employer's policy must be submitted to the Department or to a

contracting agency upon request.

Employers can obtain a Model Sexual Harassment Policy by contacting the

Department.

___________________________

DISCRIMINATORY CLUB ACT

Pursuant to 775 ILCS 25/0.01 et seq., no private organization selling goods

or services to the State or receiving any award or grant from the State, nor

any public body, may pay any dues or fees on behalf of its employees or

agents or may subsidize or otherwise reimburse them for payments of their

dues or fees to any discriminatory club. A “discriminatory club” includes any

club, society, organization, or association, which discriminates in its

membership policy or in access to its services or facilities. Facilities that are

distinctly private in nature, such as restrooms and shower rooms, are exempt

as to discrimination based on sex.

(IDHR EMPLOYER REPORT FORM 1/30/2015) Definitions, Clauses and Policies - Keep for your records

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