CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable: South Chicago SA Associates, L.P._
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. feci 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:_
OR
3. [ ] a legal entity with a right of control (see Section ILB.l.) State the legal name of the entity in . which the Disclosing Party holds a right of control:_
B. Business address ofthe Disclosing Party: 701 Lee Street, Suite 500_
Pes Plaines, IL 60016_
C. Telephone: 847-768-5100 Fax: 847-635-2148 Email: j finisgPathwaySL.com
D. Name of contact person: Jerome E. Finis_
/'
E. Federal Employer Identification No. (if you have one): 20-5891111_,
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):
To enter into a lease with the City of Chicago for the new South Chicago Senior Center located at 9233 S. Burley Avenue, Chicago, IL_' _
G. Which City agency or department is requesting this EDS? Department of General Services for
Department of Family and Support Service' If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # N/A_and Contract #_
Ver. 09-01-10
Page 1 of. 13
SECTION TI - 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: State of Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[]Yes []No |y]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 titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any 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
South Chicago SA Investor, LLC_Limited Partner_
South Chicago SA Partners, LLC_Administrative General Partner_
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,
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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 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
! ■ '
Name Business Address Percentage Interest in the
Disclosing Party
South Chicago SA Investor, LLC 701 Lee Street, Suite 500 99.99%
Des Plaines, IL 60016
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 , UNo
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: (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.
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Name.(indicate whether retained or anticipated to be retained)
See attached exhibit
Business Relationship to Disclosing Party Address (subcontractor, attorney, lobbyist, etc.)
Fees (indicate whether paid or estimated.) NOTE: "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
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?
[] Yes
[ ] No [x] 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?
[ ] Yes
,[]No
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), if the 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 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 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.
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Retained Parties Exhibit to EDS |
South Chicago SA Associates, L.P. |
|
|
|
|
Name |
Business Address |
Relationship |
Fees |
Mackie Consultants, Inc. |
9575 W. Higgins Road |
Surveyor |
$ 22,880.68 |
Retained |
Rosemont, IL |
|
Paid |
Mackie Consultants, Inc. |
9575 W. Higgins Road |
Engineering |
$ 78,193.21 |
Retained |
Rosemont, IL |
|
Paid |
Harley Ellis Devereaux |
401 W. Superior |
Architect |
$ 650,267.45 |
Retained |
Chicago, IL |
|
Paid |
Lyon & Caron, LLP |
790 Estate Drive, Suite 180- |
Attorney |
$ 21,244.53 |
Retained |
Deerfield, IL |
Land Acquisition |
Paid |
Bonestroo, formerly Northern Environmental Consultants |
85 Revere Drive, Suite H |
Site remediation |
$ 59,308.93 |
Retained |
Northbrook, IL 60062 |
|
Paid |
Valerie S. Kretchmer & Associates |
2707 Walnut Avenue |
Market Study |
$ 21,325.69 |
Retained |
Evanston, IL |
|
Paid |
Renzi & Associates |
1300 S. Paulina, 4th Floor |
Land Appraisal |
$ 6,200.00 |
Retained |
Chicago, IL |
|
Paid |
Applegate & Thorne-Thomsen |
322 S. Green Street, Suite 400 |
Attorney |
$105,000.00 |
Retained |
Chicago, IL |
Finance closing |
Paid |
Pepper Environmental Technologies, Inc. |
411 Lake Zurich Road |
Environmental Remediation |
$ 52,593.00 |
Retained |
Barrington, IL 60010 |
|
Paid |
Dost Valuation Group, Ltd. |
419 South 7th Avenue |
Appraiser |
$ 3,300,00 |
Retained |
LaGrange, IL 60525 |
|
Paid |
Illinois Housing Development Authority |
401 N. Michigan Avenue, Suite 700 |
Tax credit reservation |
$ 159,177.81 |
Retained |
Chicago, IL |
|
Paid |
Illinois Housing Development Authority |
401 N. Michigan Avenue, Suite 700 |
Application fees |
$ 3,800.00 |
Retained |
Chicago, IL |
|
Paid |
Illinois Housing Development Authority |
401 N. Michigan Avenue, Suite 700 |
ERP asset management fees |
$ 191,000.00 |
Retained |
Chicago, IL |
|
Paid |
Illinois Environmental Protection Agency |
1021 N. Grand Avenue East |
Permit for Storm Water |
$ 4,108.95 |
Retained |
Springfield, IL 62794 |
Discharge |
Paid |
City of Chicago |
318 S. Michigan Avenue |
Application fees |
$ 2,500.00 |
Retained |
Chicago, IL |
|
Paid |
City of Chicago |
318 S. Michigan Avenue |
Inspection/review fees |
$ 40,329.25 |
Retained |
Chicago, IL |
|
Paid |
Seeco Consultants |
7350 Duvan Drive |
Geotechnical engineering |
$ 34,965.50 |
Retained |
Tinley Park, IL |
|
Paid |
Schiff Hardin LLP |
6600 Sears Tower, 233 S. Wacker Drive |
Legal fees - remediation |
$ 16,718.15 |
Retained |
Chicago, IL |
|
Paid |
Julia Redwine, Inc. |
62 Elmwood Lane |
Interior Design |
$ 30,251.23 |
Retained |
Lincolnshire, IL 60069 |
|
Paid |
Sentinel Investigations & Security |
10450 South Western |
Security |
$ 29,888.00 |
Retained |
Chicago, IL 60643 |
|
Paid |
Christopher Burke |
9575 W. Higgins Road |
Traffic Impact Study |
$ 8,518.46 |
Retained |
Rosemont, IL |
|
Paid |
Willis of Illinois |
233 S. Wacker Drive |
Insurance |
$ 12,381.00 |
Retained |
Chicago, IL 60606 |
|
Paid |
IFF |
One N. LaSalle, Suite 700 '■' |
Interest on Loan |
$ 8,420.00 |
Retained |
Chicago, IL 60602 |
|
Paid |
First American Title Insurance |
30 N. LaSalle I |
Title Insurance & recording fees |
$ 22,753.00 |
Retained |
Chicago, IL 60602 |
- |
Paid |
Albert Whitehead |
10 N. Dearborn, Suite 600j |
Legal fees |
$ 20,937.93 |
Retained |
Chicago, IL 60602 |
|
Paid |
Cole Taylor Bank |
225 West Washington |
Letter of credit fees |
$ 29,198.49 |
Retained |
Chicago, IL 60606 ' |
|
Paid |
Los Padres Bank |
401 E. Main Street |
Legal fees on FHLB-SF AHP |
$ 2,723.00 |
Retained |
Santa Maria, CA 93454 i |
|
Paid |
Sonnenschein, Nath & Rosenthal |
233 S. Wacker, Suite 780Q |
Legal fees |
$ 33,884.60 |
Retained |
Chicago, IL 60606 |
|
Paid |
Sidley Austin |
One S. Dearborn |
Legal fees |
$ 4,206.50 |
Retained |
Chicago, IL 60603 ' |
|
Paid |
JPMorgan Chase |
10 S. Dearborn, 10th Floor |
Financing fees |
$ 40,826.00 |
Retained |
Chicago, IL 60603 j |
|
Paid |
PSL Management LLC |
701 Lee Street, Suite 500 ; |
Organizational fees |
$ 15,000.00 |
Retained |
Des Plaines, IL 60016 ! |
|
Paid |
FLS Group, LLC |
4711 W. Golf Road, Suite 200 |
Accounting/cost certification |
$ 3,842.00 |
Retained |
Skokie, IL 60076 |
|
Paid |
Pathway Development LLC |
701 Lee Street, Suite 500 ; |
Developer fee |
$ 125,029.60 |
Retained |
Des Plaines, IL 60016 |
|
Paid |
NHS Redevelopment Corporation |
1279 N. Milwaukee, 5th Floor |
Developer fee |
$ 31,257.40 |
Retained |
Chicago, IL 60622 |
|
Paid |
Testing Services |
360 S. Main Place |
Soil/material testing |
$( 1,997.50 |
Retained |
Carol Stream, IL 60188 [ |
|
Paid |
Vedder Price |
222 N. LaSalle , Suite 2600 |
Legal fees - zoning |
$ 198,378.73 |
Retained |
Chicago, IL 60601 |
|
Paid |
Kane McKenna |
150 N. Wacker Drive, Suite 1600 |
Legal fees - zoning |
$ 18,622.71 |
Retained |
Chicago, IL 60606 |
|
Paid |
|
|
|
|
|
|
|
|
|
|
|
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: ;
a. 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;
b. 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 contractjunder 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;
c. 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;
d. 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
e. 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, 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 tbe 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 "Agents").
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<
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:
a. 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; ;
b. 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
c. 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
d. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
4. 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.
5. 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 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.
j
6. 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.
7. 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:
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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. 1
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1. The Disclosing Party certifies that the Disclosing Party (check one) [ ] is lx] is not .
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
)
2. 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 ofthe 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 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) 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):
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.
1. In accordance with Section 2-156-110 of the 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 UNo
j
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.
Page 7 of 13
2. ' Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other 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 the 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
3. 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 Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 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 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 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:
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SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations 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): i
(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 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.
3. 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.
4. The Disclosing Party certifies that 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".
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.
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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?
pq Yes [ ] No
If "Yes," answer the three questions below:
1. Have ypu developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[JYes pq No
2. 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?
fcl Yes []No
3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes W No
If you checked "No" to question 1. or 2. above, please provide an explanation:
The applicant is a newly formed entity. The partnership will own the real estate;_
it will have no employees.__
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. 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.
B. 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.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N.
Page 10 of 13
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances. /
C. 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.
D. 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. 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 of the Municipal Code.
The Disclosing Party represents and warrants that:
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 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 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 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.
Page 11 of 13
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 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.
South Chicago SA Associates, L.P. (Print or type name of Disclosing Party)
By: South Chicago SA Partners, LLC, its administrative general partner By: PSL Management LLC, its sole manager
(Sign here)
Jerome E. Finis (Print or type name of person signing)
Manager
(Print or type title of person signing) Signed and sworn to before me on (date) I3l / Q. 13o to
By:
at
Cook
County, Illinois
(state).
Commission expires: V//7- ( 1(
Notary Public.
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFD3AVIT
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 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 U.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 of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 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 ofthe 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.
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Page 13 of 13
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Rules Regarding Economic Disclosure Statement and Affidavit
These Rules are promulgated pursuant to Section 2-154-050 of the Municipal Code. These rules are intended solely to provide guidance on interpretation of Chapter 2-154 of the Municipal Code and are not intended to abrogate any disclosure requirements contained in 65 ILCS 5/8-10-8.5 ("Disclosure"), as applicable.
1. An entity that is any unit of the United States federal, state or local government or any agency or instrumentality thereof shall not be required to file an EDS.
2. An entity that holds an ownership interest in an Applicant of greater than 7.5%, but less than 100%, shall not be required to file an EDS if it is one ofthe following and, in lieu of an EDS, provides the disclosure information required in certain instances below:
(a) a foundation having a current tax exemption under Section 501 (c) of the Internal Revenue Code, so long as such foundation provides a copy of its most recent IRS Form 990; or
(b) (i) a government entity, agency, department or instrumentality or (ii) a pension fund maintained by such a government body, or (iii) an enterprise created by Federal or state statute, but not formed as a business corporation or a not-for-profit (e.g., Fannie Mae, Federal Home Loan Corporation, SLM Corporation) or (iv) a government-owned corporation (e.g., Government National Mortgage Association); or <■
(c) a registered investment adviser that holds an ownership interest of greater than 7.5%, but less than 22.5%, beneficially for its third party investors, so long as such registered investment adviser provides a copy of its most recent Form ADV and its most recent amendment thereto; or
(d) a mutual fund that holds an ownership interest of greater than 7.5%, but less than 22.5%, beneficially for its third party investors, so long as such mutual fund provides a copy of its form N-l A and the most recent amendment thereto; or
(e) such other entity that holds an ownership interest of greater than 7.5%, but less than 22.5%,. as a beneficial owner for a class of other third party investors and is regulated by and required to make periodic filings with the federal Securities and Exchange Commission under the Securities Act, the Securities and Exchange Act, the Williams Act the Public Utility Holding Company Act, or the Investment Company Act or pursuant to comparable foreign securities regulatory and filing requirements, provided that (i) such entity provides a copy of such most recent filing or report, and (ii) the Corporation Counsel determines that such filing or report and the entity's disclosures therein reasonably satisfy the purposes and intent of the EDS Form.
3. Section 2-154-010 of the Municipal Code requires disclosures to be made when a person or entity "makes application to the City of Chicago for action." This phrase shall be construed not to apply, and thus not to require submission of an EDS, if all of the following circumstances are present:
(a) The action is being undertaken at the request of the City.
(b) The action is being undertaken for the primary benefit of the City.
(c) The affected party is not seeking the action and would not participate in the action if not for the City's request.
(d) The affected party is uniquely situated, such that the City would be unable to seek the benefit at issue from a different party. Examples include an easement granted for the City's benefit, or site access granted by a railroad or airline for the City's benefit.
4. The participation in a transaction by a party solely in that party's capacity as an escrowee or similar administrative capacity, where that party otherwise has no contracting relationship with the City in that transaction, shall not obligate that party to submit an EDS.
NOTE: The exceptions in these Rules are set forth as a general matter, and depending on the facts and circumstances of a particular transaction, the City reserves the right to require an EDS from any one or more of the types of entities listed herein.
Ver. 4-16-07
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