Office of the City Clerk - Record #: O2012-8198

This record contains private information, which has been redacted from public viewing.

Record #:

O2012-8198

Type:

Ordinance

Status:

Passed

Intro date:

12/12/2012

Current Controlling Legislative Body:

Committee on Zoning, Landmarks and Building Standards

Final action:

1/17/2013

Title:

Zoning Reclassification Map No. 6-F at 2920 S Lowe Ave - App No. 17634

Sponsors:

Misc. Transmittal

Topic:

ZONING RECLASSIFICATIONS - Map No. 6-F

Attachments:

1. O2012-8198.pdf

Date	Journal Page Number	Action By	Action	Result	Action Details	Meeting Details	Captions
1/17/2013	45662	City Council	Passed	Pass	Action details	Meeting details	Not available
1/14/2013		Committee on Zoning, Landmarks and Building Standards	Recommended to Pass	Pass	Action details	Meeting details	Not available
12/12/2012	42319	City Council	Referred		Action details	Meeting details	Not available

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

SECTION 1. That the Chicago Zoning Ordinance be amended by changing all the RS-3 Residential Single Unit (Detached House) District symbols and indications as shown on Map No. 6-F in the area bound by:

A perpendicular line to South Lowe Avenue 397.68 feet north of and parallel to West 30^th Street; South Lowe Avenue; a perpendicular line to South Lowe Avenue 372.68 feet north of and parallel to West 30^th Street; the perpendicular public alley to West 30^th Street and parallel to South Lowe Avenue.

to those of a RT-3.5 Residential Two-Flat, Townhouse and Multi-Unit, and a corresponding use district is hereby established in the area above described.

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

Address: 2920 South Lowe Avenue

/7 6?V

CITY OF CHICAGO

APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE

ADDRESS of the property Applicant is seeking to rezone:

2 92 0 South Lowe

2. Ward Number that property is located in:

3. APPLICANT Zhang Huan LIU & Yong Na LEI

ADDRESS ²⁹²⁰ ^s- ^Lowe CITY Chicago

STATE IL ZIP CODE PHONE³¹²"³⁴⁵"⁵⁷⁰⁰

EMAIL^lro^^ertson®^s^^^^awC@NTACTPERSON ^Lee ^R°t^,ertson

Is the applicant the owner of the property? YES NO

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

ADDRESS CITY '

STATE ZIP CODE PHONE_

EMAIL CONTACT PERSON

If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:

ATTORNEYLee A. Robertson /Schain Burney Banks & Kenny, Ltd. ADDRESS ⁷⁰ ^West Madison, #4500

CITY Chicago STATE ^IL ZIP CODE ⁶⁰⁶⁰²

PHONE 312-345-5700 FAX³¹²"³⁴⁵"⁵⁷⁰¹ EMAIL IrobertsonOsbbklaw.com

**The Estate of Lavergne Wilson, Executor Thomas Wilson, owns the adjacent property at 2 922 South Lowe. The proposed zoning amendment will allow Mr. Wilson to sell 2922 South Lowe as a legal zoning lot. Please see the enclosed letter from Mr. Wilson.

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.

N/A

7. On what date did the owner acquire legal title to the subject property? 7/2 010

8. Has me present owner previously rezoned this property? If yes, when7 No

9. Present Zoning District ^RS ³ Proposed Zoning District ^RT ^3,5

10. Lot size in square feet for dimensions') 310 0 ^s ^F

11. Current Use of the property Residential

Reason for rezoning the property To allow the subdivision of a 50x124 zoning lot

into two 25x124 zoning lots. The exisiting single family residnece at 2920 South

Lowe will remain. The property at 2922 South Lowe will remain RS-3 for a proposed single family residence.

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 use will remain residential after the zoning change. The existing single family residence on the property will remain the same and owner i

will add two parking spaces to serve the existing single family j

■ ■ i

On May 14^th, 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

COUNTY OF COOK STATE OF ILLINOIS

first duly sworn on oath, states that all of the above documents submitted herewith are true and correct.

7hdtAt Wvum Uvj V»S

statements and the statements contained in the docum

Signature of Applicant

Subscribed and Sworn to before me this

Notary Public

. day of QfhM*~ 20 13*

OFFICIAL SEAL TONY T SHU Notary Public - State of Illinois My Commission Expires Oct 5, 2013

www

For Office Use Only

Date of Introduction:

File Number:

Ward:

v,r.>

December 4, 2 012

Honorable Daniel S. Solis Chairman, Committee on Zoning 121 North LaSalle Street Room 304

Chicago, Illinois 60602

Committee Members:

The undersigned, Lee A. Robertson, being first duly sworn on oath, deposes and says the following:

That the undersigned certifies that he has complied with the

requirements of Section 17-13-0107-A of the Chicago Zoning

Ordinance by sending the attached letter by United States Postal

Service first class mail on such property owners who appear to be

the owners of said property within the subject area not solely

owned by the applicant, and on the owners of all property within

250 feet in each direction of the lot line of the subject

property, exclusive of public roads, streets, alleys and other

public ways, or a total distance limited to 400 feet, and that the

notice contained the address of the property sought to be rezoned;

a statement of intended use of said property; the name and address

of the applicant; a statement that the applicant intends to file

an application for a change in zoning on approximately December

4, 2012; that the applicant has made a bonafide effort to

determine the addresses of the parties to be notified under

Section 17-13-0107-A of the Chicago Zoning Ordinance; that the

applicant certifies that the accompanying list of names and

addresses of surrounding property owners within 250 feet,

recognizing the above limits, is a complete list containing the

names and last known addresses of the owners of the property

required to be served and that the ajffplicant. has furnished in

addition a list of the persons so served/. . [J

Lee A. Robertson Attorney for Applicant

Subscribed and Sworn to before me thi£K3^_ day of December, 2012

Notary Public

OFFICIAL SEAL PAMELA F. WALKER Notary Public - State of Illinois My Commission Expires Sep 09,2015

December 4,2012

Dear Sir/Madam:

In accordance with the Amendment to the Zoning Code enacted by the City Council, Section 17-13-0107-A of the Chicago Zoning Ordinance please be advised that on or about December 4, 20121, the undersigned, will file an application for a change in zoning, for the property located at 2920 South Lowe Avenue from RS-3 Residential Single Unit (Detached House) District to RT-3.5 Residential Two-Flat, Townhouse and Multi-Unit District.

The applicant and owner of the subject property are Zhang Huan Liu and Yong Na Lei with an address at 2920 South Lowe Avenue, Chicago, IL 60616.

The purpose of the rezoning is to allow the subdivision of a 50x124 zoning lot into two 25x124 zoning lots. The existing single family residence at 2920 South Lowe will remain. The property at 2922 South Lowe will remain RS-3 for a proposed single family residence.

I am the duly authorized attorney for the applicant and owner. My address is 70 West Madison, Suite 4500, Chicago, Illinois 60602. My number is (312) 345-5739.

PLEASE NOTE THAT THE APPLICANT IS NOT SEEKING TO PURCHASE OR REZONE YOUR PROPERTY. THE APPLICANT IS REQUIRED BY LAW TO SEND YOU THIS NOTICE BECAUSE YOU OWN PROPERTY LOCATED WITHIN 250 FEET OF THE SUBJECT PROPERTY.

Lee A. Robertson

Attorney for Owner and Applicant

December 3, 2012

Chairman, Committee on Zoning Room 304 - City Hall Chicago, Illinois 60602

Dear Committee Members:

I am the Executor of the Estate of Lavergne Wilson, the title holder to the property located at 2922 South Lowe. The estate would like to sell 2922 South Lowe but the lot is not a separate zoning lot from 2920 South Lowe. Due to the size of the existing home at 2920 South Lowe, separating the property into two zoning lots would create a non conforming use for 2920 South Lowe. In an effort to assist the estate, the owners of 2920 South Lowe have applied for a zoning amendment application to change the zoning of 2920 South Lowe from RS-3 to RT'J.S" R-¥=5. This zoning change would fully legalize the existing house at 2920 South Lowe and each individual lot would become a separate zoning lot.

Thomas Wilson, Executor of the Estate of Lavergne Wilson

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: Yang Na LEI

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[x] the Applicant

[] 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:

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:

B. Business address of the Disclosing Party: 2 92 0 South Lowe

Chicago, IL 60616

Telephone: 312-225-2200 Fax: Email:
Name of contact person: Tony Shu
Federal Employer Identification No. (if you have one): ^N/A
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):

Zoning Amendment for 2920 South Lowe, Chicago, IL 60616

G. Which City agency or department is requesting this EDS? ^DHED

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

Specification # N/A and Contract # N/A

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 [ ]

[ ] Publicly registered business corporation [ ]

[ ] Privately held business corporation [ ]

[] Sole proprietorship []

[ ] General partnership (Is

[ ] Limited partnership

[ ] Trust [ ]

Limited liability company Limited liability partnership Joint venture

Not-for-profit corporation

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: N/A

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 [x] 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 N/A

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?

[]Yes bdNo

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

N/A

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, 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

{\W~'^:: not an acceptable response.

N/A ■ ¹ '. '. : '

(Add sheets if necessary) ; ■'

f^Q Check here if the Disclosing Party has hot retained, nor expects to retain, any such persons or entities.

SECTION V -- CERTIFICATIONS

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.

Has any person who directly or indirectly owns 10%^;or more of the Disclosing Party been declared in arrearage on any child support obligations.by any Illinois court ofcompetent jurisdiction?

[ ] Yes f^JNo [ ] No. person directly or indirectly owns 10% or more of the

Disclosing Party. j

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 j*] No ; ■;'. V '

.■■■r';-'_:np_;t ■' ;^!ii;«;!r^;i.'i.^ ■■ ¹

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 legai 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; oremployee 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

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:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
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
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:

N/A

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").

N/A ■ ;

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. N/A

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

The Disclosing Party certifies that the Disclosing Party (check one)

[ ] is £c] is not

a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.

If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:

"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 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):

N/A

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.

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 ^x]No

NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.

Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.

Does the Matter involve a City Property Sale?

[ ] Yes [x] No

If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:

Name Business Address Nature of Interest

N/A

4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.

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.

* 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

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):

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

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

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

Is the Disclosing Party the Applicant?

[ ] Yes [x] No

If "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)

[]Yes []No

Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?

[]Yes []No

Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?

[ ] Yes [ ] No

If you checked "No" to question 1. or 2. above, please provide an explanation: N/A

Page 10 of 13

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.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.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to 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. 1. 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. 1., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.

Yang Na LEI

(Print or type name of Disclosing Party)

By:/^f9^^-

(Sign here)

Yang Na LEI

(Print or type name of person signing)

(Print or type title of person signing)

Signedj and sworn to before me on (date) Qtfo bv^)\ ^ ^^

County, ( 6- (state).

Notary Put

1C.

Commission expires:

OFFICIAL SEAL TONY T SHU Notary Public - State of Illinois My Commission Expires Oct 5, 2013

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 Parmer thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section 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 Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?

[ ] Yes [*\ No

If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.

N/A

Page 13 of 13

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: Zhang Huan LIU

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

ft] the Applicant

[ ] 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:

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:

B. Business address of the Disclosing Party: 2 92 0 South Lowe

Chicago, IL 60616

Telephone: 312-225-2200 Fax: Email: _____
Name of contact person: Tony Shu
Federal Employer Identification No. (if you have one): N/A
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):

Zoning Amendment for 2920 South Lowe, Chicago, IL 60616

G. Which City agency or department is requesting this EDS? ^DHED

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

Specification # N/A and Contract # N/A

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:

J_ Person [ ]

] Publicly registered business corporation [ ]

] Privately held business corporation [ ]

] Sole proprietorship [ ]

] General partnership (Is

] Limited partnership

] Trust [ ]

Limited liability company Limited liability partnership Joint venture

Not-for-profit corporation

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:

N/A

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 [x] N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

Name Title N/A

Page 2 of 13

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 &<]No

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

N/A

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

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)

N/A

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.

';< : . i/

(Add sheets if necessary) ^: .

QO Check here if the Disclosing Party has not retained, nor expects .to retain, any such persons or entities. SECTION V--CERTIFICATIONS

COURT-ORDERED CHILD SUPPORT COMPLIANCE ,

Under Municipal Code Section 2-92-415, substantialpwners 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 6wns'-^: 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?

[ ] Yes J*] 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 j*] No :' v.:" : ' ^; V ::; w. . \ ; ^:

FURTHER CERTIFICATIONS

1. Pursuant to Municipal Code Chapterl-23, Ajti₁cle I ("Article I")(which the Applicant should

consult for defined terms (e.g., "doing bjisine.ss'^^ 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 no^an'^ 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.rcorispiracy 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 tnat 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 4of 13.

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:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
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

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
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:

N/A

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.

■ N/A

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

The Disclosing Party certifies that the Disclosing Party (check one)

[ ] is £c] is not

a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.

If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:

N/A

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.

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 ^K]No

NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.

Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken 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 [xj No

If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:

Name Business Address Nature of Interest

N/A

4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.

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.

_ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the

SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

A. CERTIFICATION REGARDING LOBBYING

N/A

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 of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Page 9 of 13

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

Is the Disclosing Party the Applicant?

[ ] Yes [j_ No

If "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)

[]Yes []No

Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?

[]Yes []No

Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?

[]Yes []No

If you checked "No" to question 1. or 2. above, please provide an explanation: N/A

Page 10 of 13

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.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.

If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to 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.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.

Zhang Huan LIU

(Print or type name of Disclosing Party)

By: ^kM^- j|AfC6lt D (A

(Sign here)

Zhang Huan LIU

(Print or type name of person signing)

(Print or type title of person signing)

Signed^and sworn to before me on (date)

(state).

County,

Notary Public!

Commission expires:

OFFICIAL SEAL TONY T SHU Notary Public - State of Illinois My Commission Expires Oct 5. 2013

w mr w w m m m

w> w

Page 12 of 13

'Ml¹'!

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

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-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.

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 H No

N/A

Page 13 of 13

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

Legal name of the Disclosing Party submitting_;this EDS. Include d/b/a/ if applicable:

Thomas Wilson ' "i ' ., ^: ' ' ' \

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this'ED'S is: A'-

[] the Applicant 7-"V '.

or ' ;ir^ryWs.':■}■' ■ '

[ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the

Applicant in which the Disclosing Party hoidsUn ■interest:

OR -V/' ' '.

3. [] a legal entity with a right of contrql (see Section II.B.l .) State the legal name of the entity in

which the Disclosing Party holds a right of control: ■ ■'. ; _:

X Executor of the Estate of Lavergne Wilson, the owner of the property

_ located at 2922^South Lowe .' ■ i. V

Business address or the Disclosing Party: ■ 16409 Stuart Avenue

I'- - Orland Park, IL 60467

Telephone: 312-345-5700 Fax:.- i_;312--34'5^57^:01 ^;. Email: lrobertson@sbbklaw. com
Name of contact person: Lee Robertson ^: ^: v- ¹ ■■' ■
Federal Employer Identification No. (if you have one): N/A
Brief description of contract, transactioJ;^f/.o^-h?r ui\djbrta1cihgpreferred to below as the "Matter") to which this EDS pertains. (Include project-number and; location of property, if applicable):

Zoning Amendment for 2 92 0 South L6we^: ^: i " ' \

: '.;(.■■ .-.IS.;;;!.; \,\ :■ ' ;,

Which City agency or department is requesting this EDS? ^DHED

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

Specification # ; ;. ■ ' -and Contract'^f#

Ver. 01-01-12 Page 1 of 13

SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY ::r ;i.S).^ . . .

■:' : .-i _; : \ ^: ^:;h''.:i"i;.; '. ..

1. Indicate the nature of the Disclosing Party: .^:

Person . [ J. Limited liability company

Publicly registered business corporation [ ] Limited liability partnership

Privately held business corporation ■-. ' [ J Joint venture .

Sole proprietorship [] Not-for-profit corporation .

General partnership (is the not-for-profit corporation also a 501(c)(3))?

Limited partnership [ J Yes [ ] No

Trust [ J Other (please specify)

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

n/a '' ' ''' .-: "< V

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? .

[ J Yes [ ] No ' ' . '■ ' _;/' _<J 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). _v

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 submrtan EDS on its own behalf.

Name Title N/A

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 .-'

Name N/A

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.

Business Address Percentage Interest in the

Disclosing Party

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 1.2 months before the>date this EDS is signed?

[] Yes [j§ No .vv^i^i;^,- '; ■'■'

If yes, please identify below the name(s) of such City elected official(s) and describe such

relationship(s): mi.-:;-: C i.

N/A

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and .business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, Caswell 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 thah: ( l )'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 qr 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.

'■'"■■f^: 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.

Schain Burney Banks & Kenny 70 West Madison, #4500 Estimated $5,000

Chicago, IL 60602

(Add sheets if necessary)

[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS

COURT-ORDERED CHILD SUPPORT COMPLIANCE

Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?

[ ] Yes |x] No [] No person directly or indirectly owns 10% or more 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 [x] No

FURTHER CERTIFICATIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is 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

The Disclosing Party and, if the Disclpsm^ entity, all of those persons or entities

identified in Section II. B.l. of this EDS: '; _;A?^;;:.\,-"

are not presently debarred, suspended, pi'op.Q$;e4;fpr.debarrnent, declared ineligible or voluntarily excluded from any transactions by any federal^state of local unit of government;
have not, within a five-year period preceding the date of this. EDS, been convicted of a criminal
offense, adjudged guilty, or had a ciyil 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 civil!y.chafged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the ;date of this EDS, had one or more public transactions (federal, state or locaI^te.rminate^'-f6r_vcause'ii6r^:default; and

■'i:i.hf i: Jy; ;■ "-^K?;■''!^: ¹' ii'-. ^V,

have not, within a five-year period precedingftHe date.of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding;^!6rViri' 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:¹;

■i i -i f

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 withfederal 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^ Contractor, is under common

control of another person or entity; ;..'-.-VT ;;" ■ \ '■< , .

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").

ke-Srbf 13

■u ...

Neither the Disclosing Party, nor any Contractor, nonany Affiliated Entity of either the Disclosing Party

or any Contractor nor any Agents have, auii^:ng,th'e'fiv^,e'yea'r;s-beiof^;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: _i ■. .; _; ,. ... _v;,.-.

■ j; .'■ ■: ^i,'a;¹;; A., '.y. ;■ ■

a. bribed or attempted to bribe, or been.,^ of bribery or attempting to

bribe, a public officer or employee bt.'the.'Ci^y^'fhe/'S-tate o,^ Illinois, or any agency of the federal government or of any state or local government-m the United States of America, in that officer's or employee's official capacity; : '/*;^:;\■\= ₅ _::'.'.)

1. agreed or colluded with other bidders or prospective bidders, or been a party to any such
2. 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 . ;

1. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or '
violated the provisions of Municipal'Co.de^Secti'oh 2-927610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor,; or any of their employees, officials,
agents or partners, is barred from contracting witlrany 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) ahy^:|i"rnH or of the United States of

America that contains the same elemerits as'lhe,■offense^ O'CTid^rigging or bid-rotating.

Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control -of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S.;^;Departrnent of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List j the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters
2-55 (Legislative Inspector General), 2-56;(Inspec.tof,.General) and .2-156 (Governmental Ethics) of the

Municipal Code. ; ^: i' . .

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^'

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"). '

N/A ■ ■-' ■-, '

9. To the best of the Disclosing Party'l.^ reasonable inquiry, the following is a

complete list of all gifts that the Disclosing-Party has" giv;eri''o.r 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.

N/A ' '■ _;

C. CERTIFICATION OF STATUS AS.FINANCIAL INSTITUTION

The Disclosing Party certifies that the pj'sclbsin-g Party (check one)

[ ] is p] is not

a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.

■'■ fv.'.ij'Jv'Nv.' .coin: :;' .;' .^::;'i!'^::ir^:_;>

If the Disclosing Party IS a financialv^hstit^ti'o^^"thpn^.the;Disclosing Party pledges:

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):

N/A ■ : ' ^:

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

¹ ■

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.

In accordance with Section 2-156-IT 0 of the Municipal Code: Does any official or employee of the City have a financial interest in-his of'-her own nameor in the name of any other person or entity in the Matter?

[ ] Yes pc] No ■,: ;.,;

NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., 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|financiak his of. 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?

L J Yes [j_ No '■ ,';

If you checked "Yes" to Item D. l.,provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:

Name Business Address >■ : ^:; V ' i7 Nature of Interest

N/A v ■ .

4. The Disclosing Party further certifies.that npiprohibited financial interest in the Matter will be acquired by any City official or employee;. I ■;;;/V^i: :j' ^:' '

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. ' ; ': ^ ¹

^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. forl^arjnagjfc.-to; or injury or death of their slaves), and the Disclosing Party has found no such records. V - AAV. ,

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'6r 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 al^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 hot federal funding.

A. CERTIFICATION REGARDING LOBBYING^vl^';' ■ ''^J-,.

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);' ' '^i:W''V^r : ' ^f .

N/A '-^:: K\- ' '■

(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.) j. _:;

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 oremployee of Congress, or an employee of a member of Congress, in connection witr£^ffiffi&f$$$jiy''f?<J.eraHy'funded contract, making any federally funded grant or loan, entering into any co/6peratiye agreement, or to extend, continue, renew, amend, or modify any federally funded contract,.grant, loan, or cooperative agreement.

. ; Page9of 13 j \\£<-

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) jt is not an organization described in section
501(c)(4) of the Internal Revenue Codeiqf,.}^?.^; or. (ii) it is an organization described in section

501(c)(4) of the Internal Revenue Cbdeipf 1986 but has not engaged and will not engage in "Lobbying

Activities". ■' _; ,

If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above-from all subcontractors before it awards any subcontract and the Disclosing Party must.maintain all such, subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EN^RLOyMENT 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 [J No

If "Yes," answer the three questions below:

Have you developed and do you have on file affirmative action programs pursuant to applicable

federal regulations? (See 41 CFR Part 60-2.) / ','■"■0." i 'r ^;

[ ] Yes [ ] No ■ N/A ''j ■ ; _: "

Have you filed with the Joint Reporting Committee, the Director of the Office of Federal

Contract Compliance Programs, or the Equal^ Opportunity Commission all reports due

under the applicable filing requirements?; ■ ' ,_;, . ' '\; ,\

L J Yes []No n/a:.^';--' t ■ ^; ^: .^V!

Have you participated in any previous .contracts'or subcontracts subject to the equal opportunity clause?

[ | Yes [ ] No ^N/A

If you checked "No" to question 1. or 2. above, please provide an explanation:

N/A ,

Page 10 of 13.

SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE V :

The Disclosing Party understands and agrees that:

The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material.inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing. Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also. be;:Obtainedfrom the City's Board of Ethics, 740 N.

Sedgwick St., Suite 500, Chicago, IL 606i-.6)--^:(3"l'2)^^'-^6^b'."^:'The disclosing Party must comply fully

with the applicable ordinances. ^;_;S(\■■ y. .';.

If the City determines that any information provided in^this EDS is false, incomplete or inaccurate, any contract or other agreement in connection With'-which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages. ,
It is the City's policy to make this document available to the public on its Internet site and/or upon

request. Some or all of the information provided; oh this EDS and any attachments to this EDS may be

made available to the public on the Internet, in response tea 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. At. ^}-' < Ay%A-;\ ■■■ !.-'r':^

' ^Vl:0' ; '■" .■■ff'AA'i^r- ■ . /.". '■

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 Discjosing; Party or:i;ts,Affilia.ted 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,iany facility^listed.by'■ (the:U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintairied^byt'the U^S^Ceneral 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.'aboveiand.wili 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 thisEDS'.^

CERTIFICATION

Under penalty of perjury, the person sighing below: (1) warrants.that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City. ^: i .

Thomas Wilson ■ '.^:;^'^ ' - ^;'\.

:~~■ w.4}h'.i'^J~~'^v-' '■' Uii i'v/.-i ,:y :"i "■■ i

(Print or type name of Disclosing Party) . _:. ,;.: ;

' ' '. .-. vv ,\. \ ' >' 

By: izMJjJjJ^ ■■ . P : '/'■

(SignSJere) _ ' ' 'jf V"-'j'

Thnirias Wilson 1_

(Print or type name of person signing)

(Print or type title of person signing)

Signed and sworn to before me on (date^.^^inrbgY-b^

at YJXyvU County, -UlUfNgyS " " (state). ' :

Notary Public.

Commission expires

SV?';-:

Page, 12. of 13

■ m m * f

OFFICIAL SEAL SUANNE BOWMAN Notary Public - State of Illinois ^;. My Commission Expires Mar 10, 2014

' JA32 jAiamo

i MAMW08 3MUAU2

< jiortiW !o «tc)8 - :ii!du^Q. yitiolf

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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" of 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, niother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or slepsister,6r 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. : ( ' 1^; ,!''j^iV£v: MM'iT'

^:*'-'''.ⁿ'i;"V Vⁱ'V"-'^- ^;1

Does the Disclosing Party or any "Applicable!" Party"-'.'dr-'any-Spouse orbomestic Partner thereof currently

have a "familial relationship" with an elected city official or department head?

[ ] Yes kt\Ko i;;Vf v;;).r_:: ■■/■ii

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.

Legislation Text

Legislation Details

Legislation Details (With Text)