NOT FOR PROFIT ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VII, Section 6(a) of the 1970 Constitution of the State of Illinois, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the City wishes to support the charitable, educational and philanthropic activities of established not-for-profit corporations and encourage the continued viability and growth of such activities; and
WHEREAS, many not-for-profit corporations own property that adjoins streets and alleys that are no longer required for public use and might more productively be used in furtherance of such activities; and
WHEREAS, the City would benefit from the vacation of these streets and alleys by reducing City expenditures on maintenance, repair and replacement; by reducing fly-dumping, vandalism and other criminal activity; and by providing support for such charitable, educational and philanthropic activities; and
WHEREAS, the City can promote strong communities by facilitating services to the public, and increase the City's job base through the vacation of public street(s) and/or alley(s) for no compensation; and
WHEREAS, the properties at 500-530 S. Laflin Street and 501-531 S. Laflin Street ("Developer-Owned Property") are owned by Rush University Medical Center f/k/a Rush-Presbyterian St. Luke's Medical Center, an Illinois not-for-profit corporation ("Developer"); and
WHEREAS, that a portion of S. Laflin Street laying adjacent to the Developer-Owned Property between W. Harrison Street and W. Congress Parkway was previously closed to vehicular traffic pursuant to an ordinance adopted by City Council of the City of Chicago, on May 4, 1977 and recorded with the Office of the Cook County Recorder of Deeds on June 9, 1977 as Document No. 23960780; and
WHEREAS, the Developer now seeks to vacate said portion of S. Laflin Street; and
WHEREAS, the Developer is in the process of working to redevelop the adjacent Developer-Owned Property into a new ambulatory care center (the "Project"), which will be part of the Developer's existing hospital and medical campus located west of S. Ashland Avenue; and
Page 1
WHEREAS, the Developer proposes to use said portion of the public street to be vacated herein to serve the Project to be constructed on the Developer-Owned Property adjacent to the area to be vacated; and
WHEREAS, the City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent of the public use and the public interest to be subserved is such as to warrant the vacation of the part of the public street legally described in this ordinance; now therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. Legal Description
THAT PART OF S. LAFLIN STREET LYING EAST OF THE EAST LINE OF LOTS 1, 50, 51 AND 52 IN BLOCK 32, LYING EAST OF A LINE DRAWN FROM THE SOUTHEAST CORNER OF SAID LOT 1 TO THE NORTHEAST CORNER OF SAID LOT 52 AND LYING EAST OF A LINE DRAWN FROM THE NORTHEAST CORNER OF SAID LOT 50 TO THE SOUTHEAST CORNER OF SAID LOT 51; LYING WEST OF THE WEST LINE OF LOTS 24, 25, 26 AND 27 IN BLOCK 33, LYING WEST OF A LINE DRAWN FROM THE SOUTHWEST CORNER OF SAID LOT 24 TO THE NORTHWEST CORNER OF SAID LOT 25 AND LYING WEST OF A LINE DRAWN FROM THE SOUTHWEST CORNER OF SAID LOT 26 TO THE NORTHWEST CORNER OF SAID LOT 27; LYING SOUTH OF A LINE DRAWN FROM THE NORTHEAST CORNER OF LOT 1 IN BLOCK 32, TO THE NORTHWEST CORNER OF LOT 24 IN BLOCK 33 AND LYING NORTH OF A LINE DRAWN FROM A POINT ON THE EAST LINE OF LOT 50 IN BLOCK 32 WHICH IS 29.31 FEET NORTH OF THE SOUTHEAST CORNER OF SAID LOT 50 (AS MEASURED ON SAID EAST LINEVTO A POINT ON THE WEST LINE OF LOT 27 IN BLOCK 33 WHICH IS 25.97 FEET NORTH OF THE SOUTHWEST CORNER OF SAID LOT 27 (AS MEASURED ON SAID WEST LINE)ALL IN LAFLIN AND LOOMIS'S RESUBDIVISION OF BLOCKS 5, 18, 21, 30, 31, 32, 33 AND 41 AND SUBDIVISION OF BLOCKS 6, 9, 19 AND 20 IN CANAL TRUSTEES' SUBDIVISION OF THE WEST 1/2 AND THE WEST 1/2 OF THE NORTHEAST 1/4 OF SECTION 17, TOWNSHIP 39 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT THEREOF RECORDED JANUARY 31, 1863 AS DOCUMENT 62082 IN BOOK 161, PAGE 75, AND RE-FILED DECEMBER 31, 1872 AND RECORDED JANUARY 8, 9, 10 AND 11, 1873 AS DOCUMENT 76155 IN BOOK 3, PAGES 65 AND 66, IN COOK COUNTY, ILLINOIS. SAID STREET CONTAINING 19,747.3 SQUARE FEET OR 0.4533 ACRES, MORE OR LESS as shaded and legally described by the words "HEREBY VACATED" on the plat hereto attached as Exhibit A (the "Vacated Area"), which plat for greater clarity, is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacation.
SECTION 2. The Commissioner of the Chicago Department of Transportation is hereby authorized to accept and approve a redevelopment agreement or similar instrument restricting the use and improvement of the Vacated Area to social service purposes which include, but shall not be limited to, its use as a two lane driveway for patient drop off, the
Page 2
creation of sidewalk curbs and planters, service loading and landscaping, all to serve the Project, and for such uses and improvements that are "accessory", as that term is defined in the Chicago Zoning Ordinance, to the Project, such uses and improvements to be operated and owned by a not-for-profit corporation, subject to the approval of the Corporation Counsel as to form and legality. The restriction on use and improvement in the redevelopment agreement or similar instrument shall be for a term of forty (40) years and upon breach of such restriction the Vacated Area shall revert to the City and be subject to the terms and conditions of the dedication by which it has been heretofore held by the City.
SECTION 3. The City hereby reserves a forty-six (46) foot wide easement within the Vacated Area centered at 31 feet west of the east line of S. Laflin Street ("Sewer Easement") in, upon, over, and under the Vacated Area (the "Easement Area") for the existing Department of Water Management 60-inch public sewer and associated sewer structures that serve areas along S. Laflin Street including upstream of the Vacated Area, and for the installation of any additional sewers, as now located, or which in the future may be located in the Easement Area (said existing "sewer," "associated sewer structures" and "additional sewers" hereinafter collectively referred to as "Service Facilities"), and for the maintenance, renewal and reconstruction of such Service Facilities.
SECTION 4. The vacation herein provided for is further made upon the express condition that the Developer must meet all conditions memorialized in the Water Department letter dated June 19, 2019, attached hereto and made a part hereof as Exhibit B. .
SECTION 5. The vacation herein provided for is further made upon the express condition that no other use made of the Easement Area, which in the sole discretion of the respective municipal officials having control of the Service Facilities, would interfere with the use, maintenance, renewal, or reconstruction of the Service Facilities or the construction of additional municipally-owned Service Facilities. It is further provided that any Developer prompted adjustments to the Easement Area must be submitted to the Department of Water Management for review and express approval prior to construction and any such adjustment shall be paid for by the Developer, its successors or assigns. The Developer, its successors or assigns assume any cost beyond customary surface restoration work performed by the City, for repair to any privately-owned physical improvement in, upon, above, or under the Vacated Area that may become damaged as a result of the City exercising its easement rights pursuant to this ordinance.
SECTION 6. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Developer shall file or cause to be filed in the Office of the Recorder of Deeds of Cook County, Illinois, a certified copy of this ordinance, together with a redevelopment agreement complying with Section 2 of this ordinance, and approved by the Corporation Counsel, and the attached plat approved by the Chicago Department of Transportation, Acting Superintendent of Maps & Plats.
SECTION 7. This ordinance shall take effect and be in force from and after its passage and publication. The vacation shall take effect and be in force from and after its recording.
Page 3
Vacation Approved:
Approved as to Form and Legality
Arthur Dolinsky Senior Counsel
Introduced By:
Page 4
EXHIBIT "A"
Laflin Street I
I
PLAT OF VACATION
of Part of S.
DWIGHT D. EISENHOWER!
North Line of W. Congress Pkwy.
A'
A
North Line of Lots in Block 32 .A/so, South Line of IV. Congress Pkwy.
PKWY.
North Line of Lots in Block 33 A/so, South Line of VV. Congress Pkwy.
25'R \ 25'R | 25'R.| 25 Northeast Comer of Lot
66' R
25'R I 25'R I 24'R \ 25'R
Use 5
I
24^23
Co o -J
~ S1
66: R
Q Ii lay JI
'5'R> V" 66.00' ~1 V5R | 25'R | 25'R | 25'R \ 25'R | 25'R I 24'r\ 25'R I 1_/ ortocriic-7>i rr Northwest Comer of Lot 24 n tsy OUt)/ fc
Residential
21
20
19
22
Use:
CM
LU
18
17
Zoned: PD 168 m ^ \ 4 \ 3 \ 2*fc I VacatJit I f |g
CM
Residential Zoned: PD 168|1010|7_ m
Rejco
¦5S,L*« _
JO lui
I ej
LAFLIN AND LOOMIS'S ^ 2 iRESUBDMSIONi <8 irdedJan.8, 9, [10 & 11J18733 as Doc. 76155 1 w
Souf/jeasi* Corner of Loit-
Southwest bomer of|Lot 24 | I
£ I—
"G
f25'R ~~7 rtO Northeast Comer of Lot 52—^ 52
Vacant
£cc Vacated "C" Alley ~~'
Northwest Comer of Lot 25
20 Ft. Vacated Alley "G
"G1" ¦o
25
Vacant 26
>P^- Southwest Comer of Lot 26
?C 725VR _
"G'
51
Southeast Comer of Lot 57-v
125'R ^
Vacated "G1" Alley
T Norbeast Conner of Lo\ 50—'
K 20 Ff. vacated ^ "G"'A/fey
8 L_
o n: O
tu.S si
cmq;
Vacated
Alley
Use: Residential Zoned; PD 168
- Northwest Cimer of Lit 27
LAFLIN AND LOOMIS'S
ofde
eel oil cm
i r
Km
155 IP
rvi1
1 eri in
33 I 34
43 I 44
RESUBDMSION Recofded Jan\8, 9, 10 A 11, 1873 as Dac.7615i
Si i
CM
45 46
47 48
49 I 50
th I I Use: Residential I
S Zoned: PD 168 5!
27 i 28 | 29 | 30 31 , 32
2f ^Sb^t^sf3^y^i977-\|910|_25J_R ]_2£R J_25_R_L 25' Rj 25' R_ |_25\R J^yRU/^ 6 Southeast Comer of Lot 50-
Closed to Vehicular Traffic by Ordinance Passep July 1$, 1977 and Rec. July 15,1977 as Doc. No. 24014034
ofw. Harrison Si _f Opening and Widening by Ordinance Passed May 4, 197] \and Rec. June 9, 1977 ( 73-68) as Doc. No. 23960778
25'R
66'R
R_L 25' Rj 25'R_]_251R 125%X$4^22§^'^ L Southwest Comer of Lot27[_
• South Line of Lots in Block 33
ST.
¦ South Line of Lots in Block 32
ABBREVIATIONS:
D = DEED DIMENSION
E = EAST
EXT. = EXTENDED
M = MEASURED DIMENSION
N = NORTH
R = RECORD
R.O.W. = RIGHT-OF-WAY
S = SOUTH
W = WEST
W. HARRISON
( Originally a 66.00' Wide Right-of-Way)
30
NOTES:
60
LINE TYPES USED:
LOT LINES
GRAPHIC SCALE
1 inch = 60 ft.
SURVEY NO. N-130102 VACATION
ALL DISTANCES SHOWN HEREON ARE MEASURED UNLESS SHOWN OTHERWISE.'
THE BASIS OF BEARINGS IS ASSUMED.
DATE: FEB. 21. 201B
STREETS AND ALLEYS LIMITS OF VACATION TRAFFIC FLOW DIRECTION VACATED STREET LINE —
NATIONAL SURVEY SERVICE. INC.
DCSION FIRM UCCNSC NUUBCKi 184.002760
PROFESSIONAL LAND SURVEYORS
SO S. MICHIOAN AVENUE. SUITE 200 CHICAGO. ILLINOIS MM03 WWW.NAT10NALSURVCYSEIIVICI.COM TELt SI2-S3O-t4a0 JUMIMMWTI0NALSURVEIMIWLE.COM FAXl 311-eSO-S«a4
"G1" - Vacation of Public Alleys Passed May 4,1977 by Ordinance Rec. June 9,1977 (73-68) Doc. No. 23960779 IMPORTANT
[ wim m rtfr jwo iwrmwi. nuns thovot. thus;' 4jer hum 4 pwzr mo fa par. ait m rkt mo nmn mu* O NATIONAL SURVEY SERVICE, INC. 2019 "ALL RIGHTS RESERVED"
CDOT # 17-28-17-3825 page 1 of 3
CIVIL 3D PROJECTS 2018/N130102-AUX/130102.dwg
Ji '
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D
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S. ASHLAND AVE.
(100'R.O.W.) -»> 325.75'R
S. LOOMIS «-
(•66'R.O.W.;
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EXHIBIT "A"
PLAT OF VACATION
of Part of S. Laflin Street
THAT PART OF S. LAFLIN STREET LYING EAST OF THE EAST LINE OF LOTS 1, 50, 51 AND 52 IN BLOCK 32, LYING EAST OF A LINE DRAWN FROM THE SOUTHEAST CORNER OF SAID LOT 1 TO THE NORTHEAST CORNER OF SAID LOT 52 AND LYING EAST OF A LINE DRAWN FROM THE NORTHEAST CORNER OF SAID LOT 50 TO THE SOUTHEAST CORNER OF SAID LOT 51; LYING WEST OF THE WEST LINE OF LOTS 24, 25, 26 AND 27 IN BLOCK 33, LYING WEST OF A LINE DRAWN FROM THE SOUTHWEST CORNER OF SAID LOT 24 TO THE NORTHWEST CORNER OF SAID LOT 25 AND LYING WEST OF A LINE DRAWN FROM THE SOUTHWEST CORNER OF SAID LOT 26 TO THE NORTHWEST CORNER OF SAID LOT 27; LYING SOUTH OF A LINE DRAWN FROM THE NORTHEAST CORNER OF LOT 1 IN BLOCK 32, TO THE NORTHWEST CORNER OF LOT 24 IN BLOCK 33 AND LYING NORTH OF A LINE DRAWN FROM A POINT ON THE EAST LINE OF LOT 50 IN BLOCK 32 WHICH IS 29.31 FEET NORTH OF THE SOUTHEAST CORNER OF SAID LOT 50 (AS MEASURED ON SAID EAST LINE) TO A POINT ON THE WEST LINE OF LOT 27 IN BLOCK 33 WHICH IS 25.97 FEET NORTH OF THE SOUTHWEST CORNER OF SAID LOT 27 (AS MEASURED ON SAID WEST LINE) ALL IN LAFLIN AND LOOMIS'S RESUBDIVISION OF BLOCKS 5, 18, 21, 30, 31, 32, 33 AND 41 AND v SUBDIVISION OF BLOCKS 6, 9,19 AND 20 IN CANAL TRUSTEES' SUBDIVISION OF THE WEST 1/2 AND THE WEST 1/2 OF THE NORTHEAST 1/4 OF SECTION 17, TOWNSHIP 39 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT THEREOF RECORDED JANUARY 31,1863 AS DOCUMENT 62082 IN BOOK 161, PAGE 75, AND RE-FILED DECEMBER 31,1872 AND RECORDED JANUARY 8, 9,10 AND 11,1873 AS DOCUMENT 76155 IN BOOK 3, PAGES 65 AND 66, IN COOK COUNTY, ILLINOIS.
SAID STREET CONTAINING 19,747.3 SQUARE FEET OR 0.4533 ACRES, MORE OR LESS
STATE OF ILLINOIS j\ COUNTY OF COOK /
I. JOSEPH A . LIMA, AN ILLINOIS PROFESSIONAL LAND SURVEYOR. DO HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DESCRIBED HEREON FOR THE PURPOSE OF VACATING THE SAME AND THAT THE PLAT HEREON DRAWN IS A CORRECT REPRESENTATION THEREOF. DIMENSIONS ARE SHOWN IN FEET AND DECIMAL PARTS THEREOF AND ARE CORRECTED TO A TEMPERATURE OF 62' FAHRENHEIT. THIS PROFESSIONAL SERVICE CONFORMS TO THE CURRENT ILLINOIS MINIMUM STANDARDS FOR A BOUNDARY SURVEY.
THE FIELD WORK WAS COMPLETED ON FEBRUARY 21, 2018
SURVEY PREPARED FOR
.JQSEPJA_AUJMA_ IOIS PROFESSIONAL LAND SURVEYOR NO. 3080
AND MAILED TO:
MS. ALYSSA SCATCHELL
RUSH UNIVERSITY MEDICAL
CENTER
1750 W. HARRISON STREET SUITE: 319, JELKE CHICAGO, IL 60612-3824 PH: 312-563-0072
PiN's AFFECTED:
17-17-122-017: Lots 51 & 52, Block32 17-17-122-032: Lot 50, Block 32 17-17-122-038: Lot 1, Block 32 17-17-123-021: Lots 25 & 26, Block 33 17-17-123-044: Lot 24, Block 33 17-17-123-045: Lot 27, Block 33
MY LICENSE EXr-ltfES 11/30/2020
CDOT# 17-28-17-3825
DATE: FEB. 21. 2018
C.D.O.T.
SURVEY NO. N-130102 VACATION THIS INSTRUMENT PREPARED BY-
NATIONAL SURVEY SERVICE. INC.
DESIGN FIRM LICENSE NUMBER: 1S4.OO27S0
PROFESSIONAL LAND SURVEYORS
SO S. MICHIGAN AVENUE. SUITE 300 CHICAOO, ILLINOIS SO0O3 1WWW.NATIONALSURVCYSERVICC.COM TEL: 3l2-t3O-S4S0 JI »l»««l»T10M«IJUIIVE>»eiMCE.eCIM FAX: 312-110 »«»<
O NATIONAL SURVEY SERVICE, INC. 2019 "ALL RIGHTS RESERVED"
CIVIL 3D PROJECTS 2018/N130102-AUX/130102.dwg
Department of Water Management city of chicago
June 19,2019
City of Chicago Department of Transportation Division of Infrastructure Management Office of Underground Coordination 30 North LaSalle Street, 3rd Floor Chicago, Illinois 60602
Attn: Mr. Jai Kalayil
Coordinator of Street Permits
Re: Proposed Vacation (Not-for-Profit) Ordinance 28th Ward
For Rush University Medical Center
S. Laflin Street - W. Congress Parkway and W. Harrison Street
OUC File No. 2017-78156 BMP Project No. 17-28-17-3825 Water Atlas Page: 285 Sewer Atlas Page: 39-2-29
Dear Mr. Kalayil:
This letter is an updated response to your inquiry dated September 11, 2017 concerning the proposed vacation. This response supersedes all previous responses.
The Department of Water Management - Water Section
Based on our records, there are no water facilities within the limits of the area proposed for vacation. Therefore, the Water Section has no objection to the proposed vacation.
All water services no longer in use must be permanently terminated as part of the proposed development by permit per DWM standards at the developer's expense.
For questions regarding water facilities, please contact Andrew McFarland at (312)
742-7027. ' l
The Department of Water Management - Sewer Section
Based on sewer records, there is a 60-inch public sewer on S. Laflin Street located at 31 feet west of east line of S. Laflin Street flowing south entering the proposed area to be
Mr. Jai Kalayil June 19, 2019
, Page 2 of2
vacated. The 60-inch sewer is serving areas along S. Laflin Street including upstream of the area to be vacated. This 60-inch sewer must be retained and maintained.
Based on drawings received on 06/06/2019, the Sewer Section will approve the proposed street vacation, provided the beneficiary must agree with the following conditions:
There must be a reservation of forty-six (46) feet wide centered at 31 feet west of east line of S. Laflin St for the existing 60-inch public sewer.
The Sewer Section requires a minimum of thirty-two (32) feet of vertical clearance from ground level for the entire width and length of the reservation to provide access to construction machinery that would be necessary in the event of a break or if maintenance or relocation were required in the future.
The City of Chicago Department of Water Management must have continuous 24-hour access without any obstructions like fences, bollards or canopy on, over, upon, or blocking access to the area where the reservation is required.
All proposed plans for improvements must be submitted to and approved by the Department of Water Management - Sewer Section prior to construction.
Within the boundaries of the reservation set forth in Section (i) above, the beneficiary of the vacated ROW shall be responsible for any/all repair, renewal replacement, or removal of any physical improvements on the vacated area which may be damaged in connection with the maintenance and repair, or replacement of the sewer main. Examples of improvements include, but are not limited to, the sidewall retaining wall for the depressed dock, the landscape island, the private drainage system, pavement and sidewalks.
vi. Within the boundaries of the reservation set forth in Section (i) above., the beneficiary of the vacated ROW Shall be responsible for timely removal of the entire overhead removable canopy including frame and panels for the maintenance and repair, or replacement of the sewer main. The removal of canopy including frame and panels shall be at the sole cost and expense of the beneficiary.
No trees can be installed within 10-feet of the City's Sewer in the area to be vacated ROW where a reservation is.
Any adjustments to the Sewer Section's facilities in the vacated ROW where a reservation is required must be paid by the beneficiary.
For questions regarding sewer facilities, please contact Anupam Verma at (312) 742-7108.
Very truly yours,
Randy Conner Commissioner
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Rush University Medical Center
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[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:
_ AA ™. tv . ¦ - - 1700 West Van Buren Street, Suite 301
Business address of the Disclosing Party: ;
Chicago, IL 60612
nT1 . 312-942-6886 v 312-942-4233 _ Justin_T_Johnson@rush.edu
Telephone: Fax: Email:
Justin T. Johnson Senior Corporate Counsel | Assodata General Counsel
Name of contact person: ~ _
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 file Not for Profit Street Vacation Application for the proposed vacation of Laflin Street between Congress Pkwy. and Harrison St.
. . . Chicago Department of Transportation
Which City agency or department is requesting this EDS?
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
N/A N/A
Specification # ",rK and Contract # "/fA
Ver.2018-1 Page 1 of IS
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
] Person [ ]
] Publicly registered business corporation [ ]
] Privately held business corporation [ ]
] Sole proprietorship [x]
] General partnership (Is
] Limited partnership
] Trust [ ]
Limited liability company Limited liability partnership Joint venture
Not-for-profit corporation
he not-for-profit corporation also a 501(c)(3))?
[x] Yes [ ] 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 of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ] Yes [ ] No [x] Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. 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 Appendix D Executive officers and all directors
Rush System tor Health Sole member' (corporate parent)
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) in excess of 7.5% of the Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Page 2 of 15
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
Not Applicable. The Disclosing Party is a not-for-profit corporation.
Note: Rush University Medical Center's sole 'member1 (corporate parent) is Rush System for Health, for which a separate economic disclosure statement is being provided.
SECTION HI - 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-month period preceding the date of this EDS? [ ] Yes [x] 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 ofthis EDS? [ ] Yes [x] 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:
Does any City elected official or, to the best of the 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 of the Municipal Code of Chicago ("MCC")) in the Disclosing Party? []Yes [x]No~
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partners) and describe the financial interest(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 of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 15
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
See AppendixEi attached.
(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 of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No [x] No person directly or indirectly owns 10% or more of the 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 ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date ofthis EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any 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 of 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 of any 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, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) ofthis EDS:
are not presently 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 ofthis 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;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the 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 ofthis 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 the 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 directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any 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, any Contractor 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 Contractor, nor any Agents have, during the 5 years before the date ofthis EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such 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 officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state 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 of such 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)(5)(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 of engaging 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.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, 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 with 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 subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
10. [FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired
or to be hired in connection with the Matter certifications equal in form and substance to those in
Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
Ver.2018-1 Page 6 of 15
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. Ifthe Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
N/A
If the letters "MA," 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.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the 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, of the City of Chicago (if none, indicate with "N/A" or "none").
N/A
13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at 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 contribution 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.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [x] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Page 7 of 15
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
N/A
Ifthe letters "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. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes . [x]No
NOTE: If you checked "Yes" to Item D(l), proceed to Ttems D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
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 the Matter involve a City Property Sale?
[ ] Yes [x] No
If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of 15
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
N/A
Ifthe letters "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. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ]Yes [x]No
NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
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 the Matter involve a City Property Sale?
[ ] Yes [ ] No
If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of 15
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. If the Disclosing Party checks (2), the Disclosing Party must disclose 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 with the Matter voidable by the City.
x 1. 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 slavery 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 Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI » CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: Ifthe Matter is federally funded, complete this Section VI. Ifthe Matter is not federally funded, proceed to Section VII. For purposes ofthis Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION 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 of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
N/A
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be 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 of the Disclosing Party with respect to the Matter.)
2. The Disclosing 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 or entity to influence or attempt to influence an officer or employee of any agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 Page 9 of 15
SECTION VH » FURTHER ACKNOWLEDGMENTS AND CERTD7ICATION
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any 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 seeking City contracts, work, business, or transactions. The full text ofthis ordinance and a training program is available on line at www.citvofchicago.ora/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 City determines that 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 at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information 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 which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
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. Ifthe Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGD3DLITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
Page 11 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 of the date furnished to the City.
Rush University Medical Center
(Print or type exact legal name of Disclosing Party)
By: 7)rM M ¦UCjQaaAj^' (Sign here)
Diane M. McKeever
(Print or type name of person signing)
Secretary, The Trustees
(Print or type title of person signing)
Signed and sworn to before me on (date) feW\rv| 10,71)1*) at CxiOrC County, ^ImQ'S (state).
Notary Irjujplic
>k4
"OFFICIAL SEAL"
«2 0a<2-
Maritza Ramses Notary Public, State of Illinois
My Cmaiuioa Eipircs Fcbruiry 27, 2822
Commission expires:
Page 12 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the 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 Party'' or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the 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 or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section n.B.l.a., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes [x] No
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Not applicable.
Page 13 of IS
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUDLDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] Yes [x] No
Ifthe Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] Yes [ ] No [x] The Applicant is not publicly traded on any exchange.
If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.
Page 14 of IS
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City of Chicago Economic Disclosure Statement and Affidavit Section IV - Disclosure of Subcontractors and Other Retained Parties
HDR Architecture
30 W. Monroe St. 8700 Chicago, IL 60603 Relationship: Project Architect Estimated Contract: $3,924,534 Consultant is retained
Jacobs
525 W. Monroe St. #1600 Chicago, IL 60661 Relationship: Program Manager Estimated Contract: $785,601 Consultant is retained
National Survey Service, Inc. 30 S. Michigan Ave. #200 Chicago, IL 60603 Relationship: Surveyor Estimated Contract: $66,500 Consultant is retained
Neal & Leroy, LLC
120 N. LaSalle St, Suite 2600 Chicago, IL 60602 Relationship: Outside Council Estimated Contract: $90,000 Consultant is retained
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Rush University Medical Center - Laflin This recertification is being submitted in connection with Street Vacation Plat #17-28-17-3825 [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.
Rush University Medical Center Date: 7^/f9
(Print or type legal name of Disclosing Party)
By:
(signiiere)
Print or type name of signatory: Title of signatory:
^Signed and sworn to before me on [date] 7-3—/^ t by
Mat)* M Mc/eesiUr- , at ^>&— County, /OJAJa/^ [state].
Notary Public.
Commissiotrexpires:_
OFFICIAL SEAL JACQUELINE BURGESS
NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES 02/16V23
CITY OF CfflCAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Rush System for Health
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] 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
[x] 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:
Rush University Medical Center
r, o aa ft. ™- , • n * 1700 West Van Buren Street, Suite 301
Business address of the Disclosing Party: ;
Chicago, IL 60612
„T1 . 312-942-6886 _ 312-942-4233 _ Justin_T_Johnson@rush.edu
Telephone: Fax: Email:
~ XT f , f Justin T. Johnson
Name of contact person: _
E. 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 file Not for Profit Street Vacation Application for the proposed vacation of Laflin Street between Congress Pkwy. and Harrison St.
, . ,. Chicago Department of Transportation
Which City agency or department is requesting this EDS?
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
N/A N/A
Specification # and Contract #
Ver.2018-1 Page 1 of 15
SECTION H - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
] Person [ ] Limited liability company
] Publicly registered business corporation [ ] Limited liability partnership
] Privately held business corporation [ ] Joint venture
] Sole proprietorship [x] Not-for-profit corporation
] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
] Limited partnership [x] Yes [ ] No
] Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
liinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ] Yes [ ] No [x] Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. 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 Appendix D Executive officers and all directors
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) in excess of 7.5% of the Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Page 2 of 15
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
Not applicable. The Applicant is a not-for-profit corporation
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-month period preceding the date of this EDS? [ ] Yes [x] 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 [x] 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:
Does any City elected official or, to the best of the 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 of the Municipal Code of Chicago ("MCC")) in the Disclosing Party?
[ ] Yes [x] No
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 interest(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 of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 15
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
None.
(Add sheets if necessary)
[x] 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 of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No [x] No person directly or indirectly owns 10% or more of the 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 ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date ofthis EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any 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 of 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 of any 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, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 ofIS
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II(B)( 1) of this EDS:
are not presently 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 ofthis 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;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with comrnitting any of the 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 the 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 directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any 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, any Contractor 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 Contractor, nor any Agents have, during the 5 years before the date ofthis EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such 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 officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state 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 of such 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)(5)(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 of engaging 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.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, 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 with 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 subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
Ver.2018-1 Page 6 of 15
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. Ifthe Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
N/A
If the letters "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.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the date ofthis EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
N/A
13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date ofthis 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 contribution 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.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [x] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Page 7 of 15
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. If the Disclosing Party checks (2), the Disclosing Party must disclose 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 with the Matter voidable by the City.
x 1. 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 slavery 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 Party has found no such records.;
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. Ifthe 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. CERTIFICATION 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 of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
Not applicable.
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be 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 of the Disclosing Party with respect to the Matter.)
2. The Disclosing 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 or entity to influence or attempt to influence an officer or employee of any agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 Page 9 of 15
of a member of Congress, in connection with the award of any 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) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the 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 of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the 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:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ]Yes [ ]No
Have 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?
[ ] Yes [ ] No [ ] Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [ ] No
If you checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTOTCATION
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any 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 seeking City contracts, work, business, or transactions. The full text of this ordinance and a training program is available on line at www.citvofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, LL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
If the City determines that 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 at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information 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 which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. Ln the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. Ifthe Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGD3DLITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
Page 11 of IS
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 of the date furnished to the City.
Rush System for Health
(Print or type exact legal name of Disclosing Party)
By: if- UC&A/O-^/
(Sign here)
Diane M. McKeever
(Print or type name of person signing)
Secretary, The Trustees
(Print or type title of person signing)
Signed and sworn to before me on (date) C^hr\>^rV\^ fWi2Ql£) ,
at (jQfC County, Cf[\\ru>*=> (state).
'""OFFICIAL SEAL""' Maritza Ramses Notaiy Public, State of Illinois
My CM-htioi Expires Febrmry 27, 2022
Page 12 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the 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 Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the 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 or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section ILB.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, ifthe 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 Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ]Yes [x]No
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Not applicable.
Page 13 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTDJICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] Yes [x] No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] Yes [ ] No [x] The Applicant is not publicly traded on any exchange.
If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.
Page 14 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www.arnlegal.com ). generally covers a party to any agreement pursuant to which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises.
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(l) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
[ ] Yes
[]No
[x] N/A -1 am not an Applicant that is a "contractor" as defined in MCC Section 2-92-385. This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(1). If you checked "no" to the above, please explain.
Page 15 of 15
Appendix D
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(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose ofthis page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Rush University Medical Center - Laflin This recertification is being submitted in connection with Street Vacation Plat #17-28-17-3825
[identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that
he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2)
warrants that all certifications and statements contained in the Disclosing Party's original EDS
are true, accurate and complete as of the date furnished to the City and continue to be true,
accurate and complete as of the date of this recertification, and (3) reaffirms its
acknowledgments.
Rush System for Health
(Print or type legal name of Disclosing Party) By:
(sign here)
Print or type name of signatory: Title of signatory:
t>eMoK free Ptes/P&Jr ML*/Srtf&P
Signed and sworn to before me on [date] .fay
JZiane /-/. Udkacut* , at CoOtL- County, XUjfJffS [state].
A Slj^YY^ Notary Public.
mission expires:_
OFFICIAL SEAL JACQUELINE BURGESS
NOTARY PUBLIC STATE Of ILLINOIS MY COMMISSION EXPIRES:02rl6fl3