RESOLUTION FOR RENEWAL OF CLASS 6(B) REAL ESTATE TAX INCENTIVE FOR THE BENEFIT OF FREEDMAN SEATING COMPANY, AN ILLINOIS CORPORATION, AND REAL ESTATE LOCATED GENERALLY AT 4545 WEST AUGUSTA BOULEVARD IN CHICAGO, ILLINOIS PURSUANT TO COOK COUNTY, ILLINOIS REAL PROPERTY ASSESSMENT CLASSIFICATION ORDINANCE
WHEREAS, the Cook County Board of Commissioners has enacted the Cook County Real Property Assessment Classification Ordinance, as amended from time to time (the "Ordinance"), which provides for, among other things, real estate tax incentives to property owners who build, rehabilitate, enhance and occupy property which is located within Cook County and which is used primarily for industrial purposes; and
WHEREAS, the City of Chicago (the "City"), consistent with the Ordinance, wishes to induce industry to locate and expand in the City by supporting financial incentives in the form of property tax relief; and
WHEREAS, Freedman Seating Company, an Illinois corporation (the "Applicant"), leases certain real estate located generally at 4545 W. Augusta Boulevard, Chicago, Illinois 60651, as further described on Exhibit A hereto (the "Subject Property") from Freedman Seating Land Holdings, LLC-Series 4545, an Illinois limited liability company and owner of the Subject Property (the "Owner") and has substantially rehabilitated a 165,000 square foot industrial facility thereon; and
WHEREAS, on July 8, 1998 the City Council of the City enacted a resolution supporting and consenting to the Class 6(b) classification of the Subject Property by the Office of the Assessor of Cook County (the "Assessor"); and
WHEREAS, the Assessor previously granted the Class 6(b) tax incentive in connection with the Subject Property in 1998; and
WHEREAS, the Applicant has filed with the Office of the Assessor of Cook County (the "Assessor") an eligibility application for renewal of a Class 6(b) tax incentive under the Ordinance; and
WHEREAS, it is the responsibility of the Assessor to determine that an application for a Class 6(b) classification or renewal of a Class 6(b) classification is eligible pursuant to the Ordinance; and
WHEREAS, the Ordinance requires that, in connection with the filing of a Class 6(b) renewal application with the Assessor, an applicant must obtain from the municipality in which such real estate is located a resolution expressly stating that the municipality has determined that the industrial use of the property is necessary and beneficial to the local economy and that the municipality supports and consents to the renewal of the Class 6(b) classification, now therefore,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1: That the City determines that the industrial use of the Subject Property is necessary and beneficial to the local economy in which the Subject Property is located.
SECTION 2: That the City supports and consents to the renewal of the Class 6(b) classification with respect to the Subject Property.
SECTION 4: That this resolution(shal/ be effective immediately upon its passage and
SECTION 3: That the Clerk of the City of Chicago is authorized to and shall send a certified copy of this resolution to the Office of the Cook County Assessor, Room 312, County Building, Chicago, Illinois 60602 and a certified copy of this resolution may be included with the Class 6(b) renewal application filed with the Assessor by the Applicant, as applicant, in accordance with the Ordinance.
Honorable tfoma/Mitts Alderman, 37th Ward
approval.
I
EXHIBIT A Legal Description of Subject Property
(SEE ATTACHED)
Common Address: 4545 West Augusta Boulevard, Chicago, Illinois 60651 Permanent Real Estate Tax Index Number (PIN) for the Subject Property: 16-03-316-011-0000
EXHIBIT A LEGAL DESCRIPTION
PARCEL Is
THAT PART OF BLOCKS 10, 11 AND 14 JS SNYDER AND LEE'S SUBDIVISION OP THE EAST 1/2 OF THE SOUTHWEST i/4 OF SECTION 3, TOWNSHIP 35 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, TOGETHER WITH THAT PART OF TBS 66 FOOT VACATED STREETS, LYING BETWEEN BLOCKS 10 AND 11 AND BLOCKS 11 AND 14 AND THAT PART OF A 33 FOOT STRIP OF LAND WEST OF AND ADJOINING BLOCKS 10,. 11 AND 14 AFORESAID, ALL LYING NORTH AND WEST OF THE FOLLOWINGsXIESCRIBSD .LINES s
COMMENCING AT A POINT IN THE EAST LINE OF THE RIGHT OF KAY OF THE CHICAGO AND
NORTHWESTERN RAILWAY COMPANY SO FEET NORTH OF THE SOOTS LINE OF SAID BLOCK 14
EXTENDED VEST AS MEASURED ALONG SAXD EAST RIGHT OF WAY LINE; THENCE SOOTH ALONG
THE EAST LINE OF SAID RIGHT OF HAY LINE 155 FEET; THENCE EAST ON THE EXTENDED
NORTH LINE OF BLOCK 15 ZN SAID SNYDER AND LEE'S SUBDIVISION AFORESAID 55 FEET;
THENCE NORTHWESTERLY TO A POINT 33 FEET NORTH OF THE NORTH LINE OF SAID BLOCK 15
AND 33. FEET EAST OF TEE EAST LINE OF SAID RIGHT OF WAY OF SAID RAILROAD COMPANY;
THENCE NORTH 14 DEGREES 59 MINUTES 35 SECONDS VEST ALONG A LINE THAT INTERSECTS
THE POINT OF COMMENCEMENT FOR A DISTANCE OF 108.65 FEET TO THE POINT OF BEGINNING
OF THE LINES BEING DESCRIBED; THENCE SOOTH 89 DEGREES 16 MINUTES 08 SECONDS EAST
77.85 FEET; THENCE SOUTH 0 DEGREES 28 MINUTES 33 SECONDS BAST 42.0 FEET; THENCE
NORTH 89 DEGREES 42 MINUTES 30 SECONDS BAST 211.93 FEET; THENCE NORTH 00 DEGREES
08 MINUTES 53 SECONDS WEST 149.70 FEET; THENCE NORTH 49 DEGREES 42 MINUTES 19
SECONDS WEST 106.53 FEET; THENCE NORTH 43 DEGREES 29 MINUTES 2B SECONDS EAST
135.65 FEET; THENCE NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 123.23 FEET;
THENCE SOUTH 89 DEGREES 50 MINUTES 00 SECONDS WEST B.32 FEET; THENCE NORTH 00
DEGREES 10 MINUTES 00 SECONDS WEST 79.97 FEET; THENCE NORTH 89 DEGRESS 50 MINUTES
00 SECONDS EAST 14.10 FEET; THENCE NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST
191.18 FBET; THENCE SOUTH 89 DEGREES 50 MINUTES 00 SECONDS NEST 13.78 FEET;
THENCE NORTH 00 DEGREES 10 MINUTES, 00 SECONDS WEST 97.60 FEET; THENCE NORTH 83-*
DEGREES 50 MINUTES 00 SECONDS EASTjS.BI FEET; THENCE NORTH 00 DEGREES 10 MINUTES
00 SECONDS WEST 85.56 FEET TO A POINT IN TEE NORTH LINE OF BLOCK 10 AFORESAID .
337.43 FEET WEST OF TEE NORTHEAST CORNER OF SAID BLOCK (EXCEPT THEREFROM THAT
PART DESCRIBED AS FOLLOWS: $ ,
BEGINNING AT THE INTERSECTION OF THE EAST LINE OF THE RIGHT OF WAY OF THE CHICAGO AND NORTHWESTERN RAILWAY COMPANY AND THE SOUTH LINE OF AUGUSTA BOULEVARD; RUNNING THENCE SOUTH ALONG THE EAST LINE OF SAID RIGHT OF WAY 420 FEET; THENCE NORTHERLY TO A POINT IN THE SOUTH LINE OF AUGUSTA BOULEVARD 12 FEET BAST OF SAID PLACE OF BEGINNING i THENCE WEST ALONG THE SOUTH LINE OF SAID AUGUSTA BOULEVARD TO THE PLACE OF BEGINNING; AND EXCEPT THAT PART DESCRIBED AS FOLLOWS t
BEGINNING AX A POINT XN THE BAST LXNB OF T33 RIGHT OF WAY OF THE CHICAGO AND NORTHWESTERN RAILWAY COMPANY 90 FEET NORTH OF THE EXTENDED SOUTH LINE OF SAID BLOCK 14, AS MEASURED ALONG SATO BAST RZGKT OF WAY LINE; RUNNING THENCE SOUTH ALONG THE EAST LINE OF SAXD RIGHT OF NAY LINE 156 FEET; THENCE EAST ON THE EXTENDED NORTH LINE OF BLOCK 15 IN SAID SNYDER AND LEE'S SUBDIVISION AFORESAID, 55 FEET; THENCE NORTHWESTERLY TO A POINT 33 FEET NORTH OF THE NORTH LINE OF SAID BLOCK 15 AND 33 FEET EAST OF THE BAST LINE OF SAXD RIGHT OF WAY OF SAID RAILWAY COMPANY AND THENCE NORTHWESTERLY TO THE PLACE OF BEGINNING), ZN COOK COUNTY,
Page 1 of 5
ILLINOIS.
PARCEL 2:
THAT PART OP BLOCK 10 IN SNYDER AND LEE'S SUBDIVISION OF TEE EAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 3, TOWNSHIP 39 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN,' DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT ON THE NORTH LINE OF BLOCK 10 AFORESAID 337.43 VKKT WEST OF THE NORTHEAST CORNER-THEREOF* THENCE NORTH 89 •DEGREES 50 MINUTES- 00 SECONDS EAST ALONG THE NORTH LINE THEREOF lO^O-FBET; THENCE SOUTH 0 DEGREES 10 MINUTES 00 SECONDS EAST 89.13 FEET; THENCE SOUTH 89 DEGREES 50 MINUTES 00 SECONDS WEST 13.81 FEET; THENCE NORTH 0 DEGREES 10 MINUTES 00 SECONDS WEST 3.57 FEET; THENCE NORTH 89 DEGREES 50 MINUTES 00 SECONDS BAST 3.81 FEET; THENCE NORTH 0 DEGREES 10 MINUTES 00 SECONDS WEST 85.56 FEET TO THE POINT OF BEGINNING, IN COOJC COUNTY, ILLINOIS.
PARCEL 3:
A NON-EXCLUSIVE PERPETUAL EASEMENT IN FAVOR OF PARCELS 1 AND 2 AFORESAID FOR. VEHICULAR AND PEDESTRIAN INGRESS AND EGRESS AS CREATED BY GRANT OF EASEMENT FROM AMERICAN NATIONAL BANK AND TRUST COMPANY OF CHICAGO AS TRUSTEE UNDER TRUST AGREEMENT DATED DECEMBER 5, 1985 AND KNOWN A5 TRUST NUMBER 100929-06 TO BOULEVARD BANK NATIONAL ASSOCIATION AS TRUSTEE UNDER TRUST AGREEMENT DATED JULY 1, 19B7 AND KNOWN AS TRUST NUMBER 8564 RECORDED AUGUST 24, 1987 AS DOCUMENT 87467309 AND FILED AUGUST 24, 1987 AS DOCUMENT LR3645594 OVER THE FOLLOWING DESCRIBED LAND:
THAT PART OF BLOCK 10 IN SNYDER AND LEE'S SUBDIVISION OF THE EAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 3, TOWNSHIP 39 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT ON THE NORTH LINE OF BLOCK 10 AFORESAID 327.43 FEET WEST OF THE
NORTHEAST CORNER THEREOF; THENCE SOOTH 0 DEGREES 10 MINUTES 00 SECONDS EAST 30.0
FEET; THENCE NORTH 89 DEGREES 50 MINUTES 00 SECONDS EAST 23.0 FEET; THENCE NORTH 0
DEGREES 10 MINUTES 00 SECONDS WEST 30.0 FEET TO TEE NORTH LINE OF BLOCK 10 AFORESAID;
THENCE SOUTH 89 DEGREES 50 MINUTES 00 SECONDS WEST ALONG SAID NORTH LINE 23.0 FEET TO
THE POINT OF BEGINNING, IN COOK COUNTY, ILLINOIS. 4 .'
PARCEL 4;
A NON-EXCLUSIVE EASEMENT IN FAVOR OP PARCELS 1 AND 2 AFORESAID FOR PEDESTRIAN AND VEHICULAR INGRESS AND EGRESS AS CREATED BY DECLARATION OF EASEMENTS FROM AMERICAN NATIONAL BANX AND TRUST COMPANY OF CHICAGO AS TRUSTEE UNDER TRUST AGREEMENT SATED DECEMBER 5, 1986 AND KNOWN AS TRUST NUMBER 100929-06 TO BOULEVARD BANK NATIONAL ASSOCIATION AS TRUSTEE UNDER TRUST AGREEMENT DATED JULY 1, 1987 AND KNOWN AS TRUST NUMBER 8564 RECORDED AUGUST 34, 1987 AS DOCUMENT 87467307 AND FILED AUGUST 24, 1987 AS DOCUMENT LR3645592 OVER THE FOLLOWING DESCRIBED LAND I
THAT PART OF BLOCKS 11, 14 AND 15 IN SNYDER AND USE'S SUBDIVISION OP THE BAST 1/2 OP THE SOUTHWEST 1/4 OF SECTION 3, TOHHSHJJ 39 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, AND PART OF THE 66 FOOT VACATED STREETS LYING BETWEEN BLOCKS 11 AND 14 AND BLOCKS 14 AND 15 AND PART OF LOTS 12 AND 13 IN THE SUBDIVISION OF THE EAST 1/2 OF BLOCK 15 OF SNYDER AND LEE'S SUBDIVISION AFORESAID AND FART OF VACATED ALLEY
■ • 7.V Page 2 of 5
8 ^ ^8^968086
8
7
ADJOINING LOTS 12 AMD 13 AMD PART OF VACATED STREET WEST OF AND ADJOINING LOTS 12 AND 13 DESCRIBED AS FOLLOWS:
COMMENCING AT A POINT IN THE EAST LINE OF THE RIGHT OF WAY OF TBS CHICAGO AND NORTHWESTERN RAILWAY COMPANY 90 FEET NORTH OF THE SOUTH LINE OF SAXD BLOCK 14 EXTENDED WEST AS MEASURED ALONG SAID EAST RIGHT OP WAY LINE; THENCH SOUTH ALONG THE EAST LINE OF SAID RIGHT OF WAY LINE 156 FEET; THENCE EAST ON THE EXTENDED NORTH LINE OF BLOCK 15 IN SAID SNYDER AND LEE'S SUBDIVISION AFORESAID 55 FEET; THENCE NORTHWESTERLY TO A POINT 33 FEET NORTH OF THE NORTH LINE OF SAXD BLOCK 15 AND 33 FEET EAST OF THE EAST LINE OF SAID RIGHT. OF HAY--OF SAXD RAILROAD COMPANY; THENCE NORTH .14 DECREES 59 MINUTES 36 SECONDS WEST ALONG A LINE THAT INTERSECTS THE POINT OF COMMENCEMENT FOR A DISTANCE OF 108.65 FEET/ THENCE SOUTH 89 DEGREES 16 MINUTES OS SECONDS EAST 77.85 FEET; THENCE SOUTH 0 DEGREES 28 MINUTES 33 SECONDS EAST 42.0 FEET; THENCE NORTH 89 DEGREES 42 MINUTES 30 SECONDS EAST 211.93 FEET TO THE POINT OF BEGINNING; THENCE NORTH 00 DEGREES OB MINUTES 53 SECONDS WEST 149.70 FEET; THENCE .NORTH 49 DEGREES 42 MINUTES 19 SECONDS WEST 106.53 FEET; THENCE NORTH 43 DEGREES 29 MINUTES 28 SECONDS BAST 135.65 FEET; THENCE NORTH 90 DEGREES EAST 20^0 FEET; THENCE SOUTH 0 DEGREES 26 MINUTES 20 SECONDS EAST 480.04 FEET; THENCE SOUTH 89 DEGREES 24 MINUTES 52 SECONDS EAST 24.0 FEET; THENCE SOUTH 03 DEGREES 05 MINUTES 12 SECONDS WEST 195.19 FEET TO THE SOUTH LINE OF LOT 13 AFORESAID; THENCE SOUTH 69 DEGREES 40 "MINUTES 00 SECONDS WEST ALONG SAID SOUTH LINE AND ITS WESTERLY EXTENSION 30.0 FEET; THENCE NORTH 00 DEGREES 49 MINUTES 29 SECONDS WEST 358.45 FEET; THENCE SOUTH 89 DEGREES 12 MINUTES 30 SECONDS WEST 13.73 FBBT TO THE POINT OF BEGINNING, XN COOK COUNTY, ILLINOIS.
PARCEL 5i
A NON-EXCLUSIVE BASEMENT IN FAVOR OF PARCELS 1 AND 2 AFORESAID FOR PEDESTRIAN AND VEHICULAR INGRESS AND EGRESS AS CREATED BY DECLARATION OF EASEMENTS FROM AMERICAN NATIONAL BANK AND TRUST COMPANY OF CHICAGO AS TRUSTEE UNDER TRUST AGREEMENT DATED DECEMBER 5, 1986 AND KNOWN AS TRUST NUMBER 100929-05 TO BOULEVARD BANK NATIONAL ASSOCIATION AS TRUSTEE UNDER TRUST AGREEMENT DATED JULY 1, 1987 AND KNOWN AS TRUST-* NUMBER 8564 DATED JULY 31, 1987 AND RECORDED AUGUST 24, 1987 AS DOCUMENT B7467307 AND FILED AUGUST 24, 1987 AS DOCUMENT LR36455S3 AND AMENDED BY FIRST AMENDMENT TO DECLARATION OF EASEMENTS DATED AUGUST 25, 1987 AND RECORDED DECEMBER 22, 1987 AS DOCUMENT B7671544 AND FILED DECEMBER 22, 19B7 AS DOCUMENT LR3676098 OVER THE FOLLOWING DESCRIBED LAND: ,
VT PAR? 07 BLOCKS 10 AND 11 IN SNYDER AND LEE'S SUBDIVISION OF THE EAST 1/2 OF THE SOUTHWEST ,1/4 OF SECTION 3, TOWNSHIP 39 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN, 'TOGETHER WITH THAT PART OF THE 66 FOOT VACATED STREET LYING BETWEEN BLOCKS 3,0 AND 11 DESCRIBED A3 FOLLOWS:
COMMENCING AT A POINT IN THE EAST LINE OF TBS RIGHT OF WAY OF THE CHICAGO AND NORTHWESTERN RAILWAY COMPANY SO FEET NORTH OF THE SOUTH LXNB OF SAXD BLOCK 14 EXTENDED WEST AS MEASURED ALONG SAID EAST RIGHT OF WAY LUTE; THENCE SOUTH ALONG THE EAST LINE OF SAID RIGHT OF WAY LINE 156 FBBT; THENCE EAST ON THE EXTENDED NORTH LINE OF BLOCK 15 IN SAID SNYDER AND LEE'S SUBDIVISION AFORESAID 55 FEET; THENCE NORTHWESTERLY TO A POINT 33 FEET NORTH OF THE NORTH LINE OF SAXD BLOCK 15 AND 33 FEET BAST OF THE EAST UNE OF SAXD RIGHT OF WAY OF SAXD RAILROAD COMPANY; THENCE NORTH 14 DEGREES 59 MINUTES 36 SECONDS WEST ALONG A LINE THAT INTERSECTS THE FOUNT OF COMMENCEMENT FOR A DISTANCE OF 108.65 FEET; TiuaiCE SOUTH 89 TWCBgES 16 MINUTES 08
Page 3 of 5
SECONDS EAST 77.85 FEET/ THENCE SOOTH 0 DECREES 28 KZNOTBS 33 SECONDS EAST 42.0 FEET/
Thence north 89 decrees 42 minutes 30 seconds east 311.93 feet; thence north 00
DEGREES 08 MINUTES 53 SECONDS NEST 143.70 FEET/ THENCS NORTH 49 DEGREES 42 MINUTES 19 . SECONDS WEST IOC.S3 FEET; THENCE NORTH 43 DEGREES 29 MINUTES 28 SECONDS EAST 135.-55 FEET TO THE POINT OF BEGINNING/ THENCE NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 123.23 FEET; THENCE SOUTH 89 DEGREES 50 MINUTES 00 SECONDS WEST 8.32 FEET; THENCS NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 79.97 FEET; THENCE NORTH 89 DEGRESS 50 MINUTES 00 SECONDS EAST 14.10 FEET; THENCS NORTH 00 DEGREES 10 MINUTES OO SECONDS WEST 24.31 FEET; THENCE NORTH 89 DEGREES 50 MINUTES 00 SECONDS EAST 53.50 FEET TO TEE WEST FACE OF A 1 STORY• BRICK BUILDING; THENCE SOUTH 'O DEGREES 11 MINUTES 22 SECONDS -EAST ALONG SAID WEST FACETS.01 FEET7 THENCE SOUTH 10 DEGREES 21 MINUTES 40 SECONDS WEST ALONG THE WEST FACE OF SAID 1 STORY BRICK BUILDING 121.0 FEET; 'I'HKW-* SOOTH 00 DEGREES 00 MINUTES 00 SECONDS WEST ALONG SAID WEST FACE OF BRICK BUILDING 13.55 FEET TO A LINE DRAWN NORTH 90 DEGREES EAST THROUGH THE POINT OF BEGINNING; THBNCe'sOUTH 90 DEGREES WEST ALONG SAID LINE 37.17 FEET TO THE POINT OF BEGINNING, IN COOK COUNTY, ILLINOIS (EXCEPTING THEREFROM THAT PART FALLING IN PARCEL 6A} .
PARCEL 6A«
j
A NON-EXCLUSIVE EASEMENT IN FAVOR OF PARCELS 1 AND 2 AFORESAID FOR PEDESTRIAN AND VEHICULAR INGRESS AND EGRESS AS CREATED BY DECLARATION OF BASEMENTS MADE BY AMERICAN NATIONAL BANK AND TRUST COMPANY OF CHICAGO AS TRUSTEE UNDER TRUST AGREEMENT DATED"*"'" DECEMBER 5, 1985 AND KNOWN AS TRUST NUMBER 100929-05 TO BOULEVARD BANK NATIONAL ■ ASSOCIATION AS TRUSTEE UNDER TRUST AGREEMENT DATED JULY 1, 1987 AND KNOWN AS TRUST NUMBER 8554 RECORDED AUGUST 24, 1987 AS DOCUMENT 87467307 AND FILED AUGUST 24, 19B7 AS DOCUMENT LR3545592 AND AMENDED BY FIRST AMENDMENT DATED AUGUST 25, 13B7 AND RECORDED DECEMBER 22, 1987 AS DOCUMENT 87671544 AND FILED DECEMBER 22, 19B7 AS DOCUMENT .CR3676098 OVER THE FOLLOWING DESCRIBED LAND t THAT PART OF BLOCKS 10 AND 11 IN SNYDER AND LEE'S SUBDIVISION OF. THE BAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 3, TOWNSHIP 39 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN, TOGETHER WITH THAT PART OF THE 66 FOOT VACATED STREET LYING BETWEEN BLOCKS 10 AND 11 DESCRIBED AS FOLLOWS;
COMMENCING AT A POINT IN TKS EAST LINE OF THE RIGHT OF WAY OF THE CHICAGO AND
NORTHWESTERN RAILWAY COMPANY 90 FEET NORTH OF TEE SOUTH LINE OF SAID BLOCK 14
EXTENDED WEST AS MEASURED ALONG SAID EAST RIGHT OF WAX LINE; THENCS SOUTH ALONG^TEB
EAST LINE OF SAID RIGHT OF KAY LINE 156 FE5T; THENCE EAST ON THE EXTENDED NORTH?LINE
OF BLOCK 15 IN SATO SNYDER AND LEE'S SUBDIVISION AFORESAID 55 FEET; THENCE '"''
NORTHWESTERLY TO A POINT 33 FEET NORTH OF THE NORTH LINE OF SAID BLOCK 15 AND 33 FBBT EAST OF THE EAST LINE OF SAID RIGHT OF WAY OF SAID RAILROAD COMPANY; THENCS NORTH 14 DEGREES 59 MINUTES 36 SECONDS WEST ALONG A LINE THAT INTERSECTS THE POINT OF COMMENCEMENT FOR A DISTANCE OF 10B.65 FEET; THENCE SOUTH 65 DEGREES 16 MINUTES 08 SECONDS BAST 77.85 FEET; THENCE SOUTH 0 DEGREES 2B MINUTES 33 SECONDS EAST 42.0 FEET; THENCE NORTH 89 DEGREES 42 MINUTES 30 SECONDS BAST 211.93 FBBT; THENCE NORTH 00 DEGREES 08 MINUTES 53 SECONDS WEST 149.70 FEET; THENCS NORTH 49 DEGREES 42 MINUTES 19 SECONDS WEST 106.53 FEET; THENCE NORTH 43 DEGREES 29 MINUTES 28 SECONDS EAST 135.65 FEET; THENCE NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 123.22 FEET; THENCE SOUTH 85 DEGREES 50 MINUTES 00 SECONDS WEST 8.32 FEET; THENCE NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 79.97 FEET/ THENCE NORTH 89 DEGRESS 50 MINUTES 00 SECONDS EAST 14.10 FEET; THENCE NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 39.91 FEET TO THE POINT OF BEGINNING* THENCE CONTINUE NORTH 00 DEGRESS 10 MINUTES 00 SECONDS WEST 151.27 FEET; THENCE SOUTH 89 Tntavm? 50 .MINUTES 00 SECONDS WEST 13.78 FEBT; •]V»>T NORTH -00
room
l I
Page 4 of 5
; DEGREES 10 MINUTES 00 SECONDS NEST 52.84 FEET; THENCE NORTH 89 DEGRESS 50 MINUTES 00 'SECONDS BAST 12.58 FBBT; THENCE NORTH 0 DEGREES 10 MINUTES 00 SECONDS WEST 5.58 FEET; r THENCE NORTH B9 DEGREES 50 MINUTES 00 SECONDS BAST 28.54 FEET TO THE WEST FACE OF A 1 ' STORY BRXCX BUILDING; THENCE SOUTH 00 DEGRESS 10 MINUTES 00 SECONDS EAST ALONG SAID
WEST FACE 51.0 FEET; THENCE SOUTH 9 DEGREES 33 MINUTES 01 SECONDS EAST 49.01 FEET TO ' A CORNER OF A 1 STORY BRICK BUILDING; THENCS SOUTH 00 DEGRESS 10 MINUTES 00 SECONDS . EAST ALONG A WEST FACE OF SAID 1 STORY BRICK BUILDING 110.34 FEET; THENCE SOUTH 89
DEGREES 50 MINUTES 00 SECONDS WEST 35.33 FEET TO THE POINT OF BEGINNING, IK COOK : COUNTY, ILLINOIS.
PARCEL SB: " ■«•—
EXCLUSIVE EASEMENT IN FAVOR OF PARCELS 1 AND 2 AFORESAID FOR THE SOLE PURPOSE OF PARKING NOT MORE THAN 12 AUTOMOBILES, AS CREATED BY PARKING BASEMENT AGREEMENT FROM AMERICAN NATIONAL BANK AND TRUST COMPANY OF CHICAGO AS TRUSTEE UNDER TRUST AGREEMENT DATED DECEMBER 5, 19B6 AND KNOWN AS TRUST NUMBER 100929-05 TO BOULEVARD BANK NATIONAL ASSOCIATION AS TRUSTEE UNDER TRUST AGREEMENT DATED JULY 1, 1967 AND KNOWN AS TRUST NUMBER 8564 DATED AUGUST 25, 1987 AND RECORDED DECEMBER 22, 1987 AS DOCUMENT 87671545 AND FIXED DECEMBER 22, 1987 AS DOCUMENT LR3676099 OVER, ON AND ACROSS THE FOLLOWING DESCRIBED LAND:
THAT PART OF BLOCKS 10 AND 11 IN SNYDER AND LEE'S SUBDIVISION OF THE EAST 1/2 OF TEE SOUTHWEST 1/4 OF SECTION 3, TOWNSHIP 39 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN, TOGETHER WITH THAT PART OF THE 66 FOOT VACATED STREET LYING BETWEEN BLOCKS 10 AND 11 DESCRIBED AS FOLLOWS;
COMMENCING AT A POINT IN THE EAST LINE OF THE RIGHT OF MAY OF TBS CHICAGO AND NORTHWESTERN RAILWAY COMPANY 90 FEET NORTH OF THE SOUTH LINE OF SAID BLOCK 14 EXTENDED WEST AS MEASURED ALONG SAID EAST RIGHT OF WAY LINE; THENCE SOUTH ALONG THE EAST LINE OF SAID RIGHT OF WAY LINE 1S6 FSST; THENCS EAST ON THE EXTENDED NORTH LINE OF BLOCK 15 IN SAID SNYDER AND LEE'S SUBDIVISION AFORESAID 55 FEET; THENCE NORTHWESTERLY TO A POINT 33 FBBT NORTH OF THE NORTH LINE OF SAID BLOCK 15 AND 33 FEET EAST OF THE EAST LINE OF SAID RIGHT OF WAY OF SAID RAILROAD COMPANY; THENCE NORTH 14 DEGRESS 59 MINUTES 36 S2CXUZDS WEST ALONG A LINE THAT INTERSECTS THE POINT OF COMMENCEMENT FOR A DISTANCE OP 108.65 FEET; THENCE SOUTH 89 DECREES IS MINUTES .08 SECONDS EAST 77.85 FEET; THENCS SOUTH 0 DEGREES 38 MINUTES 33 SECONDS EAST 42.0?FEET; THENCE NORTH 89 DEGREES 42 MINUTES 30 SECONDS EAST 211.93 FEET; THENCE NORTH 00^ /. j ' DEGREES 08. MINUTES 53 SECONDS WEST 149.70 FEET; THENCS NORTH 49 DEGREES 42 MINUTES 19 SECONDS WEST 106.53 FBBT; THENCE NORTH 43 DEGREES 29 MINUTES 28 SECONDS EAST 135.65 FEET; THENCE NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 123.23 FEET TO THE POINT OF BEGINNING; THENCE SOUTH 89 DEGREES 50 MINUTES 00 SECONDS 8.32 FEET; THENCS NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 79.97 FEET; THENCE NORTH 89 DEGREES 50 MINUTES 00 SECONDS EAST 14.10 FEET; TSSNCS NORTH 00 DEGREES 10 MINUTES 00 SECONDS WEST 24.31 FEET; THENCE NORTH 89 DEGREES 50 MINUTES 0O SECONDS EAST 53.50 FEET TO THE WEST FACE OF A 1 STORY BUCK BUILDING; THENCE SOUTH O DFHWBBS IX KTNUTE5 22 SECONDS EAST ALONG SAID WEST FACE 95.01 FEET; THENCE SOUTH 10 DECREES 21 MINUTES 40 SECONDS WEST ALONG THE WEST FACE OF SAID 1 STORY BRICK BUILDING 9.43 FEET; THENCE SOUTH 89 DEGREES 50 MINUTES 00 SECONDS WEST 57.60 FEET TO THE POINT OF BEGINNING, {EXCEPT THEREFROM THAT PART LYING EAST OF A LINE 2675 FEET WEST OF AND PARALLEL WITH THE WEST FACE OF SAID 1 STORY BRICK BUILDING}, IN COOK COUNTY, ILLINOIS.
Page 5 of 5
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
- Legal name of the Disclosing Party submitting this EDS. Include d7b/a/ if applicable:
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
- ^ the Applicant
OR
- [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (see Section ll.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
-
- Business address of the Disclosing Party: ^5^5 V\l Analgia "fo,yfct
- TelephonerrB 52.4 Fax: Tia C2527^ SO Email:
- Name of contact person: Ccaic^ *fC€£&\iA0.W
E. Federal Employer Identification No. (if you have one)iip
F'. 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):
"Rer>euO<^ y>f CX&tsi (fiCk) \\\uuMi<Je. v*#pcAUr^ aim*/, pfop^rf-y -:
G. Which City agency or department is requesting this EDS? H**V£iV^ aif\d "ExonafffvCc ~Os^e\o^Y\e»A
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Ver. 01-01-12
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature of the Disclosing Party:
[] Person []
[ ] 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(o)(3))?
[ ] Yes [ ] No
Other (please specify)
2, For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
.MmoiS
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 £f*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
ftutow ft ^-teWkftf
t>^ 9AJ^o£A V-E Sflpf_>
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
<\*A>
£r«($ fncfa**\ W Mutate feOfeSI
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 M No
If yes, please identify below the name(s) of suoh City elected official(s) and describe such relationship(s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disolosing 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 oonneotion 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, tho
Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
i
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
^wu-dt.'Sal*™* |U W^€tuV^^ not an acceptable response.
, flSOflAM
(Add sheets if necessary)
[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.
SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
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 D(f No [ ] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ ] Yes [ ] No
B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Parry 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 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 oharged by, a governmental entity (federal, state or local) with oommitting 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 looal government.
- The certifications in subparts 3, 4 and 5 concern:
- any "Contractor" (meaning any contractor or subcontractor used by the Disolosing 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 Disolosing 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 respeot 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 Disolosing 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:
-
- bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
- agreed or colluded with other bidders or prospective bidders, or been a party to any suoh agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
- made an admission of such conduct described in 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 then- 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:
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 oertified to the above statements,
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
- The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
- If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
- 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 ^[ 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 mis Part D.
Does the Matter involve a City Property Sale?
nYes [JNo
- 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
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee. |
i
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.
)C 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 reoords 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 reoords, inoluding the names of any and ail 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):
(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 Disolosing 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
I
- 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?
Jjfl 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.)
JC 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?
JOYes []No
- Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
$0Yes (]No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTD2S, 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 contraots, work, business, or transactions, The full text of these ordinances and a training program is available on line at www.citvofChicago.org/Ethics. and may also be obtained from the City's Board of Ethios, 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 me Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or mat 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.lF.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.
(Print or typendffle or Disclosing Party)
y(S^nhere) 1
.Ccaf^ *ZceieArtax\
(Print or type name of person signing)
~5*&4«c£
(Print or type title of person signing)
^ OFFICIAL SEAL
Signed and sworn to before me on (dateW ^-^/flOlT
Bt COcU County, IL-. (state).
Notary Public.
Commission expires: U/?<*,/19 .
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a 'Tarnilial 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 (lj all executive officers of the Disclosing Party listed in Section HB.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 ty\ 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 oonneoted; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Title of signatory:
This recertification is being submitted in connection with <?6^gAjt-| p*{ CLfi "hie* [identify the Matter], Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.
Signed and sworn to before me on [date] l/^/^li , by
|2c\rJAJgi ^- rWurt at Ctoaul County, jj___jr_t>! J [state].
Notary Public.
Commission expires: W li-^j tV
HOTAi
ILLINOIS
P«SS:
Ver. 11-01-05
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:
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. the Applicant
OR
2. [] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (see Section ll.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: M5^5 V\J AiA^uStet
CMt&aer* VL UD(aZ[
- Telephone:T73> 624 2dHO Fax: T75 2€2. ~H60 Email: c/Vrigf fi> fo^fouti^aeakdoy-
- Name of contact person: fiTXi'^ fo?gJUvu*V\
- Federal Employer Identification No. (if you have one):;
- 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):
- Which City agency or department is requesting this EDS7rlouStyu^diM Pcohmk\o ^gUii,opw>_r».T
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Ver.01-0M2 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 J)4 Limited liability company
[ ] Publicly registered business corporation [ ] Limited liability partnership
[ ] Privately held business corporation [ ] Joint venture
[ ] Sole proprietorship [ ] Not-for-profit corporation
[] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
[ ] Limited partnership [ ] Yes [ ] No
[ ] Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
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 ^J/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
Svni-fa- Cdhen Mention r
t>oV(d CoW€v\ j Wm\oer
i I
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
i
i
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
SECTION 111 - 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 pjNo
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
J^xf 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, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No ^fNo person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ ] Yes [ ] No
- 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
I
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ll.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:
-
- bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer oremployee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
- agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or j
- 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.
I
- 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:
i
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").
M
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 is not
a "financial institution" as defined in Section 2-32-45 5(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):
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 |jj 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 []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
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 ho 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): j
(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.
i i
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
If "Yes," answer the three questions below:
[]No
1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[]Yes
[]No
2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[]Yes
3. Have you participated in any previous contracts or subcontracts subject to the
equal opportunity clause? i
[JYes []No '
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Patty 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.citvofchicago.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 maybe 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. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A, on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (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 dajc furnished to the City.
(Printer type name of person signing)
(Print or type name of Disclosing Party)
(Print or type title dpperson signing)
Signed and sworn to before me on (date) is
at CCcM- County. IL-UNO)i (state).
~&d-ul (AM. ttcK^f&ir^ Notary Public.
Commission expires: H I <3<?//jr
Page 12 of 13
I
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 JLB.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 1^1 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.
I
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:
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. J the Applicant j
OR ;
2. J>fl 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: ftr*c_WiiJ ^tain/c, **c*tJi &o\d,*tcxtr' Str/cS
or ! 7 ^KT teis
3. [ ] a legal entity with a right of control (see Section ll.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
- Business address of the Disclosing Party: M-SMS VAJ A^^t/sfa "fejv/<i
- Telephone: Tt3 5:_W 2^<4D Fax: T7*> "Hfeo Email:Cr*i£®(ketAwaiiJ&^.caA\
- Name of contact person: Gyxio^ ^gfijliftAA-vv
- Federal Employer Identification No. (if you have one):.
- 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):
"Renew**! oP U K tW.gwtivft ffyAi^ ^rh^Ay
- Which City agency or department is requesting this EDS? HntySm^ fy^^y. T^^apMeYvr
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # !__ and Contract #
Ver. 01-01-12
Page 1 of 13
t
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
] Person . _ p4 Limited liability company
] Publicly registered business corporation [ ] Limited liability partnership
] Privately held business corporation [ ] Joint venture
] Sole proprietorship [ ] Not-for-profit corporation
] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
] Limited partnership [ ] Yes [ ] No
] Trust [] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
\\\iv\o\s
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 ^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.
Title
Name
"ttoift bvnfhri - Cx)f\tv\ , '■ Mewliofr
!
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
Of*^ ffe*Wv\ HStlsW/a^sh^,* lot,*) 33% ,
T><XvA<* £oKc»v UGuc vO Acu^isfa-W^ koiftl 3S%
SECTION in - 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 BDS is signed?
[]Yes j^No
If yes, please identify below the name(s) of such City elected officials) and describe such relationship(s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
i
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
#f 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, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No p<fNo person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement? '■
[ ] Yes [ ] No j
!
- 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 Disclosing Party is a legal entity, all of those persons or entities identified in Section JJ.B.1. of this EDS:
- are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
- have not, 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").
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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:
- bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
- agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
- made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
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- 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 S/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. j
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- 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:
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not-include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
- The Disclosing Party certifies that the Disclosing Parry (check one)
[ ] is is not
a "financial institution" as defined in Section 2-32-45 5(b) of the Municipal Code.
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- 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):
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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 |^ 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 []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
no prohibited financial interest in the Matter will
4. The Disclosing Party further certifies that 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 mis EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
y{ 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):
(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. 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.
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- 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".
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[]Yes ^No If "Yes," answer the three questions below:
- Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
- Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Bqual 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 >
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If you checked "No" to question 1. or 2. above, please provide an explanation:
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SECTION Vn - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
■ 1
- The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
- The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-1S6 and 2-164 of the Munioipal 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.citvofchicago.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:
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F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (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 ofJihe date furnished to the City.
(Print or type^/ame of Disclo^ing-PffrtyJ
(S/gnhere) ~
(Print ot type name of person signing)
l^t'UtiAftU/i^r^ Member
(Print or type title or person signing)
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Signed and sworn to before me on (date) I /13/U
at Ccov County, ILL) A/6) 3 (state).
i
^/TUzAJ? (A4*- Hap/iU^ Notary Public.
Commission expires: H/dq/lS'
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDLX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-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 HB. 1 .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
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.
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