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 and 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 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 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 and descriptive information regarding the nature of the debarment and/or legal proceeding. Step 8 Disclosure of Current and Pending Contracts Complete only if bid, or contract has an annual value over $25,000 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, or other ongoing procurement relationships with State of Illinois agencies or universities? Yes No If “Yes”, please specify Attach an additional page in the same format as provided below, if desired. Agency/University Project Title Status Value Contract Reference/P.O./ Bulletin # Please explain the procurement relationship: Step 9 Sign the Disclosure All vendors must complete regardless of annual bid, offer, or contract value Subcontractors with subcontract annual value of more than $50,000 must complete This disclosure is signed and made under penalty of perjury by an authorized officer or employee on behalf of the Offeror pursuant to Sections 50-13 and 50-35 of the Illinois Procurement Code. This disclosure information is submitted on behalf of: Name of Disclosing Entity:
Appendix 3 Section 1 “The Early Years” Items*: Required: Exhibit 1 – Woese text (bio, early life) (See Appendix 1) Exhibit 2 – Photos of (early career) Optional: Exhibit 3 – Letter of Correspondence with (if permission obtained from Wellcome Library) Exhibit 4 – of ribosomal DNA molecule, central to Woese’s work Exhibit 5 – Video content – interview with Woese (early life) Exhibit 6 – Photo montage loop Section 2 “The Discovery Period” Items*: Required: Exhibit 7 – text (discovery of Archaea, U of I history) Exhibit 8 – Photos of Woese (in lab discovery period) Optional: Exhibit 9 – Film of the discovery of Archaea (photo) Exhibit 10 – Notebooks w/annotations on Archaea discovery (photo) Exhibit 11 – 1977 publications on Archaea (2) Exhibit 12 – “The Genetic Code” by Carl Woese, book Exhibit 13 – New York Article on Woese Exhibit 14 – Original DNA model paper overlays (oversize, in folio) Exhibit 15 – Video content – interview with Woese from 2011 on the moment of Archaea discovery Exhibit 16 – Photo montage loop Exhibit 17– Artwork from the Glow Worm – Work Detail Section 3 “Post-Discovery Career Work” Items*: Required: Exhibit 18 – The National Medal of Science Exhibit 19 – U of I of Trustees medal & photo Exhibit 20 – MacArthur Award Certificate Exhibit 21 – The Crawfoord Medal Exhibit 22 – van Leeuwenhoek Medal
Exhibit 6 – Photo montage loop Exhibit 7 – Woese text (discovery of Archaea, U of I history) Exhibit 8 – Photos of Woese (in lab discovery period) Exhibit 9 – Film of the discovery of Archaea (photo) Exhibit 10 – Notebooks w/annotations on Archaea discovery (photo) Exhibit 11 – 1977 publications on Archaea (2) Exhibit 12 – “The Genetic Code” by Carl Woese, book Exhibit 13 – New York Times Article on Woese Exhibit 14 – Original DNA model paper overlays (oversize, in folio) Exhibit 15 – Video content – interview with Woese from 2011 on the moment of Archaea discovery Exhibit 16 – Photo montage loop Exhibit 17– Artwork from the Glow Worm – Work Detail Exhibit 18 – The National Medal of Science Exhibit 19 – U of I Board of Trustees medal & photo Exhibit 20 – MacArthur Award Certificate Exhibit 21 – The Crawfoord Medal
Exhibit 22 – van Leeuwenhoek Medal Exhibit 23 – ARCHAE license plate Exhibit 24 – Woese text (Acceptance of Archaea, work at U of I, IGB contributions) Exhibit 25 – Photos of Woese (IGB/Illinois era) Exhibit 26 – Artwork from the Glow Worm – Shadow Detail Exhibit 27 – Ikenberry Chair Medal Exhibit 28 – U of I Carl Woese Trading Card Exhibit 29 – content – Work at U of I, with IGB Exhibit 30 – montage loop Exhibit 31 – Additional content from Spurlock Museum display piece Exhibit 32 – Artwork from the Glow Worm – Work Detail