Fes '2.o 2
ORDINANCE
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all ofthe RS3 Residential Single - Unit (Detached house) District symbols and indications as shown on Map No. 14-1 in the area bounded by
A line 261 feet South of and parallel to West 59lh Street; the alley next East of and parallel to South California Avenue; a line 291 feet South of and parallel to West 59* Street; and South California Avenue.
to those of a RT4 Residential Two-Flat, Townhouse and Multi- Unit District.
SECTION 2. This ordinance shall be in force and effect from and after its passage and due publication.
APPLICATION FOR AX AMRNDMF.NT TO Till- CHICAGO ZONING ORDINANCE
ADDRESS ofthe property Applicant is seeking to re/one: 5927 S California Ave.
, , Ward 16
\\ arc! Number lhat property is located in:
APPLICANT Mario Ledesma Zarate
ADDRF.SS 5927 S California Ave. CITY Chicago
STAT!" IL ZrP CODF. 60629 PHONE .
tlbconstructioncom@gmaii.com . , ., ,
EMAIL CONTACT PERSON Miriam (wife)
is the applicant ihe owner ofthe property? YES ^es NO
iflhe applicant is not the owner ofthe properly, please pro\ ide the lb; lowing mforr,ai;or regarding thc owner and attach written authorization from the owner allowing the application to proceed.
OWNER
ADDRESS CITY
STATt: ZIP COOL PHONE,
liMAIL CONTACT PERSON
Ifthe Applicant Owner ofthe property has obtained a lawyer as their representative .or the rezoning. please pvoviac the following information:
ATTORNEY Robert Martinez
~c 5310 S Archer Ave.
crrv Chicago state iL zip code 60632
Pi iONT, 773 818 3020 FAX 773 751 5246 email R@martinezlawllc.net
Ifthe applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
On what date did the owner acquire legal title to thc subject property? July 17, 2020
Has the present owner previously rezoned this property? If yes, when?
No.
Present Zoning District RS - 3 Proposed Zoning District RT4
10. Lot size in square feet (or dimensions) 3,750
ii n ,t\c>\ * two unit
11. Current use of thc property
12. Reason for rezoning thc property Intent to use the basement as a third unit.
13. Describe the proposed use ofthe property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage ofany commercial space; and height of the proposed building. (BE SPECIFIC)
Two unit building converted to a three unit. The lot is 30 x 125, there are three parking spaces in the rear. Building height to remain at 28 feet 2 inches.
14. The Affordable Requrements Ordinance (ARO) requires on-site affordable housing units and/or a Financial contribution for residential housing projects with ten or more units that receive a zoning change which, among other triggers, increases the allowable floor area, or, for existing Planned Developments, increases thc number of units (sec attached fact sheet or visit www.cityofchicago.org/ARO for more information). Is this project subject to the ARO?
YES NO N°
Page 2
COUNTY OF COOK STATE OF ILLINOIS
Mario LeAfjsma , being first duly sworn on oath, states that all ofthe above
statements and the statements contained in the documents submitted herewith arc true and correct.
Signaturq^rT Applicant
Subscribed arid Sworn to before me this
I G day o f Vex: her- , 20 j2j
Notary Public
ROBERTO MARiO MARTINEZ '
Official Seai|910|Notary Public - State of Illinois I
My Commission Expires Sep 3, 2024 j
Date of Introduction: File Number:
Ward:
— 3RN3AV WNyQJFJVd fLfcfJGS- 3r
"WRITTEN NOTICE" FORM OF AFFIDAVIT (Section 17-13-0107)
February 3, 2022
Honorable Thomas M. Tunney Chaimian, Committee on Zoning 121 North LaSalle Street Room 304, City Hall Chicago, Illinois 60602
Tlie undersigned Mario Ledesma being first duly sworn on oath deposes and states the following:
The undersigned certifies that he has complied with the requirements of Section 17-13-0107 of the Chicago Zoning Ordinance, by sending written notice to such property owners who appear to be the owners of the property within the subject area not solely owned by thc applicant, and to the owners of all property within 250 feet in each direction of thc lot line of the subject property, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 fect. Said "written notice" was sent by First Class U.S. Mail, no more than 30 days before filing die application.
The undersigned certifies diat thc notice contained the address of the property sought to be rezoned; a statement of the intended use of the property; the name and address of the applicant; the name and address of the owner; and a statement that the applicant intends to file the application for a change in zoning on approximately February 23, 2022.
The undersigned certifies that the applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-0107 of the Chicago Zoning Ordinance, and that the accompanying list of names and addresses of surrounding property owners within 25.0. feet of the subject site is a complete list containing the names and addresses of the people required to be served.
Signature
Subscribed and Sworn to before me this
Martinez
Law llc
4115 W 26th STREET CHICAGO IL 60623
TEL: (773)818-3020 FAX: (773) 522-1302
.February 7, 2022
Dear Property Owner:
In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance, specifically Section 17-13-0107, please be informed that on or about February 23, 2022, the undersigned will file an application for a change in zoning from RS3 to RT4 on behalf of applicant Mario Ledesma Zarate for the property located at 5927 S California Ave. Chicago, IL 60629.
The applicant intends to Rezone to RT4 for (3) units. The building footprint is 1,628 SQ. FT. The subject property is currendy zoned RS3 and the lot is improved with a two (2) unit building. The applicant needs this zoning change in order to utilize a proposed apartment in the basement, converting 2 Dwelling Units to 3 Dwelling Units with (3) on-site parking. There will be no changes to the height ofthe building.
The applicant is the owner ofthe property located at 5927 S California Ave. Chicago IL 60629.1 am the attorney for the applicant and the contact person for this application. My address is 4115 W. 26* Street Chicago, Illinois, 60623 and my telephone number is (773) 818 - 3020.
Please note that the applicant is not seeking to rezone or purchase your property. The applicant is required by law to send this notice because you own property within 250 feet of the property to be rezoned.
Very truly yours,
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/ inapplicable: Mario Ledesma Zarate
Check ONE ofthe following three boxes:
Indicate whether thc Disclosing Party submitting this EDS is:
|Xj the Applicant
OR
Q a legal entity currently holding, or anticipated to hold within six months after Cily action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as thc
"Matter"), a direct or indirect interest in excess of 7.5% in thc Applicant. Stale the Applicant's legal
name:
OR
[] a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1)) State the legal name ofthe enlity in which the Disclosing Parly holds a right of control:
B. Business address of thc Disclosing Party: _5927 S California Ave.
Chicago, IL 60629
Telephone: . Fax: Email: tlbconstructioncom@gmail.com
r» m c . l Miriam
Name or contact person:
E. Federal Employer Identification No. (if you have one):
F. Brief description ofthe Matter to which this EDS pertains. (Include project number and location of property, if applicable): Seeking a zoning change from RS3 to RT4, at 5927 S California Ave., Improved with two units, plans to add one more
G. Which City agency or department is requesting this
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification ti and Contract li
Ver.2018-1 Page 1 of 15
SECTION II - DISCLOSURE OE OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing Par X] Person
| Publicly registered business corporation j Privately held business corporation Sole proprietorship
General partnership
] Limited partnership
'Trust
| | Limited liability company
n Limited liability partnership
| | Joint venture
| | Not-for-profit corporation
(Is the not-for-profit coiporation also a 501 (c)(3))?
? Yes ["JNo | | Other (please specify)
For legal entities, thc stale (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the Slate of Illinois: Has the organization registered lo do business in thc Slate of Illinois as a foreign entity?
? Yes r~j No [ [Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles, if applicable, of: (i) all executive officers and all directors of the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls thc day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
2. Please provide the following information concerning each person or legal entity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including ownership) in excess of 7.5% ofthe Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Page 2 of 15
limited liability company, or interest, of a beneficiary of a trust, estate or other similar entitv. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an IIDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has thc Disclosing Party provided any income or compensation to any City elected official during thc
12-month period preceding the date of this FDS? QJ Yes QJ No
Docs thc Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-month period following thc date of this LDS? QJ Yes [J] No
If "yes" to cither ofthe above, please identify below the name(s) of such Cily elected official(s) and describe such income or compensation:
Docs any City elected official or, to the best ofthe Disclosing Parly's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party?
QJ Yes [Jj No
If "yes," please identify below the namc(s) of such City elected official(s) and/or spousc(s)/domestic partncr(s) and describe thc financial intcrcst(s).
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
Thc Disclosing Party must disclose thc name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), 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 lo be paid. Thc Disclosing Parly is not required to disclose employees who arc paid solely through the Disclosing Parly's regular payroll. Iflhe 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 15
Name (indicate whether Business Relationship lo Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTK:
lo be retained) lobbyist, etc.) "hourly rate" or "l.b.d." is
not an acceptable response.
Robert Martinez 5310 S Archer Ave. Attorney $4,000" pajMario Cruz 2450 W. DIVISION ST. Architect $8,000 pajd
,A . .r CHICAGO ILLINOIS 60622
(Add sheets it necessary)
f~~| Check here ifthe Disclosing Parly has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED CIIfLD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout thc contract's term.
Has any person who directly .or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
| | Yes x" No |JJJ No person directly or indirectly owns 10% or more of thc Disclosing Party.
If "Yes," has thc person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
QYes
B. FURTHER CERTIFICATIONS
1. [This paragraph 1 applies only ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date of this EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance ofany public contract, the scivices of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or enlity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so ihcy can be considered for agency contracts in thc future, or continue with a contract in progress).
2. Thc Disclosing Party and its Affiliated Entities are not delinquent in the payment of any line, fee, tax or other source of indebtedness owed to thc Cily of Chicago, including, but not limited lo, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by thc Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(13')(1) of this HDS:
arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, during thc 5 years before thc 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 slate antitrust statutes; fraud: embezzlement; theft: forgery; bribery; falsification or destruction of records; making faisc statements; or receiving stolen properly;
e. 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 subparagraph (b) above;
d. have not, during the 5 years before the date oflhis EDS. had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during thc 5 years before thc 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 thc City or by the federal government, any stale, or any other unit of local government.
Thc Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
5. Certifications (5), (6) and (7) concern:
o the Disclosing Parly;
0 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"): o any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Parly, or is, with thc 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 thc ineligible entity. With respect to Contractors, the term Affiliated Entity means a person or enlity 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 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 15
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of cither the Disclosing Party or any Contractor, nor any Agents have, during the 5 years before the date of this HDS. or. with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before thc date of such Contractor's or Affiliated Entity's contract or engagement m connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe federal government or ofany state or local government in the United Slates 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 subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracls Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
Neither thc Disclosing Party, nor any 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 ofany stale or ofthe United States of America that contains thc same elements as thc offense of bid-rigging or bid-rotating.
Neither thc Disclosing Party nor any Affiliated Enlity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither thc Applicant nor any "controlling person" [sec MCC Chapter 1-23, Article I for applicability and defined terms] ofthe Applicant 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 lo commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe 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 MCC Chapter 1 -23, Article I applies to the Applicant, lhat Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] Thc Applicant and its Affiliated Entities will not use. nor permit their subcontractors to use, any facility listed as.having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or lo be hired in connection with the Mailer certifications equal in form and substance lo those in Certifications (2) and (9) above and will not, without the prior written consent ofthe Cily. use any such
Ver.2018-1 Page 6 of 15
contractor/subcontractor thai docs noi provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
1 1. Ifthe Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Parly must explain below:
Iflhe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Parly certified lo the above statements.
12. To thc best of the Disclosing Party's knowledge after reasonable inquiry, thc following is a
complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-
month period preceding thc date of this FIDS, an employee, or elected or appointed official, ofthe City
of Chicago (if none, indicate with "N/A" or "none").
None.
13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that thc Disclosing Party has given or caused to be given, at any lime 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 $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list thc name ofthe City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
Thc Disclosing Party certifies that thc Disclosing Party (check one)
rj is fx] 's not
a "financial institution" as defined in MCC Section 2-32-455(b).
{('the Disclosing Party IS a financial institution, then thc Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. Wc understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in thc loss ofthe privilege of doing business with thc City."
Page-7 of 15
Iflhe Disclosing Parly is unable to make this pledge because it or any of its aflliiat.es (as defined In MCC Section 2-32-455(b)) is a predatory lender wilhin ihe meaning of .MCC Chapter 2-32. explain here (attach additional pages if necessary):
Iflhe letters "NA," the word "None." or no response appears on the lines above, it will be conclusively presumed that thc Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
I. In accordance with MCC Section 2-156-1 10: To the best ofthe Disclosing Party's knowledge after reasonable inquiry, does any official or employee ofthe Cily have a financial interest in his or her own name or in thc name ofany other person or entity in the Matter?
QYes
NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" lo item D(l), skip Items D(2) and D(3) and proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elecled official or employee shall have a financial interest in his or her own name or in thc name ofany other person or entity in the purchase ofany property that (i) belongs to thc Cily. or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process al the suit of the Cily (collectively, "Cily Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
? Yes
3. If you checked "Yes" to Item D(i), provide the names and business addresses ofthe Cily officials or employees having such financial interest and identify the nature ofthe financial interest:
Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
!•:. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither (I) or (2) below. Ifthe Disclosing Party checks (2). the Disclosing Party must disclose below or in an attachment to this EDS all information required by (2). Failure to comply with these disclosure requirements may make any contract entered into with thc Cily in connection with the Matter voidable by the City.
. The Disclosing Party verifies that thc Disclosing Party has searched any and all records of the Disclosing Parly 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 thc Disclosing Party has found no such records.
? 2. Thc Disclosing Parly verifies that, as a result of conducting thc 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 ali such records, including ihe names ofany and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: Ifthe Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes oflhis Section VI, tax credits allocated by the Cily and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
I. List below thc names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of thc Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or iflhe 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, as amended, 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 ofany agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.20IX-l Page 9 of 15
of a member of Congress, in connection with the award ofany federal ly 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.
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( I) and A(2) above.
The Disclosing Party certifies that cither: (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," as that term is defined in the Lobbying Disclosure Act of 1995. as amended.
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to thc City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit thc following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes [J No
If "Yes," answer thc three questions below:
No
I. Have you developed and do you have on file affirmative action programs pursuant to applicable federal retaliations? (See 41 CFR Part 60-2.) ? Ye^s
Have you filed with the Joint Reporting Committee, thc Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under thc applicable filing requirements?
| [ Yes ? No j^j Reports not required
Have you participated in any previous contracts or subcontracts subject lo the equal opportunity clause?
? Y« fx]No
If you checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
SECTION VII -- FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Parly understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this FDS will become part ofany contract or other agreement between the Applicant and the City in connection with the Vlatlcr. whether procurement, City assistance, or other City action, and are material inducements to the City's execution ofany contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. Thc full text of this ordinance and a training program is available on line at www.cityofchicauo.oru/Ethics . and mav also be obtained from thc City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago. fL. 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other Cily transactions. 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 lo the public on ils Internet site and/or upon request. Some or all ofthe information provided in, and appended to, this EDS may be made publicly available on thc Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy ofany information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time thc City takes action on the Matter. Iflhe 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 lo MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
Page 11 -of IS
CERTIFICATION
Under penally of perjury, the person signing below: (1) warrants that he/she is authorized lo execute this FDS, and all applicable Appendices, on behalf ofthe Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as ofthe date furnished to the City.
Mario Ledesma Zarate
(Print or type exact legal name of Disclosing Party)
By:
(Sign here)
Mario Ledesma Zarate
(Print or type name of person signing)
Owner
(Print or type title of person signing) Signed and sworn to before me on (date)
Commission expires:
Page 12 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is ro be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7-5%. It is not to be completed by any legal entity which has only an indirect ownership interest in thc Applicant.
Under MCC Section 2-154-015, thc Disclosing Parly must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if. as of thc date this EDS is signed, thc 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, molhcr-in-law, son-in-law-, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Parly" means (1) all executive officers of ihe Disclosing Party listed in Section II.B.I.a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Parly, iflhe Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Parly. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Docs the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected cily official or department head?
Yes
If yes, please identify below (1) thc name and title of such person, (2) thc name ofthe legal entity lo which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) thc precise nature of such familial relationship.
Page 13 of 15
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 thc Applicant exceeding 7.5% (an "Owner"), ft is not to be completed by any legal entity which has only an indirect ownership interest in tlie Applicant.
Pursuant lo MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant lo MCC Section 2-92-416?
? Yes fx]No
Iflhe Applicant is a legal entily publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant lo MCC Section 2-92-416?
| [ Yes x" No r~J The Applicant is not publicly traded on any exchange.
3. Tf yes to (I) or (2) above, please identify below the name of each person or iegal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which thc pertinent code violations apply.
Page 14 of 15
CITY Ol7 CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to be completed only by an Applicant that is completing this FDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www.amicgal.com ). generally covers a party to any agreement pursuant lo which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises.
On behalf of an Applicant that is a conlractor pursuant to VICC Section 2-92-385,1 hereby certify that thc Applicant is in compliance with MCC Section 2-92-385(b)( I) and (2). which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants" wage or salary history from current or former employers. I also certify thai the Applicant has adopted a policy that includes those prohibitions.
QYes ? No
N/A - I atn not an Applicant that is a "contractor" as defined in MCC Section 2-92-3X5.
This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(T).
If you checked "no" lo the above, please explain.
Page 15 (if 15