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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. 2-G at 1061 W VanBuren St - App No. 18105
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Topic:
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ZONING RECLASSIFICATIONS - Map No. 2-G
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FINAL FOR PUBLICATION SUBSTITUTE ORDINANCE 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 DS-3, Downtown Service District symbols shown on Map 2-G in the area generally bounded by: West Van Buren Street; a line. 556.65 feet west of and parallel to South Morgan Street; Tilden Street; and a line 858.12 feet west of and parallel to South Morgan Street to the designation of DX-7, Downtown Mixed-Use District. SECTION 2. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the DX-7, Downtown Mixed-Use District symbols shown on Map 2-G in the. area described in Section, 1 above, to those of a Residential Planned Development, subject to the use and bulk regulations set forth in the Plan of Development attached hereto and made a part hereof. SECTION 3. This ordinance takes effect after its passage and approval and due publication. Common Address: 1061 West Van Buren Street FINAL FOR PUBLICATION RESIDENTIAL-BUSINESS PLANNED DEVELOPMENT No. Plan of Development Statements The area delineated herein as Residential-Business Planned Development No. ("Planned Development"), consists of approximately 28,749 square feet (0.65 acres) of property located'^^1'•'West Van Buren Street (the "Property"), as more fully depicted on the attached Planned Development Boundary and Property Line Map. The Property is under the single designated control ofthe Applicant, Pizzuti Development, LLC. . The requirements, obligations and conditions contained within this Planned Development shall be binding upon the Applicant, its successors and assigns and, if differerit'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 an amendment, modification or change (administrative, legislative or otherwise) to this Planned Development is made, shall be under single ownership or single 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 tojbe 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, assigns or grantees and approval by the City Council. 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 Jto: 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 ofthe 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. This Plan of Development consists of Seventeen Statements; a Bulk Regulations and Data Table; an Existing Zoning Map; an Existing Land-Use Area Map; a Right-of-Way Adjustment Map; Site Plan; Typical Parking Plan; Landscape Plan; Amenity Deck Applicant: Pizzuli Development, LLC Address: 1061 West Van Buren Street Date Introduced: July 30, 2014 Plan Commission- October 15, 2015 FINAL FOR PUBLICATION Landscape Plan, 25th Floor Plan; A Green Roof Plan; Building Elevations prepared by Epstein and Arquitectonica dated October 15, 2015; and a Bonus Floor Area Worksheet. The following uses are permitted in the area delineated herein as a Residential-Business Planned Development: Residential dwelling units (located above the ground floor); financial services; office; retail sales; food and beverage retail sales; eating and drinking establishments; catering services; accessory parking; and 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 Property shall be 10.15 in accordance with the attached Bulk Regulations Table. For 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 28,749 square feet and a base FAR of 7.0. The improvements to be constructed on the Property will utilize the following FAR bonuses: , . - ' 4 Base FAR: . . 7.0 - . Affordable Housing: 1.75 . . . Transit Infrastructure: 1.40 Total FAR: 10.15 Upon review and determination ("Part II Review"), and pursuant to Section 17-13-0610 ofthe 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 Plans 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 review associated with the site plan review or Part II reviews are conditional until final Part II approval. The Applicant shall comply with the Rules and Regulations for the Maintenance of Stockpiles promulgated by the Commissioners of the Departments of Streets and Applicant- Pizzuti Development, LLC Address: 1061 West Van Buren Street Date Introduced: July 30. 2014 Plan Commission: October 15, 2015 FINAL FOR PUBLICATION Sanitation and Fleet and Facility Management and Buildings, pursuant to 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 by the Zoning Administrator, pursuant to Section 17-13-0611-A ofthe Zoning Ordinance, upon written application by the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. 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 to ' '" ensure compliance with all applicable laws and regulations-related to access-for persons with disabilities arid to 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. Applicant shall achieve basic L.E.E.D. Certification under the Leadership in Energy and Environmental Design ("L.E.E.D.") Green'Building Rating System arid provide a minimum 50% green roof over the net roof area. The Applicant acknowledges and agrees that the rezoning of the Property from DS-3 to DX-7 for this Planned Development triggers the requirements of Section 2-45-110 of the Municipal Code (the "Affordable Housing Ordinance" Or "AHO"). 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 ofthe development of affordable housing units; or (iii); any combination of (i) and (ii). The Applicant further acknowledges and agrees that this Planned Development is subject to Section 17-4-1004 ofthe Zoning Ordinance, which also requires 'on-site affordable housing or payment of a fee in lieu of providing affordable housing for rezbnirigs in DC, DX and DR districts that increase the base floor area ratio. If a planned development is subject to the requirements of both sections (2-45-110 and 17-4-1004), the developer may elect to satisfy the AHO requirements by complying with the affordable housing floor area bonus1 .provided for in Section 17-4-1004. Pursuant to' Section 17-4-1004-B of the Zoning Ordinance, the Applicant has requested an increase in',the floor area ratio for the Property, as set forth in the bonus worksheet, required under Section 17-4-1003-D and attached hereto as an Exhibit ("Bonus Worksheet"). In accordance with the formulas set forth in Section 17-4-1004-C and. the Bonus Worksheet,.the Applicant acknowledges and agrees that it must provide either a minimum of 12,578 square feet of floor area, (the "Affordable Units") in the building receiving the affordable housing floor area bonus ("Eligible Building"), with an affordable unit mix comparable to the overall mix and approved by DPD's density bonus Applicant: Pizzuli Development, LLC Address: 1061 West Van Buren Street Date Introduced: July 30, 2014 Plan Commission: October 15, 2015 FINAL FOR PUBLICATION project manager prior to issuance oflhe first building permit, or make a cash payment in lieu of providing affordable housing in the amount of $1,167,209.40 ("Cash Payment"), or $38,907.00 per unit ("Pro Rata Amount"). Prior to the issuance of any building permits for the Eligible Building, including without limitation, excavation or foundation permits, the Applicant must either make the required Cash Payment or provide a performance bond or other security in the amount of the Cash Payment ensuring construction of the Affordable Units. If the Applicant elects to construct the Affordable Units, it must also enter into an Affordable Housing Agreement with the Cily pursuant to Section 17-4-1004 prior to the issuance of any building permits for the Eligible Building, including without limitation, excavation or foundation permits. The terms of the Affordable Housing Agreement and any amendment thereto are incorporated herein by this reference. The Applicant acknowledges and agrees that the Affordable Housing Agreement will be recorded against the Eligible Building and will constitute a lien against each Affordable Unit in an amount equal to the Pro Rata Amount. The City shall-execute partial releases of the Affordable Housing Agreement prior to or at the lime of 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. In addition to the Affordable, Housing Agreement, the Applicant acknowledges and agrees that, pursuant to Section 17-4-1003-D(3), the Bonus Worksheet will serve as an official record of bonuses and amenities. The Applicant musl comply with the applicable affordable housing standards and requirements set forth in Section 17-4-1004, the terms of winch are incorporated herein by this reference. Notwithstanding anything to the contrary contained in Section 17-4-1003-E, the Commissioner of the Department of Planning and Development may enforce remedies for breach of the Affordable Housing Agreement, and enter into settlement agreements with respect to any such breach, subject lo the approval of the Corporation Counsel, without amending the Planned Development. Pursuant to Section 17-4-1020 of the Zoning Ordinance, the Applicant has requested an increase in the floor area ratio for the. Properly by contributing funds to the Chicago Transit Authority ("CTA") for improvements and repairs to public transit infrastructure located in proximity to its development project. In accordance with the formula set forth in Section 17-4-1020-C, the Applicant acknowledges and agrees that it must make a cash payment to the CTA in the amount of $933,767.52. This Planned Development shall be governed by Section 17-13-0612 of the Zoning Ordinance. Should this Planned Development Ordinance lapse, the Zoning Administrator shall initiate a Zoning Map Amendment lo rezone the property to DX-7, Downtown Mixed-Use District. Applicant: Pizzuti Development, LLC Address: 1061 West Van Buren Street Dale Introduced: July 30, 2014 Plan Commission: October 15. 2015 FINAL FOR PUBLICATION RESIDEN TIAL BUISNESS PLANNED DEVELOPMENT NO. And BULK REGULATIONS AND TABLE Gross Site Area: Area to be vacated in the Public Way: Area in Public Way: Net Site Area: Maximum Floor Area Ratio: Base Floor Area Ratio: Affordable Housing Bonus: Transit Infrastructure Bonus: Maximum Building Height: Maximum Number of Dwelling Units: Minimum Number of Parking Spaces: Minimum Number of Loading Berths: Minimum Number of Bicycle Parking: Minimum Setbacks: 42,785 Square Feet 6,353 Square Feet 7,683 Square Feet 28,749 Square Feet 10.15 7.0 1.75 1.40 275' - 298* 140 .|1010|100 In accordance with the Site Plan The maximum number of efficiency units cannot exceed 40% ofthe total number of units. Applicant: Pi/.zuli Development. LLC Address: 1061 West Van Buren Street Date Introduced: July 30, 2014 Plan Commission: October 15.2015 o z x: < a. UJ O < a: > or o H to g Q 13 H co UJ o z < >- o w w -J r- ^ < . • £ _| 111 H H U- Q uj u_ " to UJ C£ cog UJ CO O ' I— —I CO < • Z UJ UJ o Q tl. 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Affordable Housing Profile Form (Rental)
Submit this form to the Department of Planning & Development for each project that triggers an affordability requirement (including CPAN, ARO. and the Density Bonus).
This completed form should be returned (via e-mail, fax, postal service or interoffice mail), to: Kara Breems, Department of Planning & Development, 121 N. LaSalle Street, Chicago, IL 60602. E-mail: kara.breems@cityofchicago org Telephone: (312) 744-6746.
For information on these programs/requirements, visit www.cityofchicago.org/dpd
Date: 5 tP'fcrVyt/? .P^ J-t>>_S
v
SECTION 1: DEVELOPMENT INFORMATION
Development Name: jYzZf*/ zi-^t^&T* • Development Address: icoi W V.M '^x'^^r3 r,ic: ^ -r" Ward: .'cr
If you are working with a Planner at the.City, what is his/her name? FaK^ *;^>v i-z S .'' > +~><.ZsType of Cily involvement: Land write-down
(check all that apply) Financial Assistance (If receiving tif assistance, win tif funds be
used for housing construction? ")
K Zoning increase, PD, or City Land purchase ¦"if yes. please provide copy of the TIF Eligible Expenses
SECTION 2: DEVELOPER INFORMATION
Developer Name: pf.^vri dz^lZLcTm&J*, L-U"c_
Developer Contact (Project Coordinator): B. <'/V .'
Developer Address: JJ rlK* yr«t&£r.t ,C*.vnf^ c*t '/5J-°
Email address:.£#^**^ »-Yz;v'/.««.,•¦> May we use email to contact you? (Yes) No
Telephone Number: t-^- - yfcx^
SECTION 3: DEVELOPMENT INFORMATION
a) Affordable units required
For ARO projects: x 10%* = (always round up)
Total units total affordable units required
*20% if TIF assistance is provided
For Density Bonus projects: 3'*."'/¦£ X 25% = fc.bll.tf.
Bonus Square Footage* Affordable sq. footage required
'Note that the maximum allowed bonus is 20% of base FAR in dash-5, 25% in da3h-7 or -10, and 30% of base FAR In da3h-12 or -16 (s'/VAV.cltvdfchici'QO.ord/zo'rilnQ foi zoning Info),
b) building details
In addition to water, which ofthe following utilities will be included in the rent (circle applicable):
Cooking gas electric gas heat electric heat other (describe on back)
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?
ANAL FOR PUBLICATION
iisiidiLited dale for the; commencement ot marketing
Estimated dntr: tor completion of construction of the: affordable units
Numba-
c" Dedroo ms/Unil
loi each unit configuration, till out d sepaiatf row, as npplicabls.(sgn example).
Expected Market Rent
Piopo6ed Affordable Rem"
Total Square footage/Unit
Number of Unite
Urtfl Type-
" r ~'~ "' n ' 1 Proposed
Level of Affordability|1010|51000
759
800
: f>f?d.'i hath
(60% or loss-of AMI) i
Affordable-Units
Unil Mix CK lo p.-cceed'
Market
Rate
Units
N/A
N/A
"n/a"
*ft?m fimounls uiutalivJ ^nniKilly :n llu:"Cil/ \.! CludO'.*'.'. M:n»mniii /V'lofd,!CiSECTION 4: PAYMENT IN LIEU OF UNITS k . ...
*\ •
When do you expect to make the payment -in-lieu?
S>>.<
(lypica/ly corresponds withi issuance ol building pct'mrts) ' Month/Year ¦
ijw ARb.proky.ta ; use >htf following formula to calculate payment owed:
K 10% X $100,000 = S..._ . _
Number of total units (round up to-nearest . ¦: .v Amount owed
in development whole number)
For Density D'onus projects, use the followiiigformgla to Calculate pnyinont owed.
x 60% x $
Amount owed
Bonus Floor Arr;a (oq It) median price per base'FAR-loot
(horn Inble below)
Submarket (Table for iisc with the Density Bonus fees-in-lieu calculations)
.Lp'op: Chicago Kiver on north/v/Csl'. Corig'fCSi) on south;- Lake Shore Or on east Mdith Division 6iV north: Clitcaoo River on south/west: Lake'Sliofe Dr. on east
South". Congress on north Stevenson or south. Chicago River on v.cs:, Ls'r.r:
Shore Dr. on east ' • .
Date.
West: Lake fln ncrth; Congress on south. Chi'caflo Rh/er-6n east: Racine on wast AVitboriznt(t>ri to Proceed (to be completed by Do»artmcnt'-'of DPD1
Kara Hreems
ot /'.soy aoi!» „
Dale
¦tOepaitment of Ram unci & Ijovrioprnent •1
CITY OF CHICAGO
DEPARTMENT OF PLANNING AND DEVELOPMENT BUREAU OF ZONING AND LAND USE APPUCA TION FOR ZONING BONUS REVIEW
WORKSHEET: FAR BONUS CALCULATION
Property Address:. 1061 M- Van Buren
ON-SITE BONUSES
Amenity Amenity area (in sq.ft.) Lot aroa (in sq.ft.) Premium Factor Base FAR FAR Bonus calculated
Formula:
(A/B)-C-D
Affordable Housing -On-Sito |99|(D
Public Plaza and Pocket Park |99|
Chicago Rivorwalk |99|
Winter Garden |99|
Through-Block Connection Indoor) • ; 0.66
Through-Block Connection (Outdoor) |99|
Sidewalk Widening |99|
Arcado 1.25
i/Vator Feature 0.3
Upper-Level Setbacks [-7 &-10 Districts) 0.3
Upper-Level Setbacks (-12 &-16 Districts) 0.4
Lower-Lovol Planting Terrace |99|
Green Roofs 0.3
Underground Parking [Levels -1 & -2) 0.15
Underground Parking [Lovol -3 or lowor) 0.2
Underground Loading 0.15
Parking Concoaled by Occupiable Space 0.-1
FAR Bonus Cap
compare with
00 (-5) 1.75 (-7)
.50 (-10) 3.60 (-12) 4.80 (-16)
25% ol D
30% Of D
30% of D
30% ol D
25% of D
Total FAR Bonus On-Site Improvements
Page 1 of 2
OFF-SITE BONUSES
Calculation of Financial Contribution
Amenity Formula.
Formula dsn contribution lor 1 sq Ii ol FAR bonus — 0 8 * median cost ol 1 sq 11 ol buMdabie 'loor aroa
O.i:,.: fAR
BoiuisckI Squaro Foot Desired
median cost of
I sqfl of buildablo
Discoiinl Factor rioor area (in $).
! Sea City Survoy ol
i_ Lanri Cos I
Otf-Sila Park or Riverwalk
Street Lighting aiid Landscaping
Transit Infrastructure Improvements
08
"o.e"
0.8
-08-0.8
40,248.6
7.0
. ^ ..... c
$29
_5Q_.3i_)_.__,
Pedwav Improvements
'.2...Q
'o.a
Adopl-A-Landriiark
Affordable I lousing
Education
90,559.IS.
Lot Area (Infsq. ft.)
Comparison to FAR Bonus Cap
Total Bonusod
Amenity Square Faet
Oe sired
..
Formula
Off-Site Park or Riverwaik
Street Lighting and Landscaping "28.749 '"'
Transit Station Improvements 40,248.60
Pedwav Improvements
Adopt-A-Landrnark Affordable Housing 50,310.75 28,749
Education
FAR Bonus calculated
ZXL ' _J__4.
7V0 1.75
FAR Bonus Cap:
Compare with 20%' of H .
20% of H 20% of H
20% of H
20% of H (-5) 25% of H (-7, -10) 30% ol H (-12. -161
Summary
Base FAR
jTolal Ftnani
FAR Bonus for Oi-Site Improvements FAR Bonus tor Otf-Sito Improvements Total FAR
iinciai Contribution
7.0
N/A
...3_.!5 10 ¦ 1 5
$2,100,976.92
Maximum Floor Aroa with Qasu FAR Floor Area
Signature dKApp|rc^Tt
Rev April L'Otr.
201 ,24 3 SF
._ HJA
_9_0.r_5.5_ 9,.3 5 .SF. 291,802.35 SF
Dale Received by (Dept of Planning & Dev )
Page 2 of 2
FINAL
REPORT to the
CHICAGO PLAN COMMISSION from the
DEPARTMENT OF PLANNING AND DEVELOPMENT OCTOBER 15, 2015
FOR APPROVAL: RESIDENTIAL BUSINESS PLANNED DEVELOPMENT
APPLICANT: PIZZUTI DEVELOPMENT, LLC
LOCATION: 1061 WEST VAN BUREN
Pursuant to the provisions of the Chicago Zoning Ordinance, Title 17 of the Municipal Code of Chicago, the Department of Planning and Development hereby submits this report and recommendation on a proposed Business Planned Development application for your review and recommendation to the Chicago City Council. The application was introduced to the Chicago City Council on July 30, 2014. Notice of this public hearing was published in the Chicago Sun-Times on October ,1, 2015. The Applicant was separately notified of this public hearing.
The Applicant proposes to reclassify the subject property from DS-3, Downtown Service District to a DX-7, Downtown' Mixed " Use District prior to establishing the planned development. , The applicant is submitting this application pursuant to section 17-8-0502-Tall Buildings which, requires planned development review and approval for any proposed residential building in a DX-7- Zoning District that meets .or exceeds 155 feet. Additionally, the project is regulated under section 17-8-0513-B Large Residential Developments.
SITE AND AREA DESCRIPTION
The site is located in the Near West Side Community Area (28) of the City within the West Loop Neighborhood. The subject property is irregular shaped parcel and consists of 28,749 square feet and includes a 6,343 square foot parcel of South Aberdeen Street. The vacation of South Aberdeen Street is part of a separate ordinance and will be reviewed by the City of Chicago's Department of Transportation.
The project site is located on the south side of West Van Buren Street. The properties to the north of West Van Buren Street consist of a two-story commercial building currently zoned DS-3, Downtown Service District. The properties to th'e.south. of the project include South Tilden Street and the Right-of-Way of Interstate 290 expressway. The properties directly to east and northeast are zoned with a mix of DX-3, DX-5, DX-7 Downtown Mixed Use Districts and Residential Business Planned Development no. 897. The site is not located in a Tax Increment Financing (TIF) District or. in the Lake Michigan and Chicago Lakefront Protection District.
Page 1 of 4
The site is well-served by public transit; The Chicago Transit Authority's (CTA) Racine Station Entrance and ihe Morgan Street on the Blue Line. The Morgan Street Station entrance is located approximately 550 feet and the Racine Station entrance is less than 735 feet the subject property. The CTA's Ashland Street (#9) bus, the Van Buren/ W. Jackson Blvd. (#126) Bus line and the West Harrison Street (#7) bus line are a few blocks from the site. Finally, South Jackson Street is a designated bike route, leading to the City's larger bike network and several DIVVY Bike Stations are located in close proximity to the project site.
PROPOSAL DESCRIPTION
The applicant proposes to construct a mixed-use building with ground floor retail, and accessory uses. The proposal includes the construction of a twenty-four (24). story building (275 feet) with a roof top mechanical penthouse, two-hundred and ninety-eight (298) dwelling units and one-hundred and fifty-one (151) accessory parking spaces.
The~grpund floor vyill¦ accommodate approximately .8,000 square feet, of retail and
commercial space, a residential entrance lobby, .bicycle parking spaces, storage space
and a mechanical equipment room. The retail space is divided into two separate areas
but may also be subdivided depending on the final tenant occupancy. The ground floor
contains nine (9) accessory spaces on the. ground floor and the remaining one-hundred
and forty-two (142) spaces.are^located on levels .two through four. The. project will also
provide a minimum 50% green roof area. Additionally an amenity level will be located on
the-fifth-floor terrace. • .- ; .-:
DESIGN
The building fronts West Van Buren "Streetsand features an architectural storefrontr system which provides entry to the residential lobby and the retail space. A steel canopy provides a design element to identify the residential entrance for the lobby. The second through the fourth floor-contain the parking, spaces and all four elevations on these levels are covered with a metal painted louver panel system. The fifth floor contains the amenity floor and is identified by a glass guard rail system and provides a setback to the ::buildingbon all four*sides. The sixth floor level is the-first .exclusive residential floor. The . residential tower portion/of the project also .begins at this level. The^design of the residential tower is composed of a combination of architectural window system with aluminum slabs covers on all four sides of the facades.
ACCESS/CIRCULATION
The vehicular access to the site is accessed from a private drive. The private drive allows for two way traffic 'and allows for access .from West Van. Buren Street and South Tilden Street. Loading for the building will occur internal to the site by two loading berths and are accessed from South Tilden Street.
LANDSCAPE / SUSTAINABILITY
The applicant has agreed to meet the requirements of the City of Chicago's Landscape Ordinance. The proposed project is in conformance with the landscaping and parkway greening requirements and also conforms to the : standards of the Stormwater ordinance. To meet the requirements of the City of Chicago's Sustainable Development Policy the project will achieve LEED certification and include an approximately 50% green roof over the net roof area.
Page 2 of 4
BULK/USE/DENSITY
The site is currently lamed
The project is taking an additional floor area bonus for additional floor area of 1.4 F.A.R via the CTA Transit Infrastructure Bonus in the amount of $933,767.52. The project is also taking an additionaV-i\75 F.A.R through the Affordable Housing Bonus via a cash payment of $1,167,209.40 to the City of Chicago Affordable Housing Opportunity Fund. The base F.A.R of 7.0 and the two F.A.R bonuses will allow the project to achieve a maximum F.A.R. of 10.15.
RECOMMENDATION
The Department of Planning and Development has reviewed the project materials submitted by the Applicant and have concluded that the proposed development would be appropriate for the site for the following reasons:
The project complies with the Standards and Guidelines for Planned Developments in the Zoning Ordinance (Section 17-8-0900).
Compliance with Zoning. The proposed Planned Development would increase the maximum Floor Area Ratio (F.A.R.) stipulated but would remain consistent with the surrounding community. This project would have similar uses "as the surrounding areas, which include residential, commercial, and parking.
Pedestrian Orientation. The entire street frontage of the building along
West Van Buren Street is enlivened by a glass facade looking directly onto the
street frontage. i .
Urban and Building ¦ Design. The building's design emphasizes the contrast among the various types of architectural styles and vocabulary along both West Van Buren Street. '
The public infrastructure facilities and city services will be adequate to serve the proposed development at the time of occupancy. The proposed Planned Development has been reviewed by the Chicago Department of Transportation and all requested changes have been made.
Motor vehicle parking would be accessed from curb cuts along West Van Buren Street. Pedestrian/vehicle conflicts will be minimized by the significant setback of the parking entrance, providing a greater site angle for drivers, and by a pedestrian warning light at the entrance.
The proposed development is compatible with the character of the surrounding area in terms of uses, density, and building scale.
Page 3 of 4
The proposed Planned Development would be consistent in bulk, density, and Floor Area Ratio (F.A.R.) with the surrounding area. The proposed project will ¦ remain at an underlying zoning of DX-7 Downtown Mixed Use District and achieve a maximum total Floor Area Ratio (F.A.R.) to 10.15. This project would have similar uses as the surrounding area, which includes residential, commercial, and parking.
The height of the proposed 25-story mixed-use building (275 Feet) is within the context of the surrounding area. Directly east of the site is Planned Development No. 867 approi^':.by. XftyCouncil on Wednesday, June 29, 2005; Planned Development No. 867 allows for a maximum building height of 330 feet and a 308 dwelling unit apartment tower with ground floor retail and accessory parking spaces. This building will be of similar-height, scale and proposes similar uses as the proposed project before you today.
3. The public infrastructure facilities and city services will be adequate to serve the proposed development at the time of occupancy.
Transportation, Traffic Circulation and Parking. The pedestrian access point for the residential building is located on West A/an' Buren Street, and loading will occur internal to the site-and-accessed from South Tilden Street. The project site plan has been reviewed by other City departments arid any comments received have been incorporated into the revised application.
: Based oh the foregoing, it- is the recommendation of the Department of Planning and Development .that the revised application for a Residential Business Planned. Development for Pizz'uti Development, LLC be'approved and the recommendation to tHe City Council Committee on Zoning, Landmarks and Building Standards be "As-Revised, Passage Recommended"
Department of Planning and Development ¦ ¦- ¦
Bureau of Planning and Zoning '
Page 4 of 4
Chicago Plan Commission October 15. 2015
Residential Business Planned Development 1061 West Van Buren Street
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1061 West Van Buren
FINAL
Department of Planning and development CITY OF CHICAGO
1061 WEST VAN BUREN STREET RESOLUTION
WHEREAS, the applicant, Pizzuti Development, LLC, proposes to reclassify the
subject property from DS-3, Downtown Service District to a DX-7,
Downtown Mixed Use District prior to establishing the residential business
planned development. The applicant proposes to construct a mixed-use
building with ground floor retail, and accessory uses. The proposal
includes the construction of a twenty-four (24) story building (275 feet)
• with a roof top mechanical penthouse, two-hundred and ninety-eight (298)
dwelling units and-one-hundred and fifty-one (151) accessory, parking spaces; and : •
WHEREAS, this application is submitted by the Applicant, as a mandatory application pursuant to section 17-8-0502-Tall Buildings which, requires planned-' ¦ : development-review and approval for any proposed residential building in a DX-.7 Zoning District that meets or exceeds 155' feet.-Additionally, the project is regulated under section 17-8-0513-B Large Residential Developments; and
WHEREAS, proper legal notice of the hearing before the Chicago Plan Commission was published in the Chicago Sun-Times on October 1, 2015. The Applicant was separately notified of this hearing and the proposed zoning application was considered at a public hearing by this Plan Commission on October 15, 2015; and
WHEREAS, the Plan Commission has reviewed ihe application with respect to the provisions of the Chicago Zoning Ordinance and finds that the proposal wilt be consistent with said provisions; and
WHEREAS, the Department of Planning and Development recommended approval of the application, with the recommendation and explanation contained in the written report dated October 15, 2015, a copy of which is attached hereto and made a part hereof; and
121 NOR TH LASALLE STRCLT, ROOM 1000, CHICAGO ILLINOIS 60602
FINAL
WHEREAS, the Chicago 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 October 15, 2015 giving due and proper consideration to the Chicago Zoning Ordinance; and
NOW, THEREFORE, BE IT RESOLVED BY THE CHICAGO PLAN COMMISSION:
THAT the final application dated October 15, 2015 be approved as being in conformance with the provisions, terms and conditions of the corresponding zoning application; and
THAT this Plan Commission recommends approval to the City Council Committee on Zoning, Landmarks and Building Standards of the final zoning application dated October 15, 2015; and
THAT the above-stated recitals to this resolution together with the report of the Commissioner of the Department of Planning and Development be adopted as the findings of fact of the Chicago Plan Commission regarding the zoning map amendment and planned-development application^ ...
Approved: October 15, 2015 RBPD No.
RECEIVED OCT 1 5 2015
CITY OF CHICAGO
AMENDED APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS ofthe property Applicant is seeking to rczone:
1061 West Van Buren
Ward Number that property is located in: 25
APPLICANT Pizzuti Development, LLC
ADDRESS 629 North High Street - Suite 500 .CITY Columbus
STATE Ohio ZIP CODE 43215 PHONE 630.981.3802
EMAIL . rbaziuk@pizzuti.com CONTACT PERSON Robert Baziuk
4. Is-the applicant the owner of the Property? YES ' NO
If the applicant is not the owner of the property, please provide the following information regarding the owner and attach written authorization from t,he owner'allowing the application to proceed.
OWNER Pizzuti BP LLC
ADDRESS 629 North High Street - Suite 500 CITY Columbus
STATE Ohio ZIP CODE 43215 PHONE 630.981.3802
EMAIL rbaziuk@pizzuti.com CONTACT PERSON Robert Baziuk
If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Edward J. Kus / Taft Stettinius & Hollister LLP
ADDRESS 111 East Wacker Drive - Suite 2800
CITY Chicago PHONE 312.836.4080
STATE Illinois ZIP CODE 60601
FAX 312.275.7586 EMAIL ekus@taftlaw.com
6. Ifthe applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of ail owners as disclosed on the Economic Disclosure Statements.
Pizzuti Equities, Inc.
Joel S. Pizzuti
Jcdcom Limited Partnership
On what date did the owner acquire legal title to the subject property? 2015
Has the present owner previously rezoned this property? If Yes, when?
NO
9? Present Zoning District DS-3 Proposed Zoning District DX-7:to RPD :
Lot size in square feet (or dimensions) 28,749 Square Feet r
Current Use of the property commercial building + surface parking
Reason for rezoning the property to develop a building containing ground floor retail and
residential units above with accessory parking
Describe the proposed use ofthe property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and height ofthe proposed building. (BE SPECIFIC)
The proposed building will contain approximately 298 dwelling units with a minimum of 140
parking spaces. There will be approximately 6,000 SF of retail space. The building height will be
approximately 275'.
On May 14th, 2007, the Chicago City Council passed the Affordable Requirements Ordinance (ARO) that requires on-site affordable housing units or a financial contribution if residential housing projects receive a zoning change under certain circumstances. Based on the lot size of the project in question and the proposed zoning classification, is this project subject to the Affordable Requirements Ordinance? (See Fact Sheet for more information)
YES X NO
amended application for an amendment - 1061 van buren
COUNTY OF COOK STATE OF ILLFNOIS
Robert Baziuk, 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.
For Office Use Only
Date of Introduction:.
File Number:
Ward:
amended application for an amendment -1061 van buren.doc
Department of Planning and Development
CITY OF CHICAGO
MEMORANDUM
TO: Alderman Daniel S. Solis
Chairman, City Council Committee on Zoning
David L. Reifman Acting Secretary Chicago Plan Commission
DATE: October 16, 2015
RE:, Proposed Residential Business Planned Development for property generally located at 1061 West Van Buren Street.
On October 15, 2015, the Chicago Plan Commission .recommended approval ofthe proposed planned development submitted by Pizutti Development, LLC. A copy of the 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 of the 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)
21 NORTH LASAU.K STRKKT. ROOM looo. CHICAGO. ILLINOIS 60002
October9,2015 ^ \Ojll \\S
COMMITTEE ON ZONING, LANDMARKS AND BUILDING STANDARDS
Notice of Public Hearing
YOU ARE HEREBY NOTIFIED that a public hearing on the request to establish a Residential Planned Development as described below, will be heard by the Committee on Zoning, Landmarks and Building Standards on October 27, 2015 at 10:00 a.m. in the City Council Chambers, 2nd Floor of City Hall, 121 North LaSalle Street, Chicago.
YOU ARE RECEIVING THIS NOTICE ofthe public hearing because-your property is within 250 feet of the subject site. Please refer to the general boundary description and common address below.
APPLICANT: Pizzuti Development, LLC
. 629 N. High Street, Suite 500 Columbus, Ohio 43215
OWNER: Pizzuti BP, LLC
629 N. High Street, Suite 500 Columbus, Ohio 43215
PREMISES AFFECTED: The Subject Property consists of approximately 28,749 square feet and is generally located on the south side of West Van Buren Street at Aberdeen Street. The property was occupied by Blue Plate Catering Company.
COMMON ADDRESS: 1061 West Van Buren Street
CURRENT ZONING: The Subject Property is currently zoned DS-3, Downtown Service District.
PROPOSED ZONING: The application seeks a change from DS-3 to DX-7, Downtown Mixed-Use District, and then to the designation of a Residential Planned Development.
PROPOSED USE: The Applicant proposes to develop a new multi-unit residential building with approximately 6,000 square feet of ground floor retail space. The building will contain 298 dwelling units with a minimum of 140 accessory on-site parking spaces. The height of the proposed building is approximately 275 feet.
FOR ADDITIONAL INFORMATION, PLEASE CONTACT
Edward J. Kus
Attorney for Applicant
Taft Stettinius & Hollister LLP
312.836.4080
Taft/
Taft Stettlnius & Hollister LLP
October9, 2015
Daniel Solis Chairman
Committee on Zoning, Landmarks and
Building Standards
121 North LaSalle Street
Room 304, City Hall
Chicago, Illinois 60602
RE: 1061 West Van Buren Street
The undersigned, Edward J. Kus, being first duly sworn on oath, deposes and states the following:
The undersigned certifies that a written Notice of Public Hearing in accordance with the provisions of the Chicago Zoning Ordinance was sent by first class mail on October 9, 2015 to such property owners who appear to be the owners of all property within the lot lines of the subject property and within 250 feet in each direction of the lot lines of the subject property, exclusive of public roads, streets, alleys and other public ways.
The undersigned certifies that the notice contained the date and time of the Committee on Zoning, Landmarks and Building Standards hearing; the address of the property which is the subject of the application; a statement of the intended use of the property; and the name and address of the applicant and owner.
The undersigned certifies that the applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-0107-A ofthe Chicago Zoning Ordinance and that the accompanying list of names and addresses of surrounding property owners within 250 feet of the subject site is a complete list containing the names and addresses of the people who were served.
Attorney for the Applicant
Subscribed and sworn to before me this day of
October 2015.
Notary Public
I
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I GENERAL INFORMATION
I,egal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
JEl2JLU±iJ)JL^
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
fcfl the Applicant
OR
[ ] a Jegal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (sec Section 1I.B.1.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
Business address of the Disclosing Parly. T'WO KU Ta r)0/fl-, Ph(?; S'Ul-ft 2-2 0
JdilknhuS, 0rf_j,32l£
Telephone: k30.9ft/. 3oQ2. Fax: (cWMI 3ftfl.3 Email: IT b (Lz,\\k t& pl.1. U f / U fAj
Name of contact person:
&2jLLLL
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):
•PlcwnPf/ dfvf-l/y.twnf Sf M)/, 1)1 < ttr\d 1)01 l\JM \fo.r\ SilrY/V
G. Which City agency or department is requesting this EDS? P ,l\j(r> (jQ J^pp^- (if flo^nn inn dn fL,
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please' complete the following:
Specification II and Contract //
Page 1 of 13
SECTION 11 - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate die nature of the Disclosing P [] Person
[ ] Publicly registered business corporation [ ] Privately held business corporation [ ] Sole proprietorship [ ] General partnership [ ] Limited partnership [] Trust
jyj Limited liability company
[ ] Limited liability partnership
[ ] Joint venture
[ ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
[JYes MNo [ ] Other (please specify)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Of i in
For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?
{XIYes []No []N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. 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 all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal litleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and tille of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name - Title
Pl-Li.ui\' Ff]a\hi?s j hi & ¦ UAnajinn Mjmhejzj
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 Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve fulldisclosure.
Name Busings Andres* Percentage Interest in the
Disclosing Parly
IlumH epitifi, liic- TYva Uiram&JftjkfijSurtf ?-z.Q
LdiUnhiLs^JLH 431lS
-hii f\7j.uti " foy.
. f'fifom UrnifPi-J -fnYrnersh" /3,5 "/.
SECTION 111 - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
f ] Yes ft No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(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 the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (J) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship lo Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
lo be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
[ ] Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the 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 court of competent jurisdiction?
[ ] No person directly or indirectly owns 10% or more of the Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[JYes
B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Parly submitting this EDS is the Applicant and is doing business with the 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 I is a continuing requirement for doing business with the City. NOTE: If Article I 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
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state 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 the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the Cily or by the 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 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 or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or slate or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, 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 Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agenls").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of cither the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, 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 matter of record, but have not been prosecuted for such conduct; or
violated the 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 partners, is barred from contracting with any unit of state or local government as.a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Dcbarred'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.
Ifthe Disclosing Party is unable lo certify to any of the above statements in this Part B (Further Certifications), the Disclosing Parly must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed thai the Disclosing Party certified lo the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current, employees of the Disclosing Parly who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if n oivb,; radicate wth "N/A" or "none").
ti/i\ ~
9. To the best of the Disclosing Parly'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 any time during the 12-month period preceding the execution date of this EDS, lo an employee, or elected or appointed official, of the City of Chicago. For purposes of this 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 $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is ^4 is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapler 2-32 ofthe Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapler 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Ifthe Disclosing Party is unable lo make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: 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 enlity in the Matter?
[ ] Yes M No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Ilem D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Docs the Matter involve a City Property Sale?
[ ] Yes [0 No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any Cily official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither i. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X. 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that pTorWeS coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: Ifthe Matter is federally funded, complete this Section VI. Ifthe Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe Disclosing Party with respect lo 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 the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or enlity 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
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.J. and A.2. above.
The 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 not engaged and will not engage in "Lobbying Activities".
Ifthe 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
Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ 3 Yes [ ] No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures','arici;acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicaHQ.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 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 transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all 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 the Cily 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.
E. The information provided in this EDS must be kepi current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. Ifthe 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 (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 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 Ifthe 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 ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. 1. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: Ifthe Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf-of the Disclosing Party, and (2) warrants that 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.
Pizzuti Development LLC
(Print or typfi-name of Disclosing,Party)
(Sign here) Scott B. West
(Print or type name of person signing)
Executive Vice President (Print or type title of person signing)
Signed and sworn to before me on (date) J)Q\>{ 16 7^1 f ,
at pfly^f. u County, (state).
Notary Public. ,.
Commission expires: (( 3 O'l V
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code 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 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 of the Disclosing Party listed in Section ll.B.l.a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, ifthe 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?
[ ] Yes JX] No
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title 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
BU1LD1N&tkffiiK"SCOFl7 LAW/PROBLEM 1 ,ANDLORD 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 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest iii the Applicant.
Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofllaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes f>cTNo
Ifthe Applicant is a legal enlity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofllaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
[ ] Yes 1 ] No f>4[Not Applicable
If yes to (1) or (2) above, please identify below the name ofthe person or legal entity identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND TH AT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
(DO NOT SUBMI T Tl IIS PAGE WITH YOUR EDS. The purpose of litis page is for you to recertify your EDS prior to submission to City Council or on ihc'ilatc of closing. If unable lo locality truthfully;'the Disclosing Parly must complete a new EDS with correct or corrected information)
RECl-KIT FJ CATION
Generally, for lise with City Council mailers. Not for City procurements unless requested.
This recertification is being submitted in connection with "jh< 0j?jjJLccJt.>, cvf /()(?/ l\J • y'a-^&u"**
[identify ihe Matter]. Under penalty of perjury, the person signing below: (1) warrants that
lic/shc is authorized to execute this EDS icratificalion on behalf of the Disclosing Party, (2)
warrants that all certifications and .statements contained in the Disclosing Party's original EDS
arc true, accurate and complete as oflhe tlnlc furnished to the City and continue to be true,
acauatc and complete us oflhe dale of this recertification, and (3) reaffirms its
acknowledgments.
Pi ~2.-2.vrr i j)£^eu.j)nic^r U-C Date: 'OSTcZEZ
(Print or type legal name of Disclosing I'arty)
I'rint or type name of signatory:
Zae^L ST. PilzW
Title of signatory:
[statcj.
CITY OF CHICAGO KCONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERASiINFORMATION
A. Legal name of die Disclosing Paity submitting this EDS. Include d/b/a/ if applicable:
PI22UTl BP LLC . .
Check ONE <» I"(11 c .^fo 11 imV i j 11» three boxes:
Indicate vvhcih'cr.tHcDisclosing Party submitting tins bpS"is:
1. ?> thejtppH«*e+ i)W;Jch 'c£ i»*T f:OR-
?N * . t
2. a legal entity holding a director indiicci interest in Ihe Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an. interest: ^ . ^
OR
j. a legal entity with a right of control (sec Section II.B.I.) Stale the legal name of the entity in
which the'Disclosing Party holds a right of control: „
13. Business address ofthe Disclosing Party: 629 N?RJ!lH,G.l^.sI?.EIL^Vi!?^?9_
' COLUMBUS, OHIO 4321S . , ¦ 1 .
Telephone: WP;981-3802 ,pax: 630-981-3803 Email: woaziuk@pizzuti.com t
Name of epiiiact person: robsikawu*
13. Federal Employer Identification No. (if you have one):
I- Unci'cle.scriptibn of contract, transaction or other undertaking (referred to below ns the "Matter") to which Ihis liDS'.perluins,(Include project nuinbor'aTid'location of property; if applicable):
PLANNED DEVELOPMENT OF l'601^_101'ANOi1107 WEST VAN BUREN ^ _ _
G. Which.Gity agency cr department's requesting this "b'DS?q»'CAGQOEPT_pF PLANNING AMD DEV
If the Mallet; is a contract being handled by the City's Department of Procurement Services, plca.se complete the following:
Specification // ,_ ^ and Contract//-_. ^
Page I .of '13.
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY I. Indicate iho nature oflhe Disclosing Parly:
Person 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 *:-!Ycs ''""'No
.. Trust : Other (please specify)
1. For legal entities, the suite (or foreign country) of incorporation or organization, if applicable: DELAWARE^
3. For legal entities not organized in the State of Illinois: Has the organization registcred to do business in ihe State oflllinois as a foreign entity?
? Yes . f --No • : N/A
H. 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 nil members, if any, which are legal entities: If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal litlcholdcr(s).
If the entity is a general partnciship, limited partnership, limited liability company, limited liability partnership or joint venture, list below.the name and title ofcach general partner,'managing member, manager or any'other person or entity that controls Ihe day-to-.dny .management ofthe Disclosing.Party. NOTE: l-iich legal enlity listed below must submit an EDS oh its own behalf.
Name Title
PIZZUTI BP HOLDINGS LLC MANAGING MEMBER ,
¦ ? Please priivide the' lollowing information concerning each person or entity having a direct or , indirect beneficial interest (including ownership) in excess or7.5°'u ofthe Disclosing Party. Examples ol .such an iuteicst include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a'limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, stale "None." NOTE: Pursuant to Section 2-154-030 oflhe, 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
'>_«7 H<&!-l OT-'^Tc Soo D isclosing Parly
fIziuJi-^p.112!£!.N_, rfZBP:APARTMENTS, LLC j^J&^Vff 5t£ft. ^ 30
SECTION III - BUSINESS RELATIONSHIPS WITH CITY.ELICCTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined'in Chapter 2-156 of the Municipal' Code, witli any City efectcd;official in the-12 months before the date this EDS is signed?
- Yes s No
If yes. please identify below the namc(s) of such City elected iifficial(s) andxlcscribc such' relalionship(s):
SECTION IV DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
I he Disclosing Parly must disclose the name and busiiiess.addiess of each subcontractor, attorney-, lobbyist, accountant, consul tarn and any other person or entity whom the'Disclosing U.rirty has retained or expects to retain in connection with' the Matter, asSvc II ns the nature ofthe relationship, and the total 'diuouniofthc fees paid or estimated to lie "paid. The Disclosing Party is noUequircd to djsclose, employees who are paid solely through the Disclosing Pafty|s^regular payroll. '<
"Lobbyist" means any person or entity who undertakes lo influence any legislative or administrative action on'behaIf of any person or entity qthcrihnh:"i'l) a nol^fpr-profit entity, on an tmp'aid^basis, or (2) himself. "Lobbyist" also moans any person or entity any part of wlidsc'dutiesas an.employee of aiiothcr'inci'udcs undertaking to influence any legislative or administrative action.
* If'the Disclosing Parly is uncertain whether a disclosure is required undci'ihis Section, the' Disclosing Pariy must'-citlierThsk the City wlicihcr disclosure is required ormakc the disclosure.
Page 3 of 13,.
Name (indicate whether retained or anticipated to be retained)
Business Address
Relationship to Disclosing Party Fees (indicate whether
(subcontractor, attorney, paid or estimated.) N OTE:
lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
/; Check here if the Disclosing Party has not retained, nor expects lo retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED.CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.:
Has uny person who directly or indircclly owns J 0% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
; No person directly or indirectly owns 1 ()%¦ or more of the Disclosing Party.
If ;'Yes,".has the.person entered into a court-approved agreement for payment of all support owed.and is the person in compliance wilh that agreement?
Yes
U. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code-Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements)? ifthe Disclosing Party submitting thisEDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged wilh, or has admitted guilt, of, or has ever been convicted of, or placed under supervision lor, any criminal offense involving actual, attempted, or conspiracy lo commit bribery, theft, fraud; forgery, perjury, dishonest>\or deceit'against an'O'fficer or employee ofthe City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance wilh Article J is n continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicanl,The permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page A of 13
2. The Disclosing Parly and, ifthe Disclosing Parly is a legal entity, all of those persons or entities identified in Section II. D.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, stale 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 wilh: obtaining, attempting to obtain, or performing d public (federal, state or local) transaction or contract under a public transaction; a violation, offedcra!or state antitrust statutes; fraud; embezzlement; theft; forgery; biibcry; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for.-or criminally or'eivilly charged by, a:gpvcrnmcntalrcntily-(federal, state or local) with committing any Ofthe offenses set forth in clause B:2.b. of this Section V;
have not, within a'five-ycnr period preceding the date of this EDS. had one or more public transactions (federal, state or local) terminated for cause or default; arid
have not, within a five-year period preceding the du'te of thi.s EDS, been convicted, adjudged guilty, or founddiable in a civihprocecding, or in any criminal or civil action, including actions concerning ciivironinenlal^yioln'iions; instituted by the Cily oi by the federal government", any: slate, or any other uiiit of local government.
3. The certifications in subparts 3, A and 5 concern:
the Disclosing Party: t
¦ any "Contractor" (meaning any contractor or subcontractor used.by the Disclosing Party in connection with the Mailer,: including but not limited io!all persons.or Icgaf entities disclosed under Section IV, "Disclosurc'ofSubcontiaclors and OthenRetaihed parties");
any "Affiliated Entity" (meaning a person .or entity that,;directly or indirectly: controls the
; Disclosing Party^'is controlled by the Disclosing Parly, or is, with the Disclosing Party, tinder 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 businc.sS'.ehtit^'foUowing.'thc ineligibility of a business entity lb do business wilh federal or slate or local government, including the Cily, using substantially the samc-managemcrit, ownership, or principals as the ineligible entity); with respect to Contractors, the term .Affiliated Emily means n pcison or.cntity that directly or indirectly controls the Contractor, is'controlled by if, or; with l)ic Contractor, is,-under common control ofanother person or entity;
any responsible official.of.thc Disclosing Parly, any Contractor or any Affiliated Entity or any oilier official, agent oi employee of the Disclosing Party, airy Contractor or any Affiliated Entity, acting pursuant'to the direction or authorization of a-responsible official ofthe Disclosing'PaVty,-any Contractor or any Affiliated Entity (collectively "Agents"). ?
Page 5 of 13
Neither the Disclosing Tarty, nor uny Contractor, nor any Affiliated Entity of cither the Disclosing Party or any Contractor nor any Agents have, during the live years before the dale this EDS is signed, or, with respect lo a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Conliactor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the Slate of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded wilh.other bidders or prospcctivcibiddcrs, 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 (o bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b.;above that is a matter of record, but have not been prosecuted for such conduct: or
violated (he provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
A.- Neither ihe Disclosing Party. Affiliated Entity or Contractor, oi any of their crnployccs.officials, agents.or partners, is barred from contracting with any unit of state or local government as a result of engaging iri or being convicted of (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-roluting in r violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither ihe DisclosingiParly nor any Affiliated Entity is listed on any of the following lists maintained by Ihe Office of foreign Assets Control ofthe U.S. Department ofthe Treasury or the Bureau of (n'duslry'andSecurily of the U.S. Department of Commerce or their successors: the Specially
Page 6 of 13
^ Designated Nationals List, the Denied Persons List, the Unverified'List, the Entity List nitd the-Debarred List.
The Disclosing Party understands and shall comply wilh the applicable requirements of Chapters 2-"55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Eiliics) of the Municipal Code.
If the Disclosing Party is unable lo certify to any of the above statements in this PartB (Further Ceililicalioris). Ihe Disclosing Parly must explain below:
1 r the letters "NA," the word "None," or no response appears on (lie lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge aftCT reasonable inquiry, the following is a. complete list of all current employees of the Disclosing Party who were, at any time during the 12-ntonth period preceding tlicoxeca*iontd^e,;of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A'* or "none").
9. To the bcsl'of the Disclosing Party's knowledge-after.reasonable inquiry, the following is;a complete list of all.gifls that the Disclosing Party-has given^or caused to be given, at anytime during the 12-mondi period preceding the execution date of this EDS.Uo an employee, or elected for appointed official, of thc:Cily of-Chicago For purposes of this statement, a "gift" doe's not" include: (i) anything made generally available to City employees''or to the generaKpublic, or (ii) food or^drink pro'videiUn the course of'official City business and .having a'rclail value of.lcss than $20 per recipient (if none, indicate wilh "N/A" or "none"). As to<'any gift listed below, please also.list the name of the City recipient.
N/A .
C-. CimTlFlCATlO^.OF STATUS AS FINANCIAL INSTITUTION
The Disclosing.Party certifies itint thc'Disclosing Party (check one)
¦ j is is nol
a "financial institution" as defined iivSection 2-32-455(b) of the-Municipal.Code.
Ifthe Disclosing Party IS a financial'institution, theri the Disclosing Partyplcdges;
¦ ' '. r.*>"-. A. ' ' . :.j . jpf . .
"Wc are not and will no.t become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We furtherpledge that nonc:of our affi.Iiates;.is,-a.n"Ifthe Disclosing Party is unable loinakc. tli is pledge because it or any of its.affiiiatcs.tas'defined in . Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter "|; 2-32 of the Municipal Code, explain here (attach additional pages if necessary): :>
Page 7 of 13
II* I ho Idlers "NA," ihe word "None," or no response appears on ihe lines above, il will be conclusively presumed thai ihe Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapler 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance wilh Section 2-156-110 of the Municipal Code: Does any official or employee ofthe Cily have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
'""Ves /;No
NOTE: If you checked "Yes" lo Item D.L, proceed to Items D.2. and D.3. If you checked "No" lo Item D.I., proceed to Part E.
Unlcss.sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have u financial interestiin his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sdkl by virtue of legal process at the suit of the City (collectively,' "Cily Property Sale"). Compensation for property taken pursuant to the Cily's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Docs.thc.Matter involve a'City Property Sale?
.Yes ?No
If you checked "Yes" to.Item D.l piovide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:';
Name Business Address Nature of Interest
4. The Disclosing Party further ceriifies thai no prohibited financial interest in the Matter will
b'eacquired by any Cily official or employee. . ,
I". CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please, check either I. or 2. below. Ifthe Disclosing Parly checks.2., the Disclosing Parly must disclosc'hclow or in an attachment to this EDS all information required by paragraph 2. Failure to
Page s of 13
comply will) these disclosure requirements may inuke any contract entered into with the City in connection will) Ihe Matter voidable by the City.
X- I- I l»e 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 slavcho'tiwmsuranoc^li^^ the slavery era (including insurance policies
issued 10 slaveholders that provided coverage Tor damage to or injury or death of tlicir slaves), and the Disclosing Parly has found no such records.
2: i 'le DisclosinuT'ariy verifies that, as a result of conducting the scarch-iii step I above, the
.Disclosing Party has found records of investments or. profits fronvslnvery or.slaveholder insurance policies. Thc'Disclpsing Party verifies that the following constitutes full-disclosure'.of all such records, including the names''6"f any and nil slaves or slaveholders'described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FIJNDED MATTERS
NOTE: If the Mutter iVfcdcniHy.funded, complcl'c.lhis Section VI. If the Matter is not federally, funded, piqcccd io Section V/J. For purposes of this Section VI, lax credits allocated by the Cily
arid proceeds of debl obligations of the City are nof federal' funding.
•' < <¦
A. CERTIFICATION REGARDING-LOBBYING
I. I.'ist below the names of; all persons oivcnlilics registered.under the federtd Lobbying' Disclosure Act of 1995 .who have made lobbying contacts on behalf of the Disclosing Party with respect to the Mailer: (Add sheets if necessary):
j>^~ *.r*(f> , ... '' ' '
(If no explanation appcarWr begins on the lines above, or if the letters "NA" or if-llic word "None" a'ppcaifil wiU be-conclusivcly presumed that the Disclosing Party means that NO persons,6r,enlitics fegisiered'iihder'lhe Lobbying Disclosure Act of 1995 have made lobbying contucls on bcliull'of the Disclosing Party with respect lo-lhe Matter:)
2. The Disclosing Party has riot spent and will not expend any federally appropriated funds' lo pay any person or entity listed in Paragrnph.A. I. above Tor his or her lobbying activities or to pay any -¦<''' :j;crson oneniity'io influence or attempt lo influence an officer or employee of any;agp»cy, as defined by applicable federal law, a member of Congress, an officer, or 'employer; of Congress; or an employee pfn memberof Congress;-iii connection with the award of any federally funded contract,- making any • federally funded grant or loan, cnlering'irito any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan;'"or cooperative agreement.
Page'9 of 13
The Disclosing Party will submit nn updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy oflhe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that cither: (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) of the Internal Revenue Code of 1986 but bus not engaged and will not engage in "Lobbying Activities".
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and-substance to paragraphs A. I. through A.4. above from all subcontractors befdrc.it awards any snbcontract.and the Disclosing Parly must maintain all such subcontractors' certifications.for the duration of the Matter andjmust make such certifications promptly available to Ihe City upon request.
Ii* CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If ihe Maticr is federally funded, federal regulations require the Applicant and all proposed s'.ulicoiuiactors (o suhmit (he following information with their bids or in writing at (lie oufsct'of negotiations.
Is (he Disclosing Pariy.Jhe Applicant?
Yes .No If "Yes." answer the three questions below:
Have you developed ami.do you have on file affirmative action progrums pursuant to.applicable federal regulations? (See 41 CFR Part 60-2.)
¦ .VYes' " '.No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs,'or. the Equal Employment Opportunity Commission'all reports "due under the applicable filing requirements?
Yes . \ No
Have you participated in any.previous contracts or subcontracts subject to the equal opportunity clause?
Yes No
: i
If yoii-eheckcd "No" to queslip'n I. of 2. above, please provide an explanation:
Page 10 of 13
SliCTION VII — ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Parly understands and agrees that:
The-cc.rliiicalions, disclosures, and acknowledgments contained in this EDS will become part of any contract or oilier agreement between the Applicant and the City in connection with the Matter, whether procurement; City assistance, or other City action, and arc material inducements to the Cily's execution of any contract oi'Inking other action wilh respect to'lhc Matter. The Disclosing Party understands that it must comp'ly wiih all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of ihe Municipal Codc.'imposc certain duties and obligations on persons or'ehlitics seeking City/contracts; work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cilvofchicimo.org/Etliics . and may also be obtained from the City's Board of Ethics, 740 N'.
Sedgwick St., Suite 500, Chicago, 1L0O6I6,"(312) 744-9660. The Disclosing Partyrmist comply fully with the applicable ordinances.
Ifthe. City determines that any information provided in this EDS.is false, incomplete or inaccurate, any contract oi^otlier agreement in connection with which it is submitted may be rescinded or be'void or voidable, ahd^lhe City rimy pursue.any remedies under the contract oragrecment(tf not rescinded or void), at law, or inequity, including terminating the Discfdsing Party's participation in the Matter,and/or declining to allow ihe Disclosing Party lo participate in other transactions with the City Rcmcdics.at, law for a false statement of material fncl may include incarceration and an award to the City of treble damages.
- D. It is the City's policy lb make this document available.to the public 6n,jts Internet site aruh'or upon
request Somcor all'pf the information provided on this,EDS and any attachments to this EDS maybe
made available to the public, on trie. Internet, in response to a Freedom of'lnformnlion Act request, or
otherwise. By/completing aild,signing this EDS, the Disclosing Parly waives.and releases any possible
rights or claims which it may ha ye against the Cily;in connection with the public release of information
c'onlaii'ietHn this EDS and'also authorizes the Cjty-to verify the accuracy of;rihy information submiticd
in this E,E»S. „ "A'' ' '. • ' c "
E. The .in formation provided in Ibis EDS must be .k'cpf current. ItVthc event of changes, (he Disclosing Pnrly.;must supplement this EDS lip to the time the Cily lakes action on-the'M otter.- If life Matter is 'a contract- being.handlcdjjy-.lhe.Cily.'s Department of Procurement Services, the Disclosing .Party must update this EDS.as the contrnct'rc'quircs. NOTE: With respect io Matters subject to Article Tof Chapter 1-23 of lhe Municipal'Codc (imposing PERMANENT INELIGIBILITY for certain specified, offenses),(ihe.infoimution provided.herein regarding eligibility must be kepi current for a longer period, as required by Chapler 1-23 and Scclion 2-154^020 of the Municipal Code/"'-'
The Disclosing Parly represents and warrants.ihni:
•rP.agc 11 of. 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by Ihe Illinois Depaitmeni of Revenue, nor are the Disclosing Parly or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges; sewer charges, license Ices, parking tickets, property taxes or sales taxes.
F.2 Ifthe Disclosing I'arly is the Applicant, the Disclosing Party and its Affiliated Entities will nol use. nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Panic's List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If:the Disclosing Parly is the Applicant, Ihe Disclosing Parly will obtain from any coniiuctors/subcontraclors hired or lo be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above nnd vyill not, without the prior written consent of the City, use any such conlraclor/siiboonlrnclor thai docs not provide such certifications or that the Disclosing Parly has reason to believe has not provided or cannot provide truthful certifications.
NOTE: Ifthe Disclosing Parly cannot certify as to" any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
-CERTIFICATION
Under penalty oFperjury, the person signing below: (I) warrants that he/she,is authoirzcd to execute this EDS-and Appendix A (if applicable) on behalf of Ihe Disclosing Party, and (2) warrants that all certifications arid statements contained in this EDS and Appendix A(if applicable) arc true, accurate arid complete as oflhe date furnished to the City.
PIZZUTI BP LLC '
(Print or type name o ("Disclosing Parly)
By:. , ^.(s/^Mm^
(Sign here)
-William
(Prim or type name ofcpcrsbn signing)
/r(,y... .
(Prinl or type title of person signing)
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is lo be completed only by (si) the Applicant, and (b) any legal entity which lins n direct ownership interest in the Applicant exceeding 7.5 percent. Iris not lo be completed by any Icfnil entity which litis only an indirect ownership interest In Hie Applicant.
Under Municipal Code Seclion,2-154-015, the Disclosing Party'mus\di.sclose whether such Disclosing Party ,or aiiy-"ApplicnbJcfPa"riy^*or any Spouse or DomesticTnflne'r'lhcrcof ciirrcntly'lias a ''familial relationship" wilh -any elected city official or department head. A "familial rclationship".exists if, as of the dute this EDS is •signal, the Disclosing Parly or airy "Applicable Parly" or any Spouse or Domestic Partner thereof is related to ' ihcmayor. nny aidcrman. the;city clerk, ihe city 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" mcnns(l) all executive officers ofthe Disclosing Party listed in Section H.D.l.a:, ifthe Disclosing Party is a coiporation; alhpattners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and'limitcdI partners ofthe Disclosing Party, if.the Disclosing Party 'V 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 of the Disclosing Party; and (3) any person having mote than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief -.operating oflkerVexeeiilivc director, chief financial officer, treasurer or secretary of "a" legal entity or nny person exercising similar authority.
. Does the Disclosing Parly or any "Applicable-Parly" or any Spousc.or Domestic Partner thereof currently li;i\ e a "familial relationship" with an elected cily official or department head?
\'r Yes t ¦ ^ *-J"No
II yes. please idcnlify below (Ifthe name arid-title of such person, (2) the name of the legal cntily-to which such person is'connected; (3) thename'and title of the elected city official or department head-tb whom such person bus a familial relationship, and (4) (he precise nature of such familial relationship. *
Pat-c 13 of 13
CITY OK CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX IJ
BUILDING CODIC SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to he completed only by (a) the Applicant, and (b) any legal entity which litis a-direct ownership interest iu.tlic Applicant exceeding 7.5 percent (an "Owner"). It is not robe completed by any legal entity which has only tin indirect ownership interest in the Applicant.
1. Pursuant to Mumcipal'Code Section 2-154-010, is the Applicant or nn^Owner identifiedas a building code scofflaw or problem landlord pursuant lo'Seclion 2-92'416 oflhe Municipal Code?
Yes • j/] No
FJ
2. ' If ihe Applicant is a legal entity publicly traded on any exchange, is any officer or director of
the Applicant identified as n.butiding code scofflaw or problem landlord pursuant to Section 2-92-416 oflhe Municipal Code?
Q]Yes [Z]No "' [y^l Not-Applicable
3. If yes to (I) or (2) above, please identify below the 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,AGREEMENt that this appendix b is incoupoua fed by
REFERENCE INTO, AND MADE A PART OK, THE*ASSOCIATED EDS, AND THAT THE REPRESENTATIONS. .MADE IN/HIIS APPENDIX B ARE
SUBJECTTO;jyie^'ertifiCation made under penalty of
PEK Tli RY ON PACE 12 OF IHE ASSOCIATED EDS. v
l'H|>- 14 Of I't
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION 1 -- GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
BLI, LLC
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party.submitting this EDS is:
f :j the Applicant
or:
f/; a legal entity holding a direct. or*indirecHnteresl-in the A^pliwuU: State the legal name of the
c .-'.-oApplicfttt* in which the Disclosing Party holds an interest: p^uiippnoMmga.uc
3. j ''~1 a legal entity with a right of control (see Section 11.13.1.) State Ihc.legal name oTtheciitityih
which the Disclosing Parly:holds a right of control: .
B. Business address of the Disclosing Party: 029-North High Stiect. Suite 500; ______
Columbus.Ohlo 43215 ^
Telephone: 630.9ai.3802 __ _ Fax: c3o.98i.3O03 _ Email: rcGV^k@pj£iuM.«rcm
Name of contact person: Rob«ioaauk .
Fedora) Employc^Jdenlifioation No. (if you have one). I -
Brief description of contract, (ransaclionor other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Planned Development at 106.1,1101 and -1.107 West Van Buion
G. Which City agency, or department is rcqucstihg.this EDS? Department pt Planning and Dovoiopmom'
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete.the following:
Specification # _ and Contract it _ _ _
Page I of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
I. Indicate the nature ofthe Disclosing Party:
i"jc Person V: Limited liability company
f"j Publicly registered business corporation ; Limited liability partnership
f 1 Privately held business corporation ; Joint venture
j't Sole proprietorship ' , Not-for-profit corporation
General partnership (Is Ihe not-for-profit corporation also a 501(c)(3))?
Limited partnership Yes »'¦' No
> Trust . Other (please specify)
2.' For-legal entities, the State (or foreign country) oFiiVcorporalioii or organization, if applicable OHIO
3.- For legal entities.noi organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?
Yes '-No T£N'A
B. IFTIIETMSCLOSING PARTY ISA LEGAL ENTITY:
1. List below thcjfull names and titles-of ull executive officers and all direclors ofthe enlity. NOTE: For not-for-profit corporations, also list below all members, if any, which arc legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titlcholdcr(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership oi joint venture; list below Ihe name and title of each general partner, managing member, manager or any other 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.
Name Title JOEL S. PiZZUTI PRESIDENT
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial.interest (including ownership) in excess of7.5% oflhe Disclosing Party. Examples of such an interest-include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-031) ofthe Municipal Code of Chicago ("'Municipal Code"), the City niny require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name '.'Business'Address Percentage Interest in the
(fZf ^- I'MQH "sr Disclosing Parly
JOEL S. PI22UTI Cm.S cA «+saiS "_J00
SECTION 111 -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any Cily elected official in the 12 months before the date this EDS is signed?
yYes «C'No
If yes. please identify below the namc(s) of such City elected official's) and describe such relationship^):
SECTION IV - DISCLOSURE OF SUBCONTRACTpUS AND OTHER RETAINED PARTIES'
The-Disclosing Pariy.must disclose the name arid 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 Sn connection with "the' Matter, as well as the nature of the relationship, and The total amount oflhe Ice's paid or estimated to be paid. The'Disclosing Party is not required to disclose employees wli'r/'are paid solely through the Disclosing Party's regular, pity roll.
"Lobbyist" means an/pcrsori or cntily,_\vho undertakes to influence any. legislative or administrative action on behalfof anypcrson^'or cnlify;other than: (l>) a not-for; pro fit entity, on art unpaid basis, or (2) himself, "Lobbyist" also means any person or entity any part of whose duties as an employee of rinolhcr incliidcs'undcriakiug io Influence any legislative or administrative action.
If the-Disclosing Partyjs tmccriain whether a disclosure .is required under this Section, the Disclosing pjtt ty must cither nsk the City whether disclosure is required or make the disclosure. *
Page 3 of 13
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 "l.b.d." is
not an acceptable response.
(Add sheets if necessary)
/' Check here if the Disclosing Patty has not retained, nor expects to retain, any such persons or entities SKCTJOJN-V CERTIFICATIONS
A. COURTrORDliRHD ClIlLD SUl'POKT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
lias 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'court of competent jurisdiction?
Yes " ¦/• No ' No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for. payment of all support owed and is the person in compliance with thai-agreement?
'-Y.es , No
IL FURTHER CERTIFICATIONS
1. PursuanUp^Municipal Code Chapter 1-23, ArticleT"("Arficle J'*)(which the Applicant should consult for defined terms (e.g., "doing business") andTegal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business wilh the City, then the Disclosing Party cerlificsas'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 iiivofving'uctiiar, attempted, or conspiracy to commit bribery, theft, fraud,'forgery, perjury, dishonesty or deceit against an officer or employee of the Cily or any sistcr-agency; and (ii) the Applicant understands and acknowledges that compliance with Article f is ii continuing requirement for doing business^ ith. the City. NOTE: If Article 1 applies to the Applicant, ;the.permanchl compliance lim'eframe-in.Article 1 supersedes some five-year compliance timeftnmes in certifications 2 anil'3 below
Pat;o4.-of:.-l3.
6 , •
2. The Disclosing Parly anil, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section 11.13.1, of this EDS:
are not presently deharrcd, 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 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 n public (federal, state 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;
e. are not presently indicted for,-pr criminally or-civilly charged by, n governmental entity (federal, stale or local) with committing nny of the 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, slate or local) terminated for cause or,:defnult; and
have not. within a five-year periodpieeeding the'date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or*in any-criminal or civil nction; including actions concerning environmental violations, instituted by the City or by the federal government, any stale, or any other unit of local government.
3. The certifications in subparts 3, 4 and;5-conccrn:
• the. Disclosing Parly;
any "Contractor"'(meaning any contractor 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 ''AffiliaiethEniity'* (meaning atperspn or entity thali;direetly onndircctjy: controls the
Disclosing Party, is controlled by the Disclosing Parly, or is; with the Disclosing Party, under
common control;,of inojher person or entity. Indicia.decontrol;include,'without limitation:
- interlocking management or ownership; identity of interests among family-members, shared facilities
and equipmenu'comnion use of employees; or organization of a business entity following the
ineligibility of a business entity to do business wita fcderal or state or local government, including
the Cily, using substantially the same manageinent,v'owncrship, or.principnls as the ineligible entity);
with respect lo Contractors, the term Affiliated Entity means a person or enlity that directly or.
indirectly controls the Contractor, is controlled by il, or. with (he Contractor, is under common
conlrol'Of another person ofrcntiry; . ^
any responsible official ofthe Disclosing Party, any Contractor or.any Affiliated Entity or any other official, agent or employee of ihe'Disclosing Parly, any Contractor or any Affiliated Enlity, acting pursuant to'the.direction or authorization^!' a responsible official of'thc'Disclosing Party, any ' , ConlraciorvOpany A ffilinicd Enlity .'(collectively ''Agents").
¦ , Page-S.of 13
Nciilicr the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, dining Ihe five years before the date ibis EDS is signed, or, wilh respect 10 a Contractor, an Affiliated Enlity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to,bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the Ciiy, the State of Illinois, or nny agency of the federal government or of any state or local government in the United Stales of America, in lhat officer's or employee's official capacity;
agreed or colluded with other biddcrsor prospective bidders, or been a party to nny such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in,rc.slfainl;o'f 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 lhat is a matter of record, but have not been prosecuted for such conductor
d: violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinuncc).
A. Neither the Disclosing Party, Affiliated Enlity or Contractor, or any of their employees, officials, nagcnts'or partners, is barred from contracting with any tinil of state or locnl government as a result of engaging in or being convicted of (I) bid-rigging in-violatibn o'f 720 ILCS 5/33E-3;(2) bid-rotating in violnnon'*olY7'20 ILCS 5V33.E-4; or (3) any similar offense of any state or of the United States, of America that contains.the same elements as Ihe offense of bid-riygihg or bid-iotaling.
5. Neither the Disclosing Parly nor any Affiliated Entity is listed on any of the following lists maintained by the Office of FbTcign.'Asscls Control ofthe U.S. Depailment oflhe Treasury or the -Bureuu of Industry and Security oflhe U.S. Department of.Comnierce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and'4hc Debarred Cist.
i 6. The Disclosing Party understands and shall comply wilh the/applicable icquircmcnts of Chapters 2-55 (Legislative Inspector General), 2-5(5 (Inspector. General) mul 2-156-(Governmental Ethics) ofthe Municipal Code.
Page 6 of 13
7. If (he Disclosing Party is unable to certify to any of the above statements in this Part 13 (Further Certifications), the Disclosing Party must explain below:
If ihe letters "NA," the word "None," or no response appears on ihe lines above, it will be conclusively presumed that, the Disclosing Party certified to the above statements.
8. To the best oflhe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any lime during the 12-month period preceding the -execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
N/A
9. 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 giyeti, a'l a'ny timc d'uring the 12-moriih period preceding Ihe execution."date of this EDS,"'o ah employee, or elected.or appointed official, of the Cily of Chicago. For purposes of this statement, a '"gift" does not.includc: (0 anything made generally available lo«City employees or to, the general public o! (ii) food "or drihkypfovided in the course of oTficiaTCitybiisiness and having .-h. ret all value of less than S20 per recipient (if hone;1 indicate with."N/A" or "none"). As to any?gift listed below, please also\list the namo^of the City recipient.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1. The Disclosing Party certifies ihat'ttie Disclosing Parly (check otic)
,; ¦ is " v/l is not
a "financial,institution'! as defined in Section 2:32-455(b)W)f the Municipal Code.
2., Ifthe Disclosing Party'lSa financial institution, then the Disclosirig'Party pledges: ¦¦'
¦ * •; ; • ; .:, -' ^ ... • -
"We arc not and will nottbecomc a predatory lender as defined in Chapter 2-32 of the Municipal Code. We.furtherpledge that none of our affiliates is>, and none of them will become.,»a-predutory^ lender as-defined in Chapter 2-32 of the. Municipal Code.: Wo understand that becoming a prcdatpt y^ lender or bccoming'a'n affiliate of a predatory lender may.rcsult'in the loss ofthe piivilege. of doing business with the City."
Ifthe Disclosing Party is unable to make thisiplcdge because it or any ol" its affilialcs-(as defined in ,
Section 2.-32-4.5 5(b,) oI" the Municipal Code) is a- predatory lender within the meaning of Chapter A
2-32"of the Municipal-Code,I cxplairirierc (attach additional pages if'necessary):, . ., "" T"'
-¦V
Page'/ of 13
Ifthe leltcis "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed thai the Disclosing Parly certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapler 2-156 oflhe Municipal Code have the same meanings when used in this Part D.
In accordance wilh Section 2-156-110 ofthe Municipal Code: Docs any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Mailer?
:. - Yes v No
NOTE: If you checked "Yes" to Item D. I., proceed to Items D:2. and D.3. If you checked "No" to Item D.l.; proceed lo Part E. ,
Unless sold'pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of tiny property lhat (fhb.elongs to Ihe City, of (ii) is sold 'for'taxcfTor assessments, or (iii) is sold by virtue of legal process at the suit oflhe City (collectively, "Cily Properly Sale"). Compensalioii for properly taken pursuant to the.City's eminent domain/power docs liofconstitute a financial interest within the meaning of this Part D.
Does (lie-Matter involve u City Property Sale?
Yes V No
If you checked "Yes" lo Item, D.l provide the names and busine.ss addresses oflhe Cily officials or employees having such interest and identify the nature of-stich interest:
v 1
Name Business Address Nalure:of Interest
4. The Disc.lo.smg Party, further.certifies that no prohibited financial interest iii the Matter will
be acquired by any City official or employee. ' ;
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check-either 1. or 2. below. Ifthe Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS alfiriformation required by paragraph 2. Failure to
Page 8 of 13
comply wilh ihese disclosure requirements may make any contract entered into wilh the City in connection with the Matter voidable by the Cily.
. ^.a.'- The Disclosing Purty verifies lhat the Disclosing Party has searched any and ull 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 lo slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
;<. 2. The Disclosing Party verifies that, as a result of conducting the search in step I above, the Disclosing Party has found records of investments or/profits from slavery or sluveiioldcr,insurance policies. The Disclosing Parly verifies that the following eonstitutcsTull disclosure, of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTlONVl -- CERTIFICATIONS FOR FEDERALLY FUNDED.MATTERS
NOTE: Ifthe Matter-is federally funded, complete this Section VL jf the Matter is not federally funded, proceed to Section. VII:-For puiposes ofthis Section V.l.taxicredits.allocatcd'by, the City and proceeds oTdcbl obligations of the City arcTiot federal fuiidiiig.
-A. CERTIFICATION REGARDING LOBBYING
I. List.bclow the namcs'ofall persons orentities-registered undenthc.fcdcral Lobbying Disclosure :Acl of 1995 who have made lobbying contacts pn;bchalfof Ihe Disclosing Party with respect to die Matter: (Add sheets if necessary):
'.(If no-explanalion appears or begins
2V ThcTJisclosirig,Party has not spcntvahd.will not .expend'any federally appropriated funds to pay
'any pcisoii or enlity-listed'in Paragraph A.l. nb'o'yc for his or her lobbying, net iv'ilies or to pay any
person or-ciitity to influence oratfempt to influence an officer or employee of any agency, as dcfincnpplicahltMcderal law/a member of Congress,'an officer or cmployce of Gongrcss,,or an employee of a.
.member of Congress, iii eoim'eclion/^ilh the .award of hh'y-'fcdcrajly funded contract,, making any - ;-r
federally funded gram or loan, entering into any cooperative agreement, or to extend, continue, renew,,
¦/amend,- iir modify any federally funded contract, grant,' lonii; or-coofScrativr agreement.
;. .- . Page 9-of, 13 ;' J '
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy oflhe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Phrryrcrtifics that cither: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) il is an organization described .in section 501(c)(4) of the Internal Revenue Code of I9S6 but has not engaged and will not engage in "Lobbying Activities".
Ifthe Disclosing Party is'lhc Applicant, the Disclosing Party must obtain certifications cqu'ril in form and substance to paragraphs A.l. through A.4. above from all subeontracfo/s'before it awards any .subcontract"and the Disclosing Party must maintain nil such subcontractors' certifications for the duration of thc-Mattef arid must make such certifications promptly avnilable to the City upon request.
B. . C E R T11M C A TIO N; R E G A R D1N G EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to,submit the following information wilh their bids or in writing at the*outset of negotiations.
Is the Disclosing Parly ihe'Applicant?
Yes ;'jK'o
It "Yes." answer the three questions below:
1. Htiye...:Ycs .-/.'No
, 2. Have you filed with (he Joint Reporting Committee, the Director of the Office of Federal Contract Comph'ance Programs, or the Equal Employment Opportunity Commission oil reports due under thcapplicable fiiing;rcquircmchls?
,?.Ycs «::No : .
3. Have you participated in any previous contracts or subcontracts subject to the equalopporluniiyclnu.se ?
¦¦ Yes . -. No
Page 10 of" 13
If you checked "No" to question I. or 2above, please provide an explanation:
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
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, or other City action, and arc 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.hll statiifcs, ordinances, and regulations on which this EDSis based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164.of the Municipal Co'dc,.impose .ocriuin duties and obligations;!))] persons or enlities-seeking City contracts, work, business, or transactions. The full text of these ordinances and a lraining:program isa'vailablc on "line at www.cilyofchicauo.dru/Etliics . and may also be obtained from the .City's Board of Ethics, 740.N.
Sedgwick St., Suitc.500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully" wilh "the applicablc'ordinanccs;
Ifthe City determines that any information provided in :|his EDS is false, incomplctc.or inaccurate,, any contractor other agreement in connection with .wlitch it is submitted may belrescindcd qr.be void or voidable, ,pnd thejCily may pursue any'remedics.under the contract or.agreemenl (if.nbt rcscinded.or void), at law, orin equity, including terminating the Disclosing Party's participation in the Mailer and-or declining to allow the Disclosing, Pariy to participate in 'other transactions wilh the City. Remedies at law for a false statement of material, fact may include incarceration and,an award to the City of treble damages.-,
It is the City's policy tp.inakc'this document available loathe public on its" Internet site and/or„upojr request-. Some or rill p'fihe information provided on this.•EDS.ant). any attachments to-this EDS inpy'bc made available to'the public'dti the. Internet, in response to a; Freedom of fnTprmntion Act request, or otherwise. Uy completing and signing this EDS, the Disclosing Party waives and releases nny possible-rights or.cjaims.which it may'have ngainsfthe'Ciiy in connection wilhithc p'liblic^rclcas'e of information)" contained in'lhis EDS" and nlso authorizes the City io' verify 'trie-accuracy of any information 'submitted
in WvEDS. - "t^V ' ' ¦'? • ;
:' v- ¦ .
ii. The iriformaiiomprovidcd in Iliis-EDS must be kept current.; In the-event of changes, thc; Disclosing
Party must supplement this EDS up to th'e'lime ihe City-takes action on Ihe Maitcr.'jJf tlic Mntter is a
contract being handled by the Cily's.p.epa'rtnient of Procuiement Services, the Disclosing Party must
update this EDS;as the contract requires. NOTE: With respect to Matters subject to. Article I of
Chaptcf i-23-o>thc Municipal Code (imposing PERM ANENT IN. e'ltGIBILITY for certain specified
offenses), thc. iiiformalion provided herein regarding eligibility must be kept'current for if longer period,
as rcquired.liy Chapler- I-23 and Section'2-154-020 of the M unicipal Code. / ¦;'* <£¦ri,---. 1;.'- . , .'¦ .'"''• '•/**¦''" - . '
¦the Disclosing.Pariy rcpiesent's 'ami warrants ill at: t . ,
¦'* ': ' '-i.' i*':*: ¦>,<¦¦• . '"
Page 11 of 13
F. I. The Disclosing Party is not delinquent in Ihe payment of any lax administered by the Illinois Department of Revenue, nor are ihe Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the Cily. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 Ifthe Disclosing Party is the Applicant, (he Disclosing Parly and its Affiliated Entities will not use, nor permit their subcontractors lo use, any facility listed hy the U.S. E.P.A. on the federal Excluded Parlies Lis! System ("EPLS") maintained by the U. S. General Services Administration.
F.3 Ifthe Disclosing Party is ihe Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. I. arid F.2. above and will not, without Ihc-prior written consent of the City, use any such contractor/subcontractor dial does'not provide such certifications or that the DisclosingM'arty has reason to believe has not provided or cannot provide truthful certifications.
NOTE: Ifthe Disclosing Parly cannot certify as to any ofthe items in F.l., F.2. or F.3. above, an explanatory statement must be attached tqtliis EDS.
CERTIFICATION
Under penally of perjury, the person signing below: (1) warrants that hc/shc is authorized to execute this EDS and Appendix A (if applicable) on buhalfofthc Disclosing Party, and (2) warrants lhat all certifications and statements contained in this EDS and Appendix A> (if applicable) are true, accurate and complete as of lhc'dnlc furnished to the Cily.
8LI LLC
(Print or typc^iiame of person signing)
(Print or type title of person signing)
Signed and sworn to before mc on (date) ^±{;_i/u.6JLM.f-^.l^.^^^m.t,
"I Jx. KaHuf^ County, _J.hub ^ (state),
... SkiuMUu* . i Noinry
Commission expires: 10 I %„£ OF;*?-'
Page 12 of 13 """•"uo
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is 16 be completed nnly by (a) the. Applicant, and (b) any legal entity which has a'direct ownership interest In die Ap'plicnnt exceeding 7.5 percent. It is not to he completed by any lcgal entity which has only aii Indirect ownership interest in (he Applicant.
"Under Municipal Code Section 2r \ 54-015, (he Disclosing'l'nriy musl disclose whether sucrfDisclosingipnrty oi any '¦Applicablc-Pany'-' or-nny Spouse or Domestic Partner thereof ciiiTCriUy has. a 'Tamilialfrelatipnsitip'' with any elected city official or department head. A "familial relaliqnship""exists if, as of tliedalclhis EDS is!. signed, thc;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/lepartincnl head as spouse or domestic partner or as any of the following, vyhcthcr jby blood or adoption: pnrent, child, brother or sistcr. aunt or uncle; niece or nephew, grntidparcnt,.grandch*ilcf, father-iii-law. mdtlfcr-in-law. son-inrlaw, daughter-in-law; stepfather" or stepmother, stepson or stepdaughter, stepbrother or stepsister,-or half-brother or half-sister.
"Applicable Party" means (I j all executive officers of thc;Discl6sirtg Party listed in Scctiorfll.B: ItovJf the Disclosing Party is.acorporation; all partners of the Disclosing Party, ifthe Disclosing Party is a general -'
i. partnership, nil general partners and limited partners of the Disclosmg'Pnrty, if the Disclosing-Party is n. exercising similar authority:
Docs the-Disclosing-Party or any "Applicable Party" or any Spouse or Domestic Partner tlicrcoTcurrehtly have tC'familial reialionship'-wilh an clcclcd city official or depa^ f
" VYcs - - "° ;v- r-:. ¦ : -.^ • •'•
•' if yes, pleu.se'idenlify'beloyN't Ifthe name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the" name and title of the elected cityfc-flicial or department head lo whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
;V5.
-v* ¦
Page 13 or 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is no! to be completed by any legal entity which has only ah indirect ownership interest in the Applicant.
1. 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"of the Municipal' Code?
? Yes j/]
2; .Ifthe Applicant is a legal enlity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
QjYcs [^]No- [/) Not Applicable
3. If yes to (1) or (2) above, please identify below tiie-namckd' the person-or legal entity vtdentiftedas ahuilding code scofllaw or problem landlord and the address ofthe building or buildings to which ihe pertinent code violations.apply.
FILLING OU T THIS APPENDIX B CONSTITUTES ACKNO.VVIJiJ)GI\lENT AN^VGREEMENTlliAT THIS APPENDIX B 1S.INCORPORA'FED BY REFERENCE INTO, AND MADE A PART OFyrilE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN.THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENAI .TV OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Puge 14 of 1.4
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the Disclosing Parly submitting this EDS. Include d/b/a/ if applicable: Pizzuti BP Holdings, LLC
Check ONE ofthe following three boxes:
Indicate whether ihe Disclosing Parly submitting this EDS is: 1. i_ J the Applicant
OR ' ,. .
.2. /ba.legal entity holding a direct or-indirect ihlercst in thcP^ppKttmi. Stale the legal name of the
^^,-.-">.Ap|»ltOR " ~
3. i 'a legal entity with a right of control (sec Section II. B. 1.1 State the legal name ofthe entity in
which the Disclosing Party holds a right of control: _ ...
-B. Business address of the Disclosing Party': ' 029 North High street, Suiie 500 ,
- Gclumbu9. Ohio 4321S _1 _ _ _
Telephone: 630.ae1.3002 _< Fax: «aamMva _ Email: RBhduMftH^com .
Name of contact person: jj*£ri"£'.•* L_ _ —
.r - - - - -¦
t
Federal Employer Identification No. (if you -have one)':'.
V., Brief description oi contract, transaction or.otbcr undertaking (referred to below as the "Matter") lo. which.lhis EDS pertains (
Planned Dovcloproont at 1061.1101 and 1107-Wost Van Buren _
G. Which City agency or department is requesting this ED*S?^l«'inOTtjofPian^ond Dovoi^reni
If thc
Specification # . ^ ¦• and Contract // . .. .
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing Party:
! Person |j/J Limited liability company
1 Publicly registered business-corporation J"J Limited liability partnership
i j Privately held business corporation Q Joint venture
I i Sole proprietorship | Not-for-profit corporation
! ; General partnership (Is the not-for-profit corporation also a 501(c)(3))?
I*-* Limited partnership QYes I JNo
Trust j~1 Other (please specify)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
OHIO
For legal entities not organized in the Stale oflllinois: Has the organization registered to do business in the State oflllinois as. a foreign entity?
!?> Yes QNo IjN/A
Ii. IF THE DISCLOSING PARTY IS A LEG AL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For n'bt-'for-pro'fil corporations, also list below all members, if any, which arcTcgaI entities. If. (here are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s):;
If Ihe 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 orahy other person or entity that controls the day-to-day management ofthe Disclosing Parly. NOTE: Each legal entity listed below must submitanEDS on its own behalf.
Name Tille
PIZZUTI DEVELOPMENT LLC MANAGING MEMBER
2. Please provide the following information concerning each person or enlity having, a-djrect or indirect beneficial interest (including ownership) in excess of 7.5% of Ihe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint vctttitre,
Page 2 of 13
interest ol 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 2-154-030 oflhe Municipu) Code of Chicago (-'Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended lo achieve full disclosure.
Name
PIZZUTI DEVELOPMENT LLC SLI LLC
:¦¦ ttusincssAddrcss
C{.-;fc5.„„o.L+_JJ .3 ij 5.
Percentage Interest in the Disclosing Party 53.92
35.86
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Parly had a "business relationship," as defined in Chapter 2-156 of the MunicipaJ Code, with any CityVclcctcd official in the 12 months-before the dale this EDS. is signed?
Yes ? No
ifycs^plcasc identify below the namefs) of such City elected official(s) and describe such rclations.hipfh)'.'
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Parly must disclose the name and busiiicss address oreach subcontractor,,titlorney, lobbyist, accountant; consultant and any other person or enlity whom the Disclosing Party has rcinincd or exjjccts to retain in connection with the, Mattel, as well as Die 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 Parly's regular payroll.
"Lobbyist" means nny,person or enlity who undertakes to influence any legislative or administrative action on behalf of any.person of enlity othei than: (I.J.a^not-for-profit entity,:on ah unpaid basis, or (2.) himself. "Lobbyist" also means any person or entity any part of whose duties as an cmployccof another includes undertaking to influence any legislative or administrative action.
Ihihe Disclosing Parly is uncertain whether » disclosure i.s'required under this Section, the Discjosing: Party must cither ask ihe Cily whether disclosure is required or make the disclosure.
*-xT' ¦ ¦ <-.
Page 3 of 13 "
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 "l.b.ri " is
not an acceptable response.
(Add sheets if necessary)
V Check here ifthe Disclosing Parly has not retained, nor expects-to relain, any such persons or entities. SECTION7V - CERTIFICATIONS *
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE ,
Under 'Municipal ("ode Section 2r°-2-4I5, substantial owners of business entilics-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 cornpeteni jurisdiction?
-"
.Yes yj'No . No person directly or indirectly owns 10% or more ofthe
Disclosing Party.
If "Yes," has ihe person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
, : Yes'' No
R. FURTHER CERTIFICATIONS.
1. . Pursuant lo.Municipal Code Chapter 1-23, Article 1 ("Article l")(which the Applicant should consult fo redefined teims (eg.^ "doing business") and legal requirements), ifthe Disclosing Parly ' submitting this EDS is the Applicant and is doing business witIr^liic City, thch'thVDisclosing Parly cerlifios'as follows: (i) neither the Applicant nor apy controlling person is currently indicted or charged'' wilh, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal'offe'nse involving actual, attempted, or conspiracy tpcomriiilbribery, theft, fraud, forgery, i-perjury, dishonesty or deceit against an officer or employec-,6f the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing icqtiiremeiii Cot doing business with.the Oity.yNOTE: If Article I applies lo the Applicant,thc.pcrmancnt:cpmplianci: timcliame in Article I supersedes some five-year compliance timeframes'in'ccrtifications 2 and 3 belo.w.
Paged of J3
2. The Disclosing Parly and, il'ihc Disclosing Parly is a legal ctiiiiy,.all of those persons or'entilies identified in Secliuu II.B.I. of this EDS:
arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, stale or local unit of government;
have not, within a five-year period preceding the date of this CDS; been convicted of a criminal offense, adjudged guitty, or had a civil judgment rendered against them in connection with: obtaining, attempting to oblain, or performing a public (federal, stalc.or local) transaction or contract under a public transaction; a violation oT federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen properly;
arc-not prcVeiUly.indicVcdJbrj«;9fxriininally^of .civilly charged by; a governmental entity (federal, state or local).with committing any ofthe offenses set forth in clause B.2,b. of this Section V;
A. hovciioi,.\vithiii a five-year- period preceding I he dale ol .this.EDS^had o'nc.or-morc public, transactions (federal, statc:orioerii) Icrmintited for cause or default; and
e. have not, within a five-year period preceding Ihe date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in nny criminnl or civil action, including actions concerning environmental violntions, instituted by lhc»Gity or by the federal"government, any slate, or any other unit of local government.
3. The certifications in subparts 3; 4 and 5 concern:
• the Disclosing Parly:
• any "Coiitincior'\(tneaning any contractor or subcontractor used by;thc Disclosing Parly in connection with the Mallei-, including but.not limited io\all persons or legal entities disclosed under Scciion IV, "Disclosure of Subcontractors and Oilier, ltetaine~d Parties");
« any "Affiliated Entity" (meaning n.person or entity that, directly or indirectly: controls'thc Disclosing Parly, is controllcd,by the,Disclosing Party, on>is, with the Disclosing Patty, under commoirconirji.ij'of aiilDther.pcrson or.entity. Jiidjcin of.control include; without liinit'alion: '. interlocking management or/dwhcrsh'ip; identity of interests among family;incfhbcrs-, shared facilities* arid equipment; common use of cmployecs:'or organization of a business entity following the ' ineligibility of r» liusmcs's'.ciuiiy ioYdo business with federafor stale or.loSnl government, including . rhe City, using substantially the same management, ownership, or principals'as.thc incligibje entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly eoiilrol.s.the"Contractor, is.conlrollcd by it, or,' with the Contractor, is under common control of another person or entity;
¦ any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity,or'nriy u
olher.ol'I'icial, agent orl-mplpyec oflhe Disclosing Party; any Contractor or nny Affiliated Enlity,
aciiiig pursuant to the'direction or-au'lhorizati'on of a responsible .official of the Disclosing Party;,ariy Contiaeior or any Affiliated Entity'lcollcctivcly "Agents").- ~ ¦ "
Page 5 .of 13
Neither 1 he Disclosing Parly, nor any Contractor, nor any Affiliated Entity of cilhci the Disclosing Party oi nny Contractor nor any Agents have, during the live years before the dale this EDS is signed, or, wilh respect to a Coniractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before ihe dale of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the Cily, (he Slate of Illinois, or any agency ofthe federal government or of any slate or locnl government in the United Slates of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been n 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 thai is a malier of record; but have not been prosecuted for such conduct; or
violated (he 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 partners, is barred from contracting with any un'il of stale or local government as.a result of engaging iii or^being convicted of (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violntion of 72*0 ILCS 503E-4; or (3) any similar offense of any state, or of the United Sialcsof America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither Ihe Disclosing Party nor any Affiliated Enlity is listed on anyof the following lists maintained by ihc.Officc of Foreign Assels Control oflhe U.S. Department oflhe Treasury or the Bureau of Industry and Security ofthe U.S. Department of Commerce or (heir successors: Ihe Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
if). The Disclosing Party understands and shall comply with tfic applicable rcquircmcnts'of.Chupters 2r55> (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.
Piige6of 13
7. If the Disclosing Party'is unable to certify to any of the above statements in this Part D (Further Certifications), ihe Disclosing Parly must explain below:
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Tarty certified lo the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Parly who were, at any lime during the 12-month period preceding the execution .date of this EDS. an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
N/A
9. To. the best of the Disclosing Party's knowledge after reasonable inquiry, the following is.a complete list of all gifts that the Disclosing Party, has given or caused lo be given, at any time during the 12-tnbnth period preceding tlie execution date 'of this EDSVto ah employee, of eleeiedor appointed official, of the City of Chicago. For purposes of this statement, a "gift" docs not include: (i) anything made generally available lo City employees or to the general.public, or (if) food or/drink provided in Ihe course of official Cily business and haying a retail value of loss than $20 per recipient (if none, indicate .with""N/A".or "none"). As to any gift fisted below, please also list the name ofthe Cily recipient.
N/A
C. CERTIFICATION OF STAT;US AS FINANCIAL INSTITUTION
1. The Disclosing Party certifies that the Disclosing Party (check one)
! •¦• is /. is not
a "financial institution" as defined in Section 2r32-455(b) of thc-Municipal Code'.'
2. , If the Disclosing Parly IS a financial institution, then the Disclosing Party pledges:
> ' .,** ... '• '¦ .:'' '
"Wxe are. not and will not become a predatory lender as defmed-.jn Chapter 2,-32.of die .Municipal
Code. We further pledge that none of oTtr affiliates .is. and no'ric of them'will become,'a predatory 1
lender as defined in'CHaptcr.2-32 of. thc^ unicipaiiCode;.:.;\y,e understand,that becoming a.predatory
lender or becoming an affiliate of a predatory lender may jcsult iii the loss of the privilege of doing
business with tlie City." ^
Ifthe Disclosing Tarty'ls unable to.make this,pledge bccausc.it or any of its alTiliaies-(asSection 2-32-455(b) ofthe Municipaf&adc) is aprcdatory lender within the meaning of Chapter .,,
2-32 of the Municipal Code, explain here (attach additional pages if.nccessary): ;. .
Ifthe letters "NA," the word "None," or no response appears on (he lines above, it will be conclusively presumed that the Disclosing Party certified lo the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 oflhe Municipal Code have the same meanings when used in this Part D.
1. In accordance with Section 2-156-110 oflhe Municipal Code: Does any official or employee
of the City have a financial interest in his or her own name or in the name of any other person or
entity in the Mailer?
:'¦ Yes X. No
NOTE: If you checked "Yes" to Itcm'D.l proceed lo ItemsT>.2. and;D.3. If youVehecked^,,No,, i<7> Item D.I., proceed to Part E.
2. - Unless sold pursuant ui n 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 op
any other person or enlity in the purchase of any properly that (i) belongs to the City, or (it) is sold
for taxes or assessments, or (iii) is sold by virtue of IcgaTproccss at Ihe suit of the City (collectively,
"City Properly Sale")'. Compensation for properly taken pursuant to the City's eminent domain power
docs not.constitute a financial interest within the meaning of this Part D.
Does the.Matter involve a Cily Property Sale?
; -Yes ? No
3. If you checked. "Yes", lo Item D.I., provide the names and business addresses ofthe City
officials or employees having such interest and identify the nature of such interest:
Name ' ¦ Business Address Nature of Interest
4. The Disclosing Parly further certifies that no prohibited --financial interest iii;lhc.'Mattcr will-be acquired by any'Ciiy official "or employee.
E. CERifTFJCA'TlOV REGARDING SLAVERY ERA BUSINESS
Please check either I. or 2. below. If the Disclosing Parly cheeks 2., Ihe Disclosing;I';irty musl' disclose below or in an attachment'to this EDS all information required by paragraph 2. Failuic to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the' City in connection wilh Ihe Matter voidable by llic City.
^ I. The Disclosing Parly verifies thai 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 slnvcliolderinsafanccipo/icies during (he slavery era (incJuding.insurance policies issued lo slaveholders lhat provided coverage for damage to or injury or death of their slaves), and the Disclosing Parly has found no such records.
| 2. The Disclosing Party verifies lhat, as a rcsuli of conducting the search in slep 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-thc names of.any-and all slaves or slavcholdcrs'dcscribcd.ih'those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE. Ifthe Matter is federally funded, complete.this Section VI. Ifthe Matter is not federally funded, proceed to Section VII. For purposes ofthis Section VI, Inx credits allocated by the.City andpfocee'ds of.debl, obligations oflhe City are not federal funding.
A. CERTIFICATION REGARDING LOU DYING
I, List bcld\v!thc names of all persons or entities registered undehthcTcdcral Lobbying Disclosure Act,of-l995 who have made lobbyingxonlacts on behalf of the Disclosing Party with respect lo the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above; or iLthe.letters "NA" or it ihe word "None' appear, if will'be conclusively presumed that the Disclosing Party mcahs.thatNO pcrsoris'or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying.eonitucts on behalf of the Disclosmg Parly with respect to.the.Mailer.)
2. The Disclosing Party has not speni aiid 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 lo pay any person or entity lo influcnco-or attempt to influence an officer ordnploycc of anyagcncy, as defined by applicable federal law, a member o^Congrcs.s.'ah'officerbr employee of Congress, or an employee of a. member of Congress, in connection with Ihe award of any federally funded contract,jmaking any federally funded'.ginnt o'floan, cntcringdnto any cooperative agreement, or tq.extend, continue, renew, amend, or modify any fcdcially funded contiacl, g'fa'ht,' loan, or. coopcrativc agreement.
' ¦'¦ Page 9 of I3> " 5
The Disclosing Parly will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy oflhe statements and information set forth in paragraphs A.l. and A.2. above.
The Disc losing Pony 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 not engaged and will not engage in "Lobbying Activities".
If the Disclosing Parly is Ihe Applicant, Ihe Disclosing Parly must obtain certifications equal in form arid substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party'mnsl maintain all such subcontractors' certifications for the duration ofthe Matter and 'must make such certifications promptly available to the.Gity upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
Ifthe Mailer is federally funded, federal regulations require the Applicant and nllproposcd subcontractors lo submit the following.information wilh their bids or.itfwritingiat the outset of negotiations.
Is the Disclosing Party Ihe Applicant?
1 Yes Objo If "Yes." auswerihe three questions below:
I. Have you developed and do you have on file affirmative action programs pursuant lo applicable federal regulations? (See 4 I CFR Part 60-2.)
1. ' V*-'S " %: VN°
Have you filed with the Joint Reporting Committee, the Director oflhe Office of Federal •Contract Compliance,Programs, or the Equal Employment Opportunity Commission all reports due
under ihe applicable filing requirements?
! . Yes ' - No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
!v*Yos No
If you cheeked "No" to question I. or 2, above, please provide an explanation:
Page 10 of 13
SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
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, or other City action, and arc material inducements to the City's execution of any contract or inking other action wilh respect to the Matter. The Disclosing Party understands that il must comply with all statutes, ordinances, and regulations on which this EDS is.bascd.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the'Municipal Codc^imposc certain.dittics and pbligations.on persons or entities-seeking City contracts, work, business, or transactions. The full text of llicsc ordinances and a .training program is available on line al.w.ww.ciivofcliictigo.orK/Elliics, atuT muy also be db'tained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, ILV60610, (3i2):.744-9660. Thc-Disclosing Party must comply fully w.iih the applicable ordinances.
If the City determines tbatany information provided, in this EDS is false,incomplete or inaccurate, any contract or other agreement in connection with which it is submittedi'may.'Be; resandedjor be void or voidable, and the City may pursiic any,remedies uiider the contract or agreement (if hot rescinded or void), at law, or in equity, including tcrminaling tlic Disclosing Party's participation in 'the Maitcr.nnd/or declining to allow the Disclosing Party to participate in oilier transactions with the City. Remedies at ItiWsfdr a false statement'of material-faclmay include incarceration and an award id the City oftrcblc damages;
the public oh thcVlnlcrnct, in;rcsponsc.to.n.Frecdom ^Information Act request, or iplcting and signingVthis EDS, the Disclosing Party Vvaivcs nhd.rcleases nny^pdssiblc
D. M is the Cily'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'th'is EDS may be made-available io the public otherwise By conif
rights or claims which it may have .-against the Cifyin connection with thepublic releasei'qf.infofination
contained in this;EDS and aiso,authprizcs thc.G-ity io verify the accuracy of any information submitted
.in this EDS. ' « " - ¦ ¦' *'
E. The information provided in rlits EDS 'musl be kept current. jn the event of changes, the Disclosing Party 'must supplement this EDS up to the time ihe 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 updntc'this GDS.'asilte contracUequires. NOTE: With respect to Matters subject ro Article lof ? Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELTGlDILITYJlbr certain specified offenses), the 'information provideif herein regarding eligibility must.be k«pi;ciirrent for a longer^pcriod, as,required by Chapter 1-23 and Scclion 2-154-020 of the Municipal Code. ^K'• •* * £*'
The Disclosing Party represent iinJ-warranli--thai: ,^ -
:K ¦> Page 1 I of 13: -
I7.1. The Disclosing Par ty is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor arc the Disclosing Parly or its Affiliated Entities delinquent in paying nny fine, fee. tax or other charge owed to the Cily. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 Ifthe 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 ("EPLS") maintained by the U. S. General Services Administration.
F.3 Ifthe Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance io those Tn F.l. and F.2. above and will not, without the prior written consent ofthe City, use any such contractor/subcontractor llinl does not provide such certifications or that the Disclosing Parly has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If llie'Oisc losing Party eaniiot certify as to any ofthe items in F.l., F.2. of "F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty oTperjury, the person signing below: (I) warrants lhat he/she is authorized to execute this-EDS and Appendix A (if applicable),on behalf of the. Disclosing Party, and (2) warrants'thal all certifications anil statements contained in this EDS and'Appendix A (if applicable) are'truc, accurate and complete as ofthe dale furnished io the Cily:
PIZZUTi.BP HOLDINGS LLC _
(Print or type,name of Disclosing Party)
-^C^jJ^A^—
(Sign here)
¦ W u (I $mia$ _
(Print or type name of person signing) -f
J:U£x
(Prini braypc tille of person signing)
Signed and sworn to before mc^'uHifevic^ at ^J^^^^^^oat^^^^^^^ (stale).
jjpHolary Public.
Jn.nW.pif,::;: \—^^^^t- X
Xlfl^gl^Pugenof 13
fit ',n,l* „
CITY 01* CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix Is to be completed only by (n) the Applicant, and (b) any legal entity which has a direct mvnerslilp lnterest in the Applicnnt.exceeding 7.5 percent.- It Is not to he completed by.any legal entity which has only an indirect ownership,interest In the Applicant.
Under Municipal Code Section 2:154-015, (lie Disclosing Party mtisl.disclose whether such Disclosing Party or any/'Applieablc thirty" qrfthy Spouse or Domestic Partner thereof currently has a "familial 'relationship" with any elected'city official or department head. A 'familial relationship" exists if, ns oflhe. dale this EDS is< signed. theDiselosing Party or any "'Applicable Party" or any Spouse'or Domcsticd'artncr thereof is related to the mayor;'any alderman^ the city clerk, the city treasurer or any "cily; department ^
partner or as any ofthe following, whether by blood oraiiopiiqn: parcnt.chijd; brother of sister, aunt or uncle, niece or nephew, grandparent, grandchild, fmhcr.;in-la\v;;inoiher-in-law, son-in-law, daughter-in-law, stepfather, or s.tepmother, stepson or slcpdaiighicr.;stcpbr'6tlicr or stepsister or half-brother or half-sister.
. '."Applicable Pariy^mcans~j(T) nll-cxcctilivcofficersof the Disclosing Party listed in Section 11:13.1.n., if ttic Disclosing Party is n'corpora'tion; all partners of the Disclosing-Pnrty, if the Disclosing Party is a general partnership: "all general partners and limited partners of the Disclosing Party, if. Hie pisclosing'vPait^-is a limited partnership: all managers, managing members and members of ihc Disclosing Party, ifthe Disclosing Party is a liniilcdJiabiliiy company;.(-2) all principal officers oflhe Disclosing Party; and (3) anypcrson having more than a 7.5 pcrccni ownership'interest in the Disclosing Parly.^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. "*
Docs the .Disclosing Party or any "Applicable Pnrty" or any Spouse or Domestic Partner thereof currently
have a "familial relationship" with an elected cily official-or department head?-: # '
>V :-. ¦ {. "si Yes ' :«If yes. please identify bclovv f I) the name and title of such person, (2) the name of the legal entity lo which such person is connected; (3)' the mime and title of the elected city official or department head to whom such, person lias a familial relationship, ajul (4) the prccisc'hature'ofsuch fmniliahrclntionship
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
Tins Appendix Is to be completed only by (n) the Applicant, and (b) any legal entity whichlms a direct ownership interest in the Applicant cxcccding''7.'5'pcrccnt (an "Owner"). It is not to bcWmplclcd by any legal entity which has only an indirect ownership interest In the Applicant.
1. , Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owrier idciilified as a building code scofflaw or problem landlord pursuant to Section 2-92-41 fi.of the Municipal Code?
No
? Yes
2. If the Applicant is a legal entity publicly tradedkon any exchange, is any officer or director of the. Applicant identified as a building code scofflaw or problem landlord pursuant.tb Section 2-92-4J 6 or the Municipal Code?
QYcs dNo Not Applicable-
.3. If yes to (1) or (2) above, please identify below the name of the person or legnl entity
idciitifiedtas a building code scofflaw or problem landlord and the,address of the building or
buildiiigs to which the pertinent code violations apply. ""' ••-
FILLING OUT THIS APPENDIX B CONSTITUTES.ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS,INCORPORATED BY'. REFERENCE INTO, AND MADE A PART OF; THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MATJE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE,UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCI ATED EDS;
l';>i;e M ol' M
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the. Disclosing Party submitting this EDS. Include d/b'/a/ if applicable: P2BP Apartments, LLC
Check ONE of 1he following three boxes:
Indicate whether the Disclosing Party.submitting this EDS is:
| Ihe Applicant
• ."0R „w.^A
iyj a legal entity holding a direct or indirect interest in the Appfeantt? Slate the legalname ofilhe
<&vw*J^^T^***R^n'which the Disclosing^ Party holds an interest: pizzuti bp, llc . . ._
OR
3. ; ~,-a legal entity with a right of control (sec Section Il.B.I.) Stale the legal name ofthe entity in
which Ihe Disclosing Party holds a right of control:
Ti„ Business address of the Disclosing Party: 5242 Bateson Beach Road ^ '
-¦Thornvllle. Ohio 43078 ' -
Telephone": 740.4B7.2bi 9 Fax: 740.4c7.7519 _ Email: PYorh6@ooiumbus.it.com _ .
Name of contact person: fjvayw-^*« ^
E. Federal Employei 'Identification.No. (if you have one): ...
F-. Brief description of contract, transaction.or other undertaking (refcrred to below as the "Mutter") to. which this EDSipertains. (include projecthumber-arid-ldcation of property, if applicable): .
Planned Development at 1061,1.101 and 1107 Wpst Van Buren ...
G. Which' Cily agency or department is requesting this 'EPS? Department ot Planning ana Development .
.Ifthe Matter is a contract being,handled by the City's Department of Procurement Services, please complete the following:. ->
Specification ti _^ and Contract it :
Page,], of. 13
SLC I'lOiN 11 -- DISCLOSURE OP OWNERSHIP INTERESTS
A. NATURE OT THL- DISCLOSING PARTY
I. Indicate I ho nnuirc.uf the Disclosing Pail Pet son
Publicly registered business corpnriiliun
Privately liclcl business corporation
Sole proprieiorslup
General partnership
Limiied partnership
Trust
? Limited liability company
Limited liability parlnership
Joint venture
v Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
'Yes . No
Otlier fplease specify)
2. Tor legal entities, ihe slate (or foreign country) of in'coiporation or organization, if applicable: OHIO
3. Pm ley.il cnliiics;noi organized in the State oflllinois: Mas the organization registered to do business in the State nf Illinois ns a foreign entity?
- Yes No N.'A
IL II TIIEDISCLOSING PARTY IS A LEGAL ENTITY: ,
I. Lisl below.ihe full names and titles of till executive officers mid all directors of.lhc enlity. .NOTE: For not-for-profit corporations, also lisl below nil members, if nny, which are legnl entities. If there ate no such members, write "no members." For trusts, estates or. other similar entities, list.below ihe legcl Itilchoider(s).
II the entity is a general partnership, limited partnership, limiied liability company, limited liability partnership orjoinl venture, list bclpw-thc name and litle of each general partner, managing member, manager or any other person orcniiiy Hint controls (he day-to-day management ofthe Disclosing Party. NOTE!: Each legal eiiiiiy listed b'elnw must submit an EDS on its own behiilf.
Name1 Title
PGGGY W. YERKG- , MANAGING MEMBER
2., ('lease pun ide the following information concerning each person or enlity having a direct or iudiicci beneficial inicrexi (including ownership) in excess of 7.5% oflhe Disclosim/Puriy. Examples ol'siieh an ini'cresl include shares in a eorpnralinn, partneiship interest in a partnership orjoinl venture,
Page 2 of 13-
Percentage Interest In the Disclosing Parly 70
12.5 _^ 12.5
interest ol'a member or mjiwiycr in a limiied liability company, or interest oTn beneficiary of a trust, osiale nr other similar ctuily. If none, siale "None." NOTE: Pursuant to Section 2-15'!-0J0 oflhe Municipal Code of Chicago ("Municipal Code"), the Ciiy may require any such additional information from any applicant which js reasonably intended to achieve full disclosure.
Name Business Address
PEGGY W.YERKE Tt-tec.-iViM.t- oil t/307^
MARK S. YERKtfTRUST "
fsmnu » tiki rttrnts in :i »
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
'Ma;; ilit* Disclu.sttu! Party had :i "business re hi I ions hi p." as dofiiied in Chapter 2-156 of the Municipal Code, with "any Ciiy elected official in Ihe 12 months before tbe'dnte this EDS is signed?
Yes ?No
If ycs; please identifyIjcIow the nnmu(s) of such Gity elected officiates) and describe such relationship(s):
.SECTION D -- DISCLOSURE OF SUBCONTRACTORS ANCOTHER RETAINEO'PARTIES
The Disclosing Parly must disclose the name and business address of each subcontractor, utlorncy; lobbyist,'accountant, consnltaniond any oilier person of entity whom the Disclosing Party has retained or-expecis to retain in connection with the Matter, as-well ns the nature of the relationship, an'd the total amount of ihe fees paid or estimated to he paid. The Disclosing Parly is not required lo disclose
employees-,\\'Ko"iire paid solely through the Disclosing Parly's regular payroll.
•¦. ',..' ¦/.¦>'
> ¦ '< - - /
'"Lobbyist" means any person or entity who undertakes to influence nny'lcgislativc or administrative' acu'on oiTbohalfuf-nny person or enlity other than: (I) a not-for'projlt entity, on ail unpuid basis, or (2) himself. "Lobbyist" also moans any person orcnlily. nny pari.of whose duties as on employee of another includes undertaking 16 influence any legislative or administrative action.
Ifthe Disclosing Cany is uncertain whether a disclosure is required under this Section; (he Disclosing Party must cither ask the Cily whether disclosiirc'is rc'rtuircd.or make thc^isclosiirc.
Page 3"of 13
Name (indicate whether Business retained or anticipated Address to be retained)
Relationship lo Disclosing Party Fees (indicate whethur
(subconlraolor, attorney, paid or estimated.) NOTE:
lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
/! Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -« CERTIFICATIONS
A. COlJRT-QRpiiRl-D CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract wilh the City must remain in compliance wilh their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Parly been declared in arrearage on any child support obligations by any Illinois court of competcnFjurisdiclion?
" Yes '/"No ' 'No person directly or indirectly owns 10% or more oflhe
Disclosing Party.
If "Yes," has the person entered into.a court:approvcd agreement for payment of all support owed and is the person in compliance with that agreement?
' ' Yes f" No
13. l';URTlllilU:fn< lTI^CATl6NS
1. . Pursuant to.Municipal Code Chapter 1-23, Article 1 ("Article 1")(which.the Applicant should, oonsult-for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Parly submitting this EDS.is the Applicant and is doing business with the City,.tlien the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guill 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 oflhe City or any sister agency; and (ii) the Applicant understands arid acknowledges that compliance with Article I is a continuing.requirement for doing business with the City. NOTH: 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 A of 13
2. The Disclosing Party ;tiu), HTlie Disclosing Parly is n legal entity, nil oflhosc persons or entities identified in Section II.O. I. of this EDS;
:i. ;ire not presently deburred, suspended, ptoposed for debarment, declared ineligible or voluntarily e,\cl>idcd fiomiuiy transact iuus by any federnl. slate or local unit of government;
b. have not, within u five-year period preceding the dale of (his 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 n public (federal, stntc or local) transaction or contract under n public transaction; a violation of federal orslnlc.anlitrusl.siaiules; fraud; embezzlement; theft; forgery; bribery; falsification nr desin/ciion of records; making fal.se statements: or receiving stolen property;
e. are not present/yjndieted Ibr. or criminally or civilly charged by, a governmental entity.(federal, state 01,local) with coalmining any of Ihe offenses, set forth in clause' B.Z.brof'lhis Section V;
d. fcnvejnni, wilhhf a five-year period preceding the dattvof this EDS. had one or more public
transactions (federal, state or local) terminated for cause or default; and
e, have not, within a fiveryenr pel iod preceding the date of this EDS, been convicted, adjudged,
guilty, or fouiul linble in a civil proceeding-,.or in nny criminal or civil^nelioh, including'nctidns
concerning cnvironincnuil-viohiiionsinstituted by the Cily or by Ihe federal government, any
slate, or^any oilier uh'il.of-loenl goyernineiit. '
3. .TJK.ctTlifiealions in subparts 3. 4 and 5 concern:
the Disclosing"Parly";
¦ any "Contractor" (meaning nny contractu! or subcontractor used by theDisclosing Party in cqnncction,.wilh (lie.tyiutlL-r, including but noi-limilcd Ip all.persons onlcgul entities disclosed under Section IV. "Disclosure of Subcontractors ,md Other Retained Parties");
any "Aftiliaied Enlity" (meaning a person or enlity lliat/directty ur'mdirccily: conlrolsj.ih.c
Disclosing Paiiy, is coiitroiled.by the Disclosing Porty.-or is, with the Disclosing Parly; under
common control oftinoihor person or entity. Indicia "o,f control include, Ayiihrjut- limitaliuii: *
i^iiLN'hiekiiig'maiiageniciii^r-owncrsliip; identity of interests among family members, shared.facilities
:md equipment; common use of employees; or organizatipn of lubusin'css entiiy following; the "J"
ineligibility of a business,entity lo do business with federnl or state/or local go'vcfiiinaiil.'mcriidinjj
the Cityi using sub'sinntjally'thr. same management,.ownership, or principals as the ineligible entity);
with respect m Contractors, the term Affiliated Emily menns'n?pcrson or chtity ihni.dirccih/.or
indirectly controls the Conirncipr, is eoiiirolJcd'by^i'l, or. wiih.iln: Contractor, is under common
control or.mothcr peisou or entity; 2 \.
tiny lespnnsiblc official of the Disclosing Parly, any Contractor or ony Affiliatcd.Eiitity or any
other offieial, agent or employee of the Disclosing Parly, uiiy Contractor or nny Affiliated, Entiiy,
:ieiii)|;,ptnsii;mt (o.llie dfrection or authorizniinn of-n re'spbnsible offieiyl.of the Disclosing Paiiy, nny
! 'oiuraeior.or :ipy Affiliated Entiiy (collcclivc!y",Agcnls"). ' ' '"'
Page 5 of 13
Neither the Disclosing Puny, nor any Contractor, nor any Affiliated Entity of cither the Disclosing Party or any Contractor nor any Agents have, during the live years before the dale ibis EDS is signed, or, with respect lo a Contractor, an Affiliated Entity, or an Affiliated Emily of a Contractor during ilic five years beloie the dale ofsueh Contractor's or Affiliated Entity's contract or engugciucut in connection with the Mailer:
a. bribed or attempted In bribe, or been convicted or adjudged guilly of bribery or attempting to
bi ibe, a public officer or employee of the Cily, the Slate of Illinois, or any agency of the federal government or of any stale or local government in the United States of Amcricn, in that officer's or employee's official capacity;
b. agreed or colluded with other bidders or prospective bidders, qr been n party to any such
agieemeui. or been convicted or adjudged guilly of agreement or collusion among bidders or
prospective bidders, in restraint nfTreedoiii of competition by agreement lo bid n fixed price or
oiherwisc; or
»:. mnde'juh aihiiissioii of such conduct described in a. or b. above that is o mailer of record, bui have not been prosecuted .for such conduct: or
d. violated (he provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party. Affiliated Enlity or Contracior, or any of their employees, officials, agents or partners, is barred from contructuig-wiih any uiiil of slate 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-rolriting in violation of "2(1 ILCS 5 '33E-Neither the Disclosing Party nor any Affiliated Entity is listed.on uny.of the following lists iVwiintn'iifd by the Olfice/oT foreign As.scis;Conlrol oflhe U.S.-Department ofthe Treasury or the Hureait of Industry and Security of the U.S.'Department of Commerce or their successorsMhc Specially Designated Nationals Lisl. ihe Denied Persons Lisl, the Unverified List, the Entity Lisl iind the Debarred List.
The Disclosing Party understands and shall comply wilh the applicable requirements orChajiteis '2-55 (Legislative Inspeclor.Gcncral), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal. Code.
Page 6 of 13-
7 Ifthe Disclosing Parly is unable io certify io any ofthe above, statements in this Pari B (further Certilieaiions). ihe Disclosing Party musl explain below: ,
Jf the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
S. To the best of the Disclosing party's knowledge after reasonable inquiiy, the following is a complete list of all current employees of the Disclosing Parly who were, at any time during ihe 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
N/A
9. To the best ofthe Disclosing Party's knowledge, after reasonable inquiry, the following is a complete-list of all gifts lhat the Disclosing Parly has given or caused lo be given, at any time during the 12-month period preceding the execution dale of thisTiDS, to art employee,'or elected or appointed official, of the City of Chicago. Tor purposes of this statement, a "gift" does not include: (i) anything made generally available lo City employees or|to the general public, or^ii) food or drink provided hAhc course of official Cily business and having a rctail valuc of less than $20 per recipient (if none, indicate wilh "N/A''.or "none"'). As to any gift listed below, please also list die name of the City recipient.;
¦ N/A'
C. CERTIFICATION OK STATUS AS FIN A NCI AL 'INSTITUTION
The Disclosing Party certifies lhat the Disclosing Party (check one)
i ' is '/' is not
a "financial institution" as defined in Section 2-32-455(b);of the Municipal Code.
If the Disclosing;Party IS a financial institution, then the Disclosing Parly pledges:
"•We are ndt^ano^will-nbl become a predatory lender as defined in Chapler 2-32 oflhe Municipal
Code. We further pledge that none pf„our affiliates is, and none of them will become, a predatory
lender as defined in Chapter 2-32 of the Municipal-'Code"." We understand that becoming a predatory
lender or becoming an affiliate of a predatory dender may re'suli*iiuthe'Toss of the privilege of doing
business with the City!" „ * g
•>A& ' ' 'JS
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliales>(as defined in Section 2-32-455(b) of thc'Municipal Code) is a predatory lender within the meaning of Chapter' 2-32 oflhe Municipal Code, explain hero (attach additional pages if necessary): • - *"
I Cl he letters "NA," thr word "Wane." or no response nppenrs on (he lines nhuve, it will be conclusively presumed (h.K (lie Disclosing Party certified to the above statements.
D. CERT (PICA "HON REGARDING INTEREST IN CITY BUSINESS
Any words nr terms thai arc defined in Chapter 2-156 oflhe Municipal Codchave the sunie meanings when used in this P;m D.
I. In accordance with Section 2-I.V6-1 10 oflhe Municipal Code: Does any official or employee ofthe City have ;i financial interest in his or her own mime or in the name o'fnny other person or entity in ihe Matter''
Yes ? No
NOTE. If you rhecked "Yes" 10 Item D.I., proceed lo Items D.2. and D.3. If you checked "No" lo llcm D.l...proceedWPun E.-
I. Unless sold pursuant to a process of competitive bidding, or othcrwiscpcrmiilcd, no Gily elected official m employee shall have a financial interest in his or.her own name or in the nainc of nny other person or emiiy'iri ihe purchase of any properly that (i) belongs to ihe Cily, or (ii) is sold lor laser, or assessments, or (iii) is sold by virtue of leual process hl'the soil of the City (collectively, "(f ily Properly Sale"). Compensation for property taken pursuant to'the City's eminent domain power dues tint constitute I'maneinl interest vviihin the meaning of litis Purt D.
Docs' the Matter involve a City Properly Sale?'
Yes ?No
^. If you checked "Yes"'to llcm D.I provide die uaiuc* and business, nddi esses oflhe City officials or employees haviim sttch interest and identifythe natii'rc'of such interest:
Name business Address Nature o'f.liitcrcst
A Die Diselosiru; Party fmiher certifies thai no prohibited fiiia'iicial'iulercsl in'llic'MaUcr will be a'.qiiiied" by any City official or employee.
E. CERTIFICATION REGARDING'!;'l",A*VERY'ERA BUSINESS
Please check either 1 or '> below. II" the Disclnsini; Parly eliccv.u 2:, ihc.-Disclosing Parly must' disclose beloVWur in'aii uil.ii.hnicut to (his EDS nil infoimolion required by paragraph 2. Failure to
comply with these disclosure requirements may make any contract entered into wilh the Cily in connection with the Matter voidable by llic Cily.
_^_l. The Disclosing Parly verifies thai ihe Disclosing Parly has searched tiny and till records of the Disclosing Parly and any and jjl predecessor entities regarding records of investments or profits from slaver)' or slaveholder'itistfTttricc'policies during Ihe slavery ctn (including insurance policies issued to slaveholders that provided coverage Tor damage to or injury or death oT their slaves), and the Disclosing Parly has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
D.isclosiii'J! Party has found records of investments or profits from slavery or slaveholder insurance policies. 'l'be'Di"c.lo;;'mg'Pariy verifies tlial ihe followirig'consliiutcs full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
skction vt CEimncAT jons i?or federally funded-matters
NOTE. Ii tlie;M:itter is;feder:illy funded, complete this Section VJ. If Ihe Matter is not ftdcrnlly funded, proceed u> Section V||. Eur. pin poses of IhisScclioii Vl.la'x credits allocated by.lhc Cjty' and proceeds of debt .obligations of Ihe Cily arc not federal-funding.
A. CEHTIEICA I ION REGARDING LOBBYING
I. List below the names 'of all persons or entities registered under the federal Lobbying Disclosure Aci of 1995 who have made lobbying cuiu'acis oh bchair of the Disclosing Parly with respect lo tiie,Matlcr:.:(/Ydd sheets if necessary):
• (I I" iio'e.\pl:m'aiion ;ippe';n;s\ir begins onrlhe lines nbove.'W ifthe letters "NA" orif the word "None" 'appeal;,'it w ill be conclusiyclypresumcchhoi llic Disclosing Party means ihni NO persons or cnlilies
retiistercd under Ihe Lobbying Disclosure Act of 1995 have made lobbyiitg;conlucts on'bchnlf of tho
Diselbsmg'Pariy with "respect to the Matter.)
2. The Disclbsmg'Porty has not spent mid will noi expend-ariy federally appropriated funds to pay any person or entiiy listed in Paragraph A.l. above for:his or her lobbying aetivities or to pay any per-tcm or entity io influence qi attempt to influente uji'ofl'icer or employee of any/agcncy.'as defined by appjicabfc fede'rdI law.'.it member of Congress."an officer or employee of Congress, or an employee of a* member ol' Cohgress,-iii;eonneciion wi.lluhc award of any federally funded contract, making nny- -federally; fu'rii/ii'd giai'u or loan, entering into any cooperative Agreement, or fo-cxccnd,-ii(i(tucf' rene w/-. amend, or modify any kdcrally funded contract, grant,- loan, orcooperative njjrccmchL ¦ '¦ v:
; - Page 9 of'l 3
J. The Disclosing Party ivill submit an updated certification hi the end of each calendar quarter in which there occurs any event that materially affects ihe accuracy ofthe statements and information set forth in parjgiaphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not nn organization described in section 50l(c)(«t) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section
501 II ihe Disclosing Party is the.Applicant, lite Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards nny subcontract and (he Disclosine Parly musl maintain all such subcontractors' certifications Tor the duration oflhe Mailer and must make such certifications promptly available to the City upon request.
CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
JIT he Matter is federally funded/federal icgulalions require the Applicant and all proposed subcoiitrackirs to .stihmii the 7Is the Disclosing Party the Applicant?
Yes No "
If "Yes." answer the three questions below:
Have yon developed and do' you have on file afl'irmuliviVaeticn programs pursuant lo applicable federal regulation's? (See 'I I CFR Part 60-2.)
Yes No
*-
Have you filed With ihe Joinl Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all-reports due under the applicable filinc.requirements?
Yes . No
Have ytw participated in>:i'ny previous contracts or subcontracts subject to the equal opportunity clause'.1
Yes No
11'you checked "No" to question I. or 2. above, please piov'ide on explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Pnriy undcxsiaiicLsaAA. The CLTtii'icaiions, disclosures, and acknowledgments contained in cliis: EDS will become pari of any contract or oilier ajjrecmcni'between the Applicant and llic City in conneelion wilh Ihe Matter, whether procurement, Cily assistance, or oilier City action, and nre material inducements lo the City's'execution ol aiiy contract nr taking other action with respire! to ihe Mailer. The Disclosing Party understands that ii musi comply with all suuules, ordinance;;, and regulations on which (his EDS is based.
13. Tin: CiiyVGoveriimenial Ethics and Campaign Financing.Ordinances, Chapters 2-156 and 2-164 of the.Municipal Code, impose certain/duties¦aiiil.ubhgiiiions on persons or entities seeking City contracts; work, business; or^iraiisaciiuns. The full lest of.lhcsc ordinances and a training program is nvailablc;on line ui ww'w.eiivofcliic'aeo.om/Ethics, and livay also be obtained from the City's Board of Ethics; 740^.
Sedgwick Si., Suite S00, Chicajjo, IL 60610, (312) 744-9660. The Disclosing Party musl comply Tul'ly ¦with llic applicable ordinances.
C.- IIThe Ciiy determines dim any inTorimuion provided in this EDS is false, incomplete or inaccurate, any crtiiirnci or oilter agreemeni in connection with whicli.il is snbmiued may be rescinded or lie void or vnidfiblc-anil the City may pursue any reincdies'UntJer llic contract or'agrecuienl (if noi rescinded oi •¦¦>¦ void), ai law, o'r'in equiiy, incliidiuu:(eriiiinnting ihe Disclosing Party's pnfticipationju the Matter anil'or declining id allow the Disclosing Party to] participate in other; transactions wilh thcCity. Rcmcdicsat law for a false statement of materia! faciniiiy include incarceration and an uwardTo Ihe Cily of treble damages.
D. lt is Ihe Cily's policy ttrmake tliis document Available to llic public on iis'lnierncl site and:or upon
requesi. Some oi all of the informalion provided on IhisTiDS an'd.'nny attachments to tliis EDS may be
made available to the public oil.llic Imcrncr, in rcsppns.c lo a Freedom of Information Act request, or .,
otherwise IV. eniiipleiiiig-.iiiUvsigiiiiig'"'tliis EDS, the Disclosing Parly^vvaives'ynd releases nny possib'jc
•rights'on claims \C hit:IiTl Ti'uiy have against the Cily in connection .with tlio public release of information
contained in this EDS ami.also authorizes the Ciiy io verify.the acctiracy,of any inforinnlion submitted.;,
= inthis.ilps. ~'** ' v;'- v!:~- .-Y.-J; •>;• .'•»>•* \ ¦ -' '¦
E. The information provided in this EDS inusi be kepi current. In tlic_cvcnt of changes, thc'Dis'closing'•
-P-nriyjnusi supplenieni this fiDS;np io the tiniclltc Ciiy takes action on the Mnitcr. If the''Matter is ly
eoniracl ueiiiL'.:liandled.ljyupdate this CDS as tticVontract iequires.< NOTE:. Wilh respect to Ma'tlnrs:subjcct 10 Article ! of •/* x
Chapter I -2 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY forecitain specified
offenses), the in forma lion ptov iilcd-hwcin,regarding eligibility must be kept'current for a longer period,
'tis required by.Chapter 1 -23.and Se'ciion 2-1 54-020:01' the Municipal Code' "
Tift Disclosing.Paify,represents and warrants.Iluit: ' ".
i
. l'aj;e I I of 13 .
.CixMcion Bank7404672078
10/05/2015 61:31
P. I. The Dltclcjiaa J^ty h aoi dcllnqu«ni In (ho paymoni of any (ax administered by the Illinois Dvpnrtmcnt o rn* wove, «or arc Ihe Oikcloitoa Parly or lU Affiliated Emltiw delinquent In paying eny Iiiie, Fee, lux or other cltorjjo owed to the City. TKis Includes, but (l not limited to, all Wflttr chnrflti, «cwcr charges, IIcciik fceJ,.p«rVlnrJ( tlckcn, properly (axes or dales taxes.
f.l (/"die Disclosing Party Is the Anpl/«in<, \ho Dljeloslng Party and iu Affiliated entitle* will not tile, nor permit their jolicoiiluctoni to uie. any fncllliy listed by (be U.S. B.P.A. on tin federal Excluded Parties List Sysicni ("EI'LS") innlniulocd by the U. S, General Servieoi AdrnlnlstKtioit.
F.3 11' ihe DiMloslns Parly Ih llic Applicant, ihe Dtj'oloiitlg Party will obtain item oriy coiiiiociortAuibedrilraetort lu'rcd,orto be hired In connection' with the Mailer certifications equal In form and stibJtnnce to lliosc In F.l. and F.2- above rind will not, wllhoffttho prior written conjent ofthe Ciiy; use nny such coiiiracior/Huhcciniraclorthot does net p'foWdeWti e'ortificaitloflil or (lint Uw Disclosing forty \\n rcaioit io.bc|icvc has not provided or tonhot provide truthful ccrtlfiwtioM.
' NOTR: ir iHe' DliieloJiini! Parly cannot certify h» to nny of the item* Iii F.l., F,2i or F.J. above, on uxpionoiory tlnicmcal musl be allocked to lilt* EDS,
CERTIFICATION
Under penally of perjury, the per wo ilgninj Below: (1) worunls that he/she la autliorircd.to execute ¦this ep.S.flnd Appeiidlx-AXIf iippllcnhle) on behalf of lh« Plielailng Parly, and (2) wprrMiU lhat all ccriifiic'iiiioni und jtutcmenlj contained In lhl»;ED5 ind Appendix A (If opplicsblc) are true, oceuraie
and complete as of die dale furnl»lic'PZ8P APARTMENTS,'LLC
(Prim ort'vpenariicnfOlscfosina'Poriy)
SiyjicJ and iwoniito before mc on fdjtc)
.•in -' ''i.
V^iif^A. BRANOI CRUMLEY
Notary PubUc.-SUta'of Ohio My Commlflolon Explrot '" W-)f-20M
a Cbmmlxsioncxjiires;
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT AJTGNMX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is In be completed only by the Applicant, and (b) any legal entity which has u direct ownership littc-tc'stTjs flic Applicant ovceedinjj; 7.5 percent.' It is not to be completed by ony legal-entity Hliieh hus only :u'i iiidii eci owneiship interest In the Applicant.
Under MuiiieipTil Coiiif Section 2-154-015, the Disclosing Pnriy must disclose wfrclher such. Disclosing Party or nny "Applicable Party" or nny Spouse or Domestic Partner ilicrcof currently bos a "familial relnljpnship" with nny elected city ollici:il9or dcpnhmeiil bond. A "Familial relationship'' exists if, as orUic datcthisEDSis signed. Ibc Disclosing Piirty^or nny "Applicable Party" or any Spouse or Domcslic Partncr thereof is related lo ihe"iu;'i'yor/;iny .ililerin'iin.jlie city.clcil;,' the cily tielisiucr or any cily. dcparlmcni head as spouse or domestic partner or us any ofUic foliou'iiig,- whether by blood or adoption: parent, child, brother or sister, mini or uncle, niece'or nephew, grandp.iicnl. grandchild; f-.iilier-in-law. molhcrrin-Inw. son-in-lnw, dii»ghler-in-law,.stepfather. or stepmother, stepson or stepdaughter, stepbrother or stepsister or hnlf-br'olhcror half-sister.
"Applicable Pnny" liicnns (I )jtll executive olTiccrs ofthe Disclosing Party listed in Section II.U.T .a., ifthe.
Disclosing Party is a coipuinlipn; ull pai titers of.iltc Disclosing^pVtty.Tfjhc: Disclosing Party is a general ,
partncrship;,iill general partners and-limitcd partners ofi'hc Disclosing Pnrty.'if llic Disclosing Parry is a limited
parincrship: nil mnii.tgcrs. 'managing members and members of the Disclosing; Parry, ifthe Disclosing Parry is a
limited liability company; (2) nll'nrincipal officers oflhe Disclosing Party; and (3) any'pcrsohhoViiig more than
n 7.5" |ierLent oniici'.ship inlereM iii the Disclosing Pnriy. "Principal officers" means the president, chief*-
opci-.iiing officer, V\\c.:itlivc director,' chief funuiei.il officer, treasurer or secretary of a.lcgol.entity or anypeison
exercising .simit.ir authority. . ...
' ¦ ¦
Does iiie'Discln.siiiE'P;irty or any "Applicable Party" or any Spouse or Domestic Partner thereof currently
have v "familial relationship" wilh an elected cily official or departmcnt'head'/ ^ , •
: •'•'< >- • * . .-• . . • -
J.Ycs '^No. * " '.Jfyes. please idcntify^belou (1) Ihe name and title of such person, (2) thc'nninc of theJugalcntiLy to which such person''is ebnnccted;.(3)Mlie ijitinie.aiid title of the elected city official or department head lo whom.such peVson litis' ai fuiiiilinl relaii6n'ship,:and (A) the precise nature ofstich' familial relationship;-''- V- \-s;.v-*.t
CITY OF CHICAGO :J{£GNOMW*mSCLOSURE STATEMENT and AFFIDAVIT APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
Tills Appendix is to be completed only by (o) the Applicant, and (b) any legal entity which lias n direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is nol lo he completed by any legal entity which has only on Indirect ownership interest in the Applicant.
I, Pursuanl to Municipal Code Section 2-154-010, is die Applicant qr-nny Owner, identified as a building code scofllaw or problem.landlord pursuanl to Sectioiv2-92-4I(j ofilhc Municipal Code?
No|1010|If the Applicaiit.is a.lcgal entity publicly traded oh any exchonge, is anypfilccror director of (he Applicant identified ns a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
QJ Yes QJ No [^] Nol Applicable
3. If yes to (t).or (2) ubovc, please idcnlifyrbclow llic name ofthe person or legal entity identified as a building code scofflaw or problem landlord and the address of the building o< buildings lo which the pertinent code violations apply.
'FILLING OUT THIS APPENDIX B CONSTITUTES. ACKNOWLEDGMENT . AND AGREEMENT THAT THIS APPENDIX B iS;INCORPO RATED BY REFERENCE IN'i;0, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT'f HE REPRESENTATIONS M^DE IN THIS APPENDIX B ARE SUlVj^CTTO THE CERTIIT C ATI ON ;MA D E UNDER PENALTY OF PElftURY ON PAGE 12 OFTHE ASSOCIATED EDS.
I'.".;./ M llf 10|
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
Legal name of the Disclosing Party submitting thisEDS. Include d/b/a/ if applicable:
JljJjlALtLljfJJjii-if S IfliL ,
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR
[] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. lyi a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a righl of control: Pf 7SLIA 11 T)t.V pmP.r\-t~ L [.(Business address of the Disclosing Party: Twti flUrft.Cl 0 V n fldftly S\.t ifv, Z TP
io i u>>nh us _ Oh "
Telephone: fcSO/ifl,. 3ft02. Fax: fc ^j. Name of contact person: /v?.f) hfVf 6 (til A \X L,
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):
P j ft nn erf, rity.? inf tY)f/\i hr \ i? 01, 110 / r 1 07 u)?$> + V-fan fi n r-ejd
Which City agency or department is requesting this EDS? [h j (p rja l)(.f}f. (if ? I fl nh frt(j fc¥\l(,
Divff-op norVi-r-
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract //
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
[ ] Person [ ]
[ ] Publicly registered business corporation [ ]
Privately held business corporation [ ]
[ ] Sole proprietorship [ ]
[ ] General partnership (Is
[ ] Limited partnership
[ ] Trust [ ]
Limited liability company Limited liability partnership Joint venture
Not-for-profit corporation
the not-for-profit corporation also a 501(c)(3))?
[ ] Yes [ ] No
Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Pf laxAinrt,
3. For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?
, |>jYes []No []N/A-
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:'
1. List below the full names and titles of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
Ifthe entiiy is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, lisl below the name and title of each general partner, managing member, manager or any other 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.
Name Title
R.nnnid. A. fijj.at, DUTrfgr, Chftirmft/^,r Cf.D
JjJ.LX...llLUA±i gmiCtf-flt r CM
W/ilflft/yh J Si-finnan, EVP i (,fJL
y^fr ft. i\)ftt EVP ^Qiff.ifXrij y C^mral Uans.ei
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Parly. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
9p\M/ li-jp^i T^hro^cV^ f/arl D'sdojmg r^rty
23^
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[]Yes £cjNo
If yes, please identify below the name(s) of such City elected official(s) and describe such relalionship(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 the Matter, as well as the nature of the relationship, and the total amount oflhe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a nol-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.
Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must cither ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
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.
(Add sheets if necessary)
Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the 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 jX) No [ J No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
t ] Yes [ ] No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the 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 I is a continuing requirement for doing business with the City. NOTE: If Article I 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
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for dcbannent, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-yearperiod preceding the date of tliis 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, slate or local) with committing any of the 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
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmentalviolations, instituted by the City or by the 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.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 or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entiiy means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or 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 responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
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 five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to'bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State oflllinois, 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 a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the 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 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 5/33 E-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 the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security ofthe U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.
Ifthe Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best pf the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current emjjJoy££S.of,the.Disclosing Party who were, at any time during the 12-monlh period preceding the^ecirtion date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
zz
9. To the best of the 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 any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of tliis 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 $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is Kl is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We 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."
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 oflhe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGAfiJMNG'INTEREST IN CITY BUSINESS
Any words or terms that arc defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee 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 [Xj No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.L, proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any properly lhat (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 ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[]Yes JYjNo
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Parly further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
K. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Parly must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders thatpnmded*coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those.records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: Ifthe Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section.VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (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 the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
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 lor 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
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Paxty certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Rcvenuc'Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
Ifthe 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 to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [ ] No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
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, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicago.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.
Ifthe 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 transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
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 the Matter. Ifthe 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 (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 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of J 3
F.l. The Disclosing Party is not delinquent in the payment of any lax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed lo the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the 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 Pnrties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 Ifthe Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the 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: Ifthe Disclosing Party cannot certify as to any ofthe items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty ofperjury, the person signing below: (1) warrants that he/she1 is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that 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.
Pizzuti Equities Inc.
(Sign here)
(Print or type>name of Disclosing Party) By:
Scott B. West
(Print or type name of person signing) Executive Vice President
(Print or type title of person signing)
at P/Mf-E-
Signed and sworn to before me on (dale) ,) c>u-/ ) to Z£>t 7 ,
Munty, O^-V'O (state). /fllAL"'>.
Commission expires:
Page 12 of 13
M^Mis
RON G. SCHWIND
Notary Public, Slate ot Ohio My Co'iimiss'On txpitss i{ - 3D-
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which lias only an indirect ownership interest in the Applicant.
Under Municipal Code 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, 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 of the Disclosing Party listed in Section Il.B.l.a., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners oflhe Disclosing Party, ifthe 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 of the 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?
[ ] Yes (X) No
If yes, please identify below (1) the name and title of such person, (2) the 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
CITY OF CHICAGO ECONOMIC DISC LOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFX.AW/PROBLEM LANDLORD CERTIFICATION
Tliis Appendix is to be com]plcted only by (a) the Applicant, and (b) any legal entiiy which has a direct ownership interest in the Applicant exceeding 7:5 percent (an "Owner"). It is not to be completed by any legal enlity which.has only an indirect ownership interest in the Applicant.
1. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofllaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
[ ]Yes TXj.No
Ifthe 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 Section 2-92-416 of the Municipal Code?
L JYes [ ]No ViNotApplicable
If yes to (1) or (2) above, please identify below the 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 APPEN DIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, HIE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
(DO NOT SUBMIT THIS PAG I: WITH YOUR EDS. The purpose oflhis page is for you to recertify yi>ur EDS prior lo submission to Ciiy Council or on the date ofclosing. {Tunable to recertify tmlhriillyv'thciDisalDsiiiy-Party must complete n new EDS wilh correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters, Nol for City procurements unless requested.
This recertification is being submitted in connection with T?» i3»3 ,y)f^JC d /^k' W Va-j ^i^tJ
[identity the Mailer). Under penalty of perjury, the person signing below: (1) warrants' that
he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2)
warrants thai all certifications and statements contained in the Disclosing Party's original EDS
are (rue, accurate and complete as oflhe date furnished to the City and continue to be true,
accurate and complete as oflhe date oflhis rccertilicatiou, find (3) reaffirms its
acknowledgments.
Or- r
) ; :Z.?-vr\ »=h
(Print or type legal name of Disclosing Parly)
Piinl or type name of signatory:
3e£ S. fi'221/it
Title of signatory:
Sifined and sworn to before me on [date]
,iiiii'»«t ominiksi
"> P("ZXC£Q_Lal p-eJfY-^^ County, _<2_r+tp
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAJL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
J pf / f o rn, I itytfrd' /W hJ f
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. [ "J the Applicant
OR
2. a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest: . FjLZiAtt D £ l.flpiWf LLC
OR
3. [ ] a legal entity with a right of control (see Section II.B.l.)' State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
Business address of the.Disclosing Party: 7t,Vf) \ \' lUlfl V&.> f (Ii C(> Su.i fV. 2 Z.Q
Mum bus OH *3 7mS
Telephone: \g30. U1. 3ft Q ?. Fax: 360?) Email: fhOaLl U t fi, f I 7,7.U. Mf*J
Name of contact person: jLfjbfp f {> (k 1 ii l^Ls
Federal Employer Identification No. (if you have one): j
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):
f\LnM(i (\e\j?(jof,Y)?m .of jfrOi; /IQJ <*>A'1 //{H 'vJtsi VhrJ tSlirstJ
Which City agency or department is requesting this EDS? (U*r (IftQ T)P fh fff PlfcHfli-rtn (illd.
De.VU OptY) fVff>
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please' complete the following:
Specification U and Contract #
Page 1 of 13
SECTION 11 — DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1 Indicate the nature of the Disclosing Party:
[ ] Person [ ] 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 [ ] 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 Slate oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?
[]Yes >$No []N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. 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 all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal 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 other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name ^ Title
PDi InVpXtmhoh inc. §\inn'ai Phrtvier,
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 Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name ...Business Address Percentage Interest in the
Disclosing Party . •
JftW 1 fiuuti Two (lUrwovA. flaw f Smtt 120 33 lb 7.
U\umhu\ OH 431/5
DjXOL- filUsti i!
Ellfd Fauitt . ^ : 33 'h
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes $ No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(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 the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Parly's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
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.
(Add sheets if necessary)
^4. Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the 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 court of competent jurisdiction?
[ ] Yes ^<]No [] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance wilh that agreement?
[JYes [JNo
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapler 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then Ihe Disclosing Parly 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 I is a continuing requirement for doing business with the City. NOTE: If Article I 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
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section Il.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period' preceding the date of tliis 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 nol 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 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
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the Cily or by the 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 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 or indirectly: controls the Disclosing Party, is controlled by the Disclosing Parly, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common conlrol 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 ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
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 five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State oflllinois, 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 a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the 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 partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security oflhe U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If theletters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
9. To the best of the 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 any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" 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 $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is ^] is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-.32 ofthe Municipal Code. We 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 Cily."
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-1.56-110 ofthe Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes DO No
NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant.to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ ] Yes $ No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Parly 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
Please check cither 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholderiasurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: Ifthe 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 federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 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 any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity lo 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
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The 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) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[]Yes []No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[]Ycs []No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[lYes []No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in tliis EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution, of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which tliis EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at w\yjy.citvofchicaRO.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.
Ifthe 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 transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all 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 the City in connection with the public release of information contained in this EDS and also authorizes the Cily to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the evenf of changes, the Disclosmg 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 Article I 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 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor arc the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed lo the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
I- " f/V
F.2 If the Disclosing Partyls 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 ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the 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: If the Disclosing Party cannot certify as to any ofthe items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute
this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that 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.
Jedcom Limited Partnership
By: PDI Investments Inc., General Partner
(Print or type name of Disclosing Party)
(Sign here) Scott B. West
(Print or type name of person signing)
Vice President (Prinl'or type title of person signing)
Signed and sworn to before me on (date) v3 Ouy / 0 1-D IHryk--^''v
at _ FMggy rJ^Countv. 0*4(0 (stale). /a^J %fy\ RON G SCHW1ND
Commission expires: l (' 3 O ' ( ^
£/Ej|a^iEg|3at* \ Nolary Pjbiic. State ol Ohio
Notary Public. \* {^^^rtf * / My Ccmnfcson Expiies
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent; It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code 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 cleric, the city 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 (1) all executive officers ofthe Disclosing Party listed in Section ILB.I.a., ifthe 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, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, ifthe 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 cily official or department head?
[ ] Yes f*If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title 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 SCOFFTLAW/PUOBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entiiy which has a direct ownership interest in the Applicant exceeding 7.5 percent (ah "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
1. 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?
2. Ifthe Applicant is a legal entity publicly traded on nny exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant lo Section 2-92-416 ofthe Municipal Code?
f J Yes [ ] No Not Applicable
' 3. If yes to (1) or (2) above, please identify below the name oflhe person or legal entity
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT TH AT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND Til AT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
(DO. NOT SUMMIT THIS PAGE WITH YOUR EDS. The purpose oflhis page is for you to recertify your EDS prior to submission lo City Council or on the (late of closing. Jf unable lo lecertify truthfully, the Disclosing Party musl complete a new EDS wilh correct or corrected information)
KECKKTIFI CATION
Generally, for use wilh City Council mutters. Not for Cily procurements unless requested.
This reccrtilication is being submitted in connection with "M1 \0 af>p&I
[identify the Matter]. Under penally of perjury, ihe person signing below: (1) warrants that
he/she is authorized to execute this EDS reccriificntion on behalf of the Disclosing Party, (2)
warrants thai nil certifications and statements contained in the Disclosing Party's original EDS
arc true, accurate and complete as oflhe dale furnished:lo Ihe City and continue lo be true,
accurate and complete as ofthe date oflhis reccilificntiun, and (3) reaffirms its
acknowledgments.
-Tg)rft,^ /_nr* irfifr PfiATPKl&Mip Dale: UCQfciZ ^ 2c 5
(Prinl or typo legal name of Disclosing Parly)
Prinl or lype name of signatory:
3r3r-/ S. Pi'Zvd, Title of signatory:
Signed and swopAto before me on fdnte] CXX I 2^>/5 by
.: y ij^J8a^f--~rat~ HtA&u.'J County, ... P.tf'.9.
^...^OiNO^^iary Public.
ision empires: *o
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERALINFOJRMATJON
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
PDi irWPAf frlrnM' MC.-
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[] the Applicant
OR
[] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. Dwhich the Disclosmg Party holds a right of control: JtYifQlYy Llfflltcd i-jlfff, fl / f>
Business address ofthe Disclosing Party: TlVfi Mwffl-rTb'Yfc/ fjftCP, Suiir- ZlJ)
f/Olu/rtkif.C, flfi
Telephone: fofl. Z&Ql Fax: . ^1:5603 Email: rkflTJllfc® f(7.7i\tl\Cd fVV
Name of contact person: fLobh't ,$A L/ iLt'/
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):
fl-ft-rwri devPlnfm^A fit Hhf P'tL 110 7 WKY lW favrtrf
Which City agency or department is requesting this EDS? (ftUi Dfpi- M fj&rintflfl O-n ft
development
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract it
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
[ ] Person [ ] 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 [ ] No
[ ] Trust t ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Ohio
3. For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?
[ ] Yes (Kl No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
Ifthe 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 other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
joe I S. FI?.?Aiii fVvviHfAt ': TrmskYtr
^totf ft. tOe,V-r Vlit A'fSi'dfnf : $fcretiKr,j
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% oflhe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party .• (
Jolt S. rmuh' Ta/o ^vanovL P\u.e^Sinl-c, W) 33 73 A t
Columbus, OH ^2/5 ;
DmrA, fi?.7uh ^ 3f) h '/,
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes [yj No
If yes; please identify below the name(s) of such City elected official(s) and describe such relatioriship(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 the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
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.
(Add sheets if necessary)
J^fcheck here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the 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 pO No [] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ J Yes [ ] No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article 1 ("Article l")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the 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 I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article 1 supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state, or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or stale 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 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
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
3. 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 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 or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, wilh the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, 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 Affiliated Entity or 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 responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
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 five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State oflllinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the 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 partners", is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on 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: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands arid 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 the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all currentranplqyees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
9. To the best of the 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 any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this 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 die course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
#
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is j$ is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. Wc further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business wilh the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 ofthe Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D:2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no Cily elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entiiy in the purchase of any property that (i) belongs to ihe City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ ] Yes » No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies lhat no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below: Ifthe Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholderiasiuancc policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI ~ CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: Ifthe Matter is federally funded, complete this Section VI. Ifthe Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf ofthe 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 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
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies lhat either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
Ifthe Disclosing Parly is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[]Yes []No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[]Yes []No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[]Ycs []No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
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, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchica go.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 606J0, (312) 744-9660. The Disclosing Party must comply fully wilh the 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 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 transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. Ifthe 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 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 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 Ifthe 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 ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or lo be hired in connection with the Matter certifications equal in form and substance to those in F. 1. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: Ifthe Disclosing Party cannot certify as to any ofthe items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that'he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf ofthe Disclosing Parly, and (2) warrants that 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.
PDI Investments Inc.
(Print or type name of Disclosing Party)
Bv: . ^J^f^AU4
^Sigii here)
Scott B. West
(Print or type name of person signing)
Vice President
(Print or type title of person signing)
(slate).
Signed and sworn to before me on (date) ^Jut-V /6 'Lfi i^f ,
at flUJiM4Ci^ ^jGounly, Q\\ iO /¦o.„,v> . •• ^» a #""
Commissiorr'expires: /1 - 3 6 - ( ^
RON (j. SCHWIND Notary PuoJic. State oi Oiv MyCouiinssiflii F^i'O':
II - jo ¦;<-
Page 12 of 13 .^.pf .
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which lias only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Parry" 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 tliis 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 cleric, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.1 .a., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, ifthe Disclosing Partyis a limited partnership; all managers, managing members and members ofthe Disclosing Party, ifthe 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.
Docs 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?
[ ] Yes
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is coimected; (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 TODt S'COFFT.AW/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 percent (an "Owner"). It is not to be 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?
[ JYes j>Ifthe 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 Section 2-92-416 of the Municipal Code?
[ ] Yes ' (." ] No f^'Nol Applicable
If yes to (1) or (2) above, please identify below the 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 AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIAT ED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERT I FICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
(DO NOT SUMMIT THIS PAGE WITH YOUR EDS. The purpose oflhis page is for you lo recertify your EDS prior to submission to City Council or on the dale of closing. If unable to icccrtify trulhfully^ihc Disclosing Party must complete a new EDS with correct or corrected information)
KECIiimFJCATION
Generally, for use with City Council mailers. Nol for City procurements unless requested.
This rccerlilication is being submitted in connection with-fat /iryJ^-t-tC^ tof" lOt- > tv> [identify the Matter]. Under penally of perjury, the person signing below: (1) warrants that he/she is authorized lo execute this EDS recertification on behalf of the Disclosing Party, (2) warrants thai all certifications and statements contained in the Disclosing Parly's original EDS arc true, accurate and complete as oflhe date furnished to the Cily and continue to be true, accurate and complete as oflhe date of this reccrlificalion, and (3) reaffirms ils acknowledgments.
Date: flKS&l \;
Print or type name of signatory: ^
3be£ P> '?9ui
Title of signatory:
fkiidbu/i
Signed and sworn to before mc on [datej ^yCT^- / . by
0 Q£ri~ S ?l"2^~37( . at nZsK&^i-' County, _Q_M t fi. [stalcj.
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