Posting Date Contract Number Description Department Recommended Action Recommended Vendor Contract Amount MBE/WBE Participation MBE/WBE/DBE type Direct Participation Indirect Participation # of Bids Received # of M/WBE Bids Received CCA Concurs Link

4/7/2017 1625-15681 Dry and Canned Goods Juvenile Temporary Detent. Cntr - 440 Award Black Dog Chicago Corporation dba Black Dog Corporation $3,854,203.34 Black Dog Corporation MBE (8) 90.00% 4 3 Y http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1625-15681 Savan Source Inc WBE (7) 10.00% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1625-15655 Fresh Produce Juvenile Temporary Detent. Cntr - 440 Award Cristina Foods Inc $220,560.00 Cristina Foods, Inc. MBE (9) 90.00% 3 2 Y http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1625-15655 Balton Corporation WBE (6) 10.00% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1684-15558 Diesel and Unleaded Fuel *Countywide--Multiple Departments - 001 Award Black Dog Chicago Corporation dba Black Dog Corporation $1,224,721.53 Black Dog Corporation MBE (8) 95.00% 3 2 Y http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1684-15558 Savan Source, Inc. WBE (8) 5.0% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1645-15735 Steamfitter Supplies Dept of Facilities/Mgmt - 200 Award Marco Supply Company, Inc. dba Johnson Pipe and Supply Corporation$1,167,485.31 2 0 Y http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1645-15735 Boye Janitorial MBE (6) 25.0% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1645-15735 Inter-City Supply Co. WBE (6) 10.0% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1645-15610 Stanley Best Acess Supplies Facilities Management Award Root Brothers Manufacturing and Supply Company $252,830.00 3 1 Y http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1645-15610 Nelson Transport MBE (6) 25.0% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1685-15811 Roselle Road at Schaumburg Road Transportation and Highways - 500 Award A Lamp Concrete Contractors, Inc. $889,351.29 7 0 Y http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1685-15811 Vilber, Inc. MBE (7) 5.00% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1685-15811 Alas Trucking, Inc. WBE (9) 1.00% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1685-15811 Electric Resource Management, Inc. MBE (6) 10.00% http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1645-15846 Floor Tile Supplies Dept of Facilities/Mgmt - 200 Award Tiles in Styles, LLC dba Taza Supplies , LLC $609,661.00 Tiles In Styles, LLC dba Taza Supplies LLC WBE (8) 25.00% 1 1 Y http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

4/7/2017 1653-15530 Computer Hardware Maintenance Office of the Chief Info. Officer - 009 Award System Solutions, Inc. $1,389,964.25 System Solutions, Inc. MBE (8) 100.00% 3 2 Y http://opendocs.cookcountyil.gov/procurement/intent-award/170412-Intent_to_Award_EDS.pdf

CoNTRACT NO. 1645-15735

COOK COUNTY DISGLOSURE OF OWNERSHIP INTEREST STATEMENT

The Cook County Code of Ordinances ($2-610 ef seq.) requires that any Applicant for any County Action must disclose informationconcerning ownership interests in the Applicant. Thls Disclosure of Ownership lnterest Statement must be completed with allinformation current as of the date this Statement is signed. Furthermore, this Statement must be 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 inthis Statement will be maintained in a database and made available for public viewing.lf you are asked to list names, but there are no applicable names to list, you must state 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 the County Board or County Agency being voided.

"Applicanf'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 Department, 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" "Entitl/' or "Legal Entity" means a sole proprietorship, corporation, partnership, association, business trust, estate, two or

more persons having a joint or common interest, trustee of a land trust, other commercial or legal entity or any beneficiary orbeneficiaries thereof.

This Disclosure of Ownership lnterest Statement must be submitted by :

1. An Applicant for County Action and2. A Person that holds stock or a beneficial interest in the Applicant and is listed on the Applicant's Statement (a "Holder") must file aStatement and complete #'l only under Ownership lnterest 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 I

This Statement is an:

ldentifying lnformation:

lApplicant or

I Original Statement or

[ .'# ] StocUBeneficial lnterest Holder

[ ]Amended Statementl7z

Name 5u. -\ Sk\,r"u

StreetAddress: fiq'?t (aJ 5n+1\',r*.

4'4.r*44*{:-s

FE'N NO.: b* : I ,") {_ t l) \[,

{*-rs<

Citv: - .\n.s :-o rt*g state: T*l:=_

tnonu ^o.,rUU-=*=

" Ooo* raxruumoer'(E'o\_ ry!i_1,-_iaH

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

Corporate File Number (if applicable):

Form of Legal Entity:

t I Sole Proprietor

t 1 Business Trust

t I Other (describe)

tltI

Address

53oa

.a.-zrOZIP UOOe: '9 Lt:s. E) t

Email: \r{,N {t;'-<

Partnership

Estate

Corporation

Association

Trustee of Land Trust

Joint Venture

wI]

tlt1

Ownership lnterest Declaration :

1. List the name(s), address, and percent ownership of each Person having a legal or beneficial interest (includingownership) of more than five percent (5%) in the ApplicanUHolder.

Percentage lnterest inApplicanUHolder

[ "15

EDS-6 July/2016

CoNTMCT NO.'1645-1 5735

2. lf the interest of any Person listed in (1) above is held as an agent or agents, or a nominee or nominees, list the nameand address of the principal on whose behalf the interest is held.

Name of AgenVNominee Name of Principal Principal's Address

ls the Applicant constructively controlled by another person or Legal Entity? t lYes l,:r';:3 I No

lf yes, state the name, address and percentage of beneficial interest of such person, and the relationship under whichsuch control is being or may be exercised.

Name Address Percentage ofBeneficial lnterest

Relationship

Corporate Officers, Members and Partners lnformation:

For all corporations, list the names, addresses, and terms for all corporate officers. For all limited liability companies, list thenames, addresses for all members. For all partnerships and joint ventures, list the names, addresses, for each partner or jointventure.

Name Address Title (specify title of Term of OfficeOffice, or whether managero r partn erljoi n,

;i:::, 9

Declaration (check the applicable box):

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

i/ County Agency action.

l\A I state under oath that the Holder has withheld no disclosure as to ownership interest nor reserved any informationrequired to be disclosed.

fr t!-.^ If UeSr.L-errn*

Title?*l: / ^// 'i'l I dV

Date

*t'Y5" q?5n " ?*\L*n,!!4ftW8 ffbYwsorn Vt &K . r{,e/r

E-mail address

Subscribed to and sworn before methis 2l oay otfuNodu,zolt.

. dJJCa*Julyl2O16EDS-7

Notary Public Signature

Phone Number

CONTRACT NO.'1645-1561 0

COOK COUNTY DISCLOSURE OF OWNERSHTP INTEREST STATEMENT

The Cook CountyCode of Ordinances ($2-610 ef seq.) requires that any Applicant for any County Action must disclos.e information

concerning ownership interests in the Applicant. This Disclosure of Ownership Inlerest Statement must be completed with all

information current as of the date this Statement is signed. Furthermore, this Statement must be kept current, by filing an amended

Statement, until such time as the County Board or County Agency shall take action on the application. The information contained in

this Staiement will be maintained in a database and made available for public viewing.

lf you are asked to list names, but there are no applicable names to list. you must state NONE An incomplete Statement will be

reiurned and any action regarding this contract will be delayed. A failure to fully comply with the ordinance may result in the action

taken by the 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" ruuns any action by a County Agency, a County Department, or the County Board regarding an ordinance or

ordinance amendment, a iounty Boird approval, or other County agency approval, with respect to contracts, leases, or sale or

purchase of real estate"person" "Entity" or "Legal Entity" means a sole proprietorship, corporation, partnership, association, business trust, estate, two or

more persons iraving Jloint oi common interest, trustee of a land trust, other commercial or legal entity or any beneflciary or

beneficiaries thereof.

This Disclosure of Ownership Interest Statemeni must be subrnitted by :

1. An Applicant for County Action and

2. A peison that holds stock or a beneficial interest in the Applicant and is listed on the Applicant's Statement (a "Holde/') must file a

Statement and complete #1 only under Ownership lnterest Declaration.please print or type responses clearly and legibly. Add additional pages if needed, being careful to identify each portion of the form to

which each additional page refers.

ldentifying Information:

Nr " lbnt"l- 8,a+4uts l}t"*-.i 5:t,08\t/ ("t

DtBtA: r FEIN No.: ,3 6 * Szcfu a

StreetAddresr, (U'3o 7 -Zf f, f,\n.. c [,,; Ja^ $vrcity: CL.-c,,Sg r "State:

-Tt Zip code. 6cl z8

Phone No.: ? 772A q -5?w FaxNumber: ???UV^t SU: Email:4fc'v*e ro*thro'f [*r, u-

This Statement is being made by ttre t [ ] Applicant or

This Statement is an: [ ] Original Statement or

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

[ ]StocUBeneficial lnterest Holder

I lAmended Statement

Corporate File Number (if applicable):

Form of Legal Entity:

t I Sole Proprietor

I ] Business Trust

t I Other (describe)

Name

A,ftvu^ AED5.6

tltl

Partnership

Estate

Corporation

Association

Trustee of Land Trust

Joint VentureVrtl

tlI]

Ownership lnterest Declaration:

l. List the name(s), address, and percent ownership of each Person having a legal or beneficial interest (including

ownership) of more than five percent (5%) in the ApplicanUHolder.

Address(oSai:zi, S rh&1,5,,a fiw

Percentage lnterest inApplicanUHolder

July/2016

2.

coNTRACT NO.'1645-1 561 0

lf the interest of any Person listed in (1) above is held'as an agent or agents' or a nominee or nominees' list the name

,nJ "oiiu."

of the'principal on vrhose behalf the interest is held'

ls the Applicant constructively conlrolled by anolher person or Legal Entity? { lYes I lNo

lf yes, state the name, address and percentage of benelicial interest of such person, and the relationship under which

such control is being or may be exercised'

RelationshiP

Address Title (sPecifY titte of Term ol Offrce

Oflice. or whelher manager

J.d ILl03o?-2s-svr"-\d.. rL or parlner{oint ve,nture)

I\| ft,ut-

Declaration (check the applicable box):

Corporate Otficers, Members and Partners lnformation:

For all corporations, list the names, addresses, and terns for all corporate officers' For all timited liabilitv companies' list the

narnes, addresses for ar members. For all p"rtnerrffil"J;"inirJnirr"*, ririitr" n,*;;, addresses, ior each partner or joint

venture.

Name

II

I state under oath thal the Applicanthas vrithheld no disclosure as to ownership interest in the Applicant nor reserved

any information, data or pi"L r" to lhe intended ,t;;;;;;;" f"iwhich the Applicant seeks County Board or other

County AgencY action.

I sfale under oath fhaf the Holder has withheld no disclosure as to ownership interest nor reserved any information

required to be disclosed.

Subscribed to and swdrn before ryre

thi; qtn oay otNft(h, zo[.

EDS.7