OFFICE OF THE MAYOR
CITY OF CHICAGO
LORI E. LIGHTFOOT
MAVOR
October 27, 2021
TO THE HONORABLE, THE CI TY COUNCIL OF THE CI TY OF CHICAGO
Ladies and Gentlemen:
At the request ofthe Commissioner of Planning and Development, I transmit herewith ordinances authorizing the budget, scope of services and service provider agreements for various Special Service Areas.
Your favorable consideration of these ordinances will be appreciated.
Mayor
ORDINANCE REGARDING SPECIAL SERVICE AREA #27
WHEREAS, special service areas may be established pursuant to (i) Article VII, Sections 6(1) and 7(6) of the Constitution of the State of Illinois ; (ii) the provisions of the Special Service Area Tax Law, 35 ILCS 200/27-5 et seq., as amended from time to time (the "Act"); and (iii) the Property Tax Code, 35 ILCS 200/1-1 et seq., as amended from time to time; and
WHEREAS, the City Council (the "City Council") of the City of Chicago (the "City") has previously enacted a certain ordinance on the date specified on Exhibit A attached hereto and hereby made a part hereof and published in the Journal of Council Proceedings (the "Journal") for such date at the pages specified on Exhibit A hereto, and amended on the date(s) specified on Exhibit A hereto and published in the Journal for such date(s) as specified on Exhibit A hereto (as amended from time to time, the "Establishment Ordinance") which established a certain special service area as indicated therein and as identified on Exhibit A hereto (the "Area") and authorized the levy of certain annual taxes, not to exceed the annual rate (the "Levy Cap") indicated therein and as described on Exhibit A hereto, of the equalized assessed value of the taxable property therein (the "Services Tax") to provide certain special services in and for the Area in addition to the services provided by and to the City generally as specified in, the Establishment Ordinance (the "Special Services"); and
WHEREAS, the Establishment Ordinance provided for the appointment of a certain special service area commission for the Area (the "Commission") to advise the City Council regarding the amount of the Services Tax for the Area to be levied and for the purpose of recommending to the City Council for the Area: (i) a yearly budget based upon the costs of providing the Special Services; (ii) an entity to serve as service provider (the "Service Provider"); (iii) an agreement between the City and the Service Provider for the provision of Special Services to the Area (the "Service Provider Agreement"); and (iv) a budget to be included in the Service Provider Agreement (the "Budget") (the aforementioned items (i) through (iv) shall be known collectively herein as the "Recommendations"); and
WHEREAS, the Commission identified on Exhibit A hereto has heretofore prepared and transmitted to the Commissioner of Planning and Development (the "Commissioner") their Recommendations to the City Council, including the Budget attached hereto as Exhibit A; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO AS FOLLOWS:
SECTION 1. Incorporation of Preambles. The preambles of this ordinance are hereby incorporated into this text as if set out herein in full.
SECTION 2. Appropriations There is hereby appropriated the sum in the amount and for the purposes necessary to provide the Special Services in and for the Area, the estimated amount of miscellaneous income and the amount required to be raised by the levy of the Services Tax indicated on Exhibit A hereto: Collectable Levy, Estimated Loss Collection, Carryover Funds, TIF Rebate Fund, and Estimated Late Collections and Interest.
SECTION 3. Levy of Taxes. There is hereby levied pursuant to the provisions of (i) Article VII, Sections 6(a) and 6(l)(2) of the Constitution of the State of Illinois; (n) the Act; and (iii) the Establishment Ordinance, the sum of the "Total Requested Levy" indicated on Exhibit A hereto
SSA 27 Levy Ordinance 2021 v1
as the amount of the Services Tax for the Area for the tax year 2021.
SECTION 4. Filing. The City Clerk of the City (the "City Clerk") is hereby ordered and directed to file in the Office of the County Clerk of Cook County, Illinois (the "County Clerk") a certified copy of this ordinance on or prior to December 28, 2021, and the County Clerk shall thereafter extend for collection together with all other taxes to be levied by the City, the Services Tax herein provided for, said Services Tax to be extended for collection by the County Clerk for the tax year 2021 against all the taxable property within the Area, the amount of the Services Tax herein levied to be in addition to and in excess of all other taxes to be levied and extended against all taxable property within the Area.
SECTION 5. Service Provider Agreement. The Commissioner, or a designee of the Commissioner (each, an "Authorized Officer"), are each hereby authorized, subject to approval by the Corporation Counsel as to form and legality, to enter into, execute and deliver a Service Provider Agreement as authorized herein with the entity indicated on Exhibit A hereto as the Service Provider, for a one-year term in form acceptable to such Authorized Officer, along with such other supporting documents, if any, as.may be necessary to carry out and comply with the provisions of the Service Provider Agreement. The Budget shall be attached to the Service Provider Agreement as an exhibit. Upon the execution of the Service Provider Agreement and the receipt of proper documentation, the Authorized Officer and the City Comptroller are each hereby authorized to disburse the sum appropriated pursuant to Section 2 above to the Service Provider in consideration for the provision of the Special Services described in the Budget. The Department of Planning and Development shall promptly make a copy of the executed Service Provider Agreement (and any amendments thereto) readily available for public inspection. The Authorized Officer is also authorized to sign amendments to the Service Provider Agreement entered into pursuant to this Section 5 so long as such amendments do not alter the identity of the Service Provider and/or the amounts appropriated and/or levied pursuant to Sections 2 and 3 hereof.
SECTION 6. Enforceability. If any section, paragraph or provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such section, paragraph or provision shall not affect any ofthe remaining provisions of this ordinance.
SECTION 7. Conflict. This ordinance shall control over any provision of any other ordinance, resolution, motion or order in conflict with this ordinance, to the extent of such conflict.
SECTION 8. Publication. This ordinance shall be published by the City Clerk, in special pamphlet form, and made available in her office for public inspection and distribution to members of the public who may wish to avail themselves of a copy of this ordinance.
' SECTION 9. Effective Date. This ordinance shall take effect 10 days after its passage and publication.
SSA 27 Levy Ordinance 2021 v1
EXHIBIT A SPECIAL SERVICE AREA #27
Area Levy Cap Total Requested Levy Commission Service Provider
27 0.25% $893,029 West Lakeview Lakeview Roscoe Village Chamber of Commerce
Establishment Ordinance
Date: November 16, 2011
Journal pages: pages 14966 through 15097
See attached Budget.
SSA 27 Levy Ordinance 2021 v1
Exhibit A Budget
Special Service Area #
West Lakeview
2022 BUDGET SUMMARY
Budget and Sen/ices Period: January 1, 2022 through December 31, 2022
2021 Levy
CATEGORY
(Funded Categories Comprise Scope of Services)
11.00 Customer Attraction
'2.00 Public Way Aesthetics
3.00 Sustainability and i Public Places
;4.00 Economic/
| Business Development
Collectable Levy
$244,600
$209,011
$101,000 $62,500
Estimated
Loss Collection
$0 $6,152
$0
$0
Carryover Funds
$30,000
$90,000 $0
$0
$0 $4,500
; Estimated Rebate Late Fund #0D06 ! Collections ! and Interest
$0 $0
$0 $6,152
$0
$0
Total All Sources
$274,600!
$315,815
$101,000
$62,500
j 5.00 Public Health and ISafety Programs
6.00 SSA Management 7.00 Personnel
' Sub-total
' GRAND I .
TOTALS : LevvTotal
$18,000
$58,657 $193,109 $886,877;,
$893,029
$0
$0 $0 $6,152
$0
$0
$18,000 $58,657 $193,109
$120,000! $4,500| $6,152{ $1,023,681!
LEVY ANALYSIS
i Estimated 2021 EAV:
Authorized Tax Rate Cap:
• Maximum Potential Levy : limited by Rate Cap:
'Requested 2021 Levy Amount'
, Estimated Tax Rate to Generate , 2020 Levy:
5457,452,453] 0.250%!
$1,143,631
$893,029 0.1952%i
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Lakeview Roscoe Village Chamber of Commerce
Check ONE ofthe following three boxes.
Indicate whether the Disclosing Party submitting this EDS is:
1. [X ] the Applicant
OR
[ ] a legal entity currently holding, or anticipated to hold within six months after City action on the contract, transaction or other undertaking to which this EDS pertains (referred to below as the "Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant =s legal
name:
OR
[ ] a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:
Business address of the Disclosing Party: 1409 W. Addison St.
Chicago. Illinois
Telephone: 773-472-7171 Fax: __ Email: becca(g).lrvcc.org
Name of contact person: Rebecca Girsch
Federal Employer Identification No. (if you have one): _
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
To allow the Lakeview Roscoe Village Chamber of Commerce to enter into a contract with the City
to provide services wfithin SSA 27.
Which City agency or department is requesting this EDS? Dept. of Planning & Development
Ifthe Matter is a contract being handled by the City^s Department of Procurement Services, please complete the following:
Specification #
Vcr.2018-1 Page 1 of 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. N ATI. RE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing ] Person
] Publicly registered business corporation ] Privately held business corporation ] Sole proprietorship ] General partnership ] Limited partnership ] Trust
Party:
[ ] Limited liability company [ ] Limited liability partnership [ ] Joint venture ^ Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
[ JYes XJ.No [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Illinois
3. For legal entities not organized in the State oflllinois: Has the organization registered lo do business in the State oflllinois as a foreign entity?
^ Organized in Illinois
B. IF THF DISCLOSING PARTY IS A LEGAL ENTITY:
I. List below the full names and titles, if applicable, of: (i) all executive officers and all directors of the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title See attached No members which are legal entities
2. Please provide the following information concerning each person or legal entity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including ownership) m excess of 7.5% ofthe Applicant. Examples ofsuch an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Ver 20IX-1 Piigc.-2 of 15
1409 W.Addison St. Chicago.lL 60613
Phone 773.472.7171 Social LakcviewRoscoeVillage
Lakeview
CHAMBER OF COMMERCE
LakcviewRoscoeVillagc.org
Board of Directors
Jennifer Austin Stephanie Biederman Frank Campise Matthew Carr Ben Castronovo Doug Dunlay Angela Garbot Jeff Hoffman Michael Jorndt Ron Kinn (Secretary) Joia Kopelow
Sandy O'Kane (President)
Ryan Oestreich Ana Pineda Lisa Santos
Jeff Shapiro (Treasurer)
Ellie Thompson
Michael Valitchka (Vice President)
Jennifer Weiss
Executive Director
Becca Girsch
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
None
SECTION III — INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-monlh period preceding the date of this EDS? [ ] Yes L^No
Does the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-month period following the date of this EDS? [ ] Yes ^ No
If "yes" to either of the above, please identify below the name(s) of such City elected official(s) and describe such income or compensation:
Docs any Cily elected official or. to the best ofthe Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party?
[ J Yes p
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partner(s) and describe the financial intcrest(s).
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects.to retain in connection with the Matter, as well as the nature of the relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Parly is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. Ifthe Disclosing Parly is uncertain whether a disclosure is required under this Section, ibc Disclosing Parly must either ask the City whether disclosure is required or make the disclosuie
Piige 3 of 1 5
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or :mticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained ) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
See attaches
(Add sheets if necessary)
[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes | j No p<3 No person directly or indirectly owns 10% or more ofthe Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ ] Yes | | No
FURTHER CERTIFICATIONS
[This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-ycar period preceding the date of this EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance ofany public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity ol specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract in progress).
The Disclosing Party and its Affiliated Entities are not delinquent in the payment ofany fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, properly taxes and sales taxes, nor is the Disclosing Party delinquent in the payment ofany tax administered by the Illinois Department of Revenue.
P;ige 4 of 15
1409 W. Addison St. Phone 773.472.7171
Chicago, IL 60613
Social l.akevicwRoscneVillage
Lakeview
CHAMBER OF COMMERCE
LakeviewRoscoeVillage.org
2022 Anticipated Retained Parties
A.C.T. Group
6228 N. Broadway, Chicago, IL 60660 Subcontractor, auditing firm Estimated $5,000 Retained
Bartlett Tree Experts -4151 W Lake St, Chicago, IL 60624 Subcontractor, tree care Estimated $30,000 Anticipated
Blake Residential & Commercial Development 16360 Wood St., Markham, IL 60428 Subcontractor, People Spot maintenance Estimated $10,000 Anticipated
BrightView Landscapes
230 N. Western Ave., Chicago, IL 60612
Subcontractor, landscaping and snow removal
Estimated $53,840 / $12,800
Anticipated
Chicago Event Graphics
400 N Hart St, Chicago, IL 60622
Subcontractor, banners
Estimated 58,000
Anticipated
Clean Slate
1540 S. Ashland Ave., Ste. 105, Chicago. IL 60608
Subcontractor, litter abatement Estimated 593,288
Anticipated
Matt Cotten & Associates
121 N. Marion St., Ste 2, Oak Park, IL 60301
Subcontractor, website maintenance
Estimated $1,000
Retained
PORT Urbanism
53 W. Jackson Blvd., Ste. 925, Chicago, IL 60604
Subcontractor, architect Estimated $10,000 Retained
Ripson Communications
220 N. Green St., Chicago, IL 60607
Subcontractor, public relations services
Estimated $30,000
Anticipated
Southport Construction
3737 N Southport Ave, Chicago, IL 60613
Subcontractor, winter decorations
Estimated 574,000
Anticipated
Z Factory
916 W. Waveland Ave , Floor 2, Chicago, IL 60613
Subcontractor, graphic design Estimated 54,500 Anticipated
The Disclosing Party and. ifthe Disclosing Party is a legal entity, all of those persons or entities identified m Section 11(B)(1) of this EDS:
are not piesently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not. during the 5 years before the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
arc not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in subparagraph (b) above;
have not. during the 5 years before the date of this EDS, had one or more public transactions (federal, .state or local) terminated for cause or default; and
have not. during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
Certifications (5), (6) and (7) concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity). Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including Ihe City, using substantially the same management, ownership, or principals as the ineligible entity. With respect to Contractors, the term Affiliated Entity means a person or entity that dueeily or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is uniiei common control of another person or entity;
.ins responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, ans ( oiiiiactor or any Affiliated Entity (collectively "Agents").
Page 5 of 15
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any C ontractor, nor any Agents have, during the 5 years before the date of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the d.ite ofsuch Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public oi'lieet or employee of the City, the State oflllinois, or any agency ofthe federal government or of any siaie or local government in the United States of America, in that officer's or employee's official capacity.
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission ofsuch conduct described in subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage); (a)(.\H Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result ol'cngaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Ncithci the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United Slates Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chaptei I -2.V Article I for applicability and defined terms] of the Applicant is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business w ith the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontr.iciors lo use, any facility listed as having an active exclusion by the U.S. EPA on the federal System ioi Award Management ("SAM").
10 ( Ft )R \!'!'!. I CANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to Iv ii:ic>! in connection with the Matter certifications equal in form and substance to those in Certi!kaim!i^ t?) and (9) above and will not. without the prior written consent ofthe City, use any such
contractor subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further
Certification-,!, the Disclosing Parly must explain below:
None
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed thai the Disclosing Party certified to the above statements.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none"). None
13. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete lisi of all gifts that the Disclosing Party has given or caused to be given, al any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $25 per recipient, or (iii) a political coniribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies lhat the Disclosing Party (check one)
! | is is not
a "financial institution" as defined in MCC Section 2-32-455(b)
II" the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are no; and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge ilia; none of our affiliates is. and none of them will become, a predatory lender as defined in MCC ( iiapier ."'-"'2. We understand that becoming a predatory lender or becoming an affiliate of a predators lender may result in the loss ofthe privilege of doing business with the City."
Page 7 of 15
Ifthe Disclosing Tarty is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(0)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (au.ich additional pages if necessary): N/A
Ifthe loners "NA." the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CF.RTil-l CATION REGARDING FINANCIAL INTEREST fN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
1. In accordance with MCC Section 2-156-1 10: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
IX] No
NOTF: II von checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" to Item D( i i. skip Items D(2) and D(3) and proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does Ihe Matter involve a City Property Sale?
f 1 Ves
3. Ifyou cheeked "Yes" to Item D(l), provide the names and business addresses of the City officials or cmplovees having such financial interest and identify the nature of the financial interest:
Nature of Financial Interest
4. The l):s; losing Party further certifies that no prohibited financial interest in the Matter will be acquired .my City official or employee.
E. CIKTil K ATI OK REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. Ifthe Disclosing Party checks (2), the Disclosing Party must diselo-.e below or in an attachment to this EDS all information required by (2). Failure to comply with these disclosure requirements may make any contract entered into with the City in connection u uh ihe Matter voidable by the City.
X i The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slave: \ or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Patty has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Parly has found records of investments or profits from slavery or slaveholder insurance policies Tlie Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names ofany and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: 11 the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CHRTll l( VI ION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995. as amended, who have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no cxplaia.ion appears or begins on the lines above, or ifthe letters "NA" or if the word "None" appeai. it v. dl !x- conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf ol li e ' >isc losing Partv with respect to the Matter.)
2 The I iisdosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any
person oi eiiiii-. io influence or attempt to influence an officer or employee ofany agency, as defined
by applicable :'dcial law, a member of Congress.' an officer or employee of Congress, or an employee
Ver.2n|s.j Page 9 of 15
of a member of Congress, in connection with the award ofany federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A(l) and A(2) above.
The Disclosing Party certifies that either:'(i) it is not an organization described in section 501(c)(4) ofthe Iniernal Revenue.Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities." as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes." answer the three questions below:
fla\ e you developed and do you have on file affirmative action programs pursuant to applicable federal regulations'' (See 41 CFR Part 60-2.)
! ] Yes [ j No
Ha\e you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
I 1 Yes [ ] No [ ] Reports not required
Flaw: you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
I ! Yes [ ] No
Ifyou checked "\o" to question (1) or (2) above, please provide an explanation:
SECTION VTI - FURTHER A C K N O WE ED G M E NTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany contract or other agreement between the Applicant and the City in connection with the Matter, whether proemcmeni, Cily assistance, or other City action, and arc material inducements to the City's execution ofany contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities socking City contracts, work, business, or transactions. The full text of this ordinance and a training program is available on line at www.cityofchicago.org/Ethics . and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
Ifthe Cily determines lhat any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law. or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other City transactions. Remedies al law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is ihe City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe infonnation provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims w hich il may have against the City in connection with the public release of information contained in this I DS and also authorizes the City to verify the accuracy of any information submitted in this I DS
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update diis 1- DS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23. Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information pun 'ded herein ; cgardmg eligibility must be kept current for a longer period, as required by M( C Chapici I-23 yrv ¦ ¦ lion 2-154-020.
Pace 1 I of 15
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as ofthe date furnished to the City.
Lakeview Roscoe Village Chamber of Commerce
(Sign here)^ Rebecca Girsch
(Print or type name of person signing) Executive Director
(Print or type title of person signing)
Signed and sworn to before me on (date) Ql hi
at C-ook _ County, / (state).
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CITY OF CHICAGO KCONOM ;C DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix- is to In: completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in (he Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Parly" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any clceied city official or department head. A "familial relationship" exists if, as of the date ihis FDS is signed. ;hc Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related lo lhe mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law. mother-in-law. son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother •. ; stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section
II. B. 1 .a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing
Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the
Disclosing Party is a limited partnership; all managers, managing members and members of the
Disclosing Party, ifthe sing Party is a limited liability company; (2) all principal officers of the
Disclosing Party; and (a j aiu person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officer;.' ; cans the president, chief operating officer, executive director, chief financial officer, ireasinc secretary of a legal entity or any person exercising similar authority.
Does the Diselosin;; . or any "Applicable Party" orany Spouse or Domestic Partner thereof currently have a 'Tamil; ,. .• ¦ionship" with an elected city official or department head?
[ ) Yes IX No
If yes, please identify bJ.-w (]) the name and title of such person, (2) the name of the legal entity to
which sttch person is c- i . . cl; (3) the name and title of the elected city official or department head to
whom such person has ;al relationship, and (4) the precise nature ofsuch familial relationship.
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CITY OF CHICAGO C DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX B
BIT EDING ( SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be c : etcd only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in th leant exceeding 7.5% (an "Owner"). It is not to be completed by any
legal entity which has o; .:\ indirect ownership interest in the Applicant.
Pursuant to MCC Se 1 54-010, is the Applicant or any Owner identified as a building code
scofflaw or problem lane;. pursuant to MCC Section 2-92-416?
[ ] Yes X No
Ifthe Applicant is a i . entity publicly traded on any exchange, is any officer or director of
the Applicant identifier . .lilding code scofflaw or problem landlord pursuant to MCC Section
2-92-416'.'
[ ] Yes , No ^ The Applicant is not publicly traded on any exchange.
3. If yes to (1) or. (2) a. , lease identify below the name of each person or legal entity identified as a building code scofl I. v. problem landlord and the address of each building or buildings to which the pertinent code viola.tit . pply.
CITY OF CHICAGO I'C DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX C
PROHIBIT ION ()• \GE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to he •¦ ted only by an Applicant that is completing this EDS as a "contractor" as
defined in MCC Scctii ¦¦: .:S5. That section, which should be consulted (www.amlegal.com ).
generally covers a pari; v >: agreement pursuant to which they: (i) receive City of Chicago funds in
consideration for service k or goods provided (including for legal or other professional services),
or (ii) pay the City mor . license, giant or concession allowing them to conduct a business on
City premises.
On behalf oi an Applie is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that
the Applicant is in coir ¦ . wish MCC Section 2-92-385(b)(l) and (2), which prohibit: (i) screening
job applicants based on age or salary history, or (ii) seeking job applicants' wage or salary
history from cut rent oi . i employers. 1 also certify that the Applicant has adopted a policy that
include-, iho-.e prohibit!. •
XJ Yo
[ ] No
[ ] N/A lam not an ; . : ii lhat is a "contractor" as defined in MCC Section 2-92-385. This certification shall i ihe affidavit required by MCC Section 2-92-385(c)(I).
Ifyou checked "no" to ; \e. please explain.
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