Office of the City Clerk - Record #: O2014-5843

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

Record #:

O2014-5843

Type:

Ordinance

Status:

Passed

Intro date:

7/30/2014

Current Controlling Legislative Body:

Committee on Transportation and Public Way

Final action:

11/5/2014

Title:

Vacation and dedication of public alley(s) in area bounded by S Indiana Ave, E 38th St, S Prairie Ave and E Pershing Rd

Sponsors:

Dowell, Pat

Topic:

ALLEY - Dedications, - ALLEY - Vacation

Attachments:

1. O2014-5843.pdf

Date	Journal Page Number	Action By	Action	Result	Action Details	Meeting Details	Captions
11/5/2014	96161	City Council	Passed	Pass	Action details	Meeting details	Not available
10/29/2014		Committee on Transportation and Public Way	Recommended to Pass	Pass	Action details	Meeting details	Not available
7/30/2014	86696	City Council	Referred		Action details	Meeting details	Not available

NOT FOR PROFIT ORDINANCE

WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VII, Section 6(a) of the 1970 Constitution of the State of Illinois, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and

WHEREAS, the City wishes to support the charitable, educational and philanthropic activities of established Not for Profit Corporations and encourage the continued viability and growth of such activities; and i

WHEREAS, many Not For Profit Corporations own property that adjoins streets and alleys that are no longer required for public use and might more productively be used in furtherance of such activities; and

WHEREAS, the City would benefit from the vacation of these streets and alleys by reducing City expenditures on maintenance, repair and replacement; by reducing fly-dumping, vandalism and other criminal activity; and by providing support for such charitable, educational and philanthropic activities; and

WHEREAS, the City can promote strong communities by facilitating services to the public, and increase the City's job base through the vacation of public street(s) and/or alley(s) for no compensation; and

WHEREAS, the properties at 3801-3857 S. Indiana Avenue, 3806-3858 S. Prairie Avenue and 200-224 E. Pershing Road, are owned by Apostolic Faith Church, an Illinois Not For Profit Corporation; and

WHEREAS, Apostolic Faith Church, an Illinois Not For Profit Corporation, proposes to assemble and use the portion of the public alleys to be vacated herein for parking in association with the construction of their new facility; and

WHEREAS, the City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent of the public use and the public interest to be subserved is such as to warrant the vacation and dedication of parts of public alleys described in the following ordinance; now therefore,

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

Page 1

SECTION 1.

Dedication;

THAT PARCEL OF LAND IN HOLMES' SUBDIVISION LOCATED IN THE WEST HALF OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4 OF SECTION 34, TOWNSHIP 39 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS. ANTE-FIRE MORE PARTICULARLY DESCRIBED AS FOLLOWS: LOT 47 (EXCEPT THE SOUTH 6 FEET THEREOF) IN HOLMES' SUBDIVISION OF THE WEST 1/2 OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4 OF SECTION 34, TOWNSHIP 39 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE ANTE-FIRE PLAT THEREOF RECORDED MAY 28TH, 1873, BOOK 9, PAGE 185, DOCUMENT NUMBER 105491, IN COOK COUNTY, ILLINOIS

Vacation:

THAT PARCEL OF LAND IN PICKET'S RESUBDIVISION OF LOTS 1 TO 19, INCLUSIVE OF HOLMES' SUBDIVISION LOCATED IN THE WEST HALF OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4 OF SECTION 34, TOWNSHIP 39 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE ANTE-FIRE PLAT THEREOF RECORDED MAY 28TH, 1873, BOOK 9, PAGE 185, DOCUMENT NUMBER 105491, IN COOK COUNTY, ILLINOIS, MORE PARTICULARLY DESCRIBED AS FOLLOWS: THE ENTIRE NORTH-SOUTH 16 FOOT WIDE ALLEY (EXCEPT THE NORTH 69 FEET THEREOF, ALSO BEING THAT PORTION FROM THE WESTERLY EXTENSION OF THE NORTH LINE OF THE SOUTH 6 FEET OF LOT 47 IN SAID HOLMES' SUBDIVISION NORTH) IN THE BLOCK BOUNDED BY AND PARALLEL TO SOUTH INDIANA AVENUE TO THE WEST, AND SOUTH PRAIRIE AVENUE TO THE EAST; EAST PERSHING ROAD TO THE SOUTH AND EAST 38TH STREET TO THE NORTH; ALSO THE ENTIRE EAST-WEST 16 FOOT WIDE ALLEY JUST NORTH OF AND PARALLEL TO EAST PERSHING ROAD IN THE BLOCK BOUNDED BY EAST 38TH STREET TO THE NORTH, EAST PERSHING ROAD TO THE SOUTH, SOUTH PRAIRIE AVENUE TO THE EAST AND SOUTH INDIANA AVENUE TO THE WEST

both as shaded and legally described by the words HEREBY DEDICATED FOR PUBLIC ALLEY" and "HEREBY VACATED" on the plats hereto attached as Exhibit A and Exhibit B respectively, which plats for greater clarity, are hereby made a part of this ordinance, be and the same vacations are hereby closed, inasmuch as the same are no longer required for public use and the public interest will be subserved by such vacations.

SECTION 2. The Commissioner of Transportation is hereby authorized to accept and approve a redevelopment agreement or similar instrument restricting the use and improvement of the public way vacated in Section 1 of this ordinance to social service purposes which include, but shall not be limited to the preparation of meals and food boxes for community distribution, homework assistance to neighborhood schoolchildren, collection of clothes, toys and outerwear for community members, outreach to seniors, provision of summer camp services, and for such use and improvements that are accessory, as that term is defined in the Chicago Zoning Ordinance, to such social service purposes, such uses and improvements to be owned and operated by a non-profit corporation, subject to the approval of the Corporation Counsel as to form and legality. The restriction on use and improvement in the covenant, agreement or instrument shall be for a term of 40 years and upon breach of such restriction the public way herein vacated shall revert to the City and be subject to the terms and conditions of the dedication by which it has been heretofore held by the City.

Page 2

SECTION 3. Apostolic Faith Church, an Illinois Not For Profit Corporation acknowledges that all currently public sewers and appurtenances within the areas to be vacated shall become the private property and maintenance responsibility of the Apostolic Faith Church, an Illinois Not For Profit Corporation. If and when the existing sewer and appurtenances within the areas being vacated are abandoned, the abandonment plans must meet the Department of Water Management Sewer Design Section's requirements.

SECTION 4. The dedication for a public alley is accepted upon the express condition that it be constructed according to the most current version of the Chicago Department of Transportation Regulations for Opening, Repair and Construction in the Public Way and its appendices, and as agreed to by the applicant in the attached Duty to Build Agreement (Exhibit C), hereby made a part of this ordinance.

SECTION 5. The vacation and dedication herein provided for are made upon the express condition that within 180 days after the passage of this ordinance, the Apostolic Faith Church, an Illinois Not For Profit Corporation shall deposit in the City Treasury of the City of Chicago, a sum sufficient to defray the costs of removing paving and curb returns, and constructing sidewalk and curb at the entrance to that part of the alleys hereby vacated; and constructing the new alley to be dedicated, in accordance with current Department of Transportation Construction Guidelines for construction of public way.

SECTION 6. The vacation and dedication herein provided for are made upon the express condition that within 180 days after the passage of this ordinance, Apostolic Faith Church, an Illinois Not For Profit Corporation, shall file or cause to be filed for record in the Office of the Recorder of Deeds of Cook County, Illinois, a certified copy of this ordinance, a redevelopment agreement complying with Section 2 of this ordinance and approved by the Corporation Counsel, and original plats as approved by the Superintendent of Maps and Plats.

SECTION 7. This ordinance shall take effect and be in force from and after its passage. The vacation and dedication shall take effect and be in force from and after its recording.

Vacation/Dedication Approved:

feiAJlik

Rebekah Scheinfeld Commissioner of Transportation

Approved" as to Form ancL^egalit

A-^"

Richard Wendy Deputy /Corporation Counsel

till- AueQO

Honorable Pat Dowell Alderman, 3^rd Ward

Page 3

EXHIBIT "B"

LEGAL DESCRIPTION OF VACATION: l^r

THAT PARCEL OF LAND IN PICKECTS RESUBDMSION OF LOTS 1 TO 19 INCLUSIVE OF HOLUES^- SUBDIVISION LOCATED IN THE WEST HALF OF THE SOUTHWEST 1/* OF THE SOUTHEAST 1/* OF THE SOUTHWEST 1/4 OF SECTION 34. TOWNSHIP 39 NORTH. RANGE 14. EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE ANTEFIRE PLAT THEREOF RECORDED MAY 28th. 1873. BOOK 9. PAGE 185. DOCUMENT NUMBER 105491. IN COOK COUNTY. ILLINOIS. MORE PARTICULARLY DESCRIBED AS FOLLOWS: THE ENTIRE NORTH-SOUTH 16 FOOT WIDE ALLEY (EXCEPT THE NORTH 69 FEET THEREOF. ALSO BEING THAT PORTION FROM THE WESTERLY EXTENSION OF THE NORTH LINE OF THE SOUTH 6 FEET OF LOT 47 IN SAID HOLMES' SUBDIVISION NORTH) IN THE BLOCK BOUNDED BY AND PARALLEL TO SOUTH INDIANA AVENUE TO THE WEST. AND SOUTH PRAIRIE AVENUE TO THE EAST: EAST PERSHING ROAD TO THE SOUTH AND EAST 38TH STREET TO THE NORTH: ALSO THE ENTIRE EAST-WEST 16 FOOT WIDE ALLEY JUST NORTH OF AND PARALLEL TO EAST PERSHING ROAD IN THE BLOCK BOUNDED BY EAST 36TH STREET TO THE NORTH, EAST PERSHING ROAD TO THE SOUTH. SOUTH PRAIRIE AVENUE TO THE EAST AND SOUTH INDIANA AVENUE TO THE WEST.

TOTAL AREA-10.764.50 ACRES-0.2471

.r mom a cmt kc cr m

t-t* ■m-ooi-tfli m

STREET _fe

1 tT-M-JJM-M-UT 4

RM=5

HERETOFORE DEDICATED

REC

EAST 38th

=264.00

mm on w n i-n-m-m cot m I 3* jtw n* UH «9

I J. «■ U LOT *4 > II III IMUH «J

If 11 Ml MHW 41

IT-jM-iM-4*»-UrT *

w ii~~Bmi~~ti r

17-31 «B< MI-WI a

h-34-jm-oijm»i a

» » » OX LW JL IT H IH CM LOT M

, NORTH LDC LT LOT

V VCIT LINE OT LOT 47 \ . t8

39-4V20" 89*.

SOUTH LINE OT NORTH

■ iwtrnrr

OF LOT 47

je_

HEREBY VACATED

t: t

90°18"40"

1264.00'

_. 1/2 ot the solmwcsr iu of ink southeast 1/4 oV- t

TOWNSH1H 39 NORTH. RM4GE M4 ANTE hRE. I

"HOLMES' SUlVlMSON if THE W^ST SOUTHWST 1/4 OF SECTION 34.1 TO

25 ¹ 26 ¹ 27 I 28 I 29

[ V A Q A N T| LArND

ssmI3nff

REC. & MEAS.=264.00'

■ RM=5

ROAD

^EAST ^ PERSHING

HERETOFORE DEDICATED

■ keen

3_vest ulc

I TO BE |

>Za DEDICATED FOR i

I PUBLIC ALLEY I

L, J

DF S0UT> |AVCNUC

THE 5URVTTOR HAS HOT RESEARCHED TIC APPUCABLE ZOMMC BUtLDHC

cooes, setbacks on sPtcnc uses allowed mthh tho zommc

CUSStnCATOi CONTACT THE CITY OF CHCACO.

II ^v>

D3WTWENT OF ZOMMC CITY HALL 121 NORTH LASALLE STREET BOOM 90S. CMCAOO LUHOe (312) 744-W17, FAX J12-7446»2 FOR COTTBTCATON. VERRXATDN AMD SPGCF1C MATTERS PERTAINS TO THE A90VC NOTED ZOMMC CUOSF1CATKM.

TO BE DEDICATED FOR PUBUC A

HEREBY VACATED

STREET CENTER L PROPERTY BOUND LOT UNE5

coi

NOTE NO yONUWCNTS FOUND

COMPARE ALL POS-JTI BEFORE BUUMC NO KFWMEUEMT5 SHOULD K. MADE CN THE BASS OT THS PLAT ALONE.

CRITICAL FELD MOHUMENTATKM SHOULD BE ESTABU5HCD PRDR TO THE CC«BCHCEMENT OF ANY AMD ALL CCNSTRUCTCK PLEASE REFER TO DEED, TITLE POUCY AMD A* LOCAL ORDMNCES FDR BUUWS UtC NESTWCTCTB[M*>/0* EASEHEKTS NOT SHOWN HLTON.

1 t

ALL DHEKSDMS AW MEASUHEUEMTS ARE SHOWN M FEET AMD DECMAL PARTS THEKCOr. AND ARE CORRECTED TO A TCHPCRATURC OT 62 DECREES FAHRENHEIT.

69*41^,2<r

90^o18'40'^,

4<e-

¹ \

THS PROFESSIONAL SEKWX CONFORMS TO THE CURRENT UMC4S MM* 6TAM0ARDS OF PRACTKX APPUCABLE TO SOUNDARY SURVEYS. UHOCS PROFESSIONAL LAND SURWYOR HO. 039-0OO90S3.

L.R. Pass, P.L.S.

TJL ttax 439M

T«L: (T79) m-lYOt ftlMH. BBboIb KMM3 ru (771) TT»-«t»

mar noi vo. uu-004144

COOK COUNTY

APOSTOUC FAITH CHURCH

■SHOD? HOUCI F. sunt tea s. Donuu atbtoi

TaL: (773) »T»-»W» CUeaf* BBtMb «MB3 r*u (TT3) ■

CDOT #34-03-12-3589

■ XH I lb I"

Apostolic Faith Church

Bishop Horace E. Smith, M.D. Pastor

SUBDIVISION/DEDICATION APPLICATION

DUTY TO BUILD AGREEMENT (Must be completed by the applicant, not their attorney) For the a. construction of the new alley; b. inclusion of a guardrail at the northern edge of the new alley (to protect the nonapplicant property), and c. the improvement of the remaining public alley.

In support of my current application with the Chicago Department of Transportation's Maps and Plats unit, for a subdivision/dedication of my private property, I hereby state that I am the applicant or the company agent for the applicant company involved in the project, and that I have the authority to agree to the below terms of the Subdivision. Please initial:

Horace E. Smith

Signed: Printed name:

I am aware that I am responsible for the construction of all public, and private rights of way (streets, alleys, etc) described on the Plat of Subdivision/Dedication.

I further understand that all rights of way (both public and private) must be built to City specifications, as detailed in CDOT's Regulation for Openings, Construction and Repair in the Public Way.

Lastly, I understand that construction deposits will be required to assure that the work is done correctly. An inspection will be conducted by the City upon completion of the work. The City of Chicago reserves the right to require demolition and reinstallation^ofpny facilities that are judged to be sub par or that do not adhere to the City's stent

Date:

Title: Pastor, CEO on behalf of

Apostolic Faith Church

Organization: Apostolic Faith Church, an Illinois not-for-profit corporation

Address: 3823 South Indiana Avenue. Chicago, Illinois Zip: 60653

Phone/fax: (773) 373-8500/(773) 373-6902

Email: susan.smith@afcchicago.org / laurie.iordan(a),afcchicago.org

otary Public.

Commission

Signed and sworn to me before me on (date) Or^County, jifW^State).

OFFICIAL SEAL LAURIE S JORDAN NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES:09/11/13

3823 South Indiana Avenue Chicago, Illinois 60653-1712 Office: (773) 373-8500 Fax: (773) 373-6902

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

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

Apostolic Faith Church

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

1. the Applicant

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:

3. [ ] a legal entity with a right of control (see Section ILB. 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: 3823 South Indiana Avenue

Chicago, Illinois 60653

Telephone: 773-373-8500 Fax: 773-373-6902 Email: STJsan.sndthgafcchicago.org /

laurie.jordan@afcchicago.org

Name of contact person: Susan D. Smith

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

F. Brief description of contract, tiansaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):

Please sea "Attachment A"

G. Which City agency or department is requesting this EDS? Department of Transportation

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

Sp ecific ation # and C ontract # ■

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 [ ]

[ J Privately held business corporation [ ]

[ ] Sole proprietorship [X]

[ ] General partnership (Is

[] Limited partnership

[] Trust []

Limited liability company Limited liability partnership Joint venture

Not-for-profit corporation

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

D3 Yes [ ] No

Other (please specify)

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

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

[ ] Yes [ ] No [ ] N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

1. List below the Ml 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 Please see "Attachment B"

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

None

SECTION HI - 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

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 R^latiotiship to Wsclosing Perty Fees (indicate whether

retained or aaricipated Address (subcontractor, attorney, paid or estimated.) NOTE:

to be retained) lobbyist, etc.) "hourly 1318" or ^b.d." is

not an acceptable response.

dHriry &.&gcc. 20 B. OadcSb, #1150, Oaricsp, IL 6Q6Q2 atear^f Bfc. $4P,DCQ

Shfczfcy & HluasofciaL 33 N, Tfeadan, Ste. 800_r CMcacp, 3ti 60GQ2 StaiBf id. $40,000 BCD TivrtjTiafeT? 3921 N. IfetinaaSfc, #100 Jrnh'anFirilre M 4S303 ftrrMect B=fc.$1,400,000 Eport & Mron, Be. 83B. aeeL 9j._f OnrrfTo, H» 60615 OJBtaziimteiq^ E=±.$350,000

(Add sheets if necessary)

[ J Check here if the Disclosing Party nag not retained, nor expects to retain, any such, persons or entities.

SECTION V - CEBLTIB1CATIONS

A- COTJRT-OSDERJED 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 men* child support obligations throughout th© contract's term.

Has any p erson. who directly of indirectly awns 10% of more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of cojnpetEHit jurisdiction?

11 Yes [1 No [ ] No person directly or infeectfy 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 die person in compliance with that agreement?

□ Yes [JNo

B. F0RTEE3. CERTIFICATIONS

L Pursuant to Municipal Code Chapter 1-23, Article I ("Article Tawniest the Applicant should consult for defined terms (e.g., "doing business*) and legal rcqmrenientK), i£ute Disclosing Party BU&mittibag this ED S is tho Applicant and is doing business 'with the City, then the Disclosing Party certifies as follows: (T) neither H.e Applicant nor any controlling person is crarxesnny indicted or charged with, or hafi admitted gout of, or has ever been convicted of, orpkeed 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 employe© of the City or any sister agency; and (u) the Applicant understands¹ and acfcoowlodgeB that compliance with Article I is a confirming requirenient for doing business with the City. NOTE: If Article I applies to die Applicant, the permanent compliance ' timeframe In Article I supersedes gome five-year compliance tirne&ames in certifications 2 and. 3 below.

Page 4 of 13

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

Kenig, Lindgren, O'l lara, Aboona, Inc. 9575 West Higgins Road Suite 400, Rosemont, IL 60018 Traffic Consultant Est. $6,500

2. The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section TJB.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;
arc 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 ot 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 Affdiated 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 or employee of the City, the State of Illinois, or any agency of the federal government or of any state ot 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
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.
Ifthe 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 mquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").

None

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a

complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the

12-month period preceding the execution date of this EDS, to an employee, or elected or appointed

official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything

made generally available to City employees or to the general public, or (ii) food or drink provided in the

course of official City business and having a retail value of less than $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)

[ 3 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."

Ifthe 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 bd 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. Ifthe Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all infonnation required by paragraph 2. Failure to

Page 8 of 13

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

^x 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

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

Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:

SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

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

A. CERTIFICATION REGARDING LOBBYING

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.

Page 9 of 13

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

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information witjh 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.)

[3 Yes []No

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

[ ] Yes [ ] No

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

[ 3 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, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.

Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, mcluding 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 infonnation submitted in this EDS.
The infonnation 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. Ifthe 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/sub contractor 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 date furnished to the City.

e name of LQisqlosing Party)

Apostolic Faitn Cmurch

Sign here) (Print or type name of person signing)

erson signing)

(Print or type title of pei

m_ Notary Public.

Commission expires

Signedjand srworn to before me on fdate) at U-M^ County, \JaJMMJs (state).

«^Mue.twi<y lumps

■r«HU(BIGPME&0ar11/17

Page 12 of 13

ww***""" u

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 H.B. La., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, ifthe 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 [afl No

If yes, please identify below (1) the name and tide 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

Attachment A

Applicant's Application for Not-For-Profit Street or Alley Vacation with the City of Chicago's Department of Transportation for the vacation or closure of a portion of the north-south public alley just west of, and parallel to, S. Prairie Avenue and the vacation or closure of the entire east-west public alley just north of, and parallel to, E. Pershing Road within the block bounded by S. Prairie Avenue to the east, S. Indiana Avenue to the west, E. 38th Street to the north and E. Pershing Road to the south.

Attachment B

Horace B. Smith, M.D., Pastor, Chief Executive Officer, Chairman, Board of Trustees,

Sylvia Franklin, Trustee,

Susan D. Smith, Ao^inirustrator,

Gayle L. Kates, Trustee,

Alphonso Adams, Trustee,

Tommie James Selvie, Trustee,

James E. Spark, Trustee

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.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

Apostolic FaitztT^Church

(Sign here) (Print or type name of person signing)

Td4>r IC ED

(Print or type title of person signing)

If,-2qI4

mj&Dtary Public.

Commission expires

Signeo^and^worn to before me on (date) County.

0FRCML8ML ; LAURg S HOBNSBJ j~~omi~~wi

, NOTARYPUeUC-8TATlOFUi«e i MYCOMMSSKMBPRESttffVir

Page 12 of 13

2S0WU J « 3MT3 - Olffilfl YfWW

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

A. Legal name of lie Disclosing Party subrmtting this EDS. Include d/b/a/ if applicable: Apostolic Faith Church

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:

1. the Applicant

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

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

which the Disclosing Party holds a right of control:

B. Business address of the Disclosing Party: 3823 South Indiana Avenge

Chicago, Illinois 60653

Telephone: 773-373-8500 Fax: 773-373-6902 Email: susan.sndthgafcchicago.org /

lauxie.jordan@afcchicago.org

Name of contact person: Susan D, Smith
Federal Employer Identification No. (if you have one): .
Brief description of contract, transaction or other rmdertaMng (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):

Please see "Attachment A"

G. Which City agency or department is requesting this EDS? Department of Transportation

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 J5Q

[ ] General partnership (Is

[] Limited partnership

□ Trust []

Limited liability company Limited liability partnership Joint venture

Not-for-profit corporation

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

M Yes [ ] No

Other (please specify)

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

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

[JYes []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 j 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.

I Name Title Please see "Attachment B"

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 I of such an interest include shares in a corporation, parmership interest in a partnership or joint venture,

! Page 2 of 13

Name Business Address Percentage Interest in the

Disclosing Party

None

SECTION m - 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 M 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

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 R^lantmsbip to Disclosing Party Fees (indicate whether

retained or anticipated Address (subcontractor, attorney, paid or estimated.) JJOXE:

fo be retained) lobbyist etc.) hourly rats" or ^tb.d." is

not an acceptable response.

Charily 20 H. OadcSfc., jfllSff, Cbdcegj, U, 63S02 afctanzy Bfc. $40,D0Q

Brj«t& 2£naj, Sc. 8Z3B. Basel, aj., Cuffrfo, H» 60615 CbosfccrtkrtteBgp: Efefc.$350,000 (Add sheets if necessary)

[ J Check here if the Disclosing Party has not retained, nor expects fo retain, any snch persons ox enrMes. SECTION V - CE&imCATIONS

COtTRT-OBDEKJBD CHILD SUPPORT COMPLIANCE

Under Municipal Code Section 2-92-415, snbstarrtial owners- of buBrnesB entities that contract with the City must remain in compliance with rneir child support obligations tirronghoutfoo contract's term.

Has any person, who directly or rnditecfty awns 10% of more of the Disclosing Party been declared in arrearage on. any child rapport obligations by any Illinois court of cojnpetEUt jurisdiction?

[ I Yes [i No U No p erson <firecdy or hufirectiy owns 10% or nuoro of the

Disclosing Parry.

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 L3No

PURTHEBL CBimHCATIOHS

1. Pursuant to Mmrisirial Code Chapter 1-23, Article I ("Article I^which the Applicant shDukt conealt for defined terms (e.g., "doing business") andlegal n^rarenients), if die Disclosing Party submitting this ED S is the Applicant and is doing business -with the City, then the Disclosing Party certifies as follows: (x) neither the Applicant nor any controlling person is currandy indicted or charged with, or has admitted graft of, or has ever been convicted of, orplacelunder supervisaon for,, any criminal offense, involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against as officer or erogloyee of me City or any sister agency; and (Ii) the Applicant understands and acknowledges mat cornpliance -with Article I is a confirming reqnsrejneni for doing business with the City. NOTE: If Article I applies to fee Applicant, the permanent compliance * timeframe in Article I supersedes some five-yeas compliance timeframes in certifications 2 and. 3 below.

Page 4 of 13

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

Kenig, Lindgren, OTIara, Aboona, Inc. 9575 West Higgins Road, Suite 400, Rosemont, IL 60018 Traffic Consultant Est. $6,500

2. 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 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, mcluding actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.

3. 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: mterlocking 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 mdirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13

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

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

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

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 is not

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

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

"We are not and will not become a predatory lender as defined in 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 los6 of the privilege of doing business with the City."

Page 7 of 13

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

D. CERTIFICATION REGARDING 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?

[ 3 Yes bd 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 PartE.

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.

^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 mjury 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

SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

A. CERTIFICATION REGARDING LOBBYING

2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A, 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

. Page 9 of 13

The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either, (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".

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

Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following infonnation 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 Equal Employment Opportunity Commission all reports due under the applicable filing requirements?

[ ] Yes [ ] No

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

[]Yes []No

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

Page 10 of 13

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

The Disclosing Party understands and agrees that:

A. 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

I it must comply with all statutes, ordinances, and regulations on which this EDS is based.

! B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of ; the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N.

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

If the City determines that any infonnation 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, mcluding 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

i rights or claims which it may have against the City in connection with the public release of information j contained in this EDS and also authorizes the City to verify the accuracy of any information submitted \ in this EDS.

! E. The information provided in this EDS must be kept current In the event of changes, the Disclosing i Party must supplement this EDS up to the time the City takes action on the Matter. Ifthe 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:

I Page 11 of 13

j i

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.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

Church

Apostolic Faitl. (Print^r-itVpe name of Disclosing Party)

Sign here)

ornce

(Print or type name of person signing)

(Print or type title of person signing)

QjK Notary Public.

Signedjand sworn to before me on (elate)

_ County, ULVUaMa (state)

<\U\n

^Sm j. f\dik^ - A/2

^^ :aj ^

Commission expires:

OFRCMLflEM.

MrooMM88nNExnREsmni/i7

Page 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 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 ILB.l.a., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, ifthe 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, ifthe Disclosing Party is a limited habilrry 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 [Xi 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

Attachment A

Applicant's Application for Not-For-Profit Street or Alley Vacation with the City of Chicago's Department of Transportation for the vacation or closure of a portion of the north-south public alley just west of, and parallel to, S. Prairie Avenue and the vacation or closure of the entire east-west public alley just north of, and parallel to, E. Pershing Road within the block bounded by S. Prairie Avenue to the east, S. Indiana Avenue to the west, E. 38fh Street to the north and E. Pershing Road to the south.

Attachment B

Horace B. Smith, M.D., Pastor, Chief Executive Officer, Chairrnan, Board of Trustees,

Sylvia Franklin, Trustee,

Susan D. Smith, Administrator,

Gayle L. Kates, Trustee,

Alphonso Adams, Trustee,

Tornmie James Selvie, Trustee,

James E. Spark, Trustee

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 Gity. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 Ifthe 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.

i F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. 1. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: If the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

Apostolic Fait

(Sign here)

Horace ^tYii^h

(Print or type name of person signing) (Print or type title of person signing)

. and sworn to before me on (date) at /C0$t County, MJU^^W (state)

Notary Public.

Commission expires:

official seal wureswbwsc*jcrcm

MY C0M18S0N EmftOVf 1/17

Page 12 of 13

f JA38JM3mO

Legislation Text

Legislation Details

Legislation Details (With Text)