OFFICE OF THE MAYOR
CITY OF CHICAGO
RAHM EMANUEL
MAYOR
January 25, 2017
TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO
Ladies and Gentlemen:
At the request of the Commissioner of Fleet and Facility Management, I transmit herewith ordinances authorizing the execution of lease and use agreements.
Your favorable consideration of these ordinances will be appreciated.
Mayor
Very truly yours,
ORDINANCE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1: On behalf of the City of Chicago as Tenant, the Commissioner of the Department of Fleet and Facility Management is authorized to execute a Lease renewal with Besly Court Associates, as Landlord, to permit the renewal of the lease agreement for occupancy of 8,700 square feet of office space located at 1642 North Besly Court for continued use as a training center by the Department of Public Health; such Lease renewal to be approved by the Commissioner of the Department of Public Health and approved as to form and legality by the Corporation Counsel in substantially the following form:
LEASE NO. 10069
FIRST AMENDMENT TO LEASE
THIS FIRST AMENDMENT TO LEASE (this "Amendment") dated as of
, 2017 (the "Amendment Execution Date") by and between BESLY COURT
ASSOCIATES, an Illinois general partnership ("Associates"), CHICAGO TITLE LAND TRUST COMPANY, not personally but solely as Trustee under a Trust Agreement dated August 27, 1985 and known as Trust Number 65380 ("Land Trust"), and THE CITY OF CHICAGO, an Illinois municipal corporation and home rule unit of government ("Tenant" or "City").
RECITALS
WHEREAS, Land Trust is the owner of the real property more commonly known as 1642 North Besly Court, Chicago, Cook County, Illinois (the "Building"); and
WHEREAS, Associates is the beneficiary of the Land Trust; and
WHEREAS, Associates and Land Trust are collectively referred to in this Amendment as "Landlord"; and
WHEREAS, Tenant leases and occupies approximately 8,700 square feet of office space located on the second floor and mezzanine of the Building together with 35 parking spaces adjacent to the building (collectively, the "Premises") under a lease with Landlord dated February 10, 2012 (the "Lease"), notwithstanding the fact that Land Trust was not identified in the Lease; and
WHEREAS, Landlord and Tenant desire to modify certain terms and conditions of the Lease, all on the terms and conditions hereinafter set forth; and
NOW, THEREFORE, in consideration of the mutual covenants of the parties herein and other good and valuable consideration, the receipt and sufficiency of which are hereby mutually acknowledged, Landlord and Tenant agree as follows:
Definitions. All capitalized terms used but not defined in this Amendment shall have the same meanings ascribed to them in the Lease.
Term. Landlord and Tenant hereby agree that the expiration date of the Lease is hereby extended to December 31, 2023, unless sooner terminated as set forth it the Lease.
Rent. Tenant shall pay base rent for the Premises in the amount of:
Twelve Thousand One Hundred Eighty-Nine and 00/100 Dollars ($12,189.00) per month for the period beginning on the Amendment Execution Date and ending on December 31, 2017, with said amount being pro-rated on a per diem basis in the event the Amendment Execution Date is not the first day of the month.
Twelve Thousand Four Hundred Thirty-Two and 78/100 Dollars ($12,432.78) per month for the period beginning on January 1,2018 and ending on December 31, 2018.
Twelve Thousand Six Hundred Eighty-One and 44/100 Dollars ($12,681.44) per month for the period beginning on January 1,2019 and ending on December 31,2019.
Twelve Thousand Nine Hundred Thirty-Five and 06/100 Dollars ($12,935.06) per month for the period beginning on January 1, 2020 and ending on December 31, 2020.
Thirteen Thousand One Hundred Ninety-Three and 77/100 Dollars ($13,193.77) per month for the period beginning on January 1, 2021 and ending on December 31, 2021.
Thirteen Thousand Four Hundred Fifty-Seven and 64/100 Dollars ($13,457.64) per month for the period beginning on January 1, 2022 and ending on December 31, 2022.
Thirteen Thousand Seven Hundred Twenty-Six and 79/100 Dollars ($13,726.79) per month for the period beginning on January 1, 2023 and ending on December 31, 2023.
Holdover. Any holding over by Tenant shall be construed to be a tenancy from month to month only beginning January 1, 2024 with rent at the same rate set forth in Section 3(g) of this Amendment provided that during this hold over prior the Tenant shall be engaged in good faith negotiations with the Landlord for the renewal of this Lease. In the event, however, that Landlord terminates this Lease pursuant to Section 10.10 of the Lease and Tenant remains on the Premises beyond the applicable termination date, Tenant shall pay to Landlord rent at one and one half times (1.5) the rate set forth in Section 3 of this Amendment. Provided Tenant continues to occupy the Premises, Tenant's obligation to pay these amounts shall survive the expiration of this Lease.
Insurance. The Landlord shall procure and maintain at all times, at Landlord's own expense, during the term of this Lease, the insurance coverages and requirements specified below.
The kinds and amounts of insurance required are as follows:
Workers Compensation and Employers Liability Insurance. Workers Compensation and Employers Liability Insurance, in accordance with the laws of the State of Illinois-covering all Landlord's employees and Employer's Liability coverage with limits of not less than $100,000 for each accident or illness in connection with work performed by Landlord.
Commercial Liability Insurance. (Primary and Umbrella). Commercial Liability Insurance or equivalent with limits of not less than $2,000,000 per occurrence, for bodily injury, personal injury, and property damage liability. The City of Chicago is to be named as additional insureds on a primary, non contributory basis for any liability arising directly or indirectly from this Lease.
In an effort to meet the aforementioned insurance requirements, the Landlord has independently determined that it will obtain, at its sole cost and expense, for the Tenant, a commercial general liability policy (the "Tenant's Commercial Policy") with the Tenant listed as the named insured. The Tenant's Commercial Policy will be issued on an occurrence basis and will include the ISO Comprehensive General Liability policy wording as the basis of the
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Tenant's Commercial Policy and will include fire damage legal liability. The Tenant's Commercial Policy will provide $2,000,000 bodily and property damage coverage per occurrence and in the aggregate against claims filed against Tenant arising out of Tenant's occupancy of the leased premises located at 1642 North Besly Court, Chicago, Illinois.
Automobile Liability Insurance. (Primary and Umbrella). When any motor vehicles (owned, non-owned and hired) are used in connection with work to be performed by Landlord, the Landlord shall provide Comprehensive Automobile Liability Insurance with limits of not less than $1,000,000 per occurrence, for bodily injury and property damage caused by such vehicles.
Property Insurance. Property insurance coverage shall be maintained by the Landlord for full replacement value covering the building in which the Premises is located to protect against loss, damage to or destruction of such building.
The Landlord shall be responsible for all loss or damage to personal property (including but not limited to materials, equipment, tools and supplies), owned or rented, by the Landlord.
6. Other Terms of Insurance. Within thirty (30) days after receipt of written request from Tenant, the Landlord will furnish the City of Chicago, Department of Fleet and Facility Management, Office of Real Estate Management, 30 North LaSalle Street, Suite 300, Chicago, Illinois 60602, a Certificate of Insurance evidencing the required coverage to be in force on the date of this Lease. The Landlord shall submit evidence on insurance prior to the commencement of the Term. The receipt of any certificates does not constitute agreement by the City that the insurance requirements in the Lease have been fully met or that the insurance policies indicated on the certificate are in compliance with all Lease requirements. The failure of the City to obtain certificates or other insurance evidence from Landlord shall not be deemed to be a waiver by the City. Non-conforming insurance shall not relieve Landlord of its obligation to provide Insurance as specified herein. Nonfulfillment of the insurance conditions may constitute a violation of the Lease.
The Insurance shall provide that should any of the applicable policies be canceled before the expiration date thereof, the issuing insurer will endeavor to mail 60 days prior written notice to be given to the City in the event coverage is substantially changed, canceled, or non-renewed but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
Any and all deductibles or self insured retentions on referenced insurance coverages shall be borne by Landlord.
The Landlord agrees that Landlord shall waive the right of subrogation against the City of Chicago.
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The Landlord expressly understands and agrees that any coverages and limits furnished by Landlord shall in no way limit the Landlord's liabilities and responsibilities specified within the Lease documents or by law.
The Landlord expressly understands and agrees that any insurance or self insurance programs maintained by the City of Chicago shall apply in excess of and not contribute with insurance provided by the Landlord under the lease.
The required insurance shall not be limited by any limitations expressed in the indemnification language herein or any limitation placed on the indemnity therein given as a matter of law.
Notice. All notices, demands and requests which may be or are required to be given demanded or requested by either party to the other shall be in writing. All notices, demands and requests by Landlord to Tenant shall be delivered by national overnight courier or shall be sent by United States registered or certified mail, return receipt requested, postage prepaid addressed to Tenant as follows:
Department of Fleet and Facility Management Office of Real Estate Management City of Chicago
30 North LaSalle Street, Suite 300 Chicago, Illinois 60602
or at such other place as Tenant may from time to time designate by written notice to Landlord and to Tenant at the Premises. All notices, demands, and requests by Tenant to Landlord shall be delivered by a national overnight courier or shall be sent by United States registered or certified mail, return receipt requested, postage prepaid, addressed to Landlord as follows:
Besly Court Associates 1640 West Hubbard St. Chicago, Illinois 60622
or at such other place as Landlord may from time to time designate by written notice to Tenant. Any notice, demand or request which shall be served upon Landlord by Tenant, or upon Tenant by Landlord, in the manner aforesaid, shall be deemed to be sufficiently served or given for all purposes hereunder at the time such notice, demand or request shall be mailed.
Hiring Plan Prohibitions.
(i) The City is subject to the June 16, 2014 "City of Chicago Hiring Plan", as amended (the "2014 City Hiring Plan") entered in Shakman v. Democratic Organization of Cook County, Case No 69 C 2145 (United States District Court for the Northern District of Illinois). Among other things, the 2014 City Hiring Plan prohibits the City from hiring persons as governmental employees in non-exempt positions on the basis of political reasons or factors.
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Landlord is aware that City policy prohibits City employees from directing any individual to apply for a position with Landlord, either as an employee or as a subcontractor, and from directing Landlord to hire any individual as an employee or as a subcontractor. Accordingly, Landlord must follow its own hiring and contracting procedures, without being influenced by City or City employees. Any and all personnel provided by Landlord under this Lease are employees or subcontractors of Landlord, not employees of the City. This Lease is not intended to and does not constitute, create, give rise to, or otherwise recognize an employer-employee relationship of any kind between the City and any personnel provided by Landlord.
Landlord will not condition, base, or knowingly prejudice or affect any term or aspect of the employment of any personnel provided under this Lease, or offer employment to any individual to provide services under this Lease, based upon or because of any political reason or factor, including, without limitation, any individual's political affiliation, membership in a political organization or party, political support or activity, political financial contributions, promises of such political support, activity or financial contributions, or such individual's political sponsorship or recommendation. For purposes of this Lease, a political organization or party is an identifiable group or entity that has as its primary purpose the support of or opposition to candidates for elected public office. Individual political activities are the activities of individual persons in support of or in opposition to political organizations or parties or candidates for elected public office.
In the event of any communication to Landlord by a City employee or City official in violation of paragraph (ii) above, or advocating a violation of paragraph (iii) above, Landlord will, as soon as is reasonably practicable, report such communication to the Hiring Oversight Section of the City's Office of the Inspector General ("OIG Hiring Oversight"), and also to the head of the relevant City department utilizing services provided under this Lease. Landlord will also cooperate with any inquiries by OIG Hiring Oversight.
Reaffirmation of Lease. Except to the extent expressly set forth in this Amendment, all of the terms and conditions of the Lease shall remain in full force and effect and are hereby ratified and affirmed. If there is any conflict between the terms and provisions of the Lease and the terms and provisions of this Amendment, the terms and provisions of this Amendment shall control.
Governing Law and Severability. This Amendment shall be governed by and construed in accordance with the laws of the State of Illinois. In the event that any provision of this Amendment shall at any time be found to be invalid or otherwise rendered unenforceable, such provision shall be limited to the extent necessary to render the same valid, or shall be excised from this Amendment, as the circumstances require, and this Amendment shall be construed as if said provision had been incorporated herein as so limited or as if said provision had not been included herein, as the case may be.
Counterparts. This Amendment may be executed in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. This Amendment may be executed and delivered via email or PDF.
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12. Effectiveness. This Amendment is not effective unless and until the same is signed and delivered by both Tenant and Landlord.
[Signature Page to Follow]
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LEASE NO. 10069
IN WITNESS HEREOF, the parties hereto have caused this Amendment to be duly executed on the date first written above.
LANDLORD:
BESLY COURT ASSOCIATES, an Illinois general partnership
By:
Name:
Its:
CHICAGO TITLE LAND TRUST COMPANY, not personally but solely as Trustee under a Trust Agreement dated August 27, 1985 and known as Trust Number 65380
By:
Name:
Its:
TENANT:
CITY OF CHICAGO, an Illinois municipal corporation and home rule unit of government DEPARTMENT OF PUBLIC HEALTH
By:
Name:
Its: Commissioner
DEPARTMENT OF FLEET AND FACILITY MANAGEMENT
By:
Name:
Its: Commissioner
APPROVED AS TO FORM AND LEGALITY:
BY: DEPARTMENT OF LAW
By: '
Chief Assistant Corporation Counsel
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1642 North Besly Court Lease No. 10069
SECTION 2: This Ordinance shall be effective from and after the date of its passage and approval.
city oi chicago economic disclosure statement and affidavit
SECTION t -- GENERAL INFORMATION
A. Legal name of the Disclosing Parly submitting this EDS. Include cl-i> :i• if applicable:
^g'Zlf c^?t>/?7^s0-j-faCheck ONE of flu*, following three boxes:
Indicaic whether tin-. Disclosing Party submitting this EDS is:
1. Wf the Applicant
/ OR
2. } J a iegt:i emity holding a director indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OK
3. | j :j legal cnwty with a right of control (sec Section 1EB.L) Stale the legal name of the entity in
w Inch the Disclosing Party holds a right of control: ,
IL Business address of the Disclosing Party: /^V*? jrv—
j^J^^t^V.,. ^Jk.
.line oi conlaei person: !.:', recurs :m Employer Identification No. (ifyou have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") jo which slits EDS pertains. (luchide project number and local ion of property, if applicable):
C Which City agency or department is requesting this EDS? /^&/^^/&&35&&y
ft'Use Malic: is a contract being handled by the City's Dopanmou of Procurement Services, please complete the following:
Speeifieaiion and Contract r-
Page I of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATLRL OP I HE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Pa [ | Person
j ] Publicly registered business corporation j j Privately held business corporation f ] Sole proprietorship ^ General partnership j ) Limited partnership [ } Trust
j j Limited liability company j ]¦ Limited liability partnership | | Joint venture | ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501 (c)(3))?
i 1 Yes . [JNo [ } Other (please specify)
Tor legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. E'or legal entities not organized m the Stale of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
! : i f No 1 J N A
B. !r THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: Lor not-for-profit corporations, also list below ail members, if any. which are legal entities. If there are no such members, write "no members." f or trusts, estates or other similar entities, list below the legal titlehoiden
!f the entity is a general partnership, limited partnership, limned liability company, limited liability partnership or joint venmro. list below the name and title of each general partner, managing member, manager or any other person or entity that control* the day-io-day management of the Disclosing Party. NOTE: Each legal eivtity listed below must submit an EDS on Us own behalf.
Nil me Title
^><£^. J?^*S«£<< _ .^Af^^. SM7^^
__>**xj*^r J**£3% _
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial mtei cm (ineludiny ownership) in excess of 7.5% of the Disclosing Party, Examples o; such an interest include shares in a corporation, partnership interest in a partnership or joint venture.
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interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. It none, state "None." NOTE: Pursuant 10 Section 2-1 54-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant winch is reasonably intended lo achieve lull disclosure.
Name Business Address Percentage Interest in the
Disclosing Party ^-—~-cV'
/^ rf^ jo SA :+4^jxzcm 34.^^ ^ -r... - - - —
SECTION Ui - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICI ALS
Has the Disclosing Party had a "business relationship," as defined it) Chapter 2-156 of the Municipal Code, witli any City elected official in the 12 monlhs before the date this EDS is signed':'
! ! Yes
If yes. please identify below ihe name(s> of such City elected official(s) and describe such relations!! ip(s):
SECTION IV DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose ihe name and business address of each subconlractoi, attorney, lobbyist, 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 estimaled to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (I) a not-for-profit entity., on an unpaid basis, or 12) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence anv legislative or administrative action.
if the Disclosing Party is uncertain whether a disclosure is required under Ihis Seclion, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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Name (.indicate whether retained or anticipated to be retained )
Business Address
Relationship to Disciosmy Party (subcontractor, attorney, lobbyist, etc.)
Fees (indicate whether
paid or eslimated.) NOTE: ""hourly rate." or T.h.d." is not an acceptable response.
(Add sheets if necessary)
| j Cheek here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. C"OURT-ORDER1 • D CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-4 1 5. substantial owners of business entities that contract, with ihe 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?
if "Yes." lias the person entered into a court. app:o\ed agreement for payment of all support owed and is the person in compliance with thai, agreement?
| ] Yes
B. FURTHER CERTIFICATIONS
1. Pursuant ro Municipal Code Chapter 1-23, Article ! ("Article l")(which the Applicant should consult for defined terms (e.g "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant, nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision lor, 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 Article I applies to the Applicant, the permanent compliance timeframe in Article I Supersedes some five-year compliance timeframes in certifications 2 and 3 below
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2. The Disclosing Parly and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ll.B.l. 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, within a five-year period preceding 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. Irand; embezzlement: theft; forgery: bribery; falsification or destruction of records; making false statements: or receiving stolen property:
e. 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 m clause B.2.b. of this Section V;
have not. within a five-year period preceding the date of this EDS. had one or more public transactions (federal, state or local) terminated for cause or default; and
have not. within a five-year period preceding 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 slate, or any other unit of local government.
3. The certifications in subparts 3. A and 5 concern:
riie Disclosing Party:
any "Contractor * (meaning any contractor or subcontraciot used by the Disclosing Party tn connection wish 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 ihaf, directly or indirectly: controls the Disclosing Parly, 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 imeiests among family members, shared facilities and equipment; common use of employees; or organisation of a business entity following the ineligibility of a business entity to do business with fed era! or slate 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 oj another person or entity;
- any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any oilier official, :igent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorizat ion of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Parly, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or. with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before ii>e 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 uf the federal government or of any state or local government in (lie 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 a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of M unicipal Code Section 2-92-610 (l iving Wage Ordinance).
Neither the Disclosing Party. Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting w ith any unit of state or local government as a result of engaging in or being, convicted of 11} bid-nygtng in violation of 720 il ,CS v33E-3; (2) bid-rotating in violation of 720 ii.CS 5 33E-4; or (3) any similar offense of any .state or of the United Stares* 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 any of the following lists maintained by die Office of foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, (he Entity List and the Debarred List.
The Disclosing Party understands and shall comply with ffuj applicable, requirements of Chapters 2-55 (Legislative inspector General). 2-56 (Inspector General) and 2 I 56 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), die Disclosing Party must explain below:
d<>A/£ _
Page 6 of 13
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.
S. 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 I 2-nionth period preceding the execution date of this EDS, an employee, or elected or appointed oiTrciai. of the Citv of Chicago (if none, indicate with "N/A" or ""none").
... A
°. To the best of the Disclosing Party's knowledge after reasonable inquiry, (lie following is a complete list of all gifts that, the Disclosing Party has given or caused to be given, at any time during the I 2-momh period preceding the execution dale of this EDS. to an employee, or elected or appointed official, of the City of Chicago, for purposes of this statement, a "giff 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 $20 per recipient, (if none, indicate with "N/A" or "none"). As to anv «ift listed below, please also list the name of the Citv recipient.
_ '...".„ . _ _ _ ...
C. CERTIFICATION OE S ! ATtjS AS FINANCIAL INSTITUTION
I The Disclosing Party certifies that the Disclosing Party (cheek one)
f j >s p$ is not
a "financial institution" as defined in Section ?-32-455(b) of the Municipal Code.
2. 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 Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. 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."
if the Disclosing Party is unable to make this pledge because it or any of its affiliates fas defined in Seetion 2-32 -155(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the loiters "NA," the word "None," of no response appears on (lie lines above, it will be conclusively presumed that the Disclosing Parly certified to the above statements.
D. CERTIFICATION' REGARDING INTEREST IN CITV BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have (he same meanings when used in this Part D.
1. In accordance with Section 2-156- i 10 of the M unicipal Code: 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 m the Matter?
NOTE: Ifyou checked "Yes" to Item D.l., proceed to Items I).2. and D.3. Ifyou cheeked "No" to item D. I.,. 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 she purchase of any property that (j) belongs to the City, or (ii) is sold inr taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively. "Oily Property Sale") Compensation for property taken pursuant: to the City's eminent domain pow< does not constitute a. financial interest within the meaning of this Pan D.
Does the Matter involve a City Property Sate".'
[ ] Yes [ j No
Ifyou checked "Yes" to Item D.l provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
A. The Disclosing Party further certifies thai no prohibited financial interest in the Manor will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SI AVERY ERA BUSINESS
Please cheek either I . or 2. below, jfth.c Disclosing Party cheeks 2., the Disclosing Parly must disclose below or in an attachment to ihi>. EDS all information icquired by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
yA „ 1. The Disclosing Party verifies that the Disclosing Party has -searched any and all records o f 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 I 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 V I. If the Matter is not federally funded, proceed to Section VIE For purposes of this Section VI. tax credits allocated by the City and proceeds of debt obligations of ihe City are not federal funding.
A. CEIM IK1CAT!ON REGARDING LOBBYING
i. List below ihe names of all persons or entities registered tinder the federal Lobbying Disclosure Ac! of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: ( Add sheets >f necessary):
(if no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, ii will be conclusively presumed that the Disclosing Party means thai NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect lev 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. ?. above for bis 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 officei or employee of Congress, or an employee 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, giant, loan, or cooperative agreement.
age 9 of 13
V The Disclosing Party will submit an updated eerti!leation 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.
4, The Disclosing Party certifies thai either: (t) it is not an organization described in section
501(c)(4) of the Interna! Revenue Code of 1986; or (ii) it is an organization described in section
501(c)(4) of Die interna) Revenue Code of 19S6 but lias not engaged and will not engage in "Lobbying
Activities".
5. if the 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 Diselosmg 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 ail proposed subcontractors io submit the following information with their bids or in writing at the outset oi negotiations.
Is the Disclosing Party the Applicant?
I | No
If "Yes." answer ihe three questions below:
). Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations ' (Sec 41
2. Have you filed with ihe Joint Reporting Committee, the Director of die Office of Federal
C ontract Compliance Programs, or the Equal Employment Opportunity Commission ail reports due
under the applicable filing requirements?
i i Yes " JVf No
3. Have you participated in any previous contracts or subcontracts subject to the
equal opportunity clause?
MYes £4 No
]\ you checked "*No" to question 1. or 2. above, please provide an explanation:
./-:V-vU-^ ?s^^/^^:jr.^
Page 10 of 13
SECTION VII -- ACKNOWLEDGMENTS, CONTRACT COM PI 1ANCE. PEN A ETtES. I>ISCI>OSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become pan 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 ail statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Elides and Campaign Financing Ordinances. Chapters 2-156 and 2-16-1 oJ' the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.eityofellicago.org/Ethics , and may also be obtained from the City's Board of Ethics. 740 N.
Sedgwick St Suite 500, Chicago, ii. 60610. (312) 744-9660. The Disclosing Party must comply fully wtih the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete, or inaccurate, any contract or other agreement tn connection with which it is submitted may be rescinded or be void or \oidable , 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 ihe Matter and-'or declining to allow the Disclosing Party to participate in other transactions with the City. 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 ail of the information provided on rliis EDS and any attachments to this EDS may be made available to die public 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 againsi 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.
E. 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 this EDS as the contract requires. NOTE: With respect 10 Matters subject to Article 1 of
Chapter 1-23 of (he Municipal Code (imposing PERMANENT INl.LICfBILn Y for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter I -23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party t epres.cn ($ and warrants that:
Page I I of 13
Ki. Tiie Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine. fee. tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use. nor permit their subcontractors fo use. any facility listed by the ITS. E.P.A. on the federal Excluded Parties List System ("EPFS") maintained by the U. S. General Services Administration.
E.3 If the Disclosing Party is the Applicant, the Disclosing Party 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 E.I. and F.2. above and will not. without, the prior written consent of (Sic City, use any such contractor/subcontractor diat does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: if the Disclosing Party cannot certify as to any of the items in E.E, E.2. or E.3. above, an explanatory statement must be attached it) this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute tills EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants ihai all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
(Print or type name of Disclosing Party)
(Print or type name of person signing)
yff^*'?^*^ /y4^ <*4sSf (Print or type title of person signing)
Signed and sworn to before me on (date) f\i^t^\0P^_ * foQlKp
a! L.^-dti. County. Av^y4^tAJ'K-^~ (state).
¦:s- (I
Notarv Public.
Commission expire
I
.aa.^ <^3f A c> 5
" Officio! Scaf" Katelyn Marie hSarkovtrt.
Hotar, i'libiic, State of tedliwa Hesident of Lake Co If-i My commiwton expires August 23, 2C23
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT H EADS
This Appendix is to he completed only l>y (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. Ii is not to he completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code 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 an> 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 Parly" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department bead as spouse or domestic partner or as any of the following, whether by blood oi 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 Parly" means (I) all executive officers of die Disclosing Party listed in Section IE 15.1 .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership: all general partners and limited partners of die Disclosing Party., if the Disclosing Party is a limited partnership; all managers, managing members and members ol'the Disclosing Parly, if the Disclosing Party is a limned liability company; (2) all principal officers of the Disclosing Party: and (3) any person having more than a 7 5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating olficer. 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 Parry"" or any Spouse or Domestic Partner thereof currently have a "familial relationship"* with an elected city official or department head?
i 1 Ves ^JX^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.
Page i3 of 13
CITY OK CHICAGO ECONOMIC DISCLOSURE STA TEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOEFLAW/PROBLEM LANDLORD CERTIFICAT ION
T his Appendix is to Ik- completed only by (at the Applicant,and (l» any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner1'). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant
S. Pursuant to Municipal Code Section 2- i 54-01 (). is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal
Code?
! Yes
3. If yes to 11) or (2) above, please identity below the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX It IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF,THE ASSOCIATED EDS, AND THAT THE REPRESENTATION'S MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICAT ION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
(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.
City's lease of property at 1642 N. Besly Ct.
This recertification is being submitted in connection with
[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.
Besly Court Associates
(Print or type legal name of Disclosing Party) By:
(sign here) Print or type name of signatory: Harold Slager
Title of signatory: Managing Partner
t
ied and sworn to before me on [date] [JnAiJJUXjM .Mtyfl, by
seHA&e ^WrV'L at^^iw^i^Cojaty, (MJlS^ [state] ^JiUcA^1
Notary Public.
Commission expires:_
?'WSN. Official Seaf
=7*^^ R0SE MARIE BAXTER
(SEAL)0) Resident of Lake County, IN
Jfv_^d/ My commission expires
vfiiiS^ June 5, 2019
Ver. 11-01-05 1 i u i , L ^ ^ „
CITV OF CM 10AGO ECONOMIC DISCLOSURE ST ATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
Legal name of the Disclosing Early submitting this EDS. Include d/b/a < if applicable;
Check ONE of Ihe following three boxes:
indicate v\ hether the Disclosing Party submitting this EDS is: !. j^f the Applicant / OR
2. [ j a legal ennty holding a direct or indirect interest in the Applicant. Slate the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [ j a legal entity with a right of control (see Section ILILL) State the legal name of the entity in
which (he Disclosing Party holds a right of control: ..
Business address of the Disclosing Party: , ^^jS^&*t^.^ZZ~~.
<://j-<'<*Jv. /s&I'sZjz.
Telephone: ^/^.r^/^Z^ Fax: ^^rr^<'^^€3'.... bmail: fc&~ <-&^*
Name of contact person: . //s&tfJCf*. r^^^P1,
Federal Employer Identification No. (ifyou have one):
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which tliis EDS pertatns. (include project number and location of property, if applicable):
ii. VVhich City agency or department is requesting this EDS? /^"Z^^^^^'^'^Y
II'the Matter is a contract being handled by the City's Department of Procurement Services, please complete the fed lowing:
SpcCi!':c;':1;on .*• .-in! Contract
Page lot 13
SECTION II -- DISCLOSURE OE OWNERSHIP INTERESTS
A. NATURE OP THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing f | Person
f ] Publicly registered business corporation j ] Privately held business corporation I ] Sole proprietorship Jtff General partnership | j Limited partnership [] Trust
j | Limited liability company
| ]¦ Limited liability partnership
| J Joint venture
j ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
[]Yes []No [ j Other (please specify)
Eor legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. Eor legal entities not organized in the Slate of Illinois: Has the organization registered to do business m the State of Illinois as a foreign entity?
! I Yes [ | No 1 j N/A
B. Ir THE DISCLOSING PARTY IS A LEGAL ENTITY:
I. Lis! below the full names and tides of all executive officers and all directors of the entity. NOTE: Eor not-for-profit eorporaiions. also list below all members, if any. which are legal entities. If there are no such members, write "uo members." Eor trusts, estates or other similar entities, Est below ihe legal tiileholdei(s).
if the. entity is a general partnership. limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
^fW^^_J&*£<££ /ftyy-?^'^. f^'^f™.
.y^y^L „ ______ _._,
2. ."lease provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples ol Mich an interest include shares in a corporation, partnership interest in a partnership or joint venture.
Page 2 of 13
interest, of a member or manager in a limited liabiliiy company, or interest of a beneficiary of a imsi. estate or other similar entity, if none, state ¦"None." NOTE: Pursuant to Section 2-1 54-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Percentage Interest in the Disclosing Party
SECTION Hi - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 mouths before the date this EDS is signed?
If yes. please identify below the naine(s) of such Ciiy elected official(s) and describe such relationship(s):
SECTION IV - DISCLOSURE OK SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, 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 io disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (I) a not-for-profit entity, on an unpaid basis, or ( 2 ) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking io influence any legislative or administrative action.
if the Disclosing Patty 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 13
Name (indicate, whether Business Relationship to Disclosing Party Foes (indicate whether
retained or anticipated Address (subcontractor, attorney. paid or estimated.) NOTK:
io be retained) lobbyist, etc.) "hourly rale" or "t.h.d." is
not an acceptable response.
(Add sheets if necessary)
| j Cheek 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 Municipal Code Section 2-92-4 15. substantial owners of business entities that contract w ith ihe City must remain in compliance with their child support obligations throughout the contract's term,
Has any person w ho directly or indirectly owns 10% or more of the Disclosing Party been declared iu arrearage on any child support obligations by any Illinois court of competent jurisdiction?
{ j Yes d/No [ J No person directly or indirectly ow ns 10% or more of the
Disclosing Party.
it" "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?
I 1 Yes j j No
FURTHER CEiCl lElCATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(whieh the Applicant should consult for defined terms (e.g "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (j) neither the Applicant nor any controlling person 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 Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below
Page 4 of 13
Tito Disclosing Party and, if the Disclosing Patty is a legal entity, all of those persons or entities identified in Section 11.B.I. of this EDS:
it. 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. within a five-year period preceding 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:
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 clause B.2.b. of this Section V;
have not. within a five-year period preceding, the date of this EDS. had one or more public transactions (federal, state or local) terminated for cause or default; and
.have not. within a five-year period preceding 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 certifications in subparts 3, A and 5 concern:
vhe Disclosing Party;
any "Contractor'' (meaning any contractor or subcontractor used by the Disclosing Party in connection with ihe Matter, including but run limited to ali persons or iegal 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 laeilities and equipment; common use of employees: or organization of a business entity follow ing the ineligibility of a business entity to do business with federal or state or local government, including she City, tismg 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 bv it. or. with the Contractor, is under common control of another person or entity;
- any responsible official of the Disclosing Party, any Con tractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, anv 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").
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 five years before the date this EDS is signed, or. with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before she date of such Contractor's or Affiliated Entity's contractor 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 Slates 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
e. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
d. violated the provisions of Munieipal Code Section 2-92-610 (Living Wage Ordinance).
A. Neither the Disclosing Party. 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 (I} bid-rigging in violation of 720 11 .CS 5-W3E-3; (2) bid-rotating in violation of 720 ILCS .v'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 Emily is listed on any of the following lists maintained by she Office of foreign Assets Control of the U.S. Department of the Treasury or the Bureau of industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, ihe Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General). 2-56 (inspector General) und 2-156 (Governmental Ethics) of the Municipal Code.
li the Disclosing Parry is unable to certify to any of the above statements in this Part B (Eunhcr Certifications), the Disclosing Party must explain below:
^sfe-^/s;; _ _ _ _ _
Page 6 of 13
if the letters "NA." site word "None." or no response appears on the lines above, it will be conclusively presumed thai the Disclosing Party certified to the above statements.
8. 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 lime during the I 2-ntonlh period preceding the execution date of this IiDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or ''none").
... _
o. 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 F'DS, 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 $20 per recipient (if none, indicate, with "N/A" or "none"). As jo anv gift listed below, please also list the name of the City recipient.
_.^fcr_ LL _ _
C. CliimHCATlON OF STA TUS AS FINANCIAL INSTITUTION
The Disclosing Patty certifies thai the Disclosing Party (cheek one)
f j is p(f is not
a "financial institution" as defined in Section 2-32-4 55(b) of the Municipal Code.
if ihe Disclosing Party JS a financial institution, then the Disclosing Party pledges:
"We are not una will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is. and none of them will become, a predatory lender as defined m Chapter 2-32 of die Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory tender may result in the loss of the privilege of doing business w itii the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2 32 455(b) of the Municipal Code) is a predatory lender within ihe meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
_
Page 7 of 13
I {"the letters "N'A," the word "None," of no response appears on the lines above, it will be conclusively presumed ihatthe Disclosing Parly certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-1 10 of the Municipal Code: Does any official, or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
1 i Vcs y$Ko
NOTE: Ifyou checked "Yes" to Item D.l., proceed to Items I).?, and D.3. Ifyou checked "No" to Item D.l., 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 j j No
Ifyou checked "Yes" to Item D.E, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies thai no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SI AVERY ERA BUSINESS
Please check either i . or 2. below, if the Disclosing Parly checks 2 the Disclosing Parly must disclose below or m an attachment to diss EDS all information required by paragraph 2. Failure to
Page S of 13
comply with these disclosure requirements mav make any contract enrcred into with rhc City in connection with the Matter voidable by the City.
/N I. The Disclosing Pany verifies that the Disclosing Party has searched any and ail 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 Parry has found no such records,
2. The Disclosing Party verifies that, as a result of conducting the search in step I above, the Disclosing Pany has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that (lie 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 Mailer is federally funded, complete (his Section VI. If the Matter is nut federally funded, proceed to Section VIE For purposes of this Section VI. tax credits allocated by the City ami pi oc(.\'XiS of debt obligations of the City are not federal funding.
A. C'Ek'l !rICATION REGARDING LOBHYING
i. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of i'^5 who have made lobbying contacts on be-half of the Disclosing Party with respect to the Matter: ( Add sheets if necessary):
(if no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appeal, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the. Disclosing Party with respect-to the Mattel.)
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 of a member of Congress, in connection with die award of any federally funded contract, making any federally landed grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, giant, loan, or cooperative agreement.
Page 0 of \?>
3. The Disclosing Puny \\ iii submit an updated certification at (he end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information se! forth in paragraphs A.l. and A.2. above.
¦5, The Disclosing Party certifies thai cither: (i) ii is not an organization described in section 501(e)(4) of the Interna! Revenue Code of 19.S6; or (ii) it is an organization described in section 50 l(c)(4) of the Internal Revenue Code of 198b but has not engaged and will not engage in "Lobbying Activities".
5. If the Disclosing Pany is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from ail subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Mutter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION/ REGARDING EQUAL EMPLOYMENT OPPORTUNITY
if the Matter ;s federally funded, federal regulations require the Applicant and all proposed subcontractors to submit tire following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party she Applicant?
V es j j No
!l "Yes." answer ihe three questions below:
Have you developed and do you have on file affirmative action programs pursuant ro applicable federal regulations'' (Sec 4] C'ER Part 60-2.)
f ) Vcs jfl No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal
C ontract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements? I IVcs rxfNo
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
i ] Vcs ^4 No
It you checked "No" to question i. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPEIANCE. PENALTIES. DISCLOSURE
The Disclosing Pany understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agrecmenr between the Applicant and the City in connection with the Matter, whether procurement. City assistance, or other Cily 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 thai it must comply with all statutes, ordinances, and regulations on which this EDS is based.
13. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at wwAy.ejjyofclvicago.orgd'ihies. and may also be obtained from ihe City's Board of Ethics. 740 N.
Sedgwick St Suite 500, Chicago. !L 60610, (312) 744-9660. The Disclosing Party must comply fully with die applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any eonlnict or other agreement m 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 nor rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in (he Matter and-'or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
it is die City's policy to make this document available to the public on its Internet site and/or upon request. Some or ail of the information provided on rhis EDS and any attachments to this EDS may be made available, to die public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS. the Disclosing Pany 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.
E. T he. 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 this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter i-23 of ihe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
fhe DiscloMiig Party represents arid warrants that:
Page 11 of 13
El. The Disclosing Pany is not dcliiiqucnl in '.he payment of any tax administered by the Illinois. Department oi'Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any-fine, fee. tax or other charge owed to the City. This includes, but is not limited to, ;dl water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not. use. nor permit their subcontractors to use. any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPFS'') maintained by the U. S. General Services Administration.
E.3 If the Disclosing Party is the Applicant, the Disclosing Party 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 F. I. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: if the Disclosing Party canned certify as to any of the items in F.L, F.2. or E.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penally of perjury, the person signing below: < Ej warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this El.)S and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
"(Sign here)
( Print or type name of Disclosing Party)
(Pi nit or type name of person signing) (Print or type title of person signing)
Signed and sworn to before mc on (date) flvVfhA h&e 1 7* 't'Q1^
.. L^-4l£ County. A'^d-J.^S^S-,, C'tate).
/
Notarv Public.
Commission expires: (Aa*-* «^» ^d^r?
-Offictot 8s«r 1 \ Katelyn Wade Markcvtcts ¦
p Hot»rv - iibite, State »{tadlttu ' >ij Hetitfem of Lska Co Hi ¦/ My commiofan expires
August 23, 2023 '
Page 12 of 13
CITV OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AEE1 DAVIT
APPENDIX A
FAMfLLU.'RELATIONSHIPS WITH ELECTED CITY OEEIC1ALS AND DEPAR TMENT HEADS
This Appvndi.v. is (o he completed only by (a) the Applicant, and (h) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to he completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code 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" exisis 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 11.8.1 .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if ihe Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Pany is a limited partnership; ail 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 > percent ownership interest in Ihe Disclosing Party. "Principal officers" means the president, chief operating olttcer. executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Docs 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?
! ]Ycs ^p(fNo
If yes, pi ease identify below til the name and title of such person. (2) the name of the le-gal entity to which such person is connected; (3) the name and title of the elected city offic ial or department head to w hom such person has a familial relationship, and ( 4) the precise nature of such familial relationship.
Page L>of 13
CITY OK CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX H
BUILDING CODE SCOEELAW/]>RORLEM LANDLORD CERTIFICATION
This Appendix is to Ik- completed only by (a) the Applicant.and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 75 percent (an "Owner"). It is not to be completed by any legal entity which has only un indirect ow nership interest in the Applicant.
Pursuant to Municipal Code Section 2-i 54-010. is the Applicant or any Owner identified as a building code scofflaw or nroblem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
! IVes jX'KV>
I j the Applicant is a legal entity publicly traded on any exchange, is any ol'llccr or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-4 16 of the Municipal Code?
! ! Yes | ] No \y4Not Applicable
3. i! yes to (1) or (2) above, please identity below the name ofthe person or legal entity
identified as a building code scofflaw or problem landlord and the address ofthe building or buildings to which the pcrlinent code violations apply.
KILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX ft IS INCORPORATED BY REFERENCE INTO, AND MADE A PARI OE. THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OFTHE ASSOCIATED EDS.
(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.
City's lease of property at 1642 N. Besly Ct.
This recertification is being submitted in connection with
[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.
Besly Court Associates
(Print or type legal name of Disclosing Party) By:
(sign here) Print or type name of signatory: Harold Slager
Title of signatory: Managing Partner
ned and sworn to before me on [date] LJnMJXCuMJ 1 I, by
sekA/Ce QosCfe'l- at^g^^W/r^Co^ufaty, (MJl/^ [state] kjhdt&t^
Notary Public.
Commission expires:_