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OFFICE OF THE MAYOR
CITY OF CHICAGO
RICHARD M. DALEY
MAYOR
April 13, 2011
TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO
Ladies and Gentlemen:
At the request of the Commissioner of Housing and Economic Development, I transmit herewith an ordinance authorizing the execution of a loan agreement, provision of affordable housing tax credits and a fee waiver for New Moms, Inc.
Your favorable consideration of this ordinance will be appreciated.
ORDINANCE
WHEREAS, the City of Chicago (the "City"), a home rule unit of government under Section 6(a), Article VII of the 1970 Constitution of the State of Illinois, has heretofore found and does hereby find that there exists within the City a serious shortage of decent, safe and sanitary rental housing available to persons of low and moderate income; and
WHEREAS, the City has determined that the continuance of a shortage of affordable rental housing is harmful to the health, prosperity, economic stability and general welfare of the City; and
WHEREAS, the City Council of the City of Chicago (the "City Council"), by ordinances adopted on September 27, 2007, and published in the Journal of Proceedings of the City Council (the "Journal") for such date at pages 8741 through 8874, has previously approved a certain redevelopment plan and project (the "Redevelopment Plan") for the Austin Commercial Tax Increment Financing Redevelopment Project Area (the "Redevelopment Area") pursuant to the Illinois Tax Increment Allocation Redevelopment Act, as amended'(65 ILCS 5/11-74.4-1 et seq.) (the "Act"), designated the Redevelopment Area as' a redevelopment project area pursuant to the Act, and adopted tax increment financing pursuant to the Act as a means of financing certain redevelopment project costs (as defined in the Act) in the Redevelopment Area incurred pursuant to the Redevelopment Plan; and
WHEREAS, the City Council, by ordinance adopted on July 28, 2010 and published in the Journal for such date at pages 97411 through 97450 (the "Prior Ordinance"), has previously approved the conveyance of the real property commonly known as 5327 West Chicago Avenue, Chicago, Illinois (which is currently anticipated to be known as 5353 West Chicago Avenue in Chicago, Illinois), which is currently improved with a two-story building that formerly served as the 15th District Police Station (as more particularly described on Exhibit C to this ordinance, the "Property"), to New Moms, Inc., an Illinois not-for-profit corporation ("New Moms") (together with any single purpose entity owned, in whole or in part, and controlled by New Moms, the "Developer") for $1.00; and
WHEREAS, pursuant to the Prior Ordinance, the conveyance was subject to the Developer's execution, delivery and recording of a redevelopment agreement in the form of Exhibit C attached to the Prior Ordinance and made a part thereof (the "Land Sale Redevelopment Agreement"); and
WHEREAS, the Prior Ordinance required that the City would not have an obligation to convey the Property to the Developer unless and until the City Council also approved certain City financing and all conditions set forth in the Land Sale Redevelopment Agreement and the City financing documents were satisfied; and
WHEREAS, the City has certain funds available from a variety of funding sources ("Multi-Family Program Funds") to make loans and grants for the development of multi-family residential housing to increase the number of families served with decent, safe, sanitary and affordable housing and to expand the long-term supply of affordable housing, and such Multi-Family Program Funds are administered by the City's Department Housing and Economic Development ("HED"); and
WHEREAS, HED has preliminarily reviewed and approved the making of a loan to the New Moms Housing Development LLC, an Illinois limited liability company of which New Moms is the sole member (the "Borrower") in an amount not to exceed $4,100,000 (the "Loan"), to be funded from Multi-Family Program Funds for certain eligible costs of the Project (as described in Exhibit A attached hereto and made a part hereof) pursuant to the terms arid conditions set forth in Exhibit A; and
WHEREAS, the City conveyance of the Property to the Developer and the construction of the Project are consistent with the goals and objectives of the Redevelopment Plan; and
WHEREAS, the Borrower, or an entity affiliated with the Borrower, has applied for grant funds through the Federal Home Loan Bank of San Francisco in connection with the Project in an amount of approximately $700,000, which such grant may be secured by a mortgage junior to the lien of the mortgage securing the Loan, and which such grant may be additionally secured by a recapture agreement and/or such other security as may be acceptable to the Authorized Officer (as hereinafter defined), but the making of such grant is not a condition to the making of the Loan; and
WHEREAS, the Illinois General Assembly pursuant to 20 ILCS 3805/7.28 (as supplemented, amended and restated from time to time) has authorized a program allowing the allocation of certain tax credits for qualified donations made in connection with affordable housing projects (the "Donation Tax Credit Program"); now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The above recitals are expressly incorporated in and made a part of this ordinance as though fully set forth herein.
SECTION 2. The seventh WHEREAS clause of the Prior Ordinance is hereby amended by deleting the language indicated by strikeout and adding the language indicated in brackets as follows:
"WHEREAS, the Developer intends to demolish the Police Station and construct a new mixed-use facility that will include a day care, program offices and approximately forty (40) residential rental units that will be rented to very low income mothers between 18 and 21 years of age and with one or more children at affordable rents [low- and moderate-income persons] (as more fully described on Exhibit B attached hereto and made a part hereof, the "Project"); and"
SECTION 3. The eighth, ninth, tenth and eleventh WHEREAS clauses of the Prior Ordinance are hereby deleted in their entirety.
SECTION 4. SECTION 6 of the Prior Ordinance is hereby deleted in its entirety and hereby replaced with the following SECTION 6:
"SECTION 6. To the extent that any ordinance, resolution, rule, order or provision of the Municipal Code of Chicago, or part thereof, is in conflict with the
provisions of this ordinance, the provisions of this ordinance shall control."
SECTION 5. The first paragraph of Exhibit B of the Prior Ordinance is hereby amended by deleting the language indicated by strikeout and adding the language indicated in brackets as follows:
"The Developer shall lawfully demolish and dispose of the Police Station. The Developer shall.thereafter construct a new mixed-use four (4) story building having approximately 49,561 square feet. Approximately 16,195 square feet shall be used for day care facilities and program offices. Approximately 33,366 square feet shall be developed for forty (40) residential apartments (approximately thirty (30) of which shall be studio apartments and the remaining ten (10) of which shall be one bedroom apartments), which shall be leased to mothers 18 21 years of age and such mothers' children) whose household income is at or below thirty percent (30%) of the area median income (such a household, an "Eligible Household"), at rents affordable to households earning fifty percent (50%) or less of the area median income (such rent, an "Affordable Rent"), [low- and moderate-income persons.]"
SECTION 6. The Authorized Officer is hereby authorized to enter into and execute such amendments to the Land Sale Redevelopment Agreement as shall be necessary or advisable in connection with the Project.
SECTION 7. The Developer is hereby designated as the developer for the Project pursuant to Section 5/11-74.4-4 of the Act.
SECTION 8. The City hereby approves the conveyance of the Property as a donation to New Moms from the City under the Donation Tax Credit Program in connection with the Project. The Authorized Officer is hereby authorized to transfer the tax credits allocated to the City under the Donation Tax Credit Program in connection with the conveyance of the Property to an entity satisfactory to the^Authorized Officer on such terms and conditions as are satisfactory to the Authorized Officer (the "Transfer"). The proceeds, if any, received by the City in connection with the Transfer are hereby appropriated, and the Authorized Officer is hereby authorized to use such proceeds, to make a grant to the Borrower, New Moms, or to another entity affiliated with the Borrower, in his or her sole discretion, for use in connection with the Project (the "Grant"). The Authorized Officer is hereby authorized, subject to approval by the Corporation Counsel, to enter into and execute such agreements and instruments, and perform any and all acts as shall be necessary or advisable in connection with the implementation of the Transfer and the Grant. Upon the execution and receipt of proper documentation, the Authorized Officer is hereby authorized to disburse the proceeds of the Grant to the Borrower, New Moms, or to another entity affiliated with the Borrower, as applicable.
SECTION 9. Upon the approval and availability of the Additional Financing as shown in Exhibit A hereto, the Commissioner of HED (the "Commissioner") and a ,designee of the Commissioner (each, an "Authorized Officer") are each hereby authorized, subject to approval by the Corporation Counsel, to enter into and execute such agreements and instruments, and perform any and all acts as shall be necessary or advisable in connection with the implementation of the Loan. The Authorized Officer is hereby authorized, subject to the approval
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of the Corporation Counsel, to negotiate any and all terms and provisions in connection with the Loan which do not substantially modify the terms described in Exhibit A hereto. Upon the execution and receipt of proper documentation, the Authorized Officer is hereby authorized to disburse the proceeds of the Loan to the Borrower.
SECTION 10. In connection with the Loan by the City to the Borrower, the City shall waive those certain fees, if applicable, imposed by the City with respect to the Project and as more fully described in Exhibit B attached hereto and made a part hereof. The Project shall be deemed to qualify as "Affordable Housing" for purposes of Chapter 16-18 of the Municipal Code of Chicago (the "Municipal Code"). Section 2-45-110 of the Municipal Code shall not apply to the Project or the Property.
SECTION 11. To the extent that any ordinance, resolution, rule, order or provision of the Municipal Code, or part thereof, is in conflict with the provisions of this ordinance, the provisions of this ordinance shall control. If any section, paragraph, clause or provision of this ordinance shall be held invalid, the invalidity of such section, paragraph, clause or provision shall not affect any of the other provisions of this ordinance.
SECTION 12. This ordinance shall be effective as of the date of its passage and approval.
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EXHIBIT A
New Moms Housing Development LLC, an Illinois limited liability company of which the sole member is New Moms, Inc., an Illinois not-for-profit corporation ("New Moms")
Construction of a building to be located on the Property which shall contain certain commercial space, common areas and parking facilities, and approximately 40 residential dwelling units which shall be one-bedroom and studio units for low- and moderate-income persons
Source: Multi-Family Program Funds
Amount: Not to exceed $4,100,000
Term: Not to exceed 22 years
Interest: Zero percent per annum
Security: Non-recourse loan; second mortgage
on the Property (the "City Mortgage")
Amount: Term:
Source:
Interest: Security:
$6,216,548
Not to exceed 22 years, or another term acceptable to the Authorized Officer
Illinois Housing Development Authority, through its Neighborhood Stabilization Program, or another source acceptable to the Authorized Officer Zero percent per annum
Mortgage on the Property senior to the lien of the City Mortgage, or other security acceptable to the Authorized Officer
2. Amount: $400,000 .
Term: Not to exceed 22 years, or another term acceptable
to the Authorized Officer Source: U.S. Department of Housing and Urban
Development, through its Supportive Housing
Program, or another source acceptable to the
Authorized Officer
3. Amount: Approximately $266,000
Source: New Moms and/or the Borrower, from proceeds derived from the transfer of Donation Tax Credits allocated by the City, or another source acceptable to the Authorized Officer
Amount: $10,000
Source: Borrower, from the proceeds of a donation from Clocktower Tax Credits, LLC to New Moms, or another source acceptable to the Authorized Officer
Approximately $646,900
Borrower, from the proceeds of grants from various entities, foundations and individuals to New Moms and/or the Borrower
Approximately $114,274 Borrower, from the proceeds of a grant from the Illinois Department of Commerce and Economic Development to New Moms and/or the Borrower, or another source acceptable to the Authorized Officer
Fee Waivers
EXHIBIT B
Department of Construction and Permits
Waiver of Plan Review, Permit and Inspection Fees:
A. Building Permit:
Zoning
Construction/Architectural/Structural
Internal Plumbing
HVAC
Water for Construction Smoke Abatement
B. Electrical Permit: Service and Wiring
C. Elevator Permit (if applicable)
D. Wrecking Permit (if applicable)
E. Fencing Permit (if applicable)
F. Fees for the review of building plans for compliance with accessibility codes by the Mayor's Office for People with Disabilities imposed by Section 13-32-310(2) of the Municipal Code of Chicago
Department of Water Management
Tap Fees
Cut and Seal Fees
(Fees to purchase B-boxes and remote read-outs are not waived.)
Permit (connection) and Inspection Fees Sealing Permit Fees
Department of Transportation
Street Opening Fees Driveway Permit Fees Use of Public Way Fees
EXHIBIT C
LEGAL DESCRIPTION OF PROPERTY
(SUBJECT TO FINAL SURVEY AND TITLE COMMITMENT)
COMMONLY KNOWN AS: 5327 West Chicago Avenue [anticipated to be known as 5353
West Chicago Avenue]
PERMANENT INDEX NO. 16-09-104-048 and 16-09-104-001
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
6
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. the Applicant i OR
2. [ ] 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. i[ ] 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:_
B. Business address of the Disclosing Party:__ :
Chtc^ap ( XL~ bole V^h
C. Telephone: B^BMBBP^jy Fax:^JB^P^BH^E Email: Lt/ndoU^lilin @ALWfflotnhlrtu6ff^
D. Name of contact person: AuotqjuL, McLo^rlli'l^
E. Federal Employer Identification No. (if you have one):__
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which: this EDS pertains. (Include projectnumber and location of property, if applicable)^, *
G. Which City agency or department is requesting this EDS?__
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Spebification #_and Contract #
Ver. 09-01-10
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature of the Disclosing Party:
Person j^<£, Limited liability company
Publicly registered business corporation [ ] Limited liability partnership Privately held business corporation [ ] 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)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[]
Yes [ ] No ^N/A
B. IF 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: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list 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
/Vclo Mams, Int.-rtumkHS anoU manaa.jng /y),rr>)&os~
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,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 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.
Name Business Address Percentage Interest in the
Disclosing Party
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipa Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes No
If yes,;please identify below the name(s) of such City elected official(s) and describe such relationship(s): , .
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing'Party must disclose the name and business address of each subcontractor, attorney, lobbyist, 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 totai 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 aii employee of another includes undertaking to influence any legislative or administrative action.1
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
e577/>flv</^ot an accCptaDje response.
(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
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No ^K] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[]Yes []No
B. FURTHER CERTIFICATIONS
1. : 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 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 for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or empIoyee,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
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section li.B.l. of this EDS;
a. 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;
b. 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;
c. i 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;
d. 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
e. 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, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meanirtg any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV. "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly:' controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity; \
' any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either! the Disclosing Parljy 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: i
v t
a. bribed or attempted to bribe, or been convicted or adjudged guilty of briberyjor attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
b. agreed or colluded with other bidders or prospective biddeis, or been a partyjto 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
c. 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 Municipal Code Section 2-92-610 (Living Wage Ordinance).
4. 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 (1) bid-rigging in violation of 720 ILCS 5/33E-3;|(2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the Unitpd States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
5. : 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 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, the Entity List and the Debarred List.
6. 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.
7. 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.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1.
The Disclosing Party certifies that the Disclosing Party (check one)
[Jis
is not
a "financial institution" as defined in Section 2-32-455(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 trie 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) 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):
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 of the Municipal Code have the same meanings when used in this Part D.
1. 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 othier person or entity in the Matter?
[ ] Yes p&^o
NOTE: If you checked "Yes" to Item D.I., proceed to Items D.2. and D.3. If you checked "No" to Item D. 1., proceed to Part E.
Page 7 of 13
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.
DoesSthe Matter involve a City Property Sale? []Yes []No
3. If you checked "Yes" to Item D.I., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name
Business Addressr
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 comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City. j
y>C 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. !
; i ! ' . 1
_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 alLsuch records, including the names of any and all slaves or slaveholders described in tho'se! records:
Page 8 of 13
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 the City and proceeds of debt obligations of the1 City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING j
1. : List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party respect to the Matter: (Add sheets if necessary):
with
(If no explanation appears or begins on the lines above, or if the letters "N A" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO ipersons o- 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. i The Disclosing Party has not spent and will not expend any federally appropriated fiinds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activitiesjor 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 eriployee of;, member of Congress, in connection with the award of any federally funded contract, makin * 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.
3. ; The Disclosing Party will submit an updated certification at the end of each calendar which there occurs any event that materially affects the accuracy of the statements and info forth in paragraphs A.l. and A.2, above.
quarter in imation set
4. 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". ,
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certificatioijis form and substance to paragraphs A.l. through A.4. above from all subcontractors' before it subcontract and the Disclosing Party must maintain all such subcontractors' certifications fo duration of the Matter and must make such certifications promptly available to the City upo:i
equal in awards any rthe request.
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B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
£4 Yes No If "Yes," answer the three questions below:
1. 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.
2. 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?
XfYes []No .
3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
JX]Yes []No
If you checked "No" to question 1. or 2. above, please provide an explanation:
A/cw Moms Housing ^t>-MOp/nt/>J- LLL e.mf^ou^ fcv'o cm^JoiJ^is tr\d is CXxmph accordiftV foHl lCF/Q. TVf leO-Z.fPi
tXxmph accordifi^ foHl LFfi, f/\r^- (p0~2.rp'
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that: ,
A. 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 Mattur, 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.
B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 ar the Municipal Code, impose certain duties and obligations on persons or entities seeking work, business, or transactions. The full text of these ordinances and a training program is line at www.cityofchicago.org/Ethics. and may also be obtained from the City's Board of Etl
City
d 2-164 of contracts, liable on ics, 740 N.
ava
Page 10 of 13
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must cpmply fully] with the applicable ordinances.
C. If the City determines that any information provided in this EDS is false, incomplete or
any contract or other agreement in connection with which it is submitted may be rescinded voidable, and the City may pursue any remedies under the contract or agreement (if not: void), at law, or in equity, including terminating the Disclosing Party's participation in the declining to allow the Disclosing Party to participate in other transactions with the City; law for a false statement of material fact may include incarceration and an award damages.
inaccurate, j
or be void or
i
rescinded or ! Matter and/or Remedies at to!the;City of treble
D. It is the City's policy to make this document available to the public on its Internet site arid/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 Informa otherwise. By completing and signing this EDS, the Disclosing Party waives and rights or claims which it may have against the City in connection with the public release of
contained in this EDS and also authorizes the City to verify the accuracy of any infqrmatior in this EDS. 'I
' I :
E. The information provided in this EDS must be kept current. In the event of changes,! the
Party must supplement this EDS up to the time the City takes action on the Matter. If the rv atter is a i contract being handled by the City's Department of Procurement Services, the Disclosing Party must j update this EDS as the contract requires. NOTE: With respect to Matters subject! to Article I of | Chapter 1-23 of the 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.
:iqn Abt request, or releases Eny possible!
information! submitted
Disclosing!
The Disclosing Party represents and warrants that:
F. 1. ; The Disclosing Party is not delinquent in the payment of any tax administered Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinqu fine, fee, tax or other charge owed to the City. This includes, but is not limited to sewer charges, license fees, parking tickets, property taxes or sales taxes.
by the ent in all water
Illinois paying any charges,
F.2 ; If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated- Entitle s will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the fedeial Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 i 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 eLual in form and substance to those in F.l. 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 certificatibns
Page 11 of 13
NOTE: If the Disclosing Party cannot certify as to any of the items in F.I., F.2. of E.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized tdi this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) iwarrant certifications and statements contained in this EDS and Appendix A (if applicable) are true and complete as of the date furnished to the City.
h/mi /I/cms ,hcus.iut Ll\i/Jr>f?mxr)}- ILL (Print or type name of Disclosing Party)
8^: N)tw ^msp^t^-j its. soR. (YUflvb-vr
By: QjjL^JusJb^^ IAa^^Lj^^-L,
(Sign here)
mt
(Print or type name of person signing) (Print fjr type title of person signing)
Signed and sworn to before me on (date) -^fijt) j 20l| at Cocj<^_County, ^-\\\y\q\S (state).
OFFICIAL SEAL j j NICOLETTE JURGENS-TAMMINGA \ Notarv Public* NOTARY PUBLIC-STATE OFttUWMS ;
Notary r-uoiicj myCOMM!SSionexpires-.0M5/12 \
Commission expires: ^/^j ^2.
execute j that all i accurate j
Page 12 of 13
)
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 ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any which has only an indirect ownership interest in the Applicant. j j
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 relati any elected city official or department head. A "familial relationship" exists if, as of the date this signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partnfer thereof the mayor, any alderman, the city clerk, the city treasurer or any city department head asispouse or partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-la or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
, auit
has a direct entity
It gal
ionship" wit EDS is is related to lomestic or uncle, stepfathei
"Applicable Parry" means (1) all executive officers of the Disclosing Party listed in Section Il.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing ^arty isja general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Part;' is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person havi lg more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, c lief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority. I j
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof have a "familial relationship" with an elected city official or department head? |
[ ];Yes
currently
If yes, please identify below (1) the name and title of such person, (2) the name of thd legal entity to which such person is connected; (3) the name and title of the elected city official or department head to wjiom 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
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if app icable|:
McllO Mofl?Sj Trie._
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. [] the Applicant
OR
2. Jtf a legal entity holding a direct or indirect interest in the Applicant. State the legal *V- "~ * ~ ■ ------' 'd-Uiu)
Applicant in which the Disclosing Party holds an interest: Sols, ttyuffber'___
OR /Jousin£j2wJopfen}-j
nlame of the Morns
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:_
B. Business address of the Disclosing Party: <2-$H<b W thciCA^
3
C. Telephone: .7 7 3 302 £-320 Fax: -373 £62. 63ZO Email: amtLu^Uhnhns.
D. Name of contact person: fytfjqLu^ HlLou^Ii*^
E. Federal Employer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "h which ;this EDS pertains. (Include project number and location of property, if applicable!):
q»tsish>u *£ tfomtt* #M°( **>-UMrooms, g&rd^L apvtoesifc JoU'
G. Which City agency or department is requesting this EDS?
atter") to
If the Matter is a contract being handled by the City's Department of Procurement S complete the following:
Specification #
and Contract #
Ver. 09-01-10
Page 1 of 13
;, please
SECTION 11 DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
]. Indicate the nature of the Disclosing Party:
[ ] Person
f ] Publicly registered business corporation [ ] Privately held business corporation [ ] Sole proprietorship [] General partnership [ ] Limited partnership [] Trust
[] Limited liability company [ ] Limited liability partnership ■ ^ [] Joint venture ^^Not-foT-profit corporation (Is the not-for-profit corporation alsb a 501(c)(3}))?
J^Yes [ ] No '.
[ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the State of Illinois: Has the organization registered to c business in the State of Illinois as a foreign entity? i
□ Yes []No [IN/A
B, IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors Df the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which arejlegal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list bslow 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 controts the day-to-day management of the Disclosing party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name
McU-u^h'n ^zLJ ' ceo
Title
lose
chairperson*
Qjo
5 e <Ur t+oj^-tj
2. Please prbvide the following information concerning each person or entity having a direct cr 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,
: j
Page 2 of 13 ! j
interest of a member or manager in a limited liability company, or interest of a beneficiary of a estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-l£4-030jof Municipal Code of Chicago ("Municipal Code"), the City may require any such additional inr from any applicant which is reasonably intended to achieve full disclosure. |
■trust, the
formation
Name
Business Address
A/ONE
Percentage Interest inlthe Disclosing Party l
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-15'6 of the Mi nicipal Code, with any City elected official in the 12 months before the dale this EDS is signed?
□ Yes
If yes, please identify below the name(s) of such City elected officials) and describe such relationship(s): , j
__X//A _,_L_
SECTION IV ~ DISCLOSURE OF SUBCONTRACTORS AND OTHER RETATNEDiPARTiES
The Disclosing Party must disclose the name and business address of each subcontractor, attoijney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has ret iined or expects to retain in connection with the Matter, as well as the nature of the relationship, and ths total amount of the fees paid or estimuted to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. I
! j
"Lobbyist" moans any person or entity who undertakes to influence any legislative <or administ alive action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, :r (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. j
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the! Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Parry 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
x not an acceptable response,
LigUk-n - Ca\z. 6roMf> teUsL FiiTartq-Consulforvr- fr5o,oQO cs[. -
(Add sheets if necessary)
[ j Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.
SECTION V - CERTIFICATIONS
r .■
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities thut contract with the City must remain in compliance with their child support obligations throughout the contract's term.
S Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in ' arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[]Yes []No ^WNo person directly or indirectly owns'l 0% or more of the
Disclosing Party.
i 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?
[ ] Yes [ ] No
B. FURTHER CERTIFICATIONS
1. 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 recrairements), 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 for, any . criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury,1 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
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons identified in Section JJ.B.l. of this EDS:
or entities
or
1 . ! !
a. are not presently debarred, suspended, proposed for debarment, declared ineligible orj voluntarily excluded from any transactions by any federal, state or local unit of government;
b. have not, within a five-year period preceding the date of this EDS, been convicted of ii criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection; witn: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction 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;
c. are not presently indicted for, or criminally or civilly charged by, a governmental entity (fi :deral state or local) with committing any of the offenses set forth in clause B.2.b. ofthis Sectior V;
d. 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
e. have not, within a five-year period preceding the date ofthis EDS, been convidted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including ac ions concerning environmental violations, instituted by the City or by the federal government, i ny state, or any other unit of local government.
3. 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 entiticsjdisclosed ujndcr Section IV, "Disclosure of Subcontractors and Other Retained Parties"); j
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, in'cludjing the City, using substantially the same management, ownership, or principals as the ineligible ei tity); 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; 1 j
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity dr anl 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 Part}, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 33
Neither the Disclosing Parry, nor any Contractor, nor any Affiliated Entity of either the Disclos or any Contractor nor any Agents have, during the five years before the date this EDS is signed, respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the f before the date of such Contractor's or Affiliated Entity's contract or engagement in connection Matter:
iftg Party or, with years th the
five
wi
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or atterriptin bribe, a public officer or employee of the City, the State of Illinois, or any agency of the government or of any state or local government in the United States of America, in that or employee's official capacity,
b.
;to
bdernl o Ticer's
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 pr ce or otherwise; or
c. made nn admission of such conduct described in a. or b. above that is a matter.of record, lh.it have not been prosecuted for such conduct; or
d. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
4. 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 j-esu ;t of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotat ng in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States; of America that contains the same elements as the offense of bid-rigging or bid-rotating.;
5. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following list; maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury rir 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, the Entity List and the Debarred List.
6. The Disclosing Party understands and shall comply with the applicable requirements of CI 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) Municipal Code.
7. If the Disclosing Party is unable to certify to any of the above statements in this Part B: (Fu Certifications), the Disclosing Party must explain below:
aprers )f the
ther
Ml
Page 6 of 13
If the letters "NA," the word "None," or no response appeors on the lines above, it will be conch sively presumed that the Disclosing PQrty certified to the above statements.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1. The Disclosing Party certifies that the Disclosing Party (check one) [ ] is j$<J 'S not
a "financial institution" as defined in Section 2-32-455(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 (as defined in Section 2-32-455(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):
Ml
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 of the Municipal Code have the same meanings when used in this Part .D,
1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee
Df the City have a financial interest in his or her own name or in the name of any other entity in the Matter?
[ ] Yes y± No
person, or
NOTE: If you checked "Yes" to Item D.I., proceed to Items D.2. and D.3. If you checked "No" tjo Item D.I., proceed to Part E. r
Page 7 of 13
of
k
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City: elected official or employee shall have a financial interest in his or her own name or in the name any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sot for taxes or assessments, or (hi) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale? [] Yes []No
3. If you checked "Yes" to Item D.I., 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 wijl 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 tc comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
-X" 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profi 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 Parry 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: ;
Page 8 of 13
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 the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
i
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Mutter: (Add sheets if necessary):
A/A
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None appear, it will be conclusively presumed that the Disclosing Party means that NO persons or enti les 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 t > 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 def ned by applicable federal law, a member of Congress, an officer or employee of Congress, or an employ ;e of a member of Congress, in connection with the award of any federally funded contract, making any federally fuaded grant or loan, entering into any cooperative agreement, or to extend, continue, rt new, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
3. The Disclosing Party will submit an updated certification at the end of each calendar quarlcr in which there occurs any event that materially affects the accuracy of the statements and informatic n set forth in paragraphs A.l. and A.2. above,
4. 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".
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 awarofs 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 requjst.
<
Page 9 of 13
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outsc t of negotiations.
Is the Disclosing Party the Applicant?
[JYes >3No If "Yes," answer the three questions below: r,
1. Have you developed and do you have on file affirmative action programs pursuant t) applicable federal regulations? (See 41 CFR Part 60-2.)
[]Yes []No
j
2. 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
3. Have you participated in any previous contracts or subcontracts stibject to the equal opportunity clause?
[]Yes []No
If you checked "No" to question 1. or 2. above, please provide an explanation:
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS will becom contract or other agreement between the Applicant and the City in connection with the Matter procurement, City assistance, or other City action, and are material inducements to the City of any contract or taking other action with respect to the Matter. The Disclosing Party understands it must comply with all statutes, ordinances, and regulations on which this EDS is based
part of any , whether s execution that
B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 alnd 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 wailable on line at www.citvofchicago.org/Ethics. and may also be obtained from the City's Board of Etjhics, 740 N.
Page 10 of 13
1
Sedgwick St., Suite 500, Chicngo, 1L 6061,0, (312) 744-9660. The Disclosing Party must coropty fully with the applicable ordinances.
C. If the City determines that any information provided in this EDS is false, incomplete or inacc any contract or other agreement in connection with which it is submitted may be rescinded or be voidable, and the City may pursue any remedies under the contract or agreement (if not rescinde i void), at law, or in equity, including terminating the Disclosing Porty's participation in the Matter declining to allow the Disclosing Party to participate in other transactions with the City. Remcd " law for a false statement of material fact may include incarceration and an oward to the City of damages.
D. It is the City's policy to moke this document available to the public on.its Internet site and/or request. Some or all of the information provided on this EDS and any attachments to this EDS made available to the public on the Internet, in response to a Freedom of Information1 Act rcques otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any rights or claims which it may have against the City in connection with the public release of inforfoati contained in this EDS and also authorizes the City to verify the accuracy of any information subnitted iu this EDS,
urate, void or or
and/or es at treble
jpon ay be or ble on
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E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Parry 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 njust update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chnpter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information, provided herein regarding eligibility must be kept current for a longer ;>eriod, as required by Chapter 1 -23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
F, 1. The 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 poyin > 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 use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the:federal Ex Parties List System ("EPLS") maintained by the U. S. General Services Administration.
not luded
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subconlractors hired or to be hired in connection with the Matter certifications equal is. form and substance to those in F.l. and F.2. above and will not, without the prior written consent |f 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.
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NOTE: If the Disclosing Parry cannot certify as to any of the items in F.l,, F.2. or F.3. above, an explanatory statement must be attached to 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 tha: all certifications and statements contained in this EDS and Appendix A (if applicable) are true, acc irate and complete as of the date furnished to the City.
A/e.io Morns, Inc._
(Print or type name of Disclosing Party)
(Sign here)
fes/otW i cef>
(Print or type title of person signing)
at County,
Signed and sworn to before me on (date)
(state).
Notary Public.
Commission expires:.
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT H DADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has: direct ownership interest in the Applicant exceeding 7.5 percent. It Is not to be completed byany legal entity which has only an indirect ownership interest in the Applicant.
g Party with
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosir or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relations!) any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is relal ed to the mayor, any alderman, the city cleric, the city treasurer or any city department head as spouse or dome; tic partner or as any of the following, whether by blood or odoption: parent, child, brother or sister, aunt or i nele, 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" mcons (I) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Parly, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a 1: mited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Patty is a limited liability company, (2) all principal officers of the Disclosing Party; and (3) any person having mo: e 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 JfcJ
No
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to wl .ich 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
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