Office of the City Clerk - Record #: O2014-4951

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

Record #:

O2014-4951

Type:

Ordinance

Status:

Passed

Intro date:

6/25/2014

Current Controlling Legislative Body:

Committee on Zoning, Landmarks and Building Standards

Final action:

7/30/2014

Title:

Zoning Reclassification Map No. 15-G at 1127-1137 W Granville Ave - App No. 18080

Sponsors:

Misc. Transmittal

Topic:

ZONING RECLASSIFICATIONS - Map No. 15-G

Attachments:

1. O2014-4951.pdf

Date	Journal Page Number	Action By	Action	Result	Action Details	Meeting Details	Captions
7/30/2014	86420	City Council	Passed	Pass	Action details	Meeting details	Not available
7/28/2014		Committee on Zoning, Landmarks and Building Standards	Recommended to Pass	Pass	Action details	Meeting details	Not available
6/25/2014	82837	City Council	Referred		Action details	Meeting details	Not available

ORDINANCE

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

SECTION 1. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the B1-3 Neighborhood Shopping District symbols and indications as shown on Map No. 15-G in the area bounded by

West Granville Avenue; a perpendicular line to West Granville Avenue 200 feet east of and parallel to North Broadway Avenue; the public alley next south of and parallel to West Granville Avenue; a perpendicular line to West Granville Avenue 100 feet east of and parallel to North Broadway Avenue,

to those of a B3-3 Community Shopping District.

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

1127-37 W. Granville Avenue

Common Address of Property:

^/ Bo go.

CITY OF CHICAGO ^elS^o/^

APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE

1. ADDRESS of the property Applicant is seeking to rezone: I 127-1 137 W. GRANVILLE

Ward Number that property is located in: 48

APPLICANT BAR-1STA, LLC

ADDRESS 3161 N. HALSTED ST, #402 CITY CHICAGO

STATE IL ZIP CODE 60657 PHONE 847-971-3060

EMAIL alanrstoll@me.com CONTACT PERSON ALAN STOLL

Is the applicant the owner ot" the property? YES NO X_

If the applicant is not the owner of the property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed.

OWNER 1127 GRANVILLE, LLC

ADDRESS 1232 W. BRYN MAWR AVE CITY CHICAGO

STATE II- ZIP CODE 60660 PHONE ⁷⁷³-⁸⁷⁸-⁹⁰⁰⁴

EMAIL racecrlcl(aaol.com CONTACT PERSON RAE ANN CECRLE

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

ATTORNEY ANDREW T. HAYS

ADDRESS 55 W. WACKER DR. STE 1400

CITY CHICAGO

PHONE 312-626-2537

STATE IL ZIP CODE 60601

FAX 3 12-488-2616 EMAIL ahays@haysfirm.com

6. If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.

ALAN STOLL

CI IRIS BOWLER

On what date did the owner acquire legal title to the subject property? March 31. 2008
Has the present owner previously rezoned this property? If yes, when?

No.

Present Zoning District B-l-3 Proposed Zoning District B-3-3
Lot size in square feet (or dimensions)

11. Current Use of the property RESTAURANT

Reason for rezoning the property TO ALLOW A RESTAURANT WITH BAR SEATING

AND CONSUMPTION ON PREMISES-INCIDENTAL ACTIVITY LIQUOR LICENSE

Describe the proposed use of the property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space: and height of the proposed buildinc (BE SPECIFIC)

Tlie property located at I 133 W. Granville will house a restarurant that has bar seating and will serve liquor to its guests under a Consumption on Premises-Incidental Acvitivy liquor license.

14. On May 14^th, 2007, the Chicago City Council passed the Affordable Requirements Ordinance (ARO) that requires on-site affordable housing units or a financial contribution if residential housing projects receive a zoning change under certain circumstances. Based on the lot size of the project in question and the proposed zoning classification, is this project subject to the Affordable Requirements Ordinance? (See Fact Sheet for more information)

YES NO X

COUNTY OF COOK STATE OF ILLINOIS

ALAN STOLL

_, being first duly sworn on oath, states that all of the above

statements and the statements contained in the documents submitted herewith are true and correct.

Signature of Applicant

Subscribed and Sworn to before me this

20 N.

.day of.

l -

OFFICIAL SEAL MARTIN DICRISCI JR Notary Public - State of Illinois My Commission Expires Jul 16, 2016

NdWy Public

For Office Use Only

Date of Introduction:

File Number:

Ward:

,) _etOft!t!i t<> S.»S»3 3lil<«i1 Y>;otf »

To: 17738785004 From: 13124882616 Date: 06/10/14 Time: 1:22 PM Page: 02/19

OWNER'S AUTHORIZATION TO FILE ZONING AMENDMENT APPLICATION

NOW COMES, Rac Ann Cccrlc, being first duly sworn, and states under oath and swears or affirms on oath that the following statements are true:

The Property located at 1133-1135 W. Granville, Chicago, IL 60660 ("Property") is owned by I 127 Granville, LLC. A copy of the Warranty Deed attached related to the Property is attached hereto as Exhibit 1.
I am aware that BAR-1STA, LLC is applying to change the zoning of the Property from B-l to B-3.
On behalf of 1127 Granville, LLC, I consent to and authorize BAR-ISTA, LLC's Zoning Amendment Application related to this Property.

FURTHER AFFIANT SAYETH NOT

Rae Ann Cecrle, Manager of 1127 GRANVILLE, LLC,

SUBSCRIBED ANDSWORN TO before Me this \ { day of 02014.

.^^^UUwvl J

Notary Pub ft

P. A. LEVINE OFFICIAL SEAL Notary Public, State of Illinois My Commission Expires March 13, 2018

Prepared by: Erwin & Associates, LLC 4043 North Ravenswood Avenue, Suite 208 Chicago, Illinois 60613

Return to: Michael D. Schleslnger Robbins, Salomon & Patt, Ltd. 25 East Washington Street, Suite 1000 Chicago, Illinois 60602

Future Taxes to Grantee's Address ( ) OR to: 1127 Granville, LLC

1232 West Bryn Mawr Avenue

Chicago, Illinois 60660

WARRANTY DEED (Individual to LLC) The Grantor(s) Tamas I. Bosze, married to Alina Bosze*

Doot: 0809109035 Fee: $38.00

Eugene "Gene" Moore RH8P Fee:$l0.00 Cook County Recorder ot Deeds Date: 03/31/2008 02:07 PM Pg: 1 ot 2

(The above space for Recorder's use only)

, County of Cook

of the City

State of Illinois

Dollars and other good and valuable consideration, in hand paid, convey(s)

of Chicago

for and in consideration of Ten ($10.00)

of the City

of Chicago

and warrants) to 1127 Granville, LLC

State of Illinois

the following described real estate situated in

whose address is 1232 West Bryn Mawr Avenue

County of Cook

the County of Cook

in the State of Illinois to wit:

LOTS 32 AND 33 IN BLOCK 12 IN COCHRAN'S SECOND ADDITION TO EDGEWATER, BEING A SUBDIVISION OF THE EAST FRACTIONAL 1/2 OF SECTION 5, TOWNSHIP 40 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, (EXCEPT THE WEST 1320 FEET OF THE SOUTH 1913 FEET AND EXCEPT RIGHT OF WAY OF CHICAGO, EVANSTON AND LAKE SUPERIOR RAILROAD) IN COOK COUNTY, ILLINOIS \ "(Note: This is non-homestead property as to the Grantor and his spouse.)

hereby releasing and waiving all rights under and by.yirtue of the Homestead Exemption Laws of the State of Illinois.

Permanent Index Numbers):

Property Address: 1127-37 West Granville Avenue, Chicago, Illinois 60660

^rDkted1his

31"

Tamas I. Bosze

City of Chicago Dept. of Revenu 548204

03/31/20081

STATE OF ILLINOIS

COUNTY OF COOK

day of March

)ss

)

,2008

Real Estate Transfer Stamp $11,486.25

B^h00730 99

I, the undersigned, a Notary Public, in and for said County and State aforesaid, certify that Tamas I. Bosze

personally known to me to be the same person(s) whose name(s) subscribed to the foregoing instrument, appeared before me this day in person, and acknowledged that he signed, sealed and delivered the said instruments as his free and voluntary act for the uses and purposes therein set forth, including the release and waiver of the right of homestead.

Given under my hand and Notarial Seal this 31" day of March ,2008

cfcylu^- U situ/Ufa.

Buyer, Seller or Kepresenti

Notary Public, State of My commission expires:

356-2021

lnformatl©FR©»Mp8fiAtorripany. 8t

ANDREA MJARCHNE NOTARY PUBUC STATE OP B1M0IS MY COMMISSION EXPWE$:QW0r11

0809109035 Page: 2 of 2

CITY Ol CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I -GENERAL INFORMATION

A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable: BAR-ISTA. LLC

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[X] the Applicant

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

Applicant in which the Disclosing Party holds an interest:

3. [ ] a legal entity with a right of control (see Section 1I.B.1.) State the legal name of the entity in

which the Disclosing Party holds a right of control:

B. Business address of the Disclosing Party: 3161 N. HALSTED ST. #402

CHICAGO. IL 60657

Telephone: _847-971 _:j060_ Fax: Email: alanrstoll(a!me.com
Name of contact person: ALAN STOLL
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, ifapplicable):

ZONING AMENDMENT APPLICATION RELATED TO 1 133-1 135 GRANVILLE

G. Which City agency or department is requesting this EDS? Dept. of Housing & Economic Development

Bureau Planning & Zoning

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

Specification # and Contract #

V er. 01-01-12

Page 1 of 13

SECTION II -

- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

[X] Limited liability company [ ] Limited liability partnership [] Joint venture [ ] Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))?

1. Indicate the nature of the Disclosing Party:

[ ] Person [)

[ ] Publicly registered business corporation [

[ ] Privately held business corporation [

[ ] Sole proprietorship [

[ ] Yes [ ] No

[ ] Other (please specify)

[ ] General partnership (1

[ ] Limited partnership

[ ] Trust [

For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable:

ILLINOIS

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

[] Yes

[]No

|X] N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

I. 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 ALAN STOLL MEMBER

MEMBER

CI IRIS BOWLER

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

ALAN STOLL 3161 N. HALSTED. #402. CHICAGO 60657 50%

CHRIS BOWLER 3161 N. HALSTED, #402, CHICAGO 60657 50%

SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS

Has the Disclosing Party had a "business relationship," as defined in Chapter 2-1 56 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?

[]Yes [>j No

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

SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.

"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2 ) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.

If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must cither ask the City whether disclosure is required or make the disclosure.

Page 3 of 13

Name (indicate whether Business Relationship to Disclosing Party Pees (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. Andrew Havs (retained) -- Hays Firm LLC, 55 W. Wacker Drive,_l_4th Floor, Chicago, IL_6_060I -- $4,304 (paid)

(Add sheets it necessary)

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

COURT-ORDERED CHILD SUPPORT COMPLIANCE

Under 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 [)J No person directly or indirectly owns 1 0%> 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 l"')(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 II.B.I. of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, slate 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, stale 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 thai, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Parly, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:

1. bribed or attempted to bribe, or been convicted or ad judged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
2. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
3. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of stale 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 Slates 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 certified to the above statements.

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

9. To the best of the Disclosing Parly's knowledge after reasonable inquiry, ihe 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 dale of this EDS, to an employee, or elected or appointed official, of the City of Chicago, for purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than S20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. None.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

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

[ ] is [X] 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 thai 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, il 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 2-156-1 10 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 [tf No

NOTE: If you checked "Yes" to hem 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 Cily, or ( ii) is sold lor taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Properly 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 Cily 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 Cily in connection with the Matter voidable by the City.

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

the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

_2. The Disclosing Party verifies that, as a result of conducting the search in step I 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:

^ECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTEXJT the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, prNceed to Section V JI. For purposes of this Section VI, tax credits allocated by the City and proceeds o'tsdebt obligations of the City are not federal funding.

A. CERTIFICATIONN^EG ARDING LOBBYING

1. List below the names msall persons or entities registered under the federal Lobbying Disclosure Act of 1995 who haveViade lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if iWessary):

(If no explanation appears or begins on the lines above, olsif the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Thirty means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have madcSl^bbying 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 arKemployee of a member of Congress, in connection with the award of any federally funded contract, makingNany federally funded grant or loan, entering into any cooperative agreement, or to extend, conlinue/lsinew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Page 9 of 13

\ 3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in wiSich there occurs any event that materially affects the accuracy of the statements and information set fortlWi paragraphs A.l. and A.2. above.

TlW Disclosing Party certifies that either: (i) il is not an organization described in section 501(c)(4) o\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 DisclosTug Party is the Applicant, the Disclosing Parly 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 iruist make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDlWi EQUAL EM PLOYMENT OPPORTUNITY

If the Matter is federally funded, ledera\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? \

[X] Yes [ ] No \

If "Yes," answer the three questions below: \

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

[]Yes []No \

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

| | Yes | | No \

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

[]Yes []No \

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

Page 10 of 13

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

The Disclosing Party understands and agrees that:

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

Sedgwick St., Suite 500, Chicago, JL 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 il is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.

The Disclosing Party represents and warrants that:

Page 11 of 13

F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 If .the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.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 (ifapplicable) are true, accurate and complete as of the date furnished to the City.

BAR-ISTA, LLC

(Print or typtfTiame of Disclosing/ Party)

(Sign here)

ALAN STOLL

(Print or type name of person signing)

MEMBER

(Print or type title of person signing)

Signed and sworn to before me on (date) JL^ 3 ^-o i*~t at cToflUi County, (state).

OFFICIAL SEAL MARTIN OICRISCI JR Notary Public - State of Illinois My Commission Expires Jul 16, 2016

Page 12 of 13

;V.J" .jAiOi'-llO U)i, .:■>!■:.■'J .-lO'flS:Ti.»"r>L] V^f'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 Parly 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 dale this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?

[ ] Yes [X] No

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

Page 13 ol" 13

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable: I 127 GRANVILLE. LLC

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

[ ] the Applicant

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

Applicant in which the Disclosing Party holds an interest:

3. §(\ a legal entity with a right of control (sec Section II.B. I.) State the legal name of the entity in

which the Disclosing Party holds a right of control: I 127 GRANVILLE. LLC

B. Business address of the Disclosing Party: 1232 W. BRYN MAWR AVE.

CHICAGO. IL 60660

Telephone: ______ fax: Email: racecrlel@aol.com
Name of contact person: RAE ANN CECRLE

Ii. Federal Employer Identification No. (if you have one):

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, ifapplicable):

ZONING AMENDMENT APPLICATION RELATED TO 1 133-1 135 GRANVILLE

G. Which City agency or department is requesting this EDS? Dept. of I lousing & Economic Development

Bureau Planning & Zoning

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

Specification # and Contract #

V ci . 01-01-12

Page 1 of 13

SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

[X] Limited liability company [ ] Limited liability partnership [] Joint venture [ ] Not-for-profit corporation

(Is the not-for-profit corporation also a 501(c)(3))?

1. Indicate the nature of the Disclosing Parly:

f ] Person [>

[ ] Publicly registered business corporation [

[ ] Privately held business corporation [

[ ] Sole proprietorship [

[ .1 Yes [ ] No

[ ] Other (please specify)

[ ] General partnership (I

[ ] Limited partnership

[ ] Trust [

iinization, ifapplicable:

For legal entities, the state (or foreign country) of incorporation or orga

ILLINOIS

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

[ ] Yes

[]No

M 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 titlcholder(s).

Name Title

RAE ANN CECRLE MANAGER

Page 2 of 13

Name Business Address Percentage Interest in the

Disclosing Party

RAE ANN CECRLE 1232 W. BRYN MAWR AVE. CHICAGO. IL 60660 J00%

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 [X] No

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

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

"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 i

Name (indicate whether Business retained or anticipated Address to be retained)

None.

Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)

Fees (indicate whether paid or estimated.) NOTE: "hourly rate" or "t.b.d." is not an acceptable response.

(Add sheets if necessary)

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

COURT-ORDERFD CHILD SUPPORT COMPLIANCE

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

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

[ ] Yes [X] No [ ] No person directly or indirectly owns 10% or more of the

Disclosing Party.

If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?

[ ] Yes [ J No

FURTHER CERTIFICATIONS

I. 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 II.B. 1. of this CDS:

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

Page 5 of 13

1. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
2. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
3. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

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

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.

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. None.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

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

[ ] is [X] is not

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

If the Disclosing Party IS a financial institution, then the Disclosing Parly 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."

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 2-156-1 10 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

[ ] Yes [X] No

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

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

Does the Matter involve a City Property Sale?

[ ] Yes [ ] 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 of employee.

E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to

Page 8 of 13

comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

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

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

Disclosing Parly 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.

CERTIFICATION REGARDING LOBBYING

1. Li^Kbelow the names of all persons or entities registered under the federal Lobbying Disclosure AcKif 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matte*: (Add sheets if necessary):

(If no explanation appears or begins on tluN<nes above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that tnNDisclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995^11 ave made lobbying contacts on behalf of the Disclosing Parly with respect to the Matter.)

2. The Disclosing Party has not spent and will not expend anyNJederally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbyhm activities or to pay any person or entity to influence or attempt to influence an officer or employee^*! any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congr&sjj, or an employee of a member of Congress, in connection with the award of any federally funded contracLN^aking any federally funded grant or loan, entering into any cooperative agreement, or to extend, corrHmrc, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Pa»e9of 13

\ The Disclosing Party will submit an updated certification at the end of each calendar quarter in whicrvthere occurs any event that materially affects the accuracy of the statements and information set forth inSparagraphs A.l. and A.2. above.

The TDisclosing Parly certifies that either: (i) it is not an organization described in section 501(c)(4) of t\e Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of theVJnternal 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 iiTust 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: \

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

[ ] Yes []No \

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

L 1 Yes [ ] No \

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

[ ] Yes [ ] No \

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

Page 10 of 13

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

The Disclosing Party understands and agrees that:

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 arc material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics. and may also be obtained from the City's Board of Ethics, 740 N.

Sedgwick St., Suite 500. Chicago, IL 60610, (312) 744-9660. The Disclosing Parly must comply fully with the applicable ordinances.

If the Cily 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 Parly'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 I I of 13

to: 17738785004 From: 13124882616 Date: 06/10/14 Time: 1:22 PM Page: 18/19

F.l. The Disclosing Party is not delinquent in the payment of any Lax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any tine, 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 Parly 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. K.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 If the Disclosing Parly 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 P.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 (ifapplicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in Ibis EDS and Appendix A (ifapplicable) are true, accurate and complete as of the date furnished to the City.

1127 GRANVILLE, LLC

(Print or typ_£_imoe of Disclosing Party)

(Sign here)

RAE ANN.CE_C.RLE_

(Print or type name of person signing)

MANAGER

(Print or type title of person signing)

Signadand sworn to before me on (date)

_ Notary Public.

at ___^_r^__.^L,_-. County, (state).

Commission expin

PA. LEVINE OFFlC'AL SEAL " Notary _Publ,c. State of lllincs ] My Commission Exaires L , ,., March 13, 20l8P*'ge 12 of 13

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any cily 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 (I) all executive officers of the Disclosing Party listed in Section M.B.I.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 \xl No

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

Page 13 of 13

ORDINANCE

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

SECTION I. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing the zoning designation from Class Bl-3 District on Map No. 15-G for the property described as follows:

Street Address 1127-1137 Granville

Legal Description

Lots 32 and 33 in Block 12 in Cochran's Second Addition to Edgewater, being a subdivision of the east fractional 1/2 of Section 5, Township 40 North, Range 14, east of the Third Principal Meridian, (except the west 1320 feet of the south 1913 feet and except right of way of Chicago, Evanston and Lake Superior Railroad) in Cook County, Illinois,

to a zoning designation of a Class B3-3 District.

SECTION 2. This ordinance takes effect after its passage and approval.

Common Address of Property: 1127-1137 W. Granville Ave

AFFIDAVIT OF MAILING PURSUANT TO SECTION 17-13-0107

June 18.2014

Honorable Daniel S. Solis Chairman. Committee on Zoning 121 North LaSalle Street Room 304. City Hall Chicago, Illinois 60602

The undersigned, Andrew T. Hays, being firs! duly sworn on oath deposes and states the following:

The undersigned certifies that he has complied with the requirements of Section I 7-13-0107 of the Chicago Zoning Ordinance, by sending written notice to such property owners who appear to be the owners of the property within the sub ject area not solely owned by the applicant, and to the owners of all property within 250 feet in each direction of the lot line of the subject property, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. Said "written notice" was sent by First Class U.S. Mail, no more than 30 days before filing the application.

The undersigned certifies that the notice contained the address of the property sought to be rezoned; a statement of the intended use of the property; the name and address of the applicant; the name and address of the owner: and a statement that the applicant intends to file the application for a change in zoning on approximately June 18, 2014.

The undersigned certifies that the applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-0107 of the Chicago Zoning Ordinance, and that the accompanying list of names and addresses of surrounding property owners within 250 feet of the subject site is a complete list containing the names and addresses of (he people required to be served. / |

FURTHER, AFFIANT SAYETII NOT.

Subscribed and sworn to before me

<n. iriti itk ir> ii JAIME L. NOLAN OFFICIAL SEAL

Hays Firm LLC 55 W. Wacker Dr, 14 Floor Chicago, IL 60601

June 18.2014

Dear Property Owner:

In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance, specifically Section 1 7-13-0107, please be informed that on or about June 18. 2014, the undersigned will file an application for a change in zoning from 13-1-3 to B-3-3 on behalf of BAR-1STA, LLC for the property located at 1 127-1137 W. GRANVILLE.

The applicant, BAR-ISTA, LLC, intends to use the subject property to operate a full service restaurant at 1 133 W. Granville with bar seating and serve liquor for consumption on the premises of the restaurant. This location currently houses the m.henrietta restaurant which has no license to serve liquor.

BAR-ISTA, LLC is located at 3161 N. Halsted St, #402, Chicago, IL 60657. The contact person for this application is Alan Stoll, 3161 N. Halsted St, #402, Chicago, IL 60657, Telephone: 847-971-3060. The owner of the property is 1127 Granville, LLC, which is located at 1232 W. Bryn Mawr Ave, Chicago, IL 60660 and Rae Ann Cecrle is the Manager of 1127 Granville, LLC.

Please note that the applicant is not seeking to rezone or purchase your property. The applicant is required by law to send this notice because you own property within 250 feet of the property to be rezoned.

Sincerely,

Andrew T. 1 lays ATI 1/jn

PHONE (773) 736-1344 FAX (773) 736-4818

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PLAT of SURVEY

McTIGUE & ASSOCIATES, LTD. PROFESSIONAL LAND SURVEYING SERVICES

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