contract vendor name - cook county,...
TRANSCRIPT
Contract No. 1330-12749Vendor Name: APPLIED INDUSTRIAL TECHNQLDGIES, INC.
AMENDMENT NO. 3
This Amendment modifies Contract No. 1330-12749, for Industrial Maintenance, Repair and OperatingCommodities and Services by and between the County of Cook, illinois, herein referred to as "County'ndApplied Industrial Technologies, Inc., authorized to do business in the State of illinois hereinafter referred toas "Contractor":
RECITALS
Whereas, the County and Contractor have entered into a Contract approved by the Chief ProcurementOfficer on September 10, 2013, (hereinafter referred to as the "Contract" ), wherein the Contractor is toprovide Industrial Maintenance, Repair and Operating Commodities and Services (hereinafter referred to asthe "Supplies" ) from September 10, 2013 through July 31, 2014, with three, one-year renewal options, in anamount not to exceed $120,000.00;and
Whereas, Amendment No. 1 was authorized by the Chief Procurement Officer on August 27, 2014 for arenewal beginning on August 1, 2014 through July 31, 2015; and
Whereas, Amendment No, 2 was authorized by the County Board on September 9, 2015 for a renewalbeginning on August 1, 2015 through July 31, 2016 and an increase of $120,000.00; and
Whereas, the Contract will expire July 31, 2016, and the agreed upon Supplies are still required; and
Whereas, a renewal is desired for the continuation of Supplies; and
Whereas, an increase in the amount of $200,000.00 is required for the continuation of Supplies; and
Whereas, the County and Contractor desire to renew the Contract for 12 months beginning on August 1,2016 through July 31, 2017.
Now therefore, in consideration of mutual covenants contained herein, it is agreed by and between theparties to amend the Contract as follows:
1. The Contract is renewed through July 31, 2017.
2. The Contract is increased by $200,000,00 and the Total Contract Amount is revised to$440,000.00.
3. The attached Identification of Subcontractor/Supplier/Subconsultant, Economic DisclosuresStatement, and MBE/WBE Utilization Plan forms are incorporated and made a part of this Contract.
4. All other terms and conditions remain as stated in the Contract.
Rev tnnS
Contract No, 1330-12749Vendor Name: APPLIED INDUSTRIAL TECHNOLOGIES, INC.
In witness whereof, the County and Contractor have caused this Amendment No. 3 to be executed on thedate and year last written below.
County of Cook, illinois
Chief Procurement Officer
kj(4
State's Attorney (if applicable)
Appl ed Industrial Technologies, Inc.JI,signed 55
Kurt W. Loring
Type or print name
Bo ~4f 2.c)l(o
Vice President
Title
Date: April 18, 2016
Rev I/I/IS
Contract No. 1330-12749Vendor Name: APPLIED INDUSTRIAL TECHNOLOGIES, INC.
ATTACHMENT
Rev I/I/15
Cook County oooo ouctnONLe of the Chief Prooureme»t ONoer
tdontlfhagun of suboonttaotor/Suppger/Subcottsuhant Form
Ths Sudor/Proposer/Responded ('Ihs contiedsFj wN fugt oompble and muscle and errbmg sn Menggoawn ofScbconlreolor sr/8ubconaugenl Fmm fige) wlh each.ghL Requeet Icr Prmmssl, aad ttesueel forOuaWcegrm, 'Ihe Conlraslormuol complete tlw WF for emh Subsontmstot~gu pplleror gutwotnuNent whish~hag be used on the centmcL In Ihs event Iiral gnm are tuiy changes (sunuwcegon et sulmonlredors.gupldbm or 8vbconeugsnls, gm 0oniredor nwsl Ns an updated ISF,
bldg(Fur(IFC Noc 1330-12748
Tote( Nidor Pronosal An»unb
ConuedocAppged Industrial Technologlsa, Inc.
Aogrorhnd Contact(or Conbsd«Dun Rogogmsg AddmssIConhecto/Ir 23gggbeppgwkcom
C~ompe Addmas(
4343 West 138th StreetCgy, WeLandZto~, Crsetwnod, N. 30443Telephone ecd Fev(Co drooled Frxxx pss) wn 12sr Fax'. I(mt ses 1ssiNssnmed smd and
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Com pony Address(Subconhudorp
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Nots: Ifpan guest, s copy of ag ndgen svbconbsd«egmsmonts martha provided to Ihs OgpO.
Oescrlouon of Bsrviess sr nsovgsoTotal Frtxw at
saba outroar targ«vices er nuosuvs
The eubcenired dooumenls wN Incorporate sg requbummn ol lhs cmdradmvenlsd lo the coabscbu ss eppgcsbls.Ths eubwduwl vill ln no wsy hbrd« lhs Sub~cop(err/SubcosuNM horn malnlahhig Ne progmss on anyother corned on which lt ls otgr«a Suluwnlrsdcdgeppger/Suboonsugmd er principal oonlnmior. This dlsolosum bmade wgh Nm undemtsndlng (hm gw Contmohu Is noi urn(sr any chcwadences reNevad of ts sblwos anyobllgisms, end Is meponslbm («me organlsedorL part«nonce; end queghl ot work, Tide hmn dern not approvecny'pmposod changes, revisions orinodp(esgose to Ihe eontract epproxmd Mswwswthlgratlou lxlan. Anychanges to gi congeal(a approved NtngwswUNsegan plan must be aubmwsd to the owee of thsConhsot Compgangn
Contractor g/PName
Applied Industrial Techgplgglss, Inc.
sir/jF;Pdme Cmuraolor Sgnsturs
ISF I etgotg
OFFICE OF CONTRACT COMPLIANCE
JACQUEUNE GOMEZ
DIRECTOR
115 N. Clark, County Building, Room 1020 o Chicago, Illinois 60602 o I312) 603-5502
May 5, 2016
YONI PRECKWINKLE
PRESIDENI
Cook County Board
of Commissioners
RICHARD R. BOYKIN
1st District
ROBERT STEELE
2nd District
JERRY BUTLER
3rd District
STANLEY MOORE
4th District
Ms. Shannon E. Andrews
Chief Procurement Officer
118 N. Clark Street
County Building-Room 1016Chicago, IL 60602
Re: Contract No. 1330-12749 (Amendment No. 3)Industrial Maintenance, Repair and Operating Commodiffes and Services
Facilities Management Department
Dear Ms. Andrews:
The Office of Contract Compliance is in receipt of the above-referenced contract amendment and has reviewed it forcompliance with the Minodty and Women- owned Business Entaiprises (MBE/WBE) Ordinance. After 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
8th 0~strict
PETER N. SILVESTRI
9th District
Bidder: Applied Industrial Technologies, Inc.
Original Contract Value: $120,000.00
Contract Extension; 12 months (Amendment No. 1)New Contract Term: August 1, 2014 through July 31, 2015Increased Amount: $120,000.00Amendment No. 2)
New Contract Amount: $240,000.00Increased Amount: $200,000.00 (Amendment No. 3)New Contract Amount: $440,000.00Contract Extension: 12 months
New Contract Term: August 1, 2016 through July 31, 2017Contract Goal. 25% MBE, 10% WBE
BRIDGET GAINER
10th Distnct
MBE/WBE
R & Y Transport Services
Status
MBE -6Certlfvina Ausncv
Cook County
Commitment
6% (Direct)
JOHN P. DALEY
11th District
JOHN A FRITCHEY
12th District
Full WBE Waiver Granted: Due to the specifications and necessary requirements for performing the contract make it
impossible or economically infeasible to divide the contract to enable the contractor to utilize WBEs in accordance with
the applicable participation. Other relevant factor include that the Prime is out of state and that makes it difficult to seekindirect participation.
LARRY SUFFREDIN
13th District
GREGG GOSUN
14th Distnct
IIMOTHY 0 SCHNEIDER
15th District
JEFFREY R. TOBOLSKI
16th District
SEAN M MORRISON
17th District
The ONce of Contract Compliance has been advised by the Requesting Department that no other bidders are beingrecommended for award, Revised MBE/WBE forms were used in the determination of the responsiveness of thiscontract.
Sincerely,
Jacqueline Gomez
Contract Compliance Director
JG/smp
cc: Aaron Moser OCPO
Kathv Weiss-Botica, Facilities Management
$ Fiscal Responsibility 'f Innovative Leadership II)Transparency 6I Accountability JEST Improved Services
MNNININN UTILIZATION PLAN PON)N I
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L SISDERIPRCPCSERU80INESTATUth (cbcchnsrnynpAhhce)
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XShthrlpreycrar IC md a acrdnd USE Cr IWS Ran SSI a Atat Vlmlna nhh NRERESE Pcrnane IallCN rlWnl SEIE nat VUE Rate ¹hndrccty or hdncthr hryn Steaatsm Sfths hrrosct yf ca, cenykn Sadtnny hctensad lhs tartcO)cd hans-Etna'.
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MBFMISSLKTIRROFIMTENT FORM2
hyuusE Fbw R 8 Y Transport Bervlmm
Cwbw Fm,w, Randy hgmynfe, Jr.
14226 Minerva
Ctyrgmhc Dugan, IL Egu 80419
phon¹ 708 S39 S412 p 708.84MW
Cerglymg Ammed
CsNlcugw Eupbsgcc Date;
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FEIN N 20W03069
Eeet. rendytranon [email protected]
Psrgcgisgcm I IIObsd ( I(Ingram
vyg 8m hsvygg Nmbsoubcceirscsng any oflhs goods orc¹vhms of Ihic cwbwtlo enolhar lhmy
IIIINo I )Yss-Plcececsechmplsnugcn, Pmpocmlgubccnlrsclcr(et:
The eAwlysd MIYYBE Isprepumd to pmvMs Ihs hdouhg commcdlgesiBsnd¹mfor Ibe sbovs nsundprdecd conlrs¹ prmrm Cpcmb rumrcurc Wycu¹dtm ISMSFFS¹bpuu¹uuccnmcr ucrs mutlupunumr cccmruh, sycdr mmywdarucrd
R s Y delivery wig ha ilggzed for ag cook Comfy departments racpdrhtE f»lghl smvtca. In Bddlgon
eddhlon, R 8 Y mgl be coneIderod a umlforsd height asrder In e¹vmms ag customers In the Chtosgo
metro awn,
Indents sic Dogw AmounL psmmwus miil Ihe Tonus srp¹uncut hu gm abewdeccrmes comm¹m acr gerviw¹Cecil Ccwiy ~ 100% nunrmc crat Memmonm
Au OBIOI'Cuetcniom m 80% net 30
TME UNDHNSMED PARRES ydEIEE gmt Ibis tsgmat Inhmt wgl bocmw a hhdlng Eobmmlred Ageemsnt lor Ibe ubmuuudb condgcwd Ipw (II Ihe Shmwpropwer'a mcegt of a algwd ecnhwt ham Ne County ot Codr, (2I Undsmlgwd
mmshhg mwplhud wiN eg relovwt cuadwNM, codes, ordhwcsu eml clelulos r¹phcd le Owlrador, Ccob
comfy, wd the paigcgime as s NBEAMBE smisr gmrmsw umdc TIMU¹mrclgned porgwdo she scrfgylhat Ihsydhlmnagh gn slo Nm document wgiatsmwundcr Deccrlpgonsf senSaf Supply Foedmdvmmcmuplel¹L
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PETITION FOR WAIVER OF SIBEIWBEPARTICIPATHNI FORM 2
A, BIDDEIVPROPOSER HEREBY RECUESTS;
FULL MBE WAIVER FULL WBE WAIVN
Q REDUCTION (PARTIAL NBR and(sr WBE PARTICIPATION)
qt of Reducyon for MBE Pargctfmthn
%of Reduction (or WBE PaNclpagon
B, REASON FOR FULUREDUCTION WAIVER RECIUEST
BNdsriprapcssr shag obeck sack liam tppgcsbh to gs reason for a waiver mqussL Adrgganelly. supp«gnydocuraanlagoa shell be acbmNed wgb Ibh request,
0 (I] Lack of suNcfenlqualigad MBEc and(or WBEs capable a(pmvMlng gm goods or servhas rsqukedby Ike canuoaL (phase explain)
(4) The spscNcayons arrdnecessmy aqukaeents (or pad«ndng Ne conlrealmabe Slmpasshh orec«mmhally krknxgbh h divide glee«Nrsct la ensMs gmeoatlaat«lo el(he MBEa snd/ar V(BEs klacocrdanco wgb gw appgcsblo psrtkgpmhn. (Please axpkda)
0 (s) Pdca(a) quo!adby paiengal MBEs andhrwBEa sre nbovs compsiNvo levels and haraasa coal ofdoing business and wavid make~of suck MBE arNhr WBE bN econondcegy kapmcgcaNe,hklng hlo~tbe p roenlega of lolal'oonlnwl pdao repras«ded by oucb MBE and(or WSEbN, (I'loaaeauphfn)
Q (4) Tkara are otk«mhvanl factors makhy Slmprnslble or ecarmmhrByln(esclble lo uglhe MBE and(or((BEgm a. (Ffsmmexpfatn)
C, GOOOFAI(H EFFORTS TO OBTAIN N BE(SOBPARTICIPATION
Q (I} Made lirmdy wdfhnsollcihlian lo kfenNsd MBEs aml WBEs hr INlhallon of g«xhnnd(or sarvtcm,cnd provtded MBEa and WBEs wlib a Nasty oppnitunlly lo owhw end obtah retnrant apocNoslkms,lame snd aondNam ef the proposal to enable MBEs and WBEc lo pmpsre anhhrmed raaponao lo
sahgallan, (Attach of copy wrEtan oath)hthns made)
(k) Used the s«visas and asalstsnca ot the ONce of Contract Comylhnce shy. (Please explain)
Q (s) Tknuiy nollthd wrd used iks ssrvhas end asdskcice of community, mhorl(y and uaxnenbuslhoss
«g«dmmons, (ABoab ef aopir wrlNen sothftmhns msr(e)
Q (4) Fagcwad up on NON aolhgalion ol blBEs cnd wBEa to dahnalna E arms ara Int«sNod In dungbusiness, (Altanb euppoIEng dacumeabdlon)
(I) Engaged MBEs 4 NOEs for dlrecNndkerx parlhipatlon. (Please explain)
D. OTHER RELEVANT INFORMATION
Agacb any olnar documanlayan ralagve lo Good Fallh Efforts In aomplykN wgh MBBWBEpamalpagan,
M/rarer ulmrauon Plan .form S Ravtaacr 01/So/24
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Deer Applicant,
Cb>d> Cowty hss >use>red your appheatlo¹ A e¹ttfh¹t ton et>ooh>llsl will >ovtov your spplbnllon tbrcoo>pts>su>self lhrtbor Inlbnustlan Js needed you udlt >noel>u ae e¹sIL Onao rovlewod ynu will be no>If/ed oryour so>h>L please conn>ol tbo CerNleation Seclh¹ al (310)0034302 Idynu Ju>va ¹>J»p>esth¹n
COON COIN4TYECONOMIC DISCLOSURE STATSNENY
AISO EXECUTIOII DOCUggESTINDEX
Deecrlotlon
InslruoNons for Cclnplegon of ED8
Ccdghstlons
Economlc arld OguuDIsrfosums, Agkhaa of ChgdSupport Obggsflons, Ohclosure of Ownasldp Intelsat
and Famglal Refegonshlo Ohcknuoe Form
Cook County Afgdevg fOr Wage Thol Cngnance
Contract and ED8 Execugon Page
Cock Courey Signature Pega
EDSI g
EOS 1-2
ED82-12
EO819 14
ED815.17
EDS 18
SECTOR 1IhlsrRUCTIOkm FCR CDMFtSTIDR DF
Ecolfokuc DISCLCSDRE sraIEMEslr Astu Exselftmst DDCDMEsr
Tfus Eoonomb Dfscfocum Nntemem and ExecuNon Document f'Eus') ls to be complshrd and executedby every Bidder on a cmndy oommcl. avmy proposer msponding lo a Request for Prognosis, and everyRssponderg responding Io a Request for Quaggcegonsr snd olhets as re~qulmd by Ihe chMI prooursmemOSosr. Ths tnteougon of the EDS shak sevens Ste exscugon of e conlraol awarded by lhe County. TheChief Frocursment Ofhcer mssrvec lhe dght lo request lhst Ihn Bidder or Pmposer, or Respondentprovkfs an updated EDS on an annual basis.
Deflnlsons. Terms used In ibis Ecs and not othenvise defined homin shak have Ihs meanings given losuch leans In Ihs Instiumkms to Bidders, oeneral condklons, Request for proposals, Request forQuskgcrdlons, ss appkcsble,
Aggfefe means s person thai dlreoNy w «xgrscgy through one or more Intennsrksiiec, Controls lsConlroked by, or is under common Conbol with the Person spetf Ned,
Appgcscf means a pmson whc sxecuhm this EDS,
Sdder means any person who submks a Ski.
Code mesne the Code of Ordkrsrxxnk Cook Counly, lklnob avageble on munbcds.corn,
confront slmk Inolude sny wrlken document lo make prccummenls by or cn behalf ofCook County.
Contmcfor or Contradkrg Pcrly means a person thai entsm into e Conlnut with theCounty.
Control means ths unleNered eulhcrgy lo directly or indheclly manage govemence,sdrnlnlstregon, unuk, nnd ag other arqxxue cf a business.
EDS mesne this cpmplsle Economic fgcckxtum Statement and kkmoutlon Document,including ag sselkrnc Noted tn the Index end any sgaohmmds,
Jofnr Verdure means sn association of two or more Persons proposing lo perform a for.pmlk business enterprbe. Jofnl Verdums must have an agreement In uvklng specifyingIhe lerms snd condNons of Ihs msscnshtp between the psrtrmm snd Ihelr rahtgonchbrsnd mspecgvc osporudMSy for the Confract
tabby or lobbying means fo, for compenssgon, attempt lo Nuance a county of%el orCounty employee wNh nrspeol lo any Cmmly matter.
tobbybf means sny person who lobMm.
parson or Penmns manna eny indhiduai, corporalfon, psrtnemhlp, Jofnl Vsntum, trust,sssodation, LimkedUabkky Company, stde prcpdetorchbr or other legal entNy.
ikobfbgcd Aotc.means sny of Ihe aokons or oocwnmoes whloh kmn Ihe basis fordlsquslgbagon under Ihe Code, or under ths CeMflcagorw hemlnager sal ktrA
Rroposalmesns a response to sn RFP.
Reposer means a pemon submkkng a Proposal.
Response means response lo an RFQ.
Respondent means s person mspondlng to an RfQ,
RFP mesne a Request fcr Proposals Issued pursuant lo this Prccuremsnl Cade.
RFQ means n Request for Quskflcalloos Issued to obtain Ihe quakkcatlonc of lrdsrcnted psrtlsc.
s001c
848TRIICIIOcm MN COMPLBTIOM OFBCORoksIC DISCLOSDRE STATEMhqf T AMDENECIITTOMDOCDMBtfr
secNon 1:InetnrcNcns. 8ecgon 1 eels fmlh Ihe Inetruc gone fer compte gng and execugng Ibis EDS,
seoNon 6:cerBfloatlone. secgon 6 sole fcrgt eedghathne thol «e rsqul»d for oonkaoihg parges underIhe Cods and olher appgcsbls laws, Bxacugon of thh BDS ccnetgulss s warranty Ihd all lbe shlemealssnd cdrggcstlcne contained, and sg the fech ehued, In N» CerINcsUone srs Irue, aWed end complete aeof the dele of oxecuNon,
8ecgon fh Economic and Other Dhcloeurrm Statement. Seclkm 6 Ic Ihe County'c mqulred Bconomhand other Dlschxums INalamenl form. Exruxdkrn of this EDS consglutse a warranty that Ml 0»tutor«agon pmvtdsd ln 6» I?DS Is trmq ccnurd and comphte ae ol Ibe dale of ex«xSon, snd hinds 0»Apploent IO lhe werranNes, mprassnlsgone, agreemenh and ackncwledgemsnle ccnkdnsd Iherrdn.
Requhed tlpdetes. The Appgcant lc requhad Io keep ail lnfcnnsucn pmvtded ln 0th EDS current mul~ In fhe event of erqf change In the hdwnagcn prrxxded, hdudlng bui nol Ihdhxl to any chancewhich»cold render Ines«us» or Incomphde any oerggceNsn. at statement made h this BDS, d»Applhmd shall supplement Ihle EDS up Io Ihe Ihns 0» Courity lehm scthn, by tlgng an amended EDNorsuch clhor dccumcntphm as Is Iuquked.
Addmonal Information. The County's Sovemmenlel Shhe aml Campaign Pinsnolng OrdinancesImpose c«tab duges snd obNgagone on persons or enggse eeekfng County contrada, work, brwinass, ortrancscNons, snd the Appgcam h expected to comply logy H7Mf theee ordinances. For further Informsgcnphoae contact Ihe Dkedor of EIMcc at (tlgf tuxt4304 (00 w. NssMngtcn st. Bugs s040, chicago IL80802) or visit lhe wsb eNs at cockcountyll.oovfegrt»4rcnrd.of.
Autberhed Signers of conlmct and EDS ErwcuScn,page. N the Appgcant le a oorpomtlon, IhePresMtnd and Secmmry must exaoute Ihe EDS. In Iheqventxmn 0th BOS Is dxerxnedby someone cgrerthen tha pmeldenL aNach hereto s cortlged ccplr of Ntst saigon of Ike corp«ale ~,or oNerauthcihethn hy lhs cmporethn, muhfschiy to 0» sounh NIMpormke 0» porsrm h axeouh'EDS hrsaki corps»Non, If the corporation h nol mghtorsd Ic Ihe Stele of Ngnole, o espy cf Ihe Dedgtcals ofQcod Su»ding from the elate of lncorporsgcn mmfbe eubmgled wkh Ihh Signature Page.
It Ihe Appgcsrtt le e p rlnersMp or joint ventum, all partners ar foht vsnturere must emeute the ED8,volts cns p«incr or lckd venluro Nee been auNcrhed lo sign Qr the parlnereMP or joint venture, Inwkhh csee the p«tnersldp agreement, reeohrgon or evMonrm of arch authorNy sathkudory lc Ihe offheof Ihe CMei Prccummsnl OMcer must be eubmMed wkh this Signatum Pugh
If the Appkcsnt lc a mamber~nsged LLC ak members n»el aeeule Ihe EDS, unless otksrwlceprcvMed In Ihe cperegng agmsmsnl, roeofugcn cr ether corponds documents. N Iha Applhanl h smanager~caged LLC, Ibe manager(S) must eueCWe the ED@ The Appgeent must etteCh either acertified espy of lhe operagqg sgreemenL eeecfuthn or other uuNwlwulon, eudsf«nwy lo Ihe County,demcnekugng such person has tbs euthorgy lo execute the EDS on bshatf of Ihs LLC. If Ihs LLC le nolregistered In lhe Slats ot Ihoh. a copy of a current Corgtlcste of Scod Slsndhg fram ths elate atIncorponulon must bs cubmlned with IMe signal»a page.
If Ihs Appgcant Ie s Sole Proprletcmhtp, Ihe sole pmprlstcr muet execuh Ihs BD8.
A "Pednerehlp" "Joinl Venhue'r '8ole Pmprllorhlp'perating dmhc du Assumed Mane must bereglstwed wkh the Nllnole county In wMch It lc lcmusd. ss provided ln 805 ILcs 405 (201+, enddccumenlathn evktendng mglstratlcn must be eubml gad wgh Ihe EDB.
80S 11
SECTION 2
CERTIFICATIONS
THB FOLLOBBHS CBRBFICATIOHS ARB MADE PURSUANT TO BTATE IAW AND THE COOL TNB APPLICANT IS CAUTIONEDTO CAREFULLY READ THESE CERTIFICATIOHB P(EOR TO SION(NS THE SISNATUI(E PACE. SISNINS THE SKN(ATURBPACE SHALL CONSTITUTE A WARRANTY ((Y THB APPLICAN)'HAT A(l THE STATBMEI(Y8, CERTIFICATIONS ANDINFORMATION SET FORlH WITIEH THESE CERTIFICATIDNS ARh TRUR COMPLETE AND CORRECT AB CF THE CATE THESIBHATIJRE PARE IS SISNED. THE APPLICANT IS NOTIFIED THAT IF THE COUNTY LEARNS 'fHAT ANY OF THEFOLLOWING CERTIFICAllOHS WERE FALSELY MADIL THAT ANY CONTRACT ENTERED INTO llBTK THE APPUCANT BHALLBE 8UBSECY TO TERMINATICIL
PERSONS AHD BRTIYIESSU(LIBCT IO DISQUAL(F(CATION
Ho Parson or business onBY ohe( bs au»rued o conlrasl nr sub «mirac(, hu a period of h» (5) iisam (rom lho dais ofconvkNon or entry ol s plan or admission of pulL elvh or criminal, II that pe»on or business oaths
1) Hss been oonvlcted of sn acl cmnmmed, witkin Ihe Stalest%nolo, of bribery or s(empling lo bdbe on oNcer oremployee of e udg ot stats, tsderal or local government or school dlsktcl M Ihs stria of ltlnolc In tuel oNcofs oremployee'e oNcisl oepscny;
2) Hss bowr convtc(od by ledsraL stale ar k»sl govmnmsnl ofen ect of DN.dg ging or age»Fling lo rig hms ae doiinsdhr 5» Sherman And Trust Ac( anil Ch(rkm Ao( AoL 15 U 8 O. Secgon 1
steed„')
Hss boen cmwloled of(cd dgglng orausmpdng lo rigbids under 5» laws of federal, mr(e orlccal gcuersmcn(
4) Has been convhiad ot an ad commBled, wttNn 5» Mals, otprtoedr(nu or adempdna to bi Fricoc ss detnedby Ihesaw»en And Truel Ac( snd Ihe Clayton AOL 15 U.S,C. Ssolhn I, «t ssdu
5) Hss been rxmv(ded otpdcedtrlng or adempgny to lix prices ualergw laws the Stake
5) Has bean mmvlolml ot defrauding or sBempynp lo da(und eny umt of stale or toosl povems»nl or school dhhmlaBhln Ihe Oslo of Blnolc;
y) Has wads an mhnlrekm of gutt o(such condr»l ss set I'onh la eubseodorm (I) Ihrough (S)above whloh srbdselonise maBer ot mnrnL wi»5»r or nol such pardon or bueinsm enNy wae sub)ecl lo yrocaaullon lor Ii» ogenca oroffenses mlmluod Iol or
5) Has entered a plea of rxvu tv»tandem Io chas(m ofbrhsry, pdcovtxing, bid.dgg(nB or tmud, ar aet hath br eub.~s (1).through (8) above.
In tho ossuofbrg»ry or anonurtbrg lo brg», a bush»as entlb may notus ewmded e oonlraot 5 an oBclal, sgam oromphycem such bmhSsa enBY ccmmghm Ihe pr'obhdNS Am on bebNt or 5» buchtesa sngiy and pu»u ra'ta (hh dbhrnhm onulhodsolkm ot sn ol(her, dyne(Fr or other rncgorudblo otal o(lhe hus(naos enNy, snd such FrcHhBed Aot accurradu(thhIhree yosm tulor lo Ihs nvmrd of Ihs con(reol, In addNon. a business aaRT shag be dlaquMed 8 sn dhmer, pwlmv orshsrshotdw oenlroBng, diracay ar Indlrrhdy, bh(L or (nore ot lho budnoss sngly, or on bdlinr of dro busln«» enNy hscpar(coned any Prohhhed Aal wlbtn dvs
yearn
pdor la ihe sward ot Ihe Conbnc(
THE ApylUCANY HEREBYOEHTIFIBS yf(AN The Appccanl has »ed (ha pnwlclons ot seodenA, Parsons and EnBh»Bub)act ls Dhcurdldcalion, Ihnl Iha Applhsnl hae nol aonynldad any pmhRBed Act asl forth In Ssogon A, snd thai evvwd otthe co«ass( lo It» Appgaanl »auld not vkdste Ihe prouhior» of ouch secgon or of lhe coda
(L BID RKsQIHS OR BID R(ITAT(HS
YHA AFAL(5AHY HERBE'y OSRII(588 YIIAYr hr eooontem wyh ydd I(cs drdd &ff. ncdbcr fhe Appycsru ncr asyANystad Bgy Ia bared dern sweat of Ibh Conihsat es s nwuli of e ocnvtrgwr for Ine vfokdhn cf diets iowa~Nil.
dd piny «rsklmlaliay.
C. DRUSFREEWORKPLACBACT
THE App(ICANT rrdRBBY ctdtYHES THAT; The Apclhant wB provkle e drug hee workplace, sr requlmd by (50 ILOS dsors),
5/2015
D. DELINQUENCY INPAYN$ 5T OF TAXEN
THE 4pp(JOAN FHEREOF OERTIFIEE THAL yfw Ayolloanf tc nof «I onrmr or a pcrfy eeeeIN for Inc pspmwt ofany laror bm~by coak cnmrly by a hacrmunhheRF, or by Ne Nfcoh ospcrfmcnf of ttcwnua «blok mus tm orms hdacmtucrK contr ec birr swords(a colrmmtcr'cuossupcct prtmrnml le Ro corfu Gkeplor 05 thrtkm Npf yf,
L HINNAN RISHTS ORINNANGS
No pwson wtw lv a pwiy lo s rnnlrsct wkk coak county ('orcut') eheN on0a0e ln unhwkd rhutmlnatlon or csmml twnuum estauehsl any Indlvkluel In Nre INns or oedidonc of emphymsnl, orodN, pubNn srvmmmodstkmn tlouctns, or provlskm of GovnlrhcENee, cancans or proprsms Icode clmptm 42. Eecdon 4240 st aatf).
H
ILLINOIS HVNAN RIONS ACT
THE APPLfCAHT HERESY CE)IN FINE W4tt 5 m N coutuymtpo wtR Rs Nbmfc Human Rhkh Ard (FFN f(GN ary rdkt, andsprees Ih arkmiiymsmdubmuwh affiio Act ac part ofyeconlrecfusfobNFNhna
INSPECTOR SENNRAL ERICK COUNTY COBL CHAPTER 54, SECRON 24 1T4 and ScsNas 84850)
The Appltmml bee not vdtEdty keyed lo orwpwme h an kwac50adon by Nw Cook County hdsysndsnt Inspwcor sensmt or Icrepnn lo um Independent Inspcmor Oenwsl ony snd aN InfcnnaNon oncernle conduct wMch Ihcy knuu to hvolve couapuon, orother wlmkml accvky, by enolhu county employee or ottctcl, wkloh oancems kh or her ossa el amploymem or cvunh relaledImlweckon
Tbs Appkoenl bas mpwted dtuusy snd wkbaul mur usdrm delay arly suspected or Imown kcudulent aolMIy h hs ccuntycproheamcm procom to he GSco of the Cook Cmmly lwipeclor Omwmt
CAINPAISN CONTRIBUTIONS (COOK COUNTY COOL CHAPTER 2, SECTOR 24INN)
THE APPLICANT CERTIFIES THATr It bac lead snd shell comPly wSI Ibe Cook Counlyc Gnttrwnao concamhp camps(0nconkkruNorw. which lc ccdEsd at Cbspler 2, Dtvhhn 2, Bubdlvlchn Il Socfon 605, aml can ba med In hc ensely stwvtvrmuntooaa.calli,
SIFTBA05 (GCDK coUNTY GCDL GHAPTER L sscTICNhdyd)
THE APPLKIAHT CERIIFIES THAT: tt hsc rand mrd sba5 comply wkh he Cook County'c Gwhsncs conosmlnp vcaivh0 sndcoiicEnssms snd Nvom, whhhm codi5ed at chapter 2, Dlviskm 2. NuhNvhkm N. Semimr NT4, snd osn bc read h th onhety at
LIVINS WAS E ORDIN ANGE PIIEFSREN GE (COOK COUNTY OOPS'HAPTER 04i SECTION 00HNII I
tkdom mpmccty wslvml by Iba Cock Govnly Board of Cmnmlcslonem, Ibs code requires thol a NvtnN uaNs muci be paid hkvdvtdush mkpteyed by e Gonhwcor vdrtch bsc a County Ctm tract and hy oN subcontmchm af ecch Conkacku tmder a countyGonlrecL Itummbout Nm duraNcn of such County cmamct The amount of suck svktu ways lc mriusily by Ihs cbhf Hnsndslcmcer of ms connh. and ckaNlmpm tsd on Ilw chkd pmcurarsent DINcervr wsbsks.
The hrm vctmksof'e ucsd In Baoson 4, L of Ibis EDs. apadcoeky ernkukm conimcic wkk Nw hNucbrg
I) Nobpor PmN Orpanlcwone(ttsNnsd ac aomporadonhmdnN tecmumptshhrc umhrSemon NDI(Ggl) ofdw UrhadNhle lntemel Revenus code and moapnhod unior Ibe @noh Shts noir prolil lank
2) Comnmnky Dovetopm«N Stock Grants;
0) Cock COUllty WelkcOopwlnrallt,')
Shodffc IHodr Aksrnshm Program,'and
6) Department of comccsm kvnslsv,
EDSC 00010
SEOTIOS) S
REQUBSED DIBCLDBUSIES
I, olgctogURB of'CBETIBT OONTAOTB
Living persons Ihal have mode krbbylng conteote en your behag whh mspscl lo Ihlc eontmck
Nome
None
Aodmcs
LOCAL BUSINESS PREFEIISNOS STATBUERT IOOOS, CHAPTER UL SECTION Sc.kgo)
Loccr nosrnccs meenc s pwson, inc%fits a foreign comweyen aulhorbed lo Iransad huslnsss In ggnob, tuwlng s acne sdeociebgchmenl hnsrtnd wghhi iho ccunly al vtdch Il Ic trswmcgng bucinurw on Ihe dele when s Bkl Is subnklsd lo the Coway, and«mcn entlso)o gm msprdty of he regular, hs gme work Iwos wgmn II» counly A Jtbu vmmuo shag cenrmule e I eml BusInws If one«mom pmsons Ihsl qusgly sc e "Looal Bvskmcs" hoM lnlwsels lotegro tnwr SO penuml in Ihe Joint Vmswe evan Bum Joint venusedoes noL sl gw Ume ol grs Bid submmel. leva such a bone Sds mrtabllshmenl nigdnilm County,
a) RAppikwnisMa9Stwkmcs" endsgnsdabomy
Ymr. Ncr
b) Syec, Sct business addressee wlgrln Cook Comdy
ONSIDE wss7 ISkr/ S~Qi)FMiapryA. WJ'.. COB NS
/to /Ip:7kvctrscx AoE,
ErM.rduyrf IJW .MJ.',dctycrky )o) Coos Appilosnl employ ine me)ority of Sc refpdsr SUHlme woNonw wghln Cock Cmmlyy
Yeu
g. TNB CNBOBIIPPORT BNPOROEUBNTOROIRANOEIOOOB,OHAPTBR gq,ssovtowssdyg)
Every Applksni mrs County prlvssgs simp be In lug compgcnce wgh sny chad supptm mder bofmu such Aypgcenl ls enlsed to mcehe ormnsw e county prMsye. Yyhsn dsbrquwn chid support mmls, the county ~ lmg nol Issue or nmew my counly privgego, end maylovdm eny Oovlty Prhgsge,
AU Appgcenls svo mqulmd to review Iho Cook County Astdsvs or Ohsd Suppmt Obsgasens swashed tb ihb BOS (BO84) sndcomplete tlw AShfmdL based un the hunnwUons in ttw Aidavlt,
S@l)S
4, REALESTATE OWNERSHIPDHCLOSURES.
The Annlkurnlnnml tndosle by cheddss Ers eppropdale pnwlekm bohr« snd pnnkdnd sll requsod lnbnnsdrm Ihnt ellhsn
a) Trm Rscatns h a coaudeta Ibl of ed md esurto ormodby Bm Applknud kl cook countp
PERMANENT INDEX HUMSRTRSE
(ATTACH SHEET IF NECESSART TO LIST ADIEHONAL EICRXNUkMERS)
b) The Appucant owns no msl oslatahl Cook Coonkl.
6, EXCEPTONB TO CERTIFICATICNS OR OIBCLOSURSS.
Il Ihe Appllmmle unable lo osnlly Io any of Ihs cerNlcallons or any other sfelem«us «mlalned kr Ihls EDBand nbl esplalnsd ebswhore In
Ns EDB, Bm AppkcentntustanplslnbeI«m
IfNe Edam, 'NA; Ihe wed 'None'or'No Response eppesm steve, or Elbe apeos blankbook, R wlllbecsnckreludy preaum«r dmt Ihe
Appdosnl cerBIedlo sll Cerdsosllons and olwr stmsmenls c«dsSrsd In this EDS,
NEOIB
COOKCO(SFFY DtSCLOSI((IE OF OWNERSISP S(TSRESTSTATSIAEbtT
Tho cook county coda of ordlnonoos ((8$10 et eeu.) rrituhm Ihel any Appllmnl Im oay CNnty Aeden mml dlsrl«m IrdoanNon: . 'mourning ownsmhhr hlonu« ln the Apptkmnl This tfaetsaum td ownmshIP talon«I dortarnam nm«be on«pleiad wkh ollInfer«see ourrmu ee or Ibe data dds Statement Ic stgnsd. Puukannomr tkh Sthtamum must be ksPI euhesk hy ISAP bn aa«agedstuttmunl, unit such dme ss firn ccwnhr ttorud or county Agency shay iako aNon on Iks oppllosgsn, The hunts«lian oonlslned la'kta ghdemenl ws bs malnlatned In a du«base end«ada smhebm 1st pubde ulowbrta
g you are asked m grt nenes, bul Ihom «e no epplkwhle names te lbt, Iron eu«t amia klDNE. An Irocoagteta sfatemenl ns beretumsd oml eny sudan rroanpns thfo rtnrura«ws bo ustayruk A wuro Io fuyy e«sph'of lb the mdkumoe may mauk In gw ames
I
«boll by lire Callrdy9erlrd er Coullly Agerlar bolrlg voided.
Appyoenp mam« eay Enyhr or neman madnp en epptoatkm lo so county for any comfy Aeon.
toe«rty Astern" aw«w any saNe hy a caunly Aganny, a coualy OpaatnusA «Bw county Bomd red«thap on anhnance orordinhnae ~s county Bo«d appruuat, ot olhru cotmhf agency appmwrk uhh mapeol lo eontnula, lessee, or sale orpurehses of mal arista.
'Ipureon" "Enff(rF or segaf Baldy'ne«m a ante props«semis, eeq«tauon, amino«ma, oaaoetattos, burbuas Inwk relate, Iua ormom persons kmdnp a Ielnl or con«um hrlereul, trustee ot a fond lmsi, other commatolef or tepid enmy or any heneflol«y arhorn!lie'e! ries go«ok
This tuadoawo ol own«atda Inlererl his«ream must be aubnolad by'.
I, An Aw4oant for County Aolhn end
2.A person llral i«ma stook or p henahdat I«areal In ihe Apphmnt sod ls titled on ho Ayplhaal'a lst«nenl is 'Hrtdsr) must so ssmtaswnl and osmykdepl r«ly under ownership Internettooot««tea.
Fmnae pdnl or lyps mtpomm d«uhr and hhlhty Add eddhlonal pages If na«ted, babe asmful lo identify each parton ef llm lonn mi wmeh esoh eddt tanrttrsge refer«
Thin huriernenl le being made by the I nrrr ( All pyoanl or ( )~al Inkmrsl Natu«
(4)odgftwi Btetamamor ( ) Amandadgtat«nantThis Blaienlentlo ml:
Idantgylng ~'rNa«a AODSOd (Oduatrfnt TOOIIOO(OOIOA. IOO.
DIBIA; FEIN Nofddm 5AAT FOUR D~3441 17428
Street Add(at«4843 Wont TSSSI Stroet
cits (:roattsrood Stat« IL yfp Coro; 80445
PhenaNou 78>~ 1237 ~sxuumhoy P()8) 889.1821
Dank County Bushmen Rapt«rauon Nmaben
(Sofa proprlruor, Jstet Vali lorn Penn«ahhr)
On«urete Fya munmer df apNrwbtek
Pare of lapel Engty.
( ) Bole Pepptater ( ) Pains«hip
f ) Business )turn ( ) Estate
( ) Other (des«Isa)
con«milan ( ) Thw«s of Lend Trrm
( I noae««tun I ( Joint tranture
ASOIS
File Number 5922-460-3
To all to whom these Presents Shall Come, Greeting:
I, Jesse White, Secretary of State of the State of Illinois, do
hereby certify thatAPPLIED INDUSTRIAL TECHNOLOGIES, INC., INCORPORATED IN OHIO AND LICENSEDTO TRANSACT BUSINESS IN THIS STATE ON JANUARY 16, 1997,APPEARS TO HAVECOMPLIED WITH ALL THE PROVISIONS OF THE BUSINESS CORPORATION ACT OFTHIS STATE RELATING TO THE PAYMENT OF FRANCHISE TAXES, AND AS OF THISDATE, IS A FOREIGN CORPORATION IN GOOD STANDING AND AUTHORIZED TOTRANSACT BUSINESS IN THE STATE OF ILLINOIS.
In TeStimOng Whereef, I hereto set
rny hand and cause to be affixed the Great Seal ofthe State of Illinois, this 11TH
day of JUNE A.D, 2008
Authenacelion 0: 0816301820Authenticate at: http: //www.cyberdriveillinoie.corn
SECFIETARY OF STATE
BOARD OF DIRECTORS
Peter A. DorsmanL, Thomas HiltzEdith Kelly-GreenDan P. KomnenovichJohn F, MeierVincent K, PetrellaNeil A. Schrimsher (President and Chief Executive Officer)Jerry Sue ThorntonPeter C. Wallace (Chairman of the Board)
OFFICERS
Neil A. SchrimsherThomas E. ArmoldTodd A. BarlettFred D. BauerMark O. EiseleWarren E. Hoffner, IIIKurt W. LoringChristopher MaceyJody A. ChabowskiShaun S. McElhannon
President & Chief Executive OfficerVice President-SalesVice President-Acquisition & Global Business DevelopmentVice President-General Counsel & SecretaryVice President-Chief Financial Officer & TreasurerVice President-General Manager, Fluid PowerVice President-Chief Human Resources OfficerCorporate ControllerAssistant ControllerAssistant Treasurer
Applied Industrial Technologies, Inc.I Applied Plaza
Cleveland, OH 44115216-426-4000
Ownership Inteumt eeolsrsdon:
l. Lfet Ihe name(e), addmsu, and pmeenl ownemhlpof each Pmaonhevlnp aledsl or beneldslhdomal(lntfudlrty ~)ofmore Bran Nve peroanl (6%)In dm AppyesnyHolder.
stems
See attached
2, If ths hdammof coy psmon yamdln (I}above le lmhl se sn spent or ayonle, ore nominee or nonmeeu, br(the name end
addnuv of Ihs pdno(ml on whose behalf lhe Inhuosl le hehL
Stoma of Ap flfoadnm Name of Rlndpsl Prlnulpsfs Addmas
NIA
ls Ihs Appyumt oonetruolhmly oonhuyedby another panmn or Loyal Enllyv ( ) Yes t urf ) Na
lf yae suds the nmns, sddrom and psreanlede ofbanabdal Inlomel of euoh swoon and the rehaonahlp under whbheuuh
eonuul la belay ca nmy bo amrabed.
Pmosnmge of Itelmlonehbraensyulal Intwuel
corporafs oalrmm, Numbers snd parlnam Inhuumeon:
For sll oorpordlanv, Nd Iho nsrmm, sddmmaa, snd Ianna for aN oorporsls oaowa. For all Nmllod Nablllly oampanlee, Net lb a nanme,
addresses for el mambos, For all pmlnmshlps and(olrdvenluma, Ital the names. oddraaaes, for aaoh pomml or)ulnl vsntwa,
ttwne Addreao TNa (epaayy Nds af Tann efOaueOboe, or whilhsr menteuror parlner(foun verdure)
See attached
beeluradon (obeah the appaoebla broth
I state under oath that Ihe Appyosnt has wbhheld no asdosum as lo ownmohlp Intmaet In tho Ayphmnt nor reserved
any Informauon, date or plan ae lo ths Intended uee orpvrpmm lor whbh Ihe Appyosnt souse oowdy Board or other county
Apanoy audua.
I state under oath Ihat Ihe Hokmr hue wyhheld nu dbdoawe se to ouvuuuhIP Inhram nor muenmd any Infarnmllan reuulred lo
bo disclosed.
EDB.f I/2OIB
Beneficial Ownership of 5% or more Applied Industrial Technologies, Inc.Common Stock
(as of June 30, 2015)
Royce 4 Associates, LLC —11.0%745 FiAh AvenueNew York, NY 10151
BlackRock~ Inc. —8.9%40 East 52" StreetNew York, New York 10022
The Vanguard Group, Inc. —6.8%P. O. Box 2600Valley Forge, Pennsylvania 19482-2600
Neuberger Berman Group LLC —6.1%605 Third AvenueNew York, New York 10158
Applied Industrial Technologies, Inc. Retirement Savings Plan -5.2%c7o%ells Fargo Bank, N.A.901 Marquette Avenue, Suite 500Minneapolis, MN 55402
COOK COUNTY SySCLOSURE OP OIIYNENSHIP INTEREST 8TATSINENT SSNATURE PANE
Tom Armold trios Presldenl
Nsnuoofrrmhodrod nsprSrmptssvo fplssss print w typo) TNe
9-ZS-~ay'f'.Slprfshrm Dote
236388sppaed.oem f703) 339-1237
Eunsy sddmss phone Number
Subsor3isd lo snd sworn hslors rnnthls~doyol ryrsru,20 rf
„gc ~Z 'l5wosLNotruy Publl
Ny oommlsshm rurplrom
Nstsry Seal
'iANNE P. MISENKO
')"llctary Public, State of Ohio
My Commission Expires
o/ November 7, 2017
EPSut er2016
COOK COUNTY BOARD OPRTIIICS60 W. WASHINOTON SI'RBBT, SVI'I'B 3040
CHICAOO, I(.L(NOIS 606023(2/60343040/t(cc 312/6004(000Fex
P40(lllAL RSLATIONSHtP DISCLOSURR PROVISION
Nsnstlsni D(re(santo Reautrsnisnti
Doing s sly((geom anmvsi of business with tbs County rc(tubm lhst you dlselase to the Board of glides ilio mtstwies of soy dbml liatrciislonshlps whh sny Coun(y amph(pm or niiy person hohgng c1eetlve atgm In ilia Stats of Ighwis, ilia Comty. or bi anyinuiimlpsgiy whlds tlw Coimty. Tko Bthtcs Ongnanee dafhtm s slgnifioan( smcunt of business Ibr dw pwpose of (his dbdoswcmuulninwa i m mom (lian 023 000 In sggmgats County barns, oontrmts, psrehssos sr solos tn any eahndm ycsr,
Ifynu am umum of wlwker tho businsm you 44 wlib gw County or a County agenoy will emsi thb (bmshold, ew os (ho sids ofcsmloa by completbtg tlis suselws Bmglal dlselomm Ibm( barnum, among otbw potent(41 penal(be, my pwmn Ibund gugty offsglag tn maim s sauulrsd disdosmo or hnowingly Sling a Ibbc, mlsicwgng, or h(complete dbshwmo wgl be pmhtbkcd Som doh(gany business whh (be County lbr a psrhd nf (tune yosm, 2tw rat uired dlsofsswe should bc t gad with 4m Board of B(h(m by tmumy1 ofcadi ca(andi year iu wldoh yrm am dohig business wkh (lw Couaty aml egebr with each I hl/S(epnsst/quolallm( lo do businesswiib CooL Coamy. %» Roan( ofSt(6m may strew a late Bib(0 tbe of0100per day aileron in(tint 30dsy gmoi Iicdod.
Tbs pcmmi snt b doing trna)ness with dw county mum dlsokee his or her Ibmslal telatlonshtps. If(he pcmon on the coumy barn orcontract or pmelmdng Som or caging to (lw Ccmnty hr a buslaem entity, thea the buslnem eatlty inde( dlsolose tlw Bsiillalmist(mali(lit ofSrs tudlvldmls wlw are nod, during tlie year prior lo doing 0mb(css wttb tho County. uwm
~ its ISO(d ofd(imtoms~ I(s ofgesna~ Iu cmplayses nr indepclidsid mmirseiois rmponsgds fer tho genera! a4mlnlwraiion of ibe entity,~ iti agcms eutlwrisid io execute docurmnts on bdmtfof the entity, asd~ lti en(ployccs iviio dltseiiy engsge or engaged ln doing wnrh with tlis Cuunly on bubelf of thc amity.
Oo not liadims m cmnast ihs Board ef Btlilcr at (312) 6034304 Ibr emlstmso ln dsiennlning Ibc (nope of suy reaulrcd Bmgislreisiionibtp dtrdosme,
Addi((snot ttslMllsnsi
"/mni/ic/ retmtcmtdyr" nicene a pars(m who h s spnuie, domes(io per(no'r oivg un(au psr(ner of s County eniployce or gm(c,Coo niy or oiustcl psl oNolsl, m'0 yemon wlm ls related lo smh nn employee or umelat, whether by bhmd, inc rdsgo or adoptkm, asai
G0CI0
SisterAunt
UneteNieceNephew
Q Pilrcili0Chihl0SroilicrCIa0G0cj0
Onmil(mien(4hxmicMldI'sihcrin laiv
Idogtcsln.tsw,Son (n-tow
Dough(eshulaw
Broihm ln-lswStets(du-Isw
0DClG000
Smp/ether
StcpmolherS(e porn(
StcpdaiisliterStepbrotherStepsisterHalfbro(herRalfslsicr
0/20(0
COOK CAIUNY BOhRD OP ETJNCSPAJSILUIL RELSTJONStftp DJSCMSURE IrOJtht
A, PRIISON DDJNU OR SRRRIIVU 7YI DO BUSINESS WPJR TER COUNTY
Nsmeef pemmDolng Bustecss with ibe fhiunhc huphsos Jndueuchnt suotmohogsos, lno.I
Addecmufp¹cecthdrUEndncmwilhilwcnimtf; s«s neet teach scceot, uceatuceh, xs esses
Phoiwmnnb¹ ofpewon Doing Business irith Itwctmmy; ivoc) Ise.sssv
miiag sddwia of I'eruct Dsbm Bmlii¹ts with Itic Coiietyi 286~A4mlf Pwwm Doing Budnccs with ihc fksrnty N a Ettdnem Entity, pro@Me lbo esnw, title and contact lnformsgon ibr itis
iadNhhwt ceietd¹tirg ihisdlmkesm on bdwif ofthe Penmn Dslrig Senlmnc with Ilw cow sy:veu Awsstd 'lilac ecessdwil, ~vao ses 1M7
B, DRSCIUPTIONOIISUSIN¹ne WJTU TUII COUNTY
dppeededNrhmsf psgw ei carried midytr r wed coe0'osse soetmcs pssuharn erects rendhr ember char hwri
deitim dw iufewhs'pae'tfrhh rysekuwre (or ihs pnweeding iwfsrefsCwer ffdfrefrwwu fr uwdr ee,lsesery I),Ideerkrw
'lhe hmmnuinbor, coskatd aumbct, purobme order number, resuwi for prspemt nemlw andfar r¹tumt fsr qusligcetion
nunSmt assooist¹l wiih Ihehucfnew yeu am doing or seeking Io do etlhlle Oounty:
'llw egscgste ileger vnluo of the business you em doing or soaking Io do wldi ibe County, 6
Tho name, tlilc a¹l conte¹ ingnnmtloc for tlm Cmmty otgofst(s) or~c)invoiv¹l lu netpchutns its business you arc
doing or sacking lo do vdthdw Csestty:
Tlic name, this sad csnisol tnfeeimlkui tur Iho Copety oSalsl(s) nr employee(s) iuvoivwl in mamglug Ilw bminow you mc
doing ormddag to do wlih ibcCounty:
C. JDSCfdISUIIR OKPAMILJAL Bgt,h'llOIISIUPS WJTRCAUIJTT RNPJAJPERS JIR SThTE. COUNTT OR
linnwcsphL RLBcrRD INuiJCIA Ul
Check rhe h¹r ifwr sppyar e¹dprvvfde isleted SIBremden whwv rcrrd¹f
0 The Peme¹Detng Dvslneii vdlh S¹Dmssy N en kugvtduat sad tbsro le us familial relationship bsiwoin Ibis iedlwdesl
swl miy Cseh Gaumy ¹nptey» or any pcr¹m hotdhg elective o Slee lu dw Shso eflglnois, ceok One ay, or any
nmnldyelhy within Cook Cmauy,
E Tbe pieseuUoingBusiusss wEI Sw Couniy to n Imdnsw audU and Stem)inc tenrSat rehmmihlpbmwewt say m¹nbw
uf t lib bsrhwss asflty's lead ofdlwotem, oiBse, pswons reihohdblo thr Scuemt aibnlnistnuhm ofebs bruluws enthy,
egocts euthotlsed to esaeuts d¹mments on heliall'ohho hudlnum onlliy er employees dlnmtly cngsgod In coiwsstusl work
willi Ihe cswffy enbshdli'of Iha bsslness estity, nwl any Cook County empkttnw or any psrsonhohgng aleellvo ofsco la Ihe
State ofBliesis, Cook County, er any ieunldpMky cdgdu Cook County.
SOS.IO SI26ts
COOK COUN YP BOARD OP BTIIICSPASI ILIA L RELATIONSHIP DISCLOSURE FORM
0 TlmPmcon DoMS Business with the Coonty Ie aa Individual and Btere ls a familial relsBasshlp between this lmllvidualsnd al learn ene Cook Cooniy mnptoyue su 6/or a pamon or porsonc lmMlng a/sot/vs oBice In dm Stats ot'llinois, Otmkcouniy, end/or eny nmnlclpagty within cook county. The familial rdatleiwhltm ars as folhctwt
Nasm sf IndMduslDcl»aBuctssis irlih Ihc Camey
HsamoffmlmcdCeimty SblemiJposittonofnebmd Nstumofl'smll/slBIIIPkncsor gian Coiiiltysr Cmmty EumbtpmsrgtmnCocon'ckuhasbtsMtmtclpal Slcmmt Otticial or lilsslclpsl ElrcimlOISsisl
ffstmu spine R ssmbt/, sr/rs'h sii io/tdvmm/r/mr/ fot/etrbtg /Its sharc fmstN.
The Pamon Doing 8 imlncss wbb the County ls a bushtem ssgly and Ihors Is a familial rchtdsmcMP between at leml oscmctnbcr oftide business malty's bmud ofdltcolms, oNoem, petaonc esponslble Ibr Ssneml edtnlnlslnakut of the buckramentity, agents euthorhad lo enemas doeinnents mt lmhalfof Ilrh bnslnms entity snd/orenipktyccs ifnmlly ensttsed loooeuaenml mark wllh the ctmnty oa beNilf of the business entity, on deans hemi, end nl bmw one cook County employeesnd/ore pmson lmldlng ctectlce effiee M Ibe Stats of illinois, Cook Cntmty, and/br any tnunMpsllty within Cook Coamy, mithr other. The fs mglel rahtBonshlps are ss fogewm
Nmim ol'Nembcrof Sorelct'l)lmcaulbr BcctmmSsttty Dc/us Itcctssss mlih
tlm County
NmscefRclclcll cocsiy Stirs slllt I'eclttsll ofRetund NismsefRmlgtlitlimpteymor Sma„Demur or Cotmty Pmployce eigtmc, Couiuy RohdemblpMuntctpct BhmcdOBNct nr Mcstcipst BhcmdOMsl
Neinco/0/Bier for Ilm/nsm Name ofRelated Couaiy Ytttesad pcultlsa o/tissues Nnnmo/fsplllolfmtltyDolssbiirtccmvdth Smplctcmorstcm,ccuntyor Cauntygniploymorsaue,Bourns Belctloswlpiim Dimity Msetclysl /heated Oatctcl or Munhtpst Fainted INBclsl
BDS 11
Nstw nfl'crms aennnrlhlc Name ofgeletml Cawb Tgle md posltlmr ofgslalsd Naimeof yainglsllbr tin Oensml Hmpkgw or slav, cwstyor csumy Hmploiwor ghm, cntmty ReanlmshlpAdmlnlslnnkmof the Mmwipal1!betel Qdlclsl nr Munieipsl Htertrd OHktalRllslacrr Rlldty BchlgHurl toss udth <lm Ocusty
Nauru af Agent Augmrlsnlm Hseouie tlocumams ihrBmlnees fmthy BeingBushwa rrldr the Csurnty
Nsms nf Reland Ccmrly 1'His sad Pnsllkm ofRchumlRmphswmtnsshcnmuyor county gmsloyceersnda, cuuntyMmdctpat Btecmd 0IBelnl nr hitmlohml Blaulul Qlgrtel
Nsuw ofyuuHlcllie kuonthly
Name ot'Hmployss ofHeslurm prllgy HsmetgBltgsgul In Cnhg Bsstscmudlh the emmy
Name of Itdesnl IMunly Title and Inotgon ofkehscd NauwsftkmdttclHmtdo)scar gtluc, cwntv or cesnly Rlitplommsr gtme, Calmly HetmtnsrtgpMuntdpel Igcctcd Ottlsinl or Municipal HlecicdQIHslsl
(frnorv sprees lr needed urlm0 ns urkgrionnl rhcellhffmrhrg rim uhorofm mar.
YBRIFICA'I'I I 'I'o tin baal ofury kntueledga, Ste lafonualtmt I hgvo prov)dad on 8th diss)came Htmt la scoarata mid cemphtn Iackn I oninaoea or Iscomplete dlselosurs Is punhlmbls by Inw, InolmHng but nol Harited m Htms end debannenh
/gigllflfurc ofReclpielll Dalo
HUBhf IT Cnbdpl BTRD Fo)thg TOr Cook County Board of Htkloa
89 Was) Waahlngmn Street, SuHs 3040.Chicago, IStools 80402CIBce'(3I2)8034304- Psx (312)403-9988Coo kCouhtydghlesecc okcoon tylhgov
'p etna, duntcrtla panner, civil unton pmlner or pa rani, chikl, slhBng, mmt, 1~toto, niece, nspltmv, Hrwdpatent or gmndoh)ld
by blood, tnandsgo (I.r. In laws and step mist)one) or ndoptkm.
HCS 12 g/8018
SRGYtON 4
GOOK COUhryy APFIDAVyy FOR WAGR 222Rtry ORDINANCR
Blacum Mvy I,mrta, every ponwrk avasvwnr sunvwnnw cwvam caoglng o caahakl usl ccvh coumy mud WNnalv vdh Ula cash comfy wage Tlwhtudkwnm vw INh In chaslvt 04, Ardno w, svcneh Trs, Any pwvonrthawlwlht caner wha 8th lo owapty vml Coak cwnly vlmgo Than odlmae4.may mqvon Ihal gw chief Pmvuwnwnl cmmr drmd o redmgoa crwolmr m sqrwdaww vdtl Uecien 24 Ifqpg,
'contmol" wmm my Iwhlwl dotallwll to nuke pro owwlwlm by w 4n hob dt 4l cwh covmy
"polar vr mews any muwdml, oorponmvn, panawehlp, Jofnl vwauw, trvvl, evacclalkw, Uwthd Ihbsly company vote smpuohwhlp a ogmrla04I easy.
pmcwwnnlr llworn obldelrls oufpgm. lÃpanvwnL Uacs, w swvrcm of eay kllui
"aosvtoarfar Oouop rrwom arri pllwoa 4l paw ella who own lu how ~ leaatydm plucwd 125%) or moro porcramsa cf Irmnlel Io ew bm(mm INUIU
seeking s county prhdoge, Inuvdwg lhasa shareholders, Uanwal er imqad pwhwm henegvhdm and pumlpahl ogcwu wkwa 4 hwunssl eollhr Ia snkrdvsmt credo pmprwbmMp. Sobwansoi Own'or meara thai Iruhddvd or ade smtvbuor.
All pemcnSubeuaN t}wwra are maubed lo coowlsw em esdadl and wuvply vnh ma cool ceunly wage Tkoh onhnvava bafam ony ormrecl Ivswarded. mpwove of Ihh Iwm eonvghaas s ceauwslkm Ihe mlbmmhm pnwldod bvlaw Ia carted wld vcmplala, lnd mal tlw Inmdavragn aqpaw Iah kwn
,lwvnwmuarwwefmwvdedoe of vuvh Mfonaallon.
L Couinmt hlforend font
Contmcl Numlmn 1330-12748
Counly LlslhUAgenoy (mquesgng Pmmaameng: Cooh County
tt. paluoamuh4iohhsl cwlml hddrmsqonl
Person (corfvunm UnRy Namo2 Appiied tndustrlat Technoiogles, tnw
Subalongsl Owner Complete Norns:
PEINU 044117420
Date oi sldh;
Weel Address: 4843 Went 138UI Shee(
Chy;
Home Phone QQ5 388 1233
Uunsg address: 2358appged.corn
Sifnols
Driver'e Uoense No:
Zi'0445
Zlix
RL Comphanee whh Wage Lees:
Inshln the past Rm years hss Uw Pmmmfsubslsnusl owner. hl eny fudkdsl or admtnkwegvu protwsrsqk been csnvlomd of, mdered aplea, made sn asntsshm ofUuht or gabwy, ar hsd sn edndntstlmlm Undlng mode far commtmng a repealed or wflff'uf vtotsikm of wly ofthe tohovdug knur.
Ffkroh Nhpe pafmenf and cupockn AOL 020 ILcs t fdrf et sag„TRU MAN
UWohhdnbaunr vvbga AIN,0204LCS tddff st eeq. YSU~ffsroh b&rhw Adrrmmlwrf end ftolmfabrp Norfposdan Ael, 820 ILcs 05rr et asq„YUs or~0
Umpkhvm CIOOONvatforv AoL SSUILCS 1Udrt et swr., YSU a~NO
Pafr Lahvv Smndanfa Acref fpgtL 20 LLS C 201 et mvq, YUU op@Any ocmpembs etsS ststufocr rsgrdatkm of lmy slsfe. whfoh gcvanw ths payment ctwages YUU o~o
U Ura porscnfglsalandal owner annawwd "Yes" lo any of itis questions above, 5 le megglbto lo atder hdo n ccntracl whh cook
County, but canrequssl a reducdon ol vwdvw under UeeUan RL
008.13
IY, Seqmw(for byslvsr sr Ikerbmkon
y puwontsubalsnllsi ownm answered "Yee" lo eny of Ihs qrmssons above, k msy wquesl s reducbon or waiver In
oaootdsruw wlm ssodon yo-I 70(d), provided swt Ihs request lor mduoyon of waiver li made on the bmla ol one or mors otIbs fupowlny mkhtw ibm bsvo tenon pines;
7hom hao hoes e Dane dds chenve kl ouluudtyr or owurrd ot lhe Ineyv@w Rsmon or suborn& ownerYddo kto
otavtvvruuy eolkur has Dean taken epelnrl sa kupvktuat(of eywekrte tor Iho uob dhtnv des lo me vwlevonYSSorhto
Renal orulon lrsa hnwr taken lo pwvuru a wourwnae 01 Ihe mile klukrv rive lo the vmquapkoepuo or dotardYiPS svHO
Other(sinew Ihst the perron or Suhotenihd Owner babws em mlevenl.Ykkormo
flic pemonkudrmanvsl owner mesr uukuvr doouuumtedan lo euooou Ihe haste ol ke wauaot lar s whuukbn or welwu. The osier~renrenl omasrroeeniao Iko nant Io make audktonat kwnwee end rauuesterkksuruuuoouinantsdov
Y, Alymmyontbe pewonlsubalnoll~st osm tdiylmw Ihal a+pstemsats wmtolnsd In the Aipdsvk nre Ima. souusle and complete.
Slkeabuo; Orna 8- w 3- SIO/4,
Norns of Pmoon olgnmk (Pdnfh Tom Annold Vina Prssldrmt
,&Submdbed end aw below ms Ibis GRAN dsy of /77~/rt PO / (-,K
fsolaru pubsa slsnetum tdotary SealRom r The akmw htXrma lion le eugeet to verftleetlon prior lo the awont ot@sOonhuot,
DIANNE P. MISENKONotary Public, State of Ohio
My Commission Expires
November 7, 201 7
SOS.I4 kikety
SECTION 5
CONTRACT AND EDS EXECUTION PAGEPLEASE EXECUTE THREE ORIGINAL PAGES OF EDS
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 Officer in
writing if any of such statements, certifications, representations, fade or information becomes or is found to be untrue, incomplete orincorrect during the term of the Contract or County Privilege.
Applied Industrial Technologies, Inc.
Corporation's Name
(708) 389-1237
Telephone
Execution by Corporation
Kurt W. Loring x.
President's Printed Name and Sigfture
Fred Bauer x.
Secretary Signature
April 18, 2016
Date
Execution by LLC
LLC Name *Member/Manager Printed Name and Signature
Date 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 Signature Assumed Name (if applicable)
Date Telephone and Email
DIAhINE P. MISEhIKO
Notary public, State of Ohio
M Commission ExpiresY
i r r 7 2017
day of Anril, 20~.My commis5lw'eRNprsm
Notary Public Signature
*Ifthe operating agreement, partnership agreement or governing documents requ ion by multiple members, managers,partners, or joint venturers, please complete and execute additional Contract and EDS Execution Pages.
EDS-15 8/2015