Office of the City Clerk - Record #: O2015-777

This record contains private information, which has been redacted from public viewing.

Record #:

O2015-777

Type:

Ordinance

Status:

Passed

Intro date:

1/21/2015

Current Controlling Legislative Body:

Committee on Finance

Final action:

3/18/2015

Title:

Multi-Family Program Funds loan to PP Family LLC for construction of affordable housing at 5001 S Lawndale Ave

Sponsors:

Emanuel, Rahm

Topic:

AGREEMENTS - Loan & Security, - FINANCE FUNDS - Multi-Family Program Funds

Attachments:

1. O2015-777.pdf

Date	Journal Page Number	Action By	Action	Result	Action Details	Meeting Details	Captions
3/18/2015	103050	City Council	Passed	Pass	Action details	Meeting details	Not available
3/16/2015		Committee on Finance	Recommended to Pass	Pass	Action details	Meeting details	Not available
1/21/2015	101234	City Council	Referred		Action details	Meeting details	Not available

OFFICE OF THE MAYOR

CITY OF CHICAGO

RAHM EMANUEL

MAYOR

January 21, 2015

TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO

Ladies and Gentlemen:

At the request of the Commissioner of Planning and Development, I transmit herewith ordinances authorizing the execution of Multi-Family Loan agreements.

Your favorable consideration of these ordinances will be appreciated.

Mayor

Very truly yours,

O R DI NANCE

WHEREAS, the City of Chicago (the "City"), a home rule unit of government under Section 6(a), Article VII of the 1970 Constitution of the State of Illinois, has heretofore found and does hereby find that there exists within the City a serious shortage of decent, safe and sanitary rental housing available to persons of low and moderate income; and

WHEREAS, the City has determined that the continuance of a shortage of affordable rental housing is harmful to the health, prosperity, economic stability and general welfare ofthe City; and

WHEREAS, the City has certain funds available from a variety of funding sources ("Multi-Family Program Funds") to make loans and grants for the development of multi-family residential housing to increase the number of families served with decent, safe, sanitary and affordable housing and to expand the long-term supply of affordable housing, and such Multi-Family Program Funds are administered by the City's Department of Planning and Development ("DPD"); and

WHEREAS, DPD has preliminarily reviewed and approved the making of a loan to PP Family, LLC, an Illinois limited liability company (the "Borrower"), the managing member of which is PP Family Manager, LLC, an Illinois limited liability company (the "Managing Member"), in an amount not to exceed $6,689,009 (the "Loan"), to be funded from Multi-Family Program Funds pursuant to the terms and conditions set forth in Exhibit A attached hereto and made a part hereof; now, therefore,

BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO

SECTION 1. The above recitals are expressly incorporated in and made a part of this ordinance as though fully set forth herein.

SECTION 2. Upon the approval and availability of the Additional Financing as shown in Exhibit A hereto, the Commissioner of DPD (the "Commissioner") and a designee of the

Commissioner (collectively, the "Authorized Officer") are each hereby authorized, subject to approval by the Corporation Counsel, to enter into and execute such agreements and instruments, and perform any and all acts as shall be necessary or advisable in connection with the implementation of the Loan The Authorized Officer is hereby authorized, subject to the approval of the Corporation Counsel to negotiate any and all terms and provisions in connection with the Loan which do not substantially modify the terms described in Exhibit A hereto Upon the execution and receipt of proper documentation, the Authorized Officer is hereby authorized to disburse the proceeds of the Loan to the Borrower.

SECTION 3. The Project (as described on Exhibit A hereto) shall be deemed to qualify as "Affordable Housing" for purposes of Chapter 16-18 of the Municipal Code of Chicago Section 2-45-110 of the Municipal Code of Chicago shall not apply to the Project or the Property (as defined on Exhibit A hereto)

SECTION 4 To the extent that any ordinance, resolution, rule, order or provision of the Municipal Code of Chicago, or part thereof, is in conflict with the provisions of this ordinance, the provisions of this ordinance shall control If any section, paragraph, clause or provision of this ordinance shall be held invalid, the invalidity ofsuch section, paragraph, clause or provision shall not affect any of the other provisions of this ordinance

SECTION 5. This ordinance shall be effective as of the date of its passage and approval

EXHIBIT A

PP Family, LLC, an Illinois limited liability company, the managing member of which is PP Family Manager, LLC, an Illinois limited liability company (the "Managing Member"). BYNC Development LLC - Series Park Place, an Illinois limited liability company, is a member of the Managing Member, the sole member of BYNC Development LLC - Series Park Place is Back of the Yards Neighborhood Council, an Illinois not-for-profit corporation.

Acquisition of real property located at 5001 South Lawndale Avenue (the "Property") and construction thereon of 14 buildings and of approximately 78 dwelling units contained therein as one-, two- and three-bedroom units for low- and moderate-income families and certain shared amenities which may include a parking lot, a rain garden, and a community building with a management office, maintenance facility, community room, computer lab and exercise room

Amount: Not to exceed $6,689,009

Term: Not to exceed 30 years

Source: Multi-Family Program Funds

Interest: Not to exceed zero percent per annum, or another rate or rates

acceptable to the Authorized Officer Security: Non-recourse loan; mortgage on the Property (the "City Mortgage")

Amount: Approximately $13,000,000 (the "Bridge Loan"), or such other

amount acceptable to the Authorized Officer

Term: Not to exceed 30 months, or another term acceptable to the

Authorized Officer

Source' Bank of America, NA, or another entity acceptable to the Authorized

Officer

Interest A variable rate of interest equal to one month LIBOR plus a

margin of 250 basis points, with a maximum interest rate not to exceed that which may be paid on the Bridge Loan under Illinois State Law, or another rate or rates acceptable to the Authorized Officer

Security: A mortgage on the Property senior to the City Mortgage, or other security acceptable to the Authorized Officer

Amount Approximately $750,000, or such other amount acceptable to

the Authorized Officer

Term Not to exceed 20 years, or another term acceptable to the

Authorized Officer

Source IFF (formerly known as Illinois Facilities Fund), or another entity

acceptable to the Authorized Officer

Interest Not to exceed seven percent per annum, or another rate or rates

acceptable to the Authorized Officer

Security A mortgage on the Property senior to the City Mortgage, or

other security acceptable to the Authorized Officer

Low-Income Housing Tax Credit ("LIHTC")

Proceeds: Approximately $17,062,929 all or a portion of which may be paid in on a delayed basis and all or a portion of which may be used to retire all or a portion of the Bridge Loan.

Source: To be derived from the syndication of $1,688,695 LIHTC allocation by

the City

Amount: Approximately $875,000, or such other amount acceptable to

the Authorized Officer

Term: Not to exceed 40 years, or another term acceptable to the

Authorized Officer

Source: To be derived from the sale of approximately $1,871,122 Illinois Affordable Housing Tax Credits allocation by the City which sale proceeds will be either loaned to the Borrower by Back of the Yards Neighborhood Council or contributed as capital to the Borrower by the Managing Member

Interest: Not to exceed zero percent per annum, or another rate or rates acceptable to the Authorized Officer

Security: A mortgage on the Property junior to the City Mortgage, or other security acceptable to the Authorized Officer

Amount: Approximately $1,000,000, or such other amount acceptable

to the Authorized Officer

Term: Not to exceed 18 years, or another term acceptable to the Authorized

Officer

Source: Bank of America, NA, or another entity acceptable to the Authorized Officer

Interest Not to exceed zero percent per annum, or another rate or rates

acceptable to the Authorized Officer Security A mortgage on the Property senior to the City Mortgage, or

other security acceptable to the Authorized Officer

Amount Source

S100

Managing Member

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I -- GENERAL INFORMATION

Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:

^ _

Cheek ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

j^. ^tne Applicant

[ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe

Applicant in which the Disclosing Party holds an interest:

3. [] 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: CP CP iff T\ mrjtf? 2f\ Suik (I Si
2. Telephone: 1SL\\~ Q£V5^&5Z.Fax: ^<k^^JyiD^'~^<^0\ Email: D>Vud 6Q 5ft flfiWe., Com

D. Name of contact person: . X&V a .CA ^>f'!it~ __

FL Federal Employer Identification No. (if you have one):

1". Brief description of contract, transaction or oiher undertaking (referred to below as the "Matter") to winch ihis EDS pertains. (Include project number and location of property, ifapplicable): Ap^roVa/ of

P\cmvi\'j i nevetopyif/it Mu/h - family farvWna hr forlc Place VevdiofMerit-

D^par^ment-o¹? Plan ni no

G. Which Cily agency or department is requesting this EDS? rj)eV&b^|<)3£l^

If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:

S|!eeiileation U an; (oniraei

SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature of the Disclosing Pc [ ] Person

[ ] Publicly registered business corporation [ ] Privately heid business corporation [ ] Sole proprietorship [ ] General partnership [ ] Limited partnership [ ] Trust

P<[ Limited liability company

[ ] Limited liability partnership

[ ] Joint venture

[ ] Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))?

[ ] Yes [ ] No

[ J Other (please specify)

2. For legal entities, the stale (or foreign country) of incorporation or organization, ifapplicable:

X"l\mo\s

For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[ ] Yes [ ] No ^N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

1. List below the full names and titles ofall 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).

Ifthe entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an l-DS on its own behalf.

Name Title

"PRrotvuiy- J^ML(^-LUl_ J^v\km^ i «Cj MmMr

2. Please provide the following information concerning each person or entity Slaving a direct or '.r.direet beneficial interest (including ownership) in excess of 7 s% ofihe Disclosing Party. Examples ofsuch an interest include shares in a corpoiaiio;:. pa i triers hip i meres: in a partnership or joint venture,

inieresi of a member or manager in a limited liability company, or mieiesi of a beneficiary; oi a trust, estate 01 olhei similar entity I f none, slate "None." N OT \i. Pui suant to Sec lion 2- i vl -030 of the Municipal (.'ode of Chicago ("Municipal Code"), the City may require any such additional information fiom any applicant which is reasonably intended to achieve full disclosuie.

Name Business Address Percentage interest m lhe

j-p^ Disclosuui Party

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SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS

lias 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 ^No

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney,

lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated 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.

Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Parly must either ask the City whether disclosure is required or make the disclosure.

Name (indicate whether Business retained or anticipated Address to be retained)

Relationship to Disclosing Party Fees (indicate whether

(subcontractor, attorney, paid or estimated.) NOTE:

lobbyist, etc.) "hourly rate" or "t.b.d." is

not an acceptable response.

See a-i~\af)\^r\

(Add sheets if necessary)

[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS

A. 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?

[JYes [ ] No f^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 ofall support owed and

is the person in compliance with that agreement?

[jYes []No

B FURTHER CERTIFICATIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(\vhieh the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of. or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer oi employee ofthe City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article ; is a continuing requirement for doing business with the City. NOTE' If Article I applies to ii;o Applicant, ihe permanent compliance timeframe m Article I supersedes some fi\e-year compliance timeframes in certifications 2 and 3 below.

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2. The Disclosing Party and, if lhe Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not. within a five-year period preceding the dale of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in 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.

3. 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"); ■ 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 ofcontrol include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization ofa business entity following the ineligibility of a business entity to do business with federal or stale or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Enlity means a person or entity that directly or indirectly controls the Contractor, is controlled by if or, with lhe Contractor, is under common control of another person or enlity;

any responsible official ofthe Disclosing Party, any Conti ."ictor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or tiny Affiliated Kntity. acting pursuant to the direction or authorization of a responsible official ol "ihe Disclosing Party, any (.'out: actor or anv A ffiliated Enlity (eoiiectivelv "Agents'").

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 ofa Contractor during the five years before the date ofsuch Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:

1. 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 State oflllinois, or any agency of the federal government or ofany state or local government in the United States of America, in that officer's or employee's official capacity;
2. 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
3. made an admission ofsuch conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on 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 2-1 56 (Governmental Ethics) ofthe Municipal Code.
Ifthe Disclosing Party is unable io certify to any of tlie above statements in this Part B (Further Certifications), the Disclosing Party must explain below

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall current employees ofthe Disclosing Party who were, at any time during the 12-inonth 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").

tJ/A :

9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes 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 of the City recipient.

-Ulk :

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

1. The Disclosing Party certifies that the Disclosing Party (check one)

[ ] is £4»is not

a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.

2 li 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 ofthe Municipal Code. We further pledge that none ofour 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 oi becoming an affiliate ofa predatory lender may result in the loss ofihe privilege of doing business with the City."

Ifthe Disclosing Party is unable to make this pledge because it oi any of its affiliates (as defined in Section 2-32--^;o5(b) ofthe Municipal Code) is a predatory lender w.thtn the meaning of Chapter i he Municipal Code, explain here (attach additior.a' pages ;i necessary}-

Ifthe letters "NA." the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Parly certified to the above statements.

D CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section 2-156-1 10 ofthe Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter?

[]Yes i^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?

f ] Yes [)^No

If you checked "Yes" to Item D.l., provide the names and business addresses ofihe Cily officials or employees having such interest and identify the nature ofsuch interest'

Name Business Address Nature of Interest

4. The Disclosing Party further certifies that no prohibited financial interest in the Mailer will he acquirer! by any City official or employee

L < 1 H i'iKCA i ION REGARDING SLAVERY LR A Bl.SlNLSS

Please check either 1 or 2. below. Ifthe Disclosing Parly checks 2 . ihe Disclosing Party must disclose !k:1ow <>r in an attachment to this EDS all m formation required by paragraph 2. Failure io

Pace 8 of I 3

comply with these disclosure requirements may make any contract entered into with the City in connection with the iMaitcr voidable by the City.

__1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the

Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names 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 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):

(Jf no explanation appears or begins on the lines above, or if the letters "NA" or ifthe word "None" appear, it wiil 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 Mtitter.)

2 The Disclosing Party has not spent and wili not expend anv federally appropriated funds to pay any pei son oi cnt:ty listed m Paragraph A.l. above for his or her lobbying activities oi to pay any peison oi entity to influence or attempt to influence an officer or employ c-e of ary agency, as defined by applicable ledciai law, a member of Congress, an officer or employee ofCongress, or an employee ofa member ofCongress. in connection with the award ofany federally funded contract, making any federally funded grant or loan, entering into any cooperative agree men:, or :o extend, continue, renew, amend, or modify any federally funded contract, gram, loan, or coopera^:;ve agreement

Page 0 of 13

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

Ifthe 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?

fc^Yes [ ] No

If "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable fedeia! regulations? (See 41 CFR Part 60-2.)

! i Yes I^No

Have you filed with the Joint Reporting Committee, the Director of rhe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission ail reports due under the applicable filing requirements'?

[jYes [>4No

Have you participated in any previous contracts or subcontracts subject to ihe equal opportunity clause?

I i Ves ^Ko

If you checked "No" to question I or 2. above, please provide ;u' explanation

.pLirjic^:... enKy _ ... __ _ _.

Pane 1 0ol 13

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 ofany 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 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.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies 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 iequest. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom cd" 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 rhe Cily to verify the accuracy ofany information submitted m this EDS

E 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 ihe City takes action on the Matter. Ifthe Matter is a contract being handled by the City's Department of Piocuiernent Services, the Disclosing Party must ■update this EDS as the contract requires. NOTE: With respect to Matters sub-ect to Article 1 of Chapter 1-23 ofthe Municipal Code (imposing PERM AN ENT IN EL ICI BIL IT V for certain specified offenses), ine information provided herein regarding eligibility must be hep: current lor a longer period, as lequired by Chapter 1-23 and Section 2-1 54-020 of ihe Municipal Code

The Disclosing Party represents and warrants that:

F.1. The Disclosing Party is not delinquent in the payment ofany 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 'Ifthe Disclosing Party is the Applicant, the Disclosing Paity and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 Ifthe 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 ofthe City, use any such contractor/subcontractor lhat 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 ihe items in F. 1., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

Under penally of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (ifapplicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (ifapplicable) are true, accurate and complete as of the date furnished to the City.

fnyvifl/, LLC

(Print orjype name of Disclosing Party)

By: \ J.-p-J* \>

(Sign here)

l)avid 3>Md.

(Print or tvpe name of person si«ninti)

Preafari. Da'eity?waft, rr^r.; Member, Sr.nsvue toebf'mertf, LLC, M^rrPcer

flrmsVwd Wti&ttai, llc, bAecr^x, ?Pffrr% Manque, MemPfr ?pram\_y uq

(Print or type l:l!e of person signing)

(. OIUKV.

Signed and sworn to before me on (date) _ J/L,/ j /1 *~(

■^u CfccVrC- Cou.r.y. XL (state)

Nola:\ Pnbl.

£va frusm OFFICIAL SEAL Noiory Pulji.c. Slats ot Illinois My Commission Exoiros Auyusl 06. ?C 16

Cornnm.sio- expires. *df 1*6

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 2-154-0! 5, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any 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 of the Disclosing Party listed in Section II.B. La., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a genera! partnership; all general partners and limited partners ofthe Disclosing Party, ifthe 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. "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.

I ] Yes [X] No

If yes. please identify below (1) the name and title ofsuch person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature ofsuch familial relationship

CITY OF CHICAGO ECONOMICDIS C L O S U R E S T A T E M E N T AND AFFIDAVIT

SECTION 1 -- GENERAL INFORMATION

A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:

LLC

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

J<J a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe

Applicant in which the Disclosing Party holds an interest: "P^ ^i^lyYljW j L-LC

3. [ ] 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: (fl jg (j? D( AWldtl iZA ₍ fCf 1 1(9 2-
Telephone: 2HA '9SLl'606l Fax: fM^(s2"^0l Email: \J)avdft(®Btiwfofe. CVrT)
Name of contact person: J)aVi'o\ 'BlT'Df

L federal Employer Identification No. (if you have one): . [

F Brief description of contract, transaction or other undertaking (referred to below as the "Matter") io which, this EDS pertains. (Include project number and location of property, ifapplicable). AlffCOvO. \

jnw-.-ocoroe UoWiA6-mx Credits, DcraHori -r_ax Ofedite, ar^d Be^r+men^c

Ci. Wlncn City agency or department is requesting tins EDS? (jlfYj, P\{)/}_^X)x I'l f

li ihe Matter is a contract being handled by ihe City's Department of Proeuretr.eut Senices. please complete '.he followi:;g.

S pe::: i h. a; ion ami c ontract

n 01 01-i.?

Page i of H

SECTION II -

- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature ofthe Disclosing [ ] Person

[ ] Publicly registered business corporation [ ] Privately held business corporation [ ] Sole proprietorship [ ] General partnership [ J Limited partnership [ ] Trust

Party:

J^f"Limited liability company

[ ] Limited liability partnership

[ ] Joint venture

[ ] Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))?

[ ] Yes [ ] No

[ ] Other (please specify)

2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:

3. For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[]No

[ ] Yes

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY-;

1. List below the full names and titles ofall executive officers and all directors of the enfity. 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).

. ■ . //-, ; . . LLP

Name Title

2 ['lease pro\ ide the following information concerning each person or entiiy having a direct or indirect beneficial interest (including ownership) in excess of 7.5°o ofihe Disclosing Party. Examples ofsuch an interest include shares in a corporation, partnership interest m a partnership or joint venture.

interest ofa member or manager in a limited liability company, or inlerest ofa beneficiary ofa trust, estate or other similar entity. If none, state '"None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the

Disclosing Party

(Opn^ill LLC -Sena fhr\C p/ACf 1101 W tilth Sr-. in,I

fldor. Cfticacw, Il faMI _; i^r)^c/o JL

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?

If yes, please identify below the name(s) ofsuch City elected official(s) and describe such

relationship(s):

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Parly must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who tire 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.

It" lhe Disclosing Party is uncertain whether a disclosure is required under this Section, lhc Disclosing Party must either ask the City whether disclosure is required or make the disclosure.

Paste 3 of 13

Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether

retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:

to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is

not an acceptable response.

(Add sheets if necessary)

£*f Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

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 [ ] No .P^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 ofall support owed and

is the person in compliance with that agreement?

i i Ves [ J No

B FURTHER CERTIFICATIONS

! Pursuant to Municipal Code Chapter 1-23, Article 1 ("Article I")(which the Applicant should consult to r defined terms (e g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then ihe Disclosing Party certifies as follows: (1) 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 c: iiiMua! offense iuvoK Ing actual, attempted, or conspiracy to commit bribery, theft, iiaud, loigcry, pei iii - y. ■:!isiionestv or deceit against an officer or employee of ihe City or any sister agency, and (ii) ihe Appucai;; understands and acknowledges that compliance with Article 1 is a corP.n.mg requirement io; doiii... business w i:h ihe City NOTE: If Article I applies to the Applicant, the permanent compliance .:mef:an:e m Article I supersedes some five-year compliance iimcnamcs m cert:iicanons 2 and 3 Peiuw

T he Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction: a violation of federal or state antitrust statutes; fraud: embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions

concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.

The certifications in subparts 3, 4 and 5 concern:

the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section. IV, "'Disclosure of Subcontractors and Other Retained Parties"};

any ' Affiliated Entity'' (meaning a person or entity that, directly or indirectly controls the Disclosing Party, is controlled by lhe Disclosing Party, or is. with the Disclosing Party, under common control of another person or entity. Indicia ofcontrol include, without limitation, interlocking management or ownership: identity of interests among family membeis, shaied facilities and equipment, common use of employees; or organization ofa 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 oi entity thai directly or indirectly controls the Contractor, is controlled by it. or, with the Contractor, is under common conirol ol another person or entity:
anv responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any oine; c: i :csi 1. a gem o: employee ofihe Disc losing Pai ty. any Con try;" ioi o; any ^;\ :: il iated Eu;:;y. acting puiMiam to tiic direction or authorization ofa responsible official ofthe Disclosing Paitv, any Conirncioi orai:\ Affiliated Eniiiy (collectively "A cents")

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 ofsuch Contractor's or Affiliated Entity's contract or engagement in connection wilh 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 oflllinois, or any agency ofthe federal government or ofany state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists

maintained by the Office of foreign Assets Control ofthe U.S. Department ofthe Treasury or the Buieau of industry and Security ofthe U.S. Department of Commerce or their successors the Specially Designated Nationals Eisi, ihe Denied Persons List, the Unverified List, tire 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 Parly is unable to certify io any of the above siaiements in tins Pan B ( Further Certifications'!, ihe Disclosing Party must explain below:

Tf 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 ofall current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe Citv of Chicaeo (if none, indicate with "N/A" or "none").

m " -I.

9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the i 2-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 S20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

The Disclosing Party certifies that the Disclosing Party (check one)

[ 1 is pjNis 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 'tender as defined in Chapter 2-32 ofthe Municipal Code Wti further pledge that none ofour 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 iender may result in the loss of the privilege of doing business u r.h the Citv."

if site Disclosing Pai ty is unable to make this pledge because it or any ol" u- a ffiMales fas defined in Section 2-3 ?--! 5 C; b) ofthe Municipal Code) is a predatory lender w-uhir the meaning oi Chapter .' oi the Municipal Code, explain here (attach additional pages if necessary r

Page 7 of 1 3

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.

1). CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section 2-1 56-1 10 ofthe Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter?

[]Yes ^No

NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.

Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.

Does the Matter involve a City Property Sale?

[ ] Yes /pfNo

I f you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature ofsuch interest"

Name Business Address Nature of interest

~i. lhe Disclosing Partv further certifies that no prohibited financial interest in the Matter will e acquired by anv C i:y official or employee.

E CE R fine. ATION REGARDING SLAVERY ERA BUSINESS

. s e:: 11 e i

or 2 below. If the Disclosing Party checks 2 ttacliireni to this EDS all information requnei

ICme s of 13

tlte Disclosing P;.u iv must by iianutianh 2 Failure u:

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 ■ 1 he Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

_ _ 2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names ofany and all slaves or slaveholders described in those records:

SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally

funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the 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):

(If no explanation appears or begins on the lines above, or ifthe letters "NA" or if tiie word "None" appear, it wd! 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 ihe Matter.)

2 The Disclosing Party has not spent and will not expend any federailv appropriated funds to pay any person or entity listed in Paiagraph A 1. above tor his or her lobbying activ ties or :o nay any person or eni it;-, n ■ :r flee nee or attempt to in Hue rice an o fficer or employee ol anv agency, as ie: med b .applicable iecieini .aw. a member ofCongress, an officer or employee ol" Congress, or an employee of menibei of Congiess. :n connection wnh the award ofany federally funded contract, making ;.ny federally funded grant or loan, entering into any cooperative agieemer.t, or to extend, conlmue, renew, amen;:, or modi.'- an\ lederaliy funded contract, giant, 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 ofthe statements and information set forth in paragraphs A.l. and A.2. above.

4. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in ''Lobbying Activities".

5 Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

Is the Disclosing Party the Applicant?

[ ] Yes

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.)

} Yes f } 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 ail reports due under the appiicable filing requirements?

[jYes [JNo

Have you participated in any previous contracts or subcontracts subject to the

equal opportunity clause'.'

I 1 No

I: you checked "\o" to cuiespon

or 2. above, please provide an explanation

Page 10 of 13

SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

Fhe certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 ofany 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 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.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
lt is the City's policy to make this document available to the public on its Internet site and/or upon request Some oi ah 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 ofany information submitted m this EDS.

E 'I'he mfoi maiion provided in this EDS must be kept currenl In the event of changes, lhe Disclosing 'Party must supplement litis EDS up lo the time the Cily lakes action on the Matter, if the Matter is a contract being handled by the City's Department of Procurement Seiv ices, ihe Disclosing Party must updaie thi-, EDS as the coniract icq in res NOTE: With respect to Matteis subject to Article 1 of Chapter 1-2? o' tlie Mmrcipal Code (imposing PERMANENT INELIGIBILITY ioi certain specified offenses;, the information, provided herein regarding eligibility must be kepi cunent lor a longer period, as requiie;.: by Chapier 1 23 and Section 2-154-020 ofihc Municipal Code.

'I'he Disclosing Pa:;v icprescnis and warrants lhat:

Pauc i I oi 13

F.2 ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 Ifthe 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 ofthe 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: Ifthe Disclosing Parly cannot certify as to any of the items in F.I., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

Under penalty of perjury, the person signing below: (1.) warrants that he/she is authorized to execute

this EDS and Appendix A (ifapplicable) on behalf ofthe Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (ifapplicable) are true, accurate and complete as of the date furnished to the City.

isclosing Party)

(Print or type name of Disc

By:

f J. .-, i

¹ 'JULLX.

( Print or ivpe name of person sicnum)

r, LLC

dr,

Sri+ ^no. j /Member; fcr.rv-htYt T>wel^«wf, lLCj Memhe

ft Hoiting, llc\; Member, ?P Forney MmaofC,

(Print oi type tide (Vf person sitrnintt.)

Sicneo run:: sv¹

a: 0 COiG.

\<6

■ hefoie mc on (date)

On. my. XL.

.omrnissnm c \ n: res.

(state)

Notarv Public

u F:-1 c. a i s f ■■■ i Nofe'v^Dnc sIa»VoV.M,no.:; Mr comm,_5s,on E>_l!l(e.,

"U[iu:A Ob ?OiK

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 inlerest 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 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 of the Disclosing Party listed in Section II.B. La., 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, ifthe 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. "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.

Docs tiie 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?

j j Yes .;X[ No

if yes, please identify below ! 1) the name and title ofsuch person, (2) the name ofthe legal entity to which such person is connected; (3j tlie name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature ofsuch familial relationship.

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION 1 - GENERAL INFORMATION

Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:

Bnnsmre holdi^, llc

Check ONE ofthe following throe boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

'£Q a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe

Applicant in which the Disclosing Party holds an interest: PPl-Gfll/ly LLQ

3. [ ] 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 ofthe Disclosing Party: ($(_9{q Dm rlfll& fc\ ,S^e 1(02.

Mar+ftbrook, \l (sOO(a±

Telephone: a^LM-ffflT-gftZFax: Email: Tm^O W^fiYlSho/^ Q^m
Name of contact person: iDfrVfd f?)^r1f~

i' Federal i n.pfo. .: identification No. (if you have one): _ _

F - Brief dcscnption of contract, tiansaciion or other undertaking (referred to below as the ' Matte:") to which this F.DS pertains. (Include project number and location ofproperly, ifapplicable): fKfipfO^'

Lou;-icc:G!ne HotUiHq rax Or?dc+j_; S-krfe TbiXtt/o^ Tax Or*dii*S_t4rd 1>ep*rwr)*r\i~ ef

flmnl/iij I TV^^M^if M^i'-rV^/y FW/V?/ fyr Van ?)ac<? Vaelopsnenl-

( i. Which Cr.y agency or dep:trtment is requesting this EDS'.^VXl DCV'f; \Ci/\l')cyYi

i f :'.! Scatter is n ^ontiaet hemiji handled bv the Cilv's Denarlmen; of Procurement Services, nlease

SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature ofthe Disclosing Pe [ ] Person

[ ] Publicly registered business corporation [ ] Privately held business corporation [ ] Sole proprietorship f ] General partnership [ ] Limited partnership [ ] Trust

ty:

Limited liability company [ ] Limited liability partnership [ ] Joint venture [ ] Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))?

[ ] Yes []No [ ] Other (please specify)

2. For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable:

1 Ll\MQ<£

3. For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[]Yes []No f^N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

there are no such members, write "no members." For trusts, estates or other similar entities, list below

the legal tiileholderf s;

Ifthe entity is a ueneial pat'.nership. limited partnership, limited liability company, limited liability partnership or join; \cuture, list below the name and title of each genera! parmer. managing member, manager or any oiher person or entity that controls the day-to-day management of the Disclosing Party. NOTE. Each legal eniiiy listed below must submit an EDS on its own behalf

Name Title

y nn$w/c. De.^.eio f<nr> uuq. .M.?'wbe.r

Please P! o\ue die lo lowing m leu maiion concerning each person or entity hr.\mg ;: direct or i bcnci'icnil interest (including ownership) in excess of 7.5% of the Disclosing Parly Example-. : an :n:erc>; inehiee shares in a corporation, partnership interest in a partnership or joint vcniuie.

interest ofa member or manager in a limited liability company, or interest ofa beneficiary ofa trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Inteiesi in the

Disclosing Party

fyiAShofa uevilofitiaiti LLC &U Dimci^c M-JtilioSi .Ncr+M&rctt,

-1^Jj2QDOlA ±QQJ/u_ _

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 J#Js^To

If yes, please identify below the name(s) ofsuch City elected official(s) and describe such relationship^):

SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Partv mast disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and tiny olher person or entity whom the Disclosing Parly has ictamed or expects :o retain :n connection wilh the Matter, as well as the nature of the relationship, and the total amount ofihc fees rut id or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely ihrough 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 nol-for-profit eniiiy, on an unpaid basis, or (2) himself "Lobbyist" also means any person or entity any pari of whose duties as an employee of another mchides undertaking to influence any legislative or administrative action.

ifthe Disclosing. Party is uncertain whether a disclosure is required under this Section, the Disclosine Par!\ nn.si eiiherask :he<h:y whether disclosure is required or make :he disclosure

Page 3 of 13

Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether

retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:

to he retained) lobbyist, etc.) "hourly rate" or "t.b.d." is

not an acceptable response.

(Add sheets if neccssaiy)

Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

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 [ ] 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 m compliance with that agreement?

f J Yes '' ' No

B FUR TH FR CERTIFICATIONS

I. Pursuant to Municipal (lode Chapter 1-23, Article i ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows- if; nctthci the Applicant nor any controlling person is currently indicted or charged with, or Mas admitted gird of. or has ever been convicted of, oi placer! under supervision for. any criminal offense involving aci,ml. attempted, or conspiracy to commit bribery, theft, fiaud. forgery, penury, dishonesty oi deceit against ;m officer or employee of ihe Cny or any sister agency, anc ini ihe Applicant uiKk:'s;;-::d-, and acknowledges thai compliance wiih Article i is a continuing lequiremeni f-u domg business v. pi; the ( ;ty NOTE ' i f A i tide I applies to the Applicant, ihe pe: maueni couiphnnce

2. The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft: forgery; bribery; falsification or destruction of records; making false statements: or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in 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.

3. 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 Mattel, including but not limited to all persons or legal entities disclosed undei Section IV, "Disclosure of Subcontractors and Other Retained Parties");

any "A ffiliated fruity" (meaning a person or entity that, directly or indirectly, eontiols the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia ofcontrol include, without limitation: interlocking management or ownership, identity of interests among family members, shared facilities and equipment, common use of employees, or organization ofa business entity lollowing the ineligibility ofa 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 Contir.etors, the term Affiliated Entity means a person or entity that directly or iiuiueci'y controls the Contractor, is controlled by it. or, with the Contractor, is under common contro. ol another pei.son or enlity.
any responsible official of the Disc'osing Party, any Contractoi or any A ; filiated Entiiy or any o;he: official, aneni er employee of tlie Disclosing Party, any Comiacioi or any A ffihaicd Entitv. acting pursui-m: to the dire*. .Ion or authorization ofa responsible official of the Disclosing Pnity. any Contractor or any A f: ilia'ed Entiiy (collectively "Agents").

1. bribed or attempted lo bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State oflllinois, or any agency ofthe federal government or ofany stale or local government in the United States of America, in that officer's or employee's official capacity;
2. 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, m restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
3. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Asseis Control ofthe U.S. Department ofthe Treasury or the Bureau ot' Industi v and Security ofihe U.S. Department of Commerce or theii successors' ihe Specially Designated Nationals List, ihe Denied Persons List, the Unverified List, the E^:ntity List and the Debarred List
The Disclosing P'uiv undersiands 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 Pmty is unable to certify to any ofihc above statements m ihis Part B (Further Certifications), the Disclosing Party must explain below

Page ( of 13

If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that ihe Disclosing Party certified to the above statements.

8. To the best ofihe Disclosing Party's knowledge after reasonable inquiry, the following is a complete iist of al! current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe Citv of Chicago (if none, indicate with "N/A" or "none").

M/fo _.' _.

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes 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 of the City recipient.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

The Disclosing Party certifies that the Disclosing Party (check one)

[jis p$ is not

a "financial institution" as defined m Section 2-32-455(b) ofthe Municipal Code.

Ifthe Disclosing Party IS a financial institution, then the Disclosing Parly pledges:

"We are noi ami will no: become a predatory lender as defined in Chapter 2-32 ofihe Municipal Code. We further pledge ihai none ofour affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofihc Municipal Code. Wc understand that becoming a predatoiy iender or becoming an affiliate of a piedatorv lender may result in the loss ofthe privilege of doing business wiih the City

if :h: Discios'rg Pure- :- unable io make this pledge because it or any of its affiliates (as define;' m Section 2■■ 32--ori b) of the Municipal Code) is a predatory lender wilhm the meaning of ( iiaptci

Ifthe letters "NA." the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Parly certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms lhat are defined in Chapter 2-1 56 of the Municipal Code have the same meanings when used in this Part D.

PI No

1. In accordance with Section 2-1 56-1 10 of the Municipal Code: Docs any official or employee ofthe City have a financial interest in his or her own name or in the name ofany other person or entiiy in the Matter?

[ 1 Yes

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.

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?

[ ] Yes

3 If yoti checked "Yes" to Item D.l provide the names and business addresses ofthe City officials or employees having such interest and identify the nature ofsuch interest:

Name

Nature of Interest

Business Address

I'he Discios:;; g )'.-.: :\ further certifies that no prohibited financial interest in ihe Matter will

be acciuued hv anv

xRiCNG SLAVERY ERA BUSINESS

ifthe D isc iosinrr Partv checks 2., die D isclosmii Pa:: v must

nitacnmeni to this I: DS a

disclose below or ;n

information r

required by paragraph 2 Fai uic to

Pace S 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.

I The Disclosing Party verifies that the Disclosing Party has searched any and all records of

the Disclosing Party and any and ai! predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the

Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names ofany and all slaves or slaveholders described in those records:

SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section V11. for purposes of this Section VI, lax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.

A. CERTIFICATION REGARDING LOBBYING

1. List below the names of all persons or entities registered under the federal Lobbying

Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter. (Add sheets if necessary):

(If no explanation appeals or begins on the lines above, or ifthe ieiters "NA" or if the word "Norte" appear, ii will be conclusively presumed thai the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Aci of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect :o the Matter.)

2 The Disclosing Par.y n.e no! speni and will noi expend any federally appropriated funds ;o pa; any person or e::'i'\ h-icu n i'mnuraph .A I rbove tor his or her lobbying nciiviiies or :o pnv anv person ur entity :o : iMuenee o: aiicnn! io milucr.ee an officer or employee of any agency, as defined rippiicab.c iederai law. a iverune" oi Congress, an officer or employee of Coiigiess. cn an employee o member oft ongicss. in conuecpon w::n ihe award ofany federally funded contract, making any federally funded grani or loan, entering m;o i.nv cooperative agreement, or to extend, conlmue. renew amend, or modi:\ air. 'cderaiiv iuncicd conlract. urant. loan, or cooperative aereemeni

.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 ofthe statements and information set forth in paragraphs A.l. and A.2. above.

The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?

[]Yes X^NoIf "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 4 1 CFR Par; 60-2.)

[ ] Yes [ 1 No

Have yon filed with tlie Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, os the Equal Employment Opportunity Commission all reports due under (he applicable filing requirements?

[]Yes j; j No

3 I lave you participated in any previous contracts or subcontracts subject to the equal opportunity clause'.'

^; Y es i ' N e

SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 ofany 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 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.

Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies 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 ah of the information provided on this EDS and any attachments to this EDS may be made available to the public ou ihe Interne:, in response to a Freedom of Information Act request, or otherwise By completing and s:gniug tins EDS, the Disclosing Party waives and releases any possible rights or chums which it may have against the City in connection with the public release of information contained in iii is FDS and also nmborizes ihe City to verily the accuracy ofany informanon submitted in ihis EDS.
The information provided m this EDS must he kepi current. In the event of changes, ;he Disclosing Party must supplement tins EDS up to the nine ihe City takes action on the Matter. Ifthe Matter is a contract being handled bv ihe City's Department of Piocuicment Services, the Disclosing Party musi updaie this EDS as ihe contrai ; reqni-es VOTE: With respect to Mailers subject to Ai tide I of Chapter 1-23 ofthe Mmi-apc! : ode rmposmg PERMANENT INELIGIBILITY forceitam specified offense--), the inlo;maiio;; p;o\ -nee herein repardirtg eligibility must be kepi cunent for a Ionucr period, as :equiier: by Chapter 1-23 and Section 2-15- 020 ofthe Municipal Code.

The Disclosing Party represents and wairants tha:.

Ihute I 1 of 1 ^

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 lhe City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPFS") maintained by the U. S. General Services Administration.

F.3 Ifthe 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 ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Parly has reason lo believe has not provided or cannot provide truthful certifications.

NOTE: If the Disclosing Party cannot certify as to any of the 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 (ifapplicable) 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 of the date furnished to the City.

hrmshore Holding _t li?

(Print oirjype name of Disclosing Party)

By: ll^Lf.

(Sign here)

DcWid hnnr

(Print or type name of person signing )

Prtsidem, -B^nf u^veiof merit, +y\p. j Member, Bnnjhore T)et/<*hf/nt/ftc MmM..._h frn/Untyc. Ho ioii . LLC

(Print or type title of person sign.tug)

x L~

S'gned and sworn

"C . Cooi^-

Corr.missior

Nonpublic stateon;.._r._s-iurjust OF, /Oifl

Votary Public

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any 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) ail executive officers ofthe Disclosing Party listed in Section II.B.l.a., ifthe Disclosing Party is a corporation; all partners of the Disclosing.Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means 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" v, ith an elected citv official or department head?

i J Ye.- J>No

If yes, please identify below (I) the name and title ofsuch person, (2) the name ofthe legal entity to which such, person is connected: il) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the pi ease nature ofsuch familial relalionship.

CITY OF CHICAGO ECONOMIC DISCLOSE)RE STATEMENT AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

Legal name of trie Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:

_ &OMh0f.t Oeveloprr^it, LLC __

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

pf 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: rp pQYYli/y LLC.

3. [ ] 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 ofthe Disclosing Party: CoOpU TX»f\d-ee Qd il 0 Z

Telephone: Wj-.?27-##Z Fax: <bUl-6Ul- WOi Email: l/lti &£>Bhmjkore- C6rr->
Name of contact person:

Tkvld brint

federal Employer Identification No (if you have one). .

E. Bi icf desc: ipt mm ofcontract. iransaciion or other undertaking (referred to bciow as the "Matte:"; to which ;h:s EDS pertains. (Include project number and location ofproperly. if applicable): -«^W/<>^⁰-^ Or- _

lquj- , ocootml hGU^.nti -rexk Cretins, Sbcu-e Vana\icw T6w CYed\u'_t cm\ titpCtrfnMnt at

dMOkll .?l)lW.o^£n^r MMJir&M'iiy...- Funds/u for fbrK Place. dli^lcfrruni-

^pepaA rvne a r of -Pio n n > noj

G. Wltlch City agency or department is lequesimg this EDS'- PtrYjl>r^,v' IcpfDfiyrr

Ifthe M iiiier is a coni raci be, eg handled by tlie C:ly^: s Department of Procurement Services, please complete tne ioi.owin

\ IT. (M-lll-l.

Pane : of \\

SECTION II -

- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature of the Disclosing P; j ] Person

[ ] Publicly registered business corporation f ] Privately held business corporation j ] Sole proprietorship [ ] General partnership [ ] Limited partnership [ ] Trust

Limited liability company [ ] Limited liability partnership [ ] Joint venture [ ] Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?

[ ] Yes [ ] No

[ ] Other (please specify)

2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:

X LLJ NO IS

For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[ 1 Yes [ 1 No J^N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

there are no such members, write "no members." For trusts, estates or other similar entities, list below

the legal titlehohier(s).

Title

Mennur

Ifthe entity \s a geneiai partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title ol each genera! partner, managing member, manage:^- 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

KJS iiioA ts'%(■. ^hmco inc-

Snnv Ekw \0f min:t_r. rnr-

2 Encase po'\icic the loihissuig informabon concerning each pe; sen or entity ha\ing a direct o; indirect beneficial interest (including ownership) ir. excess of 7.5% of the Disclosing Par ty. Examples ofsuch an interest include shares m a corporation, partnership interest in a paitncisiiip o: joint venture,

interest ofa member or manager in a limited liability company, or interest ofa beneficiary ofa trust, estate or olher similar entity. If none, state "None." NOTE: Pursuant lo Section 2-1 54-030 ofthe Municipal Code of Chicago ("Municipal Code"), the Cily 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

RJS tel¹ £stoie .SsfUiC.es, Tkic ^.UM. ttjjaifce &),Ma\ 02 J^Q^pfcc^, [.l ^

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 L^Jo

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and anv olher person or entity whom lhe Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofihe relalionship, and the total amouni of the ices paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely ihrough 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 entiiy oiher than: (1) a not-for-profit entiiy, on an unpaid basis, or (2) himself. "Lobbyist" also means anv person or entiiy any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.

If ihe Disclosing pa ity is uncertain whethei a disclosuie is required under this Section, the Disc.tn iug P;i;:v mils: either ;.o s the City whether disclosure is required or make ihe disclosure.

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.

(Add sheets if necessary)

[yc heck here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

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?

[JYes [ ] No J^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 ofall support owed and

is the person in compliance with that agreement?

f 1 Yes. ; I No

B FURTHER CERTIFiC.ATIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article l")(which the Applicant should consul; for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (:) neither the Applicant nor any controlling person is currently indicted or charged with, ot has admitted end: of. or has evei been convicted of. oi placed under supervision for, any criminal offense involving ac'.tiai. attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjure, dishonesty o: ciecei: against an officer or employee of the City or any sister agency, and (si) the Applicant uudcisiancls ami acknowledges thai compliance with Article 1 is a continuing requirement for doing business w ith trie ( :t\ NO fE. If Article i applies to tlie Applicant, tlie permanent compliance iimeiiame m Article I supersedes some five-year compliance timeframes m certifications 2 and 3 below-.

4 of

The Disclosing Party and, ifthe Disclosing Party is a legal entity, allof those persons or entities identified in Section II.B.l. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud: embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in 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 lo all persons or legal entities disclosed under

Section IV. "Disclosuie of Subcontractors and Other Retained Parties");

any "Affiliated Entity" (meaning a person or enlity 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 ofcontrol include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment, common use of employees; or organization ofa business entity lollowing ihe ineligibility ofa business entity to do business with federal or state or local government, including the City, using suhstaniially ihe same management, ownership, or principals as the ineligible entity): with respect to Contractors, the term Affiliated Entity means a person or entity thai directly or indirectly eontiols tlte Contractor, is controlled by it, or. v. ith ihe Contractor, is under common

emtio! of another peison o: entiiv,

any responsible official ofihe Disclosing Paity. any Contractor oi any A ffiliated Eniiiy or any oiner official, ag.cn: or employee of the Disclosing Parly, any Coiiiracior or any A ffiliaied Enti;\, acting p'.MSunr.i ie the direction oi autiiori/atiou ofa responsible official ofihe Disc'osmg Parly, any Contractor o: any Af:iha:ed Entiiy (collectively "Agents").

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 ofa Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:

1. 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 oflllinois, or any agency ofthe federal government or ofany state or local government in the United States of America, in that officer's or employee's official capacity;
2. 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
3. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Enlity is listed on any ofthe following lists

maintained by the Office of Foieign 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 Debancd Eisr.

The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-1 56 (Governmental Ethics) of the Municipal Code.
If die Disclosing Paity ,s unable to certify to any ofthe above statements m this Pan B (Further Certifications), the Disclosing Party must explain below:

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall currenl employees ofihe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe Citv of Chicago (if none, indicate with "N/A" or "none").

-W-

9. To the best ofthe Disclosing Parly's knowledge after reasonable inquiry, the following is a complete list ofall gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" docs 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 of the City recipient.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

The Disclosing Party certifies that the Disclosing Party (check one)

[ ] is Jfi is not

a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code

Ifthe. Disclosing Party IS a financial institution, ihen the Disclosing Party pledges:

"We are no; and will noi become a predatory lender as defined m Chapter 2-32 ofihe Municipal Code. We further pledge ihai none ofour affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofihe Municipal Code. Wc understand that becoming a predatory lender or becoming an affiliate ofa predatory lendei may result in lhe loss ofihe privilege of doing business with lhe City."

If the Disclosing party is unable lo make this pledge because ii or any of its affiliates (as defined in Section 2-32-455(b? ofihe Municipal Code; is a predatory lender wiihm the meaning of Chapier 2-32 ofihe Meniepop Code, oxplem here (aitach addiP.onai pages if necessary')-

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section 2-156-1 10 ofthe Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

[ ] Yes Jft 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 ^No

If you cheeked "Yes" to Item D.l , provide the names and business addresses ofthe City officials or employees having such interest and identify the nature ofsuch interest:

Name Business Address Nature of Interest

<1. The Disclosing Pnnv further certifies thai no prohibited financial interest in the Matter will be acquired bv any City official or employee

E. CER 1 IFK A"! 10 N REGARDING SEA V ER Y ERA BUSINESS

Please check eithe; 1. cu 2 below ifthe Disclosing Party checks 2., the Disclosing Partv must disclose below o: m an attachment to this EF)S ail information required by paragraph 2. Failure to

Pane * 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 ofall such records, including the names ofany and all slaves or slaveholders described in those records:

SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.

A. CERTIFICATION REGARDING LOBBYING

1. List below the names of all persons or entities registered under the federal Lobbying

Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with resect to the Matter: (Add sheets if necessary)-

(If no explanation appears or begms on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under ihe l.obhving Disclosure Aci of 1995 iiave made lobbying contacts on behalf of the Disclosing Party with respect to the Matter )

2. The Disclosing Paitv ha^ no: spent and will not expend any federally appropriated funds to pay anv pei son or enmy listed in Paragraph A 1 above for his or her lobbying activities or io nay any neison cn euiiiv to .loiuence oi attempt to mfiuer.ee an olfice: or employee ol any agency, as deimed f applicable federal law. a member nf Congress, an officer or employee ofCongress, or tin employee oi member ofCongress, m connection with the award ofany feudally funded contract, making any federnHv funded giant or loam entering into any cooperative agreement, or to extend, conlmue, renew.

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Parly is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. ihrough A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?

[]Yes pfNo If "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable, federal regulations'' iSee-M CFR Pari 60-2.)

[ 1 Yes i ] No

Have you filed wiih ihe Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Em ploy mem Opportunity Commission all reports due under ihe applicable filing requirements'⁵

I ■ Yes M No

3 Have you participated m any previous contracts or subcontracts subject to the equal opportunity clause'.'

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 ofany 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 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.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City, Remedies 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 ail ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on ihe 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 ii may have against the City m connection with the public release of information contained in this EDS and also authorizes ihe City to verily the accuracy of any information submitted in tins EDS

E. The information provided in this EDS must be kepi current in the event of changes, the Disclosing

Party must supplement this EDS up io the time the Citv takes action on the Matter. Ifthe Matter is a

contract being handled by ihe City's Department of Procurement Services, the Disclosing Party musi

uptime this EDS as the contract iequires. NOTE: With resnec: to Matters subject to Article I of

(hapter I ■■■ 2 3 ofthe Municipal Code (imposing PERMANENT IN ELIGIB1 LI IV foi ccitair. specified

oifcuses:. :he inloimiMio:-; provided he rem regard m.' c^; i :e i E11:' \ :nii>i ne kepi cuirenl lor a longer pepod.

as required by Chapter 1-23 and Section. 2-1 s4-020 ofihe Vi i.iucipa! ('ode.

The Disclosing Parry represents and warrants tha:.

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 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 Ifthe 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.I., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf ofthe 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 of the date furnished to the City.

(Print or type-name of Disclosing Party)

By: \ i>-V V- Cz:K""

(Sign here)

.1km. e>nnt _

(Print or tvne name of person smning)

Pre)-dint bn/if v^/^Wri-h, inc.)

(Print or :\pe title of person sn:nm£>)

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, lt is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., ifthe Disclosing Party is a corporation; all partners ofthe 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, ifthe Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary ofa 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?

[ J Yes J^No

If yes, please identity below ( I ) the name and title ofsuch person, (2) the name ofthe legal entity to which such person is connected: (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature ofsuch familial relationship.

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I -- GENERAL INFORMATION

A. Legal name ofihe Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:

U-

Check ONE of the follow ing three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

y[ a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe

Applicant in which the Disclosing Party holds an interest: ^ p fr/j₍ fy LjjQ

OR ⁷

3. [] 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:

B. Business address of the Disclosing Party: /jfeC? V(J-Y\(\rC Pd- WI/01

Telephone:-22^-^7-5062 Fax: PPQ^M- <WOf Email: TX\W%®&TinJfcre Ccni
Name of contact person- J)(l l/±fl (3/'//ji _

E Federal Employer Identification No. (if you have one):

E. Brief desci lptton of contract, transaction or other undertaking (referred to below as the "Matier") to which this EDS pertains (include project number and location of property, ifapplicable): ftpprcwj? #f

PW\-{\\m t tevefop/mewf Mu/fr"-fyi.mily... TurAing for Park- Piece 'Vevelopmcnl ■

Ci. Which City agency o: department is teuuestmg this EDS?_Qft£l t)6M-£lQpfYtf?nt" _.

If :he Vs utter is a contiact being handled by the City's Department ofProcireine.nl Services, please

jiiii

o j i e c i 11 c a t

\n !;l-OI-i:

SECTION II DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

[ j Limited liability company [ ] Limited liability partnership [] Joint venture [ ] Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?

1. Indicate the nature ofthe Disclosing Party: [ ] Person [ [ ] Publicly registered business corporation [

Limited partnership

Privately held business corporation [ [ ] Sole proprietorship [ 1 ] General partnership (]

[ ] Trust

[ j Yes [ ] No

[ j Other (please, specify)

2. For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable:

3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[ ] Yes

[]No

jtfN/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

1. List below the full names and titles of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below

the legal titleholder(s).

Ifthe entity is a general partnership, hunted partnership, limited liability company, limited liability partnership or joint venture, list below tlie name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.

N a m e

DMxi 8(M.H"

2 Please pro^-, ide ihe io.low me m!o; miiiiou concerning each person or entity having dnee: or muirect beneficial nteiesi (incimEug owreiship] ,;i excess of ⁷ 5% ofihe Disclosing Party. Examples of sac!; an micics; include shares in a c>■:po:ation. partnership mteres: m a partnership or joint ventuie.

interest ofa member or manager in a limited liability company, or interest ofa beneficiary ofa trust, estate or oiher similar entiiy. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the

Disclosing Party

lyxtiti . a^fc %AA\(b)orx^n±J±m^_t m%

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 JN No

If yes, please identify below the name(s) of such City elected official(s) and describe such

relationship(s):

SECTION IV DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any oiher person or entity whom the Disclosing Party has retained or expects lo retain :n connection with she Matter, as well as the nature ofihe relationship, and the total amount ofthe fees paid or estimated to be paid, lhe Disclosing Party is not required to disclose employees who are paid solely ihrough the Disclosing Parly's regular payroll.

"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any peison oi entity other than: (1 ) a not-for-profit entity, on an unpaid basis, or (2) himseir . "Lobby ist" also means any pei son or entiiy any part of whose duties as an employee of another includes undertaking to influence anv legislative or administrative action.

Ifthe Disciosiu::.: Partv m miceriam whether v. disclosure is recinred under this Section, the Disclosing Pi.ii:y miisi either nsk ihe (I i\ \\ bethel disciosmc is ieqinred or make ihe disclosure.

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.

(Add sheets if necessary)

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

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 ^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 ofall support owed and

is the person in compliance with that agreement?

i j Yes { ' No

B LU R T H FR C L RT 1FIC A 'I IONS

I Pursuant to Municipal Code Chapter i .IE Article I ("Article E')(which the Applicant should consult for defined terms (e.g., ''doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the (.ity, then ihe Disclosing Party certifies as follows' (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of. or he-, ever been convicted of. or placed under supervision for. any criminal offense involving actual, aitcmptcd. or conspiracy lo commit bribery, theft, iraud, ioigcry, pcrpirv. dishonesty or deceit an.mo ; an office; or employee of the City o: any sislei agency; and (ii j die Applicant undeisiamls and acknowledges that compliance with .Article I is a continuing requirement lor domm besmess with 'he Ciiv NO'!'!- E' Aiiicle I applies ,o fit Applicant, the permanent compliance timeframe m Aiiicle 1 supersedes some f;ve-\ear compliance timelrarries in cer!11 icaiions 2 and 3 below.

The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting lo obtain, or performing a public (federal, stale or local) transaction or contract under a public transaction: a violation of federal or state antitrust statutes; fraud; embezzlement; theft: forgery, bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any

state, or any other unit of local government.

The certifications in subparts 3, 4 and 5 concern:

the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in

connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV. "Disclosure of Subcontractors and Other Retained Parties"); ' any "Affiliated Entity" (meaning a person or entiiy that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Parly, under common conirol of another person or enlity. Indicia ofcontrol 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 lollowing the ineligibility ofa business entity to do business with federal or state or local government, including the Cily, using substantially the same management, ownership, or principals as the ineligible entity): with respect lo Contractors, ihe iern: Affiliated Entity means a person or enlily that directly or indirectly controls ihe Conlraclor. is controlled by ii, or, with lhe Conlraclor, is under common control of another person or entity,

any responsible offical ofihe Disclosing Party, any Contractor or any Affiliated Entity or any oihei officiai, agent or employee o: die Disclosing Party, any Contractor or any A ffiliated Entity, aciing ruirsmin: io the direction oi :o thon/mion o: a responsible official ofthe Disclosing Parly, any Contractor or any Affiliated Entiiv ;coiieci:vely "Agents").

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 oflllinois, or any agency ofthe federal government or ofany slate or local government in the United States of America, in that officer's or employee's official capacity,
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists

maintained by the Office of IA>;e:gn Asseis 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 fist, tlte Denied Persons List, the Unverified List, the Entity List and the Debarred List.

'I'he Disclosing Party nude stands 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.
Ifthe Disclosing Party is unable to certify to any of the above statements in tins Part B (Further Certifications), the Disciosini.: !'ar:\ mi.-j explain below*

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").

N/ft I __

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or lo the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $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.

JUA

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

The Disclosing Party certifies that the Disclosing Party (check one)

[ ]>^s j^'S not

a "financial institution" as defined m Section 2 ■ 3 2 - 4 5 5 (b) ofthe Municipal Code.

Ifthe Disclosing Pasty IS a financial m-iitution, then the Disclosing Party pledges.

"We arc not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We furthei pledge ti st none of oui affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code Wc understand that becoming a predatory lender or becoming an affiliate of a predatory 'ender may result in the loss ofthe privilege of doing business with the Cuv "

If lhe Disclosing Pariv is unable to n :>kc this pledge because it or any of its affiliates (as defined in Section 2--32-'i55/h) of the M unieqed Code) is a predaiory lender within the meaning of Chapter

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-1 56 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section 2-1 56-1 10 of the Municipal Code: Docs any official or employee ofthe City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter?

[JYes DTNo

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 ofany property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.

Does the Matter involve a City Property Sale?

[ ] Yes rXNo

If you checked "Yes" to Item D 1., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature ofsuch interest:

Name Business. Address. Nature of Interest

4 lhe Disclosing Paiiv i m Uer ce:: i! :es that no prohibited financial interest, in the Matter w id be acquired by any Ci:y official oi employee.

E CERT lEICATlON HI GAEUiNC si A Y i !: 3 ERA BUSINESS

Please check either I or 2. below i; :hc Disc losing Party checks 2 ihe Disclosing Party must disclose nolo v. or m art eiiachmem :o this (UTS aii mfoiinaiion required by paiagraph 2 Emm re to

comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all piedecessor 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 Parly has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Parly verifies that the following constitutes full disclosure ofall 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

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 Parly with respeel to the Matter. (Add sheets if necessary)-

(If no explanation appears or begins on the ! tr.cs above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed thai the Disclosing Parly means that NO persons or entities registered under the Lobbying Disclosuie Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)

2 The Disclosing Parly has not so em. and will not expend any federally appropriated funds to pay any person oi entity listed in Pioagiaph A : above for ins or her lobbying activities or lo pay any person or entity to in flue rice or ,e temp; to :n flue nee an o ffieer or employee of any a gen eye as dc! in en by applicable ledeiai bus . a member e f eo.m,.; o-g an ofheer or employee ofCongress. or an employee ol a mcrnbei of Congress, in connection with :1m award ofany federally funded contract, making any federally funded gran; or loam entering into any cooperative agreement, or to extend, continue, renew, .'.mend, or modify am. fedemlA funded cm.:: act. giant, loan, or cooperative agreement.

P,me v i > f i 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 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(e)(4) ofthe 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".
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.L through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?

[]Yes J^No If "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 4! CFR Part 60-2.!

M Yes [ j No

Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Fquai Employment Opportunity Commission all reports due under the applicable filing requiiements''

f ! Yes ; "j No

Have you participated m any previous contracts or subcontracts subject to the equal opportunity clause?

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 ofany 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 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.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies 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 io make ihis document available to the public on its Internet site and/or upon request. Some or all of ihe infonnation piovided on this EDS and any attachments to this EDS may be made available to the public on the internet, m response to a Freedom of Information Aci request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection wilh the public release of information contained in this EDS and also authorizes the City to verify ihe accuracy ofany information submitted in this EDS.

E The information provided in this EDS must be kepi currenl. In the event of changes, the Disclosing Party must supplement this EDS up io the time the City takes action on the Matter. If lhe Matter is a contiact being handled by the City's Department of Procurement Services, the Disclosing Party must update ihis E: )\ a- ;he contract ■cqinres NOTE: With respect io Matters subject to Article 1 of Chanter 1-23 ofthe Municipal < ode 'imposing PERMANENT INELIGIBILITY for eeriam specified offenses), me inuirmaimn prnvmcd herein regarding eligibility must be kept current foi a longer period, as icquired by Clhapie: ' -23 am.: Secfon 2-1 5'H)20 of the Municipal Code

The Disclosing Pari¹- represents and warrants thar

Page : 1 of 13

F.2 Jf the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 Ifthe 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 ofthe City, use any such contractor/subcontractor that does not provide such certifications or lhat 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 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 (ifapplicable) 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 of the date furnished to the City.

(Print or type name of Disclosing Party)

ImiiMt.

(Print or type title of person signing)

istatej.

Signed and sworn io belorc me on (date)

County, XL-

i j-\ hhUSU f r^F'^C'AL SEAL V KuOiic. State of Illinois Commission Expires Aoqusi OS. 201S

■mm:s.s:ou expire

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, ifthe 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. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising .similar authority.

Does the Disclosing Parly oi tiny "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?

[ j Yes

If yes, please identify below (1) the name and title ofsuch person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person lias a familial relationship, and (4) the precise nature ofsuch familial relationship.

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:

R~3S Zeal ZsYate Series_# 3h<2 .

Check ONE of the lollowing three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

\X. a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe

Applicant in which the Disclosing Party holds an interest: 'QP f-ClVYlt /V', LL.C

3. [] 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: jfJifj} Cu/vi^g P^l - Tr^rllO'2.

7e\e»hone:d&^Ll-4Zl-&53 Fax: 9Ml'j&2-QM Email: g/^hS(ftfoii*ffarg Ccs^
Name of contact person: ^{(hfJLKcl Sti Offl'(\Q
Federal Employer identification No (if you have one):
Brief description of eoninici, transaction or oilier undertaking (referred tn below as the "Matter") to which tins EDS pertains. (Include project number and location of property, ifapplicable): Ap^CcjrJl erf

LoLv--£r>cjD<Y\e. rlocAjincj Tax c fed'tr, S-fcttc Ponoti'on tcxx cr-?cl'fj, one) uefc^menr of ?Kwfiif\(j SVevtiopmin-t Mm/H'-family fondly kr %fi<- ?\Q(\~ 'bevplopnmii-

-pepavf W ' > -j- c-f- Plan rn m

G Which City agency or department is requesting this EDS?J5mcT f^V^^p^C^aD")~ ^

If ihe Matter is a conlract being handled by the City's Department of Procurement Services, please complete the following

Specification ' _ _ _ and Contract __

Ver. 01 -Ul -I 2

Page I of 13

SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature ofthe Disclosing Party: [ ] Person f

[ ] Publicly registered business corporation ffi. Privately held business corporation [ ] Sole proprietorship [ ] General partnership [ ] Limited partnership [ ] Trust

! ] Limited liability company [ ] Limited liability partnership [ ] Joint venture [ j Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))?

[ ] Yes [ ] No

[ ] Other (please specify)

2. For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable:

j \ \[{16\S

3. For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[]No

[ ] Yes

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

1. 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).

Ifthe entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each genera! partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party NOTE: Each legal entiiy listed below must submit an EDS on its own behalf.

Name

ilk

Mmi her/ Ouurw

111 Please piovide die following mfoimmiion concerning each nei --on entity him me. dueci oi indirect beneficial mteiest (including owiteiship) in excess of 7.5% of the Disclosing Party Examples ofsuch an interest include shaies in a corporation, partnership inlerest in a partnership or joint venture.

interest ofa 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 2-1 54-030 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

diehard MOrHM, titill Dundee £/j &lloⁱL_l NofrinWo0k_f \LQ>Do{q2_; [od

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 ANo

If yes, please identify below the name(s) ofsuch City elected official(s) and describe such relationship(s):

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney,

lobbyist, accountant, consultant and any other person or enlity 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 amounl ofthe 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.

Ifthe Disclosing Parly is uncertain whether a disclosure is required under this Section. lhc Disclosing Paiiy must either ask ihe City whether disclosure is required or make the disclosure

Page 3 of !3

Name (indicate whether Business retained or anticipated Address to be retained)

Relationship to Disclosing Party Fees (indicate whether

(subcontractor, attorney, paid or estimated.) NOTE:

lobbyist, etc.) "hourly rate" or "t.b.d." is

not an acceptable response.

(Add sheets if necessary)

Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

SECTION V -- CERTIFICATIONS

A. 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

[ ] 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?

1 No

[ 1 Yes

B. FURTHER CERTIFICATIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(whieh the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Paity certifies as follows^- (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, ot 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 o i ficer or employ ec ofthe City or an v sisiei agency; and (ii) the Applicant understands and tick now ledges that compliance with Article I is a continuing require mem io; doing business with the City. '\ii : 2 if Amcic I applies to the .Applicant, the peinianeni compliance timeframe m Article I suoeisedc< some five-vear compliance timeframes m certifications 2 and 3 below

2. The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against (hem in connection with: obtaining, attempting lo obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in 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.

3. 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"); ■ any "Affiliated Enlily" (meaning a person or entity that, directly or indirectly, controls the Disclosing Parly, is controlled by the Disclosing Parly, or is, with the Disclosing Patty, under common control of another person or enlity. Indicia ofcontrol include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees: or organization ofa business enlity following the ineligibility ofa business entity to do business with federal or stale or local government, including the City, using substantially the same management, ownership, or principals as the Ineligible enlily): 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 enlity;

any responsible official ofthe Disclosing Party, any Contractor or anv Affiliated Entity or any other o f' i...: a'. agent or employee ofihc Disclosing Parly, anv Conlraclor or any Affiliated Entity, ;te!:r;g 'pursuant to ihe direction oi anthem; nation ol a responsible ol'n'iai oi the Dismosm;:: Pari'., anv Contractor or any Affilialed Entiiy (collectively "Agents").

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entiiy 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 ofa Contractor during the five years before the date ofsuch Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:

1. 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 oflllinois, or any agency ofthe federal government or of any slate or local government in the United Stales of America, in that officer's or employee's official capacity;
2. 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
3. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists

maintained by the Office of Foreign Assets Control ofthe EES. 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 Li si.

The Disclosing Party understand:- and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2.-1 56 (Governmental Ethics) ofthe Municipal Code.
Ifthe Disclosing Party is unable ;o certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Paity mus: explain below

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Parly certified to the above statements.

8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicaeo (if none, indicate with "N/A" or "none").

-ti/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 during 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.

-tm

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

The Disclosing Party certifies that the Disclosing Party (check one)

[ ] is J&}^s ^not

a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.

Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges.

"Wc are not and will not become a predatoiy lenciei as defined in Chapter 2-32 ofthe Municipal Code. Wc further pledge thai none ofour 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 precatory lender may result in ihe loss of ihe privilege of doing business with the City "

If the Disclosing Parry is unable to make this pledge because i: or any of its. affiliates (as defined in Section 2-32-453(b) of ihe Municipal (. ode) is a vuedatoiy lender within the meaning of Chaptei

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed lhat the Disclosing Party certified lo the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-1 56 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section 2-1 56-1 10 of the Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

[ ] Yes 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 [J(No

If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature ofsuch interest:

Name Business Address Nature of Interest

4 The Disclosing Party further cer.ilies tha: no prohibited financial interest in the Matter will be acquired by anv Cuy official or euip.oyee

E. CER'i IF iCA fiON REGARDING cjE.-'-.V; -RV I.KA BUSINESS

Please check cither I or 2 below. ' f the DisIomiig Party checks 2., the Disclosing Party must disclose below oi m an attachment to :h.s 1 DS ;.!! information returned b\ paragraph 2 Failure to

comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

/J^_\. 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 rhe 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 I 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 disclosuie of all such records, including the names ofany and all slaves or slaveholders described in those records:

SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

A. CERTIFICATION REGARDING LOBBYING

1. List below the names ofall persons or entities registered under the federal Lobbying

Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with

respect to the Matter: (Add sheets if necessary).

(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of i 995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter )

2. The Disclosing Party has not srsent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A I alio-, e io: his or her lobbying activities or to pay any person or entity io influence or at ten ioi to in i Lie nee an o i'i icer or employee o f any agency, as defined by applicable fedeial law, a member oi \ 'emigre-:--, en office; or employee ofCongress, or an employee oi a member of Contiress. ir: connection with ihe award of anv icderallv iunded conlract. maknut anv federally funded grant or loan, enieimg into any eooper.;'.: ec agreement, or to extend, continue, renew,

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
Ifthe Disclosing Party is ihe Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?

[]Yes $>£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.)

[ i Yes f ] No

Have you filed with the Joint Repotting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the: Equal Employment Opportunity Commission all reports due under ihe applicable filing requirements''

[ 1 Yes [ j No

3 Have you participated in any previous contracts or subcontracts subject to ihe equal opportunity clause?

; j Yes I 1 No

'f you cheeked "No" to 'question ' o; 2 above please provide an explanapon.

SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

A The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 ofany contract or taking other action with respect io 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 full text of these ordinances and a training program is available on line at www.citvofchicago.org/Ethics. and may also be obtained from the City's Board of Ethics, 740 N.

Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
lt is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, lit response to a Freedom oi'Information Act request, or otherwise. By completing and signing this EDS. the D.sclosir.g 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 authonzes the City to verify the accuracy ofany 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 ihis EDS up to the tunc tlte Citv takes action or. the Matter. Ifthe Matter is a contract belna handled bv the City's Dcpaitmcni of Procurement Services, ihe Disclosing Party must update this EDS as the coniraci requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenscsi. the information provided herein rcmdim- e-;ei!ulp\ must be kepi current fore 'onge: penod. as i cci l: i red by Chapter 1-23 and Section 2-153-020 ofihe Vhmicipal Code

The Disclosing Party represents and warrants thai.

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 Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection 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 of the items in F. 1., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

certifications and statements contained in this EDS and Appendix A (ifapplicable) are true, accurate and complete as of the date furnished to the City.

frrs gfagfetefcservi^JYic.

(Print or type name of Disclosing Party)

B^^Z - UP_^

(Sign here)

XirMrrl Scio^nn

(Print or type name of person signing)

Vmt&hft

(Print or type title of person signing)

Signed and sworn to before me on (dare) Dt?-£> ■ \ (}fi^l-^L[

at d<rxrK~~ County, (((fA^'S _ (state).

(

UtKK

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe 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. "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 ofticiai or department head?

If yes, please identify below (1) the name and title ofsuch person, (2) the name ofthe legal entity to which such person is connected: (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nattue of .such familial relationship.

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:

. rx",.^pn?-/ llc - Seoes fbr\c PIac^

Check ONE ofthe following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

1. [ ] the Applicant

2. 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: Y P F&flli \y_} L-Lft

3. [ ] a legal entity with a right ofcontrol (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: 17$/ u) <>+

QnWiO., iu ?

Telephone: TixtHh X<t 3tt Email: C£HtO>0 8/^ °M>
Name of contact person:
Federal Employer Identification No. (if you have one): _J \

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, ifapplicable): Apff(0<l<2$ of

louj-t'KtjMe. Houring ~ra* credit/, Me ^nok'^K to* 6f(6\b dwd tjeparmvent

Which City agency or department is requesting this EDS? AvVfA Oc?V't'J frp (Y\- t% f

If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:

and Contract ??

Specification ~

SECTION II -

- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature of the Disclosing Partv:

[ ] Person

[ j Publicly registered business corporatioi

[ ] Privately held business corporation

[ ] Sole proprietorship

[ ] General partnership

[ ] Limited partnership

[ ] Trust

^ Limited liability company

[ i Limited liability partnership

[ ] Joint venture

[ ] Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))?

[ ] Yes [ ] No

[ ] Other (please specify)

For legal entities, the state (or foreign country) of incorporation or organization, if applicable:

3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[JYes

[]N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

List below the full names and titles ofall executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).

manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.

Name <. , - Uf/Ylfcrll - ^Tule

^y fine/ nvM-l/K MfKds KeiC^hrnrtCnu-,

P(V> .U:Cv):r3 -Chao rnui^ ₀r ?:ca\d '£>cc.\(\ ^cmY)-ejkx ?}\ct...Qisi{\ I

t(CV\g CAiiM:. ;Pff?_Si. d&XtA ttO OO-Vl .QfOc J'mYl (\_]cCu\l&>$ h,

l?ctVfj.c£L.lic.hri-u-iA/\md V;c{ - "\:_cn$-Life/ Cesc\( Do-;ai, na . _.

Please provide the following information cor.ceining each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% ofthe Disclosing Parly. Examples ofsuch an interest include shaies m a eorpm aiiun, pai mciskip intercsl in a partnership or joint venture.

interest ofa member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the

^ ^ i Disclosing Party

fyf^snsdb&te. iJlLhtlllllL /' _o/

\^h6u£kftr-l<>ok> (LoorlUL fUhGHrO it- (00/6

SECTION III BUSINESS RELATIONSHIPS 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?

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

SECTION IV ~ DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total

amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who aie 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 cf whose duties as an employee of another includes undertaking to influence any legislative or administrative action.

Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.

Page 3 of

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.

(Add sheets if necessary)

here if the Disclosing Party has not retained, nor expects to 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 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

[ ] No person directly or indirectly owns 10% or more ofthe

Disclosing Party.

If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?

[ ] Yes [ ] No

B. FURTHER CERTIFICATIONS

1. Pursuant to Municipal Code Chapter 3 -23, Article I ("Article 1")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit againsl ;m officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges thai compliance with Article I is a continuing requirement for doing business with rhe City. NOTE: if Article 1 applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

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;

1. have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
2. 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;
3. 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
4. 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");

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 ofcontrol include, without limitation^-interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization ofa business entiiy following the ineligibility ofa 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 ofthe Disclosing Party, any Contractor or arty Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization ofa responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively ' Agents")

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 ofsuch 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 of the City, the State of Illinois, or any agency of the federal government or ofany state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in

violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.

Neither the Disclosing Party nor any Affiliated Entity is listed on 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 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.

The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector Genera!) 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:

If the letters "N A," 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.

To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").

~~Jlfi-~~ ETTZTTI-

To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during 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 S20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION 1. The Disclosing Party certifies that the Disclosing Party (check one)

a "financial institution" as defined in Section 2-32-455(b) ofthe 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 ofthe Municipal Code. We further pledge that none ofour affiliates is, ar.d 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 ofa predatory lender may result m (he loss ofthe privilege uf 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 2-32-4 5 5(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)

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter? /

[} Yes tfWo

NOTE: If you checked "Yes" to Item D.U, proceed to Items D.2. and D.3. If you checked "No" to Item D.U, 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 [sj/uo

If you checked "Yes" to Item D.U, 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

comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

y 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the

Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names ofany and all slaves or slaveholders described in those records:

SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: Ifthe Matter is federally funded, complete this Section VI. Ifthe 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

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):

(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that tlie Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf ofthe 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 entiiy listed in Paragraph A.!. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee ofany agency, a.s defined by applicable federal law, a member ofCongress, an officer or employee ofCongress, or an employee ofa member of Congress, in connection with the award ofany federally funded contract, making any federally funded grant or loam entering into any cooperative agieement, or tu extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agieement.

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) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".

If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain al! such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?

[]Yes

If "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)

[ ] Yes [ ] No

Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?

[ ] Yes [ ] No

Have you participated in any previous contracts or .subcontracts subject to the equal opportunity clause?

'[jYes []No

If you checked "No" to question 1. or 2. above, please provide an explanation-

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 full text of these ordinances and a training program is available on line at www.cityofchicaRO.orR/Ethics, and may also be obtained from the City's Board of Ethics, 740 N.

Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies 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 ofany 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 tune the City takes action on the Matter. Ifthe 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 1 of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kepi current for a longer period, as required by Chapter 1 -23 and Section 2-;54-030 ofthe Municipal Code

'The Disclosing Party represents and warrants that

F.I. The Disclosing Party is not delinquent in the payment ofany 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 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P. A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 If the Disclosing 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 of the 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.

LHjrMc G.»ioo

(Print or type name of person signing)

fel^f

(Print or type title of person signing)

Signed and sworn to before me on (date) u;Q:VT.!.>ev" H' / ''O^l .

at Coo 'f-. _ County, J.\\\>--Q >■■■■ (state).

f ' < ! !'""■

MtvlbtVw -l-A i_Jil^:I'>Ljb^\ _ Notary Public.

T " "~^x"~ ' "' '" 7"

Commission expires. (;'/ - i-U '^'Uuq .

OFFICIAL SEAL MARIA G HEVAREZ Notary Public - Slate of lilinols

*=tf Page 12 of 13

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B. La., 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 ofthe Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently

have a "familial relationship" with an elected city official or department head?

[ ] Yes

If yes, please identify below (1) the name and title ofsuch person, (2) the name of the legal entity to which such person is connected: (3) the name and title ofthe elected city official or department iiead to whom such person has a familial relationship, and (4) the precise nature ofsuch familial relationship.

P?u-e 13 of i'i

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I -- GENERAL INFORMATION

Legal name of the Disclosing Party submitting this FDS. Include d/b/a/ if applicable:

cf fhe Yank b/ei/jh\x>rhood Cmmil

Check ONE ofthe following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

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: rr PtffYlify l~LC

3. [ ] 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: ^J. ^1 " ^<^^>^~ . A.

I- (syc^>0^cl

Telephone: fa 441k Fax: 3^3S><r Email: CjlMiCO & ty$G*OU
Name of contact person:
Federal Employer Identification No. (if you have one): '

F. Brief description of contract, transaction oi other undertaking (referred to below as the "Matter") to

which this EDS pertains. (Include project number and location of property, ifapplicable): fappccilod cf

Uco-^CG'^ rtcusii^ itxx Qfediis, S-ra+ti fcfvrtfcrt tcvc CceAi^, arid ^par+mert/-

o^piflrini^i & n?\iQ\offnen^ Mulh- for^ly Fundiy (vr PflriL-Pfaee Dei/obpmesit.

p e v⁰ C< r r- t(Ys £ , y v c v- p i a. n n i .n a

G. Which City agency or department is requesting this EDS?Qry1 T>?V■?\0j p ri f r

Ifthe Matter is a contract being handled by lhc City's Department of Procurement Services, please complete the following:

Specification # and Contract « _

Ver. 01-01-12

SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

[ ] Limited liability company [ ] Limited liability partnership [ ] Joint venture

Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?

1. Indicate the nature ofthe Disclosing Party:

] Person [

] Publicly registered business corporation [

] Privately held business corporation [

] Sole proprietorship

fv^Yes []No [] Other (please specify)

] General partnership (I

] Limited partnership

] Trust [

2. For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable:

3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[JYes

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

1. 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 genera] 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

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 Parly Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,

Page 7 of 13

interest of a member or manager in a limited liability company, or interest ofa beneficiary ofa trust,-estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name

Business Address

Percentage Interest in the Disclosing Party

SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS

Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?

UYes

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total

amount of the fees paid or estimated lo 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 enlity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, or. 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.

Ifthe 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

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.

(Add sheets if necessary)

[t^'Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS

COURT-ORDERED CHILD SUPPORT COMPLIANCE

Under Municipal Code Section 2-92-4 3 5, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.

Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?

[ ] Yes [ ] No K/No person directly or indirectly owns 10% or more of the

Disclosing Party.

If "Yes," has the^: person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?

[ ] Yes [ ] No

FURTHER CERTIFICATIONS

i Pursuant to Municipal Code Chapter 1 -23, Article 1 ("Article J")(w!;ich the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Parly submitting this EDS is the Applicant and is doing business with the City, ihen the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article i is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in ceitificattons 2 and 3 below.

The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery, bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any 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");
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 ofcontrol 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 ofa business entity to do business with federal or state or local government, including tiie 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 ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Parly, any Cor.tracioi or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively ''Agents")

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 ofsuch 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 of the City, the State 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;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office 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.

6 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.

7. ifthe Disclosing Parly is unable io certify to any ofthe above statements in this Part 8 (Further Certifications), the Disclosing Party must explain below:

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").

9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, 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 S20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

1. The Disclosing Party certifies that the Disclosing Party (check one)

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 ofthe Municipal Code. We further pledge that none ofour affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofihe Municipal Code. We understand that becoming a predatory 'lender or becoming an affiliate of a predatory lender may result in the loss of ihe privilege of doing business with the City."

Ifthe Disclosing Party is unable to make this pledge because ii or any of its affiliates (a.s defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender w::n;r. tlie meaning of Chapter 2 32 ofthe Municipal Code, explain here* (attach additional pages if necessary)-

If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have ihe same meanings when used in this Part D.

In accordance with Section 2-156-1 10 of the Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter? /

[]Ycs IVNo

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?

[]Ycs [yJiNo

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.

E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

Please check either i or 2. beiov. Ifthe Disclosing Party checks 2 , tne Disc losing Party mus: c'i.e lee below ur in aii aitaciuuen: to this EDS all information required by ::eu ni!,; aph 2 Fa J ere ie

rage So! 13

comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

V 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 ofall such records, including the names ofany and all slaves or slaveholders described in those records;

SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. Ifthe 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

1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):

(If no explanation appears or begins on the lines above, or if the letters "NA^:' or if rhe word ^|:Nonc" appear, it will be conclusively presumed thai the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party 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 enlity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of tiny agency, as defined b applicable federal law, a member ofCongress, an officer or employee of Congress, or an employee of member ofCongress, in connection with the award of any federally funded contract, making any federally funded grant or loan, enlenniJ into any cooperative agreement, or ir ouend, coiUmne. renew amend, or modify any federally funded conrract, grnnl. !u«n, or coopeiaiive agieeirenl.

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 1 986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".

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 City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

Is the Disclosing Party the Applicant?

[ ] Yes

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.)

[]No

[]Ycs

1 ] No

2. Have you filed with the Joint Reporting Committee, the. Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?

[ ] Yes

3. Have you participat equal opportunity clause? [ 1 Yes

:ed in any previous contracts or subcontracts subjecl to the

1 f you checked "No" to question 1. or 2. above, please provide an explanation

SECTION VII-- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 full text of these ordinances and a training program is available on line at www.cityofchicago.ore/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.

Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies 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

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. Ifthe 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 subjecl to Article 1 of Chapter 1-23 ofihe Municipal Code (imposing PERMANENT INELIGIBILITY lor certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter :-23 and Section 2-154-020 ofthe Municipal Code

The Disclosing Party represenrs and warrants that'

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 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will net use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 Ifthe 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.U and F.2. above and will not, without the prior written consent ofthe 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 F.U, 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 of the date furnished to the City.

(Print or type name of Disclosing Party)

By: (/^^ OAtS?

(Sign he$

clAifr CMico

(Print or type name of person signing)

{£u>i& it^r

iPnnt or type title of person signing)

Signed and sworn to before me on (date) / C pr)": \")<-' '" [_/ ■

at '. CO 1/ County. "SJ\, no \ '-. fstate).

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.

"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section ILB.l.a., ifthe Disclosing Party is a corporation; all partners ofthe 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 ofthe Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary ofa 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, plensc identify below (1) the name and title ofsuch person, (2) the name ofthe legal entiiy 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 ofsuch familial relationship.

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

S E C 110 N I -- G E N E R A L IN FO R M A TIO N

Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:

LJS, Bancorp Community Development Corporation

Check ONE ofthe lollowing three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

[yj 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: PP Family, LLC (expected to hold 99.99%

OR interest at closing)

3. [] 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 ofcontrol:

Business address of the Disclosing Party: 1307 Washington Avenue, Suite 300

St. Louis, MO 63103

Telephone: 314-335-2600 Fax: 314-335-2601 Email: kacey.mahrt(a>usbank.com
Name of contact person Kacev Mahrl

L. Federal Employer Identification No. (Tf you have one): ' ''

F. Brief description ol contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location ofproperly, ifapplicable)

-Quistruction ol 78 nm I s ol allurdahle housing

Department ol

Ci. Which City agency or department is requesting this EDS? Planning and_Development (DPP)

Ifthe Mailer is a contract being handled by the City's Department of Proeureinenl Services, please complete the follow mg

Specification *;' NA and Conlract // NA

\ it. (ii-oi-i:

I'aiee 1 of 13

SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature ofthe Disclosing | ] Person

| | Publicly registered business corporation [X] Privately held business corporation [ ] Sole proprietorship [ ] General partnership [ ] Limited partnership | ] Trust

Party:

| ] Limited liability company

[ ] Limited liability partnership

[ ] Joint venture

[ ] Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))'.'

! I Yes ! I No

[ | Other (please speeify)

2. For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable:

Minnesota corporation

For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[X] Yes

[]No

[ ] 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 arc no such members, write "no members." For trusts, estates or other similar entities, list below the legal tillehoklcr(s).

Ifthe entity is a general partnership, limited partnership, limited liability company, limited liabilily partnership or joint venture, list below the name and title of each general partner, managing member, manager or any oilier person or entiiy that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.

Name Title

Za.ch.ar.yJk^

jnizubeth^Stojir, Prc.sidcnl

J\ri.S_LyJfu.tistcii.scnillKilmi_;!iiuaJ.(.).liiceL _

Kristen Swilzcr.J lead ol Assei Management ._

Please provide the following infonnation concerning each person or enlity having a direct or indirect beneficial interest (including ownership) m excess of 7 5"'n ofthe Disclosing Parly. Examples ofsuch an interest include shares in a corporation, partnership interest in a partnership or joint venture.

Pa Lie 2 of I 3

interest ofa member or manager in a limited liability company, or interest ofa beneficiary -of a 4 ru sty-restate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest m the

Disclosing Party

U.S. Bank National Association 800 Nicollet Mall, Minneapolis, MN 55402 100%

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 [X] No * To the best of our knowledge, after due inquiry

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTFIER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and tiny other person or entity whom the Disclosing Party has retained or expects to retain m connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solelv 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 anv person or entity other than: (1) a not-for-profit eniitv, on an unpaid basis, or (2 ) himself "Lobbyist'" also means any person or entity any part of whose duties as an employee ol another includes undertaking io influence any legislative or administrative action.

ll'ihe Disclosing Parly is uncertain whether a disclosure is required under lhis Scclion. ihe Disclosing I'artv mum eiiher ask the City whether disclosure is required or make tlie disclosure

Un tic 3 of I 3

Name (indicate-whether------ Business " Relationshipto Disclosing Party Fees (indicate vvhethei

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.

(Add sheets if necessary)

(XI Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS

COURT-ORDERED CHILD SUPPORT COMPLIANCE

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 [ ] No |xl 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 1 ("Article l")(\vlnch the Applicant should consult For defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting ihis EDS is the Applicant and is doing business wilh the City, then lhe Disclosing Party certilies 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 super\ ision for. any criminal offense involving actual, attempted, or conspiracy to commit bribery, thefi. fraud, forgery, perjury, dishonesty or deceit against an officer or emplov ee ofthe Cily or an y sister agency: and (nl the Applicant iindersiaiids and acknow ledges that compliance with Article I is a continuing reqiiiremeni loi doing business with the Citv NOT E: IF Article I applies to the Applicant, lhe permanent compliance timeframe m Article I supersedes some Five-year compliance timeframes in certifications 2 and 3 below.

Paete 4 of 1 3

The-Diselosing Party and. ifthe Disclosing Party is a legal entity, all o'f-those persons or entities identified in Section 11.13.1. of this EDS:

1. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from anv transactions bv anv federal, state or local unit of government;
2. have not, within a five-year period preceding the date of this EDS, been convicted ofa criminal offense, adpidged 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;
3. arc 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;
4. 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
5. 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 Parlies");
any "Affiliated Entity" (meaning a person or entity thai, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Parly, or is, w ith the Disclosing Party, under common control of another person or enlity. Indicia ofcontrol include, without limitation: interlocking management or ow nership: identity of interests among family members, shaied facilities and equipment: common use of employees; or organization erf a business entity follow ing the ineligibility ofa business entity to do business with federal or stale or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity): with respect to Coniraciors. the term Affiliated Entity means a person or entity that directly or indirectly controls the Conlraclor. is controlled by it, or, with the Conlraetor. is under common control of another person or entity,
any responsible ollicial ofihe Disclosing Party, any Contraclor or any Affilialed Emily or any olher official, agcni m employee of the Disclosing Parly, any Contractor or any A ffiliated I: nlity. acting pursuant lo the direction or authorization ofa responsible official ofthe Disclosing Parly, any Conlraclor or anv Affiliated Entity (collectively "Agents")

Pace 5 of 1 3

Neither theid^isclosing" 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 ofa Contractor during the five years before the date ofsuch 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 ofany state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission ofsuch conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of tlie U.S. Department ofthe Treasury or the Bureau ol Industry and Security ofthe U.S. Department of Commerce or their successors: the Specially Designated Nationals f ust, the Denied Persons List, the Unverified List, the Entity List anil the Debarred List
The Disclosing Party understands and shall comply with tlie applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe M u inc i pa I Code.
Ifthe Disclosing Pariv is unable lo certify to any ofthe above statements in this Part 13 (Further Certifications), the Disclosing Party must explain below:

Paue 0 oF I 3

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

S. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list ofall current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this FDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A"' or "none").

.None

9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a

complete list ofall gifts that the Disclosing Party has given or caused to be given, at any time during the

12-month period preceding the execution date of this EDS, to an employee, or elected or appointed

official, 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 of the City recipient.

None

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

The Disclosing Party certifies that the Disclosing Party (check one)

[ ] is [Xj is not

a "financial institution" a.s defined in Section 2-32-455(b) ofthe Municipal Code.

Ifthe Disclosing Party IS a financial institution, then lhe Disclosing Parly pledges:

"We are not and will not become a predatory lender a.s defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none ofour affiliates is. and none of them will become, a predalory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate ofa predatory lender may result in the loss ofthe privilege id'doing business with the Cny."

Ifthe Disclosing Piutv is unable lo make ihis pledge because it or any of its affiliates (as ilefined in Section 2-32-4 5N h) ofthe Municipal Code) is a predatory lender within ihe meaning ol'Ohnpler 2-32 ofthe Municipal Code, explain here (attach additional pages i f necessary)

Page 7 of 13

Ifthe letters "NA." the word "None." or no response appears on the lines above, il will be conclusively presumed that the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part 1).

In accordance with Section 2-156-1 10 ofihe Municipal Code: Does any official or employee ofthe City have a financial inlerest in his or her own name or in the name ofany other person or entity in the Matter?

[ ] Yes Ixl No * To the best ofour knowledge, after due inquiry

NOTE: If you checked "Yes" lo Item D.U, proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.

Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.

Does the Matter involve a City Property Sale?

[ ] Yes |X] No

If you cheeked "Yes" lo Item D.U, provide the names and business addresses ofthe City officials or employees having Mich interest and identify llie nature ofsuch interest:

Name Business Address Nature of Interest

4. The Disclosing Pariv furiher certifies that no prohibited financial interest m lhc Matter w ill be acquired bv anv Citv official or employee

E. C E R F11 1C A I ION R I G A R DIN G S L A V E R Y E R A BUSINESS

Please check cither 1 . or 2 below I F the Disclosing Party checks 2 . the Disclosing Parly must disclose below or in an aline hnieni lo ihis IDS all in formal ion required by paragraph 2 Failure lo

Pa>-e X of 1 3

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 ofall such records, including the names ofany and all slaves or slaveholders described in those records:

SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: Ifthe 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

1. List below the names of all persons or entities registered under the federal Lobbying

Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter' (Add sheets if necessary):

(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed thai the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of l^l)95 have made lobbying contacts on behalf of the Disclosing Party with respect lo the Mattel'.)

2 The Disclosing Lu rl \ has not spent and will not expend any federally appropriated funds to pav anv person or enlitv listed in Paragraph A I . above for his or her lobbying activities or to pay any person or enliiv lo influence or uticinpi to influence an officer or employee ofany agency, as dehned 1 applicable federal law. a member ofCongress. an officer or employee ofCongress. or an employee ol member of Congress, m connection with the award ofany federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify anv lederalK funded contract, grant, loan, or cooperative agreement.

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
I'he Disclosing Party certifies that either: (i) it is not an organization described m section 501(c)(4) ofthe Internal Revenue Code of 1986: or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of I9S6 but has not engaged and will not engage in "Lobbying Activities".
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal m form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

Is the Disclosing Party the Applicant?

[]Yes [vJNo If "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations⁰ (See 4 I CFR Pan 1)0-2.)

| | Yes | | No

Have you filed w ith the Joini Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employmenl Opportunity Commission all reports due under the applicable tiling requirements'.-'

I j Yes | | No

Have you pariicipatcd in anv pre\ ions contracts or subcontracts subject lo the equal opportunity clause'.'

| I Yes | | No

11 you checked "No" lo question 1 or 2. above, please provide an explanation

Page 10 of 13

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 ofany contract or taking other action wilh 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 full text ofthese ordinances and a training program is available on line at wwvv.cityofch icago.org/E thics, 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.

Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
ll is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on lhe Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, lhe Disclosing Party waives and releases any possible rights or chums which it iimv have against the City in connection with the public release of information contained in this IDS and nFo authorizes the City to verily the accuracy ofany information submitted in this EDS.

E. The information provided in this EDS must be kept current. In lhe event of changes, the Disclosing

Party musi supplement this IDS up to the time lhe City bikes action on the M titter. Ifthe Mailer is a

contraci being handled bv the City's Department of Procurement Services, the Disclosing Party must

update this EDS as the contract requires. NO I E: With respect to Matters subjecl to Article 1 of

Chapter 1-23 ofihe Municipal ('ode I imposing PERMANENT INELIGIBILITY for certain specified

ollcnses). tlie information pro\ u.led herein regarding eligibility must be kepi current for a longer period,

as required by Chapter 1-25 and Section 2-154-020 ofthe Municipal Code.

I'he Disclosing Pnrlv represents and warrants that

Puree I I of 13

F. 1. The Disclosing Parry is not delinquent in the payment ofany tax administered by the ITIinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee. tax or other charge owed to lhe City. Phis includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to rise, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPFS") maintained by the U. S. General Services Administration.

F.3 Ifthe 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 ofthe 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 F.1., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

U.S. Bancorp Community Development Corporation (Print or type name of Disclosing Party)

By: tmL/

r (icrei

(Sit K.iecv Mal.trt

(Print or type name of person signing)

.Vice President

( Print or type title of person signing)

i slate).

Signed and sworn to belorc me on iGiueS i-x-i^HAwt J-^u- \_

^;| ¹ $hL®U S. £krV__ County,

\oiarv Public

Commission e^v-'ii .

Piute I 2 of F

AMANDA G MARTINE Notary Public Notaiy Seal Stale ol Missouri. Saint Louis City Commission # 11209935 ' My Commission Expires Jul 5, 2015

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

"Applicable Party" means (I) all executive officers ofthe Disclosing Party listed in Section II.B.l.a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, ifthe 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. "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 anv "" Applicable Parly" or any Spouse or Domestic Partner thereof currently have a "'familial relationship'" with an elected cily official or department head?

[ J Yes [X J No - 'i c, []_1C |_K._st- ₀('_0UI- knowledge, alter due inquiry

If yes, please identify below ( 1) the name and title ofsuch person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head lo whom such person has a familial relationship, and (4) the precise nature id'such familial relationship.

PaLte 15 of 13

CITY OF CHICAGO F. C O N O M ICDISCLOSURE ST A T E M E N T AND AFFIDAVIT

S EC TION I G E N E R A L IN FO R VIA I IO N

Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:

U.S. Bank Nationa\_ Associution

Check ONE ofthe following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

[x] a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe

Applicant in which the Disclosing Party holds an interest: PP Family, LLC

3. [] 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 ofthe Disclosing Party: 800 Nicollet Mali

Minneapolis. MN 55402

Telephone: 314-335-2600 Fax: 314-335-2601 Email: kacey.mahrt@usbank.com
Name of contact pei soir KacevjyJaJiil
Federal Employer Identification No. (if you have one): .
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include proiect number and location of property, ifapplicable)-

Construction ol 78 unit.s.ofalfordaide housing

Department of

Which City agency or department is requesting this EDS? Planning and Development (DPI))

Ifthe Mailer is a coniiact being handled bv the Citv's Department of Procurement Services, please complete the follow ing

Specification // NA and Contract // NA

\ tr. iii-ih-i:

Facie I of 15

SECTION II DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

Indicate the nature ofthe Disclosing Party:

[ | Person |" ] Limited liability company

[ ] Publicly registered business corporation [ ] Limited liability partnership

[ ] Privately held business corporation [ ] Joint venture

[ ] Sole proprietorship [ ] Not-for-profit corporation

[ ] General partnership (Is the not-for-profit corporation also a 501(c)(3))''

[ ] Limited partnership [ ] Yes [ ] No

[ ] Trust [Xj Other (please specify)

National banking association

For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable: United States

3. For legal entities not organized in the State of Illinois: Flas the organization registered to do business in the State of Illinois as a foreign entity?

* U.S. Bank National Association operates

_r -j y_es [- j |vj₀ r-\>| branches in the state oflllinois under the

authority of its natioanl bank charier and is

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY: ^theref°^r! ^n0t ^^d ^l° ^regiStC1' ³⁵ * ^f°^reign

corporation with the state.

1. 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).

Ifthe entity is a general partnership, limited partnership, limited liability company, limited liability partnership or |oint venture, list below the name and tille of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entiiy listed below must submit an EDS on its own behalf.

Name Lille Please see attached

2 Please provide lhe following informanon concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% ofthe Disclosing Party Examples ofsuch an interest include shares in a corporation, partnership interest in a partnership or joint venture.

U.S. Bank National Association Organizational Structure

December 19. 2014

U.S. Bank National Association Board of Directors

Carlson, Jennie P. Cecere. Andrew Chosy, James L Collins, Arthur D Jr. Davis, Richard K Dolan, Terrence R. Elmore, John R. Hoesley, Joseph C. Joseph, Pamela A. Parker, P W (Bill) Payne, Richard B Jr. Runkel, Mark G. Schnuck, Craig D. Stone, Kent V. von Gillern, Jeffry H.

U.S. Bank National Association Executive Officers .	Title :, /■.: ■;/.;■ \% i^jWMi&w.^:d:^-"k
Davis, Richard K.	Chairman, President and Chief Executive Officer
Carlson, Jennie P.	Executive Vice President
Chosy, James L.	Executive Vice President, General Counsel and Secretary
Runkel, Mark G.	Executive Vice President and Chief Credit Officer
Cecere, Andrew	Vice Chairman and Chief Financial Officer
Dolan. Torrance; R	Vice Chairman
Elmore. John R	V"e Chairman. Community Banking and Branch Delivery
Hoesli.'V. Joseph C	\'ic>:: Ghaiffrar
Joseph, Pamela A
Parker. P W (Bill)	Vii :e Chairman and Chief Risk Officer
Payne, Richard B Jr	Vice Chainnan
Stone. Kent V	Vice Chairman. Consumer Banking Sales and Support
von Gillern. Jeffry 11	Vice Chairman

Name Business Address Percentage Interest in (he

Disclosing Party

U.S. Bancorp __8(XLN±c^ 100% .

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 [y-j No * To the best of our knowledge, after due inquiry

If yes, please identify below the name(s) of such City elected official(s) and describe such rclationship(s):

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

I lie 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 Parly litis retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated lo be paid. The Disclosing Parly is not required lo disclose employees who are paid solelv ihrough the Disclosing Party's regular payroll.

"Lobbyist" means any person or enlily who undertakes to influence any legislative or administrative action on behalf of anv person or enlily olher lhan ( I) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" iilso means anv person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.

If lhe Disclosing Party is unceriain whether a disclosure is required under this Section, ihe Disclosing Party inu-u eiiher ask lhe Cily wlieilier disclosure is required or make the disclosure

I hi Lie 3 cd' 1 3

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.

(Add sheets if necessary)

[X] Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS

COURT-ORDERED CHILD SUPPORT COMPLIANCE

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 [ ] No [xj 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 m compliance with that agreement?

I I Yes f ] No

FURTHER CERTIFICATIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article L")(which the Applicant should consult For defined terms (e g "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Parly certifies as follows (i) neither the Applicant nor anv 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, aliempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit againsl an officer or employee ofthe City or tiny sister agency: and (n) the Applicant understands and acknowledges thai compliance with Article 1 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-vear compliance timeframes m certifications 2 and 3 below

I'auc 4 of 13

The Disclosing Party and, if theDisclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:

1. 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;
2. have not, within a five-year period preceding the date of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, stale or local) transaction or contract under a public transaction: a violation of federal or state antitrust statutes; fraud; embezzlement; thefl: forgery: bribery; falsification or destruction of records; making false statements; or receiving stolen property;
3. are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
4. 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
5. 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 of 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 wilh the Matter, including but not limited lo all persons or legal entities disclosed under Section IV, ■'Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Enlity" (meaning a person or entiiy that, directly or indirectly controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Parly, under common control of another person or enlity. Indicia ofcontrol include, without limitation: interlocking management or ownership, identity of interests among family members, shared facilities and equipment; common use of employees, or organization ofa business entity following the ineligibility ofa business entity to do business with federal or state or local government, including the Cily, using substantially the same management, ownership, or principals as the ineligible enlity): with respect to Contractors, lhe 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 ol another person or entity:
any responsible official ofthe Disclosing Partv. any Contractor or any Affilialed Entiiy or any oiher official, agent or employee ofthe Disclosing Party, any Contractor or any Atliliated Entity, acting pursuant to the direction or authoi i/.ai ion ofa responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Auents").

Pa etc 5 of 1 3

Neither the Disclosing" Party,"nor tfhy 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 ofa Contractor during the five years before the date ofsuch Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:

1. 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 oflllinois, or any agency ofthe federal government or ofany stale or local government in the United States of America, in that officer's or employee's official capacity:
2. agreed or colluded with other bidders or prospective bidders, or been a parly 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
3. made an admission ofsuch conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Asseis Conirol ofihe U.S. Department ofthe Treasury or the Bureau of Industry and Security of lhe U.S Deparunent of Commerce or their successors: the Specially Designated Nationals Fist, the Denied Persons List, the UnveriFied List, the Enlity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements ol'Chaplcrs 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Munieipal Code.
Ifthe Disclosing Pariv is unable to certify to any ofthe above stalemenls in this Part 13 (Further Certifications), the Disclosing Party must explain below

l^JjTli>Jiy_^cc'_AUJCi])Jf¹¹¹. P> JBJ'iislimiMMLlJ^^ ilfi^iJKi'.e-N^cptuq.ilJLlo the

certification

Parte 0 of 15

Attachment B

City of Chicago Economic Disclosure Statement and Affidavit

Statement Regarding Further Certifications

U.S. Bank National Association itself is a mortgage lender. U.S. Bank National Association is also one of the largest corporate trustees in the United States and in such capacity is trustee of numerous mortgage-backed securitization trusts that each hold multiple real property mortgages. From time to time, mortgage borrowers in Chicago default on payment of real estate taxes or otherwise fail to comply with City of Chicago's requirements with respect to certain mortgaged properties. This can result in legal action against the borrower by the City of Chicago, which legal action may name U.S. Bank National Association as the mortgage holder (either in its individual capacity or in its capacity as a trustee). As of December 22, 2014, U.S. Bank National Association was aware of outstanding claims against it (individually or in its capacity as trustee) totaling $154,040.89 wherein the City of Chicago or one of its departments or divisions (including the Department of Buildings and the Department of Streets and Sanitation) is the creditor. The vast majority of this amount is related to properties that U.S. Bank National Association holds in trust and for which it does not do the servicing. U.S. Bank National Association, both in its individual capacity and in its capacity as a trustee meets periodically with various City officials to address these claims.

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

(S. To the best ofthe Disclosing Parly's knowledge after reasonable inquiry, lhe following is a complete list ofall current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").

None

9. To the best ofthe Disclosing Parly's knowledge after reasonable inquiry, the following is a

complete list ofall gifts that the Disclosing Party has given or caused to be given, at any time during the

12-month period preceding the execution date of this EDS, to an employee, or elected or appointed

official, ofthe City of Chicago. For purposes 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 of the City recipient.

None

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

The Disclosing Party certifies that the Disclosing Party (check one)

[yj is [ ] is not

a "financial institution" as defined in Section 2-32--l55(b) of tlie Municipal Code.

Ifthe Disclosing Partv IS a financial institution, then the Disclosing Party pledges:

"We are not and will not become a predatory lender as defined m Chapter 2-32 ofthe Municipal Code. We further pledge that none ofour afliliales is, and none ol them will become, a predatory lender as defined m Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate ol'n predatory lender may result in the loss ofthe privilege of doing business with the City."

II the Disclosing Party is unable lo make this pledge because it or any of its affiliates (as delmet! in Section 2-32-d55(b) ofihe Municipal Code) a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):

Pauc 7 of I 3

Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined m Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.

ln accordance with Section 2-156-1 10 ofthe Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter?

[ ] Yes [XJ No * To the best ofour knowledge, after due inquiry

NOTE: If you checked "Yes" to Item D.U, 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?

[ I Yes [Xl No

If you checked "Yes" to Item D.l . provide the names and business addresses ofthe Cily officials or employees having such mlcresl and identify the nature ofsuch intercsl:

Name Business Address Nature of Interest

4. The Disclosing Partv Further certifies that no prohibited financial inlerest in the Matter will be acquired by anv Cilv official or employee

P CER I 11 IC A HON REGARDING SLAVERY ERA BUSINESS

Please check cither I or 2 below Ifthe Disclosing Party checks 2 , the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2 Failure to

Page S of 15

comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

_1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Parly has found no such records.

_X_ 2. The Disclosing Party verifies that, as a result of conducting the search in step I above, the

Disclosing Party has found records of investments or profits from slavery or slaveholder insurance

policies. The Disclosing Party verifies that ihe following constitutes full disclosure ofall such

records, including the names ofany and all slaves or slaveholders described in those records:

Please see Attachment A and the related letter dated April 29. 2004.

SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. Ifthe 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

1. List below the names of all persons or entities registered under the federal Lobbying

Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party w ith respect to the Matter: (Add sheets if necessary j-

(If no explanation appears or begins on lhe lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed lhat the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Aci of 19°5 have made lobbying contacts on behalf ofthe Disclosing Parly with respect lo the Vlatler )

2. l he Disclosing Parly has noi spent and will not expend any federally appropriated funds lo pay any person or entity listed in Paragraph A I above for his or her lobbying activities or to pay any person or entity lo influence or attcmpl to influence an officer or employee ofany agency, as dehned by applicable federal law. a member ofCongress, an officer or employee ofCongress, or an employee ofa member of Congress, m connection wnh the award ofany federally funded contract, making any federally funded grant or loan, entering mio anv cooperuiivc agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Page ^l; of I 5

Attachment A

City of Chicago Economic Disclosure Statement and Affidavit

Statement Regarding Slavery Era Business

U.S. Bank National Association was formed from the following major banks: (1) Star Bank, National Association (Cincinnati, Ohio) changed its name to Firstar Bank, National Association (Cincinnati, Ohio) effective February 1999; (2) Mercantile Bank National Association (St. Louis, Missouri) merged into Firstar Bank, National Association (Cincinnati, Ohio) effective April 2000; (3) United States National Bank of Oregon (Portland, Oregon) merged with First Bank, National Association under the title U.S. Bank National Association effective August 1997; (4) U.S. Bank National Association merged into Firstar Bank, National Association, and the succeeding bank, changed its name to U.S. Bank National Association effective August 20.01. These banks acquired through mergers and acquisitions numerous smaller banks. There are five hundred and forty-two U.S. Bank National Association predecessors. Thirty-five predecessors were founded before the abolition of slavery in December 1865. Thirteen of the pre-1866 predecessors were established in southern slave-holding states and territories, including Kansas, Kentucky, Missouri, and Tennessee.

In reviewing historical records held in various external repositories in accordance with the research requirements as set forth in the City of Chicago Office of the Corporation Counsel opinion letter dated April 29, 2004 (attached hereto), U.S. Bank National Association has identified external records of its predecessors which necessitate disclosure. The conveyance records, while showing no record of direct ownership of enslaved individuals did contain records of founders and/or directors of predecessor banks owning enslaved individuals, as well as a record where an enslaved individual was the collateral for a loan. Specifically, the first president of predecessor Marion National Bank of Lebanon, Kentucky (founded in 1856), Benedict Spalding, owned two enslaved individuals in 1850 In 1860 someone with a similar name "Benidict Spalding'' is also listed as having owned fourteen enslaved individuals. In addition, certain members of the Marion National Bank of Lebanon's board of directors (called "commissioners") owned approximately forty-seven enslaved individuals in total (the records include abbreviated names, which we conclude may be references to commissioners). The first president of predecessor First National Bank of Clarksville, Tennessee (founded in 1865), S.F. Beaumont, owned one enslaved individual in 1860. The first president of predecessor St. Louis Building and Savings Association, Missouri (formed in 1857), Marshall Brotherton, owned ten enslaved individuals in 1850 and four enslaved individuals in 1860. Merchants Bank (founded in 1857) and Bank of St. Louis (founded in 1857), both predecessors, along with a group of other St. Louis firms, issued a mortgage to Charles McLaran that was secured by his property, which included an unspecified number of enslaved individuals However, the 1860 Federal Census Slave Schedule for St. Louis provided that Charles McLaran owned thirteen enslaved individuals.

The above is only a summary U S. Bank National Association has previously provided the City of Chicago with supporting attachments.

U.S. Bancorp, the parent company of U.S. Bank National Association, was founded after the slavery era and has no separate assets or activities that pre-date the 20th century. As such, it has no disclosure separate from that of the bank.

April 29, 2004

City nf Chicago

Richard M. Daley, Mayor

Department of Lrnv

M.n:iS. Georges Corporation Counsel

Cily Hall, Room 600 121 North LaSalle Street Chicago, Illinois 60602 (312) 744-6900 (312) 744-8538 (FAX) (312) 744-2963 (TTY)

http://wwiv.ci.clii.il.u5

Hon. Edward M. Burke

Chairman, CityCoune.il Committee on Finance City Hall, Room 302 121 North La Salle Street Chicago Illinois 60602

Re: Question regarding Ticoiiomic Disclosure Statement and Affidavit, Part VI ("Certification Regarding Slavery Era Business") and Resolution pending before the Joint Committee on Finance and Human Relations

si:;: i>].-.-i '.n;.-ir.o tik.f'h:::

Dear Alderman Burke:

In a letter dated Apid 26, 2004, you indicated that a special committee of the City Council, consisting of the combined Committee on Finance and the Committee on Human Relations, currently has under consideration a resolution that raises certain issues regarding interpretation of Section 2-92-585 ofthe Chicago Municipal Code, the Business, Corporate and Slavery Era Insurance Ordinance. That ordinance requires every city contractor to "complete an affidavit verifying that the contractor has searched any and all records of the company or any predecessor company regarding records of"investments or profits from slavery or slaveholder insurance .policies during the slavery era. 'I'he names ofany slaves or slaveholder::; described in those records must be disclosed in the affidavit." (bniphasis supplied)

'i he affidavit requirement of Section 2-92-585 has been incorporated into tbe. standaid Economic Disclosure Statement ("LIDS") completed by city contractors as Part Vi, en Ml led "'Slavery Certification." 'I'he LUS requires an entity contracting with ihe city io vei if'y that it has "searched any and all records of the Undersigned and any and all predecessor entities foT records of investments or profits from slavery, Ihe slave, industry, or shareholder insurance policies." (Lmphasis supplied) The LIDS form then requires the contracting entity to disclose Ihe results oi "that search.

You have asked specifically whether it is "reasonable to interpret the language Tecurds ofihe undersigned and any anil all predecessor entities' to mean | ihe contractim: entity':: j ; ei ords and the iceonis of lis predecessor entities." Por the. reasons (hat follow, it is lhe opinion ol This otlice lhat the answer is in Ihe

Hon. Edward M. Burke April 29, 2004 Page 2

affirmative. A search required for proper compliance with and disclosure under Section 2-92-585 must include all known records ofthe contracting entity and each of its predecessor entities, to which records the contracting entity has or can obtain access.

Neither the ordinance nor any Illinois decision defines a "predecessor" enlity of a city contractor. Under the general rules of statutory construction, the word should be given its ordinary meaning. Black's Law Dictionary defines "predecessor" as "one who goes or has gone before; the correlative of

'successor' Applied to a body politic or corporate, in the same sense as

'ancestor' is applied to a natural person." This simple analogy indicates that every known antecedent entity of a city contractor acquired entities, components of earlier mergers, entities acquired by and subsumed into a prior entity that became a predecessor of a contracting entity - should be treated as a predecessor. This is especially appropriate when one considers the preamble to the ordinance adding Section 2-92-385 to the Chicago Municipal Code. The fifth, paragraph ofthe preamble (found at page 94891 ofthe Journal of Proceedings of the City Council of October 2, 2002) refers to records located in the archives of current insurance firms, documenting slave insurance policies "issued by a predecessor insurance firm; the sixth paragraph (id.) refers to "insurers and businesses whose successors remain in existence today." Tims the, City Council recognized that, as the American economy lias expanded and become more complex, modern business may include different business disciplines (insurers and oiher businesses).

The appropriate extent ofthe mandated records search can also be discerned Irom the preamble. The final paragraph ofthe preamble (p. 91892) contains a finding ofihe City Council that entities "doing business with the City of Chicago shall take any and all step:; in good faith to disclose any records within their possession or knowh'dgc xchxWxx^ to investments or profits from the slave industry including insuiance policies.." (Emphasis supplied) In order to implement this statement ofthe Council's intent, a contracting entity may not ignore records lhat are aichivcd outside the entity's possession (u.g. in a museum, university library, historical society or trade association). To ignore deliberately the existence ofsuch known records could not possible constitute a "good faith" effort to take "any and all .sh.-p.s¹' io document Ihe contractor's history. The breadth ofthe City Coimc.irs desired disclosure also led this department, in the revision ofihe EDS necessary to implement Section 2-92-585, to change the ordinance's disjunctive in die reference lo "any and all records ofthe [contracting) company or its predecessors" to a conjunctive in the EDS ("any and all records of

Hon. Edward M. Burke April. 29, 2004 Page 3

the [contracting enlity] and any and all predecessor entities").

Should you need additional assistance, please do not hesitate to contact

me.

Very truly yours,

MARA S. GEORGES

Corporation Counsel

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986: or (ii) it is tin organization described in section 501(e)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".

5. Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

Is the Disclosing Party the Applicant?

[ ] Yes tyj 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 ( PR Pari 60-2.)

I I Yes | ] No

flave you filed with lhe Joint Reporting Committee, lhe Director of the Office of Federal Contract Compliance Programs, or the F.qiial Lmployment Opportunity Commission all reports due under the applicable filing requirements'.'

| j Yes [ ] No

-i Have you participated m anv previous coniracis or subcontracts sub|ect to the equal opportunity clause'.'

I j Yes j j No

11 you checked "No" lo question I. or 2. above. pleu>c provide an explanation:

Pace Liol 1

SECTION VII ACKNOWLEDGMENTS, CON I RACT INCORPORATION, C O \I PIT A N C E, P E N A L TIE S, DI S C L O S U R E

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany conlract 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 ofany 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 full text ofthese ordinances and a training program is available on line at www.cityofcb.icago.org/ E t hics. and may also be obtained from the City's Board of Ethics, 740 N.

Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is lhe 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. 13y completing and signing this I DS. the Disclosing Party waives and releases any possible rights or claims which it may have against the City m connection with the public release of information contained in this EDS and also authorizes the Citv lo verify the accuracy ofany information submitted m this EDS.

li. The in formation provided m this IDS must be kept current. In the event of changes, the Disclosing Partv must supplement this EDS up lo the time tlie Citv takes action on the Matter Ifthe Matter is a contract being handled by the Otv's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires NOTE: VV itli respect to Mailers subject to Article 1 of Chapter 1-23 ofthe Municipal Code limposiiig PERMANENT INELIGIBILITY lor certain specified offenses), the informanon provided herein regarding eligibility must be kepi current lor a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.

I he Disclosing Pariv represents und warrants lhat'

Piuie I I of 13

F.1. The Disclosing Parly is not delinquent in the payment ofany lax 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 ihe City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, properly taxes or sales taxes.

F.2 Jf (he Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPFS"; maintained by the U. S. General Services Administration.

F.3 Ifthe Disclosing Party is the Applicant, Ihe Disclosing Parly 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 F.J. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor thai does noi provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: Ifthe Disclosing Party cannot certify as to any ofthe items in F.I., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (ifapplicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (ifapplicable) are true, accurate and complete as ofthe date furnished to the City.

U.S. Bank National Association

(Print or type name of Disclosing Party)

Bv; rWAL/

(SVgn here)

Kacey Malirt.

(Print or type name of person signing)

. -V. ice.P resident

(Prim or lype Ulle of person signing)

Signed and sworn to belorc rue ou idalci -.-/C'l *1H - ___

ai ^tJ^OUi'i.C'i'W Cotmly. /VIA _ _ (sia'.e)

, _ ■. __ _, _ Notary Public

f ommission expires _ _ _ _ _

AMANOA 6 MARTINEZ Notary Public - Notary Seal State ol M.ssouri. Saint Louis Cily ^5,3 Commission #11209 5

⁵¹⁰² ^S,n/_n,u#uo«ss.u.u_>oo

P.::V 12 of

CH Y OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED C IT Y OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) (he 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 DiscIosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any 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.l .a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

Does the Disclosing Parly or anv "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?

| JYes |X.| No " 'fo the best of our knowledge, after due inquiry

If yes, please identify below (1) the name and title ofsuch person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person litis a familial relationship, and (4) the precise nature ofsuch familial relationship.

Piute I 3 of I.'

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I -- GENERAL INFORMATION

A. Legal name ofthe Disclosing Party submitting this HDS. Include d/b/a/ ifapplicable:

U.S. Bancorp

Check ONE ofthe following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

| ] the Applicant

[xl 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: PP Family. LLC

3. [] a legal entity with a right of control (see Section II.B.l.) State the legal name of tlie entity in

which the Disclosing Party holds a right ofcontrol:

Business address of the Disclosing Party: 800 Nicollet Mall

Minneapolis. MN 55402

Telephone: 314-335-2600 Fax: 314-335-2601 Email: kacey.mahrt@usbank.com

I). Name of contact person: Kacey Mahrt.

Federal Employer Identification No. (if you have one):,
Uriel'description of contract, transaction or olher undertaking (referred lo below as the "Matter") lo which this CDS pertains. (Include project number and location ofproperly, t f ;ip[il icciblc) ■

Construction ol 78 units of affordable housing

Department ol

Which Cily agency or department is requesting this EDS? Planning and Development (DPD)

If lhe Mailer is a conlract being handled by the City's Department of Piocuremenl Services, please complete the following:

Specification// NA and Conlract/; _ Ni A

VYi. ni-Hi I 2

Page 1 of 13

SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OK THE DISCLOSING PARTY

1. Indicate the nature ofthe Disclosing P;

[ ] Person

fX] Publicly registered business corporation [ J Privately held business corporation | J Sole proprietorship [ ] General partnership [ ] Limited partnership [ ] Trust

2. For legal entities, the state (or foreign c

[ ] Limited liability company [ ] Limited liability partnership [ | Joint venture [ ] Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))?

[ J Yes [ ] No

[ j Other (please specify)

ntry) of incorporation or organization, ifapplicable:

Delaware

3. For legal entities not organized in the State oflllinois: Has the organization registered to do business in the State oflllinois as a foreign entity?

[ ] Yes ij No [ ] N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

there are no such members, write "no members." For trusts, estates or other similar entities, list below Ihe legal titleholder(s).

Ifthe entity is a general partnership, limited partnership, limited liability company, limited liability partuei ship or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entiiy that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entiiy listed below must submit an EDS on its own behalf.

Tilk

Nam o

.Please' see.attached

2. Please provide the following information concerning each person or enlily having a direct or indirect beneficial interest (ineluding ownership) in excess of 7.5% ofihe Disclosing Party Examples ofsuch an mlcresl include shares in a corporation, partnership intercsl in a partnership or joint venture,

Page 2 of 13

U.S. Bancorp Organizational Structure

December 19, 2014

U.S. Bancorp Board of Directors

Davis, Richard K

Baker, Douglas M. Jr

Belton, Y Marc

Buyniski Gluckman, Victoria

Collins, Arthur D Jr

Harris, Kimberly J

Hernandez, Roland A

Johnson, Joel W.

Kirtley, Olivia F

Levin, Jerry W.

O'Maley, David B.

Owens, O'dell M.

Schnuck, Craig D.

Stokes, Patrick T. '

Wine, Scott W.

Woo Ho, Doreen

UlS^n^ufx'ecutiv-^
Davis, Richard K.	Chairman, President, and CEO
Cecere, Andrew	Chief Financial Officer and Vice Chairman
Carlson, Jennie P.	Executive Vice President
Chosy, James L.	Executive Vice President, General Counsel and Secretary
Gifford, Craig E.	Executive Vice President and Controller
Oldshue, Paul F.	Executive Vice President
Quinn, Katherine	Executive Vice President
Runkel. Mark G	Executive Vice President and Chief Credil Officer
Seniors, Timothy W	Executive Vice President
Stern. John C	Executive Vice President and Treasurer
Dolan Terrance R	Vice Chairman
Flmore, John R	Vice Chairman
Hoesley, Joseph C	Vice Chairman
Joseph. Pamela A	Vice Chairman
Parker. P W (Bill)	Vice Chairman and Chief Risk Officer
Payne. Richard B Jr	Vice Chairman
Stone. Kenl V	Vice Chairman
von Gillern. Jeffry 11	Vice Chairman

interest ofa member or manager in a limited liability company, or interest of a beneficiary ofa trust, estate or other similar entity. If none, state "None." NOTE: Pursuant lo Section 2-1 54-030 ofihe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage interest in the

Disclosing Party

SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS

Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?

[ ] Yes [yj No * To the best of our knowledge, after due inquiry

If yes, please identify below the name(s) ofsuch City elected official(s) and describe such relationship(s):

SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Parly must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom llie Disclosing Parly has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the tolal amount ofihe fees paid or estimated to be paid. Tlie 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 tiny legislative or administrative action on behalf of any person or entity other than: (1) a uot-foi-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or enlity any part of whose duties a.s an employee of another includes undertaking to influence any legislative or adniinistralive aelion.

If lhe Disclosing Party is uncertain whether a disclosuie is required under this Section, the Disclosing Party must either ask lhe City whether disclosure is required or make lhc disclosuie.

Page 3 of 13

Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether

retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:

to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is

not an acceptable response.

(Add sheets if necessary)

[Xj Cheek here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?

[ ] Yes [ ] No [X] No person directly or indirectly owns 10% or more ofthe

Disclosing Party.

If "Yes," has the person entered into a court-approved agreement for payment ofall support owed and is (he person in compliance with that agreement?

[ 1 Yes [ j No

13. F U R T Fl F R C E R TI F1C A TI ON S

]. Pur.suanl to Municipal Code Chapter 1-23, Article 1 ("Article F')(vvhich the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor tiny 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, ilieft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of Ihe City or any sister agency; and (ii) Ihe Applicani understands and acknowledges thai compliance wilh Article 1 is a continuing requirement for doing business with the City. NOTE: If Article 1 applies lo lhe Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Paged of 13

The Disclosing Parly and, ifthe Disclosing Parly is a legal entiiy, all of those persons or entities identified in Section II.B.l. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against (hem 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 stale 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 entiiy (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 lhe Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties"');
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Parly, is controlled by the Disclosing Party, or is, with the Disclosing Parly, under common control of another person or entity. Indicia ofcontrol include, without limitation: interlocking management or ownership; identity of interests among family members, shaied facilities and equipment, common use of employees; or organization ofa business entity following the ineligibility ofa business entity to do business with federal or state or local government, including the Cily, using substantially the same management, ownership, or principals as the ineligible entity): wilh respect to (.ion true tors, the lerm Affiliated Enlity means a person or entity thai directly or indirectly eontiols (he Contractor, is controlled by it, or. with lhe Contractor, is undei common conirol of another person or entity:
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Emily or any oihei official, agent or employee ofthe Disclosing Parly, any Conirnclur or any Affilialed Kntity, acting pursuant to the direction or authorization ofa responsible official ofthe Disclosing Paity, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13

1. 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 oflllinois, or any agency ofthe federal government or ofany state or local government in the United States of America, in that officer's or employee's official capacity;
2. 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
3. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense ofany state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by lhe 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 L ist, the Denied Persons List, the Unverified List, the Entiiy Lust and the

De bailed List.

b. 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 (."'ode

7 Ifthe Disclosing Party is unable to certify to any ofthe above statements in this Part H (Further Certifications), the Disclosing Party must explain below:

11' 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 ofall current employees ofthe Disclosing Party who were, at any lime during the 12-month period preceding the execution dale of this EDS, an employee, or elected or appointed official, ofthe Cily of Chicago (if none, indicate with "N/A" or "none").

None

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes 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 of the City recipient.

None .

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION 1. The Disclosing Party certifies that the Disclosing Party (check one)

[ ] is [x] is not

a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.

2 Ifthe Disclosing Parly 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 ofthe Municipal Code Wc further pledge that none ofour 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 lendei or becoming an affiliate ofa predatory lender may result in the loss ofthe privilege of doing business with the City."

If lhc Disclosing Parly is unable to make (his pledge because it oi any of Ms affiliates (as defined in Section 2-32--^;l55(b) ofthe Municipal Code) is a predatory lender wiihm lhe meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages i f necessary)¹

Page 7 of i 3

Ifthe letters "NA," the word "None," or no response appears on the lines above, il will be conclusively presumed that the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section. 2-156-110 ofthe Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter?

[]Yes [XJNo * To the best of our knowledge, after due inquiry

NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.

Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe Cily (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?

i I Ye., [X]No

3 If you checked "Yes" to Item D.L, provide lhe names and business addresses ofthe City officials or employees having such inlerest and identify the nature ofsuch interest:

Nanie Business Address Nature of Interest

■-! l he Disclosing Party further certifies lhat no prohibited financial interes: in the Matter will be acquired by any City official or employee.

E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

Please cheek either I. or 2. below. Ifthe Disclosing Party cheeks 2 lhe Disclosing Party niusi disclose below or in an attachment to Ibis EDS all information required by puingrnph 2. Failure to

Page X of 13

comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable hy the City.

1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of

the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Parly has found no such records.

X 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 ofall such records, including the names ofany and all slaves or slaveholders described in those records: The Disclosing Party was founded in 2001, after the slavery era ended, and therefore has no disclosure to make

in this regard. The operating bank that the Disclosing Party holds, U.S. Bank National Association, has disclosed

its slavery era business history on its EDS regarding this Matter.

SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. Ifthe 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 ofihc Disclosing Party with respect lo the Matter: (Add sheets if necessary):

(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will he conclusively presumed that, the Disclosing Parly means lhat NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Paily wilh respect to the Matter.)

2 The Disclosing Paiiy has not spent and will not expend any federally appropriated funds to pay any person oi entity listed in Paragraph A.l. above for his or Iter lobbying activities or to pay any person or entity lo influence or aUempt to influence an officer or employee ofany agency, as defined Inapplicable federal law, a member ofCongress, an officer or employee ofCongress, or an employee ol a member ofCongress, in connection with (he award ofany federally funded contract, making any federally funded grant or loan, entering inlo any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded conlract, grant, loan, or cooperative agreement.

Page 9 of 13

The Disclosing Parly will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (j) it is not an organization described in section 501(c)(4) of the internal Revenue Code of 1986; or (ii) it is an organization described in section

501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".

Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?

[ ] Yes [fl No

If "Yes," answer the three questions below:

1 . Have you developed and do you have on file aifirmative action programs pursuant io applicable

federal regulations? (See 41 CFR Part 60-2.)

1 ] Yes [ ] No

2. Have you filed with the Joinl Reporting Committee, lhe Director ofthe Office of Federal Conlract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?

| ] Yes [ ] No

3 Have you participated in any previous conlracts or snbeonlracls subject to lhe equal opportunity clause?

| | Yes | ] No

If you checked "No"' to question I or 2. above, please provide an explanation:

Page 10 of 13

SECTION VII ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Parly understands and agrees thai:

The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany 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 ofany contract or taking other action with respect to the Matter. The Disclosing Party understands that il 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 full text of these ordinances and a training program is available on line at www.cjtyofchicago.org/E11iics, 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.

Ifthe 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 tlie Matter and/or 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 (he City's policy to make this document, available Co the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Infoimation 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 againsl the City in connection with the public release of information contained in this EDS and also authorizes the Cily to verify the accuracy ofany information submitted in this EDS.

E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing

Paity must supplement this EiDS up to the lime the City lakes action on the Matter. Ifthe Matter is a

conlract being, handled by llie City's Department of Procurement Services, the Disclosing Party must

update this EDS as the contract requires. NOTE: With respect lo Matters subjecl lo Article I of

Chapter 1-23 of Hie Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified

offenses), lhe infoimation provided herein icgarding eligibility must be kepi currenl for a longer period,

as i cq u i reel by Chapter 1-23 and Section 2-154-020 ofihc Municipal Code.

I he Disclosing Paily represents and warrants that:

Page 1 I of 13

F.2 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affilialed Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Fixcluded Parlies Eisl System ("EPLS") maintained by the U. S. General Services Administration.

F.3 If the Disclosing Party is the Applicant, the Disclosing Pat ty will obtain from any contractors/subcontractors hired or lo 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: Ifthe Disclosing Party cannot certify as to any ofthe items in F.I., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of 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 of the date furnished to the City.

U.S. Bancorp

(Print or lype. name of Disclosing Party)

(SigVs here}

Laura F. iiednarski

(Print or type name of person signing)

Senior Vice President (Print or type title cd'person signing)

;ii Hennepin

before me on (date) January J3, 2015 .

^_i^5^^L'^NDAE ^coll,ns

NOTARY PUBLIC MINNESOTA

County. Jvlimiescita (state).

Notary Public

Commission c\pires'

Page 12 of 13

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITV OFFICIALS AND DEPARTMENT HEADS

Under Municipal Code Section 2-154-015, the Disclosing Parly must disclose whether such Disclosing Party or any "Applicable Parly" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any 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 Parly" means (1) all executive officers ofthe Disclosing Party listed in Section II.B. I.a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary ofa legal entity or any person exercising similar authority.

Does "he Disclosing Party or any "Applicable Parly" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head''

[ ] Yes [Xj No * To the best of our knowledge, after due inquiry

If yes, please identify below (1) the name and title ofsuch person, (2) (he name ofthe legal entity to which such person is connected; (3) Ihe name and title of the elected city official or department head to whom such person has a familial relalionship, and (4) the precise nature ofsuch familial relationship.

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Legislation Text

Legislation Details

Legislation Details (With Text)