RICHARD M. DALEY
MAYOR
OFFICE OF THE MAYOR
CITY OF CHICAGO
January 13, 2011
TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO
Ladies and Gentlemen:
At the request of the Commissioner of Housing and Economic Development, I transmit herewith ordinances authorizing the sale of city-owned property and amendments to previously authorized land sales.
Your favorable consideration of these ordinances will be appreciated.
Very truly yours,
ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of government by virtue of the provisions of the Constitution of the State of Illinois of 1970, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, pursuant to ordinance adopted on May 12, 2010 (the "Prior Ordinance"), and published in the Journal of Proceedings of the City Council of the City of Chicago ("City Council") for such date at pages 91198 through 91229, the City Council has previously approved the sale of the three parcels of land that are owned by the City and commonly known as 6805, 6813 and 6817 South Halsted Street, Chicago, Illinois and which are legally described on Exhibit A attached hereto (the "Property''), to Beloved Community Family Wellness Center, an Illinois not-for-profit corporation ("Developer") for Three and No/100 Dollars ($3.00), in order to construct a parking lot thereon (the "Project") which will be adjacent to Developer's existing medical facility; and
WHEREAS, the Prior Ordinance and the redevelopment agreement attached thereto established an outside closing date for the City's conveyance of the Property to the Developer for the Project, which outside closing date has lapsed; and
WHEREAS, the City desires to extend such outside closing date so that the City may convey the Property to the Developer so that the Developer may proceed with the Project; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The foregoing recitals are hereby incorporated by reference and made a part of this ordinance.
SECTION 2. The sale of the Property to the Developer for Three and No/Dollars ($3.00) is hereby again approved. This approval is expressly conditioned upon the City entering into a redevelopment agreement with the Developer substantially in the form attached to the Prior Ordinance (the "Redevelopment Agreement"), provided, however, that the outside closing date for the City's conveyance of the Property to the Developer under such Redevelopment Agreement shall be June 30, 2011.
SECTION 3. If any provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such provision shall not affect any of the other provisions of this ordinance.
SECTION 4. Except as amended hereby, the terms and conditions of the Prior Ordinance and the Redevelopment Agreement shall remain in full force and effect. All other ordinances, resolutions, motions or orders in conflict with this ordinance are hereby repealed to the extent of such conflict.
S:ORD/BELOVEDCOMMFAMWELLCTRAMDT.l
1
SECTION 5. This ordinance shall take effect immediately upon its passage and approval. Attachment: Exhibit A- Legal Description of Property
2
EXHIBIT A LEGAL DESCRIPTION OF PROPERTY
(SUBJECT TO FINAL SURVEY AND TITLE COMMITMENT)
PARCEL 1
LOTS 3, 4 AND THE NORTH 6 FEET 10 INCHES OF LOT 5 IN BLOCK 4 IN SMITH'S ADDITION TO NORMALVILLE, A SUBDIVISION OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 21, TOWNSHIP 38 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
PARCEL 2
LOT 6 AND THE SOUTH 18 FEET 2 INCHES OF LOT 5 IN BLOCK 4 IN SMITH'S ADDITION TO NORMALVILLE, A SUBDIVISION OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 21, TOWNSHIP 38 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
PARCEL 3
LOT 7 IN BLOCK 4 IN SMITH'S ADDITION TO NORMALVILLE, A SUBDIVISION OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 21, TOWNSHIP 38 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
COMMONLY KNOWN AS: 6805 SOUTH HALSTED STREET
6813 SOUTH HALSTED STREET 6817 SOUTH HALSTED STREET CHICAGO, ILLINOIS 60621
PERMANENT INDEX NO.: 20-31-306-002,
20-31-306-003 20-31-306-004
1
EXHIBIT B
REDEVELOPMENT AGREEMENT
[SEE ATTACHMENT]
ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of government by virtue of the provisions of the Constitution of the State of Illinois of 1970, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, pursuant to ordinance adopted on May 12, 2010 (the "Prior Ordinance"), and published in the Journal of Proceedings of the City Council of the City of Chicago ("City Council") for such date at pages 91198 through 91229, the City Council has previously approved the sale of the three parcels of land that are owned by the City and commonly known as 6805, 6813 and 6817 South Halsted Street, Chicago, Illinois and which are legally described on Exhibit A attached hereto (the "Property"), to Beloved Community Family Wellness Center, an Illinois not-for-profit corporation ("Developer") for Three and No/100 Dollars ($3.00), in order to construct a parking lot thereon (the "Project") which will be adjacent to Developer's existing medical facility; and
WHEREAS, the Prior Ordinance and the redevelopment agreement attached thereto established an outside closing date for the City's conveyance of the Property to the Developer for the Project, which outside closing date has lapsed; and
WHEREAS, the City desires to extend such outside closing date so that the City may convey the Property to the Developer so that the Developer may proceed with the Project; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION I. The foregoing recitals are hereby incorporated by reference and made a part of this ordinance.
SECTION 2 The sale of the Property to the Developer for Three and No/Dollars ($3.00) is hereby again approved. This approval is expressly conditioned upon the City entering into a redevelopment agreement with the Developer substantially in the form attached to the Prior Ordinance (the "Redevelopment Agreement"), provided, however, that the outside closing date for the City's conveyance of the Property to the Developer under such Redevelopment Agreement shall be June 30, 2011.
SECTION 3. If any provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such provision shall not affect any of the other provisions of this ordinance.
SECTION 4. Except as amended hereby, the terms and conditions of the Prior Ordinance and the Redevelopment Agreement shall remain in full force and effect. All Other ordinances, resolutions, motions or orders in conflict with this ordinance are hereby repealed to the extent of such conflict.
S:ORD/BELOVEDCOMMFAM WELLCTRAMDT. 1 1
SECTION 5. This ordinance shall take effect immediately upon its passage and approval. Attachment: Exhibit A- Legal Description of Property
2
EXHIBIT A LEGAL DESCRIPTION OF PROPERTY
(SUBJECT TO FINAL SURVEY AND TITLE COMMITMENT)
PARCEL 1
LOTS 3, 4 AND THE NORTH 6 FEET 10 INCHES OF LOT 5 IN BLOCK 4 IN SMITH'S ADDITION TO NORMALVILLE, A SUBDIVISION OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 21, TOWNSHIP 38 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
PARCEL 2
LOT 6 AND THE SOUTH 18 FEET 2 INCHES OF LOT 5 IN BLOCK 4 IN SMITH'S ADDITION TO NORMALVILLE, A SUBDIVISION OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 21, TOWNSHIP 38 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
PARCEL 3
LOT 7 IN BLOCK 4 IN SMITH'S ADDITION TO NORMALVILLE, A SUBDIVISION OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 21, TOWNSHIP 38 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
COMMONLY KNOWN AS: 6805 SOUTH HALSTED STREET
6813 SOUTH HALSTED STREET 6817 SOUTH HALSTED STREET CHICAGO, ILLINOIS 60621
PERMANENT INDEX NO.: 20-31-306-002
20-31-306-003 20-31-306-004
1
EXHIBIT B REDEVELOPMENT AGREEMENT
[SEE ATTACHMENT]
V
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of Disclosing Party submitting this EDS. Include d/'b/a/ if applicable:
Beloved Community Family Wellness Center_
Check ONE of the following three boxes:
indicate whether Disclosing Party submitting this EDS is:
1. |X| the Applicant
OR
2. [ J a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the Applicant in which Disclosing Party holds an interest:_\__
OR
3. [ J a specified legal entity with a right of control (sec Section II.B.I.b.) State the legal name of the entity in which Disclosing Party holds a right of control:________
B. Business address of Disclosing Party: 6821 S. Halsted Street___________
Chicago, IL 60621
D. Name or contact person: j^^jejJohriS^_____________________
E. Federal Employer Identification No. (if you have one): 043828358__
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
To purchase three vacant lots owned by the City of Chicago for $1.00 each. To be used as a parking lot for a community health center
G. Which City agency or department is requesting this EDS? Chicago DepartmentteeaaauaasaDevelopment
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification #__________and Contract #______
Vcr. 11-01-05
Page I of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF DISCLOSING PARTY
I. Indicate the nature of the Disclosing Parly: [ J Person
| J Publicly registered business corporation | ] Privately held business corporation [ J Sole proprietorship | | General partnership"" [ J Limited partnership* [ ] Trust
[ ] Limited liability company* [ J Limited liability partnership* [ ] Joint venture* |X] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
M Yes [ ] No
[ ] Other (please specify)
* Note B.I .b below.
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: State of Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
I J Yes
No
W N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1 .a. List below the full names and titles of all executive officers and all directors of the entity.
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).-
Title
Chairperson, Board of Directors
Steve Long Vice-President, Board of Directors
Lawrence A. Seals Secretary, Board of Directors
TJr. PeteTFriedell Board of DirectoTs
Kacy Rush Board of Directors
Margie Johsnon Executive Director (Ex-Officio)
l.b. If you checked "General partnership," "Limited partnership." "Limited liability
company," "Limited liability partnership" or "Joint venture" in response to-Item A.l. above (Nature of Disclosing Party), list below the name and title of each general partner, managing member, manager or
Name
Paul Williams
Page 2 of 13
f
any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
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, interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended lo achieve full disclosure.
Name Business Address Percentage Interest in the.
Disclosing Party
N/A
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has lhe Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any Cily elected official in the 12 months, before the date this EDS is signed?
[ j Yes No
If yes. please identify below the name(s) of such Cily elected official(s) and describe such relations!) ip(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose lhe name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total
Page 3 of 13
amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Parly's regular payroll.
"Lobbyist"1 means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (I) a not-for-profit entity, 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 Parly 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.
Name Business Relationship to Disclosing Party Fees
(indicate whether Address (subcontractor, attorney, (indicate whether
retained or anticipated lobbyist, etc.) paid or estimated)
to be retained)
Ron Piekarz-2880 North Elston Avenue, Chicago, IL 60618. Architect-S23.000 paid-partial payment estimated cost $182,600 Diane Gianos-321 North Clark Street. 26th Floor, Chicago, IL 60610, Attorney. S600.00 estimated
( Add sheets if necessary)
I J Check here if the Disclosing party has not retained, nor expects lo retain, any such persons or entities.
SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-41 5, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the term of the contract.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ j Yes I | No [Xj No person 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 f J No
Page 4 of 13
B. FURTHER CERTIFICATIONS
1. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
b. have not, within a five-year period preceding the date of ibis 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:
c. are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with commission of any of the offenses enumerated in clause B. I .b. of this Section V;
d. have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
e. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
2. The certifications in subparts 2, 3 and 4 concern:
the Disclosing Party;
any "Applicable Party" (meaning any party participating in the performance of the Matter, including but not limited to any persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Parly, or is. with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal Or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect lo Applicable Parties, the term Affiliated Entity means a person or entity that directly or indirectly controls the Applicable Party, is controlled by it, or, with the Applicable Party, is under common control of another person or entity;
Page 5 of 13
any responsible official of the Disclosing Party, any Applicable Party or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Applicable Party or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Applicable Party or any Affiliated Entity (collectively "Agents").
Neither the Disclosing Party, nor any Applicable Party, nor any Affiliated Entity of either the Disclosing Party or any Applicable Party nor any Agents have, during the five years before the date this EDS is signed, or, with respect to an Applicable Parly, an Affiliated Entity, or an. Affiliated Entity of an Applicable Party during the five years before the date of such Applicable Party's or Affiliated Entity's contract or engagement in connection with the Matter:
a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the Slate of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
b. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
c. made an admission of.such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
d. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
3. Neither the Disclosing Parly, Affiliated Entity or Applicable Party, 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 (I) 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 Stales of America that contains the same elements as the offense of bid-rigging or bid-rotating.
4. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the QiTice of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
5. The Disclosing Party understands and shall comply with (I) lhe applicable requirements of the Governmental Ethics Ordinance of the City, Title 2, Chapter 2-156 of the Municipal Code; and (2) all the applicable provisions of Chapter 2-56 of the Municipal Code (Office of the Inspector General).
Page 6 of 13
6. If lhe Disclosing Party is unable to certify to any of tbe 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.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
For purposes of this Part C. under Municipal Code Section 2-32-455(b), the term "financial institution" means a bank, savings and loan association, thrift, credit union, mortgage banker, mortgage broker, trust company, savings bank, investment bank, securities broker, municipal securities broker, securities dealer, municipal securities dealer, securities underwriter, municipal securities underwriter, investment trust, venture capital company, bank holding company, financial services holding company, or any licensee under the Consumer Installment Loan Act, the Sales Finance Agency Act. or the Residential Mortgage Licensing Act. However, "financial institution" specifically shall not include any entity whose predominant business is the providing of tax deferred, defined contribution, pension plans to public employees in accordance with Sections 403(b) and 457 of the Internal Revenue Code. (Additional definitions may be found in Municipal Code Section 2-32-455(b).)
1. CERTIFICATION
The Disclosing Party certifies that the Disclosing Party (check one)
[ J is [Xj is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the Cily."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter
Page 7 of 13
2-32 of the Municipal Code, explain here (attach additional pages if necessary): 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.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
1. In accordance with Section 2-156-1 10 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
I | Yes pq No
NOTE: If you checked "Yes" to Item D.I proceed to Items D.2. and D.3. If you checked "No" to Item D.I., proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ J Yes L J No
3. If you checked "Yes" to Item D.I., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of 13
11 CERTIFICATION REGARDING SLAVERY ERA BUSINESS
The Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities for records of investments or profits from slavery, the slave industry, or slaveholder insurance policies from the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves) and has disclosed in this EDS'any and all such records to the Cily. In addition, the Disclosing Party must disclose the names of any and all slaves or slaveholders described in those records. Failure to comply with these disclosure requirements may make the Matter to which this EDS pertains voidable by the City.
Please check either I. or 2. below. If the Disclosing Parly checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all requisite information as-set forth in that paragraph 2.
X 1, The Disclosing Parly verifies that (a) (he Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities for records of investments or profits from slavery, the slave industry, or slaveholder insurance policies, and (b) the Disclosing Party has found no records of investments or profits from slavery, the slave industry, or slaveholder insurance policies and no records of names of any slaves or slaveholders.
__2. The Disclosing Party verifies that, as a result of conducting the search in step 1(a) above, the
Disclosing Parly has found records relating to investments or.profits from slavery, the slave industry, or slaveholder insurance policies and/or the names of any slaves or slaveholders. The Disclosing Party verifies thai the following constitutes full disclosure of all such 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.
A. CERTIFICATION REGARDING LOBBYING
I. List below the names of all persons or entities registered under lhe federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Begin list here, add sheets as necessary):
N/A
Page 9 of 13
a
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means thai NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Mailer.)
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. I. above for his or her lobbying activities or to pay any person or entity to influence or attempt lo 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 lhe award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of lhe statements and information set forth in paragraphs A.l. and A.2. above.
If the Matter is federally funded and any funds other than federally appropriated funds have been or will be paid lo any person or entity for influencing or attempting 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 Matter, the Disclosing Parly must complete and submit Standard Form-LLL. "Disclosure Form to Report Lobbying," in accordance with its instructions. The form may be obtained online from the federal Office of Management and Budget (OMB) web site at http://www.whitehouse.gov/omb/grants/sflllin.pdf, linked on the page http://www.whitchouse.gov/omb/grants/grants_forms.html.
4. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the Cily 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.
Page 10 of 13
Is lhe Disclosing Parly lhe Applicant?
[X] Yes [ J No
If "Yes." answer the three questions below:
1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
1X1 Yes 1 J No
2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
rXl Yes ' | 1 No
3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
IJYes [X] No
If you checked "'No" to question I. or 2. above, please provide an explanation:
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Parly understands and agrees that:
A. By completing and filing this EDS, the Disclosing Party acknowledges and agrees, on behalf of itself and the persons or entities named in this EDS, that the City may investigate the creditworthiness of some or all of the persons or entities named in this EDS.
B. 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 thai it must comply with all statutes, ordinances, and regulations on which this EDS is based.
C. The City's Governmental Ethics and Campaign Financing Ordinances. Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
Page 11 of 13 -
D. 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 Cily may pursue any remedies under the contract or agreement (if not rescinded, void or voidable), 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 lhe City. Remedies at law for a false statement of material fact may include incarceration and an award lo the Cily of treble damages.
E. il is the City's policy to make this document available to the public on its internet-site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Parly 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.
F. The information provided in ibis EDS must be kepi current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. 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.
The Disclosing Party represents and warrants that:
(j. The Disclosing Party has not withheld or reserved any disclosures as to economic interests in the Disclosing Party, or as lo lhe Matter, or any information, data or plan as to the intended use or purpose for which the Applicant seeks City Council or other City agency action.
For purposes of lhe certifications in H.l. and H.2. below, the term "affiliate" means any person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by lhe 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 lo do business with the federal government or a state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity.
H.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its affiliates delinquent in paying any fine, fee, lax or oilier 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.
H.2 If the Disclosing Party is the Applicant, the Disclosing Parly and its affiliates will not use, nor permit their subcontractors to use, any facility on the U.S. EPA's List of Violating Facilities in connection with the Matlcr for lhe duration of lime that such facility remains on the list.
Page 12 of 13
H.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 lhe Matter certifications equal in form and substance to those in H.l. and H.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in H. I., H.2. or H.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this EDS on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS are true, accurate and complete as of the date furnished to the City.
Beloved Community Family Wellness Center Date- December 9, 2010
(Print or type name of Disclosing Party)
Margie Johnson
( Print or type name of person signing)
Executive Director
( Print or type title of person signing)
efore me on (date)
ounty, A\j2^'n-/9^&- (state). ' '
Signed and sworn to b
at ___C 6)£rP County, A'LM£i,-,n-/9<^ (state)
Notary Public.
Commission expires: fy\^yj.L$ Cc^ £~Qf/
OFFICIAL SEAl KAREN T OWENS Notary Public - State of Illinois My CommtMton ExpIrM Apr 6. 2011
Page 13 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 oltlie 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 cily treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter,.stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (I) all corporate officers of the Disclosing Party, if the Disclosing Party is a corporation: all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Parly. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
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?
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
[] Yes
department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized lo execute this EDS on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS are true, accurate and complete as of the date -furnished to the Cuy.
Date: ^~9~ 1Q
(Prim orSype name of Disclosing Party)
(Siiin here) \\
o n
V
(Print or type name of person signing)
(Print or type title of person signing)
before me on {date) f)c&f/MrL 7 2.Q10. by f]CUttJ) 1 L^20&^< County. J).&Ua>jQ4_4. (State). '
Signed and sworn lo at (> __
expires: ^-Ald'' £2-0
Notary Public.
Commission expires:
KAHEN T OWENS Notary Public . state of Illinois My Commission Expires Apr 6, 2011
AFFIDAVIT
Beloved Crarmunity Family /^afnfSS _______(the "Ai'llanl"), hereby
certifies and declares us follows:
1. Neither the Affiant nor any Controlling Person (as defined below) of the Affiant has ever been convicted or in custody, under parole or under any other non-custodial supervision resulting from a conviction in a court of any jurisdiction for the commission of a felony of any kind, or of a criminal offense of whatever degree, involving:
(a) bribery or attempted bribery, or its equivalent under any local, stale or federal law. of any public officer or employee of the City of Chicago (the "Cily") or of any Sister Agency (as defined below); or
(b) theft, fraud, forgery, perjury, dishonesty or deceit, or attempted theft, fraud, forgery, perjury, dishonesty or deceit, or its equivalent under any local, stale or federal law, against the City or any Sister Agency; or
(c) conspiring to engage in any of the acts set forth in items (a) or (b) of this Section 1.
2. Neither the Affiant nor any Controlling Person of the Affiant has made in any civil or criminal proceeding an admission of guilt of any of the conduct set forth in items (a) through (c), inclusive, of Section I above, under circumstances where such admission of guilt is a matier of record but has not resulted in criminal prosecution for such conduct.
3. Neither the Affiant nor any Controlling Person of the Affiant is charged with or indicted for any felony or criminal offense set forth in items (a) through (c). inclusive, of Section 1 above. Such ineligibility shall remain in effect until final adjudication is made with respect to such felony or criminal offense.
As used herein. "Controlling Person'' shall mean any person who (1) is an officer, . director, limited liability company manager, managing member, partner, general partner or limited partner of any business entity; or (2) owns, directly or indirectly through one or more intermediate ownership entities, more than 7.5% of the ownership interest in any business entity: or (3) controls, directly or indirectly through one or more intermediate ownership entities, the day-to-day management of any business 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 under this section, using substantially the same
management, ownership or principals as the ineligible entity.
As used herein. "Sister Agency" shall mean (1) the Board of Education of the City of Chicago; (2) Chicago Park District; (3) Chicago Transit Authority; (4) Community College District No. 508, Cook County. Illinois; (5) Chicago Housing Authority: or (6) the Public Building Commission of Chicago.
Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this Affidavit on behalf of the Affiant, and (2) warrants that all certifications and statements contained in this Affidavit arc true, accurate and complete as of the dale hereof.
Beloved Community family Wellness Center (Print or type name of Affiant)
By:
(Sign here)
Margie Johnson
(Print or type name of person signing)
Executive Director
(Print or type title of person signing)
Signed and sworn to before me on (date) J/ j-
at
County.
:'--'-./■:■(}- (State).
Notary Public.
Commission expires: -/J- -. c
--m m
OfFICUl MAI KAMNTOWtta Notary Pxjbiic - ttoto ol MnoU m CommWoo lxp*+t Apr 6. JO) l