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Contract No, 1446.135g5Vendor Name: STAR DETECTIVE 8 SECURITY AGENCY, INC,
AMENDMENT NO. 3
This Amendment modizes Contract No. 1445-13595, for Unarmed Security Guard Services by and between the County of Cook,88nois, herein referred to as "Counly" and Shv Detective 8 Security Agency, Inc,, authorized to do business In ths Stats of illinoishereina8er referred to ss "Contractor":
RECITALSWhemas, the County and Contractor have entered into a Conhsct approved by the Chief Procurement Oflicer on September 11,2014, (herelnafler referred lo as ths "Contract" ), whsmin the Contractor is to provide Unarmed Security Guard Services(hereinafter referred to as the "Services") fmm Chtobsr I, 2014 through February 28, 2016, In sn amount not Io exceed$65,232.00; end
Whsmas, Amendment¹'I wae authorizedbylhe County Board on April 1, 2015and executed on Apr828, 2015 for an increasein gre amount of $157,680.00 and an extension period for one (1)year beginning March 1, 2015 through February 28, 2016; and
Whereas, Amendment ¹2 was executed on Apdl 21, 2016 for an incmase In ihe amount of $60,788.00 snd an extension periodfcr four (4) months beginning February 29,2016 through June 30,2016; and
Whemas, the Cook County Juvenile Temporary Detention Center Parking Garage located at 1101 S. Hamilton Ave., Chicago,llinrxs desires certain and similar Services of Ihe Contractor and is added to this contract effective Sephmber 1, 2016; and
Whereas, an extension is deiired for the continuation of Services; and
Whemas, an Increase in Ihs amount of $23,900.00 is r'squired for ihs ccntlnuatlon of Services; and
Whereas, the County and Contractor desire to extend the Contract for five (5) months beginning on July 1, 2016 thmughNovember 30, 201 8,
Now Iherefore, In ccnskhragqn of mutual covenants contained herein, it ls agreed by and between the parges to amend theContract as follows:
The Contract is extended through November 30, 2INS.
2 The Contract is increased by $23,900.00 and ths Total Contract Amount le revised to $307,580.00
. 3. The attached Economic Dtecloeums Statement, IdeniNcation of Sub4ontrsctors/Suppliers/Sub-Consultants Form andMBE/WBE Ugliza8on Plan forms are Incorporated and made a part of thkr Contract.
4. All other terms end conditions remain as stated in the Contract.
In witness whereof, the County and Contractor have caused this Amendment No. 3 tc be executed on the date snd year lastwNten below.
By xJ c7 A.&Gr.LF Jf 6 5Sate'e Attorney {ifapplicable)
Star iv ecu(ily Agency, Inc.
Type or print name
S;C.HTige. ~(iu
xvv rnns
Contract No 1445 13595Vendor Name: STAR DETECTIVE & SECURITY AGEhlCY INC
ATTACHMENT
Rev t/t/t 5
CONTRACT NO. 1446-155ue
Cook County ftfcemhi+:Oyyrne of the Chief ir otnaernent.ONner
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OFFICE OF CONTRACT COMPUANCE
JACQUELINE GOMEZ
DIRECTOR
118 N. Clark, County Building, Room 1020 e Chicago, Illinois 60602 ~ (312) 603-5502
July 21, 2016
TONI PRECKWINKLE
PRESIDENT
Cook Coulltii Beald
of Commisiieners
RICHARD R. BOYKIN
1st District
ROBERT STEELE
2nd District
Ms. Shannon E. Andrews
Chief Procurement Officer
118N. Clark Street
County Building-Room 1018
Chicago,IL 60602
Re: Contract No, 1445-13595 (Amendment No, 3)Unarmed Security Guard Services
Facilities Management (Lead Department)
JERRY BUTLER
3rd District
STANLEY MOORE
4th Distnct
Dear Ms. Andrews:
The Ogice of Contract Compliance is in receipt of the abo~eference contract amendment and has reviewed It forcompliance with the Mtnoitty- and Women- owned Business Enterpdises (MBE/WBE) Ordinance. Agar careful review, it
has been determined this amendment is responsive to the Ordinance.
DEBORAH SIMS
5th District
JOAN PATRICIA MURPHY
6th District
JESUS G. GARCIA
7th District
LUIS ARROYO, JR
6th District
PETER N. SILYESTRI
9th District
BRIDGET GAINER
10th District
Bidder; Star Detective and Security Agency, Inc.
Original Contract Value: $65,232,00Increased Amount: $157,680.00 (Amendment No. I)New Contract Amount $222,912.00New Contract Extension: 12 months
New Contract Term: March 1, 2015 through February 29, 2016
Increase Amount: $60,768.00 (Amendment No. 2)
New Contract Amount: $283,680.00
Conbact Extension:4 months
New Contmct Term: February 29, 2016 through June 30, 2016
Increased Amount $23,900.00 (Amendment No. 3)New Coniract Value: $307,580.00
Contract Extensions: 5 monNs
New Contract Term: July1,2016 through November 30,2016
JOHN P. DALEY
11th District
JOHN A. FRITCHEY
12th District
MBBWBE Status
Star Detective & Security Agency, Inc. MBE-6
Allpolnts Security & Detecbve, Inc. WBE-6
Cerbfvmo Aaencv
Oily of Chicago
Cook County
'Commitment percentages are based on the new contract value.
Commitment'0%
(Direct)
10% IDirecfl
100% Total
LARRY SUFFREDIN
13th District Revised MBE/WBE forms were used in the determination of the responsiveness of this contract.
GREGG GOSUN
14th District
TJMOTHY O. SCHNFIDER
15th DistrictContract Compliance Director
JEFFREY R. TOBDLSKI
16th District
SEAN M MORRISON
17th District
JG/smp
cc: Barbie Flock, OCPO.
Slqis Jacobs-EI, Facilities Management
Endosure(s) Letter of Intent, MBE/WBE Reciprocal
I)) Fiscal Responsibility 'f Innovative Leadership Transparency & Accountability@Improved Services
MBE/WBE UTtL(ZAT(Oh( PLAh) - FORM 1
BIDDERIPROPOSER MBE/WBE STATUS: (checir the appropriaie line)
Bidder/proposer is a certified MBE cr wBE firm (If so. assch copy of currant Letter oi ceriiscation)
Bidder/Proposer is a Joint Venture and one or more Joint Venture partnem are csrtiTied MBEs or WBEs. (If so, attach copies of Letler(s) of
cer@icascn, a copy of Joint venture Agrsemeni deady descdibing the role ol lhe MBE/wBE firm(s) and ils ownership iniereu in Ihe Jcirs
venture snd a completed Joint venlure Astdavil —available online at wwwnekccuntvil oov/conlrscrcomollancsl
Bidder/proposer Is nct a certiliad MBE or wBE firm, nor a Joint venlure with MBE/wBE pannem, bui will utilize MBE snd wBE firms either
direcay or Indirectly In the perfonnance ot the Contract. (iso, compleie Sectons II below and the Lsller(s) of Intent -Form 2)
IL Direct Psrsdpation of MBE/WBE Firms Indirect Parddpatlon of MBE/SWSE Firms
NOTE: Where goals have not been aohleved thmugh direct psrdmpat(on, Bidder/Pmposer shag include documentation ouglning effotts toachieve Direct Participation at the time of Btd/Proposal submission, indirect Parffcfpstion will only be cons)dered after ag efforts toachieve Dhsct Patt(cipagon have been exhausted. Only after wrlffen documentation of Good Faith Efforts Is received will indirect
Psrtidpstlon be constderarL
MBEsii/BEs that wff perform as subcontractors/suppfrers/consultants include the following:
MBE/WBE riumA O 0E C E
Add„„. 2112 E. 71ST STREET CHICAGO ILLINOIS 60649
E diMAIL@ALLPOINTS SECURITYINC,COM
Contact Pemon: O 8 Phone:
Dollar Amount panlcipaiion: S
Pensnl Amount of Participation:
"Laser of Intent attached? „X"Current Leger of Certification llached? Yes v
No
No
B)DDER/PROPOSER HEREBY STATES Ihat all MBEJWBE firms included in this Plan are cerwied MBEsi WBEe by ai least ons oi the entities Iislsd vi Ihe General
Conditions- Seclion 19
MBE/WBE Finn:
Address:
E-mail:
Contact Panes:
Dollar Amount Participation: S
Percent Amaunt bi Participation:
Phone:
*Lacer oflnlanlatiached? Yescurrent Latter of csrtilicalion aaached? Yss
No
No
A//sch sddiyicna/ sheets as naadad.
* Latter(s) of intent and current Letters of Certification ~ms be submitted at the time of bid.
M/WBE Utigzation Pisn —Form 1 Revised 01/29/2014
MBEIWBE LEITBR OF INTENT - f685 2
IWWBE Finn:ALLPDINTssEDURITTANDDETECTlvE c ibm IW, COOK COUNTY
Cergtying Agency:
SHARON BENSON ~k~~onD~„. 5/2/2017
Add~s. 2112 E. 71STSTREET EW„,.~ AFRO-AMERICAN
Chyfstmw~ ''"+
2bc S ~ e WpmpoesgCrmtmmtk1~13595
~ . 773455-57(j0 pMN g. ~348052
E5'AIL4ALLPOINTSBEOURITYINC'QQM
Emsg:
Psrlicipsgon: @Direct Dndtrect
ws the Mlwgg limbo subconkscgag any of Ere goods or sendtws of this wnlrm¹ m another gnnf
g No Qyec- please agach daaegnoL proposed BshcontreNo¹aj;
1hs undwdgnsdMENBE h prepared le pmvide the Iogsnh8 CnmmodSesfgenkes for Ihe above named Pro(self ContmcL pr
mew epem is dewhsiro roily deswihe NSSE Frees prvpqssd Iwpe of wart; ewnw peyewm ecrwduie, ecech ertdfcsnrt eheeisi
UNARMEP SECURITY SERVICES
Indhsm Ihe Dogmnmnunt. parcanimse. and ihs Towns of Pdvmeoi for gm aboyodescdbsd CcmmodWssl Servk»s:reo
1NE UNDERSIGNED PARTIE6 AGREE Ihal Edc Laser el kdw¹ v8 become s bhugng Svbconhm¹ fdpssmmrt Ior 5» stun»wcrk, condBcaed upon (Ij Ihs BMdmfpmpcaeA monks af a signed cons»¹ fmm gte couidy nf cook; (gj Undwsisned
8 r rmastrdng cmnp5snl uMI Nl relovtmt Iadengeh, cndsh nrSnwces snd slahiles iaguksd by ~,O»k, sad girds lo paigdpate as s MBEIMSE I(nn fsr 5» a(toys war The Undemlgnad pmges do also calgi'y Ihst 5»y
dim~¹ th i(I5usmM to Ibis dscun»at ungl aft arses under Descdpdgn col supply and Fesfcost wmu comph¹rnL
m r~WWgnahnd (k(INMEI
SHARON BENSONPdnl Nnsls
pl/Qrtrf+ 5 Clrsyjs,(rFirm Name
~/~(l a. ~
Subscrhsd snd ewmn before me
Ibm~ dsy of ~d.4 gd rrte
Ra!my Pubfic ~Candi
DABLEI4E BEI.LOFFICIAL SEAL
Wormy ouiuiu. Siaie ol lllinowrdy Commission Esprres
Signatursg%fe Bfdderrfrropoesrj
JAMES HUCKABEEPdnt Name
6TAR DETECTIVE AND BECURTY AGENCY, INC
Firm Name
.i„l,.Date
Subscribed and sworn bofors ms
ihisA~dayof lKZw .25/4//)
Notmy Pubic IfrlXliner
DASLENE BELLOFFICIAL SEAL
lao i sr y F uvl la. slere or Illr nore
My Commission Eaprres"I5~4i~. ryo»
AbI II%
c ~rCook County Government
MAVBE Reciprocal Certification Affidavit
Firm Name STAR DETECTIVE AND SECURITY AGENCY. INC.
Address 813 E. 75TH STREET
County COOK
Phone( 773 )874-1900
Email ibuckabee(Rstarsecuritvinc.corn
State ILL
City CHICAGO
Zip 60619
I JAMES E. HUCKABEE(Arrriror(sed Reyrueerrrorice)
, S.V.P(Prarr Tiiie)
of STAR DETECTIVE AND SECUIUTY AGENCY.INC do hereby
aflirm:(h'arne ofFirrn)
I) STAR DETECTIVE AND SECURITY AGENCY.INC is a Minority and/or Women Business Enterprisedrome ofFirni)
currently
certified
by
th City ofChicago as: [ X ] Black- [ ] Hispanic- [ ]Asian- [ X ]Woman-
ovmed business.
2) With respect to STAR DETECTIVE AND SECURIlYAGENCY INC, the personal net worth ofthequalifying(dame ofF(mr)
(51%) individual(s) does not exceed $2,210,847, excluding the individualrs ownership interest in theM/WBE firm snd the equity of the owner*s primary residence, and otherwise meets the requirementsof Chapter 34, Article IV of tbe Cook County Procurement Code. (As per Section 34-253 of IheCook County Pmcurement Code, an individual's personal net worth includes only his or her ownShare of assets held jointly or as community/marital property with the individual'sspouse.)
3) The average annual gross receipts of STAR DETECTIVE AND SECURITY AGENCY.INC
(Nacre ofF(rrn)
as derived fmm tax filings over the five most recent years, does not exceed the Small Business SizeStandards published by the U.S. Small Business Administration found in Title 13,Code of FederalRegulations, Part 12!. (bttn://www.sba.nov/content/small-business-size-standards)
Upon penalty ofperjury, I JAMES E.HUCKABEE(dorlrnrieed /Ieyrosenlarire)
afilnn that, to the best of my
knowledge and e iege information herein is true and accurate.
Signature / ~ Tide S.KP
prv'ure 7/2//16
Subscrib+ and sworn to before me this day of ~~ / ~/(o(/ (Mo[tth) (Year)
n(orrey's Siaccboc)
My Commission Expims D ~~/Iore QSNENE SELL
OFFICIAL SEALNolcry public. Sielc or llriooicbnycommiceion Enpirec
ssey 05. 2010
1
OFFICE OF COPITRACT COMPLIAIVCE
IACQUELINE CYQMEX
DIRECTOR
116 N. Clark, County Building, Room 1020 o Chicago, illinois 60602 0 (312) 603-6602
TOirEI PRECKVVEBEKLE
PRESIDENT
Cook County aonsri
of Commissioners
RICHARD R. BOYRIN
1st District
ROBERT STEELE
2nd Ois\rid
JERRY BUTLER
3rd Dlstrltl
STANLEY MOORE
4th District
DEBORAH SIMS
Sth District
JOAN PATRICIA MURPHY
6th District
JESUS G. GAROA
7th District
LUIS ARltOYO R.6th District
PETER N. SILVESTRI
Stir Distrid
BRIDGET GAINER
10th District
JOHN P. OAlEY
11th District
JOHN A, FRITCHEY
12th Distrirt
LARRY SUFFREDIN
13th District
GREGG GOSUN
14th District
Msy 2, 2018
Ms. Sharon Benson, President
Allpolnts Security snd Detective, Inc.
2112 East 71s'heetChicago, IL 80840
Annual Certificatio Expires: INay 2,2017
Dear Ms. Benson;
Congmtulafions on your continued eligibility for Cerfificalion as a INInorky.owned Business Enterprise(tfiBE) and WomenNJwned Buiiness Enterpdse (WBE) by Cook County Government. This cerfification isvafid until INay 2, 202tk however, you must re-validate your firms'ertificafion annually.
As a condition of confinued Cerfiflcsfion during the five (5) year term, you must ffis an annual 'Ifo Chausse
I((("within shty {SSJbusiness dayeyrlor to lhe date of the annual exgirahoni Failure to Ia~A davit may msult in the termination ofyoui Cerfificafion. You must nofify Cook County's ONce of Contract
of any change in ownetsNp cr control or any other msgsrs or facts atfeafing your firitys
eligfiility for Certlficafion within fifteen (15)business days of Such chaiee.
Cook County Govemnmnt may commence acfion to mmovs your firm as a csriilied vendor if you fall tonofify us of any changes cf facts aNec$ % your firm's Cerfificafion, or if your firm otherwise file to cooperatetsidh ths County in any inquiry or irwssfigation. Removal cf your status may also be consnsncsd if your firm
is found to be invohmdin bidding or contractual Irreguktdfiea
Your firm's name wifi be listed in Cook County'B Dimctory of cerlied firms in the folktwing area(s) ofspeialty:
Licensed fsrofessional Smvtces: Armed and Unarmed Security Guard Services;Alarm Response and Mobile Patml
Your firm's parfiipafion on Cook County contracts will be credited toward MBE or WBE goals in your
area(s) of specially. While your psdkdpation on Gook County contracts is not limited to your specialty, credit
inward INSE or WSE goals will be given only for work done in the specbdty category.
Thank you for your continued interest in Cook Counly Govemmenfs Minority, Women and Veteran
Business Enterprise Programs.
Sincerely,
TIMOTHY 0 SCHNEIOER
15th District
JEFFREY R.TOBDLSRI
16th Distnct
Jacqueline Gomtm
Contract Compliance Director
JG/ek
SEAN M. MOAIESON
17th District
$ Fiscal Responsibility f Innovative Leadership Transparency EI Accountability g Improved Services
CONTRACT ¹: 1445-13595
COOK COUNTYECONOMIC DISCLOSURE STATEMENT
AND EXECUTION DOCUMENTINDEX
Section Description
Instructions for Completion of EDS EDS i- ii
CerfITicaflons
Economic and Other Disdosures, Affidavit of ChildSupport Obligations, Disclosure of Ownership Interest
and Familial Relationship Disclosure Form
Cook County Affidavit for Wage Theft Ordinance
EDS1-2
EDS 3 —12
EDS 13-14
Contract and EDS Execution Page
Cook County Signature Page
EDS 15-17
EDS 18
CONTRACT M 1445-135g5
SECTION 1
INSTRUCTIONS FOR COMPLETION OFECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT
This Economic Disdosure 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 ProcuremsntOfficer. 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 Respondentpmvide 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 forQualification, as applicabls.
Affiliate means a person that directly or indirectly through one or more intermediaries, Controls isControlled by, or is under common Control with the Person specified.
Appiicsnt 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 authodity to directly or indirectly manage governance,administration, work, and afi other aspects of s business.
EDS means this complete Economic Disclosure Statement and Execution Document,including all sections fisted in ths Index and any attachments.
Joint Vents 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 respscfive responsibility for the Contract
Lobby or lobbying means to, for compensation, attempt to influence a County official orCounty employee with respect to any County matter.
Lobbyist means sny person who lobbies.
Person or Persons means any individual, corporation, partnership, Joint Ventura, trust,asstx:tation, Limited Liability Company, sole proprietorship or other legal entity.
Prohibited Acts means any of the actions or occurrences which form the basis fordisqualification under ths Code, or under the Certifications hereinafter set forth.
Proposal means a response to an RFP.
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.
ED&I
CONTRACT ¹: 1445-13505
INSTRUCTIONS FOR COMPLETION OFECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT
Section 1:Instructions. Section 1 sets forth the instructions for completing and executing this EDS,Section 2: CsrtificaSons. Section 2 sets forth certiTtcations that are required for contracting parties underthe Code and other applicable laws. Execution of this EDS constitutes s warranty that all the statementsand certifications contained, and all the facts stated, in the Certificabons are true, correct and complete asof the date of execution.
Section 3: Economic and Other Disclosures Statement. Section 3 is ths County's required Economicand Other Disclosures Statement form. Execution of this EDS constitutes a warranty that all theinformation provided in the EDS is true, correct and complete as of the date of execution, and binds theApplicant to the warranties, representations, agreements and ackncwledgements 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,
the'pplicantshall supplement this EDS up to ths time the County takes action, by filing an amended EDS orsuch other documentation as is required.
Additional Information. The County's Governmental Ethics and Campaign Financing Ordinancesimpose certain duties and obligations on persons or entities seeking County contracts, work, businetw, ortransactions, and ths 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, IL80802) orviaitthtrwsb-sits at cookcountyil:gov/ethics-boanl-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 otherauthorization by the Corporation, satisfactory to the County that permits ths person to execute EDS forsaid corporation. If the corporation is not registered in the State of illinois, a copy of the CerNficate ofGood Standing from the stats of incorporation must be subm'itted with this Signature Page.
If the Applicant is a partnership or joint venture, all partners or joint venturers must execute the EDS,unless one partner or joint venture has been authorized to sign for the partnership or joint ventum, inwhich case, the partnership agreement, resolution or evidence of such authority satisfactory to the Officeof the Chief Procurement Officer must be submitted with this Signature Page.
If ths Applicant is a member-managed LLC sll members must execute the EDS, unless otherwiseprovided in the operating agreement, resolution or other corporate documents. If the Applicant is smanager-mansged LLC, the manager(s) must execute the EDS. The Applicant must attach either acergfied copy othe operating agreement, resolution or other authorization, satisfactory te the County,demonstrating such person has the authority to execute the EDS on behalf of the LLC. If the LLC is notregistered in the Stats of illinois, a copy of a current Certificate of Good Standing from ths state ofincorporation must be submitted with this Signature Page.
If the Applicant is a Sole Proprietorship, the sole pmpristor must execute the EDS.
A "Partnership" "Joint Venture" or "Sole Proprietorship" operating 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.
Effective October 1, 2015 all foreign corporations and LLCs must be registered with the illinoisSecretary of State's Ofhce unless a statutory exemption applies to the applicant. Applicants who areexempt from registering must provide a written statement explaining why they are exempt fromregistering as a fomign entity with the illinois Secretary of State's OMce.
EDss
CONTRACT ¹ 1445 13595
SECTION 2
CERTIFICATIONS
PERSONS AND ENTITIES SUBJECT TO DISQUALIFICATION
No pemon or business entity shall be awarded a contract or sub-contract, for a period of five (5) years from the date ofconvicbon or entry of a plea or admisEion of guilt, civil or criminal, if that person or business entity:
1) Hss been convicted of an act committed, within the State of filinois, of bribery or attempting to bribe an officer oremployee of a unit of stats, federal or local government or school district in the Stats of illinois in that officsr'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. Section 1 et seq.;
Has been convicted of bid-iigging 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 price-fixlng or attempting to fix prices as defined by theSherman Anfi-Trust Act and the Clayton Act. 15 U.S.C. Section 1, ef ssq.;
Has Seri convicted of price-fixing or attempting to fix prices under tile Ifiws the Stiite;
Has been convicted of defrauding or attempfing to defraud any unit of state or local government or school distdictwithin the Sate of illinois;
3)
4)
5)
6)
7) Has made an admission of guilt of such conduct as set forth in subsections (1) through (6) above which admission isa matter of record, whether or not such person or business entity was subject to prosecution for the offense orofFenses admitlad to; or
6) Hss 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.
ln the case of bribery or attempting to bribe, a business entity may not be awarded a contract if an official, agent or employeeof such business snfity committed the Prohibited Act on behalf of ths business entity and pursuant to ths direction orauthorization of sn officer, director ar other responsible oBcial of the business entity, and such Prohibited Act occurred withinthree years prior to ths award of ths contract. In addition, s business entity shall be disqualified if sn owner, partner orshareholder controlling, directly or indirectly, 20% or more of the business entity, or an oBcer of the business entity hasperformed any Prohibited Act within five years pdior to the sward of the Contract.
THEAPPLICANT HEREBY CERTIFIES THAT: The Applicant has read the provisions of Section A Persons and Entities—
Suu)ecrtoDisqualification, that the Applicant has not committed any prohibited Act set1orth in Section A, andfftst award ofths Contract to the Applicant would not violate ths provisions cf such Sscbon or of the Code.
THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE. THE APPLICANT IS CAUTIONFOTO 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 ANPINFORMATION SET FORTH WITHIN THESE CERTIFICATIONS ARE TRUE, COIIIIPLETE AND CORRECT AS OF THE DATE THESIGNATURE PAGE IS SIGNED. THE APPLICANT IS NOTIFIED THAT IF THE COUNTY LEARNS THAT ANY OFFPI LOWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACT ENTERED INTO WITH THE APPLICANT SHALLBE SUBJECT TO TERMINATION.
B. BID-RIGGING OR BID ROTATING
THE APPLICANT HEREBY CERTIFIES THAT: In accordance with 720 ILCS 5/33 E-11, neither the Applicant nor anyAiffifafed Entity is bared from award of this Contract as a result of s conviction for the violation of State laws prohibiting bid-rigging or bid rotating.
C. DRUG FREE WORKPLACE ACT
THEAPPLICANT HERESY CERTIFIES THAT'. The Applicant will Provide a drug free workplace, as required by (30 ILCS 5SO/3).
EDS-1
CONTRACT ¹: 1445-13595
DELINQUENCY IN PAYMENT OF TAXES
THE APPLICANT HERESY CERTIFIES THAT: The Applicant is not an owner or e party responsible for the payment of anytax or fee administered by Cook County, such as ber award of a contract or subcontract pursuant to the Code, Chapter 34,Section 34-171.
HUMAN RIGHTS ORDINANCE
No person who is a parly to a contract wilh Cook County ("County" ) shall engage in unlawful discrimination or sexual harassmentagainst any individual in the terms or condibons of employment, credit, public accommodations, housing, or proviMion of CountyfaciliTiss, services or programs (Code Chapter 42, Section 4240 et seq.).
ILLINOIS HUMAN RIGHTS ACT
THE APPLICANT HERESY CERTIFIES THATi It is in comPliance with the illinois Human Rights Act (TT5 ILCS fir2-105), anrtayass to abide by the requirements of the Act as part ofits con!ractual obligabons,
INSPECTOR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTION 34-174 and Secgon 34-250)
The Applicant has not wfilfufiy failed to cooperate in an investigation by the Cook County Independent Inspector General or toreport to the Independent Inspector General sny and afi information concerning conduct which they know to involve corruption, orother criminal activity, by another county employee or oflicial, which concerns his or her oflice of employment or County relatedtransaction.
The Applicant has ieporled directly and without any undue delay any suspected or known fraudulent activity in the County'sProcurement process to ths Offic of the Cook County Inspector General.
CAMPA(GN CONTRISUTIONB (COOK COUNTY CODE, CHAPTER 2, SECTION 2-555)
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 its entiretyat www.municode.corn.
GIFT BAN, (COOK COUNTY CODE, CHAPTER 2, SECTION 2474)
THE APPLICANT CERTIFIES THAT: It hss 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 entiretyat www.municode.corn.
LIVING WAGE ORDINANCE PREFERENCE (COOK COUNTY CODE, CHAPTER 34, SECTION 34-150;
Unless expressly waived by the Cook County Board of Commissioners, the Code requires that s living wage must be paid toIndividuals employed by a Contractor which has a County Contract and by afi subcontractors of such Contractor under a CountyContract, throughout ths duration of such County Contract. The amount of such living wage is annually by the Chief FinancialOflicer of the County, and shall be posted on the Chief Procurement Officer's website.
The term "Contract's used in Section 4, I, of this EDS, specifically excludes contracts with the folketing:
1) Not-For Profit Organizations (definsd as a corpomfion having tax exempt status under Section 501(C)(3)of the United
State Internal Revenue Code and recognized under the lfiinois Skaa not-for -profit law);
2) Community Development Block Grants;
3) Cook County Works Department;
4) Sheriff's Work Alternative Program; and
5) Department of Correction inmates.
EDS-2
CONTRACT (ti 1446.13696
SECTION 3
REQUIRED DISCLOSURES
1, DISCLOSURE OF LOBBYIST CONTACTS
List all persons that have made lobbying contads on your behalf with respect to this contract:
NameNONE
Address
2. LOCAL BUSINESS PREFERENCE STATEMENT (CODE, CHAPTER 34, SECTION 34-2Ãl)
Local business mesne a Person, including a foreign corporation authorized to transact business in illinois, having a bona fideestablishment located within the County at which it is transacting business on the date when a Bid is submitted to the County, andwhich employs the majoriity of its regular, full-time work force within the County. A Joint Venture shall constitute a Local Business if oneor more Persons that qualify as a "Local Business" hold interests totaling over 50 percent in the Joint Venture, even if the Joint Venturedoes not, at the time of the Bid submittal, have such a bona fide establishment within the County.
a) ls Applicant a "Local Business" as defined abovsg
No:
b) If yes, list business addresses within Cook County:
813 E. TSTH STREET CHICAGO ILLINOIS 60619
c) Doss Applicant employ the majority of its regular full-time workforce within Cook County7
3. THE CHILD SUPPORT ENFORCEMENT ORDINANCE (CODE, CHAPTER 34, SECTION 34172)
Every Applicant for a County Privtlege shall bs in full compliance with any child support order before such Applicant is entSed to receive orrenew a Counly Privilege. When delinquent child support exists, the County shall not issue or renew sny County Privilege, and msyrevoke any County Privilege.
All Applicants are required to review the Cook County Affidavit of Child Support Obligations attached to this EDS (EDSJI) andcomplete the Affidavit, based on the instructions in the AtfidaviL
CONTRACT¹ )445 (3595
4. REAL ESTATE OWNERSHIP DISCLOSURES.
The Applicant must indicate by checking the appropriate provision below and providing all required informaEon that either.
a) Ths following is a complete list of all real estate owned by ths Applicant in Cook County;
PERMANENT INDEx NUMBFR(s). 20-26-300-021-0000 V265
20-26-300-022-0000 V265
20-26-300-023-0000 V265(ATTACH BHEET IF NECESSARY TO LI87 ADDITIONAL INDEXNUMBERS)
OR:
b) ~The Applicant owns no real estate in Cook County.
S. EXCEPTIONS TO CERTIFICATIONS OR DI8CLOBURES.
If the Applicant is unable to cerbfy to any of the CerMcations or any other statements contained in this EDS and not explained elsewhere inthis EDS, the Applicant must explain below.
NA
It the letters, "NA", the word "None" or "No Response" appears above, or if ths spar» is left blank, it will be conclusively presumed that theApplicant certilied to all Certificagons and other statements contained in this EDS.
ED&4
CONTRACT g: 1445.135g5
COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEIIENT
The Cook County Code of Ordinances (I)2-810 ef seq.) requires that any Applicant for any County Action 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.
6 you are asked to list iiames, but thai'e are no appficable names to list, you must slate NONE. An liicomplste Statement will bereturned and any action regarding this contract will be delayed. A failure to fully comply with the ordinance may result in ths actiontaken by the County Board or County Agency being voided.
"Applicanf'eans 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 regarding an ordinance orordiiiarice amendment, a County Board approval, or other County agency approval, with respect to contracts, leases. or sale orpurchase of real estate.
"peraort" 1Enfify" or "Legal Entity" means a sole proprietorship, corporation, partnership, association, business trust, estate, two ormore persons having a Joint or common interest, trustee of a land trust, other commercial or legal entity or sny beneficiary orbeneficiaries thereof.
This Disclosure of Ownership Interest 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 ggg is listed on the Applicant's Statement (a "Holder") must fil aStatement and complete 81 only under Ownership Interest Declaration.
please print or type responses clearly and legibly. Add additional pages if needed, being careful to idenfify 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 ls an: [ g [Original Statement or [ ] Amended Statement
Identifying Information:
Name STAR DETECTIVE AND SECURITY AGENCY, INC.
0/B/A:
Street Address 813 E. 75TH STREET
City CHICAGO
Phone No 77~74-19006~a~a: ILL
Fax Number;
FEIN NP . 36-2604200
Zip Code: 60619JHUCKARE EsiETARE ECU RITYIHC CC M
Cook County Business Registration Number:(Sole Proprietor, Joint Venture Partnership)
Corporate File Number (if applicable):
Form of Legal Entity:
Sole Proprietor Q Partnership Corporation g Trustee of Land Trust
Business Trust Q Estate, Q Association Q Joint Venture
Other (describe)
CONTRACT fii tdd5.15566
Ownership Interest Declaration:
List the name(s), sddmss, and percent ownership of each Person having a legal or beneficial interest (including ownership) oimore than five percent (5%) in the Applicant/Holder.
Name Address
DOMINIQUE A. WALLACE 18501 IIIICHAEL COURT
HAZEL CREST ILLINOIS 60429
Percentage Interest in
Applicant/Holder
100%
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 andaddnws of the prindpal on whose behalf the interest is held.
Name of Agent/Nominee
N/A
Name of Principal Principal's Address
Is the Applicant constructively controlled by another person or Legal Entity? [ I Yes I g ] No
If yes, state the name, address and percentage of beneficial interest of such person, and the relationship under which suchcontrol ls being or msy bs exercised.
RelationshipName
N/A
Percentage ofBeneficial Interest
Corporate OIBcers, Nlembers and Partners Information:
For afi corpondions, list the names, addresses, and terms for afi corporate officem. For all limited liabiliiy companies, list the names,addresses for afi members. For afi partnelships and joint ventures, list the names, addresses, for each partnei'r Joirit ventiire.
Name
N/A
Address Title (specify title ofOffica, or whether manageror partner/joint venture)
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, data or plan ss to the intended use or purpose for which ths Applicant seeks County Board or other County
Agency action.
I state under oath that the Holder has withheld no disdosure as to ownership interest nor reserved any information required tobe disclosed.
EDS-7
CONTRACT ¹: 1445-13595
COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEINENT SIGNATURE PAGE
DOMINIQUE A WALLACE PRESIDENT/CEOName of rizsd ApplicantfHolder Rsprsaentati s (please print or type) Title
Signature /y pats gr''[email protected] 773- f7) yrjjdE-mail address Phone Number
Subscribed to and sworn before myt
this ~/ day of ~No/, 20 jfs
Notary Public Signature
My compjiisittn ettpirea
DARLENE BELLI OFFICIAL SEAL
ttotsrV Public, Ststs oi Itiincrs~r fj My Commission EsorrsrM sr 05, 2018
CONTRACT g: 1445-13595
COOK COUNTY BOARD OF ETHICS69 W. WASHINGTON STREET, SUITE 3040
CHICAGO, ILLINOIS 60602312/603-4304 Office 312/603-9988 Fax
FAMILIAL RELATIONSHIP DISCLOSURE PROVISION
Nenotism Disclosure Reauirement:
Doing a significant amount of business with the County requires that you disclose to the Board ofEthics 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, connucts, 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 auached familial disclosure form because, among other potential penalties, any person found guilty offfdling to make a required disclosure or knowingly filing a false, misleading, or incomplete disclosure will be prohibited &om doingany business with the C~ou for aperiod of three years. The required disclosure should be filed with the Board ofEthics by January1 of each calendar year in which you are doing business with the County and a@un with each bid/proposaVquotation to do businesswith Cook County. The Board ofEthics may assess a late filing fee of $100 per day after an initial 30-day grace period.
The person that is doing business with the County must disclose his or her familial relationships. Ifthe person on the County lease orcontract or purchasing &om or selling to the County is a business entity, then the business entity must disclose the familialrelationships of the individuals who are and, during the year prior to doing business with the County, were:
~ its board ofdirectors,~ its otficers,~ its employees or independent contractors responsible for the general admimstration of the entity,~ its agents authorized to execute documents on behalf ofthe entity, and~ its employees who directly engage or engaged in doing work with the County on behalf of the entity.
Do not hesitate to contact the Board of Ethics at (312) 603-4304 for assistance in determining tbe scope of any required familialrelationship disclosure.
AditittonalDegnitions:
"Famil/al re/a/tons/rip" means a person who is a spouse, domestic partner or civil union partner of a County employee or State,County or municipal official, or any person who is related to such an employee or official, whether by blood, marriage or adoption, asa:
DParcntD Child
O Brother
O Sister
O AuntC]UncleCINieceCJNephcw
O GrandparentO GrandchildCl Fathcrin-lawCIMothcsindawCISonin-lawODaughter in-law
DBrothesinqawO Sister-in-law
C] Stepfather
H Stepmother
O Stepson
CI Stepdaughter
H Stepbrother
Cl Stepsister
C]Hal$ brother
C3 Ha5sister
EDS-9
COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM
CONTRACT tk 1445-13595
PERSON DOING OR SEEKlNG TO DO BUSINESS WITH THE COUNTY
Name of Person Doing Business with the County: DOMINIQUE A WALLACE
Address ofPerson Doing Business with the County; 18601 MICHEAL COURT HAZELCREST ILLINOIS 60429
Phone number ofPerson Doing Business with the County: 773-874-1900
Email address ofPerson Doing Business with the County: JHUCKASEEIBSTARSECURITYINC.COM
If Person Doing Business with the County is a Business Entity, provide the name, title and contact information for theindividual completiog this disclosure on behalf of the Person Doing Business with the County:DOMINIQUE A. WALLACE 773-874-1900
B. DESCRIPTION OF BUSINESS WITH THE COUNTYAppend additional pages as needed and for each County lease, contract, purchase or sale sought and'or obtainedduring the calendar year of this disclosure (or the proceeding calendar year ifdisclosure ir made on January /),identify:
The Ibase'riugtbsr contract ntimbar, purchase'order nuniber, request'for proposal number and/or request for qualificatlonnumber associated with the business you are doing or seeking to do with the County: '4484ssss
The aggregate dollar value of the business you are doing or seeking to do with the County: $ zs scc cc
The name, title snd contact information for the County offfcial(s) or employee(s) involved m negotiating the business you aredoing or seeking to do with the County:
Q(29 t L Bt s . )arcades I2)i'rlccfaE 6l lac. l Le 4 vllauvnietttud-
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:
vbt2'9- Lrfrl'racufss Ir3 I grrrfufI Ro4)- R.I.3* ~ AmsrpM ba>+<g
C. DISCLOSURE OF FAMILIAL RELATIONSHIPS WITH COUNTY EMPLOYERS OR STATE. COUNTY ORMUNICIPAL ELECTED OFFICIALS
Check the box that applies and provide related information where needed
The Person Doing Business with the County is an individual and there is no familial relationship between this individualand any Cook County mnployee or any person holding elective office in the State of Illinois, Cook County, or anymunicipality within Cook County.
The Person Doing Business with the County is a business entity and there is no familial relationship between any memberof this business entity's board of directors, officers, persons responsible for general administration of the business entity,agents authorized to execute documents on behalf of the business entity or employees directly engaged in conlractual workwith the County on behalf of the business entity, and any Cook County employee or any person holding elective offipe in theState of Illinois, Cook County, or any municipality within Cook County.
EDS-10
CONTRACT tt: 1445-13595
COOK COUNTY BOARD OF ETHICSFAMILIAL RELATIONSHIP DISCLOSURE FORM
The Person Doing Business with the County is an individual and there is a familial relationship between this individualand at least one Cook County employee and/or a person or persons holding elective oBice in the State of Illinois, CookCounty, and/or any municipality within Cook County. The familial relaflonships are as follows:
Name of Individual DoingBusiness withthe County
NONE
Name of Related County Title and Position ofRelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Oflicial or Municipal Elected Oiflcial
Naune ofFamilial
Retsdonship'f
more space is needed, attach an addiflonal sheet following the above formar.
The Person Doing Business with the County Is a business entity and there is a familial relaflonship between at least onemember of this business entity's board ofdirectors, oiflcers, 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 oifloe in the State of illinois, Cook County, and/or any municipality within Cook County, onthe other. The famflial relationships are as follows:
Name ofMember ofBoardofDirector for BusinessEntity Doing Business with
the County
NONE
Name ofRelated County Title sad Position of Related Nstum ofFamilialEmployee or State, County or County Employee or State, County RelationshipMunicipal Elected Oiflcisl or Municipal Elected Otflciat
Name of Offlcer for Business Natne of Related County Title snd Position of RelatedEntity Doing Business with Employee or State, County or County Employee or State, Countythe County Municipal Elected Otflciat or Municipal Elected Oiflcisl
NONE
Nauae of FamilialRelationship
EDS-11
CONTRACT 0: 1445-13595
Name of Person Responsible
for the GeneralAdministration of theBusiness Entity DoingBusiness with the County
NONE
Name of Related County Title and Position of RelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Otficiat or Municipal Elected Oigcial
Nature ofFamilialRelationship
Name ofAgent Authorized
to Execute Documents forBusiness Ennty DoingBusiness wdh the County
NONE
Name ofRelated County Title and Position ofRelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Otficial or Municipal Elected Otficial
Nature of FamilialRelationship
Name ofEmployee ofBusiness Entity DirectlyEngaged io Doing Businesswith the County
NONE
Name ofRelated County Title and Position of RelatedEmployee or State, County or County Employee or State, CountyMunicipal Elected Official or Municipal Elected Oificial
Nature ofFamilialRelationship
Ifmore space is needed, attach an additional sheet following the above format.
yg ATION: To the best of my knowledge, the information I have provided on this disclosure form is accurate and complete. Iac w that au inaccurate or incomplete disclosure is punishable by law, including but not limited to fines and debarment,
7 lip //c.Signaaa ofRecipient Date
SUBMIT COMPLETED FORM TO: Cook County Board ofEthics69 West Washington Street, Suite 3040, Chicago, Illinois 60602Office (312)603-4304 —Fax (312)603-9988CookCounty.Ethicscookcountyihgov
"Spouse, domestic partner, civil union partner or parent, child, sibling, aunt, uncle, nieoe, nephew, grandparent or gnmdchildby blood, marriage (l.e. in laws and step relations) or adoption.
EDS-12
CONTRACT 8: 1445-13595
SECTION 4
COOK COIINTY AFFIDAVIT FOR WAGE THRIIT ORDINANCE
EfluadVS May 1,2cid, OVSiy Pmcsn, rncruurno uminammf a~we. Seeung ~ Contrast Wgh COCk COunty mrna COmPly Whhme Cook County Wage ThegOrdinance set fulh in Chapter 24, hrllds IV, Secgcn 17D. Any Psrsonrgubusngal Owner, who falls to comply whh Cook County Wage TheR Ordinance,may request gvugw Chkd Pmcwsmanl Cglcsr gmnt a mducllon or walvmin accordance whh gascon 24-17g(d).
"Couaacr mews any wrigsn document to make Procwmmmls by or on behsg of Cook County.
"porscrr msmiv sny Iridlvldusl, cupuagoii, psrtnsisMp. Jcliit Veiiliiio. Inuk svscclsgcn, Ilmksd Ilsbllky company, saki pic pilotcmhip or ichsr legal entky.
"Pruaummonr means obtaining suppges, eqWpmenL goods, or services of any Idnd.
"Subsunlkd Owner'eans any pusan or pamons who cwn or hold s twenty4lvs percent (25%) or more percenlsgs of Interest In any business sngtyseeking s Casey prMlege, Inchslng those stmndnsdsm, general or gmhed pahnsm, b sdckutm and phndpakr, except where a badness enRy Is anindhddusl crude pmpiletcmhlp, gvhslsnlisl Owner means that individual cr sch proprietor.
As pa~eccl ownem mo imluiiod to ccmphse this agldavh and comply with the cook ccunly wsgs Thsfl onlirwnco bsfws any ccnusct bawarded. Iggnstum of this form cuudkhm a cshlscsgsn the Information pnwlded below ls ccneci and complete, and that the indMdual(a) slgnlng eris farmhaehuum oelmnsl Imcumdm cfmch Iiiciiiiligcn.
I. Contraot Int'onnagon:
1445-13595t Arvl/ Prvl IL IWI Al&vl v i i vu ynrv IJpggd+ ravfr((Q(
A-dwrvwc .County Using Agency (mqumgng Praauremen0:
II. Perecnfgubsbtntfst Owner Inform%an:
pereari (Carpcnda Ent)jName). STAR DETECTIVE AND 'SECURITY AGENCY, INC.
Substengai Owner Compte Nemo. DOMINIQUE A. WALLACE
36 2604200
Data af Sbgk-~~ 813E.75TH STREET
ce. CHICAGO
Home Phone: (77d) d74 - 1DDD
III. Compliance with Yyags Laws:
5„„. ILLINOIS z p. 60619
JHUCKASEESTARSECURITYINC.COM
Within the past five years has gm Person/Substsngel Owner, in any judicial or admbdstragve pmceedtng, been convicted of, entered sibm-mmteun-admivsten-sfgutlyor-ihthilhy. or4mdan adminlstmfhm-gnd)ng madegvr aommhgng a mpeshnl or willful-vkdagon af any afthe fallavdng bwm:
No Iguuys wage psymeid and calleatlan Act, 820 ILcs I1drf el seq.,
No lggram Minimum Wage Act, 820 ILCS ftgyf et seq.,
No ISnais Worker Adjushnent and Refraining Naigicstian Act 820 ILCS dgri etssq.,
No &nplcyae Claceiihmtlan AOt, 820 ILCS Igdlf et Seq„
No Ptdr Labor Standards Acf of 1988, 28 V.S.C 201, el ssq.,
No Any comparable surfe statute or reguhrgrm of sny stets, which governs the payment of wages
It the personSubstangal Owner answered "Yes" to any af the questions abwe. It Is ineligible la enter into s Canbuct with CookCounly, but csn request a mducgan or waiver under Seotlon IY.
CONTRACT k 1dxt8.18888
tw. Rsstrnmt for Waiver or Raducgon
lf Pmecnlgubetanlhl OWner anSWtnad aYSSe tO aaf Cf the quentiane abOVe, it mey requeat S reduCgcn Or WalVer InenomdanCO Vdlh geCNOn Nxt-178(d), PeNed that thn mllueet fOr rnduCNOn Of WaiVer ia made On the baSIS Of Ona Or mOPS Omf
the fosowlng actions ttna have taken lance:
Nn thee hae bean s hone Nde change ln ownenddn or const of thn tnnayglte person cr subshndel owrnw
No otscgdsiary scNcn has been taken ayslnst the Nngdduelfs) ~ for the ach giving rise tn the vfofagrm
itn ~l acNnn hss been ttdron to pevsfd a ocurmnce of the acts ghffig dse to the dfsqvNSeeN'w Or'dehusg
Nn otharfacforathst Nrefserson or sahentw ownsrbeNes sm rohnnmt,
Thn Pwsnrsdtubnhnrgal Owner ulnar nubme fnnumnnhann tn nwmvt thn nash nf ics manner fnr a mdnCNnn or warvar Vras agartnromnam'ait NNtardhhiaAm fhn'rfaht&lmsba nisednfIil fnnuirteii nha nsnuent ~,~teachv. Atttnaagon
Thetsaraonlsubstangst s that ON ststenIenls contained in thsAtgdsvtt are true, accurate snd comahte.
Sign alum: r ~:~/(~i'mne
Ot Parsec.dgnlng (l4tjI'W~ffbr 8- diderr- Thar.
8u ndawomtojiefcmmethls / 9 diyof ~,20 1 Vo
/X
'ttrhwy.tsebgo~ %08lLENE BELLNotar ybs abovofrfgwmedenfe'out(feei'to vNrfffcwyon Nidor to tbe 5 coattaobg I A I. s EAL
sieIarvneblIn BIa<e oi llllnoIsMV Ce'hl'miseIon ExnIree
'ulsr 05, ESIS
CONTRACT k 1445.tSESS
SECTION 5
CONTRACT AND EDS EXECUTION PAGEPLEASE EXECUTE THREE ORIGINAL COPIES
The Applicant hereby certifies and warrants that all of the statements, certifications and representations set forth in this EDS are true,complete and correct; that the Applicant is in full compliance and will continue to be in compliance throughout the term of the Contract orCounty Privilege issued to the Applicant with all the policies and requirements set forth in this EDS; and that all facts and information
provided by the Applicant in this EDS are true, complete and correct. The Applicant agrees to inform the Chief Procurement Oificer in
writing if any of such statements, certifications, representations, facts or information becomes or is found to be untrue, incomplete orincorrect during the term of the Contract or County Privilege.
STAR DETECTIVE AND SECURITY AGENCY
Corporation's Name
773-874-1900
Execution by Corporation
fr ornior'o r A Irio flarL J~ tfr2ro-.rr'arePresident's I rinted Name and Signature
[email protected] o Email
~/ol(cSecret@+nature Date
Execution by LLC
LLC Name *Member/Manager Prin d Name d Signature
Date Telephone and Ema
Execution by Partnership/Joint Ve
Partnership(Joint Venture me *Partner/Joint Venturer Printed Name and Signature
Date Telephone and Em
Execution by Sole Proprietors
Printed Name and Signatur Date
Telephone
Subscribed and sworn to Ipyfore me thisIL( day of~,20IIEa .
GI /
My commission expires:
DARLENE SELLOFFICIAL SEAL
NOlary Pabiio,sratacr IlanO sMy Commission Expiros
May 05. 201 8
Notary Public Signature Notary Seal
EDS-16
NZ 10965
1,000~ 000100.000
10,0001,000,0005,000,0005,000,000GEITL AGGREGhlE UMff APPLIES PER
X I POLICY mrrr LCC
AulOMOSILE uhacrrY
ANY AUTO
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TINS CERTIFICATE IS ISSUED AS A NATTER OF INFORMATION ONLY AND CONFERS ND RIOHTB UPON THE CERTIFICATE HOLDER. THM
CERTIFICATE DOEB NOT AFFRIMATIVELY OR NEDAlWELY ANIEND. EXTEND OR ALTER THE CDVERADE AFFORDED BY THE POLICRRR
BELow. THII cERTIFIGATE oF INsURANGE DOER NDT coNBTITUTE A coNTRAGT sETwEEN THE IssUINS INBURERNI), AUTHoRIzED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMpoRTANT: If Bs csrtmaam holder Is an ADDITIONAL IN8URED, the paUay(las) must be andonwd. If 8UDRODATION IB wAIYED, sub)aat hl
dm tanns and caedhtons of Ihe poRcy, certain poRalas may mqulre an andomemsnt A amtement on this centgcets does not aonfar Hglds lathscarNlmrte holder In Neu of such andsrsamsmfs).
paocucsr Iryrm Lilurersen(845) 735-0700 laea) 'l33-0303
One Blue Hill Plane llindoraenanaahenicg3oup. ccaSuite 530 SSCRESSIRPFCRCIHGCWERAGE HSIC 0Pearl River snusaanAlliod World Surrhlus Lines 24319lesssa IWURSI e:Star Detective and Securi.ty Agency, Inc. ~SURER C 1
813 B. 75th Street snulsR caSSIRERE1
Chicago ZL 60619 IHSURSl P 1
COVERAOES CERTIFICATE NLNSDER:2015-2016 REVISION NUMSEILTHIS IS TC CRRRFY THAT THE POLICIES OF INSUISANCE USTED BELOW HAVE BEEN ISSUED TC THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NDTVYITHSTANDIHO ANY REQUIREMENT, TRAM OR CDNDlllOH OF ANY CONTRACT OR OTHER DOCUIINHT WITH RESPECT TD WHICH THISCERTIFICATE MAY BE ISSUED OR IUAY PERTAIN, THE NBURANCE AFFORDED BY THE PCUCIRS DESCRIBED HERBH IS SUBJECT To ALL THE TERSSS,EXCLUSIONS AHD CONDlllONS OF SUCH POLICIES. LSSTSSHOWN MAY HAVE SEEN REDUCED BYPAID CLAIMS.
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SESCSPTIOH OF OlaRSSCNS I LCC¹llouar VSIICLm I¹aaeh SlXSO lal. Addnenal Remmlm Saheda!e. If mere eeaaa le rehalmdlSubject to a signed and dated vritton contract or Nritten agreenant that includes an additional insuredreguirarsont in favor of of the certificate holder, County of Cook, ita coaaniesioners, ~a 4 ageats,individually and collectively.
CERTIFICATE HOLDER CANCELLATION
County of Cock
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BECANCELLED BEFORETHR RXPIRAlmn OATS THEREOF, NOTICE WILL BR DELIVERED INACCORDANCR WllH THE POLICY PROVNIONSL
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