SUBSTITUTE NOT FOR PROFIT VACATION ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VII, Section 6(a), of the 1970 Constitution of the State of Illinois, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the City wishes to support the charitable, educational and philanthropic activities of not-for-profit corporations and encourage the continued viability and growth of such corporations; and
WHEREAS, many not-for-profit corporations own property that adjoins streets and alleys that are no longer required for public use and might more productively be used in furtherance of such activities; and
WHEREAS, the City benefits from the vacation of such streets and alleys because it: (a) reduces City expenditures for maintenance, repair and replacement; (b) reduces fly-dumping, vandalism and other criminal activity; and (c) provides support for charitable, educational and philanthropic activities; and
WHEREAS, when the City vacates streets and alleys that revert to ownership by not-for-profit corporations engaged in charitable, educational and philanthropic activities, the City obtains additional benefits by building stronger, more productive communities and by facilitating the provision of social services by such not-for-profit corporations; and
WHEREAS, the City Council has determined that due to the aforementioned additional benefits it is in the public interest to vacate the public way without compensation, where the abutting owner is a not-for-profit corporation engaged in charitable, educational and philanthropic activities; and
WHEREAS, the properties at 5441-5461 W. Lake Street and 332-346 N. Lotus Avenue, are owned by PCC Community Wellness Center, an Illinois not-for profit corporation ("Developer"); and
WHEREAS, Developer proposes to use the portion ofthe public alley herein vacated for the construction of a new primary care medical center with support services and accessory parking, which will benefit the local, medically-underserved community; and
WHEREAS, the City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent of the public use and the public interest to be subserved is such as to warrant the vacation ofthe part of the public alley described below; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. Legal Description
Vacation of: THAT PART OF THE NORTH-SOUTH 12.50 FOOT WIDE PUBLIC ALLEY IN BLOCK
2 OF FRINK'S RESUBDIVISION OF THE NORTH 36 AND 1/4 ACRES OF THE EAST HALF OF THE SOUTHEAST QUARTER OF SECTION 8, AND THE NORTH 36 AND 1/4 ACRES OF THE WEST HALF OF THE SOUTHWEST QUARTER OF SECTION 9, ACCORDING TO THE PLAT THEREOF RECORDED DECEMBER 15, 1875 AS DOCUMENT NUMBER 62995 BEING DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTHEAST CORNER OF LOT 1 (BEING ON THE WEST LINE OF SAID NORTH -SOUTH 12.50 FOOT WIDE PUBLIC ALLEY) IN E. CRAFT'S SUBDIVISION OF THE NORTH 380.75 FEET OF THE WEST HALF OF SAID BLOCK 2, ACCORDING TO THE PLAT THEREOF RECORDED APRIL 11,1876 AS DOCUMENT NUMBER 80438; THENCE NORTH 01 DEGREE 53 MINUTES 18 SECONDS WEST, ALONG THE EAST LINE OF SAID LOT 1, 60.00 FEET TO A LINE 55.00 FEET SOUTH OF AND PARALLEL WITH THE NORTH LINE OF SAID BLOCK 2 IN FRINK'S RESUBDIVISION; THENCE NORTH 88 DEGREES 20 MINUTES 35 SECONDS EAST ALONG SAID PARALLEL LINE, 12.50 FEET TO A LINE 175,00 FEET WEST OF AND PARALLEL WITH THE EAST LINE OF SAID BLOCK 2; THENCE SOUTH 01 DEGREE 53 MINUTES 18 SECONDS EAST ALONG SAID LINE PARALLEL WITH THE EAST LINE OF SAID BLOCK 2, 60.00 FEET (SAID LINE ALSO BEING THE EAST LINE OF THE 12.50 FOOT WIDE PUBLIC ALLEY) TO A POINT OF INTERSECTION WITH THE SOUTH LINE OF SAID LOT 1 EXTENDED EAST; THENCE SOUTH 88 DEGREES 36 MINUTES 01 SECOND WEST ALONG SAID SOUTH LINE OF LOT 1, EXTENDED EAST, 12.50 FEET TO THE PLACE OF BEGINNING, ALL IN TOWNSHIP 39 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN IN COOK COUNTY, ILLINOIS. VACATED PARCEL CONTAINING 750 SQUARE FEET (0.0172 ACRES), MORE OR LESS, IN COOK COUNTY, ILLINOIS, as shaded and legally described by the words "HEREBY VACATED" on the plat hereto attached as EXHIBIT A, which drawing for greater clarity, is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacation.
SECTION 2. The Commissioner of the Department of Transportation is hereby authorized to accept and approve, subject to the approval of the Corporation Counsel as to form and legality, a redevelopment agreement or similar instrument restricting the use and improvement of the public way vacated in Section 1 of this ordinance to social service purposes which include, but shall not be limited to, the provision of medical care and associated support services and for such use and improvements that are accessory, as that term is defined in the Chicago Zoning Ordinance, such uses and improvements to be owned and operated by a non-for-profit corporation. The redevelopment agreement or similar instrument shall provide that the public way herein vacated shall revert to the City, subject to the terms and conditions of the dedication by which it has been heretofore held by the City, if Developer or its successors or assigns breaches the use restriction set forth in this Section 2 during the 40-year period commencing on the date of the recording of such document. The use restriction shall remain in place into perpetuity unless released by the City subject to the payment by Developer or its successors or assigns of appraised compensation to the City.
SECTION 3. The vacation herein provided for is made under the express condition that Developer, and its successors and assigns, shall hold harmless, indemnify and defend the City from all claims related to said vacation.
SECTION 4. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance Developer shall file or cause to be filed for recordation in the Office of the Cook County Clerk / Recordings Division, a certified copy of this ordinance, together with a redevelopment agreement or similar instrument complying with Section 2 of this ordinance and as approved by the Corporation Counsel as to form and legality, and the
attached plat as approved by the Department of Transportation's Superintendent of Maps and Plats.
SECTION 5. This ordinance shall take effect and be in force from and after its passage and publication. The vacation shall take effect and be in force from and after the recording of the published ordinance, redevelopment agreement or similar instrument, and approved plat.
Commissioner of Transportation
Introduced By:
Honorable Alderman Emma Mitts Alderman 37th Ward
CDOT File Number: 09-37-22-4013
Vacation Approved:
Gia Biagi
Commissioner of Transportation
Introduced By:
arable 7-Maerman 'Alderman 37(h Ward
CDOT File Number: 09-37-22-4013
W. LAKE STREET
CITY OF CIIICAGO
*
CHICAGO DEPARTMENT OF TRANSPORTATION
I 1/10/2022
Cclia Meza Corporation Counsel Room 600 - Ciiy Hall Chicago, IL 60602-1289
Attention: Lisa Misher Deputy Corporation Counsel
Re: FCC Community Wellness Center
NFP File: 09-37-22-4013
Dear Ms. Mcza:
Pursuant to a request from Ms. Toni Hush (PCC Community Wellness Center, wc are transmitting herewith for submittal to the next available City Council session a proposed vacation of a poition ofthc N-S alley in the block bounded by VV. Lake Street, VV. Fulton Street, N. Pine Street and N. Lotus Avenue. This property is located in the 37th Ward.
PCC Community Wellness Center is ihc owner of record to the properties adjoining the deadended public alley to be vacated. The people to contact in connection with this proposed ordinance are Ms. Toni Bush at 708-383-0113 and Mr. Patrick Thompson at 773-561-1987.
A redevelopment agreement with the developer is mandated in Section 2 ofthc ordinance in keeping with the conditions ofthe NFP Vacation Program. All utilities are either not involved or have made suitable arrangements. Sections 3, 4 and 5 arc standard language regarding recording.
Sincerely,
William Higgins
Program Manager
Division of Project" Development
WH: RD
cc:
Alderman Emma Mitts (37) Alderman Howard Brookins Sandra Foreman. Maps & Plats
7 MOUTH I. A T. A ! 1 (¦ SII?HF:Y Mil IF 11IO CHICAGO IL GOGU2
CERTIFICATE OF FILING FOR
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT
EDS Number: 175986 Date of This Filing:09/09/2022 02:15 PM
Certificate Printed on: 09/09/2022 Original Filing Date:09/09/2022 02:15 PM
Disclosing Party: PCC Community Wellness Title:Presidcnt & CEO Center
Filed by: Ms. Toni Bush
Matter: Proposed vacation of an alley adjacent to the properties commonly known as 5441-5461 W. Lake Street and 332-346 N. Lotus Avenue
Applicant: PCC Community Wellness Center Specification //: Contract it:
The Flconomic Disclosure Statement referenced above has been electronically Filed with the City. Please provide a copy ofthis Certificate of Filing to your city contact with other required documents pertaining to the Matter. For additional guidance as to when to provide this Certificate and other required documents, please follow instructions provided to you about the Matter or consult with your City contact.
A copy ofthc EDS may be viewed and printed by visiting and entering the EDS number into the EDS Search. Prior to contract award, the filing is accessible online only to the disclosing party and the City, but is still subject to the Illinois Freedom of Infonnation Act. The filing is visible online to the public after contract award.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT and AFFIDAVIT Related to Contract/Amendment/Solicitation EDS # 175986
SECTION S - GENERAL INFORMATION
Legal name of the Disclosing Party submitting the EDS: PCC Community Wei iness Center
Enter d/b/a if applicable:
The Disclosing Party submitting this EDS is: the Applicant
Business address ofthe Disclosing Party:
14 Lake Street Oak Park , II , 60302 United States .
Telephone: 708-524-7678 Fax:
708-383-1378
Name of contact person: Ms. Toni Bush
F. Brief description of contract, transaction or other undertaking (referred to below the "Matter") to which this EDS pertains:
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Proposed vacation of an alley adjacent to tlie properties commonly known, as 5441-5461 W. Lake Street and 332-346 N. Lotus Avenue
G. Which City agency or department is requesting this EDS?
DEPT OF TRANSPORTATION
Specification Number
Contract (PO) Number
Revision Number
Release Number
User Department Project Number
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
NATURE OF THE DISCLOSING PARTY 1. Indicate the nature ofthe Disclosing Party: Not-for-profit corporation
Is the Disclosing Party also a 501(c)(3) organization? Yes
Is the Disclosing Party incorporated or organized in the State of Illinois?
Yes
DISCLOSING PARTY IS A LEGAL ENTITY: 1.a.1 Does the Disclosing Party have any directors?
Yes
1 .a.3 List below the full names and titles of all executive officers and all directors, if any, of the entity. Do not include any directors who have no power to select the entity's officers.
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Officer/Director:
Title:
Role:
Dr. Paul Liming Chief Medical Officer Officer
Officer/Director:
Title:
Role:
Mr. Ron Austin
Board of Directors Member
Director
Officer/Director:
Title:
Role:
Dr. Carolyn Fitzpatrick
Board of Directors Chairperson.
Director
Officer/Director:
Title:
Role:
Dr. Kenneth Blair ^
Board of Directors Treasurer
Director
Officer/Director:
Title:
Role:
Officer/Director:
Title:
Role:
Officer/Director:
Title:
Role:
Officer/Director:
Title:
Role:
Officer/Director:
Title:
Role:
Officer/Director:
Title:
Role:
Officer/Director: Title:
Mrs. Barbara Diggins Board of Directors Member Director
Mrs. Velda Brunner Board of Directors Member Director
Mrs. Teresa Reyes
Board of Directors Vice Chairperson
Director
Mrs. Patricia Ford
Board of Directors Member
Director
Mr. John McDonnell Board of Directors Member Director
Ms. Mariana Osoria
Board of Directors Secretary
Director
Mr. Patrick Garrick Chief Financial Officer
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Officer
Officer/Director:
Title:
Role:
Ms. Toni Bush President and CHO Officer
Officer/Director:
Title:
Role:
Officer/Director:
Title:
Role:
Mrs. Sara Mogue
Chief Performance Improvement Officer Officer
Ms. Wrenelha Julion Board of Directors Member Director
Officer/Director:
Title:
Role:
Mr. .Icrrard Walker
Chief Population Health Officer
Officer
Officer/Director:
Title:
Role:
Ms. Nilsa Campos Chief Operating Officer Officer
1.a.5 Are there any members ofthe not-for-profit Disclosing Party which are legal entities?
No
SECTION 111 -- INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the 12-month period preceding the date ofthis EDS?
No
Does the Disclosing Party reasonably expect to provide any income or compensation to any City elected official during the 12-month period following the date ofthis EDS?
No
D. Does any City elected official or, to the best ofthe Disclosing Party's knowledge after reasonable inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in Chapter 2-156 ofthe Municipal Code ("MCC")) in the Disclosing Party?
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No
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156). accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
1. Has the Disclosing Party retained or does it anticipate retaining any legal entities in connection with the Matter?
Yes
2. List below the names of all legal entities which are retained parties.
Name:
Anticipated/Retained: Business Address:
Relationship:
Fees
($$ or %): Estimated/Paid:
Manske Dieckmann Thompson PLLC Retained
4629 North Broadway Chicago, IL 60640 United Slates
Other
$3,400
Estimated
Name:
Anticipated/Retained: Business Address:
Vanderslappen Land Surveying, Inc. Retained
1316 N.Madison Street Woodstock, IL 60098 United States
Relationship:
Fees
($$ or %): Estimated/Paid:
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3. Has the Disclosing Party retained or does it anticipate retaining any persons in connection with the Matter?
No
SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415. substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage of any child support obligations by any Illinois court of competent jurisdiction?
Not applicable because no person directly or indirectly owns 10% or more ofthe Disclosing Party
FURTHER CERTIFICATIONS
[This certification applies only if the Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date ofthis EDS, neither the Disclosing Party nor any Affiliated Entity has engaged, in connection with the performance of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e. an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract in progress).
This matter is not a contract handled by the Department of Procurement Services
The Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
I certify the above to be true
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) ofthis EDS:
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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, during the 5 years before the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, cr found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
I certify the above to be true
The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapter 2-56 (Inspector General) and Chapter 2-156 (Governmental Ethics).
I certify the above to be hue
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor, nor any Agents have, during the 5'years before the date ofthis EDS, or, with respect to a Contractor, an Miliated.EnJLty, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
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d. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage): (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
I certify the above to be true
Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of
bid-rigging in violation of 720 ILCS 5/33E-3;
bid-rotating in violation of 720 ILCS 5/33E-4; or
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.
I certify the above to be true
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
I certify tlie above to be true
[FOR APPLICANT ONLY]
Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] ofthe Applicant 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
the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City.
NOTE: If MCC.Chapter 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
1 certify the above to be true
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM")
1 certify the above to be true
10. [FOR APPLICANT ONLY] The Applicant will obtain hotn any contractors/
subcontractors hired or to be hired in connection with the Matter certifications equal in
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form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
I certify the above to be true
To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the date ofthis EDS, an employee, or elected or appointed official, of the City of Chicago.
None
To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at anytime during the 12-month period preceding the execution date ofthis EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes ofthis statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law.
None
CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies, as defined in MCC Section 2-32-455(b). the Disclosing Party
is not a "financial institution"
CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
1. In accordance with MCC Section 2-156-110: To the best ofthe Disclosing Party's knowledge after reasonable inquiry, does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
No
CERTIFICATION REGARDING SLAVERY ERA BUSINESS
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If the Disclosing Party cannot make this verification, the Disclosing Party must disclose all required information in the space provided below or in an attachment in the "Additional Info" tab. Failure to comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
I can make the above verification
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
Is the Matter federally,funded? For the purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
No
SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, pr other ' City action, and are material inducements to the City's execution of any contract
or taking other action with respect to the Matter. The Disclosing Party understands .that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of this ordinance and a training program is available on line at www.cityofchicago.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 this ordinance.
I acknowledge and consent to the above
The Disclosing Party understands and agrees that:
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/ or declining to allow the Disclosing Party to participate in other City transactions. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23, Article
I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
I acknowledge and consent to the above
APPENDIX A - FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-015. the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild,
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father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable.Party" means (1) all executive officers ofthe Disclosing Party listed in Section II.B.I.a, if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
No
APPENDIX B - BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
1. Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416??
No
APPENDIX C-PROHIBITION ON WAGE & SALARY HISTORY SCREENING
This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www.amlegal.com ), generally covers a party to any agreement pursuant to which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises.
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On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385, I hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(1) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(1).
Yes
ADDITIONAL INFO
Please add any additional explanatory information here. If explanation is longer than 1000 characters, you may add an attachment below. Please note that your EDS, including all attachments, becomes available for public viewing upon contract award. Your attachments will be viewable "as is" without manual redaction by the City. You are responsible for redacting any non-public information from your documents before uploading.
List of vendor attachments uploaded by City staff None.
List of attachments uploaded by vendor None.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable appendices, on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all applicable appendices, are true, accurate and complete as ofthe date furnished to the City. Submission of this form constitutes making the oath associated with notarization.
Is! 09/09/2022
Ms. Toni Bush
President & CEO
PCC Community Wellness Center
This is a printed copy ofthe Economic Disclosure Statement, the original of which is filed electronically with the City of Chicago. Any alterations must be made electronically, alterations on this printed copy are void and of no effect.
13 or 13