D i sc l osure Summary Shee t

Con t rac t (PO) Number : C029725

Spec i f i ca t i on Number : C968990037

Name o f Con t rac tor : PATR ICK ENG INEER ING INC

C i t y Depar tmen t : CH ICAGO DEPARTMENT OF TRANSPORTAT ION

T i t l e o f Con t rac t : PN84CO29725 PROFESS IONAL

(Term o f Con t rac t i s no t app l i cab l e )

Do l l ar Amoun t o f Con t rac t (or max i mum compensa t i on i f a Term Agreemen t ) :

$4 , 543 . 51

Br i e f Descr i p t i on o f Work : PN84CO29725 PROFESS IONAL

Procuremen t Serv i ces Con t ac t Person : User Convers i on

Vendor Number : 1040749

Subm i ss i opEPa~eo 2003

JUN 10 2003 10 : 04RM HP LASERJET 3200

Spec i f i ca t i on No. : ( - g to $ ° ) ° ) O ( ) , 61

ADDENDUM TO D ISCLOSURE AFF IDAV IT CERT I F ICAT ION REGARD ING INTEREST IN C ITY BUS INESS

Any words or t erms tha t are de f i ned i n Chap t er 2-156 o f the Ch i cago Mun i c i pa l Code have the same mean i ngs

when used i n th i s Cer t i f i ca t i on . Comp l e t e BOTH sec t i ons 1 and 2 .

In accordance w i th Sec t i on 2-156-110 o f the Mun i c i pa l Code o f Ch i cago :

1 . Does any o f f i c i a l or emp l oyee o f the C i t y o f Ch i cago have a f i nanc i a l i n t eres t i n h i s or her own name or

i n the name o f any o ther person i n th i s con t rac t , won t , bus i ness , or t ransac t i on? X No .

Yes .

I f yes , i den t i f y the o f f i c i a l s or emp l oyees hav i ng such i n t eres t and the na ture o f such i n t eres t :

2 . Un l ess so l d pursuan t to a process o f compe t i t i ve b i dd i ng , no o f f i c i a l or emp l oyee sha l l have a f i nanc i a l i n t eres t i n h i s or her own name or i n the name o f any o ther person i n the purchase o f any proper ty tha t ( i ) be l ongs to the c i t y , or ( i i ) i s so l d for t axes or assessmen t s , or ( i i i ) i s so l d ' % v i r tue o f l ega l process a t the su i t o f the c i t y (co l l ec t i ve l y , " C i t y Proper ty Sa l e " ) . Compensa t i on for proper ty t aken pursuan t to the c i t y ' s em i nen t doma i n power does no t cons t i tu t e a f i nanc i a l i n t eres t w i th i n the mean i ng o f th i s sec t i on .

I f the con t rac t , work , bus i ness , or t ransac t i on i nvo l ves a C i t y Proper ty Sa l e does any o f f i c i a l or emp l oyee have a f i nanc i a l i n t eres t i n h i s or her own name or i n the name o f any o ther person i n the C i t y Proper ty Sa l e?

X N / A ( i . e . , the con t rac t , work , bus i ness , or t ransac t i on i s no t for a C i t y Proper ty Sa l e ) No . Yes .

I f yes , i den t i f y the o f f i c i a l s or emp l oyees hav i ng such i n t eres t and the na ture o f such i n t eres t :

3 . 1 fur ther cer t i f y tha t no such f i nanc i a l i n t eres t i n th i s con t rac t , work , bus i ness , or t ransac t i on w i l l be acqu i red by any o f f i c i a l or emp l oyee o f the C i t y o f Ch i cago.

Under pena l t y o f per j ury , I cer t i f y tha t I am au thor i zed to execu t e th i s Addendum to D i sc l osure A f f i dav i t on beha l f o f the Con t rac tor , tha t I have persona l know l edge o f the cer t i f i ca t i ons be i ng made i n i t and , tha t they are comp l e t e and t rue

SEWo2 y l Ce P2Esr0 f i I S i gna ture qA #ed O f f i cer T i t l e

Z-E V~ L RC . ~-w 5 31 Z 201 - ' 7 y 0 0

Name o f Au thor i zed O f f i cer (Pr i n t or Type ) Bus i ness Te l ephone Number

S t a t e o f - - r l l 1 RO I s .

Coun t y o f

Sworn to and acknow l edged be fore me b 7(e4 W. S-_ J l hp- t~<2s dn , Cc t - ' ( t i t l e ) o f ck . F t~ ~ , P t , r

cNr -3 - day o f w^-e - , 20Q3- .

No tAry Pub l i c My comm i ss i on exp i res on :

Sea l :

4094Q ,

(name o f s i gna tory) as (name o f con t rac t i ng par ty) th i s

OFFU2AL SEAL MARTA M OLAQUE

NOTARY PUOUC - STATE OF I I t aNOS MY CO I~ tOSM EWMES W19A

JUN 10 2003 10 : 04RM HP LF ISERJET 3200 P . 6

Con t rac tor : (A T i e i - -Z E , . ~~~ , . ~ f fR~~G 1nrL , , `

Con t rac t No . : f N g y C. o L l 2 S

Spec i f i ca t i on No . : C- (~ to $ C- )C5 00 , 31

ACKNOWLEDGMENT

Con t rac tor acknow l edges and agrees tha t the fo l l ow i ng prov i s i on i s added to and becomes par t o f the Con t rac t re f erenced above :

BUS INESS RELAT IONSH IPS W ITH ELECTED OFF IC IALS

Pursuan t to Sec t i on 2-156-030(b) o f the Mun i c i pa l Code o f the C i t y o f Ch i cago , i t i s i l l ega l for any e l ec t ed o f f i c i a l o f the c i t y , or any person ac t i ng a t the d i rec t i on o f such o f f i c i a l , to con t ac t , e i ther ora l l y or i n wr i t i ng , any o ther c i t y o f f i c i a l or emp l oyee w i th respec t to 4ny ma t t er i nvo l v i ng any person w i th whom the e l ec t ed o f f i c i a l has a bus i ness re l a t i onsh i p , or to par t i c i pa t e i n any d i scuss i on i n any c i t y counc i l comm i t t ee hear i ng or i n any c i t y counc i l mee t i ng or to vo t e on any ma t t er i nvo l v i ng the person w i th whom an e l ec t ed o f f i c i a l has a bus i ness re l a t i onsh i p . V i o l a t i on o f Sec t i on 2-156-030(b) by any e l ec t ed o f f i c i a l w i th respec t to th i s con t rac t sha l l be grounds for t erm i na t i on o f th i s con t rac t . The t erm ' bus i ness re l a t i onsh i p " i s de f i ned as se t for th i n Sec t i on 2-

-1 56-0 80 o f the Mun i c i pa l Code o f Ch i cago . _-

Sec t i on 2 . 156-080 de f i nes a " bus i ness re l a t i onsh i p " as anycon t rac tua l or o ther pr i va t e bus i ness dea l i ng o f an o f f i c i a l , or h i s or her spouse , or o f any en t i t y i n wh i ch an o f f i c i a l or h i s or her spouse has a f i nanc i a l i n t eres t , w i th a person or en t i t y wh i ch en t i t l es an o f f i c i a l to compensa t i on or paymen t i n the amoun t o f 52 , 500 or more i n a ca l endar year ; prov i ded , however , a f i nanc i a l i n t eres t sha l l no t i nc l ude : ( i ) any ownersh i p through purchase a t f a i r marke t va l ue or i nher i t ance o f l ess than one percen t o f the shares o f a corpora t i on , or any corpora t e subs i d i ary , paren t or a f f i l i a t e thereo f , regard l ess o f the va l ue o f or d i v i dends on such share , i f such shares are reg i s t ered on a secur i t i es exchange pursuan t to the Secur i t i es Exchange Ac t o f 1934 , as amended ; ( i i ) the au thor i zed compensa t i on pa i d to an o f f i c i a l or emp l oyee for h i s o f f i ce or emp l oymen t ; ( i i i ) any econom i c bene f i t prov i ded equa l l y to a l l res i den t s o f the c i t y ; ( i v) a t i me or demand depos i t i n a f i nanc i a l i ns t i tu t i on , or (v) an endowmen t or i nsurance po l i cy o f annu i t y con t rac t purchased f rom an i nsurance company. A " con t rac tua l or o ther pr i va t e bus i ness dea l i ng " sha l l no t i nc l ude any emp l oymen t re l a t i onsh i p o f an o f f i c i a l ' s spouse w i th an en t i t y when such spouse has no d i scre t i on concern i ng or i npu t re l a t i ng to the re l a t i onsh i p be tween tha t en t i t y and the c i t y ,

S IGNED :

PPR-19%L-4- E . ~a I J "7EER l d& IPJC- .

SE-AorL O ILE (KES106-q

T i t l e

Da t e

Rev. 12198

ADDENDUM TO D ISCLOSURE AFF IDAV IT

Cer t i f i ca t i on Regard i ng S l avery Era Bus i ness

Con t rac tor - - -Pa t r i ck Eng i neer i ng Inc

Pro j ec t No . / Desc . . Pro f ess i ona l Des i

Consrocr No : PN84CO29725 Spec i f i ca t i on No . : Cq~Q920037

Chaprer 2-92585 o f Tne Mun i c i pQ I Code o f Ch i cdg4 requ i res tha t any en t i t y en t er i ng i n to a con t rac t w i th The C i t y o f Ch i cago musT comp l e t e an a f f td0v i T ver i f y i ng tha t the en t i t y has seOrcnea any and a l l records o f me en t i t y and any ana a l l predecessor en t i t i es for records o f i nves tmen t s or pro f i t s f rom s l avery , The s l ave i ndus t ry . ors t aveno l aer a l surance po l i c i es f rom the s l avery era ( Inc l ud i ng i nsurance parc i es msue t l to s l oveho l de (s tha t prov i ded coverage for gomage to or i n j ury or dea th o f the i r s l aves] and rnu&T d i sc l ose i n the Q f f i dava such records To the C i t y . In add i t i on . the ora i nance requ i res Tha t the en t i t y d i sc l ose i n the o f f i aav i t the names OT any s t aves or s l oveho(ders cyescnbed i n those records Fa i l ure to CQMp l y w i th the ord i nance makes the con t rac t vo i c l arb l e on beha l f o f The C i t y .

P l ease Check e i Ther (1) or (2) INe l ovv . I t Tne Con t rac tor checks (2) , the Con t rac tor Mus t a l sc tose , De l ow or i n an a l l oc t tmenT to th i s documen t , a l l requ i s i t e i n for rnar i on c i s se t f arm i n ma t paragraph (21 .

x 11- The Con t rac tor ven i res tha t (a ) the CorTr rac tor has searcr t ec any and a l l recoroS o f the con t rac tor ana any and a l l prodae®ssor en t i t i es for records o f i nves tMen t s or pro f i t s r rorn s l avery- the s l ave i nc t a y. or s i aveno l der i nsurance po l i c i es , one (a ) Con t rac tor has found no records o f Inves tmenTs or pro f i t s f rom s l avery. the s l ave i ndus t ry , or s l ovcho l der i nsurance pouc l e i and no records o f names o f any s l aves pr s l ayeno l ders .

2 . The Con t rac tor ver i f i es tha t . as a resu l t o f conduc t i ng the searcn i n s t ep (11 (a ) above . me con t rac tor nos f auna records re i anng To i nvesr r r i en t s or pro t i n f rom s l avery. ThC+ s l ave i ndus t ry . or s l aveho l aer i nsurance po l i c i es and l or the names o f any s t aves or s i oveno l aers_ The Con t rac tor ~er j f i es ThoT i ne fo l l ow i ng Cor tsT i tu t es fu l l d i sc l osure o f a l l sucn records .

Acknow l edgmen t : L i v i ng Wage Ord i nance

CONTRACTOR ACKNOWLEDGES AND AGREES THAT I F TH IS ADDENDUM 15 BE ING SUBM ITTED IN CONNECT ION W ITH A PR IOR AGREEMENT. A MOD I F ICAT ION TO A PR IOR AGREEMENT . OR W ITH A NEW AGREEMENT , THE FOLLOW ING L IV ING WAGE PROV IS IONS SHALL BECOME PART OF SUCH MOD I F ICAT ION OR AGREEMENT AND 5uPER5EDE OR REPLACE- ANT L IV ING WAGE PROV IS IONS THAT MAY BE CONTA INED IN SUCH MOD I F ICAT ION OR AGREEMENT '

A , under Sec t i on 2-92-610 o f the Mun i c i pa l Code o f Ch i cago the bQSe wage app l i es for adna i n ca t egor i es o f workers emp l oyed i n Tne per formance o f C i t y con t rac t s . spec i f i ca l l y non-C i t y er r tp l oyec l secur i t y guards park i ng o tTendanrs , C l ay l aborers , home ana hea l th care workers . cash i ers , e l eva tor opera tors , cus tod i a l workers , and C l er i ca l workers ( Covered EMP l oyees- ) , Accord i ng l y , pursuan t to 5ec t l on 2-92-b 10 ana regu l a t i ons prornu l ga t ea . . under n

I ) i f me Con t rac tor nos 25 or more t i l l - tune emp l oyees. anc

2) I f a t any r i me dur i ng the per formance o f I l l s ' con t rac t the Con t rac tor and / or any suoconvar. tor Or any o ther en t i t y Tha t per forms any por t i on o f The canTrac t ea work (co l l ec t i ve l y " Per f ar rn i ng f arT i es " j uses 25 or more fun- t i me secur i t y guorc l s , or any numoer o f o ther fu th t l me Covered emp l oyees . then

31 Mr Con t rac tor mus t pay i ts Covered Emp l oyees ana musk assure Tha t a l l o ther Per form i ng Par r i es pay tne i r Covered Emp l oyees , no t Less Tnan Ine m i n i mum -Rose wage " as c i e t ermcnea i n occoragnce w i l n ?n i s Prov i s i on for au Work per formed pursuan t to the con t rac t ,

Page I o f 2

ADDENDUM TO D ISCLOSURE AFF IDAV IT

B_ The Con t rac tor s oo i rga t i on to pay. anC To a=re pcaymr n t o f . the Base wage w l u beg i n a t any T i me aunng `he conTraCT Term when The cond i t i ons se t for th i n A . I and A 2 above are me t . ana w i l l con t i nue therea f t er un f i t the end o f The con t rac t

C Pr i or To January 1 . 2003 . the Base wage i s $7 60 per noun . beg i nn i ng January I . 2003 . the Base Wage i s $4 05 per hour . As o f Ju l y 1 . 2003 , and each Ju l y 1 i h®rea f t er , the Base wage w i l l be aa l us t ecJ , us i ng The mos t recen t f edera l Pover ty gu l e l e l i nes for a f amuy o f four as pub l i shed annua l l y by the U . S . Depar tmen t o f Hea l th 4nC r i uman Serv i ces , ro cons t i tu t e The fo l l ow i ng : The pover ty gu i de l i nes for a fgrn i t y o f four d l v i 0ed by 2000 h f l urs or the cur ren t base wage . wn i cr t ever i s h i gher . AT a l l T i mes dur i ng The t erm o f Th i s connec t . con t rac tor end an o ther Per form i ng Par r i es mus t pay The Base wage (as od l usreq i n accoragnce w i th the above ) _ I f the paymen t o f preva i l i ng wages i s requ i red for Work or serv i ces none under th i s con t rac t , ana the preva i ung wages for Covered Emp l oyees ore h i gher than the Base wage then The Con t rac tor ana a l l o ther Per form i ng PQF f e5 mus t pay the preva i l i ng wage ra t es .

D The Con t rac tor mus t Inc l ude prov i s i ons i n au subcon t rac t s requong i ts suDcon i rac tors to pcy the Base wage To Coverea Emp l oyees The COnTraCTor agrees to prov i de me C i t y w i n c l ocumen to t ron accep t c l b t e to the Ch l er Procuremen t O f f i cer demons t ra t i ng tha t a l l Covered Emp l oyees. whe ther emp l ayeq by the Con t rac tor or by a subcranTrac tOC have been pa i d The Base wage - upon the C i t y ' s reques t for such documen t a t i on . Tne C ITY may Independen t l y aug i t v i e con t rac tor and / or subcon t rOC IOrS To ver i f y comp l i ance nerewr th . Fa i l ure to comp l y w i Tn the requ l rerhenTS o f Th i s Secron w i l l De an even t o f c l e fqu l t under Tn t5 con t rac t . and fur ther . f a i l ure To comp l y may resu l t i n rne i , go i l r t y for any award o f a C i t y con t rac t or suc )conwac t for up To Three (3) years ,

E . too t - for -Pro f i t Corpora t i ons: i f Tne Con t rac tor i s a corpora t i on na - i ng Federa l t ax-exemp t s t a tus unaer SecT l on 501 ICJ (3) o f Tne In t erna l Revenue Coae ana i s racQSn , zod ynq t i r r I r fnom no t - for -pro f l i I c l w . then The pravh , ons o f Sec t i on A throug t ' r D above co no t app l y .

Under pena l t y o f pequry. I cer t i f y tha t 1 qn ' t gwhor r zec l to execu t e Th i s Aaaenaum To D i sc l osure A f f i Gavr t on neha i f o f Tne Con t rac tor , Tr1o1 1 have persona l know l edge o f the cer t i f i ca t i ons be i ng made i n i t and Sha t they are comp l e t e ono True

(Pr i n t or t ype n

By . IwVn I Ora )

Pr i n t or Type n

T i t l e o f s l gno i

Da t e : Y. . . 9 -0 -5

cownry or

5mo0 - l . _ I i nC i s V -

cwn t y Or

S IO I i Or , _

~c~no . . l ocgeo wx7d mm en Igd t i r , l J~ 61 7. 003 ~cura neggoa . mae oom an ma i d

a - roomony ~[2L1 r~ I . -aQ I i S oewome Gor

Inra l - . Sen i ~~ J i r -~ PreS i dQ . l n1~ or i r tm l

Nerdy P , . oK

comnnsw a " aw

Page ? ,

Spec i f i ca t i on No , : C92S990002 Pre -Quah f t ca t i oa Program Da t e Approved by Law : June 25 , 2003

APP IDAV IT

The unders i gned. cer t i f i es tha t the Ecoaom i c D i sc l os= S t a t emcru And A f f i dav i t wh i ch the Consu l t an t comp l e t ed and cxecu t ed , as descr i bed above , rema i n t rue ac i d accura t e i n a l l respec t s as i f the A f f i dav i ts ara a t t ached here to .

Ver i f i mr i on

Under penWTy o f per j my , I cer t i f y tha t 1 am the Sen i or V i ce Pres i den t (T i t l e ) , o f Pa t r i ek

Eng i neer i ng , Inc . and. tha t I am au thor i zed by the Consu l t an t to execu t e th i s a f f i dav i t i n us beha l f , tha t have persona l know l z f e o f the ce tE i f i ca t i ons made i n th i s a f f i dav i t and tha t there have been no changes and tha t the same a t e t rue .

Ted W . Lachus

Narue (Type or Pr i n t )

S t a t e o f -T l l i rao i s Coun t y o f Subscr i bed and sworn to me be fore th i s , 3= day o f S ' l eT-1-eam f - ' 20 03

Pub l i c S i

My Comm i ss i on Exp i res 21 I L161 ,

OFF IM SEAL MAR tAM OLAE i A

NOTARY P l " - STATE OF wags MY cok i i am : o9-am

Spec i f i ca t i on No . : C925-99-0025 Pre -Qua l i f i ca t i on Program Da t e Execu t ed : Ju l y 18 , 2000

AFF IDAV IT

The unders i gned cer t i f i es tha t the D i sc l osure A f f i dav i t and / or A f f i dav i t (s) (co l l ec t i ve l y , the " A f f i dav i ts " ) wh i ch the Consu l t an t comp l e t ed and execu t ed , as descr i bed above , rema i n t rue and accura t e i n a l l respec t s as i f the A f f i dav i ts are a t t ached here to .

Ver i f i ca t i on

Under pena l o f per j ury , I cer t i f y tha t I am the ~2~ (T i t l e ) , o f 4~-_L (Pa t r i ck Eng i neer i ng , Inc . ) , and tha t I am au thor i zed by the Consu l t an t

to execu t e th i s a f f i dav i t i n i t s beha l f , tha t have persona l know l edge o f the cer t i f i ca t i ons made i n th i s a f f i dav i t and tha t there have been no changes and tha t the same are t rue .

~_ J- P. L04 . . . 4- ) S i gna ture o f Owner or Au thors O f f i cer

_ C2 P ' . . L ~z I~~ Name (Type o f Pr i n t )

S t a t e o f . r 11 ; »o ; s Coun t y o f e Subscr i bed and swo to me be fore th i s

a±! dayo f be c . , 200- . 4 I

My Comm i ss i on Exp i res / 0 03

UE i / 24 / 2UU3 12 : 58 FAX 312 220 0722

C ITY OF CH ICAGO ECONOM IC D ISCLOSURE sTATEMENY AND AFF IDAV IT

FOR C ITY USE

AFF IDAV IT NO

R 002

Pursuan t to Chap t er 2-154 o f the Mun i c i pa l Code o f Ch i cago ( the ' Mun i c i pa l Code ' s or , i f app l i cab l e , under § 8 . 5 o f the l i rmo i s Mun i c i pa l Purphas i ng Ac t 65 ILCS 518-10-8 . 5 ( the ' Purchas i ng Ac t ` ) , the fo l l ow i ng In forma t i on i s requ i red to be d i sc l osed be fore any C i t y agency. depar tmen t a C i t y Counc i l ac f ron . P l ease tu f t y comp l e t e each s t a t emen t , w i th a l l i n forma t i on cur ren t as o f the da t e th i s Econom i c D i sc l osure S t a t emen t and A f f i dav i t ( " EDT) i s s i gned . Every ques t i on mus t be answered . I f a ques t i on i s no t app l i cab l e , answer w i th ' N . A ' An Incomp l e t e ED$ w i l l be re turned and any C i t y ac t i on w i l l be i n t er rup t ed .

P l ease pr i n t or t ype a l l responses c l ear l y and l eg i b l y . Add add i t i ona l pages i f needed , be i ng care fu l to i den t i f y the por t i on o f the EDS to wh i ch each add i t i ona l page re f ers-

WHO MUST SUBM IT AN EDS : 1 . App l i can t s - Any i nd i v i dua l or en t i t y ( the " App l i cane ) mak i ng an app l i ca t i on to the C i t y o f Ch i cago ( the ' C i t y ' ) for ac t i on requ i r i ng C i t y Counc i l or o ther t a t t y agency approva l mas t f i l e th i s EDS . For examp l e , vendors seek i ng C i t y con t rac t s and i nd i v i dua l s or en t i t i es app l y i ng for concess i ons , l oans or gran t s are " App l i can t s . "

2 En t i t i es ho l d i ng an i n t eres t i n the App l i can t Genera l l y , whenever an ownersh i p In t eres t i n the App l i can t (such as shares o f s tDcro f the App l i can t or a l i m i t ed par tnersh i p i n t eres t i n the App l i can t , for examp l e ) Is he l d or owned by a l ega l en t i t y (such as a corpora t i on or par tnersh i p , for examp l e ) ra ther than an i nd i v i dua l , each such l ega l en t i t y mus t a l so f i l e an EDS on i ts own beha l f , and any paren t o f tha t l ega l en t i t y mus t do so , excep t as prov i ded be l ow , un t i l i nd i v i dua l owners are d i sused . P i e= see Chap t er 2-154 o f the Mun i c i pa l Code for fur ther de t a i l s t egard ' rng the na ture and ext en t o f d i sc l osure requ i red- Under the Mun i c i pa l Code , i P the App l i can t i s a corpora t i on whose shares are reg i s t ered on a na t i ona l secur i t i es exchange pursuan t to the Secur i t i es Exchange Ac t o f 1934 , on l y l ega l en t i t i es tha t own 10 96 or more o f the App f i ean f s s tock mus t f i l e EDSs an the i r own beha tE However , under the Purchas i ng Ad , l ega l en t i t i es ho l d i ng 7 . 596 or more o f a vendor App l i can t mus t f i l e EDSs .

ACKNOWLEDGMENT OF POSS IBLE CRED IT AND OTHER CHECKS : By comp l e t i ng and f i l i ng th i s EDS , the Unders i gned i eknow i edges and agrees , on beha l f o f i t se l f a i d the i nd i v i dua l s named i n th i s WS , tha t the C i t y rmy i nves l i ga t e the cred i twor th i ness o f some or an o f the i nd i v i dua l s named i n th i s EDS .

CERT I FY ING TH IS EDS : Execu t e the cer t i f i ca t i on an the da t e o f the i n i t i a l subm i ss i on o f th i s EDS_ You may be asked to re -cer t i f y th i s EDS an the l as t page as o f the da t e o f subm i ss i on o f any re l a t ed ord i nance to the C i t y Counc i l , or as o f the da t e o f the c l os i ng o f your t ransac t i on .

PUBL IC D ISCLOSURE : I t i s the Cqs po l i cy to make th i s dacumen t ava i l ab l e to the pub l i c on i t s k i sme t s i t e and / or upon , reques t

GENERAL INFORMAT ION Da t e th i s EDS comp l e t ed : _ ATar i 1 4 , _ 2003 A Who i s subm i t t i ng th i s EDS? Tha t par ty w i l l be the ' Unders i gned " throughou t th i s EDS . Ig) Check here I f you are f i l i ng as ' App l i can t ' Exac t l ega l name : Pa t r i ck Eng i neer i ng Inc . [ ] Check here i f you are f i l i ng as an " en t i t y ho l d i ng an i n t eres t i n an App l i can t ' Exac t l ega l name :

(A l so , p l ease i den t i f y App l i can t i n wh i ch th i s en t t y ho l ds an In t eres t

B . Bus i ness address : - 5 5 Eas t Monroe . Su i t e 3 A 5 0 Ch i cago , IL 60603 - C . Te l ephone , 3 12-201-7900 Fax : -3-12-220-07 21 Erma i t_ ,

D . Name o f con t ac t person : r%K E e _r r a r_ a E . I f a proauemen t Spec i f i ca t i on k C 9 2 5 4 9 0 0 0 2 and Con t rac t # _ -F . I f no t a procuremen t

1 . C i t y Agency reques t i ng EDS __ 2 . , C i t y ac t i on reques t ed (e . g_ l oan , gran t , sa l e o f proper ty) : 3 . I f proper ty i nvo l ved , f i s t proper ty l oca t i on :

G. Br i e f descr i p t i on o f pro j ec t , ( i nc l ude pro j ec t number and l oca t i on i f app l i cab l e ) : prern , a 1 i f i ea t ; nn

EDS 03 IM Fw I edera l hr - funded and nom-4ederauy fWed rmbas. Page 1 o f 13

SECT ION ONE : D ISCLOSURE OF OWNERSH IP INTERESTS

NATURE OF ENT ITY

Ind i ca t e whe ther the Unders i gned i s an i nd i v i dua l or l ega l en t i t y :

[ ] Ind i v i dua l [ ] L i m i t ed L i ab i l i t y Company

[y j Bus i ness corpora t i on ( ] Jo i n t ven ture

[ ] So l e propr i e torsh i p [ ] No t - for -pro f i t corpora t i on [ I s the no t - for -pro f i t corpora t i on a l so a 501(c ) (3)? [ ] Yes [ ] No .

[ ] Genera l par tnersh i p [ ] O ther en t i t y (p l ease spec i f y)

[ ] L i m i t ed par tnersh i p

2 . S t a t e o f i ncorpora t i on or organ i za t i on , i f app l i cab l e : I l l i no i s

3 . For l ega l en t i t i es no t organ i zed i n the S t a t e o f I l l i no i s : I s the organ i za t i on au thor i zed to do bus i ness i n the S t a t e o f I l l i no i s as a fore i gn en t i t y? [ ]Yes[ ] No D( ]N IA

B . ORGAN IZAT ION INFORMAT ION

1 . I F THE UNDERS IGNED IS A CORPORAT ION : a . L i s t be l ow the names and t i t l es o f a l l execu t i ve o f f i cers and a l l d i rec tors o f the corpora t i on . For no t - for -pro f i t corpora t i ons , a l so l i s t be l ow any execu t i ve d i rec tor o f the corpora t i on , and i nd i ca t e a l l members , i f any , who are l ega l en t i t i es. I f there are no members , wr i t e ' no members. "

Name Dan i e l P . D i e t z l er

T i de Pres i den t

Je f f rey C . Schuh Sr . V i ce Pres i den t Mark D . Rauckhors t Sr . V i ce Pres i den t Ted W . Lachu - Sr . V i ce Pres i den t

b . For corpora t i ons whose shares are reg i s t ered on a na t i ona l secur i t i es exchange pursuan t to the Secur i t i es Exchange Ac t o f 1934 , p l ease prov i de the fo l l ow i ng i n forma t i on concern i ng shareho l ders who own shares equa l to or i n excess o f 10 % (or 7 . 5 % , as app l i cab l e ) o f the corpora t i on ' s ou t s t and i ng shares . No t e : i t may be necessary for some shareho l ders to comp l e t e an EDS as an " En t i t y ho l d i ng an i n t eres t i n the App l i can t . "

Name N / A

Bus i ness Address Percen t age In t eres t

c . For corpora t i ons tha t are no t reg i s t ered on a na t i ona l secur i t i es exchange pursuan t to the Secur i t i es Exchange Ac t o f 1934 , l i s t be l ow the name , bus i ness address and percen t age o f ownersh i p i n t eres t o f each shareho l der . No t e : i t may be necessary for some shareho l ders to comp l e t e an EDS as an " En t i t y ho l d i ng an i n t eres t i n the App l i can t . "

Name Bus i ness Address Percen t age In t eres t Dan i e l P . D i e t z l er 55 Eas t Monroe , Su i t e 3450 100%

EDS 03103 For f edera l l y- funded and non- f edera l l y funded ma t t ers Page 2 o f 13

2 . I F THE UNDERS IGNED IS A PARTNERSH IP : For genera l or l i m i t ed par tnersh i ps : l i s t be l ow the name , bus i ness address and percen t age o f ownersh i p i n t eres t o f each par tner . For f i mt t ed par tnersh i ps , i nd i ca t e whe ther each par tner i s a genera l par tner or a l i m i t ed par tner . No t e : N may be necessary for some par tners to comp l e t e an EDS as an " En t i t y ho l d i ng an i n t eres t i n the App l i can t . "

Name N / A

Bus i ness Address Percen t age In t eres t

3 . I F THE UNDERS IGNED IS A L IM ITED L IAB IL ITY COMPANY : a . L i s t be l ow the name , bus i ness address and percen t age o f ownersh i p i n t eres t o f each ( i ) member and ( i i ) manager . I f there are no managers , wr i t e ' no managers , and i nd i ca t e how managed . No t e : i t may be necessary for some members to comp l e t e an EDS as an ' En t ry ho l d i ng an i n t eres t i n the App l i can t . '

Name N / A

Bus i ness Address Percen t age In t eres t

b . L i s t be l ow the names and t i t l es o f a l l o f f i cers , i f any . I f there are no o f f i cers , wr i t e ' no o f f i cers '

Name T i t l e N / A

4 . I F THE UNDERS IGNED IS A LAND TRUST , BUS INESS TRUST OR ESTATE : a . L i s t be l ow the name o f each i nd i v i dua l or l ega l en t i t y ho l d i ng l ega l b i l e to the proper ty tha t i s the sub j ec t o f the t rus t .

Name N / A

Bus i ness Address

b . L i s t be l ow the name , bus i ness address and percen t age o f bene f i c i a l i n t eres t o f each bene f i c i ary on whose beha l f t i t l e i s he l d . No t e . i t may be necessary for some bene f i c i ar i es to comp l e t e an EDS as an ' En t i t y ho l d i ng an i n t eres t i n the App l i can t . "

Name Bus i ness Address Percen t age In t eres t N / A

EDS 03103 For f edera l y- runded and non4edera l l y funded ma t t ers . Page 3 o f 13

SECT ION TWO : BUS INESS RELAT IONSH IPS W ITH C ITY ELECTED OFF IC IALS

A . DEF IN IT IONS AND D ISCLOSURE REQU IREMENT

1 . Pursuan t to an ord i nance approved by the C i t y Counc i l on December 2 , 1998 , the Unders i gned mus t i nd i ca t e whe ther i t had a ' bus i ness re l a t i onsh i p " w i th a C i t y e l ec t ed o f f i c i a l i n the 12 mon ths be fore the da t e th i s EDS i s s i gned .

2 . A ' bus i ness re l a t i onsh i p ' means any ' con t rac tua l or o ther pr i va t e bus i ness dea l i ng ' o f an o f f i c i a l , or h i s or her spouse , or o f any en t i t y i n wh i ch an o f f i c i a l or h i s or her spouse has a ' f i nanc i a l i n t eres t , " w i th a person or en t i t y wh i ch en t i t l es an o f f i c i a l to compensa t i on or paymen t i n the amoun t o f $2 , 500 or more i n a ca l endar year ; bu t a " f i nanc i a l i n t eres t " does no t i nc l ude : ( i ) any ownersh i p through purchase a t f a i r marke t va l ue or i nher i t ance o f l ess than 1% o f the shares o f a corpora t i on , or any corpora t e subs i d i ary , paren t or a f f i l i a t e thereo f , regard l ess o f the va l ue o f or d i v i dends on such shares , i f such shares are reg i s t ered on a secur i t i es exchange pursuan t to the Secur i t i es Exchange Ac t o f 1934 , as amended , a the au thor i zed compensa t i on pa i d to an o f f i c i a l or emp l oyee for h i s o f f i ce or emp l oymen t ; @ i ) any econom i c bene f i t prov i ded equa l l y to a l l res i den t s o f the C i t y; ( i v) a t i me or demand depos i t i n a f i nanc i a l i ns t i tu t i on ; or (v) an endowmen t or i nsurance po l i cy or annu i t y con t rac t purchased f rom an i nsurance company. A " con t rac tua l or o ther pr i va t e bus i ness dea l i ng " does no t i nc l ude any emp l oymen t re l a t i onsh i p o f an o f f i c i a l ' s spouse w i th an en t i t y when such spouse has no d i scre t i on concern i ng or i npu t re l a t i ng to the re l a t i onsh i p be tween tha t en t i t y and the C i t y.

B .

1 . s i gned?

CERT I F ICAT ION

Has the Unders i gned had a " bus i ness re l a t i onsh i p " w i th any C i t y e l ec t ed o f f i c i a l s i n the 12 mon ths be fore the da t e th i s EDS i s

[ ] Yes [X I No

I f yes , p l ease i den t i f y be l ow the name (s) o f such C i t y e l ec t ed o f f i c i a l (s) and descr i be such re l a t i onsh i p(s) :

" STOP I f you are f i l i ng on beha l f o f an " En t i t y ho l d i ng an i n t eres t i n the App l i can t , " go to Sec t i on Seven (No t i ce and Acknow l edgmen t Regard i ng C i t y Governmen t a l E th i cs and Campa i gn F i nance Ord i nances) , page 12 . The fo l l ow i ng sec t i ons Three through S i x are to be comp l e t ed on l y by the App l i can t i n the App l i can t ' s EDS :

EDS 03103 For t eder*- rurded and nw~Ay l anded moose. Page 4 o f 13

06 / 24 / 2003 12 : 58 FAX 312 220 0722

SECT ION THREE : D ISCLOSURE OF RETA INED PART IES

A. DEF IN IT IONS AND D ISCLOSURE REQU IREMENTS

19003

1 . Pursuan t m Execu t i ve Order 97-1 , every C i t y con t rac t , l ease , and a l l ma t t ers requ i r i ng C i t y approva l mus t be accompan i ed by a s t a t emen t d i sc l os i ng cer t a i n i n forma t i on abou t a t torneys , l obby i s ts , accoun t an t s , consu l t an t s , subcon t rac tors , and any o ther person whom the App l i can t has re t a i ned or expec t s to re t a i n i n connec t i on w i th the ma t t er i n connec t i on w i th wh i ch th i s EDS i s subm i t t ed . In par t i cu l ar , the App l i can t mus t d i sc l ose the name o f each such person , h ' i s fher bus i ness address , the na ture o f the re l a t i onsh i p , and the amoun t o f the f ees pa i d or es t i ma t ed to be pa i d . The App l i can t i s no t requ i red to d i sc l ose emp l oyees who are pa i d so l e l y through the App l i can t s regu l ar payro l l .

" Lobby i s t " means any person (7 who , for compensa t i on or on beha l f o f any person o ther than h i mse l f , under t akes to i n f l uence any l eg i s l a t i ve or adm i n i s t ra t i ve ac t i on , or ( t1 any par t o f whose du t y as an emp l oyee o f ano ther i nc l udes under t ak i ng to In f l uence any l eg i s l a t i ve or adm i n i s t ra t i ve ac t i on .

2_ i f the App l i can t i s uncer t a i n whe ther a d i sc l osure i s requ i red under th i s Sec t i on , the App l i can t mus t e i ther ask the C i t y whe ther d i sc l osure i s requ i red or make the d i sc l osure .

B . CERT I F ICAT ION

Each and every a t torney , l obby i s t , accoun t an t , consu l t an t , subcon t rac tor , or o ther person re t a i ned or an t i c i pa t ed to be re t a i ned d i rec t l y by the App l i can t w i th respec t to or i n connec t i on w i th the pro j ec t or t ransac t i on tha t Is the sub j ec t o f th i s EDS i s l i s t ed be l ow [beg i n l i s t here , add shee t s as necessary) ,

Name Us l ness Re l a t i onsh i p to Appkan i Fees Address (a t torney , l obby i s t e t c . ; ( i nd i ca t e whe ther pa i d or eAnra l ed)

re t a i ned or an fdpa t ed to be re t a i ned)

I )a CHECK HERE I F NO SUCH PERSONS HAVE BEEN RETA INED D IRECTLY BY THE APPL ICANT O i l ARE ANT IC IPATED TO BE RETA INED D IRECTLY BY THE APPL ICANT .

SECT ION FOUR : CERT I F ICAT IONS BY APPL ICANT

I . CERT I F ICAT ION OF COMPL IANCE

For purposes o f the cer t i f i ca t i ons i n A , B , and C be l ow , the t erm " a f f i l i a t e " means any en t i t y tha t , d i rec t l y or i nd i rec t l y. con t ro l s the App l i can t , i s con t ro l l ed by the App l i can t , or i s , w i th the App l i can t , under common con t ro l o f ano ther i nd i v i dua l or en t i t y . Ind i c i a o f con t ro l i nc l ude ,

w i thou t l i m i t a t i on : i n t er l ock i ng managemen t or ownersh i p ; i den t i t y o f i n t eres ts among f am i l y members , shared f ac i l i t i es and equ i pmen t ; common use o f emp l oyees ; or organ i za t i on o f a bus i ness en t i t y fo l l ow i ng the i ne l i g i b i l i t y o f a bus i ness en t i t y to do bus i ness w i th the f edera l governmen t or a s t a t e or l oca l governmen t , i nc l ud i ng the C i t y , us i ng subs t an t i a l l y the same managemen t , ownersh i p , or pr i nc i pa l s as the i ne l i g i b l e en t i t y.

A . The App l i can t i s no t de l i nquen t i n the paymen t o f any t ax adm i n i s t ered by the I l l i no i s Depar tmen t o f Revenue , nor are the App l i can t or i t s a f f i l i a t es de l i nquen t i n pay i ng any f i ne , f ee , t ax or o ther charge owed to the C i t y . Th i s i nc l udes a l t wa t er charges , sewer charges , l i cense f ees , park i ng t i cke t s , proper ty t axes or sa l es t axes. I f there are any such de l i nquenc i es , no t e them be l ow :

No-

i f the l e t t ers " NA , " the word " None , " or no response appears on the l i nes above , i t w i l l be conc l us i ve l y presumed tha t the App l i can t cer t i f i ed to the above s t a t emen t s .

EDS 03103 For f edera l l y- funded end i ron- f edera l l y funded ma f t e i s . Page 5 o f 13

B . The App l i can t and i ts a f f i l i a t es have no t , i n the pas t f i ve years , been found i n v i o l a t i on o f any C i t y , s t a t e or f edera l env i ronmen t a l l aw or regu l a t i on . I f there have been any such v i o l a t i ons , no t e them be l ow :

None

I f the l e t t ers *NA , * the word ' None , ' or no response appears on the f i nes above , i t w i g be conc l us i ve l y presumed tha t the App l i can t cer t i f i ed to the above s t a t emen t s .

C . The App l i can t and i ts a f f i l i a t es w i l l no t use , nor perm i t the i r subcon t rac tors to use , any f ac i l i t y on the U . S . EPA ' s L i s t o f V i o l a t i ng Fac i l i t i es i n connec t i on w i th the pro j ec t or t ransac t i on for the dura t i on o f t i me tha t such f ac i l i t y rema i ns on the l i s t .

D . The App l i can t w i l l ob t a i n f rom any con t rac tors / subcon t rac tors h i red or to be h i red i n connec t i on w i th the C i t y con t rac t , work , bus i ness , or t ransac t i on tha t i s the sub j ec t o f th i s EDS cer t i f i ca t i ons equa l i n form and subs t ance to those i n Sec t i on Four , 1 , A-C above and w i l l no t , w i thou t the pr i or wr i t t en consen t o f the C i t y , use any such subcon t rac tor tha t does no t prov i de the cer t i f i ca t i on or tha t the App l i can t has reason to be l i eve has no t prov i ded or canno t prov i de t ru th fu l cer t i f i ca t i ons .

I f the App l i can t i s unab l e to so cer t i f y , prov i de an exp l ana t i on :

I f the l e t t ers ' NA , ' the word ' None , " or no response appears on the l i nes above , i t w i l l be conc l us i ve l y presumed tha t the App l i can t cer t i f i ed to the above s t a t emen t s .

I I . CH ILD SUPPO RT OBL IGAT IONS- CERT I F ICAT ION REGARD ING COURT-ORDERED CH ILD SUPPORT COMPL IANCE

For purposes o f th i s par t , ' Subs t an t i a l Owner " means any person who , d i recdy or i nd i rec t l y , owns or ho l ds a 10 % or more . i n t eres t i n the App l i can t . No t e : Th i s may i nc l ude i nd i v i dua l s d i sc l osed i n Par t One (D i sc l osure o f Ownersh i p In t eres ts) , and i nd i v i dua l s d i sc l osed i n an EDS f i l ed by an " En t i t y ho l d i ng an i n t eres t i n the App l i can t . "

I f the App l i can t ' s response be l ow i s #1 or #2 , then a l l o f the App l i can t s Subs t an t i a l Owners mus t rema i n i n comp l i ance w i th any such ch i l d suppor t ob l i ga t i ons un f i l the t ransac t i on i s comp l e t ed . Fa i l ure o f the App l i can t s Subs t an t i a l Owners to rema i n i n comp l i ance w i th the i r ch i l d suppor t ob l i ga t i ons i n the manner se t for th i n e i ther #1 or #2 cons t i tu t es an even t o f de f au l t . Moreover , f a i l ure o f the App l i can t to comp l y w i th the prov i s i ons o f § 2-92-415(e ) o f the Mun i c i pa l Code a l so cons t i tu t es an even t o f de f au l t .

Check one :

_X_ 1 .

2 .

-3 .

No Subs t an t i a l Owner has been dec l ared i n ar rearage on any ch i l d suppor t ob l i ga t i ons by the C i rcu i t Cour t o f Cook Coun t y or by ano ther I l l i no i s cour t o f compe t en t j ur i sd i c t i on .

The C i rcu i t Cour t o f Cook Coun t y or ano ther I l l i no i s cour t o f compe t en t j ur i sd i c t i on has i ssued an order dec l ar i ng one or more Subs t an t i a l Owners i n ar rearage on ch i l d suppor t ob l i ga t i ons . A l l such Subs t an t i a l Owners , however , have en t ered i n to cour t -approved agreemen t s for the paymen t o f a l l such ch i l d suppor t owed , and a l l such Subs t an t i a l Owners are i n comp l i ance w i th such agreemen t s.

The C i rcu i t Cour t o f Cook Coun t y or ano ther I l l i no i s cour t o f compe t en t j ur i sd i c t i on has i ssued an order dec l ar i ng one or more Subs t an t i a l Owners i n ar rearage on ch i l d suppor t ob l i ga t i ons and (a ) a t l eas t one such Subs t an t i a l Owner has no t en t ered i n to a cour t -approved agreemen t for the paymen t o f a l l such ch i l d suppor t owed ; or (b) a t l eas t one such Subs t an t i a l Owner i s no t i n comp l i ance w i th a cour t -approved agreemen t for the paymen t o f a l l such ch i l d suppor t owed ; or bo th (a ) and (b) .

4 . There are no Subs t an t i a l Owners .

EDS 03103 For f edera l l y- funded and non- f edera l l y funded ma t t ers . Page 6 o f 13

I I I . FURTHER CERT I F ICAT IONS

A . The App l i can t and , i f the App l i can t i s a l ega l en t i t y , i t s pr i nc i pa l s (o f f i cers , d i rec tors , par tners , members , managers , execu t i ve d i rec tor ) :

1 . are no t presen t l y debar red , suspended , proposed for debarmen t , dec l ared i ne l i g i b l e or vo l un t ar i l y exc l uded f rom any t ransac t i ons by any f edera l , s t a t e or l oca l un i t o f governmen t ;

2 . have no t w i th i n a f i ve -year per i od preced i ng the da t e hereo f been conv i c t ed o f a cr i m i na l o f f ense , ad j udged gu i l t y , or had a c i v i l j udgmen t rendered aga i ns t them i n connec t i on w i th : ob t a i n i ng , a t t emp t i ng to ob t a i n , or per form i ng a pub l i c ( f edera l , s t a t e or l oca l ) t ransac t i on or con t rac t under a pub l i c t ransac t i on ; a v i o l a t i on o f f edera l or s t a t e an t i t rus t s t a tu t es; f raud ; embezz l emen t ; the f t ; forgery ; br i bery ; f a l s i f i ca t i on or des t ruc t i on o f records ; mak i ng f a l se s t a t emen t s ; or rece i v i ng s to l en proper ty ;

3 . are no t presen t l y i nd i c t ed for or o therw i se cr i m i na l l y or c i v i l l y charged by a govemmen t a l en t i t y ( f edera l , s t a t e or l oca l ) w i th comm i ss i on o f any o f the o f f enses enumera t ed i n c l ause (b) above ;

4 . . have no t w i th i n a f i ve -year per i od preced i ng the da t e o f th i s EDS had one or more pub l i c t ransac t i ons ( f edera l , s t a t e or l oca l ) t erm i na t ed for cause or de f au l t ; and

5 . have no t , w i th i n a f i ve -year per i od preced i ng the da t e hereo f , been conv i c t ed , ad j udged gu i l t y , or found l i ab l e i n a c i v i l proceed i ng , i n any cr i m i na l or c i v i l ac t i on i ns t i tu t ed by the C i t y or by the f edera l governmen t , any s t a t e , or any o ther un i t o f l oca l governmen t .

B . The cer t i f i ca t i ons i n th i s subpar t B concern : " the App l i can t ; " any par ty par t i c i pa t i ng i n the per formance o f the pro j ec t or t ransac t i on tha t i s the sub j ec t o f th i s EDS ( ' an App l i cab l e Par ty " ) ; " any ' A f f i l i a t ed En t i t y " (mean i ng an en t i t y tha t , d i rec t l y or i nd i rec t l y : con t ro l s the App l i can t , i s con t ro l l ed by the App l i can t , or

i s , w i th the App l i can t , under common con t ro l o f ano ther i nd i v i dua l or en t i t y . Ind i c i a o f con t ro l i nc l ude , w i thou t l i m i t a t i on : i n t er l ock i ng managemen t or ownersh i p ; i den t i t y o f i n t eres ts among f am i l y members , shared f ac i l i t i es and equ i pmen t ; common use o f emp l oyees; or organ i za t i on o f a bus i ness en t i t y fo l l ow i ng the i ne l i g i b i l i t y o f a bus i ness en t i t y to do bus i ness w i th f edera l or s t a t e or l oca l governmen t , i nc l ud i ng the C i t y , us i ng subs t an t i a l l y . the same managemen t , ownersh i p , or pr i nc i pa l s as the i ne l i g i b l e en t i t y) ; w i th respec t to App l i cab l e Par t i es , the t erm A f f i l i a t ed En t i t y means an en t i t y tha t d i rec t l y or i nd i rec t l y con t ro l s the App l i cab l e Par ty , i s con t ro l l ed by i t , or , w i th the App l i cab l e Par ty , i s under common con t ro l o f ano ther i nd i v i dua l or en t i t y ;

" any respons i b l e o f f i c i a l o f the App l i can t , any App l i cab l e Par ty or any A f f i l i a t ed En t i t y ; any o ther o f f i c i a l , agen t or emp l oyee o f the App l i can t , any App l i cab l e Par ty or any A f f i l i a t ed En t i t y , ac t i ng pursuan t to the d i rec t i on or au thor i za t i on o f a respons i b l e o f f i c i a l o f the App l i can t , any App l i cab l e Par ty or any A f f i l i a t ed En t i t y .

Ne i ther the App l i can t , nor any App l i cab l e Par ty , nor any A f f i l i a t ed En t i t y o f e i ther the App l i can t or any App l i cab l e Par ty have , dur i ng the f i ve years be fore the da t e th i s EDS i s s i gned , or , w i th respec t to an App l i cab l e Par ty , an A f f i l i a t ed En t i t y , or an A f f i l i a t ed En t i t y o f an App l i cab l e Par ty dur i ng the f i ve years be fore the da t e o f such App l i cab l e Par ty ' s or A f f i l i a t ed En t i t y ' s con t rac t or engagemen t i n connec t i on w i th the pro j ec t or t ransac t i on tha t i s the sub j ec t o f th i s EDS :

1 . t i r i bed or a t t emp t ed to br i be , or been conv i c t ed or ad j udged gu i l t y o f br i bery or a t t emp t i ng to br i be , a pub l i c o f f i cer or emp l oyee o f the C i t y , the S t a t e o f I l l i no i s , or any agency o f the f edera l governmen t or o f any s t a t e or l oca l governmen t i n the Un i t ed S t a t es o f Amer i ca , i n tha t o f f i cer ' s or emp l oyee ' s o f f i c i a l capac i t y ;

2 . agreed or co l l uded w i th o ther b i dders or prospec t i ve b i dders , or been a par ty to any such agreemen t , or been conv i c t ed or ad j udged gu i l t y o f agreemen t or co l l us i on among b i dders or prospec t i ve b i dders , i n res t ra i n t o f f reedom o f compe t i t i on by agreemen t to b i d a f i xed pr i ce or o therw i se ; or

3 . made an adm i ss i on o f such conduc t descr i bed i n (1) or (2) above tha t i s a ma t t er o f record , bu t have no t been prosecu t ed for such conduc t ; or

4 . v i o l a t ed the prov i s i ons o f § 2-92-610 o f the Mun i c i pa l Code (L i v i ng Wage Ord i nance ) .

C . The App l i can t unders t ands and sha l l comp l y w i th (1) the app l i cab l e requ i remen t s o f the Governmen t a l E th i cs Ord i nance o f the C i t y , T i t l e 2 , Chap t er 2-156 o f the Mun i c i pa l Code ; and (2) a l l the app l i cab l e prov i s i ons o f Chap t er 2-56 o f the Mun i c i pa l Code (O f f i ce o f the Inspec tor Genera l ) .

EDS 03103 For f edere l l y4unded end non- f edera l l y funded ma t t ers . Page 7 o f 13

D .

E .

v i o l a t i on o f 720 ILCS 5133E-4 ; or (3) any s i m i l ar o f f ense o f any s t a t e or o f the Un i t ed S t a t es o f Amer i ca tha t con t a i ns the same e l emen t s as the o f f ense o f b i d- r i gg i ng or b i d- ro t a t i ng .

Ne i ther the App l i can t nor any emp l oyee , o f f i c i a l , agen t or par tner o f the App l i can t i s bar red f rom con t rac t i ng w i th any un i t o f s t a t e or l oca l governmen t as a resu l t o f engag i ng i n or be i ng conv i c t ed o f (1) b i d- r i gg i ng i n v i o l a t i on o f 720 a CS 5133E-3 , (2 , x- ro t a t i ng i n

I f the App l i can t i s unab l e to cer t i f y to any o f the above s t a t emen t s i n th i s Par t I I I , the App l i can t mus t exp l a i n be l ow :

I f the l e t t ers ' NA , ' the word ' None , or no response appears on the l i nes above , i t w i l l be conc l us i ve l y presumed tha t the App l i can t cer t i f i ed to the above s t a t emen t s .

IV . CERT I F ICAT IO N ON STATUS AS F INANC IAL INST ITUT ION

For purposes o f th i s Par t IV , under § 2-32-455(b) o f the Mun i c i pa l Code , the t erm " F i nanc i a l Ins t i tu t i on ' means a bank , sav i ngs and l oan assoc i a t i on , thr i f t , cred i t un i on , mor tgage banker , mor tgage broker , a t rus t company , a sav i ngs bank , an i nves tmen t bank , a secur i t i es broker , a mun i c i pa l secur i t i es broker , a secur i t i es dea l er , a mun i c i pa l secur i t i es dea l er , a secur i t i es underwr i t er , a mun i c i pa l secur i t i es underwr i t er , an i nves tmen t t rus t , a ven ture cap i t a l company , a bank ho l d i ng company , a f i nanc i a l serv i ces ho l d i ng company , or any l i censee under the Consumer Ins t a l l men t Loan Ac t , the Sa l es F i nance Agency Ac t , or the Res i den t i a l Mor tgage L i cens i ng Ac t . However , " f i nanc i a l i ns t i tu t i on " spec i f i ca l l y sha l l no t i nc l ude any en t i t y whose predom i nan t bus i ness i s the prov i d i ng o f t ax de f er red , de f i ned con t r i bu t i on , pens i on p l ans to pub l i c emp l oyees i n accordance w i th Sec t i on 403(b) and 457 o f the In t erna l Revenue Code . [Add i t i ona l de f i n i t i ons may be found i n Sec t i on 2-32-455(b) o f the Mun i c i pa l Code . ]

A . CERT I F ICAT ION The App l i can t cer t i f i es tha t the App l i can t [check one ]

_ i s X i s no t

a " f i nanc i a l i ns t i tu t i on ' as de f i ned i n Sec t i on 2-32-455 (b) o f the Mun i c i pa l Code .

B . I f the App l i can t IS a f i nanc i a l i ns t i tu t i on , then the App l i can t p l edges :

" We are no t and w i l l no t become a preda tory l ender as de f i ned i n Chap t er 2-32 o f the Mun i c i pa l Code o f Ch i cago . We fur ther p l edge tha t none o f our a f f i l i a t es i s , and none o f them w i l l become , a preda tory l ender as de f i ned i n Chap t er 2-32 o f the Mun i c i pa l Code . We unders t and tha t becom i ng a preda tory l ender or becom i ng an a f f i l i a t e o f a preda tory t ender may resu l t i n the l oss o f the pr i v i l ege o f do i ng bus i ness w i th the C i t y . "

I f the App l i can t i s unab l e to make th i s p l edge because i t or i ts a f f i l i a t es (as de f i ned i n § 2-32-455(b) o f the Mun i c i pa l Code ) are preda tory l enders w i th i n the mean i ng o f Chap t er 2-32 , exp l a i n here (a t t ach add i t i ona l pages i f necessary) :

I f the l e t t ers ' NA , " the word ' None , ' or no response appears on the l i nes above , i t w i l l be conc l us i ve l y presumed tha t the App l i can t cer t i f i ed to the above s t a t emen t s .

V . CERT I F ICAT ION REGARD ING INTEREST IN C ITY BUS INESS

Any words or t erms tha t are de f i ned i n Chap t er 2-156 o f the Mun i c i pa l Code have the same mean i ngs when used i n th i s PART V.

1 . In accordance w i th § 2-156-110 o f the Mun i c i pa l Code :

Does any o f f i c i a l or emp l oyee o f the C i t y o f Ch i cago have a f i nanc i a l i n t eres t i n h i s or her own name or i n the name o f any o ther person i n the con t rac t , work , bus i ness , or t ransac t i on tha t i s the sub j ec t o f th i s EDS?

Yes. X No .

EDS 03M For f edera l l y- funded and non4edera l l y funded ma t t ers . Page 8 o f 13

2 . Un l ess so l d pursuan t to a process o f compe t i t i ve b i dd i ng , no C i t y e l ec t ed o f f i c i a l or emp l oyee sha l l have a f i nanc i a l i n t eres t i n h i s or her own name or i n the name o f any o ther person i n the purchase o f any proper ty tha t ( i ) be l ongs to the C i t y , or ( i i ) i s so l d for t axes or assessmen t s , or ( i i i ) i s so l d by v i r tue o f l ega l process a t the su i t o f the C i t y (co l l ec t i ve l y , " C i t y Proper ty Sa l e " ) . Compensa t i on for proper ty t aken pursuan t to the C i t y ' s em i nen t doma i n power does no t cons t i tu t e a f i nanc i a l i n t eres t w i th i n the mean i ng o f th i s PART V .

Does the con t rac t , work , bus i ness , or t ransac t i on i n connec t i on w i th wh i ch th i s EDS i s subm i t t ed i nvo l ve a C i t y Proper ty Sa l e? Yes.

X No .

I f you answered " yes " to ques t i on one above , i den t i f y the C i t y o f f i c i a l s or emp l oyees hav i ng such i n t eres t and the na ture o f such i n t eres t :

Name

3 .

Bus i ness Address

The App l i can t fur ther cer t i f i es tha t no proh i b i t ed f i nanc i a l i n t eres t i n the con t rac t , work , bus i ness or t ransac t i on tha t i s the sub j ec t o f th i s EDS w i l l be acqu i red by any C i t y o f f i c i a l or emp l oyee .

V I . CERT I F ICAT ION REGARD ING SLAVERY ERA BUS INESS

Sec t i on 2-92-5135 o f the Mun i c i pa l Code requ i res tha t any en t i t y en t er i ng i n to a con t rac t w i th the C i t y mus t comp l e t e an a f f i dav i t ver i f y i ng tha t the en t i t y has searched any and a l l records o f the en t i t y and any and a l l predecessor en t i t i es for records o f i nves tmen t s or pro f i t s f rom s l avery , the s l ave i ndus t ry , or s l aveho l der i nsurance po l i c i es f rom the s l avery era ( i nc l ud i ng i nsurance po l i c i es i ssued to s l aveho l ders tha t prov i ded coverage for damage to or i n j ury or dea th o f the i r s l aves) and mus t d i sc l ose i n the a f f i dav i t such records to the C i t y . In add i t i on , § 2-92-585 requ i res tha t the en t i t y d i sc l ose i n the a f f i dav i t the names o f any s l aves or s l aveho l ders descr i bed i n those records . Fa i l ure to comp l y w i th § 2-92-585 makes the con t rac t vo i dab l e on beha l f o f the C i t y .

P l ease check e i ther (1) or (2) be l ow . I f the App l i can t checks (2) , the App l i can t mus t d i sc l ose be l ow or i n an a t t achmen t to th i s EDS a l l requ i s i t e i n forma t i on as se t for th i n tha t paragraph (2) .

_x-1 . The App l i can t ver i f i es tha t (a ) the App l i can t has searched any and a l l records o f the App l i can t and any and a l l predecessor en t i t i es for records o f i nves tmen t s or pro f i t s f rom s l avery , the s l ave i ndus t ry , or s l aveho l der i nsurance po l i c i es , and (b) the App l i can t has found no records o f i nves tmen t s or pro f i t s f rom s l avery , the s l ave i ndus t ry , or s l aveho l der i nsurance po l i c i es and no records o f names o f any s l aves or s l aveho l ders .

_2 . The App l i can t ver i f i es tha t , as a resu l t o f conduc t i ng the search i n s t ep (1) (a ) above , the App l i can t has found records re l a t i ng to i nves tmen t s or pro f i t s f rom s l avery , the s l ave i ndus t ry , or s l aveho l der i nsurance po l i c i es and / or the names o f any s l aves or s l aveho l ders . The App l i can t ver i f i es tha t the fo l l ow i ng cons t i tu t es fu l l d i sc l osure o f a l l such records:

SECT ION F IVE : CERT I F ICAT IONS FOR FEDERALLY-FUNDED MATTERS

CHECK HERE [ ] AND SK IP THE CERT I F ICAT IONS IN SECT ION F IVE , PARTS ( I ) , ( I I ) , AND ( I I I ) I F THE CONTRACT , WORK , BUS INESS OR TRANSACT ION IN CONNECT ION W ITH WH ICH TH IS EDS IS SUBM ITTED IS NOT FEDERALLY FUNDED .

EDS 03103 For f edera l l y funded and non- f edera l l y funded ma t t ers. Page 9 o f 13

I . CERT I F ICAT ION REGARD ING LOBBY ING

A . L i s t be l ow the names o f a l l persons reg i s t ered under the f edera l Lobby i ng D i sc l osure Ac t o f 1995 who have made l obby i ng con t ac t s on beha l f o f the App l i can t w i th respec t to the con t rac t , work , bus i ness , or t ransac t i on tha t i s or are the sub j ec t o f th i s EDS : [Beg i n l i s t here , add shee t s as necessary) :

( I f no exp l ana t i on appears or beg i ns on the l i nes above , or i f the l e t t ers " NA " or f f the word " None " appear , i t w i l l be conc l us i ve l y presumed tha t the App l i can t means tha t NO persons reg i s t ered under the Lobby i ng D i sc l osure Ac t o f 1995 have made l obby i ng con t ac t s on beha l f o f the App l i can t w i th respec t to the con t rac t , work , bus i ness , or t ransac t i on i n connec t i on w i th wh i ch th i s EDS i s subm i t t ed. ]

B . The App l i can t has no t spen t and w i l l no t expend any f edera l appropr i a t ed funds to pay any person l i s t ed i n Paragraph (A) above for h i s or her l obby i ng ac t i v i t i es or to pay any person to i n f l uence or a t t emp t to i n f l uence an o f f i cer or emp l oyee o f any agency , as de f i ned by app l i cab l e f edera l l aw , a member o f Congress , an o f f i cer or emp l oyee o f Congress , or as- , en; l oyce o f a member o f Congress , i n connec t i on w i th the award o f any f edera l l y- funded con t rac t , mak i ng any f edera l l y- funded gran t or l oan , en t er i ng i n to any coopera t i ve agreemen t , or to ext end , con t i nue , renew , amend , or mod i f y f edera l l y- funded con t rac t , gran t , ban , or coopera t i ve agreemen t

C . The App l i can t w i l l subm i t an upda t ed Perb f i ca t i on a t the end o f each ca l endar quar t er i n wh i ch there occurs any even t tha t ma t er i a l l y a f f ec t s the accuracy o f the s t a t emen t s and i n forma t i on se t for th i n Paragraphs ( I . A . ) and ( I . B . ) above .

I f any funds o ther than f edera l appropr i a t ed funds have been or w i l l be pa i d to any person for In f l uenc i ng or a t t emp t i ng to i n f l uence an o f f i cer or emp l oyee o f any agency , a member o f Congress , an o f f i cer or emp l oyee o f Congress , or an emp l oyee o f a member o f Congress i n connec t i on w i th the f edera l con t rac t ; gran t , l oan , or coopera t i ve agreemen t to wh i ch th i s EDS re l a t es , the App l i can t mus t comp l e t e and subm i t S t andard Form-LLL , " D i sc l osure Form to Repor t Lobby i ng , " i n accordance w i th i t s i ns t ruc t i ons . The form may be ob t a i ned on l i ne f rom the f edera l O f f i ce o f Managemen t and Budge t (OMB) web s i t e a t h t tpJ / www . wh i t ehouse . aov / omb / aran t s / s f i l l i n . ad f , l i nked on the page h t tpJ / www . wh i t ehouse . oov / ombharan t s / aran t s form&h tm l .

-D . The App l i can t cer t i f i es tha t e i ther ( i ) i t i s no t an organ i za t i on descr i bed i n sec t i on 501(c ) (4) o f the In t erna l Revenue Code o f 1986 ; or ( i i ) i t i s an organ i za t i on descr i bed i n sec t i on 501(c ) (4) o f the In t erna l Revenue Code o f 1986 bu t has no t engaged and w i l l no t engage i n " Lobby i ng Ac t i v i t i es " .

E . The App l i can t mus t ob t a i n cer t i f i ca t i ons equa l i n form and subs t ance to paragraphs ( I . A) through ( I . D . ) above f rom a l l subcon t rac tors be fore i t awards any subcon t rac t . The App l i can t mus t ma i n t a i n a l l such subcon t rac tors ' cer t i f i ca t i ons for the dura t i on o f the con t rac t and mus t make such cer t i f i ca t i ons promp t l y ava i l ab l e to the C i t y upon reques t

I I . C ERT I F ICAT ION REGARD ING NONSEGREGATED FAC IL IT IES

A . The App l i can t does no t and w i l l no t ma i n t a i n or prov i de for i t s emp l oyees any segrega t ed f ac i l i t i es a t any o f i t s es t ab l i shmen t s , and i t does no t and w i l l no t perm i t i t s emp l oyees to per form the i r serv i ces a t any l oca t i on under i ts con t ro l where segrega t ed f ac i l i t i es are ma i n t a i ned . The App l i can t agrees tha t a breach o f th i s cer t i f i ca t i on i s a v i o l a t i on o f the Equa l Oppor tun i t y c l ause i n i t s con t rac t w i th the C i t y .

" Segrega t ed f ac i l i t i es , " as used i n th i s prov i s i on , means any wa i t i ng rooms , work areas , res t rooms , washrooms , res t auran t s and o ther ea t i ng areas , t i me docks , l ocker rooms and o ther s torage or dress i ng areas , park i ng l o t s , dr i nk i ng foun t a i ns , recrea t i on or en t er t a i nmen t areas , t ranspor t a t i on , and hous i ng prov i ded for emp l oyees , tha t are segrega t ed by exp l i c i t d i rec t i ve or are i n f ac t segrega t ed on the bas i s o f race , co l or , re l i g i on , sex , or na t i ona l or i g i n because o f hab i t , l oca l or emp l oyee cus tom , or o therw i se . However , separa t ed or s i ng l e -user res t rooms and necessary dress i ng or s l eep i ng areas mus t be prov i ded to assure pr i vacy be tween the sexes .

B . The App l i can t w i l l , be fore the award o f subcon t rac t s , ob t a i n i den t i ca l cer t i f i ca t i ons f rom proposed subcon t rac tors under wh i ch the subcon t rac tor w i l l be sub j ec t to the Equa l Oppor tun i t y c l ause . Con t rac t s and subcon t rac t s exceed i ng $10 , 000 , or hav i ng an aggrega t e va l ue exceed i ng $10 , 000 i n any 12-mon th per i od , are genera l l y sub j ec t to the Equa l Oppor tun i t y c l ause . See 41 CFR Par t 60 for fur ther i n forma t i on regard i ng the Equa l Oppor tun i t y c l ause . The App l i can t mus t re t a i n the cer t i f i ca t i ons requ i red by th i s paragraph F for the dura t i on

o f the con t rac t and mus t make such cer t i f i ca t i ons promp t l y ava i l ab l e to the C i t y upon reques t .

EDS 03103 For f edem i y- funded and non- f edera l l y funded ma t t ers . Page 10 o f 13

C . The App l i can t w i l l forward the no t i ce se t for th be l ow to proposed subcon t rac tors :

NOT ICE TO PROSPECT IVE SUBCONTRACTORS OF REQU IREMENTS FOR CERT I F ICAT IONS OF NONSEGREGATED FAC IL IT IES Subcon t rac tors mus t subm i t to the Con t rac tor a Cer t i f i ca t i on o f Nonsegrega t ed Fac i l i t i es be fore the award o f any subcon t rac t under wh i ch the subcon t rac tor w i l l be sub j ec t to the f edera l equa l oppor tun i t y c l ause . The subcon t rac tor may subm i t such cer t i f i ca t i ons e i ther for each subcon t rac t or for a l l subcon t rac t s dur i ng a per i od (e . g . , quar t er l y , sem i annua l l y , or annua l l y) .

I I I . C ERT I F ICAT ION REGARD ING EQUAL EMPLOYMENT OPPORTUN ITY

Federa l regu l a t i ons requ i re prospec t i ve con t rac tors (e . g . , the App l i can t ) and proposed subcon t rac tors to subm i t the fo l l ow i ng i n forma t i on w i th the i r b i ds or i n wr i t i ng a t the ou t se t o f nego t i a t i ons .

A . Have you deve l oped and do you have on f i l e a f f i rma t i ve ac t i on programs pursuan t to app l i cab l e f edera l regu l a t i ons? (See 41 CFR Par t 60-2 . ) [ A Yes [ ] No

t3 . Have you par t i c i pa t ed i n any prev i ous con t rac t s or subcon t rac t s sub j ec t to the equa l oppor tun i t y c l ause? [ )dYes ( ] No

C . Have you f i l ed w i th the Jo i n t Repor t i ng Comm i t t ee , the D i rec tor o f the O f f i ce o f Federa l Con t rac t Comp l i ance Programs , or the Equa l Emp l oymen t Oppor tun i t y Comm i ss i on a l l repor ts due under the app l i cab l e f i l i ng requ i remen t s? [ ) I Yes [ ] No

SECT ION S IX : NOT ICE AND ACKNOWLEDGMENT REGARD ING L IV ING WAGE ORD INANCE

Sec t i on 2-92-610 o f the Mun i c i pa l Code ( " L i v i ng Wage Ord i nance ' ) requ i res tha t e l i g i b l e con t rac tors (see A . 1 . and 2 . be l ow) pay a spec i f i ed m i n i mum l i v i ng wage ( ' Base Wage " ) to par t i cu l ar ca t egor i es o f workers emp l oyed i n connec t i on w i th the per formance o f cer t a i n C i t y con t rac t s . The L i v i ng Wage Ord i nance app l i es to any wr i t t en agreemen t or subcon t rac t i n connec t i on w i th wh i ch ' the C i t y i s comm i t t ed to expend or does expend funds ' and " wh i ch requ i res i n the per formance thereo f the emp l oymen t o f those ca t egor i es o f workers .

The ord i nance was amended to prov i de for a h i gher Base Wage and regu l ar i ncreases to tha t wage e f f ec t i ve January 1 , 2003 . The amended ord i nance app l i es to agreemen t s preda t i ng the amendmen t as we l l as to new agreemen t s . For purposes o f th i s Sec t i on S i x , the t erm ' Con t rac tor " i n paragraphs A through E be l ow means the App l i can t i f the L i v i ng Wage Ord i nance app l i es to a wr i t t en agreemen t i n connec t i on w i th wh i ch th i s EDS i s subm i t t ed .

[X] BY CHECK ING TH IS BOX APPL ICANT ACKNOWLEDGES AND AGREES THAT I F TH IS EDS IS BE ING SUBM ITTED IN CONNECT ION W ITH A MOD I F ICAT ION TO AN EX IST ING CONTRACT TO WH ICH THE L IV ING WAGE ORD INANCE APPL IES , THE FOLLOW ING L IV ING WAGE PROV IS IONS W ILL BECOME PART OF SUCH MOD I F ICAT ION , SUPERSED ING AND REPLAC ING ANY L IV ING WAGE PROV IS IONS THAT MAY BE CONTA INED IN SUCH MOD I F ICAT ION OR EX IST ING CONTRACT .

A . Under Sec t i on 2-92-610 o f the Mun i c i pa l Code the Base Wage app l i es for cer t a i n ca t egor i es o f workers emp l oyed i n the per formance o f C i t y con t rac t s , spec i f i ca l l y non-C i t y emp l oyed secur i t y guards , park i ng a t t endan t s , day l aborers , home and hea l th care workers , cash i ers , e l eva tor opera tors , cus tod i a l workers , and c l er i ca l workers ( " Covered Emp l oyees ' ) . Accord i ng l y , pursuan t to Sec t i on 2-92-610 and regu l a t i ons promu l ga t ed under i t :

1) I f the con t rac tor has 25 or more fu l l - t i me emp l oyees , and 2) I f a t any t i me dur i ng the per formance o f the con t rac t the con t rac tor and / or any subcon t rac tor or any o ther en t i t y tha t

per forms any por t i on o f the con t rac t ed work (co l l ec t i ve l y ' Per form i ng Par t i es " ) uses 25 or more fu l l - t i me secur i t y guards , or any number o f o ther fu l l - t i me Covered Emp l oyees , then

3) The con t rac tor mus t pay i ts Covered Emp l oyees , and mus t assure tha t a l l o ther Per form i ng Par t i es pay the i r Covered Emp l oyees , no t l ess than the m i n i mum " Base Wage " as de t erm i ned i n accordance w i th th i s prov i s i on for a l l work per formed pursuan t to the con t rac t .

EDS 03103 For f edera l l y- funded and non- f edera l l y funded ma t t ers. Page 11 o f 13

B . The con t rac tor ' s ob l i ga t i on to pay , and to assure paymen t o f , the Base Wage w i l l beg i n a t any t i me dur i ng the con t rac t t erm when the cond i t i ons se t for th i n A1 and A . 2 above are me t , and w i l l con t i nue therea f t er un t i l the end o f the con t rac t

C . Pr i or to January 1 , 2003 , the Base Wage was $7 . 60 per hour , beg i nn i ng January 1 , 2003 , the Base Wage i s $9 . 05 per hour . As o f Ju l y 1 , 2003 , and each Ju l y 1 therea f t er , the Base Wage w i l l be ad j us t ed , us i ng the mos t recen t f edera l pover ty gu i de l i nes for a f am i l y o f four as pub l i shed annua l l y by the U . S . Depar tmen t o f Hea l th and Human Serv i ces , to cons t i tu t e the fo l l ow i ng : the pover ty gu i de l i nes for a f am i l y o f four d i v i ded by 2000 hours or the cur ren t base wage , wh i chever i s h i gher . At a l l t i mes dur i ng the t erm o f th i s con t rac t , con t rac tor and a l l o ther Per form i ng Par t i es mus t pay the Base Wage (as ad j us t ed i n accordance w i th the above ) . I f the paymen t o f preva i l i ng wages i s requ i red for work or serv i ces done under th i s con t rac t , and the preva i l i ng wages for Covered Emp l oyees are h i gher than the Base Wage , then the con t rac tor and a l l o ther Per form i ng Par t i es mus t pay the preva i l i ng wage ra t es.

D . The con t rac tor mus t i nc l ude prov i s i ons i n a l l subcon t rac t s requ i r i ng i t s subcon t rac tors to pay the Base Wage to covered Emp l oyees. The con t rac tor agrees to prov i de the C i t y w i th documen t a t i on accep t ab l e to the Ch i e f Procuremen t O f f i cer demons t ra t i ng tha t a l l Covered Emp l oyees , whe ther emp l oyed by the Con t rac tor or by a subcon t rac tor , have been pa i d the Base Wage , upon the C i t y ' s reques t for such documen t a t i on . The C i t y may i ndependen t l y aud i t the con t rac tor and / or subcon t rac tors to ver i f y comp l i ance herew i th . Fa i l ure to comp l y w i th the requ i remen t s o f th i s Sec t i on w i l l be an even t o f de f au l t under th i s con t rac t , and fur ther , f a i l ure to comp l y may resu l t i n i ne l i g i b i l i t y for any award o f a C i t y con t rac t or subcon t rac t for up to three (3) years.

E . No t - for -Pro f i t Corpora t i ons : I f the con t rac tor i s a corpora t i on hav i ng Federa l t ax-exemp t s t a tus under Sec t i on 501(c ) (3) o f the In t erna l Revenue Code and i s recogn i zed under I l l i no i s no t - for -pro f i t l aw , then the prov i s i ons o f Sec t i on A through D above do no t app l y .

RESUME : A l l Unders i gneds , i nc l ud i ng " En t i t i es ho l d i ng an i n t eres t i n the App l i can t " (de f i ned on page 1 o f th i s EDS) mus t comp l e t e the rema i nder o f th i s EDS .

SECT ION SEVEN : NOT ICE AND ACKNOWLEDGMENT REGARD ING C ITY GOVERNMENTAL ETH ICS AND CAMPA IGN F INANCE ORD INANCES

The C i t y ' s Governmen t a l E th i cs and Campa i gn F i nanc i ng Ord i nances , Chap t ers 2-156 and 2-164 o f the C i t y ' s Mun i c i pa l Code , i mpose cer t a i n du t i es and ob l i ga t i ons on persons seek i ng C i t y con t rac t s , work , bus i ness , or t ransac t i ons . The C i t y o f Ch i cago Board o f E th i cs has deve l oped an e th i cs t ra i n i ng program for such persons . The fu l l t ext o f these ord i nances and the ' t ra i n i ng program i s ava i l ab l e on f i ne a t www . c i t vo f ch i caao . org / E th i cs l . and may a l so be ob t a i ned f rom the C i t y ' s Board o f E th i cs , 740 N . Sedgw i ck S t . , Su i t e 500 , Ch i cago , IL 60610 , (312) 744-9660 . The fo l l ow i ng i s descr i p t i ve on l y and does no t purpor t to cover every aspec t o f Chap t ers 2-156 and 2-164 . The Unders i gned mus t comp l y fu l l y w i th the app l i cab l e ord i nances.

[X] BY CHECK ING TH IS BOX THE UNDERS IGNED ACKNOWLEDGES THAT THE UNDERS IGNED UNDERSTANDS THAT THE C ITY ' S GOVERNMENTAL ETH ICS AND CAMPA IGN F INANC ING ORD INANCES , AMONG OTHER TH INGS :

1) Prov i de tha t any con t rac t nego t i a t ed , en t ered i n to or per formed i n v i o l a t i on o f the C i t y ' s e th i cs l aws can be vo i ded by the c i t y .

2) L i m i t the g i f t s and f avors any person can g i ve , or o f f er to g i ve , to any C i t y o f f i c i a l , emp l oyee , con t rac tor or cand i da t e for e l ec t ed C i t y o f f i ce or the spouse or m i nor ch i l d o f any o f them :

a . canno t g i ve them any cash g i f t or any anonymous g i f t ; and b . canno t g i ve any g i f t based an a mu tua l unders t and i ng tha t the C i t y o f f i c i a l ' s or emp l oyee ' s or C i t y con t rac tor ' s

ac t i ons or dec i s i ons w i l l be i n f l uenced i n any way by the g i f t ;

3) Proh i b i t any C i t y e l ec t ed o f f i c i a l or C i t y emp l oyee f rom hav i ng a f i nanc i a l i n t eres t , d i rec t l y or i nd i rec t l y , i n any con t rac t , work , t ransac t i on or bus i ness o f the C i t y , i f tha t i n t eres t has a cos t or presen t va l ue o f $5 , 000 or more , or i f tha t i n t eres t en t i t i es the owner to rece i ve more than $2 , 500 per year .

4) Proh i b i t any C i t y appo i n t ed o f f i c i a l f rom engag i ng i n any con t rac t , work , t ransac t i on or bus i ness o f the C i t y , un l ess the ma t t er i s who l l y unre l a t ed to the appo i n t ed o f f i c i a l C i t y du t i es or respons i b i l i t i es .

EDS 03103 For f edera f l y- funded and non4ederaBy funded ma t t ers . Page 12 o f 13

5) Prov i de tha t C i t y emp l oyees and o f f i c i a l s , or the i r spouses or m i nor ch i l dren , canno t rece i ve compensa t i on or any th i ng o f va l ue i n re turn for adv i ce or ass i s t ance on ma t t ers concern i ng the opera t i on or bus i ness o f the C i t y , un l ess the i r serves are who l l y unre l a t ed to the i r C i t y du t i es and respons i b i l i t i es .

6) Prov i de tha t former C i t y emp l oyees and o f f i c i a l s canno t , for a per i od o f one year a f t er the i r C i t y emp l oymen t ceases , ass i s t or represen t ano ther on any ma t t er i nvo l v i ng the C i t y f f , wh i l e w i th the C i t y , they were persona l l y and subs t an t i a l l y i nvo l ved i n the same ma t t er .

7) Prov i de tha t former C i t y emp l oyees and o f f i c i a l s canno t ever ass i s t or represen t ano ther on a C i t y con t rac t i f , wh i l e w i th the C i t y , they were persona l l y i nvo l ved i n or d i rec t l y superv i sed the formu l a t i on , nego t i a t i on , or execu t i on o f tha t con t rac t

SECT ION E IGHT : CONTRACT INCORPORAT ION , COMPL IANCE , PENALT IES , D ISCLOSURE

The Unders i gned unders t ands and agrees tha t :

A. The cer t i f i ca t i ons , d i sc l osures , and acknow l edgmen t s con t a i ned i n th i s EDS w i l l become par t o f any con t rac t awarded to the Appron t by f e C i t y i n connec t i on w i th the pro j ec t or t ransac t i on tha t i s the sub j ec t o f th i s EDS , whe ther procuremen t , C i t y ass i s t ancs , or o ther C i t y ac t i on , and are ma t er i a l i nducemen t s to the C i t y ' s execu t i on o f any con t rac t or t ak i ng o ther ac t i on w i t t y respec t to ass i s t i ng the pro j ec t or t ransac t i on tha t i s the sub j ec t o f th i s EDS . The Unders i gned unders t ands tha t i t mus t comp l y w i th the s t a tu t es , ord i nances , and regu l a t i ons on wh i ch th i s EDS i s based .

B . I f the C i t y de t erm i nes tha t any i n forma t i on prov i ded i n th i s EDS i s f a l se , i ncomp l e t e or i naccura t e , any con t rac t or o ther agreemen t i n connec t i on w i th wh i ch i t i s subm i t t ed may be vo i d or vo i dab l e , and the C i t y may pursue any remed i es under the con t rac t ( i f no t vo i d or vo i dab l e ) , a t l aw , or i n equ i t y , i nc l ud i ng t erm i na t i ng the Unders i gned ' s par t i c i pa t i on i n the pro j ec t or t ransac t i on and / or dec l i n i ng to a l l ow the Unders i gned to par t i c i pa t e i n o ther t ransac t i ons w i th the C i t y .

C . Some or a l l o f the i n forma t i on prov i ded on th i s EDS and any a t t achmen t s to th i s EDS may be made ava i l ab l e to the pub l i c on the In t erne t , i n response to a Freedom o f In forma t i on Ac t reques t , or o therw i se . By comp l e t i ng and s i gn i ng th i s EDS , the Unders i gned wa i ves and re l eases any poss i b l e r i gh t s or c l a i ms wh i ch i t may have aga i ns t the C i t y i n connec t i on w i th the pub l i c re l ease o f i n forma t i on con t a i ned i n th i s EDS and a l so au thor i zes the C i t y to ver i f y the accuracy o f any i n forma t i on subm i t t ed i n th i s EDS .

D . The Unders i gned has w i thhe l d no d i sc l osures as to econom i c i n t eres ts i n the unders i gned , or under t ak i ng , bus i ness , or t ransac t i on to wh i ch th i s EDS per t a i ns nor reserved any i n forma t i on , da t a or p l an as to the i n t ended use or purpose for wh i ch i t seeks C i t y Counc i l or o ther C i t y agency ac t i on .

E . The i n forma t i on prov i ded i n th i s EDS mus t be kep t cur ren t In the even t o f changes , the Unders i gned mus t supp l emen t th i s A f f i dav i t , up to the t i me the C i t y t akes ac t i on on the b i d , proposa l , or o ther app l i ca t i on for wh i ch th i s EDS i s be i ng subm i t t ed .

By: (s i gn ho i c )

T i t l e o f s i gna tory : Pres i den t

Pr i n t or t ype name o f s i gna tory : Dan i e l P - T) i P i -7. 1( - r

p * I In a Repraen t a t i " oapad t y. t i p . as 11101 or agen t o f an App l i can t or an en t i t y

ho l f ae hand In the App i an t . )

Cau*o f saes a AduvwWW under oa th on (da f t )

beb i e me by

WPM-a t "

(d sh i n i ng In an bngu i dua l apaer i y . )

No t ary POW

RSMV C]

EDS 03103 For f edera l y- furded and wn- f edera l l y funded ma t t ers . 11

CYNTH IA HANKOVCAK

No t ary Pub l i c , S t a t e o f I l l i no i s

My Comm i ss i on Exp i res 0109 E X

f13

JUN 10 2003 10 : 04RN HP LRSERJET 3200

RETURN TH IS " D ISCLOSURE OF RETA INED PART IES " FOR IY I W ITH IN 7 CALENDAR DAYS OF C ITY NOT I F ICAT ION

D ISCLOSURE OF RETA IN E D PART I ES

A . De fm l t l ons armdd D i sc l osure Reau i remen t s

1 . As used here i n , " Con t rac tor " means a person or en t i t y who has any con t rac t or l ease w i th the C i t y o f Ch i cago ( the " C i t y " ) .

2. Pursuan t to Execu t i ve Order 97 . 1 , every c i t y con t rac t and l ease mus t be accompan i ed by a d i sc l osure s t a t emen t prov i d i ng cer t a i n i n forma t i on abou t a t torneys , l obby i s ts , accoun t an t s , consu l t an t s , subcon t rac tors , and o ther persons whom the Con t rac tor has re t a i ned or expec t s to re t a i n w i th respec t to the con t rac t or l ease . In par t i cu l ar , the Con t rac tor mus t d i sc l ose the name o f each such person , h i s or her bus i ness address , the na ture o f the re l a t i onsh i p , and the amoun t o f f ees pa i d or es t i ma t ed to be pa i d . The Con t rac tor i s no t requ i red to d i sc l ose emp l oyees who are pa i d so l e l y through the Con t rac tor ' s regu l ar payro l l .

3 . " Lobby i s t " means any person (a ) who for compensa t i on or on beha l f o f any person o ther than h i mse l f under t akes to i n f l uence any l eg i s l a t i ve or adm i n i s t ra t i ve ac t i on , or (b) any par t o f whose du t i es as an emp l oyee o f ano ther i nc l udes under t ak i ng to i n f l uence any l eg i s l a t i ve or adm i n i s t ra t i ve ac t i on .

B . C i f i ca f a

Con t rac tor hereby cer t i f i es as fo l l ows :

1 . Th i s D i sc l osure re l a t es to the fo l l ow i ng t ransac t i on :

Spec i f i ca t i on or o ther i den t i f y i ng number : L 1) t r 8 1) ° ) 0031 CC o . t [R!>c7

Descr i p t i on o f goods or serv i ces to be prov i ded under Con t rac t : PaDF D f t1c a

' PCT2 t oG . E~ ~~ rc . E~~r. w ~ . 2 . Name o f Con t rac tor : _ -

: A r rv g t { CaZO) 12 S)

. SCC%AtE s / Mr3 . JRoE %T .

3 . EACH AND EVERY a t torney , l obby i s t , accoun t an t . consu l t an t , subcon t rac tor , or o ther person re t a i ned or an t i c i pa t ed to be re t a i ned by the Con t rac tor w i th respec t to or i n connec t i on w i th the con t rac t or l ease i s l i s t ed be l ow . At t ach add i t i ona l pages i f necessary . NOTE : You mus t i nc l ude i n forma t i on abou t cer t i f i ed MBE IWBEs you have re t a i ned or an t i c i pa t e re t a i n i ng , even i f you have a l ready prov i ded tha t i n forma t i on e l sewhere i n the con t rac t documen t s.

NAME BUS INESS ADDRES5

RELAT IONSH IP (a t torney , l obby i s t , subcon t rac tor , t i c . )

FEES ( i nd i ca t e whe ther pa i d or es t i ma t ed)

Co ITEl - C0N5%A . ' t% , 1q i W t - 15q S . 1AA t . 4k j t . *yz . S-0a (o , 1VAc ' t a (L . 71DN . (o f f PA` ' ~

k C ee i Y-+oa E , +1%-?J EU N , t , i e . 3o E . r~w^r " i A l k o o S Q Cor ' t2AC?o2 Uu Se . a t ~A , ~ ' ryE s ' i P fo t F twa ~r , ) t r . Zo E . ( I1 c -~ S J3 Cs*~ ' To f e. °1 °1 t 3 a 3 ~~

CHECK HERE I F NO SUCH PERSONS HAVE BEEN RETA INED OR ARE ANT IC IPATED TO BE RETA INED :

JUN 10 e~UU3 10 : U4r , i - , HP LRSERJET 3200

4 . The Con t rac tor unders t ands and agrees as fo l l ows :

- a . -Th l L- - i n forma t ro , , prov i ded-here i n- i s-ama t er i a [ i nducemen t - to t3 t e C i Ws- txecu t i o t to f the con t rac tor o ther ac t i on w i th respec t to wh i ch th i s D i sc l osure o f Re t a i ned Par t i es form i s be i ng execu t ed , and the C i t y may re l y on the i n forma t i on prov i ded here i n . Fur thermore , i f the C i t y de t erm i nes tha t any i n forma t i on prov i ded here i n i s f a l se , i ncomp l e t e , or i naccura t e , the C i t y may t erm i na t e the con t rac t or o ther t ransac t i on , t erm i na t e the Con t rac tor ' s par t i c i pa t i on i n the con t rac t or o ther t ransac t i on , and / or dec l i ne to a l l ow the Con t rac tor to par t i c i pa t e i n o ther con t rac t s or t ransac t i ons w i th the C i t y.

b . I f the Con t rac tor i s uncer t a i n whe ther a d i sc l osure i s requ i red under the F -xccu t i ve Order , the Con t rac tor mus t e i ther ask the Con t rac t Adm i n i s t ra tor or h i s or her manager whe ther d i sc l osure i s requ i red or make the d i sc l osure .

c . Th i s D i sc l osure o f Re t a i ned Par t i es form , some or a l l o f the i n forma t i on prov i ded here i n , and any a t t achmen t s may be made ava i l ab l e to the pub l i c on the In t erne t , i n response to a Freedom o f In forma t i on Ac t reques t , or o therw i se . The Con t rac tor wa i ves and re l eases any poss i b l e r i gh t s or c l a i ms i t may have aga i ns t the C i t y i n connec t i on w i th the pub l i c re l ease o f i n forma t i on con t a i ned i n the comp l e t ed D i sc l osure o f Re t a i ned Par t i es form and any a t t achmen t s .

Under pena l t y o f per j ury , I cer t i f y tha t 1 am au thor i zed to execu t e th i s D i sc l osure o f Re t a i ned Par t i es on beha l f o f the Con t rac tor and tha t the i n forma t i on d i sc l osed here i n i s t rue and comp l e t e -

S i gna ture J Da t e

I e O S SE~J ~ o2 V N LE l u s l oE`~ Name ( type or pr i n t ) T i t l e

Subscr i bed and swom to be fore me th i s day o f t , ~- 03

OFF IC IAL SEAL MARTA M OLAGUE

NOTARY PUBL IC - STATE OF ILL INO IS MY COMM ISS ION EXP IRES 09 . 1946

?b

S I

Rr RN TH IS " D ISCLOSURE OF RETA INED PART IES "

FORM W ITH IN 7 CALENDAR DAYS OF C ITY NOT I F ICAT ION

D ISCLOSURE OF RETA INED PART IES

A . De f i n i t i on s and D i sc l osure Reou i remen t s

1 . As used here i n , " Con t rac tor " means a person or en t i t y who has any con t rac t or l ease w i th the C i t y o f Ch i cago ( the " C i t y " )

2 . Pursuan t to Execu t i ve Order 97-1 , every c i t y con t rac t and l ease mus t be accompan i ed by a d i sc l osure s t a t emen t prov i d i ng cer t a i n i n forma t i on abou t a t torneys , l obby i s ts . accoun t an t s , consu l t an t s , subcon t rac tors , and o ther persons whom the Con t rac tor has re t a i ned or expec t s to re t a i n w i th respec t to the con t rac t or l ease . i n par t i cu l ar , the Con t rac tor mus t d i sc l ose the name o f each such person . h i s or her bus i ness address , the na ture o f the re l a t i onsh i p , and the amoun t o f f ees pa i d or es t i ma t ed to be pa i d . The Con t rac tor i s no t requ i red to d i sc l ose emp l oyees who are pa i d so l e l y through the Con t rac tor ' s regu l ar payro l l .

3 . " Lobby i s t " means any person (a ) who for compensa t i on or on beha l f o f any person o ther than h i mse l f under t akes to i n f l uence any l eg i s l a t i ve or adm i n i s t ra t i ve ac t i on , or (b) any par t o f whose du t i es as an emp l oyee o f ano ther i nc l udes under t ak i ng to i n f l uence any l eg i s l a t i ve or adm i n i s t ra t i ve ac t i on .

B . Cer t i f i ca t i on

Con t rac tor hereby cer t i f i es as fo l l ows :

1 . Th i s D i sc l osure re l a t es to the fo l l ow i ng t ransac t i on : MONROE STREET BR IDGE

Spec i f i ca t i on or o ther i den t i f y i ng number : C968-99-0037

Descr i p t i on o f goods or serv i ces to be prov i ded under Con t rac t : Arch i t ec tura l and Eng i neer i ng Des i gn

2 . Name o f Con t rac tor : Pa t r i ck Eng i neer i ng , Inc .

3 . EACH AND EVERY a t torney , l obby i s t , accoun t an t , consu l t an t , subcon t rac tor . or o ther person re t a i ned or an t i c i pa t ed to be re t a i ned by the Con t rac tor w i th respec t to or i n connec t i on w i th the con t rac t or l ease i s l i s t ed be l ow . At t ach add i t i ona l pages i f necessary. NOTE : You mus t i nc l ude i n forma t i on abou t cer t i f i ed MBE / WBEs you have re t a i ned or an t i c i pa t e re t a i n i ng , even i f you have a l ready prov i ded tha t i n forma t i on e l sewhere i n the con t rac t documen t s .

NAME BUS INESS ADDRESS

RELAT IONSH IP (a t torney , l obby i s t , sub-con t rac tor . e t c . )

FEES ( i nd i ca t e whe ther pa i d or es t i ma t ed)

COTTER CONSULT ING . INC . 150 S Wacker Dr . . Su i t e 420 sub-con t rac tor $7634 . 64 od

Techknow Eng i neers . LLC 30 E. Adams S t . . Su i t e 1 100 sub-con t rac tor $44 . 856 . 04 [ )d

Bes t Pho to Dra f t i ng . Inc . 20 E . Rando l ah S t . sub-con t rac tor $9 . 913 . 93 ad

CHECK HERE I F NO SUCH PERSONS HAVE BEEN RETA INED OR ARE ANT IC IPATED TO BE RETA INED :

The Con t rac tor unders t a i and agrees as fo l l ows .

a . The i n forma t i on prov i ded here i n i s a ma t er i a l i nducemen t to the C i t y ' s execu t i on o f the con t rac t or o ther ac t i on w i th respec t to wh i ch th i s D i sc l osure o f Re t a i ned Par t i es Corm i s be i ng execu t ed , and the C i t y may re i v on the i n forma t i on prov i ded here i n . Fur thermore , i f the C i t y de t erm i nes tha t any i n forma t i on prov i ded here i n i s f a l se , i ncomp l e t e , or i naccura t e , the C i t y may t erm i na t e the con t rac t or o ther t ransac t i on , t erm i na t e the

Con t rac tor ' s par t i c i pa t i on i n the con t rac t or o ther t ransac t i on , and / or dec l i ne to a l l ow the Con t rac tor to par t i c i pa t e i n o ther con t rac t s or t ransac t i ons w i th the C i t y .

b . I f the Con t rac tor i s uncer t a i n whe ther a d i sc l osure i s requ i red under the Execu t i ve Order , the Con t rac tor mus t e i ther ask the Con t rac t Adm i n i s t ra tor or h i s or her manager whe ther d i sc l osure i s requ i red or make the d i sc l osure .

c . Th i s D i sc l osure o f Re t a i ned Par t i es form , some or a l l o f the i n forma t i on prov i ded here i n , and any a t t achmen t s may be made ava i l ab l e to the pub l i c on the In t erne t , i n response to a Freedom o f In forma t i on Ac t reques t , or o therw i se . The Con t rac tor wa i ves and re l eases any poss i b l e r i gh t s or c l a i ms i t may have aga i ns t the C i t y i n connec t i on w i th the pub l i c re l ease o f i n forma t i on con t a i ned i n the comp l e t ed D i sc l osure o f Re t a i ned Par t i es form and any a t t achmen t s .

Under pena l t y o f per j ury , I cer t i f y tha t I am au thor i zed to execu t e th i s D i sc l osure o f Re t a i ned Par t i es on beha l f o f the Con t r c tor and tha t the i n forma t i on d i sc l osed here i n i s t rue and comp l e t e .

l Jo t~ j / a -0 ~- -~o ~J S i gna ture Da t e

Name hype or pr i n t ) T i t l e

Subscr i bed and sworn to be fore me a.

th i s 2 Y day o f Pe c e - b , e r , 20

Rev . 11 / 99 2