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Type:
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Order
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Status:
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Passed
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Title:
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Historical landmark fee waiver for property at 1441 N Milwaukee Ave
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Topic:
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HISTORICAL LANDMARKS - Permit Fee Waivers
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Attachments:
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1. Or2020-350.pdf
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ORDER WHEREAS, Section 2-120-815 ofthe Municipal Code provides that the Chicago City Council may by passage of an appropriate order waive any fees charged by the City for any permit for which approval of the Commission on Chicago Landmarks (the "Commission") is required, in accordance with chapter 2-120 of the Municipal Code; and WHEREAS the permits identified below require Commission approval, in accordance with Section 2-120-740 of the Municipal Code; now, therefore, BE IT ORDERED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. The foregoing recitals are hereby adopted as the findings of the City Council. SECTION 2. The Commissioners of the Departments of Buildings, Finance and Fire, and the Zoning Administrator are hereby directed to issue those permits for which approval of the Commission on Chicago Landmarks is required pursuant to Chapter 2-120 of the Municipal Code free of charge, notwithstanding any other ordinances of the City Council to the contrary, for the property at: Address: District/Building: 1441 N. Milwaukee Avenue ("Property") Milwaukee Avenue District The interior renovation of a second-floor residential unit located above an occupied retail establishment. The completed unit will contain four bedrooms, three bathrooms, an interior courtyard, as well as new plumbing, HVAC, and electrical systems. Owner: Owner's Address: City, State, Zip: Yollande Gottlieb Revocable Trust (December 5, 2008) - Yollande Gottlieb (Trustee & Beneficiary) and Henry Gottlieb (Beneficiary) 1415 N Dearborn Parkway, Apt. 6B Chicago, Illinois 60610 SECTION 3. The fee waiver authorized by this Order shall be effective from December 15, 2020 through October 15, 2021, and shall not apply to additional developer service fees, stop-work order fees or any fines. SECTION 4. That the permit purchaser for the Property shall be entitled to a refund of city fees for which it has paid and which are exempt pursuant to Section I hereof. SECTION 5. This order shall be in force and effect upon its passage. Daniel La Spata Alderman, 1st Ward NOTE: This is NOT a permit, nor does it constitute a Letter of Approval for the above described work. A permit application for the work must be approved by the appropriate City department(s) as well as the Commission on Chicago Landmarks for this permit fee waiver, subject to City Council approval, to be valid. BPHPS/HPD 11/19/20 MAR LEGEND I I 1441 N. Milwaukee Avenue Chicago Zoning Map (above) Street View of Site (right) Department of Planning and Development Proposed Permit Fee Waiver Milwaukee Avenue Landmark District 1441 N. Milwaukee Avenue BPHPS/HPD 11/19/20 MAR Site Photographs Proposed Permit Fee Waiver Milwaukee Avenue Landmark District 1441 N. Milwaukee Avenue BPHPS/HPD 11 /I9/20 MAR CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT SECTION 1 - GENERAL INFORMATION A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if; applicable: Yollande Gottlieb as Trustee of the Yollande Gottlieb Revocable Trust Dated 12/05/08 Check ONE of the following three boxes: Indicate whether the Disclosing Party submitting this EDS is:. 1. ? the Applicant ¦ :' OR _?2. (7) a legal entity currently holding, or anticipated to hold within six months after City action on the contract, transaction or other undertaking to which this EDS pertains (referred to below as.the "Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal name: Yollande Gottlieb as Trustee ofthe Yollande Gottlieb Revocable Trust Dated 12/05/08 '] "or ; ~ : —^-r— 3. (3 a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control: B. Business address of the Disclosing Party: 120 W. Oak St. Unit 2D Chicago, IL 60610 Telephone: ¦ !^ Fax: EmaiI: _ Name of contact person: HeniY Gottlieb Federal Employer Identification No. (if you have one): . - F. ...Brief.descriptioni:pf the Matter tp which this EDS pertains. (Include project number and location of property, if applicable): Interior'renovation of a second floor dwelling unit locatedat 1441 N. Milwaukee Ave. G. Which City agency or department is requesting this EPS?plann'"g and Development If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following: Specification # and Contract tt . _ Ver.20.l8-1 : 1 Page 1 of 15. SECTION II- DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PART Y Q Person Q Publicly registered business corporation ? Privately held business corporation "](Sole proprietorship|10 10|General partnership Limited partnership 3 Trust P Limited liability company Limited liability partnership Q Joint venture Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))? ? Yes QNo Q Other (please sr. 2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: 3. Fbrlegaten^ business in the State of Illinois as a foreign entity? . Q Yes QNo ? Organized in Illinois B. • IF THE DISCLOSING PARTY IS A LEGAL ENTITY: 1 ¦ List below the full names and titles, if applicable, of: (i) all executive officers and all Rectors of the entity^) for not-for-profit corporations, all;members; if any, which aredegal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for generator ZZ partnership* limited liability, companies, limited ^m^TT^^T*? • each general partner, managing member, manager or any other person or legal entity that directly or , indirectly controls the day-to-day management ofthe Applicant. NOTE: Each legal entity listed below must submit an EDS on its own behalf. Name ¦ ¦ TmlftPP Yollande Gottlieb Trustee 2 Please provide the following information concerning each person or legal entity haying a direct or indirect, currem^r^ months after City action) beneficial interest (including ownership)™ excess of 1,5% of the Applicant. Examples of such an interest, include shares m a ; corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a Page 2 of 15 limited liability company, or interest of a beneficiary of. a trust, estate or other simitar entity. If none,, state "None;" NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf. Name Business Address Percentage ihterestin the Applicant None ... . . . - ¦-—— :—-— SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS ' Has'the Disclosing Party;provided 12-month period preceding the date of this EDS? QYes UdlNo
Does the Disclosing Party reasonably expect to prpW
elected official during the 12-month period following the date of this: EDS? QYes ^ No
If "yes" to either of-the above, please identify be^ ydescribe suckiheo^
Does any City elected official or, to the best of the Disclosing Party's knowledge after reasonable inquiry any City elected official's spouse or domestic partner, have a financial interest (as defined in Chapter 24 56,of the MunicipalCode of Chicago ("MCC")). inUhe: Disclosing Party? : ? Yes 0No
If-yes," please identity below the namc(s) of such City elected official(s) and/or spouse(s)/domestic parther(s) and describe the financial interest(s).
SECTION IV DISCLOSURE OF SUBCON TRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any other person or entity ' whom the Disclosing Party has retained or;expects;t6 refaih in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who arc paid solely through the Disclosing Party's regular payroll. Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 15
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address .(subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is-
{V , not-aii acceptabferesponse.
34-Ten:Ll!C(. retained;.3dip N California Ave.'Chicago IL606.18; Architect; $1 Oik'paid, additional $8k anticipated '
Integra Builders, LLC, retained; 5312 S. GdrneilAve, Chicago, IL 60615; general contractor; $700k anticipated
(Add sheets if necessary)
f~l Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V « CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners Of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
sHas any person M^ip dire^ been declared in
arrearage on any child support obligations by any Illinois courtof competentjurisdiction?
I | Yes 0 No ? 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?
.QYes GjNo
FURTHER CERTIFICATIONS
1. [This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of
, Procurement Services.] In the 5-year period preceding the date of this EDS, neither the Disclosing
Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, inyestigati ve,ior other similar skills,' destgnated'by;a:public agency to help the agency monitor the. activity of specified agency vendors as-well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract :in progress).
2. The Disclosing Party and its^ Affiliated Entitiesare not delinquent in the payment of any fine, fee,
tax^or othersourceof indebtedness owed to tne City of Chicago, including, but not limited to, water
: and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment ofany tax administered by :the Illinois Department of Revenue.
Pago 4 of 15
3. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) of this EDS:
f are not presently debarred, suspended, proposed for debarment declared ineligible or voluntarily excluded from any transactions by any federal, state or local umt of government;
adjudged gu lty or had a civil judgment rendered against them in connection with: ob aimng
Public(federal,^ate or ^^^^^^ SbliltfansacfTon; a vio ation of federal or state antitrust statutes; fraud;,embezzlement, theft, forgery, Sr^ftSSion or destructiompf records; making false statements; or receiving stolen property;-
c are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in subparagraph (b) above;
W have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
e have not during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found
iliable ih% ciVil proceeding; or in any criminal or^civil action,including actions concerning
.en^ the City or by the,federal government, any state, or any other
unit of local government.
4 The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
;5. Certifications (5), (6) and (7) concern:
- • the*DisclosingParty; , , . n , ...
' . any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party m ' connection with the Maner, including but not limited to all persons orjegal entities disclosed . ^undeWSection IV, "Disclosureof Subcontractors]and Other Retained Parjies^
V any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Diseasing Party, is controlled by the Disclosing Party, or is, with die Disclosing Party, under . common control of another person or entity). Indicia of control include withouUimitation: X interlocking management or ownership; identity of interests among family mem^ shared
facilities afil equipment; common use of employees; or organization of a business entity following "; -meUneiigibility ibf 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 !?-,tha»^
under common control of another person, or entity; r any responsible rjfficial of the Disclosing Party, any Contractor or any AttiliatedEntity or.any :; other official, agent or employee ofthe Disclosing Party, any Contractor or anyAfi.hated Entity, ; acting pursuant to the direction or authorization of a responsible official ot the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
ri Ver.2018-1
Neither the Disclosing Party, nor any Contractor,, nor any Affiliated Entity of either the Disclosing Party or any Contractor, nor any Agents have, during the'.'5; ye^s:before theidaie of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency Of the federal government or of any state or local government in the United States Of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, of been a party to any such; agreement-, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in subparagraph (a).,or (b) above that is a matter of record, but have not.been prosecuted for such conductor
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense ofany state or of the United
v States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person? [see MCC
Chapter 1-23, Article 1 for applicability and defined terms] of the Applicant is currently indicted or
charged with, or has admitted guilt of, or has ever beenconvicted of, or placed under supervision for,
any criminal offense involving actual, attempted, or conspiracy to.commit bribery, theft, fraud- forgery,
perjury, dishonesty or deceit against an officer or employee ofthe City or any "sister agency";, and (ii)
the Applicant understands and acknowledges that compliance with Article I is a continuing requirement
for doing businesswith the City. NOTE: If MCC Chapter 1 -23, Article I applies to the Applicant, that
Article's p"e"rmanent;compl^ in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use,5 nor permit their subcontractors to use, any facility listed as having an ac'tiv.e^exclu'sibn'byihe.'U:S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY J The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in ^Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
Ver:2()18-1 .' Page 6 ofl 5
contractor/subcontractor that does not provide,such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. 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:
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the date of this EDS, an employee, or elected or appointed official, of the City ofChicago(if none, indicate with "N/A" or "none"). N/A
, 13. To me best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a;
¦ complete list of all gifts that the Disclosing Partyhas given or-caused t6ibe. given, at any time during the 12-month period preceding the execution date of this EDS, to an employee,- or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" docs not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided -in the course of official City, business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
n/a ¦ "
C. CERTIFICA TION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
¦ [~] is 0 is not
*
a "financial institution" as defined in MCC Section 2-32-455(b).
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in = MCC Chapter 2-32. Wc understand that becoming a predatory lender or becoming an affiliate of a predatory, lender may result in the loss ofthe privilege of doing business with the City."
Page 7 of IS
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
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 FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
1. In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee ofthe 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 rj7)No
NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
2f/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 hcr.own name*or in the name ofany 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 lega! process at the suit of the City (collectively, *"City Property Sale"). 'Compensation'for property ;takeh;purs.uant,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(l), provide the names and,business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies thai no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of 15
E CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. If the Disclosing Party checks (2), the Disclosing Party
mustdisclose below, or in-an attachment to this EDS all information required by (2). Failure tq; comply with these disclosure requirements may make any contract entered into with the City in
connection with the Matter voidable by the City.
* 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and ; the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. -The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI« CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. 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 . List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on.the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities . registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2- The Disclosing Party has not spent and will hot expend any federally appropriated funds to pay
any person or entity listed in paragraph A( 1) above for his or her lobbying activities or to pay,any
person or entity to influence or attempt to influence an officer or employee of any agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 Page 9 of 15
of a member of Congress, in .connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
3. 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( 1) and A(2) above.
¦4 . The Disclosing Party certifies^that either: (i) it is not an organization* describediin scction 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in " Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
5V Ifthe disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(T) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes [JNo
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
Yes Q 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 allSreports;due under the applicable filing requirements?
I I Yes I | No ?Reports not required
Have you participated in any,previous contracts or. subcontracts subject to the equal opportunity clause?
Yes ? No
If you checkeds''Nb" t6rquestion'(l;)'or (2) above, please provide an explanation:
Page 10 of 15
SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:'
The certifications, disclosures; arid acknowledgments contained in this EDS will become part of any contractor other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance,, or other City •action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics Ordinance* MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of this ordinance and a training program is available on line at Sv^^
also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
C. 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 hof rescinded or . .void); at«law, or in equity, including terminating.the DiscTosingiParty's .participation: in the Waiter1 . and/or declining to allow the Disclosing Party to participate in other City transactions. Remedies at
law for a false statement of material fact may include incarceration and an award to the City of treble
damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a'Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain spccified:offenses), the information provided herein regarding eligibility must be kept current-for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
Page 11 of 15
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as of the date furnished to the City.
Yollande Gottlieb as Trustee pi trie Yollande Gottlieb Revocable Trust Dated December 5, 2008 (Print or type exact legal name of Disclosing Party')
Yollande Gottlieb
(Print or type name of person signing) Trustee
(Print or type title of person signing)
Signed and sworn to before me oh (date) _
Page 12 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-01-5, the Disclosing Party must disclose'-whiether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is sighed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-iaw, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
>' . Does'the Disclosing; ,Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with.ah elected;'city Official or.department head?
? Yes [7] No
If yeSj please identify below (<1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of suchjfamilial relationship.
Page 13. of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% (an "Owner"); It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
?JYes 0No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified1 asia building code scofflaw or problem landlord pursuant to MCC Section 2-92-416? ' "
| | Yes fyf] No Q The Applicant is not publicly traded on any exchange.
If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code;Scofflaw or problem landlord and the address of each building; or buildings.to which the pertinent code violations apply.
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> CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
¦This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted fwww.amlegal.com ). generally covers a party to; any agreement pursuant; to; which they: (i) receive City of Chicago; funds in consideration for services, work or goods provided (including for legal br other professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business oh City premises.
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)( 1) and (2), which; prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
Yes
No
0 N/A - 1 am not anrApplicant that is a "contractor'' as defined in MCCSection 2-92-385. „ This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(l). Ifyou checked "no" to the above, please explain.
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