STEP 7 POTENTIAL CONFLICTS OF INTEREST RELATING TO DEBARMENT & LEGAL PROCEEDINGS (Complete only if bid, offer, or contract has an annual value over $50,000) (Subcontractors with subcontract annual value of more than $50,000 must complete) This step must be completed for each person disclosed in Step 2, Option A, Step 3, and for each entity and sole proprietor disclosed in Step 1. Please provide the name of the person or entity for which responses are provided: Within the previous ten years, have you had debarment from contracting with any Yes No governmental entity? Within the previous ten years, have you had any professional licensure discipline? Yes No Within the previous ten years, have you had any bankruptcies? Yes No Within the previous ten years, have you had any adverse civil judgments and administrative Yes No findings? Within the previous ten years, have you had any criminal felony convictions? Yes No If you answered “Yes”, please provide a detailed explanation that includes, but is not limited to the name, State agency or university, and position title of each individual. STSTEP 8 STEP 8 DISCLOSURE OF CURRENT AND PENDING CONTRACTS (Complete only if bid, offer, or contract has an annual value over $50,000) (Subcontractors with subcontract annual value of more than $50,000 must complete) If you selected Option 1, 2, 3, 4, or 6 in Step 1, do you have any contracts, pending contracts, bids, proposals, subcontracts, leases or other ongoing procurement relationships with units of State of Illinois government? Yes No. If “Yes”, please specify below. Additional rows may be inserted into the table or an attachment may be provided if needed. Agency/University Project Title Status Value Contract Reference/P.O./Illinois Procurement Bulletin #
STEP 7 POTENTIAL CONFLICTS OF INTEREST RELATING TO DEBARMENT & LEGAL PROCEEDINGS (Complete only if bid, offer, or contract has an annual value over $50,000) (Subcontractors with subcontract annual value of more than $50,000 must complete) This step must be completed for each person disclosed in Step 2, Option A, Step 3, and for each entity and sole proprietor disclosed in Step 1. Please provide the name of the person or entity for which responses are provided: Within the previous ten years, have you had debarment from contracting with any governmental entity? Yes No Within the previous ten years, have you had any professional licensure discipline? Yes No Within the previous ten years, have you had any bankruptcies? Yes No Within the previous ten years, have you had any adverse civil judgments and administrative findings? Yes No Within the previous ten years, have you had any criminal felony convictions? Yes No If you answered “Yes”, please provide a detailed explanation that includes, but is not limited to the name, State agency or university, and position title of each individual. STSTEP 8 STEP 8 DISCLOSURE OF CURRENT AND PENDING CONTRACTS (Complete only if bid, offer, or contract has an annual value over $50,000) (Subcontractors with subcontract annual value of more than $50,000 must complete) If you selected Option 1, 2, 3, 4, or 6 in Step 1, do you have any contracts, pending contracts, bids, proposals, subcontracts, leases or other ongoing procurement relationships with units of State of Illinois government? Yes No. If “Yes”, please specify below. Additional rows may be inserted into the table or an attachment may be provided if needed. Agency/University Project Title Status Value Contract Reference/P.O./Illinois Procurement Bulletin #
FormsA.15.2a.docx