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This record contains private information, which has been redacted from public viewing.
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Type:
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Ordinance
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Status:
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Passed
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Title:
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Budget and service provider agreement for Special Service Area No. 34, Uptown (Year 2017) and amendment of 2016 ordinance
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Topic:
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SPECIAL SERVICE AREAS - S.S.A. No. 34 (Uptown)
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Attachments:
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1. O2016-6403.pdf
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OFFICE OF THE MAYOR CITY OF CHICAGO RAHM EMANUEL MAYOR September 14, 2016 TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO Ladies and Gentlemen: At the request of the Commissioner of Planning and Development, I transmit herewith ordinances authorizing a budget and service provider agreement for 2017 for various Special Service Areas and an amended 2016 budget for various Special Service Areas. Your favorable consideration of these ordinances will be appreciated. Mayor Very truly yours, ORDINANCE WHEREAS, special service areas may be established pursuant to Article VII, Sections 6(1) and 7(6) of the Constitution of the State of Illinois, and pursuant to the provisions of the Special'Service Area Tax Law, 35 ILCS 200/27-5 et seq., as amended from time to time (the "Act"), and pursuant to the Property Tax Code, 35 ILCS 200/1-1 et seq., as amended from time to time; and WHEREAS, on December 7, 2005, the City Council of the City of Chicago (the "City Council") enacted an ordinance (the "Original Ordinance") which established an area known and designated as City of Chicago Special Service Area Number 34 (the "Original Area") and authorized the levy of an annual tax, for the period beginning in tax year 2005 through and including tax year 2014 (the "Original Period") not to exceed an annual rate of twenty-five hundredths of one percent (0.250%) of the equalized assessed value of the taxable property therein (the "Services Tax") to provide certain special services in and for the Original Area in addition to the services provided by and to the City of Chicago generally (the "Original Special Services"); and WHEREAS, on December 10, 2014, the City enacted an ordinance (the "Enlargement Ordinance") which (i) enlarged the boundaries of the Original Area (as enlarged, the "Area"), (ii) authorized certain special services in the Area distinct from the Original Special Services (the "Special Services"), and (iii) authorized the extension of the time period for which the levy of the Services Tax is authorized within the Area from the Original Period to a period from tax year 2014 through and including tax year 2028; and WHEREAS, the Original Ordinance and the Enlargement Ordinance are herein collectively referred to as the "Establishment Ordinance"; and WHEREAS, the Original Ordinance authorized sixteen (16) members ofthe Commission (as hereinafter defined); and WHEREAS, the City of Chicago now desires to decrease the number of members of the Commission from sixteen (16) to thirteen (13); and WHEREAS, certain funds in Fund A09 ("Fund A09") in the amount of $5,127 are available for use in connection with the Area; and WHEREAS, the Establishment Ordinance established the Area consisting of West Irving Park Road on the south to West Foster Avenue on the north along Uptown's primary north-south commercial corridors, North Broadway and North Sheridan Road. It includes properties along major and minor east-west roads throughout Uptown, including: Montrose Avenue, West Wilson Avenue, West Lawrence Avenue, and West Argyle Street; and WHEREAS, the Special Services authorized in the Establishment Ordinance include, but are not limited to: customer attraction, public way aesthetics, sustainability and public place enhancements, economic/business development, safety programs, and other activities to promote commercial and economic development; and |1010|2016 SSA34 Ord-Levy Amendment.doc WHEREAS, the Establishment Ordinance provided for the appointment of the Uptown Special Service Area Commission (the "Commission") to advise the City Council regarding the amount of the Services Tax to be levied and for the purpose of recommending to the City Council: (1) a yearly budget based upon the cost of providing the Special Services; (2) an entity to serve as a service provider (the "Service Provider"); (3) an agreement between the City and the Service Provider for the provision of Special Services to the Area (the "Service Provider Agreement"); and (4) a budget to be included in the agreement between the City and the Service Provider (the "Budget") (the aforementioned items 1 through 4 shall be known collectively herein as the "Recommendations"); and WHEREAS, the Commission has been duly appointed and qualified and has heretofore prepared and transmitted to the Commissioner of the Department of Planning and Development (the "Commissioner") its Recommendations to the City Council, including the Budget attached hereto as Exhibit A and hereby made a part hereof; and WHEREAS, on October 14, 2015, the City Council enacted an ordinance (the "2016 Appropriation, Levy, and Agreement Ordinance"), among other things, appropriating the sums necessary to provide the Special Services in and for the Area for 2016, levying the Services Tax for the tax year 2015, and authorizing an agreement to the 2016 Appropriation, Levy, and Agreement Ordinance) with Uptown United, an Illinois not-for-profit corporation, as the Service Provider (the "2016 Service Provider"), for the provision ofthe Special Services in 2016; and WHEREAS, pursuant to the 2016 Appropriation, Levy, and Agreement Ordinance the City and the 2016 Service Provider entered into a service provider agreement (the "2016 Service Provider Agreement"); and WHEREAS, the City desires to increase the budget for Special Services in the Area in 2016 by $20,937; and WHEREAS, the City therefore desires to amend both the 2016 Appropriation, Levy, and Agreement Ordinance, as set forth below, and the 2016 Service Provider Agreement, pursuant to an amendment in substantially the form attached hereto as Exhibit B; now, therefore Be It Ordained by the City Council of the City of Chicago: SECTION 1. Incorporation of Preambles. The preambles of this ordinance are hereby incorporated into this text as if set out herein in full. SECTION 2. Appropriations. There is hereby appropriated the following sums in the amounts and for the purposes necessary to provide the Special Services in and for the Area, the estimated amounts of miscellaneous income and the amounts required to be raised by the levy of the Services Tax indicated as follows: UPTOWN SPECIAL SERVICE AREA COMMISSION SPECIAL SERVICE AREA BUDGET For the fiscal year commencing January 1, 2017 and ending December 31, 2017: |1010|2016 SSA34 Ord-Levy Amendment.doc EXPENDITURES Service Provider Agreement for the provision of Special Services $843,156 TOTAL BUDGET REQUEST SOURCE OF FUNDING Tax levy at an annual rate not to exceed an annual rate of twenty-five hundredths of one percent (0.250%) of the equalized assessed value, of the taxable property within Special Service Area Number 34 Fund A09 Carryover funds currently available from prior tax years $843,156 $735,874 $5,127 $53,514 Late collections received by the City of Chicago attributable to the levy of the Services Tax in prior tax years, along with interest income thereon, if any $48,641 SECTION 3. Levy of Taxes. There is hereby levied pursuant to the provisions of Article VII, Sections 6(a) and 6(l)(2) of the Constitution of the State of Illinois and pursuant to the provisions of the Act and pursuant to the provisions of the Establishment Ordinance, the sum of $735,874 as the amount of the Services Tax for the tax year 2016. SECTION 4. Filing. The City Clerk of the City of Chicago (the "City Clerk") is hereby ordered and directed to file in the Office of the County Clerk of Cook County, Illinois (the "County Clerk") a certified copy of this ordinance on or prior to December 27, 2016, and the County Clerk shall thereafter extend for collection together with all other taxes to be levied by the City, the Services Tax herein provided for, said Services Tax to be extended for collection by the County Clerk for the tax year 2016 against all the taxable property within the Area, the amount of the Services Tax herein levied to be in addition to and in excess of all other taxes to be levied and extended against all taxable property within the Area. SECTION 5. Service Provider Agreement. The Commissioner, or a designee of the Commissioner (each, an "Authorized Officer"), are each hereby authorized, subject to approval by the Corporation Counsel as to form and legality, to enter into, execute and deliver a Service Provider Agreement as authorized herein with Uptown United, an Illinois not-for-profit corporation, as the Service Provider, for a one-year term in a form acceptable to such Authorized Officer, along with such other supporting documents, if any, as may be necessary to carry out and comply with the provisions of the Service Provider Agreement. The Budget shall be attached to the Service Provider Agreement as an exhibit. Upon the execution of the Service|1010|2016 SSA34 Ord-Levy Amendment.doc Provider Agreement and the receipt of proper documentation the Authorized Officer and the City Comptroller are each hereby authorized to disburse the sums appropriated in Section 2 above to the Service Provider in consideration for the provision of the Special Services described in the Budget. The Department of Planning and Development shall promptly make a copy of the executed Service Provider Agreement readily available for public inspection. SECTION 6. Amendment of 2016 Appropriation. Levy, and Agreement Ordinance. Section 2 of the 2016 Appropriation, Levy, and Agreement Ordinance is hereby amended by deleting the language indicated by strikeout and adding the underlined language as follows: "SECTION 2. Appropriations. There is hereby appropriated the following sums in the amounts and for the purposes necessary to provide the Special Services in and for the Area, the estimated amounts of miscellaneous income and the amounts required to be raised by the levy of the Services Tax indicated as follows: UPTOWN SPECIAL SERVICE AREA COMMISSION SPECIAL SERVICE AREA BUDGET For the fiscal year commencing January 1, 2016 and ending December 31, 2016: EXPENDITURES Service Provider Agreement for the provision of Special Services TOTAL BUDGET REQUEST SOURCE OF FUNDING Tax levy at an annual rate not to exceed an annual rate of twenty-five hundredths of one percent (0.250%) ofthe equalized assessed value, of the taxable property within Special Service Area Number 34 Fund A09 Carryover funds currently available from prior tax years Late collections received by the City of Chicago attributable to the levy of the Services Tax in prior tax years, along with interest income thereon, if any $783,322 $804.259 $783,322 $804,259 $741,001 $12,321 $4£t£)Q0 $30.937 $20,000" |1010|2016 SSA34 Ord-Levy Amendment.doc SECTION 7. Amendment to 2016 Service Provider Agreement. The Commissioner, or a designee of the Commissioner, are each hereby authorized, subject to approval by the Corporation Counsel as to form and legality, to enter into, execute and deliver an amendment to the 2016 Service Provider Agreement in substantially the form attached hereto as Exhibit B and hereby made a part hereof (the "2016 Service Provider Agreement Amendment"), and such other supporting documents, if any, as may be necessary to carry out and comply with the provisions of the 2016 Service Provider Agreement Amendment, with such changes, deletions and insertions as shall be approved by the persons executing the 2016 Service Provider Agreement Amendment. SECTION 8. Amendment to the Original Ordinance. Section 8 of the Original Ordinance is hereby amended by deleting the language indicated by strikeout and adding the double-underlined language as follows: "SECTION 8. Commission Authorized. There is hereby established the Uptown Special Service Area Commission (the "Commission") which shall consist of sixteen (16) thirteen (13) members. The Mayor, with the approval of the City Council, shall appoint the initial Commission members. Ofthe initial Commission members, 9 seven (7) members shall be appointed to serve for two year terms, and 7 six (6) shall be appointed to serve for one year terms. Upon the expiration of the term of any Commission member, the Mayor, with the approval of City Council, shall appoint a successor Commission member. Other than the initial Commissioners, each Commission member shall be appointed to serve for a term of two years and until a successor is appointed. In the event of a vacancy on the Commission due to resignation, death, inability to serve, removal by the Mayor, or other reason, the Mayor, with the approval of City Council, shall appoint a successor. Each successor so appointed shall serve for the remaining term for which he/she was appointed. The Commission shall designate one member as the Chairman of the Commission, and he/she shall serve not more than two successive two year terms. The Commission may establish bylaws for its procedural operation. The Commission shall have the powers delegated to it in Section 9 hereof. The terms and powers of the Commission members shall cease upon the termination of the time period for which the levy of the Services Tax is authorized. The members of the Commission shall serve without compensation. Every Commission member shall be required to own property or lease property as a tenant within the Area throughout the duration of his/her term on the Commission." SECTION 9. Enforceability. If any section, paragraph or provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such section, paragraph or provision shall not affect any of the remaining provisions of this ordinance. SECTION 10. Conflict. This ordinance shall control over any provision of any other ordinance, resolution, motion or order in conflict with this ordinance, to the extent of such conflict. SECTION 11. Publication. This ordinance shall be published by the City Clerk, in special pamphlet form, and made available in her office for public inspection and distribution to members of the public who may wish to avail themselves of a copy of this ordinance.|1010|2016 SSA34 Ord-Levy Amendment.doc SECTION 12. Effective Date. This ordinance shall take effect 10 days after its passage and publication. |1010|2016 SSA34 Ord-Levy Amendment.doc EXHIBIT A Budget |1010|2016 SSA34 Ord-Levy Amendment.doc 2017 SSA Budget Worksheet Chicago Department of Planning and Development -^/r ¦ • 7 Special Service Area # Service Provider Agency: Ue,T£WN;tjNJ^ 2017 BUDGET SUMMARY Budget and Services Period: January 1, 2017 through December 31, 2017 2016 Levy CATEGORY Collectable Levy Estimated Loss Collection Carry Over TIF Rebate Fund #A09 Estimated Late Collections and Interest 2017 Budget 1.00 Customer Attraction $82,250 $0 $0 $0 $20,000 $102,250 2.00 Public Way Aesthetics $399,959 $21,414 $52,056 $0 $0 $473,429 3.00 Sustainability and Public Places $10,000 $0 $0 $0 $5,000 $15,000 4.00 Economic/ Business Development $17,250 $0 $1,458 $5,127 $23,641 $47,476 5.00 Safety Programs $14,599 $0 $0 $0 $0 $14,599 6.00 SSA Management $40,200 $0 $0 $0 $0 $40,200 7.00 Personnel $150,202 $0 $0 $0 $150,202 Sub-total $714,460 $21,414 GRAND . T . . TOTALS LevyTotal $735,874 $53,514 $5,127 $48,641 $843,156 LEVY ANALYSIS Estimated 2016 EAV: ^;$3i6;43i;8^6 Authorized Tax Rate Cap: '6:256% Maximum Potential Levy limited by Rate Cap: $791,080 Requested 2016 Levy Amount. $735,874 0.23% Estimated Tax Rate to Generate 2016 Levy: •; levy change from previous year? 2015 LevyTotal $741,001 2016 LevyTotal $735,874 EXHIBIT B 2016 Service Provider Agreement Amendment |1010|2016 SSA34 Ord-Levy Amendment.doc AMENDMENT Special Service Area 34 This Amendment ("Amendment") is made and entered into effective as of the day of 2016, by and between the CITY OF CHICAGO ("City"), a municipal corporation and home rule unit of local government existing under the Constitution of the State of Illinois, acting through the Special Service Area Commission at Chicago, Illinois, and Uptown United, an Illinois not-for-profit corporation ("Contractor"). BACKGROUND WHEREAS, on December 7, 2005, the City Council of the City of Chicago (the "City Council") enacted an ordinance which established an area known and designated as City of Chicago Special Service Area Number 34 (the "Original Area") and authorized the levy of an annual tax, for the period beginning in tax year 2005 through and including tax year 2014 (the "Original Period") not to exceed an annual rate of twenty-five hundredths of one percent (0.250%) of the equalized assessed value of the taxable property therein (the "Services Tax") to provide certain special services in and for the Original Area in addition to the services provided by and to the City of Chicago generally (the "Original Special Services"); and WHEREAS, on December 10, 2014, the City enacted an ordinance which (i) enlarged the boundaries of the Original Area (as enlarged, the "Area"), (ii) authorized certain special services in the Area distinct from the Original Special Services (the "Special Services"), and (iii) authorized the extension of the time period for which the levy of the Services Tax is authorized within the Area from the Original Period to a period from tax year 2014 through and including tax year 2028; and WHEREAS, On October 14, 2015 the City Council enacted an ordinance which, among other things, appropriated the sums necessary to provide the Special Services in and for Special Service Area Number 34 for 2016, levied the Services Tax for the tax year 2015, and authorized a Service Provider Agreement (the "Agreement") with the Contractor as the service provider for the provision ofthe Special Services in 2016; and WHEREAS, the Contractor and the City have entered into the Agreement dated , 2016, in which the Contractor is to perform certain Special Services for Special Service Area Number 34; and WHEREAS, the amount of the Services Tax for tax year 2015 levied pursuant to the 2016 Ordinance was $741,001; and WHEREAS, due to cost savings realized by the Contractor in the performance of the Special Services certain surplus funds in the amount of $30,937 (the "Surplus Funds") became available for use to provide Special Services in Special Service Area Number 34; and WHEREAS, the City desires to ratify and approve the use of the Surplus Funds to provide Special Services by the Service Provider; and WHEREAS, the Contractor and the City therefore desire to make certain changes to the Agreement. The Agreement requires that modifications to it must be made in writing and signed by both parties, NOW THEREFORE, in consideration of the provisions and conditions set forth in the Agreement, the parties do mutually agree to amend the Agreement as set forth below. It is further agreed by and between the parties that the sole modifications of, changes in, and amendments to the Agreement are as follows: Exhibit 1(A), Amended Budget for 2016, is attached to this Amendment as Attachment 1 and incorporated by reference. The Agreement-Specific Information is hereby amended by deleting the language indicated by strikeout and adding the underlined language as follows: Maximum compensation amount (see Agreement Section 5.01): $741.001 $804.259 Maximum amount (see Agreement Section 5.02): $741,001 $804,259 Surplus Funds amount (see Agreement Section 5.01(b)): $0 $30,937 Exhibit 2(A), Amended Economic Disclosure Statement and Affidavit, is attached to this Amendment as Attachment 2 and incorporated by reference. All terms of the Agreement remain in full force and effect except as modified in this Amendment. SIGNED: CITY OF CHICAGO By: Commissioner, Department of Planning and Development CONTRACTOR: By: (Signature) Its: (Print Name and Title) Attest: Its: (Print Name and Title) County of State of Acknowledged on [date] before me by [title] of [f Notary Public Commission expires: Attachment 1 a*** '(A). Amended Budge, |1010| 2016 Budget and Services Summary Amendment Chicago Department of Planning >nd Development Name: Uptown SSAKM SSA Chairperson: Terry Tuohy Agency Contact: Justin Weidl Service Provider Aaepcv; Uptown LWted Phone Number 77&54-?2fJ«M" Phone Number: SSA Tax Authority Term: 2014-2030 Email: LhJofiyi2fW i^os pflal.com Email: jweidI®uptwnuni!ed,org
Date: 677/2015
2016 BUDGET SUMMARY Fund AOS + 2015 Levy Carry Over L*ii Collection* and Inttred lr.com* Th«r»on 2018 Budget
CATEGORY
1.00 Cuilorrtf Attraction 1 % " ¦ ? J K.750 |99|+ + J ¦ S 88,750
2 CO Public Way Aesthete! S 12.321 + i 378.170 5 28.937 S 20.000 S 439.437
3 00 SuttainatxHy and Public Placet" —¦$ » 13.00G S 2,000 s S 15.000
4,00 EcoDOrrJc/Butinesc Devetopmenl s $ 42.250 $ s 1 42.250
5.00 Safety Program*. * . > 19,500 s - J I 19,500
6 00 SSA ilanagerrxnt $ S 39.M0 |99| t S 39 840
7.00 Personnel . $, : I 140.482 J s S " 148 432
B.00 Lo»» Collection: 1.8% f + ? 5 13,000 $ s S 13.000
I GRAND TOTAL t 12.321 f 741.001 S 30,937 S 20,000 S 804.259
2018 Budget t 804.2SS
LEVY ANALYSIS |109|Estimated 2015 EAV- 8207.287.329 |109|Authorized Tax Rite Cap: 0250% |109|Estimated 2015 Levy- S741.001 |109|Estimated Tax Rate to Generate 20l4 Levy (Estimated 2015 Levy + Estimated 2015 EAV - Etf. Tax Rate): 0.249%
Attachment 2
Exhibit 2(A), Amended Economic Disclosure Statement and Affidavit 2016
|1010|
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION 1 - GENERAL INFORMATION
Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable;
\l?1t>v/A/ Mfzp ^ :v.: _ , ,
Check ONE of the following three boxes-;
Indicate whether the Disclosing Party submitting this EDS is:
^'ihe Applicant
OR
[ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest:; , __
OR
3. [ J a legal entity with a right of control (see Section II.B.I.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:,;. . ,. ,.: ,, , ... . ,....
Business address ofthe Disclosing Party:; i75J> ^- B^.6}il646#: fi ..... .
Telephone: 77'}"$7%-lDl> V Fax: 773~$~$678 Email: Sdtnjrfl^tJj^/^ntifitted: ef^
Name of contact person: J?Af?A P)AJ<4£5
E. Federal Employer Identification No. (if you have one): j
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") lo which this EDS pertains. (Include project number and location of property, if applicable):
//J&epeH ft? rtvi/iPer SjP&rfc Z&Zt/iteS Wrrnu/ J?Js{*3Which City agency or department is requesting this EDS? pg^x//^ ^^j? PS^7-OF/^€^7f
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification ft and Contract ft
Page 1 of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe 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 t^L^es [ ] No
[ ] Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[]Yes []No ^N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there arc 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 Parly. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
2. Please provide (he 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
HH UPTOWN UNITED
BUSINESS PARTNERS The Chamber tor Uptown
Board of Directors - 2016
FIRST AND LAST NAME BOARD TITLE
Martin Sorge President/CEO
Suellen G. Long Chair
Lucio DiPaolo Vice Chair, Business Partners
Jacqueline Loewe Vice Chair, Development Partners
Ed Stellon Vice Chair, Community Partners
Rafael Leon Treasurer
Jacqueline Zanders Secretary
Cindi Anderson Director
Scott Baskin Director
Karima Bentounsi Director
Mary Laura Jones Director
Patrick Moallemian Director
Mark Robertson Director
Tarn Van Nguyen Director
Dr. Reagan Romali Director
Patrick Thompson Director
Paul Tsang Director
Revised August 2016
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
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
t ] Yes j^No
[f 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 ofthe fees paid or estimated lo be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Parly's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking lo influence any legislative or administrative action.
If the Disclosing Parly is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask Ihe Cily whether disclosure is required or make ihe disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
lo be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets il"necessary)
[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's terra;
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 [ J No l^jo-person directly or indirectly owns 10% or more ofthe
©isclosing Parly.
ff "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
( J Yes I J No
FURTHER CERTIFICATIONS
I. 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 wilh, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy lo commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any sister agency; and (ii) thc Applicant understands and acknowledges that compliance with Article f is a continuing requirement for doing business wilh the City. NOTE: If Article I applies lo 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
2016 Submission - List of Retained Parties Estimated S $ 6,400 $ 5,000 $ 70,000 $ 31,000 $ 4,599 $ 269,750 $ 4,000 $ 1,000 OOO'S $ $ 2,500 $ 8,000 S 14,000 $ 4,000 $ 5,000 $ 5,000 $ 5,000
Service Audit, accounting Bicycle racks Landscaping Lightpole banners/ Holiday decorations Security Subcontractor Sidewalk cleaning/snow removal/ landscaping Special Events-Marketing | Special Events-Photography PR/Media Relations IT Monitoring Services Liability Insurance Graphic Design, Marketing Printing Strategic Planning Customized Bike Racks Public Art
Addr 3711 N. Ravenswood Ave., Ste. 105 Chicago, IL 60613 O O r-l OJ .ti Organization Eilts & Associates O o Landscape Concepts Management Bannerville GMP Support & Services Inc. Cleanslate Carl Wolf & Co. ; David Suarez Photography Audience Logic SMB Help Desk Non Profit Risk Services, Inc. Fisheye Graphic Services, Inc. Quicker Printers PLACE Consulating, Inc. SGL, Inc. General Comntractors You Are Beautiful, Inc.
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the dale of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting lo obtain, or performing a public (federal, stale or local) transaction or contract under a public transaction; a violation of federal or slate antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unil of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including bul not limited to all persons or legal entities disclosed under Section JV, "Disclosure ofSubconlraclors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Parly, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entily to do business with federal or stale or local government, including the Cily, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or eniily thai directly or indirectly controls ihe Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of Ihe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant lo Ihe direction or authorization of a responsible official ofthe Disclosing Parly, any Contractor or any Affiliated Eniily (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, wilh respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the dale of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted lo bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the Stale of Illinois, or any agency ofthe federal government or of any state or local government in ihe United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control ofthe 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, the Unverified List, the Entity List and the Debarred List.
The Disclosing Parly understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Cenificalions). the Disclosing Parly must explain below:
Page 6 of 13
If ihe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed (hat thc Disclosing Party certified lo the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City.oEChicago (if none, indicate with "N/A" or "none").
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any lime during the 1 2-month period preceding the execution dale of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or lo the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than S20 per recipient (if none, indicate with "N/A'* or "none"). As to any gift" listed below, please also list the name of Ihe City recipient.
, ¦ ¦¦ - ¦ ¦¦ - ¦¦ - - —- -- -- ¦¦
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
| J is |)^is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Parly IS a financial institution, ihen the Disclosing Parly pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge thai none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosing Parly is unable lo 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):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[JYes (y^No
NOTE: If you checked "Yes" to Item D.l., proceed lo Items D.2. and D.3. If you checked "No" to Item D. I., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or eniily in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Properly 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?
[ j Yes f ] No
If you checked "Yes" to Item D.l., provide thc names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies thai no prohibited financial interest in the Mailer 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 Parly checks 2 the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure lo
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection wilh the Matter voidable by the City.
t\ 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 profit's from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued lo slaveholders that provided coverage for damage to or injury or death of their slaves), and Ihe Disclosing Parly has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step I above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies thai the following constitutes full disclosure of alJ such records, including the names of any and all slaves or slaveholders described in those records:
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 lo Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe Disclosing Party wilh respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on Ihe lines above, or if the letters "NA" or if the word "None" appear, il will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under ihe Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Mailer.)
2. The Disclosing Parly has not spent and will nol 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 giant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501 (c)(4) ofthe Internal Revenue Code of 1.986; 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".
If the Disclosing Parly is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Malter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing al the outset of negoliations.
Is the Disclosing Parly the Applicant?
IJ Yes []No If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant lo applicable federal regulations? (See 41 CFR Part 60-2.)
| J Yes [ ] No
Have you filed wilh the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ J Yes f J No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
| J Yes [ j No
If you checked "No" lo question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:;
The certifications, disclosures, and acknowledgments contained in this EDS will become part, of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect lo the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-1.56 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.cityofcliicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Parly to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make Ihis document available to thc 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 lo (he 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 thc 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 ihe event of changes, the Disclosing
Party must supplement this EDS up lo the time the City lakes action on the Mailer. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update Ihis EDS as the contract requires. NOTE: With respect to Mailers subject to Article I of
Chapter 1-23 of the.Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), ihe information provided herein regarding eligibility must be kept cuirenl for a longer period,
as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page 1 I of 13
F. I. The Disclosing Party is not delinquent in the payment of any lax administered by the Illinois Department of Revenue, nor are the Disclosing Parly or its Affiliated Entities delinquent in paying any
ne, 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 Parly is the Applicant, the Disclosing Party and ils 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 wilh the Matter certifications equal in form and substance to those in F. 1. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that docs not provide such certifications or that thc Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F. I., 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 lo execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all
¦rtifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to thc City.
(Print or type name of person signing) (Print or type title of person signing)
Signed and sworn to before me on (chate)
at _ County, J (— (stale).
Sy£6U((M9
Commission cxpires:_
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, anil (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent, ft is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related lo the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section Il.B.La., if the Disclosing Parly is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe 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 the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means thc 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?
| JYes
[f yes, please identify below (1) Ihe name and title of such person, (2) thc name ofthe legal entity to which such person is connected; (3) the name and tille ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes "ft No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes [ ]No [fxj Not Applicable
3. If yes to (1) or (2) above, please identify below the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OFTHE ASSOCIATED EDS.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
l)fl€>y//A Va/iTZP
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. 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 Parly holds an interest:
OR
3. [ j a legal eutity with a right of control (see Section II.B.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
Business address ofthe Disclosing Party:
Telephone: 773''B7&-Idb'i Fax: 773 37%-}£7% Email: ^inf^S^p^\^Un!ied.arj
Name of contact person: _ JAFA PIA76&5
Federal Employer Identification No. (if you have one): j [
Brief description of contract, transaction or olher undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of properly, if applicable):
1# AU0V upr^t/ (A'/rep 77? s/Jffe trfft? A d&A/mth THf titf
Which City agency or department is requesting this EDS? ffAjfi//.V
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification ff _____ and Contract ff
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature ofthe 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 |/lYes [ ] No
Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the Slate of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[]Yes []No pQN/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
I. List below the full names and titles of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
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 ofthe Disclosing Parly. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
A/
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
m UPTOWN UNITED
BUSINESS PARTNERS The Chamber for Uptown
Board of Directors - 2016
FIRST AND LAST NAME BOARD TITLE
Martin Sorge President/CEO
Suellen G. Long Chair
Lucio DiPaolo Vice Chair, Business Partners
Jacqueline Loewe Vice Chair, Development Partners
Ed Stellon Vice Chair, Community Partners
Rafael Leon Treasurer
Jacqueline Zanders Secretary
Cindi Anderson Director
Scott Baskin Director
Karima Bentounsi Director
Mary Laura Jones Director
Patrick Moallemian Director
Mark Robertson Director
Tarn Van Nguyen Director
Dr. Reagan Romali Director
Patrick Thompson Director
Paul Tsang Director
Revised August 2016
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, stale "None." NOTE: Pursuant to Section 2-154-030 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
//avf D,SC|0S"'B Pirly
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ j Yes p^No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION TV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
_____ not an acceptable response.
J>£^~ ATTXctfgj? £/sr
(Add sheets if necessary)
[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Parly been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No jjt^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
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 lo commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, thc permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
You Are Beautiful, Inc. SGL, Inc. General Comntractors PLACE Consulating, Inc. Quicker Printers Fisheye Graphic Services, Inc. Non Profit Risk Services, Inc. SMB Help Desk Audience Logic David Suarez Photography Carl Wolf & Co. Cleanslate GMP Support & Services Inc. Bannerville Landscape Concepts Management Dero Eilts & Associates Organization 2016 Submission - List of Retained Parties
6814 N. Kilpatrrick Lincolnwood, IL 60712 10624 S. Torrence Ave. Chicago, IL 60617 3701 N. Ravenswood Avenue, Suite 205 Chicago, IL 60613 6116 N. Broadway Chicago, IL 60660 5443 N. Broadway Chicago, IL 60640 14504 John Humphrey Drive Orland Park, IL 60462 4147 N Ravenswood Ave #100 Chicago, IL 60613 5443 N. Broadway Chicago, IL 60640 2049 W. Chase Ave. Chicago, IL 60626 1055 W. Bryn Mawr Ave., #F-335 Chicago, IL 60660-4631 1540 S. Ashland Ave., Suite 105 Chicago, IL 60608 7640 W. Clarence Chicago, IL 60631 P.O. Box 184,1428 Hillgrove Western Springs, IL 60558 3200 S. Kolin Ave. Chicago, IL 60623 504 Malcolm Ave SE, Suite 100 Minneapolis, MN. 55414 3711 N. Ravenswood Ave., Ste. 105 Chicago, IL 60613 Addr
Public Art Customized Bike Racks Strategic Planning Printing Graphic Design, Marketing Liability Insurance IT Monitoring Services PR/Media Relations Special Events-Photography Special Events-Marketing Sidewalk cleaning/snow removal/ landscaping Security Subcontractor Lightpole banners/ Holiday decorations Landscaping Bicycle racks Audit, accounting Service
$ 5,000 $ 5,000 $ 5,000 $ 4,000 $ 14,000 $ 8,000 $ 2,500 $ 5,000 $ 1,000 $ 4,000 $ 269,750 ¦tn- In io IO $ 31,000 $ 70,000 $ 5,000 $ 6,400 Estimated S
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government:
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction: a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Parly;
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 die 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 stale 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 thai direclly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Parly, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the Stale of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control ofthe 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, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA." the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS. an employee, or elected or appointed official, ofthe City of/Chicago (if none, indicate wilh "N/A" or "none").
J/a
9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during thc 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than S20 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.
m/a .
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ]is f>iis not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Party IS a financial institution, then thc Disclosing Parly 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 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
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 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
It'the letters "NA." the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 ofthe Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes (4 No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
| J Yes | ] No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies 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 lo
Page X of 13
comply with these ciisclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
___\_1. The Disclosing Party verifies that the Disclosing Parly 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:
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 ofthe City are not federal funding.
¦ A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed thai 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 wilh respect lo the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay-any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity lo influence or attempt to influence an officer or employee of any agency, as defined by-applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded granl or loan, entering into any cooperative agreement, or lo extend, continue, renew, amend, or modify any federally funded contract, granl, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
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.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes | J No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes | ] No
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ J Yes | j No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ J Yes | J No
If you checked "No" lo question 1. or 2. above, please provide an explanation:
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SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with alt statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-1.56 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 ww w.citvofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
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 al law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection wilh the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the lime 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 Parly must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Pa sic 1 1 of 13
F. 1. The Disclosing Parly 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
ne, 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 Parly is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the rvtatter certifications equal in form and substance to those in F. 1. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that docs not provide such certifications or that thc Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any ofthe items in F. I., 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 thc Disclosing Party, and (2) warrants that all •rtifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate
and complete as ofthe date furnished to the City.
(Print or type name of person signing)
(Print or type title of person signing)
Signed and sworn to before me on (d,ate) at C0O/t _ County, _
Notary Public.
Commission expires:___^_l^J-^z£li^L.
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if. as 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 ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, fad:er-in-law, mother-in-law, son-in-law. daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section II.B. 1 .a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5 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 Parly or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
es
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.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes r](]No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[JYes [ ]No Not Applicable
3. If yes to (1) or (2) above, please identify below the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOW LEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OFTHE ASSOCIATED EDS.
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