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This record contains private information, which has been redacted from public viewing.
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Type:
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Ordinance
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Status:
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Passed
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Title:
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Zoning Reclassification Map No. 5-I at 2328-2348 N California Ave - App No. 18484
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Topic:
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ZONING RECLASSIFICATIONS - Map No. 5-I
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FINAL FOR PUBLICATION ORDINANCE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. Title 17 of thc Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all ofthe CI-1 Neighborhood Commercial District symbols and indications as shown on Map No 5-1 in the area bounded by: The 16 foot public alley next south of and parallel to West Fullerton Avenue; North California Avenue; a line 241 feet south of and parallel to West Fullerton Avenue; the 16 foot public alley next west of and parallel to North California Avenue; the 16 foot public alley next northeast of an parallel to North Milwaukee Avenue. tJ SECTION 2. To those of a B2-3 Neighborhood Mixed-Use District; SECTION 3. Changing all of the B2-3 Neighborhood Mixed-Use District and all of the Residential Business Planned Development 1276 symbols and indications as shown on Map number 5-1 in the area bounded by: The 16 foot public alley next south of and parallel to West Fullerton Avenue; North California Avenue: the 16 foot public alley next northeast of and parallel to North Milwaukee Avenue; the 16 foot public alley next west of and parallel to North California Avenue; the 16 foot public alley northeast of and parallel to North Milwaukee Avenue. SECTION 4. To those of Residential Business Planned Development 1276, as amended.- SECTION 5. This ordinance takes effect after its passage and due publication. Common Address of the Property: 2328-2348 North California, Chicago, Illinois RESIDENTIAL-BUSINESS PLANNED DEVELOPMENT NO. 1276, AS AMENDED PLANNED DEVELOPMKNT STATEMENTS The area delineated herein as Residential-Business Planned Development Number 1276, ("Planned Development") consists of approximately 30,534 square feet of property which is depicted on the attached Planned Development Boundary and Property Line Map ("Property") and is owned or controlled by the Applicant, Savoy RE Development, LLC. The requirements, obligations and conditions contained within this Planned Development shall be binding upon the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. All rights granted hereunder to the Applicant shall inure to the benefit of the Applicant's successors and assigns and. if different than the Applicant, the legal title holder and any ground lessors. Furthermore, pursuant to the requirements of Section 17-8-0400 ofthe Chicago Zoning Ordinance, the Property, at the time of application for amendments, modifications or changes (administrative, legislative or otherwise) to this Planned Development are made, shall be under single ownership or designated control. Single designated control is defined in Section 17-8-0400 ofthe Zoning Ordinance. All applicable official reviews, approvals or permits are required to be obtained by the Applicant or its successors, assignees or grantees. Any dedication or vacation of streets or alleys or grants of easements or any adjustment of the right-of-way shall require a separate submittal to the Department of Transportation on behalf of the Applicant or its successors, assigns or grantees. Any requests for grants of privilege, or any items encroaching on the public way, shall be in compliance with the Plans. Ingress or egress shall be pursuant to the Plans and may be subject to the review and approval of the Departments of Planning and Development and Transportation. Closure of all or any public street or alley during demolition or construction shall be subject to the review and approval of the Department of Transportation. All work proposed in the public way must be designed and constructed in accordance with the Department of Transportation Construction Standards for Work in the Public Way and in compliance with the Municipal Code of the City of Chicago. Prior to the issuance of any Part II approval, the submitted plans must be approved by the Department of Transportation. 4. This Plan of Development consists of 16 Statements: a Bulk Regulations Table; an Existing Zoning and Land Use Map; a Planned Development Boundary and Property Line Map; Site Plan: a Landscape/Green Roof Plan; and Building Elevations prepared by Studio 222 Architects and dated June 16, 2016, submitted herein. Full-sized copies ofthe Site Plan, Landscape Plan and Building Elevations are on file with the Department of Planning and Development. In any instance where a provision of this Planned Development conflicts with Applicant. Savoy RE Development, LLC Address. 2328-2348 North California Introduced: September 24, 2015 Plan Commission: June 16, 2016|1010| FINAL FOR PUBLICATION the Chicago Building Code, the Building Code shall control. This Planned Development conforms to the intent and purpose ofthe Zoning Ordinance, and ail requirements thereto, and satisfies the established criteria for approval as a Planned Development. In case of a conflict between the terms of this Planned Development Ordinance and the Zoning Ordinance, this Planned Development Ordinance shall control. The following uses are permitted in the area delineated herein as a Residential-Business Planned Development: multi-family dwelling units, eating and drinking establishments (excluding drive through facilities), financial services (excluding pawn shops, pay day loan stores, and drive through facilities), food and beverage retail sales, personal service, general retail sales, office and accessory uses, accessory parking. On-prcmise signs and temporary signs, such as construction and marketing signs, shall be permitted within the Planned Development, subject to the review and approval of the Department of Planning and Development. Off-Premise signs are prohibited within the boundary of the Planned Development. For purposes of height measurement, the definitions in thc Zoning Ordinance shall apply. The height of any building shall also be subject to height limitations, if any, established by the Federal Aviation Administration. The maximum permitted Floor Area Ratio ("FAR") for the site shall be in accordance with the attached Bulk Regulations Table. For the purposes of FAR calculations and measurements, the definitions in the Zoning Ordinance shall apply. The permitted FAR identified in the Bulk Regulations Table has been determined using a Net Site Area of 30,534 square feet. Upon review and determination, "Part II Review", pursuant to Section 17-13-0610 of the Zoning Ordinance, a Part II Review Fee shall be assessed by the Department of Planning and Development. The fee, as determined by staff at the time, is final and binding on the Applicant and must be paid to the Department of Revenue prior to the issuance of any Part II approval. The Site and Landscape Plans shall be in substantial conformance with the Landscape Ordinance and any other corresponding regulations and guidelines. Final landscape plan review and approval will be by the Department of Planning and Development. Any interim reviews associated with site plan review or Part II reviews, are conditional until final Part II approval. The Applicant shall comply with Rules and Regulations for the Maintenance of Stockpiles promulgated by the Commissioners of the Departments of Streets and Sanitation, Fleet and Facility Management and Buildings, under .Section 13-32-125 of the Municipal Code, or any other provision of that Code. Applicant Savoy RE Development, LLC Address- 2328-2348 North California Introduced- September 24, 2015 Flan Commission'. June 16,2016|1010| HPtlttL \ uf\ ruuuunnJN The terms and conditions of development under this Planned Development ordinance may be modified administratively, pursuant to section 17-13-0611-A of the Zoning Ordinance by the Zoning Administrator upon the application for such a modification by the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. The Applicant acknowledges that it is in the public interest to design, construct and maintain the project in a manner which promotes, enables and maximizes universal access throughout the Property. Plans for all buildings and improvements on4he Property shall be reviewed and approved by the Mayor's Office for People with Disabilities to ensure compliance with all applicable laws and regulations related to access for persons with disabilities and to promote the highest standard of accessibility. The Applicant acknowledges that it is in the public interest to design, construct, renovate and maintain all buildings in a manner that provides healthier indoor environments, reduces operating costs and conserves energy and natural resources. At the time of a hearing before the Chicago Plan Commission, all developments must be in substantial compliance with the current City of Chicago Sustainable Development Policy set forth by the Department of Planning and Development. The Applicant will achieve Energy Star certification for the Project and will have a green roof consisting of a minimum of 100% of the net roof area, or 9,596 square feet. 15. The Applicant acknowledges and agrees that the rezoning of the Property from Cl -1 to B2-3 for construction of this Planned Development triggers the requirements of Section 2-45-110 of the Municipal Code (the "Affordable Housing Ordinance"). Any developer of a "residential housing project" within the meaning of the Affordable Housing Ordinance ("Residential Project") must: (i) develop affordable housing units as part ofthe Residential Project; (ii) pay a fee in lieu of the development of affordable housing units; or (iii) any combination of (i) and (ii). In accordance with these requirements and the Affordable Housing Profile Form attached hereto as Exhibit A, the Applicant has agreed to provide 10% or 14 affordable housing units in the Residential Project for households earning up to 60% of the Chicago Primary Metropolitan Statistical Area median income (the "Affordable Units. At the time of each Part II review for the Residential Project, Applicant may update and resubmit the Affordable Housing Profile Form to the Department of Planning and Development ("DPD") for review and approval. If the Applicant subsequently reduces the number of dwelling units in the Residential Project, DPD may adjust the requirements of this Statement 15 (i.e., number of Affordable Units) accordingly without amending the Planned Development. Prior to the issuance of any building permits for the Residential Project, including, without limitation, excavation or foundation permits, the Applicant must execute an Affordable Housing Agreement in accordance with Section 2-45-110(i)(2). The terms of the Affordable Housing Agreement and any amendments thereto are incorporated herein by this reference The Applicant acknowledges and agrees that the Affordable Housing Agreement will-be recorded against the Residential Project and will constitute a lien against each Affordable Unit. The City shall execute partial releases of the Affordable Housing Agreement prior to or at the time of the sale of each Affordable Unit to an income-eligible Applicant: Savoy Rli Development. LLC Address: 2328-2348 North California Introduced: September 24, 20! 5 Plan Commission: June 16, 20)6 NWAL l-UK KjtiLlCAIlUN buyer at an affordable price, subject to thc simultaneous execution and recording of a mortgage, restrictive covenant or similar instrument against such Affordable Unit. The Commissioner of DPD may enforce remedies for breach of the Affordable Housing Agreement, and enter into settlement agreements with respect to any such breach, subject to the approval ofthe Corporation Counsel, without amending the Planned Development. If this Planned Development does not receive city council approval by July 13, 2016, the project will be subject to Section 2-45-115 ofthe Municipal Code (the "2015 ARO"). In such event, the Applicant shall meet with the Department of Planning and Development to determine the application of the 2015 ARO to the project, and the 2015 ARO requirements will replace and supersede the affordability requirements set forth in this Section 16. This Planned Development shall be governed by Section 17-13-0612 of the Zoning Ordinance. Should this Planned Development ordinance lapse, the Commissioner of the Department of Planning and Development shall initiate a Zoning Map Amendment to rezone the property to B2-3 Neighborhood Mixed Use District. Applicant: Savoy RU. Development. LLC Address: 2328-2348 North California Introduced: September 24, 2015 Plan Commission: June 16.2016|1010| PIMAI PHD DIIDI IpATIAM RESIDENTIAL-BUSINESS PLANNED DEVELOPMENT NO. 1276, AS AMENDED BULK REGULATIONS AND DATA TABLE GROSS SITE AREA: AREA IN PUBLIC RIGHT-OF-WAY: NET SITE AREA: Maximum FAR: Maximum Dwelling Units: Minimum Accessory Parking Spaces: Minimum Bicycle Parking: Off Street Loading Berths: Building Height: 44,679 sq. ft. 14,145 sq.ft. 30,354 sq. ft. 4.0 138 44 138 bike spaces 1 71'-0 ft. 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FINAL FOR PU6LICA1IUN
2007 Affordable Housing Profile Form (Rental)
Submit this form to the Department of Planning & Development (DPD) for projects that are subject to the 2007 ARO. Projects submitted after October 13, 2015 - or that do not receive City Council approval by July 13, 2016 - will be subject to the 2015 ARO. More information is online at www.cityofchicaqo org/ARO.
This completed form should be returned to: Kara Breems, DPD, 121 N. LaSalle Street, Chicago, IL 60602. E-mail: kara.breems@citvofchicaQO.org Telephone: (312) 744-6476
Date: 6/6/16
SECTION 1: DEVELOPMENT INFORMATION
Development Name: Savov on the Park
Development Address: 2340 N. California Avenue, Chicaqo, IL, 60647 Ward: 1st
If you are working with a Planner at the City, what is his/her name? Noah Szafraniec Type of City involvement: [ [ City Land
(check all that apply) i—i Financial Assistance (If receiving tif assistance, win tif funds bo
| j used for housing construction? J \') "if yes, please provide copy
I . of the T-IF Eligible 'Expenses ! !
L/j Zoning increase and/or PD
SECTION 2: DEVELOPER INFORMATION
Developer Name: NOCA 2340, LLC Developer Contact (Project Coordinator); Enrico Piatt Developer Address: 110 E. DELAWARE, Chicago, 60616 Email address: efplati@savovdevelODment.eQm Telephone Number: 3^ 4g8 80Q8
SECTION 3: DEVELOPMENT INFORMATION
a) Affordable units required
For ARO projects: ira x 10%* = }_ (always round up)
Total units total affordable units required
*20% if TIF assistance is provided
For Density Bonus projects: X 25% =
Bonus Square Footage* Affordabte sq. footage required
*Note that the maximum allowed bonus is 20% of base FAR in dash-5; 25% in dash-7 or -10; and 30% of base FAR in dash-12 or -16 (www.citvofchicaqo.crq/zoninq for zoning info).
b) building details
In addition to water, which of the following utilities will be included in the rent (circle applicable):
m (73 ? m- ?
Cooking gas electric gas heat electric heal other (describe on back)
? LZj D El
Is parking included in the rent for the: affordable units? yas no market-rate units? yes no
If parking is riot included, what is the monthly cost per space? $iso'
Estimated date for the commencement of marketing: 1 o/1 /17
FINAL rQK PUBLiCAiiUft
Expected Market Rert
Proposed Affordable Rent'
Estimated date for completion of construction of the affordable units: 2/1 /17 For each unit configuration, fill out a serjaratejpw. as applicable (see example).
Total Square Footage/Unit
Unit Type*
759
800
$1000
1 bed/1 bath
I Number Number | of of Units j Bedroo ms/Unit
Affordable Units
Studio/1 Bam
462|10 10|Example
1 Bed/ Bafti
e|1010|573 857
798
2 Boa! 2 Gath
855
464
1395
Studio/ 1 Bath
41|10 10|10.26
N/A
N/A
Market
1725
633
57|1010|Rate
Units
N/A
927
2575
26
1 Bed/1 Bath
2 Bed/ 2 Bath
'Rent amounts updated annually in tho "City of Chicago's Maximum Alfofdanto Monthly Rcp.s Chart" SECTION 4: PAYMENT IN LIEU OF UNITS
Month/Year
When do you oxpect to make the payment -in-Heu?
W/A-T5L_
(typically corresponds with issuance of building permits)
X 10% =
For ARO projects, use the following formula to calculate payment owed:
(round up to nearest whole number)
X $100,000 = $
Amount owed
Number of total units in development
For Density Bonus projects, use the following formula to calculate payment owed:
= $
x 80% x $
Bonus Floor Area (sq ft) median price per base FAR foot Amount owed
Submarket (Table for use with the Density Bonus fees-in-lieu calculations) Median Land Price per Base FAR Foot
Loop:.Chicago River on norih/Wost; Congress on south; Lake Shore Dr or east S31
North: Division on north; Chicago River on south/west; LakB Shore Dr. on east $*3
South: Congress on north; Stevenson on south; Chicago River on west; Lake Shore Or. on east $22
Wost: Lake on north; Congress on south; Chicago River on east; Racine on west S29
Date
#¦ \f- pro\ec-*r Joe* ^Or r*ce-ive C rhv CoOW*\ cvppfDVM [py 7.13.1k, -Hnl. 1x>\$ AVO
v/M A(ply.
Department of Planning and Development
CITY OF CHICAGO
MEMORANDUM
Alderman Daniel S. Solis Chairman, City Council Committee on Zoning
David t_. Reifman Secretary
Chicago Plan Commission
DATE: * June 17, 2016
RE: Proposed amendment to Planned Development No. 1276 for property generally located at 2328 North California Avenue.
On June 16, 2016, the Chicago Plan Commission recommended approval ofthe proposed planned development submitted by Savory R.E. Development LLC. A copy of the proposed amendment is attached. I would very much appreciate your assistance in having this introduced at the next possible City Council Committee on Zoning hearing.
Also enclosed is a copy ofthe staff report to the Plan Commission which includes the Department of Planning and Development, bureau of Planning and Zoning recommendation and a copy ofthe Resolution. If you have any questions in this regard, please do not hesitate to contact me at 744-5777.
cc: Steve Valenziano
PD Master File (Original PD, copy of memo)
12 1 NORTH LASALLE STREET. ROOM 1000, CHICAGO, ILLINOIS 60602
FINAL
REPORT to the
CHICAGO PLAN COMMISSION from the
DEPARTMENT OF PLANNING AND DEVELOPMENT
JUNE 16, 2016
PROPOSED AMENDMENT TO RESIDENTIAL BUSINES PLANNED DEVELOPMENT #1276 (APPLICATION NO. 18484)
SAVOY R.E. DEVELOPMENT, LLC
2328 NORTH CALIFORNIA AVENUE
Pursuant to the provisions of the Chicago Zoning Ordinance, Title 17 of the Municipal Code of Chicago, the Department of Planning and Development hereby submits this report and recommendation on a proposed amendment to Residential Business Planned Development #1276 for your review and recommendation to the Chicago City Council. The application was introduced to the Chicago City Council on October 08, 2014. Notice of this public hearing was published in the Chicago Sun-Times on June 1, 2016. The Applicant was separately notified of this public hearing.
The property is identified as 2328 N. California Avenue and is generally located along the western side of North California Avenue, where West Medill Avenue terminates creating a "T" intersection. The applicant, Savoy R.E. Development, LLC, proposes to construct a six-story, 138 dwelling unit building with retail use at the ground floor. Additionally, the proposal would provide 44 parking stalls on site.
This application has been submitted as a mandatory planned .development pursuant to section 17-8-0515-B of the Chicago Zoning Ordinance which states that expansion of an existing planned development that would result in an increase in building height, lot area, or number of dwelling units must be reviewed and approved by the Chicago Plan Commission.
PROJECT BACKGROUND AND DESCRIPTION
The subject site consists of approximately 30,000 square feet and is currently improved with a vacant, unused car wash facility, a 2-story mixed-use building and a vacant parcel of land. The applicant proposes to demolish the buildings and to then construct a six-story, 138 dwelling unit building with retail use at the ground floor; additionally, the proposal would provide 44 parking stalls accessed from the rear of the building, as well as, space for the parking/storage of 138 bicycles.
SITE AND AREA DESCRIPTION
FINAL
DESIGN
The proposed project will be primarily finished with a Metal Panel System accented at the top with metal coping and at the base by stone or masonry. The elevations will be accented with the functionally necessary store front window
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and door systems, as well as, typical glazing systems for residential uses on the floors above. Lastly, along the alley you will see overhead door system and louver panels used for access to the garage and the necessary ventilation of the space. The proposed color palette includes off-white, light gray and silver.
LANDSCAPING AND SUSTA1NABIL1TY
The entire planned development will be compliant with the requirements of the Chicago Landscape Ordinance.
The subject site will be designed to be in compliance with the current City of Chicago Sustainable Development policy and will provide a vegetated roof which will total a minimum of 50% of the net roof area which equates to 9,596 square feet of area. Additionally, the subject building will obtain Energy Star certification.
ACCESS / CIRCULATION
The 44 parking stalls provided are all accessible via the public alley running along the rear of the building. The subject site also has 138 bicycle parking/storage spaces available to the tenants the spaces are located on the ground level and are accessed both via the main residential lobby entrance and the rear garage entrance. All parking provided will meet the layout and design requirements as stated under 17-11-1000 ofthe Chicago Zoning Ordinance.
BULK/USE/DENSITY
The proposed project will be a 138 dwelling unit residential building with retail uses on the ground floor. The current maximum allowable Floor Area Ratio (FAR) for the proposed underlying zoning district (B2-3) is 3.0; however, the
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Chicago Zoning Ordinance allows a property in a -3 zoning district that is located within 1,320 feet of a rail station and provides no more than a 1 d.u. to 1 parking space ratio to take an increase from 3.0 to 3.5 FAR, additionally the proposal includes 100% of the required affordable housing units on site and thus is allowed an additional FAR increase of 3.5 to 4.0.; the proposed planned development will be limited to this maximum of 4.0 FAR. The proposed project will have a maximum building height of 71'-0". The minimum lot area per unit (MLA) for the site will be an average of 220 square feet. The proposed planned development will maintain setbacks that are consistent with information contained on the plans and exhibits provided in the planned development documentation. All remaining bulk, use and density items will be in substantial compliance with the stipulations of Section 17-3-0400 for B2-3 zoning districts.
RECOMMENDATION
The Department of Planning and Development has reviewed the project materials submitted by the Applicant and compared this proposal to the requirements of the Chicago Zoning Ordinance and existing development in the community. The area around this project is composed of a mixture of various uses including commercial, retail, and residential and is accessible from public transit. Based on that analysis, DPD has concluded that this proposal is appropriate for this site and supports this development for the following reasons:
1. Promotes economically beneficial development patterns that are compatible with the character of existing neighborhood (per 17-8-0103), as evidenced by the design of the project, and the fact that the
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proposed uses are in context with the character of the adjacent properties and also meet the needs of the immediate community;
Promotes transit, pedestrian and bicycle use, ensures accessibility for persons with disabilities and minimizes conflicts with existing traffic patterns in the vicinity (per 17-8-0904-1-2, 3 & 4), as evidenced by the site's close proximity to public transit in the form of various CTA bus lines and the California blue line stop which is located within 600 feet of the proposed development; the accessibility accommodations made on-site for the building users; pedestrian and bicycle ingress and egress options provided to the building users in the form of 138 bicycle parking stalls and provides vehicle parking at the rear of the building as suggested in 17-8-0904-C-2 of the Chicago Zoning Ordinance; and lastly, ensuring that the design ofthe site works within the confines of the current existing traffic patterns at the site and creates little or no adverse impact to those patterns;
Building Orientation and Massing (per 17-8-0906-B), as evidenced by the project design which brings the edge of the building up to the street frontage and provides large transparent storefront windows to create an active building wall;
All sides and areas of the buildings that are visible to the public should be treated with materials, finishes, and architectural details that are of high-quality and appropriate for use on primary public-right-of-way-facing fagade (per 17-8-0907-A-4), as evidenced through the information contained within this report, the proposed material is to be a metal panel system with a stone or masonry base accented in areas with aluminum window systems as shown on the elevations in the exhibits for this planned development, and the corresponding proposal renderings;
The project meets the purpose and criteria set forth in the Chicago Zoning Ordinance and its adoption would not have any adverse impact on the public's health, safety or welfare:
Per 17-13-0308-C, the proposed development is compatible with surrounding developments in terms of land use, as well as, the density and scale of the physical structure.
Per 17-13-0308-D, the proposed underlying zoning for this planned development is B2-3 and is similar to other business and commercial zoning districts, both adjacent to this site and in the immediate area.
Per 17-13-0308-E, the public infrastructure facilities and City services will be adequate to serve the proposed development at the time of occupancy and the project will comply with the requirements for access in case of fire and other emergencies. The proposed project has been reviewed by the Mayor's Office for People with Disabilities and the
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Department of Transportation and all requested changes have been made. Copies of this application have been circulated to other City departments and agencies and no comments have been received which have not been addressed in the application.
Based on the foregoing, it is the recommendation of the Department of Planning and Development that this application for the establishment of a Planned Development be approved and that the recommendation to the City Council Committee on Zoning Landmarks and Building Standards be "Passage Recommended."
Bureau of Zoning and Land Use Department of Planning and Development
Department of Planning and Development city of chicago
2328 NORTH CALIFORNIA AVENUE PROPOSED AMENDMENT TO BUSINESS RESIDENTIAL PLANNED
DEVELOPMENT #1276 (APPLICATION NO. 18484)
RESOLUTION
WHEREAS, the applicant, Savoy R.E. Development LLC, has submitted an application to
omanrl Diicinoeo Rooirlon+ial PlannnH Plox/olnrvmont if1 97fv anrl
WHEREAS, the Applicant is proposing to increase the lot area of the planned development to incorporate additional acquired property and then to construct a six-story 138 dwelling unit building with retail use on the ground floor, the applicant will provide 44 automobile parking stalls on the ground floor as well as space for 138 bicycles onsite; and,
WHEREAS, the Applicant is proposing to rezone the property from Business Planned Development #1276 and C1-1 (Neighborhood Commercial District) to a B2-3 (Community Shopping District) and then to a Business Planned Development #1276, as amended; and,
WHEREAS, the Applicant's request to rezone the property was introduced to the City Council on September 24, 2015; and,
WHEREAS, proper legal notice of the hearing for this application before the Plan Commission was published in the Chicago Sun-Times on June 1, 2016 and the Applicant was separately notified of this hearing; and,
WHEREAS, the proposed zoning application was considered at a public hearing by this . . Plan Commission on June 16, 2016; and,
WHEREAS, the Department of Planning and Development recommended approval ofthe application, with the recommendation and explanation contained in the ' written report dated June 16, 2016, a copy of which is. attached hereto and made a part hereof; and,
WHEREAS, the Plan Commission has fully reviewed the application and all associated informational submissions, the report and recommendation of the
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
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Department of Planning Development and all other testimony presented at the public hearing held on June 16, 2016, giving consideration to the applicable provisions of the Zoning Ordinance.
NOW, THEREFORE, BE !T RESOLVED BY THE CHICAGO PLAN COMMISSION:
THAT the final application dated June 16, 2016 be approved as being in conformance with the provisions, terms and conditions ofthe corresponding zoning application; and,
THAT the above-stated recitals to this resolution together with the report of the Department of Planning and Development be adopted as the findings of fact of the Plan Commission regarding this zoning map amendment application; and,
Martin Cabrera, Jr. Chairman
Chicago Plan Commis
THAT this Plan Commission recommends approval to the City Council Committee on Zoning, Landmarks and Building Standards ofthe final zoning map amendment application dated June 16, 2016, as being in conformance with the provisions, terms and conditions ofthe Zoning Ordinance.
PD No.: 1276, as amended Approved: June 16, 2016
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
CITY OF CHICAGO
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS of the property Applicant is seeking to rezone:
2328-2348 North California Avenue
2. 3.
Ward Number that property is located in:.
APPLICANT Savoy R.E. Development LLC
ADDRESS P-O-Box 11165 STATE "-
ZD? CODE.
EMAIL efplati@savoydevelopment.com CONTACT PERSON Enr'co P'ati
NO_
Is the applicant the owner of tlie property? YES
If the applicant is nol the owner of the property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed.
OWNER ^ee atlacned Exhibit A for ownership information
ADDRESS. STATE
CONTACT PERSON
If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
Katriina S. McGuire c/o Thompson Coburn LLP
ADDRESS 55 E. Monroe Street, 37th Floor
CITY Chicago PHONE 312-580-2326
STATE IL ZD? CODE 60603
PAX 312-782-1826 EMAIL kmcguire@thompsoncoburn.com
6. If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names
of all owners as disclosed on the Economic Disclosure Statements.
NOCA 2340 LLC - Enrico Plati. CAL1 2340 LLC & HALLE-JOE, LLC
2342 California LLC - Francisco J. Macias
On what date did the owner acquire legal title to the subject property? Apnl 2015
Has thc present owner previously rezoned this property? If yes, when?
Present owner of 2328-2340 N. California rezoned that portion of the subject property on April 15, 2015.
Present Zoning District C1'1 and RBPD 1276 Proposed Zoning District B2-3 then to RBPD 1276, as amended
Lot size in square feet (or dimensions'! 30,534
Current Use of the property. Car wasn' mixed use buildin9
Reason for rezoning the property to develop the subject property with 138 residential dwelling units,
commercial space and parking. 2328-40 N. California Aye present zoning RBPD 1276 and 2342-48 N. California Avenue present zoning district C1-1.
Describe the proposed use of the property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and height of the proposed building. (BE SPECIFIC)
The development will include 138 residential dwelling units and approximately 9.000 square feet of commercial space. The development will have 44 parking spaces and 138 bicycle spaces. The building will be 74'-4" tall.
14. On May 1401, 2007, the Chicago City Council passed the Affordable Requirements Ordinance (ARO) that requires on-site affordable housing units or a financial contribution if residential housing projects receive a zoning change under certain circumstances. Based on the lot size of the project in question and the proposed zoning classification, is this project subject to tlie Affordable Requirements Ordinance? (See Fact Sheet for more information)
YES x . NO
COUNTY OF COOK STATE OF ILLINOIS
Enrico piati , being first duly sworn on oath, states that all of the above
statements and the statements contained in the documents submitted herewith are true and correct.
Signature of Applicant
Subscribed and Sworn to before me this
day of , 20 .
Notary Public
For Office Use Only
Date of Introduction:
File Number: ;
Ward:
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Farago Family Investment Trust Dated September 1, 2007
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
I I the Applicant
OR
_ 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: Halle-Joe, LLC
OR . .
3. f-] a legal entity with a right of control (see Section II.B.1.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 2034 N. Clark Street, Chicago, IL 60614
Telephone: 773-281-2200 Fax: 773-?Bl-1?46 'Email: anajr.pPPQ0maii r-nm
Name of contact person: Joseph V. Farago .
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 project number and location of.property, if applicable):-
Zoning Amendment for the property located at 2328-2348 North California Avenue
Which City agency or department is requesting this EDS? Department of Planning and Development
If tlie Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
• Specification #, : and Contract # .
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SECTION II -DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY
[ j Person
l_j Publicly registered business corporation , ) Privately held business corporation f~] Sole proprietorship }" ! General partnership • j Limited partnership pT- Trust
[7] Limited liability company I I Limited liability partnership f"l Joint venture
Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))? ? Yes DNo
Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable-Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a'foreign entity?
? Yes ONo fjg N/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 of the entity.
NOTE: For not-for-profit corporations, also list below all members, if any, which are legaLentities. If
there are uo such members, write "no members." For trusts, estates or other similar entities, list below
the legal titleholder(s). •¦ •
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day .management of the Disclosing Parry. NOTE: Each legal entity listed,below must submit an EDS on its own behalf.
Name Title
Dale Weiss Trustee ¦
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 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
D'clnsing Party
Patti Jo Farago 2034 N. Clark SI. Chicago, IL 60614 I '
Joseph P. Farago 2034 N. Clark St Chicago, IL 60614 ;
Halle G. Farago 2034 N. Clark St., Chicago, IL 60614 I \
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 : (3 No •
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship^):
None . ;
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.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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Name (indicate .whether... Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not ah acceptable response.
(Add sheets if necessary)
i_J 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 tlie 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?
I-] Yes G*l No ? 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 [7JNo
B. FURTHER CERTIFICATIONS
I. Pursuant io "Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms-(e.g., "doing-business") and legal requirements), if the Disclosing Party -submitting this EDS is the Applicant and is doing business'with the City, then the Disclosing Parry certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or,charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with die City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ll.B.l. of this EDS:
a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from any transactions by any federal, state or local unit of government;
b. have not, within a five-year period preceding the date of 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 die 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 Gity 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 of control include, without limitation:
interlocking management or ownership; identity of interests among family members, shared facilities
and equipment; common use of employees; or organization of a business entity following the
ineligibility of a business entity to do business with federal or state or local government, including
the City, using substantially the same management, ownership,-or principals as the ineligible entity);
with respect to Contractors, the term Affiliated Entity means a.person or entity that directly or
indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common
control of another person or entity;
• any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, orany agency ofthe federal government or of any state or local government in the United States of America, in, that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any. such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom bf 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 Co ntf actbrv or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (i) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating m violation of 720 ILCS 5/33E-4; or (3) any similar offense-of any state or of the United States of America tiiat 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.
The Disclosing. Party understands arid shall'comply with the applicable requirements bf Chapters "2-55 (Legislative-Inspector General), 2-56 (Inspector G'eneral).and 2-156r(Governmental Ethics)''of the
Municipal-Code.-.
If the Disclosing. Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain beldw;: ,
None , . '
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the 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 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, 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
1. The Disclosing Party certifies that the Disclosing Party (check one)
? is* (3 is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
1. In accordance with Section 2-156-110 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 of any other person or entity in the Matter-?
? Yes rj3.N0 . -
NOTE: If you checked "Yes" to.Item D.I., proceed to Items D.2. and D.3. If you checked "No" to Item D.I.¦ proceed to Part E. .
2. Unless sold pursuant to a process of competitive bidding, orotherwise.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 die meaning of this Part D'.
Does the Matter involve a City Property Sale?
? Yes rJj'No
3. If you checked "Yes" to Item D.L, provide the names arid business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address , Nature of Interest
None . . - . L ¦
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 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
\__Ll . 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 profit! 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.
I.-.J 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 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 of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
None . . . '.—/
(If uo 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 brentities registered under tlie 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 riot spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal'law, a member of-Congress, an officer or employee of Congress, or an employee of a. member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
Thc Disclosing Parry 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".
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 fronrall 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 widi their bids or in writirig.at the outset of negotiations.
Is the Disclosing Part}'thc 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.)
Yes ONo
Have you filed with the Joint Reporting Committee, die Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes ' fjjNo "
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes ONo
If you checked "No" to question 1. or 2. above, please provide an explanation: None
Page 10 of 13
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 of any
contract or other agreement between the Applicant and the City in connection with the Matter, whether
procurement, City assistance, or other City action, and are material inducements to the City's execution
of any contract or taking other action with respect to the Matter. The Disclosing Party understands that
it must comply widi all statutes, ordinances, and regulations on which this EDS is based.
B. 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/Bdiics , 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 die 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 ah 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 maybe made available to the public on the Internet, in response to a Freedom of Information Apt request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted, in this EDS. ¦
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 the City takes action oh tlie Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Parry must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided'herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, die 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.l. and F,2. above and will not, without the"prior written consent of the City, use any such contractor/subcontractor that.does notprovide 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.l., 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 ahdstatements contained in this EDS and Appendix-A-(if applicable) are,true, accurate and complete as of me date furnished to the City. ,
Farago Family Investment Trusl Dated September 1, 2007 (Print'or type name of Disclosing Party)
X
(Print or type name of person signing)
person signing)
(Print or type 'title of p<
at Oho\^ County, J1-^
Signedjmd sworn to before me on (date) /-2 ,
fsWte)-. ^
Notary Public.
¦ MAOV jo Bffgwe-
OFFICIAL-SEAL Notary Public. Stato of Illinois My Commission Expires June 05. 2017
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a 'Tamilial relationship" with any elected city official or department head. A "familial relationship" exists if,'as ofthe date this EDS is signed, die Disclosing Party or any "Applicable Parry" 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 H.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Parry 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 Parry" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
? Yes fx] No
If yes, please identify below (1) the name arid title of sucli person^ (2) the name of die legal entity to which such person is connected; (3) the name.and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
None ; : ¦
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity
which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner").
It is not to be completed by any legal entity which has only an indirect ownership interest in
the Applicant. . •
Pursuant to MunicipalCode Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416: of the Municipal Code? '
QjYes [~x]No .
If the Applicant is a legal" entity publicly traded on any exchange; is any officer or director of the Applicant identified as a building cbde'sc'offlaw or problem landlord pursuant to Section
¦ 2-92-416 of the Municipal Code?
~j Yes . |~~|.'No |V[ Not Applicable
If yes to (l),or (2) above, please' identify bclowthe name ofthe person or legal entity identified as a building code scofflaw or problemrlandlord and the address of the building or buildings to which the pertinent code-violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS,' AND THAT THE' REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE TJNDERPENALTY OF PERJURY ON PAGE 12 OFTHE ASSOCIATED EDS.
Page 14 of 14
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Zoning Amendment for the property located at This recertification is being submitted in connection with 2328-2348 North California Avenue [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants thai all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.
Farago Family Investment Trust Dated September 1,2007 (Print or type legal name of Disclosing Party)
{sign hcre)Vj
^lt or type name of signatory: Joseph V. Farago
Title of signatory:
E>mc fie-fury
Signed and sworn to before me on [date] y^pL v. V^ujpu at G^k-
Notary Public.
OFFICIAL SEAL-ROBERT P. HAHN NOTARY PUBLIC STATE OF ILLINOIS
< M
Vcr. 11-01-05
CITY OF CHICAGO . ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Savoy R.E. Development LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[*] thc Applicant
OR
[ ] a legal entity holding a direct or indirect interest in the Applicant State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (see Section II.B.l.) State thc legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: P.O. Box 11165, Chicago, Illinois 60611
Telephone: 312-642-2700 Fax: Email: efplatf@savovdeveiopmeni.com
Name of contact person: Enrico Plali
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^ if applicable):
Zoning Amendment for property located al 2328-2348 North California Avenue
Which City agency or department is requesting this EDS? Department of Planning and Devetopment
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # : and Contract #
Page 1 of 13
SECTION II DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
[ ] Person (X] Limited liability company
[ ] Publicly registered business corporation [ ] Limited liability partnership
[] Privately held business corporation [] Joint venture
[] Sole proprietorship f] Not-for-profit corporation
[ ] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
[ ] Limited partnership [ 3 Yes [ ] No
[ ] Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal-entities not organized in the State of Illinois: Has the organization registered to do business in die State of Illinois as a foreign entity?
[ 3 Yes [ 3 No ft N/A
JB. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full namcs^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 ritleholder(s).
If thc 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 otier person or entity thatcontrols the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below/must submit an EDS on its own behalf.
Name Title
JEnrico Plali Manager : : ¦ : :——•
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% ofthe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or-interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 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
Enrico Plati P.O. Box 11165, Chicago. IL 60611 ' [
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 [X] No
If yes, please identify below the name(s) of such City elected officials) and describe such rclationship(s): ,
None :
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 he 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 adrninistrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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.
Katriina S. McGulre. Thompson Cobum LLP 55 E. Monroe St. 37th FL, Chicago, IL 60603AtlomeV Est 515.000
(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 fx] No [ ] No person direcdy or indirecdy owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement forpayment of all support owed and is the person in compliance with that agreement?
? Yes be] No
B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms; (e'.g., "doing'business") and legal requirements)',- if the (Disclosing Party submitting this EDS is the Applicant and is:doing business with th'e Cityj'then the.DiscIpsing Party . certifies as follows: (i) neither the Applicant nor any controlling person is;currendy. indicted or charged with, or has admitted guilt of, or has ever been convicted of, dr 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 certifications 2 and 3 below.
Page 4 of 13
2. Thc Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section JI.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;
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;
arc not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of thc 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 mat^ directly or indirectly: controls the . Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local-government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
• any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither thc Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or.attempted to bribe, or. been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or. employee of thc City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such
agreement, qr 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 o.above that is a matter of record, but have not been prosecuted for such conduct; or
violated-the provisiohs of Municipal Code .S ection 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 of local go vernment asja 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 f&e'Uriited Statcs of. America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neithe'rthe Disclosing Party.npr anyAffihated Entity is listed on any ofthe following lists,.
maintained by the Office of Foreign Assets.Contrpi of they.S/Department ofthe Treasury;orthe,
Bureau of Industry ahd Security ;of the ry.S. Department of Commerce of their successprs: the Specially
Designated Nationals Listj1tueD.em^djPersons List,'tie jTj)ay_nfic'd Lis^ the EntityXist and the •
Debarred List. v:' - ' ' ¦
The Disclosing Party understands and shaU, comply with' the applicable requirements of Chapters'
2-55 (Legislative Inspector General), 2-56,(Inspector General) and 2-456 (Governmental Ethics),,'of tie
MunicipalCode. • ¦•¦ ........ . '
If the Disclosing Party is unable to certify, to any of the above statements in this Part B (Further Certifications), thc Disclosing Party must explain below:
None ; ¦ . ! ¦
Page 6 of 13
If the letters "NA," thc word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all current employees 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 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
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) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Parry 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 of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Nona .
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have tlie 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 of any other person or entity in the Matter?
[JYes ¦ pC]No
i
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
Does the Matter involve a City Property Sale?
[JYes IXJNo
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having-such interest.and identify the nature of such interest:
Name Business Address Nature of Interest
None . - ¦ : :
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either I. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
_X_1. The Disclosing Party verifies that thc 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 Parry 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 disclosure of all such
records, including the names of any and all slaves or slaveholders described in those records: None
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 tie Disclosing Party with respect to the Matter: (Add sheets if necessary):
None ' ¦ . ¦_
(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 Parry 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 entity listed in Paragraph A.l. above for his of her-lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page9ofl3
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 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 DNo
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 4.1 CFR Part 60-2.)
Yes ? No
Have you .filed with the Joint Reporting Committee, the Directo.r.of tlie Office of Federal Contract Compliance Programs, iof the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes UNo ,
Have you participated-in any previous contracts or subcontracts subject to the equal opportunity clause? •
Yes , ' , fJ.No
If you checked "No" to question 1. of 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 of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Parry 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 Parry must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or maccurate, 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 thc City's policy to make this document available to the public on its Internet site and/or upon, request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
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 the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, thc Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be-kept current-for a longer period,.
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that . . •
Page 11 of 13
F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant/the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the UJ S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Parry will obtain from any contractors/subcontractors iired or to be hired in connection with the Matter certifications equal in form and substance to those in F.I. and F.2. above _nd will not, without the prior written consent ofthe City, use any such contactor/subcontractor that does not provide ;such certifications, or that the Disclosing Party has reason to believe has riot provided ;6r'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) pn behalf of the Disclosing Party, and (2) warrants.that all certifications and statements contained in this EDS and Appendix A (if applicable) arc true, accurate and complete as -ofthe date furnished to the City. "-
Enrico Plali
(Print or type name of person signing) Manager ¦
(Print or type title of person signing)
Notary Public.
Commission expires:.
Page 12 of 13
Signed and sworn to before me,on (datcfyefitflktr$ f . at Cfif\\/- ,- County, (state).
OFFICIAL SEAL . MICHAEL TONEILL . Notary Public - Slate of Illinois My Commission Expires Jan 14, 201S
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSBTPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relarionship" 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 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 H-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 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. 'Trincipal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currenfly have a "familial relationship" with an elected city official or department head?
I] Yes [X] No
Jf yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name arid title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
None ' \ • \ :
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to MunicipakCode Section 2-1 54t0 10, is,the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92^416 of the Municipal Code? •
[ ] Yes [ X] No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
• [ ]Yes ¦ . .No/ [X ] Not Applicable
3. If yes to (1) or (2) above; please identify below the name ofthe person or legal entity
' identified as a'buildihg bode scofflaw-or problem-landlord and ihe-adHress-'of flies building or buildings to which the pertinent code violations apply.
N/A •¦¦
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT TITJS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party musl complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Zoning Amendment for the property located at This recertification is being submitted in connection with 2328-2348 North California Avenue
[identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) wan-ants that all certifications and statements contained in the Disclosing Party's original EDS arc tme, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.
Savoy R.E. Development LLC
(Print or type legal name of Disclosing Party)
.1
(sign here) Print or type name of signatory:
Enrico Plati
Title of signatory: Manager
Signed and sworn to before me on [date] c/--/\g
Notary Public.
iSr
Commission expires
GEORGE TRIARCHOU ' Official Seal P Notary Public - State of Illinois My Commission Expires Jan 20. 2020
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable: CALI 2340 LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
I 1 the Applicant
OR
[xj 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: NOCA 2340 LLC
OR . . . '
3. [7] 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: ' -
J3. Business address of the Disclosing Party: 3216 N. Cicero Avenue. Chicago, IL 60641
Telephone: 312-263-5452 • ._ Fax: 312-263-5759 - Email: sienseniffrnjwnhirann mm
Name of contact person: Scott Jensen "
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, if applicable):
Zoning Amendment for the properly located at 2328-2348 North California Avenue
Which City agency or department is requesting this EDS? Department of Planning and Development
If the Matter-is-a contract being.handlcd by the City's Department of Procurement Services, please complete the following: ¦
Specification # and Contract #.
Page 1 of 13
SECTION II-
- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
• Person [X] Limited liability company
LJ Publicly registered business corporation ? Limited liability partnership
, 1 Privately held business corporation [_J Joint-venture
fi Sole proprietorship ? Not-for-profit corporation
[J General partnership (Is tlie not-for-profit corporation also a 501(c)(3))?
Li Limited partnership CjYes QNo
i Trust _ _ ? Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a'fbreign'entity?
Yes ?"No _\ N/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 arc legal entities. If
there are no such members, write "no members." For trusts, estates or other similar entities, list below
the legal tideholder(s). • ;
If thc entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the' nameand tit!e:of each general partner, managing member, manager or any other person or entity, diat 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
Berry Real Estate Management Corporation ' ¦'¦ Manager ¦ .
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 1.5% ofthe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional informal from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party ,
Robert T. Berry and Patrica Berry as Joint Tenants 3216 N. Cicero Avenue. Chicago. IL 60641
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of thc Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes (3 No •
If yes, please identify below the name(s) of such City elected official(s) and describe such
relationship(s): ' ' •
None
SECTION IV-DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of die fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely flirough the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself, "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If thc 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 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)
:_J 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 die Disclosing Party been declared- in arrearage an any child support obligations by any Illinois court of competent jurisdiction?
Yes fjxj No ? No .persdn 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 ¦ nNo
B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal .Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined1 terms (e.g., "doing business") and'legalHqmrements), if tfre-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 or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
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;
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.
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 andOther RetainedParties");> '
any "Affiliated Entity" (meaning a person orentity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under ' common control of another person or entity. Indicia of control include, without limitation: interlocking management' or ownership; identity of interests among family members, shared facilities and equipment; common iise of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership,-or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls thc Contractor, is controlled by it, or, with the Contractor, is under common . control of another pcrson~orentity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any odier official, agent or employee of the Disclosing Parry, any Contractor 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")
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before tlie date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
a. bribed or attempted to'bribe, or been convicted or adjudged guilty of bribery or attempting to
bribe, a public officer or employee of the City, the 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;
b. . agreed or colluded with other bidders or prospective bidders,:or been a party to any. such
agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or
prospective .bidders, in restraint of freedom of competition by .-agreement to bid a fixed price or
otherwise; or ¦ ' " ¦ : - ¦
made an admission of such conduct described in a. of b^above that is a matter,of record, but have not been prosecuted for such conduct; of
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;gavemment as a result'of engaging in or being convicted of (J) 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 me United,States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing.Party nor any 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 Indus try^and Security ofthe U.S. Department of Commerce or their successors: the 'Specially
Designated Nationals List, the Denied/Persons List,.the Unverified.List, the Eudty .List and the
Debarred List. ' :-- : -
The Disclosing Party.understands and shall coriiply withithe.applicable requirements of Chapter's- ' 2-55 (Legislative Inspector Geheral),'r2-56 (Inspector General) and.-2-l 56 (.Governmental Ethics) ofthe MunicipalCode. . : • .
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
None
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it wilt be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the 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 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 dnie 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 520 per recipient (if none, indicate
with "N/A" or "none"). As to any gift listed below, please also list the name of tlie City recipient.
None ' ;
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
LJis g] is not.'
a "financial institution" as defined'in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a.predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party js unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
None . .
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
1. In accordance with Section 2-156-110 of thc 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 HNo .
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 Matterinvolve a City Property Sale?
nYes l_ No •
3. 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 of such interest:
Name -Business Address Nature of Interest
None ' - - ¦ ' • ¦ . : ; .
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 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
___L 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 profit 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.
I... J 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 die names of any and all slaves or slaveholders described in those records:
None
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 widi respect to the Matter: (Add sheets if necessary):
None • ¦_;
(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 thc Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress,-in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy 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 Parry is the Applicant, thc'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 ail sucJrsubcontractors* 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 DNo
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? (Sec 41CFR Part 60-2.)
Yes QNo
Have you filed with the Joint Reporting .Committee, the Director of the Office of Federal" Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes ' ,; -©No. . ¦ v
Have you participated in any previous contracts or subcontracts subject to the
equal opportunity clause? ¦ , . ,
Yes ? No
If you checked "No" to question 1.-or 2. above, please provide an explanation:
None ¦ '¦ i .......
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 of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.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. • ' ;
D. 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 ofthe information provided on this EDS and any attachments to this EDS maybe
made available to the public on the Internet, in response to a Freedom of Information Act request, or
otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible
rights or claims which it may have against the City in connection with the public release of information
contained in this EDS and also authorizes the City to verify the accuracy of any information submitted.,
in this EDS.
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 the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided'herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If die 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 thc U.S. E.P.A. on the'federal Excluded Parties L'ist System ("EPLS"0 maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, tlie 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.l. and,F.2. above and will not, wi'thout'the prior written consent ofthe City, use any such contractor/subcontractor thatdoes not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthfid'certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.L, 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 arid Appendix A (if applicable) on^behalf of the Disclosing-Party, and.:(2) warrants that all certificatidns:and statements contained in this EDS and Appendix A (if applicable) arc true, accurate and complete-as of the date furnished,to.the City.
CAL1 2340 LLC
(Pjjnt-or4roeLnanie of Disclosing; Party) .
(Sign here) / ./ J
(Print or type name of person signing) (Print or type title/of person signing) -.
SigntfrTj^nd swom-to before me 0H;fdateD<^H/MJ at V Q-C|f l County, dj-JjJr (/(state)
lotary Public.
Commission expires: QFflGJAfc-SEAfc-
Margaref M. Samson ^ _ _ Nolary Public, State of Mnfi§& f of 13 My Commission Expires 09/20/2017
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its 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 die 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.l. and F.2. above and will not, without the prior written consent of tlie 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 tnithful certifications.
NOTE: If the Disclosing Party cannot certify as to any of thc items in F.l., 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.
(Prinuir-type name of Disclosing Party) Jign here) ^
»ncd and swo, at i-QC«^ County, "^LT6C
(Print or type name of person signing) (P/int or type title «f person signing) Signed and sworn to before me on (date)
4- IMOtflfyfUDIlC ~b!8TB Of nllnois
! My Commission' Expires 09/20/2017
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 interestin the Applicant
Under Municipal Code Section 2-I54-0I5, 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 tin's EDS is signed, die 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 thc following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-rih-law, mother-in-law] son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister. ,¦.
"Applicable Party" means (I) all executive officers of the Disclosing Party iisted in Section ILB.l.a., if the
Disclosing Party is a corporation,- all partners of the DisclosingParty, if the Disclosing Party is a general
partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited
partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a
limited liability company; (2):all principal, officers of the Disclosing Party; and (3) any person having more than
a 7.5 percent ownership interestin the'Disclosing Parry. "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 tlie Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currendy have a "familial relationship" with an elected city official or department head?
? Yes ¦ • , . fx] No
If yes, please identify below (1) the name and tide of such.person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official,or department head to whom.sUch person has a familial relationship, and (4) the precise nature of such familial relationship. ; ;
None
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUfJLDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed.only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner1'). It is not to be completed by any legal entity which has only an.indirect ownership interest in the Applicant.
Pursuant to Municipal CodeScction 2A 54-010, is the Applicant or any Owner idehtified.as a building'co'de scofflaw. or. problem,landlord pursuant to Section 2-92-416 ofthe Municipal Code? •
p| Yes [x~|No . " •
If the Applicantisa- legal entity publicly traded on any exchange, is any officer-or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section
' :- 2-92416;of the Municipal Code? .
f7] Yes :'. [ [No f~xj Not Applicable
If yes to (1) or (2) above, please identify below :the name of tbe;.p.erson or legal entity ¦identified as abuilding.code. scofflaw or problem landlord and the address of the'buildihg or buildings to which the pertinent code violations apply. .
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT' THAT THIS APPENDLX B IS INCORP ORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIAITSD'EDS, AND THAT THE REPRESENTATIONS MADE IN.THIS APPENDLX B ARE SUBJECT TO THE CERTDHCATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OFTHE ASSOCIATED EDS.
Page 14 of 14
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Parry submitting this EDS. Include d/b/a/ if applicable: NOCA 2340 LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. the Applicant and Owner
OR
2. Q a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Parry holds an interest: ¦
OR
3. (71 a legal entity with a right of control (see Section U.B1.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 540 N. Dearborn. PO BOX 101163. Chicago. IL 60610
Telephone: 312-642-2700 Fax: - Email: efpteliiasavoyrtevelopmRni mm
Name of contact person: Enrico piati
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 project number and location of.property, if applicable):
Zoning Amendment for lhe property located at 2328-2348 North California Avenue
Which City agency or department is requesting this EDS? Department of Planning and Development
If Che Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page I of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
I. Indicate tie nature of the Disclosing Party:
i. .J Person [x] Limited liability company
U Publicly registered business corporation ? Limited liability partnership
I 1 Privately held business corporation Joint venture
r~] Sole proprietorship [J Not-for-profit corporation
[_J General partnership (Is the not-for-profit corporation also a 501(c)(3))?
[_J Limited partnership OYes ONo
F~ Trust Q Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entities not organized .in the State of Illinois: Has the organization registered to do business in the State of Illinois as a'foreign entity?
? Yes QNo 0N/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 of the entity. NOTE: For not-for-profit corporations, also list below all members, ifany, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below tlie legal titlehoIder(s).
If the entity is a general .partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing .raember, 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 oh its own behalf. . •.
Name Title
Enrico F. Plali "Manager 1 - ' • i. .
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest-include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional informatii from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
Halle-Joe. LLC 2034 N. Clark St. Chicago, 1L BD614 40.70%
CALl 2340 LLC 3216 N. Cicero Avenue. Chicago, IL 60841 40.70%
Enrico F. Plati 540 N. Dearborn. PXBox 101163. Chicago. IL 60161 ^
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 0No •
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
None ' ' ¦
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 tile fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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.
Katrflna S. McGure/Thompson Coburn LP (retained) 55 E. Monro St - 37lh FL. Chicago. IL 60603 Attorney Est $25.000
(Add sheets if necessary)
?* 1 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 2-92-415, 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 {23 No fj 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?
CI Yes ? No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currendy indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) thc 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, mc permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of tins 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 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, Jor 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.limitcd 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 thc Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government,-including . the City, using substantially the same management, ownership,-or principals as the ineligible entity); with respect to Contractors^ the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is Under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either tlie Disclosing Party or any Contractor nor any Agents have, during the five years before the date'this EDS is signed or with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State bf 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, orbeen 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 1
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;tfic provisions ofMunicipal Code Section 2-92-610 (Living Wage,Ordinance).
Ncidier 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-gdvernment.as. a result of engaging in or being convicted of (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in' violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state 'or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed onanyofdie. following, lists
maintained by the O ffice of ForeignAssets Cpntrol of me U.S.'Department of the Treasury or the
Bureau of Industry and Securiry>of.the U.S. Departmeritpf Commerce or their successors: the .Specially
Designated Nau'oh'als'Lis^the Denied Persons List, the Unverified List, tiie Entily List and the
Debarred.List. '¦' ' ' ,
The Disclosing Party understands and*shall comply with the applicable requirements of Chapters ¦
2-55 (Le;gisiatiye Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe
Municipal Co'de. :•'*'J • •- 1 • - ¦.
If the Disclosing 'Party is unable to certify to any of tlie above statements in.this Part B (Further Certifications), me Disclosing Party must explain below:
None " • '
Page 6 of 13
If tbe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to tlie above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all current employees of the Disclosing Party who'were, at any time during the 12-
month period preceding the execution date of this EDS, an employee, or elected or appointed official,
of the City of Chicago (if none, indicate with "N/A" or "none").
None
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
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
widi "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 thc Disclosing Party (check one) ? is [xjisnot
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a.predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in
Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter
2-32 of the Municipal Code, explain here (attach additional pages if necessary):
None . :
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
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.
1. In accordance with Section 2-156-110 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 of any other person or entity in the Matter?
? Yes H No
NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. arid D3. If you checked VNo" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted,, noCity 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 tbe meaning of thisPart D:
Does the Matter involve a City Property Sale? . nYes __No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
None : ¦¦ : [ 1 ' ¦ ¦ ' ¦ - ¦ ¦ ¦ ¦
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 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
f*~l 1 • The Disclosing Party verifies that tlie 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.
, \, ...1,2. 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:
None ¦ ¦ ¦ ' '
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 respect to the Matter: (Add sheets if necessary):
None ; : : ; ¦
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word VNone" appear, it will be conclusively presumed that the Disclosing Party means" thatNO personsior.entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.-)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence of attempt to influence an .officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with tlie award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of tlie 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".
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 subc'oritracto^ceru^cations for the duration of the Matter arid 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 Parry the Applicant?
Yes QNo
If "Yes," answer the three questions below:
Have you developed and do you have on file affirrnative action programs pursuant to applicable
federal regulations? (See 41 CFR Part 60-2.) '* • ,:
Yes DNo
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 - ONo '. ; - / \ ¦ - -
Have you participated in any previous contracts or subcoritracts.subject to the. equal opportunity clause?
Yes ? No
If you checked'"No" to question 1. or 2. above, please provide an explanation: None •
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 of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City acdon, 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.citvofchicago.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 Ereedolm of Information Act request,, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted, in dais EDS.
E. Thc 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 die City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 21 of 13
F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes;
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by. the U.S. E.P.A. on the federal Excluded 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.l. and F.2. above and will not, without- the,priqr 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 nol'provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.L, 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 ©iscl6sing,Party, .and .(2) warrants that all certifications and statements coritaihed ih'this EDS'and Appendix A;.(if applicable) are trae,'accurate and complete as of the date furnished to the City.
(Print or type name of person signing)
(Print or type title of person signing)
Signed;ahd sworn to before me on (date) at COO V— .f] County. ~_VL^.
Commission expires
: Ol/(f \\
OFFICIAL SEAL . MICHAEL TONEILL , Notary Public - Stite of Ullnon My Commission Ex£irK Jin 14,2016
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDLX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) tlie Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Parry" 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, die 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 .1 .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners 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 thc 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 DDNo .
If yes, please identifVibelow (f) the name and title of such person; (2) the name of the legal entity to which such person is connected; (3) the.narne and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship. -
None . ¦ ! ': .
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUJXDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
• TI1'^ Appendix is to be completed only .by,(a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an "indirect ownership interest in the Applicant.
I. Pursuant to Municipal Code Section 2-154-010, is.the Applicant or any Owner identified as a . building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
QYes.
2. If the Applicant is a legal entity publicly traded pn any .exchange, is any officer or director.of : the Applicant identified as a building code scofflaw or problem 'landlord pursuant.to Section •2-92-416.6f the Municipal Code? ¦
| [ Yes . ) jNo. X Not Applicable
If yes to (I) or (2) above, please identify below,-the name of the person or legal entity ; identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FIDLING OUT THIS APPENDLX B CONSTITUTES.ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDLX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PARTOF, THE ASSOCIATED'EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Zoning Amendment for the property located at This recertification is being submitted in connection with 2328-2348 North California Avenue [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) wan-ants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as ofthe date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.
noca 2340 LLC Date: (^,/;z/\C
(Print or type legal name of Disclosing Party)
(sign heits)^ Print or type name of signatory: Enrico Plati
Title of signatory:
Manager
County, _
Notary Public.
Signed and sworn to before me on [date] G I ~2- /\C,
^toRVCO ?L^\ at rofiU
us
Commission expires:
GEORGE TRIARCHOU Official Seal Notary Public - State of Illinois Mv Commission Expires Jan 20, 2020
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Berry Real Estate Management Corporation
Check ONE of the following three boxes:
Indicate whether die Disclosing Party submitting this EDS is:
f___ die Applicant
_ OR
__J a legal entity holding a direct or indirect interest in die Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest: -
OR . ...
3. [X] a legal entity widi a right of control (see Section II.B.1.) State the legal name of the entity in
which die Disclosing Party holds a right of control: CAU 2340 LLC - " : '
B. Business address of the Disclosing Party: 3216 N. Cicero Avenue. Chicago. IL 60641- ,
Telephone: 312-263-5452 Fax: 312-263-5759 Email: sJensen@mjwchicago.com
Name of contact person: Robert Berry
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, if applicable):
Zoning Amendment for the property located at 2326-46 North California Avenue : .
Which City agency or department is requesting this EDS? Department of Planning and Development
If the'Matter is a contract being handled by the City's Department of Procurement Services, please complete the fallowing:
Specification # [ and Contract #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY
I. Indicate the nature of the Disclosing •""j Person
L_j Publicly registered business corporation r*\ Privately held business corporation f-] Sole proprietorship {_] General partnership • j Limited partnership i 1 Trust
m Limited liability company
f~l Limited liability partnership
f i Joint venture
f~] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
? Yes _]No fj Ofier (please specify)
2. For legal entities, the state (or foreign Illinois
3. For legal-entities not organized in the.State of Illinois: Has the organization registered to do business in the State of Illinois as a'foreigri entity?
" '- ".'V c
f-JYes Q-No H N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the fuUna'mcs'and-titlesrof all exccutive.afficers and all directors of the entity.
NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If
diere 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 gen eral 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 thatcontrols 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
Robert Berry " President '. • .¦
2. Please provide die following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of die Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), die 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
Robert Berry 3216 N. Cicero Avenue. Chicago, IL 60641 ;
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has die 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 0No •
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
None
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose tiie 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 die fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whedier 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 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)
jXj 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 niore of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[7) Yes Q_ No ? No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has die 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 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements); if iheTJisclosing 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 widi, or has admitted guilt of, or has ever been convicted b'f, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any. sister agency; and (ii) die Applicant understands and acknowledges that compliance with Article I is a.continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ll.B.l. of tins 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, widiin 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 die 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 die Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity-following tlie 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 terni Affiliated Entity, means a.person or entity that directly or indirecdy 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 of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents"). # .
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed or with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders; or been a party.to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in 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).
4. Neither the Disclosing Party, Affiliated Entity or-Contfacto'r, 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 Contro I of the 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, tlie Entity List arid the Debarred List. '
The Disclosing Party.understands and shall comply with'the.app.licable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe MunicipalCode.
If thc Disclosing Party is unable to certify'to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
None ¦
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the 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 Chicago (if none, indicate with "N/A" or "none"). None
9. To the best of thc 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 die 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.
None ; ; : ;
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
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) of the Municipal Code.
If the Disclosing Party IS a financial institution, tiien the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of die Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a.predatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it.or any of its affiliates (as defined in
Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter
2-32 of the Municipal Code, explain here (attach additional pages if necessary):
None , . . —
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of thc Municipal Code have the same -meanings when used in this Part D.
1. In accordance with Section 2-156-110 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 (3 No .
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. arid 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 die 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?
n^es (3 No
3. If you checked "Yes" to Item D.l., provide the names arid business addresses of the City
officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
None ¦ - >. , t„ ¦ . •__ _i :
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 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with, these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
The Disclosing Party verifies that tlie Disclosing Parry 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 tiiat provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
J J.2- The Disclosing Party verifies that, as a result of conducdng 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: None •
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 die federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party widi respect to the Matter: (Add sheets if necessary): "
None : • 1 ;
(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 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 entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an.officer or employee of any agency, as defined by applicable federal law, a-member of Congress, an officer or employee of Congress, or an employee of a • member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13 .
The Disclosing Party will submit an updated certification at the end of each calendar quarter in
which there occurs any event that materially affects the accuracy of the statements and information set
forth in paragraphs A.l. and A.2. above. ' ¦
The Disclosing Party certifies that either: (i)it is riot 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".
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 ofthe Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If die 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 DNo
If "Yes," answer the three quesdOns'belov/'.- ...
Have you developed and do you have on file affirmative action programs pursuant to.applicable federal regulations? (See 4I.CFR Part 60-2.)
Yes QNo
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs,.or tie Equal Employment Opportunity Commission all reports due under the applicable filing requirements? .
Yes ' ' ? No "
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes QNo '
If you checked "No" to question 1. or 2. above, please provide an explanation: None
Page 10 of 13
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in tins EDS will become part of any
contract or otiier 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 tin's EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of die 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/Ediics , and may also be obtained from die 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 odier 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 arid an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted, in this EDS.
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 the City takes action on tlie Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to-Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided'herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If tlie 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, die Disclosing Parry 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.I. 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 thc Disclosing Party has reason to believe has not provided or cannot provide tnithful certifications.
NOTE: If the Disclosing Party cannot certify as to any of die items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.""
CERTIFICATION ,
Under penalty of perjury, the persan.signmg below: (1) warrants thathe/she is authorized to execute this EDS'arid-Appendix A (if.appficable).c-n 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 Cityi
Berry Real Estate Management Corporation
(Print •er-type.name of Disclosing Party)
(Print or type title of person signing)
at ( r3^y County, J-PJ.j
F.L The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its 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 docs not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If thc 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.
Berry Real Estate Management Corporation
(Print or type name of Disclosing Party)
(Print or type name of person signing)
(Print or type title of person signing)
Signgd and sworn to before me on (date) /
at G OQ /< County, HZT LL Estate)/
Commission expires
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDLX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant,
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner diereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date flu's EDS is signed, die Disclosing Parry 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 die 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, stepbrotiier or stepsister or half-brother or half-sister.
"Applicable Party" means (I) all executive officers ofthe Disclosing Party listed in Section ILB. La., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Parry 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 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 (x]No
If yes, please identify below (1) the name and tide of suchperson, (2) the name of die legal entity to which such person is connected; (3) the name and tide of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature bf such familial relationship.
None . .——
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and ((b) any legal entity which has a direct ownership interest in the Applicant'exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which'has only an indirect ownership interest in the Applicant.
I. Pursuant to Municipal Code.Scction 2-154-01.0, Is the Applicant or any Owner identified as a
building code scofflaw. or problem landlord pursuant to'Section 2-92-416 ofthe Municipal
Code? ¦ . " . ¦"'
QYes
If the Applicant is a legal entity .publicly traded dn'any exchange, is any officer or director bf the Applicant identified as a building code'scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?.. •
' ¦¦• |~] Yes- ' , '' . '. [~~{No.; ; - [T[ Not Applicable
If yes'fo (I) or .(2) above, please,identify below the name of thejperson or legal entity identified as a building.cade scofflaw of problem landlord and the address of the'buildirig or buildings to which the pertinent codei'violatibns applyl .
FILLING:OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDDC B IS INCORPORATED BY REFERENCE INTO^AND MADE APART OF, THE ASSt)CIATEBrEDS,. AND THAT THE REPRESENTATIONS MADE IN THIS APPENDLX B ARE SUBJECT TO THE CERTDJICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Parry submitting this EDS. Include d/b/a/ if applicable: Hal/e-Joe. LLC
Check ONE of the following three boxes:
Indicate whether die Disclosing Party submitting this EDS is:
| | the Applicant
OR
_T\ 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: NOCA 2340 LLC
OR
3. [7] a legal entity with a right of control (see Section II.B.I.) State the legal name of tlie entity in
which the Disclosing Party holds a right of control: - '• ' •
B. Business address ofthe Disclosing Party: 2034 N. Ctark Street, Chicago, IL 60S14
Telephone: 773-281-2200 ¦».; Fax: 773-2B1-1246 Email: acal6e90aqrriail.cim
Name of contact person: Joseph V. Farago
Federal Employer Identification No. (if you-have one): ¦—.- — - ,-
Brief description of contract, transaction or o ther undertaking (referred to below as the; "Matter") to which this EDS pertains. (Include project number and location bf.property, if applicable):
Zoning Amendment for the property located at 2328-234B North. California Avenue
Which City agency or department is requesting this EDS? Department of Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # ¦ : and-Contract # ._ : ._
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate die nature of tlie Disclosing Party:
[~j Person [Xj Limited liability company
'._ J Publicly registered business corporation ? Limited liability partnership
, j Privately held business corporation' QJj Joint venture
p) Sole proprietorship [~] Not-for-profit corporation
f_J General partnership (Is the not-for-profit corporation also a 501(c)(3))?
: j Limited partnership QYes r~)No
f~ Trust _ Q Other (please specify) ¦ ,
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois .
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in tlie State of Illinois as "a'foreign entity? '• ¦">' ¦¦>'<
fJYes DNo 0N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY: '
1. List.below die full names and titles of all executive officers and all directors of the entity.
NOTE: For not-for-profit corporations, also list below- all-members, if any, which are.legal entities If
there are no such members, write "no members." For trusts, estates or other similar entities, list below
the legal titleholder(s).
If the entity is a general partnership, limited,partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of tbe Disclosing Party. NOTE: Each legal entity listediielow must submit ah EDS on its own behalf.
Name Title
Joseph V. Farago " Manager
• 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 Parry. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or otiier similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), die 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
Farago Family Investment Trust Dated 9/1/2007 i i
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 diis EDS is signed?
? Yes 0 No •
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship^):
None • '
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 ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Parry'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: (I)n not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any'paft of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If thc 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 13
Name (indicate whedier 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)
. ] Check here if the Disclosing Parry 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? '
[7] Yes 0No ? No person.directly or indirectly owns 10% or more of the
Disclosing Parry.
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? ,
n Yes - r~]No.
B. FURTHER CERTIFICATIONS ,. .
1. PursunntWMunicipal.Co'deiGhapter. 1,-2-3,-Article I("Article I")(v/hich the Applicant should consult for defined terms ;(e.g.,."doing business"), and legal requirements)-if the Disclosing Party submitting this EDS is the Applicant and is.doing.business with the City,'then the Disclosing Party certifies as follows: (i) neither the Applicant nor.any .controlling person is. currently indicted or charged widi, or has admitted guilt of, or has ever been convicted o'f, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.1. 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;
have not, widiin 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, widiin 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 tlie 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 tlie 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 Parry, under common control of another.person or entity. Indicia of control include, without limitation:' interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following' tlie ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership,-or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a.person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
- any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of tlie Disclosing Party, any Contractor 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").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, widi respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during die five years before die date of such Contractor's of Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convictedor adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City,- the State of Illinois, or any agency of die 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. orb. above diat is a matter of record, but have not been prosecuted for such'conduct; or
violated the provisions of Municipal Code Section 2-92-61Q (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 (i) bid-rigging in violation of 720 ILCS 5/33E-3; (2)"bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither, the Disclosing Pa : maintained by the Office of Foreign Assets Go'ntrdl-of.the U;S. Department .of the Treasury'or the ' Bureau of Industry. and.Securiry of the U.Sv Department ofCommerce.or their successors: the Specially Designated Nationals List, the Denied Persons List,! the Unverified List, die Entity List and-the Debarred List.
" :j ¦ ': ... '
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) ofUie Municipal Code.-
If the Disclosing Party is unable to certify to any of die above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
None
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who'were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official of the City of Chicago (if none, indicate 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 tiiat 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 die
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 09 is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges: .
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, arid 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 apredatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined, in
Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter
2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
¦ None ! : :
Page 7 of 13
If die letters "NA," die word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
I. 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 of any other person or entity in the Matter?
? Yes [JNo.. . ,
NOTE: If you checked "Yes" to-I tern. 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 lo 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 s'old by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken.pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[~J Yes __ No
3. If you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
None ¦ '' ' ¦ ; ¦ : ¦ ¦¦ - - : : '. ¦ '
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 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply widi these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
j, I 2. The Disclosing Party verifies that, as a result of conducting die 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
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 Parly with respect to the Matter: (Add sheets if necessary): ' !
None '
(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 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 entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee o'f any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded-contract, making any • federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section
501 (c)(4) 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 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 putset.of , . -
negotiations. ; L. . ,
Is the Disclosing Party the Applicant?
Yes DNo
If "Yes," ansv/er the -three questioris^below: ;
Have you developed and do you have on file affirmative action prograrris pursuant to applicable
federal regulations? (See.4.1.CFR Part 60-2.) ' -
Yes ? No
Have you filed with" the Joint Reporting Committee,, the Director of the Office of Federal Contract Compliance Programs, or the.Equal Employment Opportunity Commission all reports due under the app'licab|e'-filirig-requircments? ...
Yes"' ' "'"" !_J No :
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes ? No
Ifyou checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII — ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTDSS, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or otiier City action, and are material inducements to the City's execudon of any contract or taking other acdon with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which tliis 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/Efliics , 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 die Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted, in this EDS.
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 the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its 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 die Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors' hired or to be"hired iri^connection with the Matter certifications equal in form and substance to those'in F.li and F.2. above and will not, without the prior written consent of the City, use.any such contractor/subcontractorthat does not provide such certifications or that the Disclosing Party has reason to believe has notprovided or cannot provide trathful certifications.
NOTE: If the Disclosing Party cannot'certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty ofperjuryj the person signing-below: (1) warrants that he/she is authorized to execute this ED S and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants• Uiat all certifications arid statements-cont'aineddn this EDS and Appendix A (if applicable) are true, accurate and complete as ofthe; date'furfjushed to me City.
Halle-Joe, LLC
(Print or type nanie of Disclosing Party)
(Print or type name of person signing)
(Print or type title bf pers on signing)
rAW-^o-BTrorrorj—
OFFICIAL SEAL Notary Public, Statu of Illinois My Commission Expires June 05, 2017
Signed and sworn to before me on (date).
at GOO County, f£
.(sk&O. Notary Public.
Page 12 of 13
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Parry must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Zoning Amendment for the property located at
This recertification is being submitted in connection with 2328-2348 North California Avenue [identify the Matter]. Under penalty of perjury, tlie person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf ofthe Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Parry's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.
Halfe-Joe, LLC
(Print or type legal name of Disclosing Party)
Joseph V. Farago
Title of'Signatory:
Manager
Signed and sworn to before me on [date]
'So^pC 1/ ("cm*vr-T3 , at (
Commission expires:
Ver. 11-01-05
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-I54-0I5, 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, tlie 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 die 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 ILB.l.a., if the Disclosing Party is a corporation; all;partners of die Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownereMp interest m-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 Parly" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
? Yes -t ; ., , LIB No .
If yes, please identify'.b'eiow (l)'the name and tide of such person, (2).Lhe;name ofthe legal entity to which such person is connected;, (3) the. name and title ofthe elected city official of department head to whom such person has a familial relationship, and (4) th e precise nature of such familial.relationship.
None • ' : - ;
Page 13 of 13
QTY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDLX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
. This Appendix is;:tb-be'completed .only-bywhicli has a direct ownership interest s the Applicantexceeding 7.5 percent (an "Owner").
It is not to be completed by any legal entity which has only an indirect ownership interest in
the Applicant • -
I. '- Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw'of problem landlord pursuant to Section 2-92-4-16 of the Municipal . Code? ' • <' ' ¦ ¦
[~~}Yes [gNo ' '
If the Applicant is a'legal entitypublicly traded onariy exchange, is any officer or director of. the Applicant identified as a building code scofflaw or problem landlord pursuant to Section • 2^92^16-of'_he^MuhicipaI £ocle?r ...- ,.:. .
Applicable
3. Ifyesto:C10or(2):aboyej:pleaseideriti . ¦ identified as a building.code scqfflawpr problem landlord and the address of fhe buildirig bf buildings to which the pertinent code violations'apply.'¦¦ ¦
' FILLING OUT'THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT REFERENCE INTO, A^^
AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF ' PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS, Include d/b/a/ if applicable:
2342 California LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
__ tiie-App-iean-t- Owner
OR
CU 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: .
OR
3. ff] a legal entity with a right of control (see Section Il.B.l.) State the legal name of die entity in •
which die Disclosing Party holds a right of control: \ • ;
B. Business address of die Disclosing Party: 2437 N. Francisco Avenue. Chicago. IL 60647
'Telephone: 847-456-3423 Fax: . 'Email: fmacias4866@pmail.com
Name of contact person: Francisco J. Maclas
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 project number and location ofproperty, if applicable):
Zoning Amendment for the property located at 2342-48 N. California Avenue
' ¦¦ - ¦ Department of Planning and Development, City Council,
_ . . , . . . „_.„_ Plan Commission. Committee on Zoning
Which City agency or department is requesting tins LDS?
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the fallowing:
Specification ft and Contract #
Page 1 of 13
SECTION II-
- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
i. J Person [X] Limited liability company
j_J Publicly registered business corporation Q Limited liability partnership
, ] Privately held business corporation [J Joint venture
f-] Sole proprietorship f—j Not-for-profit corporation
_j General partnership (Is the not-for-profit corporation also a 501(c)(3))?
Limited partnership [_Yes ONo
, • Trust ? Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entitics.not organized in die State of Illinois: Has the organization registered „ do'
business in the State of Illinois as a'ibreign entity? ,.
? Yes .ONo ? N/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 tideholder(s).
If the entity is a-general partnership, limited partnership, limited liability company, limited liability partnership, or joint venture, list below the name and title of each general partner, managing member, manager or any other person or. entity that controls the day-to-day management of the DisciosingParty. NOTE: Each legal entity listed below must submifari EDS'on its own.behalf.
Name Title ''"
Francisco J. Macias . • Sole Member
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of.the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interestin a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or odier similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
Francisco J. Macias 2437 N. Francisco Ave, Chicago, IL 60647
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 r_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 of the fees paid or esdmated to be paid. The Disclosing Party is not required to disclose employees who arc 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 of entity other than: (I) a not-for-profit entity, on an unpaid basis,'or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whettier a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make thc 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 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 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 diroughout the contract's term.
Has any person who directly or indirectly' owns 10% of more of the. Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
y • ¦
fl Yes „l No ? No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes,".has the person entered into a court-approved agreement for payment of all support owed and is the person.' in compliance-'w-ith- that agreement?.,, ''
? Yes \ GNo ;
B. FURTHER CERTIFICATIONS
1. Pursuant to'Municipal Code.Chapter. 1-23, Article I ("Article I")(which the Applicant' should consult for defined terms (eig./'doing business") and legal' requirements), if the Disclosing Party submitting this EDS "is tlie' Applicant and is doing business widi theCity, 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 or employee of the 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 the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 1I.B.1. 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
e. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any odier 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 die 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, direcdy or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, witiiout 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 die ineligibility of a business entity to do business With federal or state or local government, including the City, using.substantially the same management, ownership,-or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of an other person or entity;
• any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other-official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to
bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of the federal
government or of any state or local government in die 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 ™c;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 (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of rhe.Dnit.cd 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.ofithe 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. ' " . ' ¦ ¦
The Disclosing Party understands and shall comply with the applicable requirements bf Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (GovernmentalEthics) of the Municipal Code. .
If die D isclosing Party, is unable.to certify to any of the'above statements in. this Part B (Further
Certifications), the Disclosing Party must explain below: ' '.
None .- '
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to thc above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all current employees of the 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 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, 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 f_ is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a.predatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of die Municipal Code) is a predatory lender within the meaning of Chapter' 2-32 of tlie Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
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.
1. 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 of any other person or entity in the Matter?
? Yes PfjNo . .
NOTE: If you checked "Yes" to Item D. 1., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E. "
2. Unless sold pursuant tea 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 odier person Of entity in the.purchase of any property that (i) belongs-to die 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 tlie meaning of this Part D.
Does the Matter involve a City Property Sale?
3. If you checked "Y.es" to Item D.L, provide the names and business addresses ofthe City
officials or employees having such interest and identify die nature of such interest-
Name B usiness Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in die Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in ah attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
J]__l. 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.
I I 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
1. List below the names of all persons or entities registered under tire 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):
None ¦ ,
(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 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 entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by. applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A. 1. 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 die 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. 1. through A.4. above-from all subcontractors before it awards any subcontract and die Disclosing Party must maintain all such'SubcpntractorsV.cerdfi'catioris 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 widi their^bids'or in writing at the outset of negotiations.5'1'-' ~>lm; ;. . (!u. /. . (
Is the Disclosing Party the Applicant? .
? Yes ? No X N/A
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 DNo
Have you filed widi the Joint Reporting Committee, the Director of the Office of Federal Contract CorhpliahcerErograms, or the.Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes ' ' QNo "' ' -
Have you participated in any previous contracts or subcontracts.subject to the : equal opportunity clause?
Yes QNo
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 Party understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of anv
contract or other agreement between the Applicant and the City in connection with the Matter, whetiier
procurement, City assistance, or other City action, and are material inducements to the City's execution
of any contract or taking other acdon with respect to the Matter. The Disclosing Party understands diat
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.orK/Ethics . and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (3 12) 744-9660. The Disclosing Party must comply fully widi 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 thc 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 die 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 die public on the Internet, in response to a Freedom of Information Act request, or
' otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted, in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, die Disclosing
Party must supplement this EDS up to die time the City takes action on the Matter. If the Matter is a'
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: Widi respect to Matters subject to Article I of
Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for; certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as-required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that: ,
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are die 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 tbe 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 die Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired 'n connection with the Matter certifications equal in form and substance to those in F.l. 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 die Disclosing Party cannot certify as to any of die items in F.l., F.2. or F.3. above, ah 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 1 > 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. ''"''¦
2342 California, LLC ' -' :
(Print or type name of Disclosing Party)-
Francisco J. Macias
(Print or type name of person signing)
Sole Member
(Print or type title of person signing)
Signed and sworn to before me^fti (date) _ at ^Q; -SEAL
./ 77%^MIlW.SOB}ERAJ
Commission eU\vz\- NoWS^
W.^V^A*_*^'^^^^^^^^wN**^rfws^»_«
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which lias 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 "famiiial relationship" exists if, as of the date tiiis 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 die 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 j son-in-law, daughter-in-law, stepfatiier or stepmotiier, stepson or stepdaughter, stepbrother or stepsister or half-brother of half-sister.,
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section ILB.l.a., if the
Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general
partnership; all general partners and limited partners of die 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;f(2) all.principal officers of die Disclosing Party; and (3), any person having more than
a 7.5 percent ownership interest in the Disclosing Party. "Principal officers"'means die president, chief -
operating officer, executive director, chief financial' officer, treasurer or secretary of a legal entity or any person
exercising similar authority. • ''"¦''
Docs the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" widi an elected city official or department head?
? Yes ' . L_No / . .
If yes, please identify below (1) the name and title of such person,;(2) the name of die legal entity to which such person is connected; (3) the name and title of die elected city, official or department head to whom such person has a familial relationship, and (4) the precise nature of such farhilialrelationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION .
This Appendix is:to be completed only by,(a) the Applicant, and (b) any legal entity •which' has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which lias.only an indirect ownership interest in the Applicant.
Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a ' building code scofflaw or problem laridlord.pufsuatit to Section 2-92-416 of the Municipal 'Code?
£3 Yes . . ... [x]No '
If the Applicant is:a Jegal enti.typublicly traded on any exchange, is.anypfficer of director of the Applicant identified as a'b'uirding'coddscofflaw^or problem landlord .pursuant to Section
•; -2-92-416 ofthe Municipal Code? ""' ' """ '" • -"
•|7~] Yes , (No - I Xj Not Applicable
3. If yes Xo (l).or.(2),abq ye,' pleaseidentify bel6wme.name ofthe person or legal entity -•. ^identified as. a buildirig^code scofflaw Of-problem landlord and-tSe^diess of the building .or buildings to which 'the pertirienfcbde violations.:apply. .,
FILLING,OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSO CIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE S UBJECT TO THE CERTIFICATION MADE UNDER PENALTY-OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Zoning Amendment for the property located at This recertification is being submitted in connection with 2328-2348 North California Avenue [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants mat he/she is authorized to execute this EDS recertification on behalf of die Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as ofthe date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.
2342 California, LLC Date: (Print or type legal name of Disclosing Party)
Francisco J. Macias
Title of signatory: Sole Member
Signed and sworn to before me on [date] _
Notary Public.
Commission expires
frnaCiSCO rr. Mftf iq. , at OOOC County,
[state].
-r^'by-
Illinois
ALVA M TELLEZ OFFICIAL SEAL Notary Public. Soto of Illinois My Commission Expiros April 27, 2019
Ver. 11-01-05
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