FINAL FOR PUBLICATION
ORDINANCE
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. That the Chicago Zoning Ordinance be amended by changing all the current Bl-2 Neighborhood Shopping District symbols and indications as shown on Map No. 7-F in the area bounded by:
West Diversey Parkway; North Lehmann Court; a line 175.00 feet south of West Diversey Parkway; and the public alley next west of North Lehmann Court
to those of a B3-5 Community Shopping District which is hereby established in the area described above.
SECTION 2. That the Chicago Zoning Ordinance be amended by changing all the current B3-5 Community Shopping District symbols and indications as shown on Map No. 7-F in the area bounded by:
West Diversey Parkway; North Lehmann Court; a line 175.00 feet south of West Diversey Parkway; and the public alley next west of North Lehmann Court
to those of a Business Planned Development which is hereby established in the area described above.
SECTION 3. This Ordinance shall be in force and effect from and after its passage and due publication.
Property Address: 601 - 09 W. Diversey Pkwy. / 2726 - 36 N. Lehmann Ct.
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BUSINESS PLANNED DEVELOPMENT.
PLAN OF DEVELOPMENT
BULK REGULATIONS AND DATA TABLE
Gross Site Area: Net Site Area:
Area Remaining in the Public Right of Way:
26,589.00 sq. ft. 18,900.00 sq. ft. 7,689.00 sq. ft.
Maximum Floor Area Ratio: Minimum Setbacks: Maximum Number of Rooms: Minimum Number of Parking Spaces: Minimum Number of Off-Street Loading: Maximum Building Height:
5.0
Per Site/Landscape Plan 150 (keys) • 70 spaces
Two berths (10 ft. x 25 ft.)
120 ft. to top of occupied penthouse
133 ft. to top of mechanical penthouse
Minimum Number of Bicycle Parking Spaces: 8 spaces
APPLICANT: L.V.M. Corporation
ADDRESS: 601 - 09 W. Diversey Pkwy. / 2726 - 36 N. Lehmann Ct.
INTRO DATE: June 17, 2015
PLAN COMMISSION DATE: December 17, 2015
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BUSINESS PLANNED DEVELOPMENT STATEMENTS
The area delineated herein as Planned Development Number , ("Planned
Development") consists of approximately 18,900 square feet of property which is depicted on the attached Planned Development Boundary and Property Line Map ("Property") and is owned or controlled by the Applicant, L.V.M. Corporation.
The requirements, obligations and conditions contained within this Planned Development shall be binding upon the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. All rights granted hereunder to the Applicant shall inure to the benefit of the Applicant's successors and assigns and, if different than the Applicant, the legal tilleholder and any ground lessors. Furthermore, pursuant to the requirements of Section 17-8-04O0 of the Chicago Zoning Ordinance, the Property, at the time of application for amendments, modifications or changes (administrative, legislative or otherwise) to this Planned Development are made, shall be under single ownership or designated control. Single designated control is defined in Section 17-8-0400 ofthe Zoning Ordinance.
All applicable official reviews, approvals or permits are required to be obtained by the Applicant or its successors, assignees or grantees. Any dedication or vacation of streets or alleys or grants of easements or any adjustment ofthe right-of-way shall require a separate submittal to the Department of Transportation on behalf of the Applicant or its successors, assign or grantees. Any requests for grants of privilege, or any items encroaching on the public way, shall be in compliance with the Plans.
Ingress or egress shall be pursuant to the Plans and may be subject to the review and approval of the Departments of Planning and Development and Transportation. Closure of all or any public street or alley during demolition or construction shall be subject to the review and approval of the Department of Transportation.
All work proposed in the public way must be designed and constructed in accordance with the Department of Transportation Construction Standards for Work in the Public Way and in compliance with the Municipal Code of the City of Chicago. Prior to the issuance of any Part 11 approval, the submitted plans must be approved by the Department of Transportation
This Plan of Development consists of fifteen (15) Statements: a Bulk Regulations Table; an Existing Zoning Map: a Planned Development Boundary and Property Line Map; a Site/Landscape Plan; a Green Roof Plan and Building Elevations submitted herein. Full-sized copies ofthe Site Plan/Landscape Plan and Building Elevations are on file with the Department of Planning and Development. In any instance where a provision of this Planned Development conflicts with the Chicago Building Code, the Building Code shall control. This Planned Development conforms to the intent and
APPLICANT: L.V.M. Corporation
ADDRESS: 601-09 W. Diversey Pkwy. / 2726 - 36 N. Lehmann Ct.
INTRO DA 1 b: June 17, 201 5
PLAN COMMISSION DATE: December 17, 2015
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purpose of the Zoning Ordinance, and all requirements thereto, and satisfies the established criteria for approval as a Planned Development. In case of a conflict between the terms of this Planned Development Ordinance and the Zoning Ordinance, this Planned Development Ordinance shall control.
The following uses are permitted in the area delineated herein as a Business Planned Development: Hotel, Restaurants with incidental service of liquor and outdoor seating (at-grade and roof top), retail uses, office, artist sale or work space, communication service establishments, financial services (except payday/title secured loan store or pawn shops), medical service and accessory uses.
In accord with Section 17-10-0503 of the Municipal Code, the Applicant may lease to members of the public on an hourly, daily, weekly or monthly basis up to forty-five percent (45%) of the minimum required 70 residential parking spaces.
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 ofthe Planned Development.
For purposes of height measurement, the definitions in the Zoning Ordinance shall apply. The height of any building shall also be subject to height limitations, if any, established by the Federal Aviation Administration.
The maximum permitted Floor Area Ratio ("FAR") for the site shall be in accordance with the attached Bulk Regulations Table. For the purposes of FAR calculations and measurements, the definitions in the Zoning Ordinance shall apply. The permitted Floor Area Ratio identified in the Bulk Regulations Table has been determined using a Net Site Area of 18,900 square feet and a base FAR of 5.0
Upon review and determination, "Part 11 Review", pursuant to Section 17-13-0610 of the Zoning Ordinance, a Part II Review Fee shall be assessed by the Department of Planning and Development. The fee, as determined by staff at the time, is final and binding on the Applicant and must be paid to the Department of Revenue prior to the issuance of any Part II approval.
10. 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 reviews associated with site plan review or Part II
reviews, are conditional until final Part II approval. The extended parkway along
Lehmann Court south of the parking garage entrance shall be landscaped in
accordance with the Landscape Ordinance and shall be constructed and maintained by
the Applicant.
APPLICANT: L.V.M. Corporation
ADDRESS: 601 -09 W. Diversey Pkwy. / 2726 - 36 N. Lehmann Ct.
INTRO DATE: June 17, 2015
PLAN COMMISSION DATE: December 17, 2015
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The Applicant shall comply with Rules and Regulations for the Maintenance of Stockpiles promulgated by the Commissioners of the Departments of Streets and Sanitation, Environment and Buildings, under Section 13-32-125 of the Municipal Code, or any other provision of that Code.
The terms and conditions of development under this Planned Development ordinance may be modified administratively, pursuant to section 17-13-0611-A ofthe Zoning Ordinance by the Zoning Administrator upon the application for such a modification by the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors.
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 and to promote the highest standard of accessibility.
14. 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.
The applicant has agreed to provide a 50% green roof over the net roof area of
approximately 6,419 sq. ft. and achieve Building Certification to comply with the
City of Chicago's Sustainable Development Policy.
15. This Planned Development shall be governed by Section 17-13-0612 of the
Zoning Ordinance. Should this Planned Development ordinance lapse, the
Commissioner of the Department of Planning and Development shall initiate a
Zoning Map Amendment to rezone the property to a B3-5, Community Shopping
District.
APPLICANT: L.V.M. Corporation
ADDRESS: 601 - 09 W. Diversey Pkwy. / 2726 - 36 N. Lehmann Ct.
INTRO DATE: June 17,2015
PLAN COMMISSION DATE: December 17, 2015
EXISTING ZONING MAP
FINAL FOR PUBLICATION
Applicant: LVM Corporation
Address: 601 - 09 W. Diversey Pkwy. / 2726 - 36 N. Lehmann Ct.
Intro Date: June 17, 2015
Plan Commission Date: December 17, 2015
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Inn at Lincoln Park 601 W Diversey Pkwy. Chicago, IL 60614 Planned Development Boundary and Property Line Map ASK-052A
iMurd January 12. 201b
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Applicant: LVM Corporation
Address: 601 - 09 W. Diversey Pkwy. / 2726 - 36 N. Lehmann Ct.
Intro Date: June 17, 2015
Plan Commission Date: December 17, 2015
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Applicant: LVM Corporalion
Address: 601 - 09 W. Diversey Pkwy. / 2726 - 36 N. Lehmann Ct.
Intro Date: June 17, 2015 Plan.Commission Date: December 17, 2C
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NET ROOF AREA 12,837 SF
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Department of Planning and Development
city of chicago
MEMORANDUM
TO: Alderman Daniel S. Solis
Chairman, City Council Committee on Zoning
FROM:
David l>. Reifman Secretary
Chicago Plan Commission DATE: December 18, 2015
RE: Proposed Planned Development for property generally located at 601 West Diversey Parkway.
On December 17, 2015, the Chicago Plan Commission recommended approval ofthe proposed planned development submitted by LVM Corporation. A copy ofthe proposed planned development is attached. I would very much appreciate your assistance in having this introduced at the next possible City Council Committee on Zoning hearing.
Also enclosed is a copy of the staff report to the Plan Commission which includes the Department of Planning and Development, bureau of Planning and Zoning recommendation and a copy 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)
121 NORTH LASALLE STREBT. ROOM 1000. CHICAGO. ILLINOIS 60602
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REPORT to the
CHICAGO PLAN COMMISSION from the
DEPARTMENT OF PLANNING AND DEVELOPMENT DECEMBER 17, 2015
FOR APPROVAL: PROPOSED PLANNED
DEVELOPMENT (APPLICATION NO. 18402)
APPLICANT: L.V.M CORPORATION
LOCATION: 601 WEST DIVERSEY PARKWAY
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 Planned Development for your review and recommendation to the Chicago City Council. The application was introduced to the Chicago City Council on June 17, 2015. Notice of this public hearing was published in the Chicago Sun-Times on December 2, 2015. The Applicant was separately notified of this public hearing.
The property is identified as 601 W. Diversey Parkway and is situated at the intersection of West Diversey Parkway and North Lehman Court. The applicant, L.V.M Corporation, proposes to demolish the existing building on the site known as the "Inn at Lincoln Park" and proposes to construct a nine-story, mixed use building comprised of approximately 7,700 square feet of retail/restaurant space on the ground floor with 150 hotel keys and approximately 70 accessory parking stalls on the floors above.
This application has been submitted as a mandatory planned development pursuant to section 17-8-0512 of the Chicago Zoning Ordinance which states that planned development review and approval is required for any building in a B or C dash 5 zoning district which is to exceed 80'-0" in height.
SITE AND AREA DESCRIPTION
The subject property is located at the southwest corner of the intersection of North Lehman Court and West Diversey Parkway. The subject site is located adjacent to business, commercial, and residential uses. East of the subject site parcels of land are zoned B1-2, Neighborhood Shopping District, and B1-5, Neighborhood Shopping District. North of the site are parcels of land zoned Residential Business Planned Development #306, B3-2, Community Shopping District, and B3-5 Community Shopping District. West of the site are parcels of land zoned B1-2, Neighborhood Shopping District. South ofthe site are parcels
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of land zoned RM-5 Residential Multi-Unit District and B1-2 Neighborhood Shopping District. The site is not in the Lake Michigan and Chicago Lakefront Protection District. The site is not located within a designated Tax Increment Financing (TIF) District. The site is not located within the boundaries of a Chicago Landmark District and it does not contain any designated local or national landmark structures or sites.
The subject site is served by various CTA bus routes, the following routes have stops located less than 1/a mile from the subject site: #8 (Halsted) #22 (Clark); #36 (Broadway); #37 (Sedgwick); #74 (Fullerton); #76 (Diversey); #77 (Belmont); #134(Stockton/La Salle Express); #143 (Stockton/Michigan Express); #151 (Sheridan) and #156 (LaSalle).
PROJECT BACKGROUND AND DESCRIPTION
The subject site consists of approximately 18,900 square feet and is currently improved with a hotel and an accessory surface parking lot. The applicant proposes to demolish the existing building and then to construct a nine-story mixed-use building which will contain approximately 7,700 square feet of retail/restaurant use on the first floor and a 150 key Hampton Inn hotel and 70 accessory parking stalls on the floors above.
DESIGN
The proposed building will be primarily finished with a choice of one of three materials: fiber cement panels, thermosetting resin panels, or insulated metal panels. The elevations will be accented with aluminum doors and windows as needed. The first floor elevation along the north and west sides will be finished in an aluminum and glass store front glazing system. The area of the building that translates to the second and third floor will be finished in a translucent glass curtain wall system this will screen the parking garage but allow some of the light to filter out of the building as a design feature. The most recent proposed color palette includes silver or gray for the primary finishes, a translucent white or translucent off white for the polycarbonate curtain wall, and a metallic gray or silver for the metal finishes in the door and window systems.
LANDSCAPING AND SUSTAINABILITY
The entire planned development will be compliant with the requirements of the Chicago Landscape Ordinance specifically in terms of parkway trees.
The subject site will be designed to be in compliance with the current City of Chicago Sustainable Development policy and will provide a vegetated roof totaling a minimum of 50% of the net roof area which equates to 6,419 square feet of area. Additionally, the subject building will obtain building certification.
ACCESS / CIRCULATION
The seventy (70) parking stalls provided are all accessible via a two-way traffic driveway off of North Lehman Court, the driveway will lead to a two-way traffic ramp bringing visitors up to the parking floors and back down out of the building.
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In addition to this driveway a set of two additional driveways will be provided off of North Lehman Court to allow for a one way traffic pattern to allow for a pick-up/drop-off lane and a bypass lane. The subject site also has 8 bicycle parking spaces available. All parking provided will meet the layout and design requirements as stated under 17-11-1000 ofthe Chicago Zoning Ordinance.
BULK / USE / DENSITY
The proposed project will be a mixed-use building comprised of retail/restaurant use on the first floor and a 150 key hotel on the floors above. The current maximum allowable Floor Area Ratio (FAR) for the proposed underlying zoning district (B3-5) is 5.0; the proposed planned development will be limited to this maximum 5.0 FAR. The proposed project will have a maximum building height of 120'-0" to the parapet of the building and an overall maximum height of 133'-0" to the top of the mechanical penthouse/elevator overrun. The proposed planned development will maintain setbacks that are in compliance with the requirements of the B3-5 zoning designation. All remaining bulk, use and density items will be in substantial compliance with the stipulations of Section 17-3-0400 for B3-5 zoning districts.
RECOMMENDATION
The Department of Planning and Development has reviewed the project materials submitted by the Applicant and compared this proposal to the requirements of the Chicago Zoning Ordinance and existing development in the community. The area around this project is composed of a mixture of various uses including commercial, retail, and residential uses and is accessible from public transit. Based on that analysis, DPD has concluded that this proposal is appropriate for this site and supports this development for the following reasons:
Promotes economically beneficial development patterns that are compatible with the character of existing neighborhood (per 17-8-0103), as evidenced by the design of the project, and the fact that the proposed uses are in context with the character of the adjacent properties and also meet the needs ofthe immediate community;
Promotes transit, pedestrian and bicycle use, ensures accessibility for persons with disabilities and minimizes conflicts with existing traffic patterns in the vicinity (per 17-8-0904-1-2, 3 & 4), as evidenced by the site's close proximity to public transit in the form of various CTA bus lines; the accessibility accommodations made on-site for the building users; pedestrian and bicycle ingress and egress options provided to the building users in the form of 7 bicycle parking stalls, and lastly, ensuring that the design of the site works within the confines of the current existing traffic patterns at the site and creates little or no adverse impact to those patterns;
All sides and areas of the buildings that are visible to the public should be treated with materials, finishes, and architectural details that are of high-quality and appropriate for use on primary public-right-of-way-facing facade (per 17-8-0907-A-4), as evidenced through the
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information contained within this report, as shown on the elevations in the exhibits for this planned development, and the corresponding proposal renderings;
The project meets the purpose and criteria set forth in the Chicago Zoning Ordinance and its adoption would not have any adverse impact on the public's health, safety or welfare:
Per 17-13-0308-C, the proposed development is compatible with surrounding developments in terms of land use, as well as, the density and scale ofthe physical structure.
Per 17-13-0308-D, the proposed underlying zoning for this planned development is B3-5 and is similar to other business and commercial zoning districts, both adjacent to this site and in the immediate area.
Per 17-13-0308-E, the public infrastructure facilities and City services will be adequate to serve the proposed development at the time of occupancy and the project will comply with the requirements for access in case of fire and other emergencies. The proposed project has been reviewed by the Mayor's Office for People with Disabilities and the Department of Transportation and all requested changes have been made. Copies of this application have been circulated to other City departments and agencies and no comments have been received which have not been addressed in the application.
Based on the foregoing, it is the recommendation of the Department of Planning and Development that this application for the establishment of a Planned Development be approved and that the recommendation to the City Council Committee on Zoning Landmarks and Building Standards be "Passage Recommended."
Bureau of Planning and Zoning Department of Planning and Development
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Department of Planning and Development city of chicago
RESOLUTION
601 WEST DIVERSEY PARKWAY PROPOSED PLANNED DEVELOPMENT ( APPLICATION # 18402)
WHEREAS, the applicant, L.V.M Corporation, proposes to establish a Business Planned Development in the Lincoln Park Community Area; and
WHEREAS, the applicant proposes to construct a nine-story mixed-use building with 150 hotel keys, approximately 7,700 square feet of ground floor commercial space, and at least 70 off-street parking spaces; and
WHEREAS, the application has been submitted as a mandatory planned development because the proposed building would be higher than 80 feet in a B3-5 Community Shopping District; and
WHEREAS, an application for a Planned Development approval was introduced into the City Council on June 17, 2015; and
WHEREAS, notice of the public hearing to consider the application was published in the Chicago Sun-Times on December 2, 2015; the applicant was notified ofthe hearing; and the proposed Planned Development application was considered at a public hearing by this Plan Commission on December 17, 2015; and
WHEREAS, this Plan Commission has reviewed the application with respect to the Planned Development provisions ofthe Chicago Zoning Ordinance and finds that the proposal would be consistent with that ordinance; and
WHEREAS, the Department of Planning and Development recommends approval of the application, which recommendation and the reasons therefore are contained in the Department's written report dated December 17, 2015, a copy of which is attached hereto and made a part hereof; and
WHEREAS, this Plan Commission has fully reviewed the application and all
information submissions associated with the proposed development, the
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
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report and recommendation ofthe Department of Planning and Development, and all other testimony presented at the public hearing held on December 17, 2015, giving due consideration to the Planned Development Standards and Guidelines contained in the Chicago Zoning Ordinance;
NOW, THEREFORE, BE IT RESOLVED BY THE CHICAGO PLAN COMMISSION:
THAT the final Planned Development Application, dated June 17, 2015, be approved as being in conformance with the provisions, terms and conditions ofthe Chicago Zoning Ordinance; and
THAT this Plan Commission recommends approval to the City Council Committee on Zoning, Landmarks and Building Standards ofthe final Planned Development Application, dated, June 17, 2015; and
THAT the above-stated recitals to this resolution, together with the report ofthe Department of Planning and Development, be adopted as the findings of fact of the Chicago Plan Commission regarding this Zoning Map Amendment and Planned Development Application.
Approved: December 17, 2015
RBPD No.
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
CITY OF CHICAGO # 'rJMo^.
APPLICATION FOR AN AMENDMENT TO RECEIVED
THE CHICAGO ZONING ORDINANCE DEC 1 7 2015
ADDRESS of the property Applicant is seeking to rezonc:
601 - 09 W. Diversey Pkwy. / 2726 - 36 TM. Lehmann Ct.
Ward Number that property is located in: 43rd
3. APPLICANT L.V.M. Corporation
ADDRESS 601 W. Diversey Pkwy
CITY Chicago STATE IL ZIP CODE 60614
PHONE 312-636-6937 CONTACT PERSON Rolando R. Acosta
4. Is the Applicant the owner of the property? YES X NO
If the Applicant is not the owner of the property, please provide the following
information regarding the owner and attach written authorization from the owner allowing the applicant to proceed.
OWNER
ADDRESS
CITY STATE ZIP CODE
PHONE CONTACT PERSON
5. If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Rolando Acosta
ADDRESS 1030 W. Chicago Ave. CITY Chicago
CITY Chicago STATE IL ZIP CODE 60642
PHONE 312-636-6937 FAX 312-253-4440
6. If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
Virendra D. Patel
On what date did the owner acquire legal title to the subject property?
Has the present owner previously rezoned this property? If Yes, when?
Yes. July 21.2004
Present Zoning District Bl-2 Proposed Zoning District B3-5 then to PD
Lot Size in square feet (or dimensions) 18.900 sf
Current Use of the property Four story hotel with 77 rooms and 16 parking spaces
Reason for rezoning the property: Redevelopment ofthe Property
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 o the proposed building. (BE SPECIFIC) 9 story
plus penthouse building containing a 150 key hotel and approximately 7,700 sq. ft. of
retail and restaurant (with the incidental service of liquor and outdoor seating) space.
70 parking spaces and one loading berth
On May 14lh, 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 ofthe project in question and the proposed zoning classification, is this project subject to the Affordable Requirements Ordinance? (See Fact Sheet for more information)
NO X
COUNTY OF COOK STATE OF ILLINOIS
I, _._yjc!or_Pj»t:el , 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.
Ii rru
Signature or Applicant President, L.V.M. Corporation Subscribed and Sworn to me before this 23rd day of, May 2015.
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For Office Use Only Date of Introduction:
File Number:
Ward:
CITV OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMA TION
A. Legal name of ihc Disclosing Party submitting this EDS. Include d/b/a/ if applicable: L.V.M. Corporation
Check ONE ofthe following three boxes:
Indicate whether ihc Disclosing Party Submitting this EDS is:
tj<} ihc Applicant
OR
[ ] a legal entity holding a direct or indirect interest in the Applicant State the legal name ofthe
Applicant in which the Disclosing Parly holds an interest:
OR
3. j ] a legal entity wilh a right of control (sec Section II.B.l.) State the lcg3l name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Pony: 601 W. Diversey Pfcwy.
Chicago, IL 60614
Telephone: ^z-G36yS37 Fax: Email: rctamto(^t»!33C*gur.com
Name of coniacr person; Rolando R-Acosta
\l. Federal Employer Identification No. (if you have one):
F. 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):
Pkmn«l Development for GOt - 09 W. Oivcrscy ParhwfiyCTSB - 3G N. U&nian Ct
G. Which City agency or department, is requesting this EDS? DPD
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 PAR
1. Indicate the nature of tiic Disclosing
( | Person
[ J Publicly registered business corporation
i(l Privately held business corporation
[ ] Solo proprietorship
i j General partnership
{ j Limited partnership
f 1 Trust
Party:
| 1 Limited liability company | \ Limited liability partnership {] Joini venture f J Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
I ] Yes [ ] No
f ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Illinois
3. For legal entities not organized in Ore State of I llinois: Has the organization registered to do business in the Slate of Illinois as a foreign entity?
[lYcs [INo [JN/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
I. . List below the fall 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 arc legal entities. If there are no such members, write "no members." For trusts, estates or other simitar entities, list below the legal titlcbolder(s).
If the entity is a general partnership, limited partnership, (united 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 most submit an EDS on its own behalL
Name Title
Vircrtara D. Patel President. Secretary and Soto Director
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, stale "None." NOTE: Pursuant., lo Section 2-IS4-U30 of the Municipal 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 Business Address Percentage Interest in the
Disclosing Party
Virendo D. Patel 691 W. Diversey Pkwy Chicago. IL 60614
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICI ALS
Has the Disclosing Parly 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 VYcs WNo
If yes, please identify below Ihc namc(s) of such City elected official(s) and describe such rclauonship(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 ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who arc paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action On behalf of any person or entity other than: (I) a not-for-profit entity, oo 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.) NO I K:
to be retained) lobbyist etc.) "hourly rate" or "l.b.d." is
not an acceptable response.
Rolando R. Acosta 1030 W. Chicago Ave. Chicago. IL G05&2 Aity. $20.000 (est)
(Add sheets if necessary)
| j Check here if the Disclosing Party bas not retained, nor expects to retain, any such persons or entities. SECTION V — CERTIFICATIONS
CpURT-ORDERED CHILD SUPPORT COMPLIANCE -
Under Municipal Code Section 2-92-415, substantial owners of business entities tbat 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 M No f] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes3" has the person entered into a cobrt-approved agreement for payment of all support owed and is the person in compliance with tbat agreement?
r j \'e.s [JNo
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter I -23, Article I ("Article rj(wlu"ch the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business.wilb the City, then the Disclosing Party certifies as follows: (i) neither ihc Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or bas 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 of the City or any sister agency: and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business wilh (he 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
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:
arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded front 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, suite 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
c. . have not, within a five-year period preceding Ihc date of (Jus 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 tbc 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*');
atiy "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 Disclostog 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 A ffiliatcd Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorisation of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Pony, nor any Contractor, nor* any A ffilinicd Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this CDS 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 oUicr 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 n fixed price or otherwise; or
made an admission of such conduct'dcscribcd irt 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, ihc Disclosing Party, Affiliated Entity or Contractor, or any of ibeir 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 (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bjd-rotating in violation of 720 ILCS 5/33E-4; or (3) any simitar 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 of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department ofthe 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, (he 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 (lie above statements in this Part B (Further Certifications), the Disclosing Forty must explain below:
Page 6 of 13
If ihc tellers "NA," ihc word "None," ot no response appears on the lines above, il will be conclusively presumed that ihc Disclosing Pany 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 current employees of ihc Disclosing Party who were, at any time during ihc I 2-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the Cily of Chicago (if none, indicate with "N/A" or "none").
None
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 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.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
* - The Disclosing Party certifies that the Disclosing Party (check one)
f 1 is IX] is not
a "financial institution" as defined in Section 2-32-4S5(b) of the Municipal Code.
2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"Wc arc not and will not become a predatory lender as defined in Chapter 2-32 of tlte Municipal Code. Wc further pledge that none of our affiliates is, and none of them will become, n predatory lender as defined in Chapter 2-32 of the Municipal Code. Wc 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."
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 of ihc Municipal Code, explain here (attach additional pages if necessary);
Page 7 of 13
If ihc .Idlers "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.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that arc defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
I. In accordance with Section 2-156-110 of the 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 Matter?
IJY<* W NO
NOTE: If you checked "Yes" to Item D.1proceed tolitems P,2. and D.3 If you checked "No'Uo ItemD.I.,proceed[to Part E.
2- Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have o financial interest in his or her own name or in (he 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 of ihc City (collectively. "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power docs not constitute a financial interest within the meaning of this Part D.
Docs the Matter involve a City Property Sale?
[1 Yes (I No
3. If you checked "Yes" id 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 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 cither I. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment lo this EDS all information required by paragraph 2. Failure to
PageRof 13
comply wilh ihcse. disclosure requirements may make any contract entered into with the City in connection with (he Matter voidable by the City.
* 1 ¦ The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage lo or injury or death of their slaves), and the Disclosing Parly ha? found no such records.
The Disclosing Party verifies that, as a result of conducting the search in step I above, ihc
Disclosing Parly 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: IT the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed lo Section VII. For purposes of this Section VI, tax credits allocated by ihc Ciiy and proceeds of debt obligations of the City arc not federal funding.
A. CERTIFICATION REGARDING LOBBYING
I. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act or 1995 who have made lobbying contacts on behalf ofthe Disclosing Party with respect to die Matter: (Add sheets If necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if Ihc word "Norte" appear, it will be conclusively presumed tbat the Disclosing Party means tbat NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying conlacts 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 parson or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity io influence or attempt to influence an officer or employee of any agency, as defined by applicable federal low, a member of Congress, an officer or employee of Congress, or an employee of a member ofCongrcss, in connection with the award of any federally funded contract, making any fcdcrally funded grant or loan, entering into any cooperative agreement, or to extend, coniinuc, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Parry will submil an updated certification sit 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 citben (i) it is not an organisation described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or(ti) 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 Party is the Applicant, the Disclosing Party must obtain cert ifications 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 tbc Matter and most make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal, regulations requite 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?
[JYes [JNo If " Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (Sec 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of tbc Office of Federal Contract Compliance PfOgrams. or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[JYes [JNo
Have you participaicd in any previous contracts or subcontracts subject to the equal opportunity clause?
f)Yes f}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 Parry 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 wilh respect to the Matter. The Disclosing Party understands that it must comply wilh all statutes, ordinances, aud regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of ihc 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,citvofehicaflo,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 folly with tbc 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 wHh 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 Jaw 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 conlaincd in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in tin's EDS must be kept current In the event of changes, the Disclosing
Party must supplement thus EDS up to Ihe time the City lakes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
apdate this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 or the 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.
Tbc Disclosing Party represents and warrants that:
Page 11 of 13
F.l. The Disclosing Party is not delinquent ir. ihc payment of any tax administered by tlie. Illinois Department of Revenue, nor a;e the Disclosing Party or its Affiliated Kntirics delinquent in paying any fine. fee. tax or other charge owed to the City. This includes, but is not limited 10. iii! water charges, sewer charges, license fees, parting tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will riot use, nor permit their subcontractors to use, any facility listed by Ihc U.S. E.P.A. on d\c federal Excluded Parties List System ("EPLS") maintained by the U. S, General Services Administration.
F.3 If Ac Disclosing Parry is (he Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or 10 be hired in coouCCtion with tbc Minter certifications equal in form and substance to those in F.l: and F.2. above and will not, without the prior written consent of the Ciry, use any such contractor/subcontractor that docs not provide sucb certifications or that the Disclosing Parly bas reason to believe has not provided or cannot provide truthful ecrtifiealions.
NOTE: If the 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 pf perjury, the person signing below; (1) warrants tbat 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 Stateraenis contained in this EDS and Appendix A (If applicable) are true., accurate and opmplcie as of the date furnished to the City.
(Print or type name of"bisclosir»g Party)
By:
(Sign here)
(Printer type name of person signing)
Pt'itb (-NT
(Prifit or type tide of person signing)
Signed and sworn to before tne on
at Cook. County, tEnois (stare).
y^/f,^^^^^---^"1 Notify Public.
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CITY OF CHICAGO ECONOMIC: DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RElJVTlONSHIPS 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 lie 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 Part/* or any Spouse or Domestic Partner thereof currently has a "familial relationship" with •zry ejected cily official or department head. A "familial relationship*' exists if, as ofthe date this EDS is signed, die Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to tlte 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, grandcluld, 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 Part)'' means (1) all executive officers ofthe Disclosing Party listed in Section ll.B.l.a., if the 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 of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of lite Disclosing Party; and (3) any person having more than a 7.5 percent owncrslup interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial oQicer. 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?
I lYcs DQ No
If yes, please identify below (I) the name and title of such person, (2) the na me 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) ihc precise nature ofsueh familial relationship.
Page 13 of \y
CjTv g& c:hk a,-
ECONOMIC DLSCf jOSmRE 5T.VT£MF-NT AND AFFiDAY ?: APPENmx i
BUILDING CODS SCX>mAWA'80BKJ«i LANDLORD CERTIFiCATiOJ-
f Lis Appendix is to bs coicpfcted oaty by fa) (be Appjfcsci, end (t>) any legs! catty (vbid) has a.direct owrttrsbip inicrcstin (be Applicant exceeding 7-5 (screen I (an / ¦Owner"). it Is not to be coqupklcd by. flay legal entity wfcreft has only an indirect o^oersbip iotcrcst ia f&e Applicant.
•. Pursuant to MontEipal C ode Section 2-(54-010. is the Applicant or any Owner identified as a building co&t scofTlaw or problem testdiurd pursuant to Section 2-92-416 nf the Municipal Code?
r-]-Yes-" PQho
2. If lit? Applicant is a lesii! entity fnsblicty traded on any exchange, is any officer or direcor of [fee Applicant identified as a bajlding code ssoffian- or problem landlord purs^an lo Session 2-92-416 of rite Municipal Code?
I JYes J' JNo fXi Not Applicable
5 it yes to {i) ct (-J «J»w, ptese uicfiu'ty fte'ow Ote nam* of tne person w lego I entttj
identifted as & building code scofflaw or problem landlord and t?te address ofthe building or buildings to which the pertinent code violctitnts apply.
FILLING OUT THIS APPENDIX 8 CONSTITUTES ACKJVO WLEDGM ENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED 3 Y REFERENCE INTO. AND MADE A PART OF, THE ASSOCIATED £DS, AND THAT THE REPRESENTATIONS MADE TN THIS APF5ND1X 8 ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PER.ll/RV C*V PAGE IZ OPTBE ASSOCIATE!? EDS.
June 10, 2015
Chairman, Committee on Zoning Room 504, City Hall Chiiago. Illinois 60602
Chairman:
'lTie undersigned, Rolando R. Acosta, being first duly sworn on oath, deposes and say the following:
That the undersigned certifies tbat he has complied with the requirements of the Chicago Zoning Ordinance, Title 17, Section I3-OI07-A of the Municipal Code of Chicago, by serving written notice by USPS first class mail, to Ihc owners of all property within 250 feci in each direction ofthe loi Jincs of the subject property, the boundaries of which arc:
West Diversey Parkway: North l^chmann Court; a line 175.00 feet south of West Diversey Parkway; and the public alley next west of North Lehmann Court
exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet, and that the notice contained the address and description of the property which is the subject of the application under the Chicago Zoning Ordinance; a statement of the intended use of said property; the name and address ofthe applicant; and a statement that the applicant intends to file said application on approximately June 10, 2015; that the applicant has made a bona fide effort to determine the addresses of the parties lo be notified under the cited section of the Municipal Code of the City of Chicago; that the applicant certifies that the accompanying list of names and addresses of surroundiog property owners within 250 feet, recognizing the above limits, is a complete list containing the names and last know addresses ofthe owners ofthe property required to be served and that ihc applicant bas furnished in additjotnrHstjof tlie persons so served. yX\x^[[^^Y
/^X'Rolando R. Acosta
Subscribed and sworn to before mc this June 10,2015.
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