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 be amended by changing all the Ml-1 Limited Manufacturing/Business Park District symbols and indications as shown on Map No.9-1 in the area bounded by
West Irving Park Road; a line 276 feet west of and parallel to North •v Western Avenue; the alley next south of and parallel to West Irving Park Road; and a line 326 feet west of and parallel to North Westen Avenue,
to those of a B3-5 Community Shopping District.
SECTION 2. This ordinance shall be in force and effect from and after its passage and due publication.
Common Address of Property:
17-13-0303-C(l) Narrative & Plans - 2431 W. Irving Park Rd., Chicago, IL
Proposed Zoning: B3-5 Community Shopping District
Lot Area: 6091 square feet
Proposed Land Use: The Applicant is proposing to adapt and convert the existing storage
building to a mixed-use building with commercial/retail space on floors one and two, and a total of six (6) residential units above. The mixed-use building will be supported by six (6) off-street parking spaces. The building's 61 ft. height will remain without change. The building's existing footprint will also remain without change.
The Project's Floor Area Ratio: 23,656 square feet (3.8 FAR)
The Project's Density (Minimum Lot Area Per D.U.): 1,015.17 square feet per D.U.
(6 dwelling units proposed)
The amount of off-street parking: 6 vehicular parking spaces
Setbacks:
Front Setback: Zero
Rear Setback: 31 ft.-6 inches (for residential floors)
Side Setbacks:
East: Zero West: Zero
Building Height: 61 ft.
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CITY OF CHICAGO APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS of the property Applicant is seeking to rezone:
2431 W. Irving Park Rd Chicago, IL
Ward Number that property is located in: 47
APPLICANT: 2431 W Irving Park. LLC
ADDRESS: . CITY:. .
STATE: .= ZIP CODE: PHONE: 312-782-1983
EMAIL: nick@sambankslaw.com CONTACT PERSON: Nicholas J. Ftikas
Is the Applicant the owner of the property? YES NO X
If the Applicant is not 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: Phoenix Bond & Indemnity Company
ADDRESS: 444 W. Lake St Ste. 3330 CITY: Chicago
STATE: Illinois ZIP CODE: 60606 PHONE: 312-782-1983
EMAIL: nick@sambankslaw.com CONTACT PERSON: Nicholas J. Ftikas
If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY: Law Offices of Samuel V.P. Banks. Nicholas Ftikas
ADDRESS: 221 N. LaSalle St 38th Floor
CITY: Chicago STATE: Illinois ZIP CODE: 60601
PHONE: (312) 782-1983 FAX: 312-782-2433 EMAIL: nick@,sambankslaw.com
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.
Andrew Smith and Dragan Djonovic, Managers
On what date did the owner acquire legal title to the subject property? Purchase subject
to zoning change approval.
Has the present owner previously rezoned this property? If Yes, when? No
Present Zoning District: Ml-1 Proposed Zoning District: B3-5
Lot size in square feet (or dimensions): 6.091 sq. ft. (50 ft. x 121.82 ft.)
Current Use of the Property: The subject property is currently improved with a five-story
commercial building most recently used as a storage facility.
Reason for rezoning the property: The Applicant is proposing adapt and convert the
existing building to a mixed-use building with commercial/retail space on floors one and
two, and a total of six (6) residential units above. A zoning change is required to comply
with the bulk regulations of the B3-5 zoning district.
Describe the proposed use of the property after the rezoning. Indicate the number of
dwelling unit number of parking spaces; approximate square footage of any commercial
space; and height of the proposed building. (BE SPECIFIC): The Applicant is proposing
to adapt and convert the existing storage building to a mixed-use building with a total of
approximately 10,372 sq. ft. of commercial/retail space on floors one and two, and a total
of six (6) residential units above. The mixed-use building will be supported bv six (6) off-
street parking spaces. The building's 61 ft. height will remain without change. The
building's existing footprint will also remain without change.
14. The Affordable Requirements 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 the number of units (see attached fact
sheet or visit www.cityofchicago.org/ARO for more information). Is this project subject to
the ARO?
YES NO X
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'. Nicholas Ftikas NOTARY PUBLIC. STATE OF ILLINOIS^ Mv nommissioniExpires September 28,2024
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Written Notice, Form of Affidavit: Section 17-13-0107
January 26, 2022
Honorable Thomas Tunney
Acting Chairman. Committee on Zoning
121 North LaSalle Street
Room 304 - City Hall
Chicago, Illinois 60602
To Whom It May Concern:
The undersigned, Nicholas Ftikas, being first duly sworn on oath, deposes and says the following:
That the undersigned certifies that he has complied with the requirements of Section 17-13-0107 ofthe Zoning Code ofthe City of Chicago, 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 the Applicant, and on the owners of all property within 250 feet in each direction of the lot line of the subject property, exclusive ofthe public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. That said written notice was sent by USPS First Class Mail no more than 30 days before filing the application.
That the undersigned certifies that the notice contained the address of the property sought to be rezoned as 2431 W. Irving Park Rd., Chicago, Illinois; a statement of intended use of said property; the name and address of the Applicant and Owner; and a statement that the Applicant intends to file an application for a change in zoning on approximately January 26, 2022.
That the Applicant has made a bonafide effort to determine the addresses of the parties to be notified under Section 17-13-0107 of the Zoning Code of the City of Chicago and that the Applicant certifies that the accompanying list of names and addresses of surrounding property owners within 250 feet is a complete list containing the names and last known addresses ofthe owners of the property required to be served.
Law Offices of Samuel V.P. Banks
Attorney for Applicant
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, OFF ICI.AL SEAL
, VINCENZO SERGIO
NOTARY PUBLIC. STATE OF ILLINOIS
Mv Commission Expires JANUARY 6 2024
Via USPS First Class Mail
January 26, 2022
Dear Sir or Madam:
In accordance wilh the Amendment to the Chicago Zoning Code enacted by the City Council, Section 17-13-0107-A, please be informed that on or about January 26, 2022, I, the undersigned, intend to lile an application for a change in zoning from a Ml-1 Limited Manufacturing/Business Park District to a B3-5 Community Shopping District, on behalf of the Applicant, 2431 W Irving Park, LLC, for the property located at 2431 W. Irving Park Rd., Chicago, IL.
The Applicant is proposing to adapt and convert the existing storage building to a mixed-use building with commercial/retail space on floors one and two, and a total of six (6) residential units above. The mixed-use building will be supported by six (6) off-street parking spaces. The building's 61 ft. height will remain without change. The building's existing footprint will also remain without change.
The Applicant, 2431 W Irving Park, LLC, maintains principal offices at
The current Property Owner, Phoenix Bond & Indemnity Company, an Illinois corporation, maintains principal offices at 444 W. Lake St., Ste. 3330, Chicago, IL 60606.
I am the attorney for the Applicant. I will serve as the contact person for this zoning application. My address is 221 N. LaSalle St., 38th Floor, Chicago, IL 60601. My telephone
number is (312) 782-1983.
Sincerely,
Law Offices of Samuel V.P. Banks
Nicholas J. Ftikas Attorney for the Applicant
*PIease note the Applicant is NOT seeking to purchase or rezone your property.
*The Applicant is required by Ordinance to send this notice to you because you are shown to own property located within 250 feet of the property subject to the proposed Zoning Amendment.
To whom it may concern:
I, Andrew Smith, as Manager of 2431 W Irving Park,. LLC, an Illinois limited,liability
company and Applic-ant cqnrcninig the subject prpperty located at 2431 W. Irving Park
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FORM OF AFFIDAVIT
Chairman, Committee ]qn Zoning . Rooirf304 -City Hall
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J '-inTARY-PUBLIC. STATE OF ILLINOIS 1 My lommission Expires September 28,2024
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: 2431 W Irving. Park, LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[x] the Applicant
OR
[ ] a legal entity currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State 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 entity in which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party:
Telephone: 312-782-1983 Fax: 312-782-2433 Email: nick@sambankslaw.com
Name of contact person: Nicholas Ftikas - Attorney
Federal Employer Identification No. (if you have one):
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
Zoning Amendment Application for 2431 W. Irving Park Rd., Chicago, IL
G. Which City agency or department is requesting this EDS?^ DPD
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Ver.2018-1 Paget of 15
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 [ ] Not-for-profit corporation
] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
] Limited partnership [ ] Yes [ ] No
] Trust [ ] Other (please specify)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Illinois
For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ] Yes [ ] No [x] 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 paitner, managing member, manager or any other person or legal entity that directly or
indirectly controls the day-to-day management ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Andrew Smith Manager Dragan Djonovic Manager
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 entity. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
Andrew Smith - 658 W. Melrose, Unit 1, Chicago, IL 60657 50% Dragan Djonovic - 2952 W. Irving Park Rd., Ste 2W, Chicago, IL 60618 50%
SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS? [ ] Yes [X] No
Does the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-month period following the date of this EDS? [ ] Yes [X] No
If "yes" to either of the above, please identify below the name(s) of such City elected official(s) and describe such income or compensation:
N/A
Does any City elected official or, to the best of the Disclosing Party's knowledge after reasonable inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in Chapter 2-156 of the Municipal Code of Chicago ("MCC")) in the Disclosing Party? []Yes [xJNo
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partner(s) and describe the financial interest(s).
N/A
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (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 to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. 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 15
Name (indicate whether Business Relationship to Disclosing Party
retained or anticipated Address (subcontractor, attorney,
to be retained) lobbyist, etc.)
Attorney
Law Offices of Sam Banks
221 N. LaSalle St., 38th Floor
Fees (indicate whether paid or estimated.) NOTE: "hourly rate" or "t.b.d." is
not an acceptable response.
Est. $6,500.00
Chicago, IL 60601
(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 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 the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes (x] No [ ] No person directly or indirectly owns 10% or more ofthe Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ ] Yes [ ] No
B. FURTHER CERTIFICATIONS
[This paragraph 1 applies only if the 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 of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity 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 they can be considered for agency contracts in the future, or continue with a contract in progress).
The Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, 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 the Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(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, during the 5 years before 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 subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
Certifications (5), (6) and (7) 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 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 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 either the Disclosing Party or any Contractor, nor any Agents have, during the 5 years before the date of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 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 of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in 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)(Contracts Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
Neither the 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 (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ELCS 5/33E-4; or (3) any similar offense ofany state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] of the 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 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 MCC Chapter 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The 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").
10. [FOR APPLICANT ONLY] The Applicant 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
Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
Page 6 of 15
contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
N/A
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.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
N/A
13. 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 $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 the name ofthe City recipient.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [X] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
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 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. 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."
Page 7 of 15
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
N/A
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 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.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes [X] No
NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and D(3) and 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 ofany other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ ]Yes |x]No
If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
N/A
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of 15
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 (2). Failure to comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
N/A
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
N/A
(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, 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 of any agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 Page 9 of 15
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.
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) 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," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
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. N/A _ Not Federa||y Funded
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No [ ] Reports not required
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:
N/A
Page 10 of 15
SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany contract or other agreement between tlie 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 Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of this ordinance 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 this ordinance.
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 City 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 to the public on its Internet site and/or upon request. Some or all of the information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to 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 15
GERTfflGATIpN
Utider^eiia^ signing below warrants that he/she is authorized to execute
this.ED^ (2) warrants thatall
cer^ricau^hs and statements cbri^ all applicable Appendices, are true, accurate
ahdieomplete ai of the date furnished to &e City:
ffinnfror t\^e;exacf:iegal name;6f Disclosm
iSblafylPjiaBiiS
'¦./••¦i^wt.'V"*'"wr#\*,- ...».
i<|omn^sipff$e]gi>ues::
OFFICIAL SEAL
Nicholas Ftikas NOTARY PUBLIC, STATE OF ILLINOIS My Commission'Expires September 28,2024
Page li.oflS
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%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section JJ.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, 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% 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 title 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.
N/A
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 the Applicant exceeding 7.5% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] Yes Dfl 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 MCC Section 2-92-416?
[ ] Yes [ ] No [x] The Applicant is not publicly traded on any exchange.
If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.
N/A
Page 14 of 15
CITY OF 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 EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www.amlegal.com ), generally covers a party to any agreement pursuant to 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 contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(l) 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 that the Applicant has adopted a policy that includes those prohibitions.
[ ] Yes [ ]No
&(] N/A -1 am not an Applicant that is a "contractor" as defined in MCC Section 2-92-385. This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(1). If you checked "no" to the above, please explain.
N/A
Page 15 of 15
To:'y/h"qm it. may concern:
I, Andrew W. Marks, a Director.and Officer ofthe Phoenix Bond ¦«&-Indemnity Company,
airi. Illinois corporation.and OAVrienof the subject property located at 2431 W. Irving Park
,T£dvji Chicago, IL,, authorize tlw VJP--, Banks to file a Zoning
>i^en[a^nvent' Application on behalf* of the. Contract Purchaser, and Applicant, 2431 W Jr-yjhg^
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of tlie Disclosing Parry submitting this EDS. Include d/b/a/ if applicable: Phoenix Bond & Indemnity Company
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[X] the Applicant- Property Owner
OR
[ ] a legal entity currently holding, or anticipated to hold within six months after City action on
the conn-act, transact ion. or other undertaking to which this EDS pertains (referred to below as the
"Mattel-"), a direct orindkect interest in excess of 7.5% in. the Applicant. State the.Applicant's legal
name:. ___ '
OR
[ j a legal entity with a direct or indirect right of control of the'Applicant (see Section H(B)(1)) State: the legal name Ofthe entity in which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 444 W. lake St #3330
Chicago, IL 60606
Telephone: 312-782^1983 Fax: 312-782-2433 Email: nick@sambankslaw.corh
Name of contact person: Nicholas Ftikas - Attorney
Federal Employer Identification No. (if you have one):
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
Zoning Amendment Application for 2431 W. Irving Park Rd., Chicago, it
G. Which City agency or department is requesting this EDS'?, DPD
If the Matter is a contract being handled by the.City's Department of Procurement Services, please complete the following:
Specification ____ and Contract #
Vcr.2018-1 Page 1 of 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing Party:
[ ] Person [ ] Limited liability company
[ ] Publicly registered business coiporation [ ] Limited liability partnership
[X] Privately held business corporation [ J Joint venture
[ ] Sole proprietorship [ j Not-for-profit corporation
[ j Genera! partnership (Is the not-for-profit corporation also a 501(c)(3))?
[ ] Limited partnership [ ] Yes [ 3 No
f ] Trust [ ] Other (please specify)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Illinois
for legal entities not organized in the State of Illinois: Has tlie organization registered to do business in the State of Illinois as a foreign entity'?
[ ]Yes [ ]Nb [X] Organized inIllinois
B. IF TILE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full najnes and titles, if applicable, of: (i) all executive officers and all directors of lhe entity, (u) for not-for-profit corporations, all members, if any, which arc legal entities (if there are no such members, wrife ''no nic^bcrs whibh are legal entities"); (wi) for trusts, estates or other similar entities, the trailtfc,; executor, administiator, or similarly situated party;, (iv) for general or limited partnerships, Umited habih'ty companies, liinited liahiftty parmei^Wps or joint ventures, each general partner, managing member; manager or any other person or legal entity that directly or indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Stanford Marks Presidem
Andrew NCarits Secretary/Director
2. Please provide the following infonnation 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% of the Applicant. Examples of such an interest include shares.—. a corporation, partnership interest in a patttiership or joint veotitre. interest of a member or manager in a
Page, 2 oi'15
limited liability company, or interest of a beneficiary of a irust, estate or other similar entity. If none, state *;None."
NOTE: Each legal entity- listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
Stanford Marks AAA W. Lake St., #3330 100%
SECTION TH - INCOME OR COMPENSATION TO. OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has tlte Disclosing.Party provided any income or compensation to any City elected official during the
12-month period preceding the dale of this EDS? [ JYes DC] No
Does the Disclosing Party reasonably expect to provide any income or compensation to.any City
elected bfficiafduring the t2-_.onthperiod following the date 6f this EDS? [ ] Yes pX] No
If "yes" to either of the above, please identify below tbe namc(s) of such City elected official(s) and describe such income or compensation:
N/A
Does any City elected official or, to the best of the Disclosing Party's knowledge after reasonable
inquiry^ any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter.2-156 of the M^.„'cipai:db'-e.'dfs^c«gO: ("MCC")) iri the Disclosing Party?
[ ] Y e s D0 N 6
If "yes," please identify below the name(s) of such City elected official(s) and/or spousc(s)/domestic. partnerfs) and describe the financial interest(s).
N/A
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (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 ihe nature of me relationship, and flje. total .amount of the- fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. If the. Disclosing Party is uncertain whether a disclosure \s required tinder 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 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.
Law Offices of Sam Banks
_221_N. LaSalie St., 38th Floor Attorney Est- S6.50O.O0
Chicago, IL 60601 ~ ™~
(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
COURT-ORDERED CHILD 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 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?
[ 3 Yes (x3 No [ ]No person directly or indirectly owns 10% or more of the Disclosing Party,
If "Yes," has the person entered mtO;;acis the person in compliance with that agreement?
[ ] Ye s [ ]N o
FURTHER CERTIFICATIONS
1. [litis paragraph 1 applies only if the Matter is a contract being handled by ihe City's Department of
Procurement Services.] tn the 5-year period preceding the date of this EDS, neither the Disclosing
Party nor any Affiliated Entity [see definition tn (5) below] has engaged, to connection with the
performance of any public contract, the services of an integrity monitor, independent private sector
inspector general," or integrity compliance consultant (i.e., an individual or entity with legal, auditing,
investigative, or other similar skills, designated by a public agency to help tlie agency monitor the
activity of specified agency vendors as weft'as. help the vendors reform their business practices so they
can be considered for agency contracts in ihe future, or continue with a contract in progress)'.
2, The Disclosing Party and its Affiliated Entities arc not delinquent in the payment of airy fine, fee,
tax. or other source of indebtedness owed to the City of Chicago, including, but not limited to, 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 the Illinois Department of Revenue,
Page 4 of 15
Tlie Disclosing Party and., if lhc Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(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, during the 5 years before the date oflhis 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 chilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in subparagraph (b) above;
have not, during the 5 years before tbe date of this EDS, had one or more public transactions (federal, state or local) tenhinated for cause or default; and
have not, during the; 5 years before the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceedings 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
Ilie Disclosing; Party understands ^ with the appl icable requirements of MCC.
Chapters 2^56 (Inspector General) and 2-15.6 (Governmental Ethics).
Certifications (5), (6) and (7) concern:
the Disclosing Party;
any ,"Conto6to? (m.^aniug:kny contractor or subcontractor used by the Disclosing Party in connection witfrme M
under Section TV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (msaiti^ or .entity that, directly or indirectly: controls the
Disclosing Party, is controlled by the Disclosing Party, or is, with die Disclosing Party, under
common control of another person oreMjty). 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 mdirec.tly 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 JESntrty 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 15
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 5 years before tlie date of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before tlie date of such Contractors 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 Slate of Illinois, or any agency ofthe federal government or ofany state or local government in. the United States of America, in that officers, 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 me provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a J3asc Wage); (a)(5)(Debarment Regulations); or (a)(6)(Mihimum Wage Ordinance).
Neither the Disclosing Party, nor any Affiliated Entity or, Contractor, or any of their employees, ofilcials, 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) bidrrotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United State? of America that contains the same elements as tlie offense of bid-rigging or bid-rotating,
Neither the DLsclosing'^arry nor any Affiliated Entity 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 the Applicant nor. any "controlling person" [sseMCC Chapter 1^23, Article I for applicability and defined termsTpf the Applicant is currently indicted or charged with, or has admitted guilt of, or has e\rer been convicted of. or placed under supervision for, any criminal offense involvmg actual, attempted, or conspiracy to commit bribery, theft; fiaud, 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 1 is a continuing requirement for doing business with the City. NOTE: If MCC Chapter 1.-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compiianco timeframes in this Section V.
[FOR APPLICANT ONLY] Tlie 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").
lG, [FOR APPLICANT Q^Y] The Applicant will obtain from any contractorsysubcontractors hired or to ibe hired in iOThhedriori with the; Matter certifications equal in form and substance to those in
Certifications (2) and (9) above and will. not. without the prior written consent of the. City, use .any such
Ver.2018-1 Page 6 of IS
contractor/subcontractor that docs not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. If die Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
N/A
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.
12. 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 date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with '"N/A" or "none").
N/A
13, 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, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (j) 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 525 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 the name ofthe Citv recipient.
" N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that die Disclosing Party {check one)
[ ]is [Xjisnot
a."financtal institution" as defined in MCC Section 2-32-455(b).
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 MCC Chapter 2-32. Wc further pledge that none of our affiliates is, and none of them will become, a predatory' leader as defined in MCC-Chapter 2-32. We understand that becoming a predatory lender or becoming ati affiliate of a
predatory lender may result in the loss of the privilege of doing business with the City."
Page 7 of IS
If lhc Disclosing Party is unable to make this pledge because it or any of im affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages i f necessary):
... ' N/A
If the letters "NA," the word "None,51 or no response appears on the fines above, it will be conclusively presumed that the 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 ihe same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Patty's knowledge after reasonable inquiry, 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?
[]Y«s W No
NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
Unless sold pursuant to a process of competitive: bidding, or otherw ise permitted, no City elected official or employe* shall have-a financial interest in his" or her' own name or in the name of airy other person Or entity in .the purchase of any property that (i) belongs to the City, or (ii) is sold for taj«s or assessments, Or :(iti) is spldby virtue of legal process atthc suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[]Ycs K]No
If you checked M Yes" to Item D(l),,providc the names and business addresses of tbe City officials or employees having such financial interest and identify the nature of the financial.'interest:
Name Business Address Nature of Financial Interest
N/A
4. The . Disclosing Party. further certifies that no prohibited financial tatearest in the Matter will be acquired by any City official or employee.
Page 8 of15
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. If tlie Disclosing Party checks (2), the Disclosing Party must disclose below or in. an attachment to this EDS all infonnation required by (2). Failure to comply with these disclosure, requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2, The Disclosing Party verifies mat, 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 sucb records, including the. names ofany and all slaves or slaveholders described in those records:
N/A
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Mattajr Is federally funded, complete this Section VI. if the Matter is noi federally fondeii, proceed to Sration VTL For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are hot 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, as amended, whohave made .lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if hecessarv):
N/A
(If no explanation appears or begins on the lines above, or if tlie letters "NA." or if Ibe word ,rNonc" 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 io pay air>^ pie^n or entity listed
person or entity to influence or attempt to influence an officer or employee of any agency, as denned
by applicable federal law. a member of Congress, an officer or employee of Congress, or an employee
Vcr.2018-1 Page 9 of 15
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.
The Disclosing Party will submit an updated certification at tlie end of each calendar quarter in which there occurs any event that materially affects the accuracy of (he statements and information set forth in paragraphs A(l) and A.(2) above.
Tlie Disclosing Party certifies thai 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 buf has not engaged and will not engage in "Lobbying Activities." as that term is defined in the Lobbying Disclosure Act: of 1995, as amended,
5:. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal io form and substance to paragraphs A(l ) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to. the City upon request,
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations; N/A. Not Federally Funded
Is the Disclosing Patty the Applicant?
MYes t ]No
If "Yes'," answer the three questions below:
Have you developed and do you have, on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2;)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, tlie Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Oppoitun ity Comniission all reports due under the applicable.filing nsquhemcnts?
[ ] Yes [ j No [) Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity- clause?
[ ]Yes [ ]No
Tf you checked "No" to question (1) or (2) above, please provide an explanation:
____ N/A
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SECTION VU - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
'The Disclosing Party understands and agrees that;
The certifications, disclosures, and acknowledgments contained in this EDS will become pail 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 faking 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. The full text of this ordinance and a training program ts available on line at www,citvofchicago.ore/Ethics. and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance,
C- If die City determines thai any infonnation provided in this EDS is false, incomplete or inaccurate, any contractor 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 ih th.e.Mattcr and/or declining to allow-the Disclosing Party to participate in other City 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 to the public on its Internet site and/or upon
request Some Or all of tbe information provided in, and appended to. this EDS maybe made publicly
available on mc Liferoet^ a Freedom oflnfonriatioh Actinsquest Or dthciwts'e. By
completihg and signing mis 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 thforjnatioh
contained in this EDS and also authorizes the City to verify the accuracy of any information submitted
in this. EDS.
Tlie information provided in this EDS must be. kept current. In the event of changes, tlie Disclosing Party must supplement this EDS up to the time fee 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 : Wi th respect to Matters subject to 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 15
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf of the 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.
Phoenix Bond & Indemnity Company (Print o/1(ypc exact legal name of Disclosing Party)
By: _^
(Sign here)
Andrew Marks (Print or type; name of person signing)
Directoi
(Print or type-title-of person signing)
Notary Public
Comrnission expires: ^ j Z $ f ,
Signed and swom to before me on (date) fljll (
at. Cook. County,. Illinois .(state).
UhHCIALSEAL"
Nicholas Ftikas; NOTARY PUBLIC, STATORLUNQIS
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 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%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any 'Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if,.as of the date this EDS is signed, the Disclosing Parry or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, die 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
ILB. La., if the Disclosing Party is; ii corporation; all partners of the pisclpsing Party,, if the Disclosing
Party is a. general partnersliip; all general partners and limited partners of theDisclosing Party, if the
Disclosing Party i^^ managing members and members ofthe
Disciqsrag Party, if the Disclosing Party is a h^ited habiltry company; (2) all principal officers of the Disclosing Party; and (3) any person having morethaaa 7.5% ownership interest in Disclosing Panty;;"Prihbipar6fficcrsn means the president, chief operating o fficer, executive director, chief financial officer, treasurer or secretary of a legal .entity or any person excising 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?
[ 3 Yes [X] No
Lf yes. please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) tlie name arid title of tlie elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
N/A
Page 13 of IS
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOITLAVvTPROBLEVI 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% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
L Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw'or problem landlord pursuant tu MCC Section 2-92-416?
[ ] Yes j)c] 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 MCC Section 2-92-416?
E ] Yes [ ] No D<] The Applicant is not publicly traded on any exchange.
If ye.s to (l).or (2) above, please identify below tbe name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.
N/A
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CITY OF CHIC AGO 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 EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www.amlega.l com), generally covers a parry to any agreement, pursuant to 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 & business on City premises.
On behalf Of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-38 5(b)(1) 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-that the Applicant has adopted a policy that includes those prohibitions.
[ ]Yes [ I No
EK] N/A -1 am not an Applicant that is a "contractor" as defined; in MCC Section 2-92-385 This certification shall serve as tiie affidavit required by MCC Section 2-92^385(c)(1). If you checked "no1* to the above, please explain:
N/A
r
Page 15 of 15