HScV .
OFFICE OF THE MAYOR
CITY OF CHICAGO
RAHM EMANUEL
MAYOR
July 26, 2017
TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO
Ladies and Gentlemen:
At the request of the Commissioner of Planning and Development, I transmit herewith an ordinance authorizing an amendment to a deed for property located at 3739 West Ogden.
Your favorable consideration of this ordinance will be appreciated.
Mayor
Very truly yours,
ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of government by virtue of the provisions of the Constitution of the State of Illinois of 1970, and as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, pursuant to an ordinance adopted by the City Council of the City on January 21, 2015, and published at pages 101800 through 101803 in the Journal of the Proceedings of the City Council ("Journal") of such date, the City conveyed the real property located at 3739 West Ogden Avenue, as legally described on Exhibit A attached hereto (the "Property"), to Lawndale Christian Health Center, an Illinois not-for-profit corporation ("Owner"), for Twenty-Eight Thousand and No/100 Dollars ($28,000); and
WHEREAS, the City transferred the Property by Quitclaim Deed dated May 21, 2015, and recorded in the Office of the Recorder of Deeds of Cook County, Illinois, on May 21, 2015, as Document No. 1514113026 (the "Deed"); and
WHEREAS, the conveyance of the Property to the Owner was subject to the express condition that a parking lot be constructed on the Property within twelve (12) months from the date of the Deed; and
WHEREAS, the Deed provided that, in the event the foregoing condition was not met, the City may re-enter the Property and revest title in the City; and
WHEREAS, a parking lot has not been constructed on the Property as required; and
WHEREAS, the Owner seeks to expand its existing facilities and construct a building to serve as a senior center on the Property instead of a parking lot; and
WHEREAS, the Department of Planning and Development ("DPD") has reviewed the Owner's proposal and determined that the proposed uses of the Property are in the best interests of the City; and
WHEREAS, the Owner agrees to complete construction of the senior center within two years of the date of the Deed, which date can be extended for an additional year with the written consent of the Commissioner of DPD; and
WHEREAS, the City has agreed to amend the Deed to permit the proposed improvements to the Property within the time frame set forth above; 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 part of this ordinance as though fully set forth herein.
SECTION 2. The Commissioner of DPD (the "Commissioner") or a designee of the Commissioner is each hereby authorized, with the approval of the City's Corporation Counsel as to form and legality, to negotiate, execute and record a First Amendment to Deed Restrictions in substantially the form attached hereto as Exhibit B (the "First Amendment"), and such other supporting documents as may be necessary or appropriate to carry out and comply with the
provisions of the First Amendment, with such changes, deletions and insertions as shall be approved by the persons executing the First Amendment.
SECTION 3. If any provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such provision shall not affect any of the other provisions of this ordinance.
SECTION 4. All ordinances, resolutions, motions or orders in conflict with this ordinance are hereby repealed to the extent of such conflict.
SECTION 5. This ordinance shall take effect immediately upon its passage and approval.
Attachments: Exhibit A - Legal Description of Property
Exhibit B - First Amendment to Deed Restrictions
EXHIBIT A
LEGAL DESCRIPTION
LOTS 1 AND 2 IN THE RESUBDIVISION OF BLOCK 4 IN MILLARD AND DECKER'S ADDITION TO CHICAGO, A SUBDIVISION OF THAT PART IN THE EAST 1/2 OF THE SOUTHWEST Va LYING SOUTH OF OGDEN AVENUE IN SECTION 23, TOWNSHIP 39 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
ADDRESS: 3739 WEST OGDEN AVENUE CHICAGO, ILLINOIS 60623
16-23-324-006-0000
EXHIBIT B FIRST AMENDMENT
(ATTACHED)
FIRST AMENDMENT TO DEED RESTRICTIONS
THIS FIRST AMENDMENT TO DEED RESTRICTIONS ("First Amendment") is made
on this day of , 201_, by and between the CITY OF CHICAGO, an Illinois municipal
corporation ("City"), acting by and through its Department of Planning and Development ("Department"), having its principal offices at City Hall, 121 North LaSalle Street, Chicago, Illinois 60602, and LAWNDALE CHRISTIAN HEALTH CENTER, an Illinois not-for-profit _ corporation ("Owner").
RECITALS
WHEREAS, pursuant to an ordinance adopted by the City Council of the City ("City Council") on January 21, 2015, and published at pages 101800 through 101803 in the Journal of the Proceedings of the City Council ("Journal") of such date, the City conveyed the real property located at 3739 West Ogden Avenue, as legally described on Exhibit A attached hereto (the "Property"), to Owner for Twenty-Eight Thousand and No/100 Dollars ($28,000) for the construction of a parking lot; and
WHEREAS, the City transferred the Property by Quitclaim Deed dated May 21, 2015, and recorded in the Office of the Recorder of Deeds of Cook County, Illinois, on May 21, 2015, as Document No. 1514113026 (the "Deed"); and
WHEREAS, the Deed required the Owner to build a parking lot on the Property within twelve (12) months from the date of the Deed and imposed certain additional conditions and restrictions running with the land (collectively, the "Deed Restrictions"); and
WHEREAS, a parking lot has not been constructed on the Property as required; and
WHEREAS, the Owner wishes to expand its facilities, and has asked the City to amend the Deed Restrictions to allow construction of a building to serve as a senior center on the Property instead of a parking lot; and
WHEREAS, the City Council, pursuant to an ordinance adopted on , 2017, and
published at pages through in the Journal of such date, authorized the
execution of this First Amendment.
NOW, THEREFORE, in consideration of the foregoing recitals and the mutual covenants
|1010|
and agreements of the parties, the parties agree as follows:
The foregoing recitals constitute an integral part of this First Amendment and are incorporated herein by this reference with the same force and effect as if set forth herein as agreements of the parties. Capitalized terms not otherwise defined herein shall have the same meanings given to said terms in the Deed.
The second paragraph of the Deed is hereby deleted in its entirety and the following is substituted in lieu thereof:
This conveyance is subject to the express condition that, within two years of the date of this deed, which date can be extended for an additional year with the written consent of the Commissioner of the Department of Planning and Development, the Property shall be improved with a building that provides services to seniors, in accordance with plans and specifications approved by the Grantor. In the event that this condition is not met, the Grantor may re-enter the Property and revest title in the Grantor. Grantee, at the request of Grantor, covenants to execute and deliver to the Grantor a reconveyance deed to the Property to further evidence such revesting of title. This right of reverter and re-entry in favor of the Grantor will terminate upon the issuance and recordation of a certificate of completion, release or similar instrument by the Grantor.
Except as otherwise provided in this First Amendment, the terms and conditions of the Deed remain in full force and effect.
(Signature Page Follows)
|1010|
IN WITNESS WHEREOF, this First Amendment to Deed Restrictions has been signed as of the date first written above.
CITY OF CHICAGO, an Illinois municipal corporation and home rule unit of government
By:
David Reifman
Commissioner of Planning and Development
LAWNDALE CHRISTIAN HEALTH CENTER, an
Illinois not-for-profit corporation
By:
Name: Title:
THIS INSTRUMENT WAS PREPARED BY, AND AFTER RECORDING, PLEASE RETURN TO:
Lisa Misher
City of Chicago Department of Law 121 North LaSalle Street, Suite 600 Chicago, Illinois 60602 (312) 742-3932
|1010|
STATE OF ILLINOIS )
)SS.
COUNTY OF COOK )
I, the undersigned, a Notary Public in and for said County, in the State aforesaid, do hereby certify that David Reifman, the Commissioner of the Department of Planning and Development of the City of Chicago, an Illinois municipal corporation ("City"), and personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and, being first duly sworn by me, acknowledged that, as said Commissioner, he signed and delivered the foregoing instrument pursuant to authority given by the City as his free and voluntary act and as the free and voluntary act and deed of the City, for the uses and purposes therein set forth.
Given under my hand and notarial seal on , 201_.
Notary Public
STATE OF ILLINOIS )
) SS.
COUNTY OF COOK )
I, the undersigned, a Notary Public in and for said County, in the State aforesaid, do
hereby certify that , the of Lawndale Christian Health Center, an
Illinois not-for-profit corporation (the "Corporation"), personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and, being first duly sworn by me, acknowledged that he signed and delivered the foregoing instrument pursuant to authority given by the Corporation, as his free and voluntary act and as the free and voluntary act and deed of the Corporation, for the uses and purposes therein set forth.
Given under my hand and notarial seal on , 201_.
Notary Public
|1010|
EXHIBIT A
LEGAL DESCRIPTION
LOTS 1 AND 2 IN THE RESUBDIVISION OF BLOCK 4 IN MILLARD AND DECKER'S ADDITION TO CHICAGO, A SUBDIVISION OF THAT PART IN THE EAST 1/2 OF THE SOUTHWEST V* LYING SOUTH OF OGDEN AVENUE IN SECTION 23, TOWNSHIP 39 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
ADDRESS: 3739 WEST OGDEN AVENUE CHICAGO, ILLINOIS 60623
16-23-324-006-0000
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION 1 - GENERAL INFORMATION
Legal name of Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Lawndale Christian Health Center
Check ONE of the following three boxes:
Indicate whether Disclosing Party submitting this EDS is:
&c] the Applicant
OR
[ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which Disclosing Parry holds an interest: t
OR
[] a specified legal entity with a right of control (see Section II.B.l.b.) State the legal name of
the entity in which Disclosing Parly holds a right of control:
Business address of Disclosing Party: 3860 W Ogden Ave
Chicago, IL 60623
Telephone: 872.588.3018 pax: 872.588.3119 Email: josephlesch@lawndale.org
Name of contact person: Joseph LeSCfl
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):
3745 W Ogden, former city property change of use from parking lot to building structure
Which City agency or department is requesting this EPS? DePa"m*nt °f Pla"ni"9 a"d Ec°"°mic Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OP DISCLOSING PARTY
1. Indicate the nature of the Disclosing P [ ] Person
[ ] Publicly registered business corporation [ ] Privately held business corporation [ ] Sole proprietorship f ] General partnership* [ ] Limited partnership* [] Trust
ty:
[ ] Limited liability company* [ ] Limited liability partnership* [ ] Joint venture* |K] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
fee] Yes [ ] No
[ ] Other (please specify)
* Note B.l.b below.
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 do business in the State of Illinois as a foreign entity?
[]Yes []No J^N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
l.a. List below the full names and titles of all executive officers and all directors of the entity.
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 tirleholder(s).
Name Title
See attached document - no members are legal entities
1 .b. If you checked "General partnership," "Limited partnership," "Limited liability
company," "Limited liability partnership" or "Joint venture" in response to Item A.l. above (Nature of Disclosing Party), list below the name and title of each general partner, managing member, manager or
Page 2 of 13
any other person or entity that controls the day-to-day management of the Disclosing Parly. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
N/A
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 Part}'. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, slate "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
None
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 [k] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
-AL/A
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 total
Page 3 of 13
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.
Name Business Relationship to Disclosing Party Fees
(indicate whether Address (subcontractor, attorney, (indicate whether
retained or anticipated lobbyist, etc.) paid or estimated)
to be retained)
(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 term of the contract.
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 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
Page 4 of 13
B. FURTHER CERTIFICATIONS
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with commission of any of the offenses enumerated in clause B.l.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 2, 3 and 4 concern:
the Disclosing Party;
any "Applicable Party" (meaning any party participating in the performance of the Matter, including but not limited to any 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 Applicable Parties, the term Affiliated Entity means a person or entity that directly or indirectly controls the Applicable Party, is controlled by it, or, with the Applicable Party, is under common control of another person or entity;
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• any responsible official of the Disclosing Party, any Applicable Party or any Affiliated Entity or any other official, agent or employee of the Disclosing Parly, any Applicable Party or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Parly, any Applicable Party or any Affiliated Entity (collectively "Agents").
Neither the Disclosing Party, nor any Applicable Party, nor any Affiliated Entity of either the Disclosing Party or any Applicable Parly nor any Agents have, during the five years before the date this EDS is signed, or, with respect to an Applicable Party, an Affiliated Entity, or an Affiliated Entity of an Applicable Party during the five years before the date of such Applicable Party'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 lo bribe, a public officer or employee of the Cily, the State of Illinois, or any agency of the federal government or of any state or local government in. the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above mat is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Muuicipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Applicable Party, 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 stale or of the United Slates 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 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.
The Disclosing Party understands and shall comply with (1) the applicable requirements of the Governmental Ethics Ordinance of the City, Title 2, Chapter 2-156 of the Municipal Code; and (2) all the applicable provisions of Chapter 2-56 of the Municipal Code (Office of the Inspector General).
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- 6. If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Parly must explain below:
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
For purposes of this Part C, under Municipal Code Section 2-32-455(b), the term "financial institution" means a bank, savings and loan association, thrift, credit union, mortgage banker, mortgage broker, trust company, savings bank, investment bank, securities broker, municipal securities broker, securities dealer, municipal securities dealer, securities underwriter, municipal securities underwriter, investment trust, venture capital company, bank holding company, financial services holding company, or any licensee under the Consumer Installment Loan Act, the Sales Finance Agency Act, or the Residential Mortgage Licensing Act. However, "financial institution" specifically shall not include any entity whose predominant business is the providing of tax deferred, defined contribution, pension plans to public employees in accordance with Sections 403(b) and 457 of the Internal Revenue Code. (Additional definitions may be found in Municipal Code Section 2-32-455(b).)
CERTIFICATION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is (k] 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) of the Municipal Code) is a predatory lender within the meaning of Chapter
Page 7 of 13
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.
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 fed. No
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.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ ] Yes [ ] No
If you checked "Yes" to Item D.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 will be acquired by any City official or employee.
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E. CERTIFICATION REG ARDING SLAVERY ERA BUSINESS
The Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities for records of investments or profits from slavery, the slave industry, or slaveholder insurance policies from the slavery era (including insurance policies issued lo slaveholders that provided coverage for damage to or injury or death of their slaves) and has disclosed in this EDS any and all such records to the City. In addition, the Disclosing Party must disclose the names of any and all slaves or slaveholders described in those records. Failure to comply with these disclosure requirements may make the Matter to which this EDS pertains voidable by the City.
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 requisite information as set forth in that paragraph 2.
K 1. The Disclosing Party verifies that (a) the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities for records of investments or profits from slavery, the slave industry, or slaveholder insurance policies, and (b) the Disclosing Party has found no records of investments or profits from slavery, the slave industry, or slaveholder insurance policies and no records of names of any slaves or slaveholders.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1(a) above, the
Disclosing Party has found records relating to investments or profits from slavery, the slave industry, or slaveholder insurance policies and/or the names of any slaves or slaveholders. The Disclosing . Party verifies that the following constitutes full disclosure of all such 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.
A. CERTIFICATION REGARDING LOBBYING
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 Matter: (Begin list here, add sheets as necessary):
Page 9 of 13
(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.)
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.
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
If the Matter is federally funded and any funds other than federally appropriated funds have been or will be paid to any person or entity for influencing or attempting 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 Matter, the Disclosing Party must complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The form may be obtained online from the federal Office of Management and Budget (OMB) web site at , linked on the page .
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 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 upou request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations. .
Page 10 of 13
! I
Is the Disclosing Party the Applicant? ! j
[]Ycs | ] No ; |
If "Yes," answer the three questions below: I
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal ;
Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due j
under the applicable filing requirements? j
[]Ycs []No !
i
Have you participated in any previous contracts or subcontracts subject to the I 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:
By completing and filing this EDS, the Disclosing Party acknowledges and agrees, on behalf of itself and the persons or entities named in this EDS, that the City may investigate the creditworthiness of some or all of the persons or entities named in this EDS.
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 ww w .cilyofcbi cago .org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
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D. If the City determines that any information provided in this EDS is false, incomplete or
inaccurate, any contract or other agreement in connection with which it is submitted may be
rescinded or be void or voidable, and the City may pursue any remedies under the contract or
agreement (if not rescinded, void or voidable), at law, or in equity, including terminating the
Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to
participate in other transactions with the City. Remedies at law for a false statement of material fact
may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or 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 Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. 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.
The Disclosing Party represents and warrants that:
The Disclosing Party has not withheld or reserved any disclosures as to economic interests in the Disclosing Party, or as to the Matter, or any information, data or plan as to the intended use or purpose for which the Applicant seeks City Council or other City agency action.
For purposes of the certifications in II. 1. and H.2. below, the term "affiliate" means any 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 the federal government or a state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity.
l. 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 affiliates 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.
H.2 If the Disclosing Party is the Applicant, the Disclosing Party and its affiliates will not use, nor permit their subcontractors to use, any facility on the U.S. EPA's List of Violating Facilities in connection with the Matter for the duration of time that such facility remains on the list.
Page 12 of 13
H.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in H.l. and H.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in H.l., H.2. or H.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 on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS are true, accurate and complete as of the date furnished to the City.
Lawndale Christian Health Center Date: 07.14.2017
(Print or type name of Disclosing Party)
Joseph A. Lesch (LCHC Agent)
(Print or type name of person signing)
Director of Facilities Planningv
(Print or type title of person signing)
Signed and sworn to before me on (date) ^ ^ly l^/ Z O I 7^ Dy ^p£ep\n f\. Le5^-K t
at C 6° '<¦ County, X ^~ (state).
Commission expires: V^A(
Page 13 of 13
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Subtontractors and other retained or anticipated to be retained in connection with the Matter | Notes Total fees anticipated. 1 Billed hours Fees shown indicate what has been billed to date J
Fees S 1,600 | S 3,963 | OO o 7-1 $ 288,800 | $ 3,400 | Billed hourly | TBD |
Relationship to Disclosing Party Appraisal Ftrm | Closing Attorney | Surveyor | Architect j Permit Expeditor Zoning Attorney | General Contractor |
Business Address 53 W Jackson Blvd, Suite 915, Chicago, IL 60604 | 53 W Jackson Blvd, Suite 550, Chicago, IL 60604 | 1316 Bond St, Suite 108, Naperville, IL 60563 | 935 W Chestnut St, Suite 520, Chicago, IL 60642 | 225 West Hubbard - 5th Floor, Chicago, IL 60654 | 1 N LaSalle St, Suite 600, Chicago, IL 60602 | TBD |
Retained or Anticipated Retained Retained Retained Retained Retained Retained | Anticipated |
07 14 2017 | Name Madison Appraisal, LLC Wagenmaker & Oberly Weaver Consultants Built Form Cornerstone Permit Company Mauck & Baker, LLC | TBD |