This record contains private information, which has been redacted from public viewing.
Record #: O2012-6535   
Type: Ordinance Status: Passed
Intro date: 10/3/2012 Current Controlling Legislative Body: Committee on Zoning, Landmarks and Building Standards
Final action: 12/12/2012
Title: Zoning Reclassification Map No. 17-G at 1331 W Albion Ave - App No. 17579
Sponsors: Misc. Transmittal
Topic: ZONING RECLASSIFICATIONS - Map No. 17-G
Attachments: 1. O2012-6535.pdf
ORDINANCE
 
 
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing the RS3, Residential, Single-Unit (Detached House) District symbol as shown on Map No.17-G in the area generally bounded by:
West Albion Avenue; a line starting at a pointl 99.28 feet east of North Glenwood Avenue extended south to a point 199.60 feet east of North Glenwood Avenue; the alley next south of and parallel to West Albion Avenue; and the alley next east of and parallel to North Glenwood Avenue
 
to those of a B2-5, Neighborhood, Mixed-Use District.
 
SECTION 2.  This ordinance takes effect after its passage and approval.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Common Address: 1331 West Albion Avenue
 
 
 
 
 
 
 
CITY OF CHICAGO
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
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1.    ADDRESS of the property Applicant is seeking to rezone:
 
1331 West Albion
 
2.    Ward Number that property is located in: 40
 
3.    APPLICANT      Heartland Alliance International, LLC
 
ADDRESS        208 South LaSalle Street -#1818        CITY Chicago
 
STATE     Illinois      ZIP CODE   60604      PHONE 312.660.1300
epowley@
EMAIL     heartlandalliance.org       CONTACT PERSON    Elizabeth Powley / Exec. Dir.
 
4.    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    Chicago Province of the Society of Jesus      
 
ADDRESS    2050 North Clark Street            CITY Chicago      
 
STATE     Illinois       ZIP CODE   60614      PHONE 773.975.6870
treasurer@jesuits-
EMAIL     chgdet.org            CONTACT PERSON    Theodore G. Munz, S.J.
 
5.    If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY     Edward J. Kus / Shefsky & Froelich      
ADDRESS    111 East Wacker Drive - Suite 2800      
CITY      Chicago            STATE   Illinois       ZIP CODE 60601      
PHONE    312.836.4080      FAX   312.275.7586        EMAIL ekus@shefskylaw.com
 
 
6.     If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
Applicant is an LLC - see attached list      
 
 
 
 
 
 
 
 
 
7.     On what date did the owner acquire legal title to the subject property? 1973
 
8.     Has the present owner previously rezoned this property? If Yes, when?
NO
 
 
 
9.     Present Zoning District     RS3            Proposed Zoning District B2-5
  1. Lot size in square feet (or dimensions)   6,564 square feet      
  2. Current Use of the property     Counseling / Office      
  3. Reason for rezoning the property    To allow the property to be used for counseling/office
  4. uses for the Heartland Alliance Marjorie Kovler Center.      
13.      Describe the proposed use of the property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and height of the proposed building. (BE SPECIFIC)
The building was built in 1938 as a convent. There are single-cell rooms with no parking-
There are no residential units. The building is 4-stories. After rezoning, the building will be used
for counseling offices for the Marjorie Kovler Center. Existing building to remain as is.      
  1. On May 14lh, 2007, the Chicago City Council passed the Affordable Requirements Ordinance (ARO) that requires on-site affordable housing units or a financial contribution if residential housing projects receive a zoning change under certain circumstances. Based on the lot size of the project in question and the proposed zoning classification, is this project subject to the Affordable Requirements Ordinance? (See Fact Sheet for more information)
 
YES      NO X
 
 
 
 
1221306 1
 
COUNTY OF COOK STATE OF ILLINOIS
 
Signature of Applicant
 
 
, being first duly sworn on oath, states that all of the above statements and the statements confained in the documents submitted herewithare true and correct.
Subscribed and Sworn to before me this ^/-j   daVfzffkeptember 2012.
 
 
OFFICIAL SEAL _  SARA E THOMAS NOTARY PUBLIC • STATE OF ILLINOIS MY COMMISSION EXPH_$:07/11/16
 
For Office Use Only
 
 
Date of Introduction:.
File Number:      
Ward:      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1221306_1
 
 
Heartland Alliance (HA) Board of Directors
Chair: Scott L. Goodman, Sterling Bay Companies Vice Chair: Lynn C. Todman, PhD, The Adler School Secretary: Glenn D. Newman, Exelon Corporation Treasurer: Karen E. Otto, Witt/Kieffer
 
Directors:
Shubhada Ahya, MD, Northwestern University School of Medicine
Alan R. Braxton, Macquarie Capital Advisors
Linda T. Coberly, Winston & Strawn LLP
Ruth A. Colby, Silver Cross Hospital
Araceli Esquivel, Health Care Service Corporation
Julia E. Getzels, The Art Institute of Chicago
Elaine H. Klemen, Psychotherapist
Ray J. Koenig 111, Clark Hill PLC
Suellen G. Long, Bridgeview Bank Uptown
Christopher D. Lueking, Latham & Watkins LLP
Wendy A. Manning, The Boeing Company
Theodore W. Michalke, NeuStrategy, Inc.
Arthur Moore, Moore Investment Properties, LLC
Kathe A. Pate
Frank F. Quinn, UBS Financial Services, Inc.
Sandy J. Rebitzer
Marita Rhea, Bank of America
 
 
Ryan Ruskin Payman Salehi
Steve E. Scholl, Allstate Insurance Company
Jeanne M. Sullivan, Jeanne M. and Joseph P. Sullivan Foundation
Guy F. Summers, Farrell Group, LLC
Harlan R. Teller
Robert H. Tucker
Lori S. Tuffield, Management Advisory, The PrivateBank Giovani Twigge, IDEXX Laboratories, Inc. Andrew T. Ward, CFA, The Boeing Company Thomas O. Weeks
Barclay C. Welch, Ansonia Properties, LLC
Paul A. Zucker (also on HH Board), City Real Estate Incorporated
 
 
 
 
(Liz Sode, Assistant Treasurer) (Sara Thomas, Assistant Secretary)
 
1331 West Albion Avenue Type 1 Rezoning
 
 
The building on the subject property is a former convent built in 1938 for the Sisters of the Holy Child. The convent building provided sleeping rooms for the sisters on the upper floors and included areas of accessory community service rooms. The building is four-stories in height and contains approximately 14,697.5 square feet of floor area, plus a basement. There is no parking at the building, as there was no minimum parking requirement at the time of construction for convents.
The rezoning is necessary to allow for the continued use of the building as the Marjorie Kovler Center, a counseling center for people, families and communities who are affected by torture. The building remains the same. There will be no additions or new construction to the building. The building will not be used for residential, but rather for office use. The Marjorie Kovler Center is a counseling center that provides case management, forensic evaluation and other multidisciplinary services.
Pictures of the existing building and floor plans are attached hereto as exhibits.
 
B2-5 Standards
Existing Building
Permits mixed use, including office
Will be office use
No parking for 1st 35,000 SF or 2 x lot area
0 parking spaces for office use - 14,697SF
Maximum height is 55'
Existing height is approximately 40'
Maximum FAR is 5.0
Existing FAR is approximately 2.24
Required Front Yard Setback is 12.5'
Existing Front Yard Setback is 24.94'
Required Side Yard Setback is 5'
Existing Side Yard Setback is 0'
Required Rear Yard Setback is 0'
Existing Rear Yard Setback is approx. 20'
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lower Level      
SCALE:     1 / 8 "      =      1 ' - 0 "
 
 
 
 
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3,323.75 sq f
 
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Third Floor
SCALE:     1 / 8 "
 
 
 
 
 
RE: 1331 West Albion Ave.
 
September 26, 2012
 
Daniel Solis Chairman
Committee on Zoning, Landmarks and
Building Standards
121 North LaSalle Street
Room 304, City Hall
Chicago, Illinois 60602
 
The undersigned, Edward J. Kus, being first duly sworn on oath, deposes and states the following:
 
The undersigned certifies that the notice requirements of Section 17-13-0107 of the Chicago Zoning Ordinance were complied with by causing written notice to be sent by first class mail, to such property owners who appear to be the owners of all property within the lot lines of the subject property and within 250 feet in each direction of the lot lines of the subject property, exclusive of public roads, streets, alleys and other public ways.
 
The undersigned certifies that the notice contained the address of the property which is the subject of the application; a statement of the intended use of the property; the name and address of the applicant; and a statement that the applicant intends to file an application for a Zoning Amendment on or about October 3, 2012.
 
The undersigned certifies that the applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-0107-A of the Chicago Zoning Ordinance and that the accompanying list of names and addresses of surrounding property owners within 250 feet of the subject site is a complete list containing the names and addresses of the people who were served.
 
EdwardVJ. Kus Attorney for the Applicant
 
Subscribed and sworn to before me this 26th day of September 2012.
 
 
1223226 1
 
 
 
Shefsky Sc Froelich
Attorneys at Law
111 E. Wacker Drive, Suite 2800 Chicago. Illinois 60601-3713
Tel 312.527.4000 Fax 31 2.5274011 www.shefskylaw com
 
 
 
September 26, 2012
 
 
 
 
Dear Sir or Madam:
 
In compliance with the notice requirements for an Amendment to the Chicago Zoning Ordinance, please be informed that on or about October 3, 2012, an application for an Amendment to the Chicago Zoning Ordinance will be filed on behalf of the Applicant, Heartland Alliance International, LLC, for the property commonly known as 1331 West Albion Avenue.
 
The Applicant, Heartland Alliance International, LLC, seeks to continue the use of the building at 1331 West Albion Avenue for the Marjorie Kovler Center, a counseling center for people, families and communities affected by torture. The existing building is a former convent constructed in 1938 and there will be no physical changes to the building. The application seeks a change in zoning from RS3, Single-Family District, to B2-5, Neighborhood Mixed-Use District, to allow the Kovler Center to provide offices for its counseling services.
 
The contact information for the Applicant is as follows: Heartland International, LLC, 208 South LaSalle Street, Suite 1818, Chicago, Illinois 60604. The current owner of the property is the Chicago Province of the Society of Jesus.
 
Please note that your property is not being rezoned. The Applicant is required by law to send this notice to you because you own property within 250 feet of the subject site.
 
Questions about this notice may be directed to the Applicant's attorney, Edward J. Kus, at 312.836.4080, at Shefsky & Froelich Ltd., Ill East Wacker Drive, Suite 2800, Chicago, Illinois 60601.
 
Very truly yours,
 
SHEFSKY & FROELICH, LTD.
 
Edward J. Kus
 
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
 
SECTION I -- GENERAL INFORMATION
  1. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Heartland Alliance International, LLC
 
Check ONE of the following three boxes:
 
Indicate whether the Disclosing Party submitting this EDS is:
  1. [yf the Applicant
OR
  1. [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:      
OR
3.      [] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:      
R n ■    aa*   rn n■ » • p t    208 South LaSalle
  1. Business address of the Disclosing Party:
Chicago, Illinois 60604-1004
 
 
n _ . . 773.751.4071 _ 773.381 .4073 r meverson@heartlandalliance.org
C. Telephone:      Fax:      Email:      
D. Name of contact person
. Mary Lynn Everson
 
E. Federal Employer Identification No. (if you have one):
 
F. Brief description of contract, transaction or other undei      is the "Matter") to
which this EDS pertains. (Include project number and loc... able):
Rezoning of property located at 1331 West Albion Avenue, Chicago, Illinois 60626-4701
 
G. Which City agency or department is reques
 
h.< .bi. eds:. Department of Zoning
 
 
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
 
Specification #      and Contract #      
 
Vcr. 01-01-12
 
 
 
Page 1 of 13
 
 
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
 
A. NATURE OF THE DISCLOSING PARTY
 
1.   Indicate the nature of the Disclosing Party:
I  | Person      □ Limited liability company
|   | Publicly registered business corporation      Q Limited liability partnership
I  | Privately held business corporation      Q Joint venture
|  j Sole proprietorship      f/] Not-for-profit corporation
| | General partnership      (Is the not-for-profit corporation also a 501(c)(3))?
|  | Limited partnership      I^Yes      | |No
□ Trust      [] Other (please specify)
 
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
 
3.   For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
 
|   |Yes      |   ^io [/|N/A
 
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
 
1.   List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
 
Name Title See attached.
 
 
 
 
 
 
2.   Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
 
Page 2 of 13
 
 
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None.'' NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
 
Name      Business Address      Percentage Interest in the
Disclosing Party
N/A
 
 
 
 
 
 
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
 
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
 
es
/
 
No
 
 
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
 
 
 
 
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
 
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature 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.
 
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
 
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
 
 
 
 
 
Page 3 of 13
 
 
 
Name (indicate whether Business retained or anticipated Address to be retained)
Relationship to Disclosing Party   Fees (indicate whether
(subcontractor, attorney,      paid or estimated.) NOTE:
lobbyist, etc.)      "hourly rate" or "t.b.d." is
not an acceptable response.
 
/// £ WKtir^
A 17lxrt&/
 
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(Add sheets if necessary)
[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
 
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
 
Mas 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?
 
J No person directly or indirectly owns 10% or more of the Disclosing Party.
 
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
|   |Yes      [ [No
B. FURTHER CERTIFICATIONS
1.   Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of. or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
 
 
Page 4 of 13
 
  1. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section TLB. 1. of this EDS:
  1. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
  2. have not, within a five-year period preceding the date of this EDS, been convicted 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;
  3. are not presently indicted for, or criminally or civilly-charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
  4. have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
  5. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
  6. The certifications in subparts 3, 4 and 5 concern:
  • the Disclosing Party:
  • any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section [V, "Disclosure of Subcontractors and Other Retained Parties");
  • any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is. with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
•      any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
 
 
Page 5 of 13
 
 
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
    1. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State 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;
    2. agreed or colluded with other bidders or prospective bidders, of been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise: or
    3. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
  1. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
  1. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
  2. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
  3. The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
  4. If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
None.
 
 
 
 
 
 
 
Page 6 of 13
 
 
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
 
8.   To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"). None.
 
 
 
9.   To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than S20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. None.
 
 
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION 1.   The Disclosing Party certifies that the Disclosing Party (check one)
 
J is not
 
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
 
2.   Tf the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
 
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
 
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
 
 
 
 
Page 7 of 13
 
 
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
 
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
 
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
  1. In accordance with Section 2-156-1 10 of the M unicipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
 
 
NOTE:  If you checked "Yes" to Item D.I., proceed to Items D.2. and D.3. If you checked "No" to Item D.I., proceed ro Part E.
  1. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
 
Does the Matter involve a City Property Sale?
 
|   |Ves      | |No
  1. If you checked "Yes" to Item D.I., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
 
Name      Business Address      Nature of Interest
 
 
 
 
 
 
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
 
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
 
Please check either I. or 2. below. If the Disclosing Party checks 2 the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
 
 
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
 
x  l. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era;(including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
 
      2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
 
 
 
 
 
 
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
 
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
 
A. CERTIFICATION REGARDING LOBBYING
 
1.   List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary): None.
 
 
 
(If no-explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
 
2.   The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
  1. 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.
  2. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
5.      If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
 
 
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
 
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
 
Is the Disclosing Party the Applicant?
 
 
 
 
 
 
 
 
If "Yes," answer the three questions below:
 
 
1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
 
 
 
2.   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?
 
3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
 
 
 
If you checked "No" to question I. or 2. above, please provide an explanation:
 
 
 
 
Page 10 of 13
 
 
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
 
The Disclosing Party understands and agrees that:
  1. 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.
  2. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchica.go.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N.
 
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
  1. If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
  2. It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
 
E.      The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article 1 of
Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
 
The Disclosing Party represents and warrants that:
 
Page 11 of 13
 
F.l.    The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
 
F.2     If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
 
F.3     If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
 
NOTE: If the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
 
CERTIFICATION
 
Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
 
Heartland Alliance International, LLC
 
Elizabeth Powley
(Print or type name of person signing
 
Senior Director, Heartland Alliance International
(Print or type title of person signing)
 
 
 
 
Signed and sworn to before me on (date) TTUfliAt-) Zl/ S-Ol?- ,
at      Qjciot//       County,   I WiV^Ot S (state).
Co/hmission expires: Oll\\j\\o
 
 
Notary Public.
 
Page 12 of 13
 
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
 
 
 
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
 
 
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
 
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of die date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
 
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
 
Does the Disclosing Party or any "Applicable Parry" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
 
 
 
 
 
 
 
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.
 
 
 
 
 
 
 
 
 
 
Page 13 of 13
 
 
Heartland Alliance (HA) Board of Directors
Chair: Scott L. Goodman, Sterling Bay Companies Vice Chair: Lynn C. Todman, PhD, The Adler School Secretary: Glenn D. Newman, Exelon Corporation Treasurer: Karen E. Otto, Witt/Kieffer
 
Directors:
Shubhada Ahya, MD, Northwestern University School of Medicine
Alan R. Braxton, Macquarie Capital Advisors
Linda T. Coberly, Winston & Strawn LLP
Ruth A. Colby, Silver Cross Hospital
Araceli Esquivel, Health Care Service Corporation
Julia E. Getzels, The Art Institute of Chicago
Elaine H. Klemen, Psychotherapist
Ray J. Koenig III, Clark Hill PLC
Suellen G. Long, Bridgeview Bank Uptown
Christopher D. Lueking, Latham & Watkins LLP
Wendy A. Manning, The Boeing Company
Theodore W. Michalke, NeuStrategy, Inc.
Arthur Moore, Moore Investment Properties, LLC
Kathe A. Pate
Frank F. Quinn, UBS Financial Services, Inc.
Sandy J. Rebitzer
Marita Rhea, Bank of America
 
 
Ryan Ruskin Payman Salehi
Steve E. Scholl, Allstate Insurance Company
Jeanne M. Sullivan, Jeanne M. and Joseph P. Sullivan Foundation
Guy F. Summers, Farrell Group, LLC
Harlan R. Teller
Robert H. Tucker
Lori S. Tuffield, Management Advisory, The PrivateBank Giovani Twigge, IDEXX Laboratories, Inc. Andrew T. Ward, CFA, The Boeing Company Thomas O. Weeks
Barclay C. Welch, Ansonia Properties, LLC
Paul A. Zucker (also on HH Board), City Real Estate Incorporated
 
 
 
 
(Liz Sode, Assistant Treasurer) (Sara Thomas, Assistant Secretary)
 
AUTHORIZATION OF OWNER
 
 
 
Chicago Province of the Society of Jesus, as owner of the property located at 1331 West Albion, Chicago, Illinois, hereby authorizes Heartland Alliance International, LLC ("Heartland"), its attorneys and agents, to file all necessary documents for a proposed zoning amendment. There is a pending contract of sale of the property to Heartland and we have no objection to the proposed zoning change.
 
 
 
Chicago Province of the Society of Jesus
 
By
 
Theodore G. Munz, S~J. Its Treasurer and Authorized Agent
 
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
 
SECTION I - GENERAL INFORMATION
  1. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Chicago Province of the Society of Jesus
 
Check ONE of the following three boxes:
 
Indicate whether the Disclosing Party submitting this EDS is:
  1. [ ] the Applicant
OR
  1. (X| a legal entity holding a direct or indirect interest in the Applicant. Slate the legal name of the Applicant in which the Disclosing Party holds an interest: Chicago ProvxncS- of the Society
0R      of Jesus as Seller to" Hear nan or Alliance, purchaser
3.      [] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:      
  1. Business address of the Disclosing Party:       2050 North Clark Street      
Chicago,  Illinois 60614
treasurer(dj esuits •
  1. Telephone: 773-975-6870    Fax: 773-975-0230       Email: chgdet.org      
  2. Name of contact person: Theodore GV Munz , S.J.      
  3. Federal Employer Identification No. (if you have one;       
  1. Brief description of contract, transaction or other und      s "Matter") to
which this EDS pertains. (Include project number and 1 ):
Rezoning of property located at 1331 West Albion, Chicago, IL
  1. Which City agency or department is requesting this EDS? DePartment Zoning
 
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
 
Specification #      ,.     and Contract #      
 
Ver. 01-01-12
 
 
 
Page 1 of 13
 
 
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
 
A. NATURE OF THE DISCLOSING PARTY
 
1.  Indicate the nature of the Disclosing Party:
[]      Person      ...■[■] Limited liability company
[]      Publicly registered business corporation     [■] Limited liability partnership
[]      Privately held business corporation      [ ] Joint venture
[]      Sole proprietorship      ^ 'P3 Not-rAor-profit corporation
[ ]      General partnership       (Is the'ri©t-foi>prc>fH corporation also a 501(c)(3))?
[]      Limited partnership      [ ] Yes []No
[]      Trust      . [ ] Other (please specify)
 
2. For legal entities, the state (or foreign country) of'incorporation or organization, if applicable: An Illinois not-for-profit corporation
 
3.  For legal entities not organized in the State of .Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity? ■■"
 
[] Yes      []No      ; &:]'N7A
B. IF THE DISCLOSING PARTY IS A LEGA^ ENTITY;
  1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture-, list below the name ^nd* title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an'EDS on its own behalf.
Name Title
Timothy P. Kesicki,  S.J. President/Director      
Patrick" K". " Fairbanks , S . J . Director
James F. Riley,  S.J.      ...     " Director
"James S. .Prehn, S.J.       ~~        !rr~-     -secretary   —- -       
Theodore G. Munz,  S.J.      • ,' Treasurer      
Members:'   There;:are:mo Meftibers vwhich are legal entities as stated in
  1. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation. pajrtnereliip interest in a partnership or joint venture,
 
Page 2 of 13'
 
 
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
 
Name      Business Address      Percentage Interest in the
Disclosing Party
N/A
 
 
 
 
 
 
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
 
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
 
[ ] Yes      K] No
 
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
 
 
 
 
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
 
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature 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.
 
"Lobbyist" means any person or entity who. undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
 
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
 
 
 
 
 
Page 3 of 13
 
 
Name (indicate whether    Business      Relationship to Disclosing Party   Fees (indicate whether
retained or anticipated       Address       (subcontractor, attorney,      paid or estimated.) NOTE:
to be retained)      lobbyist, etc.)      "hourly rate" or "t.b.d." is
not an acceptable response.
 
 
 
 
 
 
(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
  1. COURT-ORDERED CHILD SUPPORT COMPLIANCE      jj/a
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with theirchild support obligations throughout the contract's term.
 
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes      [ ] No      [ ] No person directly or indirectly owns 10% or more of the
Disclosing Party.
 
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
 
[ ] Yes      [ ] No
  1. FURTHER CERTIFICATIONS
 
1.   Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
 
 
Page 4 of 13
 
  1. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
    1. are not presently debarred, suspended;, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
    2. have not, within a five-year period preceding the date of this EDS, been convicted 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;
    3. are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
    4. have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
    5. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
  1. The certifications in subparts 3,4 and 5 concern:
 
•      the Disclosing Party;
  • any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
  • any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity; Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
  • any responsible official of the Disclosing.Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
 
 
Page 5 of 13
 
 
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
    1. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State 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;
    2. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
    3. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
  1. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
  1. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
  2. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
  3. The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
  4. If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
 
 
 
 
 
 
 
 
Page 6 of 13
 
 
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
 
8.  To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an, employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
 
 
 
 
9.  To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
 
 
 
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
  1. The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is      ?] is not
a "financial institution" as defined in Section 2-32-455(b) Of the Municipal Code.
  1. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
 
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
 
 
 
 
Page 7 of 13
 
 
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
 
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
 
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
  1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[]Yes PQNo
 
NOTE: If you checked "Yes" to Item D.I., proceed to Items D.2. and D.3. If you checked "No" to Item D.I., proceed to PartE.
  1. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ ] Yes      ft) No
  1. If you checked "Yes" to Item D.I., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
 
Name      Business Address      Nature of Interest
 
 
 
 
 
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
 
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
 
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
 
 
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
 
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:
 
 
 
 
 
 
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
 
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
 
A. CERTIFICATION REGARDING LOBBYING
 
I.   List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
 
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 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
 
2.  The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.L above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract,, grant, loan, or cooperative agreement.
Page 9 of 13 .
 
  1. 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.
  2. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) itis 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".
  3. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
 
 
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
 
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
 
Is the Disclosing Party the Applicant?
[ ] Yes      KJ No
If "Yes," answer the three questions below:
  1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes      [ ] No
  1. 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
  1. 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:
 
 
 
 
Page 10 of 13
 
 
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
 
The Disclosing Party understands and agrees that:
  1. 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.
  2. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N.
 
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
  1. If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
  2. It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
  3. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154*020 of the Municipal Code.
 
The Disclosing Party represents and warrants that:
Page 11 of 13
 
 
F.l.   The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
 
F.2    If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
 
F.3    If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
 
NOTE: If the Disclosing Party cannot certify as to any of the items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.
 
CERTIFICATION
 
Under penalty of perjury, the person signing below: (J.) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
Chicago Province of the Society of Jesus (Print or type name of Disclosing Party)
By:    <^£Zr^ T^T^r-^^z. r/      
(Sign here)
Theodore G. Munz, S.J. (Print or type name of person signing)
Treasurer (Print or type title of person signing)
 
 
Signed and swohi to before me on (dateyj^/^
at      County, \<lJsL.^wjKstate).
 
Notary Public
 
Commission expires:
 
Page 12 of 13
OFRCWtSEAL TIMOTHY C TOGMEY NOTARY PUBUC • STATE OFttlWOIS W COMMSStON EXPtRE&OlSrnT
 
 
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
 
 
 
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
 
 
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
 
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "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-fin-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
 
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section ILB.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable-party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
 
[ ] Yes      pC] 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.
 
 
 
 
 
 
 
 
 
 
;Page 13 of 13
 
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5812 W. HIGGINS AVENUE      IVI IVI   S U R VE
CHICAGO, ILLINOIS 60630      PROFESSIONAL D
^iriffi^^      » ALTA/ACSM
NORTH
ASSUMED
LOT 7 IN BLOCK 7 IN THE NORTH SHORE BOULEVARD Si ACRES) IN SECTION 32, TOWNSHIP 41 NORTH, RANGE
COMMONLY KNOWN AS: 1331 W. ALBION AVE., CHICAG PIN #11-32-318-004-0000 TOTAL LAND AREA » 6,564 sq.ft.
TOTAL BLDG. AREA (EXTERIOR FOOTPRINT AT GROUND
 
 
i CO.,
1184-003233
i Title
INC.
Survey "
 
PHONE: (773) 282-5900 FAX:      (773) 282-9424
 
 
E EAST Vi OF THE SOUTHWEST Vi (EXCEPT THE SOUTH 30 IRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
 
_ _ ____
SAN/STOR' SEWEB M4' w   SAN/ST0RU SEWS «4"
 
 
 
 
 
 
 
 
 
 
 
f-^AVEr      
 
 
 
CROSS CUT AT 3.00 NORTH * ON UNE EXT. " (CfttSS FOUND AT JXO NORTH * O07 VESI)
.W. CORNER OF IRON FENC£ POST IS 0.04* * 1.4-1'N.
 
25 FT.   BUILDING UNE
 
\   \   "\    \   T " .CORNER OF BLOS. #1325N IS 24.92*S. 4 O.IOt
 
 
 
 
 
 
WEST FACE OF IRON ' FENCE IS O.OB EAST