FINANCIAL AUDIT SERVICES _part7 pptx

In relation to the business arrangement with Scientific Games Corporation “SGC”, is your company required to obtain any gaming or business related authorizations or licenses?. Has the Bu

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B Has this business ever had a license revoked or suspended or an application withdrawn? YES _ NO

If YES, provide details List all cases without exception

C In relation to the business arrangement with Scientific Games Corporation (“SGC”), is

your company required to obtain any gaming or business related authorizations or licenses? YES _ NO

If yes, list the name, address, and phone number of the governmental agency and the type of

license or authorization required Indicate the date the company filed or plans to file the application for licensing or approval

6 CRIMINAL INFORMATION AND LITIGATION

A Has the Business, any of its subsidiaries, or any of its Control persons ever been INDICTED

or CONVICTED of any criminal offense (except MINOR traffic violations)?

YES _ NO _

B Has the Business, any of its subsidiaries, or any of its Control Persons ever been the

subject of, requested to testify before, or been subpoenaed to produce documents by a GRAND JURY or CRIMINAL INVESTIGATION? YES NO

C Has the Business, any of its subsidiaries, or any of its Control Persons ever been

involved in any material civil litigation which was based in whole or in part on conduct which allegedly violated a state or federal law or sought civil damages in an amount exceeding $250,000? YES _ NO

If YES, complete the following:

Plaintiff / Defendant Court & Case Number City, County & State Disposition

D Has the Business, any of its subsidiaries, or any of its Control Persons been the subject of any order, judgment, or decree of any court of competent jurisdiction permanently or

This is trial version www.adultpdf.com

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temporarily enjoining it from otherwise limiting its participation in any type of business, practice, or authority?

YES _ NO _

7 RELATIONSHIP WITH GOVERNMENT OFFICIALS

A Is any director, officer, employee or agent of your company (a) an officer or employee of

a domestic or foreign government, agency, ministry or instrumentality thereof, (b) an officer or employee of a government-owned or government-controlled entity, (c) an officer or employee of a public international organization, or (d) an officer, employee, or official of a domestic or foreign political party?

YES _ NO _

If yes, provide details

B Is any immediate family member (spouse, child, parent, etc.) of a director, officer,

employee, or agent of your company (a) an officer or employee of a domestic or foreign government, agency or ministry, (b) an officer or employee of a government-owned or government-controlled entity, (c) an officer or employee of a public international organization, or (d) an officer, employee, or official of a domestic or foreign political

party?

YES _ NO _

If yes, provide details

C Does any officer or employee of a domestic or foreign government, agency, ministry, or

officer or employee of a government-owned or government-controlled entity, officer or employee of a public international organization, or officer, employee, or official of a domestic or foreign political party have any interest or stand to benefit in any way as a result of your proposed agreement to work with Scientific Games or any of its

subsidiaries?

YES _ NO _

If yes, provide details

8 FINDER OR BROKER FEE

Is the Business paying any broker, finder or other person a fee or compensation of any kind for this business arrangement with SGC? YES _ NO _

If YES, provide details

9 FINANCIAL INFORMATION

Attach FINANCIAL STATEMENTS of the business for the most recent fiscal year end If the business or any of its subsidiaries are publicly traded companies, please attach the most recent proxy statement List separately any major creditors of the business that are not commercial lending institutions or regulated credit facilities

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UPON COMPLETION PLEASE E-MAIL OR FACSIMILE THE

PERSONAL DISCLOSURE

AND AUTHORIZATION FOR RELEASE OF INFORMATION

FORMS TO:

Robert Kelly Compliance Investigator Scientific Games Corporation

1500 Bluegrass Lakes Parkway Alpharetta, Georgia Telephone (770) 664-3894 Fax (678) 762-5755 Email: bob.kelly2@scientificgames.com

Mary Kathryn Wright Compliance Coordinator Scientific Games Corporation

1500 Bluegrass Lakes Parkway Alpharetta, Georgia Telephone (678) 297-5548 Fax (678) 762-5755 Email: mary.wright@scientificgames.com

Christine Garofola Compliance Coordinator Scientific Games Corporation

1500 Bluegrass Lakes Parkway Alpharetta, Georgia Telephone (770) 664-3822 Fax (678) 762-5755 Email: christine.garofola@scientificgames.com

NOTE: To expedite your required background investigation, you may FAX or EMAIL the completed Personal Disclosure and Authorization to Release Information forms

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RELEASE AUTHORIZATION – BUSINESS ENTITY

To all Courts, Banks, Financial and Other Institutions, and all Governmental Agencies – federal, state, and local, without exception, both foreign and domestic

has authorized Scientific Games Corporation to

(Name of Business Entity)

conduct a full investigation into its background and activities

Therefore, you are hereby authorized to release any and all information pertaining to , documentary or otherwise, as requested by an appropriate

employee of the Scientific Games Corporate Legal Department or an independent investigator engaged

by Scientific Games

This authorization shall supersede and countermand any prior request or authorization to the contrary

A photostatic copy of this authorization will be considered as effective and valid as the original The undersigned is authorized to sign this Release Authorization on behalf of _

(Domestic)

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ATTACHMENT C – M/F/DBE REQUIRED FORM

BEP UTILIZATION PLAN

The BEP Utilization Plan must be submitted with RFP

(the Bidder) must submit the following BEP Utilization Plan as part of the RFP in accordance Sections 1.16 and 2.2 of the RFP

(the Bidder) makes the following assurance and agrees to include the assurance in each subcontract with a subcontractor or supplier utilized on this contract:

Name:

_ Title:

Telephone: ( _) extension _

Email:

_

We submit one (1) of the following statements:

We are certified (or are eligible and have applied to be certified) with BEP

and plan to fully meet the BEP utilization goal through self-performance

We attach Section I to demonstrate our Plan fully meets the BEP Utilization

Goal of 20% through subcontracting

We attach Section I to detail that we do not fully meet the M/F/DBE utilization

goal We also attach Section II, Demonstration of Good Faith Efforts

Section I

Utilization of Certified Vendors

Please submit a separate Section I for each proposed certified vendor

To achieve the BEP utilization goal through subcontracting, the following is proposed:

1) The proposed certified vendor‘s company name, address and phone number:

_

Attach separate sheet, if utilizing more than one (1) BEP Firm

At the time of submission, the above certified vendor is:

Certified with the CMS Business Enterprise Program (BEP)

Meets the criteria and has submitted an application for certification with BEP

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(BEP certification must be completed before contract award)

Certified as a disadvantaged, minority, or woman business enterprise with the

following governmental agency or private organization:

(BEP certification must be completed before contract award)

2) Statement of Work (SOW)

3) The total estimated cost to Northstar for this contract is $ The portion of the contract which will be subcontracted to BEP certified vendor(s) is $ , or % of the total cost of the contract

Section II

Demonstration of Good Faith Efforts to Achieve BEP Subcontracting Goal

If the BEP subcontracting goal was not achieved, the Good Faith Efforts checklist must be completed The Vendor will promptly provide evidence in support of its Good Faith Efforts to Northstar upon request

Good Faith Efforts Checklist

Insert on each line below the initials of the authorized Vendor representative who is certifying on

behalf of the Vendor that the Vendor has completed the activities described below If any of the items below were not completed, attach a detailed written explanation why each such item was not completed If any other efforts were made to obtain BEP participation in

addition to the items listed below, attach a detailed written explanation

_ Identified portions of the project work capable of performance by available BEP vendors, including, where appropriate, breaking out contract work items into economically feasible units

to facilitate BEP participation even when the Vendor could perform those scopes with its own forces

_ Solicited through reasonable and available means (e.g., written notices, advertisements) BEP vendors to perform the types of work that could be subcontracted on this project, within sufficient time to allow them to respond

_ Provided timely and adequate information about the plans, specifications and requirements of the contract Followed up initial solicitations to answer questions and encourage BEP vendors to submit proposals or bids

Negotiated in good faith with interested BEP vendors that submitted proposals or bids and thoroughly investigated their capabilities

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Made efforts to assist interested BEP vendors in obtaining bonding, lines of credit, or insurance as may be required for performance of the contract (if applicable)

Utilized resources available to identify available certified vendors

BIDDER

By:

Its:

Date:

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ATTACHMENT D - DEVIATIONS AND EXCEPTIONS

Name of Bidder:

Bidder shall complete and submit this Attachment with Bidder‘s Proposal if Bidder proposes to deviate from or take exception to any of the RFP requirements Bidder must identify each such deviation and exception and describe the nature and extent thereof, providing the information in order of the RFP in the following format:

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