This record contains private information, which has been redacted from public viewing.
Record #: O2021-3836   
Type: Ordinance Status: Passed
Intro date: 9/14/2021 Current Controlling Legislative Body: Committee on Zoning, Landmarks and Building Standards
Final action: 10/14/2021
Title: Zoning Reclassification Map No. 9-L at 3746-3756 N Cicero Ave - App No. 20809
Sponsors: Misc. Transmittal
Topic: ZONING RECLASSIFICATIONS - Map No. 9-L
Attachments: 1. O2021-3836.pdf
c.
ORDINANCE

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

SECTION 1. Title 17 ofthe Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all ofthe B3-1 Community Shopping District symbols and indications as shown on Map No. 9-L in the area bounded by

West Grace Street; North Cicero Avenue; a line 107.32 feet south of and parallel to West Grace Street; and the alley next west of and parallel to North Cicero Avenue.



to those of a Cl-1 Neighborhood Commercial District.

SECTION 2. This ordinance shall be in force and effect from and after its passage and due
publication.
































Common Address of Property: 3746-3756 N. Cicero

CITY C)lv CHICAGO r-s .

APPLICATION FOR AN AMENDMENT TO 1 THE CHICAGO ZONING ORDINANCE


ADDRE.SS ofthe property Applicant is seeking to rezone:
3746-3756 North Cicero LLC

„, JXT , . . . 30th Ward
Ward Number that property is located in:
AnmT^A^r3750 Nortn Cicero LLC
ADDRESS
APPLICAN f
3750 N Cicero Chicago
STATE11 Z,PCODE60641 PHONE773*37"1116
email kklint@staalsen.com C0NTACT PERS0N Ken Klint

Is the applicant the owner ofthe property? YES NO
Ifthe applicant is not the owner ofthe property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed. i

OWNER

ADDRESS CITY

STATE ZIP CODE PHONE

EMAIL CONTACT PERSON

Ifthe Applicant/Owner ofthe property has obtained a lawyer as their representative for the rezoning, please provide the following information:
Jordan Matyas I Max A. Stein
A 11 orney J_|99|
AI^ort 20 W. Kinzie St., 17th Floor | 1 N. Franklin, Suite 1200
ADDRESS ' '
CITy Chicago STATE "~ ZIP code 60654 I 60606
JM-312.968.9600
JM-jordan@1818advocacy.com PHONE MS-312.300.5505 FAX EMAIL MS-mstein@boodlaw.com







Page 1
6.










On what date did the owner acquire legal title to the subject property?

Has the present owner previously rezoned this property? If yes, when?
No



Proposed Zoning District

Lot size in square feet (or dimensions)
l 1 Current Use of the property 0ffices and storage for COnstrUCtiOP. Company
12. Reason for rezoning the property Allow for contractor's storage of construction equipment and/or supplies in enclosed portions ofthe property.
Describe the proposed use ofthe properly after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square fqptage of any commercial space; and height ofthe proposed building. (BE SPECIFIC)
To allow the use standards ofthe C1-1 Zone, contractor will continue to use property as offices and now storage for construction company,
maintaining the current 9 parking spaces and the existing building height of 18 feet. No residential use.
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.cityolchicago.org/ARO for more information). Is this project subject to the ARO?

YES NO*




Page 2
COUNTY OF COOK STATF. OF ILLINOIS


beini> first duly sworn on oath, states that all ofthe above statements and the statements contained in the documents submitted herewith are true and correct.



Subscribed and Sworn to before me this
Bl ST~ day of Clu^i^ , 20 Al

OFFICIAL SEAL NELIDA RODRIGUEZ
NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES:12/18/23
No tar
try Public 0 J


For Office Use Only































Page 3-
MM SURVEYING CO., INC

NORTH
ASSUMES
PLAT OF SURVEY
OF
PARCEL 1
THE: NORlh i<\ FEET 2 INCHES OF LOT 1 if.' KOEST=R AND ZANDER'S fWYLAND PftPK AUD'T'ON TO IRVING PARK, A SU30rVISi0N Or LOl J IN L::RCUiT COJ«7 COMf-'ISSlCNERS PARTITION or THE SOU-'H HALF Of-" He NORTrT EAST CjA^TuR. AND I-AST HAL." OF7''.E i7A=>^ -IA: r OF- Tl-": NOKT'J \\'~Tr QUARTER (EXCEPT NORTH 20 ACRES THEREOF) :.N SEC ION 71. TOWNSHIP 40 NORTH "«east of the: third =rin::ipal h^.:^;.^, in cook tou'ity ii lino'S
PIN --si 3-21-?_i g-035 PARCEL 2
LOT 1 (EXCEPT THE NORTH 2* FEfT 2 INCHES AND EXCEPT SOUTH ?5 FEET "i HEREOc) !N KO'-STFR AND ZANDER'S GRAYLAND PARK ADDITION TO IRVING PARK SUBDIVISION OF LOT j IN CIRCUIT COURT COMMISSIONERS PARTITION OF "HE SOUTH ONE-HALF (3 j£) OF THE NORTH EAST-QUARTER. {NE %) AND EAST ONE-HALF-" ;e ^) OP THE EAST ONE-HALF (E ¥•) OF THE NORTH WEST ONE-ODARTER
="¦•() NORTH, RANGE L3, EAST
PIN
(NW ¦/„) ^EXCEPT NOR-'-H 20 ACRES THEREOF; IN SECTION 2.1. TOWN'S
OF THE THIRD PRINCIPAL. MERIDIAN, in COOK
3-21-219-03G

W.
COMMPNLY KNOWN AS 3746-5G N. CICERO AVE , CHICAGO, IL 60541 TOTAL LAND AREA = 13,415 sq.fi .
GRACE


|109|C\r\ FENCE POST' IS
1 ^-J.UU/ 0 29 NORTH " '


ASPHALT AREA
PARCEL 1


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125.00


LEGEND
i LINK rt.S'i ¦ WOOD FW




O^OER ^0 - -SCALE 1 INCI
ENCLOSED ?*>UE POT&r / 0C«VC2"*"C-; O^r.!.1 FRAME °0FCI-£ f -:=.-jC\'^
of:n c»;c ¦¦'oro-
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ir*s ?sorr?sm\L seaicE coNrotJMS io he cusfrw iljj-noi^ a=wuv
ST«JIWf!I)3 -T)r ^ BOUHWTf SUB'.t?
FOR 3UILDING LINES. FJASEMctirS AND OTHlR RE51'? I CT :(WS MOT SHOftTi HESLCfJ. ^E^LS 70 lO.^i O-ICO 7 ¦ ~LE POLiC* LEG^L UESCRFTltlH SOHID ON UlS WGviuai B-: ;,;r
AND .'.'L'ST 5F tOMF'ARCj ^iT^ 0;t[) anE)/!;E TTTLE POLiC^
Au. DiMcNS10M5 *R= SI*JWN :^ FED AMD PECMV fy-TTS T.'F.Ri\0T

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Wo. Ki iA S'.jrvcyir,g Co., if.c , ao her*oy c ; ."i u; w •:¦ nova s u r v e y e a the g b o v c c e s c1 b ? proper:./ ync i h a t hit u I a \ hereon drown corract r«prcsentotion o; so:a sjrvcv
^5,
:;ST
Ri!.i ¦'LL Lid Survcycr ^:o j LIC =TVF NOVEMBER 30 202.7
WRITTEN NOTICE AEEIDAVIT (SECTION 17-13-0107)


September 1, 2021

Honorable Thomas M. Tunney Chairman, Committee on Zoning 121 North LaSalle Street Room 304, City Mall Chicago, Illinois 60602


I, Max A. Stein, one of the attorneys for 3750 North Cicero LLC, the owner of the property located at 3746-56 N. Cicero, being first duly sworn on oath deposes and state the following:

I certify that I have complied with the requirements of Section 17-13-0107 of the Chicago Zoning Ordinance, by sending written notice to such properly owners who appear to be the owners of the property within the subject area not solely owned by the applicant, and to the owners of all property within 250 feet in each direction ofthe lot line ofthe subject property, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. Said "written notice" was sent by First Class U.S. Mail, no more than 30 days before filing the application.

I certify that the notice contained the address ofthe property sought to be rezoned; a statement of the intended use ofthe property; the name and address of the applicant; the name and address of the owner; and a statement that the applicant intends to introduce the application for a change in zoning at the City Council meeting on September 14, 2021.

I certify that the applicant has made a bona fide effort to determine the addresses ofthe 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 250 feet ofthe subject site is a complete list containing the names and addresses of the people required to be served.


Subscribed and Sworn to before me this




BOODELL & DOMANSKIS, LLC
Max A. Stein Office: 312-300-5505 Fax: 312-300-5546 nisiein(fl.;boodlaw.com





July 27, 2021

Dear Resident:

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 August 16, 2021, the undersigned will file an application for a change in zoning from its current zoning of B3-1 to a new zoning of Cl on behalf of 3750 North Cicero LLC for the property located at 3746-3756 N. Cicero.

The applicant intends to have the current occupant, Staalsen Construction Company, continue to use the property, including storing materials related to its construction business inside buildings already on the property.

3750 North Cicero LLC is located at the subject property, 3750 N. Cicero. I am the contact person for this application, and you can reach me at mstein@boodlaw.com or 312-300-5505.

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.

Max A. Stein
Attorney for 3750 North Cicero LLC
Boodell & Domanskis, LLC One North Franklin, Suite 1200, Chicago, IL 60606 T:312.938.4070 F:312.540.1162 www.boodlaw.com

Very truly yours,

Boodell & Domanskis, LLC
Max A. Stein Office: 312-300-5505 fax: 312-300-5546 mslein@,boodla\v.com


August 31, 2021

Dear Resident:

I write with an update regarding the zoning application we will be tiling on behalf of 3750 Nortli Cicero LLC for the property located at 3746-3756 N. Cicero.

In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance, specifically Section 17-13-0107, on or about September 1, 2021, I will file an application for a change in zoning from its current zoning of B3-1 to a new zoning of Cl-1 on behalf of 3750 North Cicero LLC for the property located at 3746-3756 N. Cicero. The applicant expects the application to be introduced at the City Council meeting scheduled for September 14, 2021. The applicant seeks this change to allow the use standards ofthe Cl-1 Neighborhood Commercial District. Specifically, the applicant intends to have the current occupant, Staalsen Construction Company, continue to use the property, including storing materials related to its construction business inside buildings already on the property.

3750 North Cicero LLC is located at the subject property, 3750 N. Cicero. 1 am the contact person for this application, and you can reach me at mstein@boodlaw.com or 312-300-5505.

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 ofthe property to be rezoned.

N4ax A. Stein
Attorney for 3750 North Cicero LLC
Boodell & Domanskis, LLC One Nortli Franklin, Suite 1200, Chicago, IL 60606 1:312.938.4070 F:312.540.1162 www.boodlaw.com

Very truly yours,

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: 3750 North Cicero LLC

Check ONE ofthe following three boxes

Indicate whether the Disclosing Party submitting this EDS is:
\7\\ the Applicant
OR
Q 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
Q a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:


B. Business address of the Disclosing Party: 3750 N. Cicero
Chicago, IL 60641
Telephone: 773-637-1116 Fax: Email: kklint@staalsen.com
Name of contact person: Ken Klint
Federal Employer Identification No. (ifyou have one): . .

Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):

Application for Zoning Amendment to change the Chicago Zoning District from B3-1 to C1-1 for property at 3746-56 N. Cicero.
Which City agency or department is requesting this EDS? of Planning & Development

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

Specification # and Contract #
Ver.2018-1 Page 1 of 15

SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS

A. NAT URL OF THE DISCLOSING PARTY
Person
Publicly registered business corporation
Privately held business corporation
Sole proprietorship
General partnership
Limited partnership
Trust
f/j Limited liability company
I | Limited liability partnership
| j Joint venture
| [ Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
? Yes ? No | [ Other (please specify)

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

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

j | Yes 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 the day-to-day management of the Applicant.

NOTE: Each legal entity listed below must submit an EDS on its own behalf.

Name Title
Kenneth E Klint, Sole Manager Ruth M Klint, Sole Member


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. I f none, state "None."
NOTE: Bach legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
None





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? Q Yes [/] 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 j/j No
If "yes" to either ofthe above, please identify below the name(s) of such City elected official(s) and describe such income or compensation:


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 ofthe Municipal Code of Chicago ("MCC")) in the Disclosins Party? QYes 0NO
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partners) and describe the financial interest(s).



SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (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 of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. Tf 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 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.
Jordan Ma;yas (Retained). 20 W Kinzie. 1 /th Floor Chicago, IL 60654, Attorney, Estimated So.000 Max Stein (Retained), 1 N Franklin, Suite 1200. Chicago. !L 60606. Attorney. Estimated 34,000

(Add sheets if necessary)
| | Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
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 ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?

[ | Yes J No Q 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 Q No
FURTHER CERTIFICATIONS

[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 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 pay ment of any tax administered by the Illinois Department of Revenue.


Page 4 of 15

3. The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section I'(B)(1) of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily-excluded from any transactions by any federal, stale or local unit of government;
have not, during the 5 years' before the dare of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes: fraud: embezzlement; theft; forgery, bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in 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 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 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 ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in 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 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on 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 termsj 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 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").
[FOR APPLICANT ONT,Y| 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 ofthe City, use any such
Ver.20I8-l Page 6 of 15

contractor/subeontractor thai docs not provide such certifications or that the Applicant has reason lo believe has not provided or cannot provide truthful certifications.

11. Ifthe Disclosing Party is unable to certify Lo any ofthe above statements in this Part B (Further Certilications). ihe Disclosing Party must explain below:

None


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

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



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: (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 of the City recipient.

None


C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
|~~] is [/] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
Ifthe 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 ofthe privilege of doing business with the City."

Page 7 of 15

Ifthe Disclosing Party is unable to make this pledge because it or any ol its affiliates (as delined 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):

None

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

D. CERTIFICATION REGARDING 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 ofthe Disclosing Party'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?

Yes f/J No
NOTE: Ifyou checked "Yes" to Item D(l), proceed to Items D(2) and D(3). Ifyou 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 of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.

Does the Matter involve a City Property Sale?
Yes QNo
Ifyou 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 ofthe financial interest:

Name Business Address 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.

Page 8 of 15

E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

Please cheek either (1) or (2) below. It'the Disclosing Patty 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. . -

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






SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

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




(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that 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( 1) above for his or her lobbying activities or to pay any
person or entity to influence or attempt to influence an officer or employee 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 ai the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A( 1) and A(2) above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) 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.
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A( 1) through A(4) above from all subcontractors before it awards any subcontract and 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

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

Is the Disclosing Party the Applicant?
? Yes
If "Yes," answer the three questions below:
? No

1. Flave you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
QYes
2. Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?


3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
? Yes ? No

Ifyou checked "No" to question (1) or (2) above, please provide an explanation:




Page 10 of 15

SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION

The Disclosing Party underslands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics 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.citvofchicago.ora/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.
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 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 lo 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 infonnation 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

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.


3750 North Cicero LLC
(Print or type e^xac>legal name of D^sclosirjg Party)
a'
[Sign here)
Ken Klint
(Print or type name of person signing)
Manager
(Print or type title of person signing)


Signed and sworn to before me on (date) h^-^ 3/ jf c'Q-/ ,
t
at d*>s^<- County, S£2-
Notary Public Commission expires:

$ OFFICIAL SEAL
? NELIDA RODRIGUEZ
: NOTARY PUBLIC - STATE OF ILLINOIS
- MY COMMISSION EXPIRES: 12/18/23




















Page 12 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAV IT
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 ofthe Disclosing Party listed in Section II.B.l.a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe Disclosing Party is a general partnership: all general partners and limited partners of the Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe 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?
QYes
If yes. please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.









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 g] 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 J/] No F/J The Applicant is not publicly traded on any exchange.


3. 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.
























Page 14 o f 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 .amleaal.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 - I 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)(l). If you checked "no" to the above, please explain.





















Page 15 of 15