DEDICATION ORDINANCE
Be it Ordained by the City Council ofthe City of Chicago:
SECTION 1. The Commissioner ofthe Chicago Department of Transportation, or her designee, is each hereby authorized and directed to approve a dedication of certain property owned by the Chicago Title Land Trust Company, as successor Trustee ("Land Trustee") to Lakeside Bank, as trustee, under a trust agreement dated May 3, 1985 and known as trust number 10-1037 ("Chicago Title Land Trust 10-1037") along the northern side of W. 36th Street bounded by S. California Avenue and S. Richmond Street, and legally described in the attached plat (Exhibit A, CDOT File: 36-12-15-3725) which, for greater clarity, is hereby made a part of this ordinance.
SECTION 2. The dedication for public way is accepted upon the express condition that funds be deposited into the City Treasury of the City of Chicago sufficient to defray the costs of removing paving and curb returns, and constructing newly dedicated public street according to the current version of the Chicago Department of Transportation Regulations for Opening, Repair and Construction in the Public Way and its appendices, and as agreed to by the beneficial owner of Chicago Title Land Trust 10-1037 ("Beneficial Owner") in the attached Duty to Build Agreement (Exhibit B), hereby made a part of this ordinance.
SECTION 3. The Land Trustee and the Beneficial Owner each acknowledge that all private sewers within the area to be dedicated shall be abandoned or relocated at the expense of the Beneficial Owner. Abandonment plans must be reviewed, approved and permitted by the Chicago Department of Water Management, Sewer Design Section prior to work, with as-built drawings submitted within 45 days of completion, with final acceptance dependent upon physical and video tape inspection by the Chicago Department of Water Management.
SECTION 4. The dedication herein provided for is made upon the express condition that within one hundred eighty (180) days after the passage of this ordinance, the Land Trustee and/or the Beneficial Owner shall file or cause to be filed for record in the Office ofthe Recorder of Deeds of Cook County, Illinois a certified copy of this ordinance, together with the full sized corresponding Plat as approved by the Chicago Department of Transportation / Superintendent of Maps.
SECTION 5. This ordinance shall take effect and be in force from and after its passage. This dedication shall take effect and be in force from and after the recording ofthe plat.
Page 1
Dedication Approved:
Rebekah Scheinfeld Commissioner
Approver as tO/Forrri^and Legal
Richard Wendy /TJeputy Corporation Couns
Honorable/George Cardenas Alderman/12th Ward
Page 2
1 .J .0
!lLy!Mi!A>il!t: This belt»\\ document must here-produced cn ihe applicant's letterhead, executed, and notarised'
SUBDIVISION / 1)1 IMC A I ION APIM.K A 1 ION DUTY TO Bill!) AORI'.KM K.N 1
(Must he completed by the applicant, not their auomc-y)
In support oi my current application with the Chicago Depart i net ii of'i 'ransporiatioirs Maps at it! Phils unit, lor a subdivision -''dedication of my private property. 1 hereby stale thai I am the applicant or the company agent for the applicant company involved in the project, and that I have the authority to agree to the below terms ofthe Subdivision. Please initial:
I am aware that 1 am responsible for the construction of all public and private rights of way (streets, alleys, etc) described on the Plat oi' SubdivisiorvDcdication.
I further understand lhat all rights of way (both public and private) must 'he built to City specifications as detailed in CXK)T'sJtion for Opening?. Construction and Repair in the Public Wav.
Si cued:
Lastly. ! understand that construction deposits will lie required to assure that the work is done correctly. An inspection will he conducted hy the- City upon completion ofthe work. The City of Chicago reserves the right to require demolition and reinstallation of any facilities that are judged to he suh par or thai do not adhere to the Cilv's standards.
l)ilu,: October20, 2015
Thi.-.- Beneficial Owner
rimed name; Michael Tadin
Ui'iiani?
Nation: Chicago Title Land Trust Company as Trustee u/t/a dated 5/3/85 & known as Trust No 10-1037
c/o Michael Tadin, 4450 S. Morgan St. zl]X Chicago, IL 60609
773 254-36445 ; 773 254-7195 mtad i n@mar inacartage .com Subscribed and sworn to before me this
5 A
CiOt'-'.JJ: -C ?TAr? '.)L*3U^ YS;-r
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
CHICAGO TITLE LAND TRUST COMPANY AS TRUSTEE UNDER TRUST NO. 10-1037 DATED 05/03/1985
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR Ptope/k.
[*] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
i Applicant in which the Disclosing Parry holds an interest: 34faQ 'S- L^al&SAm k/e
OR
f] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
Business address of the Disclosing Party: 10 s LASALLE suite 2750
CHICAGO, IL 60603
Telephone: 312-223-2195 fax: 312-223-4139 Email:
Name of contact person: TRUST OFFICER
Federal Employer Identification No. (if you have one): N/A
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") lo which this EDS pertains. (Include project number and location of property, if applicable):
APPLICATION FOR SPECIAL USE FOR PROPERTY AT 3460 S CALIFORNIA AVE. CHICAGO,IL
Which City agency or department is requesting this EDS? zoning board of appeals
If the Matter is,a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # ¦ N/A and Contract # n/a
Page 1 of 13
SECTION H - DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY
Indicate the nature of the Disclosing Party:
[ ] Person [ ] Limited liability company
[ ] Publicly registered business corporation [ ] Limited liability partnership
[ ] Privately held business corporation. [ ] Joint venture
[ ] Sole proprietorship [ ] Not-for-profit corporation
[ ] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
[ ] Limited partnership [ ] Yes [ ] No
[] Trust [xj Other (please specify)
LAND TRUST AS SELLER OF PROPERTY
For legal entities, the state (or foreign country) of incorporation or organization, if applicable: ILLINOIS LAND TRUST
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 jk] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
List below the full names and titles of all executive officers and all directors of the entity: NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
MICHAEL A. TADIN 25% BENEFICIAL OWNER OF LAND TRUST
ANTHONY N. FRATTO 35% BENEFICIAL OWNER OF LAND TRUST '
ALBERT BOUMENOT 25% BENEFICIAL OWNER OF LAND TRUST ^
RONALD MARASSO 25% BENEFICIAL OWNER OF LAND TRUST
Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interestof 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
MICHAEL A.- TADIN 4450 S. MORGAN AVE. CHICAGO, IL 60609 25%
ANTHONY N. FRATTQ 264 0 S. PRINCETON CHICAGO., IL 60616 25%
ALBERT BOUMENOT 2103 W EVERGREEN CHICAGO, IL 60623 25V
RONALD MARASSO 2907 S CANAL ST. CHICAGO, IL 60616 ' 25%
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes &c] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
n/a .;'
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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Name (indicate whether 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.
N/A
(Add sheets if necessary)
[x] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION y - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [x] No [ ] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[]Yes I] No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which. the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Parry certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Parry and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section E.B.I. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared, ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted.of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or perforating 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 clause B .2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions Concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
• the Disclosing 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");
c 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 of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant,to the direction of authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor' any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City,.the 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, ot been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition, by agreement to bid a fixed price or
• otherwise; or
made an admission of such, conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or •
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 LLCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department ofthe Treasury or the Bureau of Industry and Security ofthe U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
N/A
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above-statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at anytime during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate 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 all gifts that the Disclosing Party has given or caused to be given, at any time daring; the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed' official, of the 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
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [xj is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
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 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
N/A
Page 7 of 13
If the letters "N A," the word "None," or ho 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.
Ln accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes [x] No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.L, proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[]YeS [] N0 NOT APPLICABLE
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either I. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
x 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era {including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found.no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS! FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter, is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter: (Add sheets if necessary):
NOT APPLICABLE - THE MATTER IS NOT FEDERALLY FUNDED.
(If no explanation appears or begins on the lines above, or if the letters !1NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2, The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for bis or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that'materially affects the accuracy of the 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 RevenueCpde of 1986 but has not engaged and willnot engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A,4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration 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?
NOT APPLICABLE - THE MATTER IS NOT FEDERALLY FUNDED.
[JYes []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
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [ j No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION vTI ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
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 fall 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.
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 and7or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the.Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F.1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parries List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F, 1. and F.2. above and will not, without, the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any ofthe items in F.1., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as ofthe date furnished to the City.
CHICAGO TITLE LAND TRUST COMPANY AS TRUSTEE UNDER of Disclosing Party)
(Print or type title of person signing)|1010|
Signed and sworn to before me on (date) july^ 2015
at coo^ County, Illinois (state).
\*^&Jffll&>^'--~ Notary Public.
Commission expires:_ nil fan
, if a$ Trustee in the exerose «f tf
ft js SXgfSSiij? UfitMSiOOS Sfia SJjTEStf tint tf-ttfc &3T£>i
^innic^'tej^sj^tatiQns, corensnts, undsrtaks^s agrsejratris herein made on the part of the Trustee la&rtt&irlJy it solely in its capacity as-Trustee snsl personally, jlfo personal liability or personal iKporst® tssstsd by or $ha9 at any time bs asserted or enforce egsnsr ihs Trustse on account of any warranty, inttess rejjresentatien, covenant, undertaking or agreement of Trtfstee in this m^trtmianL
trw fftflwflifi^eeastafeji in tfe e*rflftogtbn
oanlfipatton ts teyC* sgteiy In rdiatea ttsmon ^twnap^t^few^mnwlbythjtniatoc fn Its liyflvidual cepacfiy, for tho truth or accuracy or the fs«* thsreh atsrtd.
|10 10|Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by.any legal entity < which has only an indirect ownership interest in the Applicant
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Parmer 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 of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild^ father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section II.B.1. a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership- all general partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. 'Trincipal 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?
t ] Yes [X] No
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title 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 SCOFFLAW7FROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an ^Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant
1. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a . building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
Yes
?
2. If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
QjYes LJNo [/] Not Applicable
3. If yes to (1) or (2) above, please identify below the name of the person or legal entity
identified as a buttding code scofflaw or problem landlord and the address ofthe building or buildings to which the pertinent code violations apply.
Not applicable.
FILLING OUT THIS APPENDIX 3 CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
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(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 tmthfully, 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.
Application for dedication for widening This recertification is being submitted in connection with of 35th street (west of California Ave .) [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that Quc File # : he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) 2015-68352 warrants that all certifications and statements contained in the Disclosing Party's original EDS Project No . are true, accurate and complete as ofthe date furnished to the City and continue to be true, 36-12-15-3725 accurate and complete as ofthe date of this recertification, and (3) reaffirms its acknowledgments.
6.
(Print or type legal name of Disclosing Party) By:
Print or type name of signatory:
iAiSgLD.'illOrgia
Title of signatory:
(sign here)
2016
/£-/i'3j Date: January
This instrument is executed by the undersigned Land Trustee, not personally but solely as Trustee in the exercise of the power and authority conferred upon and vested in it as such Trustee. It is expressly understood and agreed that all the warranties, indemnities, representations, covenants, undertakings and agreements herein made on the part of the Trustee are undertaken by it solely in its capacity as Trustee and not personally. No personal liability or personal responsibility is assumed by or shall at any time be asserted or enforceable against the Trustee on account of any warranty, indemnity, representation, covenant, undertaking or agreement of the Trustee in th.s instrument.
Tha In'ormatton ccntrsincci lr. this certification hr.s bcon •ri.-rntetifd toihokint! trustee by tha txtiefcir.iHr or r.rnt na/SS-^&SpTand the certificate!.? rtudc sotely in reiianne thereon end no remoriSRMic/ i j .n-9'imed by ths trustee In its i.'iciv'uus! csjiscltv, for tha truth or accwaiy of thti t*Lts llmiairt fits tod.
Signed and swom to before me on [date] January // • 2016 , by
" -¦•**--3 , at cook County, Illinois [state].
Notary Public.
^ 4t ¦?¦ <¦' ^ « *" *- - *' '* * 9 • '
I "OFFICIAL SEAL"
SILVIA MEDINA *
Notary Public. Stata of Illinois l
Ver. 11-01-05