contract corporation

Contract No, 1388-13279Vendor Name: GLOBETROTTERS ENGINEERING CORPORATION

AMENDMENT NO. 2

This Amendment modifies Contract No.1388-13279 for Broadband Project Phase IV by and between the County ofCook, illinois, herein referred to as "County" and Globetrotters Engineering Corporation, authorized to do business in

the Stale of illinois hereinafter referred to as "Contractor":

RECITALS

Whereas, the County and Contractor have entered into a Contract approved by the County Board on January 15,2014, (hereinafter referred to as the "Contract" ), wherein the Contractor is to provide Fiber Optic Services (hereinafterreferred to as the "Services" ) from January 15, 2014 through December 31, 2015, with one (1)one (1) year extension

option, in an amount not to exceed $408,646.00; and

Whereas, Amendment ¹ 1 was executed by the Chief Procurement Officer on June 4, 2015 for twelve (12) monthsbeginning January 1, 2016 through December 31, 2016, in the amount of $102,800.00;and

Whereas, the Contract will expire on December 31, 2016 and the agreed upon Services are still required; and

Whereas, an extension is desired for the continuation of Services; and

Whereas, the County and Contractor desire to extend the Contract for one year beginning on January 1, 2017 toDecember 31, 2017.

Now therefore, in consideration of mutual covenants contained herein, it is agreed by and between the parties toamend the Contract as follows:

1. The Contract is extended through December 31, 2017.

2. The attached Economic Disclosures Statement, Identification of Sub-Contractors/Suppliers/Sub-Consultants Form and MBE/WBE Utilization Plan forms are incorporated and made a part of this

Contract.

3. All other terms and conditions remain as stated in the Contract.

In witness whereof, the County and Contractor have caused this Amendment No. 2 to be executed on thedate and year last written below.

County of Cook, illinois Globetrotters Engineering Corporation

Chief Procurement Officer

B,:State's Attorney (if applicable)

Signed

Michael J. McMurrav

Type or print name

Date. Zl SWW(o/4/ ZG(4

President

Title

Date: June 21. 2016

Rev i/i/15

Contract No, 1388-13279Vendor Name: GLOBETROTTERS ENGINEERING CORPORATION

ATTACHMENTS

a/:v r/r/IS

CONTRACT NO. 1388-13279

Cook CountyOflice of the Chief Procurement Ofgcer

Identiigication of Subcontractor/Supplier/Subconsultant Form

OCPO ONLY.O Oisouefinco(LocoA Check Comoiote

The Bidder/Proposer/Respondent ("ths Contractor" ) will fully complete and execute and submit an Idsntltication ofSubcontractor/Supplier/Subconsultant Form ("ISF")with each Bid, Request for Proposal, and Request forQualification. The Contractor must complete the ISF for each Subconbsctor, Supplier or Subconsultant whichshall be used on the Contract. In the event that there are any changes in the utilization of Subcontractors,Suppliers or Subconsufiants, the Contractor must file an updated ISF.

Authorized Contactfor Contractor:

Email Address(Contractor):

Michael J.McMurrsy

marketing figpec-nroup.cpm

Bid/RFP/RFQ No.: Contract No. 1388-13279

Total Bid or Proposal Amount: 511,446.00

Contractor: Globetrogers Engineering Corporation

Date: June 21, 2016

Contract Title: Broadband Project Phase IV

Subcontractor/Supplier/Subconsultant to be SPAAN Tech, Inc.added or subsfriute:Authorized Contact forSubcontractor/Supplier/ Smite Shah, PresidentSubconsultant:Email Address(Subcontractor): [email protected]

Company Address(Contractor):

300 S.Wacker Driive

Suits 400Company Address(Subcontractor):

311 S.Wacker Driive

Suite 2400

City, State andZip (Contractor):Telephone and Fax(Conbsctor)Estimated Start andCompletion Dates(Contractor)

Chicano, IL 60606T: (312) 922-6400F: (312)922-0267

1/1 5/2014 —12/31/2017

City, State and Zip(Subcontractor);Telephone and Fax(Subcontractor)Estimated Start andCompletion Dates(Subcontractor)

Chicano, IL 60606T: (312) 277-8800F: (312) 277-8808

1/'I 5/2014 —12/31/201 7

Note: Upon request, a copy of afi written subcontractor agreements must be provided to the OCPO.

Dsscrlotion of Services or SuoolieaTotal Pres of

Subcontract forServices or Suoollss

Engineering Support Services $179,006.00

The subcontract documents will incorporate afi requirements of the Contract awarded to the Contractor as applicable.The subcontract will in no way hinder the Subcontractor/Supplier/Subconsullant from maintaining its progress on anyother contract on whkh it is either s Subcontractor/Supplier/Subconsultant or principal contractor. This disdosure ismade with the understanding that the Contractor is not under any circumstances relieved of its abilities andobllgafions, and is responsible for the organization, performance, and quality of work. This form does not approveany proposed changes, revisions or modifications to the contract approved MBE/WBE Utilization Plan. Anychanges to the contract's approved MBE/WBE/Utilization Plan must be submitted to the Office of theContract Compliance.

Contractor Globetrotters Engineering Corporation

Name

Title

Michael J. McMurray

President

Prime Contractor Signature Date June 21, 2016

ISF-1

MBE/INBE UTILIZATION PLAN ~ FORBI 1

BIDDER/PROPOSER HEREBY STATES that all MBE/WBE firms included in this Plan are certified MBEs/WBEs by at least one of the entities lishd in the GeneralConditions —Sedion 19.

I. BIDDER/PROPOSER MBE/WBE STATUS: (check the appropriate line)

Bidder/Proposer Is a certified MBE or WBE Ilrm. (If so, auach copy of current Letter of Certification)

Bidder/Proposer is a Joint Venture and one or more Joint Venture partners are certified MBEs or WBEs. (If so, attach copies of Letter(s) idCertification, a copy of Joint Venksu Agreement clearly describing the role af gre MBE/WBE firm(s) and its ownership interest in the JointVenture and a completed Joint Venture Aflidsvit-available online at wvvw.cookcountvil.aov/contraotcomoliance1

X Bidder/Proposer is not a cmrtiged MBE or WBE Ilrm, nor a Jaint Venture with MBE/WBE partners, but will utilize MBE and WBE firms slihsrdirectly or indirectly in the performance of the Contract. (If so, complete Sections II below snd the Leger(s) ai Intent- Form 2),

S. X Direct Participagon of MBE/WBE Firms Indimct Pa licipagon of MBE/WBE Firms

NOTE: Where goals have not been achieved thrutsih direct participadon, Bidder/Proposer shall include documentation otrBfning efforbr toachieve Direct Participation st the time of Bid/Proposal submission. Indirect Parsrripation will only be considered eltw ag efforts toachieve Direct Participation have been exhausted. Only atter wrlNan documsntason of Bood Faith Efforts ls received will IndirectParticipation be considered.

MBEs/WBEs that will perform as subcontradors/suppliers/consugants include the following:

SPAAN Tech, inc.

Addmss:

E-mail:

311 S.Wacker Drive, Suite 2400, Chicago, IL 60606

[email protected]

Contact Pemoni Ms. Smita Shah

DagarAmountParlicipatlon: S 179.006.00

Percent Amount of Participation:

'Letter of Intent agaohed? Yes X'Current Letter of Certification attached? Yes X

No

No

(312) 277 8810

35

MBE/WBE Firm:

Address.

E-maik

Contact Person:

Dollar Amount Participation: S

Percent Amount sf Participation:

Phone:

*Letter of Intent anached?"Current Letter of Cert Tiication attached?

YesYss

No

No

4//ach add/i/ansf sheets as needed.

*Letter(s) of Intent and current Lettem of Certilicabon must be submitted at the time of bid.

M/WBE Utilization Plan - Form 1 Revised: gt/29/2014

MBE/WBE LETTER OF INTENT - FORM 2

M/wBE Firm'PAAN Tech, Inc.

cpntact perspn Ms. Smita Shah, President

311 S.Wacker Drive, Suite 2400

cd /stw. Chicago, ILzip: 60606

(312)2774810 Fax (312) 277-8811

Certifying Agellcy: I y

Certification Expiration Date: 2/" /20" 7

EihnjcfiyAsian Indian American

Bjd/Prpppsagcpntrsct/k 1388-13279

FFJN rt 36%245016

submittalsspaantech.corn

Parficipation: IXI Direct [ I Indirect

Will the M/WBE firm be subcontracting any of the goods or seniices of this contract to another firm?

[XINo [ I Yss —Pease attach explansfion. Proposed Subcontractor(s):

The undsrsigried M/WBE is prepared to prmride the following Commodities/Senrices for the above named Project/ Contract I//more space is needed Io arity deeense ht/IVSE Fino's pm posed scope cr tooth snd/or pennant schedule, attach odra/pnst shee/sj

Engineering Services

Indmme the Dollar Amount, Percenteoe, and the Terms of Pavment for the above4escribsd Commodities/ Services:

$179,006.00

THE UNDERSIGNED PARTIES AGREE fital this Letter of Intent will become a binding Subcontract Agreement for Ihe abovevmrk, conditioned upon (I) the Bidder/Pmposer's receipt of a signed contract from the County of Cook; (2) UndemignedSubcontractor remaining compliant with all relevant crederdials, codes, ordinances and statutes nntuired by Contractor, CookCounty, end the State to participate as a.MBE/WBE firm for the above work. The Undersigned Parfies do also certify that theydid nc)rit(fix their signatures

'ent unfit afi areas under Description of Service/ Supply and Fee/Cost were compkrisd,

ature (M/WSE) Signature (Prime ader/Proposer)

Michi E. Pena Michael J. MCMurra)/

Print Name Print Name

SPAAN Tech, Inc. Globetrotters Engineering CorporationFhmName Firm Name

June 21, 2016 June 21, 2016Date Date

Subscribed snd swam before me

this21 stdsy of June 2016

Notary Public f7</LAIC UdJV~/

OAIIOLVN VALsMllIOOFFICIAL SEAL

taooey public - State or iaeoisSiy commission Eorms

Anm 14, xple

Subscribed and sworn before me

this21Stdeyof June .20~.Notary Public 6klA/AH I )i)f~4@i

shrcommsshr oommissioo sxpms

M/WSE Utilization Plan - Form 2 Revised: 1/29/14

DEPARTMENT OF PROCUREMENT SERVICES

CITY OF CHICAGO

IlAR 0 J 20(8

Ms. Smita ShahSPAAN Tech, Inc.311 S.Wacker Drive, Suite 2400Chicago, IL 60606

Dear Smite Shah:

We are pleased to inform you that SPAAN Tech, Inc., has been recertified as a Minority BusinessEnterprise ("MBE")and Women Business Enterprise ('WBE") by the City of Chicago ('ity" ),This MBE/WBE certification is valid until 2/1/2017; however your firm's ceifification must berevalidated annually. In the psst the City has provided you with an annual letter confirming yourcsrtificstion; such htters will no longer be issued. As a consequence, we mqulre you to be evenmom diligent in filing your annual Nohange Affidavit 60 days before your annual anniversarydate.

It is now your responsibility to check the City'0 certiTication directory and verify your certificationstatus. As s condition cf continued oertification dudng the live year period stated above, you mustfile an annual N~hange Affidavit. Your firm's annual No&hangs Affidavit is due by 2/1/2016.Please remember, you have an alfirmative duty to file your NaChange AIIidavlt 60 days prior tothe date of expiralion. Failure to fil your annual No-Change Atfidavit may result in the suspensionor rescmsion of your certification.

Your firm'0 five year certification will expire on 2/1/2017, You have sn affinnative duty to file forrecerfification 60 days prior to the date of the five year anniversary date. Therefore, you must filefor recertification by 12/1/2016.

It is important to note that you also have an ongoing aifirmative duty to notify the City of anychanges in ownership or contml of your firm, or any other fact affecting your finn's eligibility forcertification within 10 days of such change, These changes may include but are not limited to achange of address, change of business structure, change in ownership or ownership structure,change of business operations, gross receipts and or personal net worth that exceed the programthreshold. Failure to provide the City with timely notice of such changes may result in thesuspension or rescission of your certification. In addition, you may be liable for civil penalfies underChapter 1-22, "False Claims", of the Municipal Code of Chicago.

Please note —you shall be deemed to have had your certification lapse and will be ineligible toparticipate as a MBE/WBE if you fail to:

~ File your annual No-Change Affidavit within the required time period;~ Provide finandal or other records requested pursuant to an audit within the required time

period;

ISI NORTH LASALLK STREET, ROOM 806, CHICAGO, ILLINOIS 60602

BPAAN Tech, inc Page2of2

~: Notify the City of any changes affecting your firm's certification within 10 days of such:change; or

~ .File ycur rscertlcation within the requimd time period.

="-": -::Please be reminded of your contractual obligation to cooperate with the City with respect to anyieviews, audits or investigation of its contracts and affirmative action programs, We strongly. 'encourage you to assist us in maintaining the integrity of our programs by reporting instances orsuspicionp uf fraud. or abuse to the City's Inspector General at chlcagoihspectorgeneral.org, or8664G-TIPLINE(866WSRT64).

,- Be Edvkied that if you or your firm is found to be involved in certification, bidding and/or contractualfraud or abuse, the City will pursue decertification and debarment In addition to any other penaltyimposed by lsw, any person who knowingly obtains, or knowingly assists another in obtaining acontract with the City by falsely representing the individual or entity, or the individual or entity

'aisisted ls guilty of a misdemeanor, punishable by incarceratkm in the county jail fcr a period not to',. exceed six.months, or a 8ne of not less than $5,000 and not more than $10,000or both.

Your grm's name will be listed in the City's Directory ef Minority and Women-Owned BusinessEnterprises in the specialty area(s) of:

', NAICS Code{a):: 841330-Electrical Engineering Services

- 641330 —Engineering Services..541350-Inspecgon Services, Building or Home" 541512-Systems Integration Design Consulting Services, Computer541612-CAD Systems Integragon Design Services

,':: 841512-Computer Hardware Consulting Services541612-Computer 8oflware Consulting Services

'41513-Facgltles {la.,clients facilities) Man~ment and Operation Services, ComputerSystems or Data Processing

661210-Facilities (except computer operagon) Support Services

Your firqI'8 {ter8dpatlon on City contracts wgl be credited only toward Minority BusinessEnte~mf 1Nomen Business Enterprise goals in your area(s) specialty. While yourparticipation on City contracts is not limited to your area of specialty, credit toward goals will be

. given only for work that is self-performed and providing a commercially useful function that is donein the approved specialty category.

, Thank you for your Interest in the City's Minority and Women-Owned Business Enterprise{MBE/WBE) Program.

Sincerely,

: Ri. First

, RB/do

m us ra

' ICook County Government

M/WBE Reciprocal Certification Affidavit

Finn Name SPAAN Tech, Inc.

Address 311 S.Wacker Drive, Suite 24pp; Chica

COOk State Illinois 60606

Phone ( 312 ) 277-8800 Email [email protected]

Michi E, Ptfna

(drrrirorised Representative)

of SPAAN Tech, Inc.(steam ofFirm)

SPAAN Tech, Inc.

(¹me ofFirm)

Vice President

(print late)

do hereby aflirm:

is a Minority and/or Women Business Enterprise

currently certified by the City ofChicago as: [ ] Black- [ ]Hispanic- [X]Asian- [X]Woman-ownedbusiness.

2) With respect to SPAAN Tech, Inc., the personal net worlh of the qualifying

(Nome ofFirm)(51%)individual(s) does not exceed $2,210,847, excluding the individual's ownershp interest in theM/WBE firm and the equity of the owner's primary residence, and otherwise meets the requirementsof Chapter 34, Arlicle IV of the Cook County Pmcurement Code. (As per Section 34-263 of theCook County Pmcurement Code, an individual's personal net worth includes only his or her ownShare of assets held jointly or as community/marital properly with the individual's spouse.)

3) The average annutd gross receipts of SPAAN Tech, Inc.

(¹me ofFani)as derived &om urx filings over the five most recent years, does not exceed the Small Business SizeStandards published by the U.S.Small Business Administration found in Title 13,Code of FederalRegulations, Part 121.(htto://www.sba.zov/content/small-business-size-standards)

Upon penalty of per]my 1 Michi E. Pena affirm that, to the best ofmy(darirortsed Representarive)

knowledge and belief, the information herein is true and accurate.

Ttt( Vice President Date June 21, 2016

Subscribed and sworn to before me this

/ /))/))tee /)(///)I/(st)notary's S~)

M„c '.'u . M) /r/

day of June / 2016(Month) (Year)

Notary's Seal

CARoLYN YALRNTINCOFFICIAL SEAL

Notary public sans of arsonMy Commission Bmym

April 're, Nnaevlsed 8/20 ]4s sm

PETITION FOR WAIVER OF MBE/WBE PARTICIPATION - FORM 3

A. BIDDER/PROPOSER HEREBY REQUESTS:

FULL MBE WAIVER FULL WBE WAIVER

REDUCTION (PARTIAL MBE end/or WBE PARTICIPATION)

% of Reduction tor MBE Partidpation

% of Reducgon for WBE Participation

B.REASON FOR FULL/REDUCTION WAIVER REQUEST

Bidder/Proposer shall check each item applicable to ils reason for a waiver request. Additionally, supportingdocumentation shall be submitted with this request.

(1) Lack of sufficient qualified MBEs and/or WBEs capable of providing the goods or services requiredby the contract. (Please explain)

(2) The specifications and necessary requirements for performing the contract make il impossible oreconomically infeasible lo divide the contract to enable the contractor to utilize MBEs and/or WBEs inaccordance with the applicable participation. (Please explain)

(3) Price(s) quoted by potengial MBEs and/or WBEs are above competitive levels and increase cost ofdoing business and would make acceptance of such MBE and/or WBE bid economically impracticable,taking into consideration the percentage of total contract price represented by such M BE and/or WBEbid. (Please explain)

(4) There are other relevant factors making it impossible or economically infeasible to utilize MBE and/orWBE firms. (Please explain)

C. GOOD FAITH EFFORTS TO OBTAIN MBE/WBE PARTICIPATION

(1) Made timely written solicgalion to Identiffed MBEs and WBEs for utilization of goods and/or services;and provided MBEs and WBEs with a timely opportunity to review and obtain relevant specifbattons,terms and conditions of the proposal to enable MBEs and WBEs to prepare an informed response tosolicitation. (Attach of copy written soliciMions made)

(2) Used the services and assistance of the OMce of Contract Compliance staff. (Please explain)

(3) Timely notified and used the services and assistance of community, minority and women businessorganizagons. (Attach of copy written solkltations made)

(4) Followed up on initial soficitation of MBEs and WBEs to determine if firms are interested in doingbusiness. (Attach supporgng documentation)

(5) Engaged MBEs & WBEs for direct/indirect participation. (Please explain)

D. OTHER RELEVANT INFORMATION

Attach any other documentation relative to Good Faith Efforts in complying with MBE/WBE participation.

M/VVBE Utilization Plan - Form 3 Revised: 01/29/14

OFFICE OF CONTRACT COMPUANCE

JACQUELINE GOMEZ

DIRECTOR

118N. Clark, County Building, Room 1020 ~ Chicago, Illinois 60602 ~ i312) 603-5502

July 29, 2016

TONE PRECKININKLE

PRESIDENT

Cook County Board

of Commissioners

RICHARD R BOYKIN

1st District

ROBERT STEELE

2nd District

Ms. Shannon E. Andrews

Chief Procurement Dicer118N. Oark Street

County Building-Room 1018

Chicago, IL B0602

JERRY BUTLER

3rd District

STANLEY MOORE

4th Distnct

Re: Globetrotters Engineering Corporation

Contract Nod 1388-13279(Amendment No. 2)

Broadband Project Phase IV

Bureau of Technohgy

DEBORAH SIMS

5th DistrictDear Ms. Andrews:

JOAN PATRICIA MURPHY

6th District

JESUS G. GAROA

7th Distort

The Oflice of Contract Compliance is in receipt of the above-referenced contract amendment and has

reviewed this contract for compliance with the Minority- and Women- owned Business Enterprises (MBE/I/BE)

Ordinance. After careful review of our records as reported by the vendor, it has been determined the vendor is

in compliance with the MBE/WBE Ordinance.

LUIS ARROYO, JR

8th DistortSincerety, ~

PETER N. SILVESTRI

9th Distdct

BRIDGET GAINER

10th District

JOHN P. DALEY

11th District

Jacqueline Gomez

Contract Compliance Dimctor

JG/ale

JOHN A. FRITCHEY

12th District

LARRY SUFFREDIN

13th District

Cc: Tangela Malloy, OCPO

Doug Coupland, BOT

Ingrid Sandem, BOT

GREGG GOSUN

14th District

TIMOTHY O. SCHNEIDER

15th District

JEFFREY R. TDBOLSKI

16th District

SEAN M. NORRSON

17th District

$ Fiscal Responsibility 'f Innovative Leadership Transparency at Accountability g> Improved Services


COOK COUNTYECONOMIC DISCLOSURE STATEMENT

AND EXECUTION DOCUMENTINDEX

Section Description Pattes

Instructions for Completion of EDS EDS i-ii

Certifications

Economic and Other Disclosures, Affidavit cf ChildSupport Obligations, Disclosure of Ownership Interest

and Familial Relationship Disclosure Form

Cook County Affidavit for Wage Theft Ordinance

EDS 1-2

EDS 3-12

EDS 13-14

Contract and EDS Execution Page

Cook County Signature Page

EDS 15-17

EDS 18

CONTRACT NO 1388-13279SECTION 1

INSTRUCTIONS FOR COMPLETION OFECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT

This Economic Disclosure Statement and Execution Document ("EDS") is to be completed and executedby every Bidder on a County contract, every Proposer responding to a Request for Proposals, and everyRespondent responding to a Request for Qualificagons, and others as required by the Chief ProcurementOfficer. The execution of the EDS shall serve as the execution of a contract awarded by the County. TheChief Procurement Officer reserves the right to request that the Bidder or Proposer, or Respondentprovide an updated EDS on an annual basis.

Delnittons. Terms used in this EDS and not otherwise defined herein shall have the meanings given tosuch terms in the Instructions to Bidders, General Conditions, Request for Proposals, Request forQualiTications, as applicable.

Affiliate means a person that directly or indirectly through one or more intermediaries, Controls isControlled by, or is under common Control with the Person specified.

Applicant means a person who executes this EDS.

Bidder means any person who submits a Bid.

Code means the Code of Ordinances, Cook County, illinois available on municode.corn.

Contract shall include any written document to make Pmcurements by or on behalf ofCook County.

Contractor or Contracting Party means a person that enters into a Contract with theCounty.

Control means the unfettered authority to directly or indirectly manage governance,administration, work, and all other aspects of a business.

EDS means this complete Economic Disclosure Statement and Execution Document,including all sections listed in ths Index and any attachments.

Joint Ventura means an association of two or more Persons proposing to perform a for-profit business enterprise. Joint Ventures must have an agreement in writing specifyingthe terms and conditions of the relationship between the partners and their relationshipand respective responsibility for the Contract

Lobby or lobbying means to, for compensation, attempt to influence a County official orCounty employee with respect to any County matter.

Lobbyist means any person who lobbies.

Person or Persons means any individual, corporation, partnership, Joint Venture, trust,association, Limited Liability Company, sole proprietorship or other legal entity.

Prohibited Acts means any of the actions or occurrences which form the basis fordisqualification under ths Code, or under the Certifications hereinafter set forth.

Proposal means a response to an RFP.

Pmposer means a person submitting a Proposal.

Response means response to an RFQ.

Respondent means a pemon responding to an RFQ.

RFP means a Request for Proposals issued pursuant to this Procurement Code.

RFQ means a Request for Qualifications issued to obtain the qualifications of interested parties.

sr2015

CONTRACT NO 1388-13279

INSTRUCTIONS FOR COMPLETION OFECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT

Section 1:Instructions. Section 1 sets forth the instructions for completing and executing this EDS.Seegar 2: Certificagons. Section 2 sets forth certITicstions that are required for contracting parties underthe Code and other applicable laws. Execution of this EDS constitutes a warranty that all the statementsand certifications contained, and afi the facts stated, in the Certifications are true, comect and complete asof the date of execution.

Section 3: Economic and Other Disclosures abatement. Section 3 is ths County's required Economicand Other Disclosures Statement form. Execution of this EDS constitutes a warranty that afi theinformation provided in the EDS is true, correct and complete as of the date of execution, and binds theApplicant to the warranties, representations, agreements and acknowledgements contained therein.

Required Updates. The Applicant is required to keep afi information provided in this EDS current andaccurate. In the event of any change in the informafion provided, including but not limited to any changewhich would render inaccurate or incomplete any certification or statement made in this EDS, theApplicant shall supplement this EDS up to the time the County takes action, by filing an amended EDS orsuch other documentation as is required.

Additional Information. The County's Governmental Ethics and Campaign Financing Ordinancesimpose certain duties and obligations on persons or entities seeking County contracts, work, business, ortransactions, and the Applicant is expected to comply fully with these ordinances. For further informationplease contact the Director of Ethics at (312) 603%304 (69 W. Washington St. Suite 3040, Chicago, IL60602) or visit the wsb-site st cookcountyfi.gov/ethics-board-of.

Authorized Signers of Contract and EDS Execution Page. If the Applicant is a corporation, thePresident and Secretary must execute the EDS. In the event that this EDS is executed by someone otherthan the President, attach hereto a certified copy of that section of the Corporate By-Laws or otherauthoyzation by the Corporation, safisfactory to the County that permits the person to execute EDS forsaid corporation. If the corporation is not registered in the State of filinois, a copy of ths Certificate ofGood Standing from the state of incorporation must bs submitted with this Signature Page.

If the Applicant is a partnership or joint venture, afi partners or joint venturers must execute the EDS,unless one partner or joint venture hss been authortzed to sign for the partnership or joint venture, inwhich case, the partnership agreement, resolution or evidence of such authority satisfactory to the Officeof the Chief Procurement Officer must be submitted with this Signature Page.

If the Applicant is a member-managed LLC afi members must execute the EDS, unless otherwiseprovided in the operating agreement, resolution or other corporate documents. If the Applicant is amanager-managed LLC, the manager(s) must execute the EDS. The Applicant must attach either acertified copy of the operating agreement, resolution or other authorization, satisfactory to the County,demonstrating such person has the authority to execute the EDS on behalf of the LLC. If the LLC is notregistered in the State of lfiinois, a copy of a current Certificate of Good Standing from the stets ofincorporation must be submitted with this Signature Page.

If the Applicant is a Sole Proprietorship, the sole proprietor must execute the EDS.

A 'Partnership" "Joint Venture" or Sole Proprietorship'perating under an Assumed Name must beregistered with the illinois county in which it is located, as provided in 805 ILCS 405 (2012), anddocumentation evidencing registration must be submilted with the EDS.

EBS-ii BI2015

SECTION 2

CERTIFICATIONS

CONTRACT NOJ1388-13279

THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE. THE APPLICANT IS CAUTIOhlEDTO CAREFULLY READ THESE CERTIFICATIONS PRIOR TO SIGNING THE SIGNATURE PAGE. SIGNING THE SIGNATUREPAGE SHALL CONSTITUTE A WARRANTY BY THE APPLICANT THAT ALL THE STATEfillENTS, CERTIFICATIONS ANDINFORMATION SET FORTH WITHIN THESE CERTIFICATIONS ARE TRUE, COMPLETE AND CORRECT AS OF THE DATE THESIGNATURE PAGE IS SIGNED. THE APPLICANT IS NOTIFIED THAT IF THE COUNTY LEARNS THAT ANY OF THFFOLLOWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACT ENTERED INTO WITH THE APPLICANT SHALLBE SUBJECT TO TERMINATION.

PERSONS AND ENTITlES SUBJECT TO DISQUALIFICATION

No person or business entity shall be swarded a contract or sub-contract, for a period of five (5) years from the date ofconviction or entry of a plea or admission of guilt, civil or aininal, if that pemon or business entiiy:

1) Has been comricted of an act committed, within the State of filinois, of bribery or attempting to bribe an officer oremployee of a unit of state, federal or local government or school district In the State of fifinois in that officer's oremployee's oScial capacity;

2) Has been convicted by iisderal, state or local government of an act of bid-rigging or attempting to rig bids as definedin the Sherman Anti Trust Act and Clayton Act Act 15 U S C. Secfion 1 st seqri

3)

4)

5)

6)

Has been comricted of bid-rigging or attempting to rig bids under the laws of federal, state or local government;

Has been comridsd of an act committed, within the State, of price-fixing or attempting to fix prices as definsd by theSherman Anti-Trust Act and the Clayton Act. 15 U.S.C. Section 1, el seq.;

Has been convicted of price4xing or attempting to fix priicss under the laws ths State;

Has been convicted of defrauding or attempting to defraud any unit of state or local government or school districtwithin ths Sale of filinois;

B.

7) Has made an admission of guilt of such conduct as set forth in subsections (1) through (6) above which admission isa matter of mcord, whether or not such person or business entity was subject to prosecution for ths oflisnss oroffenses admitted to; or

8) Has entered a plea of nolo contendere to charge of bribery, price-fixing, bid-rigging, or fraud, as set forth in sub-paragraphs (1)through (6) above.

In the case of briibery or attempting to bribe, s business entity may not be awarded a contract if an oScial, agent or employeeof such business enfily committed the Prohibited Act on behalf of the business entity and pursuant to ihs direction orauthorization of an oScer, director or other responsible oScial of the business entity, snd such Prohibited Act occurred withinthree years prior to the sward of the contract, In addihon, a business entity shall be disqualifie if an owner, partner orshareholder controlling, directly or indirectly, 20% or more of the business entity, or an oScsr of ths business entity hasperformed any Prohibited Act within five years prior to the award of the ConlracL

THE APPLICANT HEREBY CERTIFIES THAT: The Applicant has read the provisions of Sechon A, Persons and EntitiesSubject to Disquslificafion, that the Applicant has not committed any prohibited Act set forth in Section A, and thai award ofthe Contract to the Applicant would not violate the provisions of such Section or of the Code.

BIDJBGGING OR BID ROTATING

THE APPLICANT HEREBY CERTIFIES THAT: In accordance with 720 ILCS 5/33 E-11, neither the Appricanl nor anyASlislsd Enlily is baaed from award of Sis Contract as a result of a conviction for the violation of State laws prNribifing bid-rigging or bid rotating.

DRUG FREE WORKPLACE ACT

THE APPLICANT HEREBY CERTIFIES THAT: Ths Applicant will provide s drug free workplace, as required by (30 ILCS 580/3).

EDS-1 8/2015

CONTRACT NO. 1 385-13279DEUNQUENCY IN PAYMENT OF TAXES

THE APPLICANT HEREBY CERTIFIES THAT: The Applicant is not an owner or e party responsible for the payment of any taxor fee administered by Cook County, by a local municipality, or by the illinois Department of Revenue, which auch tax or fee jsdefinquent, such as bar award of s contract or subcontiacf pumuant to the Code, Chapter 34, Section 34-171.

HUMAN RIGHTS ORDINANCE

No person who is a party to a contract with Cook County ("County" ) shall engage in unlawful discrimination or sexual harassmentagainst any individual in the terms or conditions of employment, credit, public accommodations, housing, or provision ot CountyfaciliTies, services or programs (Code Chapter 42, Section 42-30 et seq.).

ILLINOIS HUMAN RIGHTS ACT

7HE APPLICANT HEREBY CERTIFIES THAT: Itis in comPliance with the INinois Human Rights Act (775 ILCS 5I2105), endagrees to abide by the requirements of the Act as part of ifs contractual obligatkxrs.

INSPECTOR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTION 34-174 and Secgon 34-250)

The Appficant hss not willfully failed to cooperate in an investigation by the Cook County Independent Inspector General or toreport to the Independent Inspector General any and all information concerning conduct which they know to Involve corruption, orother criminal activity, by another county employee or oNdal, which concerns his or her oflice of employment or County relatedtransaction.

The Applicant has mporied directly and without any undue delay any suspected or known fraudulent activily in the County'sProcurement process to the ONce of Ihe Cook County Inspector General.

CAMPAIGN CONTRIBUTIONS (COOK COUNTY CODE, CHAPTER 2, SECTION 24I56)

THE APPLICANT CERTIFIES THAT: It has read and shel comply with the Cook County's Ordinance concerning campaignconbibutions, which is codified at Chapter 2, Division 2, Subdivision 0, Section 585, and can be read in its entirety atwww.muni

code.corn.

GIFT BAN, (COOK COUNTY CODE, CHAPTER 2, SECTION 24I74)

THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County's Ordinance concerning receiving andsoliciTing gifis and favors, which is codiTied at Chapter 2, Division 2, Subdivision II, Section 574, and can be read in its entirety atwww.municode.corn.

LIVING WAGE ORDINANCE PREFERENCE (COOK COUNTY CODE, CHAPTER 34, SECTION 34-150;

Unless expressly waived by ths Cook County Board of Commlsslonels, the Code requires that a living wage must be paid toindividuals employed by a Contractor which has a County Contract and by afi subcontractors of such Contractor under a CountyContract, throughout the duration of such County Contract The amount of such living wage is annually by the Chief FinancialONcer of the County, and shall be posted on the Chief Procurement Ofiicer's website.

The term "Contact" as used in Section 4, I, of this EDS, specNcally excludes contracts with the following:

1) Not-For Profit Organizations (define as a corporabon having tax exempt status under Section 501(C)(3)of the United

State Internal Revenue Code and recognized under the illinois Stale not-for -profit law);

2) Community Development Black Grants;

3) Cook County Works Depsrimenb

4) Sheriifl's Work Alternative Pmgram; and

5) Department of Correction inmates.

8/2015

CONTRACT NO 1SBB-13279

SECTION 3

REQUIRED DISCLOSURES

1. DISCLOSURE OF LOBBYIST CONTACTS

I ist all persons that have made lobbying contacts on your behalf with respect to this contract:

Name

None.Address

2. LOCAL BUSINESS PREFERENCE STATEMENT (CODE, CHAPTER 34, SECTION 34-230)

Local business means a Person, including a foreign corporation authorized to transact business In illinois, having a bona fidsestablishment located within the County at which it is transacting business on the date when a Bid is submitted to the County, andwhich employs the majority of its regular, full-time work force within the County. A Joint Venture shall constitute a Local Business if oneor more Pemons that qualify as a "Local Business" hold interests totaling over 50 percent in the Joint Venture, even if the Joint Venturedoes not, at the time of the Bid submittal, have such a bona fide establishment within the County.

s) ls Applicant a "Local Business" as defined aboveg

Yes: No:

b) If yes, list business addresses within Cook County:

300 S. Wacker Drive, Suite 400, Chicago, IL 60606

c) Does Applicant employ the majority of its regular full fime workforoe within CookCounty'es:

Ncc

3. THE CHILD SUPPORT ENFORCEMENT ORDINANCE (CODE, CHAPTER 34, SECTION 34-112)

Every Applicant for a County Pdvilege shall be in full compliance with any child support order before such Applicant is entitled to receive orrenew a County Privilege, When delinquent child support exists, ths County shall not issue or renew any County Privilege, and mayrevoke any County Pdvilege.

All Applicants are required to review the Cook County Affidavit of Child Support Obligations attached to this EDS (EDS4I) andcomplete the Affidavit, based on the instructions in the Affidavit

EDS-3 8/2015

CONTRACT NO 1 388 13278rL REAL ESTATE OWNERSHIP DISCLOSURES.

The Applicant must indicate by checking the appropriate provision bekwr and providing afi required informabon that either:

a) The following is a complete list of all real estate owned by the Applicant in Cook County:

PERMANENT INDEX NUMBER(S):

(ATTACH SHEET IF NECESSARY TO LI8T ADDITIONAL INDEXNUMBERS)

OR:

b) The Applicant owns no real estate in Cook County.

8, EXCEPTIONS TO CERTIFICATION8 OR DISCLO8URES.

If the Applicant is unabls to cerfify to any of the Cerfifications or any olher statements contained in this EDS and not explained elsewhere in

this EDS, the Applicant must explain below:

N/A

lf the letters, "NA", the word "None" or "No Response" appears above, or if the space is left blank, it will be conclusively presumed that theApplicant cerfifisd to afi Certificafions and other slalements contained in this EDS.

EDS-4 Lu2015

CONTRACT NO. 13SSI 3278

COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT

The Cook County Code of Ordinances (I]2410 ef sec.) requires that any Applicant for sny County Action must disclose informationconcerning ownership interests in the Applicant. This Disclosure of Ownership Interest Statement must be completed with allinformation cuimnt as of the date this Statement is signed. Furthermore, this Statement must bs kept current, by filing an amendedStatement, until such time as the County Board or County Agency shall take action on the application. The information contained in

fiiis Statement will be maintained in s database and made available for public viewing.

If you are asked to list names, but there are no applicable rlames to list, you must slale NONE. An incomplete Statement will bereturned and any action regarding this contract will be delayed. A failure to fully comply with the ordinance may result in the actiontaken by ths County Board or County Agency being voided.

"Applicant" means any Entity or person making an application to the County for any County Action.

County Action means any action by a County Agency, a County Deparbnent, or the County Board regarding an ordinance orordinance amendment, a County Board approval, or other County agency approval, with respect to contracts, leases, or sale orpurchase of real estate.

Person" "EnNy or "Legs/ Enfify" means a sole proprietorship, corporation, partnership, association, business trust, estate, two ormors persons having a joint or common interest, trustee of a land trust, other commercial or legal snfity or any beneficiary orbeneficiaries thereof.

This Disclosure of Ownership Interest Statement must be submitted by:

1 An Applicant for County Action and

2, A Person that hokls stock or s beneficial interest in the Applicant BFJt is listed on the Applicant's Statement (a "Holder" ) must ills aStatement and complete 81 only under Ownership Internet Declaration.

please print or type responses clearly and legibly. Add additional pages if needed, being careful to identify each portion of the form towhich each additional page refers.

This Statement is being made by the [ X ) Applicant or [ l Stock/Beneficial Interest Holder

[ X [Original Statement or [ [ Amended Statement

Zip Code: 60606

Emait market[noCeo-afcuD.COln

This Statement Is an:

Identifying Information:

Globetrotters Engineering Corporation

D/B/A: FEIN NO.: 38-2I)19661Street Address: 300 S, Wacker Drive. Suite 400city Chicago stale, illinois

Phone No.: (312) 922-6400 Fax Number: (312)922-0267

Cook County Business Regisbafion Number:(Sole Proprietor, Joint Venture Partnership)

Corporate File Number (if applicable):

Form of Legal Entity:

[ ] Sole Proprietor [ l Partnership [X] Coqmration [ ] Trustee of Land Trust

[ ] Business Trust [ ) Estate [ ] Assodation [ l Joint Venture

[ ) Other (descriibe)

EDS-B 8/2015

CONTRACT NO. 1 388-13279Ownership Interest Declarafion:

List the name(s), address, and percent ownership of each Person having a legal or beneficial interest (including ownership) ofmore than five percent (5%) in the Applicant/Holder.

Name Address Percentage Interest in

Applicant/Holder

Niranjan S.Shah 300 S.Wacker Dr., ¹400, Chicago, IL 60606 53.33')(,

Trust A c/u 2011 Shah Gift Trust 300 S.Wacker Dr.. ¹400. Chicaao. IL 60606 46.87%Trustee: Prstima Shah. Benefidarv: Aiav Shah

If the interest of any Person listed in (1)above is held as an agent or agents, or s nominee or nominees, list the name andaddress of the principal on whose behalf the interest is held.

Name of Agent/Nominee Name of Principal Principal's Address

Is the Applicant constructively controlled by another pemon or Legal Entity7 i ) Yea i X i No

If yes, state the name, address and percentage of beneficial interest of such person, and the relationship under which suchcontrol is being or may be exercised.

Name Percentage ofBeneficial Interest

Relationship

Corporate Otficers„Nlsmbem and Partners Information:

For all corporafions, list the names, addresses, and terms for all corporate officers. For all limited liability companies, list the names,addresses for all members. For sll partnerships and joint ventures, list the names, addresses, for each partner or joint venture,

Name

Please ~ attachment.

Ttfie (specify title of Term of OfficOflice, or whether manageror partner/joint venture)

Oeclaration (check the applicable box):

( ] I stale under oath that the Applicant has withheld no disclosure as to ownership interest in ths Applicant nor reservedany information, data or plan as to the intended use or purpose for which the Applicant seeks County Board or other County

Agency action.

[X) I slate under oath that the Holder has withheld no disclosure as to ownership interest nor reserved any informafion required tobe ifisdosed.

EDS-7 8/2015

Officers of Globetrotters Engineering Corporation

Name

Nlranjan S. Shah

Address

300 S.Wacker Drive, Suits 400Chicago, IL 80606

Chairman

Title Term of Offic2013—Present

Chairman, President and Treasurer 2011 —2013

Michael J. McMurray

Ajay Shah

300 S.Wacker Drive, Suite 400Chicago, IL 60606


President and Treasurer

Chairman, CEO, Treasurer andAssistant Secretary

President

Chief Operating Officer

Chief Operating Officer, GeneralCounsel & Secretary

Executive Vice President, GeneralCounsel & Seaetaiy

2005 —2011

N/A - 2005

2013 —Present

2006 —2013

2014 —Present

2012 —2014

Executive Vice President & General 2010 —2012Counsel

Vice President & General Counsel 2008 —2010

Brian McPargin

Ahmad I. Karim

Michael J. Paulius

Jack J. Svaicer

Sung Lee

Gregory A. Boltz

Wendell Fransen

Bruce Weber

Zygi Boxer

Dan Curlsy


300 S.Wacker Drive, Suits 400Chicago, IL 80606




300 S.Wacksr Drive, Suite 400Chicago, IL 60606


300 S.Wacksr Drive, Suite 400Chicago, IL 60608


300 S.Wacker Drive, Suite 400Oh@ago, IL 60806

Senior Vice President

Vice President

Vice President

Vice President

Vice President

Vice President

Chief Financial Officer

Treasurer and Controller

Treasurer

Vice President

Vice President

2013—Present

2009 —Present

2006 —Present

2002 —Present

2013—Present

2011 —Present

1898—2011

2014 —Present

2013—2014

3/2016 —Present

3/2016 —Present

3/2016 - PresentVice President

Globetrotters"aneineenne corponann


COOK COUNTT DISCLOSURE OF OWNERSHIP INTEREST STATEMENT SIGNATURE PA1aE

Michael J. McMurrayName of Authorized AppllcantlHolder Representative (please print or type)

[email protected] address

Presidenttitle

June 21, 2016Date

(312) 922-6400Phone Number

Subscribed to and sworn befom methis 21st day of June, 2016

Piu<i~i~ (AA'~~&exNotary Public 5tfrfiture "

A ri ra~aO'j7Notary Seal

Illly commission expires: 3gJ,yj j q 3gi gI

CAROLYN VALarmacI OFFICIAL8EALmNaiarr public aaaa al ltirccra

EDS-8 8/20t5


COOK COUNTY BOARD OF ETHICS69 W. WASHINGTON STREET, SUITE 3040

CHICAGO, ILLINOIS 60602312/603-4304 Office 312/603-9988 Fax

FAMILIAL RELATIONSHIP DISCLOSURE PROVISION

Neuotism Disclosure Reouiremeut:

Doing a significant amount ofbusiness with the County requires that you disclose to the Board of Ethics the existence of any familialrelationships with any County employee or any person holding elective office in the State of Illinois, the County, or in anymunicipality within the County. The Ethics Onlinance defines a significant amount of business for the purpose of this disclosurerequirement as more than $25,000 in aggregate County leases, contracts, purchases or sales in any calendar year.

If you are unsure of whether the business you do with the County or a County agency will cross this threshold, err on the side ofcaution by completing the attached familial disclosure form because, among other potential penalties, any person found guihy

ot'ailingto make a required disclosure or knowingly filing a fidse, misleading, or incomplete disclosure will be pmhibited from doingany business with the County for a period of tluue years. The requited disclosure should be filed with the Board ofEthics by January1 of each calendar year in which you are doing business with the County and atpun with each bid/proposal/quotation to do businesswith Cook County. The Board ofEthics may assess a late filing fee of $100 per day alter an initial 30-day grace period.

The person that is doing business with the County must disclose his or her familial relationships. If the person on the County lease orcontract or purchasing &om or selling to the County is a business entity, then the business entity must disclose the familialrelationships of the individuals who are and, during the year prior to doing business with the County, were:

~ its board ofdirectors,~ its officers,a its employees or independent contractors responsible for the general administration of the entity,~ its agents authorized to execute documents on behalf of the entity, and~ its employees who directly engage or engaged in doing work with the County on behalf of the entity.

Do not hesitate to contact the Board of Ethics at (312) 603-4304 for assistance in determining the scope of any required familialrelationship disclosure.

Additional Delinitionsi

"Familial relationship" means a person who is a spouse, domestic partner or civil union partner of a County employee or State,County or municipal official, or any person who is related to such an employee or olficial, whether by blood, marriage or adoption, asa:

J ParentChild

L BrotherJ SisterL Auntr UncleL NieceJ Nephew

L Grandparenta GrandchildJ Father-in-lawJ Mother-in-lawJ Son-in-law

Daughter-in-lawJ Bmlher-in-lawJ Sister-in-law

L StepfatherStepmother

L StepsonJ StepdaughterJ Stepbrother1 StepsisterL Half-brotherL Half-sister

EDS-9 8/2015

COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM

CONTRACT NO. 1 388-13279

PERSON DOING OR SEEKING TO DO BIJSINESS WITH THE COIJNTY

Name ofPerson Doing Business with the County; GIObetrOtterS Engineering COrpOratiOn

Address ofPerson Doing Business with the County 300 S.Wacker Drive, Suite 400, Chicaao, IL 60606

Phone number ofPerson Doing Business with the County: (3"2) 922+400

Email address ofPerson Doing Business with the County: [email protected]

If Person Doing Business with the County is a Business Entity, provide the name, title and contact information for theindividual completing this disclosure on behalf of the Person Doing Business with the County:

Michael J. McMurra)/, President, (312) 922-6400, marketinggec-group.corn

B. DESCRIPTION OF BUSINESS WITH THE COUNTYAppend additional pager as needed and for each County lease, contract purchme or sale sought and/cr obtainedduring the calendar year cfthis disclosure (or the proceeding calendar year ifdisclosure is made on January /),identify:

The lease number, contract number, purchase order number, request for proposal number and/or request for qualificationnumber associated with the business you are doing or seeking to do with the County:

Contract No. 1388-13279

The aggregate dollar value of the business you are doing or seeking to do with the County: $ 61 I 446 00

The name, title and contact information for the County official(s} or employee(s) involved in negotiating the business you aredoing or seeking to do with the county; Tanaela Moses-Mal lov. CPPB, Senior Contract Negotiator,

(312)603-6827, Tangela. Mallo)/iicookcount)/il.gov

The name, title and contact information for the County official(s) or employee(s) involved in managing the business you aredoing or seeking to do with the county; Fitz Miller, Director - Telecom & Network Infrastructure,

(312)603-1415,fitz.miller(mcookcountvil.gov

DISCLOSIJRK OF FAMILIAL RELATIONSHIPS WITH COUNTY EMPLOYEES OR STATE. COUNT Y ORMUNICIPAL ELECTED OFFICIALS

Check the box that applies and provide related information where needed

The Person Doing Business with the County is an individual and there is no familial relationship between this individualand any Cook County employee or any person holding elective office in the State of Illinois, Cook County, or anymunicipality within Cook County.

The Person Doing Business with the County is a business entity and there is no familial relationship between any memberof this business entity's board of directors, ofFicers, persons responsible for general administration of the business entity,agents authorized to execute documents on behalf of the business entity or employees directly engaged in contractual workwith the County on behalf of the business entity, and any Cook County employee or any person holding elective office in theState of Illinois, Cook County, or any municipality within Cook County.

EDS-10 8/2015

COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM

CONTRACT NO 1388-13279

O The Person Doing Business with the County is an individual and there is a familial relationship between this individualand at least one Cook County employee and/or a person or persons holding elective oBice in the State of Illinois, CookCounty, and/or any municipality within Cook County. The familial relationships are as follows:

Name of Individual DoingBusiness with the County

Name of Related County Title and Position ofRehecd Nature ofFamilialEmployee or State, County or County Employee or Stale, County RelationshipMunicipal Elected Olgcial or Municipal Elected Otgciat

Ifmore space is needed, attach an additional sheet following the above formaL

The Person Doing Business with the County is a business entity and there is a familial relationship between at least onemember of this business entity's board ofdirectors, officers, persons responsible for general administration of the businessentity, agents authorized to execute documents on behalf of the business entity and/or employees directly engaged incontractual work with the County on behalf of the business entity, on the one hand, and at least one Cook County employeeand/or a person holding elective office in the State of Illinois, Cook County, and/or any municipality within Cook County, onthe other. The familial relationships are as follows:

Name of Member ofBoardofDirector tbr BusinessEntity Doing Business with

the County

Name of Related County Title snd Position of Rehued Nature ofFamilialEmployee or State, County or County Employee or Stale, County RelationshipMunicipal Elected Otgctal or Municipal Elected Otgcial

Name ofOlgcer for Business Name of Related County Title and Position of Related Nature ofFamilialEntity Doing Business with Employee or State, County or County Employee or State, County Relationship"the County Municipal Elected Otgcial or Municipal Elected Otgcial

EDS-11 S/2015

Name ofPerson Responsible

for the GeneralAdministration of theBusiness Entity DoingBusiness with the County

CONTRACT NO. 1 388-13278Name ofRelated County Title and Position of Related Natue ofFamilialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected OtBeiat or Municipal Elected Otgciat

Name ofAgent Authorized

to Execute Documents forBusiness Entity DoingBusiness with the County

Name ofRelated County Title snd Position ofRelated Natwe of FamilialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected Oflicial or Municipal Elected Otgdal

Name ofEmployee ofBusiness Entity DirectlyEngaged ia Doing Businesswith the County

Name ofRelated County Title and Position of Related Nature ofFamilialEmployee or State, County or County Employee or Stale, County Relationship*Municipal Elected Oigcisl or Municipal Elected Oigcisl

Ifmore space is needed, attach an addi'iional sheer following the above format.

VERIFICATIONt To the best of my knowledge, the information I have provided on this disclosure foun is accurate and complete. Iacknowledge that an inacburate or incomplete disclosure is punishable by law, including but not limited to fines and debarment.

June 21, 2016Signature ofRkipient Date

SUBMIT COMPLETED FORM TO: Cook County Board ofEthics69 West Washington Street, Suite 3040, Chicago, illinois 60602Oflice (312)603-4304- Fax (312) 603-9988CookCounty.Ethicstwctmkcountyikgov

Spouse, domestic partner, civil union partner or parent, child, sibling, aunt, uncle, niece, nephew, grandparent or grandchildby blood, marriage (i.e. in laws snd step relations) or adoption.

EDS-12 8/2015

CONTRACT NO 1 388-13279SECTION 4

COOK COUNTY AFFIDAVIT FOR WAGE THEliT ORDINANCE

Effectiv May 1, 2015, every person, Incladlna saaesendel Ownem, seekktg s contract wffh cook county must comply with the cook county wage ThefiOrdinance set fodh In Chapter 34, Artlde IV, Section 179. Any Person/Substantial Owner, who falls to comply with Cook County Wage Thefl Ordinance,may request that the Chief Procwement ON car grant a reduction or waiver in accordance with Section 34-179(d).

"Contmcr'eans any mitten document to make procurements by or on behalf of Cook County.

"person" means any individual, corporation, partnership, Joint Venture, trust. association, limited liability company, sale proprietorship or other legal entity

"procuremenr means obtaining supplies, equipment, goods, or services of any kind.

"substentltd Owned means any person or persons who own or hold a twenty-five percent (28%) or more percentage of interest in any business enmyseeking a Cawtty Privilege, induding those shareholders, general ar llmasd partners, bsneaciarles and prlndpaka except where a business entity is anindividual or sole proprietorship, Srawtsntisl Owner means that individual sr sole proprietor.

All persons/Substantial Owners are required to camplete this affidavi and comply with the Cook County Wage Ihefi Ordinance belore any Contmra rsawarded. Sgnature of this ioml oansfitutes a certlficsfion the information pravided below is correct and complete, and that the individual(s) signing this formhas/have oersonsl knowledae of such Information.

I. Contract Information:

Contract Number: 1388-13279

County Using Agency (requesbng Procurement). Information TechnOIOgy

II. Person/Bubatantlal Owner Information:

Person (Corporate Entity Name): GIObetratterS Engineering COrpOratian

Substantial Owner Complete Name; Nil anlan S. Shah

FEINS 36-2819661

Date of Birth:

Street Address. 300 S. Wacker Drive, Suite 400

E-mail address: marketing@geo-grcup,COm

cjty'hicagoHome Phone: ~0 655 - 8894

III. Compgsnca with Wage Laws:

state illinois

Driver's Ucenss No

zip: 60606

Within the past five years has the Person/Substantial Owner, in any judicial or administrative proceeding, been convicted of, entered aplea, made an admission of guilt or liability, or had an administrafive finding made for committing a repeated or willful violation of any ofthe following laws:

////no/s Wage Payment and Collection Act 820/LCS I15/f et seq., YES o No

////nois Minimum Wage Act, 820 /LCS 105/f et seq., YES a+No

////nois Worker Adjusbnent snd Retraining Notification Acf, 820 /LCS 85/f ef seq., YES o NO

Employee C/ass/fi'cation Act, 820 /LCS 185/1 et ssq., YES a+No

Fair Labor 8/sndsn/s Ac/of 1938, 29 USC. 201, st ssq., YES a+No

Any comparable stale slatu/e or regulation of sny state, which governs the payment of wages YES oQNO

If the Person/Substantial Owner answered "Yea" to any of the questions above, it is ineligible to enter into a Contract with CookCounty, but can request a reduction or waiver under Section IV.

EDS-13 8/2015


IV. Request for Waiver or Reduction

If Person/Substantial Owner answered "Yes" to any of Ihe questions above, it may request a reduction or waiver inaccordance with Section 34-179(d), provided that ths request for reduction of waiver is made on the basis of one or more ofthe following actions that have taken place:

There has been s bone fide change In ownership or Control of the lnsllglbls Person or Substantial OwnerYES or NO

Discpi/hery action has been taken against the individual(s) responsible for the acts giving rise to the violationYES or NO

Remedial action hss been taken to pmvsnt a rscunsnce of ths acts giving rise to the disqua/Scat/on or defaultYES m'NO

Other factors that the Person or Substangal Owner believe are relevant.YES or NO

Tha prerson/Substantial Owner must submit documental/on to suooart iha basis af its rsaussi for a mduciian or waiver Ths Chiefprocunsmsnl OScar nsssrvss ihs riahi Io make sddlilansl Inauirias and rsauest add/i/ons/ dacumsniation.

V. AftinaationThe Person/Substanflal Owner aff s that all statements contained in the A%davit are true, accurate and complete.

em. Jeee21,2010

Name of Parson signing (Print): MiChael J. MCMuryav Title; PreSident

Subegaited and sworn to belt()re me this 218( day of JuDa 20 16

( JldlJ~ ()4ASPi~iaRotary Pub c Signatuis Netary Se stotsry Publro- Stets or sltoom

uy Commission ExpiresNote: The above Informafon ls subject to verigcatlon prior So the swsnf of the ContracI Jtpnt ts, 2010

EDS-14 8/2015

SEclloN 5CONTRACT NO. 1388-13279

CONTRACT AND EDS EXECUTION PAGEPLEASE EXECUTE THREE ORIGINAL COPIES

The Applicant hereby certifies and warrants that all of the statements, certifications and representadons set forth in this EDS are true,complete and correct; that the Applicant is in full compliance and will continue to be in compliance throughout the term of the Contract orCounty Privilege issued to the Applicant with all the policies and nxtuirsments set tbrth in this EDS; and that all facts and informationprovided by the Applicant in this EDS are true, complete and consct. The Applicant agrees to inform the Chief Procumnent Officer in

writing if any of such statements, certifications, representations, facts or information becomes or is found to be untrue, incomplete orincorrect during the term of the Contract or County Pdivilege.

Execution by Corporation

Globetrotters Engineering Corporation Michael J. MCMurray /(Corporation's Name President's Printed Name and Signaturd

(312) 922-6400Telephone

Secreta~igfdgre ~marketinggec-group.corn

Email

June 21, 2016Date

Execution by LLC

LLC Name "Member/Manager Printed Name and Signature

Date Telephone snd Email

Execution by Partnership/Joint Venture

Partnership/Joint Venture Name *Partner/Joint Venturer Pdnted Name and Signature

Date Telephone and Email

Execution by Sole Proprietorship

Printed Name snd Signature Date

Telephone Email

Subscribed and sworn to before ms this21st day of June, 20~.

/ Aj/(J//it ( jIMi~nNotary Public Signatuf

My commission expires:

Notary Seal

0

Iur Commrssloo ExpiresAprs 14, 2010

If the operating agreement, partnership agreernsnt or governing documents requiring execution by multiple members, managers,partners, or joint venturers, please complete and execute additional Contract and EDS Execution Pages.

EDS-16 8/2015