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This record contains private information, which has been redacted from public viewing.
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Type:
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Ordinance
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Status:
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Passed
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Title:
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Zoning Reclassification Map No. 4-F at 1344-1360 S Union Ave, 700-714 W 14th St and 701-713 W Liberty - App No. 18133
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Topic:
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ZONING RECLASSIFICATIONS - Map No. 4-F
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HNAL FOR PUBLICATION SUBSTITUTE ORDINANCE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. That the Chicago Zoning Ordinance be, and is hereby amended by changing all the Ml-3 Light Manufacturing / Business Park District symbols and indications as shown on Map No. 4-F in the area bounded by: West Liberty Street; South Union Avenue; West 14th Street; and a line 149.96 feet west of and parallel to South Union Avenue to those of a B2-5 Neighborhood Mixed Use District. SECTION 2. That the Chicago Zoning Ordinance be, and is hereby amended by changing all the B2-5 Neighborhood Mixed Use District symbols and indications as shown on Map No. 4-F in the area bounded by: West Liberty Street; South Union Avenue; West 14th Street; and a line 149.96 feet west of and parallel to South Union Avenue to those of a Residential Planned Development No. , which is hereby established in the area above described, subject to such Use and Bulk Regulations as set forth in the Plan of Development herewith attached and made a part hereof and to no others. SECTION 3. This ordinance shall be in force and effect from and after its passage. Common Address of Property. 1344-60 S. Union Avenue; 700-14 W. 14th Street; 701-13 W. Liberty Street FINAL FOR PUBLICATION RESIDENTI AL PLANNED DEVELOPMENT NO. PLANNED DEVELOPMENT STATEMENTS The area delineated herein as Residential Planned Development Number , ("Planned Development") consists of approximately 25,926 net square feet of property (.59 acres) which is depicted on the attached Planned Development Boundary and Property Line Map ("Property") and is controlled by the Applicant, PMG UV Investments, LLC, (the "Applicant"). The requirements, obligations and conditions contained within this Planned Development shall be binding upon the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. All rights granted hereunder to the Applicant shall inure to the benefit of the Applicant's successors and assigns and, if different than the Applicant, the legal title holder and any ground lessors. Furthermore, pursuant to the requirements of Section 17-8-0400 of the Chicago Zoning Ordinance, the Property, at the time of application for amendments, modifications or changes (administrative, legislative or otherwise) to this Planned Development are made, shall be under single ownership or designated control. Single designated control is defined in Section 17-8-0400 of the Zoning Ordinance. All applicable official reviews, approvals or permits are required to be obtained by the Applicant or its successors, assignees or grantees. Any dedication or vacation of streets or alleys or grants of easements or any adjustment of the right-of-way shall require a separate submittal to the Department of Transportation on behalf of the Applicant or its successors, assign or grantees. Any requests for grants of privilege, or any. items encroaching on the public way, shall be in compliance with the Plans. Ingress or egress shall be pursuant to the Plans and may be subject to the review and approval of the Departments of Planning and Development and Transportation. Closure of all or any public street or alley during demolition or construction shall be subject to the review and approval of the Department of Transportation. All work proposed in the public way must be designed and constructed in accordance with the Department of Transportation Construction Standards for Work in the Public Way and in compliance with the Municipal Code of the City of Chicago. Prior to. the issuance of any Part II approval, the submitted plans must be approved by the Department of Transportation. 4. ' This Plan of Development consists of 16 Statements: a Bulk Regulations Table; an Existing Zoning Map; a General Land-Use Map; a Planned Development Boundary and APPLICANT: PMG UV Investments, LLC ADDRESS: 1344-60 S. Union Avenue; 700-14 W. 14th Street; 701-13 W. Liberty Street FILING DATE: July 30, 2014 PLAN COMMISSION DATE: May 19, 2016 cop PHD* if Property Line Map; Site and Landscape Plan; General Roof Plan; and Building Elevations (North, South, East and West) dated May 19, 2016, submitted herein. In any instance where a provision of this Planned Development conflicts with the Chicago Building Code, the Building Code shall control. This Planned Development conforms to the intent and purpose of the Zoning Ordinance, and all requirements thereto, and satisfies the established criteria for approval as a Planned Development. In case of a conflict between the terms of this Planned Development Ordinance and the Zoning Ordinance, this Planned Development Ordinance shall control. The following uses are allowed in the area delineated herein: residential, accessory parking and related accessory uses. On-Premise signs and temporary signs, such as construction and marketing signs, shall be permitted within the Planned Development, subject to the review and approval of the Department of Planning and Development. Off-Premise signs are prohibited within the boundary of the Planned Development. For purposes of height measurement, the definitions in the Zoning Ordinance shall apply. The height of any building shall also be subject to height limitations, if any, established by the Federal Aviation Administration. The maximum permitted Floor Area Ratio ("FAR") for the site shall be in accordance with the attached Bulk Regulations Table. For the purposes of FAR calculations and measurements, the definitions in the Zoning Ordinance shall apply. The permitted FAR identified in the Bulk Regulations Table has been determined using a Net Site Area of 25,926 square feet. The Applicant acknowledges and agrees that the rezoning of the Property from the Ml-3 designation to a B2-5 designation and then to Residential Planned Development No. ' for construction of this Planned Development triggers the requirements of Section 2-45-110 of the Municipal Code (the "Affordable Housing Ordinance"). Any developer of a "residential housing project" within the meaning of the Affordable Housing Ordinance ("Residential Project") must: (i) develop affordable housing units as part of the Residential Project; (ii) pay a fee in lieu of the development of affordable housing units; or (iii) any combination of (i) and (ii). In accordance with these requirements and the Affordable Housing Profile Form attached hereto as Exhibit A, the Applicant has agreed to provide 10 affordable housing units in the Residential Project for households earning up to 60% of the Chicago Primary Metropolitan Statistical Area median income (the "Affordable Units"), or make a cash payment to the Affordable Housing Opportunity Fund in the amount of $100,000 per unit ("Cash Payment"). At the time of each Part II review for the Residential Project, Applicant may update and resubmit the Affordable Housing Profile Form to the Department of Planning and Development ("DPD") for review and approval. If the Applicant subsequently reduces the number of dwelling units in the Residential Project, DPD may adjust the requirements of this Statement 9 (i.e., APPLICANT: PMG UV Investments, LLC ADDRESS: 1344-60 S. Union Avenue; 700-14 W. 14,h Street; 701-13 W. Liberty Street FILING DATE: July 30, 2014 PLAN COMMISSION DATE: May 19, 2016|1010| number of Affordable Units and/or amount of Cash Payment) accordingly without amending the Planned Development. Prior to the issuance of any building permits for thc Residential Project, including, without limitation, excavation or foundation permits, the Applicant musl either make the required Cash Payment, or execute an Affordable Housing Agreement in accordance with Section 2-45-110(i)(2). The terms of the Affordable Housing Agreement and any amendments thereto are incorporated herein by this reference. The Applicant acknowledges and agrees that the Affordable Housing Agreement will be recorded against the Residential Project and will constitute a lien against each Affordable Unit. The City shall execute partial releases of the Affordable Housing Agreement prior to or at the time of the sale of each Affordable Unit to an income-eligible buyer at an affordable price, subject to the simultaneous execution and recording of a mortgage, restrictive covenant or similar instrument against such Affordable Unit. The Commissioner of DPD may enforce remedies for breach of the Affordable Housing Agreement, and enter into settlement agreements with respect to any such breach, subject to the approval of the Corporation Counsel, without amending the Planned Development. If this Planned Development does not receive city council approval by July 13, 2016, the project will be subject to Section 2-45-115 of the Municipal Code (the ""2015 ARO*')- Tn such event, the Applicant shall meet with the Department of Planning and Development to determine the application ofthe 2015 ARO to the project, and the 2015 ARO requirements will replace and supersede the affordability requirements set forth in this Section Upon review and determination, "Part II Review", pursuant to Section 17-13-0610 of the Zoning Ordinance, a Part II Review Fee shall be assessed by the Department of Planning and Development. The fee, as determined by staff at the time, is final and binding on the Applicant and must be paid to the Department of Revenue prior to the issuance of any Part II approval. The Site and Landscape Plan shall be in substantial conformance with the Landscape Ordinance and any other corresponding regulations and guidelines. Final landscape plan review and approval will be by the Department of Planning and Development. Any interim reviews associated with site plan review or Part II reviews, are conditional until final Part II approval. The Applicant shall comply with Rules and Regulations for the Maintenance of Stockpiles promulgated by the Commissioners of the Departments of Streets and Sanitation, Environment and Buildings, under Section 13-32-125 of the Municipal Code, or any other provision of that Code. The terms and conditions of development under this Planned Development ordinance may be modified administratively, pursuant to section 17-13-0611-A ofthe Zoning Ordinance by the Zoning Administrator upon the application for such a modification by the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. APPLICANT: PMG UV Investments, LLC ADDRESS: ,1344-60 S. Union Avenue; 700-14 W. 14,h Street; 701-13 W. Liberty Street FILING DATE: July 30, 2014 PLAN COMMISSION DATE: May 19, 2016|1010| FINAL FOR PUBLICAT The Applicant acknowledges that it is in the public interest to design, construct and maintain the project in a manner which promotes, enables and maximizes universal access throughout the Property. Plans for all buildings and improvements on the Property shall be reviewed and approved by the Mayor's Office for People with Disabilities lo ensure compliance with all applicable laws and regulations related to access for persons with disabilities and lo promote the highest standard of accessibility. The Applicant acknowledges that it is in the public interest to design, construct, renovate and maintain all buildings in a manner that provides healthier indoor environments, reduces operating costs and conserves energy and natural resources. In accordance with the City of Chicago Sustainability Matrix, the project shall incorporate photovoltaic cells totaling approximately 2,624 square feet on the roof (or 25% of the otherwise required Green Roof) and the building will achieve LEED Certification. This Planned Development shall be governed by Section 17-13-0612 of the Zoning Ordinance. Should this Planned Development ordinance lapse, the Commissioner of the Department of Planning and Development shall initiate a Zoning Map Amendment to rezone the property to the B2-5 district. APPLICANT: PMG UV Investments, LLC ADDRESS: 1344-60 S: Union Avenue; 700-14 W. 14th Street; 701-13 W. Liberty Street FILING DATE: July 30, 2014 PLAN COMMISSION DATE: May 19, 2016 RESIDENTIAL PLANNED DEVELOPMENT NO. BULK REGULATIONS Gross Site Area: 40,406 SF Area in the R-O-W: 14,488 SF Net Site Area: 25,926 SF Maximum Floor Area Ratio: 5.0 Minimum Number of Off-Street Loading Spaces:|910|Minimum Number of Off-Street (accessory) Parking Spaces: 99 Minimum Number of Bike Parking Spaces: 99 Maximum Building Height: 80-0" Minimum Required Setback: Per Site Plan APPLICANT: PMG UV Investments, LLC ADDRESS: 1344-60 S. Union Avenue; 700-14 W. I4,h Street; 701-13 W. Liberty Street FILING DATE: July 30, 2014 PLAN COMMISSION DATE: May 19, 2016|1010| 2007 Affordable Housing Profile Form (Rental) Submit this form to the Department of Planning & Development (DPD) for projects that are subject to the 2007 ARO. Projects submitted after October 13, 2015 - or that do not receive City Council approval by July 13, 2016 - will be subject to the 2015 ARO. More information is online at www.cityofchicago.orci/ARO .
This completed form should be returned to: Kara Breems, DPD, 121 N. LaSalle Street, Chicago, IL 60602. E-mail: kara.breems@cityofchicago.org Telephone: (312) 744-6476
Date: 4/1/2016
SECTION 1: DEVELOPMENT INFORMATION
Development Name: 700 W 14th Street Development Address: 700 W 14th Street Ward: HthWard
If you are working with a Planneratthe City, what is his/her name? Dan Klaiber
Type of City involvement: | | City Land
(check all that apply) i—i Financial Assistance (If receiving TIF assistance, will tif funds be
I I used for housing construction? J I*) *if yes, please provide copy
I . of the TiF Eligible Expenses I|910|[Vj Zoning increase and/or PD
SECTION 2: DEVELOPER INFORMATION
Developer Name: PMG UV Investments, LLC Developer Contact (Project Coordinator): Benjamin Brichta Developer Address: 935 W Chestnut St, Suite 430, 60645 Email address: bbrichta(®propertYmq.com Telephone Number: ^3^2) 919-7642
SECTION 3: DEVELOPMENT INFORMATION
a) Affordable units required
For ARO projects: _99 x 10%* = Jio (always round up)
Total units total affordable units required
*20% if TIF assistance is provided
For Density Bonus projects: X 25% =
Bonus Square Footage* Affordable sq. footage required
*Note that lhe maximum allowed bonus is 20% of base FAR in dash-5; 25% in dash-7 or -10; and 30% of base FAR in dash-12 or -16 (ww.cityofchicaqo.org/zoninq for zoning info).
b) building details
In addition to water, which of the following utilities will be included in the rent (circle applicable):
0 ? LJ ? ?
Cooking gas electric gas heat electric heat other (describe on back)
? 0 ?[/] Is parking included in the rent for the: affordable units? yes no ¦ market-rate units? yes no
If parking is not included, what is the monthly cost per space? $200
Estimated date for the commencement of marketing: 3/1/2018
Estimated date for completion of construction of the affordable units: 5/1/2018
Unit Type* Number of Units Number of Bedroo ms/Unit Total Square Footage/Unit Expected Market Rent Proposed Affordable Rent* Proposed Level of Affordability (60% or less of AMI) Unit Mix OK to proceed?
Example 1 bed/1 bath|999|800 $1000 759 60%
Affordable Units ?
?
?
Market Rale Units 1RD/1BA 53|99|AAA - 720 $1,700 N/A N/A ?
2BD/2BA 39|99|975-1082 $2,600 N/A N/A ?
3BD/3BA+|99|3+ 1221 - 1850 $4,500 N/A N/A ?
For ARQ projects, use the following formula to calculate payment owed:
Number of total units in development
99 x 10%=J_9 x $100,000 = $1,000,000
(round up to nearest Amount owed
whole number)
For Density Bonus projects, use the following formula to calculate payment owed:
x 80% x .$
Bonus Floor Area (sq ft) median price per base FAR foot Amount owed
Submarket (Table for use with the Density Bonus fees-in-lieu calculations) Median Land Price per Base FAR Foot
Loop: Chicago River on north/west; Congress on south; Lake Shore Dr on east $31
North: Division on north; Chicago River on south/west; Lake Shore Dr. on east $43
South: Congress on north; Stevenson on south; Chicago River on west; Lake Shore Dr. on east $22
West: Lake on north; Congress on south; Chicago River on east; Racine on west S29
|1010|Kara Breems, DPD
Authorization to Proceed (to be completed by Developer & DPD) j cCj-H/L
Date
4/1/2016
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Department of Planning and Development
CITY OF CHICAGO
MEMORANDUM
Alderman Daniel S. Solis Chairman, City Council Committee on Zoning
vid L. Reifn cretary icago Plan
May 20, 2016
RE: Proposed Planned Development for property generally located at 1344 South Union Street, 700-14 West 14th Street and 701-13 West Liberty Street.
On May 19, 2016, the Chicago Plan Commission recommended approval ofthe proposed planned development submitted by PMG UV Investments, LLC. A copy ofthe proposed planned development is attached. I would very much appreciate your assistance in having this introduced at the next possible City Council Committee on Zoning hearing.
Also enclosed is a copy of the staff report to the Plan Commission which includes the Department of Planning and Development, bureau of Planning and Zoning recommendation and a copy ofthe Resolution. If you have any questions in this regard, please do not hesitate to contact me at 744-5777.
cc: Steve Valenziano
PD Master File (Original PD, copy of memo)
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
Chicago Plan Commission
Proposed PD 1350 S Union
May 19, 2016
|1010|5/20/2016
5/20/2016
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|1010|5/20/2016
FINAL
REPORT to the
CHICAGO PLAN COMMISSION from the
DEPARTMENT OF PLANNING AND DEVELOPMENT
MAY 19, 2016
APPLICANT: PMG UV INVESTMENTS, LLC
LOCATION: 1344-1360 SOUTH UNION STREET, 700-714 WEST 14th STREET
and 701-713 WEST LIBERTY STREET
FOR APPROVAL: 1) REZONING FROM M1-3 (LIMITED
MANUFACTURING/BUSINESS PARK DISTRICT) toB2-5 (NEIGHBORHOOD MIXED USE DISTRICT); and 2) ESTABLISHMENT of a RESIDENTIAL PLANNED DEVELOPMENT
INTRO DATE: JULY 30, 2014
PD THRESHOLD: MANDATORY PLANNED DEVELOPMENT - THE PROJECT
EXCEEDS THE HEIGHT THRESHOLD OF 75' (80') IN A B2-5 ZONING DISTRICT (SECTION 17-8-0512-A)
PROJECT SUMMARY
The project consists ofthe development of a 80' residential building (6 stories plus partial 7th) with 99 dwelling units and 99 enclosed parking spaces on an approximately 25,926 square foot site. The project will provide 2,624 square feet of photovoltaic cells on the roof and will achieve LEED certification. The dwelling units will consist of a mix of efficiencies, one, two and three bedroom units. The enclosed parking will be accessed via West Liberty Street and South Union Street. The main pedestrian entrance to the building will be from West 14th Street. The site would be rezoned from M1-3 to B2-5 prior to establishing the proposed Residential Planned Development. (See Exhibits)
BULK/USES/DENSITY/ARO
The PD will cap the Floor Area Ratio for the project at 5.00. The PD will allow for residential units, accessory parking and accessory uses. The Minimum Lot Area (MLA) for the project is 261 and the percentage of efficiencies will be less than 30%. The Applicant filed the project within the deadline established under the City of Chicago's 2007 ARO (Affordable Requirements Ordinance). The Applicant will comply with the ARO by paying $1,000,000 ($100,000 x 10 units) into the Affordable Housing Fund.
|1010|
ZONING CONTEXT (site in green):
|1010|
EXISTING AERIAL (site in red, building since demolished):
RECOMMENDATION
The Department of Planning and Development has reviewed the project materials submitted by the Applicant and compared this proposal to existing development in the community. The area around this project consists of a large mixed use/residential planned development surrounding the site while the Dan Ryan expressway (1-90/1-94) is immediately east of the site. The project represents an opportunity to construct a compatible residential infill project along South Union Street, West Liberty Street and West 14th Street in Chicago's Near West Side Community Area.
Based on that analysis, the Department of Planning and Development has concluded that this proposal is appropriate for this site and supports this development for the following reasons:
1. The proposed rezoning of the subject property is appropriate under Chapter 17-13 of the Zoning Ordinance. Specifically, the proposed B2-5 underlying zoning classification and or the project is 1) consistent with plans for the area, including the Roosevelt Union Tax Increment Financing Area (17-13-0308-A); 2) appropriate because of growth and development trends (17-13-0308-B); 3) compatible with the character of the surrounding area in terms of uses, density and building scale (17-13-0308-C); 4) compatible with surrounding zoning districts (17-13-0308-D) and, 5) the public infrastructure facilities and city services will be adequate to serve the
J)
FINAL
proposed development at the time of occupancy (17-13-0308-E).
2. The project meets the purpose and criteria set forth in Chapter 17-8 of the Zoning
Ordinance and its adoption would not have any adverse impact on the public's
health, safety or welfare. Specifically, this project meets the following provisions of
Chapter 17-8:
Promotes economically beneficial development patterns that are compatible with the character of existing neighborhoods (per 17-8-0103), as evidenced through the project's design and massing remaining within the context of adjacent structures;
Promotes that primary pedestrian entrances be located at sidewalk level and help to provide building identity and presence on the street (per 17-8-0905-B) as evidenced
Promotes green design by conserving non-renewable energy and scarce materials (per 17-8-0908-A) as evidenced by the proposed photovoltaic cells incorporated into, and LEED certification sought, as part of the project; and,
All sides and areas of the buildings that are visible to the public are treated with materials, finishes and architectural details that are of high-quality and appropriate for use on primary street-facing facade (17-8-0907-A-4), as evidenced through the material callouts in this report and on the elevations.
3. The project has been reviewed and approved by the Chicago Department of
Transportation, Mayor's Office for People with Disabilities and the Fire Department.
Based on the foregoing, it is the recommendation of the Department of Planning and Development that this application for a Residential Planned Development be approved and that the recommendation to the City Council Committee on Zoning, Landmarks and Building Standards be "Passage Recommended".
Bureau of Zoning and Land Use Department of Planning and Development
|1010|
FINAL
DEPARTMENT OF PLANNING AND DEVELOPMENT CITY OF CHICAGO
RESIDENTIAL PLANNED DEVELOPMENT 1344-60 SOUTH UNION AVENUE; 700-714 WEST 14th STREET; 701-713 WEST LIBERTY STREET
RESOLUTION
WHEREAS, the Applicant, PMG UV Investments, LLC, has submitted an application seeking approval for a Residential Planned Development on a 25,926 square foot property currently zoned M1-3 (Limited Manufacturing/Business Park District); and,
WHEREAS, the Applicant intends to rezone the property from M1-3 (Limited Manufacturing/Business Park District) to B2-5 (Neighborhood Mixed-Use District) prior to establishing the proposed Residential Planned Development; and,
WHEREAS, the Applicant proposes to construct an 80' building with 99 dwelling units and accessory parking on the subject site; and,
WHEREAS, the Applicant's request to rezone .the property was introduced to the City Council on July 30, 2014; and,
WHEREAS, proper legal notice of the hearing before the Plan Commission was published in the Chicago Sun-Times on May 4, 2016. The Applicant was separately notified of this hearing and the proposed zoning application was considered at a public hearing by this Plan Commission on May 19, 2016; and,
WHEREAS, the Plan Commission has reviewed the application with respect to the provisions of the Zoning Ordinance and «finds that the proposal will be consistent with said provisions; and,
WHEREAS, the Department of Planning and Development recommended approval ofthe application, with the recommendation and explanation contained in the written report dated May 19, 2016, a copy of which is attached hereto and made a part hereof; and,
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
FINAL
WHEREAS, the Plan Commission has fully reviewed the application and all informational submissions associated with the proposed amendment, the report and recommendation of the Commissioner of the Department of Planning and Development and all other testimony presented at the public hearing held on May 19, 2016, giving consideration to the Zoning Ordinance;
NOW, THEREFORE, BE IT RESOLVED BY THE CHICAGO PLAN COMMISSION:
THAT the above-stated recitals to this resolution together with the report of the Commissioner ofthe Department of Planning and Development be adopted as the findings of fact of the Plan Commission regarding this zoning map amendment application.
THAT this Plan Commission recommends approval to the City Council Committee on Zoning, Landmarks and Building Standards ofthe final zoning application dated May 19, 2016.
Chairman
Chicago Plan Commission
RPD No.
Approved: May 19, 2016
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
Introduced- 7/30/2014
Plan Commission: 5/19/2016
Applicant* 18133
CITY OF CHICAGO
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
RECEIVED
MAY 1 9 2016
2. 3.
ADDRESS ofthe property Applicant is seeking to rezone: 1344-60 South Union Avenue; 700-14 West 14th Street; 701-13 West Liberty Street
Ward Number that property is located in: 11th Ward
APPLICANT PI^G Investments, LLC
ADDRESS 935 West Chestnut Street, Suite 430
STATE lllinois ZIP CODE 60642
EMAIL c'° sborstein@nealandleroy.com CONTACT PERSON c'° Scott Borslein
NO
Is the applicant the owner of the property? YES
If the applicant is not the owner of the property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed.
OWNER Liberty Union, LLC
ADDRESS 111 West Washington, Suite 1300
PHONE 312/263-7100
CONTACT PERSON Richard Ginsburg
If the Applicant/Owner ofthe property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Scott R. Borstein ADDRESS 120 North LaSalle Street, Suite 2600
ZIP CODE 60602
EMAIL sborstein@nealandleroy.com
If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
NLG Chicago Investments, LLS -100%
On what date did the owner acquire legal title to thc subject property?_
Has the present owner previously rezoned this property? If yes, when? NO
B2-5 then to Residential
Present Zoning District M1'3 Proposed Zoning District Planned Development
Lot size in square feet (or dimensions) 25,926 sf
1L. Current Use of tlie property Vacant
12. Reason for rezoning the property Develop a mixed use building with 99 parking paces, 99 bike spaces; and 99 Residential Units
13. Describe the proposed use of the property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and height of the proposed building. (BE SPECIFIC)
Applicant intends to develop a mixed use building with 99 parking spaces, 99 bike spaces and 99 units in an 80 foot structure.
14. The Affordable Requrements Ordinance (ARO) requires on-site affordable housing units and/or a financial contribution for residential housing projects with ten or more units that receive a zoning change which, among other triggers, increases the allowable floor area, or, for existing Planned Developments, increases the number of units (see attached fact sheet or visit www.cityofcliicago.org/ARO for more information). Is this project subject to the ARO?
YES X
COUNTY OF COOK STATE OF ILLINOIS
_, being first duly swom on oath, slates that all of tlie above
statements and the statements contained in the documents submitted herewith are true and correct-PMC) UV Irivestmsjils^LC By GNP lri?eSfmems,-Inc.
Signature of Applicant
Subscribed and Sv(or: day of
Notary Public
, -~ ~ ^ — ^ ^. ^
HILLIE M. SEMPRIT OFFICIAL SEAL Notary Public - State of Illinois My Commission Expires
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I|1010|
Date of Introduction:.
File Number:
Ward:.
CITY or CM If A CO
i: (: () i\ () m i c i) i s c: i. () s u r i ; s i a r E m e n i
AND A I- II DAVIT
SECTION I --GENERAL INI ORMAHON
I cgal name of the Disclosing I'arly submitting tliis LDS. Include d/b/a/ ii*applicable:
NLG Chicago Investments, LLC _
Check ONE of the following llu ce boxes:
Indicate whether the Disclosing I'arly submitting this EDS is:
|" | the Applicant
OR
|>:] a legal entity holding a direct or indirect interest in thc Applicant. State thc legal name ofthe
Applicant in which lhe Disclosing Party holds an interest: PMG UV Investments, LLC
OR
3. [ ] a legal entity with a right of control (sec Section II.B. I.) State the legal name ofthe entity in
which ihe Disclosing Party holds a right of control:
Business address ofthe Disclosing Party: 935 W Chestnut St, Ste 430
Chicago, IL 60642
Telephone: 630-273-1260 Eax: Email: ngottlieb@propertymg.com
Name of contact person: Noah Gottlieb
II. 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):
Planned Development application for property at 1350 S Union Ave
Which City agency or department is requesting this EDS? Department of Planning and Development
If ihe Matter is a contract being handled by thc City's Department of Procurement Services, please coniplcie the following:
Specification 11 _. and Contract //
SECTION II -- DISCLOSURE Ol OWNERSHIP INTERESTS
A. NATURE Ol Till- DISCLOSING PARTY
Indicate lhc n;i
[ j Person
[ j Publicly registered business corporation
| ] Privately held business corporation
| ] Sole propriciorship
| j General partnership
| ] Limited partnership
I ] Trust
Limited liability company | J Limited liability partnership | | Joint venture | ) Not- fo r- p ro f'i t c o rp o ra t i o n
(Is the not-for-profit corporation also a 50* 1(c)(3))?
[JYes [JNo [ J Other (please specify)
2. for legal entities, the stale (or foreign country) of incorporation or organization, if applicable:
Illinois
3. For legal entities not organized in the Slate of Illinois: Mas thc organization registered to do business in thc State of Illinois as a foreign entity?
Lxl N/A
B. IT THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below thc full names and lilies of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, if any, which arc legal entities. If there arc 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 oilier person or entity that controls thc day-lo-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Noah Gottlieb Manager
Page 2 of 13
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% ofthe Disclosing Parly. Examples
interest of a member 01 manager in a limited liability company, or interest ol'a heneficiarv of a trust, estate or oilier similar entity. IT none, stale "None." NOIL: Pursuant to Section 2-1 54-0."* 0 ofthe 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 Parly
N°.?lLS?-olt!iell_-._ .9:i!Lw Chestnut St. Ste 430, Chicago. IL 60642 100%
SECTION HI - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a ''business relationship," as defined in Chapter 2-1 56 ofthe Municipal Code, with any City elected official in thc I 2 months before the date this EDS is signed?
f. I Yes bJ No
11" yes. please identify below tlie namc(s) of such City elected official(s) and describe such rclatioiiship(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 thc Matter, as well as the nature ofthe relationship, and thc total amount ofthe fees paid or estimated to be paid. The Disclosing Parly is not required to disclose employees who arc paid solely through thc Disclosing Party's regular payroll.
"Lobbyist'' means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (I) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist"" also means any person or entity any part of whose duties as an employee of another includes undertaking ro influence any legislative or administrative action.
If thc Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Parly must cither ask the City whether disclosure is required or make the disclosure.
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Name (indicate whether retained or anticipated to he retained)
Business Address
Relationship to Disclosing Party Fees (indicate whether
(subcontractor, attorney. paid or estimated.) NO TE:
lobbyist, etc.) "hourly rate" or "t.b.d."' is
nol an acceptable response.
(Add sheets iI" necessary)
|>:J Check here if the Disclosing Parly 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 thc contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois courl of competent jurisdiction?
f ] Yes fx] No ( ] No person directly or indirectly owns 10% or more of thc
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is thc person in compliance with that agreement?
[' 1 Yes
B. FURTHER CERTIFICATIONS
I. Pursuant to Municipal Code Chapter 1-23, Article I ("Article l")(which the Applicant should consult for defined terms (e.g., "doing business'") and legal requirements), if the Disclosing' Party submitting this EDS is the Applicant and is doing business with thc 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 employee ofthe City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article 1 is a continuing requirement for doing business with thc City. NOTE: If Article 1 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. I he I.')iscli'MiiLi Party and. it'tiie Disclosing Party is a legal enlily. all of those persons or entities
identified in Section I I. of this 1-DS:
arc no! presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, slate or local unit of government;
have nol. within a five-year period preceding the dale of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them 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 properly:
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, stale or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
have not. within a five-year period preceding tlie date of this EDS, had one or more public transactions (federal, stale or local) terminated for cause or default; and
have not, within a five-year period preceding thc dale 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 Ihe City or by the federal government, any state, or any oilier unit of local government.
3. The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contraclor or subcontractor used by the Disclosing Parly 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 ot 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 thc ineligible entity); with respect to Contractors, thc term Affiliated Entity means a person or entity that directly or indirectly controls the Contraclor. 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 A ("filiated Emily or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant lo the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Enlily (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either tlie Disclosing Parts' or any Contractor nor any Agents have, during lhe five years before the date this EDS is signed, or. with respeel to a Contractor, an Affiliated Entity, or an Affiliated Enlily of a Contractor during thc five years before the dale of such Contractor's or Affiliated Entity's contract or engagement in connection with the Mailer:
bribed or attempted lo bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, lhe State of Illinois, or any agency of the federal government or of any state or local government in thc United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price, or otherwise: or
made an admission of such conduct described in a. or b. above that is a matler of record, but have not been prosecuted for such conduct; or
violated thc provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or part nets', is barfed from contracting with any iinirof state Or local government as a result of engaging in or being convicted of (I) 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 United States of America that contains thc same elements as the offense of bid-rigging or bid-rotating.
Neither lhe Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of foreign Assets Control ofthe U.S. Department ofthe Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: thc 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 the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.
If lhc Disclosing Party is unable to certify to any of the above statements in this Part B (further Certifications), thc Disclosing Party must explain below:
N/A _ _
Pauc6of 13
If die letters "NA." the word "None." or no response appears on lhe lines above, it will be conclusi vcl v presumed thai the Disclosing Party certified to (he above statements.
•S. To the best of Ihe Disclosing Parly's knowledge after reasonable inquiry, ihe following is a complete- list of all current employees ofthe Disclosing Party who.were, at any iime during the 12-month period preceding the execution date of this LDS, an employee, or elected or appointed official, ofthe City ol'Chicago (if none, indicate with "N/A" or*'none"). N/A
v. To ihe best ofthe Disclosing Party's knowledge after reasonable inquiry, thc following is a
complete list of all gifts that the Disclosing Party has given or caused lo be given, at any lime during the
12-monlh period preceding the execution dale of this LDS, 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 S20 per recipient (if none, indicate
with "N/A" or "none"). As to any gift listed below, please also list (he name ofthe City recipient.
N/A ___
C. CERTIFICATION Of STATUS AS FINANCIAL INSTITUTION
1, The Disclosing Party certifies that thc Disclosing Party (check, one)
| J is [J is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We arc not and will not become a predatory lender as defined in Chapter 2-32 of tlie Municipal Code. We further pledge that none of our affiliates is, and none of ihcm will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. 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."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within thc meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary): N/A
Page 7 of 13
If lhc "osiers "NA." she word "None." or no response appears on lhe lines above, it will be conclusively presumed thai tlie Disclosing I'arly certified to the above statements.
D. CERTIFICATION REGARDING INTER EST IN CITY BUSINESS
Any words or terms that arc defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Pari D.
In accordance with Section 2-l5d-l 10 ofthe Municipal Code: Docs 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 cntily in the Matter'.'
1.1 Yes [xJNo
NOTE: If you checked "Yes" to Item D.l proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant lo 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 enlily in the purchase of any property that (i) belongs lo the Cily. or (ii) is sold for taxes or assessments, or (iii) is: sold by virtue of legal process at the suit of thc City (collectively. "City Properly Sale"). Compensation for property taken pursuant to the City's eminent, domain power docs not constitute a financial interest within the meaning of this Part D.
Docs thc Matter involve a City Properly Sale?
|. ] Yes fx! No
If you checked "Yes" to Item D.I provide the names and business addresses ofthe City officials or employees having such interest and identify thc nature of such interest:
Name Business Address Nature of Interest
4. Thc 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
o¦_ :,„]. : .»- "i u'si... i.- n«- *"> «u.-. r\:.,^i.w.:ii....
l il v, 11 v. f* k.' i u i l t i . *' i z,. i' v. i v.' vv , i| 111 v. i./ i.'M^K.i.iiiit; i hi \ y *^ 11 m-vj i\ t- -. * 11 u t .-> v.-1 Ktn 1111; i tj 111 li ^ i.
disclose below or in an attachment io this EDS all information required by paragraph 2. Failure to
Page X of 13
comply wiih ihc-c disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the Cily.
: I. The Disclosing Party verifies that lhe Disclosing Parly has searched any and all records of Ihe Disclosing Parly and any and all predecessor entities regarding records of investments or piofits from slavery or slaveholder insurance policies during the. slavery era (including insurance policies issued lo slaveholders thai provided cov erage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step I above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the Following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CEK 11EICA HONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Mailer is federally funded, complete this Section VI. If lhc Matter is not federally funded, proceed to Section VIE For purposes of this Section VI. tax credits allocated by thc Cily and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING n/A
I. List below the names of all persons or entities registered under thc Federal Lobbying Disclosure Act oF 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to thc Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if thc 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 respeel to the Matter.)
2. Thc 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.
Page 9 of 13
.i. l ilt: Disclosing Pany wiii -submit an updated certification at thc end ol each calendar quarter in which there occurs any event, dial materially affects the accuracy of lhc statements and information set forth in paragraphs A.l. and A.2. above.
4 The Disclosing Party certifies thai cither: (i) it is not an organization described in section 501(c)(4) of tlie Internal Revenue Code of 1986: or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 19X6 hut 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 awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe 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 lo submit thc following information with their bids or in writing al the outset of negotiations. n/A
Is the Disclosing Party the Applicant?
I ] Yes |. 1 No
If " Yes." answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant lo applicable federal regulations? (See 4 1 CFR Part 60-2.)
[JYes MNo
Have you filed with the Joint Reporting Committee, thc Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[JYes [JNo
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [| No
If you checked "No" to question I. or 2. above, please provide an explanation: '
Page 10 of 13
SECTION VII - ACKNOWEIf.DCM ENTS, CONTRACT INCORPORATION. COM I'EIANCE, PENALTIES, DISCLOSURE
Thc Disclosing Party understands and agrees lhal:
A. Thc certifications, disclosures, and acknowledgments contained in this EDS will become pari of any contract or other agreement between the Applicant and thc Cily in connection with the Matter, whether procurement. City assistance, or other Cily action, nnd are material inducements to the City's execution of any conlraci or taking other action with respect lo Ihe Matler. Thc Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
13. The Cily's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of (he 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 al www.citvofc11icauo.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.
if lhc 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 thc contract or agreement (if nol rescinded or void), at law. or in equity, including terminating the Disclosing Parly'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.
Il 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 thc 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 thc public release of information contained in this EDS and also authorizes tlie City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on thc Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, thc Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article 1 of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-1 54-020 ofthe Municipal Code.
The Disclosing Party represents and warrants lhat:
Page I I of 13
E.I. The Disclosing i:ariy is 1101 delinquent in the payment of any lax administered by lhc Mlmnis Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paving anv fine. fee. ta.\' or other charge owed to the City. This includes, but is not limited to. all water charues. sewer charges, license fees, parking tickets, property taxes or sales (axes.
2 If the Disclosing Parly is the Applicant, lhe Disclosing Party and its Affiliated Entities will not use. nor permit their subcontractors to use. any facility listed by lhc U.S. E.P.A. on thc federal Excluded Parties List System ("EP1.S") maintained by the U. S. General Services Administration.
3 If thc Disclosing Parly is the Applicant, the Disclosing Parly will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance lo those in E. I. and E.2. above and will not, without thc prior written consent ofthe City, use any such contractor/subcontractor that docs not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: IT thc Disclosing Party cannot certify as lo any ofthe items in E. 1 E.2. or F.3. above, an explanatory statement must be attached lo this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute t.his"EDS~and Appendix A (if applicable) on bchalf of thcTDisclosing Parfyrand (2) warrantsihat all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
NLG Chicago Investments. LLC
Noah Gottlieb (Print or type name of person signing)
Manager
(Print or type title of person signing)
Signed and sworn to before mc on (dale) Ay*A j%. J*r>\&>
at Ccok County. (state).
ANDREW KERB
OFFICIAL SEAL
Notaiy Public. Slsto ol Illinois
My Commission Expires
Orjtnhflr ?7. ?ni«t
¦ ¦ . . ' .1
Page 12 of 13
CITY Or CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to ho completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to he completed by any legal entity which has only an indirect ownership ink-rest in the Applicant.
Under Municipal Code Section 2-154-015, thc Disclosing Party must disclose whether such Disclosing Party or any "'Applicable Party'" or any Spouse or Domestic Partner thereof currently has a "familial relationship'" with any elected city official or department head. A "familial relationship" exists if. as ofthe date this EDS is signed, thc Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to tlie mayor, any alderman, the city clerk, the cily treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law. son-in-law, daughter-in-law. stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (I) all executive officers ofthe Disclosing Party listed in Section 11.13.La., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if thc Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if thc 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 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?
[ I Yes [*] No
If yes, please identify below (I) the name and title of such person, (2) thc name of the 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 such familial relationship.
Page. 13 of 13
cn v or Chicago
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX Ii
BUILDING CODE SCO FEE A W/PRO BI, EM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) thc Applicant, and (h) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to he completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to Municipal Code Section 2-154-010. is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofThe Municipal Code? "
I lYcs fx) No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem tandlord pursuant to Section 2-92-4 16 ofthe Municipal Code?
| | Yes-— | JNo "" " " - [XI NorApplieable
3. lives to (I) or (2) above, please identify below thc name ofthe person or legal entity
identified as a building code scofflaw or problem landlord and the address ofthe building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMEN T THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF,THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CER TIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
/ v
CITY Ol'- CHICAGO ECONOM 1C DISCLOSURE STAT EM EN T AND A EE ID AY'IT
SEC'I ION I --GENERAL IN E<) R M ATI ON
A Legal name of" lhc Disclosing Party submitting this EDS. Include d'h/a/-if applicable:
PMG UV h'yj'slnients.j.LC
Check ONE ofthe following three boxes:
Indicate whether lhe Disclosing Party submitting this EDS is:
\y] the Applicant
OR
| ] a legal entity holding a direct or indirect interest in the Applicant. Statu ihe legal name ofthe
Applicant in which thc Disclosing Party holds an interest: _ _
OR
3. | 1 a legal entity with a right of control (see Section II.13.1.) Stale (he legal name ofthe entity in
which lhe Disclosing Party holds a right of control:
13. Business address ofthe Disclosing Parly: 935 W Chestnut St, Sta 430
Chicago, IL 60642 ^
Telephone: _§30-273^1260 Fax: Email: ngottlieb@properlymg.com
Name of contact person: Noah Gottlieb
Federal Employer Identification No. (if you have one. i |109|'— : /
E. 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):
Planned Development application for property at 1350 S Union Ave
G. Which Cily agency or department is requesting this EDS? Department of Planning and Development
If the Mailer is a contract being handled by ihe City's Dcparlineni of Procurement Services, please complete the following:
Specification // t nnd Contract U
Page I of 13
i... \ /.> • i\ i*. v j r \ j w is i\ f\.S ri 11' 1f\ I i', K r, ;"i I N
A. NA I URE Ul; "l itI£ DISCLOSING I'AIM'Y
1. Indicate tlie nature of die Disclosing I'ariy:
( I Person fxj Limited liability company
| '] Publicly regisic-rcd business corporation | J Limited liability partnership
| | Priviucly hold business corporation | J Joint venture
[' ] Side proprietorship | ] Nor-IY>r-profil corporation
I. ] General partnership (Is.thc not-t'or-profit corporation also a 301(c)(3))':
| J Limited partnership [ | Yes I J No
I J Trust ( J Other (pleasc speciTy)
2. For legal entities, (he state (or foreign country) of incorporation or organization, if applicable:
«
Illinois
3. for legal entities nor organized in the State of Illinois'; lias the organization registered to do
business in the Slate eff Illinois.as a foreign entity?
I JYes U No 1x3 N/A
B. IP TDK DISCLOSING PARTY IS A LEGAL ENTITY:
I. List below die full names and titles of all executive officers nnd all directors ofthe eniiiy. NOTE: F-ornol'-fftr-prff'fiV."c'6Tp6"rftt>ons, also list below nil members, if tmy,-which are legal entities. If there.are no such members, write "no members." For trusts, estates or other similar entities, list below the legal tiilcholder(s).
If the entity is a general patUicrsh'ipj limited, partnership, limited liability company, limited liability partnership or joint venture-, list-helow-ihe murieand tide of each general partner; managing member, manager or any other person or entity lhat controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS un its own behalf.
Name Title
NLG Chicago Investments, LLC Manager
2. Please provide thc following information.concerning each person or entity having a direct or indirect beneficial interesl ('including ownership) in excess of 7:5% of the. Disclosing Parly. Examples (if such an interest include shares in a corporation, partnership interest in a partnership or joint venture.
Page 2 of 13
iniiMvsi of a member or manager in a limited liability company, or interest of a honei iciai y uf.i trust, estate or other similar entity. If none, state "None." NOTE: I'ui'siiant to Section 2-1 54-030 ofthe Municipal (.'otic of Chicago ("Municipal Code'1), the Cily may require any such additional information from any applicant which is reasonably intended lo achieve full disclosure.
Name Business Address Percentage. Interest in ihe
Disclosing Party
NI.G Chicago Investments, LLC 93!5 VV CheslnulJSt. Sto 430. Chicago, IL 60642 100%
SECTION 111 - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Mas the Disclosing I'ariy had a "business relationship," as defined in Chapter 2-1 56 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
f. 1 Yes (x| No
If yes, please identify below the namc(s) of such City elected official(s) and describe such relationship^):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PAR I IES
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 thc Matter, as well as the nature of the relat ionship, and the total amount ofthe fees paid or estimated to be paid. Thc Disclosing Party is not required io disclose employees wdio are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes tq. influence any legislative or administrative action on behalf of any person or entity other than:'('I) a no(>for-profil 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 thc Disclosing Pat ty is uncertain whether a disclosure is required under this Section, the Disclosing Party must cither ask thc City whether disclosure is required or-inake the disclosure.
Page .1 of 13
\.nne '. 1111iiu:i;whether iu;- iiiess Relationship n.i Disclosing i'ariy foes (indicate whether
retained or anticipated Address (subcontractor, attorney. paid or estimated.) NOTE:
'o lie retained.) lobbyist, etc.) "hourly rale" or "t b.d." is
not an ae.cepta'ole response.
. li^lS B?!-^!" 203 N LaSallo si. Chicago. II.,60601 Attorney ,,$(40,000) estitnated
Cordogan Clark & Associates, lnc 716 N Wells St. Chicago, IL1_60654_ Arcliitccl_ 5(400,000) estimated
( 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
A. CO I i RT-0 R D E RE I > CHILD SUPPORT COMPLIANCE
Under Municipal. Code Section 2-92.-41 5, substantial owners of business entities (hat contract with the City must remain in compliance with their child support obligations throughout the contract's term.
I las any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in
.arrc;Kagcon.any cjiild suppj^
f ] Yes [x] No ( j No person directly or indirectly owns 10% or more of the
Disclosing Party.
I ("Yes," has the person entered into a court-approved agreement for payment of all support owed and is tho person in compliance with that agreement?
[jYes [1 No
Ii, ITjRTHI£RCERflPICAtl()NS
I. Pursuant to Municipal Code Chapter I-23,.Article I ("Article•!").(which the Applicant should consult for defined terms (e-^., "doing.busificss") and legal re()uircmCiH^);.if1he.D.i^cipsin^-j>:uly submitting Ihis EDS^is the 'Applicant and is doing business: with "the City, (hen tIicV Disci16king,Party certifies as follows: (i) neither the Applicant nor any controlling persdn is currently indicted or charged with, or has admitted guilt of, or lias 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 ordecc.il against an officer or employee ofthe City or any sister agency; and (ii) the Applicant t'lhcier.stands'aiuhiicknovvledges lhal compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to thc Applicant, the permanent compliance ihnofrninc in Article 1 supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
.;. I Ik- Disclosing I'ariy and, if the Disclosing I'ariy is a legal entity, all oi'those persons or eniiiio. identified in Section ll.l.i.l. of ihis EDS:
a. are nol presently debarred, suspended, proposed for debarment, declared ineligible or voluuiariiv
excluded from any transactions by any federal, slate 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, stale or local) transaction or contract under a public transaction: a violation of federal or stale antitrust statutes: fraud; embezzlement: theft: forgery; bribery; falsification or destruction of records: making false statements; or receiving stolen property;
arc not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, slate or local) with committing any of the offenses set forth in clause B.2.b. of this Section V:
have not, within a fivc-ycar period preceding thc date of this.EDS, had one or more public transactions (federal, slate or local) terminated for cause or default; and
c, have noi. within a fivc-ycar 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 hy the City or by the federal government, any state,, or any other unit of local government.
3. The certifications in subparts 3, 4 and 5 concern:
ihe Disclosing I'ariy;
any "Contractor-' (meaning any contractor or subcontractor used by the DisclosingJ'art.y in connection with thc Matter,,including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors arid Other Retained Parties");
. • any "Affiliated Entity" (nj.caning a person or cntily-that, direelly or indirectly: cgn.lrc.ls Ihe Disclosing Party, is controlled by the Disclosing Party, or is, with ihe Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: inter.look.ing inanagcme.nl ;;pr ownership; identity of interests anipng family members;,, shared facilities arid .equipment;coimnon usc-of employees; or organization of a.busincss entity following tlie ineligibility of a business entity to do business with federal or state or local government, including thc City; using substantially thc same management, ownership, or principals as the ineligible entity); wiih-respect to Contractors, the term A ffiliated Entity means a person or entity thiil directly or indirectly controls the Contraclor, is controlled by it. or, with thc 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 Contraclor or any Affiliated Entity, acting pursuant to lhc direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the-Disclosing i'lii iy. nor any Contractor, nor any A.I'l'iiialccJ Euiuy of eiihei liic i'Mseiosini.'. Parly or any Contractor nor any Agents have, during lhe. five years heroic ihe date this EDS is signed, or. x*. ii 1 respeel in a Contiaetoi, an Affiliated Emily. Oi: an Affiliated Entity of a Contraclor during the five years' hefote lhc dan: of such Contractor's or Affiliated Entity's contract or engagement in connection with the Manor:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee, of th'c;Giiy. the State of Illinois, or any agency of thc federal government or of any state or local govcriihicut'in-the United Slates of America, in thai.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-ofTrocdoin of competition by agreement In hid a fixed price or otherwise: or
made an admission, of such eoiidupt:dcsci:ibed:iu a. or b. above that is a matter of rocord.-bul have not been pmsceuted Pot such cohduei- or
violated (he provisions of Municipal Godc'Section 2-92-61.0 (Living Wage Ordinance-):
4. Neither the Disclosing Early. ATfilialedl.Utli'ty or Contractor, or-any of their employee's, officials.
- a geirts o r-p a rt iKM\sv i s-ba ira
engaging in or'being convicted of (l i bid-rigging in violation of 7.20 ILCS 5/33E-3." (2)'bid-rotaiing- 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 ijof any A-ffiliatcd Entity is listed on any of the following lists
maintained by llic Office of Forei^n/A^set^ of (lieTreasury'p"r--thc
Bureiiu of Industry and SecitritYof'th'c 'UiSr¦¦R^p^rfmc.nt'b'ffGsinn'iefCc' of their successors: ilicJSpociaIiy
Designated. Naiionajs-'Listyithc'''DcKidd^erSpns-'Ui'isi, the-Unverified List, die 'Entityr'L?isLraiid?ili6-
Dchaned List. >;
(r. Tlie Disclosiiig 'Party¦ u;h.diiVstaTids'fsiifyffIifil 1 c'dmpjyw'it.ti>tLii.j j:ipIicjihIe recjifii;eilVehts¦ f>f-CHIiapfcrs
2-5:5¦(¦Legislative. Inspector General);^ (Govefuinculiil,Elhics)'oj';(hc
Muii'icipai'Code ¦ ¦¦¦'' ' ''¦ r
7. If thc'Disclosing I'ariy is uniiblfc loiccriify to any of the above statements iii'thisPari B -(Further Certifications), the Disclosiiig Party iiiu'st "explain below:
, N/A _ J... .__ , ' .
Paget} of 13'
Il'ilio Idlers "NA." lhc word "None." or no response appears on lhe lines above, ii will be cone lusivel v presumed lhat the Disclosing Parly certified lo the above slalerneiiis.
M. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, thc following is a complete list of all current employees ofthe Disclosing Parly who were, at any time during the I 2-monih period preceding the execution date of this liDS. an employee, or elected or appointed official, ofthe Cily of C;hicago (if none, indicate with '"N/A" or "none"). N/A
9. To the best ofthe Disclosing Parly's knowledge after reasonable inquiry, thc following is a
complete list of all gifts that thc Disclosing Party has given or caused to be given, at any time during lhe
12-month period preceding the execution date of Ihis liDS, to an employee, or elected or appointed
official, of (he. City of Chicago, for purposes of Ihis -statement, a "gift" docs not include: (i) anything
made generally available to City employees or to the general public, or (it.) food or drink provided in the
course of official City business and having a retail value of less than S20 per recipient (if none, indicate
with "N/A" or "none1'). As to any gift listed below, please also list lhc name ofthe Cily recipient.
N/A :
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
Thc Disclosing I'ariy certifies that the Disclosing Party (check one)
| | is y is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Tarty IS a financial institution, then the Disclosing Party pledges:
"Wc arc not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. Wc further pledge thnt.none pfi-our afflliatcs is, and none of thctu 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 a ('filiate-of a predatory lender may result in thc loss ofthe privilege of doing business with the City."
If lhc Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a.predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary): N/A
Page 7 of 13
If ihe loners "NA." tin: word "None." or no response appears on the lines above, il will be. conclusively presumed lhal lhe Disclosing I'ariy certified.to the above sialemenis.
i:>. CERTIFICAI'ION REGARDING INTERES I IN CITY BUSINESS
Any words ur terms that arc defined in Chapter 2-1 56 of the. Municipal Code have, the same meanings when used in this Pan D.
In.accordance with Section 2-156-1 10 ofthe Municipal Code: Does any official or employee ol the City have a financial interest in,his or her own name or in the name of any other person or entity in the Matter?
1.1 Yes Ik) No
NOTE:; If you checked. "Yes" to Item D. I., proceed'to. Items D.2. and D.3. If you checked "No" io Item D. l proceed to Part E.
Unless sold pursuant io a process of competitive bidding, or otherwise-permitted, no City dueled 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 (he 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 laken:pursufuutp ihc,City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Docs the Mailer involve a City Property Sale?
IJ Yes [xj No
If you checked "Yes" lo Item D. I., provide the names and business addresses ofthe City officials or employees having such interest and identify .tlie nature, of such -interest:
Name 13ashless; Address Nature of Interest
4. The. Disclosing Thirty, further certifies that no prohibited financial interest in Ihe Matter will be acquired by; nny'Cii.y official or employee?
F CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please Check cither 1. or 2. below. If thc Disclosing Party checks 2., thc Disclosing Party must 'disclose below or in tin rmnchrficm so this EDS rd! iiMonivatiGii required by paragraph 2. failure to
Page .Sof 13
comply with ihcse disclosure rec.piirc-mcnls may make any conlracl entered inio with the City in eoitneeiion Willi the Matter voidable, by the Cily.
x I. The Disclosing I'ariy verifies that the Disclosing I'ariy has searched any and till records of lhe Disclosing I'ariy and any and all predecessor entities regarding records of investments oi profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued lo slaveholders lhal provided coverage for damage to or injury or death of their slaves), and ihe Disclosing I'ariy has found no such records.
_ 2. The Disclosing I'ariy verifies thai, as a result of conducting the search in step I above, the Disclosing. I'ariy has found records,of in vestments or profits from slavery or slaveholder insurance policies. The Disclosing I'ariy 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 -- CE.RTIFICAT.i.ONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If lhe Matter is nol federally funded, proceed to Section VII. For purposes of this Section. VI. tax credits allocated by the Cily and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING N/A
1. List below the names of all persons or entities registered under thc federal Lobbying Disclosure Act of 1995.who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter; (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" .or.-if the, word "None" appear, it will be conclusively presumed that lhe Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.).
2. The Disclosing Parly has nol spent and will .not expend any federally appropriated funds to pay any person or enlily listed in Paragraph A.L above for his or her lobbying activities or lo pay any person or enlily to influence or attempt to ini1.uen.ee 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 inio any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
3. The Dist losing I'ariy will submit an updated certification at the end ol each calendar quarter in '.'/Inch there occurs any event that materially affects the accuracy ofthe stalenu-nis and information *e( forth m paragraphs A.l. and A.2. above.
•). The Disclosing Party certifies thai, cither: (i) it is not an organization described in section 501(e)(4) ofthe Internal Revenue Code of 19S6: or(ii) il is an organization described in section 5111(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
5. If the Disclosing- PartyTs ihe-Applicant. the Disclosing Party inusi.ob't;iiii:ceftirications equal in form and substance: to paragraphs A.L. through A.4. above froth all subcontractors before it awards any subcontract and lbi> Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Ma tier, and must make sucly certifications promptly available lo the Cily upon request.
B. CbRT.IT I CATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If thc Matter is federallyfunded, federal regulations require the A pplicant:and ail proposed subcontractors to submit the following information With their bids or in writing at the outset of negotiations. t4l/
Is |hc--Disciosing Pariythe Applicant? --— - -- ----
[JYes []No If "Yes." answer Ihe three questions below:
Have you developed and do you have on file affirmative action programs-pursuant to applicable, federal regulations'? (See, 4 I tiiivR:Part 60-2.)
- IJYes " .[ ] No
Have you filed with the Joint Reporting Committee, the Director rd' the Officejof Federal C()idract Coriipliarice. Prqgiain/s, or'the Equal Employment Opportunity Conmiissi'on all reports due under ihe applicable filing requirements?
(' ] Ye"s- ¦ [T'No ,. '
Have you .participated in any previous contracts or subcontracts subject to the equal opportunity clause?
f ] Yes ' [l. No
If you-checked "NV to question Ivor 2. above, plenscpiovide an explanation:
Page lO-bf 13
SUCTION VII ~ ACKNOWU'CDCMENT.S, CONTRACT INCORPORATION, C ();VI VIA A N CI., I' I'", N A I.TIES, I) IS C I, O SURE
The Disclosing I'ariy understands ami agrees thai:
A Tlie certifications, disclosures, and acknowledgments contained in this EDS will become part ot'any couiract or mlicr agreement between the Applicant anil the City in connection with lhe-Mailer, whether procurement. Cily assistance, or olher Cily action.,and are material inducements to the Cily's execution of any conlracl or taking other action with respect to.the Matter. Thc .Disclosing.Parly understands that il must comply with all statutes, ordinances, and regulations on which this EDS is based.
13. The, City's Governmental Ethics.and Campaign Financing Ordinances, Chapters 2-1 56 and 2-164 of the Municipal Code, impose.certain duties and obl.igulidiis.ini persons or entities seeking Cily contracts, work, business, or transactions. The full IcxLdf these .ordinances and n (raining program is available on line al www.citvoI'diicago.or, and may also b'cobta'ined from ihe Cily's Board of Ethics, 740 N.
Sedgwick St., Suite 500. Chicago. IL 60610. (312) 744-9660. The Disclosing I'ariy must comply fully with lhc applicable ordinances.
If the City deienninus lhal 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 \ did or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded pr void), ai: law, or in equity, including terminating lhe .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 nf material fact may include incarceration and an award to the City of treble damages.
Ii is the City's policy to make this document available to (he public on its Internet site and/or upon request. Some or all of the information provided on ihis EDS and any attachnicnts to this EDS may he made available to the public on thc 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 Id verify the accuracy of any information, submitted in this EDS.
E. The information provided in this EDS must be kept.current. In the event of.changes, lhc 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 lei Article I uf
Chapter 1-23 ofthe Municipal Code (imposing IMiRMANENTINEEIGIRILlTY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required, by-Chapter, I-23 and.Section 2-1 54-020 of thc-Muincipal Code.
Thc Disclosing Pimy rep rose n is and'warrants thai:
Page 11 of 13
I-'. I. I he Disclosing Parly is no) delinquent in lhc payment of any tax administered by the. Illinois Department of Revenue, nor are Ihe Disclosing Party or its Affiliated F.ntilies delinquent in payiiu: any fine, fee. tax or other charge owed to the Cily. This includes, but is nol limited to. all water charges, server charges, license fees, parking tickets, properly (axes or sides taxes.
F.2 If the Disclosing Party is lhe Applicant, the Disclosing Party and its Affiliated Entities will not use. nor permit their subcontractors to use. any facility listed by thc U.S. 1Z.P.A. on the federal Excluded Parties List System ("EP1S") maintained'by. thclJ. S: General Services Administration.
I'.3 If the Disclosing Party is thc Applicant, the Disclosing Party will obtain from any conlraclurs/subconiraclors.hired or lobe hired iii connection with thc Matter certifications equal in form and suhsinnce lo those in and F.2. above aiid will not. without the prior written consent of ihe Cily. use any such contractor/subcontractor¦that|does noFprovidc such certifications.or (hat die Disclosing Parly has reason to believe has nol provided or cannot provide truthful certifications.
NOTE: If the Disclosing Parly cannot certify as to any ofthe items in I-". I F.2. or F.3. above, an explanatory, sluiemcni must be attached lo this EDS.
CERTIFICATION
Under penalty of perjury, the -.person signing, below: (I) warrants that.he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of thc Disclosing Party, and (2) warrants that all cenincaiions and siaicmcnls.cqnlfiincd in this EDS and Appendix A (if applicable) are true, accurate aiul complete as ofthe dale furnished'id the City.
PMG UV Investments, LLC
Noah Gottlieb : -. '
(Print or type name of person signing)
Manager iJLG CWy, A) :U-C , :&-> rVJ^y-r ((' TMC , IM-X
(Print or type title1 of personrsigning)
(state).
Signed and sworn to before nie on (date) -fry. A 3% TcAte
Couniy.
Notary Public.
^ OiVoi'OSSiOi't OXpifO.S*. 0./ < i .-• _~<':^\_
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL KELA 1 HONSHU'S W.ITH ELECTED CITY OFFICIALS AND DEPARTMENT MEADS
This Appendix is In lie .completed only by (a) (he Applicant, and,(b) any legal entity which has a dii ce( ownership.interest in lhc Applicant exceeding 7.5 percent. It is not to he completed liy.any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing-Party musl disclose whether such Disclosing Party or any ¦'Applicable. Parly'1 or any Spouse Or Domestic.PaitncrlhcrcnPcuiTciitly has a "Tamilial rejalionship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, ihe 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 ofthe following, whether by'hlond or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, sonrin-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or slepsister or half-hrdthcr or half-sister.
"Applicable Party'- means (I) all executive officers ofthe Disclosing Party listed in Section ll.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Parly is agcneral partnership; all general partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all 'managers; managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) till principal officers ofthe Disclosing^ Party:.and (3) any person having more than a 7.5 percent ow'hci'Shipi interest in the Disclosing Party. "Principal officers- means' the president, chief operating officer, executive director, chief-financial officer, treasurer or secretory of a legal entity or any person exercising similar authority.
Docs thc Disclosing Party or any "Applicable Patty" or any Spouse or Domestic Partner thereof currently have-a "familial relationship" with an elected city official or department head?
i; ) Yes i [xj No
If yes. please identify below Cf) the name and title of such person. (2) the/niiinc of the legal entity to which such person is-connected.; '('3)the ftatnc1 and title ofthe elected city pfficialordeptirtmcnt head to whom such person has a familial relationship, and (4) the precise nature of such '-familial relationship:
Page 13 of 13
CITY OK CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX II
BUILDING CODE SCOiTT.AVV/PROBI.EM LANDLORD CERTIFICATION
This Appendix is to Incompleted only hy 00 the Applicant, and (h) nny legal entity which lias: a'dircet. •' eis 11 i | V: i ii t cV c's |^ i rit t li 6 =A ip |) 1 i ca tit exceeding 7.5 percent (an "Owner")-It is not to he completed by aiiy legal entity which lias only an indirect ownership interest in (he Applicant.
INirs\iant to Municipal CbI I Ye. txlNo
(f-tlie-.Ap|iliuaitt.:ts';i legal entity piiblicly Inidcd on nny exchange,. isNany.otTiccr or director" of tlie A|)pliciintHdcn.tificd:'a's n^uijd tag, code scofflaw of problem lahcjlord pursuant to Section ?-92-4l6 ofthe Municipal Code?
-|. |-Yes -— r-- -| i -No- - -—|-X];NorApplicablc"-"
3; - If yes.lo(-E>,,;o.r'(2.) iibtiyc^pjciisc ly/-bc]lo.vy.fhe nnmc«o^lh.c.^crsQnlor;lc,gal entity
identified a.saTnhlding eo.^ ofthe buildingor
buildings to which the pertinent-code violations apply.
FILLING OUT THIS ATMMiNDlX: B CONSTITUTES ACKNOWI .IiDCMENT
ANUAGREEjyM
Ai^DTlJAT^Hji^
SUBJECT TOTfiE CERTiFicATION MADE UNDER PENALTY OF PEfUUKY ON PAGE 12 OF TME ASSOCIA I ED EDS.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/h/a; if applicable:
Li'tierTin. Mis&C/ LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: ' • J^i^'h*-' Applicant OR
2. | ] a legal entity holding a direct or indirect interest in thc Applicant. State (he legal name ofthe
Applicant in which the Disclosing Party holds an interest: ...
OR
3. [ j a legal entity with a right of control (sec Section 11.13.1.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: /// JL', lL%*fJ: / <••/•t)? A C/'/T-*- f
Telephone: ^ j).-1L^ ~)l&O Fax: \Q. Ok^Q/o? .Emailojf(j, &
Name of contact person :j/V^c; hat/ (~P /A'< ^/'t^
E. Federal Employer Identification No. (if you have one):|
- • —- j
Brief description of contract, transaction or other undertaking (referred to below as thc "Matter") to which this EDS pertains. (Include project number and location of property, if applicable) .
Planned Development application for property at 1350 S Union Ave
Which City agency or department is requesting this EDS? Department of Planning and Development
If the Matter is a contract being handled by thc City's Department of Procurement Services, please complete the following;
Specification tr and Contract #
Page 1 of 13
SECTION II DISCLOSURE OF OWNEUSHIP INTERESTS
A N ATUR Ii OF Till- DISC LOSING PARTY
[ ] Person
[ ] Publicly registered business corporation
f ] Pn\atciy¦ licl.il .business corporation-
( ] Sole proprietorship
[ ] General partnership
[ J Limited partnership
1 ] Trust
Pd"Limited liability company [ J Limited liability partnersliip [ J Joint venture j j Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))'
( ] Yes | | No
[ ] Other (please specify)
2. f or legal entities, thc stale (or foreign country) of incorporation or organi7aiion, if applicable:
3. For legal entities not organized in the Stoic of Illinois: Mas the organization registered to do business in the. State of Illinois as a foreign entity?
( ] Yes""" ( 1 No f 3 N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
I. 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 ail members, if any, which arc legal entities. If there arc no such members, write "no members." For trusts, estates or other similar entities, list below the legal tilleholder(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 bther person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE. Each legal entity listed below must submit an EDS on its own behalf.
2. Please provide llic 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 ;i corporation, partnership interest in a partnership or joint v enture.
Page 2 of 13
interc^ 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 2-1 54-030 of the Municipal Code of Chicago ('"Municipal Code"), thc 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
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-1 56 ofthe Municipal Code, with any Cily elected official in thc 12 months before the date this EDS is signed?
I J Yes j\fNo
If yes. please identify bclow'lhe namc(s) of such City elected officiates I and describe such rclationship(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party.iriust 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 thc relationship, and the total amount of the liiesi paid;of: estimaicd
"Lobbyist" means any;ncrs.on'-p:r-.ent!ty;.\vbovuridedake!; to influence any legislative or administrative
action on behlVii" df.anyip'e (I) a not-for-profit entity, on an unpaid basis, or (2)
himself. "Ld6byistv'ifsi»:.t^c.'?lh'sl d'ti'xpc*rson^6^^.Uty.any.part.of whose duties as an employee of
•another includes undcnKliing jo^nnu^^ or administrative action.
If the Disclosing Party is-unccrtain whether a disclosure is required under this Section,'the Disclosing Party must ciihefcask the City whether disclosure is required or make thc'discldsure.
Page 3 of 13
Name (indicate whether Business retained or anticipated Address to be retained)
Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)
Fees (indicate whether paid or estimated.) NOTE: "hourly rate" or "i.b.d." is not an acceptable response.
(Add sheets if necessary)
[ ] Check here if the Disclosing Party has not retained: noncxpecis to retain, any such"1 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
thc City must reniain ^
Has any person who directly, or indirectly owns 10% or moreof thc Disclosing Party been declared in arrearage ori.any child support obligations by any Illinois court of competent jurisdiction?
f) No person directly or indirectly owns 10% or more ofthe
Disclosing Party.
If *'Yes." .has the person'entered into a eourt-appro.vcd-agreement for payment of all support owed and is the. per'sori-in compliance .with ithat agreement?
... a
[JYes . (]No
B. FURTHER CERTIFICATIONS
I. 'P,ursuantt^ 1.-23; Article'I;("A'Aic]eT").(whicn the Applicant should
consult Tor,3efj.hed:|crnVf ic;'y0 "doing business") and legal requirements), if the Disclosing'Parly
submitiing tHis EDS is the Applicani and is doings business with the City, then the Disclosing Party
certifies as.fpllows: (I) neithcr. the Applicant nor any-controlling persqnTsxurrentiy indicted or charged
with, or'iias adiiiittcd.guilt of. or has .ever been convicted of; or placed under supcrvision-fqr,.ariy
criminal d'fl^ actuah alteiripted; or conspiracy to'commif^'ribery. theft;' fraud; forgery,
perjury, disKpn'esty.or deca empJoyee'bf'lh'el'Gity or any'sister agency; and (ii) the
Applicant und_brsirands and'Bcknowledges thai-compliance wiihvAniclc 1 is a continuing.-requirement for doing busines's'with thc City. NOTE: If Ariicle I applies .to the Applicant, the permanent compliance liinefraiiic in A rticle I supersedes'some five-year coinplianec timeframes in ecriificaiions 2 and 3 below.
Page 4 of 13
'I he Disclosing Puny and. if die Disclosing Pany is a legal emity, all of Uiose persons or entities identified in Section IJ.B.l. of (his f.DS:
u. 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 liDS. been convicted of a criminal offense, adjudged guilty, or had u 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:
arc not presently indicted for. or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of lhc offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default: and
c. have not, within a. five-year period precediiig .ihedatc of this EDS, been convicted, adjudged guilty, of found liable in a civil proceeding. or in any criminal or civil action.-.including actions concerning environmental violations, instituted by the City or by thc federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern;
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with thc Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and.Othcr Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls thc 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 limiutlion: interlockingninriitgctncnt bro.wnorsllip: idcritilyj'ii"f intcrests among family members, shared facilities and'cciuipnicnt:•common use o.^enipi^yge^rQl^rgahization of a business entity following the inelig.ihtliiy p.f a busihess.eritity to:dp-.^.s>ih.css-\5'Ulvfederal or state or local government, including the City, using substantially the same'-'m'anagcnVcnt; ownership, orprincipnls as the: itieligible entilyj; wjth respect to Contractors, the, term AffiliHte.d;iiiitit>';ineans n\persori or entity that directly or indirectly controls the Contractor, is controlled by it. or. wilh thc Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any olher official, agent or employee of lhe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant lo thc direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing I'ariy. nor any-C ohtiacior. .nor nnv A fi'i I iated Entity of cither the Di>ch.»shig Parly or any Contractor ni'u any Agents have, chiririg ihe In e wars before lhe date ihis liHS is <¦ iu'iicJ. <.u'. with respect to a Contractor, an Affiliated Entity, or an Affiliated liniiiy of a Contractor during the .five years he fore the date of such Contractor* ObAffiliaicd Entity's conlracl or engagement in connection with tlie Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, apublic officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state orlocal 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 collision among bidders or rr^^P«Su^.\*lj.d.derS. it* 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 thai is a matter of record, but have not been prosecuted for such conduct: or
violated the provisions of Municipal Gode'Scction 2-92-610 (Living Wage Ordinance!.
Neither the Disclosing Party,-Affiliatcd-Entit'y or Contraclor, or any of their employees, officials,
agcpts or' p^rlnersV;i^:barrcd-ffom ^ont^-gtingAVtm' any unit of state or local-government as a result of
engaging. ui br;:^ violation of 720 ILCS 5/33E-3; (2) bid-rotating in
violation of"720i;iL"CS 5/33E-4; or (o)fany,siniilar offeiise of any state oi-of the United States of
America lhuVcpn.tain>Vih'c.;i:amc elements as the offense of bid-rigging or bid-rotating.
^Vith^1f;tK&:pji.^Jc^in.^.piiriy nprany A ffiliated Entity is ijsted ondiiy of t'h^fdll^i m&iniaine^
Bureau of Industry and Security •iifetiiff.Ui'Si Department of-Gomin^rc^^ .ihe.;S^cjally
Designated Naiioh'alJ;^ UnvcnfiffrList,^ and .life
Debaned List.
The Disclosing Party understands and shall comply with thc applicable requirements of Chapters 2-55 (LegislativeInspector.General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal.C.bde.
7. If thc Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Ccrtificaiions). the Disclosing Party must explain below:
il llic letters "NA," lhe wore! ''None." or no response appears on the lines above, it will be eonclusiveh piesumcd that the Disclosing Patty certified to the above statements.
8. To ihe best of ihe Disclosing Parly's knowledge after reasonable inquiry, thc following is a complete list of all current employees ofthe Disclosing Party who were, at any lime during lhe 12-month period preceding lhc execution date of this LDS, an employee, or elected or appointed official, of the Cily of Chicago (if none, indicate with "N-A" or "none").
9. To ihe best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall gifts that the Disclosing Party has given or caused to be given, at any time, during the 12-month period preceding thc execution dale 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 (he general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than S20 per recipient (if none, indicate with "N/A"' or "none"). As to any gift listed below, please also list thc name of the City recipient.
zzzzizz^g^zz: zzz:zzzzzzzzz
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
Thc Disclosing Party certifies that the Disclosing Party (check one)
f. ] is a "financial institution" as defined in Section 2-32-455(b) of lhc Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"Wc are not and will not become a predatory lender as .defined in Chapter 2-32 ofthe Municipal Code. Wc further pledge that none of our affiliates is, and.none of them will become, a predatory lender as delTneU in Chapter 2-32 of the Municipal Code, We understand that becoming a predatory lender or becotiviin^:an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosiiig Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-.v2-45.5tbj of the Municipal Code) is a predatory lender within the meaning of Chaptor 2-32 ol'the Municipal Code, explain here-| attach additional pages if necessary}:
Page 7 of 13
tf iho 1ctiers. "NA." lite wotd "None." or no response appears on the hues above, ii will be conclusively presumed thai the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that arc defined in Chapter 2-15.6 ofthe Municipal Code have the same meaning}, when used in this Part-D.
In accordance with Section 2-156-1 10 of the Municipal Code: Does any official or employee of thc City have a financial interest in his or her own name or in thc name of any.other person or entity in thc Matter?
f. 1 Yes ])(No
NOTE:: If you checked "Yes" to" Item D. i proceed to Items D.2. and D.3. If you checked "No" to lieni D. I proceed to Part E.
Unless sold pursuant to a'process of competitive bidding, or otherwise, permitted, no City
elected official or employee shall have a financial interest in his oi her own name or in "he name of
any other person or entity in ihc^puf^ that (i) belongs to the City, or-(ii) is sqld
for taxes or assessments, or (iiij is:Sold>y 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.intcrcsl-within the meaning of this Part D.
Docs the Matter involve a City Property Sale?
| ] Yes []No
If you checked "Yes"to-Itcm;D.L. provide the names and business addresses ofthe City officials or employees havingsuchjhtercst .and'identify the nature of such interest-
Name Business Address Nature, of Interest
4. The Disclosing Parly further certifies that no prohibiicd.financial interest in lhc Mailer will be acquired'by any City'official6r-*c'iVfpl6y.e.e.
E. CERTIFICATION REGARDING: SLA VERY ERA BUSINESS
Please check either !. or 2. below., [f the Disclosing Party cheeks 2 the Disclosing Parly must disclose below or in an attachment to this EDS all information required by paragraph 2. f ailure to
Page 8 of 13
comply u iih these disclosure requiiemciu.s may make any contract entered into w itli the City in connection with the Mailer voidable by the City.
2\ I. The Disclosing Party verifies lhat thc Disclosing Patty has searched any and all records of the Disclosing Party and any and till predecessor entities regarding records of investments or profits irony slavery or rlaveh'olde.r insurance'policies during thc slavery era (including insurance policies issued to:slave!ioldcrs that provided coverage fordamage to or injury or death of their slaves), and the Disclosing Parly has found no,such records.
2. The Disclosing Party verifies that, as a result of conducting thc 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 fedcraMy;furided|.complctc this: Section VI. If the .Matter is.not federally funded, protced to Section VIE For purposes of this Section VI, tax credits allocated by thcXity and proceeds of debt obligations of the City arc not federal funding.
A. CERTIFICATION REGARDING LOBBYING
I. List below thc names of all persons or entities registered under thc federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of thc Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins oh the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed thai the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of thc Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.L above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency,-as defined by applicable federal law. a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grain or loan, entering ihlo any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, gram. loan, or cooperative agreement.
Page 9 of 13
Die Disclosing i'ariy will submit an updated certification at the end of e.vh calendar quarter in which there occurs any event that materially affects ihe accmacy of the staiemenis and information set forth in paragraphs A.l. and A.2. above.
Thc Disclosing Party certifies that either: (i) it is not an organization described in section 501 (c)(4) ofthe internal-Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has nol engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is thc Applicant, thc 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 Disc-losing Party must maintain all such subcontractors' certifications for the duration of thc Matter and must make such ecriificaiions promptly available to lhc City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal rcgulaiions.rcquirc the Applicant and all proposed
subcontractors to submit thc following information with their bid? or in writing ai thc outset of
negotiations ._ _ _ - -•- — -
Is thc Disclosing Party the Applicani?
( ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on'file affihnative.actipn programs pursuant to applicable federal regulations? (Sec 41 CFR Part 60-2.)
t 1 Yes f]No
Have ypu filed with the Joint Reporting Committee, the Director of the Office of Federal Clpntraci Compliancei: "Progratfi?.'.or the'Equal Employment Opportunity Commission all reports due liniler tlie applicable jilihg'fcrfritrenicrits?
[JYes [ ] No
Have ypii participated in any previous coniracts or subcontracts subject lo the equal opportunity clause?
[ jYes ( ] No
If you checked "No" to question I. or .2. above, please p f o v i d e" a n c x p I a n a i i d n:
Page 10 of 13
SECTION N'H -- \CK N O W E E DC M E \ T S. CONTRACT INCOU POR.VTION. COM P EIA N CE, PE N AETIES. DISCLOSE R E
The Disclosing Pany understands and agrees that:
A The ecriificaiions. disclosures, and acknowledgment contained in this F.DS will become part of any contract or other agreement between the Applicant and lhc City in connection with the Matter, whether procurement. City assistance, or other City action, and arc material inducements to thc City's execution of any contract or taking other action with respect to the Manor. The Disclosing Party understands that it musl comply with all statutes, ordinances, and regulations on which this EDS is based.
13. The Ciiy's Governmental Tillies and Campaign Financing Ordinances, Chapters 2-1 5 ft'and 2-1 <)4 of the Municipal Code, impose certain dulics and obligaiimis on persons or eniities .seeking City coniracts. work, business, or transactions. The full-text of these ordinanccs-and a (raining program is avnilable-oii line al .vv\v'w.citvofchicatio.ori>.'Ethic.s. and may also be obtained from the City's'Board of Ethics. 740 N.
Sedgwick St., Suite 500. Chicago. IL 60610. (312) 744-9660. Thc Disclosing Parly must comply fully with lhc applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and thc City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in thc Matter and/or declining to allow the Disclosing Pany 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 thc City of treble damages.
It is thc City's policy to make this document available to thc public on ils Internet site and/or upon request. Some or all ofthe 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 thc City in connection with the public release of information contained in this EDS and also authorizes thc Cily to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on lhc Matter. If thc Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE-: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (iuiposing:PERM ANENT INELIGIBILITY for certain specified
offenses), the information.providcd herein regarding eligibility must be kepi current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 ofthe .Municipal Code.
Thc Disclosing Party represents and warrants that:
Page I I of 13
F.l. Thc Disclosing I'ariy is nol delinquent in the payment of any inx administered by the Illinois Department of Revenue, nor are the Disclosing Parly or ils Affiliated Entities delinquent in paying any-fine, fee. tax or other charge ow ed to the City. This includes, but is not limited to. all w ater charges, sewer charges, liccnsc-fccs. parking tickets, properly taxes or sales taxes.
F.2 lfthc Disclosing Party is the Applicant, the Disclosing "Party and.its Affiliated Entities will not use. nor.permit their subcontractors to use. any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPES'') maintained by the U. S. General Services Administration.
F.3 If the Disclosing.Parly'isithe Applicant. the Disclosing Party will obtain from any cpniractors/subconiractors,hired or to be hired in connection with the Matter certifications equal in fonnratfd substance to .those inF. 1. and.F.2- above and will not, Without the prior written conseni of the City, use'-any such eontraelor'subconiractor-lhai 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 ofthe items in 1.1., F.2. or F.3. above, an explanatory statement must be attached to this F.DS.
CERTIFICATION
'Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute
thisVEDS^and'Appehdjx A and (2),warrants that all
cch7llc'$itioris:and'statements contained in this EDS and Appendix A (if applicable) arc true,accurate and complete as df"ihe"'dafc furnished to the City.
Lj^/jru tic
¦{¦P)m'.t;0^y^
(Print prty^
(Print .or type title of person -signing)
Signc'd and sworn to before me .on,(d«tlc) Ujfhj^. jJt^_'&A.fa
Notary Public. i ,,,; oubik^^.pi:
/Corrrnii::yipn E^pirtis- -j
'" OpnCIAL.P/EAl { v.-^srsf.NE-P.'tvilSKELl 1
Xj: . . .: I ft c , V Mv Cwnmissipn*
Commission tvxpircs:^^,^, S^ggHp. \ ...^J£iif&&~<*'*
Page 12 of 13
CITY Ol- CHICAGO ECONOMIC DISCLOSURE .STATEMENT A.M.) AI II DAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is lo be completed onlv by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in ilic.AppHcani exceeding| 7.5 percent. It is' not to he completed b\ any legal entity which has only an indirect jpvncrsliip inft'rtfSt in the Applicant.
Under Municipal Code Section 2-154-015. the Disclosing Party musl disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city otTicia) or department head. A "familial relationship" exists if. as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Part/' or anySpousc or Domestic Partner thereof is related to the mayor, any alderman, thc city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following: whether hyblood or adoption; parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law. mother-in-law. son-in-lnuvdaughter-in-law', stepfather or stepmother, stepson or M'e^atigBtcy^sti'pbmthcr-tu'istppsisicr or half-broihei orhaif-sisicr.
"Applicable Parry" means (1) all executive officers of the Disclosing Pany listed in Section II.B.l.a., if the Disclosing Party is a corporation: all partners of lhc Disclosing Party, if the Disclosing Party is a general partnership; all general partners, and'limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing, members and members ofthe Disclosing Pany. if the Disclosing Party is a limited liability company; {2).a'i)Does thc Di.sclosing.Party or any "Appiicablc"PartyM or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city* official or department head'.'
[. ] Yes j^No
If yes. please identify below (I') the name and title of such person, (21 thc name ofthe legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX B
BUILDING CODE SCOFFLAW/I'ROBLEM LANDLORD CERTIFICATION
T^lns.Ar^ only by (n) -tlic.-A>plicant;.-arid!(bViari'y.lc'«al Vtiikfity'
wtiich.baV^ in tluy Applicant evct'cdini; ~;5-.percent (an •Vp>viicr''o.
If-is1 1-"t«»J:t>"j!.Tt'-titiV|il«itTtlVl>y• tiii\^Ic;iI C-ntity;.yv'litch^hrts 0ryl<¦ an indirect ownership iiiter.es ( in the Applicant.
1. Pursuant to MunicipalCodc-Section 2-154-O10; is die Applicant or any Owner identified as a building code scofflaw-or problem landlord pursuaiu to Section 2-92-41.6 of the Municipal Code?
[ JYes ¦ .kyfcb
. If'ihivApj^icanf is'g;lrgal cntiiypubliclwiradcd on any exchange, in 7iny oiTlccr or director of
¦uSe»Appljcapj2-9^40'pfiHeM
[ JYes I )No jAf^01 Applicable
H)>'es 'u>:7( I) -fir. '(2') ;3 la pvc^ ¦ p l (»scV id cm j.! "y. .be j p w -.ihe name ofinc person or legal entity ${i£n(i(i$ii;as {a^ildi^^Q^^lila^ or problem: landlord and the address of the-building or b'uilqings: to-i*!ticfi''tKtfp^ninVnt code violations'aprjl>
FILLING O UT THIS APPENDIXB CONSTITUTES ACKN'O WLEDjGMENT AND AGREEMENT THAT THIS APPENDIX B ES INCORPORATED 13 V REFER^jNtE IjNiPj AND MADE A'PART OF, THE ASSOCIATED EDS,
AjNd.t-hXt^t^ B A RE
SU.^£f:^ PENALTY OF
PER'JUR-Y-'6l^/PAGE''l2 OF THE ASSOCIATED EDS.
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