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This record contains private information, which has been redacted from public viewing.
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Type:
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Ordinance
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Status:
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Passed
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Title:
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Zoning Reclassification Map No. 14-C at 5543-5559 S Cornell Ave, 1634-1664 E 56th St, 5534-5558 S Cornell Ave, 1604-1624 E 56th St and 5528-5532 S Cornell Ave - App No. 18328
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Topic:
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ZONING RECLASSIFICATIONS - Map No. 14-C
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FINAL FOR PUBLICATION SUBSTITUTE OR.DINANCE Be It Ordained by the City Council of the City of Chicago: SECTION 1. Title 17 ofthe Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all Residential-Business Planned Development No. 282, As Amended and other symbols and indications as shown on Map Number 14-C in the area bounded by: a line 264.06 feet south of and parallel, to East 55th Street; South Cornell Avenue; the alley next north of and parallel to East 56th Street (lying east of South Cornell Avenue); South Hyde Park Boulevard; East 56th Street; a line 200.02 feet west of and parallel to South Cornell Avenue; the alley next north of and parallel to East 56th Street (lying west of South Cornell Avenue); and the alley next west of and parallel to South Cornell Avenue to those of Residential-Business Planned Development No. 282, As Amended, which is hereby established in the area described above, subject to such use and bulk regulations as are set forth in the Plan of Development herewith attached hereto and made a part hereof and no others. SECTION 2. This Ordinance shall be in force and effect from and after its passage and due publication. Common Addresses: 5543-59 South Cornell Avenue/ 1634-64 E. 56th Street 5534-58 South Cornell Avenue/1604-1624 E. 56th Street 5528-32 South Cornell Avenue I Residential-Business Planned Development Number 282, as Amended Plan oi" Development Statements The area delineated herein as Residential-Business Planned Development Number 282, as Amended (the "PlannedlDevelopment") consists of approximately one hundred twenty thousand nine hundred fifty (120,950.44) square feet (two and seventy-eight hundredths (2.78) acres) (the "Property") net site area which is depicted on the attached Planned Development Boundary, Property Line, Right-of-Way Adjustment and Subarea Map. The property is divided into three (3) subareas. Subarea A is owned by Windermere House, LLC. Windermere House, LLC is "Applicant" under this Ordinance with respect to Subarea A; Solstice on the Park, LLC is "Applicant" with respect to Subarea B; and 5528 S. Cornell Avenue Owner, LLC is "Applicant" witli respect to Subarea C. Windermere House, LLC, Solstice on the Park, LLC and 5528 S. Cornell Avenue Owner, LLC are collectively referred to in this Ordnance as the "Applicants". All applicable official reviews, approvals or permits implementing this Planned Development are required to be obtained by the Applicant or Applicants as specified in Statement 3. Any dedication or vacation of streets, alleys, or easements, any adjustments of right-of-way, or any consolidation or re-subdivision of parcels, shall require a separate submission on behalf of such Applicants or their respective successors, assignees, or grantees and approval by the City Council. The requirements, obligations and conditions contained within this Planned Development shall be binding upon each Applicant* its respective successors and assigns, grantees and lessees and, if different than an Applicant, the legal titleholders:or any ground lessors of its Subarea. All rights granted hereunder to the Applicants shall inure to the benefit of the Applicants' respective successors and assigns and, if different than the Applicants, the legal titleholder or any ground lessors of their respective Subareas. Furthermore, pursuant to the requirements of Article 17-8-0400 ofthe Chicago Zoning Ordinance, at the time applications for amendments, modifications or changes (administrative, legislative or otherwise) to this Planned Development are made, the Property shall be under single ownership or under single designated control. Single designated control for purposes of this Statement shall mean any application to the City for any amendment to this Planned Development or any other modification or change thereto (administrative, legislative or otherwise) shall be made or authorized by all the owners of the Property and any ground lessors, subject however to the following exceptions and conditions: (a) an agreement among property owners, the board of directors of any property owners association, or a covenant binding property owners may designate the authorized party for any future amendment, modification or change; (b) except to the extent such an agreement is in effect, any changes or modifications to this Planned Development applicable to or in a given Subarea need only be made or authorized by the owners and/or any ground lessees of such Subarea provided there is no adverse effect on any other Subarea; and (c) where portions of the improvements located APPLICANTS: Subarea A: Windermere House, LLC; Subarea B: Solstice on the Park, LLC; Subarea C: 5528 S. Cornell . Avenue Owner, LLC ADDRESSES: Subarea A: 5543-59 S. Cornell Ave./1634-64 E. 56"' St.; Subarea B: 5534-58 S. Cornell Ave./1604-1624 E. 56,h St.; Subarea C; 5528-32 S. Cornell Ave. DATE: March 11, 2015 REVISED: February 18, 2016 I I i I I I I FINAL FOR PUBLICATION on the Property have been submitted to the Illinois Condominium Property Act, the term "owner" shall be deemed to refer solely to the condominium association ofthe owners of such portions of the improvements and not to the individual unit owners therein. 4. The following uses shall be permitted within the Planned Development: Subarea A: Multi-unit residential, accessory and related uses, and Residential Support Services as enumerated in Section 17-17-01.04-Y ofthe Zoning Ordinance, provided, however, Subarea A. at the time of adoption of this amended Planned Development Ordinance has approximately thirty thousand (30,000) square feet of floor area devoted to non-residential uses, including including retail, General Restaurant, office, medical office, dental office, and daycare/childcare facilities and may continue to have those and similar non-residential uses within no more than thirty thousand (30,000) square feet of floor area. Subarea B: Multi-unit residential; Vacation Rental; accessory parking for all three Subareas; up to 45% non-accessory parking in accordance with Section 17-10-0503 of the Zoning Ordinance, including six (6) parking spaces for the adjacent school site, provided that no special use shall be required for the foregoing; uses that are accessory and related amenities for the principal residential use, including fitness center, pool, meeting rooms and office space to support residents engaged in school or home occupations, party room, convenience retail not to exceed 1,500 square feet in floor area, and drop-off dry cleaners (no On-Premise plant). Subarea C: Multi-unit residential and accessory uses. Any portion of the Property may be used on an interim basis during construction for construction staging, the storage of construction materials, and parking for construction purposes. 5. This Planned Development consists of these seventeen (17) statements, a Bulk Regulations and Data Table, and the following plans (collectively, the "Approved Plans") prepared by Studio/Gang/Architects, Ltd. and dated February 18, 2016: Existing Zoning Map; Planned Development Boundary, Property Line, Right-of-Way and Subarea Map; Site Plan - Extended; Subarea B Site Plan; Landscape Plan; Landscape Detail; Green Roof Plan; Lower Level Parking and Tower Plan; Level 1 Parking and Tower Plan; Level 2 Parking Plan; Level 3 Parking Plan and Subarea B Souths North, East and West Elevations. These and no other zoning controls shall apply to the Property. The Planned Development conforms to the intent and purpose of the Chicago Zoning Ordinance, Title 17 ofthe Municipal Code of Chicago, and all requirements thereof, and satisfies the established criteria for approval as a planned development. In any instance where a APPLICANTS: Subarea A: Windermere House, LLC; Subarea 13: Solstice on the Park, LLC; Subarea C: 5528 S. Cornell Avenue Owner, LLC ADDRESSES: Subarea A: 5543-59 S. Cornell Avc./1634-64 E. 56,h St.; Subarea B: 5534-58 S. Cornell Ave./1604-1624 E. 56'" St.; Subarea C: 5528-32 S. Cornell Ave. DATE: March 11,2015 REVISED: February 18,2016 I i provision of this Planned Development conflicts with the Chicago Building Code, the Building Code shall control. On-Premise signs shall be permitted within the Planned Development subject to the review and approval of the Department of Planning and Development (the "Department"). Temporary signs such as construction and marketing signs shall be permitted subject to the review and approval of the Department. Off-Premise signs shall not be permitted in the Planned Development. The improvements on Subarea B of the Property shall be designed, constructed, and maintained: (i) in substantial conformance with this Planned Development and the Subarea B Site Plan, Landscape Plan, and Building Elevations; and (ii) in accordance with the parkway tree and the landscaping and screening provisions of the Chicago Zoning Ordinance. With respect to the driveway and vehicle use area on the south side of the building proposed for Subarea B, where the unique design of the building is reflected in the Site Plans and Landscape Plans, the Approved Plans shall control. The landscaping and screening provisions of the Chicago Zoning Ordinance shall control in the event of any other conflict with the Subarea B Site Plans and Landscape Plans. Off-street parking and off-street loading facilities shall be provided in compliance with this Plan of Development. The required parking. facilities within the Planned Development shall be permitted to have drive aisle and parking space dimensions in substantial conformity with those" depicted oh'the Approved Plans. Nothing in this Plan of Development will prohibit automotive lifts or valet parking if applicable approvals and licenses are obtained:; Any service drive or any other means of'.ingress or egress, including for emergency vehicles, shall be adequately designed and paved in accordance with the provisions of the Municipal Code and the regulations of the . Chicago Department of Transportation ("CDOT");in effecf at the-time of review. Tnere.shall be no parking of storage of garbage receptacles within such service drives or within fire lanes. Any change to off-street parking ingress and egress as depicted in the Approved Plans shall be subject to the review arid approval of CDOT and the Department. All work ih the public way must-be designed and constructed in accordance with CDOT Construction Standards for Work in the Public Way and in compliance with the ; Municipal Code of the City of Chicago. Closure of all or part of any public streets or alleys during demolition or construction shall be subject to the review and approval of CDOT. The Applicants as. specified in Statement 3 shall obtain the applicable official reviews, approvals and permits from the various City Departments and or Committees regarding the use of the public way for any encroachments of public way space including encroachments on, over or under the street, sidewalk, parkway or alley. Such approval APPLICANTS: Subarea A: Windermere House, LLC; Subarea B: Solslice on the Park, LLC; Subarea C: 5528 S. Cornel! Avenue Owner, LLC ADDRESSES: Subarea A: 5543-59 S. Cornell Avc./l634-64 E. 56"' St.; Subarea B: 5534-58 S. Cornell Avc./l604-1624 E. 56,b St.; Subarea C: 5528-32 S. Cornell Ave. DATE: March 11,2015 REVISED: February 18, 2016 ! ra/M. rim s^UbLlCA'i ION and permits sliall require a separate submittal on behalf of such Applicants or their respective successors, assignees or grantees and approval by the City Council. For purposes of height measurement, the definitions in the Zoning Ordinance shall apply. In addition to the maximum height of the building and any appurtenance thereto prescribed in this Planned Development, the height of any improvement shall also be subject to height limitations as approved by the Federal Aviation Administration. For purposes of F.A.R. calculations and floor area measurements, the definitions in the Chicago Zoning Ordinance shall apply, provided, however, no floor area used for parking and loading will count as floor area for F.A.R. purposes. It is also hereby acknowledged that: (i) any existing non-conformities with respect to F.A.R. and minimum lot area ("M.L.A.") within Subarea A are legal non-conformities; and (ii) in accordance with the attached Bulk Regulations and Data Table, F.A.R. and M.L.A. for Subarea B and Subarea C are permitted to be calculated on an aggregate basis, and F.A.R. and M.L.A. from Subarea C are being incorporated into Subarea B to permit the construction of the improvements to be located within Subarea B. The terms, conditions and exhibits of this Planned Development ordinance may be modified administratively by the Zoning Administrator upon the application for such a modification by die Applicants as specified in Statement 3 and after a determination is made by the Zoning Administrator that such a modification is minor, appropriate and consistent with the nature of the improvements contemplated in this Planned Development and the purposes underlying the provisions hereof. Any such modification of the requirements of this Planned Development by the Zoning Administrator shall be deemed to be a minor change in the Planned Development as contemplated by Section 17-13-0611 ofthe Chicago Zoning Ordinance. It is acknowledged that interior parking layouts and demising walls for the rooms and other interior spaces as shown on the Approved Plans are illustrative only and that the reconfiguration of such interior spaces shall not be deemed to require any further approvals pursuant hereto. • The Applicants acknowledge that it is in the public interest to design, construct, renovate and maintain all buildings in a manner that provides healthier indoor environments, reduces operating costs and conserves energy and natural resources. Development within Subarea B shall be in substantial compliance with die current City of Chicago Sustainable Development Policy set forth by the Department as follows: The Applicant for Subarea B shall: (a) obtain LEED certification, Green Globe or Energy Star certification for the Subarea B development; and (b) provide a vegetated ("green") roof on at least fifty percent (50%) of the Net Roof Area within Subarea B as shown on the Green Roof Plan (approximately 6,600 square feet). "Net Roof Area" shall exclude: rooftop parking areas, perimeter setbacks, roof areas occupied by rooftop structures and roof-mounted equipment, and roof areas above any enclosed mechanical penthouse. The Applicants acknowledge that it is in the public interest to design, construct and maintain the building and other improvements within Subarea B in a manner that APPLICANTS: Subarea A: Windermere House, LLC; Subarea B: Solstice on the Park, LLC; Subarea C: 5528 S. Cornell Avenue Owner, LLC ADDRESSES: Subarea A: 5543-59 S. Cornell Ave,/1634-64 E 56,h St.; Subarea 13: 5534-58 S. Cornell Ave./1604-1624 E. 56lh St.; Subarea C: 5528-32 S. Cornell Ave. DATE: March 11,2015 REVISED: February 18, 2016 i I PINAL FOR PUBLICATION promotes, enables, and maximizes universal access throughout Subarea B. Plans for all buildings and improvements within Subarea B shall be reviewed and approved by the Mayor's Office for People with Disability ("M.O.P.D.") to ensure compliance with all applicable laws and regulations related to access for persons with disabilities and to promote a high standard of accessibility. Upon Part II Review for any improvements within Subarea B, a Part II Review Fee shall be assessed by the Department pursuant to Section 17-13-0610 ofthe Chicago Zoning Ordinance. The fee as determined by staff at the time is final and binding on the Applicant and must be paid to the Department of Revenue prior to the issuance of any Part II approval for Subarea B. All further development within the Planned Development shall comply with the Rules and Regulations for the Maintenance of Stockpiles promulgated by the Commissioners of the Departments of Streets and Sanitation, Fleet and Facility Management and Buildings under Section 13-32-125 of the Municipal Code of Chicago or any other provision of that Code. Unless substantial construction has commenced within six (6) years following adoption of this amendment to the Planned Development, and unless completion is thereafter diligently pursued, the Zoning Administrator shall initiate a Zoning Map Amendment to rezone the Property to the pre-existing classifications of Residential, Business Planned Developmerif Number 282as 'amended and modified prior to the approval-of this Plan of Development. Said six (6)years may be extended for up to one (1) additional year, if before expiration; the Zoning Administrator determines that a good cause for such an extension is shown. APPLICANTS: Subarea A: Windermere House, LLC; Subarea C: Solstice on the Park, LLC; Subarea C: 5528 S. Cornell Avenue Owner, LLC ADDRESSES: Subarea A: 5543-59 S. Cornell Ave./! 634-64 E. 56"' St.; Subarea 13: 5534-58 S. Cornell Ave./1604-1624 E. 56"' St.; Subarea C: 5528-32 S. Cornell Ave. DATE: March II, 2015 REVISED: February 18, 2016 I I FINAL FOR PU'BUCAI Residential-Business Planned Development Number 282, As Amended Plan of Development Bulk Regulations and Data Tabic "Gross Site Area (178,750.49 square fect/4.l6"acresy-:Net Site Area (120,950.44 square fcet/2.78 acres) + public right-of-way (57,799.96 square feet/1.33 acres) Net Site Area: Subarea A Subarea B Subarea C TOTAL Maximum Floor Area Ratio: Subarea A: Subarea B: Subarea C: 51,892.30 square feet 52,503.47 square feet •16,554.67 square feet 120,950.44 square feet 6.5* (Blended for overall Planned Development) 6.41 (per existing condition) 7.0* 1.82 (per existing condition) * excludes all floor area devoted to parking and loading. Maximum Dwelling Units and Efficiency Standards: Subarea A: Maximum 220 Dwelling Units (including at least 33 Efficiency Units) Subarea B: Maximum 250 Dwelling Units (including 81 Efficiency Units) Subarea C: Maximum 53 Dwelling Units (including 44 Efficiency Units) TOTAL: Maximum 523 Dwelling Units As listed in Statement 4 Subarea A: Subarea B: Minimum Off-Strect Parking Spaces to be provided: 0 (per existing condition) Prior to completion and initial occupancy of Subarea B building (but excluding construction periods): 163 During construction within Subarea B: 0 Subarea C: Following completion and initial occupancy of Subarea B building: 316 0 (per existing condition) Minimum Bicycle Parking 1 for each 2 auto spaces provided Minimum Off-Street Loading Berths Subarea A: 0 (per existing condition) Subarea B: 2 at 10 feet by 25 feet Subarea C: 0 (per existing condition) Maximum Building Heights: Subarea A: Subarea B: Subarea C: Existing, no change requested by Applicant 299 feet to underside of top habitable floor Existing, no change requested by Applicant Minimum Setbacks from Property Line: Subarea A: Existing, no change requested by Applicant Subarea B: In substantial conformance with Site Plans Subarea C: Existing, no change requested by Applicant APPLICAN TS: Subarea A: Windermere House, LLC; Subarea 13: Solstice on the Park, LLC; Subarea C: 5528 S. Cornell Avenue Owner, LLC ADDRESSES: Subarea A: 5543-59 S. Cornell Avc./l634-64 E. 56'" St.; Subarea B: 5534-58 S. Cornell Avc./l604-1624 E. 56"' St.; Subarea C: 5528-32 S. Cornell Ave. DATE: March 11, 2015 REVISED: February 18, 2016 I ADDRESSES BY APPLICANTS BY EXISTING ZONING MAP STUDIO/ SUBAREA: SUBAREA: SCAL£ GANG A: 5543-59 S. Cornell Ave./ A: Windermere House. LLC; /ARCHITECTS 1634-64 E. 56th St.; 8: Solstice on the Park. B: 5534-58 S. Cornell Ave./ LLC; 1604-1624 E. 56th St.; C: 5528 S. Cornell Avenue Owner. DATE: March 11, 2015 C: 5528-32 S. Cornell Ave LLC; REVISED: Feb: 18. 2016 : GROSS PD 282 AMENDED AREA = 178,750.40 SF V' RIGHT OF WAY = 57,799.96 SF NET PD 282 AMENDED AREA = 120,950.44 SF ALLOWABLE BUILT AREA: 120,950 SF x 6.6 FAR = 798.270 SF SUB AREA A: SUB AREA B SUB AREA C: FLOOR AREA BREAKDOWN FOR F.A.R PURPOSES: CL of R.O.W. Windermere House = 332,549 SF (existing) Maximum Available = 435,670 SF 5528 S Cornell = 30,051 SF (existing) ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC; B: Solstice on the Park, LLC; PLANNED DEVELOPMENT BOUNDARY, PROPERTY LINE, RIGHT-OF-WAY ADJUSTMENT & SUB-AREA MAP SCALE: NTS STUDIO/ GANG /ARCHITECTS DATE: March 11. 2015 REVISED: Feb. 18, 2016 FINAL FOR PUBLICATION ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S.Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC; B: Solstice on the Park, LLC; C: 5528 S. Cornell Avenue Owner, LLC; STUDIO/ GANG /ARCHITECTS DATE: March 11. 2015 REVISED: Feb. 18, 2016 FINAL FOR PUBL1CAT ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC; B: Solstice on the Park, LLC; C: 5528 S. Cornell Avenue Owner. LLC; STUDIO/ GANG /ARCHITECTS DATE: March 11. 2015 REVISED: Feb. 18. 2016 LEGEND BUILDING OUTLINE \ VEHICULAR CIRCULATION „^D CITY FIRE HYDRANT - -)< EXISTING LIGHT POST —X NEW LIGHT POST / 'I. PROPOSED PAVERS nrthL rOR p[7h EXISTING PARKWAY TREE ' ' l" TO BE PROTECTED EXISTING TREE 10 BE REMOVED PROPOSED PARKWAY TREE LOADING TRUCK ONLY REMOVED, SPECIES ACER ADDRESSES BY APPLICANTS BY SUBAREA: SUBAREA: A: 5543-59 S. Cornell Ave./ A: Windermere House, LLC; 1634-64 E. 56th St.; B: Solstice on the Park. B: 5534-58 S. Cornell Ave./ LLC; 1604-1624 E. 56th St.; C: 5528 S. Cornell Avenue Owner. C: 5528-32 S. Cornell Ave LLC; EXISTING-STREET LIGHT ^ (TYP.) STUDIO/ GANG /ARCHITECTS DATE: March 11. 2015 REVISED: Feb. 18. 2016 FINAL FOR PUBLICATION KtOtlt i£Ur=U> •» intw LOUMG ICS 10 VI (MC IfS Tl M s w cunt*. r:i'H uuw >T\ TREE PROTECTION DETAIL \ ? / o". PARKWAY TREE PLANTING DETAIL • V ' SCALE: NTS ADDRESSES BY APPLICANTS BY LANDSCAPE DETAILS STUDIO/ SUBAREA: SUBAREA: GANG A: 5543-59 S. Cornell Ave./ A: Windermere House, LLC; /ARCHITECTS 1634-64 E. 56th St.; B: Solstice on the Park. SCALE: NTS B: 5534-58 S. Cornell Ave./ LLC; 1604-1624 E. 56th St.; C: 5528 S. Cornell Avenue Owner. DATE: March 11. 2015 C: 5528-32 S. Cornell Ave LLC; REVISED: Feb. 18.2016 t it Ii \la i V.-! ': PCRCNNIALS LUE] C'ZJ ADDRESSES BY APPLICANTS BY SUBAREA: SUBAREA: A: 5543-59 S. Cornell Ave./ A: Windermere House. LLC; 1634-64 F. 56th St.; B; Solstice on the Park, B: 5534-58 S. Cornell Ave./ LLC; 1604-1624 E. 56th St.; C: 5528 S. Cornell Avenue Owner. C: 5528-32 S. Cornell Ave LLC; STUDIO/ GANG /ARCHITECTS DATE: March 11, 2015 REVISED: Feb. 18. 2016 level 01 pkg el5T \_ (?11.20'CCD) ADDRESSES BY SUBAREA: A: 5543-59 S.'Cornell Ave./ 1634-64 E. 56lh St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC; B: Solstice on the Park, LLC; C: 5528 S. Cornell Avenue Owner. LLC; STUDIO/ GANG /ARCHITECTS DATE: March 11. 2015 REVISED: Feb. 18, 2016 ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC; B: Solstice on the Park, LLC; C: 5528 S. Cornell Avenue Owner. LLC; STUDIO/ GANG /ARCHITECTS DATE: March 11, 2015 REVISED: Feb. 18.2016 I ;. U iL ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.: C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC: B: Solstice on the Park, LLC; C: 5528 S. Cornell Avenue Owner. LLC; STUDIO/ GANG /ARCHITECTS DATE: March 11. 2015 REVISED: Feb. 18, 2016 ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S.Cornetl Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC; B: Solstice on the Park, LLC- C: 5528 S. Cornell Avenue Owner. LLC; STUDIO/ GANG DATE: REVISED: /ARCHITECTS March 11, 2015 Feb. 18. 2016 FfMAL FOR PUBLICATION ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC; B: Solstice on the Park, LLC; C: 5528 S. Cornell Avenue Owner. LLC; LOWER LEVEL PARKING AND TOWER PLAN SCALE: V=40--0" STUDIO/ GANG /ARCHITECTS DATE: March 11, 2015 REVISED: Feb. 18. 2016 ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House, LLC; B: Solstice on the Park, LLC; C: 5528 S. Cornell Avenue Owner, LLC; LEVEL 1 PARKING AND TOWER PLAN SCALE: V=40--0" STUDIO/ GANG DATE: REVISED: /ARCHITECTS March 11. 2015 Feb. 18. 2016 ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House. LLC; B: Solstice on the Park, LLC; C: 5528 S. Cornell Avenue Owner. LLC; LEVEL 2 PARKING AND TOWER PLAN SCALE: 1"=40-0" STUDIO/ GANG DATE: REVISED: /ARCHITECTS March 11, 2015 Feb. 18. 2016 FiMAL FOR PUBiJCATION ADDRESSES BY SUBAREA: A: 5543-59 S. Cornell Ave./ 1634-64 E. 56th St.; B: 5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.; C: 5528-32 S. Cornell Ave APPLICANTS BY SUBAREA: A: Windermere House. LLC; B: Solstice on the Park. LLC; C: 5528 S. Cornell Avenue Owner, LLC; STUDIO/ GANG /ARCHITECTS DATE: March 11. 2015 REVISED: Feb. 18. 2016 i DlPARTMENT OF PLANNING AND DEVELOPMENT CITY OF CHICAGO MEMORANDUM TO: FROM: .— fj- David ii- Reifman Secretary: ' Chicago Plan Commission DATE:-; On February 18 2016, the Chicago Plan Commission aril552aSouth Cornell ^^at^aSstancJin having this:,ntroduced?atthe Also^ rtpfe have any^uestions in th.s-regard, File (Original PD, copy of memo) , recommendation and/a copy f^^ffi&fr please do not hesitate to contact me at 744 cc: Steve Valenziano •PD Master 121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602 o < u X u|1010|g to co O U o CNJ co" >-ro Z5 i_ iL) on CQ i c OJ E "a c oj ro OJ E "" < LD :0 OJ cnj a: OJ > aj Q oj "a £ -a _o oj £ < CO 05 c c TJ OJ CM 00 C\J ¦a +-> 4- C (TS o C «+- u O TO OJ CO; JE IS 0 o aj OP I i i I FINAL REPORT to the CHICAGO PLAN COMMISSION from the DEPARTMENT OF PLANNING AND DEVELOPMENT FEBRUARY 18, 2016 FOR APPROVAL: PROPOSED 2016 AMENDMENT TO RESIDENTIAL BUSINESS PLANNED DEVELOPMENT #282, AS AMENDED and, PROPOSED LAKE MICHIGAN AND CHICAGO LAKEFRONT PROTECTION ORDINANCE APPLICATION NO. 666 APPLICANTS: 1) SOLSTICE ON THE PARK, LLC ^ WINDERMERE HOUSE, LLC ^; | 5528 S. CORNELL AVENUE OWNER, LLC LOCATION: 1604-64 EAST 56^-STREET; 5543-59 SOUTH CORNELL AVENUE; 5528-58 SOUTH CORN ELL AVEN U E Pursuant to the.provisions ofthfeiGTijcagd^ of>the ofChicago; the Department of Planning and"Devefepmentj"DPp") hereby submits this report and recommendatk>n;Te^a^ B?usinesjs^lanned''bevelog^
to the Chicago City Council. Thaappli^ Zoning Ordinance
was introduced into the City Cbft^ •••„,•!•
DPD also submits for your review arid approval proposed Lake Mich/igan;andA6'hicago
"Lakefront Protection Ordinance;.^ to Sedtion ^6;-4-i0p ofthe
Lake Michigan and Chicago"LakefrphL Protection Ordinance. The -jsubjecFsite isilocated
within the Private Use Zone. The.lakefront application was filed with DPD on March 11,
2015. : ¦>¦'> : T$
Proper legal notice of the publichearing, fori both the .zoning application^ and; ilakefront application was published;^the Chicago Sun-Times on February 3,201.6.jThe Applicants were separately notified of this hearing.
The Applicants, Solstice on the Park, LLC, Windermere House, LLC and 5528 S. Cornell Avenue Owner, LLC, propose to amend Planned Development #282 to allow Solstice on the Park, LLC, to construct a 299! mixed use building with 250 dwelling units and parking to beiocated at 1604-1624 East 56th Street/5528-32 South Cornell Avenue and referred to as Subarea B.
BACKGROUND
Residential Business Planned Development #282 (PD #282) was first enacted in 1982 and included the existing Windermere 13-stbry residential and commercial building located at
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FINAL.
approximately 1664 E. 56 Street and a vacant site directly to the west at approximately 1604 E. 56th Street that was used as parking. PD #282 was substantially amended in 2008 to include an additional 3-story residential building located at approximately 5528 South Cornell Avenue and to accommodate a 299' residential tower with 150 dwelling units and accessory parking to be located on the existing parking lot at approximately 1604 E. 56th Street and known as Solstice on the Park (Solstice). The original underlying zoning for PD #282 was R6 and R7 which translates into the current zoning designations of RM6 and RM6.5.
The proposed 2016 Amendment to PD #282 makes changes to the site plan, dwelling unit and parking count and other minor changes to the 2008 version ofthe Solstice on the Park project.
SITE AND AREA DESCRIPTION
The subject site is officially located within the eastern section of the Hyde Park Community Area along East 56th Street, across the street from Jackson Park. PD #282 includes approximately 120,950 square feet of net site area and is irregularly shaped. It is bounded generally;by:Hyde Park Boulevard to the east, East 56th Street on the south and a private drive/public alley to the west which forms the boundary with Bret Harte Elementary School. To the north, it is bounded by a,public alley located between Hyde Park Boulevard and S. Cornell Avenue on the eastern half of the site while on the western half of the site it is bounded by private residential property north of 5528 S. Cornell Avenue.
As stated, PD #282 includes two existing residential buildings. The Windermere House is a 1920's 13-story courtyard^style apartment building with approximately 220 dwelling units and ground floor commercial uses (Subarea A). The building at 5528 S. Cornell Avenue is a 53 unit, 3-story residential building (Subarea C). The Solstice project is planned to be located on the current parking lot site located at 1604 East 56^ Street (Subarea B).
The area surrounding the site is generally zoned :RM-5 (Residential Multi-Unit District), RM-6.5 (Residential Multi-Unit District) and POS-1 (Parks and Open Space District). Area land uses include other high rise residential buildings, smaller-scaled multi-family residential buildings and Bret Harte Elementary School. As stated, the site is across the street from Jackson Park, which is a large multi-acre regional park on the South Side of Chicago. Higher density residential buildings located along East 56th Street help to frame Jackson Park.
The subject site is very well served by existing public transit resources. In addition to the Chicago Transit Authority's nearby #15 (Jeffrey Local) bus and #28 (Stony Island) bus, the 55th Street Metra Electric Line Station is approximately 350 feet southwest of the subject site.
As stated, the site is located within the Private Use Zone ofthe Lake Michigan and Chicago Lakefront Protection District. The site is not located within a Chicago Landmark District, and neither of the two existing buildings within the planned development are Chicago Landmarks. The property is also not located within a Tax Increment Financing District.
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PROJECT DESCRIPTION
The Solstice project is being constructed on a 52,503 square foot site bounded by S. Cornell Avenue, E. 56th Street, a private drive on the west adjacent to Bret Harte Elementary School and a public alley to the north. As stated, the Solstice project will be Subarea B in the planned development. The project consists ofthe construction of a 27-storymixed use building that will include approximately 250 dwelling units, 316 accessory parking spaces and additional ground floor commercial space.
No physical changes are contemplated at this time to the'existing Windermere House (Subarea A)tesidentiai/ground floor commercialibuilding (220/dwelling units) or the 5528 S. Cornell (Subarea C) residential building (53 dwelling units).
DESIGN/LANDSCAPING
The Solstice project consists of a proposed tower on the southern; portion of Subarea B
and a connected part two-stbry/part three-story garage on the northern portion of the site.
The tower will -be* setback from East 56fh Street approximately 28' to accommodateithe
drop-off area and garage access. Ah additional setback and 'landscaped , area will be
located mid-block on S. Cornell Avenue at the pedestrian access to the garage and
s6cbndary-access tb'the^ tower in addition to a 9' setback along all of S. Cornell Avenue.
The 'first1 floor'of the tower ;(will! include lobby space and' a .tsmall... amount, of
commercial/amehity'spaeeiL . ;. : -v.
Floors 2 thru 26 of the tower c'dritain the residential units .and are approximately. 14,000
square feet each: Various units bn the'south'side of the building, which overlooks Jackson
Pa'rk"will!;eontaih •terra'ces-drbai'cohies-. . ¦¦!
The tower itself jis -ah innovative* design that is' positioned, to maximize natural: cooling
through the.angles cut into the south-facing (Jackson Park) facade. Materials include
glass;' glasWguardrail'ahd^ The parking garage^cladding is proposed to'be
a modular masonry screen which is designed to blend in with the surrounding masonry residentiarbuilding's iri the neighborhood. The maximum height of the tower will be 299'.
-"The^TbjfeefwiirfUir^c^ along S. Corneli and East 56th-Street.
ACCESS/CIRCULATION
The Solstice project will accbnhmbdate 316 parking spaces in a part two/part thr.ee^level structurecl 'parking system located to the north of, and connected to, the proposed tower. The parking garage will be partially located1 below grade as-well. Access to'the garage will be achieved via East 56th Street and the public alley located between Subarea B and Subarea C. A vehicular drop-off drive area will be located directly in front of the proposed tower and will also be accessed via 56th Street. The drop-off drive area will feed into the garage as well. Parking will primarily serve the residents of;Solstice and the two existing buildings in the planned development, but six spaces will be reserved for the adjacent Bret Harte Elementary School (by easement) and up4o 45% of the spaces will be available for
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lease to non-occupants in accordance with Section 17-10-0503 ofthe Chicago Zoning Ordinance.
The primary pedestrian access point to the building will be via East 56lh Street, while secondary access will be via S. Cornell Avenue. Pedestrian access to the garage will also be available from S. Cornell Avenue. Bicycle storage for 150 bikes will be provided in the lower level of the Solstice building.
Two 10' x 25' loading berths will serve the Solstice building. One will be accessed via East 56lh Street, and the other via the public alley to the north.
SUSTAINABILITY
The Applicant will provide approximately 6,600 square feet of green roof and will achieve either LEED, Green Globes or Energy Star certification for the Solstice project. The project will also comply with the Storm Water Management Ordinance, implementing best practices in all storm water management. The Green Roof Plan included as an exhibit to this report highlights the location of the green roof on the building.
BULK/USE/DENSITY -
This 2016 Amendment to PD #282 will establish an overall FAR (Floor Area Ratio) cap for the project at 6.5 and FAR limits for each Subarea as follows: 6.41 in Subarea A (per existing conditions); 7.0 in Subarea B; and: 1.82 in Subarea C (per existing conditions). The FAR caps to be established by;the 2016 Amendment for the overall planned development and for Subarea B will be lower than what is allowed .by the current plan of development standards (6.6 FAR for the overall planned development, and 8.0 FAR for Subarea B). :
Uses for the project will include residential, accessory parking, limited ground floor nonresidential (commercial) and accessory^uses. ;
A total of 523 dwelling units will be permitted within this planned development. This includes the proposed 250 units within Solstice as well as the existing 273 units located in Subareas A and C. The Minimum Lot Area for the planned development overall will be 231 square feet, which is slightly less than the minimum under the Chicago Zoning Code of 234. Approximately '30% of the units over the entire planned' development will be efficiencies,-which is less than the 40% maximum under the Chicago Zoning Code.
RECOMMENDATION
The Department of Planning and Development has reviewed the proposed 2016 Amendment to PD #282 and the materials submitted by the Applicant and compared this proposal to existing development in the community. The area around this project consists generally of high-rise and other multi-family residential uses, and the proposal represents an opportunity to construct a compatible residential/mixed use development project along East 56th Street in Chicago's Hyde Park Community Area.
Based on that analysis, the Department of Planning and Development has concluded that
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this proposal is appropriate for this site and supports this development for the following reasons:
1. The project meets the purpose and criteria set forth in Chapter 17-8 of the Zoning Ordinance and its adoption would not have any adverse impact on the public's health, safety or welfare. Specifically, this project meets the following provisions of Chapter 17-8:
a. Promotes pedestrian interest, safety and comfort by creating safe and
attractive walkways and pedestrian routes and by emphasizing building
entries through architecture and design (per 17-8-0905-A), as evidenced by
the project's incorporation of a significant building entrance;, ._ ,
b. Reinforcesdesirable urban features found'within the surrounding area,-such
• as siting-patterns, massing arrangements and streetscapecharacteristics (per
17-8-0906-A), as evidenced.by.the compatibility of the project's.mass and site design with the surrounding buildings in-the Hyde Park Community Area and adjacency to Jackson .'Park;
Provides adequate, inviting, usable and accessible open space for workers, visitors and residents, provides a sense of place-associated with the development and provides substantialilandscaping of the openrareas (per 1j7-8-0909-A), as evidenced by the incorporation of balconies,and terraces along •the: south (Jackson iPark) faeihg facade.of the tower;
Conserves non-renewable energy and scarce materials (per17r8-0908-A) as
evidenced by the project's goal of building certification and the, incorporation
of asgreen roof v ': ¦ ¦
Promotes the safe and efficient circulation of pedestrians, cyclists and motor vehicles (per 17-8-0904-A1) as evidenced by the project's site plan that provides-appropriate drop-off, vehicular, access and loading functions; and
. f. All sides and areas ofthe buildings ;that are. visible rto. the public are.treated with materials, finishes and architectural details that are of high-quality and appropriate for use on primary street-facing facade (17-8r0907-A-4), as : evidenced through: the material callouts in this report and> on;the elevations.
2~. The site7is consisteht w of the Metra" Station Typology Study iwhich
passed the Chicago Plan; Commission in 2014. The Metra Study, identifies the Metra Electric 55th Street Station as a "Major Activity Center" which is considered a major node of activity outside ofthe central area. The study further supports higher density housing near Major Activity Center stations. ¦¦¦¦¦¦
• 3. The public infrastructure facilities and city services will be adequate to serve the proposed development at the time of occupancy. The proposed project has been reviewed by the Mayor's Office for People with Disabilities and the Department of Transportation and all requested changes have been made. Copies of this application have been circulated to other City departments and agencies ,and no comments have been received which have not been addressed in the application.
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4. The project will comply with the requirements for access in case of fire and other emergencies.
Based on the foregoing, it is the recommendation of the Department of Planning and Development that this application for a Residential Business Planned Development be approved and that the recommendation to the City Council Committee on Zoning, Landmarks and Building Standards be "Passage Recommended".
The Department of Planning and Development has reviewed the project materials submitted by the Applicant with regards to the Policies and Purposes ofthe Lake Michigan and Chicago Lakefront Protection Ordinance and has concluded that the proposed development would be in compliance with the applicable Policies ofthe Lakefront Plan of Chicago and the Purposes of the Lake Michigan and Chicago Lakefront Protection Ordinance, as they apply to development in the Private Use Zone, specifically:
Policy No. 10 (Ensure a harmonious relationship between lakeshore parks and community edges but in no instance allow private development east of Lake Shore Drive): The proposal consists of an appropriate residential infill project that will reinforce the multi-unit residential district that exists in this area of the City and minimally impact the lakefront park system; and,
Policy No. 14 (Coordinate all public and private development within the water, park and community zones): This site is located within the Private-Use Zone, and the development has been coordinated with the appropriate City departments and community to minimize fhe impact of construction and to ensure it remains in context with the surrounding neighborhood.
With respect to the Policies not. enumerated here, the. Department of Planning and Development has determined that.they are either not applicable to development in the Private Use Zone or that the proposed project will not have a detrimental effect on the Lake Michigan shoreline or any wildlife habitats therein. This is because the proposed project is separated from the shoreline, does not reduce existing open space or wildlife habitat and does not interfere with existing access to, or use of, the lake and its parks.
Based on the foregoing, it is the recommendation of the Department of Planning and Development that this development application, being in conformance with the provisions ofthe Lake Michigan and Chicago Lakefront Protection Ordinance, be approved, subject to compliance with the exhibits including site and Landscape Plans and elevation drawings dated February 18, 2016 and presented before you today.
Bureau of Zoning and Land Use Department of Planning and Development
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DEPARTMENT OF PLANNING AND DEVELOPMENT CITY OF CHICAGO
1604-64 EAST 56th STREET; 5543-59 SOUTH CORNELL AVENUE; 5528-58 SOUTH
CORNELL AVENUE
2016 AMENDMENT TO RESIDENTIAL-BUSINESS PLANNED DEVELOPMENT #282,
AS AMENDED
RESOLUTION
WHEREAS, the Applicants, .Solstice on the Park, LLC, Windermere House, LLC and 5528 S. Cornell Avenue Owner, LLC, propose to amend Planned Development #282 to allow Solstice on the Park, LLC, to construct a 299' .mixed use building with 250 dwelling units and parking to be located at 1604-1624 East 56^'Stre^5528-32 South-
WHEREAS, Windermere House, LLC is the,owner of an existing mixed use building with approximately 220'dWelling units located at 1634-64 East 56th Street/5543-59 South Cornell A.venue (Subarea A); and,
WHEREAS, 5528 S. Cornell. Avenue Owner, LLC, is the owner of a residential building with.approx^ Cornell Avenue (Subarea C); and,
WHEREAS, the,Applicant's request to rezone the property was introduced to"the City
— Council on March'18, 2015; and, ..
WHEREAS, proper legal notice of the hearing before the Plan Commission was published in the Chicago Sun-Times on February 3, 2016. The Applicants were separately notified of this hearing and the proposed zoning application was considered at a public hearing by this Plan Commission on February 18, 2016; and,
WHEREAS, the Plan Commission has reviewed the application with respect to the provisions of the Zoning Ordinance and finds that the proposal will be consistent with said provisions; and
WHEREAS, the Department of Planning and Development recommended approval ofthe application, with the recommendation and explanation contained in the
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
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written report dated February 18, 2016, a copy of which is attached hereto and made a part hereof; and,
WHEREAS, the Plan Commission has fully reviewed the application and all informational submissions associated with the proposed amendment, the report and recommendation of the Commissioner of the Department of Planning and Development and all other testimony presented at the public hearing held on February 18, 2016, giving consideration to the Zoning Ordinance;
NOW, THEREFORE, BE IT RESOLVED BY THE CHICAGO PLAN COMMISSION:
THAT the above-stated recitals to this resolution together with the report of the Commissioner of the Department of Planning and Development be adopted as the findings of fact of the Plan Commission regarding this zoning map amendment application; and,
THAT this Plan Commission recommends approval to the City Council Committee on Zoning, Landmarks and Building Standards ofthe final zoning application dated February 18, 2016; and,
RBPD No. #282, as amended, 2016.* Approved: February 18, 2016
121 NORTH LASALLE STREEJtROOM 1000, CHICAGO, ILLINOIS 60602 -
CITY OF CHICAGO I »j QA^'
InitiaVj^^^^f^^ APPLICATION FOR AN AMENDMENT TO j-J S'Z'O'i
THE CHICAGO ZONING ORDINANCE
FEB 1 8 2016
ADDRESS of the property Applicant is seeking lo rezone: , f)
5543-59 South Cornell Avenue/ 1634.-64 East 56lh Street -j. \j I
5534-58 South Cornell Avenue/ 1604-1624 East 56th Street Initial: ^IC^^^
5528-32 South Cornell Avenue
¦ VV ard Number that property is located in: Ffon
Windermere House, LLC (owner of Subarea A), Solstice on the Park, LLC|109|APPLICANT (owner °* Subarea B), and 5528 S. Cornell Avenue Owner, LLC (Owner of Subarea C)
ADDRESS 32 North'Dcan Street CITY ^"8lf!W004'
SfATE New Jersey z]p CQDE 07631 PHONE
EMAIL Pcassel@silIin'iangrouP com CONTACT PERSON PeterCassd
Is the applicant the owner of the properly? .YES i .xx; ,. ¦¦ NO
If (he applicant is not the owner of the properly, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed.
OWNER Sameas APPlica"* -
ADDRESS ¦ ' CITY
STATE ZIPCODE . \ ' "-- ; PHONE_
EMAIL CONTACT PERSON
5. If the Applicant/Owner of the property has obtained a lawyer as their representative for the
rezoning, please provide the-following-informatioivr - — -.-— -—
ATTORNEY Redder Price PC (Danielle Meltzer Cassel)
ADDRESS 222 N°Tth LaSalle Slreet'Suile 2600
CITY Chicago STATE minois ZIP CODE 60601
PHONE 312-609-7962 p/^x 312-609-5005 EMAIL dcassel@vedderprice.com
Application Signature Page
IN WITNESS WHEREOF, Windermere House, LLC, Solstice on the Park, LLC, and 5528 S. Cornell Avenue Owner, LLC each have caused the attached Application to be executed, as of this 9,l> day of March, 2015, by a duly authorized signatory.
SOLSTICE QPTTHE PARK, LLC, a Delaware limited liability company
By: AL-Solsticepn the Park, LLC, a Delaware limited liability company, its Manager
David H. Gefsky, its Vice President
WINDERMlSfeE HOUSE, LLC, an Indiana limited liability company By: AL-Wj!ndemnere House, LLC, an Indiana limited liability company, its Manager
By:
David H. Gefsky, its Vice President
5S28 S. CORNEMi AVENUE OWNER, LLC, a Delaware limited liability company By: 5528 S. Gqrne' I Avenue, LLC, an Indiana limited liability company, its Sole Member By: AL-S528 S. Cornell, LLC, an Indiana limited liability company, its Manager
^David H. Gefsky, its Vice President
STATE OF NEW JERSEY ) 1
) SS
COUNTY OF BERGEN )
I, the undersigned, a NOTARY PUBLIC in and- for said County, in the State aforesaid, DO HEREBY CERTIFY, that David H. Gefsky, personally known to me to be the same person whose name is subscribed lo the foregoing instrument as an authorized signatory for SOLSTICE ON THE PARK LLC, for WINDERMERE HOUSE, LLC, and for 5528 S. CORNELL AVENUE OWNER, LLC, appeared before me this day in person, and acknowledged that he signed and delivered the said instrument as his own free and voluntary act, and as the free and voluntary act of each such limited liability company, for the uses and purposes therein set forth.
GI VEN under my hand and Notarial Seal this 9tJl day of March, 2015.
^Notary Public J^^fcl- Hw-Te Commission Expires ^jjlJl^L^-
^ ^ JEANETTE MARIE COLON
ff&^&K NOTARY PUBLIC OF NEW JERSEY
P@#d I.D. 8 2419776
'' My Commission Expires 4f12/20_L1-
FINAL
Department of Planning and Development city of chicago
1604-64 EAST 56th STREET; 5543-59 SOUTH CORNELL AVENUE; 5528-58 SOUTH
CORNELL AVENUE LAKE MICHIGAN AND CHICAGO LAKEFRONT PROTECTION ORDINANCE
APPLICATION No. 666
RESOLUTION
WHEREAS, The Applicants, Solstice on the Park, LLC, Windermere House, LLC and 5528 S. Cornell Avenue Owner, LLC, propose to amend Planned Development #282 in order to construct a 299' mixed use building with 250 dwelling units and parking, referred to as Solstice on the Park to be located at 1604-1624 East 56th Street/5528-32 South Cornell Avenue; this site is located within the Private Use Zone-of the Lake Michigan and Chicago Lakefront Protection District; and,
WHEREAS, an application for Lake Michigan and Chicago Lakefront Protection Ordinance approval was filed with the Department of Planning and Development on March 11, 2015; and,
WHEREAS, proper legal notice of a hearing before the Chicago Plan Commission on the Lake Michiganand Chicago Lakefront 'Protection Ordinance application was published in the Chicago Sun-Times on February 3, 2016; the Applicant was separately notified of this hearing; and the Lake Michigan and Chicago
_: Lakefront ¦ Protection Ordinance application was considered at a public
hearing by this Plan Commission on.February 18, 2016; and, .
WHEREAS, this Plan Commission has reviewed the application with respect to the Lake Michigan and Chicago Lakefront Protection Ordinance and finds that the proposal would be consistent with the Purposes of that Ordinance and the Policies of the Lakefront Plan of Chicago; and,
WHEREAS, the Department of Planning and Development recommends approval ofthe application, which recommendation and the explanation thereof is contained in the Department's written report dated February 18, 2016, a copy of which is attached hereto and made a part hereof; and,
WHEREAS, this Plan Commission has fully reviewed the application and all informational submissions associated with the proposed development, the report and
121 NORTH LASALLE STREET, ROOM 1000,-CHICAGO, ILLINOIS 60602
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recommendation of the Commissioner of the Department of Planning and Development and all other testimony presented at the public hearing held February 18, 2016, giving consideration to the Lake Michigan and Chicago Lakefront Protection Ordinance;
NOW, THEREFORE, BE IT RESOLVED BY THE CHICAGO PLAN COMMISSION:
THAT the above-stated recitals to this resolution together with the report of the Commissioner ofthe Department of Planning and Development be adopted as the findings of fact of the Chicago Plan Commission regarding this application; and,
THAT the final application dated February 18, 2016, be approved as being in conformance with the provisions, of the Lake Michigan and Chicago Lakefront
; Protection Ordinance. ,^ r^VI.
Lakefront Application No. 666 Approved: February 18, 2016
121 NORTH LASALLE STREET,. ROOM 1000, CHICAGO, ILLINOIS 60602
re:ceived
FEB 1 8 2015
- - APPLICATION NUMBER C^.C^ '"tfrn^J?^ tu)
MAR 112015 —Initial:. .7 ^^3 st-
¦^py CITY OF CHICAGO
t • AN APPLICATION TO THE CHICAGO PLAN COMMISSION UNDER THE LAKE MICHIGAN AND CHRTATjD LAKEFRONT PROTECTION ORDINANCE
(This Application Must Be Typewritten)
The Chicago Plan Commission has^provided this Application Form in accordance with Section 194B-6;1 (a) ofthe Lake Michigan;and.Chicago'Lakefront Protection Ordinance. The Conditions under which the provisions of this Ordinance, are applicable arc; stated in Section 194B-5.1 of the Ordinance. The;process of Plan Commission review and public hearing on each proposal within the Lake Michigan and Chicago Lakefront Protection District will commence with the Applicant's submission to the Chicago Plan Commission of a completed Application Form and the required proof of notice. Strict compliance with Section 194B-6.1(c) is required.
The staff of the Department of Planning, is available to provide technical assistance to the Applicant, .before , preparation of his application, during the processing stages, and to review the application at submission to the Chicago Plan Commission. Copies ofthe Ordinance and this Application Form and examples offormsforboth notification and proof of notice, are available from the Commissioner of Planning, in Room 1003, Lakefront Unit, City Hall, 121 N. La Salle StrcetvChicago, Illinois 60602. Phone.744-6551.
This Application Form consists-pf Five Parts on 17 page's: v .
Part One: General Information - ! ¦¦ ¦ ¦
Part Two: Character of Proposal
Part Three: Zoning Information
Part Four: Potential Impact of Proposal (2 Sections)
Part Five: Disclosure Forms (6 Sections) •
A copy of this Application will be available for public inspection in the office of the Commissioner of Planning, Room 1000, five days prior to the date of which the public hearing on this Application before the Chicago Plan Commission is to commence.
Date of receipt irrDP:
In Bldgs.:_
Date of Applicant Notice to taxpayers of record:_
Date set for public hearing
_ycs_
-SECTION BELOW FOR OFFICE USE ONLY-
. • ZBA action necessary?
yes _
Status-
Disclosure necessary?
Simultaneous Planned Development
processing yes no
Date on which Plan Commission
published newspaper notice:
Previous Application this address?
yes no; number
Date of publication of report of Commissioner of DP.
Date forwarded to DIS
DPW_ Other
DSS_ Pk D.
yes
Zoning map amendment''
DISPOSITION
_, to
A pproved
Disapproved_ Continued
Date Applicant notified of decision.
SITE ADDRESS
GUIDELINES FOR COMPLETING PART ONE OF THE APPLICATION
Part One of this Application provides general information to the Plan Commission for use in preparing its public notices of the proposal set forth in the Application and in preparing its review of that proposal.
The date entered in I. should be the date on which the Application is filed.
The location of the site of the proposal should be given by street address; if there is no address, the location must be described in relation to existing streets, rights-of-way or other fixed points of reference.
The Applicant must state his own name, address and telephone number and the name, address and telephone number ofthe owner of the subject property. The Applicant must be either the owner of the subject property or his duly authorized agent or representative, and, ifthe Applicant is an agent or representative, the Applicant must submit proof to the Commission that he is authorized to represent the owner of the subject property.
Whenever the ownership of the subject property is complex - a partnership, corporation, land trust or association - the Applicant shall so indicate. Further, the Commission may require disclosure of all real parties of interest in the subject property.
The description of a proposal should include, at a minimum, types of land uses and space uses, floor area, number of dwelling units and height of proposed structures in feet or stories. Additional concise information may also be included.
Under the provisions of Section 194B-6.1 (c) of the Lake Michigan and Chicago Lakefront Protection Ordinance, the Applicant must submit to the Commission at the time of filing an Application a list of the names and last known addresses of the owners of all property .on which notice must be served, the method of service employed, the names and addresses of persons so served, and a statement certifying that the Applicant has complied with the noticing provisions of Section 194B-6.1(c) ofthe Lake Michigan and Chicago Lakefront Protection Ordinance. The Commission will not accept an application unless and until the Applicant furnishes the required list and certificate.
6. If there are any other approvals required from other public agencies before the Applicant
can proceed with his proposal, they should be listed; except that other City of Chicago
licenses and permits may be omitted as items requiring listing herein. If no other
approvals are required, enter "NONE" under VI A. Examples of items which should be
listed include approval of FHA financing, a U.S. Corps of Engineers permit, Federal
Aviation Authority Approval, among others.
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PART ONE: GENERAL INFORMATION
Date of Application: March 11 ? 2015
Address or location of the Site of the Proposal: Subarea-A: 5543-59 S. Cornell Ave./1634-64 E. 56th St.; Subarea B: 5534-58 S. Cornell Ave/1604-1624 E. 56lh St.; Subarea C: 5528-32 S. Cornell Ave.
Information on the Applicant and the Owner A. Applicant
Windermere House, LLC (Subarea A). Solstice on the Park, LLC 770 O/l 7 Q A ^1
1. Name: (Subarea U). and 5528S Cornell Avenue Owner, LLC (SuliareaC) Phoiie". 'J*/. J
2. Address: 32 North Dean Street, Englewood NJ 07631
B. Owner
Name: Same as Applicants Phone:
Address:
If the Applicant is riot the owner, check here that proof has been attached
to this Application that the Applicants the duly authorized-agent Or representative of the owner.
If the ownership of the subject property is complex, the Applicant shall indicate the type of ownership:
1. Land Trust ' ; 2. _¦ Partnership or Association
3_ Corporation 4. X See attached organizational charts
IV Brief Description' of the Proposal: Amendment of Residential-Business Planned Development 282,
primarily to accommodate hew .uses and interior configuration for the Solstice on the Park project originally
approved in 2008.
V. VI.
THe' ribti'cihg provisions of Section 194B-6.1 (c) have been completed as they apply to the
Applicant: Check here X . . < >c
The Applicant must also Obtain the following approvals in addition to the approval ofthe
!(Plan;C6mmission: , . . ,
Natlife'6f ApproVal: Amendment of Residential-Business Planned Development 282,
! Agency: City Councils ¦• ._
Nature of Approval; Multiple administrative approvals referenced in Planned Development
Agency: Various City Departments, including DPD, MOPD and CDOT
C. Nature of Approval: "_ ' ¦ ' '¦¦ ¦- ¦ - :
Agency: ' ;
Address: Subarea A: 5543-59 S. CorneU Ave./1634-64 E. 56th St.;
Subarea B: 5534^58 S. Cornell Ave./1604-1624 E. 56th St.; Subarea C: 5528-32 S. Cornell Ave.|1010|Windermere House, LLC
Organizational Structure
Lyrical-Antheus Management GP, LLC (a Delaware LLC)
50%
Lyrical-Antheus Management,,L.P. (a Delaware LP)
Managing Member
0% GP Interest
Lyrical-Antheus GP II, LLC (a Delaware LLC) Manager Managed
GP Interest (Carried Interest)
LP Interests
Investors each owning less than 7.5%
Lyrical-Antheus Realty Partners II, L.P. (a Delaware LP) Claridge Associates, LLC (10.28%)
\
Antheus Capital, LLC (a New Jersey LLC)
Member-Manager
AL-Windermere House, LLC (an Indiana LLC)
Sole Member
Gothic Corporation (24.88%)
Manager
y
Windermere House, LLC (an Indiana LLC)
I
I
Solstice on the Park, LLC
Organizational Structure
Lyrical-Antheus GP II, LLC (a Delaware LLC) Manager Managed
Investors each owning less than 7.5%
Lyrical-Antheus'Realty Partners II, L.P. (a Delaware LP) ¦c Cfaridge Associates, LLC (10.28%)
x
"Antheus~Capital7LLe~ (a New Jersey. LLC)
Member-Manager
AL-Solstice on the Park, LLC (a Delaware LLC)
Sole Member
Gothic Corporation
——(24-88%)
Manager
Solstice on the Park, LLC (a Delaware LLC)
I
5528 S Cornell Avenue Owner, LLC
Organizational Structure
Lyrical-Antheus GP II, LLC (a Delaware LLC) Manager Managed
GP Interest (Carried Interest)
LP Interests
Investors each owning less than 7.5%
Lyrical-Antheus Realty Partners II, L.P. (a Delaware LP) < Claridge Associates, LUC (10.28%)
Antheus Capital, LLC (a New Jersey LLC)
Member-Manager \ I
AL-5528 S Cornell, LLC (an Indiana LLC)
Sole Member
Gothic Corporation (24.88%)
Manager
5528 S Cornell Avenue, LLC (an Indiana LLC)
5528 S Cornell Avenue Owner, LLC (a Delaware LLC)
02/18/2015
GUIDELINES FOR COMPLETING PART TWO OF THE APPLICATION
All graphic materials must be submitted in an 8.5" x 11" format and must be suitable for clear and sharp, black and white reproduction. Each map or diagram should have a scale and a north arrow. Each sheet of graphic material must be labeled with the appropriate figure number. If there arc multiple sheets comprising one figure - for example figure 4 - those sheets should be labeled consecutively, for example Figure 4-1, Figure 4-2, etc., and each sheet should contain the address of the site ofthe proposal in the lower left corner.
For Figure 1, the Applicant should consider the "vicinity of the site" to be at least as extensive as the area for which he is required to give notice plus any intervening streets or other public rights-of-way.
For Figures 3 and 4, the Applicant should consider that "recreation areas" and "recreation space and facilities" include game courts, swimming pools and pool areas, game rooms, exercise rooms, party rooms, community rooms, observation decks and sun decks.
The required narrative statement should describe the features ofthe proposed development, including size and mix of dwelling units, mix of uses on the site, etc. It should present a basic rationale for the development.
For Figure 6, the Applicant is urged to provide any materials at 8.5" x 11" which will facilitate the review of his Application.
|1010|
PART TWO: CHARACTER OF THE PROPOSAL
This portion of the Application must be completed by attaching the following items, correctly sized and labeled, to the Application:
I. Figure 1: A Map ofthe Vicinity of the Site, showing Lake Michigan, lakefront parks,
preferential streets, schools, parks, major institutions. All streets on this map should be -
named, and the outline and height on all structures on properties immediately adjacent to
,- the site of the proposal must be shown.
II. 'Figure 2: A Map of the Existing Site, showing locations-and dimensions of lot lines;
¦ contour intervals (5-foot); existing structures, walkways, driveways, special features.
. Figure 3 : The.Proposed-Site Plan, showing locations and dimensions of proposed y . structures,-driveways and walkways; proposed exterior parking areas; proposed exterior
open space and recreation areas.
¦ Figure. 4: Proposed Floor Plans, including Jhe. ground floor, atypical floor, anyfloor with,
• s' recreation-sp*ace.or.,facilities. . .'• . : ¦;'
-'" Figure 5: An Elevation or Cross-sect ion, showing the height and number of stories for all
v; proposed structures. •¦; ;-¦ -]¦ 'V-' :;
VL/%.Narratiye: A Statement Describing the Proposed Development. /-^^.r^''j
In-addition, .the Applicant is encouraged to provide additional graphic materials, visual aids; e.g:, photographs, renderings, data tables, among.others. Any such exhibits shall be labeled Figure 6;':
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5543-59 S. Cornell Ave./ 1634-64 E. 56th St.;
5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.;
5528-32 S.Cornell Ave'
STUDIO/ GANG
/ARCHITECTS
Windermere House. LLC;
Solstice on the Park. LLC;
5528 S. Cornell Avenue Owner. LLC;
February 18. 2016
LEVEL 01 PKG 1l -2-0- \ (* 11.20'CCD)
5543-59 S. Cornell Ave./ 1634-64 E. 56th St.;
5534-58 S.Cornell Ave./ 1604-1624 E. 56th St.;
5528-32 S. Cornell Ave''
STUDIO/ GANG
/ARCHITECTS
Windermere House, LLC; Solstice on the Park. LLC; 5528 S. Cornell Avenue Owner. LLC;
February 18, 2016
5543-59 S. Cornell Ave./ .1634-64 E. 56th St.;
5534-58 S. Cornell Ave./ 1604-1624 E. 56th St.;
5528-32 S. Cornell Ave
STUDIO/ GANG
/ARCHITECTS
Windermere House. LLC;
Solstice on the Park, LLC;
5528 S. Cornell Avenue Owner, LLC;
February 18. "2016
5543-59 S. Cornell Ave./ 1634-64 E. 56th St;
5534-58 S. Corneli'Ave./ 1604-1624 E. 56th St.;
5528-32 S. Cornell Ave
STUDIO/ GANG
/ARCHITECTS
Windermere House, LLC; Solstice on the Park. LLC; 5528 S. Cornell Avenue Owner,
February 18. 2016
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APPLICATION TO THE CHICAGO PLAN COMMISSION UNDER THE LAKE MICHIGAN AND CHICAGO LAKEFRONT PROTECTION ORDINANCE
Addresses: 5543-59 South Cornell Avenue/1634-64 East 56th Street (Subarea A); 5534-58 South Cornell Avenue/1604-1624 East 56th Street (Subarea B); and 5528-32 South Cornell Avenue (Subarea C)
PART TWO: CHARACTER OF THE PROPOSAL VI. Narrative: A Statement Describing the Proposed Development.
Residential-Business Planned Development 282 is located at the north end of Jackson Park in Chicago's Hyde Park neighborhood and is comprised of three Subareas. (See Figures 1.1, 1.2 and 13.)
Brief History and Existing Conditions. The history of the two more southerly Subareas (A and B) is directly connected to the origins of the modern-day Jackson Park as the fairgrounds of the World Columbian Exposition of 1893 and to Hyde Park's era as a lakefront resort and destination throughout the first quarter of the twentieth century. The parcels were developed with a pair of luxury apartment hotels, known as "Windermere East" and "Windermere West". (See Figures 6.1, 6.2, and 63.) Both hotels were occupied by year-round residents and by visiting guests. Both were heavily used by tire neighboring community for dining, meetings, concerts, dances and other special events. (See Figure 6-4, which includes just four examples of the hundreds of community newspaper advertisements and articles, from the 1920s through the 1950s, documenting the numerous ways in which the Windermere Hotels were a focal point of community life in Hyde Park and South Shore.) Subarea C, just to the north, was improved with a low-rise residential apartment building in approximately 1920.
Within Subarea A, the Windermere East building still stands (See Figure 1.1, Figure 1.2 and Figure 6.2) and is listed in the National Register of Historic Places. Now known as Windermere House, the building is actively used as a 220-unit residential apartment building. Its first floor, facing Jackson Park with a semi-circular forecourt, operates with a mix of commercial uses enjoyed by residents and the surrounding neighborhood, including a restaurant-bar, medical and dental off ices,.and daycare. Per its original construction, the only open space on this site is devoted to the grand forecourt facing Jackson Park. There is no on-site parking.
Within Subarea C, the original low-rise residential apartment building remains, is operated with 53 residential apartments, and has no on-site parking or commercial uses. (See Figure 1.2)
Windermere West was demolished in 1959, and the site has remained a parking lot for the past 57 years. (See Figure 1.2) After acquiring the site in 2006, Petitioner began working with Studio/Gang/Architects to develop a building that would be "worthy of the site's history and critical location at the edge of Jackson Park. (See Figure 1.2 and Figures 1.3.) Jeanne Gang and Petitioner collaborated to create the design for Solstice on the Park, a unique and site-specific high-rise condominium building with ground-breaking sustainability features and striking architecture. South-facing windows, angled for Solstice's exact location on the planet, would shade the building from the direct light of high summer sun, avoid passive heat gain, and maximize the benefit of low winter sun in colder months. Inspired by natural phenomena, Gang removed excess concrete from the design for Solstice's East and West facades based on the structure of leaves. Had it been built, Solstice would have been the first new condominium building in Hyde Park for several decades. And though the Affordable Requirements Ordinance was not applicable to the project, Petitioner voluntarily"committed to reserve all of Subarea C's 53 units for affordable housing when the Solstice development commenced.
APPLICATION TO THE CHICAGO PLAN COMMISSION UNDER THE LAKE MICHIGAN AND CHICAGO LAKEFRONT PROTECTION ORDINANCE
Addresses: 5543-59 South Cornell Avenue/1.634-64 East 56th Street (Subarea A); 5534-58 South Cornell Avenue/1604-1624 East 56th Street (Subarea B); and 5528-32 South Cornell Avenue (Subarea C)
Instead, within a few months after Solstice received its 2008 Planned Development and Lakefront Protection Ordinance approvals, the Great Recession put a stop to the entire project.
Proposed Development: In essence, Petitioner is proposing to bring-the Solstice project and Jeanne Gang's unique design to fruition, but with adaptations to accommodate interior uses that meet market demand and community needs in 2016. The primary changes to the development plan approved in 2008 (Figure 3.1, Figure 6.6 and Figure 6.7) are: (i) shifting the Solstice tower towards Jackson Park and reducing its north-south profile to reduce ¦ visual impact for residential neighbors to the North and East; (ii) utilizing the interior of the Solstice tower' for 250 smaller dwelling units, rather than 150 larger condominium units; (iii) implementing a modified garage design (with no fewer than 316 parking spaces) that responds to transit-oriented development principles, updated parking usage data, and neighborhood comments regarding the design and massing of the garage as previously approved in 2008; and (iv) shifting Solstice's primary loading/refuse collation facilities to the interior- of its North side -for reduced visibility from Jackson Park arid for increased use of the new public alley constructed by Applicants, rather than 56th Street. Solstice's proposed accessory uses and amenities could include a fitness center; pool, meeting/office space that would function as a business center for residents engaged in school or home occupations, convenience retail not to exceed 1,500 s.f., and a drop-off dry cleaners.
PART THREE: ZONING INFORMATION
The Applicant shall provide the basic data on zoning considerations for the site ofthe proposal. Calculations may be shown below on this page and on page 8.
I. Is a planned development ordinance or an amendment to an existing planned development required or permitted for the subject site?
x required permitted no
If a planned development approach is required, or if it is permitted and the Applicant chooses to seek a planned development amendment, the Applicant is not required to complete the remainder of Part Three of this Application Form.
Address:
11 Is Zoning Board of Appeals approval a variation or a special use either necessary or
|1010|contemplated in relation to the Applicant's proposal? If "yes," please explain the nature ofthe approval.
Area ¦ sq: ft. sq. ft:
sq. ft.
sq. ft.
III. Net Site Area and Existing Zoning District Classification (list that portion of the net site area in each):
District Classification
A. ' '
D. Total Net Site Area:
IV. Dwelling Units
Maximum units allowed
Without efficiency units: .
With maximum percent of efficiency units:
Proposed number of units '
Dwelling units: .
Efficiency Units: .
Total Units: . .
C. Does the Applicant intend to increase allowable floor area by reducing the number of
units constructed below the maximum allowed?
yes no.
If "yes" there will be units fewer than the maximum allowed, and the Floor
Area Ratio for the site will be increased by %.
Address:
This page for calculations.
Address:
Bulk
Base Floor Area Ratio (F.A.R.), without bonuses: .
Proposed F.A.R., include all bonuses: -
List all bonuses used in computing B., above:
1.
2. ~ ;
3.
Proposed Floor Area: sq. ft.
Percentage of floor area devoted to interior recreation space, meeting rooms, etc
%.
Off-street Parking and Loading
Minimum Required Number Proposed
Parking Spaces
Loading Docks
Setbacks
Minimum Proposed
Front
Side
Rear. .
Address:
PART FOUR: POTENTIAL IMPACT OF THE PROPOSAL
|10 10|
APPLICATION TO THE CHICAGO PLAN COMMISSION UNDER THE LAKE MICHIGAN AND CHICAGO LAKEFRONT PROTECTION ORDINANCE
Addresses: 5543-59 South Cornell Avenue/1634-64 East 56th Street (Subarea A); 5534-58 South Cornell Avenue/1604-1624 East 56th Street (Subarea B); and 5528-32 South Cornell Avenue (Subarea C)
PART FOUR: POTENTIAL IMPACT OF THE PK.OPOSAL
The Chicago Plan Commission requires that the Applicant address the Fourteen Basic Policies of the Lakefront Plan of Cliicago and the Thirteen Purposes of the Lake Michigan and Chicago Lakefront Protection Ordinance, as listed below, in a written statement to the C&mmission attached to this Application Form and labeled Part Four. The statement should indicate which policies or purposes are or are not applicable to the Applicant's proposal, and, for those policies and purposes which are applicable, the statements should discuss the potential impact ofthe proposal.
I. Fourteen Basic Policies
Complete the publicly owned and locally controlled park system along the entire Chicago lakefront.
Nor applicable. The subject site is located in the Private Use Zone as established by the Lake Michigaii and Chicago Lakefront Protection Ordinance (LPO).
Maintain and enhance the predominantly landscaped, spacious and continuous character of the lake shore parks.
Nor applicable. The subject site is located in the Private Use Zone and zvill not modify the landscaping or chardcter of the Lake Shore Parks.
Continue to improve the. water quality and ecological balance of Lake Michigan.
The subject site and; project should have no adverse impact on. water quality and ecological balance of Lake Michigan. The site will remain connected to the City of Chicago water and seiver system, and the proposed project will be designed, constructed and maintained in accordance with all applicable laws and regulations governing retention and discharge of stormwater and waste water.
Preserve the cultural, historical^ and recreational heritage of the lakeshore parks.
As noted in the Part Two Narrative, Subarea B was originally constructed and operated in the 1890s and early Twentieth Century as a luxury, lakefront apartment hotel and resort where residents, travelers, and community members could access and enjoy the hotel's commercial spaces in conjunction with Lake Michigan, the Columbian Exposition, and its successor, ]ackson Park. Hie connection between the Windermere West Hotel and lakefront as complementary publically-accessible spaces xvas ended xvith its demolition in 1959. For 57 years, the Windermere West site has operated as a private parking lot. The proposed redevelopment will restore the former connection for a new generation of residents.
5. Maintain and improve the'formal character and open water v'ista of Grant Park with no new
above-ground structures perniifted-Nof applicable. The subject site is not in or adjacent to Grant Park.
6. Increase the diversity of recreational opportunities while emphasizing lake-oriented leisure time
activities.
As noted above in our Response to the fourth Policy, a key feature of the Solstice project is to reactivate the Windermere West site, after a 57-year period as a parking lot, with high-quality residential uses and amenities. Petitioner expects residents will choose Solstice as a home in part to enjoy lakefront leisure lime activities. And if the requested
i
APPLICATION TO THE CHICAGO PLAN COMMISSION UNDER THE LAKE MICHIGAN AND CHICAGO LAKEFRONT PROTECTION ORDINANCE
Addresses: 5543-59 South Cornell Avenue/1634-64 East 56th Street (Subarea A); 5534-58 South Cornell Avenue/1604-1624 East 56th Street (Subarea B); and 5528-32 South-Cornell Avenue (Subarea C)
vacation rental use is allowed, the Planned Dciielopmeni will provide the opportunity for guests to have lodging that is proximate to Jackson Park, the Museum of Science and Industry, the University of Chicago, and other Southsidc cultural and educational institutions.
1. Protect and develop natural lakeshore park and water areas for wildlife habitation.
The subject site is located in the Private Use Zone of the Lake Michigan and Chicago Lakefront Protection Ordinance, arid the proposal is not expected to have any detrimental impact on natural lakeshore'park and water areas for wildlife habitation.
S. Increase personal safety.
Two aspects of the project may increase personal safety in the adjacent lakefront park areas as compared to existing conditions. The reactivation of this site will generate pedestrian traffic and more "eyes on the street". In addition; based on Petitioner's extensive data for this market, the project's 316 on-site parking spaces will exceed the demand generated by the Planned Development and, if allowed, provide parking for residential neighbors, which could reduce demand for on-street parking and increase the likelihood that residents can park more closely to their homes.
9. Design all lake edge and lake construction to prevent detrimental shoreline erosion.
The subject site will have no direct impact on the lake edge and shoreline erosion because it will not be located on or adjacent to tlie lakeshore or lake edge.
.10. Ensure a harmonious relationship between the lakeshore parks and the community edge, but in no instance will further private development be pecmitted East of Lake Shore Drive. Solstice on the Park is proposed to be used ahd:designed in harmony with Jackson Park. In terms of use,'[the reactivation of the site will connect new-residents and visitors to the park and lakefront. And, as described above, Jeanne Gang's design for Solstice is intimately tied to its location at the edgd of Jackson Park, -from the angle of the South-facing .windows and leaf-inspired structural,patterns to the placement and landscaping of Solstice's forecourt, which willfacedhe northern edge of the Park.
Studio/Gang describes Solstice's design-as "Form Shaped by the Sun":
""Solstice oh the Park, a... tower literally shaped by solar access, ""
challenges the current notion of pure iconography and symbolism in tall buildings. With expansive views of Jackson Park to the south and Chicago's skyline .to the north, its living spaces are chiseled to create a "self-shaded" south-facing surface in response to summer sun (all of its surfaces are precisely designed to the optimum 71° angle for Chicago's latitude), allowing sun to enter the apartments during winter for passive solar zv'aming and precluding it during summer to reduce air-conditioning usage."
11. Improve access to the lakeihore parks and reduce through vehicular traffic on secondary park roads.
Tlie proposed project is not expected to modify or adversely impact any existing pedestrian or vehicular access points to or through Jackson Park.
APPLICATION TO THE CHICAGO PLAN COMMISSION UNDER THE LAKE MICHIGAN AND CHICAGO LAKEFRONT PROTECTION ORDINANCE
Addresses: 5543-59 South Cornell Avenue/1634-64 East 56th Street (Subarea A); 5534-58 South Cornell Avenue/1604-1624 East 56th Street (Subarea B); and 5528-32 South Cornell Avenue (Subarea C)
accordance with ail applicable laios and regulations governing retention and discliarge of stormioater and waste water.
4. To insure that construction in the Lake or modification ofthe existing shoreline shall net
be permitted if such construction or modification would cause environmental or ecological damage to tlie Lake or would diminish water quality; and to insure that the life patterns of fish, migratory birds and other fauna are recognized and supported: The project does not involve any construction xoithin the Lake or modification of the existing shoreline or Jackson Park and should not cause environmental or ecological damage to the lake or diminish the water quality or impact the patterns offish, migratory birds or other fauna. Two of the Subareas will continue in , their existing developed state, and the Windermere West site, to be developed as Solstice on the Park, is currently a parking lot.
5. To insure that the Lakefront Parks and the Lake itself are devoted only to public purposes and to insure the integrity of and expand the quantity' and quality ofthe Lakefront Parks; Tlie subject site is located in the Private Use Zone and will not adversely impact the public purposes ofthe Lakefront Parks and Lake.
To promote and provide for continuous pedestrian movement along the shoreline;
The subject site is not located at the shoreline and should have no detrimental impact on pedestrian movements along the shoreline.
To promote and provide for pedestrian access to the Lake and Lakefront Parks from and through areas adjacent thereto at regular intervals of one-fourth mile and additional places wherever possible, and to protect and enhance vistas at these locations and wherever else possible;
With respect to access issues: (i) the existing pedestrian orientation of the Windermere House forecourt towards Jackson Park is being maintained, and Solstice will .include a similarly-positioned forecourt; (ii) Solstice will include ample bicycle storage for residents; and (iii) Solstice is expected to create a supply of on-site parking spaces that will increase the availability ofon-street parking for Lakefront visitors who arrive by car. In terms of vistas, Solstice's proposed architectural and landscaping design will improve views to and from Jackson Park. .
8. To promote and provide for improved public transportation access to the Lakefront;
Solstice will not include modifications to any public transportation facilities. However, based on Petitioner's extensive experience and familiarity with residential patterns in the neighborhood, Petitioner expects that Solstice residents and visitors will make extensive use of the area's substantial rail and bus systems.
9. To insure that no roadway of expressway standards, as hereinafter defined, shall be
permitted in the Lakefront Parks;
Not applicable. The project does not propose any new roadways.
APPLICATION TO THE CHICAGO PLAN COMMISSION UNDER THE LAKE MICHIGAN AND CHICAGO LAKEFRONT PROTECTION ORDINANCE
Addresses: 5543-59 South Cornell Avenue/1634-64 East 56th Street (Subarea A); 5534-58 South Cornell Avenue/1604-1624 East 56th Street (Subarea B); and 5528-32 South Cornell Avenue (Subarea C)
Strengthen the parkway characteristics of Lake Shore Drive and prohibit and roadway of expressway standards.
The subject site is not located on Lake Shore Drive, and the proposed project will have no impact on its parkway or roadway characteristics.
Ensure that all port, water supply, and public facilities are designed to enhance lakefront character.
Tlie proposed project does not involve any port, water supply or public facilities that effect lakefront character.
14. Coordinate all public and private development within the water, park, and community zones.
Tlie proposed project is located within a .Planned Development. Through the Planned Development amendment process, the project will be extensively reviewed by various City of Chicago Departments and will be designed, constructed and maintained in accordance with all applicable laws and regulations to ensure the coordination required by this Policy.
***************************
PART FOUR: POTENTIAL IMPACT OT THE PROPOSAL II Thirteen Purposes ..
1. '' '-To promote and orotect.the health, safety, comfort, convenience, and the general welfare of the people, and to conserve our natural resources;
Tlie proposed project will promote and protect health, safety, comfort, convenience, and general welfare while conserving natural resources. The project ivill provide up to 250 units of modern rental housing in a neighborhood that has seen little residential construction since Urban Renewal ended. With this half-century period .of relative dormancy, Hyde Park has extremely fezv . buildings.with modern sustainability and' accessibility features. Petitioner is also proposing to dedicate 53 existing dwelling units, in a prime, transit-rich . location, as affordable housing. And, to the extent, these uses are allowed in the final Planned Development, Solstice also will provide the neighborhood with vacation rental capacity and new-parking.
T. To identify and establish the La^cTMichigan anaXntcago Lakefront PfbT«fioTi"Bjstric"t~ and to divide that District into several zones wherein any and all development or construction, as specified in Article V hereinafter, shall be specifically restricted and regulated:
The subject site is located in the Private Use Zone as established by the Lake Michigan and Chicago Lakefront Protection Ordinance. The proposed project does not propose any modification of the current boundaries between the Private Use Zone and Public Use Zone and will be reviewed under the provisions of that Ordinance, the Planned Development provisions of the Zoning Ordinance, the Chicago Building "Code,"and'other City' ordinances to ensure'that the project's development and construction activities ivill conform.with applicable laws and regulations.
3. To maintain and improve the purity and quality of the waters of Lake Michigan:
The site ivill remain connected to the City of Chicago water and sewer system, and the proposed project ivill be designed, constructed and maintained in
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: Antheus Capital, LLC
Check ONE ofthe 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. [X] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: 5528 S CORNELL AVENUE OWNER, LLC
B. Business address of the Disclosing Party: 32 N. DEAN STREET, 2ND FLOOR
ENGLEWOOD, NJ 07631
SCHARENDOFF@ANTHEUSCAPITAL.COM
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
Name of contact person: SUSIE CHARENDOFF
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):
Amendment of Residential Business Planned Development 282.
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 #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
[ ] Person [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: NEW JERSEY
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?
M Yes [ ] No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-foi>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
DAVID fiFFSKY , MANAGING MFMRFR
ELI UNGAR MANAGING MEMBER
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
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
32 N. DEAN STREET, 2ND FL Disclosing Party
ELI UNGAR ENGLEWOOD, NJ 07631 25%
DAVID GEFSKY 25%
HARLEY UNGAR 25%
JENNIFER GEFSKY 25%
SECTION HI - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes W 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 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.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
{<] 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 ft] 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 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, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
I
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 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 ofthe 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:
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 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, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [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 of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes [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 W No
If you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or 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: Ifthe Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe 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 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.
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 arid 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:
Page 11 of 13
I
i
F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ('.'EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F:2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: 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:-: (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.
ANTHEUS CAPITAL, LLC
(Prin^f5rTyrp^^rn^of DiscUjsmg^Pal^)
(Sign here)
DAVID GEFSKY (Print or. type name of person signing) Managing
MEMBER
(Print or type title of person signing)
Signed and sworn to before me on (date) iZdahja^ (bj 2/0/5^
at feorpi-A County, ^oAtrS^ (state). .
Notary Public.
commission expires: L-^toll
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section ILB.l.a., 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 lx] 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 ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
i
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
Legal name ofthe Disclosirig\Party submitting this EDS. Include,«d/b/a/.ifjappiw
AL-5528S CORNELL, LLC .......
Check ONE ofthe following thrcc,b.oxes,:,^-. „ w. ...
Indicate whether the Disclosing Party submitting this EDS is:
1- [0= jhc. Applicant n , v^;,5,.?:;„ ;. > : ¦¦
OR" ^,;;Sv^.:-
2. [•] a legal entity holding a direct or indirect interesUn-.the,Applicant
Applicant in which the Disclosing Party holds an interest: .
3; [X] a legal-entity with .a right of control (see Section\>ri:Br^
which the Disclosing Party holds a right of control: 5528 aCQRNitL AVENUE OWNER, LLC
Business address of the Disclosing Party: 32 N DEANSTREFT.-S'ND FLOOR . ._
. .ENGLEWOOD, NJ 07631 - .;, ; ,i
Telephone: : 201-541-8003 Fax: 201^08-0555 r, ^s'y. oEmail:
Name of contact person: SUSI &CHARENDQFF ..." v- ' ,
Fe^erajjEmp^
F. Brief description of cohtract^trarisacti^ t^below as the^^MattefV^tdjf:
which this EDS .pertains. (Include project nurfiber. and location of 'prppertyi-if applicable):
Jmeht'21
G. Which City agency or department^
If the Matter, is ai contract being handl^ complete the following:
Specification-.^. ,\".'i ''11 '. ^'^'Wd^Goltxaci:^
Vcr. oi-di-12 Page 1 of 13
/'
SECTION II — DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY/
1. Indicate the nature of the Disclosing Party:
[ ] Person [Xj. Limited liability^corripahy
[] Publicly registerecLbusincss.corporation . . Ll -Ximited.diability-partn'ership •
[ ] Privately held business corporation ' t;]';J6int>veriture-;''' :i '""
[ ] Sole proprietorship [] Not-for-profit corporation ,
[ ] - General partnership (Is'then^
[ ] Limited partnership []:Y.es ; . t[ ] N.o.r
[] Trust [] Other (ple^e^speafy|};v "¦''::' :
2. For legal entities^ incorporation or brgarii^tioriT;;-if:applicabrlc:
v:{; • rOEtAWARE"
3. For legal.enHties^ript.or^ the organization registered'to'do .
business:ih'^ V:: t^::¥i$$\f \.^[;--' v1--- -
|X]Yes r:i}Nb; •**;'' [.]N/A
B. IF THE DISCLOSING'P
1. ListVbeIow4he;full'names and-titles .of^ alLdirectors;:ofrihe-entity. ;N0TE:d?o^^
.•Si?^^".:-'' J: ¦i^!;»B:'Ji:.::': ¦^¦^i>'ftj_-. ^-.'J-^if!i7l' i; j£tej.I:*ii:4*»_.-' t-W^ ••i- it. ¦ 'UiUD-ifL.-L.'^ 'iL'iV-• ,
therei are'riS'such members; w members:" For trusts, estates or other, similar entities,: list below
the;legal.Utlch9lder(s^s- - ...: •;, ¦
T£therentitv'is^
Name --Title
Fti.iMGAR^:.,;.-,'!- = ¦ - n, u^'i ~ . "^RESIDENT- ; y; ~. ,
DAVID GEFSKY '' - ¦ r?: -;,.;;"-. VICE PRESIDENT ¦¦' ¦ "V ' ¦ ::. ¦ ¦
)2. Please ¦provide tlie^ll^ or;eritityj;"having;a-direct-or;
ihSirect-be'h^
df'such anijnteresT a partnership or joint' ventrirc,
Pagc;2qf^l3fc
i I
interest of a member or manager jn;adimitea\liability company, or interestiof a beneficiary of. a trust, estate or. other similar.entity: If none, state. V-None.".NG.T;E: Pursuant to Section 2-154-030 ofthe Municipal Codeof.Chicago ("Municipal Code"), trie 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
antheus capital, llc 32 n. dean street, 2nd fl 100%
—¦¦ engleVv66d,~nj^7631 —— :
SECTION HI -- BUSINESS RELATIONSHIPS W C.-M^*$
Has the.DisclosingiParty had a "business relatio^ Code, with any Gity elected official in the 12 months before the date this EDS is signed?
•• .:.*> i:./.;;;;-.rj-lH .f\r*>-y*ij\\-i A-'- • -:\•••^•ijj-,.y• •"' - -A/' "•• ••• '•-i>i:: ••
Ifiyesisplease idcntify;;b.elow, theiname(s) of such£Gity;electcdiofficial(s):ahd)desc '¦'
relatioriship(s): ;¦!¥.:,• w:;;vyvfe;:!:^ ".: •¦ :"<:-}~&'- .¦:
SECTION IV -- DISCLOSURE OF SUBCONTRACTORSiAND OTHER RETAINED PARTIES.
,;:;^::^cgi^.:;:-';.:.¦.¦¦';'1.'t;-3.;r'fr;;,,.- '-
,.' .„ _. .,¦ . .... , ^fSij?]jp!'i^
The'Diseldsing
lob'.byist,raccpurita^
or expects to
amount'of-the^^:feesjpaid;or-estimated\to:be:paid. The' Discldsing^Barty^ is ndt'required to^isclose
"L6bbx^^
actipn^ffibehalf ^ unj^id^basis; or, (2)^
himsV^
;?lfithe^'iscips^
Disclosing Party mus^ ;L.?U^
'¦Y.-.il'i.vi'fr^
Page3;6f;rl3a
Name (indicate whether Business Relationship to Disclosing Parly Fees (indicate whether
S^^M^L^^CiPA^.l. .Address'^ _} .PiLd/^rcstij|hat«i:) .rj OTJ6';.''
tobe^nHairi'cd) •--.h ::^^4pb'byis't^e\c^ ;':-u •»*'.**.>.< '.'hourly rate"W"t.b.d:"''is-!
•«'. 'f :¦' not an acceptable response.
(Add sheets' if necessary) \G;heci^
SECTION V - CERTIFICATIONS"'3^©';ii¦.'^I^V^^'-^O^C- "- ¦ ¦ z^'^V
A^£q0R^T^
;Has ahy.;persbn:wh6^ ifrearage^ri: ahy^r^
' vT-iv^ ¦ - - ¦- -
[ ] Yes p] N,o i[ J'No^pcrson;^ 10% or more of the
DjsclosmgrParryi:
I£^
p'^iii^;?di1;ft^
I'd'oingfB'usiness^ •tiroefrarneynTArticjel sup
2. The Disclosing Party and, if the Disclosing Parly is a legal entity, all of those persons or entities idendfied in .Section 113 fJ. ofjihi§:;ECS::;; . ....... ..
a. 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;
b. hav.£,npt,-:witto EDS;, ibee.nvcpnvicted of a criminal
, offense, adjudg^
contract und^
embc2zleinent;:theft; forgery; bribery; falsification ordcslructidn of records'; making false
kareinpt pre^ (federal,
state or local) with cpmmi%ng:;ahy/:vhavevnof^^i)W
trahs&tioiis;(fiederai, s i -:
e. havejjtfo^
3. Th'e/ccrtifieatidn^ 3; :4varid-5 concern:, .'/.i^:;-. , ¦;:. '•• '>;4,;V
• the-piscl.osmgV^arJy;'. v
* anvY"Gdntractbr^
guiltyy or foundiiiablean ax criminai or civii action; iricludihg actions
-and equipment; common use.pf employees; of organizationrof a business entity'following the : inchgibilityrof ^ the'e.ityrAis^
with n&p^ •
ihdirectlyfcohto ;Gbh1ractbr;li^under^drnrrion ;»;C^e-
control.of.ariothenpersoniOr.-entity:,, y'iji • •'•> . -v^ <,^/i^jv '-^^^j^--
.^ahy'resp^^
other, official, agerUip
. ;^Kgij[)^ f^f|fcseip^ '
¦ Cpntra'ctP^^ . Vv " .y
P^ge]5^>f:-13;i
Neither the Disclosing.R'ariy,,noi any Contractor, nor¦a'hy!Affiliate;dvEntity of either the Disclosing Party
or any-Conlractor~nor any Agents have^during>me-five •yeare-b:efdrei&e/da''te'this •EDS-'is*'signcd,-.6f; with-
respect to a Contractor,.an-.Affiliated Entity, or an,Affiliated Entity-of a.Contractpr during the five years
before die date'of su^ connection-with the
Matter: ;':.-'iL::£v;";...:\tr^ ¦
~a:^bjibe$^
or/employee's official-capacity: • ...7^ „':-, - -"v: .- ';
.Otherwise; or;
b. agtee^ercqllvided^
5sion>;ofijsuc p^s&cu^'Jfo^
c. rriadc.'an. adrnissidn'.of isucKcdnduct described
hv^e^6t?b'e^n:
'4#;$ eith"erthe;Dise}^ agenti^Kp^ar^
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 DispiosTng'Pafiy' -s knowledge•aftwrafebnable inquiry, the following is a
complete list of all current employees cfthe Dis^ any time duringvthe. l2-:
month period prcccdingthc cxecutionldate^of mTs*EDSi--an^mpldyeei of elected or appointed official, of the City of Chicago (if none; :^ic^; With <*jN/A".;pr "npne"^ , . . . .
NONE
9. Tq tti'e best cT^
complete list of all gifts :thatthe?Di$^sin^dr^. has giyen orcauscd to,b'e given, at airy'. time duri'ng^t|ie
12-mdnth period precedingithe.execu^tj'o EDS, to anxrriplby^e;-br clccted:or appointed :^
the
course of official City business-andiiayii;g'ii-retaU-value of-less*than--$20 per recipientc(if ndpe^dicate with"N/A" or "none"). As to any, gift listed below ,,ptease also-list the name of the;City recipient. ,
C. CERTIFICATION OF STATUSES.F^AWCIAE INSTITUTION , ,
The Disclosing Party certifics^that the Disclose >; ,,v,,^;.; ^
[] is Mis not ...^ ... - >
a "financial ;instuul^ ,.
If the Disclosing Party/IS»^^^
lender asde'fincd in Gh'apter^3^ft^
lender or becdinijag an affih^te loss of the privilege of doing
bus'hcss'witothT^ '' ' "' "'
Ifthc;D%lb^ng^ Sectibb^-^ 455(b) b^
2-32 of the Municipal Code^ : , : .:>.;¦¦
Page 7 of 13/:, ¦
If
: :^"T,--^^*v-,iWature of Interest.,,-_Vv' . ¦
,.v;v. -,¦>¦- ¦ ¦: .•' vv'K?}i;-\.. "v.jf.';*.
I
I
I
comply with these disclosure requirements may make any contract entered into with the City in connection with the.Matter voidable'bycthe-City.i • ... i;: . i ;. .
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 qr.slavendldc^ policies
issued:to-slay,eholders.;mat pro ... ¦ ¦-,<
the D.isclpsing.Party has.fouhdmo such records: ,. ». *>••'• O. •.¦ -:;
2. The Disclosing Party verifies that, as a result bf cbhducting the search in step 1 above, the
'DisciosirigjM
policics.:.A'Fhe: : rcc\)fds,vihcluding*ti^
SECTION.yi;-:4eERT'IFICAT MATTERS^
NQT-E:.If.ihe;M:atter4s'rfedera'Uy funded, complete>this Section VI. If the Matter is not federally
funded,,proceed to Section VII. For purposes of tKis/Se^ ^
.andvprocccds pf debt obligations o -.r ?
A. CERTIFICATION PvEGARDING LOBB YING. ' v
1: .List;below the names of all persons or entities registered under triefederal Lobbying
(Ifhoexplan^mnapp^
app'ewi'j^
regrsfere^d;.uride^^^
Disclosingyfia^ [:
2. The^pisclpsing^ fany^p'ersb.^ : pcrsonpliv^ appHcJibj^
member di f|Cbngrc^ bectibh':WitlMh'e contract^ federal
amehd. or modify any.fcdcrally funded contra^ agreement. ,
I
!
i
-3. The-DiscIosingrParty willsubmit an updated ccrtificatiorittl-thc-cnd of each;calendar-quarterin-- --which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l: and A^aboye:'.? .-^r'¦¦ > ¦ -¦- --1 jC;-i->'-'
¦ " •••-!:.-s.'V'r'., ^:>l.7 7\<;.v -';;---^v'-.!.r. .¦>^"'».v::m":k .' ¦• - ¦.:¦;*-."«.-*¦,'-i^--^ ¦ •¦ ''¦¦ =
4. The'Disclb^ing PartyceftYfics thaT^citheir": ;(i) itus;not amprganization 'described in section 7 50J(c^)!qfthejinfe 5Gi(c)(4):6ftheTntefnai'P^
Activities". * •
form andiSub^tanc.e tojparagraphs^A}:! subcontract?^ dujatiompfjthc ^
B;
If ;liie;Matter is;f^ suDcbntf^
Is •the^Disclosing^p , v?^'^p^f' t^SlLv'^---
[TYes S^~^>* v ¦
H2^^Hayev#tfSfiled-witr^
fTYe.s -' ¦ '¦¦ ' "V'fc;TlN-Q'^;'r7^-; ~ ? ^&¦¦.-¦¦ v/^W- -vWvS;,./-.^- ¦
' ¦
¦3; Haye .youparttcipate .the ¦¦' ¦¦ • <••;/••;<• • -
equal^ppblrtunity/ciaus^ ;' :-7'S:;7;S.^4li;y;'
,.Ifi|p^
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that: "¦•
A. The .certification^
contract pfipthcrjagrccmcnt between the,App^ with the Matter, whether
procurerrient;iCity'a'ssisfance;Vp^ : of any contract or taking-other actijon with respect to th&MattervTh^Pisclpsing Party understands that
line at'www.citycifchicaeo.ofg/EthicSi and may also be obtainedfrom1 the City's Board-efEthics; 740 N.
Qnlrlniwi/'lr .Ct Quito i/»nnn IT 1 A 7/1 /I .Q/C/: fV't-!T-U AUTii <.X1 n.iDn ^r'^ 1./^Ami. K/lfl. 11'
Sedgwick. St., Suite 500; Chicago^ IL 60610, (312).744-#660/T;he?Pisc^ with the/applicable ordinances.
declining tojallow thc Disclo'sin in 6tii'ef%dhsac.ti6ns w
lawyfpr,:a'false statement of rri'aten^ifkctim
damages. ¦¦¦-¦=¦.-.;'!'¦ .r-{?S.o-'.-;¦.¦•.¦¦.v:v> ' ¦ ¦
rights::or elaims/whichatima^ connection with th^ .
cbritained'mvthislEDS'a^
,in;th.isi-ED,S.
E. Thenhfpnhatibnjpjro^ kept current. ^In&e/eyj^
Party, must-s^
Chapter^T^
/tAtitpft/if riatrl'/f. V> O n 1 Ax1jl-\*r ?Vi*A/"!* i r*o: A« rt a-J-w* am* ' a^Y)**X a««s*a*m*am *• C ah r* a am ¦>¦* 4-1*'a'-JITY* n/il !r\n • jv.Da w .muni
^represents^'and^warraiits that:. . - ¦¦ ¦
y.^'rv.^\.*>-:>^)^
PageTi:bfH3-;;
i
i
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F.l. The DiscIosing.Parly is:ii6t^b 1 iriq"iierit in the paymcht bf any tax ^administered by the Illinois ., Department of Rcveriue, rior 'are'Wc'-bisblosing 'P-af-ly or: i is^i^ffi li ate d .Entities del in qu cn t in'pay j ngc ai{y 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.
!pisclosing;Party>l^ NQ^jEKlf the-Di&Iq^
• explp'afary^ f? M^-i. ; ':^h€.';¦ '-M^^- ~t¦:'-fi
C E RTIFIC AT I ON
andfcoj^lete^
. S.CORNELLtiLC ;.: ' O;.;¦ :^?:'v'"''M- ••¦BYjANTrjEUS^CABiTAL " "'
8S(SjgrrrH<^|^
_ MANAGINGJMEMBER ¦ >^ vfe)/.V::I: ¦^%ft.^
Co'mrriis)iqn;expires: ,;. ,,.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is toibc completed only by (a) the Applicant, and (u) any legal entity which has a direct ownership interest in.the Applicant exceedmg 7.5.percent It is not to be completed by any legal entity which has only an indirect ownership interest in the Appiicant.
Under MunicipalCode $cctiOT.2-154/-01$i the Disclosing Party must disclose whether such'Diselpsmg.Party or any "Applicable Party" orahyiSpouse or Domestic Partner thereof currently has a "familial relatipnship" with any-elected city official or deparunenl Head. A "famiiiaf relationship" exists if, as ofthe date this EDS is signed, the Disclosing PartyJ or aiy."Apphcable Party', or ahy Spouse or Domestic Partner thereof is related to the mayor, any alderman; ,me city clerk, the city treasurer or.any city department head as spouse or domestic partner or as any of me foliowing^whcther by blood or adoption: parent, child, brether-or sister; aunt or uncle,, niece or nephew,'grandparentj grandchild, father-ih-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 SccticnTI.B.l.a., ifthe
Disclosing Party is a corporation; all partners; of the Discldsihg Party, if the Disclosing Party is' a general
partnership; -all''geheral.pl^|is;a^-Umit^i^^^rs of the:DiscIcsing Party, if thc:Di^closing Pai^ is aiimited.
partnership; all managers,.managing members arid memberspf the Disclosing Party, if tlie Disclosing Partyis a
limited liability company; .(2)|ail:pnncipal officers of (3) any-persori having more than
a 7.5 percent bwhership interestinthe Disclosing Party. "Principal officers" means thclpresid.ent, chief
operating officer, execudve director, chie secretary .of-a legal.entity or any rjersqn
exercising similar authpriiy.
Does theDisclosing Party,or;ariy"App:Ucable Party" cranySppuse or Dpmestic Parmer mereef currently have a "familial felatienship" with an dectedicity/official or department head?
[ ] Yes fx] Nb
If yes, please ,identify belcw (i);the name arid title cf such perscn, (2) the name Of the legal entity te which
such person isMbcrmected^^ pr department head ;te whom such
person has a familial relatipnsliip^ahd nature pf such familial relationship.
<
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable: 5528 S. CORNELL AVENUE, 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. [X] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: 5528 S CORNELL AVENUE OWNER, LLC
B. Business address of the Disclosing Party: 32 N. DEAN STREET. 2ND FLOOR
. ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
i
Federal Employer Identification No. (if you have one):
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, ifapplicable):
Amendment of Residential Business Planned Development 282;
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 #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY -
1. Indicate the nature of the Disclosing Party:
] Person [>3 Limited liability company
] Publicly registered business corporation [ ] Limited liability partnership
] Privately held business corporation [ ] Joint venture
] Sole proprietorship [ ] Not-for-profit corporation
] General partnership . (Is the not-for-profit corporation also a 501(c)(3))?
] Limited partnership [ ] Yes [ ] No
] Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
INDIANA
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?
WYes []No []N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
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 of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Al-fiS?fiSCORNFI 1 .110 : : MANAGER
DAVID GEFSKY VICE PRESIDENT OF AL-5528 S CORNELL, LLC
ELI UNGAR PRESIDENT OF AL-5528 S CORNELL, LLC
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
LYRICAL-ANTHEUS REALTY PARTNERS II, L.P. 32 N DEAN STREET, 2ND FL., 100%
ENGLEWOOD, NJ U/B31
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 bd 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 ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) - lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
[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 ft] 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 tluVEDS 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, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under . Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state 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:
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4-
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 ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing 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, ofthe 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.
MONF
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) 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 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."
Ifthe 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 ofthe Municipal Code, explain here (attach additional pages if necessary):
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i I
I
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes p<] 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 W No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
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: Ifthe Matter is federally funded, complete this Section VI. Ifthe 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 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) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe 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:
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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 ofthe 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 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 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. 1., F.2. or F.3. above, an explanatory statement must be attached to'this EDS.
CERTIFICATION
Under penalty of perjury, the person sighing 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) warrantsthat all certifi'catibris'and statements contained in thisi'EDS and'Appendix A (if applicable)'are true, accurate and complete as of the date furnished to the City.
5528 S CORNELL AVENUE, LLC
(Print or type name of Disclosing Party)
By:
(Sigh1 here)
DAVID GEFSKY '
(Print or type nameof person sighing)
MANAGING MEMBER (Print of type title of person signing)
BY: AL-5528 S CORNELL, LLC ITS MANAGER
BY: ANTHEUS CAPITAL, LLC ITS MEMBER-MANAGER'
BY: DAVID GEFSKY
ITS MANAGING MEMBER
Signed and sworn to before me on (date) _£i
at ^cy-tyv County, K l^iiTSg^ (state)
JEANETTE MARIE COLON
i NOTARY PUBLIC OF NEW JERSEY
f 1.0. # 2419776
My Commission Expires 4/12/20i3l_S
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 ofthe Disclosing Party listed in Section U.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes |X] No
If yes, please identify below (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 ofthe 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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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable: 5528 S CORNELL AVENUE OWNER, LLC
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: 1. [XJ the Applicant OR
2; [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
: Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 32 N. DEAN STREET. 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHAREN DOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
E. 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):
Amendment of Residential Business Planned Development 282 (5543-59 S. Cornell Ave./1634-64 E. 56th St.; 5534-58
S. Cornell Ave./1604-1624 E. 56lh St.; 5528-32 S. Cornell Ave.)
G. Which City agency or department is requesting this EDS? DePartment of Planning and Development
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
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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: DELAWARE
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?
WYes []No []N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
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.
N O TE: Each legal entity, listed below, must submit, an ED S .on its own behalf. .....
Name Title
S CORNFI I AVFNI IF, 11 C : : SOLE MEMBER
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. Exampies of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
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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
32 N DEAN STREET, 2ND FL., Disclosing Party 5528 S CORNELL AVENUE, LLC ENGLEWOOD, NJ 07631 100%
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 [xINo
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.
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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. Silliman Group - 5454 S Shore Drive, Chicago, IL - Development consultant $8,000 estimated
Vedder Price - 222 North LaSalle Street, Chicago, IL - Attorney - $100,000 estimated
Studio Gang Architects - 1212 N. Ashland, Chicago, IL - Architect - $100,000 estimated
Gettys Group - 55 West Upper Wacker Drive. Chicago, IL - Development consultant- $80,000 estimated
rates
(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 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 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.
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The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all.persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency 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 ofthe 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.
6; 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.
7. If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best 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, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe 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.
NONF
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 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
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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 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 fK]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 gfl No
If you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. Ifthe Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X l. 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: Ifthe Matter is federally funded, complete this Section VI. Ifthe Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.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:
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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 ofthe 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 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. 1. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: 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: (1) warrants that he/she is authorized to execute this EDS' and Appendix A (ifapplicable) bri1 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.
5528 S CORNELL AVENUE OWNER, LLC (Print or type name of Disclosing Party)
By:
(Sign here)
DAVID:GEFSKY
(Print or type name of person signing)
BY: '5528 S CORNELL AVENUE, LLC ITS SOLE MEMBER
BY: AL-5528 S CORNELL, LLC ITS MANAGER
BY: ANTHEUS CAPITAL, LLC ITS MEMBER-MANAGER
BY: DAVID GEFSKY
ITS MANAGING MEMBER
MANAGING MEMBER
(Print or type title of person signing)
Signed and sworn to before me on (date) fefacu^ ^-7^7^15
at &<*5%tvi County, fUaUjpjau^ (state).
Notary Public.
Commission expires: M^f^
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDED A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Parmer thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as 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 U.B. 1 .a., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, 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 D<] 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 ofthe 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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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFF LAW/PRO B LE M LANDLORD CERTIFICATION
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 (an "Qwncr"). - It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
|. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a -building,code„.scbfflaw or problem landlord pursuant/to Section 2-92-416; of the Municipal Code?
I.jYcs [X]No
If the Applicant is a legal entity publicly traded,on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or prbblem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ] Yes [ ]No [X j Not Applicable
If yes to (J) or .(2) above, please identify below the name of the person or legal entity identified as a building code scofflaw or problem landlord and the;address ofthe building or buildings to which the pertinentcode violatioris apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX. BJS INCOf^QRATED BY REFERENCE INTO, AND MADE A PART OF, THE.ASSOCIATEli.EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:
ANTHEUS CAPITAL, LLC
Check ONE ofthe 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. [X] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: SOLSTICE ON THE PARK, LLC
B. Business address of the Disclosing Party: 32 N. DEAN STREET. 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
E. 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):
Amendment of Residential Business Planned Development 282.
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 #
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SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature ofthe Disclosing Party:
[ ] Person [XJ
[ ] 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: NEW JERSEY
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?
W Yes [ ] No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below ali 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
DAVID GEFSKY MANAGING MFMRFR
ELI UNGAR MANAGING MEMBER
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,
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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
32 N. DEAN STREET, 2ND FL Disclosing Party
ELI UNGAR ENGLEWOOD, NJ 07631 25%
DAVID GEFSKY 25%
HARLEY UNGAR 25%
JENNIFER GEFSKY 25%
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 [xl 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 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
(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 ft] 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.
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The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B-2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any'Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U:S: Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General);"2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
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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.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing 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.
NONF
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 of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
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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.
1. 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 ofthe 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 M No
If you checked "Yes" to item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such, interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither 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
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.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) 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:
1 Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
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 ah 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 oh 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 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
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 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 ofthe 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) oh 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.
ANTHEUS CAPITAL, LLC
(Sign here) DAVID GEFSKY
(Print or type name of person signing) Managing MEMBER
(Print or type title of person signing)
Signed and sworn to before me on (date) fclorv**~f /o, Zd/f
at Gi?rfftA County, AJe^j (state).
J^-^***2 ^— 'S^? Notary Public.
Commission expires: ^ jl7^Zr/^ •
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JEANETTE MARIE COLON | NOTARY PUBLIC OF NEW JERSEY
I.D. # 2419776 My Commission Expires 4/12/20/V
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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 HB.1 .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes frc] 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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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Solstice on the Park, LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
fX] 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.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 32 N. DEAN STREET. 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
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):
Amendment of Residential Business Planned Development 282 (5543-59 S. Cornell Ave./1634-64 E. 56th St.; 5534-58 S. Cornell Ave. /1604-1624 E. 56,h St.; 5528-32 S. Cornell Ave.)
Which City agency or department is requesting this.EDS? DePartment of Plannin9 a"d Development
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
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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 [Xj
[ ] 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, ifapplicable: DELAWARE
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?
W Yes [ ] No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability
partnership or joint venture, list below the name and title of each general partner, managing member,
manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party.
NOTE: Each legal.entity listed below must submit an EDS.on.its own behalf.
Name Title
Al -Rnlstir.fi nn thft Park, I I C 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,
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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
LYRICAL-ANTHEUS REALTY PARTNERS II, L.P. 32 N DEAN STREET, 2ND FL, 100%
ENGLEWOOD, NJ 0/631
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 [xi 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.
Ifthe 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 o*¦» a^^AntqKIp roonAnpa
Silliman Group - 5454 S Shore Drive, Chicago, IL $8,000 estimated
Vedder Price-222 North LaSalle Street, Chicago, IL-Attorney-$100,000 estimated ,
Studio Gang Architects -1212 N. Ashland, Chicago, IL - Architect - $100,000 estimated
Gettvs Group - 55 West Upper Wacker Drive, Chicago, IL - $80,000 estimated ,
(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 p<] 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 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.
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The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency 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,' of 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 the1 Office of Foreign Assets Control of the 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:
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
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, ofthe 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.
NONF
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [xj 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 ofthe 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):
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[1 Yes [X]No
NOTE: Ifyou 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 of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
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 arid 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 []Nb
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
i I
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. 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.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: (1) warrants that he/she is authorized to execute this EDS and Appendix A (ifapplicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
SOLSTICE ON THE PARK, LLC
(Printr&t^type name of Disclosing Party) By:
(Sign here DAVID GEFSKY
(Print or type name of person signing)
BY: AL-SOLSTICE ON THE PARK, LLC ITS MANAGER
BY: ANTHEUS CAPITAL, LLC
ITS SOLE MEMBER .
BY: DAVID GEFSKY
ITS MANAGING MEMBER
MANAGING MEMBER (Print or type title of person signing)
at
Signed and sworn to before me on (date) y^?/WUy 'lb\ WS
Countv,Atoc*> ler$&y (state).
JEANETTE MARIE COLON I NOTARY PUBLIC OF NEW JERSEY
I.D. # 2419776 My Commission Expires 4/12/20/? I
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic 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 Part/' 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 TLB. La., 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 ofthe 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 ofthe 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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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a).the Applicant, and (b)/any legal entity which.has a direct ownership jntcrcs't in the Applicant exceeding 7.5 percent (an "Owner"). It is nof to be completed by any legalcntirywliich has only an indirect ownership interest in the Applicant.
Pursuant to Municipal Code Section. 2-154-01.0, is the Applicant orany Qwncr.identified as. a building code.scofflaw or problem landlord pursuant lo Section 2-92-416 of the Municipal Code?
[ JYcs [X]Nb
Ifthe Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scolTlavy or problem landlord pursuant to Section 2-92-416 of the Municipal.Cpde?
[ ] Yes [ ]No [X] Not Applicable
If yes to (1) or (2) above, please identify below the name ofthe person or legal entity identified as a, building code scofflaw or prpbjem. landlord and the address ofthe building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF/tHE .ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:
AL-W1NDERMERE HOUSE, LLC
Check ONE ofthe 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. [X] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: WINDERMERE HOUSE, LLC
B. Business address of the Disclosing Party: 32 N. DEAN STREET. 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
E. 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):
Amendment of Residential Business Planned Development 282.
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 #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature of the Disclosing Party:
Person [Xj
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, ifapplicable: INDIANA
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?
|XJ Yes [ ] No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity., NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-daymanagement of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
ANTHFt IS CAPITA! nr SOLE MEMBER
Fl I UNGAR PRESIDENT
DAVID GEFSKY VICE PRESIDENT ._
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 ANTHEUS CAPITAL, LLC
Business Address
32 N. DEAN STREET, 2ND FL
—ENGLEWOOD, NJ 07631
Percentage Interest in the
Disclosing Party 100%
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 [xl 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
i
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
f<] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes ft] 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 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
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The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state 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) arid 2-156 (Governmental Ethics) of the Municipal Code.
Ifthe Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party rhust 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, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
NONF
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 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee 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 ofthe 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 f(]No
If you checked "Yes" to Item D.I., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or 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. Ifthe 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 of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or 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.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe 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:
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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: 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.
BY: ANTHEUS CAPITAL ITS SOLE MEMBER
BY DAVID GEFSKY
ITS MANAGING MEMBER '
(Sign here)
DAVID GEFSKY (Print or type name of person signing)
MANAGING MEMBER
(Print or type title of person signing)
Signed and sworn to before me on (date) f-i^lVt^ (of 7JHat Qxj-gi^. County, (Uaj ipg^-y (state).
Notary Public.
JEANETTE MARIE COLON , NOTARY PUBLIC OF NEW JERSEY
I.D. # 2419776 rMy Commission Expires 4/12/20l2l_£
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Parmer thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section TLB. La., 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 ofthe 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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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:
ANTHEUS CAPITAL, LLC
Check ONE ofthe 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. [X] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: WINDERMERE HOUSE, LLC
B. Business address of the Disclosing Party: 32 N. DEAN STREET. 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
Federal Employer Identification No. (if you have one):
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, ifapplicable):
Amendment of Residential Business Planned Development 282.
G. Which City agency or department is requesting this EDS? Dement of Planning and Development
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
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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 [Xj
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))?
[JYes []Nq Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: NEW JERSEY
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?
[XjYes []No []N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title '
DAVID GFFSKY .MANAGING MFMBFR
ELI UNGAR MANAGING MEMBER
2. Please provide the following information concerning each person or entity having a direct or indirect beneficiai 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
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
32 N. DEAN STREET, 2ND FL Disclosing Party
ELI UNGAR ENGLEWOOD, NJ 07631 25%
DAVID GEFSKY 25%
HARLEY UNGAR 25%
JENNIFER GEFSKY 25%
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 W 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.
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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:
I to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
f<] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared'in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes ft] 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") arid legal requirements), ifthe Disclosing Party subfnitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government. ,,
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or, entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe 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 Contractors 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 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:
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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.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing 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, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
NONE
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [x] is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
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):
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¦J
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes fqNo.
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 fc] No
3. If you checked "Yes" to Item D. 1., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest: ,.
Name Business Address, Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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i
I
I i
j
i
I
i
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: Ifthe Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.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:
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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 ofthe 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. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: 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 ofperjury, 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. ::
ANTHEUS CAPITAL, LLC
(Sign here)
DAVID GEFSKY
(Print er type name of person signing) Managing MEMBER
(Print or type title of person signing)
Signed and sworn to before me on (date) telit^, /Oj £67$
at . QzrftUK County,A*e«/ ¦^x^' (state).
Notary Public.
Commission expires: ^(cLf'z&tt-
'^F^ires 4112/2012-My commission Expires *m
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 TLB. La., 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.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT " J AND AFFIDAVIT
SECTION I - GENERAL INFORMATlbl^I '
A. Legal name of the Disclosing, Party .submittihg-;thls EDS. Include?d7b7aydtapplKable:''- **?v,,*7* *
Check ONE of the following three boxcar 1 '
Indicate whether the Disclosing Party submitting this EDS is:
:'|XJ$the:^ppiic^nt L >.\ ^ .^.^r ¦ :-A%*.,.r-,:
or "• Fi^ri . (
[ ]. a. legal entity holding a direct or indirect interest in the. Applicant.^ Staie'thc -legal name of the -;
Applicant in which the Disclosing Party holds an interest: :
3. [ ] a legal entity with, a right of control (sec Section^li:^
.v. which the Disclosing Party holds a right-of control:
B. Business address of the Disclosing Party: 32 N. DFAN.STREET,2NDFLOOR
f ' v^ENGtfEWOO^
. -'Uvftf;c :-*yi> ^^a^^s^ ^ • fl^-Mi ,i '•
C. Telephorie:^ 201-541-8003 Fax: ;201-608:-655Stf. :":-r.; Ernall: - 1 -v .¦.«¦.•": ¦¦¦•v* >r:
P.: Name of contact person: SUSIE OHARENDOFF .
Ki^'il^'f?^!:^ ^;.vi-'5V!fH*--v:,.^ •; =5
• E. FcdefaliEmployerTderitificati fl^3^9 gi;.rSJ^v^v ^ ^^-^r--^
F.^Bri£f-description of cpritrac$tfansa£tibn;iprbtfiej^^ the "Marter-^td* '-?
whifch,1his EDS pertains. (Include:project«umb«'r'andlo^ati6n%)^prAmeriamOTroCR&lafential Business Hanned/D^ 56"' St.; 5534^58^
S.Corneli'i^
O.tWliicfrCi^
If the Matter is a-contract being handled by^the City's^DepartmentiOf Procurement Servicespplease
^«complete'the following: 1 SnejflM^^
Pagc'Wf^FJ1*
r nrSCI OSURE OF OWNERSHIP INTERESTS
SECTION II - DlSCI.O»uKl • ; ^ V '•'
A. NATURE OF THE DlSCLOSlNGkP;ARTT . " ^
t indicate the riamre of me Disclosing PartK j jmitcd Habjlity;Company;; -
(1 Person ¦ co tion t ! ^ted'Habil^ ,
M Publicly registered t?u^sf c0^^ .. iJoihfVen^ - ¦< -
[ ] trust 2. For
[ ] Sole^proprietorship. ^ ^mrr^^^^^^^s^ —
[] General partnership • -^ftV«C . ,.^.Kft.,,,.^4-, ^
-[i-timited.partner.ship . other (pleascisp.e?ity.):; * • ' ¦- ;
2. FoVlegal^itie^vej^i v .. w4>. ,-
bu •
„,,£--^^v . ¦ " f TN/A ; f<.
P^^of^Jif^
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 tp^Section 2-1-5,4-03 0;6f-the Municipal Code of Chicago. ("Municipal Code"), the City riiay require any such additional information from any. applicant.which is reasonably intended to achieve full disclosure.
Name Business Address . . . - Percentage w«r-
'¦ ¦¦'Disclosing.P'a'rt^
LYRICAL-ANTHEUS-REALT^PARTNERS II,LJp.^^jV-¦ <32;N:DEAN;S¥REET^iNtfEL^ 00%.;.:.: .. •
: ~^_T~ ' • ¦' ¦ENt^bWUyuSj:07J63V'""'" "
¦ i^: ':¦ '
^/-¦^-Fir-TT-.-.-,
SE.C:TIQN-m:—BUSINESS-RELATIONSHIPS ;WJIT^
Has the -Disclosing Party -had a '^business relatiohsHip^ Code, with; any Cityelectedibfficial in the 12 monthsibeforc the date -misVED^-is'sighed?
, t[.] YeT /. J; ^W N6:v %,i
If yesj'ple^se-identifybelo^ r ^ r:^ .-. ^;
relationsliip(s): L- ^.i/^X n--;;:y*I ~^;*j&;y • o£i '' 0! :-
.«-«::.—'.-*.v."'*'-'f ¦
The Disclosing Party m^st disclose-.^ lobbyist,«accountant, consultant and any otherperson or entity whom trie''Disclbsmg|Pajrtyjhas,rc orexije^teitojtetein^ Aven]as;t^^
Disclosirig:Pjart^m
Page 3^f-1-3X
Name.(indicatc whether , . Business . Relationship to-Disclosihig Party . Pees (indicate whether
retained.pi*anticipated> . ./Address-v,.^iCsubcbhu^ictbr^ttoThcy^—''. paidibKestf^
to be:retained) -/ . lobbyist; etc.j: .•'••: '¦' ''houtly.Tate'^r^ "'
. i/'-T V ¦ •n6't%n:'acceptableresp6hse.
Silliman Group- 5454 S Shore Drive, Chicago, IL- Developmentconsultant . $8,000.estimated
Vedder.Price.-. 222;North:L^Sa]lolMreet, Chicago,"IL - Attorney r'$166;6d6-estimated ¦''-
Studio^ar^Afchite^^
Ge^ys.-Group': ^.55 West Upter ¦!;-,,*--.,.
(Add'sheets.if necessary) _ ^ . .
[l] .eifeckjlie^
A.-C©'y&^ r-;. :;/p4|M;'.".
Uttdet.fe
the'Gityjm^ w^i-ttiefr cliijd^^
Has;any?persqniwhb;di
-t:,j;-"---^,-,:,:~-tibns^b\^ariyllh
[.l;Yies "r53:Njo^ [i]^,b;pe^
If Vy^sj"|a'a's!;the
eertifies;as2foilows:,M witn,pr:^
criminal-offense involving acta^ ^gfcrjui^ any.^i^ster;'agehcy;^ rApplicaniluh
•doing.busmessjwilfctJbre^
:. timeframejin Article.I supersedes'someCive-.yeariCompliance.timefr^
2. The Disclosing Party and, if thc,Disclosing Parly is a legal entity, all of thpsC:persons orenlities
identified in Section IliB.l. of .this'EpS:,.:. .,. . , , v
.a. are not presently debarred, suspcndcdj proposed! for dcbanhent, declared.irie voluntarily
excluded from any transaclibns.by any federal, state or local unit of government; i , -;i
b. have, not, w.ithin a fiye?year period^preccding thc;date,of tfaisjEpSy:b'c„e;d?:COiivicted of a criminal
or
; nffVnCf* fl A XwAcif^A .Oil \i\r >'rtr. .K b^'Vi^J wll \i\Anrr\ on'#v Vai*t\ A r\fnA *i n>ifnnf.iiVAM,V<« A'ftH^a^AH-.^M^
contract uridcr'a public transaction; a violation df.federal or-state;anUtrust-statu
embezzlement; theft;.f6fgery;tbribery; falsificatio destruction of records; 'making-false.'
statements;^-^ i^^^-.t- *
have,npt, tfansabdoh^federai-^
havc.not, within >a fiyeiycar;period preceding the date of Uiis^EDS, been cbnvicted, adjudged
guiltyj or'fdund Iiab^ cnmihal or ciy^
ineligibility^ the. G-irvjAisihe su^
.rv\nr.f^fniri fr.-#»Tiv.irAr\,rn'V»htor^/iftia'if/Vrt'e.:'i«
controlibf anqmcfr^ ,v.„,.,.„., , ,,v-;,,...^,, .
iPage 5/pf ;13^
^be^ffoial
ttthe letters "XA « #I
Presumed thif « 'r. Word "None " „P -
Ifthe letters "NA," the word "None;" bf.no response ap^^ conclusively presumed tha^
D!;CE:R^iFIC
¦:^:s_^.;:;,:.:v/.;.rt ^ . ^ ^ _ _
/A.ny ' ".
¦meanlngV;whc&used4n%M • •<>.¦•.¦¦- "^¦^¦^¦¦¦¦¦.^¦¦r-y^/.:^^' *v rvv'T-:''¦¦'
?2.:?^U.riless.:So^ eljctcd&fficiab^
>a|(||$p^
:?dqe^ribjt^nstitut^
.DoesiuieMatter involve a eityJProperty/Sale? /',;: 'v .vj-W^y;:'':-iCu:--¦¦¦¦¦¦¦ • i -^*k' • ;'W-v -'
bcjacquifed by-ahy City official or emplpyeeV '; i '¦"viv^-'^'- w'Xo ::!';X"''?|te; ': ';?;-- -.
disclose ^ 2. vEailureto
comply with these disclosure requirements may make any contract entered hrto Wiethe City in connection, with the Matter voidable by the City. . • ¦'¦ ¦¦<.¦>'¦¦»-*t—-"'¦ -'
•¦¦;>>< :-.v;.-'
X :i:'The Disclosing Party verifies that the Disclosing
issued ^ve^ld^
•the PJsqlo£in^ '^^/^r^'-' - "^ ^r^-' -*¦¦<¦--'
2 The Disclosing.Party verifies that, as a result of cbiiducting-t^ above, the
policies:-'I ne disclosing ran iy uu" ^v -~e<,-- v.-
TCCorfis}|icludini thcrianies pf any and all slaves or s^^W^^^^f1?'
SEcTioRyTpj«|c|p^ -!53S.;:;
NOTE'Tf th'e'Mattcr Is fed VL :If%«^alt*r ^otfcdcr^lly ^
^nded'^dcebd to Scctioh VII. Fbrpurppscs; o^hi^S^tidn^L ^cr^^Uoc^^y:!mc.Gity:,i ^ *« anWoceeos^of-debt obligations of the City are not.federalfuriding.
A. CERTIFICATION REGARDING LOBBYING
1 iii^belowimernames of all persons or entiti^ Discldsil^^
respeci^the^^^^ necessary): ': v^i!-^^?^^^^"" ?'
¦iabr>Hcable^
fedefauy^^ amen^olr^
3. The Disclosing Party will submit aivupdated certificatiofrat=tKc^ which there occurs any event that materially affects the accuracy of the statements and information set forth in.paragraphs. A:-l,^and A>2vabove. i . / -.-. ':"ii^' vi'"i?;'{V'- "¦^v^4;.^'-;^i>S.^ - ' '•
5Q'l.(c)l(^6ftfc 5^(pX4)^f theTnterhaf
Actiyities". ' 'Cf'^"^-- . ,;V^:¦
.. -; ^y-^Ifi|iej)isc^ formari^sufeta^
BV-GEippiC^ ..
Iftjie-M^eris^era^ . ''^f
.^co^ 'negotiations,
If "Y^s^' answer-.the three .questibnsjbclbw: , • ,-. ;i ^,
..i^ral||g^
^iequaifopp^^^ — ^B^;V^fcv:'s^;::^;:^j^i;>^^.- .
^iTf.y^^riee • v:I>
SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION,
COMPLIANCE^ ,. • ,r.-r\ ', •
The Discibsing*Party understands. ano^grcestbat: '4i?'-v-?i?^4*v-'-« v -:- - ' ¦ ;
A. The;.c,crtificahpn any
contract briother agreement between^^'d^
procurement^
Sedgwick St:, Suite 500, Chicago, IL 60610, (312) 74^966^^ Th^Di^ with the applicable ordinance '
C. If the City determines that any informationipro vided in*this.^
omerwise J:-By,eo
rightsiOrtclaims which'i^ information;.;;-;
eohtainedln|:iuii"s:ERS to verifyimeiVtciiracVib
iri.mis'EDS::V ?;';-¦ ' ' ¦' ¦¦ •'•
- „ .- '^-'.l - .::v;vi, ... .-. .ui w . ;;"'v?^.Vi^SSr:'t.'MK,;::'.'^"
E: Thednformah^
Parly;must;/uppiement itSislED
cp.iitract'be^
F-J- The Disclosing Party is not • -
t
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
This Appendixes ^ arid|bj any legale^
ownership^
which has^^ ';''' ^ •"•'^'"1
Und.crMunicipal-Gpd,e^ orapy-"^
anyfelbcled'city o'fficia^
signed, the DisclOSrag'Pa^ ofiany'Spouse orPbrri&ti^B
niecePr nephew, grandparent,stepfather
0t "
"Applicable Party" means (I);alL executive b^ Disclosing. Partyis^c^ . partnership; all geneiral'p^tners'^ parttersrupjalhrri^ litfiitbd liability compa
a ,7:5'percSentdwn^^ chief : oberating^ffire^
exercismgsimilarauUionty: - ¦ ¦¦ ¦ ¦ ^¦¦¦¦¦¦¦
''D^es^fe'Ris^ havea^famiHal
, [i] Yes' ^f^^^S;^-'^ '':.V^.'!' ';' : :'.^M- '
. If^;please|f^ •
Paige 13 of? 13
CITY OF CHICAGO ECONOMIC DISCLOSURE'^St/itfiiEME-NT'AND AFFIDAVIT
APPENDIX B
: UILDING CO DE SCO F FLAW/i»R'oBLEM LANDLO RD CERTIFICATION '^'^ " . fS:'-^:. hisrA'pp'e^
^whicrivhas a^direct ownership intere^ (an "Owner"). ;
;^iejAp))jicantrr ;"' 'T^'-—*^^
'.;i>4vP^BUMtHo'lylunipipal'fcodetS^^ identified asia|^
s^;'*-.- •."' :• .-fcv'\ • .^ir v.;-.:.<•'? ''i;4.™-.,• A^s',Asv;-':^'f-^ -**».:•• .¦^•jXKr;::.;-^^
4^^;. v . > ¦ ¦ , - ¦ v' . - * . ^ . ••il • . - v£ . f it* ' '¦ ¦ ''' '-•'.' .' \ i V *' *
r • l'Ye^;- .;^;::X^lV;|Nd^ -[Xi]""'^'¦¦'•¦¦¦^pflf yes fo^l)sdr (2) aboye;;pleaseW
;,' \ ^nd':thm;thei^presentA'T'I^n^vMA ^".;
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:
AL-SOLSTICE ON THE PARK, LLC
Check ONE ofthe 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. [X] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: SOLSTICE ON THE PARK, LLC
B. Business address of the Disclosing Party: 32 N. DEAN STREET. 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
E. 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):
Amendment of Residential Business Planned Development 282.
G. Which City agency or department is requesting this EDS? DeP^ment 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 #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature of the Disclosing Party:
] Person [Xj
] 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: DELAWARE
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?
[XJ Yes [ ] No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
Title
SOLE MEMBER
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 ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name
ANTHR IB CAPITA! IIP.
RI 1 UNGAR PRESIDENT
DAVID GEFSKY VICE PRESIDENT
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
ANTHEUS CAPITAL, LLC 32 N. DEAN STREET, 2ND FL 100%
ENGLEWOOD, NJ 07631
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 [xl 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 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.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
f<] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes P] 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 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, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
• any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state 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) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing 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.
NONF
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.
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 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 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
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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 ft No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. Ifthe Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
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 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 of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe 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:
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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 ofthe 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: 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
AL-SOLSTICE ON THE PARK, LLC
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (ifapplicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
BY: ANTHEUS CAPITAL ITS SOLE MEMBER
(Sign here)
BY DAVID GEFSKY ITS MANAGING MEMBER
DAVID GEFSKY (Print or type name of person signing)
MANAGING MEMBER
(Print or type title of person signing)
Signed and sworn to before me on (date) fc&Uufi/y /fi. 7l>/5
at fc*S$Oi. County/JNotary Public.
Commission expires: W|)^/39r7
Page 12 of 13
„. ... JEANETTE MARIE COLON
/m^L% NOTARY PUBLIC OF NEW JERSEY
PJlJjfJf I.D.# 2419776
V**:^-L/My commission Expires 4/12/20IZj
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 ofthe 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 n.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 die Disclosing Party is a limited partnership; all managers, managing members and members ofthe 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 M 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.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:
LYRICAL-ANTHEUS REALTY PARTNERS II, LP
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR
(xl 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: SOLSTICE ON THE park, LLC;
OR WINDERMERE HOUSE, LLC;
5528 S CORNELL AVENUE OWNER, LLC
3. [] a legal entity with a right of control (see Section II. B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party:
32 N. DEAN STREET, 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
E. 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):
Amendment of Residential Business Planned Development 282.
Which City agency or department is requesting this EDS? Dement 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 #
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 [ ]
[ ] General partnership (Is
[X] Limited partnership
[ 3 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:
DELAWARE
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 p<] No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are nb'such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
Ifthe entity isa 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
I YRICAI.-ANTHEUS GP II, 11 C GFNFRAI PARTNER
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
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
GOTHIC CORPORATION 280 SOUTH MAGNUM STREET, STE 210 24.88%
DURHAM, NC2//01
CLARIDGE ASSOCIATES. LLC 15 W. 53RD STREET. #248 10.28% ^_
NEW YORK, NY 10019
Other Investors with an interest less than 7.5%
SECTION HI - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes W 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 ofthe 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.
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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.
(Add sheets if necessary)
{(] Check here ifthe 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 rnore of the Disclosing Parry been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes ft] 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 arid 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, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
• any responsible official 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 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 maintairied'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'LisL
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
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing 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.
NONF
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 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
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. 1., 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 M No
If you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature, of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or 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. Ifthe Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.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) 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 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:
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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 ofthe 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 tlie 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 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
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. 1., 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 (ifapplicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (ifapplicable) are true, accurate and complete as of the date; furnished to th'e City.
LYRICAL-ANTHEUS REALTY PARTNERS II, LP (PririA^e^type^name of DiscljgSmg Party)
(Sign here) DAVID GEFSKY
(Print or type name of person signing). Managing MEMBER
(Print or type title of person: signing)
BY: LYRICAL-ANTHEUS GP II, LLC ITS GENERAL PARTNER
BY: LYRICAL-ANTHEUS MANAGEMENT,~LP " " ITS MANAGING.MEMBER ,
BY: LYRICAL-ANTHEUS MANAGEMENT GP, LLC ITS GENERAL PARTNER
BY: DAVID GEFSKY
ITS MANAGING MEMBER
Signed and sworn to before me on (date) /-g^V-fc*-^ /b^^LO'y
at (Sn^i County; f\Jnj ksrt^ (state).
Notary Public.
Commission expires: W^^Zfe/?
, NOTARY PUBLIC OF NEW JERSEY
I.D.# 2419776 My Commission Expires 4/12/20 \ f-
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFDDAVIT
APPENDLX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section U.B.l.a., if the Disclosing Party is a corporation; all partners ofthe 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 ofthe 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 fc] 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 ofthe 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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*
CITV OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is:tp 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 (an "Owner"). It is not to be completed by any legal cntity-which has only, an Indirect ownership interest the Applicant.
Pursuant to Municipal Code.Sectiqn 2-154-010, is the Applicant or any Owner identified as a building code;scoffiaw or problem landlord pursuant to Section .2-92-416 of the Municipal Code?
[ ] Yes [X]No
Ifthe Applicant is a legal cntity.publicly traded.on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416.of the Municipal Code?
[ J Yes [ ]No [x] Not Applicable
if yes to (l) or (2) above, please identify below the name of the person or legal entity .identified as a.buiIding,co.de scofflaw or.problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCEtNTO, AND MADE A PART 6F, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJUR Y ON PAGE 12 OF THE ASSOCIATED EDS.
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:
LYRICAL-ANTHEUS MANAGEMENT, LP
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. [x] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: solstice on the park, LLC;
WINDERMERE HOUSE, LLC;
5528 S CORNELL AVENUE OWNER, LLC
B. Business address of the Disclosing Party:
32 N. DEAN STREET, 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
E. 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):
Amendment of Residential Business Planned Development 282.
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 #
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 [ ]
[ ] General partnership (Is
[X] 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:
DELAWARE
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 [xjNo []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-forrprofit 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 of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
I YRICAI -ANTHF1JS MANAGFMFNIT GP I I C GFNFRAI PARTNFR
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.
Percentage Interest in the Disclosing Party 32 N. DEAN STREET, 2ND FL 25%
ENGLEWOOD, NJ 07631
25%
50%
405 PARK AVENUE, 6TH FL. NEW YORK, NY 10022
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 bi 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 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 retained or anticipated Address to be retained)
Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)
Fees (indicate whether paid or estimated.) NOTE: "hourly rate" or "t.b.d." is not an acceptable response.
(Add sheets if necessary)
{(] Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
ft] No [ ] No person directly or indirectly owns 10% or more of the
. Disclosing Party.
If'Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[] Yes [ ] No
B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing 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.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4;.or (3) any similar offense of any .state or.of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the .U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any ofthe 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, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
NONE
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is Dfl 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 ofthe 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 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA." the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes |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 M No
If you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees haying such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or 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 of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) 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 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. .... r
Is the Disclosing Party the Appiicant?
[ ] Yes [ ].No . ... -
If "Yes," answer the three questions beloy/:
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 I] 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 ofthe 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. 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 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does hot 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 ofthe items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
LYRICAL-ANTHEUS MANAGEMENT, LP (Print orjype name of Disclosing Party)
By:
(Sign helre)
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDSahd Appendix A (ifapplicable) on behalf of the Disclosing Party, arid (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.
BY: LYRICAL-ANTHEUS MANAGEMENT GP, LLC ITS GENERAL PARTNER
BY: DAVID GEFSKY ITS MANAGING MEMBER
DAVID GEFSKY : (Print or type name of person signing)
MANAGING MEMBER (Print or type title of person signing)
Signed and sworn to before me on (date) f^Wu^y ^^lo/i*"
at 6u^l/\ County ,fMoX\x}j^y (state).
JEANETTE MARIE COLON X
NOTARY PUBLIC OF NEW JERSEY I
) I.D.# 2419776 >
My Commission Expires 4/12/20 Jj?ls
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 n.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person ' exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes |X] No
If yes, please identify below (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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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: JEFFREY A. KESWiN 2007 PERPETUITIES TRUST
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. [X] a legal entity with a right of control (sec Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: SOLSTICE ON THE PARK. LLC;
WINDERMERE HOUSE, LLC;
5528 S CORNELL AVENUE OWNER, LLC
B. Business address of the Disclosing Party:
405 PARK AVENUE, 6TH FLOOR, NEW YORK, NY 10022
Telephone: 212-415-6600 Fax: 212-697-5660 Email: JKESWIN@LYRICALPARTNERS.COM
Name of contact person: JEFFREY KESWIN
E. 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):
Amendment of Residential Business Planned Development 282
Which City agency or department is requesting this EDS? Department of Planning and Development
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
[ ] Person [ ] Limited liability company
[ ] Publicly registered business corporation [ ] Limited liability partnership
[ ] Privately held business corporation [ ] Joint venture
[ ] Sole proprietorship [ ] Not-for-profit corporation
[ ] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
[ ] Limited partnership [ ] Yes [ ] No
[)j Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: NEW YORK
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 |X] No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS oh its own behalf.
Name Title
¦IFFFRFY KFSWIN INVESTMENT TRUSTEE
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
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
405 PARK AVENUE, 6TH FLOOR Disclosing Party
JEFFREY KESWIN NEW YORK, NY 10022 100%
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 WNo
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
{(] 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 fC] 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 payrnent 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: (ij 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 ah officer of 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.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any 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 ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state 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 United1 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:
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 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, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe 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.
NONF
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 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
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 £<]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 fc]No
If you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or 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. Ifthe Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or 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 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.
Page 9 of 13
The Disclosing Parly will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe 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 ail subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
Ifthe Matter is federally funded, federal regulations require the Applicant and alj 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," answ.c.r 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:
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SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Part)' 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 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 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthfui 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 andAppendix 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 tp: the City. .
JEFFREY A. KESWIN 2007 PERPETUITIES TRUST (Print or type name of Disclosinjg^Party^i
By:_
(Sign here) S
JEFFREY A. KESWIN (Print or type name of person signing)
DONOR AND INVESTMENT TRUSTEE (Print or type title of person signing)
Page 12 of 13
Signed and sworn to before me on (date) Fg.hfoQ'\) °\ ? C\S , at KYo LQ\)r,iK . County, IVfiA/J ^n\.vC (state).
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 U.B.l.a., ifthe Disclosing Party is a corporation; all partners ofthe 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, ifthe 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 fc] 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 ofthe 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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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable:
LYRICAL-ANTHEUS GP II, 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
[x] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: SOLSTICE ON THE PARK, LLC;
WINDERMERE HOUSE, LLC;
5528 S CORNELL AVENUE OWNER, LLC
Business address of the Disclosing Party: ,
32 N. DEAN STREET, 2ND FLOOR
FNGLEWOOD. NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
E. 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):
Amendment of Residential Business Planned Development 282.
G. Which City agency or department is requesting this EDS? Dement 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 #
Page 1 of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature ofthe Disclosing Party:
] Person p<|
] 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: DELAWARE
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?
[]Ycs [x]No []N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors ofthe 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 ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
LYRICAL-ANTHEUS MANAGEMENT. LP MANAGING MFMBFR
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
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
ELI UNGAR 3? N. DFAN STRFFT. 2ND Fl
ENGLEWOOD, NJ 07631
DAVID GEFSKY 25%
405 PARK AVENUE, 6TH FL,
IFFFRFY A KFSWIM 9007 PFBPFTIIITIFS TRI 1ST MFW YORK NY 1007? 5QX
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 [yj 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 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.
(Add sheets if necessary)
f<] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes ft] No [ ] No person directly or indirectly owns 10% or more ofthe
Disclosing Party.
If "Yes," lias the person entered into acourt-approved agreement for p support owed and
is the person in compliance with that agreement?
[] Yes []No
B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant arid 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, dishoriesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or" Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state 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 DisclosingParty understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
NONE
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [>3 is 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 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) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] 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, ho 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 WNo
If you checked "Yes" to Item D. 1., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.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) 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 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 '' []N6
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.
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 ofthe 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. 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 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 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
LYRICAL-ANTHEUS GP II, LLC
(Print or type name of Disclosing Party)
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.
BY: LYRICAL-ANTHEUS MANAGEMENT, LP ITS MANAGING MEMBER
BY: LYRICAL-ANTHEUS MANAGEMENT GP, LLC ITS GENERAL PARTNER
DAVID GEFSKY
(Print or type name of person signing)
BY: DAVID GEFSKY ITS MANAGING MEMBER.
MANAGING MEMBER (Print or type title of person signing)
Signed and sworn to before me on (date) f^rtcAy Zft/i»
at j>gr^/0 County, K)&j\v&*y (state).
JEANETTE MARIE COLON ?
I NOTARY PUBLIC OF NEW JERSEY Z
J I.D.# 2419776 >
My Commission Expires 4/12/20JX-S
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 ofthe 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 n.B.l.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 ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, ifthe Disclosing Party is a limited 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 5<] 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 ofthe 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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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:
LYRICAL-ANTHEUS MANAGEMENT GP, 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. |x] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: SOLSTICE ON THE park. LLC;
WINDERMERE HOUSE, LLC;
. , . 5528 S CORNELL AVENUE OWNER. LLC
B. Business address of the Disclosing Party:
32 N. DEAN STREET, 2ND FLOOR
ENGLEWOOD, NJ 07631
Telephone: 201-541-8003 Fax: 201-608-0555 Email:
SCHARENDOFF@ANTHEUSCAPITAL.COM
Name of contact person: SUSIE CHARENDOFF
E. 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):
Amendment of Residential Business Planned Development 282.
Which City agency or department is requesting this EDS? Department of planni"g a"d Development
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Ver. 01-01-12 Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
Person [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: DELAWARE
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 [x] No - []N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For-not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
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 of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
DAVID GEFSKY ! B MANAGING MFMRFR
ELI UNGAR MANAGING MEMBER
JEFFREY KESWIN MANAGING MEMBER
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
ELI UNGAR 32 N. DEAN STREET, 2ND FL 25%
ENGLEWOOD, NJ 07631
DAVID GEFSKY 25%
JEFFREY KESWIN 405 PARK AVENUE, 6TH FL, NEW YORK, NY 10022 50%
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 bd 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 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 Parry's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
f<] Check here ifthe 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 fC] 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 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, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, slate or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state 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 720JLCS 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) 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
i
I
I
i
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing 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.
NONF
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 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
If the letters "N A," 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.
1" In accordance with Scctioh 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 W No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees haying 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 l. 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 of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(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.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in' which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and'will not engage in "Lobbying Activities".
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 of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following 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
i i
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:
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E!P.A: on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
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 Y.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 sighing below: (1) warrants that he/she is authorized to execute this EDS arid 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.
LYRICAL-ANTHEUS MANAGEMENT GP, LLC
(Print or type name of Disclosing Party)
• (Sigri'her'e^ DAVID GEFSKY
(Print or type name of person signing)
MANAGING MEMBER (Print or type title of person signing)
at (&ffl
Signed and sworn to before me on (date) ^1^77, yStS
^ ft-A County, f.U.iJ.laQ-e^ (state).
^ Notary Public.
itU-Hcftebte* \ /e^'X JEANETTE MARIE COLON
oe^^r «" s £@Mm notary public of new jersey
Commission expires: M^ZCrf . \ WM$ I.D. # 2419776
My Commission Expires 4/12/20_Ll_£
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "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 TLB. La., 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 ofthe 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 t<] 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 ofthe 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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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: CLARIDGE ASSOCIATES, LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR
[X] 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: SOLSTICE ON THE PARK, LLC;
D WINLJhKMbKE HOUSE, LLC;
UR 5528 S CORNELL AVENUE OWNER, LLC
3. [ ] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
Business address of the Disclosing Party: 15 w. 53RD STREET, #24B
NEW YORK, NY 10019
Telephone: 212-956-7442 Fax: 212-245-5083 Email: SCOTT@JAMISCOTT.COM
Name of contact person: SCOTT SCHNEIDER
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):
Amendment of Residential Business Planned Development 282
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 #
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SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY I. 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: DELAWARE
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 [x]No []N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf."
Name Title
SI IRAN SCHNFIDFR ! MANAGER
LESLIE SCHNEIDER : MANAGER
SCOTT vSCHNFIDFR MANAGING MEMBER .
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,
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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
15 W. 53RD STREET, #24B Disclosing Party
SUSAN SCHNEIDER NEW YORK, NY 10013 42.61%
15 W. 53RD STREET, #24B
LESLIE SCHNEIDER NEW YORK. NY 10013 42.69%
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 [xl 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 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.
Ifthe 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.
(Add sheets if necessary)
Check here ifthe 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?
[ ] Yes P9 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 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.
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The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, .4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties"); •
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b.above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92^610 (Living Wage Ordinance).
Neither'me Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit'of state of 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 ofthe'United States of America that contains thesame elements as theoffense of bid-rigging "or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed oh any of the following 'lists'
maintained by the Office of Foreign'Assets Control ofthe U.S. Department of me 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. . ;i "
6: Th"eTDisclbsihg_Party understands and shall comply"withi the"applicable requirements of Chapters 2-55 (Legislative Inspector General); 2-56 (Inspector -General) and 2-156 (Governmental Ethics) of the Municipal Code.
7. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
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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.
8. To the best of the 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 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.
NONF
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."
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
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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 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 pf 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 Cityls 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
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
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "N A" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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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, of 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 f]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 ofthe 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 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 arid Apperidix 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.
CLARIDGE ASSOCIATES, LLC
(Sign here)
SCOTT SCHNEIDER
(Print or type narne of person signing)
MANAGING MEMBER
(Print or type title of person sighing)
Signed and sworn to before me on (date)
LAWRENCE SCHWARTZ Notary Public, State of New York No. 02SC4739979 Qualified in Nassau County. Commission Expires April 30,JJ$
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILI AL 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 ofthe 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 ofthe 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 ofthe 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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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: GOTHIC CORPORATION
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: 1. [ ] the Applicant
OR
2. [X] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
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:
980 SOUTH MAGNUM STRFFT S11ITF 201 DURHAM, NC 27701
Email: INVESTMENTS@DUMAC.DUKE.EDU
D. Name of contact person: ALICE GOULD
E. 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):
Amendment of Residential Business Planned Development 282 '
G. Which City agency or department is requesting this EPS? 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 #
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SECTION II -
- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
] Person
] Publicly registered business corporation
] Privately held business corporation
] Sole proprietorship
]. General partnership
] Limited partnership
] Trust
[ ] Limited liability company
[ ] Limited liability partnership
[ ] Joint venture
[X] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
f/Ves []No [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization,'if applicable: NORTH CAROLINA "
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 W No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors ofthe 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 arid title of each general partner, rrianaging 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
SFF ATTAHHFn I 1ST OF DFRHFRR ANr) niRFP.TORR
THE CORPORATION DOES NOT HAVE MEMBERS.
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 join
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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
C/0 DUKE UNIVERSITY
DUKE UNIVERSITY DURHAM. NC 27708 100%
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 W 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 ofthe 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.
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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.
(Add sheets if necessary)
tj Check here ifthe 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 f] 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?
IJ 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.
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The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or stale 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 ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency 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 ofthe following lists maintained by the Office of Foreign Assets Control of the U.S;Department ofthe Treasury or the Bureau of Industry and Security ofthe U.S: Department of Commerceor theirsuccessbrs: 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) arid 2-156 (Governmental Ethics) ofthe Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees 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, of the 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.
NONF
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.
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 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 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 ofthe 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 fXJNo
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 ofthe 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 of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address . Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the. slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.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 ofthe 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 [ ]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.)
[ J 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. 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 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 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
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 ofthe items in F.l., F.2. or F.3. above, an explanatory statement must be attach'ed'to this'EDS. "
CERTIFICATION
Under penalty of perjury, the person'signing'below : (1) warrants' that he/she is authorized to execute this EDS arid 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)lare true, accurate and complete as of the date'furnished'to the City. ..... .'.
GOTHIC CORPORATION
Alice E. Gould Ihvestment'Manager DUMAC, Inc. _ Authorized Agent
(Print or type name of person sighing)
David R. Shumate Executive Vice Presideni , :¦ , , DUMAC, Inc. „ Authorized Agent
(Print or type title of person signing)
Signed and sworn to before _ County
me On (date)
^O^CwVt'vi/-(statey'' ^~
NOTARY PUBLIC GRANVILLE COUNTY, NC
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 E.B.l.a., if the Disclosing Party is a corporation; all partners ofthe 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, ifthe Disclosing Party is a limited liability company, (2) all principal officers ofthe 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 be] 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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BOARD OF DIRECTORS & OFFICER LISTING for
Gothic Corporation
Neal F. Triplet!
Director and President - DUMAC, Inc.
David R. Shumate
Director and Executive Vice President - DUMAC, Inc. Gregory A. Hudgins
Director and Assistant Secretary - DUMAC, Inc.
Robert E. McGrail
Secretary-DUMAC, Inc.
Business Address for all listed above: ' DUMAC; Inc."
280 S. Mangum Street, Suite 210 -Durham, NC 27701
Current as of 9/11/2012
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: DUKE UNIVERSITY
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR
[x] 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: SOLSTICE ON THE PARK, LLC;
*_ WINDbKMEKb HUUSb, LLC;
UK 5528 S CORNELL AVENUE OWNER, LLC
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: 280 SOUTH MAGNUM STREET. SUITE 201
DURHAM, NC 27701
Telephone: 919-668-9917 Fax: 919-668-9926 Email: INVESTMENTS@DUMAC.DUKE.EDU
Name of contact person: ALICE GOULD
E. Federal Employer Identification No. (if you have one):
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, ifapplicable):
Amendment of Residential Business Planned Development 282
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 #
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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 [ ]
[ ] Publicly registered business corporation [ ]
[ ] Privately held business corporation [ ]
[ ] Sole proprietorship fX|
[ ] 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))?
MYes []No Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable: NORTH CAROLINA
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 N No [ ] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership/limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS'bn its own behalf.
Name Title
MflMFMRFRS ¦_
see attached list of officers/directors
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,
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Board of Trustees at Duke University:
Board of Trustees 2014-2015
Board Leadership
David M. Rubenstein, Chair
Co-Founder and Co-CEO, The Cariyle Group
Washington, DC
Term: 2005-2017
Richard H. Brodhead President, Duke University Durham, NC
Vice President, DuPont Wilmington, DE Term: 2003-2015
Jack O. Bovender, Jr., Vice Chair
Retired Chairman and CEO, Hospital Corporation of
America
Nashville, TN
Term: 2007-2015
Susan M. Stalnecker, Vice Chair
Anne T. Bass Fort Worth, Texas Term: 2003-2015
Christopher Brown
Business Analyst, McKinsey & Company Houston, TX Term: 2014-2016
Paula H. Crown
Principal, Henry Crown & Company Chicago, IL Term: 2003-2015
Kaveh Danesh
Graduate Student, Harvard
Term: 2013-2015
Kalherine Duch
Senior Analyst, Analyst Institute Washington, DC Term: 2014-2015
Allyson Kay Duncan U.S. Circuit Judge Raleigh, NC Term: 2011-2017
Ralph Eads III
Vice Chairman, Jeffries & Company, Inc. Houston, TX Term: 2009-2015
Frank E. Emory. Jr. Partner, Hunton & Williams Charlotte, NC Term: 1998-2015
Paul Farmer
Co-Founder, Partners in Health Cambridge, MA Term: 2009-2015
Robin A. Ferracone CEO, Farient Advisors LLC Pasadena, CA Term: 2005-2017
Bruce A. Karsh
President, Oaktree Capital Management Los Angeles, CA Term: 2003-2015
Elizabeth Kiss
President, Agnes Scott College Atlanta, GA Term: 2007-2019
Michael Marsicano
President and CEO, Foundation for The Carolinas Charlotte, NC Term: 2007-2019
Martha L. Monserrate
President, Environmental Excellence Engineering, PC Rye, NY
Term: 2009-2015 Clarence G. Newsome
President, National Underground Railroad Freedom Center Raleigh. NC Term: 2002-2019
Stephen G. Pagliuca Managing Director, Bain Capital Boston, MA Term: 2013-2019
Ann Pelham Chevy Chase, MD Term: 2014-2020
Robert R. Penn
President, Penn Resources, Inc. Dallas, TX Term: 2011-2019
Carmichael S. Roberts, Jr. Partner. North Bridge Venture Partners Waltham, MA Term: 2013-2019
Alan D. Schwartz
Executive Chairman, Guggenheim Partners, LLC
2/10/2015 10:55 AM
I
i
i
i
I
! i j
i
I
Board of Trustees at Duke University:
Xiqing Gao
Former President, China Investment Corporation Beijing, China Term: 2008-2019
Edward A. Gilhuly
Founding Partner, Sageview Capital, LP Palo Alto, CA Term: 2013-2019
Thomas M. Gorrie T.M. Gorrie & Associates, LLC Princeton, NJ Term: 2006-2017
Gerald L. Hassell Chairman and CEO, BNY Mellon New York, NY Term: 2011-2017
William A. Hawkins III President and CEO, Immucor, Inc. Atlanta, GA Term: 2011-2017
Janet Hill
Principal, Hill Family Advisors Fairfax, VA Term: 2006-2015
Betsy D. Holden
Senior Advisor, McKinsey & Company Chicago, IL Term: 2011-2017
Jeffrey C. Howard ,,
Executive Vice President, Salem Investment Counselors Winston-Salem, NC Term: 2013-2015 "
Peter J.Kahn
Attorney-Partner, Williams & Connolly LLP Washington, DC Term: 2009-2015
New York, NY Term: 2005-2017
Steven M. Scott Chairman, Scott Holdings, LLC Boca Raton, FL Term: 2014-2021
Laurene Sperling
President, Sperling Family Charitable Foundation
Wayland.MA
Term: 2010-2019
'' Ashley Crqwder Stanley United Methodist Minister Asheville, NC term: 2011-2017
Hope Morgan Ward
Bishop of the United Methodist Church
Raleigh, NC
Term: 2010-2019
2/10/2015 10:55 AM
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 W 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 ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
f<] Check here ifthe 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 moreof trie Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No f] 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 ; v"
FURTHER CERTIFICATIONS ' ' .
1. Pursuantto 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 arid 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.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are nol 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
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).
4. 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.bffenseofany state.orof-the United States of-America that contains the same elements as the offense of bid-rigging or bid-rotating.
5 . 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 ofthe U.S:Department of Commerce or theirsuccessbrs: 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
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 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, of the City of Chicago (if none, indicate with "N/A" or "none").
NONE
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe 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.
NONF
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) ofthe 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 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."
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 ofthe 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 M 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.
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. Ifthe 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 of the Disclosing Party with . respect to the Matter: (Add sheets if necessary):
(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.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that cither: (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) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
5. 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 arid 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 _ []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:
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. 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:
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: 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 penally of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (ifapplicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and'statements contained in this EDS and Appendix A (if applicable) are true, accurate and cqmpletejis of the date .furnished.to the City.
(Sigh here) ^ AlicfeE. Gould
David R. Shumate Executive Vice President DUMAC, Inc. Authorized Agent
Investment Manager
DlSMACInc.
Auuipvizcd Agent
(Print or type name of person signing)
DUKE UNIVERSITY „ (Print or type name^f ifecJ^sing^Party)
(Print or type title of person signing)
HALEY SUfTf
NOTARY PUBLIC GRANVILLE COUNTY NC* lMY COMMISSION FXPiRPQ
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "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 ofthe Disclosing Party listed in Section U.B.l.a., ifthe 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, ifthe 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 ofthe 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 lx] 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 ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
Windermere House, LLC
Organizational Structure
Lyrical-Antheus Management GP, LLC
V-if (a Delaware LLC)
50%
Lyrical-Antheus Management, L.P. (a Delaware LP)
0% GP Interest
Managing Member
\>-5
Lyrical-Antheus GP II, LLC (a Delaware LLC) Manager Managed
GP Interest (Carried Interest)
LP Interests
Investors each owning less than 7.5%
Lyrical-Antheus Realty Partners II, L.P. (a Delaware LP)
Claridge Associates, LLC (10.28%)
Antheus Capital, LLC (a New Jersey LLC)
Member-Manager
AL-Windermere House, LLC (an Indiana LLC)
Sole Member
Gothic Corporation (24.88%)
Manager
Windermere House, LLC (an Indiana LLC)
Solstice on the Park, LLC
Organizational Structure
Lyrical-Antheus GP II, LLC (a Delaware LLC) Manager Managed
GP Interest (Carriedlnterest)
LP-lp.terests
Investors each owning less than 7.5%
Lyrical-Antheus Realty Partners II, L.P. (a Delaware LP) "• < Claridge Associates, LLC (10.28%)
Antheus Capital, LLC (a New Jersey LLC) -
Merriber-Manager
AL-Solstice on the Park, LLC (a Delaware LLC)
Sole Member
Gothic Corporation , (24.88%) .',
Manager
Solstice on the Park, LLC (a Delaware LLC)
I
!
i
I i
i
i
5528 S Cornell Avenue Owner, LLC
Organizational Structure
Lyrical-Antheus GP II, LLC (a Delaware LLC) Manager Managed
GP Interest (Carried Interest)
Investors each owning less than 7.5%
Lyrical-Antheus Realty • Partners II, L.P. (a Delaware LP) < Claridge Associates, LLC (10.28%)
Antheus Capital, LLC (a New Jersey LLC)
Member-Manager
AL-5528 S Cornell, LLC (an Indiana LLC)
Sole Member
Gothic Corporation (24.88%)
Manager
5528 S Cornell Avenue, LLC (an Indiana LLC)
5528 S Cornell Avenue Owner, LLC (a Delaware LLC)
02/18/2015
A-1
SOLSTICE ON THE PARK. LLC; WINDERMERE HOUSE. LLC; ; :'r- / 5528 S.CORNELL AVENUE OWNER; LLC:-
: : (DO^^N EDS. The purpose of this page is' fdrlyouitb .
'¦. recertify-your EDS prior to submission to Gity Council or on the date'bf closing. If xmablejto { recertify truuifully, the Disclosing Party must complete a new. EDS with correct or corrected . mformation} . y^-C^M 'P>r:y\,:Zii^'-(iY^':v.: . "V'v.;^'.;' - .
fX-.U
:¦.?¦;.> • •. - '' : '-A:: ••••:.:--''::;':-.''!: ¦¦<¦¦ ijfflij!VV^\;':"i;--"' " ' :• x— ...":"."''.£.'''¦ 'V,:',,.i;.,,"V;1:^ . • ¦ ¦¦ ¦•./».-jtf'^.i-.'t ¦.
)jl-^:v> ,.-^ ^^r^M^^nSncI;J''-i^i: vS'¦ Amendment of ResidentialBu^ .11 .
T^^rec^ficatibn is being suMted in connection with Planned Development 282."::\'r[identify the Matter]. _—-.,. — ... .,,..„„,,
Date: January 27,2016
v;; Windermere house, llc
BY: AL-WINDERMERE HOUfSE?:LLTC/ ITS MANAGER -V,; r^yS ' "<^i"
-SiifSiShJ si?;- ¦
y^t/WM^y^ • BY: ¦ ANTHEUS CAPi7ALrLLC^~H;j~;;;.: :
"^'/¦K- .¦ ' . . ITS SOLE MEMBER ,-. :;V;4l$|-!|f*
(sign-nere)!;
-\?:iic;
BY: DAVID GEFSKY
he/she is. authorized to execute this EDS recertificaribn on behalf ofthe Disclosing Party;,(2;fcl1y
• i
ii^i&Yjt^ ¦•. '. Vr^a'^^&v::::;, ITS MANAGING MEMBER '^/j&^-Y? M '
ft**- .
i . • i r
-1;-
Cornmission^expires:i ~y.fc^^/ c5fc>/Tjo ^'^•n:;f;j;:|>;V.,'-^<'
10^2356452
A-2
'' SOLSTICE ON THE PARK. LLC: ¦:';¦¦¦>., ,! ^"¦.i'-A l*;'^.1: ¦
.•WINDERMERE HOUSE. LLC; . . . ¦ .-—V
i. V :i5528S CORNELL AVENUE OWNER. LLC :\ . r:y; : \: V-.'^.V^: "i-T.r.
(DO NOT YOUR EDS. The purpose of tlus page is for you. to
'? ¦ ^recertify.your EDS prior to submission to CityCouncil or on the date of closing, If unable to : " ^'recertify tratbfullyV the Disclosing Party must complete a new EDS with correct or corrected
Isiftv ^S&eSy, for use withCity Counc^ for City procurements unless requested^ y|s:1
Ci.- ••• Tp^r:y^. . . ' .1 Amendment of Residerrtial Business : ;
P^.4^|;r||yThis recertification isbehig sur^ttedin cbnnection with Planned Development282. .;,r • :~" T" i: -M [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that
%ti*U?k!i&> siiphWsheisa
its . -vS;i;&^^#«
$0':- ^^'^^'^arrantsmat all certifications ahdstatements ccmtaMed-in the Disclosing Party's onginajEDS^-:;
vVt.> • i^aretrue, accurate and complete as of the date furnished to the City and cpntin
Wfcl- =§F ^ciu^rte and complete as:of^ the datfe of ^bis i^ertificatiptii and (3> TeafBrms l
\~-y- -y&ryy acknowledgments.- < y^y:' >j^:-
¦J.'M'V
.¦vr---';f="--.-" - s 1.
:V.')3*:" 11 'yj\!r:
!E i'lX :a AL-WlNbERMEREHOUSE, LLC "'* ¦ C
Date: January27,2fjl6 x?>&' 'y/C. .
BY: ANTHEUS CAPITAL '
. -r^y-^ty^i^ ">my-'??-\&: V.W-y.'-. -^r: ITS SOLE MEMBER ^fe; '.
ff'.^ -E •• v? ¦ '.-TTS r^NAGING MEMBER-;'
^.i:;,: -j^p' :: f::>;?j^urr--- 1 ;,;*^ir^ '
:vir ¦.r.'-'-'.r!;i:-W- ¦!;i-^r?!i;:L li'.viS^^; J-'*" ': ¦.¦
. "-I- . , « , £':-;:;->-:-.--.'a-;::-.s-,"- ../('V.'
•¦. ¦ • • • ^:s, J ^
¦ .1?-. ¦ V;fv: -'^:-Y- -^'j -
"74-^ * ;yppAV]DiGEFSKY \y^- yy; t ¦^;r^^:.Xh.^'-i:'
PiSsrH;;;^' "^^^fe^^^t^i;?>*?4i&Yi::i^;-V";v: •' -Z^?.;^^i:5-• Ii- '^l- ' '• -;:<": .
||^;:^r^>;#||T^|?|signator^
II' V^^gffl^NAfilNR/MEMBER
'tag-:M^0Sim&'Sntf swbm'to.fefbre mt» nnTrifltfl]-J/f4l A A I. M iU ,
¦n;-:.'' ¦" B-1
SOLSTICE ON THE PARK, LLC; :i: • K - , ...WINDERMERE HOUSE, LLC; ¦'
'¦.u.:r::,,;.A-;-:552a s Cornell Avenue owner, llc
t r '{.¦:'(;;[ recertify your EDS prior to submission to City Council or on thedate of closing. If unable to "recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected
¦¦.v:!'. <(po NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to "' recertify your recertify truth information)
RE^RTlFiCATION
^ —— ,-rr — —--—; ; - . ¦ . - - ¦...':; '"tfWi^'-U, fi;':V\.{-v.-
fi
^-'"^•rrl warrants that all certifications and statements contained in the Disclosing Parry's original EDS ¦¦^JJi^^^±^
i! -Vr - arc true, accurate and complete as of the date furnished to the City and continue to be true, : .fY? •v-;^./-
i. ¦ ^rv/*?.C';'/:.iVi,'.'^.r ¦¦¦¦ ¦ . ,
I.3 . dcciirate and complete as of the date of this recertification, and (3) reaffirms its ''". . •'• acknowledgments. V :;.
^% :v .^r SOLSTICE ON THE PARK. LLC
SKf-flS -v i -.: ; ; • .; ———". .: . • r-. 1—-
fi yyif:' (Print or type legal name of Disclosing Party)
Date: ¦ January 27, 2016 . ^ . '^^iiY^^ii,:-^
\!-t;i-!.i
BY: AL-SOLSTICE ON THE PARK. LLG;^hi ITS MANAGER ^>.''7.^U
^ (siga here)
[''• ••i-S.vi;' " t -u^-i Print or tvnehame
BY: ANTHEUS CAPITAL,;LLC -4^"" -'V
ITS SOLE MEMBER :.;. ¦¦ yW^^^W^^^
". BY: DAVID GEFSKY ¦' -: ^ ¦ ¦=^,W^:^^Z^fy--m§ '¦¦ ITS MANAGING-MEMBER. - ^-^/^^atl'^^^x^^^S
¦ i. 1 ¦.'«-'«!.'¦¦ •ft-.'1!.'-.-:- '.'.IV. •
r^^Y^% .^MANAGING MEMBERM:¦ )r;j.
i^-illEKl^^dlanls^ me onTdateC^ ) &JS f^U. M '^."^M• %Mk04^W^I^
Notary Public. \v ^ ^ -^Ifcbrrimission expires: ^
'"'i.'-v-y' " x:- f'V;-;.'.;
B-2
SOLSTICE ON THE PARK. LLC;
WINDERMERE HOUSE, LLC; . . . . ;.'V:-"::
5528 S CORNELL AVENUE OWNER. LLC : . • '.y:: \ /^-V.,KX
(pO.NOT'SUB\IIT THIS PAGE WITH YOUR EDS^.Tlje.purpose of this page is for you to; ,;.
recertify your EDS prior to submission; to City Councilor on the date of closing. If unable to- i :
recert% tnitbiu^ Parry must completea new EDS with correct or corrected
,' ^formation); • «x 4c W ¦ . V; ¦¦¦ ¦'.V' \ \ v'v„- -j ;. "¦ ¦Y-;>;.i;>^r7-v;;;^^^j^v
' ^fi^ ' fy'i^^fJyi^ ;||. ¦. .
Ge^mlly, for use with City Council matted NotforGity^
Amendment of Residential Business V i:
v; ^iS^ftertificati6n is bemg subrm^ted in connection with: Planned Development 282
Under penalty of perjury, the person signing below: (1), warrants uSat; •.:';,. ,;. .P;:ij> i 4 h^she is authorized to execute this EDS recertification on behalf of the Disclosing Parry, (2)fc! ^:; f''. VV
¦ 'warrants that all certifications and statements contained in the Disclosing Parry's original.EDS;|;:i are true; accurate: and complete as of the date furnished to the City and continue to be truei;:,:.;/'.-;' • ;accurate:and complete as of the date of this recertification, and (3) reaffirms its .fo/v.;^v,
:'V;;.^ac^6wIedgments;i.'l.. ck 7'ii1;?:--" '•
AL^SOLSf iGE ON f Htf PARK, LLC ' 'Hf'^W^X
¦ (Prmtortype legal name of Disclosing Party) ¦¦ yv ¦ ¦ :v4€?>7?r
' ^W^v^V-¦ ^ifc^: iiv'^iA^ ANTHEUS CAPITAL Os&pS^ ::
' ¦¦• • •¦•. • • - -;:. -ii:
¦v- : :lf!i^^!7£i:? -'-V - ^IBYrvDAVlb GEFSrCr-;fc?HS5i^^^;i
¦;. .- (sigfijHere):?
^qmr^s^ S/>^'^ '.
C-1
SOLSTICE ON THE:PARK,;LLC; V ¦;¦¦ ¦;>.'¦; v, WINDERMERE HOUSE. LLC; .: :f>«SS28« CORNELL-AVENUE; OWNER, LLC'
(DO NOT SUBMfT THIS PAGE WITH YOUR EDS: The purpose of this page is for you to
^recertify your EDS prior to submission to City Council or on the date of closing. If unable to
y^'receTti^ the Disclosing Party must complete a new EPS with correct or corrected
3? I; irifonhation) ' • .¦ -.fv^'v '¦ .'¦ ¦ - sir; Ss? j.;
^McmTlFiGATiON
' ^fflf''1' ;V[identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that 1 :':-he/she is authorized/to execute this EDS recertificatioh on behalf of the Disclosing Party, (2)
Date: ' January 27,2016 ;^^.1'V;^; <:: ¦•=
BY:; 5528 StJORNEL^^ .¦
BY: AL-5528 S CORNEliL; LLC i" .;
ITS MANAGER :,i:-\^?^^:;.
::ANTrHEUS-CAPITAt|iiliC ^
ITS MEMBER-MAN! AGERpl:¦!^'!^i^;^^^^:
f.-.^;!®^ '
: -DAVIDfiEFSKY umx:
BY:" DAVID GEFSKY •% Tf " ? ¦¦" rTS MANAGING MEMBER" •-1
l^^i^SliSigned and sworn to before me.on fdatel ^JiRPdJQ< I, M by > 1;H:^p^£&<^
^^IgHf^ |fo-:p^ ¦ County, Wci^^
Notary Public.
'^^.^.fj-'v";5!'!
Verlai^irOS
•^v?v^;f Y;
i
I
I
!
i i
j
I
C-2
SOLSTICE ON THE PARK, LLC;'] WINDERMERE HOUSE. LLC:..;> 552is'S:Gb^NELL;^Av'ENUE'6WNER;:LLC
recertify your EDS^prior to Emission to City Council or on the date of closmg. ; If unable to
• recertigbM^ must co^hjte; a ney EDS wilhcor^
: ' irifoi^ti6tt)';v^ \" -'/']\ - ' ^ ' ¦¦
• '•' G^erally, for usl^ City^
Priuitbrtypenai
'¦^•^'U '. : •^;gfe;:; ;^;:i||:y;, sJ&** -*^v:. .
p^psefsi^
m
:i-:>-'
1 expires: ^^Js^^J}r^f^ (fi-f ' C^;;^-i;rVv;'v', -'-^yvyyryiyyy- ¦
;; ' ; • • ' •' V>Vsi~- jV {
1 ! ' ;r ¦ . '¦-•>•; • '¦-
I Commission expires: ¦
U ' • % MMMfmw^ r; y.
*. " yy f 'MMi^
Ver. 11-01-05
C-3
SOLSTICE ON THE PARK, LLC; WINDERMERE HOUSE, LLC; : 5528 S CORNELL AVENUE OWNER, LLC
r. <4v ^TPO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of fhispage is for you tp.:'
^recertifyyour EDS prior to subrrn^sion to City Council or on the date of closing. If unable to
;. iv;. :. : recertify tiuUifully, the Disclosing Party must complete a new EDS with correct or corrected ..
. ¦ v-f;¦-'[ ¦ J'y \';>
RECERTIFIGATION
-:use-with Gity Gouncil matters. -Not for Gity procurements unless requested. -y-;'-r-
0;ii>J- .'^ti-'£0W*.' ¦'. ¦ Amendment of Residential Business::::;
'^This recertification is being submitted in connection with Planned Development282.; ; ; ? £n^y^, ^yn-:^4Sp-j:'':^ -[identify the Matter].: Under penalty of perjury, the person signing below: (1) warrants that "\V ¦•>•*• j:£:.jy yi&^i-:;he/she is authorized to execute thisEDS recertification on behalf of the Disclosing Party, (2) -iifez ffipjL^v^^<4$' warrantstthat'all certifications and statements contahied in the Disclosing Party's original Et>S
: ^ and complete as of me date furnished to the City and continue to be true, "l.,
!i^^:.~|rM^-,---:--;^i'^iMte,and complete as ofthe date of this recertification, and (3) reaffirms its
f^^'^^f ¦ f:; AL-5528S CORNELL, LLC ¦'
,«"i:.-o:Si:;fl".' —¦— . ."". " ' : ". ' : • r-
k WfSSQK :(Print.or type legal name of Disclosing Party)
Date: January 27/2016
BY: ANTHEUS CAPITAL ITS SOLE MEMBER .
BY: DAVID GEFSKY Y ITS MANAGING MEMBER
;r --^.ir(-;--:4.-
" ^' ff '¦¦ll"
:#fl^1'
Print or type name of signatory:
:!r?"?:*;!lS?^r-i-^ ¦" ¦ ¦ ¦ ¦ —— •• ¦ ¦-——:^"xz::
SHI
MANAGING MEMBER
ed and sworn to before me or
iate
-!'S';V'.'.'?/:. " Sitrned And sworn tn hftfnrft me on
Notary Public.
!i?-^^F:-C!^f^?'5Gom^
. ...... .™ ...
v:/^ : vV;;;', WAU*uVrfctWl?* -vU
'•';iycr.ll4M5:.: ; . : "'MOTl
^y'l^Mfr'r;!"-:;
A-3, B-3, C-4
' SOLSTICE ON THE PARK, LLC; . ' WINDERMERE HOUSE, LLC;
; 5528 S CORNELL AVENUE OWNER, LLC
tiv;-! 'iii'.'
;¦ , (I^ NOT SUBMIT THIS PAGE WITH YOUR EDS: Thepurpose ofthis page is for you to ; ;recertify your EDS prior to submission s City Council or on me date of closing., If unable to; ^recertify tri4r^
X information) ;; • • ; . ¦.yr .¦ ;;fy-;::''^Y. .';.^y-^
.%i^}:s^i%^f£ ¦¦ .;v;?^; ¦¦ \ ¦ Amendment of Residential Business;- -.
is being submitted in connection with Planned Develop^nt282,,,i g., ^
^^V^%'^:fl;^:Tidentify me Matter]. .Under penalty of perjury, the person signing below: (1) warrants-tnatjf > ; ;,
]l .heVshe is authorized to execute this EDS rccertification onbehalf of the Disclosing Party g£ '.:,
fe^^^!;^;911^arrants that all certifications and statements contained in. the Disclosing Party's onginal Eps, ^ ^ r
fe' ^ ¦ ,:. j;ri _'¦ i a_ j:lA*H«>tn^nMi. nf:4ha ^ot^ fiifriictip/4.tn tlift-Citvand continue tobe^uTie,-y*}"'- ;v ;
p;;^:£:'y^;%:;^
D-4
¦'¦ SOLSTICE ON THE PARK, LLC;;;
' 'WINDERMERE HOUSE. LLC:
; 5528 S CORNELL AVENUE OWNER. LLC
; ?v ; iv'fJDO NOT SUBMIT THIS PAGE WITH YOUR EDS' The purpose of this page is for you to ^ff -? i-f v ;Y;;recertify your EDS prior to submission to Gity Council or on the date of closing. If unable.to ,;: ' " recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected; J.;.^: ¦;.
j^eERtlFICAtlON
VfJr.I V-::
ti\ "ftfp ^^eneraljyj fbruse wimCity Council matters.-Not for City procurements rmlessrequestedy
^':'-¦¦' =¦ .y/ ;- ¦'. : r Amendmentof Residential Business'''i!5:,:',
j;. - ;/|^ ; y ^This recertification is being submitted in connection with Planned Development 282. =.
I ' ¦¦; ^k". he/she is authorized to execute this EDS recertification oh behalf of the Disclosing Party, (2) ^4ft>
I:; -^'1: -Svarrants that all certifications and statements contained in the Disclosing Party's original EDSv^;^ ' ¦
S - i^'v- *u-f'*S'acknowledgments y;Sf!;-- 1 ^I^RICAL^THEIJS RE
li^l^RidAll/ANTHj^ REALTY PARTNERS II, LP l^(Pririt or type legal name of Disclosing Party)
¦ j; ::s:7.S;JSC'.:^
|i^f%*|f;^ys*: \ , ¦: - ,
':' ::£i'y: "'i^-r ¦¦'¦¦:¦:>[:-r'\ ' ¦ ¦ ¦¦y';-. ¦
i|^^?^v!-?'p^signfh^
ij^itv • • ^yftmaf or type name of signatory: •; ,
^'N^Pgy-] :: DAVID GEFSKY ''0:,'V;, ¦ ¦ " :=y; ^'Y
b- y-frl. ^il^leof signatory: ¦¦.: ;;:¦;/•; y :¦ ¦
-:' K ::1#:$MANAGINGM •.'.';:'• .' -
are true, accurateand complete as ofthe date furnished to the City and continue to be trie,': :>.y]^lfeU?^f
: .%V :'ly. accurate and complete as of the date of this recertification, and (3) reaffirms its . ¦¦<•¦¦- - - ¦
'. 'Date: .January 27.'2016' y'^'f V#?-;^jsligA;v
BY: LYRICAL-ANTHEUS GP ii ¦ LLC ', ¦. ITS GENERAL PARTNER \}'7 ; ^ . ::t ^iHfigf
BY:. LYRIGAL-ANTHE'JS MANAGEMENT, LP"f t -ITS MANAGING MEMBER : . ; ; ; . ; y v. .^i^^^rX;
BY: LYRICAL-ANTHEUS MANAGEMENT GPi^Cy
ITS GENERAL PARTNER . [ M&y.
"BY: DAVID GEFSKY ¦.^y^M^I^-fi^ ITS MANAGING MEMBER . ¦ f
' " " :v;5^,: -";J:v '
I-.";*-:'* ¦¦^'.'¦' ^V^.t ^Ife^'-'f•!
^''I'lR^iiii^eiand^
''¦' ; :^^rk ^ff^ County, ^OLl|^£i/ [ye], . :/-0^ ,^;.
ission exprres:^,
lV "'C^W ' ¦ ¦ ^ Notary rtfe^
:^£t/.-;.:¦:- ' > ".Commiss
j - •:-;
iii
^y
Xv:
:::'>^;;.
. Ver. 11-01-05
' y?M.^y
... -.Ir^'"- *
D-5
. tfsbLSTICE ON THE PARK, LLC; VbWlNDERMERE HOUSE, LLC;
^Y'- Y ^5528^ CORNELL AVENUE OWNER, LLC -i Y,-Y '¦¦¦r;' : ^'^y^y}^
- !y ¦ A YOUR EDS. The purpose of this page is for you to
' "?¦¦'•¦¦ V tl^YHrecertify yourEDS prior to submission to City Council or on the date of closing. If unable.to '< ] :^ffY;:-yfrecertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected v
'¦• h[. .-:.\<;Y%^ y. ,Y-Yi: ^.^S^^'tl ' Y'YV .REGERTTJFICATION Y- v< • Y^ Y;,;: _ ;
^¦M''^^^^^^^f^^^x^l->-- ;.''.fi- Y'YvY ;'YYY' Y-"Y:'y-\;^vY'#yY;^
# Y^ Not for City procurements urdess revested.
Y:;,^^y:f'^i.:K.&^^;r':: v.*. Y'^'Yi'v. YY . ; Amendmentof Residential Business. , . .
W Y^iiif "BftiSertincation-is^eing submitted in connection with/ ¦ Planned Development 282;/;, "< ' .
ISY^Ipisrilf ^e/steis ^aumonzed'toexecuWmis EDS recertification oh behalf of the Disclosing Party, (2>:;, / YYYY^Y vf^; warrants that aU certifications and-statements wmtaineii'm uieDisclosing Parly's original EDS- . fYY* C^v;Yii|p|||^yS|g. are:triie, accurate arid conmlete as of the date furnished to the City add continue, to
|tf^||t|| and complete as ofthe date of this recertification; and (3) : ;Y; ^^p^^;o§||rv^j??'
llfeYSiK/ill'acknbwied^ 'rYY/.y^?:'^:- YYY.Y ' -' ,^ '^^:;^^Y¦^¦^:;^f::r^:Y:?r»^.^;^;:/-. ,
iY?^Ssfl-O^ph;';2:>y" '.' :> F'-'¦ vYJffY -Y- :.:-v^^Y?yQ^ Y. Y,.;,- ^Y;:Y?Yy ¦
Y-Pyf^-Date: January 27,2016-Y Yfp^ ' Y;-
'i:; r'A^!<-z-f^k-(pn^m tvne legal name of Dtsclosrng Party) v- . ¦.¦'.¦.:-r-^T.;:--- ?"i^'v"*"^--"v.y??!fKs;:
m^m^:0M:i[^EM¦ ¦ ;.-V.;.-.Y:y * .: . . BY: LYRICAL-ANTHEUS MANAGEMENT;LP .
:£fe:;Y[S^$^ ' ¦' ""' ;' \Y^:--:-v^Y YYY- ITS MANAGING MEMBERj ::!- ,; Y YY I . -r -
Yd&Y ^ ^-V:-^—of - v ¦ " y. ¦ - ./YY:- Y.Y? ¦•:.i*'nvi i YRicAL-AhfTHEUS manageMei^gp, llc
E^WSS^^^^S^l-'-X" - - BY: DAVID GEFSKY ^'^^lY^S^fe^-¦ .
:' P- '^-iSm^. ,Y-- 'ITS MANAGINGMEMBERji^Y; • YV'i ; -
If:.;!^;^??^ Y- Y::-Y,:;-' -:ifrY|^''YY^Y:':"'iY •.
;fv,:^|||^||^ /: ¦>¦[
ii' ¦ Y ; :. V; : i^ife/MftNA^'NG MFMBER ^ v.^:;.;^^;^^,. ^ . Z$*^g:$y®&^Y :. ¦ £¦
' ,• .Y'v : < : !j:;y tP•s^fniQsinn expires: 7/^^A-c>aJA.:VQ. 'i-vy^./T,:;-':. - .^Y": Y-:;: Y: ¦ >Y:.>^ ¦ ''¦ :-\'
YY ! _ . - Y:^^YYi>-=;Y-itf:' '^Y'?" MAURA FEEWEYi; Y;;V'-:Y ;Y:-:YY;Y -;-"^?Y"':' :vY-^: y^Y- Y--^-^ vY-zYY;.:;-¦ .-:vY4i:YY:Y^Y^;#Y-.- JD^aaSOlSZ^:-::YYY.;;:,Y^YYY;;nYY;;Yn:-^ Y# Y.Y: ''^0i^^llfY^:i«W
'; . YYY: Y-,-vcryii^i-«s^Y ^;,%mrnlss!6^ Y-;Y^w:^:-<:\- ¦ ¦ '-Y^:'¦'Y-'YY"-^rfYY';"YY.:
D-6
v;Ly v;. SOLSTICE ON-THE PARK,'LLC;
YiYYrWINDERMERE HOUSE. LLC;:
: v- 552B S CORNELL AVENUE OWNER. LLC
!f Y^Y!Y'Y'vY'';;(pb\NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to Y yM^~k:¥:'Z recertify your EDS prior to submission to City Council or on the date of closing. If unable to j*lY Y?wCN|: ?YY recertify truthfully, the Disclosing Party must complete a hew EDS with correct or corrected
information)
RECERTTjnCATlipN
•/¦•••'•>•.- ¦.• • ¦-¦» ... .
accurate and completei as of the date of this receftificatibh, and (3) reaffirms its
j|Y i^ ;- -Y-^ Gity Council matters;- Not for City procurements unless requested: .,-.]
b- y4M^^ZMii--:'.'¦< YxvY- ¦ Amendment of Residential Business; '.
If'-ff^^ Planned Development 282. Y*; ¦% yf
k up''- lT [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that : Y ¦
Y ¦.¦}. : he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) ^ }
V .«YYY;- -•'' warrants that allxertificatibns and statements contained in the Disclosing Party's original EDS :
kre true, accuratei and complete as of the date furnished to the City and continue to be true, '
o .¦ • ,*%y*;¦• ¦ .'-^-^t^'i:
fc. : YY',: ; ;;^y;;, acknowledgments. -:
m .(print on
lyJrIc^-antheusman LP
type legal name of Disclosing Party)
fj.-,?&:y r >:::¦ I.
i?Y YSf£¦ Y?fe:|:{sign-tie're)-i¦-Yl:: > .
p^li^p^:"-^1 yyyyyyy;
•^^"~s ¦¦~:'t!Print or type name of signatory:
|^^^:j||;|^DAVID.<3EFSKrY
fe^^Y|f :lf We qfsign^ YY ¦ ^ ^;
.¦^:,i
' Date: ' January27,2016^ ....
"'v•'¦'¦ .•S^c' •'• y/{y'^^-BYrLYRICAL-ANTHEUS ma^gement.gp,.llgY;
ITS GENERAL PARTNER - y.yi^yy zMZy
¦ . .-. =¦¦¦ y-y:";iy y^
' BY: ¦ DAVID GEFSKY :¦¦ : Y#>Y:^Yy|#;y i;^: ¦ ITS MANAGING MEMBER'- i/s^'m?:^'
¦•: " -::'.;. :y^jy • i;;r; :.; vr%ts;,- --.TijiSt.' ¦ f/.V?fe ?:r"'3"i::
:-;y^;::';:-:S:y-''S;'^
: ; . y^y ^^'-'^y- ¦ '•&r.. j.: •'¦--->...''v. -'/'^r t '-^.V-*--
' Y^ff^' i-' i r MANAGING MEMBERz
if', yyy> ^feYiii: ^"clSigned and swom to'befbi
^iyMS&mkjMM
ind swom to before me?bnjdatel iJ/^fij 1^.7.^^^ by ; ;: Y'':'.Y:p?j,. \\^ /^^a ¦. at^VyfcU County, i^Jjamytatel. " T.'.
Jjl^jftr ^^L\ Notary Public • -
^i,'"'^Y::if;l?Y- V;^mnussion expires: V) fS^j T^ftl lr •
|.:Y %YrV'Y;Yv'::.,R- * v-Y' '';¦
I
i
D-7
SOLSTICE ON THE PARK, LLC;
WINDERMERE'HOUSE.'LLC; -.1 . ! ::ly-^.i,i
5528 S CORNELL AVENUE OWNER, LLC
(DO NOT YOUR EDS. The purpo^ page is for ypu to
recotify your EDS.^ date pf closing. ; If unable to
recertify trutlMi^.uie Disclosing Party must complete a hew EDS with corrector corrected :
information)1 ;i ¦ ¦Vy'Y'Y !':''-!y;: ;V.:v •y V- 'Y ' ' :
: Genei^ly.forYuseiwth Gity Cp.mc.il i^ .
Thi" irr^rtifiStinrfS V" C ^nnP.^nn with Planned Development 262, j:,. J
frdentipt^^
hepiisaumorized
a&it^*^ ':acouf§^
LYfflCAlM ^#jygi^;Date:^ ¦
"Titleofn^^MM^V^C^SJtr-:• ^ l,|iv;:;e^::Yif fc:, A/
I Oil Ui (1 ^-r^s^A i?& -^--.Notary Public.-; ,
Ver. 11-0145
D-8
SOLSTICE ON THE PARK,:LLC; . , i : s;. . . .
'¦WINDERrtERE HOUSE. LLC; V Y.Y';Y Y ! Y y Y Y,
5526 S CORNELL AVENUE OWNER, LLC J ,-;~Y Y"y" Y.y - ; ;V';
1Kb date of dosing, If unable to
1 Iret^ru^ of corrected
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s •¦'Y>:Y:"¦¦ .'IV.-'' '"" " ~ !.-•¦
Amendment of Residential-BUBlnaBSir^^.-^—^
y \WMl0£ Planned Development 282: ,-.;.;;>^
fc^ghe is aomorJtedto execoto this EDS reoartfficorlouon behalf ofme Disdosiog Party, (2)
i --.¦rZsg'j, 'art ^rjo^t^^ MatM], tfrataproa^'of me penm aigi^^low: (1) warrants flat¦-¦ ••;X"-
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t::YY:^;;;%|ltY .i :'l ¦^yMramttat aajBertrpcaoogs ano;B^ .
v; v. -;•» accurate B&dconmletsBS cflto c^ Y-'Y :i
H$|v:^ KESWIN 2007 PERPETUITIES TRUST ' ." Y
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,41 Notary PobBc.
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;\ OBflaFER BUT8HTEIN
H0.01BL62411S2 ' '• :Y:ptel*-i Qualified in MwYtofc County . :¦, ¦' ,Wy Comml88lon Enplrsg May 16.2019' >
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¦ SOLSTICE ON THE PARK. LLC; . WINDERMERE HOUSE, LLC; : :-;5528.S CORNELL AVENUE OWNER, LLC
(.; yry/.; ;: L:;vl;Yi:i p. ¦¦ • ;i.¦ :,\'Y; .^^^ . _t|mBCtj_^jn:. PlannedTjjayelopm^St 282;:
te^^»^hfi/^ iBanmodzed to.exeo#.tinB EDS reoemrirwi«»» v
f 7 Y^fibis^certificate ^«^riamiffibdOT?:Wwarranisfiia^< .
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Rotary Publics
>'.V«r:. 11-01^9:
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SOLSTICE ON THE PARK; LLC; ¦
WINDERMERE HOUSE. LLC;
5528 S CORNELL 'AVENUE OWNER. LLC
YfTJpNOT SUBMIT TUB PAGE WITH YCHJR-ED& The purpose of fhis page is for you to -recertify your EDS prior to submission to City Council or on me date of closing. If unable to
otmgatjgn:
( Y |:YU.$;\ iGerierally, tor mewithCity Council matters. Not rot Crry procuiementa unless requested
-•^J-^YY.'-"-^—:— - Amena^ent of Residential Business-
This recertrfioation is being submitted m connection with Ptanned Development 282.'/
». ;P4^ifyw of perjury, ite person signing below: (1) warrants that
be/she&irnt^^ this BDS icccrnnarioflmfor^ (2)
;wianintsjmat all certifications and statements contained in me Disclosing Party's original EDS
era tma; accurate and complete mi nf the data ferniwheri fn iht) f!hy nry^ mntinhn tnluy triiftt
Date: fit./ It 7
.GOTHIC CORPORATION
. (Pxint or type legal nmro ofTJisdosing Party) By:
If1'-"
David R. Shumate iEjfiaar^e\^Pn3sident DUMAC, Inc. Authorized Agent
i"U':.::-rfint br>type name uj
f "/ .'-v: Irive^entMamger' .
.v*«V','-*:/-'' ¦ "TE*-:''-/
v ^ QnTdatel ¦'
,i; < ¦ (^mmissionexpires: -ii Y'^vjfe¦ .^Sl'
7^; - MARIE BQURLOT:: _Y Y jYgNotaiy Public ^NorthCarbllnai Vii V'^:-'¦;¦ MppreCounty; ''¦:'i--
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