RESOLUTION CLASS 6(B) REAL ESTATE TAX INCENTIVE
FOR THE BENEFIT OF MEETING TOMORROW PROPERTIES, LLC, AN ILLINOIS LIMITED LIABILITY COMPANY, AND REAL ESTATE LOCATED GENERALLY AT 2901 WEST LAWRENCE AVENUE, AND 2919 WEST LAWRENCE AVENUE IN CHICAGO, ILLINOIS PURSUANT TO COOK COUNTY, ILLINOIS REAL PROPERTY ASSESSMENT CLASSIFICATION ORDINANCE
WHEREAS, the Cook County Board of Commissioners has enacted the Cook County Real Property Assessment Classification Ordinance, as amended from time to time (the "Ordinance"), which provides for, among other things, real estate tax incentives to property owners who build, rehabilitate, enhance and occupy property which is located within Cook County and which is used primarily for industrial purposes; and
WHEREAS, the City of Chicago (the "City"), consistent with the Ordinance, wishes to induce industry to locate and expand in the City by supporting financial incentives in the form of property tax relief; and
WHEREAS, Meeting Tomorrow Properties, LLC, an Illinois limited liability company (the "Applicant"), owns certain real estate located generally at 2901 West Lawrence Avenue and 2919 West Lawrence Avenue, Chicago, Illinois 60625, as further described on Exhibit A hereto (the "Subject Property"); and
WHEREAS, the Applicant intends to substantially rehabilitate an approximately 41,000 square foot industrial facility and 8,500 square foot parking garage located on the Subject Property; and
WHEREAS, Meeting Tomorrow, Inc., an Illinois corporation, plans to lease the entire Subject Property to operate its meeting and event technology solution business; and
WHEREAS, the Applicant has filed with the Office of the Assessor of Cook County (the "Assessor") an eligibility application for a Class 6(b) tax incentive under the Ordinance; and
WHEREAS, the Subject Property is located within the Lawrence/Kedzie Redevelopment Project Area (created pursuant to the Illinois Tax Increment Allocation Redevelopment Act, 65 ILCS 5/11-74.4-1 et. seg., as amended, and pursuant to an ordinance enacted by the City Council of the City), and the purposes of Redevelopment Project Areas are also to provide certain incentives in order to stimulate economic activity and to revitalize depressed areas; and
WHEREAS, it is the responsibility of the Assessor to determine that an application for a Class 6(b) classification or renewal of a Class 6(b) classification is eligible pursuant to the Ordinance; and
WHEREAS, the Ordinance requires that, in connection with the filing of a Class 6(b) eligibility application with the Assessor, the applicant must obtain from the municipality in which|1010|
such real estate that is proposed for Class 6(b) designation is located a resolution expressly ^ stating that the municipality has determined that the incentive provided by Class 6(b) is necessary for development to occur on such real estate and that the municipality supports and consents to the Class 6(b) classification by the Assessor; and
WHEREAS, the intended use of the Subject Property will provide significant present and future employment; and
WHEREAS, notwithstanding the Class 6(b) status of the Subject Property, the redevelopment and utilization thereof will generate significant new revenues to the City in the form of additional real estate taxes and other tax revenues; now, therefore,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1: That the City determines that the incentive provided by Class 6(b) is necessary for the development to occur on the Subject Property.
SECTION 2: That the City supports and consents to the Class 6(b) classification by the Assessor with respect to the Subject Property.
SECTION 3: That the Clerk of the City of Chicago is authorized to and shall send a certified copy of this resolution to the Office of the Cook County Assessor, Room 312, County Building, Chicago, Illinois 60602 and a certified copy of this resolution may be included with the Class 6(b) eligibility application filed with the Assessor by the Applicant, as applicant, in accordance with the Ordinance.
SECTION 4: That this resolution shall be effective immediately upon its passage and
Honorable Deborah f Alderman, 33rd Ward
approval.
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EXHIBIT A
Legal Description of Subject Property:
P.I.N.: 13-13-105-008-0000
Commonly Known As: 2919 West Lawrence Avenue, Chicago, Illinois 60625 LOT 2 IN BLOCK 32 IN FIRST ADDITION TO RAVENSWOOD MANOR, A SUBDIVISION OF THAT PART OF THE EAST 72 OF THE NORTHWEST 1/4 AND THE WEST 1/2 OF THE NORTHEAST 1/4 LYING BETWEEN THE SANITARY DISTRICT RIGHT OF WAY AND FAIRFIELD AND MANOR AVENUES IN SECTION 13 TOWNSHIP 40 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
P.I.N.: 13-13-105-009-0000
Commonly Known As: 2901 West Lawrence Avenue, Chicago, Illinois 60625 LOT 62 IN SUBDIVISION OF LOTS 1, 20, 21 AND 40 IN FIRST ADDITION TO RAVENSWOOD MANOR, A SUBDIVISION OF THAT PART OF THE EAST Vi OF THE NORTHWEST % AND THE WEST Vz OF THE NORTHEAST % LYING BETWEEN THE SANITARY DISTRICT RIGHT OF WAY AND FAIRFIELD AND MANOR AVENUES IN SECTION 13 TOWNSHIP 40 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
Ttt the Applicant
OR
[] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
Business address of the Disclosing Party:
Telephone: •777-754-3032 Fax: Email: raj&Ak £ M €g^K^b*o»
Name of contact person: RfljcAct kfirrVs
Federal Employer Identification No, (if you have one):
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
hpf^Lvtip^ -far G U») took C Pt-^-kfr (^c&n4>v< far P If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
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SECTION II - 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
$Q Privaieiy held business corporation [ J Joint venture
[ ] Sole proprietorship [ ] Not-for-profit corporation
[ ] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
[ ] Limited partnership [ ] Yes [ ] No
[ ] Trust [ ] Other (please specify)
2, For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
1 tli^oiS
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?
UYes []No Pfl N/A
B. IF THE DISCLOSING PARTY IS A LBQAL ENTITY:
I. List below tho full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are Jegal eotlUw. If there are no such members, write "no members." For trusts, estates or other similar entities, Hat below the legal titleholder(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
2. Please 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 of 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 n beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant (o Section 2-154-030 of tlte 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.
Name Business Address Percentage Interest in the
Disclosing Party
Mark. At^fope. ( I OQ%)
\%QZ Ui g«r4e*vj Aye, $>re lQChicago, GOG 13
SECTION III - 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 months before the date this EDS is signed?
[ ] Yes M No
If yes, please identify below the narae(s) of auoh City elected official(s-) and describe such relationship^):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINER 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 ofthe 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.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) 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 to influence any legislative or administrative action.
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.
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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. Mye.^" felfrftK ( £e*"Qf TaX irv^^ga/- ) fees (es\\yvi^\ed ) tf20jOQC>~
re-ratted RsVC Ka«- ± Ka\z a*<) fteg«n ll\d-
77 tO ujqju^^o^ sre 9oO
Chicago , IL £> Q& 0*2.
(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 Municipal Code Section 2-92-415, substantial owners of business entities that contract w,ith 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 jurisdiction1?
[) Yes J^No [ ] No person directly or indirectly owns 10% or morepf Jha
Disolosing 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
I. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(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 Parry 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 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 agenoy; 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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The Disclosing Party and, it" the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B. 1. of this EDS:
arc 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 n 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 oonvicted, 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 tbo federal government,.any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 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, inoluding 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").
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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 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 ofthe federal government or of any state or local government in the United States of Amerioa, 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 oollusioh among bidders or prospective bidders, in rostraint of freedom of competition by agreement to bid a fixed price or otherwise; or
mdde an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such oonduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Diseasing Parry, Affiliated Entity or Contractor, or any of their *n^ioyt? engaging; in or being convicted of (I.) bid-rigging in violation of 720 ILCS ^iB^'^^f^if^^j^^ violation ;of 720 ILCS 5/33E-4; or (3) any similar offense of any stato 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 any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Trsas^tiy orthe Bureau of Industry and Security of the U S. Department of Commerce or their successors: theSpeotally Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and tbe Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (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), the Disclosing Party must explain below:
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.
8. To the best ofthe 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 execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
9. To the best ofthe 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 $20 per recipient (if none, indicate with "N/A" pr "none"). As to any gift listed below, please also list the name of the City recipient.
*VA __
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is M is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
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 (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
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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.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 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?
[ ] Yes M 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., proceed to Fart 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 jaame of any other; person or entity in the purchase of any property that (i) belongs to the City, or (it); if'sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City^coUe^ftvelyj "City Property Sale"). Compensation for property taken pursuant to the City's cminenTl^dd^fl%p>>yeT does not constitute a financial interest within*he meaning of this PartD.
Does the Matter involve a City Property Sale?
[ ] Yes M No
If you 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
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
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 paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X L 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. If the Matter Is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by.{he City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the fedoral Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf 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" appear, 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 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 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.
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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 ofthe 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) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
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 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 tjie.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 [ J 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
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:
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SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
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 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 www.oityofchicago.org/Ethics . and may also bo 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 the applicable ordinances.
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 p^ bo, void .or voidable, and the City may pursue any remedies under the contract or agreement (ifnoJiejcfaid^oi, void), at jaw, or in equity, including terminating the Disclosing Party's partiolpadon'u^e^a^^a^d/or declining to allow the Disclosing Party to participate-in other transactions with the City;, &cme$ieft,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 on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Aot 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.
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 to Matters subject to Article I of
Chapter 1-23 ofthe 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.
The Disclosing Party represents and warrants that:
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F.l. The Disclosing Party is nol delinquent in the payment ofany tax administered by the Illinois Department of Revenue, nor arc 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 Parly 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 ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, (he Disclosing Party will obtain from any contractors/subcontractors hired or lo be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent ofthe Cily, use any such contractor/subcontractor that docs not provide such certifications or that ihe Disclosing Parly has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If tbe Disclosing Party cannot certify as lo any ofthe items in F.l., F.2. or F.3. above, an explanatory statement must be attached lo this EDS.
CERTIFICATION
Under penally of perjury, the person signing below: (1) 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 EDS and Appendix A (if applicable) arc true, accurate and complete as of the dale furnished to ihe City.
(Sign here)
(Print or type name ofperson signing)
(Print or type title of person signing)
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 percent. It Is not to be 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 hoad. A "familial relationship" exists if, as ofthe 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, grandohild, 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 officors ofthe Disclosing Parry listed in Section ILB.l.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 ofthe Disolosing Party, if the Disclosing Party'is a'Uniitecl partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limitod 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 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 [YJ No
If yes, please identify below (1) the name and title of such person, (2) tlte name ofthe 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 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
ThU Appendix Is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership Interest In tbe Applicant exceeding 73 percent (on ^Owuer*), It Is not to be completed by any legal entity which has only an Indirect ownei^hip Int^esje In the Applicant
Pi^wit to Municipal CodfcSection 2-154-010, itibo Applicant or any Owneride^edas.ft building wdc scofflaw or problem landlord pursuant to Section 2-92^I$Of theMa^i^ Code?
I JVes Q#tto
If^^pteomtis-frlegil etwitxpublicly tradedon any.excha^ge, is t^.j>W^^^^i$ me Ap^Uo^ ideatlflM m a buildrng caoV scofflaw or problem ]^^e^pmii^ioi^^^ 2^2^16^toe MiMo^alC^?
j 3% fcri No: [ ]WotAppJe?*lf
if^to (t)W#v^ please Itfentify bdaw^t^ ofthe pefsottarjo^
identified aa;«!^ landlord and ju^tdditssW^^fm^t
builfjingjrto vtfiieb'-^p^Er^'^eviot^ons-ftpply. '
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BV REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDDC B AJRE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
CITY OP CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Ugni ftftmoof the Disclosing Party wfaroUting ihi* EDS. Include d/b/al if applicable:
MrtKyt^ VHQofifW PgqpefrKty Lit
Cheek ONE ofcthe foltowlnp three boxes:
ladlcatp wfoctfjcr toe Duolo*ing Party submit ling this, EDS Is;
Hw'oAppU&nl
OK
p M$gi! ontHy holding a direct or Indirect Interest in the Applicant State the legal n^!c of;thjJ
App|^«ntlo-wtdcb ther Disclosing Party boldc an totetWU -
' W'"" ' .....
n iie$*rcnti*^^ I13;l^ $?afctbc.te|»4^
¦ ¦ ^^m^ : ,
TelenfaneT^^^H^^ : Fflxt ... Bmelb MtkilK&Mti^pS^^
Name of coittQCt person;.
B. FederalBnmloyeUdenUOefttion No. tffyou have otw); -^ ._-*.
P. Brief detfriptfon of contract, iranMotioa or other undertaking (referred to below a*tfcjs "Mi^ei-) itti which this EDS pertain*. (Include project number and location cf property, If applicable):*
G. Which City agency or department Is requesting this BPS? ptpatOWnt Pi^^J.a«ftJ^bpW
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following;
Specification # and Contract H
Page I of 13
SECTION II-DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY
[J Peapn
[ \ Publicly registered business corporation t-j Pfiv&tely held business corporation (.) §ole proprietorship Xi^Oene^tj^rmerjihip 'y-'^ttiteea'p^rtncrship 6 Trust
^CLimlted liability company [ J Limited liabiiiry partnership [ j Joint venture (j Not'for-profitcorpqration (Is the oot'for^rofit corporation also a.501(c)(3))?
[) Other(pleaio,specify)
2. For; legal entitles, the state (or foreign e^uittiy) o^mooipjorati9s orcf^anixdtiOfl, If^plfcablo;
DM
^x^mk^i^4i^6mt wtf ie "nb meitthcra.* For tfo^ej^ef
K0$3k»^gifwigty-iUted •boTo.w mutt w^iti$$$'$fcff& Natne
p$jr^|i^^ thejiaxoe and U^of
TWe
tfi
majuge^^ that egjngtJt ^^'M^::^
2. Please provide the following information concerning each;pco^px ^a^iMrriP&-§j|^ect or Indirect beneficial Interest (Including ownership) in excess- of 73^Wftft^Iteib^jK^Fi^. j&#Uplcs of such an interest Include shares in a corporation, partnership interest in a partnership or joint venture,
Puss 2 of 13
interest of it member or manager in a limited liability company, or interest of a beneficiary of a inut, e
Name Bmincw Address Percentage Interest in the
. , Disclosing Party
JTOto-WEftW, Inc. UflA'l
IK03vV(kfoT^ Art, in _____
ri
SECTION til—BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the}t?lSj:^siha Party hadra "towlnes* rotations*^-,*-** dcffncdiln Chapter 2rI5j6 qXthbrM
Gptfe^V^^ 12 months.before
!
- -; ¦ -'^M
SBT^epJrcfos^tE^ tho name and business addrfctaof*
lobb)^«cciunUaL. consultant and spy.other person or entity whoa ifer) or expects to rjeiflfe rn- conncction with the Matter, as well as t^o^fttin^'Qt^^^l, v„. amount oJF^a:f^fpeid or esUrnaicd to be paid, the DlscloslngJParryIs-ootri^^^toJ employe^ who-ore paid solely through the. Disclosing Parry's regular payroll
Ml^b^if^nxcans. Roy. person or entity who undertake* to action on behairof any person.or entity other than: (I) a not-for-profit^cvu^.oii'^u^p^o^i^^^^ himself. ^Lobbytti^aUo means any ponton or entity any part ofwhoso ¦4$is^.W4$P}%&&$' another irtclndos undertaking to influence soy legislative or administretrve action.
If the Disclosing Party is uncertain whether a disclosure is required under thj* SttUpft,tftc Disclosing Pony mutt either ask tho City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Parry Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to bo retained) lobbyist, etc.) "hourly rate" or uLb.d." Is
a, u. j t. . v \ .i not an acceptable response,
fiSK Kat\- ti^Z Ct«t< R^(rVf.tT<.
(Addsheets if necessary)
f J Check hareif uteBisclosing Party has not retain^, norexpectsto retain^ My such persons or entities,
SECTION V GERTlFICATIOfS'S
A.
(tKo^etso DiscJbUrtgl^y,
Jft$«i^$!(^ a*o*rtfepp^^^
tt^J^^%^aglN«!« with. thaU,j,ccmcOt? ^v.,.^^^^^^
[JYes (]No B. PU^^^R?TlFtCATIONS
lr f^a^tto K^pjltclpal Codc Chapter i-W, Article I(
certifle*^i$^
with, or hssadmttfcd s—It of* or has ever been efafo^.4j£;^ cdmlnoi^rfettse toyolylng actual, stiempted. or couspbacyt£&ioyS^ perjury* dishonesty or deeett against an officer or employee ot|fgj3&oi^ AppticttUt understands and acknowledges that compliance wl&3wn^
doing business with the City. NOTE: If Article I applies to the J^Wij^^^^Sn^^^^^ timeframe in Article I supersedes some five-year compliance ^e'i^^^t«^^it|^ja|& aed-3 hclow,
Page 4 of 13
2. Tho Disclosing Party and, if the Disclosing Pariy is u legal entity, all of those pcrsoni or entitles identified ia Section U.B.I. of this EOS:
arc not presently debarred, suspended, proposed for.debarment, declared ineligible or voluntarily excluded from nny transactions by any federal, state or local unit of government;
haye hot, within a five-year period preceding the dale of this EDS, been convicted of a criminal offense; adjudged guilty, or had a civil judgment rendered against;them.(fi\coonMUon,with: obtaining, attempting to obtain, or performing a public (federal, state of focafy-U^aSKofl.pr contract under a public transaction; a violation of federal or state antiu^st-stahjlcsj-fradd; embezzlement; theft; forgery; bribery; falsification or destruction.of recbt'ds; makingfalso statements; or receiving stolen propotry;
arc not presently indicted for, or criminally or civilly charge.d by^a.govc^ stafrortocol) with committing any of the offeoswsctf^rtilitt o_se/F.<2.b. *ijffij?^&*i*t
d» hovenot, vrithln a five-year period preceding the date of uH%£QS^ had:ono or mbxe.pUhUc • (i|i^^^.(fe4cral, stew or local) tomfo&te^iftr
e. ^at^not^.wiihin a five-year period preee
y ^$ tfjttiftofitfons in subparts 3,4 and-^toneeth':
tacllgkilfty of o .buslAcss entity to do business wflk federalorstateor.^ the City, using substantially the same management, ownership* orprinejeaifc with respect (o Contractors, tho term Affiliated Entity meant* p^
indirectly controls the Contractor, is controlled by it, or, with theC^trac? any responsible official of the Disclosing Party, any Contractor crany Affiliated fenfity 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 ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents"),
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Ditclosing Party or any Contractor nor any Agents have, during the five years before ibe date this BDS is signed, or, with respect to a Contractor, an Affiliated Entity, cr an Affiliated Entity of a Contractor during the five years boforo the date of such Contractor's or Affiliated Entity's contract or engagement In connection with the Matter:
h. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a.publie officer or employee ofthe City, the State bfiilihpis, or a^^gc^oy;oj|.^c>f
b. agreed or colluded with other bidders or proipectiveblddcr^ pX^eflJ^aj^^p. juy^sucb t^e^MU-^b^OD convicted or adjudged, guilty of a^emcniofrCoiluKbtt
pj|l$j?^ d'th^rws&or:
e, msd&ahkadmlsslon of ^oh conduct h. ahovo thatls a^t1e£of^cpjtf*hui
bjs^npttecn- prosecuted for such conduct: cr
d, vf^i^#cgprrovkrdtis ofMuatcipafe^^
m<&^jj|Jy^^ " '""J" ""
Design fl^;i?sOor^ List, the Dcnj^^ "
6. Tfc&ElicIo*uifcPajty unders^ds tnd shall comply wi&^ 2-55 (U^%4vo IxLfpcotor General), i-5e>*fy^
7. If gje EhclvjSa&Pwty it unable to certify to any of woahov**f*f«nie^ Certifications), ibe Disclosing Parry must explain below;
Page 6 of 13
If the letters *NA," the word "Nona," or no response appears on the lines above, it will be conclusively presumed thai the Disclosing Forty certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, tho following it a complete list of oil current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding (he execution date of tbii EDS, on employee, or elected or appointed official, ofthe City of Chicago (ii* none, indicate with **N/A" or"none").
wM
9. Tn the best of the Disclosing Party'* knowledge afterreasojttblew^
complete list of all gifts that the Disclosing Party has given, or cau«£d tp be/glyettj at ony time'during the
12*ffloath period pteceding the execution date Of. this BO$,. to en *th$oy£ev.o£^
official, of the Cliy pif Chicago. For purposes of this slatenie^V,^ ^an^hinj
. in^4g?|0fffany-^vidiab.ie to City, employees or-to the gencral^&e,.^
courso-of^ and having a retail vadpe pff
W«b ^^^%ppo^^ .A* to any ft Ustcd belaW,p[easo;to:ils^
C. C^tOTlCJATTON OP STATUS A&FtKAft&l'.^1,^0^^:
T^ePisolOsinir^arty certifies that the Disclosing Ps^ 0bei4e.oap)i [)U J^soot
a "finanoifll InsHturJofl" as defined in Section 2^2^55(b) of meWuniclpaVC^dc>
If the Disclosing Party IS a financial institution, then dM DlsoJosIhg PaWpl^ear
"We axeuot ao^will not become a predatory lendera*deflhc£iaG^lcfc.^ Code. Wo further pledge that none of our affiliates is, and npn^o^tfrain wlll^ornev^prcdaiory lender as iefined In Chapter 2-32 of the Municipal Code. • Wsi:«^iy lender or becoming oh affiliate of a predatory lender may result In.loss of;^©privifcgff of doing business with the City."
If the Disclosing Party it unable to make this pledge because Uor any of it* ^Uatei ^defined in Section 2-32-455(b) ofthe Municipal Code) U a predatory tender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages If necessary):
Page 7 of 13
If the letter* "NA," the word "None," or no response appears on tho lines above, It will be conclusively presumed that tbe Disclosing Party certified to the above statements.
D. CERTIPICAflON REGARDING INTEREST IN CITY BUSINESS
Any words.or tenna that are defined in Chaptor 2-156 of die Municipal Godeh'ayevU^ajmo meanings when vised In this Part D,
I. In ^cordanco with Section 2-l56rl 10 of the Municipal Code: Docs any o'fnclai:br\'enfployce Ofthe eijy^ve a ilnanciai wterest in his or bcr own name or in thenam;^ ehdry in iW):!ttattor?
n Y«
Chp^cd.#cs!!-t6 JtentD;!., proceed to fatisVP&jadJ^&Jl^^
?^ifo%ln^^tiTi
it* •
¦J. checked TfiF'lo Item D.l^ p^vldethe^^
offidflUorempu^es-hav^gsuch intcroslandit^B|SlV-i&6oifiE^raS^*^*^ .- v ' '
Business Address
4. The Pftejpjjog Party [b^er certifies that no prohibited financieLmterest'iti2ti&M&^^?!l be acquired by any City official or employee.
B. CERTIFICATION REGARDING SLAVERY BRA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party check* 2., tho Dlscloshi^Partyvmust disclose below or in an attachment to this HDS all information required by paragraph'2 Foil ore ro
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
the Disclosing Party and any and all predecessor entitles regarding records of investments or profits from slavery or slaveholder insurance policies during the stavery era (including insurance policies issued to. slaveholders' that provided coverage for damage to or injury or death of their slaves), and tho Disclosing Party has found no such records.
2. The Disclosiug Party verifies thai, a< a result of conducting the search in step I .above, the
Disclosing, Party has found records of investments or profits from slavery of slavcholdcriUuui^cc polfcies. Tho Disclosing Party verifies that the following constitutes full.disclosure of aJi. such, records, including the names of any and ail slaves or slaveholder* des^bc^^'those Ttc(aj£$;
StJ<2!f^$ ^ ~ Cl^TTJPfCATlSdNS FOR Ir£DERAW'Y: FOr^j^ M^Tpf^fii^
A. ^2^CA*tON RBOARDINO LOSBTWri
1. L&fcbetowthe names of all persons of entities ivgfstc^ uis^er^^^ s ,
Dise)owre;A.ct,of 1995 who have made Ibbbymg.contects cA&eii&Jf'^^U^iH^g^(0^L; respect to the Matter. (Add sheets If necessary):
(If ito-cxgi^jgtida appears or begins on the.lmcs above, or If we
2. The Disclosing Parry has nol spent and will not expend any fe^e^^ia^ ony person or entity listed In Paragraph A.l. obove for his or her lobbying-^
person or entity to influence or attempt to influence an officer or employee of any ogcn^ as.defrfled by applicable federal law, a member of Congress, an officer or employee of Congress, <>rjjh employee of a member of Congress, in connection with the award of any federally funded contract, molcing any federally funded grant or loan, entering into any cooperative agreement, or to extendi continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
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 ofthe 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".
If tiie 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 tlje.outset of negotiations.
Is the Disjoloalog Parry the Applicant?
rjYes []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 ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[] Yes []No
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 13
SECTION VH- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that: ¦
Tho certifications, disclosures, and acknowledgment* contained in this EDS will become;part-of any conlrncl or other agreement between (he Applicant and ibe City in connection y/}fo.\hp:)falXcti wbclber procurcmcnt. City assistance, or other City action, and are material inducements to j^eiSj^i:;e^^tl^n
, of any contract or takics other ac tion with respect to the Matter. The Disclosing Party understands thai it must comply with all statutes, ordinances, and regulations on which this BDS Is-based.
The. Ciiy> Governmental Ethics and .Campaign Financing Ordinances^ Ghapters: 2/}fJ^0d^Lx\;^,^f the Municipal.Code, impose certain duties and obligations oh person*5or eptft^
work, basjpej^, pr tra^jwtlons. The-fujl-text of these prdtaanett^^
line at ww^cfty^ also .oe.obt«ine4 ^
Sc'd^^jSu^ji^0p.t-.CSA^at9t ILtfOdlQ, (312) lAWGGQ, Th^^l^^^je^^j^^^^^^i^f;
1^ fpYil^^^ fiat may taelu4«4n«B^^
damages;
It t^OrGify^.policytto tneke thkdocument iryajiablp^^gUj^jBS^^J^ request. tym$ 0*^.of tho information provided on u^ E^^8&ot:^^^^f tt«4eavuii£leto&« p^Biioon \h*lD\amv*iM rc^fpocojp.to ft fre^dgp'i A~ owemis.e. %y compjdlfnj endI signing ibis EDS, the tiitttostag £a^i right* or cljiims wjxfch ftmsy hove against the City w eotmcctlph ^ contained ia. wis EDS and aljo authorise* the City to verify the acjajwyofcwy^^ InthisBM
The it&m*U6tapr^ EDS must be!
P«^rou« supplement(his BDS up to the dme the
contract b^g handied by tho City's Department of Procurement Service^; u^eDj^ps^g update thtejj&Sas the contract requires. NOTJSt WUhJetpect JO:^nj^^)0(.!^J^^it^' Chapter 1-23 of toe Municipal Code (imposing PERMANENT U^^^j^^^^^^^iintd offenses), (lie information provided herein regarding eligibility must, be kxptcurro^ as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants thai:
Page II of 13
2/16/201? Uiiqol|pg
JPMorgan Chaso 2/16/2017 5:45,"1G PM PAGE 1/002 Fax Server
F.l. The Disclosing Parly is, not delinquent in the payment of any lax administered by llic Illinois Department of Revenue, nor arc the Disclosing Parly or its Affiliated Entities dollnqucnt in paying any fino, fee, tnx or other charge owed lo the City. This includes, but is not limited lo, all water chnrucs, sower charges, license fees, parking tickets, proporty taxes or sales litxos.
P.2 If the Disclosing Party is tho Applicant, (lie Disclosing Parly and its Affiliated Entitles will nol use, nor permit their subcontractor* to use, tiny facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") mniiitaiiicd by the U. S. General Services Administration.
F.3 If tlte 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 substanco to those In F.l. and F.2, above and will not, without the prior written consent of tho City; use nny such conlroctor/suboontractor that does not provido JUOh ccrtificatjons or. that the Disclosing Party has reason lo believe has not providod or cannot provide truthful certifications.
NOTB: If the Disclosing Party cannot, certify at to any of the Items In F.l., F.2. or F.3. above, an explanatory -statement must be nttnehod to this EDS.
CERTIFICATION
U.Hd^r.pcoalty bfperj.ury, the person signing below (1) wor^^it^o/sbe'is authorized to execute uiilJBDS nad Appendix A (If appUcablo) on bdhnlf oftbc Disdl^
certifications rind statements contained In this BDS and Appendix A'(if applicable) nrc-iruc, accurate atldpomploto nsof tbe dste niniished to the City. . , r . -¦
(Slflu bore)
i° MeeL-f^V^ To/vvo^-rouJ VrtPerWc*) ^'i->y-'
(Print or typo name of parson signing)
hllps //tnall.qrxxjlo.coin/,fnal/L^1///s«it/15a.191da06TO9l35(7prqoclor=1
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 (he Applicant'exceeding 7.5 percent. It U not to be completed by any legal entity which has only an Indirect ownership Interest In the Applicant.
Under ly(onldpiI Code Section 2»vl$4*0l5y the Disclosing Party must dlsdw whether such piloting Party or any "Ap^icihU ?arr/, qr jny Sp^o p?^jOpffle^JPartner mes^ ^i^h^ 'rciaJtfonithip1' with any dectf^ciry officuii ordepa^WttcoA ^?"fomuiutl reUtfbrishlp"c3^^ i^S^h' si&ad, thjf. pitoJ[«{^Jo^ Qr^^^llcebjo ParQ^ orany Spouse or Dbmestfc-F^Per;^me^^j^ted;tp themo^^jft^^
partner or is any of tii e IbHmv^ p^yi&!^ niece ertjephe^ g^and^amit* grftndofcftL, fhu^fo-law, rnomcr-m-iiyy> orstepmi^ri^s
DOC^ % Dls^o^JPor^r ot any "A'pfctJeribJo ftuty** or any Spouse or-db^estfo-i^ baveatiftnmlialrelanT^^
C ] Yea
If yes, pleaseidCDtify below (I) the name and title of such person, (2) tho tiAtybf ^^ga|;ta%r ^^oh such persoo is cojtuuJWtcdj (3) the name and title ofthe elected city official oV (j^&^il^#^mt^i^h^ person has a fluniOal r^httf opship^ ted (4) the precise nature of such familial rela|^onship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX H
BUILDING CODE SCOFFLAW/PKOBLEM LANDLORD CERTIFICATION
This Appendix Is to be completed only by (u) the Applicant, and (b) any legal entity which hns a direct ownership interest in the Applicant exceeding 7.5 percent (on "Owner"). It Is not to be completed by any legal entity which has only an Indirect ownership Interest in the Applicant.
Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant lo Section. 2*91416 ofthe Municipal Code?
t ]Ycs f^SNo
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 scofQaw or problem landlord pursuant to Section 2-92r416 of th© Municipal Code"?
[ lYes tXJNo [ J.NotApplicable
If yes to (1) or (2) above; please identify below the name of the perspft or legal entity identified as a building code scofflaw or problem landlord and me 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 B IS INCORPORATED BY REFERENCE INTO. AND MADE A PART OF, THE ASSOCIATED EDS, AMD THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.