contract - cook county,...

Contract No.t 3-1M78Vendor Name: ADAPT TELEPHONY SERVICES, INC.

ANIENDMENT NO. 1

This Amendment modifies Contract No. 13-18078 for Interactive Voice Response System Consolidation

and Replacement by and between the County of Cook, illinois, herein referred to as 'County" and ADAPT

TELEPHONY SERVICES, INC., authorized to do business in the Slate of illinois hereinafter referred to as"Contractor":

RECITALS

Whereas, the County and Contractor have entered into a Contract approved by the County Board on

December 4, 2013, (hereinafter referred to as the "Contract" ), wherein the Contractor is to provide

Interactive Voice Response System Consolidation and Replacement (hereinafter referred to as the"Services") from December 4, 2013 tivough December 3, 2019, two (2) additional two-year renewal options,

in an amount not to exceed $4,193,835.79;and

Whereas, an increase in the amount of $189,941,40is required for the continuation of Services; and

Whereas, the County and Contractor desire to include additional scope of services to the Contract; and

Now therefore, in consideration of mutual covenants contained herein, it is agreed by and between the

parties to amend the Contract as follows;

1, The Contract is Increased by $189,941.40 and the Total Contract Amount is revised to

$4,383,777.19.

2. Article 5(b), Method of Payment of the Contract is deleted in its entirety and replaced vdth the

following:

All invoices submitted by the Consultant shall be in accordance with the cost provisions contained in

the-Agreement-and-shall-contain-a-detailed-description-of-the-DeIIvera blas-,including-the-quantItyof——

the Deliverabies, for which payment is requested. All invoices for services shall include itemized

entries indicating the date or ffime period in which the senrices were provided, the amount of time

spent perlbrming the services, and a detailed description of the services provided during the period of

the invoice. All invoices shall reflect the amounts invoiced by and the amounts paid to the Consultant

as of the date of the invoice. Invoices for new charges shall not include "past due" amounts, if any,

which amounts must be set fotth on a separate invoice. Consultant shall not be entitled to invoice

the County for any late fees or other penalties.

In accordance with Section 34-177 of the Cook County Procurement Code, the County shall have a

right to set off and subtract from any invoice(s) or Contract price, a sum equal to any fines and

penalties, including interest, for any tax or fee delinquency and any debt or obligation owed by the

Consultant to the County,

The Consultant acknowledges its duty to ensure the accuracy of all invoices submitted to the

County for payment. By submitting the invoices, the Consuffant certifies that all itemized entries

set forth in the invoices are true and correct. The Consultant acknowledges that by submitting the

invoices, it certifies that it has delivered the Deliverables, i.e., the goods, supplies, services or

equipment set forth in the Agreement to the Using Agency, or that it has properly performed the

services set forth in the Agreement. The invoice must also reflect the dates and amount of time

Rev I/I/15

Contract No.13-18-078Vendor Name: ADAPT TELEPHONY SERVICES, INC.

expended in the provision of services under the Agreement. The Consultant acknowledges that

any inaccurate statements or negligent or intentional misrepresentations in the invoices shall resultin the County exercising all remedies available to it in law and equity including, but not limited to, adelay in payment or non-payment to the Consultant, and reporting the matter to the Cook County

Office of the Independent Inspector General.

When a Consultant receives any payment from the County for any supplies, equipment, goods, orservices, it has provided to the County pursuant to its Agreement, the Consultant must make

payment to its Subcontractors within 15 days after receipt of payment from the County, provided

that such Subcontractor has satisfactorily provided the supplies, equipment, goods or services in

accordance with the Contract and provided the Consultant with all of the documents andinformation required of the Consultant, The Consultant may delay or postpone payment to aSubcontractor when the Subcontractor's supplies, equipment, goods, or services do not complywith the requirements of the Contract, the Consultant is acting in good faith, and not in retaliation

for a Subcontractor exercising legal or contractual fights.

3. The Contract is hereby amended to incorporate Attachment A and made part of the Contract.

4. 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.

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

In witness whereof, the County and Contractor have caused this Amendment No. 1 to be executed on the

date and year last written below.

County of Cook, illinois

Chief Pr cilrement Officer

By:sible'sAilornsf (if applicable)

ADAPT TELEPHONY S R, C.

Type or print name

Date P) OCCAM

Z/P)Lx'ev

t///15

Contract No.13-18-078Vendor Name: ADAPT TELEPHONY SERVICES, INC.

ATTACHMENT A

Rev t/r//5

I

adapt W

Statement of Work (SOW)

Cook County Bureau of Technology

IVR Contact Center

Contract: 13-18-078Amendment No. 1

July 6, 2016

Submitted by:

Adapt Telephony Services, LLC


600 Enterprise Drive, Suite 204Oak Brool<, IL 60523

~+ N1ERACYIVE INYEELIGtNceQW

SOVy —Cook County Bureau of TechnologyIVR Contact Center —Contract: 13-18-078Amendment No. 1

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Table of Contents

Table of Contents.

1. Introduction.

1.1 Project Goals and Objectives.

2. Scope of Services.,

2.1 "In-Scope" Location ..2.2 Supporting Documents.

3. Implementation Approach,

3.1 Project Phases.

3.2 Project Timeline ..4. Project Assumptions.

4. Change Control Process.

S. Professional Arrangements

5.1 Standard Support..

5.2 Payment Schedule

Attachment A —Adapt Professional Services Staffing Plan.

Attachment 8 —Cook County IVR Service Desk Contact Center Add Order....

.......2

..12

...12

..12

..15

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SOW- Cool< County Bureau of TechnologyIVR Contact Center —Contract: 13-18-078Amendment No. 1

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1, Introduction

This document provides the Statement of Work (SOW) for development and deployment of an InteractiveVoice Response system (IVR) Contact Center for the Cook County Bureau of Technology Service Desk. ThisIVR based contact center will support up to ten Service Desk agents and will help enhance current levelsof customer service by improving the process for receiving and routing incoming calls, reducing the timecallers spend waiting for an agent, and by providing improved reporting of Service Desk performance.

This IVR Contact Center is developed using the existing hardware, network, and application softwaredeployed for the Cook County IVR Replacement and Consolidation Project, completed in June 2015. Asmall application server appliance will be added to the existing IVR platform to support InteractionMarquee, a Customer Interaction Center component that provides Contact Center statistics dashboardon-line or through a wall mounted display.

1.1 Project Goals and Objectives

The goal of this project is to provide an IVR based contact center for the Bureau of Technology's ServiceDesk. This contact center will accommodate up to ten agents and two supervisors. Project objectives in

support of this goal include providing callers the option to leave the hold queue and be called back by anagent at another time, proving callers the option to participate in a post-call survey regarding the qualityof service they have received, standard Customer Interaction Center (CIC) contact center reports, andimplementation of Interaction Marquee, which provides commonly used contact center statisticsavailable via a web browser or wall mounted display.

2. Scope of Services

The scope work for this project includes the following:

~ One (1) queue for incoming calls with one (1) voice mailbox specific to that queue. Voicemailswill be routed to a Microsoft Exchange mailbox, accessible to Service Desk Agents and Suoervisors;

~ Licenses for ten (10) Agents and two (2) Supervisors;

~ Twelve (12) SIP enabled telephone handsets for use by Agents and Supervisors;

~ Call back option for callers that choose to leave the queue and be called back later by a ServiceDesk Agent (this features utilizes Adapt's SmartHold product);

~ Implementation of post call survey functionality and configuration of up to four (4) post callsurveys;

~ Deployment of Marquee functionality to display commonly used queue statistics, configuredusing nout of the box,n standard views and functionality;

~ 2 Reporting Assistant licenses, which can be used to generate simple custom reports;

~ Deployment of standard Scheduled Reports appropriate for Cook County's Service Desk;

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~ Training for up to ten (10)agents, one (1)supervisors, and three (3) BoT Telecom staff;

~ Provide prompts and other verbiage required by the IVR Contact Center. Final definition of theverbiage for these prompts will be made during the Assessment phase of this project. Promptswill be provided in English only. Cook County will provide voice talent for any prompts that mustbe recorded;

~ Integration to Cook County's telephony infrastructure utilizing the Avaya Session Manager SIParchitecture that is now utilized by the consolidated IVR platform provided by Adapt.

2.1 "In-Scope" Location

The "in-scope" location covered by this SOW are as follows:

IVR Platform LocationCook County Bureau of Technology118 N. Clark StreetChicago, IL 60602

2.2 Supporting Documents

The following attachments provide additional details that are used to govern this SOW:

~ Attachment A-Adapt Professional Services Staffing Plan. This attachment provides detail of thestaffing plan and estimated hours for Adapt and Clarity Partners to complete this project.

~ Attachment B —Cook County's Bureau of Technology Work Order. This attachment provides adetailed listing of the CIC solution components and any ancillary software and hardwarecomponents or special work included as part of the scope of this project.

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3. Implementation Approach

Adapt will employ our AI2 implementation methodology, tailored specifically to the scope of this newproject. This project will consist of the following phases.

3.1 Project Phases

Requirements Phase, during which detailed requirements are defined, documented and approved byCook County. Installation of required hardware will also be completed during this time.

Deliverable: Requirements DocumentPlanned Duration 1 week

Design / Configuration Phase, during which suitable Design documentation will be delivered,configuration of the IVR contact center, and integration to Cook County's telephony and datanetworks work will be completed.

Deliverablesl Design Document

Configured IVR

Planned Duration: 3 weeks

System Integration Testing (SIT) / User Acceptance Testing (UAT), during which integration to CookCounty's telephony infrastructure is tested (SIT) and users confirm the IVR contact center functionsper approved business requirements (UAT).

Deliverables SIT / UAT Test ScriptsCompleted SIT

Completed UAT

Planned-I3uration~meeka

Training Phase, during which training will be provided to Service Desk Agents, the Service DeskSupervisor(s) and BoT Telecommunications personnel.

Deliverables: Agent Training MaterialsSupervisor Training Materials

Planned Duration: 1 week

Deployment Phase, during which the completed IVR contact center is deployed to a live productionenvironment, and the first week of post-deployment support is provided.

Deliverable: Operational Service Desk IVR Contact CenterPlanned Duration: 1 week

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Post Deployment Support Phase, during which a second week of post-deployment support isprovided. Adapt resources will not be on-site during this phase (1 week).

Deliverable: Post Deployment Phase Sign-Off

Planned Duration: 1 week

The total estimated duration for this project is nine (9) weeks.

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8.2 Project Timeline

We estimate this project will take nine (9) weeks, including one (1) week of post-deployment support atthe completion of the Deployment phase. Duration estimates for each of these phases are providedbelow:

Reqts. Design / Configuration SIT/ UAT Training Deploy SupportWeek1 Week2 I Weeka I Week4 WeekS

IWeek6 Weekl Weekg Week9

Additionally, as company policy, Adapt will not deploy a system (Go Live) the week of, or the week after,Thanksgiving or duding the last two weekends of the year and the first weekend of the New Year. Shouldthis project conflict with that policy, additional weeks will be added to the project timeline, but will beadded at no additional cost to the Cook County Bureau of Technology.

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4. Project Assumptions

Many factors contribute to the success of a project of this nature and also to the cost of the overall effort,Our calculations and estimates for this project considered the principal drivers such as project scope,complexity, implementation approach, and duration of the effort. We also made assumptions about theCook County Bureau or Technology's participation, the technical environment, and those tasks outside ofour direct control. A listing of these overall, staffing, and technical environment assumptions is as follows:

Overttll Project Assumptions

1. This project assumes that the Polycom SIP handsets identified in Tab 2 of the Cook County IVR ServiceDesk Contact Center Add Order will be a second phone on the desks of Agents and Supervisors,dedicated for Contact Center use. The existing Avaya phones will remain in place. Power overEthernet (PoE) will be available for the Ethernet ports into which the Polycom SIP handsets will beplugged.

2. Cook County has requested this quote include telephone headsets for use by Service Center Agents.However, this equipment is not typically re-sold by Interactive Intelligence or by Adapt. Adpatrecommends headsets from Jabra, model number GN2124. We recommend that Cook Countypurchase these directly, one headset for each Agent and Supervisor, as well as spares. Theapproximate cost for these headsets is $120 each. The following link provides further information:https://www.cdw.corn/shop/products/Ja bra-GN2124-4-in-1-headset/3717794.aspx? pfm=srh

3. The following items are considered out of scope for this project:

o Call Recording functionality;o Screen Recording functionality;o Integration to Cook County's Cherwell ticketing system;o Telephony work required by Avaya (our quote includes time for Adapt to cooperate with

Avaya for this work);o Additional call port licenses (we have provided pricing as an option for budget and planning

purposes in the Cook County IVR Service Desk Contact Center Add Order);o We assume no "screen pops" are required;o We assume no scripts are required to guide Service Desk Agents in completing their calls;o We assume no customized reports are required.

4. Cook County will be responsible for the voice talent to make voice recordings for prompts requiredby the IVR contact center. Only English language prompts will be provided.

S. The Interaction Marquee functionality requires a wall mounted display and computing device toaccess a web server provided with Adapt's Interaction Marquee server. This quote assumes that boththe display and computing device will be provided by Cook County.

6. This project will use the default hold music provided by Interactive Intelligence that is played to callerswaiting in queue.

7. Integration to Cook County's telephony infrastructure will be accomplished using the Avaya SessionManager SIP architecture adopted for the consolidated IVR platform. Integration to Cook County'stelephony infrastructure using another architecture is not recommended and may significantlyincrease the cost of this project.

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g. Due to the tight schedule for this project, Cook County will be expected to sign-off on requirementsand other deliverables within five (5) business days of submission. Requested changes from thesigned-off requirements may result in Change Requests for additional time and budget for this project.

9. All changes in project scope, assumptions, deliverables, or project plan are managed using the changecontrol procedures described in Section 5.1of the Cook County IVR Consolidation and ReplacementProject Statement of Work and in Section 4 of this SOW.

Staffing Assumptions

10. Cook County will assign a Project Manager prior to or at the point of contract signing to work closelywith the Adapt project team. The Project Manager's responsibilities include facilitatingcommunication and meetings between Adapt and Cook County personnel, serving as the primarycontact for receipt and approval of deliverables, and the management of other Cook Countyresponsibilities as described in this project quote.

11.Cook County will provide technical resources to assist the Adapt project Engineer with

implementation of hardware and software components, network configuration, and other technicalrequirements.

12. Cook County will provide resources as agreed upon and identified in the project work plan to assistduring the times specified with all project deliverables including: installing client-side software,placement of telephones, user acceptance testing, and cutover assistance and are expected to beavailable onsite throughout the duration of the project as needed, and at Go Live/Cutover.

13. Cook County must provide an IVR Administrator for the new Service Desk IVR Contact Center. Adaptrecommends the administrators of the current consolidated IVR platform serve in this role.

Technical Assumptions

14. Cook County will provide the Adapt Implementation team access to and connectivity with all affectedsystems, networks, and data as requested and determined necessary to perform in-scope activities.

1~he Coo'k ~BtzTaau vi iiehyrolugy —Telectnnyrltmtcatfzntg Wtlt pmtiid~he necessaryserver/networking infrastructure to implement and utilize the system. Adapt will work with the CookCounty Bureau of Technology —Telecommunications to review the Bureau of Technology's facilitiesinfrastructure and identify any adjustments these facilities required by this project.

16. Cook County is responsible for the deployment of all client side software and all Operating Systemsoftware. Cook County is required to ensure that all workstations and servers that run InteractiveIntelligence software run an Operating System that has been tested by Interactive Intelligence. This

information is available and kept up to date on Interactive Intelligence's Test Lab site at:http: //test

lab.inin.corn/index.aspx.

17. Cook County will provide unencumbered remote access (available 24x7) to servers and gateways forremote installation and configuration of software for the project duration.

18. Adapt and interactive Intelligence do not recommend that any server running Interactive Intelligence

Software should host virus scanning software. If this is required, then the anti-virus software should

only be installed per the guidelines set forth by Interactive Intelligence and Adapt.

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19. Cook County is responsible for licensing compliance (i.e. SQL, Exchange, server/processor/user/devicelicenses, etc.) for all software programs, including but not limited to, any new or pre-existing softwareprogram to which the CIC system may make use of or connect to.

20. Cook County is responsible for any hardware (servers, gateways, IP phones, headsets, overheadpaging, security, credit card machines, time clocks, etc.) purchased by Cook County through a 3rdparty vendor. This includes the hardware, hardware support, and troubleshooting of any issuesrelated to this hardware.

21. Cook County is responsible for general network and desktop troubleshooting and optimization.

22. GoToAssist is Adapt's preferred method of connectivity for access to the servers and voice gatewaysthat are part of the CIC solution during implementation, GoToAssist is also Adapt's preferred methodof access for subsequent support.

23. Cook County will provide Internet access for the CIC servers with access granted to the Adapt andInteractive Intelligence FTP servers.

24, Administrative privileges must be granted to the staff installing the CIC client work stationapplications, these are:~ Administrative privileges on the local machine.

~ Write access to the C:~Program FilestCommon Files directory.~ Wliteaccesstothe HKEY LOCAL MACHINE and HKEY CLASSES ROOTlocationsintheregistryon

the client workstation.

Facllitfes and Security Access Assumptions

25. Cook County will provide the Adapt team access to all necessary equipment during the agreed upondate and time of installation.

26. Cook County will provide a safe and secure work environment.

27. Cook County will provide workspace for the Adapt Team while on-site to connect the Adapt laptops.If direct access for Adapt equipment is not available Cook County will provide a computer withnetwork access. Cook County will also provide telephone access for Adapt employees while on site.

28. Cook County is responsible for racking, powering, providing network access, and login credentials toall devices to be configured by Adapt unless otherwise specified in the work order.

29. Cook County is to provide a proper training facility that will be available and ready before the onsitetraining visit according to the specifications outlined by the project team.

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4. Change Control Process

Adapt recognizes that changes may occur during the course of our work, and these could affect cost,schedule, scope, or work products. It is essential to our collective success that processes are in place todeal with these in a manner that makes them manageable, understood, and accommodated within anupdated project plan. The change process is outlined below and will be used for all change matters thatoccur during this project.

Proposed Change Control Process

Step

1. Identify and log therequest

2. Assign for analysis

3. Assess options

4. Decide on a course ofaction

Description

Project team or users identify a change request need and log it for tracking throughthe process.

Most change requests require research and analysis to determine project impactand identify alternative solutions. Adapt's Project Manager has responsibility forthis work and works with the Adapt team and Cook County staff to determine andprepare a recommended course of action. Often changes can be accommodatedwithin the existing project framework and are Incorporated with no further actions.Those involving cost, schedule, scope, or work products, are moved along to thefollowing next steps.

Options are considered, business benefits are analyzed and discussed with the CookCounty user team, impacts on the project schedule and resources are assessed.

For changes that impact cost, schedule, scope, or work products, the projectManager, in conjunction with the Cook County Project Manager, decide on arecommended course of action.

S. Secure approvals

6. Issue Change Order

7. Log and communicatedecision

8. Update plans and

budgets

9, Document completedwork

Changes impacting cost, schedule, scope, or work products require the approval ofproject leadership. As determined by Cook County certain requests may requireInvolvement of the Executive Steering Committee (or proiect Sponsor), deoendingon their size, cost, and scope.

A formal Change Order is issued upon the above approval. The change orderamends Adapt's contract and the affected schedules. The change order is

incorporated as a formal amendment to the Adapt contract with Cook County.

The Change Order is logged and Its impact is communicated to the project team,users, project sponsors and any others (e.g., ININ) affected by the change.

project plans, lists of deliverables, and any other project control documents arerevised to reflect the additional work effort, scope change, and/or and scheduleimpact.

The originator and project management team are responsible for incorporating thechange into regular project reporting and subject to the same completion andquality standards.

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5, Professional Arrangements

Based on the assumptions, staffing, schedules and scope described in this SOW, the estimated fees areprovided in this section. This amount includes professional services fees, Customer Interaction Centersoftware licenses, and the McKesson Certification Fee. The professional services fee is offered on a fixed-fee basis and reflects Adapt's discounted rate for Cook County and Cook County. Out-of-pocket expensesand taxes are not included and will be invoiced as incurred. A detailed breakdown of the cost items isprovided in Attachments A and B.

Professional Services: Attachment A details the estimated cost for professional services and is basedon our understanding of the high level requirements for this project. Adapt will be delivering thisproject jointly with Clarity Partners, a certified MBE firm, and will be in compliance with MBErequirements that 359e of professional services fees be allocated to an M BE partner. The quoted pricefor professional services is $131,875.00.

Customer Interaction Center (CIC) Software Ucenses: Attachment B details the cost for CIC softwarelicenses. The CIC software licenses are not perpetual, and are only authorized for use by Cook Countyduring the term of the annual maintenance agreement(s).

The quoted ptice for CIC software licenses is $28,416.50 which includes a 1036 discount fromsoftware purchased from Interactive Intelligence. Annual software maintenance is quoted at$5,613.30,1838of the undiscounted software price. Annual software maintenance is an additionalcost to Cook County to the quoted price for CIC software licenses

Web Server Hardware and Telephone Handsets: Attachment 8 details the cost and specifications forthis hardware. The quoted price for hardware and telephone handsets is $12,810.00,which includesa five (5) year warranty care pack for the web server hardware.

The total quoted cost to Cook County for this project, including professional services, and softwarelicenses is $189,941.40. This amount includes professional services CIC software licenses and WebServers Hardware and Telephone Handsets quoted above plus three years of required annualsoftware maintenance at $5,613.30per year.

5.1 Standard Support

Cook County will receive the Adapt Standard Support program effective one week after the ngo-liven

date for Phase 1, for a period of one (1) year. The support will be added to the existing SupportAgreement for the Cook County consolidated IVR platform deployed in June 2015. Cook County mustrenew annual maintenance for the required CIC software licenses to ensure continued, authorized useof this software,

5.2 Payment Schedule

Due to contractual obligations with Interactive Intelligence, software licenses are billed to Adapt uponordering on behalf of our client. In addition, McKesson Corporation requires a fee (described above) tocertify the interface to their application is properly tested and meets their requirements. As such, an

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Initial payment is required to issue the licenses and for the McKesson certification. Therefore thefollowing payment schedule is required.

Projected Project Total - $189,94140

~ Due upon contract execution: $41,226.50

o CIC Software Licenses: $28,416.50o Web Server Hardware and Telephone Handsets: $12,810.00

~ Due upon contract execution: Year 1 CIC Software Annual Maintenance: $5,613.30

~ Due upon completion of the Requirements and Design/ Development Phases and acceptance ofthe deliverables from these phases: $65,905.00.

~ Due upon completion of the SIT / UAT and Training Phases and acceptance of the deliverablesfrom these phases: $34,240.00.

~ Due upon completion of the Deployment and Support Phase and acceptance of the deliverablesfrom this phase: $31,730.00.

~ Year 2 CIC Software Annual Maintenance, due May 5, 2017: $5,613.30

~ Year 3 CIC Software Annual Maintenance, Due May 5, 2018:$5,613.30

Any additional work that is requested by Cook County and is not outlined in the scope of this SOW isconsidered either Out of Scope or a Change Order. Any changes must be submitted in writing as anamendment to this contract and may be subject to additiona I fees (Please see our change control processdescribed in Section 4.). Adapt will estimate the time and cost needed to implement any change and theimpact it might have to the proposed pricing. Adapt will perform the requested work once the "ChangeOrder" has been completed and signed by both Parties. AntLCbangajtLprice due tn a chaogeOcder will

require a Purchase Order.

This SOW is valid for 60 days from date on the cover page.

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Statement of Work Acceptance Form

i (we) have read and understand the scope of services and fees as described in this Statement of work toCook County. On behalf of Cook County, I (we) hereby authorize Adapt Telephony services to provide theservices described in this letter.

Cook County Signature Date

Printed Name

Title

~ //Rdaptg~nur u Y

Printed Name

Title

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SOW —Cool< County Bureau of Technology)VR Contact Center —Contract; 13-18-078Amendment No. 1

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Resouce

Wanner

Adaot BusinessAnalvsis Lead/PM 32

Adapt Lead Enalneer 32

Adapt Developer

Adapt Reports Developer

Total —Adapt

Claritv BusinessAnalvst and Documentation 40

Claritv ProjectSupport 16

Inta) ClarltV

Grand Total 104

32 32 3232 '32 820 32

16

32 32 32'.8. 8, 8

32 32

24

16 168

40

16

40 40

16 1640 40 40

16 16 8

40

8 8

140 136 96 88 80 80 120 128

Attachment A- Adapt Professional Services Staffing Plan

Rents Design/Confiauration SIT/UAT Training Deploy SupportWeekl Week2 Week3 Week4 Week5 Week6 Week7 Weekg Week9 Hours

0288

276

8432

580

360120

4801,080

Rate

8 148 75

8 148 75

$ 148.75

$ 148.75$ 148 75

$ 95.00

$ 95 00

Fees

5S 42,840S 26.1805 12.4955 4,760$ 85,275

S 34,20D

3 11,400$ 45,80D

5 131.875

MBEPementage: 35%

ASSUMPIIONS 8 REQUIREMENTS

Inrludndinscooe:Configure 1Queua with voiu. mailbox s pacific to that queueCaa back option for this queueLlcansesforlOAgentsand25upervlsors12 Softphone licenses

Configure up to 4 post call surveys

Marqueeserverlicenseandconflgurationforstandardviews2 Reporting

Assistant�licenses�

(used to generate simple custom reportsScheduledReportsTrainlngforaRagents,supervisors,andaoTTelecomstaff

Nnrrnrlrelndln Cmnn.

Call RecordingFunctionality(priced as an option)ScreenRecordingFunctionality(priced asanoptionlIntegration to Cherwea

Work Required by Avaya (wig indude time for Adapt to mope rate with Avaya)Additional Port licenses (quoted for budget pl an ning purposes)Bluetoothheadsets(Adapttorecommendadevice)No Screen Pops

No Customlr ed ReportStock ININ Hold Music

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Attachment B —Cook County IVR Service Desk Contact Center Add Order

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ImiEUACTIVEINTELLIGENCE

I assn Solution .BoT Servlco Desk Contact Center

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Tsbh 11 hdaraclive Tnteegaace Safhvare TdcensesQUY PsutNa clccg mII~ Shee lhucdygom

Uesa Uhlbm, fl IAmes e uccme DDd ACO msr ODsplclo slsh-bssedmsgag Sn oae audie tyy Sumo win Iho la ense sos OhotAdvarced sapervlaore Iachide e Irrlcrsogoa lhpetvhDt uomeo arlbWDdgmop lfrstodoel lbrp orts, Worlgaurp Quests trod UlelmPhrgarrmtbrlm. This Scours lorpmrr st lost aamia SlrrtlDD.

Wmslnivca spphation to quicuy gsmml ~h aulommporlsSom sdaacd IC tables wahn Ibe to dslabs re This Sccara rugosess Unamgm nq avis m sddoa'thpods

arne

Add on'rna tobe avalabh for each rep rt assishm» has as.Adds sbny for Ueilisd Mme qdng (miceaah/Sue s) dcgvwcdle sacaeghbmorlalwaolhaMvssagsaoa Tbieltemu abobomdaedie UM osly ~ls.Shonasscrlyrlons'

confcreocr session Is utilimd by each participant in a con fonncecall. Edemal parties wiU chouse a basic session for connsctivity intathe system This session license is Sa scheduled snd sdhoconfmsces (conferences created ushg the client) that are bosralonMedia Sa as Note. A MeCh Smdm is required mth eachtan fercncc Session.

5SIQOS

UM5.M

No Ouage

Suda

UeltPrlcs

IC,710.0D

51250 00

C5.00

Enpuce

0 sw M14.0-PL05

SW-M140-PLM

SW40140 WPI I

rbnfersnce Uesdm

Media S stun

hl rscgwr WcbyurhlLhemee

500.00

555 00

IhltPrlce

STUMUU

Sub Total. hterscllw hlsulgeace Solhars

Note A Media Session is rsquhwl wuh ssclt Conference Sess hn.A Media Session allows sr Audio Cpmsrions lo be handled by theMedia Server. I Media Session D rsquhed rvith sech Us sic Session,FsuSsssionorfbnfsrmce Session.

Sbortaescrlylloas

I Ieoolbrr Mwqoco Ilogvors wmhmm opec IroDel srslrsgur ID

muyphdesfaations-as w bpqy oaaeytypcofPCdisplaydcvba -ymjc mal oato a vuU. os Ibe mpavh ore dsshtop bsadh blmepelors,orotem el ppUcrrtlemIMsuprmoogmls hb Umi

egmadioe, padagos Iba Info andes aud disp bye It visa mhInlmhce.

5510 00

575M.00

SLI575.00

0 2016 Interactive Intelligence inc.


SOW —Cook County Bureau of TechnologyIVR Contact Center —Contract: 13i18-078Amendment No. 1

ad

Table 21 Adapt Sonware

l?TV P IN.

I AOP-SMARTHOIO

Amn Baftmrm I c

Adapt Smart Hold Applicanon

thit Price gmp I

$,500DD $150000Sub.Total - Arhpl Scetera 53300,00

Bhwenmcwpg4 ts*

Smnnnapplicado th t 8 B to eque tc sheen'nufmmmtbq na dthesecaglwckmq e t c I t 'b '

4 I 0 Tl ppl to ahorecognmsohenagoodcagsrlo(ANI)ha lablca desk th mtMSIh b h Idb

he pocemi gthe gb k Th Io p d d th ~

optionlolreep titsnumbarortoenlcra ncwphononumherl'orlheeagbaek

Table 31 Technics)Support snd SgJtttsie Assurance

onr I Pa tN. Isumortonm

I$$4SJ.NV-8818 IMANOATORY a d d S pp 41st YearSIsadardgupportbequlradferan onlem

In. m R.t.S Upd I ppl t d n gAdaptweekdayafterhous

do . Igh

Sub Total ~ Technlcnl Buppsw md Salhmrs Ace uranse

RdP icc

$4,11750

$4.11'7,50

Table 0: Serverspa tn M Ip od tNa Iahwrnmwino c*

I U ip iceI smlqi

,mruvitggrdncpl)tgenhaayreqbJ(omrnahdleag)vi 0561Sirm 2012R2;Sd 0 4",.Ijawarbbs'.,'.:Alii:;I":-',.wwetnfrtlrtl,;,-,;;; „,'.'?,7I t~ Appl t S e -Medhm-C n9lsl telHSene 6CoeCPU,16OBRAM,E b dd dRAIOC I ~ %2IH ho,4 45DGISASHOnRAIOID(900(HUmbh),2 c500W RPS, 8 cog-S NIC, W md owe Server 1012Slandanl

Bd Iten $7,869.DD $7,st%00Cem Pack I'or HP OL350

Hen9�.5 Ymr - Irem IO.261.0D $3261.00

Note Adaylst gly e un 0 matCasta era use imam'ngsolhm e s chas Acronh T eJmage 'Ihlhi allhut,t iwmgetl ep i~ dna k pCICSe s Tins is destoIhemhsi n- iti d I eqd amnmli em h~s I c bugdh eifesmsca wntional esto earocesscs.

N t Ih I m I II t lllhdy q Ih oru hmlmrmfo analogstanonssuchasanalogpho,lh d', 4 d Th Mdhh Ih d lb thcc twmr

res pons bdky to provide and consists mostly of paloh pan eh and conn astor os hiss, but could inchdo other itenu Customer will bc responsible for pmvaing ag equip nwnt and wh ng.Customer mg a lao provide patoh cables to connect between equipmeat and staten panels once equipment is reek moumcd, so rhet ashlar oan bo ordead that are of tho oorroct length. Analogdmices and/oc POTS lines that customer wants to connect to the GC solution will be plugged hto IU I I port(s) on the PXS and PXO gateways or cards. Customer is res pons the for pmvtdmgBJ Nba doeandpluggingintogste y()e h I gd df POTS I e th t to I t o ecttotheCICsoluton Adaptcanpm idegutdancctoc stocmmdl t 3 d

p nv''

a d hnnbv to o nm k elatedtopmvkl'RJ-llhandoff

S DTotal ~ S 'I $51330.00

Table 51 SJP Phones, Headsels, and AccessoriesOTV I pmtNttmlnr IproduetNama lghsmlm mini a *

I U Itprlco I elprlcebo(~S'Pl%i%If(f1tfuudgtbsukvndlld(egg'ksiml(M(t)Wmcmatb)hfdRi)rdhluh)lhtgit ~III'scwyossbprt)a!(Idle';" .Iwpfirp'jtgp@iyd+ 'v .M:.','Pfm+Jgrfv(fir r .'-', .',":rrr",

vvx310 mlhnroarklopvlnmvoqaqhqh Nrimfeehtal'vDIDBcommtehpannorphtf 2npoashp th utpo e pply.

12 TH-508-PHS310OS VVX 310Ggn Pon I p n tnote Po g ly 8 bl CIC40 $140 Co n 6ml 00'A15V Rsshcki gfe B I h qwdf Ih I I p dy I pl 5 bt Ie-SIPPh . dncd I Singe astPh 18th b p d 'n lyb ptdf I ifth I ty

17gl 20161nteractive Intelligence Inc



ad

Post Call Survey - Interactton Feedback

Taiga 61 Interactive Intelligence Software LicensesOIT Part No. Saver Ltc e

I SWO1940SAOI Interaction Feedback Server

12 SW-019-40.AA01 I I w ti Feedbackadd-oo

Unit PAce

S1750.00

Sylo 00

S I T IO-I ta acSonpeedtnck Solo»re

Short Dccweudoas*

E able Intmmdo feedbackfeat »oeoincbd gd I »ofa to t d ww ga tswhoseintoawionsawtob y-abl

»quire Interaw»n Pccdbaok dd-on access license. Nota. Thee»vcrcon»onent enables coat.cag survovc bv default

Required For a «cer to hove s survey opphcd to an interaction in which

they were a panioipant, or to launch the Intonation Poodb oak a»dukeICBu I e»M age.Alsorq i» Mt t 9 db kSa w

license

ROP ue

St~ 00

Seals.os

Table 7: Technical Support and Software AssuranceOTT I Part No. I Saw»rt Ontlon

I ISSO12.NVaglg IMANDATORR Standad Supyon3 iy a~gas on q»df II

IDeecrtatlas

Savice Update application during Adapt weekday soar hours

window iav.0 I Total Tech 1»d S ppo I two gonwa e Ass ~ ance

Rct Price

SI,4910001,495.00

185 10161nteractive Intelligence Inc.

1016Adapt Teiephonygervicos, LLC

Q+ INTERACTIVE INTELLIGENCE'dINTERACTIVE

INTELLIGENCE'ot4

'Atot Ieeotie I'ot tnei or the Teoe

IT Help Desk Contact Center Add Order

Date: 7/5/2016

Support *Support¹ of Months

Start Date: End Date: Remaining (should be 3 or more)09/01/16 07/02/17 10

*Ifnumber ofmonths remaining is Z or less, please change Support End Dale to the nettt year.

Client Name:

Street:City, State, & Zip Code:Shipping Contact First & Last Name:Shipping Contact Title:Email Address for Tracking Int'o:

Shipping Contact Phone ¹:Date Needed:Special Instructions (If Any):

Cook County Government - Bureau ofTechnology69 W Washington StChicago, IL 60602

Cook County Bureau of Technology Adapt Telephony Services, LLC

(Signature)

(Printed Name)

(Title)

/ /

(Date MM/DD/YYYY)

Si'

II, I 6-o. Rrinted NIIm+)('6

(Date MM/DD/YYYY)

(P.O. Number if applicable)

Pricing valid for 60 days

Tab / Section Name: CIC Financial Summary Page 2

Financial Summarv

Base Solution - BoT Service Desk Contact CenterTable I: Interactive Intelligence Software LicensesTable 2: Adapt SoftwareTable 3: Technical Support and Software Assurance (Annual) - Year I10% Discount-Interactive Intelligence Software

Post Call Survey - Interactioa FeedbackTable 6: Interactive Intelligence Software LicensesTable 7: Technical Support and Software Assurance (Annual) - Year I10% Discount - Interactive Intelligence Software

1$1$

$Sub-Total - Base Solution:i $

1$l$

$Subtotal - Interaction Feedbacki 5

19,375.003,500.004,117.50

(1,937,50)25,055,00

8410.001,495.80(831.00)

8,974.80

Hardware, SIP Phones, Headsets, and AccessoriesTable 4: Servers $Table 5: SIP Phones, Headsets, and Accessories $

Subtotal - Hardware, SIP Phone, Headsets, and Accessories 5Professional ServicesProfessional Services IS

Subtotal - Professional Servtcesj $

11,130.001,680.00

12>810.00

131,875.00131,875.00

CIC Software Maintenance - Years 2 and 3Technical Support and Software Assurance, Year 2 - Base Solution $ 4,117.50Technical Support and Software Assurance, Year 2- Interaction Feedback $ 1,495.80Technical Support and Software Assurance, Year 3-Base Solution $ 4,117.50Teelrnteal Suppurrnnd Spftwnre assurance, Year3=1tuilrlKtiptflreeeltmk $ 1,495.80

Subtotal - CIC Software Maintenance Years 2 and 3 $ 11,226.60Irrolac@Ea@lq,«"'Bagel/S'briuafjn~

Project Totall $ 189,941.40

Cook County IVR Service Desk Contact Center Add Order 7/7/2016 5:36 PM

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II'h

85185P4

tUCl

c0Ptg

t4V

0

II Ih IIIIIIII.

fV

~l-

II'-

I I'

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aCIa

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5 zz L— 0

Tob/Option Name: Tab 2- Base Solution Page 4

ad

dILQW

INTERACTIVEINIELLIGENCE

I Baee Solution - BoT Service Desk Contact Center

12 SW4DI4.0-AL04 Contact Center Leml I

2 SW.0014.0 AAOI Interaction 8upervisor add.on

SW-Otu4 0-AA17 Inleractio R p nAnkoun

I

OTY

SW-001-4 0-AA02

Pnrl No,

U fed Messaaing add-on

CIC Session Licensm

Table It Interactive InteHigence Software LicensesQTY Pnrl No. CIC Clie t Lice es Short DescMmo *

S saic Station, Client Accms License and ACD with complete sbobused munng for one media type fm um with the loteraction Client.Ad m copen nioo, iocluda h t~ h p Liceme vnth

Workgroup, Historical Reports, Wmkeuup Queue and Dialer Plug-inmodules This license requires at least a Basic Station.wizere anven appu sation to qumrty genarme aim pie custom roporo&o lecledlC Iables within th ICkmkme. This I ense requhesan'Interac6e S p s radd-on'or'RepousPsgeAdd-o '6 lobavailsbleforeach epon ntanceiicenseAddsabilayforUnitiedM ae g(w cmwiis/ta es)dehveredtoane almbmorlnteractionMe M Sam Th ite ce alsobeordered

UM ly e 'ots6horl Descriptioas*

A eonfcmnce session is utilized by each penieipant in a oonference call.E ternal parues wig also us b se io fo connectivuy into thesyst Th' li e seis for ached leds dad-h O~(conferences created usmg the cl e t) that are hosted on Media Senora.N te.AMediaSessionisreq i d 'Ih hCo I ceSession.

$810 00

$625.0D

No Charge

$35 00

Unit Price

Rat P I

$9,720 00

$125D.DO

No Chs ne

M5 00Bxt Price

6 SWAOI-4 0-PL06

6 SW-001 I.O-PL09

QTY P tN.

I SW.0014.0.WPI I

Co f S ssion

Media Session

Internction Web Portal I 'cmse

I te t Menluee Sewn

$60 00

$$5.00U it Price.

$7,500.0D

8ub Total-Interactive loleaigence Snftwsre

Note A Medic Sessi n mquired with cack Conference Session.A Media Swoon allows lor Audio Operations lo bo hsndlad by IheMedia Server. I Media Session is requirwl with aaoh Bssio Session, Pwi

8ession or Conference Session.

Sh t Des 'ptiom*

I te I bhm ee d 1were workgnmp operational ststisti t

multiple deslmau en s - as a web page oa nny type ofPC display device-prolected ento a coll, on the su pe rviswh desktop, h an dh aid comp ulms,or external applicationsi Ma q ee miletm ststisticai i formation,

9 kmc d I f mst on and doplsysit i aMb mt

6'360 00

$51000Put Price

$7,500.00

$19,376,00

Table 2I Adapt SoitwnreQTY Pa I No. A4spt Software Licenses Sh ID ~6 *

Smanuoldapplicationth t llowscagemlorequestcallbacksinlie oft gi q e e,a dthesecagbs k~~ t th npo ito

in queue The application sl o recogninn when a good caller ID(AM)is amilable and asM tha call f thn bc sh uld be used when

processing the cagbsek. The customer is provided with sn option tokaan thn number or to enter a new ohone number for the nag back.

U it P ice Rxt P ice

~Auvomnnl NULU Anspt nmsit Bold Applicalioii $3,50tl.OD

Sub-Totnl - Adnpt Software

$3,500.00$3300.00

Table 3: Technical Sunnort and Software Assurance (Anooal'I - Year IQTY P IN. Ig pno t option Rnte

(7AM-7PMCST/CDTRemoteS ppwl,pl 0 h p t h/Igs OD-Nv.ggi 6 IMANDATGRY: standard Suppon (Service Update application during Adspt weekday sRer hours window. I 18'I!.

1st Year slnndewl support Required for ao orden Snb Total - Technlcnl Support nnd Solhvsre Aswirnnca

E*l P ce

$4.117.50

$6117.60

Table 4: ServersQTY ( part N mbe IPredact Name ISI o tDesmiptmns*

( Unit Price ( Eat priceI!ntepkbihbb B(BS(giikiHP Cmi'I'9 SeryterqdBDI,'; )(tfridgokadrrenTIHSD2; Stiindafd v:;:!„'".4',:*„';,i'"i':,@,;v'i:'Iirrham4"S/ i'»"iv

I te aetio Application getver-Medi -G 9I xlntelBG ie 6-C CPU,16OBRAM,gmbeddedRAIDCo tmller w/2 GB cache, 4 x 45D GB SAS HD in RAID 10 (900 GB

Interaction APPlicatikm Swmr- Usable),2 x 500W RPS, 8 x Dig-8 MC, Windows Server 2012I TH-900-40.HPIAS3609M Medium Appliance.Oen9 $7,869.00 $7.869.00I TH.502.3609-5CPI 5 Year Care Pack for HPDL360 G9 Care Paek Ior HP DL360 Genp-5 Ynu'-Dem M.261 OD $3361 00

Note; Adaptshaagly recammends that C~ e use imaging soltwaws such as Acronis Tr I g ith U iverssl Imslore, to image th P in~ yawl Bnckup CIC Servwn Thh is desto0 hshmwMcalnat reoftheseapnhcatio, dtbelo a ebuildti elf '

Ii cl esto epmcesses.

N tethateveryinstagationwilllikelyreqummisccganeo shanlimmf logstationssuchasanalogphoncs,fa ach m,mdmndems Thisaddtttenalhsrd are Sb th Cast ersesponsibililyle pn ide, s 4 co iists mosllyofpsleh panels and con emo c bl, but could include other items. C I 'S b esponsible for pmvidmgca equipment and wuing Customer w 0

also provide patch cables to eonneet between equipment snd station panels once equipment is rack mounted, so that oables con be ordered that sra of the conam length. Analog dances end/or pOTSlines that customer wants lo oonnaot to the CIC solution will be pluMed into RI 11 port(s) on the PXS am! FXO getaways or cards Customer is res ponnble For providing Rl 11 hsadoff and plugging1 I gateway(s)eschanalogdmiceand/orPOTSlineslhateustomermmtslocon ecttotheCICsolmion Adapt po ideguidancetocustome a d/ «3MP ny I g endo hmdbycusto o wMmm krelatedtop di nRI-llha dofF

Sub-Total-Se remi $11,130.00

Table 5: SIP Phones, Headsets, nnd Accessories

Cook County IVR Service Desk Contact Center Add Order yf//2016 6;38 Pu

Tsb/Option Nemo: Tab 2- Base Soiullon Pago 6

Pn t N b Iprod ct Nn ]short ImcmtPlians* [ Unit Price [ 6 1 pyjee

ESfy'2 oem SIEpEahcc Huclitdeii 2'ea'i ridmiked Eagle'cerimri t Ivrirc'dgfpufio tlb feiriittrec Ietsgid2sctee) '* .7 ."" * ' triVB g"'"'VX

1 lu Wtme Uesetop I'hone Utgsen Ethernet mth HU V

C paliMePmt e pl tfoms.20 POE Shtpsvnthoutpowersupply.

12 3H.SOSPHS310GE VVX 310 GME PoE Important Nota Provntontng only available tn CIC 4.0 $ 140.00'A 15th RcctacMeg bc III be charged for tbe rctma cf unope cd Tclcph sm Sabtolnl ~ SIP Phones nnd HandsetstPhonesthelbe ~ bce ope edwigo lybc~plcdbtrreturnlflhereicewa ~ tyisc e.

$1.0$0.00

$1,080,00

Cook County IVR Service Desk Content Center Add Order 7/7/2016 5'30 PM

Rd

eEQW

INTERACTIVE

INTELLIGENCE'PDnt

Call Survey - Interaction Feedback

Table 61 Interactive Intellisence Solbvsre LicensesOTY Pan No. 8 me Lkenses

I SWAII5.4.0-SA01 Intcmmion Feedback Server

12 SWOI9-4.0-AA01 IntemmionpeedbackMd-on

Unit Price

$3,750.00

$380 00

bdwvotsl - Interaction Feedback SoFt

8hw't Demi'iiit sos*Enables Interaction fccdback features t ludiuu dain eo ofautomated aurveyu aaenls whose interactions ara to bs survey-abl ~

require Intaraotion Feedback sdd-on access license. Note The server

Requiradforauaertohavcasurveyappo dtoa mteractioninwhichthey were a panimpant, orto launch th Int m Fmdback odule in

ICBusinessManaser.Also requires 1 te tm FMbackSetver

K*1

Pr'4.560.00

Ssdlo.ea

Table 71 Technical Suooort and Software Assurance IAnnusb - Year IOTY I Part No. Isuo sow D tkn Rale

f7 AM - 7 pM csT/cDT Remote sup pon, plus asar hours patch /

I ssol2Nvssla ]MANDATORY

standards

pp n /8 rwceUpdatcapplieauondurmgAd pt kdaymte ho w do [ ls'NI tv sum mmmmnw amf 0 b Total Tech kal support and Soft~eau ra cei

Ral Prke

$ 1,495.80$1,495AO

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Tab/OPtlon Name: OPtlon - Addgionsl Porn Page 8

Ra

zEQNS'NTERACTIVE

INTELLIGENCE

Table I: Interactive InteEiaence Sofhvsre LicensesOTY Pnrt No. CIC S lo Licemes Sho tn~lm *

Abssicsessionisrequired/oremmmtm el e t d call Absessionmaybeuscdmthoutanyolhersesuo typ b I ctdenter pnse Ibnmionality, including manual outbound saga; inbound DID

mgs, using the voicemail TUI or Intcrsmron Mobile 0 men and non-

ACD worlrgroup calls. Basic sessions mg allow the following Attendant

Voice Aemm itho I q I g enmlumced session. 'Dial byName'.'DislEstensionb'RemoteA '~'plysMeu* Aa th

( u h Dsr hum lo kups use of custom lumdlers and Remote Gals

Q ence)mgreq i a d cedsessioninadditi ntothebumsession Conagured remote stations mg not eq"Dy a I "u I»g cquimamwio .SeetheSessionLioenang.doc for more datads on sessrun licensing, und spec hcinformation on the fbnctions enabled by basic vs advanoed semions.

Unit Price R*I P I

15 SW4014 O.PL03 Basic Sa lo

15 SW401-4 0-PL09 Med a Se

10 SW4014 0-PL04 Advanced Session

$150 00 $2,250 00Note AMedhgessionisreq ired 'th hB icS

co nacred ans q mgth f E gmm cedfu ctionality.~mtoACDmdqpo p,d tab lookups,mmofcusto hs diem,mmiedataq eries,lntersctio F db» k ~,s draco il g ag aIntcrachonRccorder Once ane*temalcan s sa adm cedsmsim,it

in mtm'he lmemo for the durauon ofthe connected oag assamSession Licensing doe for more details an session licensing, und

speci/ic information on the funati one enabled by basis vs. advanced

maaiciis.A Mad agave allows for Aud o Operahons to be handled bytheMedraamm I Mad S o I mqu~witheachnmicgerdwupaSeason or Cenference Session

$375.00

$85 00

S I T tnl-I temcfhml teaige ceSolh are

$3 750 00

$1,275 00

$7,275.00

Table 2: Technical Suooort and Software AssuranceOTY Part No. Iguooart Ontlon

I ]$$412-NV.SSI 8 [MANDATORY. Standaul SuPPort

ItY st dmspp tnqi df

[Dmcripllon Rate

7 AM -7 PM CST/CDT Remote Suppml, plus ager hours patch ISe iceupdmespplic t d I gAd Ieimekdayalte hours cdu . I 1$%

S b-T ld-Te h i IS ppoma dS ft n A s

Eal Price

$1,30950

$1,309 50

Cook County IVR Service Desk Contact Center Add Order 7/7/2010 R30 PM

INBE/WBE UTIUZATION PLAN - FORM 1

BIDDER/PROPOSER HEREBY STATES that al MBBWBE firms included in this Plan are cerlilied MBEsNllBEs by at least one of the entities listed in the GenemlConditions -Section 19.

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

Bidder/Praposer is a certified MBE or WBE firm. (If so, attach copy of current Letter of Cerliiication)

Bidder/Proposer is a Joint Venture and one or more Joint Venture partnms are certified MBEs or WBEs. (If so, attach copies of Letter(s) ofCertification, e easy of Joint Venture Agreement desrty describing the mle af the MBE/WBE fern(s) and its awnwship interest in the JointVenture and a completed Joint VenWre Aifidavit- available online at www.caokcaanivii.aov/cantrsatcomasance)

Bidder/Proposer is not a certiTmd MBE or WBE tlrm, nor a Joint Venture with MBEiWBE partners, but will utilize MBE snd WBE firms eitherdirectly or indirectly in the performance of the contrad. (Ifso, complete srLvions II below and the Letter(s) of Intent - Form 2).

II. g Direct Pardcipstion of MBE/WBE Firms Indirect Parbciprtion of MBE/WBE Firms

NOTE: Where goals have not been achieved through direct participation, Bidder/Proposer shall include documentation outgnlng efforts toachieve Direct Participation at the time of Bid/Proposal submission, Indirect Participation will only be considered after all efforts toachieve Direct Participsgon have been exhausted. Only after written documentation of Good Faith Efforts Is received will IndirectPartlcipadon be considered.

MBEs/WBEs that will perform as subcontractors/suppliers/consultants include the following:

MBE/WBE Firm: Claritv Partners. LLC

Address; ~2N. lark St.. Suite 3500

E-mat: d.namkuncreclarttvryartners.corn

Contact Person: David Namkunn. Manaaina Partner Phone: 312-920-0550

Dollar Amount Participsilon: $ See Attached I/orksheet

Percent Amount of Psrtidpation: See Attached Vvor~ksh et

*Letter of Intent attached? Yes~ No

*Current Loiter of Certification atlached? Yes~ No

MBE/WSE Firm, n/a

Address:

E-msili

Contact Pmson:

Dollar Amount Participation: $

Percent Amount of Participation:

Phone;

*Letter of Intenl attached'/ Yes"Current Letter of Certification attached? Yes

No

No

A//ach adrgiana/ sheets as needed.

* Letter(s) of Intent and current Letters of CertiTication ntiigt be submitted at the time of bid.

M/WBE Utilization Plan - Form 1 Remsedi 01/29/201S

Cook County Contract 13-18-078Amendment No. 1Utilization Plan (Form 1)

Clarity Partners, LLC Dollor Amount of Participation ond Percent Amount of Porticipation Work Sheet

Dollar Amount of ParticipationContract Amendment No.1: $45,600Total Clarity Partners participation, Aggregate Professional Services: $624470

MBE/WBE Percent Amount of PartidpatlonAmendment No. 1: Qarity Partners 35% of $131,875Total Professional ServicesAggregate Contract Total: Clarity Partners 14'/a ($624,470 of $4,383,777.19)Aggregate Professional Services Total: Qarity Partners 22%%d ($624,470 of $2,887,585.00)Aggregate MBE / WBE Percent Participation:

Kairos Worldwide, Orginal Contract: $391,415Clarity Partners, LLC, Original Contract: $578,870Clarity Partners, LLC, Amendment No. 1: $45,600Aggregate MBE / WBE Participation: $1,015,885Percent MBE Participation: Aggregate Contract Total: 23% ($1,015,885of $4,383,777.19)Percent MBE Participation: Aggregate Professional Services Total: 359S ($1,015,855of $2,887,585)

MBE/WBE LETTER OF INTENT ~ FORM 2

M/WBE Firm: Claritv Partners. LLC

Contact Person: David Namkuna

Address: 20 N. Clark St..Suite 3600

City/State: Chicaao Zip: 60602

Phone: 312-920-0550 Fax: 312-920-0554

Email: d.nsmkuna/Mclaritvoartnsrs.corn

Participation: [+Direct [ ] Indirect

Certifying Agency: Citv of Chicaao

Certification Expiration Date; 01/1 5/1 7

Ethnicity: Asian American

Bid/Proposal/Contract M 13-18-078.Amendment 1

FEIN M 80-0123899

Will gre M/WBE firm be subcontracting any of the goods or services of this contract tc another firm2

[+No [ ] Yss- Please attach sxplanafion, Proposed Subcontractor(s): n/a

Ths undersigned M/WBE is prepared to provide the following Commodities/Services for the above named Project/ Contract: (/f

mcre space is needed Xi fully describe M/WBE Firm's proposed scope cf work and/or payment schedu/a eitsch sddi2/cns/sheets)

Ctsritv Partners. LLC is orovidina comouter svstsm intearation analvsis snd desian services INAICS

Code 541512'I for ths Cook Cauntv Bureau of Technolaav's Suooort Services It/R Cantsat Canter.

Contract Number 13-18-078.Amendment 1.

Indicate ths Dollar Amount, Psrcentaae, and ths Terms of Psvment for ths above. described Commodities/ Services;

See attached worksheet for dollar amount and percentage due Clarity Partners for Contract 13-18-078,Amendment 1. Payment Is to bs remitted to Clarity Partners within 15days of receipt of payment ofprofessional services fees from Cook County Bureau of Technology by Adapt Telephony Services, LLC

Date

this ~ dsy ofiihrsc. Af//7//5 4 16

Notary Public

uOFF[8AL S6k I"

Giga Y /tuMtmasavs

l4atsry Pubgc, Iste of llgnols

My Commission Expires 1/6/2020

IVI/WBE Letter of Intent - Form 2

THE UNDERSIGNED PARTIES AGREE that this Letter of Intent will become a binding Subcontract Agreement for gte abovework, conditioned upon (1) the Bidder/Proposer's receipt of s signed conkact from the County of Cook; (2) Undemigned

Subcontractor remaining compliant wiN aN relevant credentials, codes, ordinances snd statutes required by Contractor, CookCounty, and the State to participate ss a MBE/WBE firm for the sbtkvtLwatkMe Undersigned '-also-certify-thst-thsy-ara not a 'gnstures to this docum I until all areas under Description fService/Sup d es/Cost were completed.

Signature (MAVBE)~ Sjiinst~re 'me B)dder~rc

P~S AdE.V 5 Z-~c 4 55&A3 9 [)I/IIDFPrint Name Print Name

c-t~~+v P~risrf(kF- ArvkprlH(r-.rkrrvucfc UI f6', I r

S /a r'/r. Ã2.I )4Date

Subscribed and sworn before ms Subscriibed and sworn before me

this ~ dayof 6 I ic9 ~,20 ~~

Notary Public ~MA3LLCKCW

Cook County Contract 13-18-078Amendment No. 1MBE/WBE Letter of Intent (Form 2)

Clarity Partners, LLC Dollor Amount of Porticl potion and Percent Amount of Participation Work Sheet

Dollar Amount of PartidpationContract Amendment No.1: $45,600Total Clarity Partners participation, Aggregate Professional Services: $624,470

MBE/WBE Percent Amount of ParticipationAmendment No. 1: Clarity Partners 35% of $131,875Total Professional ServicesAggregate Contract Total: Clarity Partners 14% {$624,470 of $4,383,777.19)Aggregate Professional Services Total: Clarity Partners 22% ($624,470 of $2,887,585.00)Aggregate MBE / WBE Percent Participation:

Kairos Worldwide, Orginal Contract: $391,415Clarity Partners, LLC, Original Contract: $578,870Clarity Partners, LLC, Amendment No. 1: $45,600Aggregate MBE / WBE Participation: $1,015,885Percent MBE Participation: Aggregate Contract Total: 23% ($1,015,885of $4,383,777.19)Percent MBE Participation: Aggregate Professional Services Total: 35% ($1,015,855of $2,887,585)

Aleatha Easley

Contract Compliance Officer

Cook County Office of Contract Compliance118N. Clark St, Room 1020Chicago, IL 60602


600 Enterprise Drive, Suite 204Oak Brook, IL 60523

P 630.468.7500F 630 468.7501www.teamadapt.corn

August 2, 2016

Dear Ms. Easley:

This letter responds to your request to explain the exclusion of Kairos Consulting Worldwide, LLC (Kairos) fromthis contract amendment (Contract Number 13-18-078,Amendment No. 1).

In delivering. the project governed by Contract 13-18-078, the Interactive Voice Response Consolidation andReplacement Project, we partnered with two well qualified MBE firms: Kairos and Cladity Partners, LLC. On

that project, Kairos's responsibility and scope of work concerned providing Organization Change Managementservices and related dellverables, Including knowledge transfer and change management planning,customized project communications, training documentation customized for Cook County personnel, andend-user documentation customized for Cook County personnel. Clarity Partners provided business analysis,software testing, and related services and documentation. Clarity Partners also provided program officesupport services.

The scope of work for the project governed by Amendment 1 to Contract 13-18 078, the Bureau of TechnologyIvR-Eo~enteris.mucfrmtrre I~)f6 scope or mis project does not include the need for organizationChange Management, knowledge transfer to end-users, customized project communications, or customizedend-user documentation provided by Kairos in the previous project. While this project does require resourcesfor business analysis, software testing and program office support, the unique and niche skillset required tosuccessfully delivery these services is best provided by Clarity Partners.

Using Clarity Partners as the M BE partner to Adapt for this project, will allow Adapt to continue to utilize M BE

firms on this contraqt at a 35% participation rate. For Amendment 1, Clarity's participation rate is 35%, ofprofessional services.@he MBE participation rate for Contract Number 13-18-078, including Amendment 1 is

also 35% of aggregate professional serviceJs. Please refer to worksheets accompanying the MBE/WBEUtilization plan (Form 1) and the MBEirWBE Letter of Intent (Form 2) for detailed calculations the MBEparticipation rate.

adapfNBlllcnvz

IWPllsclCE'c~lemw

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Adapt hopes that the Office of Contract Compliance finds this explanation satisfactory regarding Adapt'sdecision to forgo partnering with Kairos on this particular project. We look forward to using Kairos on futureprojects related to this contract should the need arise for Organization Change Management services and therelated unique and niche skills. Should you have any further questions or concerns, please feel free to contactme, as I am responsible for managing Adapt's relationship with Cook County and Bureau of Technology, at630-468-7582.

Kind Regards,

PeterJ. WagnerDirector of ConsultingAdapt Telephony Services, LLC

Cook CountyOffice of the Chief Procurement Officer

Identification of Subcontractor/Supplier/Subconsultant Form

ocpo oNLY:A / Disaualificaacn(0 Check Comolete

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

Bid/RFP/RFQ No,;

/w 4vssd/Total Bid or proposal Amount: 4/6srf '0 4//. 4v&

god pv S~/Irfany cutgturcmContractor: 4 CC.

Authorized Contact / CIBV'Aaq45C-for Contractor:

Email Addressn~~~@~+~~d ~rvt(Contractor): T

PuheeAud/. DXCompany Address(Contractor): S4 IW

City, State andZip (Contractor): ~ A 6OS X 3Telephone and Fax d". /he«o sf s5'- +5 /S E(Contractor) Fr 6 Szr- r/4 ~ -08'8 4Estimated Start andCompletion Dates 4f I6( gvafb(Contractor) r r I sII gkg /6

Oats: 09/o//XO(4Contract Title:'spAxrwef de~ cI44on «/fvpldcrzafe a fSubcontractor/Supplier/SubCOnaultanttObe r /vV(by vvfcfA)dfkg

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or substituteAuthorized Contact forsubcontractor/supplier/ ~+UI4i /trf+slli Ktz /lid)Subconsultanti

)tLJ+g C(ckV 'QfkvvrkrteVS 4uk(Subcontractor)i

Company Address Exp pJ. ~rgftIC.(Subcontractor):

City, State and Zip(Subcontractor):Telephone and Fax a/ l r'5 'f Zzx ~b~(Subcontractor) P:3/g lZP red:4 4/Estimated Start and oft(Ezxr@Completion Dates(subcontractor) I f / rf / sxo/6

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

Oescrlotlon of Services or Suoolles

-COSSPXr «~—Vt)~Bukr-et«fe-n/Wan —VtVtVVC-VIWSV(Er I5/Eyr4/ 4'&B Ivt/AXCvr Con& Al'vs JS )

Total Price ofSubcontract for

Services or Suonges

I+5,~ 6drCS

The subcontract documents will incorporate all requirements of the Contract awarded to the Contractor as applicable.The subcontract will in no way hinder the Subcontractor/Supplier/Subconsultant from maintaining its progress on anyother contract on which it is either a Subcontractor/Supplier/Subconsultant or principal contractor. This disclosure ismade with the understanding that the Contractor Is not under any drcumstsnces relieved of its abilities sndobligations, 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/Uglization Plan must be submitted to the Office of theContract Compliance.

alsltcE+te (

I SF-1 8/2015

COOK COUNTYECONOMIC DISCLOSURE STATEMENT

AND EXECUTION DOCUMENTINDEX

Section Description Panes

Instructions for Completion of EDS EDS i-ii

Certifications EDS 1-2

Economic and Other Disclosures, Affidavit of ChildSupport Obligations, Disdosure of Ownership Interest

and Familial Relationship Disclosure Form

Cook County Affidavit for Wage TheR Ordinance

EDS 3 —12

EDS 13-14

Contract and EDS Execution Page

Cook County Signature Page

EDS 15-17

EDS 18

SECTION 1INSTRUCTIONS FOR COMPLETION OF

ECONOMIC 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 Qualifications, and others as required by the Chief ProcurementOflicer. 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.

Definitions. 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 intermediariies, 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 Procurements 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 the Index and any attachments.

Joint Venture 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.withrespeet-teeny-Beamy-matte;.

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 the Code, or under the Certifications hereinafter set forth.

Proposal means a response to an RFP.

Proposer means a person submitting a Proposal.

Response means response to an RFQ.

Respondent means a person 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.

EDS-i ai201 5

INSTRUCTIONS FOR COMPLETION OFECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT

Secfion 1:Instructions. Section 1 sets forth the instructions for completing and executing this EDS.Section 2: CertiTications. Section 2 sets forth certifications 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 all the facts stated, in the Certifications are true, correct and complete asof the date of execution.

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

Required Updates. The Applicant is required to keep all information provided in this EDS current andaccurate. In the event of any change in the information 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 obligafions 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) 603-4304 (69 W. Washington St. Suite 3040, Chicago, IL60602) or visit the web-site at cookcountyiLgov/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 otherauthoriization by the Corporation, satisfactory to the County that permits the person to execute EDS forsaid corporation. If the corporation is not registered in the State of illinois, a copy of the Certificat ofGood Standing from the state of incorporation must be 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 has been authorized 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 Sionature Pace.If the Applicant is a member-managed LLC all 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 acerbfied 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 illinois, a copy of a current Certificate of Good Standing from the state 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 submitted with the EDS.

EOS-ii 8/2015

SECTION 2

CERTIFICATIONB

THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE. THE APPLICANT IS CAUTIONEDTO CAREFULLY READ THESE CERTIFICATIONS PRIOR TO SIGNING THE SIGNATURE PAGE. SIGNING 'THE SIGNATUREPAGE SHALL CONSTITUTE A WARRANTY BY THE APPLICANT THAT ALL THE STATEMENTS, 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 THEFOLLOWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACT ENTERED INTO WITH THE APPLICANT SHALLBE SUBJECT TO TERMINATION.

A. PERSONS AND ENTITIES SUBJECT TO DISQUALIFICATION

No person or business entity shall be awarded a contract or sub-contract, for a period of five (5) years from the date ofconwction or entry of a plea or admission of guilt, civil or criminal, if that person or business entity:

1) Has been convicted 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 illinois in that officer's oremployee's official capacity;

2) Has been convicted by federal, 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 ei seq.;

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

Has been convicted of an act committed, within the State, of priics-fixing or sttempfing to fix prices ss defined by theSherman Anti-Trust Act and the Clayton Act. 15 U S.C.Section 1, ei seq.;

3)

4)

5) Has been convicted of price-fixlng or attempting to fix prices under the laws the State;

6) Has been convicted of defrauding or attempting to defraud any unit of state or local government or school districtwithin the State of lfiinois;

7) Hss made an admission of guilt of such conduct ss set forth in subsections (1) through (6) above which admission isa matter of mcord, whether or not such pemon or business enfity was subject to prosecution for the offense 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 bribery or attempting to bribe, a business entity msy not be swarded a contract if an official, agent or employeeof such business entity committed the Prohibited Act on behalf of the business enti~npursuant to the rtirwntico~authorization of sn officer, director or other responsible officlal of the business entity, and such Prohibited Act occurred withinthms years prior to the award of the contract. In addition, a business enfity shall be disquakfied if an owner, partner orshareholder controlling, directly or indirectly, 20% or more of the business entity, or an officer of the business entity hasperformed any Prohibited Act within five years prior to the award of the Contract

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

BID4tlGGING OR BID ROTATING

THE APPLICANT HEREBY CERTIFIES THAT: In accordance wiih 720 ILCS fir33 E-11, neither the Applicant nor anyAfirrifaied Entity is barred from swarf of this Contract as a result of a convfcfion for the vioiaiion of State laws prohibiting bid-rigging or bid rotating.

DRUG FREE WORKPLACE ACT

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

EDS-1 8/2015

D. DEUNQUENCY IN PAYMENT OF TAXES

THE APPLICANT HEREBY CERTIFIES THAT: The Applicant is not an owner or a part responsible for the peymenl of any taxor fee administered by Cook County, by a local municipality, or by the illinois Department of Revenue, which such tax or fee isdelinquent, such as bar award ofe contract or subcontract pursuant to the Code, Chapter 34, Sedan 34-171.

E. HUMAN RIGHTS ORDINANCE

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

F. ILLINOIS HUMAN RIGHTS ACT

THE APPLICANT HEREBY CERTIFIES THAT: It is in compliance with the illinois Human Rights Act (775 ILCS 5r2-105), endagmes to abide by fire requirements of Ihe Act as part ofits contractual obligafions.

G. INSPECTOR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTtON 34-174 and Section 34-260)

The Applicant has 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 ofiicial, which concerns his or her office of employment or County relatedIransaction.

The Applicant hss reported directly and without sny undue delay any suspected or known fraudulent activity in the County'sProcurement process to the ONce of the Cook County Inspector General.

H. CAMPAIGN CONTRIBUTIONS (COOK COUNTY CODE, CHAPTER 2, SECTION 24)85)

THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County's Ordinance concerning campaigncontributions, which is codified at Chapter 2, Division 2, Subdivision II, Section 585, and can be read in ils entirety atwww municoda corn

I. GIFT BAN, (COOK COUNTY CODE, CHAPTER 2, SECTION 24)74)

THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County's Ordinance concerning receiving andsoliciting gifts and favors, which is codified 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 34-180;

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

The term "Contract" as used in Section 4, I, of this EDS, specifically excludes contracts with the following;

1) Not-For ProSt Organizations (defined as a corporabon having tax exempt status under Section 501(C)(3)of the UnitedState Internal Revenue Code and recognized under the filinois State not-for -profit law);

2) Community Development Block Grants;

3) Cook County Works Department

4) Sherifl's Work Alternative Pmgram; and

5) Department of Correction inmates.

EDS-2 8/2015

4. REAL ESTATE OWNERSHIP DISCLOSURES.

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

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

PERMANENT INDEX NUMBER(S):

(ATTACH SHEET IF NECESSARY TO LIST ADDITIONAL INDEXNUMBERS)

OR:

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

5. EXCEPTIONS TO CERTIFICATIONS OR DISCLOSURES.

If the Applicant is unable to cerfify to any of the Cerfilications or any other statements contained in this EDS and not explained elsewhere in

this EDS, the Applicant must explain below.

If the letters, NA", the word "None" or "No Response" appears above, or if the space is left blank, it will be condusivsly presumed that thsApplicant certified to afi Certifications and other statements contained in this EDS.

EDS-4 8/2015

COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT

The Cook County Cods of Ordinances (g2-610 el seq.) requires that any Applicant for any County Acfron must disclose informationconcerning ownership interests in the Applicant. This Disclosure of Ownership Interest 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.

If you are asked to list names, but there ars no applicable names to list, you must state NONE. An incomplete Statement will bereturned snd 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.

"App/icanl" means any Entity or person making an application to the County for any County Action.

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

"Parson" "Entity" or "Legal Enli/y" means s sole proprietorship, corporation, partnership, association, business trust, estate, two ormore persons having a joint or common interest, trustee of a land trust, other commeraal or legal enNy or any beneficiary orbeneficiaries thereof.

This Disclosum of Ownership Internet Statement must be submitted by:1. An Applicant for County Action and

2. A Person that holds stock or a beneficial interest in the Applicant Md[ is listed on the Applicant's Statement (a "Holder" ) must file aStatement and complete ¹1only under Ownemhip Interest Declaration.

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

This Statement ls being made by the [ g [Applicant or [ ] Stock/Beneficial Interest Holder

This Statement is an: [

g]Original

Statemento [ ]Amended Statement

identifying Information:

Name I[[ Bri[FM 1¹4sr[fern// %6'iyUIC'&'xL CLE-D/B/A: FEIN NO,: 3tv (f 1 WCIS If

Street Address: 4cJus Cur Louie~ 'eris'JriLI Qs¹ Dca i 4e ZOfifrCity: C)ri.kSnrnff. State: ML Zip Code: ACR ZZPhone No.: Fax Number: Email:

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

Corporate File Number (if applicable):

Form of Legal Entity:

[ ] Sole Proprietor [ ] Partnership [ ] Corporation [ Trustee of Land Trust

[ ] Business Trust [ ] Estate [ ] Association [ ] Joint Ventum

[Jt] Other (describe) Z r turi vfr Jb DwfSr m m d'ovrL ¹2.

i'DS-6

8/2015

Ownership Interest Declaration:

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

Name Address Percentage Interest in

Applicant/Holdera~/o„u.i~. „Z sr~ ~, W,~ iI', er.V~ 2.l!ko vdlc '.i> e C D Wwx~f wc. Isovz.s

Ja [vs rerusxsrNtw /$ II secucsva Ks. Firsa$ vrcut sL F» rb g oz-

83M /o3~S9,SS S%~

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

Name of Agent/Nominee Name of Pdincipal Pnncipal's Address

Is the Applicant consbuctively controlled by another person or Legal Entityy [ [Yss [ X ) No

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

Name Address Percentage ofBeneficial Interest

Relationship

Corporate Officers, Membem snd Partnem Information:

For all corporations, list the names, addresses, and terms for all corporate officers. For all limited liability companies, list the names,addresses for all members. For all partnerships and joint ventures, list ths names, addresses, for each oartnsr or ioint ventura

Name Address Title (specify title ofOtfice, or whether manageror partner/joint venture)

5R/A IielbrsrnoC IySV nl, Aoc&vii $4 (kiCerw M Cod.raf4A 2A! Ico alKki tr 4 K r'X~ Ari)/a~I& 2 c. d6$ 'Kl

cyo 4» Coos rwkhj /sr/ Ss cv'wo $e. cvaesw 5'd-4ozo2

Term of Office

Declaration (check the applicable box):

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

Agency action.

[~ I stale under oath that the Holder has withheld no disclosure as to ownership interest nor reserved any information required tobe disclosed.

EDS-7 8/2015

COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT SIGNATURE PAGE

/" M~Name of Author)a d Applicant/ Ider e sentktivli (please print or type) Title

-7/5 lieSignature / Date~gg )p ~II/b/)tMPT) I'-DPE-mail address Phone Number

Subscribe to and swon) before me Mythis~day of ~Su t, 20 r C.

FiNotary Public \ %4%1 l~ IsrsrsureNotary

EDS-8 8/2015

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

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

FAMILIAL RELATIONSHIP DISCLOSURE PROVISION

Nenotisni Disclosure Renuirement:

Doing a significant amount of business 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 Ordinance 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 guilty offailing to make a required disclosure or knowingly filing a false, misleading, or incomplete disclosure will be prohibited from doingany business with the County for a period of three years. The required disclosure should be filed with the Board of Ethics by JanuaryI of each calendar year in which you are doing business with the County and again with each bid/proposal/quotation to do businesswith Cook County. The Board of Ethics 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 from 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 of directors,~ its officers,~ 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.

13o not hesitate to contact the Board of Ethics at (312) 603-4304 for assistance in determining the scope of any required familialrelationship disclosure.

Additional Definitions:

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

Parent!3 ChildG BrotherG Sister

Aunt! Uncle

!:NieceC Nephew

GrandparentJ Grandchild

i Father-in-lawC Mother-in-law:!Son-in-law

Daughter-in-law: Brother-in-lawi Sister-in-law

StepfatherL StepmotherI Stepson

Stepdaughter!:StepbrotherG Stepsister!3 Half-brother

Half-sister

EDS-9 8/2015

COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM

A. PERSON DOING OR SEEKING TO DO BUSINESS WITH THE COUNTY

Name of Person Doing Business with the County: dtkitI~ XNIIAott ts Siffvteeq LC Cl

Addrem ofPerson Doing Business with the County: /I,OO M1tesasptZIS/8f ~. KesiVeOdrk ~aaa~ MC 405 X3

phone number of person Doing Business with the County: AdtM mfa/eftaatn4 PLSesgsarLry I ISA ryder- ~I

Email address ofPerson Doing Business with the County: buses» A ttp shastnteta/sdsa. dsuun

If Person Doing Business with the County is a Business Entity, provide the name, title and contact information for theindjvidual completing this disclosure on behalf of the Person Doing Business with the County:slugs& pftalsfjshes a 4 spskaegsefr u+.

aha a . /ISO- dfgF ->HZ . anna I i 6e'an h u>~~a Jarte-.I

DESCRIPTION OF BUSINESS WITH THE COUNTYAppend additional pages as needed and for each County lease, contract, purchase or sale sought and/or obtained

during the calendar year ofthis disclosure (or the proceeding calendar year ifdisclosure is made on January I),identify:

The lease number, contract number, purchase order number, request for proposal number and/or request for qualification

number associated with the business you are doing or seeking to do with the County:

dam Jtr~+. JS- rip- owz dnsesmysesa+ I

~~Ma+"4'~EV»"~V&lY<i'q'VV'-".4 ~~q~,'~~s gy~ qP„ydThe name, title and contact information for the County official(s) or employee(s) involved in negotiating the business you are

doing or seeking to do with the County: Assus sra» elks-Asttstdru( dsv/ItrAcd sttIjnioss 'essgrur

3$'dt Iyys'tf. /ly/'sgegk. 5i R~nn yes''. c'@leer sd. rndstz pnhr~kne 13'-@os-4fgg

The name, title and contact information for the County official(s) or employee(s) involved in managing the business you are

doing or seeking to do with the County: Aaaa ~~lessuaf 2IA'aedciv'ay %ftsstaser/sr ssrLI't'„et stubkyel

yyyf 4.erma 0 Pi~.t'k,ease A.grades kkqMSrz-ro8- IvyC. DISCLOSURE OF FAMILIAL RELATIONSHIPS WITH COUNTY EMPLOYEES OR STATE. COUNTY OR

MUNICIPAL ELECTED OFFICIALS

Check the bos that applies and provide related information where needed

0 The Person Doing Business with the County is an individual and there is no familial relationship between this individual

and any Cook County employee or any person holding elective office in the State of Illinois, Cook County, or any

municipality within Cook County.

The Person Doing Business with the County is a business entity and there is no familial relationship between any member

of 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 work

with the County on behalf of the business entity, and any Cook County employee or any person holding elective office in the

State of Illinois, Cook County, or any municipality within Cook County.

EDS-10 8/2015


A. PERSON DOING OR SEEKING TO DO BUSINESS WITH THE COUNTY

Name of person Doing Business with the County: /1 SIA ttt< 74&afdavfvt teys tel La-c. tr LCI t

Address of Person Doing Business withthe County: 6tbt-r HvirerstrsrtssgrSfa kttg Ss'e'csC/Opt 44cak tC slthSB+

PhonenumberofPerson DoingBusinesswiththeCounty: Acr~a eel&'zma4 iy~a ~/ma AL righto- QE 7~gtEmail address of Person Doing Business with the County: %st i'au lfJJeas n V

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 Petson Doing Business with the County:

SL~ ra» dd~tt>smmnk(a!, tn3ts- /4,P-OS92 arena 'l 4 'a~ Lies drtrmadonf.. cectssr

B. DESCRIPTION OF BUSINESS WITH THE COUNTYAppend additional pages as needed and for each County lease, contract purchase or sale sought andr'or obtainedduring the calendar year of this disclosure (or the proceeding calendar year ifdisclosure is inade on January I),identify:

C.

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:

HIC - 2W the ( f'c~n sirAe k ru~a~ss sdIv rsventrat susen.a4tr*'nve )r

The aggregate dollar value of the business you are doing or seeking to do with the County: $ ~WI

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: Ras4R ss n a kke ll a Secretary. East Ii Aesr ~~p 4'

t.

ltpO t 4I. Jf+tt Art cavd 4y' Seri'fc 4Bc es cbc~ n sc ctsc I 1fysttsqCI jtg-N~ q~: c~(; r4kcafl'~ eocKa~s 4lec.r ~

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: Cia Crasis c. Jtfcnr ta assis eas svtertvi "haec.4xr 4 )fsekthtet~cr g~.,I I ~w 'LCtitMA i'~ ed S(er~ Id'. ~a illa~ i'aJ 5vtfM ~ J1os dJ. yf a r(~ 5 d . f'kc ~os. t tsar Z.phoita. I 'g ig.-'ig+-st% nl > eaecd I!eWsaocasf g coefccauar

Aefkt&.csea'ISCI.OSUREOF FAMILIAL RELATIONSHIPS WITH COUNTY EMPLOYEES OR STA'FE. COUNTY ORMUNICIPAL ELECTED OFFICIAI S

Check the bos tliat applies and provide related information where needed

I7 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 ao familial relationship between any memberof this business entity's board of directors, officers, persons responsible tbr 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


Cl 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 office 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 of Related Nature of FamilialEmployee or State, County or County Employee or State, County Relationship*Municipal Elected Oflicial or Municipal Elected Oflicial

/f more space is needed, aaach an additional sheet following the above format,

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 of Boardof Director for BusinessEntity Doing Business withthe County

Name of Related County Title sad Position of RelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Official or Municipal Elected Oflicial

Nature of FamilialRelationship

Name ofOflicer for Business Name of Related Countv Title snd Position cfRei*irrt Natun nrm iii 1

Entity Doing Business with Employee or State, County or County Employee or State, County Relationshipthe County Municipal Elected Official or Municipal Elected Official

EDS-11 8/2015

Name of Person Responsiblefor the GeneralAdministration of theBusiness Entity DoingBusiness with the County

Name of Related County Title and Position of Related Natum of FamilialEmployee or State, County or County Employee or Suue, County RelationshipMunicipal Elected Otficial or Municipal Elected OAicial

Name of Agent Authorizedto Execute Documents forBusiness Entity DoingBusiness with the County

Name of Related County Title and Position of RelatedEmployee or State, Couniy or County Employee or State, CountyMunicipal Elected OAicial or Municipal Elected Olgcial

Nature of FamilialRelationship

Name of Employee ofBusiness Entity DirectlyEngaged in Doing Businesswith the County

Name of Related County Title and Position of Related Nature of FamilialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected OAicial or Municipal Elected OAicial

lfmore space is needed, attach an additional sheet following the above format.

VERIFICATION: To the best of mv knowledee. the information I have pmvided on tl ls dtsclos»m fn~ tsaccurateand~omplete Iacknowledge that an inaccurate or incom disclosure is punishable by law, including but not limited to tines and debarment,6- f </6) t4Signature of Recipi~n Date I I

SUBMIT COMPLETED FORM TO: Cook County Board ofEthics69 West Washington Street, Suite 3040, Chicago, Illinois 60602Office (312) 603-4304 —Fax (312) [email protected]

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

EDS-12 8/2015

SECTION 4

COOK COUNTY AFFIDAVIT FOR WAGE THEFT ORDINANCE

Effective May 1, 2016, every person, ineludlno substance/ ownem, seeking s contract wist cook county must comply with the cook county wage TheftOrdinance set faM in Chapter 34, Article IV, Section 179. Any Person/Substantial Owner, who fails to comply with Cook County Wage Theft Ordinance,may request that the Chief Pracumment Officer grant a mduction or waiver in accordance with Section 34-179(d).

"Contract" means sny written document to make Procumments by or on behalf of Cook County.

"Person" means any individual, corporation, partnership, Joint Venture, trust, association, limfied liability company, sole proprietorship or other legal entity.

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

"Substantial Owner" means any person or persons who awn or hold s twenty-five percent (25%) ar more percentage of interest in any business entityseeking a County Privilege, induding those shareholders, general or limited partners, benefidaries end principals; except where a business entity is anindividual or arse proprietorship, Substantial Owner means that individual or sole proprietor.

All Persons/Substantial Ownem ere required to complete this affidavit and comply with the Cook County Wage Thelt Ordinance before any Contract isawarded. Signature of this form constitutes s certification the Information provided below is correct snd complete, snd that ths individual(s) signing this formhas/have oersonal knowledoe of such Information.

I. Contract Information:

Contract Number: /3- yE'-ok'4rvc44t

ed f+04I vrD jarxr Lv/ v I

County Using Agency (requesting Procurement)

Substantial Owner Complete Name:

FEIN¹ 7C 'jt j WS<j

II. Person/8ubstsntial Owner Information:

person (corporate Entity Name): ryts~7 Ee (Jfi ¹Lrxfic» E~tfl o~1st'O (4A 8

4'

Date of Birth:

Street Addreaa: fy ~ Xkj. AC4 fxualrf

E-mail addresw Ijhrv&sslt/g +wxfiM msfprasr/4. ~rvfI

City: C'dr C o

Home Phone: Peyjj 6$' - XN$ CEL Compliance with Wage Laws:

State: 2 LDriver's I Ioaurre Nn

Zip:

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;

illinois Wage Payment and Collection Acl, 820 /LCS 115/1 et seq., YES o~Oillinois Minimum Wage Act, 820 /LCS 105/1 et seq., YES ~NO

fllinois Worker Adjustment and Retraining Notification Act, 820 ILCS 65/1 etseq., YES a~NO

Employee Classification Act, 820 ILCS 185/1 et seq., YES o~OFair Labor Standards Acl of 1938, 29 L.S.C.201, et seq., YES or(EEF)

Any comparable state statute or regulalion of any state, which governs the payment of wages YESo~If the Person/Substantial Owner answered "Yes" to any of the questions above, it is ineligible to enter into a Contract with CookCounty, but can request a reduction or waiver under 8ectlon IV.

EDS-13 8/2015

IV. Request for Waiver or Reduction

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

There hgA been a bona fide change in ownership or Control of the ineligible Person or Substantial OwnerYES or

Disciplinary action has been taken against the individual(s) responsible for ths acts giving rise to the violationYES or 0Remedi ction has been taken to prevent a recunence of the acts giving rise to the disqualification or defaultYESor 0

Other fa that ihe Parson or Substantial Owner believe are relevant.YES NO

Tha Parson/Substantial Owner must submit documentation to suooon tha basis of its rsousst for a mduction or waiver. The ChiefProcurement Officer reserves lhs ri oht to make additional inoui ries and rscusst additional documentation.

V. AffirmationThe Person/Substangal Owner affirms that all state ntainsd in the Aflidavit are true, accurate and ~omplete.

Signature: D.tta l Ilail.>i

Name of person signing (print): P34trt 4DM~QF Title: MOSubscribed and sworn to b fore his 5 day of 4 tr i I ,20 /—

Notary Public +gnat NotaryNots: The above lntbmra is sy8Ject to verification prior to the swanf of the Con

EDS-14 8/2015

SECTION 4


Effectiv May 1, 2015, every Person, Inc/udina Substantial Ownem, seeking a Contract with Cook County must comply with the Cook County Wage TheltOrdinance set forth in Chapter 34, Article IV, Sedion 179. Any Person/Substantial Owner, who fails to comply with Cook County Wage Theft Ordinance,may request that the Chief Procurement Officer grant a redudian or waiver in accordance with Section 34-179(d).

"Con/red" means any written document to make Procurements by or an behalf of Cook County.

"Person" means any individual, corporation, partnership, Joint Venture, trust, association, limited liability company, sole proprietorship or other legal entity

"Procuiemenl" means obtaining suppges, equipment. goods, or services of sny kind.

"Substen/ial Owner" means any persan or persons who own or hold a twenty-five percent (25%) or more percentage af interest in any business entiiyseeking a Caunty Privilege, induding those shareholders, general or limited partners, benelidaries end principals; except where a business entity is anindividual or sole proprietorship, Substantial Owner means that individual or sole proprietor.

Ag Persons/Substantial Owners are required to complete this affidavit and camply with the Cook County Wage Theft Ordinance before any Contract issweated. Signature of this form constitutes a cerlittcstian the information provided below is cwrect and complete, end that the individual(s) signing this formhas/have oersonel knowledoe of such information.


Contract Number: lg- (g- OpsCounty Using Agency (requesting Procurement): rfbuv'4actca cd'~ivir i|the

/ iJ III. Pemon/Substantial Owner Information:

person (Corporate Entity Name): A (3>nd ft (u va fi exurb GW (/r L'prxex.v I

Substantial Owner Complete Name: 40 4 ek CCvh (3 ivk~FEINF 9 ( 'V(9

Date of Birth:

Street Addr.ss. 9L(0 m)ESL/. g

(IVI'qomephone;

(W~) 3>% - FIED

III. Compliance with Wage Laws:

State:

Driver's License No:

Zip: i(rg Lg L

Eunail address: )+hn 9 @4Am eJ~.C/hn

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 administrative finding made for committing a repeated or willful violation of any ofthe following laws:

///Inois Wage Paymenf and Collection Acl, 820 ILCS 115/I al saq., YES orO

//finola Minimum Wage Acl, 820 iLCS 105/I e/ seq., YES opsIl/Ino/s Worker Ad(us(mani and Retraining Notification Acf, 820 /LCS 65/I al saq., YES oq$ gO

Employee Classification Act, 820 ILCS 185/1 at aeq., YES o~OFair Labor Standards Acl of 1938, 29 U.S.C. 201, al saq., YES or~0

Any comparable state statute or regulation of any state, which governs the payment o/ wages YES or~If the Pemon/Substantial Owner answered "Yes" ta 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

SECTION 4


Effectiv May I, 201 5, every person, Inc/udlna substance/ ownem, seeking s contract with cook county must comply with the cook county wage TheltOrdinance set farth ln Chapter 34, Ariicle IV, Section 179. Any Person/Substantial Owner, who fails to comply with Cook County Wage Theft Ordinance.may request thai the Chief Procurement Officer grant a reduction or waiver in accordance with Section 34-179(d).

"Contract" means any wriitten document to make Pracwements by or on behalf of Cook County.

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

"Procuramen'eans obtaining supplies, equipment, goods, or services of any kind.

"Substantial Owner" means any person or persons who awn or hold a twenty-five percent (25%) or more percentage of interest in any business enffiyseeking a County Privilege, including those shareholders, general or limited partners, beneficiaries snd principals; except where a business entity is anindividual or sole proprietorship, Substantial Owner means that individual or sole proprietor.

All Persons/Substantial Owners are required to complete this affidavit and comply with the Cook County iNsge Theft Ordinance before any Contract issweated. Signature af this form constitutes a certificatlon the information provided below is correct and complete. and that the individual(s) signing this farmhas/have personal knowledae af such information.


Contract Number: /3-/8'- o+t?County Using Agency (requesting Procurement):

II. Person/Substangal Owner Information:

Ao A/tx d

Substantial Owner Complete Name: /is<4'fFEINF 36 t// t ~V

2A'ceto ddf Ewe wmleist evr I

Date of Birth:

Street Addmss: 2) t F~ itJF ~City: ltd')SA pule

Home Phone; (~lu &55 15'3'7III. Compliance with Wage Laws:

State.

Driver's License No

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

ii/inois Wage Payment snd Collection Acl, 820 ILCS 115/1 el seq.,

II/inois Minimum Wage Acl, 820 ILCS 105/1 af seq, YES ~N

YES or

ii/inois Worker Ad/ustmen! and Retraining Notification Acf, 820 ILCS 65/1 ef seq., YES or~Employee C/ass/7/cai/on Acl, 820 ILCS 185/1 el seq., YES o@PFair Labor 8/andsrds Acl of 1938, 29 U.S.C. 201, el ssq., YES o(g)Any comparable state s/slule or regu/afion of any state, which governs the payment of wages YES o@Q)

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

There ha~been a bona fide change in ownership or Control of lhe ineligible Person or Substantial OwnerYESo tf

Disciplinaftt action has been taken against the individual(sj responsible for the acts giving rise to the violationYES or

Remedial action has been taken to prevent a rscunence of the acts giving nss to the disqualification or defaultYES~ONer fee~ that the Person or Substantial Owner believe are relevant.YES or 0

The Person/Substantial Owner must submit documentatian to suooort the basis of its reauest for s mduction ar waiver. The ChiefProcurement Officer reserves lhe riaht to make additional inauin'es and reouest addefansl documenlalion.

V. AfTrrmationThe Person/Substardial 0 e ffirms thggtatpfnents contained in the Affidavit are true, accurate and complot.

Signature: O.tent-~-/4/ ~

Name of Person signing (Print): 8 ~q~h~kn 5kf Ttge.

Subscribed and swomtobeforeme is dayof + 4 i I ,2OI

i w p bli sigh wHater The above lnt'onnsgon Jfsu+et to verlgcatlon prior to the awa

EDS-14 8/2015

SECTION 5

CONTRACT AND EDS EXECUTION PAGEPLEASE EXECUTE THREE ORIGINAL COPIES

Ths Applicant hereby certifies and warrants that aa of ths statements, csrtifications and representations set forth in this EDS are true,

complete and conect; that the Applicant is in full compliance and will continue to be in compliance throughout the term of the Contract or

County Privilege issued to the Applicant with ay the policies and requirements set forth in this EDS; and that ay facts and information

provided by the Applicant in this EDS are true, complete and correct The Applicant agrees to inform the Chief Procurement Officer in

writing if any of such statsmenls, certifications, representations, facts or information becomes or is found to be untrue, incomplete or

incorrect during the term of the Contract or County Privilege.

Execution by Corporation

Corporation's Name President's Printed Name and Signature

Telephone Email

Secretary Signature

/Ar sR~) Cn"i/r~ tie.LLC ~

jDate

Date

'-%ZAN. C J2 47*Member/Manager print&I Nanje~nignatu~j/

444 5R a.W2-& af-tcd+AP3 F~AgPT. ~Telephone and Email

Execution by Partnership/Joint Venture

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

Date Telephone and Email

Execution by Sole Proprietorship

Printed Name and Signature Date

Telephone Email

Subscribed and sworn to before ms thisdsy of Wubt, 20+,

VMy commission expires

OFFICIAL SEALRICHARO J ROMERO

Rotary Public - State of SanolsMy Commission Expires Sep 20, 2019

Notary Public ~re Notary Seal

If the operating agreement, partnership agreement 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 6/2015

STATEMENT OF UNANIMOUS CONSENT BYTHE MEMBERS AND MANAGERS OF

ADAPT TELEPHONY SERVICES LLC

The undersigned, constituting all the Members and Managers of Adapt Telephony Services, LLC,

an Illinois limited liability company (the "Companv"), hereby adopt the following resolutions:

WHEREAS, the Company is negotiating an agreement with Cook County, Illinois, under which

the Company will provide products, software and professional services related to telephone, voicemail,

messaging, product integration and continuing maintenance and service (the "Project"); and

WHEREAS, the members and Managers wish to specifically authorize one of the Managers to

execute, on behalf of the Company, and agreement with Cook County, Illinois to provide such products,

software and services, together with all other documents, instruments and certificates appropriate ornecessary for the Project;

NOW, THEREFORE, BE IT RESOLVED, that Brian Holdampf, a Manager of and the President

of the Company be, and he hereby is, fully authorized, empowered and directed to negotiate the terms ofand to execute and deliver, for and on behalf of the Company, one or more agreements with Cook

County, Illinois, under which the Company shall provide products, software and professional services

related to telephone, voicemail, messaging, product integration and continuing maintenance and service.

FURTHER RESOLVED, that such agreements shall include such terms and provisions as Brian

Holdampf shall deem appropriate, necessary or advisable and shall approve, such approval to be

conclusively evidenced by the execution and delivery of any such agreement by him.

FURTHER RESOLVED, that Brian Holdampf is fully authorized, empowered and directed to

take any and all action which he may deem necessary to carry out the intent and purposes of the foregoing

resolutions.

Dated: July5,2016

Johfi Goodman

Constituting all of the Members and Managers

of the Company

ACORD CERTIFICATE OF LIABILITY INSURANCE~

5/31/2Q16co

Kaic p

25574INsuRER A:Trave)Am

Insunsn 8 f

INSURER 0:845UKER 0:BsSURBB8:

IBSUnsc ADAPTEL-Qt

Adapt Telephony Services, LLC600 Enterpnse Dr.Oak Brook IL 60523

INSURER p:CQVERAGES CERTIFICATE NUMBER: 949631104 REVISION NUMBER:

THIS IS TQ CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TQ THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TQ WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TQ ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

IMBR Abbcsunn POLICY BPP POLICY EXPLya TYPE OF INSURANCE IKBR WVO POLICY NuisBBB I fMM/00/yyyyl tMM/00/Yyyyl I

Llurls

A GENERAL LIABIUIY ZLP51M334241516 6/1/2016 6/1/2017i EACH OCCURRENCE $1.000,000'AMAGE TO RBNT50

COMMERCIAL GENERAL LIABILITY PREMISES lss oacuaaoael $1,000,000

CLAIMS MADE X OCCUR MEO EXP (day one pefsoh) $10.000

PERSONAL 6 AGV INJURY $1,000,000

1GENERAL AGGREGATE I $2.000,000

IPRODUCTS-COMP/OPAGG I $2000000

A 5/I/2016 6/1/2017 ]

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ANY AUTOALL OWNED SCHEDULEAUTOS AUTOS

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BA5F86258A18TEC

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NQT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NQT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

ISIPORTANT: If the certificate holder ts an ADDITIONAL INSURED, the poScy(les) must be endorsed. If SUBROGATION 16 WAIVED, sub/ect tothe terms and conditions of the poBcy, certain policies may require an endorsement. A ststement on this certificate does not confer rights to thecertificate holder in Seu of such endorsement(s).

pnooucBK NAME ('nrrin O'NPB I

CONTACT

Assurance Agency, Lld fflfc N Fwt (547'1463-7159 I laic. KolVR47'I 440-(L)231750 5 Golf Road 841AILSuite 1100 A00BEaa rnni nl/Innnttrnnr pnoencv corn

Schaumburg IL 60173 Inpvnsltfpl AppoROIKG covsnaGB

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A WORKERS COMPBM3dnonAno EMPLOYERS'ABIUYYANY PROPRIETOR/PARTNER/EXECUTIVE ~OFFICER/MEMBER EXCLUDED>(Maadatofy in Kn)If yes, dsscobe uudsfDESCRIPTION OF OPERATIONS below

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ZUP81IB334731516

HS)fssF66436716

6/1/2016

8/1/2016

6/1/2017

6/1 /2017

EACH OCCURRENCE $3,000,000

AGGREGATE $3,000,000

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E.L. EACH ACCIDENT $1,000,000

5 L. 0135ASE - EA EMPLOYEE $1,000,000

E.L 0135435 - POLICY LIMIT $1,000.000

Plofsssiohal Liabtlly ZPL81M3361A1516 6/1/2016 6/1/2017 Occur. $2,000,000 ABB. $2,000,000

083061PTION OF OPBBAYION5 1 LOCAylonp /VEHICLES (Attach ACOBO lal, AdCltiooal nemates schedule, If mole space ls requited)

Proof of Insurance Only

CERTIFICATE HOLDER CANCELLATION

ProofSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORETHE EXPIRATION OATS THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

ACORD 25 (2010/05)

AUTHORIZED REPRESENTATIVE

fg f 900-2010 ACQRD CORPORATION. AD rights reserved.The ACQRD name and logo are registered marks of ACQRD