ORDINANCE :. , . • . Q03~ 2Sot 'Z-OUZ
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: '
•\ SECTION 1. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the B1 -2 Neighborhood Shopping District symbols and indications as shown on Map No. 1 -G in the area bounded by
West Chicago Avenue; a line 72 feet west of and parallel to North Ada Street; The alley next south of andparallel to West Chicago Avenue; a line 96 feet west of arid parallel to North Ada Street.
to those of a B2-3 Neighborhood Mixed-Use. District.
! ,a SECTION 2. This ordinance shall be in force and effect from and after its passage and due
publication. . 'v.''
Common Address of Property: 1361 West Chicago Ave. Chicago IL 60642
CITY OF CHICAGO
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS ofthe property Applicant is seeking to rezonc: 13 61 W. Chicago'Ave. Chicago IL 60642
Ward;Number that property is located in: 27 APPLICANT Ali Manesh :
ADDRESS 136 7 W. Chicago Ave.
STATE IL ZIP CODE 6 0642
EMAIL ali@manesh. org CONTACT PERSON Al 1 Manesh
NO
4. • Is the applicant the owner ofthc property? YES x
If the applicant is not the owner of the property, please provide the following Information •
regarding the owncr.and attach written authorization from the owner allowing the application to
proceed. \. ¦ ¦ ¦
OWNER
'ADDRESS
STATE
EMAIL
If the Applicant/Owner of the property has. obtained"a lawyer as their representati ve for the
rezoning, please provide the following infonnation: ...
^_ STATE, . FAX
ATTORNEY ADDRESS_ CITY
EMAIL
ZIP CODE
PHONE
"Page 1
6. , 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.
y'jly :' On what date did the'owner acquire legal title to the subject property? 10-13 -2021
'. ;:8.;, . Has.the present owner previously-rezoned this property? If yes, when?
ym:::\'4::-' w-. ; ' no * '¦•¦'¦.;¦ :' :' . ¦'
]']¦'. 9: : Present Zoning District'B1 2 ¦ Proposed Zoning District B2 3
Lot size in square feet (or dimensions) 24' x 92' total. o£ 2'208 SFT - ' :
11. Current Use of the property Vacant Lot ¦ . ^ : .
¦- ' 12:' RfeaSOn for rezoning the property "° meet the bulk and density requirements of the proposed
- ¦ B2-3 to construct a new mixed-use commercial & 4 dwelling unit\building.
¦ Describe the proposed use of the property after the; rezoning. Indicate the number of dwelling ) .-¦V.'., -'Units; number of parking, spaces; approximate square fopjtagc.-of any commercial space; and -
' height ofthc proposed building. (BE SPECIFIC) V' ;;.' :.:"/...;'.
¦ ,! ' To meet.the bulk• and density of. the proposed B2-3 to construct a'.new mixed-use building with'; ' ' ¦¦';-¦' . a-501. height, a 640 sft.commercial officespace and 4 dwelling units. Also include will be . .\ ¦ 'j',.--' • .' seeking relief for.the reduction; of the required .on-site parking spaces from 4 to 2. (as per'
Transit Served Location per .section 17-10-0102-B) , and provide-4-bike spaces. In addition,',
will be seeking variance for a i71 setback instead of 30' to better match with east, and west
i ': neighbors (both have zero setback) .• ¦' ' .''''
: The Affordable Requrements Ordinance (ARO) requires on-site affordable housing units arid/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 pf units, (see attached fact shcct.or visit www.cityofchicagp.org/ARO for more.information). Is this project subject to the ARO? ¦
YES NO X '-\ . ¦ : "': \V,'"': .
Page.2
COUNTY OF COOK STATE OF ILLINOIS
_, being first duly sworn on oath, states that all of the above
^statements and the statements contained in the documents submitted herewith are true and correct.
Signature of Applicant
;:;'Sjjbsflrjbcd and Sworn to hefore me this. ' ¦
•^Ppf davofMrXkr : ,2o2Z
OFFICIAL SEAL
AKARIA PEEPLES BABBS ' ,
NOTARY PUBLIC. STATE OF ILLINOIS.; MY COMMISSION EXPIRES 05/05/2026 ,,
Date, of Introduction:
File Number:_
Ward:
Topographical Condominium, Site Plans
Of SURVEY
. Residential * ¦'.:¦¦¦'.<¦¦
ALTA
Tel. 815 485-0445 Fax 815 485-0528
commercial Studnicka and Associates, Ltd.
studnicka2000@gmail. com
17901 Haas Road Mokena, Illinois 60448
LOT 4 IN BLOCK 5 IN TAYLOR'S SUBDIVISION OF BLOCK 1 IN THE ASSESSOR'S DIVISION
OF THE EAST 1/2 OF THE NORTHWEST 1/4 OF SECTION 8, TOWNSHIP 39 NORTH,
i'*;". H. RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
W. CHICAGO AVE.
CROSS KDTCI 4.00N
24.04*
|1010|
LOT 4
'¦¦'<¦.'!
|1010|Jgri" . 24.04'
HAG NAIL' 4MIS
/ 0
: Scale: 1'.=: go feet Distances are marked in teet and decimals. .Orderedby: All Manesh ¦ Order No.: 22-2-103A
Compare all points before building by ¦ ¦ same and at once report any difference, i For building lines, restrictions, or easements not
shown hereon, refer to abstract, deed or ordinance.
Field work completed: 3/10/22
Drawn by: P.O.
Proofed by: r.S. ' :> ¦'
Design Firm Registration f 184-002791
. state of lvjnois > ,': %^H0^M- -i
COUNTY OF WUL i83 -'%foK^t ' ' •
Studnicka and Associates; Ltd., an Illinois Land Surveying Corporation does hereby certify that this professional : service conforms to the current Illinois standards tor boundary surrey. : <
Mokena, L March 21, AJ). 2022 : .
v;-'r. ;by y)t*^^::^^^
license No, .3304 Expires 11/30/22
"WRITTEN NOTICE" , FORM OF AFFIDAVIT : "' (Section .17-13-0107)
Date; 10-4-2022
Honorable Thomas M. Tunney y
Chairman. Committee on Zoning ¦ • . . ' '¦¦ vy,
.121 North 1-asalle Street . ' . . , ;:. ;. .' y. ;'/y.
Room 304,City Hall . / ;'¦ y ¦ ' ¦ y ¦' ¦ .'' . ' ;
Chicago, 11.60602 '* ¦ ::>
: The undersigned certifies that he has ^^^S^^TmS^ «o the; Chicago Zoning Ordinance.by .".f^S^Sdy owned by the applicant, and to
^e^owners ofthe property^^^Z^^^^^T^
the owners of all property within 2M feet in each^mrec _ (0 400
••• exclusive of public roads, streets, alleys and oh l—JJJ* ^ ^ 30 days heforeffl.ng.
. . feet, Said "written notice" was sent by First Class Ub. Man, , / ; . . ,
' the application. . / , ¦ ¦ '. ' : .;' ¦
-rezoned; 'a statement ofthe ^^^^S^ippHcant intends to file the.
SSundersign^ ; '
addresses of the parties to be ^'^^fj^'^a addresses of surrounding property ,
». —* «*—-i ^
: 'Mthc people required to ., y., . , y- . y -y, \ '¦ y
Vp' ¦ PUBLICNOTICE 'V
' .' ? : Date: 10-4-2022 ' . '¦ ¦ i ¦ ¦:'".';'' ' ^ ' ' ' A
y, ; : Dear Property Owner:
;':,' >, In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance,
V.;. . ! , specifically Section 17-13-0107, please be informed that on or about October 26, 2022,1, the V y\'\i'yy undersigned, will file an application for a change in zoning from Bl-2 Neighborhood Shopping
;,; : . - District to proposed B2-3 Neighborhood Mixed-Use District, on behalf of applicant, Ali Manesh, for
¦t^^^'^r '^.the property located at 1361, West Chicago Ave. Chicago IL 60642.-
-:t:y;y ¦ .Lintehd to use the subject property for a mixed used building with a proposed 50 feet'height
. V including a 640 sft commercial space on the first floor and 4 residential dwelling units
above, providing two paved parking spaces using Equitable Transit Served Oriented
¦¦ '¦'.y Development (ETOD) as per section 17-10-01002-B (the subject property is within 75 feet . ¦ ] . from CTA Bus Line 66 Chicago to Navy Pier), four bike spaces, and garbage / recycling "
:^y':-y'yyvy: bin spaces on the back. ¦ " •;' : ¦ ''¦;¦;'[. V v
¦ < ¦ y', - ; ,1, Ali Manesh, am the property owner, the applicant and the contact person, and my address is 1367
yy West Chicago Ave, Chicago IL 60642, my phone number is 312-898-3333 and my email address is ^
~y ali@manesh.org . .' y ' , ¦. : ' y„ ,. : ...:, V':.
" ;v . /-v . ¦ / ' Please note that the applicant is hot seeking to rezone or purchase your property. The applicant .
•yHf^'i.^;i•••^•f<^'?'•^tlu'M by law to send this notice because you own property within 250 feet ofthe property ; \ .
r": y t0;be rezoned. 1 ' " .y :.': ;¦ •;: /-'' '•. " 'y."".:- ,: ¦„:'¦'•'
CITY OF CHICAGO ECONOMIC DISCLOSURE-STATEMENT AND AFFIDAVIT
SECTION 1GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting, this EDS. Include d/b/a/ if applicable:
ALI MANESH.
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
the Applicant
or ¦ .;¦
21 __ a legal entity currently holding,.or anticipated to hold within six months after City action on the contract, transaction or other undertaking to which this EDS pertains (referred to below, as the "Matter"), a direct or indirect interest in excess of 7.5% in the Applicant: State the Applicant's legal
name: .- ' '' ' ' ¦ -. '¦ . ' '. . ¦ 1 '¦
¦ .:' -VV OR • '
. 3 .: __] a legal entity with a direct or indirectright of control of the Applicant (sec Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:
r, • r> • ij r_l i-. • t • n , 1367 WEST CHICAGO AVE. CHICAGO IL 60642
B. Business address of the Disclosing Party: , _
C. Telephone: 312-898-33" Fax: _________ Email: ALI@MANESH¦0RG
6. Name,of contact person: ALI ^
E.; Federal Employer Identification No. (if yOu have one):
Brief description of the Matter to which this EDS pertains. (Include project number and location of - property, if applicable):
To support my application for zoning amendment for my property'located on 1361 W. Chicago Ave. 60642
Which City agency or department is requesting this EDS? Zoning and'planning ,
If the Matter is a contract being handled by the City's Department of Procurement Services, please y complete the following:
Specification # . ' . ] and Contract # '. ' :
Vcr.2018-1 . ¦¦ - . Page t of 15
SECTION II -
- DISCLOSURE OF OWNERSHIP INTERESTS
A NATURE OF THE DISCLOSING PARTY
Indicate the nature of the Disclosing Party: ,
Person _j Limited liability company /
Publicly registered business corporation ~ Limited liability partnership . >
Privately held business corporation { | Joint venture
Sole proprietorship [__ Not-for-profit corporation
General partnership (Is the not-for-profit corporation also a 501(c)(3))?;
Limited partnership [~Yes . LZ3.No
Trust | | Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in me State of Illinois as a foreign entity?
:; Yes _ No , | [ Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY: , '.[:.{¦
1. . . List below the full names and titles, if applicable, of: (i) all executive officers and all directors of
the entity; (ii) for not-for-profit corporations, all members, if any* which are legal entities (if there
are ho such members', write "no members which are legal entities"); .(iii) for trusts, estates or other
similar entities,, the trustee, executor, administrator, or similarly situated party; (iv) for general or ;
limited partnerships, limited liability companies, limited liability partnerships or joint ventures;
each general partner, managing member, manager or any other person or legal entity that directly or
indirectly controls the day-to-day management of the Applicant. , r
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name. ¦ , y Title'
2. Please provide the following information concerning each person or legal entity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest.(including-: . . ownership) in excess of 7.5% of the Applicant. Examples of such an interest include shares in a; ;; ,. •corporation, partnership interest in a partnership or joint venture, intercstof a member of manager in a
Ver.2018:f Page 2 of 15
v : limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none,
state "None." . ' . ?''
. NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf'
Name -Business Address ' Percentage Interest in1 the Applicant:",;
SECTION III -- INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED :K. ¦ OFFICIALS
. :: i - V; Has the Disclosing Party provided any income or compensation to any City elected pfficiaTduring the
12-.month period preceding the date of this EDS? ~j Yes • ~|No
I 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 olVthis EDS? QYes , [^] No-.-.;-.'
'f:¦¦ If "yes" to either of the above-, please identify below the name(s) of such jCity elected official(s) and
describe such income or compensation: :','; .' -; :; ¦ '.".; y.- ¦ '¦!¦'¦.-•,'¦'
¦;|; . y : Does/any City elected official or, to the best of the Disclosing Party's knowledge after reasonable y ,
;|:.y .: , inquiry^ any City elected official's spouse or domestic partner.have a-financial interest (as'defined in, '
y-1y Chapter 2-156 of the Municipal Code of Chicago ("MCC")) in the Disclosing Party? ...
:V - _ Yes ' [3| No • 'y . yy ' . yy : ¦¦«.-.:
!, . ' . if "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestie
•!;!V /- partner(s) arid describe the financial interest(s).
if ;, SECTION IV ~ DISCLOSURE OF' SUBC'dNTRACtdRS AlSp OTHER RETAINED PARTIES
The Disclosing Party must disclose, the name and business address of each subcontractor, attorney, y ¦;'. .y.'i lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any other person of entity : hl.:, r ¦ whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as y ;. the nature of the relationship, and the total; amount of the fees paid or estimated to be paid. The ^:;-';v'\.,;/r-p^closing.Party is not-required to disclose emplpyees whoare paid solely through the Disclosing >' y yy .Party's regular payroll If die Disclosing Party is uncertain whether a disclosure is required under this V^V£-'J -. Section, the Disclosing Party must either ask the City; whether disclosure is required or make.the '...-,•, ;'-y:'y. disclosure. • . ^¦¦¦:.'}''¦:>'.;' 'y-';¦•¦/';yy -y:-- ^y,- y-y 'yyy'V:' y,V'yyHy¦./';'•
,y. ','.! .vven-ois-i!. ;''.¦' . ,y'. Pagejof is" . ¦ y , ¦¦ .y -V'"l'V.:yV¦; -iiJV-
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) * ' lobbyist,-etc.) . "hourly rate" or "t.b.d." is
'¦ ¦¦¦ \ not,an acceptable response.
.'Erex- Inc. 1633 Riverside Ave., St. Charles, IL 60174,' General Contractor; ,$1,200,000
Lindstrom and Associates, lindstormllc@yahoo.com , Architect, ¦'' $35, 000
(Add sheets if necessary)
f~"| Check here if the Disclosing Party has not retained, nor expects to retain,;any such persons or entities. SECTION V -r CERTIFICATIONS ' A. 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 of the Disclosing Party been declared in ¦ ^arrearage on any child support obligations by any Illinois court of competent jurisdiction?
;[_Yes ,.; [7]No (~No
person directly of indirectly owns 10% or more ofthc Disclosing Party. „'.'-
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and
is the person in compliance with that agreement? : : ¦. ,'. jK.:
[_] Yes Q No . -" :*.
B. FURTHER CERTIFICATIONS
:, 1. [This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date of this EDS, neither, the Disclosing :, ,
• Party nor any Affiliated Entity [see definition in (5) below] has engaged, ,in connection with the ; ¦
' .performance of any public contfact,, the services of an integrity monitor, independent private sector-• inspector general, or integrity compliance consultant (i.e.; ah 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 canVbeVcphMdered for agency contracts in the future,' or continue with a contract in progress). ;;'
¦ 2!' The Disclosing Party and its Affiliated Entities are hot 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 arid sales taxes;,'nor is the Disclosing; -.'
Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Ver.2018-1. Page4of 15 . '¦'•¦"'' .< ;
;. 3:' The Disclosing Party and, if theDisclosing Party is a legal entity, all of those persons or entities
y .identified,in Section 11(B)(1) of this EDS: ¦', '."''.. . 1 ^ " ¦'
y^ a ^ arc. notpresently debarred, suspended, proposed for debarment, declared ineligible or voluntarily V-excluded 'fro.m' any transactions by any federal, state-or local unit of government;! :
. ' , :b. have not, during the 5 years before the date of this EDS, been cpnvicted.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 V .'.'¦•public transaction; a violation of federal or state antitrust statutes; fraud; em^ . bribery; falsification or destruction of records; making false statements; or receiving stolen prpperty:;
'-.'i' 'are'riot presently indicted for, pr criminally or civilly charged by, a governmental entity (federal;. , 'y.',^'teor-l6cai)'with committing any ofthe offenses set forth in subparagraph (b) above; "'¦ ;, .: '
d have not, during the 5 years before the date of this EDS, had: One or more, public transactions . '
V (federal, state orjlocal) terminated for cause or default; and : ¦
•;•' c. have riot, during the 5-years'before the date of this EDS, been convicted, adjudged guilty, pr found :.; liable in a civil proceeding, or in any criminal pr 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. ¦ ... '', V ; .j-, •
4. The Disclosing Party understands and shall comply with the applicable requirements of MCC .
¦'.:' Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics). \. ¦'•; , , - ' <
' ,'5. Certifications (5), (6) and (7) concern: -'.', • '.- •'-/.-:v '. -;•¦•
; • the Disclosing Party; ¦ ¦ ¦. ' [ ¦
' ^r.'f.'a'ny-'Cbntrkctbr" (meaning any contractor or'.subcontractor used'by-'the.Disc.lpsing Party in. ;,.
,:\;'connection with the Matter, including but hot limited to all persons of legaT entities disclosed ; .
• under Section IV, "Disclosure of Subcontractors and Other Retained Parties"); . , V;,
.' • any "Affiliated Entity" (meaning a person or entity that! directly or indirectly: conr/ols 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: :
; .- ^ of interests' 'amon'g-'faMly members',- shared m
facilities 'and equipment; common use of employees; or organization of a business entity following' ;
.¦ .'the ineligibility of a business entity to dp business, with federal or state or local gbverriment,
vincluding the City, using substantially the safnje'mariagerhcht, ownership, or principals as the, ',
'.,: ,.; 'ineligible entity. .With respect to Cohtractofs, the term Affiliated Entity means apersbn or entity.
that directly or indirectly controls the; Contractor, is cbntrolied by it, or, with the Contractor, is ;1-
1 under common control of another person or entity; ,;;'>¦','
\:y <*,any responsible official.of the Disclosing 'Party, -any Contractor or any Affiliated- Entity :br any . .
.!.: '. ' other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity,'
¦] acting pursuant to the direction or authorization of a fesporisible official Pf the Disclosing Party,,; :
. any Contractor or any Affiliated. Entity (collectively "Agents").' ¦ ¦ ¦,','¦¦, "'-'¦ :Jf ^
Page 5 of 15
4y Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing
¦y y . Party of any Contractor, nor any Agents have, during the 5 years before the date of this EDS, or, with
y!y. y : respect to a Contractor, an Affiliated Entity, or an Affiliated.Eritity of a Contractor during the 5 years
rv. : before the date of such Contractor's or Affiliated Entity's .contract or 'engagement in connection with the '"¦'.
y,''.;'''.'v.'y'iMatter: '' / ; - .. ' ¦¦ ' '"'':/ ¦'.[ ' . ¦"-:' ' :.¦; v, .-.;; yvy-
; a. 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; ' ¦ , y--;-y v/y.y y-:.-: ¦
.'j, y b.y. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, y • Kf y.y or been, convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders^ . r. ¦ inrestraint of freedom of competition by agreement to bid a fixed price or otherwise; of y " t.
,;c:v made an'admission of such conduct described in subparagraph (a) or (b) above that is.a matter of
j record, but have not been prosecuted for such conduct; or ;>i
:A y. d-. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracls Requiring a Base
4,: : .y;, < vy Wage); (a)(5)0ebarment Regulations);; or (a)('6)(Mmimum Wage Ordinance)., / it y
?y!-;':''''¦'''<' '6/.;-Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees,'-!' ;. . , ; officials, agents or partners, is barred from contracting with any unit of state or local government as a '•
result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) . • . ;yy::yVy bid-rotating in violation of 720 ILCS 5/33E-4; or (3) iany similar offense of any state or of the United yj - j: y ',, Stities of America that cohtai .';
,';: kiy .'V ¦ .¦¦!Se.'ther tl?e 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-.-
;j. y ; , [FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC
iiChapter 1-23, Article I for applicability and defined terms] ofthe Applicant is currently indicted ory
y V'V^'ch'arged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, ¦¦.
%\-:kW^¦:.?n?;crimin^ offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery,
jl v- yypefj.ury, dishonesty or deceit against an officeror employee, of the City.or any "sister agency"; and (ii) . r • :
f. , ;;-'!\the; Applicant understands and acknowledges that compliance with Article I is a continuing requirement
W,'y ' . for cing business with the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, that' ' ] j
!:j- Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.' .
^St .'.,!.'. % [FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their!
'- ;.:¦'.;!!',( j1 subeptoactors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal
y . . ; System for Award Management ("SAM"). y : ¦'; y'' yy. '.
y y ¦:"! 10 i [FQR APPLICANT ONLY] The Applicant will obtain from any cohtractors/subcontracto
v;.; |" y v or-to be hired in;connection with the Matter certifications equal in form and substance to those in'-. %'::Vy
<-j-'.y y Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
'' ;'Ver.2018-l :i-.'"r-:' .'.'!"'¦'. Page 6 of 15 yV 1'. ' ' "¦', T'^ y!L'-
:;r;; ;; ¦, . . contrac.tor/subcohtractor that does not provide, such certifications or that the Applicant has reason to .'' fx.'v ;be'Iie!ye'has riot provided or cannot provide:tramTulcertifications/',
%>-^¦''>-' I!f tnc Disclosing Party is unable to certify to any ofthc above statements in this Part B (Further. ;.:!¦;!':'s;K::^;"^?^^'^s):|he bisclosing;.Party.'mu'iit explairi'belpw:¦¦ ¦ '¦;, '! ,
¦f -j' i r;; If the letters "NA," the word "None," or no response appears oh the lines above; it will be conclusively :. : presumed that the Disclosing Party certified to the above statements. ~-:-
];¦¦:/r-. f l2.To the best ofthe Disciosing Party's knowledge after reasonable, inquiry, the following is a
i| ^ ; complete list of all current employees ofthe Disclosing Party who were, at anytime during the 12- .
; j . ;•. month period preceding the date of this EDS, an employee, or elected or appointed official, of the City
;.; of Chicago (if none, indicate with "N/A" or "none"). . < .,' . ¦ j;i ¦;
| : - • 13. To the best of the Disclosing Party's knowledge after reasonable, inqui^^^ . ..."
y - ^; 'J . /- .coiTiplete list of all gifts that the Disclosing Party.has given or caused to be given, at any, time during ,"' ',;
: ; : . tne 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed \ ' •i-l'; )' ' • officii, ofthc City of Chicago, For purposes of this statement, a "gift" does not include: (i) anything' ¦ . •; ? i'! if /¦ made generally available to City employees or to the general public, pr (ii) food Or drink provided in : I'; '-
f '•¦ - tr,e course of official City business and having a retail value of less than $25 per recipient,.or (iii) a
' y, / ;:. riolitical contribution otherwise duly reported.as required by law (if none, indicate "N/A" or. .
!; • \ '. "none"). As to any gift listed below, please also list the name ofthe City recipient. : .
;;:':V ; C.; CERTIFICATION OF STATUS AS FINANCIAL INSTIL y i ^MJ.-Ji'v^
yv,; y ; I.: The Disclosing Party certifies that the Disclosing Party (check one). ¦ , ¦ f ¦/ 'f,
V V • [[] is ' ; , \~ is not '; '•'I y'v.v'.''y^.''''?^ ;V''y'.
... ; a "financial institution" as defined in MCC Section 2-32-455(b). '¦¦ f \).-,
v; : . ; 2. if the Disclosing Party IS a financial institution, then the Disclosing Party.pledges: ,C
f"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further .-/.'/. i
I y , ':':V.'. P'.cdge that none of our affiliates is, and none of them will become,, a predatory lender as defined in .'/; :f' '¦' ;'y
'¦ii 'fO. MCG. Chapter 2732. We understand that becoming a predatory lender pr becoming an affiliate of a ! f 'fi'.
: • : .predatory lender may result in the loss ofthe privilege of doing business with the City." ¦ '¦'/¦ ". :': . 'v;; 'if'/
;.y;l ; VeripjS-l J . ;i 'V, 1. ': / ; " :. Page 7 of 15 y ' ,' '' . .ff-f , ; ; . ,". ^ :y^.£.'".:i; ; 'H:',' % -'
If the Disclosing Parly is unable to make this pledge because it or any of its affiliates (as defined in ,
MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain
here (attach additional pages if necessary): . . ¦ j ¦'
. If the letters "NA," the word "None," or no respon.se appears on the lines above, it will be concl
D.
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
. I. In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge ¦ •'
after reasonable inquiry, does any official or employee ofthe City have a financial interest in his or
her own name or in the name of any other person or entity in the Matter? . , /
? Yes.;,
NOTE: If you checked "Yes" to Item D( 1),,proceed, to Items D(2) and D(3). if you checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
2./Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected
/official or employee shall have a financial interest in his or her own name or in the .name of any
other. persoh or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for :
taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively,
' '."City-Property Sale"). Compensation for property taken pursuant to the City's eminent domain i . power does not constitute a financial interest within the meaning of this Part D. ¦ ,
; Does the Matter involve a City Property Sale? - ' /V1/
ryO^y QNo V ; - ¦ ' ; ; ;^y- y
'3. Ifyou checked "Yes" to Item D(l), provide the names and business addresses ofthe City officials or employees having such financial interest and identify the nature of the financial interest:
Name . • Business Address Nature of Financial interest
4 -/The Disclosing Party further certifies that no prohibited financial, interest in the Matter will be V ••• -acquired by-any City official'-or employee::
:Ver.2b'l8-i. 1 ¦ .:'' PageRof!5 "\-.V '. ;. "'.
/E-CERTIFICATION REGARDING SLAVERY ERA BUSINESS
¦ Please check-either (I) or (2) below. If the Disclosing Party checks (2), the Disclosing Party
!,must'disclose below or iri an attachment,to this EDS all information required by (2). Failure to,
/¦comply with these disclosure requirements may make ainy contract entered into with the City ih:.;-"v
^connection with the Matter voidable by the City v . - ./ ' ;' ' f:":.r '/.-'
JSl. 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),.arid! / ¦
the Disclosing Party has found no such records
===L2- The Disclosing Party verifies that, as a result of conducting the search in step (1) .above, the '; ¦ iPjSSl^S par\y has found jecbrds of investments or profits from slavery or slaveholder insurance ;';P^Jicie5>- 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 iri those records:
SEC1TON Vi -r CERTIFICATldNS FOR FEDERALLY FUNDED MATTERS
N9T?: If the Matter is federally funded, complete this Section VI; If the Matter is not
federally funded, proceed to Section VII. For purposes of this Section' VI, tax credits allocated by '
the City and proceeds of debt obligations ofthe City are not federalfunding. .'¦', ';V;',
A. CERTIFICATION REGARDING LOBBYING '
1/ List below the names of all persons or entities registered under the federal Lobbying :
¦ Disclosure Apt of 1995, as amended, who have made lobbying contacts on behalf of the Disciosing
/Party with respect to the Matter: (Add sheets if necessary): '.¦ .
(If rib'-explari on the lines above, or if the letters, "NA'' pi if the word "None" ' ;
appear,it will be conclusively presumed that the Disclosing Party means that NO persons or entities
registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on
behalf of the Disclosing Party with respect to the Matter.) ' ' ; . ^'
. 2. The Disclosing Party has not spent and will not expend any federally appropriated funds to.pay
ai^y Pe/'son,??" entity listed in paragraph A(l) above for his or her lobbying activities or to pay any
person pr enti ty to influence or attempt to. influence an officer or employee o f any agency, as defined
by applicable federal law, a member of Congress, an bfficeror employee ''of Congress! oran employee
Yer.2dl8-r: .:,.'/ Page9of 15 = ¦ ¦.
4'Th D. , -^Wcu,cnrs and inforn
i, ••
S If* 'rv a S?, %t ™ ™?agc i„ Tol,hvina
• ( :, ,l,,;"'Kl.K.r:2|>,,m.:,„. ' , ¦ S-as amended : °yul«
vl':
^v'.^-, ' .'¦¦•'Qno.' VV->: -r-v :¦/;.¦:¦';'¦'"¦ ''i'/:
- flNo nRpn , . '^por(S due under the
3 H; : *—1 jjKeporls not required '
:;-v:---r^y;./ U No. :'- \; V.;. y^./
[fyou checked "Mo" tn ^ • ' ;" ¦ "¦¦>'
.^p^^ explanation: ¦ ,:. '
Page JO of 15
S,< T10N v,, FURTHER ACKNOWLEDG^NTS AND CERW.CAT.9N . :, ^
•1 ¦ "' ' , .-. • ,1 •„ »v»U FDS will become part oi any
: in tact or other agreement between the Applicant and t^^
Pt^istanee, or other C^.^£%™$^Party understandsJha,.
- persons or e:m«e» -^-P^y^^^'^^h-ao.org a:^ may
^Ife ordinance and a training Suite Hft ",,h;"-
¦: i3i2>744-9660. The Disclosmg Party must comply ¦ . ....
. - :;: ' ' ' ' .'¦ - ., . nr,c io fikn incomplete or inaccurate,
--fi If 'the City determines that anyHnformation ^ ^ ^ ^ Qr ^
: any'Sr other agreement m-onnectjon^ ag4meht (if notrescinded or
' or voidable, and the City may pursue any rerne^^^ p^ys participation in the Matter ;;; :
- vbMt at law or in equity, including termmating the W'JjW ^ transactions, Rcmcd.cs at,
law for a false statement ot.material tact nuiy , ^. ^. ., ^ ^.^ , _ ^ .
I .damages': • ';¦'¦'.¦/; ' .Vv;-.' 'A.'.-: '.:¦;¦ . .' , _^ ••
„ „ ,s ,K OtyN Pohcy ,0 -U *, ^^SrS^ ''WestSo^^^
'iri this EDS. - • ¦¦ .
l&a^
¦ partv must supplement this EDS up to the time f ^^gt SerVic^^ ' ^date this EDS as the contract^
by MCC Chapter 1-23 and Section 2-154-020. . ¦... -. ¦
CERTIFICATION
Ui certifications and statements c^tain^m this FDl ^Tl^ ^ <2>—* that all:
,/ and complete as.of the date furnished to the City PP ^ APP6ndl^^re true, accurate
•. Ali Manesh
].,:. ^': , (Print or t^pel^c^
j-: :;: V;;- By;
(Print or type name of person signing)
HVvr^W signing). .,'
at
Signed .and sworn to before me on (date)
^ County, XI ||fl6V5
OFFICIAL SEAL AKARIA PEEPLES BABBS . NOTARY PUBLIC. STATE OF ILLINOIS' . MY COMMISSION EXPIRES 0S/05/yn?fi
Page 12 of 15.
: ¦ CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
;/>;$.'::¦¦' APPENDIX A ¦
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS
.V; AND DEPARTMENT HEADS ¦¦."'J'
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 of
' •the 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 A ;.
¦ department head as spouse or domestic partner or as any of the following,; whether by blood or ;' ;
'adoption: parent, child, brother or sister, aunt of uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-iri-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson of
stepdaughter, stepbrother or stepsister or half-brother or half-sister >" V :
. ¦"Applicable Party" means (1) all executive-officers' of the Disclosing; Party listed in Section II. B. Lai, if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disciosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; ali managers, managing members;and members of the . Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the , Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosmg'/ Partyi; "Principal officers" means the president,; chief operating Pfficer; executive: director, chief1•" vi financial officer, treasurer or secretary of a legal entityorahy;person exercising similar authority.: '¦'¦
/ / Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof: cufrentjy have a "familial relationship" with an elected city official of department head? :
QNo
;' If yes, please identify below (I) the name and title of such person, (2) the name ofthe legai entity to /whjcK-such person is connected; (3) the name and title of the elected city official or department head to vvhpm such;person has'a-familial relationship, and (4) the precise.naturie of such famiiial relatioWship.
Vcr.2018-1 . ' Pa-;e I3ofl5
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
¦ APPENDIX B "
,v 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 2-927416?
No|10 10|2; 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 landlord pursuant to MCC Section 2-92-416? .,
|~] Mo .j^j the Applicant is not publicly traded;oh any exchange
3. If yes to (1) or (2) above, please identify below the name of each person or legal entity identified -
t . ,:; as a building code scofflaw or problem landlord and the address of each building of buildings to which
the pertinent code violations apply. ¦ ' -; ' C: ' '• '¦¦ ' "A
Page 14 of 15
¦ CITY OF CHICAGO . •
/ ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
£*-s4y\-\::'. APPENDIX C ; V y
'.'.,;;;''-v. PR'6HiBITIpN ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION;
This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as
defined in MCC Section 2-92-385. That section, which should be consulted (www.amlegal.com ),
generally covers a party to any agreement pursuant to which they : (i) receive City of Chicago funds iii
¦ consideration for services, work or goods provided (including for legal or other professional services),
pr(ii):pay the City money for a license, grant or concession allowing them to conduct a business on .'
Citypremises. _ ¦ .'.: ¦ . ¦'¦ ..." .''-. '' •'.>;;;'' "'
j' A.' On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that
•!•.•;.'• .7. the Applicant is in compliance with MCC Section 2-92-385(b)(l) and (2), which prbhibit: (i) screening
-, :- f ; 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
:. h includes those prohibitions. : ; -\.•/; .¦ .' '¦;',';;; ¦ ",-./,:'<
V r£j N/A - I am not an Applicant that is a "contractor" as defined in MCC Section 2-92-385. , ; ¦ .; This certification shall serve as the affidavit required by MCC Section 2-92-385(c)( 1).
; , :; : If you
j-M; ."i
irC ' • -Vcr.2018-1