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This record contains private information, which has been redacted from public viewing.
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Type:
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Ordinance
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Status:
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Passed
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Title:
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Zoning Reclassification Map No. 3-G at 944-946 N Elston Ave - App No. 18543T1
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Topic:
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ZONING RECLASSIFICATIONS - Map No. 3-G
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FINAL FOR PUBLICATION ORDINANCE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. Title 17 ofthe Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all ofthe M3-3 Heavy Industry District symbols and indications as shown on Map No. 3-G in the area bounded by A line 100 feet west of and parallel North Elston Avenue; West Augusta Boulevard; North Elston Avenue; a line 50 feet south of and parallel to West Augusta Boulevard to those of a B2-3 Neighborhood Mixed-Use District SECTION 2. This ordinance takes effect after its passage and approval. Common Address of Property: 944-946 North Elston SUBSTITUTE NARRATIVE AND PLANS TYPE 1 ZONING AMENDMENT 944-946 North Elston Proposed Zoning Change B2-3 Neighborhood Mixed-Use District The applicant is requesting a zoning amendment from a M3-3 Heavy Industry District to a B2-3 Neighborhood Mixed-Use District to allow for a proposed five-story, 8 residential dwelling unit building with 1,000 square feet of commercial space on the ground floor and 14 parking spaces Lot Area 5,000 sf Parking 14 Spaces Front Setback Ofeet Rear Yard Ofeet Side Setback Ofeet FAR 3.0 Building Square Footage 15,000 Square feet Building Height 65 Feet CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMEN T AND AFFIDAVIT SECTION I -- GENERAL INFORM ATION A. Legal name of tbe Disclosing Party submitting this EDS. Include d/b/a/ if applicable: 944 North Elston LLC Check ONE of the following thrcc boxes: Indicate whether the Disclosing Party submitting this EDS is: 1. the Applicant OR 2. [] a legal entity holding a direct or indirect interest in the Applicant. Slate the legal name of the Applicant in which the Disclosing Party holds an interest: OR 3. [ ] a legal entity with a right of control (see Section JLB.'.L).; State tne legal-name--of.the entity in which the Disclosing Party hoids a right of control: - ¦ . , 13. Business address ofthe Disclosing Party: 4518 1/2 Nortel Damen Avenue Chicago. ;iiiiriqif 60,625 Telephone:.I7??) 769-8500 pax: (773) 769-8830 Email: knlghtsbndge15^ao!.com Name of contact person: Oearina Zivkovic Federal Employer Identification No. fif .vqu have one): r . ^ Brief description of contract, transaction,^ which this EDSpertains. (Include project riu bf'property, if applicable): Zoning Amendment for property located at 944-946 Elston G. Which Gity agency or department-is requestingthis EDS?-DPD , , if the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following: Specification -ft-.- - - . ~ ¦ ¦. ¦ arid'Contract-fr^ ¦ ¦ Page 1 of 13 SECT-ION II -- DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY Limited liability company Limited, liability, partnership Joint venture Not-for-profit corporation '( [ ] Yes [ ]No
1. Indicate the nature of the Disclosing ParAvr Person
.1 iOther (pleasc'specify)
Publicly registered .business corporation Privately held business corporation' Sole! proprietorship General partnership • Limited partnership Trust
2. For legal entities, the state (or foreign country) of incorporation or prganizatioH, if ¦applicable: Illinois
3. For legal entities not organizediin--the State of Illinois: Has the organization-registered to do businessiiri the'State of^Illinois as a foreign entity?
[] Yes []Nq ; J/] N/A
B; IF tHE piSCLOSING PARTY ISvA^LEGA& ENTITY:
1. List:bcl6,w:thefiiil.nanvcs;and titles'of alfcxccutivc.o.fficerS'and'ali-directors of.tlic^entity.
NOTEitEpr ^ If1
there are-no such members, write "ho members." For trusts, csta.tcs,;er;oth'cr similarentitiesYlist b'eldw
the legal titlcKolder(s)!. ¦ ."L'':"
If; th'e^eritityji^ partnership er>Jpiht venture, Iisbbel6\v^0nam^ manager^
Name. Title
DeannaZjykoyic' •• • • . :. Manager ,,,
2. -Rlcasc^^ : indirect beneficial;interest (inc^ Examples of such ah interest include ;sharfcs in a.cp^orati6hi partnc ihtcrcsV'in.'avparthc^sliip or joint'ven'tUrc,
Page 2 of 13'
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, 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 to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
Oeanna Zivkovic _ 100% ,,
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as dcfined.in Chapter.2-156.of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes i/.No
If yes, please identify below the name(s) of such City elected officials) .and describe such rclationship(s):
SECTION IV -r DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED. PARTIES
t
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant; consultant and any other person or entity whom the Disclosing Party has retained or expects to retain-in connection with the Matter, as well as the nature of the relationship, and the total amount ofthe feesip'aid or estimated to be paid. The Disclo sing-Pa^ disclose employees who are paid solely through the Disclosing Party's regular payroll.
'XbbbyjstVimc.ansjany person or, entity who undertakes. to.influejnce.any le administrative
action on' b eh al f of any; person or entity other than: (1) a-M unpaid;:basisj or (2)
himse}f. '¦Lobbyist" $dsp:means any person qrjentity^ as^an employee of
another includes undertaking to influence any legislative or administrative action.
IfthcjDisclpsing.P uncertain whether a disd^ Disclosing Party must either ask: the City whether discldsu^^
Page 3 of 13
Name (indicate whether Business Relationship to Diseasing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist.etc.) "hourly rale" or "t.b.d:''lis
not'an acceptable response.
Tyler Manic 70 W Madison, #5300, Chicago, IL 60602 Attorney Estimated $10,000
(Add.sheets if necessary)
:[¦•]• Check here if the DisclqsirigT'artylhas hot rclam^ persons or entities.-.
SECTION V CERTIFICATIONS ' ' '; '
A.,ieOU.RT-OR;DERED.CHILptSU
Unfor Municipal Code-Section^ with the City must remain; in compliance with their child support obligations throughout the contract's term.
Has any person who'directi^ dccl&rediir arrearage on any child support obTigato
[3, Yes No [ yi^o.pcrsondircc ormorc ofthe
•Disblosi^
.Ift"Y;ei^ ahd .is^thejp^fsou-.ihx
B; FURTHER%ERn l: "y1. _'''[/:: '' !''iic,'ri-
j. Pursuant; to M iheiA^pficahfsh^uW con^$J^^ sub'mittin|]tKifiED ccrtifi^
withi or lias ad^iitted':guiit^f^
cfimih'al^Tf^
perjury;^
A^plipant-un
dmnglbu^iness^ N0TE:;If::ArUic^timcfram;c-in;Arte^
Page 4: of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from tiny transactions by any federal, slate or local unit of government;
havenot, within a^iye-year pcriod/precisdirig the date of this EDS,.bc.en.ponyictcd of a criminal offense;'.adjudged/guilty, prjhadijcjvil judgment.rendered against them ;jnconnection with: obtaining, attempting'to .-obtain,-;okperfprming a public (federal, state^ or .iocal);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 indictedfor, or criminally:or.civil!y charged by, a governmental entity (federal, state or local) with committing-any ofthe offenses set forth' in clause'B ;2-.b. of ;this Section V;
have npt^w:itbin4-.fiyetye^r.-.per4da preceding,the.date of this,EDS, had oneor morc;public transactions (federal, state or local) terminated for cause.or.default; and ...
have not, within a fiye.ryear.,period;prccedm dictate of this: Ep^. becn.coriyicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions
: concerning
state, or any other unit/of local government. 3. Theicertifjcatipn^
• the Disclosing Party;
any ''Gpntrac^r'^ by,fhe^pjsctosing P;arty4n
connec^onwjfli>die^^tc;r^; i]r^l^i|i^^u^A^t ;iini|^to.aU.pc«oiis .o^ie|il^atifi^s ,dis>clos;ed,undcr
Section-IV, ;YD,iscl6su^
any T^tyGglJJB®^^
Disclosing Party; isricohtrolJed^by the Disclosing Party, or is, wim^the'Disclqiull Jart)vundeX common eontr^^
int^qc^
ineligibility of a busincssjentity-to^ or state or^tocfll§ovei^men^
theCttyi using substantiallv the Sam^management, ownership, or principals as tbe ineligible entity);
with respect WiPoMracfcr^ means a person br entity that directly or
indirectly controls the GonMc^ or, w,ith the.,Coritractpjrvj
control of another person or cn'tity; "any rcspohsibl'e-qffjcia^^ Contractor :orany^^^
other official^agcnVor employee ofjthe Disclosing- Party, any Contractor or any AffiU acrihg-pursuant
Contractor or any Affiliated Entity,(collectively "Agents").
Pagc5 of .1.3
respect to a Contractor,™ Affiliated Entity or t A«V ? ^ ° ^ tKis EDS is si^<. or, with
before the date of such Contractor's ort^^ ^ ^e.fivc-yeara
Matter: Am.utcd Lnhtys contract or engagement in connection with the
or ey0yc6fco,l,pc,i,icS 6y S^nom „• bid a Lo,, p,** or
¦ ^^e^cliuii S^ft^^li^elnsp ;^un|c]p^ajrc^c"-^ :;: ^
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during tbe 12-month period preceding the execution'date; of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
n/a ' . : .
9. To the best of the Disclosing Party's.knowledge after reasonable inquiry, the following;is" a complete list of al! gifts lhat the Disclosing Party has given or caused to be given, at any time during the 12-moritfvperiod preceding the execution date of this EDS, to an employee, of elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having, a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
n/a ., ; . ._
c. certification of status as financial institution
1. The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is is not
a "financialinstitution" as defined in'Section 2-32-455(b) of the'Municipal Code.
2, If the Disclosing Party IS a'financial; m^^ Party pledges:
" We are not and will not becomea predatbry lender as/defin^'ih^Ch^pter'2-32 of the Municipal Code. AVc further pledge ^
lend eras defined in ChapterJ-3l:o.ftJie?Municjp WcrUpderstandi
lender or becoming an affiliate of a predatory lender may result in thc-loss of the privilege of doing busracss with the City."
If thciDisclpsing^Party is uMble tbif^ Scction-2-32-455(b) of the MunicipalCode) fsa.p^
2-32 of the Municipal Code.explain herej(at^had'djUonai pages if necessary):
Page 7 of ,13
If the letters "NA," the word "None," or no response appears7 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/wqrds.qr terms that are defined in Chapter 2-156 of the'M'uni'c'ip^ meanings when used in this Part'.'D.
IV In accordance witli' Section 2-156-ilO of the Mum^
of the Cityshayc.a financial interest in-Jus or her own nariie^of inAkbtiatfet of any other person or
cntittyinihe fatter? ,,. ".
['tYcs ." .'.' jylNo, 'r-.
NOTE; Ifyou checked'-"Yes" to.Itcm'D.l., proceed to Items; DV2.' and'^.J. if-^du checked "No" to
ltcrhi?p^;l,i prpcee.a!to,Part;E.; ' ' ,", . ...
2. Unless sold.pursuant to a;proccss of competitive bidding! or otherwise permitted, no City elected
any other^ person 6f 'ehtiry;ih ;me;purcha^ sold,
;fof^*&;pTr^sscs^
"Gi^rPmpcrty Sale"). Cqmpensati^
doesihpfxbn^
Does me'Matter involve a City Prbperty'Saie? ' :
[ ] Yes {/]Ncj ":y * ""^
3: If ypu> checked^ "Yes'^ ^e narnesy^^ '
officials Tbifi^plo^
Name ,f.^t, r„ %Bus,iiuiss Adffress „,, , ^^^SS1^^^ :.
4 , ;T^ .
be acquired'^ -: v . . . ... ,
E:CERTi|l^ vj'' IV ¦
Pleaseichcck either .1: pr&v bclo>v:^Ij?thc-DisclosingvBar;tyichecksV2;;ithe.;E>isclosm#Pa^:rnust disclose belciwor in an attachment to this EDS all/information^ required by paragraph'2. Failure to.
'"• Page 8 of 13; '
comply with these disclosure requirements may mtskc 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 oninjury or death oLthcir 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 Partyhasfoundxc.cords of, investments orprpfits from slavery,or.slaveholder insurance policies. The Disclosing Party.vcrifies.that the follow.ihg.c.bnstitutes fulldisclpsurerpf all such records, including the names of any and all slaves or slaveholders described in.those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
I. List below the names of all persons or. entities registered under thetfederarLobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Ad^
(If no explanation appears or begins on the lines above, or if the letters ".NA" or if the wprd-VNone" appear, it will be-conclusjvely presumed;that me Disclosing.Pwr^
registered under the Lobbying ;Disclosure Act of 1995 have made lobbyingcontacts oil behalf ofthe Disclosing Party with.respect to the.Iylatter.)
2. The Disclosing Party has not spent and will not expend any.fcdcraIly;appropriat;ed funds to pay
any person or entity listed in Paragraph A.l. above for. his or her lobbyingiactiyitics or to.pay any
-person or entity -to influcncCipr attbmpt jto, :in'flucnce\an;.pfficc^ pf;ariyoagehcy,1as defined by
applicable federal law, aVihpmber of Congress j an officer or employe^ an employee of a
member of Congress, in connection with die award pf any fedem making any
fedcfally^fundedigrant or loan, entering:intoPage 9 of 13
The Disclosing Party will submit an updated certification at "the end 'of each calendar quarter in ¦which there occurs.any event that materially affects the accuracy of the statements and.information set forth in paragraphs AV'. and A:2. above.
The Disclosing 'Party cerfifiesrth'atrciihcr: (i) it'is ndUan-'organization described in section 50:l(c)(4)'6'f"the Intefnai:Revenue infection 501(c)(4) of the Internal Rcycmic Code.of 1986 but has nptengaged and will nol engage in '! Lobbying Activities".
5. If the ifcirm-and sub1;tance;tp:para^ subcontract and the' D'iscibsTng^ duration:of4hc Mattel
B GERTlFiGATI^
If the Martcr is federaH^fundc^ .:i
subcpntractorVroiu^ wriung'at-thcl-bufeet d
negotiations. ..... {-,,, .
Is-mc Disclosing Party-& ' .
? Yes [\?p4i> - ,.; . _,.,.„, ...
li' "Yes;" answer the>three,questions;below:-. . , .
1. .'Have you'dcvelop^a^
fcd^iiregulations? (§'^^;^R^iarfi66^?; ' ""'-' ;3:'' ''' .......... -...
2\ ^Baye-yduTiledvwithfihe'^tt
GO'Htraet Compliance?Program Opportunity Commission aU repprts due
;undcY;t& ^ ' ¦¦' ™ ^-^'^ ¦ *
3/ Haye'ypu participatediim^ ¦ <-••*»•=
- cq'ual.-pppprjtupity -Plausefc-' ,'>'-.'
If yo&cbecked" "N oi." 'toriqueslibh i ^cliv2:-'&b^6fp\sik6 provide an;expian°atio.m '•'
• ' - •••• • • • : y'~T~.""'r 7Trv":'Tv' t> .-7" '
Page TO of 13 :
SECTION vn -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COM 1' LI AN C E, PENALTIES, DISCLOSURE
The Disclosing Party understands and,agrees that:
The certifications, disclosures, and acknowledgments contained in this^EDS will become part of any
contract or other agreement. bctwee,n:the,Applic in connection with the Matter, whether
procurement, City assistance,.^ materjaijtjducemen to ,tlieXity's execution
of any contract or taking other action witfrrcspect to the Matter. TWDisclosing Party understands that
it must-comply with all.statules,ordinunces, andjegulations:on:whi0Ldiis:EpS'is based. .
The City's G.oycrnmentaljEthics and Qampa^ and, 2-16,4 of
the Munipipal/Gode,.impQS^ sceking City contracts,
work, .business.jvor transactipn's. The^ R.tiaimng program is ayaila^blc on,
line at w.wwlcifyof^ also be obtained from'the City's Board'of Ethics^:740/N.
ScdgwickvSt., Suite 5.00; Chicago, IL 6061.6, (312) 744-9660. the DisclosmgTarty must complyfully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, ttny.contract.oriotheragre dr, voidable; and; the City ma
void), aldaw^prjn cqui^ declining to allow the Disc^
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 pplicy toimake'dris'dpeurn to rtie pufrU^
request. Spme'Pr all of the information this ED.S. and^anyi^ ma^he.
made ayailable to the p^ to 'a>Frce^
o thief w is e. =By; cp mp leting ahd sigiungEDSy the D isclpsmg P arty wai y' es, 'arid, releases .any :Rbwib le rigjils or clair^
c6Wtainedjihi this ED S;andaM> audjo'rize^ the City to verifyihe accuracyjpf any^^ ;
ih^this'EDS. - ; ¦¦ / :>¦:.<¦>¦ ¦'¦¦¦y. ¦ ¦¦ -Cr <:
The information provid^ current. ih.ihe.ey^^
Party must supplement ;this ED ta1ces;actibn;OnweMatter. Ifthe Matterisa
cohtr'act'beihg;handied b'ylm'eCity:iS.©epartrh;erit:of Procurement Servicesj the^Disclosing>P.ar;ty must update th'is-;EDS as the confr^f requires. 'NOT^
offensesJ?jt^^^
nsjre'quirediby 'S , , . -xj , x,<-
Thc'Disclj^sih^ that: , .y
Page 11 of 13
F.1, TheDisclosing Party is not.delinquentin-thc payment of'any lax administered by the Illinois Department of.Revenuc, nor are thcrDisclpsihg,Party,or.its'Al'fTiliatcd:Kntitics delinqv 1 ent in paying any fine, fee, tax or other charge owed to the City. This'iticludesj but is not limited to, all water charges, sewer charges, license fees, parking tickets, property.taxes'orsalcs taxes'.
-F.2''.' If'the'Di:^ Entities wilimo't":
: use; nor pcrmit-.thcir;Subcontractors to.use;-any^to federal Excluded
P^llestHslSj^
Fi3 sffcthVDjsclp^ . cpntractors/subconlractors.hired or-to be hircdlin connection with the Matter certifications equal in ¦form;"^^^ CityV use^ahyisu'c
N©TE: if thc^D.isclos'ing Party cannot-c^
explanatory^ . ?
CERTlFICATiON
:t|nrip';S^^
this;E©S^ aSdi)C2);warrants'tha^alt £e||fif|&
•ana;cOr^ " •
;Ndrt.h Elston LLC . , '... „ . . ' CITY OK CHICAGO ECONOMIC DISCLOSURE-STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITII ELECTED: GITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be:covnipj(Sted^.dnly'-by -(a):the Appllcantyand;(b). any legal entity which.ihas,a. direct ownership Interest invthe A'p^ which has ori|y an indirc^
Under Municipal Code Section 2-3 54-015, the Disclosing Party must disclose whether-such Disclosing Party ,
or any'-Applicable Pa^ with'
any elected citypfhti^ A ^familiattre^
signed, the Disclosing Party or-an^^ to the mayor, any. alderninn,-the'city
parmeroras any ofthe'ToUow child,;bromcr-or-sis{er;auht'or niece or nephew, grandparen^ or stepmothcri'St^
"Applicable Party" means (l>:all executive; officers of^iDi!sclo^n^:Paiiy listedin/Section II:B.: 1 :a., if the Disclosing'Tarty is a corporatio^a]!^
partnership; all general ipartn^ Dis;clpsing^Party, ifthc^Disclpsm^ limited
parhicrshipj; all managers^m limited liabilitVcbmna^
operating officer, exccutive/director; ch legarehtity;prvany, person
exercising similar autjh'prily'.,
DoestheT^isblp;s|^ ornnySpp^ "
have a "familialf elatiphship" with an^ect^''C}^-'bi^iai,'or!de^a^ent.hcad?
[ ]Yes ', ¦¦^--¦m':-, • v ..
such ]
person has afamiliai relauonsK^
' * '* •'which'
Page 13 of 1.3
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT-.AND AFFIDAVIT - ¦ APPENDIX B .
•.;rp;s.'.;:-. -:: v.vi. .v.
' buildings to \yhmlrlhc pertinent codc.vid!a«^^ : v'?-^
w : OF •
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing-Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council.matters. Not for City procurements unless requested.
This recertification is being submitted .in ¦connection with . ,34#ftbfih Fiston - .. [idehtifythe Matter]. Underpenalty'pfperjury, the person signing'below: (1) warrants that he/sheis. authorized to execute this EDS rccertiftcatioti .on behalf of the'Disclosing Party, (2) wa'rraritS'that all certifications and statements contained in-thy^isciosing'Parry's original EDS are true, accurate and complete as of die date furnished to the City aiidxbntiriue to be true, accurate and complete as ofthe date of this recertification, and (3) reaffirms its acknowledgments.
.944 N Elston LLC.
(Print of .type legal name of Disclosing-Party)
(sigh here) Print or type name of signatory:
Deahryiii Zivkovic .
Title of signatory:
. 'Manager/Member.
I
(I
jj
il
i
Sighed and swom to before nie on fdatcl. . fe?^Y;^ , _ , by
Mm
¦ b&tiA 2ivt»vy at . ifelA County, J3&~. [state].
Notary Public.
Commission expires:-...M'A^M1'^:.'
. , FRANCES V OWOC ;> .^^WBUe/STATEOF'lIIJNOIs'^
Vir.-II^Ol^OS-
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal nameof the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Edward C. Augustyn
Check ONE ofthe following three boxes:
Indicate whether the.Disclosing -Party submitting this EDS is:
p[ the Applicant /owner
OR "
[ j a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR ,
3. [ ] a legal,entity with aright.bf control (see Section II.B.L) State theiegalname of the entity in
which the Disclosing Party'holds'a right of control:
Business address ofthe Disclosing Party: 493'N. FultomAvenue
Villa:Park, IL 60181
Telephone: (630) 279-7066 .;. Fax: Email: . . . .
Name of contact^er^
Federal EmployerJdehtiftcatioh No. (if ybuihave'orie): .__ :
BrieT descriptidn orboid
which this EDS pertains. (Includ^ if applicable):
Zoning Amendmentfor prpperty jocated at 944-946 Elston
G. Which City agency or department is requesting this EDS? PpD.
If the Matter is a contract being^ haiidled by the City's Department of Procurement Sc.ryi.ces. please
complete the foliow'ihg: ; .
Specification # . - . ¦ and Contract. # '"' ; _^"';
Page 1 of 13
SECTION II - DISCLOSURE OE OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING-PARTY
, indicate the nature of the D.isclosingTarty^^^^^ ^^^.^ cQmpany
[^Person ... . . VitJ_ iMlimite^^^
^Publicly registered business corporauon
&Syafely--bSia»uki^ ' pi •Not-for-profit corporation, KcX3)),
Sole proprietorship . not,for-pfofit corporation also a 5'Gcncral.partnership- ¦ • ' '(^Y-es .. ..^ °
Limited^artriership: .rrri otherXpleasc specify)
Trust ———- : r~"_7": "
t j • - .
n ^ TttE DISGLbSlNi PARTY IS^A LEGAL E^T^t
ri. lFTflE^ISCLuai . . .. . . . n.aircctors,of.the entity.
- / 'i^ J&ro^^ samples,
V;,:^':':° Page'2^f : l3: %-'
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 lo Seclion 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 to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
N/A
SECTION III ~ B li SINE S S REL A TIO N S HI P S WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship,!' as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this.EDS is signed?
[JYes fcJ.No
If yes, p'lease identify below the name(s) of such City elected official(s) and describe such' relationship(s):
SECTION IV-^DISCI^
the Disclosing Partyrrhustdisclose the name and business address of each subcontractor, attorney, lobbyist, accountant, c6nsujtaiit apd
or expects to retain ih-connectibri withlthe of the'relationshipi; and.'tW total;
ampunt of the fees pa.id;of '.estimated^to the D^
employees who are paid soleiy thr^
'.'¦¦?¦;¦ ^. ';''. -'v. *yf;:-;1.\^.0,^ -{¦-. -; ¦ ¦¦¦
"Lobbyist",means ahyipersQ^ .action' on ibehalfjofM
himself:, "Lobbyist" alsq-m asi'ah'emplpyee Of :
another includeslundertaking to irifluenc action; ;; j
¦,; - . ;¦ 1: j;V? ^:;;^i-'> .\<-. ." : ¦' :' ^
¦If th'ejPjscibsingTarty^s uncertain w • :Discipsihg.RartyvmusLeither:as^ m'ak'e''th'e,.,dts'cl6'sure^
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Tarty Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
lo be retained) " ;''"lobbyist, etc.) "hourly rate" or "Lb.d." is
not an acceptable response.
(Add sheets if necessary)
Dj Check here if the Disclosing Party has not retained; nor expects retain, any suchi.persons .or.entities.„
SECTION V - CERTIFICATIONS ,. .;
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE ...
Uhder;Municipai' Cbdfe^Secti6ri,2'i92-4:i 5, .substantial owners of business cntities; lhat contract with the City must remain in compliance with their child, support-obligations throughout the.contract's term.
Has any person who;dir^tiyoor iridj^ebtly.owns 10.%^ Par^y.^een:declaxcdxin :,
arrearage on .any child support obligations by any tllinoiscourt of compefcnOjurisdiction?
[ ] Yes j^'No [¦] NP:rW^ owns"1-0%''p"rymorc'of,'.the
Disclosing Party.
If "Y.&;'^as^
isitiie.p^fsbh inco ; "
1. Pur-^^ corisufeft^fo^ submit^ngV^^^
certifies&s)to^ : wXtti^p,^ ¦". crimihal&ffths^^^
•pcrjiiry^disft^ :
^pjicari^im^
.doing^usiries
timeframe-mA^ in certification's, and-3 below;
Pagc4'Of. 1.3
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period'preceding the date of this EDS, been convicted of a criminal
offense,a'dj^ 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
statementsjipr-receiving stolempropcrty;
are not presently-indicts governmental entity (federal,
state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;!
have npt, within a,fiy.e-ycar>p.eriodJp1recedinj> toecdaie-o'f thistEDS,- had -one or more public transactions (federal, state or local) terminated for cause or default; arid
have not, wimin-a five-year.period'precedihg the date of thisEDS.bcen convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning ehyironmehtal violations;The certifications in subparts 3,4:ahdv5 concern:
the -Disclosing Party;
any "Cqht^ any. cprilxactpif p.^
connection wi^ ¦
Scetipnl^ ;^?;<; •
rany "Affili^^
Disclosing BartyyiiSiCpnt^ under ; :
cpminpn contrPl;bf;anp
.interiqc&
imlLequiiimer^ of'emplpyecs; oriprgam
ineligibility state or.^
the City, using substantially the same^ maii^gemeht,vpwnership^ or,.priricipais as the ineligible entity);
with-re^ect-tb^ .'.
indirectly cohtrolsHHe.Contractor, is cpntfoliedibyu^^ common •
. cohtrol.Pf another person or entity; . . : . . '
• any responsible'official.q£ me-DisPld^ing.^B^ty; any Contractpr.pr any Affiliated Entity pr any . omer.official Aagentlp'r^
acting'purs^ aumpfizM^ Party, any
Contractor or any Affiiiated Entity (collectively. "Agents").
Pagj^pf^
Neither the Disclosing Party, nor. any Contractor, nor any Affiliated Entity of either the Disclosing Party
or any Contrictgr.riQr any/Agents.h^ the date this EnS-:is-sighed, or, with
respect to a Contractor, an Affiliated Entity, or an. Affiliated Entity of a Contractor during the five years before the date of .such.epntractpr!s;or.Affiliated Entity!? contract or engagement in connection with the Matter:
a- ^rjJvedor^tcm
b^S^:-P^^cig^ of Illinois,-or any:agency:bf>the federal
gbyerhmicj^fQKof^ny^ officer's
or employe^ .• \. : \.: ; ¦¦¦ ; .-'^ ; ¦¦^r
or
b. agreedtor.xdl^^^ :
agreernenl};or b^ri of agreement or collusion ambrig^idders dr
otherwise;^ . ; • ::f i;f7~yW?0-¦¦ • , " ";' • ^:-ii;?r1?''c''"^
mad^ail iamis^^ pfjSucjhV^du^^ a; or b. aboveHhat is a n^tter!oTjecbrd,:b^::
hav'e npt=b^n.prpsrecuted ;. . . . .:; is ••;:: '^r^M ;^ab.-!
viplate&th^ •
agents or.parfte^ " ^agjng4n?pr;b|i|g^ vmlation of720 £^
America:diat|cphtain '
maintained totfthe?C«ffice%f ^^^.dM-^^^^'^i--' ¦-, >>i-.
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the. above statements.
8. To the best oftheDisclosing Party's .knowledge after reasonable inquiry, the following is a complete list of all current employees of theiDisclosing Party.;who 'were, .at any.time during the:12- : . month period .preceding:the execution,date'Of:this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate^ Witiv,"N/A''drv"npne",).
N/A " " ' " ' ' ' ' -- ¦ ^ ^ .;
9. To-the bes't dftbe'Disclosm^ j x
complcte;list-of all gifts:that the0iscio at any timeduringrthc
12-mpnfhper-ibd'.prcce^ihg/the'cxecu.Hp'n. qate o'f-this'.Ep.S,to .a'n employee-, of elected or appointed1 6fficial; of the City of Chicago Fqr.purpos'es-of;this;statemeht, a "gift'Vdqes not includc:-,(i) anything made generally^
course of official City business and having-a rctailvalue of less than $20.per recipient (if none, indicate
with'"N/A" or "none"). >As to anyrgift>iis ¦: >'
n/a " '",; . . " ' J - ¦
C. CERTIFicitlON OF'STATUS AS FINANCIAL
The Disclosing Party certifies that the Disclosing.Party (check one)
[ ]!is fc^ is.npt
a "financial .institution" as-defined in'Scction<2r32-455(b) ofithe Municipal.Code.
1^
"We.are'nqt and wilfdof becpm^a predatory: lender asl'd.efincd in^feKap^eV. 2r3'2-lo^-the-ilyI-unicipal
Code:. We.-'furthw
lender!^
lendcr-pr'bec^ doing, business w.ith^th.e City."
If .the Disclosing ^ Section:?^^^
2t3.2 pfjjthe Municipal Code, explain^iere^attach a'dditipnajipages .- ;-,. :-...-. ; /,
.,.. \, . ¦¦¦. ¦ ¦¦>.i-''- ...j.'; \ ¦¦¦ •¦ : ,v , j>j:i.ii»).-a. - -j.;.'jj:>. y ¦
Page7 of :13:
If.the letters "NA," the word ,,Non"e.,"n-or/no'Tesp6tfsc:«ppearsoii.the lines above, it willbc conclusively presumed that theDisclosing; Party.certified to the above statements.
D. CERTIFICATION REGARDING iNTEREST lki; Cl TY BUS1N ESS
meahn^gsj&henrfo^ .Ij.fgg:
1V' l^£ccordance with/Secfion 2}ll56%U of the^Moiriicipal;C6de:'Pocs any official or^mplbyce"J
\0^^$fe&^ in>he riame'of-any other person,or., .
ehtit^iiiithe Matter?^ >^ -fi-Ur" V:-><-\rv*~-^.<~ r^/ui^&ivt*, .¦ -X .; ¦; ^ ¦¦.*>*:.>¦. - ¦
PlltS:f;':'"''.;i|i#j'S:fir;:;'i
,N^fe^lJ^u?check;e^
Itermp,l.;-proc^ - ¦:.^iV: j;;V":-; j-:r®y':£:y$g:*<: ':r:--^ \ ¦ -.VT
doeslnbt^nsfitute ^ fihan^Hfflgfesi^ sf •©oes,;me;^ttekihvolye a/CityP^bp^y^ie?^ :' ;;
•. :i^esf.;:;v
S^^i^IC^lON^ ;W;
:dis^lqse:below.^in Failufc;to- ¦';
p- -; V^age'S bfil •'
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 arid all predecessor entities regarding records of investments or profits
from slavery or slaveholder insurance policies during the slavery era (including insurance policies
issuedtoslavehqlders thahpro.yided'coverage for damage toor injury or death of their slayes),;and
the Disclosing Party has";found no , :
2. The Disclosing.Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Partyhas found recofds:6f investments or profits from slavery or slaveholder^nsu.rance policies. 'The Disclosing/Party verifies that'.theVfolibwihg.cQ'nstitutes'iuli disclosureof all such records; including-the names' Of any 'and all'slaves br'1>lavehoiders described1, in 'tnose;fecpf ds:
SECTION VI-CERTl^^
NOTE: If-the Matter is federally funded, complete this Section VI. If the Matter is.not federally funded,iprpceed td;Secti6n:Vli. TwpurpOses of this Section VI, tax credits allbcated'by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING tOBBVING
List/below me names.of allipersPhs'o '
Disclpsure ActLpf 1^ of me Disclpsin'g^
respect:to/the Matter: (Add^sheets ifn^cessar'y): ; - ' : ¦c,;;/;.:^;;^;-:.'- ^,
(If ho expManatiqni^ if melettcre;"NA'' o^
appear, it will be cpnclusiveJypresuM Disclosing Party means-th'atfy©fperso^
registered utite^ 19.95*have made-lobbying contacts jonj&^aifprthe
Disclosing £arty wjtii-r&plfcttto u^Waliter*):;:>' '
The pis'clp.sing-Part^ any federally^apprppfiafed;^^
any^person.'bren.ti^
person or^entity tp-influen^ applicable;;fe:deral^a
member of-Gphgress,; in cpiinectipnlwitH^ thKaward:bf any federally fundedcbntract.lmaking^
federally funded -grant or Ipaniibntering i cooperative agreement^Pr to extend, cbntinue,Xehew,
amend, or'modify 'any^federally frnV agreement^'''.
' ': ' 'Page 9 of. 13 . ' ...
3. The Disclosing-P,a^ at the-end-of each calendar quarter in
which there occurs any event that materially a'ffccts thc.accuracy of the statements and inforniation set
forth -in R'aragra'iins'Aaffd;A.2:"4b1)yc.-
4. The^disclosing Ea^ in sertion
¦ ¦501 (c)(:$o^
"Activities". "
If the Matter
alter Jsfe^rallyii^d f: i
^actbfj-^ . ,
¦:ricg6tiatwnsV
-it ? .•;/
Is ithef D isclosingfEarty vittiej^ ji ucant?;._ ~?;«.« >.:
;;p;age 10^!13 !
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees.that:
The cejtificatipns, dhjjc]tosure$,.an^.actk«o>,lp;dgrn6nts .contained.in .this EDS will.becomeparf.of.any
contract or other agfe'emeni City .in connection with the Matter^whether
procurement, City assistance, or other City a 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, or^
The City'stjpve'rnmental Ethics and Chapters.2-156 and 2r 164 of
the Municipal Code,' imp^ and obligations on pcrspiis.pr entities seeking City.contracts,
work, business, pr trHns^ available on
line at ww.wicityofchicagb.Org^ .mkyVaiso be obtained from the City's Board of Ethics^74b N-
Sedgwick St., Suite 500, Chicago, IL;6Wi'6, (312) 744^9660. the:Disclosing<.Party.must.-oompJ.y-full'y--with the applicable ordinances.
C- If the City determines that any .information provided, in this-EDS is false, incomplete or inaccurate, any cphtract or other agreemp^ voidable^ftd Ifte City^ void), at law,-or in e^
dec'linirfgvfo'allW tran^cUprisiwith the^City/ Remedie¥atj
law for a false statement of material- fact may;m"ciudeJincarcerati6h and an award to the CitylbftreBle
damages. ' .'."''' V?;x*|^ ',•
D. It is thp City's policy to make mis.document avaiiab'ie tp the;public on its Internet site and/pr-kiipPn
^dc^yail^le.UP^iejp^lk otherwiseV.B
righ^^r^lairxis which it-m'ay^ of information
cpnfa'inediin this EDS and also authprfzes the Cityipfyenfyrthe accuracy of anyirifprmation
in misEpS. ;-:.'. ;. C^-':%v " ¦' '¦"''' "'¦ ' '. -v -^1' ¦
E. T^he information provided in-'this EDS musf be kept^urrent. In the event of changeSi-me;Pisclpsihg: ¦
Party.'must supplement this^EDS up B^thV iime the City tikes acU^;on the Matter, If the Matter is a
cohtractibeingta^ me Disclosing Party rnust
C-jhap^Hp23^ offensei),'^^
as required by Chapter 1-23 ;and Sectiph:2-i54-d20^Pf^ uiiicipai Code. ':' '¦ '¦ :; ^¦
The Disclosing Party re'p^'esen^ .¦.•"'¦<: -' ' •. . .• '
Page i:i)pf:13-
£:!: ..The.D_ts^^^ tax administered by-the^lllinois.
p-epartmeril-of Revenue, rnprare;^ or its Affiliated Entities.'delii^uenrin.paym
%Ji^orpthe;r charge owed^.the City.- This.includcs, but is not Hmited;tb,.ai] water charges, -
sewer charge^ license ^ '•" ' :: '¦ ;;' ;
F-2 ' If th^:Pisc]qsihg Party is the Disclosing Party and its AffiJiated Entiticsvwiiliriot
use, nor.permi.Mteir;s.ub^
Service's' A^nistrlUo^v.^d-'"'''W'Jii
"¦' :
cpritractbrs/suecontractor^ the^Matte1>cert'ificatiohs equal.iri .
.City, use any suc^contractor/sub^ that does^nbt provide such certifications or thauthe
^;P^SClpSUig^^y|h^
•SSl^^S^^ .hems,in:F:i., ^oi^3v,abov^ahu
GERTIFie:A#bN
without ¦the .pnPr written consent; of the:
•(Print- pr^ypf^am^
: y^^^y^^^yM^iy^:}\':y*M0?^::,:.;-.;cyi-C'/y^^-Cc^^&yiuy¦¦¦¦
'i . -. .-• 'My Commlsefon Expires'' V /••vlrV-;; ••'»> : ' .
Page 12-of 13;
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS-WITH ELECTED CITY OFFICIALS AND^D'EPARTMENT HEADS
ownership ihtcrcs(-in^ 7.5perce^ to be coinr)]etcd by;:aiiy.1egal entity
whichhasoii^
Ui^er Mur^ipallgode Sefctipn 2^154-015, toeTJisclpsin^ whcther/sufchDisclosing Party
anyeleci&c^ A "familial relationship is
signei-the Disciosirig
^^i^r}^yi^^^^y^A!y cleric, the city freasurer^
par^or^san-^ whether by piood oradbp chUd^hrouSeVOT sister; aunt or uncle,
W&*Jg> ^}^^^P?^l^^hdchild/ m^efariijawj soii^n^law^aug^tfeinflaw; stepfather
or. stepm;pffief;.stepsoh' or st'ep'daugiitef,' stepbrother or ^tepsisjerbr'^ ". - '
"Applicable;^ ifthe DiscIo|ing>E^;is a;co^
:P^ersh'ip-^lhg^ limited :limited;h^lit^^mpahy;;(^
ope^fi^ officer^reasurericf-secreu^ person
e'xercisingisirh'ilar authVrity;: -- :; ..v?^:,-;^.-^
l-fYes y-^uf y&f&y , .>^:np' • '•';^-^il^
'[ $^$#1^ which .
§rCh;peireon isi:<^ect^
perspri;hasafa^^
Page 13 of 1-3
CITY OF CHICAGO
(vCOjVpNlie-i-piS^ AND AFFIDAVIT
AITEND1X n
DU^piNG CODE SCOITtASv/lMiOBLEM LANDLORD CKRTinCATION Mvjijc^l1as;a-:dircc(qm
'WV°M°*??^ life c.nI>-i^n;intlic AiipHcnnt. . rY-. ;'>¦.:¦¦. ^ ¦ ¦ ¦¦¦ ¦¦ ¦-¦¦;¦-> ¦
' %y?&:.- ,v ' ' . ¦. "
: b'aiWingicode srofflaw.pr^^ ^yWlo dfihWunkipaL" ':'
w. {¦.:¦>•,¦
21 ". WlfPj^l^il^l c^pfbiicly%f^d:6n.aiiy.e^changc, is1 any 6mccr;br«dircctoV -ofS
¦ ..., • .A$f!^ landloranndthc/ayoress of.th&uHdingibrV
|