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BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. That Title 17 ofthe Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the RS-3 Residential Single-Unit (Detached House) District symbols and indications as shown on Map No. 1 I-I in the area bounded by:
A line 24.14 feet north of and parallel to West Berteau Avenue; North Sacramento Avenue; West Berteau Avenue; and the public alley next west of and parallel to North Sacramento Avenue
to those of a RM-4.5 Residential Multi-Unit District.
SECTION 2. This ordinance shall be in force and effect from and after its passage and due publication.
Common Address of Property: 4200 North Sacramento Avenue
CITY OF CHICAGO fK&^j ZZjK&Z^
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS of the property Applicant is seeking to rezone: 4200 North Sacramento Avenue
Ward Number that property is located in: 33
APPLICANT Chris KaP|on
ADDRESS 4200 N. Sacramento Ave., Unit 1R CITY Chicago
STATE IL ZIP CODE 60618 PHONE
EMAIL _. CONTACT PERSON Chris Kaplon
NO
4. Is the applicant the owner of the property? YES_
If the applicant is not the owner of the property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed.
OWNER
ADDRESS CITY
STATE ZIP CODE PHONE
EMAIL CONTACT PERSON
5. If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Matthew Allee, Schain Banks ADDRESS 70 w- Madison Street, Suite 2300
CITY Chicago STATE IL ZIP CODE 60602
PHONE (312) 345-5700 FAX (312)345-5701 EMAIL rnallee@schainbanks.com
Page 1
If the applicant is a legal entity (Coiporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements. Not Applicable
7. On what date did the owner acquire legal title to the subject property? Apnl 5'1965
8. Has the present owner previously rezoned this property? If yes, when?
No
9. Present Zoning District RS-3 Proposed Zoning District RM'4 5
10. Lot size in square feet (or dimensions)3'0286 sc*uarefeet <2414 x 125"46>
11 Current Use of the property 2"storv building with 3 dwelling units and vacant ground floor commercial space
12. Reason for rezoning the property To convert from storefront and 3 dwelling units t0 4 dwelling units with interior alterations to the storefront only.
Describe the proposed use ofthe property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage ofany commercial space; and height ofthe proposed building. (BE SPECIFIC)
To rezone the property to RM-4.5 to add a ground-level dwelling unit in the existing two story, three dwelling unit building, for a total of four dwelling units. No changes will be made to the height or exterior structure of the building
All work to add the dwelling unit will be interior. No commercial space will be provided after the conversion. The additional 2 car parking garage to remain with no additional parking being provided.
The Affordable Requrements Ordinance (ARO) requires on-site affordable housing units and/or
a financial contribution for residential housing projects with ten or more units that receive a zoning change which, among other triggers, increases the allowable floor area, or, for existing Planned Developments, increases the number of units (see attached fact sheet or visit www.cityofchicago.org/ARO for more information). Is this project subject to the ARO?
YES NO /
Page 2
COUNTY OF COOK STATE OF ILLINOIS
_, being first duly sworn on oath, states that all of the above
statements and the statements contained in the documents submitted herewith are true and correct.
Signature of Applicant/
Subscribed and Swornler1 before me this
pri dayof Wi
For Office Use Only
Page 3
PROPERTY ADDRESS: 4200 N SACRAMENTO AVENUE, CHICAGO, ILLINOIS 60618 SURVEY NUMBER: 2204 4923
22044923
BOUNDARY SURVEY COOK COUNTY
LINE TABLE
L1 Sr43'22'E 24.14'(C)
24 14' (R) L2 S89-01'46-W 125.46'(C)
125.46'(RJ L3 Nr43'22"W 24 14' (C) 24.14' (R) L4 N 89"01'46' E 125.46'(C)
GRAPHIC SCALE (In Feet) 1 inch = 30' ft.
STATE OF ILLINOIS COUNTY OF LASALLE
POINTS OF INTEREST: NONE VISIBLE
THIS IS TO CERTIFY THAT THIS PROFESSIONAL SERVICE CONFORMS TO THE CURRENT ILLINOIS MINIMUM STANDARDS FOR A BOUNDARY SURVEY GIVEN UNDER MY HAND AND SEAL THIS OA"E HEREON
ILLINOIS PROFESSIONAL LAND SURVEYOR No 297 LCENSE EXPIRES 11/30/2022 EXACTA LAND SURVEYORS, LlC =ROFESSIONA. DESIGN FIRM 184008059-0008
Exacts Land Surveyors, LLC PLSt 184008059 0 773 305.4011 316 East lackson St.'eet | Mmm. II 60450
Survey STARS
DATE OF SURVEY: 05/04/22 FIELD WORK DATE: 5/3/2022 REVISION DATE(S): (REVO 5/4/20221
SEE PAGE 2 OF 2 FOR LEGAL DESCRIPTION PAGE 1 OF 2 - NOT VALID WITHOUT ALL PAGES
PROPERTY ADDRESS: 4200 N SACRAMENTO AVENUE, CHICAGO, ILUNOIS60618 SURVEY NUMBER: 2204 4923
JOB SPECIFIC SURVEYOR NOTES:
LEGAL DESCRIPTION:
LOT 24 IN BLOCK 2 IN FIELD'S BOULEVARD ADDITION TO IRVING PARK, A SUBDIVISION OF THE EAST HALF OF THE WEST HALF OF THE SOUTHWEST QUARTER OF SECTION 13, TOWNSHIP 40 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
GENERAL SURVEYOR NOTES:
Thp Legal Description used to perform this survey was supplied by others This survey does not determine nor imply ownership of the lands or any fences shown hereon Unless otherwise noted. an examination of the abstract of title was NOT performed by thc signing surveyor to determine which instruments, if any. are affecting this properly
The purpose of this survey is to establish the boundary of the lands described by the legal description provided and to depict the visible improvements thereon for a pending financial transaction Underground footings, util'des, or other service hnes, including roof cave overhangs were not located as part of this survey Unless specifically stated otherwise the purpose and intent of this survey is not for any construction activities or future planning
.1 If there is a septic tank o- drain field mown on this survey, the location depicted nereon was either shown to thc surveyor by a third party or it was estimated by visual above ground inspection No excavation was performed to determine its location
Th'S survey is exclusively for a pending financial transaction and only to be used by the parties to whom it is certified
Alterations to this survey map and report by other -nan thc signing surveyor are prohibited
ti Dimensions are in feet and decimals thereof
Any FEWA flood zone data contained on this survey is for informational purposes only Research to obtain said data was performed at www fpma gov and may ".a\ reflect the most recent information
Unless otherwise noted 'SIR* indicates a set iron re bar. 5/8 ¦nch m diameter and twenty-four inches long
Ihe symbols reflected in the legend and on this survey may have been enlarged or reduced for clarity The symbols have been plotted at the approximate center ofthe *ield location and may not represent the actual snapc or size of thc 'caturc
Pomts of Interest jPOi'sj are select above-ground improvements, wnch may appear in conflict with boundary, building setback or easement lines, as defines by the parameters of this survey These POI's may not represeni
all items of interest to thc viewer There may be addiironal POI's which aie no: shown or called-out as POI's, or which arc otherwise unknown to the surveyor
Utilities shown on the subject property mayor may not indicate the existence of recorded or unrecorded utility casements
The information contained on ims survey has been performed exclusively by and is the sole responsibility of Exacta Land Surveyors. LLC Additional logos or references lo third oarty firms n't 'oi mforma:1.1 Due to varying construction standards, building dimensions are approximate and arc not intended to be used for new construction or planning
Surveyor bear.rigs are used Tor angular reference and arc used to show angular relationships of mcs only and are not related or orientated to true or magnetic north Bearings are shown as surveyor bearings, and when shown as matching those on the subdivision plats on which this survey is based, they arc to be deemed no more accurate as thedeierminationof a north orientation made on and for those original subdivision oiats North 00 degrees East is assumed and upon preparation of this plat, the resulting bearing between found points as shown on this survey is the basis of said surveyor bearings as defined and required lo be noted by Illinois Administrative Code Title 68, Chapter VII, Sub-Chapter B, Part 1270, Section 1270 56. Paragraph B, Sub-Paragraph 6, Item k
THIS SURVEY IS A PROFESSIONAL SERVICE IN COMPLIANCE WITH THE MINIMUM STANDARDS OP THE STATE OF -LLINOIS NO IMPROVEMENTS SHOULD BE MADE ON THE BASIS OF THIS PLAT ALONE PLEASE REFER ALSO TO YOUR DEED, TITLE POLICY AND LOCAL ORDINANCES COPYRIGHT BY EXACTA ILLINOIS SURVEYORS THIS DOCUMENT MAY ONLY BE USED 8V THE PARTIES TO WHICH IT >S CERTIFIED PLEASE DIRECT QUESTIONS OR COMMENTS TO EXACTA ILLINOIS SURVEYORS, INC ATTHE PHONE NUMBER SHOWN HEREON
SURVEYOR'S LEGEND
JNETYPES
Boundary Line
Center Line
Cham LinkorWire
Easement
" ; EdgeofWater
-O—O—\ Iron Fence
—OHL— Overhead Lines
1 Structure
Survey Tie Line
Vinyl Fence
Wallor Party Wall Wood Fence
—
SURFACE TYPES
///////¦ Asphalt
£ /-/'" A BrickorTile
Concrete
Covered Area
Water
Wood
SYMBOLS
«> Benchmark
t> A Center Line
Central Angle or Delta
Common Owner snip
A Control Point
H Catch Basin
Elevation
•XT Fire Hydrant
• Find or Set Monument
€— Guywirp or Anchor
a Manhole
© Tree
<* Utility or Light Pole
© Well
ABBREVIATIONS
(Cl-Calculated
(D) - Deed
(F) • Held
(M) - Measured
(PI-Plat
(5)-Survey
A/C - Air Conditioning
AE - Access Easement
ANE-Anchor Easement
ASBL - Accessory Setback Line
B/W-Bay/Box Window
BC- Block Corner
BFP - Backflow Preventer
BLDG-Building
BLK - Block
BM - Benchmark
BR - Bearing Reference
BRL - Building Restriction Line
BSMT - Basement
C-Curve
C/L-Center Line
C/P-Covered Porch
C/S-Concrete Slab
CATV-Cable TV Riser
CB - Concrete Block
CH-Chord Bearing
CHIM-Chimncy
CLF-Chain Link Tence
CME -Canal Maintenance
Easement
CO - Clean Out
CONC-Concrete
COR-Corner
CS/W-Concrete S-dewalk
CUE - Control Utility Easement
CVG - Concrete Valley Gutter
D/W - Driveway
DE - Drainage Easement
DF-Drain Field
DH - Drill Hole
DUE-Drainage & Utility
Easement
ELEV- Elevation
EM - Electnc Meter
ENCL- Enclosure
ENT - Entrance
EOP - Edge of Pavement
EOW-Edge of Water
ESMT- Easement
EUB-Electnc Utility Box
F/DH - Found Drill Hole
FF-Finished Floor FIP- Found Iron Pipe FIPC- Found Iron Pipe4 Cap FIR- Found Iron Rod
FIRC - round Iron Rod & Cap
FN - Found Nail
FN40- Found Nail A Disc
FRRSPK - Found Rail Road
Spike
GAR-Garage
GM-Gas Meter
ID - Identification
IE/EE - Ingress/Egress Easement
ILL - Illegible
IMST- Instrument
INT-intersection
IRRE - Irrigation Easement
L- Length
LAE - Limited Access Easemeni LB#- LcenseNo (Business) LBE - Limited Buffer Easement LE - Landscape Easement LME - Lake/Landscape Maintenance Easement LS#- License No (Surveyor) MB • Map Book ME- Maintenance Easement MES - Mitered End Section MF-Metal Fence MH- Manhole
MHWL- Mean nigh Water Line NR - Non-Radial NTS - Not to Scale NAVD88- North American Vertical Datum 1988 NGVD29- National Geodetic Vertical Datum 1929 OG - On Ground ORB-Official Records Book
ORV-Offinnl Record Volume O/A- Overall O/S-Offset
OFF - Outside Subject Property
OH-Overhang
OHL • Overhead Utility Lines
OHWL - Ordinary High Waier
Line
ON - Inside Subject Property
P/E- Pool Equipment
PB-P'at Book
PC - Pomt of Curvature
PCC - Poml of Compound
Curvature
PCP - Permanent Control Point
PI - Doinl of Intersection
PLS - Professional Land
Surveyor
PLT - Planter
POB - Point of Beginning
POC - Point of Commencement
PRC - Poml of Reverse
Curvature
PRM - Permanent Reference Monument
PSM - Professional Surveyor ft Mapper
PT - Point of Tangcncy
PUE - Public UtiNty Easemeni
R- Radius or Radial
R/W- Right of Way
RES - Residential
RGE * Range
ROE - Roof Overhang Easement RP-Radius Point
S/W - Sidewalk
SBL * Setback Line
SCL - Survey Closure Line
SCR - Screen
SEC-Section
SEP - Septic Tan<
SEW-Sewer
SIRC-Sct Iron Rod & Cap
SMWE- Storm Water
Management Easemeni
SNftD-Sct Nail and Disc
SQFT-Square Feel
STL-SurvryTie Line
STY - Story
SV-Sewer Valve
SWE - Sidewalk Easement
TBM-Temporary Bench Mark
TEL - Telephone Facilities
TOB - Top of Bank
TUE - Technological Utility
Easement
TWP-Township
TX-Translormer
TYP - Typical
UE-Utility Easement
UG-Underground
UP-Utility Pole
UR-Utility Riser
VF - Vmyl renee
W/C- Witness Corner
W/F-Water Tiller
WF - Wood Tence
WM - Water Meter/Valve Box
WV-Water valve
SCHAIN 1 BANKS
SCHAIN BANKS KENNY & SCHWARTZ LTD
Matthew Allee
70 West Madison Street
Suite 2300
Chicago, IL 60602 Main (312) 345-5700 mallee@schainbanks.com
May 10,2022
Honorable Thomas M. Tunney
Chairman, Committee on Zoning, Landmarks and Building Standards 121 North LaSalle Street Room 304, City Hall Chicago, Illinois 60602
Dear Committee Members:
The undersigned, Matthew Allee, being first duly sworn on oath, deposes and states the following:
The undersigned certifies that he has complied with the requirements of Section 17-13-0107 of the Chicago Zoning Ordinance by sending written notice to such property owners who appear to be the owners of property within the subject area not solely owned by the applicant, and to the owners of all property within 250 feet in each direction of the lot line of the subject property, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. Said "written notice" was sent by First Class U.S. Mail, no more than 30 days before filing the application.
The undersigned certifies that the notice contained the address of the property sought to be rezoned; a statement of intended use of the property; the name and address of the applicant; the name and address of the owner; and a statement that the applicant intends to file the application for a change in zoning on approximately May 23,2022.
Matthew Allee Attorney for Applicant
The undersigned certifies that the applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-0107 ofthe Chicago Zoning Ordinance, and that the accompanying list of names and addresses of surrounding property owners within 250 feet of the subject site is a complete list containing the names and addresses of the people required to be served.
SCHAIN BANKS
SCHAIN BANKS KENNY & SCHWARTZ LTD
Matthew Allee
70 West Madison Street Suite 2300 Chicago, IL 60602 Main (312) 345-5700 mallee@schainbanks.com www.schainbanks.com
May 23, 2022 Dear Sir/Madam:
In accordance with Section 17-13-0107 ofthe Chicago Zoning Ordinance, Title 17 of the Municipal Code of Chicago, please be advised that on or about May 23, 2022, the undersigned, Matthew Allee, will file an application, on behalf of the applicant, Chris Kaplon, for a change in zoning from an RS-3 Residential Single-Unit (Detached House) District to an RM-4.5 Residential Multi-Unit District for the property located at 4200 North Sacramento Avenue, Chicago, Illinois.
The owner of the subject property and the applicant ofthe Zoning Amendment is Chris Kaplon, located at 4200 North Sacramento Avenue, Unit 1R, Chicago, Illinois, 60618.
The proposed use of the property after rezoning to RM-4.5 is to convert the long-vacant ground-floor commercial space into an additional dwelling unit in the existing two story, three dwelling unit building, for a total of four dwelling units. No changes will be made to the height or the exterior structure of the building. All work to add the ground-floor dwelling unit will be interior-only. No commercial space will be provided after the conversion.
I am the duly authorized attorney for the applicant and owner. My address is 70 West Madison, Suite 2300, Chicago, Illinois 60602. My telephone number is (312) 345-5700.
PLEASE NOTE THAT THE APPLICANT IS NOT SEEKING TO PURCHASE OR REZONE YOUR PROPERTY. THE APPLICANT IS REQUIRED BY LAW TO SEND YOU THIS NOTICE BECAUSE YOU OWN PROPERTY LOCATED WITHIN 250 FEET OF THE SUBJECT PROPERTY.
Very truly yours,
Matthew Allee Attorney for Applicant And Owner
Page 1 of 1
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Chris Kaplon
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
\7\ the Applicant
OR
__ a legal entity currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name:
OR
[] a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 4200 N. Sacramento Ave. Unit 1R
Chicago, Illinois 60618
Email:
Telephone: : ' Fax:
Name of contact person: Chris Kaplon
Federal Employer Identification No. (if you have one): N/A
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
Zoning Amendment for property located at 4200 N. Sacramento Avenue
G. Which City agency or department is requesting this EDS? Dept- of Planning and Development
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Ver.2018-1 Page 1 of 15
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
Person
Publicly registered business corporation
Privately held business corporation
Sole proprietorship
General partnership
Limited partnership
Trust
| | Limited liability company [ | Limited liability partnership P~| Joint venture | | Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
? Yes QNo | | Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
N/A
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 _\ Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles, if applicable, of: (i) all executive officers and all directors of the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
N/A
2. Please provide the following information concerning each person or legal entity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including ownership) in excess of 7.5% of the Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Page 2 of 15
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
N/A
SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS? - Q Yes [/] No
Does the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-month period following the date of this EDS? Q Yes [/] No
If "yes" to either of the above, please identify below the name(s) of such City elected official(s) and describe such income or compensation:
Does any City elected official or, to the best ofthe Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party?
[] Yes g No
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partner(s) and describe the financial interest(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 (as defined in MCC Chapter 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount 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. 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 15
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.
Tyler Manic, Schain Banks; 70 W. Madison St., #2300, Chicago, IL 60602; Attorney; Est $10,000
(Add sheets if necessary)
| | Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
? Yes [7] No QNo person directly or indirectly owns 10% or more ofthe 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
[This paragraph 1 applies only ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date ofthis EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract in progress).
The Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) ofthis 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, during the 5 years before the date ofthis 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 of the offenses set forth in subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during the 5 years before 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 Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
Certifications (5), (6) and (7) concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity). Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity. With respect to Contractors, the term Affiliated 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 of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 15
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 5 years before the date of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity ofa Contractor during the 5 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 State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
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 subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] ofthe Applicant 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 MCC Chapter 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant 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 Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
Ver.2018-1 Page 6 of 15
contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. 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:
N/A
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.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the date ofthis EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
N/A
13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes ofthis 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 $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
| | is [/] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
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 MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate ofa predatory lender may result in the loss ofthe privilege of doing business with the City."
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Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee ofthe City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter?
Yes [7] No
NOTE: If you checked "Yes" to Item D( 1), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
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 ofany 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 ofthis Part D.
Does the Matter involve a City Property Sale?
Yes [/JNo
If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
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E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. Ifthe Disclosing Party checks (2), the Disclosing Party must disclose below or in an attachment to this EDS all information required by (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.
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 ofany 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, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay
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
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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.
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) of the 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," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes [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 of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
| | Yes No | [Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes Q No
If you checked "No" to question (1) or (2) above, please provide an explanation:
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SECTION VII -- FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of this ordinance 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. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
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 City transactions. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. 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 MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
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CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as of the date furnished to the City.
Chris Kaplon
(Print or type exact legal name of Disclosing Party)
(Sign here) '
Chris Kaplon
(Print or type name of person signing)
Individual
(Print or type title of person signing)
Signed and sworn to before me on (date)
at LfX")/^ County, _ (state).
Commission expires:
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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%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city 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 II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, ifthe 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% 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 [/J No
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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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% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
QYes [7] 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 MCC Section 2-92-416?
| | Yes ? No [/] The Applicant is not publicly traded on any exchange.
3. If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www.amlegal.com ), generally covers a party to any agreement pursuant to which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises.
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(l) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
[JYes
? No
[/j N/A - I am not an Applicant that is a "contractor" as defined in MCC Section 2-92-385. This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(l). If you checked "no" to the above, please explain.
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