State of Illinois Illinois Department of Human Rights Legal Division, Public Contracts Unit Make payment to: ILLINOIS DEPARTMENT OF HUMAN RIGHTS MAIL TO: IDHR - FISCAL UNIT 100 W. RANDOLPH - SUITE 10-100 CHICAGO, ILLINOIS 60601 TELEPHONE: 312-814-2432 (TTY: 866-740-3953) Contact a Public Contracts Unit Representative IDHR.PublicContracts@Illinois.gov IDHR EMPLOYER REPORT FORM (PC-1): RENEWAL OF A CURRENT IDHR NUMBER Instructions: This form is to be used by an entity RENEWING an IDHR Eligibility number. IDHR Eligibility Numbers expire five years after the date of issue, and may be renewed at that time for an additional $75 fee. The information requested is necessary to accomplish the statutory purpose set forth in 775 ILCS 5/1-101 et seq. Disclosure of this information is REQUIRED. Forms received with employment data omitted will not be processed. The gathering and retention of employee race/ethnicity and gender data is permitted by state and federal law so long as such data are kept separate from other personnel information and are not used for the purpose of committing unlawful discrimination. For administrative details, review 44 Ill. Admin. Code, Section 750.210(a). You must file a renewal if your company wants to maintain eligibility to bid on state contracts and any one of the following applies: 1) your company employs 15 or more persons at the time of application for a public contract; 2) your company has employed 15 or more persons at any time during the 365 day period prior to the date of your applying for a public contract; 3) you are directed to file by a contracting agency of the State of Illinois, any political subdivision, or a municipal corporation. A form is deemed filed when it is received by the IDHR Chicago office, PROPERLY completed, signed, and accompanied by a certified check, money order, or cashier’s check for $75 payable to the Illinois Department of Human Rights. No personal checks, business checks, or credit card numbers will be accepted. Any form without an approved form of payment will be returned unprocessed. This form must be filed prior to bid opening. Sexual Harassment Policy: NO company without a sexual harassment policy will be issued an IDHR number. If your organization has no policy, and would like a model for creating one, please visit: http://www2.illinois.gov/dhr/PublicContracts/Pages/Sexual_Harassment_Model_Policy.aspx. Federal Employer Identification Number (FEIN) must be provided. If your entity has multiple locations that all have the same FEIN, you are only obligated to pay one fee ($75) to receive an IDHR number for any locations having the same FEIN and wishing to be eligible to bid on business with the State of Illinois. The following form must be filled out for EACH location applying to do business with the State. Click here to open additional blank copies of the following form. (IDHR EMPLOYER REPORT FORM 1/31/2012) Instructions Page – Keep for your records American LegalNet, Inc. www.FormsWorkFlow.com Make Payment ($75 Certified Check, Cashier’s Check, or Money Order) to: ILLINOIS DEPARTMENT OF HUMAN RIGHTS and mail to: IDHR - FISCAL UNIT 100 W. RANDOLPH - SUITE 10-100 CHICAGO, ILLINOIS 60601 State of Illinois Illinois Department of Human Rights Legal Division, Public Contracts Unit Renewal Name of Applying Company: FEIN: Address: Prev. IDHR Number: City: State: Contact Name: Individual or sole proprietor Partnership Corporation - for profit ZIP: County: Country: Phone: Corporation - not for profit Government entity Educational institution Email: Other- MALE JOB CATEGORIES W B H FEMALE A AI T W B H A TOTAL T AI Executive/Senior Level Officials First/Mid-Level Officials and Managers Professionals Technicians Sales Workers Administrative Support Workers Craft Workers Operatives Laborers and Helpers Services Workers TOTAL W=White (Not of Hispanic Origin; B=Black or African American; H=Hispanic or Latino, A=Asian or Pacific Islander, AI=American Indian or Alaskan Native; T=Total Sole proprietorship: one employee and that same employee is the owner; must fill in the above chart for the one person. DATE OF ABOVE DATA: NOTE: ANSWER EACH QUESTION BELOW WITH INFORMATION PERTAINING TO THE WORK FORCE REPORTED ABOVE. Describe the goods or services produced at or provided by the employer. Identify the geographical area from which the company draws its employees. Use city, county, metropolitan statistical area, or distance from location. What is the maximum number of employees working for the company during a 12-month period? What is the average number of persons employed by the company on a year-round basis? How many disabled persons are employed by the company? Yes No Is the employer a federal contractor pursuant to federal executive order 11246? Does the company normally hire additional employees to perform contract work? Is the company minority owned? Is the company female owned? Does the company have a current written affirmative-action plan? Does the company have a current written sexual harassment policy? Within the past three years, has the company been declared ineligible for any public contract based on a finding of employment discrimination? If yes, attach a separate sheet fully explaining the situation. Is this form for a location which shares a FEIN with another location that is already registered with IDHR? I certify that the information provided in this report, and in any attachments thereto, is true and accurate to the best of my knowledge and belief. The employer filing this report agrees to conform with the requirements set forth in the Illinois Human Rights Act, 775 ILCS 5/1-101 et seq., and the rules and regulations of the Department of Human Rights. I am authorized to sign this form on behalf of the employer. SIGNATURE DATE TYPED NAME AND TITLE TELEPHONE EMAIL (IDHR EMPLOYER REPORT FORM 1/31/2012) Employer Report Form – Submit to IDHR with Payment Note: An Employer IDHR Eligibility Number Expires 5 years from the date of issue/renewal. RENEWAL American LegalNet, Inc. www.FormsWorkFlow.com State of Illinois Illinois Department of Human Rights Legal Division , Public Contracts Unit Definitions, Clauses and Policies Applicable to the IDHR Employer Report Form Keep for your Records Definition of employee - For purposes of this form, an “employee” is an individual performing services for remuneration for the employer. All fulltime and permanent part-time employees are to be reported. Forms received containing mathematic errors will not be processed. Description of Race/Ethnic - Race/ethnic designations as used by the Department do not denote scientific definitions of anthropological origins. For the purposes of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. However, no person should be counted in more than one race/ethnic group. They are: “White (Not of Hispanic Origin)” All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. “Black or African-American” (Not of Hispanic Origin). All persons having origins in any of the Black racial groups of Africa. “Hispanic or Latino” All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. “Asian or Pacific Islander” All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa. “American Indian or Alaskan Native” All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. Definition of categories - Each employee should be counted in only one job category. Select the category containing the jobs most similar to that performed by the employee. The jobs listed in each category are intended to provide examples, not a complete list, of all job titles falling into that category. “Executive Senior Level Officials” Individuals who plan, direct and formulate policies, set strategy and provide the overall direction of enterprises/organizations for the development and delivery of products or services, within the parameters approved by boards of directors or other governing bodies. Examples include: chief executive officers, chief operating officers, chief financial officers, line of functional areas or operating groups, chief information officers, chief marketing officers, chief legal officers, management directors and managing partners. “First/Mid Level Officials and Managers” Individuals who typically lead major business units. They implement policies, programs and directives of executive/senior management through subordinate managers and within the parameters set by Executives/Senior Level management. Examples of these kinds of managers are: first-line managers, team managers, unit managers, administrative services managers, purchasing and transportation managers, call center or customer service managers, technical support managers, and brand of product managers. “Professionals” Occupations requiring either college graduation or experience of such kind and amount as to provide a comparable background. Includes: accountants and auditors, airplane pilots and navigators, architects, artists, scientists, designers, dietitians, editors, engineers, lawyers, librarians, mathematicians, registered professional nurses, personnel and labor relations specialists, physicians, social scientists, teachers, surveyors etc. “Technicians” Occupations requiring a combination of basic scientific knowledge and manual skill which can be obtained through 2 years of post high school education, such as is offered in many technical institutes and union colleges, or through equivalent on-the-job training. Includes: computer programmers, drafters, engineering/mathematical/scientific aides, licensed/practical/vocational nurses, photographers, radio operators, technical illustrators, medical/dental/electronic/scientific technicians, etc. “Sales Workers” Occupations engaging wholly or primarily in direct selling. Includes: advertising agents and sates workers, insurance agents and brokers, real estate agents and brokers, stock and bond sales workers, demonstrators, sales workers and sales clerks, grocery clerks, and cashiers/checkers, etc. “Administrative Support Workers” Includes all clerical-type work regardless of level of difficulty, where the activities are predominantly nonmanual though some manual work not directly involved with altering or transporting the products is included. Includes: bookkeepers, collectors (bills and accounts), messengers and office helpers, office machine operators (including computer), shipping and receiving clerks, stenographers, typists and secretaries, telegraph and telephone operators, legal assistants, etc. “Craft Workers (skilled)” Manual workers of relatively high skill level having a thorough and comprehensive knowledge of the processes involved in their work. Exercise considerable independent judgment and usually receive an extensive period of training. Includes: the building trades, hourly paid supervisors/lead operators not members of management, mechanics, skilled machinists, electricians, compositors/typesetters/engravers, pattern/model makers, stationary engineers, motion picture projectionists, painters (construction/maintenance), tailors/tailoresses, arts/decorating occupations, handpainters, coaters, bakers, etc. “Operatives (semiskilled)” Workers who operate machine or processing equipment or perform other factory-type duties of intermediate skill level which can be mastered in a few weeks and require only limited training. Includes: apprentices (auto/plumbing/bricklaying/carpentry/electrical/machinist/mechanical/building trade/metalworking/printing trades, etc.), attendants (auto service/parking), blasters, chauffeurs, delivery workers, sewers/stitchers, dryers, furnace workers, heaters, laundry/dry cleaning, milliners, mine laborers, motor operators, oilers/greasers (except auto), painters (manufactured articles), photographic processors, truck/tractor drivers, welders/flame cutters, electronic equipment assemblers, butchers/meatcutters, inspectors/testers/graders, handpackers/packagers, knitting/looping/taping/weaving machine operators, etc. “Laborers & Helpers” Workers in manual occupations which generally require no special training who perform elementary duties that may be learned in a few days and require the application of little or no independent judgment. Includes: garage laborers, car washers/greasers, gardeners, farm workers, stevedores, wood choppers, lifting/digging/mixing/loading/pulling laborers, etc. “Service Workers” Workers in both protective and non-protective service occupations. Includes: attendants (hospital/other institutions, professional/personal service, nurses aides/orderlies), barbers, char workers/cleaners, cooks, counter/fountain workers, elevator operators, firefighters/fire protection, guards, doorkeepers, stewards, janitors, police officers/detectives, porters, waiters/waitresses, amusement/recreation facilities attendants, guides, ushers, public transportation attendants, etc. (IDHR EMPLOYER REPORT FORM 6/7/2011) Definitions, Clauses and Policies – Keep for your records American LegalNet, Inc. www.FormsWorkFlow.com State of Illinois Illinois Department of Human Rights Legal Division , Public Contracts Unit Definitions, Clauses and Policies Applicable to the IDHR Employer Report Form Keep for your Records ILLINOIS ADMINISTRATIVE CODE EQUAL EMPLOYMENT OPPORTUNITY CLAUSE 44 Ill. Admin. Code, Section 750. APPENDIX A. Equal Employment Opportunity Clause EQUAL EMPLOYMENT OPPORTUNITY In the event of the contractor's non-compliance with the provisions of this Equal Employment Opportunity Clause, the Illinois Human Rights Act or the Rules and Regulations of the Illinois Department of Human Rights ("Department"), the contractor may be declared ineligible for future contracts or subcontracts with the State of Illinois or any of its political subdivisions or municipal corporations, and the contract may be canceled or voided in whole or in part, and such other sanctions or penalties may be imposed or remedies invoked as provided by statute or regulation. During the performance of this contract, the contractor agrees as follows: 1) That it will not discriminate against any employee or applicant for employment because of race, color, religion, sex, marital status, national origin or ancestry, age, physical or mental handicap unrelated to ability, or an unfavorable discharge from military service; and further that it will examine all job classifications to determine if minority persons or women are underutilized and will take appropriate affirmative action to rectify any such underutilization. 2) That, if it hires additional employees in order to perform this contract or any portion thereof, it will determine the availability (in accordance with the Department's Rules) of minorities and women in the area(s) from which it may reasonably recruit and it will hire for each job classification for which employees are hired in such a way that minorities and women are not underutilized. 3) That, in all solicitations or advertisements for employees placed by it or on its behalf, it will state that all applicants will be afforded equal opportunity without discrimination because of race, color, religion, sex, marital status, national origin or ancestry, age, physical or mental handicap unrelated to ability, or an unfavorable discharge from military service. 4) That it will send to each labor organization or representative of workers with which it has or is bound by a collective bargaining or other agreement or understanding, a notice advising such labor organization or representative of the contractor's obligations under the Illinois Human Rights Act and the Department's Rules. If any such labor organization or representative fails or refuses to cooperate with the contractor in its efforts to comply with such Act and Rules, the contractor will promptly so notify the Department and the contracting agency and will recruit employees from other sources when necessary to fulfill its obligations thereunder. 5) That it will submit reports as required by the Department's Rules, furnish all relevant information as may from time to time be requested by the Department or the contracting agency, and in all respects comply with the Illinois Human Rights Act and the Department's Rules. 6) That it will permit access to all relevant books, records, accounts and work sites by personnel of the contracting agency and the Department for purposes of investigation to ascertain compliance with the Illinois Human Rights Act and the Department's Rules. 7) That it will include verbatim or by reference the provisions of this clause in every subcontract it awards under which any portion of the contract obligations are undertaken or assumed, so that such provisions will be binding upon such subcontractor. In the same manner as with other provisions of this contract, the contractor will be liable for compliance with applicable provisions of this clause by such subcontractors; and further it will promptly notify the contracting agency and the Department in the event any subcontractor fails or refuses to comply therewith. In addition, the contractor will not utilize any subcontractor declared by the Illinois Human Rights Commission to be ineligible for contracts or subcontracts with the State of Illinois or any of its political subdivisions or municipal corporations. FEDERAL EXECUTIVE ORDER 11246 The Executive Order 11246 (E.O 11246) prohibits federal contractors and subcontractors and federally-assisted construction contractors and subcontractors that generally have contracts that exceed $10,000 from discriminating in employment decisions on the basis of race, color, religion, sex, or national origin. It also requires covered contractors to take affirmative action to ensure that equal opportunity is provided in all aspects of their employment. The E.O. 11246 is administered by the Employment Standards Administration's Office of Federal Contract Compliance Programs (OFCCP) within the U.S. Department of Labor. WRITTEN SEXUAL HARASSMENT POLICY REQUIRED Illinois law requires all parties to a public contract and all eligible bidders to have a written sexual harassment policy covering their employees and applicants for employment. This requirement applies regardless of the number of persons employed or the dollar value of any public contract. This requirement is found at 775 ILCS 5/2-105(A)(4). Each sexual harassment policy must contain the following elements: 1. 2. 3. 4. 5. 6. 7. A statement that sexual harassment is illegal. The definition of sexual harassment under the Illinois Human Rights Act. A description of the acts that constitutes sexual harassment, with examples. The vendor's internal complaint procedure, including penalties. The legal recourse, investigative, and complaint process available through the Illinois Department of Human Rights and the Illinois Human Rights Commission. Information as to how a person can contact the Department and the Commission. Information regarding the protection against retaliation under Section 6-101 of the Human Rights Act. A copy of the employer's policy must be submitted to the Department or to a contracting agency upon request. Employers can obtain a Model Sexual Harassment Policy by contacting the Department. ___________________________ DISCRIMINATORY CLUB ACT Pursuant to 775 ILCS 25/0.01 et seq., no private organization selling goods or services to the State or receiving any award or grant from the State, nor any public body, may pay any dues or fees on behalf of its employees or agents or may subsidize or otherwise reimburse them for payments of their dues or fees to any discriminatory club. A “discriminatory club” includes any club, society, organization, or association, which discriminates in its membership policy or in access to its services or facilities. Facilities that are distinctly private in nature, such as restrooms and shower rooms, are exempt as to discrimination based on sex. (IDHR EMPLOYER REPORT FORM 6/7/2011) Definitions, Clauses and Policies – Keep for your records American LegalNet, Inc. www.FormsWorkFlow.com