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 the Ml-3 Limited Manufacturing/Business Park
District symbols and indications as shown on Map N0.6-E in the area bounded by
a line 200.26 feet north of and parallel to East 26lh Street; South Wabash Avenue; a line 100.13 feet north of and parallel to East 26th Street; and a line 180.68 feet west of and parallel to South Wabash Avenue,
to those of a C1-5 Neighborhood Commercial District and a corresponding
uses district is hereby established in the area above described.
SECTION 2. This ordinance shall be in force and effect from and after its passage and due publication.
2540 South Wabash Avenue
Common Address of Property:
ZONING MATRIX / ANALYSIS
Project Description: The Applicant proposes to renovate the existing building located at 2540 S. Wabash so that it can be used as a retail bike and repair shop. The existing building has a building footprint of approximately 27,428 square feet. It is currently a vacant, warehouse building. The Applicant seeks to rezone the property to allow the interior renovation of this building for a retail use. Specifically, Kozy Cyclery will sell bicycles, bicycle parks and accessories as well as perform repairs on bikes. There will be approximately 8-13 employees, depending on the season. The Applicant hopes to commence construction as soon as the entitlement process is complete.
Existing:
18,097.30 SF 27,428
Address/ Location: 2540 S. Wabash Current Zoning: M13
Parcel /Lot Area: Building Area:
PROPOSED:
Address / Location: 2540 S. Wabash
Proposed Zoning: CI-5
Parcel /Lot Area: 18,097.30 SF
Building Area: 27,428
Page 1 of 1
Map Output
Created on: 7/10/2014 11:04 A.M
'Zoning data reflects all ordinances passed in the moat recent Citv Council maeling'jf^" ■<^pyriaM:tc)'20;1J ?!<!%'oM%ibagoJgjH
Zoning Mai
Address
2540 S WABASH AVE
Zoning | | Business | | Commercial | | Manufacturing I | Residential | | Planned Development | | Planned Manufacturing |BK| Downtown Core | | Downtown Service | | Downtown Mixed | | Downtown Residential m Transportation I | Parks & Open Space Zoning Boundaries
Historic Preservation CHICAGO LANDMARKS | Chicago Landmarks
| Landmark Districts
Chicago Historic Resources Survey - Buildings subject to Demolition-Delay Ordinance |~~1 Red ] | Orange
| | Water | | Cemetery
jjjjH Lakefront
Pedestrian Streets | | Buildings | | Parcels £/K Streets /*<. Curbs
m Forest Preserve gj| Aerials (April 2008)
Information provided on the City of Chicago web site should not be used as a substitute for legal, accounting, real estate, business, tax, or
other professional advice. The City of Chicago assumes no liability for any damages or loss of any kind that might arise from the use of,
misuse of, or the inability to use the City web site and-or the materials contained on the web site. The City of Chicago also assumes no
liability for improper or incorrect use of materials or information contained on its web site. All materials that appear on the City of Chicago
i/veb site are distributed and transmitted as is, without warranties of any kind, either express or implied, and subject to the terms and
conditions stated in this disclaimer.
httns7/pisanns r.itvnfr.hir.flori nroVservlet/r.nm esri esriman F,srirnan^Servif'.eNaTTie=nvervie 7/1 0/701 4
LEGEND:
Q = SEWER MANHOLE
& ■- WATER VALVE CQj = UTILITY POLE _ TRAFFIC SIGN
FLOOD CERTIFICATE
ACCORDING TO TH FLOOD INSURANCE
DATED
THIS PROPERTY IS AS ZONE "X". COli (AREAS DETERMINE
NO FIELD SURVEYI
LOT
LOT 5
REVISED SEPTEMBER 25. 2014. (ADDED CERTIFICATION NAME)
NOTE:
THERE ARE NO PARKING SPACES ON SITE.
BASIS:
CHICAGO TITLE INSURANCE COMPANY, COMMITMENT NO. 1412 WSA447421 LP1. EFFECTIVE DATE: JULY 15. 2014.
THE LEGAL DESCRIPTION SHOWN ON THE PLAT HEREON DRAWN IS A COPY OF THE ORDER. AND FOR ACCURACY SHOULD BE COMPARED WITH THE TITLE OR DEED.
DIMENSIONS ARE NOT TO BE ASSUMED FROM SCALING.
BUILDING LINES AND EASEMENTS ARE SHOWN ONLY WHERE THEY ARE SO RECORDED IN THE MAPS, OTHERWISE REFER TO YOUR DEED OR ABSTRACTS.
ORDER NO.: 14-87972
SCALE: 1 INCH = !§ FEET
DATE OF FIELD WORK: Augus^JS^OI^
ORDERED BY: PALM I SAN O Sc. MOLTZ
Attorneys at Law
180.2' REC. 180.59' MEAS.
N. Line of E. 26th St.-
RAL EMERGENCY MANAGEMENT AGENCY (FEMA)
(MAP OF CITY OF CHICAGO ILLINOIS
h AUGUST 19. 2558T
(MINIMUM FLOODING AREA AND IS DESIGNATED
rr PANEL NUMBER 170074 0507 J
.BE OUTSIDE THE 0.255 ANNUAL CHANCE FLOODPLAIN)
is PERFORMED TO DETERMINE THIS ZONE.
TO
- KOZIOL LLC
- NORTH COMMUNITY BANK. 180 N. LASALLE STREET. CHICAGO IL 60601
- CHICAGO TITLE INSURANCE COMPANY
THIS IS TO CERTIFY THAT THIS MAP OR PLAT AND THE SURVEY ON WHICH IT IS BASED WERE MADE IN ACCORDANCE WITH THE 2011 MINIMUM STANDARD DETAIL REQUIREMENTS FOR ALTA/ACSM LAND TITLE SURVEYS. JOINTLY ESTABLISHED AND ADOPTED BY ALTA AND NSPS. AND INCLUDES ITEMS 1. 2. 3. 4. 7(a), 7(b)(1) 7(c). B. 9. 11 (a) AND 14 OF TABLE A THEREOF. THE FIELD WORK WAS COMPLETED ON AUGUST 18. 2014.
DATE OF PLAT September 26 2014
; /fefe^ m^<£Ury\
IL PROF. LAf^D SURVEYOR NUMBER 035-002819 MY LICENSE EXPIRES NOVEMBER 30. 2014.
Drawn By: ZZ. N.M.
r
66" R.O.W. PUBLIC STREET
AVE
Concrete Curb
5 g
o so
s 1
o
P3
AFFIDAVIT
Chairman Solis
Committee on Zoning Room 304, City Hall 121 North LaSalle Street Chicago, Illinois 60602
APPLICANT: Koziel, LLC
RE:
2540 S. Wabash
Dear Chairpersons:
The undersigned, Meg George, an attorney for the Applicant, Koziel, LLC, being first duly sworn on oath, deposes and states the following:
That the undersigned certifies that she has complied with the requirements of Section 17-13-0107 of the Chicago Zoning Ordinance of the City of Chicago Municipal Code by sending the attached letter by United States Postal Service First Class Mail to the owners of all property within 250 feet in each direction of the property to be rezoned, as determined by the most recent Cook County tax records of Cook County, the address of which is commonly known as 2540 S. Wabash, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet; and that the notice contained the common street address of the subject property, a description of the nature, scope and purpose of the application or proposal; the name and address of the Applicant; the date the Applicant intends to file the application to rezone the Property i.e. on October 8, 2014; that the Applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-107 and 17-13-0604-B of the Chicago Zoning Ordinance, that the Applicant certifies that the accompanying list of names and addresses of surrounding properties located within 250 feet of the subject property (excluding public roads, streets and alleys), is a complete list containing the names and last known addresses of the owners of the property required to be served, and that the Applicant has furnished, in addition, a list of the persons so ser
By:
1 'HiLJEfi.gbMVrftr
OFFICIAL SEAL . Notary Public - State of Illinois My Commission Expires MavO*L»»7 , .
Subscribed and sworn to before me
this day of October 2014.
Notary Public \J
I
NOTICE OF FILING OF APPLICATION FOR REZONING
APPLICANT: Koziel, LLC
PROPERTY: 2540 S. Wabash
PROJECT: Kozy's Cyclery
DATE: October 8, 2014
Dear Sir or Madam:
In accordance with the requirements of Section 17-13-0107 of the Municipal Code ofthe City of Chicago, please be informed that on or about October 8, 2014, Koziel, LLC, will file an application to change the zoning for the property located at 2540 S. Wabash from its current Ml-^ Limited Manufacturing Business Park District designation to the CI-5 Neighborhood Commercial District. The purpose of the rezoning is to allow Koziel, LLC to renovate the existing building for use as a retail bike and repair shop.
The property is currently owned Koziel, LLC. Koziel, LLC is located at 3541 S. Hermitage, Chicago, IL 60609. Questions regarding this school project or the rezoning of the property may be addressed to Meg George at Neal & Leroy, LLC 120 North LaSalle Street, Suite 2600 Chicago, Illinois 60602 (312) 641-7144.
PLEASE NOTE: THE APPLICANT IS NOT SEEKING TO REZONE YOUR PROPERTY. THIS NOTICE IS BEING SENT TO YOU BECAUSE YOU OWN PROPERTY WITHIN 250 FEET OF THE BOUNDARIES OF THE NEW PROPOSED PROJECT
T\
^ 18
CITY OF CfflCAGO
APPLICATION FOR AN AMENDMENT TO THE CfflCAGO ZONING ORDINANCE
- ADDRESS of the property Applicant is seeking to rezone:
- 2540 S. Wabash
- Ward Number that property is located in: 3"* Ward
3. APPLICANT: Koziel, LLC
ADDRESS: c/o Neal & Leroy, LLC, 203 N. LaSalle, Suite 2300
CITY Chicaeo STATE Illinois ZIP CODE 60601
PHONE: 312.641.7144 CONTACT PERSON Meg George
Is the applicant the owner of the property? YES X NO
If the applicant is not the owner of the property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed.
OWNER
ADDRESS
CITY STATE ZIP CODE.
PHONE CONTACT PERSON
If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Neal and Leroy, LLC
ADDRESS 203 N. LaSalle Street. Suite 2300 CITY Chicago
CITY Chicago STATEJL ZIP CODE 60601
PHONE (312)641-7144 FAX (312) 641-5137
6. If the applicant is a corporation please provide the names of all shareholders as disclosed on the Economic Disclosure Statements. See Attached EDS form
- On what date did the owner acquire legal title to the subject property?
September 26, 2014
- Has the present owner previously rezoned this property? If yes, when?
No it has not.
- Present Zoning: Ml j Proposed Zoning: Cl-5
- Lot size in square feet (or dimensions?) 18,000 SF
- Current Use of the Property vacant, warehouse, mixed use building
- Reason for rezoning the property To allow for a commercial, retail use.
- Describe the proposed use of the Property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and height of the proposed building (BE SPECIFIC)
The Applicant proposes to redevelop the existing building into a Kozy Cyclery retail
sales and repair shop.
- On May 14, 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
Ronald S. Koziel
. being first duly sworn, on oath deposes and states, that
all of the above statements and the statements contained in the documents submitted herewith are true.
Subscribed and sworn to before me this
2014
Notary Public
"sehphIt
"OFFICIAL SEAL Notary public - ftataof IIHnols
For Office Use Only
INTRODUCED BY: DATE
COMMITTEE ON
BUILDINGS
&
REZONING STAFF
REFERRED TO:
FILE NO.:
ZONING WARD NO. .
CHICAGO PLAN COMMISSION
3
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
- Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Koi.iz.1. 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
3. [ ] a legal entity with a right of control (see Section TI.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
- Business address ofthe Disclosing Party: 3 -5 *ff S~. ~H £ K A/ / 7?T Qi is.
- Telephone: ~Z%7-#2 1 L> Fax: 3 I2-S87- X'9'& j Email: /?0 /Cd Z Y,
- Name of contact person: /Xt/JAt-fS /\ O'^/ir-C
- 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):
The applicant seeks to rezone the property located at 2540 S. Wabash from the Ml^ zoning district to the CI-5 zoning district in order to redevelop an existing building into a commercial use.
- Which City agency or department is requesting this EDS? Committee on Zoning
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Vpr ni_ni_n
Pare 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party: Person
Publicly registered business corporation [ ]
Privately held business corporation [ ]
Sole proprietorship [ ]
General partnership (Is
Limited partnership
Trust [ ]
Limited liability company Limited liability partnership Joint venture
Not-for-profit corporation
the not-for-profit corporation also a 501(c)(3))?
[ ] Yes [ ] No
Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
ZLLL /AO iS
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 |)rj 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
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.
Pape2of 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
A 1/ 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 MNo
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.
Pape3nf 1.3
Name (indicate whether retained or anticipated to be retained)
Business Relationship to Disclosing Party Fees (indicate whether
Address (subcontractor, attorney, . paid or estimated.) NOTE:
lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
% (2 OoO . rO
(Add sheets if necessary)
$ Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
- COURT-ORDERED CHILD SUPPORT COMPLIANCE
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 J>f No [ ] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ ] Yes [ ] No
- FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Pape 4 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
- bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
- agreed or colluded with other bidders or prospective bidders, or been a party to any 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 ofthe U.S. Department of the Treasury or the Bureau of Industry and Security ofthe 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:
NA
Pare 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 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 of the City recipient.
Aa
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
- The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is ^fis not
a "financial institution" as defined in Section 2-32-455(b) ofthe 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." c
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):
/VA
Pare 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
- In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes No
NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. If you checked "No" to Item D.L, proceed to Part E.
- Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[]Yes MNo
- If you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
NA
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
Pape 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
NA
(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.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.
Pare 9 of 13
- The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
- The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
- If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
(4 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 j}<fNo
- 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 J>tfNo
- Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[]Yes JxlNo
If you checked "No" to question 1. or 2. above, please provide an explanation:
/>o /vo-r tf/tVE A // Y .£ A Pc O Y£j£- £
Pape 10 of 13
l
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.1. 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.I., 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.
LLC
(Print or type name of Disclosing Party)
By; / -■- -'*-7--c-g*
-'t*i.-r
(Sign here) ^ (Print or type name of person signing)
/V\ANAC*£K
(Print or type title of person signing)
Signed and sworn to before me on (date,)
at lMlr#- County, <>Jl/xvUu1^ (state).
Notary Public.
i» o ~ .T.
HILLIE M. SEMPHII OFFICIAL SEAL .
Notary Public - State of Illinois
Mv Commission Expires
MfvJRlj2CH7 ■
Pape 12 nf 13
Commission expires
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 ofthe Disclosing Party listed in Section H.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes OtfNo
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.
Pape 13 of 13