^1^18-7
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 ofthe C1-2 Neighborhood Commercial District symbols and indications as shown on Map No. 4-J in the area bounded by:
South Spaulding Avenue; West Ogden Avenue; South Christiana Avenue; the north line ofthe alley that is north of and parallel to West Ogden Avenue
to those of a RT4 Residential, Two-Flat, Townhouse and Multi-Unit District.
SECTION 2. This ordinance takes effect after its passage and approval.
Common Address of Property: 3300-3330 W. Ogden
Avenue
8291656IW-3
Department of Planning and Development
city of chicago
September 12, 2014
Mr. Errol Stone, Chairman of the Board Legacy Charter School c/o Dentons US LLP 233 S. Wacker Drive Chicago, Illinois 60606
Re: Proposed Relocation of Legacy Charter School
Legacy Charter School ("Legacy"), an Illinois not-for-profit corporation which has been educating elementary school students in the 24th Ward for over ten years, has asked for permission from the City of Chicago to file rezoning, variation, redevelopment agreement, and related City approvals for the proposed relocation of Legacy from its current location at the Chicago Public School's Roswell B. Mason School building to a vacant site bounded by Ogden Avenue on the south, Christiana Avenue on the west, Spaulding Avenue on the east, and privately owned property to the north (the "Relocation Site"). As explained below, most of the Relocation Site is owned by the City of Chicago. The proposed relocation of Legacy to the Relocation Site is supported by 24th Ward Alderman Michael D. Chandler.
A plat of the Relocation Site is attached. The City of Chicago owns Lots 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, and 34 ofthe Relocation Site. The Steans Family Foundation ("SFF") controls Lots 2, 22, and 31 within the Relocation Site. A table listing the property index numbers of all those lots is attached. The SFF, which is a supporter of Legacy, will ultimately convey title to its aforesaid Lots 2, 22, and 31 to Legacy as part ofthe assembly ofthe Relocation Site and its redevelopment as Legacy's new home.
The balance of the Relocation Site is a public alley. As indicated in the attached draft Plat of Vacation, Legacy seeks to have a portion ofthe existing alley vacated under the City of Chicago Not-For-Profit Corporation Street or Alley Vacation Program in order that the vacated portions of the alley can be incorporated into the redevelopment of the Relocation Site. In order to provide alley access to the private property owners located north of the Relocation Site, as indicated in the attached Plat of Dedication, Legacy will either itself or through the SFF cause the dedication of the northern portion of Lot 2 to create a new east/west connection between the remaining north/south segment of the alley and Spaulding Avenue. Ifthe remaining privately held lots north ofthe Relocation
121 NORTH LASALLE STREET. ROOM 1000, CHICAGO. ILLINOIS 60T.02
Site are later acquired by either the SFF or another not-for-profit with the result that the north/south segment ofthe alley is no longer needed, Legacy's proposed Redevelopment Agreement with the City - which, of course, will require approval by the Chicago Development Commission and the Chicago Council - will provide that the alley described in the Plat of Dedication would subsequently be vacated and conveyed to Legacy. Under the proposed Redevelopment Agreement, the City will convey all City-owned property within the Redevelopment Site - whether in the form of the aforesaid subdivided lots or the alley described in the Plat of Vacation - to Legacy in order to facilitate Legacy's relocation to the Redevelopment Site. The SFF controlled property within the Redevelopment Site will be conveyed to Legacy in order for construction of the new school building to proceed.
Legacy's proposed Site Plan for the Redevelopment Site is also attached. It has been favorably reviewed by both the Zoning Administrator and her staff and by Maureen West of the Chicago Department of Transportation and her staff. Lots 20 through 30, inclusive along Ogden Avenue, are located in a C-2 zoning district, while the balance of subdivided lots are zoned RT4. The goal is to rezone Lots 20 through 30 and the entirety of the existing public alley north of said lots to the same RT4 zoning district classification applicable to the rest of the Redevelopment Site. The Zoning Administrator has identified the variations required in order to redevelop the Relocation Site pursuant to the Site Plan. The Chicago Department of Transportation has expressed its support for the means of access and parking layout depicted on the Site Plan.
The proposed redevelopment of the Redevelopment Site pursuant to the Site Plan is consistent with existing land uses and will provide a proven educational benefit for the community. Legacy's goal is to obtain a No Further Remediation letter for the Relocation Site from the Illinois Environmental Protection Agency and to expedite City approvals in order for construction to proceed in 2015 and for Legacy to reopen at its new home on the Relocation Site when a new school year begins in the late summer of 2016. Accordingly, Legacy is hereby authorized:
- to file applications to rezone City-owned Lots 20, 21, 23, 24, 25, 26, 27, 28, 29, and 30 and the entirety of the existing public alley north of said lots from their existing C-2 zoning district classification as shown on the attached Site Plan to that of RT4;
- to file whatever variation applications are deemed necessary by the Zoning Administrator to proceed with redevelopment consistent with the Site Plan, including with respect to all City-owned lots within the Redevelopment Site: i.e., Parcel 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, and 34;
- to file an application for City approval of the attached Plat of Vacation under the City's Not-for-Profit Corporation Street and Alley Vacation Program, as well as an application for City approval ofthe attached Plat of Dedication;
- to file an application for approval of a Redevelopment Agreement seeking the conveyance ofthe aforesaid City-owned Lots 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, and 34 to Legacy to facilitate its relocation pursuant to the Site Plan; and
5. to submit the aforesaid City-owned Lots 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, and 34 to the Illinois Environmental Protection Agency Site Remediation Program in order to obtain a No Further Remediation Letter including the submission of IEPA SRP DRM Forms 1 and 2, copies of which are attached.
The SFF will need to supply customary consents to any of the aforesaid applications involving Lots 2, 22, and 31, currently controlled by the SFF.
I am copying the Zoning Administrator and the Commissioner ofthe Department of Transportation on the attached to facilitate Legacy's efforts and enlist their assistance on this worthwhile effort.
THE CHICAGO DEPARTMENT OF PLANNING AND DEVELOPMENT
By: Andrew Mooney
cc: Patricia Scudiero, Zoning Administrator
Rebekah Scheinfeld, Commissioner, Chicago Department of Transportation Steve Valenziano, Assistant to the Zoning Administrator Patrick Murphey, Chicago Zoning Board of Appeals Maureen West, Chicago Department of Transportation
PLAT OF DEDICATION
LEGAL DESCRIPTION
The North 16.00 foot or Lot 2 in tho Resubdivision of Lot 19 Ir Sherman ond Wolter's Resubdivision of Block 11 of the Circuit Court Partition of. the East Half of lh» Northeast Quortor, and that part of the Eost Kolf of the Southeast Ouorter lying North of Ogden Ave. of Section 23, Township 39 North, Ronge 13 East of the Third Ptlr.cicol Meridlor., occordlno. to the plat thereof recorded February 16, 1920 as Document Number 6738047. ir. Cook County. Illinois. Sold parcel cortlcining 1,674 sq. 'I. (0.03S Acres), more or l;ss.
Si *
iS
to
LEGEND
(ID 00') RECORD 10.00' USASURCD
GRAPHIC SCALE
< IH FBCT ) 1 Inch * £0 fl
Soarings ere based on the Want line of Lot 2 which b«ar» £0rj9'27"E
Firm ReglEtrotlcn No 164 003610
Dimensions arc shown rh feel and decimal porAc thereof.
No dimension* should b« aasum&d by neal* rnoosuremcnts upon tho plat.
Property corn«rs wore nol niokod ott a port of this plot
SlfcTX OF 1LL1H0IS COUNT* OF COOK
This li to c«rllly (hot I, on MlnoJj P'OtOBHOfiol l.ortd Strrvtytf, have surveyed '.ne properly mM*1"*"^ de»ci$td in the copllcni cbov*, ond Ihn*. lhis ^J^J^to%c PrefCJaioncl ft».'v-:« conioirns lo ihe current Vv""--*"~"SA2
Nino's UlniT-j/n-. 5:a*idcr4i for C Boundcry ^^^u^.-"^^"*
Glv«n Uiidrr my hand and sea) In Crilcoa.0, \ \ ^fcyiw J*f Illinois, this 15th doy of Jjly, 201J. /»f
KfSTM^
UCENSE f>R1Af|0'J 1I-20-2I1K
Field, work computed February H. 2013.
PLAT OF DEDICATION
TERRA
LTD.
Pr«pnrod foe: Denlam
233 5. Wockw Or. Suite 7S00 Chicago, IL 60605
Jcb Ko 13-116 Dale. 7f15.«
SHEET 1 OF 1
Site Acquisition Status Revised August 26, 2014
NORTH & PROPERTY LINE
t
232'
I
*■ \Q\ \
\A*\o\°\ \>*
i o \ \ \...^--
PROPOSED ALLEY VACTtON O CITY OWNED
- UNDER NEGOTIATION
- STEAMS OWNED
- TO BE ACQUIRED
Survey # |
PIN 16-23-405- |
Address |
Owner |
Type |
City-Owned |
34 |
007 |
1647 S. Christiana |
City-Owned |
Vacant Lot |
33 |
008 |
1649 S. Christiana |
City-Owned |
Vacant Lot |
32 |
009 |
1653 S. Christiana |
City-Owned |
Vacant Lot |
30 |
017 |
3328 W. Ogden |
City-Owned |
Vacant Lot |
29 |
018 |
3322 W. Ogden |
City-Owned |
Vacant Lot |
28 |
019 |
3320 W. Ogden |
City-Owned |
Vacant Lot |
27 |
020 |
3318 W. Ogden |
City-Owned |
Vacant Lot |
26 |
021 |
3316 W. Ogden |
City-Owned |
Vacant Lot |
25 |
022 |
3312 W. Ogden |
City-Owned |
Vacant Lot |
24 |
023 |
3310 W. Ogden |
City-Owned |
Vacant Lot |
23 |
024 |
3308 W. Ogden |
City-Owned |
Vacant Lot |
21/20 |
026 |
3300 W. Ogden |
City-Owned |
Vacant Lot |
Steans-Controlled |
31 |
010 |
1655 S. Christiana |
Steans-Controlled |
Vacant Lot |
22 |
025 |
3306 W. Ogden |
Steans-Controlled |
Vacant Lot |
2 |
016 |
1646/48 S. Spaulding |
Steans-Controlled |
Vacant Lot |
I
i
Illinois Environmental Protection Agency
Bureau of Land 1021 North Grand Avenus East * P.O. Box 19276 Springfield Illinois 82794-9276
Site Remediation Program (SRP) l"""EgiS".
Application and Services Agreement (DRM-1) Form
_js:oaoy__. Panial Psjmtm inofudoa _SHIM SRP Form Indudag
TJiJ» (tlfobl* (arm may 6s completed online, a copy saved reentry, printed end slgnad Man It 14 tubmltnd to (ha sr-3 Raquwttu Arai.ir.wn ___)
Remedial Projtct Managamant Section at the above eddmat. ;
I. Site Identification:
Site Name: County:
Streel Address: P.O. Box: _
City: _ _. State: IL Zip Code: Approx. site size (acres)
Illinois Inventory ID Number: . USEPA ID Number ,
Site Base Map Attached: □ Yes Q Nd Illinois EPA Perrnlt(s):
LUST/IEMA Incident Numbers), if applicable: .
II. Remediation Applicant ("RA"):
RA'e Name: Title:
Company:
Street Address: P.O.Box: .
City: Slate; Zip Code:. Phone:
FEIN or SSN:
I hereby certify that I am authorized to sign this application and services agreement. I certify that the proposed project meets the eligibility criteria set forth in Section 56.1 (a)(2) of the Environmental Protection Act (415 ILCS 5/56.1 (1 )(2)> and regulations promulgated thereunder and that this submittal and all attachments were prepared at my direction, In consideration for the Illinois EPA's agreement to provide (subject to applicable law. available resources, and receipt of the advance partial payment) review and evaluation services for activities carried out pursuant to Title 17 ofthe Illinois Environmental Proteciion Act (415 ILCS 5/58-58.12). I agree to:
- Conform with the procedures of Title 17 of the Illinois Environmental Protection Act (415 ILCS 5/58 - 58.12) and Implementing regulations;
- Allow for or otherwise arrange site visits or other site evaluations by the Illinois EPA when requested;
- Pay any reasonable costs incurred and documented by the Illinois EPA in providing such services; and
- Make an advance partial payment to the Illinois EPA for such anticipated services provided in Section V of this application.
As the RA, I understand that I may terminate this services agreement at any time, by notifying the Illinois EPA in writing that services previously requested under the services agreement are no longer wanted. Within 180 days of receipt of the notice, the Illinois EPA shall provide me with a final invoice for services provided until the date of receipt of such notification.
to the best of my knowledge and belief, this request and all attachments are true, accurate and complete, i hereby certify that I have Ihe aulhorily to enter into this agreement.
Any parson who knowingly makes a false, fictitious, or fraudulent material statement, orally or In writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent conviction is a Class 3 felony. (416 ILCS 9f44(h)).
RA's Signature: Date:
"In addition to the fees applicable under this Services Agreement, the recipient of a No Further Remediation (NFR) Letter must pay to the Illinois EPA an NFR Assessment In the amount of the lesser of $2500 or an amount equal to the costs incurred by the Illinois EPA under this Agreement (36 IAC 740.615)
IL 532 2J36 LPC 568 5/14
III. Project Objectives:
A |
Release Letter Requested. Please complete one of the subsections by checking applicable boxes and including other Information (if necessary, additortal Information may be attached to this application form): |
c |
Comprehensive No Further Remediation ("NFR") Letter |
c |
Focused NFR Letter Identify the focused contaminants of concern by checking the applicable box(es): □ Volatiles □ BTEX □ PCSs □ Metals □ Semlvolatiles □ PNAs □ Pesticides □ Other (identify) |
□ |
4(y) Latter Identify the focused contaminants of concern by checking the applicable box(es): □. Volatiles □ BTEX □ PCBs □ Metals □ Semivolatiles □ PNAs □ Pesticides □ Other (identify) Identify the media of concern by checking the applicable box(es): □ Soil □ Sediments □Other: Identify the actions (e.g. drum removal, spill response, etc.): |
|
|
|
|
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1^1^18-7 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 ofthe C1-2 Neighborhood Commercial District symbols and indications as shown on Map No. 4-J in the area bounded by: South Spaulding Avenue; West Ogden Avenue; South Christiana Avenue; the north line ofthe alley that is north of and parallel to West Ogden Avenue to those of a RT4 Residential, Two-Flat, Townhouse and Multi-Unit District. SECTION 2. This ordinance takes effect after its passage and approval. Common Address of Property: 3300-3330 W. Ogden Avenue 8291656IW-3 Department of Planning and Development city of chicago September 12, 2014 Mr. Errol Stone, Chairman of the Board Legacy Charter School c/o Dentons US LLP 233 S. Wacker Drive Chicago, Illinois 60606 Re: Proposed Relocation of Legacy Charter School Legacy Charter School ("Legacy"), an Illinois not-for-profit corporation which has been educating elementary school students in the 24th Ward for over ten years, has asked for permission from the City of Chicago to file rezoning, variation, redevelopment agreement, and related City approvals for the proposed relocation of Legacy from its current location at the Chicago Public School's Roswell B. Mason School building to a vacant site bounded by Ogden Avenue on the south, Christiana Avenue on the west, Spaulding Avenue on the east, and privately owned property to the north (the "Relocation Site"). As explained below, most of the Relocation Site is owned by the City of Chicago. The proposed relocation of Legacy to the Relocation Site is supported by 24th Ward Alderman Michael D. Chandler. A plat of the Relocation Site is attached. The City of Chicago owns Lots 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, and 34 ofthe Relocation Site. The Steans Family Foundation ("SFF") controls Lots 2, 22, and 31 within the Relocation Site. A table listing the property index numbers of all those lots is attached. The SFF, which is a supporter of Legacy, will ultimately convey title to its aforesaid Lots 2, 22, and 31 to Legacy as part ofthe assembly ofthe Relocation Site and its redevelopment as Legacy's new home. The balance of the Relocation Site is a public alley. As indicated in the attached draft Plat of Vacation, Legacy seeks to have a portion ofthe existing alley vacated under the City of Chicago Not-For-Profit Corporation Street or Alley Vacation Program in order that the vacated portions of the alley can be incorporated into the redevelopment of the Relocation Site. In order to provide alley access to the private property owners located north of the Relocation Site, as indicated in the attached Plat of Dedication, Legacy will either itself or through the SFF cause the dedication of the northern portion of Lot 2 to create a new east/west connection between the remaining north/south segment of the alley and Spaulding Avenue. Ifthe remaining privately held lots north ofthe Relocation 121 NORTH LASALLE STREET. ROOM 1000, CHICAGO. ILLINOIS 60T.02 Site are later acquired by either the SFF or another not-for-profit with the result that the north/south segment ofthe alley is no longer needed, Legacy's proposed Redevelopment Agreement with the City - which, of course, will require approval by the Chicago Development Commission and the Chicago Council - will provide that the alley described in the Plat of Dedication would subsequently be vacated and conveyed to Legacy. Under the proposed Redevelopment Agreement, the City will convey all City-owned property within the Redevelopment Site - whether in the form of the aforesaid subdivided lots or the alley described in the Plat of Vacation - to Legacy in order to facilitate Legacy's relocation to the Redevelopment Site. The SFF controlled property within the Redevelopment Site will be conveyed to Legacy in order for construction of the new school building to proceed. Legacy's proposed Site Plan for the Redevelopment Site is also attached. It has been favorably reviewed by both the Zoning Administrator and her staff and by Maureen West of the Chicago Department of Transportation and her staff. Lots 20 through 30, inclusive along Ogden Avenue, are located in a C-2 zoning district, while the balance of subdivided lots are zoned RT4. The goal is to rezone Lots 20 through 30 and the entirety of the existing public alley north of said lots to the same RT4 zoning district classification applicable to the rest of the Redevelopment Site. The Zoning Administrator has identified the variations required in order to redevelop the Relocation Site pursuant to the Site Plan. The Chicago Department of Transportation has expressed its support for the means of access and parking layout depicted on the Site Plan. The proposed redevelopment of the Redevelopment Site pursuant to the Site Plan is consistent with existing land uses and will provide a proven educational benefit for the community. Legacy's goal is to obtain a No Further Remediation letter for the Relocation Site from the Illinois Environmental Protection Agency and to expedite City approvals in order for construction to proceed in 2015 and for Legacy to reopen at its new home on the Relocation Site when a new school year begins in the late summer of 2016. Accordingly, Legacy is hereby authorized:
- to file applications to rezone City-owned Lots 20, 21, 23, 24, 25, 26, 27, 28, 29, and 30 and the entirety of the existing public alley north of said lots from their existing C-2 zoning district classification as shown on the attached Site Plan to that of RT4;
- to file whatever variation applications are deemed necessary by the Zoning Administrator to proceed with redevelopment consistent with the Site Plan, including with respect to all City-owned lots within the Redevelopment Site: i.e., Parcel 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, and 34;
- to file an application for City approval of the attached Plat of Vacation under the City's Not-for-Profit Corporation Street and Alley Vacation Program, as well as an application for City approval ofthe attached Plat of Dedication;
- to file an application for approval of a Redevelopment Agreement seeking the conveyance ofthe aforesaid City-owned Lots 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, and 34 to Legacy to facilitate its relocation pursuant to the Site Plan; and
5. to submit the aforesaid City-owned Lots 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, and 34 to the Illinois Environmental Protection Agency Site Remediation Program in order to obtain a No Further Remediation Letter including the submission of IEPA SRP DRM Forms 1 and 2, copies of which are attached. The SFF will need to supply customary consents to any of the aforesaid applications involving Lots 2, 22, and 31, currently controlled by the SFF. I am copying the Zoning Administrator and the Commissioner ofthe Department of Transportation on the attached to facilitate Legacy's efforts and enlist their assistance on this worthwhile effort. THE CHICAGO DEPARTMENT OF PLANNING AND DEVELOPMENT By: Andrew Mooney cc: Patricia Scudiero, Zoning Administrator Rebekah Scheinfeld, Commissioner, Chicago Department of Transportation Steve Valenziano, Assistant to the Zoning Administrator Patrick Murphey, Chicago Zoning Board of Appeals Maureen West, Chicago Department of Transportation PLAT OF DEDICATION LEGAL DESCRIPTION The North 16.00 foot or Lot 2 in tho Resubdivision of Lot 19 Ir Sherman ond Wolter's Resubdivision of Block 11 of the Circuit Court Partition of. the East Half of lh» Northeast Quortor, and that part of the Eost Kolf of the Southeast Ouorter lying North of Ogden Ave. of Section 23, Township 39 North, Ronge 13 East of the Third Ptlr.cicol Meridlor., occordlno. to the plat thereof recorded February 16, 1920 as Document Number 6738047. ir. Cook County. Illinois. Sold parcel cortlcining 1,674 sq. 'I. (0.03S Acres), more or l;ss. Si * iS to LEGEND (ID 00') RECORD 10.00' USASURCD GRAPHIC SCALE < IH FBCT ) 1 Inch * £0 fl Soarings ere based on the Want line of Lot 2 which b«ar» £0rj9'27"E Firm ReglEtrotlcn No 164 003610 Dimensions arc shown rh feel and decimal porAc thereof. No dimension* should b« aasum&d by neal* rnoosuremcnts upon tho plat. Property corn«rs wore nol niokod ott a port of this plot SlfcTX OF 1LL1H0IS COUNT* OF COOK This li to c«rllly (hot I, on MlnoJj P'OtOBHOfiol l.ortd Strrvtytf, have surveyed '.ne properly mM*1"*"^ de»ci$td in the copllcni cbov*, ond Ihn*. lhis ^J^J^to%c PrefCJaioncl ft».'v-:« conioirns lo ihe current Vv""--*"~"SA2 Nino's UlniT-j/n-. 5:a*idcr4i for C Boundcry ^^^u^.-"^^"* Glv«n Uiidrr my hand and sea) In Crilcoa.0, \ \ ^fcyiw J*f Illinois, this 15th doy of Jjly, 201J. /»f KfSTM^ UCENSE f>R1Af|0'J 1I-20-2I1K Field, work computed February H. 2013. PLAT OF DEDICATION TERRA LTD. Pr«pnrod foe: Denlam 233 5. Wockw Or. Suite 7S00 Chicago, IL 60605 Jcb Ko 13-116 Dale. 7f15.« SHEET 1 OF 1 Site Acquisition Status Revised August 26, 2014 NORTH & PROPERTY LINE t 232' I *■ \Q\ \ \A*\o\°\ \>* i o \ \ \...^-- PROPOSED ALLEY VACTtON O CITY OWNED
- UNDER NEGOTIATION
- STEAMS OWNED
- TO BE ACQUIRED
Survey #PIN 16-23-405-AddressOwnerTypeCity-Owned340071647 S. ChristianaCity-OwnedVacant Lot330081649 S. ChristianaCity-OwnedVacant Lot320091653 S. ChristianaCity-OwnedVacant Lot300173328 W. OgdenCity-OwnedVacant Lot290183322 W. OgdenCity-OwnedVacant Lot280193320 W. OgdenCity-OwnedVacant Lot270203318 W. OgdenCity-OwnedVacant Lot260213316 W. OgdenCity-OwnedVacant Lot250223312 W. OgdenCity-OwnedVacant Lot240233310 W. OgdenCity-OwnedVacant Lot230243308 W. OgdenCity-OwnedVacant Lot21/200263300 W. OgdenCity-OwnedVacant LotSteans-Controlled310101655 S. ChristianaSteans-ControlledVacant Lot220253306 W. OgdenSteans-ControlledVacant Lot20161646/48 S. SpauldingSteans-ControlledVacant Lot I i Illinois Environmental Protection Agency Bureau of Land 1021 North Grand Avenus East * P.O. Box 19276 Springfield Illinois 82794-9276 Site Remediation Program (SRP) l"""EgiS". Application and Services Agreement (DRM-1) Form _js:oaoy__. Panial Psjmtm inofudoa _SHIM SRP Form Indudag TJiJ» (tlfobl* (arm may 6s completed online, a copy saved reentry, printed end slgnad Man It 14 tubmltnd to (ha sr-3 Raquwttu Arai.ir.wn ___) Remedial Projtct Managamant Section at the above eddmat. ; I. Site Identification: Site Name: County: Streel Address: P.O. Box: _ City: _ _. State: IL Zip Code: Approx. site size (acres) Illinois Inventory ID Number: . USEPA ID Number , Site Base Map Attached: □ Yes Q Nd Illinois EPA Perrnlt(s): LUST/IEMA Incident Numbers), if applicable: . II. Remediation Applicant ("RA"): RA'e Name: Title: Company: Street Address: P.O.Box: . City: Slate; Zip Code:. Phone: FEIN or SSN: I hereby certify that I am authorized to sign this application and services agreement. I certify that the proposed project meets the eligibility criteria set forth in Section 56.1 (a)(2) of the Environmental Protection Act (415 ILCS 5/56.1 (1 )(2)> and regulations promulgated thereunder and that this submittal and all attachments were prepared at my direction, In consideration for the Illinois EPA's agreement to provide (subject to applicable law. available resources, and receipt of the advance partial payment) review and evaluation services for activities carried out pursuant to Title 17 ofthe Illinois Environmental Proteciion Act (415 ILCS 5/58-58.12). I agree to:
- Conform with the procedures of Title 17 of the Illinois Environmental Protection Act (415 ILCS 5/58 - 58.12) and Implementing regulations;
- Allow for or otherwise arrange site visits or other site evaluations by the Illinois EPA when requested;
- Pay any reasonable costs incurred and documented by the Illinois EPA in providing such services; and
- Make an advance partial payment to the Illinois EPA for such anticipated services provided in Section V of this application.
As the RA, I understand that I may terminate this services agreement at any time, by notifying the Illinois EPA in writing that services previously requested under the services agreement are no longer wanted. Within 180 days of receipt of the notice, the Illinois EPA shall provide me with a final invoice for services provided until the date of receipt of such notification. to the best of my knowledge and belief, this request and all attachments are true, accurate and complete, i hereby certify that I have Ihe aulhorily to enter into this agreement. Any parson who knowingly makes a false, fictitious, or fraudulent material statement, orally or In writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent conviction is a Class 3 felony. (416 ILCS 9f44(h)). RA's Signature: Date: "In addition to the fees applicable under this Services Agreement, the recipient of a No Further Remediation (NFR) Letter must pay to the Illinois EPA an NFR Assessment In the amount of the lesser of $2500 or an amount equal to the costs incurred by the Illinois EPA under this Agreement (36 IAC 740.615) IL 532 2J36 LPC 568 5/14 III. Project Objectives: ARelease Letter Requested. Please complete one of the subsections by checking applicable boxes and including other Information (if necessary, additortal Information may be attached to this application form):cComprehensive No Further Remediation ("NFR") LettercFocused NFR Letter Identify the focused contaminants of concern by checking the applicable box(es): □ Volatiles □ BTEX □ PCSs □ Metals □ Semlvolatiles □ PNAs □ Pesticides □ Other (identify)□4(y) Latter Identify the focused contaminants of concern by checking the applicable box(es): □. Volatiles □ BTEX □ PCBs □ Metals □ Semivolatiles □ PNAs □ Pesticides □ Other (identify) Identify the media of concern by checking the applicable box(es): □ Soil □ Sediments □Other: Identify the actions (e.g. drum removal, spill response, etc.): . . . B. |
Identify any support services being sought from the Illinois EPA in addition to Ihe review and evaluation services, if necessary, additional Information may be attached to this application form. |
|
r~] No additional support services ere being sought □ Assistance with community relations n Sample collection and analyses r~l Other (identify): |
c. |
Anticipated Schedule |
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SRP Document |
Projected Date of Receipt by Illinois EPA |
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Site Investigation Report |
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Remediation Objectives Report |
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Remedial Action Plan |
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Remedial Action Completion Report |
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D. |
Identify the current and post-remedation uees of the remediation site. If necessary, additional information may be attached to this application form. |
Current Use: |
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Post-Remediation Use:
IV. Written Permission from the Property Owner (check one ofthe applicable boxes and provide additional Information):
□ RA Is the property owner of the remediation site Identified in Section 1 of this application
□ RA is notthe property owner of the remediation site Identified in Section 1 of this application
Title:
P.O. Box:
Property Owner's Name:
Company: Street Address:
City:
State:
Phone:
Zip Code:
I hereby certify that the RA has my permission to enroll the site identified in Section 1 of this application into the Illinois EPA Site Remediation Program. I certify that the RA and designated representatives have permission to enter the Indicated premises for the pupose of conducting remedial investigations or activities.
Any person who knowingly makes a false, fictitious, or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent conviction Is a Class 3 felony. |41S ILCS 5/44(h)).
Date:
Owner's Signature:
For multiple property owners, attach additional sheets containing all the information above along with a signed, dated certification for each.
V*. Advance Partial Payment:
The RA shall select one of the following advance partial payment plans: ' ~
r Plan 1: A 5600 advance partial payment is included with this application. Please make the check payable to: Illinois Environmental Protection Agency". Please include "For Deposit in the Hazardous Waste Fund" and the Remadation Applicant's FEIN or SSN on the check; or
Plan 2: Request that the Illinois EPA determine the appropriate partial payment (I.e., approximately one-half of the total □ anticipated costs of the Illinois EPA, not to exceed S5.000). A completed DRM-3 form ("Request for Assessment of Advance Partial Payment for Anticipated Services") must accompany this application so that the Illinois EPA may determine the appropriate advance partial payment specific to Ihe services requested.
If this application contains plans and reports for review and evaluation by the Illinois EPA, a completed DRM-2 Form must also accompany this submittal.
The Mlnuls EPA Is authorized lo require this information under Section 415 ILCS 5(55-55.12 of Hie Environmental Protection Ac. and regulations promulgated Ihereundef. Disclosure ol this InlormBiion is required as a condition of ponlclpatiori in Ihe Site Remediation Program. Failure lo do so may prevent this form from Deln[i process and coulo lesmi In your application being rejected. This form has been approved by Ihe Forms Management Center All information submitted as pari of this application Is available to the public except when specifically designated by lhc RA to be ireated confidentially et a trado secrel or secret process In accordance wilh the Illinois Compiled Statutes. Section 7(a) ot Ihe Environmental Prelection Act, applicable Rules and Regulations of the Illinois Pollution Control Board and applicable Illinois EPA rules and guidelines.
Page 2of 4
Illinois Environmental Protection Agency
Bureau of Land 1021 North Grand Avenue East P.O. Box 19276 Springfield Illinois 62794-9276
Site Remediation Program Form (DRM-2) (To be Submitted with all Plans and Reports)
You may complete this form online, save a copy, print, sign and mall it to the address above. I. Site Identification:
Site Name:
Street Address:
City:
Illinois Inventory ID Number:
State: IL Zip Code: _
IEMA Incident Number:
P.O. Box: Phone:
II. Remediation Applicant:
Applicant's Name:
P.O. Box:
Phone:
Company:
State:
. Zip Cods:
Street Address:
City:
Email Address:
I hereby request that the Illinois EPA review and evaluate the attached project documents In accordance with the terms and conditions of the Environmental Protection Act (415 ILCS 5), Implementing regulations, and the review and evaluation services agreement.
Date:
Remediation Applicant's Signature:.
III. Contact Person for Remediation Applicant:
Zip Code:
State:
Contact's Name:
Company:
Street Address: City:
Email Address:
P.O. Box: Phone:
State:
Zip Code:
Contact Person for Consultant:
Contact's Name:
Company:
Street Address:
City:
Email Address:
P.O. Box: Phone:
IV. Review & Evaluation Licensed Professional Engineer or Geologist ("RELPEG"), if applicable:
State:
Zip Code:
RELPEG'8 Name: Company: Street Address: City:
Email Address:
P.O. Box: Phone:
IL 632-2547
LPC S66 June 2012
Page3of4
V. Project Documents Being Submitted:
Document Title: Prepared by:
Date of Preparation of Plan or Report: _
Prepared For:
Type of Document Submitted:
- Site Investigation Report - Comprehensive
- Site Investigation Report - Focused
- Remediation Objectives Report - Tier 1 or 2
□ Remediation Objectives Report - Tier 3
Q Remedial Action Plan
- Remedial Action Completion Report
- Sampling Plan
- Health and Safety Plan
□ Community Relations Plan
Q Risk Assessment
- Containment Fate & Transport Modeling
- Other:
Document Title: Prepared by:
Date of Preparation of Plan or Report:
Prepared For:.
Type of Document Submitted;
- Site Investigation Report - Comprehensive
- Site Investigation Report - Focused
Q Remediation Objectives Report - Tier 1 or 2
□ Remediation Objectives Report - Tier 3
Q Remedial Action Plan
- Remedial Action Completion Report
□ Health and Safety Plan
Q Community Relations Plan
- Risk Assessment
- Containment Fate & Transport Modeling
- Other:
Document Title: Prepared by:
Type of Document Submitted:
- Site Investigation Report - Comprehensive
- Site Investigation Report - Focused
Q Remediation Objectives Report - Tier 1 or 2
fj Remediation Objectives Report - Tier 3
- Remedial Action Plan
- Remedial Action Completion Report
Date of Preparation of Plan or Report.
Prepared For
- Sampling Plan
- Health and Safety Plan
□ Community Relations Plan
Q Risk Assessment
- Containment Fate & Transport Modeling
- Other:
Page4of4
VI. Professional Engineer's or Geologist's Seal or Stamp:
I attest that all site Investigations or remedial activities that are subject of this plsn(s) or report(s) were performed under my direction, and this document and all attachments were prepared under my direction or reviewed by me, and to the best of my knowledge and belief, the work described In the plan and report has beer designed or completed In accordance with the Illinois Environmental Protection Acl (415 ILCS 5), 35 III. Adm. Code 740, and generally accepted engineering practices or principles of professional geology, and the Information presented is accurate and complete.
Any person who/movingly makes a false, fictitious, or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 Felony. A second or subsequent offense after conviction Is a Class 3 felony. (41S ILCS SM4(h))
Professional Engineer's or
Engineer's or Geologist's Name: Geologist's Seal or Stamp:
Company:
Registration Number Phone:
License Expiration Date:
Signature: Date:
Nolo: Tho authority of a Licensed Professional GooloolsMo cortify documents submitted to the Illinois Environmental Protection Agency for review and evaluation pursuant to Tide XVII of tho Environmental Protection Act Is limited to Site Investigation Report* (418 ILCS 68.7(f), as amended by PA 824735, effective July 25, 2002. A Licensed Professional Goologlst cannot cortify Remediation Objectives Reports, Remedial Action Plane or Remedial Action Completion Reporta,
All information submitted Is available to (he public except whan specifically designated by the Remediation Applicant to be treated confidentially as o trade eocrel or secret process In accordance with the Illinois Compiled Statutes. Section 7(a) of Ihe Environmental Protection Act, applicable Rides and Regulation* of the Illinois Pollution Control Board and applicable Illinois EPA rules end guidelines. The Illinois EPA is authorized lo require this Inloimalian under Sections 41S ILCS SJSB - 58,12 ot tho Environmental Protection Act and regulations prourhillgalod thereunder. Disclosure ol this information is' required as a condition of participation In the Site Remediation Program. Failure to do ao may prevent this form from being processed and could result In your plants) or reports) being rejected. This form has bean approves by ihe Forms Management Center.
4
COMMUNITY FACILITY, LLC C/O STEANS FAMILY FOUNDATION 50 East Washington, Suite 410 Chicago, IL 60602
Date: September 29, 2014 Ms. Patricia A. Scudiero
Managing Deputy Commissioner and Zoning Administrator, Bureau of Planning and Zoning Department of Housing and Economic Development 121 N. LaSalle Street, Room 905 Chicago, Illinois 60602
Re: Consent to Rezoning Application filed by Legacy Charter School - Ogden Avenue
Dear Patti
The undersigned is the owner of Lot 22 on Ogden Avenue as depicted in the attached plat.
By means of this letter, undersigned hereby advises the City of Chicago that the undersigned consents to Legacy Charter School's application to rezone Lot 22 and adjoining property, including the public alley located to the north of Lot 22, from its existing C1-2 zoning district classification to that of RT4.
By:
Patricia Ford
Its:
Manager
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S288I659W-I
EXHIBIT 1
TO APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
The City of Chicago and the Community Facility, LLC are the owners of the subject property; both have consented to the filing of this application by Applicant. See the attached September 12, 2014 letter of authorization from Commissioner Andrew Mooney of the Chicago Department of Planning and Development, whose address is 121 North LaSalle Street, Room 1000, Chicago, Illinois 60602, and the attached consent from The Steans Family Foundation, who address is 50 E. Washington Street, Suite 410, Chicago, Illinois 60602.
82927191\V-1
John J. Lawlor
Partner
Salans FMC SNR Denton
dentons com
Dentons US LLP
233 South Wacker Drive
Suite 7800
Chicago, IL 60606-6306 USA
T +1 312 876 8000 F +1 312 876 7934
October 2, 2014
Honorable Daniel Solis Chairman, Committee on Zoning 121 North LaSalle Street Room 304, City Hall Chicago, Illinois 60602
Re: Legacy Charter School Application to Rezone 3300-3330 W. Ogden Avenue, Chicago, Illinois from C1-2 to RT4
The undersigned, John J. Lawlor, being first duly sworn on oath deposes and states the following:
The undersigned certifies that he has complied with the requirements of Section 17-13-0107 of the Chicago Zoning Ordinance by sending written notice to such property owners who appear to be the owners ofthe property within the subject 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. Said "written notice" was sent by United States Postal Service, First Class Mail, no more than 30 days before filing the application.
The undersigned certifies that the notice contained the common address and the boundaries 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 party who owns or controls the property; a statement that the applicant intends to file the application for a change in zoning on approximately September 30, 2014; and a source for additional information on the application.
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 ofthe Chicago Zoning Ordinance based on ownership information from the most recent authentic records of Cook County, 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 ofthe people require to be served.
Subscribed and sworn to before me this
day of ,2014.
Sincerely,
MARY V. SARVER
Notary Public, State of Illinois \ 4 My Commission Expires ►
330S3754W-2
John J. Lawlor
Partner
Salans FMC SNR Denton
dentons com
Dentons US LLP
233 South Wacker Drive
Suite 7800
Chicago, IL 60606-6306 USA
T +1 312 876 8000 F +1 312 876 7934
October 2, 2014
Re: Legacy Charter School Application to Rezone 3300-3330 W. Ogden Avenue, Chicago, Illinois (including the adjacent alley) from the C1-2 Neighborhood Commercial District to the RT4 Residential Two-Flat, Townhouse and Multi-Unit District
Dear Property Owner or Resident:
We are attorneys for Legacy Charter School, an Illinois not-for-profit corporation (the "applicant"), whose address is 4217 West 18th Street, Chicago, Illinois 60623.
In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance, specifically Section 17-13-0107, please be informed that on or about September 30, 2014, the undersigned will file an application to rezone the property commonly known as 3300-3330 W. Ogden Avenue, Chicago, Illinois, together with the adjacent alley (the "subject property") further described on Exhibit A, attached, from its existing C1-2 Neighborhood Commercial District Zoning classification to the RT4 Residential Two-Flat, Townhouse and Multi-Unit District zoning classification. The applicant intends to utilize the subject property for a new elementary school containing approximately 23 classrooms, gym, administrative offices, cafeteria, and accessory facilities, including landscaped grounds and surface parking to be located on the subject property and on contiguous property to the north which is already in an existing RT4 zoning district that is commonly known as 1647-1655 S. Christiana and 1646-1648 S. Spaulding.
At present, the subject property is vacant; the existing alley will be partially vacated but will remain functional by means of dedicating a new east/west link to S. Spaulding Avenue.
The City of Chicago and the Steans Family Foundation, which are the owners of the subject property, are located at 121 N. LaSalle Street, Chicago, Illinois and 50 East Washington Street, Suite 410, Chicago, Illinois 60602, respectively. The contact person for this application for additional information is John J. Lawlor, Esq., c/o Dentons US LLP, 233 S. Wacker, Suite 7800, Chicago, Illinois 60606.
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 tax records of Cook County indicate that you own property within 250 feet of the property to be rezoned.
Sincerely,
3305375l\V-2
#~\ 8(81
CITY OF CHICAGO
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS of the property Applicant is seeking to rezone:
3300-3330 W. Ogden Avenue, Chicago, Illinois
Ward Number that property is located in: 24th
Legacy Charter School
APPLICANT c/o Erro1 Stone
; Dentons US LLjV
ADDRESS 233 S. Wacker Dr., Suite 7800 CITY Chicago
STATE IL ZIP CODE 60606 PHONE 312-876-7459
y
Dentons US LLP
Is the applicant the owner of the property? YES NO xxx
Ifthe 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 See Exhibit 1, attached hereto and made part hereof
ADDRESS CITY
STATE ZIP CODE PHONE
EMAIL CONTACT PERSON
Ifthe Applicant/Owner ofthe property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY John J. Lawlor, Esq., Dentons US LLP
ADDRESS 233 S. Wacker Drive, Suite 7800
CITY Chicago STATE IL ZIP CODE 60606
PHONE 312-876-7459 312-876-7423 EMAtjljohn.lawlor@dentons.c
If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
Applicant is an Illinois not-for-profit corporation; as
a result, it has no owners.
On what date did the owner acquire legal title to the subject property? See Exhibit 1, attached
Has the present owner previously rezoned this property? If yes, when?
No
Present Zoning District Cl-2 Proposed Zoning District RT4
T ^ . . £ t, -\ 36,325 square feet
Lot size in square feet (or dimensions) -_2
Current Use of the property Vacant
Reason for rezoning the property To include the subject property within the zoning lot for a new elementary school located on contiguous RT4 property to the
north once the intervening alley js vacated.
landscaped grounds and surrace parking. Describe the proposed use of the property after the rezoning. Indicate the number of dwelling
units; number of parking spaces; approximate square footage of any commercial space; and
height of the proposed building. (BE SPECIFIC) As a new elementary school
providing approximatelyj23 classroom, gym, administrative offices, cafeteria and accessory facilities including landscaped grounds and surface parking.
On May 14th, 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
_, 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.
to before me this
2014
4 4
OFFICIAL SEAL MARY V. SARVER Notary Public, State of Illinois My Commission Expires August 27,2015
4 4
♦l
Subscribed and Swoi /vr day of
LEGACY CHARTER SCHOOL, an Illinois not-for-profit corporation
Signature of Applicant
By: STfiA?*
Its: UjL^
2/- Sztw*t
Notary Puolic
For Office Use Only
6
Date of Introduction:.
File Number:
Ward:
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Legacy Charter School, an Illinois not-for-profit corporation
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
- [x] the Applicant
OR
- [] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (see Section II.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: 4217 w. 18th street, North Building - ,
Chicago, IL 60623
- Telephone: 773-542-1640 Fax: 773-542-1699 ■ Email. errol.stone@dentons.com
- Name of contact person: Erroi stone
- Federal Employer Identification No. (if you have one): .
- Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Zoning amendment for 3300-3330 W. Ogden Avenue, Chicago, Illinois
G. Which City agency or department is requesting this EDS? Dept. of Planning and Development;
Community Development Commission
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 ofthe Disclosing Party:
Person [ ]
Publicly registered business corporation [ ]
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))?
[]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 [x] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
Ifthe 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 ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
See Exhibit A attached hereto and made part hereof.
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% ofthe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
1
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 ofthe 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
Not applicable.
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes rx] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
See Exhibit B attached hereto and made part hereof.
(Add sheets if necessary)
[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS
- COURT-ORDERED CF11LD 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 [*] No person directly or indirectly owns 10% or more of the
Disclosing Party:
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[]Yes []No
- FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe 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 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 ofthe offenses set forth in clause B.2.b. of this Section V;
- have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
- have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
- The certifications in subparts 3, 4 and 5 concern:
- the Disclosing Party;
- any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
- any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls, the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
- any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
i
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 ofthe City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
- agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
- made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
- 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) ofthe 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
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.
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, ofthe City of Chicago (if none, indicate with "N/A" or "none").
None.
9. To the best ofthe 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 ofthe 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 ofthe Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe 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
i
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?
[ ] 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?
[x] Yes [ ] No
- If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
_^ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found 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 ofthe 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 ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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- The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
- The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
- If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
- Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[]Yes []No
- Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the 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:
- 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, 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. 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 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
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F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
Legacy Charter School, an Illinois not-for-profit corporation
(Print or type name of Disclosing Party)
(Sign here)
Errol Stone
(Print or type name of person signing)
Board Chairman
(Print or type title of person signing)
Signed and sworn to before me on (date) _
at C6pk County, Z&ilffMi V
Commission expires:
(state). Notary Public.
< OFFICIAL SEAL \
\ ROBIN L. JESSEN ►
] Notary Public, State of Illinois
« My Commission Expires
J October 4, 2015
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" 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. 1.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes [x] 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.
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EXHIBIT A
BOARD OF DIRECTORS
Leslie Davis, Vice Chairman Lisa Kenner Charles Leeks Susan Lucas
Robert Messerly, Secretary
John O'Donnell
Duane Quaini
Elke Rehbock
Errol Stone, Chairman
Howard Sulkin
Andrew Tobin, Treasurer
Carolyn Vessel
Benjamin Weinberg
Debra Wesley-Freeman
John Willis
SOLE MEMBER
Dentons US LLP (That entity has over 350 partners; no individual's interest is in excess of 7.5%. Responses are limited to the Dentons US LLP entity.)
I3I1180IW-4
EXHIBIT B
SUBCONTRACTORS AND OTHER RETAINED PARTIES
Name (indicate whether retained or anticipated to be retained)
Jack Lawlor (retained)
Errol Stone (retained)
Business Address
Dentons US LLP
233 S. Wacker Dr., Suite 7800
Chicago, IL 60606
Dentons US LLP
233 S. Wacker Dr., Suite 7800
Chicago, IL 60606
Relationship to Disclosing Party (subcontractor,
attorney, lobbyist, etc.)
Attorney
Attorney
Fees (indicate whether
paid or estimated). NOTE: "hourly rate" or "TBD" is not an acceptable response. None
None
13111801W-4
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Steans Family Foundation
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
- [ ] the Applicant
OR
- [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (see Section II.B. 1.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 50 E. Washington, Suite 410
Chicago, IL 60602
^ ~ , , 312^67-5900 - 312-467-1229
- Telephone: Fax:
r-v xt e * * Patricia Ford
- Name oi contact person:
- 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, if applicable):
Zoning amendment for 3300-3330 W. Ogden Avenue, Chicago, Illinois
G. Which City agency or department is requesting this EDS?
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # ^/A and Contract #
Ver. 01-01-12
Page 1 of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
General partnership Limited partnership
Trust
1. Indicate the nature of the Disclosing Party: Person [ Publicly registered business corporation [ Privately held business corporation [ Sole proprietorship [;
[ ] Limited liability company [ ] Limited liability partnership [ ] Joint venture [y] Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
|x] 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
[X] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
See attached
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe 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 III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes [ ] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
N/A
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
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 ofthe relationship, and the total amount ofthe 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: (I ) 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.
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Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
None
(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-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 [x] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[]Yes []No
- FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe 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, ifthe 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, 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:
-
- any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
- any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
- any responsible official ofthe 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 ofthe City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
- agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
- made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
- 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 ofthe Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
- The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
- If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
N/A
Page 6 of 13
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 ofthe City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
- agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
- made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
- 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 U nited 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 ofthe U.S. Department ofthe 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:
N/A
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
N/A
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate
with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient. I
N/A , i
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
- The Disclosing Party certifies that the Disclosing Party (check one)
L 3 is |x] 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 loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in
Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter
2-32 of the Municipal Code, explain here (attach additional pages if necessary):
N/A ' "
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i i
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?
[ ] Yes [x] No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
- Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ ] Yes [X] No
- If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
N/A
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
* 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe 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 ofthe 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 ofthe Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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- The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
- The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
- If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] 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 ofthe 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:
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SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
- The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
- The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from' the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
- If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
- It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
- The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
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F.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 Ifthe 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: Ifthe Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
(Sign here) Patricia Ford
(Print or type name of person signing) Executive Director
(Print or type title of person signing)
Signed and sworn to before me on (date) _ '"} , c? cf 11 *~7~
at i.M)\~ County, imo\ ^ (state).
Notary Public.
7
n-
1-1
Commission expires:_
Page 12 of 13
MARION C. ZEHNER
OFFSCiAL SEAL Notary Public - State of Illinois My Commission Expires -A-iy 01, 2018
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B. 1 .a., if the 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 [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.
N/A
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Steans Family Foundation
Section II, B, 1 Attachment to the EDS
Chairman ofthe Board and President: Harrison I. Steans
Vice President: Treasurer: Assistant Treasurer: Secretary: Assistant Secretary:
Lois Steans Jennifer W. Steans Lois M. Steans Heather A. Steans Robin M. Steans
Directors: Harrison I. Steans
Reginald Jones Lois M. Steans Jennifer W. Steans Heather A. Steans Robin M. Steans James P. Kastenholz Leo A. Smith Leonard A. Gail
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Community Facility, LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
- [ ] the Applicant
OR
- [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
- [] a legal entity with a right of control (see Section II.B. 1.) State the legal name of the entity in
which the Disclosing Party holds a right of control: .
4. [x] the record title owner of a portion of the property that is the subjecroTthe undertaking Identified in Section I, F, which
Disclosing Party has agreed to convey to Applicant.
B. Business address of the Disclosing Party: c/o Steans Family Foundation
50 E. Washington, Suite 410, Chicago, IL 60602
- Telephone: 312-467-5900 Fax: 312-467-1229 Email: pford@fic-sff.com
- Name of contact person: Patricia Ford
- 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, if applicable):
Zoning amendment for 3300-3330 W. Ogden Avenue, Chicago, Illinois
G. Which City agency or department is requesting this EDS? Department of Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract # N/A
Ver. 01-01-12
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SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature of the Disclosing Party:
Person [x]
Publicly registered business corporation [ ]
Privately held business corporation [ ]
Sole proprietorship [ ]
General partnership (Is
Limited partnership
Trust [ ]
Limited liability company Limited liability partnership Joint venture
Not-for-profit corporation
the not-for-profit corporation also a 501(c)(3))?
[ ] Yes [ ] No
Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: 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 [ J No [x] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title Patricia Ford Manager
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
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe 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): N/A
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe 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.
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Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
N/A
(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-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 ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ J Yes |x] No [ ] No person directly or indirectly owns 10% or more ofthe
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ ] Yes [ ] No
- FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), ifthe 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, ifthe 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, state or local unit of government;
- have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
- are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
- have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
- have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
- The certifications in subparts 3, 4 and 5 concern:
-
- any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
- any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
- any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
-
- bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
- agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
- made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
- 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 (I) 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 ofthe 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) ofthe Municipal Code.
- If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
N/A
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe 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, ofthe City of Chicago (if none, indicate with "N/A" or "none"). None
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than S20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe 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 that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe 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 ofthe Municipal Code, explain here (attach additional pages if necessary):
N/A
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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 ofthe 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 ofthe 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 information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
x 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
N/A
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
N/A
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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- The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
- The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe 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".
- Ifthe 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 ofthe 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 information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[]Yes |xj 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 ofthe 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 I. or 2. above, please provide an explanation: N/A
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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, 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 ofthe 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 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
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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 Ifthe Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf ofthe 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.
(Sign here)
Patricia Ford
(Print or type name of person signing)
Manager, Community Facility, LLC
(Print or type title of person signing)
Signed and sworn to before me on (date) _ at (J-QD^l- County, ."Q 1 \v^r>fj>
Hi
.1-1- IK
4.
Commis&jott expires:
(state). Notary Public.
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MARION C. ZEHNER
OFFICIAL SEAL \ Notary Public - State of Illinois My Commission Expires July 01, 2018
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any. elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic ■ partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-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. 1.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes [x] No
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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