Office of the City Clerk - Record #: O2015-3710

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

Record #:

O2015-3710

Type:

Ordinance

Status:

Passed

Intro date:

5/6/2015

Current Controlling Legislative Body:

Committee on Housing and Real Estate

Final action:

6/17/2015

Title:

Negotiated sale of City-owned property at 3648 S Prairie Ave to Marc S. Powell and Kaitin McGrath Hannon Powell

Sponsors:

Emanuel, Rahm

Topic:

PROPERTY - Sale

Attachments:

1. O2015-3710.pdf

Date	Journal Page Number	Action By	Action	Result	Action Details	Meeting Details	Captions
6/17/2015	1178	City Council	Passed	Pass	Action details	Meeting details	Not available
6/15/2015		Committee on Housing and Real Estate	Recommended to Pass	Pass	Action details	Meeting details	Not available
5/6/2015	107624	City Council	Referred		Action details	Meeting details	Not available

OFFICE OF THE MAYOR

CITY OF CHICAGO

RAHM EMANUEL

MAYOR

May 6,2015

TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO

Ladies and Gentlemen:

At the request of the Commissioner of Planning and Development, I transmit herewith ordinances authorizing the sale of city-owned property.

Your favorable consideration of these ordinances will be appreciated.

Mayor

Very truly yours,

ORDINANCE

WHEREAS, the City of Chicago ("City") is a home rule unit of government by virtue of the provisions of the Constitution of the State of Illinois of 1970, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and

WHEREAS, the City is the owner of the vacant parcel of property located at 3648 South Prairie Avenue (Rear), Chicago, Illinois 60653, which is legally described on Exhibit A attached hereto (the "Property"), which property is located in the Bronzeville Redevelopment Project Area ("Area") established pursuant ordinances adopted by the City Council of the City on November 4, 1998, published in the Journal of Proceedings of the City Council for such date at pages 80642 and 80644 through 80778; and

WHEREAS, Marc S. Powell and Kaitin McGrath Hannon Powell (the "Grantees"), of 3648 South Prairie Avenue, Chicago Illinois 60653, have offered to purchase the Property from the City for the sum of Eleven Thousand Seven Hundred and No/100 Dollars ($11,700.00), such amount being the appraised fair market value of the Property, to improve with a parking space thereon; and

WHEREAS, pursuant to Resolution No. 15-029-21 adopted on March 19, 2015, by the Plan Commission of the City of Chicago (the "Commission"), the Commission approved the negotiated sale ofthe Property to the Grantees; and

WHEREAS, public notice advertising the City's intent to enter into a negotiated sale of the Property with the Grantees and requesting alternative proposals appeared in the Chicago Sun-Times, a newspaper of general circulation, on March 2, 2015, and March 9, 2015; and

WHEREAS, no alternative proposals were received by the deadline indicated in the aforesaid notice; now, therefore,

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

SECTION 1. The City Council of the City hereby approves the sale of the Property to the Grantees for the amount of Eleven Thousand Seven Hundred and No/100 Dollars ($11,700.00).

SECTION 2. The Mayor or his proxy is authorized to execute, and the City Clerk or Deputy City Clerk is authorized to attest, a quitclaim deed conveying the Property to the Grantees. The quitclaim deed shall also contain language substantially in the following form:

This conveyance is subject to the express condition that: 1) the Property is improved with a parking space within twelve (12) months ofthe date of this deed.

In the event that the condition is not met, the City of Chicago may re-enter the Property and revest title in the City of Chicago. Grantees, at the request of the City of Chicago, covenants to execute and deliver to the City a reconveyance deed to the Property to further evidence such revesting of title.

SECTION 3. If any provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such provision shall not affect any ofthe other provisions of this ordinance.

SECTION 4. All ordinances, resolutions, motions or orders inconsistent with this ordinance are hereby repealed to the extent of such conflict.

SECTION 5. This ordinance shall take effect upon its passage and approval.

EXHIBIT A

Purchasers: Purchaser's Address: Purchase Amount: Appraised Value:

Marc S. Powell and Kaitin McGrath Hannon Powell 3648 South Prairie Avenue, Chicago, Illinois 60653 $11,700.00 $11,700.00

Legal Description (Subject to Title Commitment and Survey):

Lot 10 in Frederick H. Bartlett's Subdivision of Lots 21 to 25 in Block 2 of Scammon's Nelson Subdivision of the Southwest % of the Northeast % of the Southwest % of the East Vz of the Southwest % of Section 34, Township 39 North, Range 14, East ofthe Third Principal Meridian, in Cook County, Illinois.

Address: 3648 South Prairie Avenue (Rear)

Chicago, Illinois 60653

Property Index Number: 17-34-309-092-0000

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I - GENERAL rNFOKMATION

A. Legal name of Disclosing Parry submitting this EDS: -include d/lvW ff applicable:

... Kailin R Pnwef.1 _ _

Check OKFi ofthe following three boxes;

Indicate whether Disclosing Tarty submitting this EDS is; MX] the Applicant OR

2.1 J a legal entity holding a direct or indirect interest in die Applicant, State the legal name of the Applicant .in which'Disclosing Party holds an'interest: OR

3. j | a k-giil entity with a right of com ml (see Section li.B.!) State the legal name of the entity m

which (he Disclosing Party holds & right of control:

i\ Kusiness-address of Disposing party:

C Telephone: / \ Fax: _ Email:

D. Name of contact person: Kaiitn'H. Powell

F...Federal Employer Identification No. (if you have one): N/A

K Brief description of contract,, transaction or oilier -undertaking (referred to below as tin?" .Matter") (o which thjs F.DS penaiftj. (Ijjckkle project number arid location of-property, if applicable):

IieiiQlii?i.ed.,.Safe at 3G48 South Pr.ijnqAv.e... Chicago

G, Which City agency or department is reqioesiiiig this' KRJj? Defil. oi Fla»tnii,i> ctntl Dovrlorimfnt

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

Specification # Kii- arid Contract ii N/A _»^,

Ver. di-oi-12

Piige 1 of 13

SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF DISCLOSING PARTY

1. Indicate the nature of ihe Disclosing P fx j.Person

i 1 Publicly registered biisines'sicdiporaUort ( ] Privately held business corporation I 1 Solepropnetorship. [ ] Generalpartnership f) I .imhedfpafiriership' [ j Trust

[ ] U:raited liability company

f I Limited liability partnership

I T Joint venture

j | Not-for-profit Corporation

(Is the not-for-profit corporation also o S01{c)(7i))?

I ] Yes I ] No

I. ] Other (please specify)

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

3. For lfiga( entities nor organised in the State-of Illinois: Has die-organization registered- to do business in the State of Ellino is as a foreign entity?

! I Yes [ ]No |X J N/A

B- II- THE DISCLOSING PARTY IS A LEGAL ENTITY:

_:I v List below the Till I names ahd titfe of all executive officers md all directors ofine entity: NOTE: For ■uotrfor-profir corporations, also-list below all members, if any, v%.iikh are legal rati ties. If there are no $iicb mernberc/Witc "iio members." For mists,- estates or other similar efttitfes, list below the legal tideiiolderfs).

f f the entity .-is- a. general pailtK-irslyp, limited -partnetship,. limited liabi tity company, limited liability partnership or joint venture. listbelow the name and tide of each general panner, managing member, manager or any'.othej;.jx;i-Kou drentity that controls the day-to-day iiianagemenr.of. itte. Disclosing Pany. NOTE: Each legal entity listed below must submit an EDS on its own hekaj.fi

Name Title

_ NA .

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 die DfaxWng Parcy. Examples of such an interest include shares, in a corporation, partnership interest in a partnership or joint venture.

interest of a member or manager jn- a limited liability company, or interest of a beneficiary of a trust, estate or other simiiareniitv. If none, state "None."-NOTE; Pursuant io Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code¹⁷), the .City may require any such additional information from my apphcaitt which is reasonably intended,to achieve foil disclosure.

Name Business Address Pcrccmage Interest in the

Disclosing Party

SECTION TH - - BUSINESS RELATIONS! IIPS Wlfli CrTH' ELECTED OFFICIALS

Has the Disclosing Party-had-a "businessrelationship,'* as defined in Chapter 2-156of the Municipal Code, with any City, elected official itv the 12 months before the date this EDS is signed?

3 JYes IX J No

If yes, please/identify below the name(s) of such City elected officials) and describe such rcIalto»sltip(s):

N/A

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing .Party must disclose the. name and business address of each .subcontt_ctor, attorney, lobbyist, accountani^coiisiiltaniand any oilier person or entity whom die Disclosing Party has retained or expects toretain in. connection >-ith the Matter, as well as the nature of the relationship, and the total amount of the fees paid .or estimated to br paid. The Disclosing Party is not nxjuirvd to disclose employees who are paid solely ihnoeigh the Disclosing Party's regular payroll,

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

if ihe Disdosirig Party Is uncertaLii whether a disclosure is required under-this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disdosorv.

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)

[x] 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 [X] No [ ] No person directly or indirectly owns 10% or more ofthe

Disclosing Party.

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

[ ] Yes [ ] No

B. FURTHER CERTIFICA TIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article 1") (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 Certified 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 1 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

2. . The Disclosing Parry and, if die Disclosing Party is n legal entity, all of those persons or entities

identified' in Section IiJB.l. of this EDS;

a. are not pit-sently debarred, sLiSjx-icled,.proposed Torddwcment,: declared ineligible or yolHnt&rily excluded from-ail}' transactions by aiVy federal, Stat(» or. local timt of government;

1). have not, within a five-year period, preceding die. .date of this EDS, been convicted of .a aiminal offense, adjudg-d.guilly, or bad. a civil judgment rendered against them in connection ■■with: obtaining, attempting 1.0 obtain, or performing a public (federal, state or local) transaction or contract undera public irartsacttqu; a violattonof federal dr state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; faisification; or destruction of records; making-false statements; or receiving stolen property;

are not presently indicted for or criminally or civilly charged by, a governmental einity (federal, state or local) with .comniiitiug any of theoffett-ses set forth jn clause B.'Z.b. of this Section V;
have not, within a five-year period preceding the date of.this.-EOS', bad one or more public transactions (federal, state or local) terminated;for cause: or default; and
have not, within a five-year period precedingi the date of this EDS, bec-ri convicted, adjudged'guilty, or found liable in a civil proceeding, 01 tn'any'criminal or civil action, including actions concerning environmental violations, instituted by the City or by the, federal government, any state, or any. mheronil. of local government,

3. The certifications in subparts 3, -i and;5 concern:

the Disclosing Fatty;

* . any "Contractor" (meaning any contractor or subeontrador used by the Disdosing Party in Cbtmeetiori with; 'the Matter, includiog but riot limitcsd lo.all.persoiis orlegal enJi ties disclosed tinder'-Section I V_r "Disclosure of Subcoritraclors and OdiecRctained Parties'"};

any ^Affiliated Entity" (meaning a person or entity that, directly, or indirectly: controls die Disdosing■ Party, is cotitrdjled by ihe Div_losiiig Party, or is, with the Disclosing.Party, tinder :common-control of aaothcrpcursoii-or entity.,Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and! equipment; corji.nion.use of employees; or organization of a business entity fbUowing-ihe irteJjgibibTy of a.busittess enuly to do businesswith, federal.or slate qr local government, including the City, using sulislahtially ihc^iiinc inanagemeEil, ownership, or principals as the'.iheligible'end'ty); with respect to Contractors, the term Affiliated Entity means a person or enrity that directly or indirectly controls the Contractor, is controlled by it, or, with-i.be Contractor, is under common control .of ■ another person Or entity;

« arty responsible official of the Disclosing Party, any Owu.RK.tqr or any Affiliated Entity or any other official, agent or employee of ihe Disclosing Pany, any Con'traabr 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").

Pago 5 of.13

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the. Disclosing Party-or any Conlrac-fnr norany Agents have, during the fiv<? years bo»fon» thf date this F.DS is signed, Or, with respect to a-Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during OVf'ive years before the. date of-such Comractor's-or Affiliated Entity's contract or engagement in connection with the Matter:

1. Imbed or attempted io 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 «he.federal government or of any state or local go%'emment in the United States of America, in that officer's or employee's official capacity ;
2. agreed, or colluded with other bidders orprospective bidders, or been a. party to any such agreement, or been convicted or adjudged guilty of agn\nneui or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or;
3. made an admission of such conduct described in.a.or b. above that.is.a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their eniployct-s, officials, agents or partners, is barred, from contracting with any unit of State- or local government as a result of en'gagingin yr being conytetcd'edf (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 "f bid-rigging orbid-miajcng.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the .following lists maintained by the Office of-Foreign Assets Control ofthe U.S. Department of the Treasury or the Bureau of.Industry and Security of the U.S. Department of Commerce or their successors:the Specially Designated Nationals.List, the Denied Persons List, the Unverified List, tlie Entity List and the Debarred List.
The Disclosing Party understands and shall Comply with (l)-(ne applicable requirements of Chapters 2r55 {LegLs'lartve Inspector General),'2-56 (Inspector General) and 2-156 (Governmental £Uui») uf- die Municipal Code.

?. If die Disclosing Party is unable io certify-to any ofthe above statements in this Pan 15 (Further Certifications), the Disclosing Party'must explain below;

W£ ^ -

Page 6 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.

8: To tfse 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_; art.employee; or elected or appointed official, of ihe City oi Chicago (if none, indicate widt "N/A" or "jioiie'"*). ' N/A

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of .all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding! the execution date of utis EDS, to an employee, of elected or appointed officiaLofihe City of Chicago. E⁷or purposes of this statement, a "gift" doe's not.include: (i) anything made generally available to Cily employees or id 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 wiiti "N/f\" or inone*'). As .to. any gift listed below, please also list ihe name of the City rtjdpteiu. N/A

C CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

1. The Disposing Party certifies thai dse. Disclosing Party (du-ck o«e)

I lis fx]-is not

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

'h If t he Disclosing Party IS a financial institution, then ihe Disclosing.Party, pledge:

"We are nut and will not become a predatory lender as defined hi Chapter 2-32 of the Municipal Codv. We fuiilicr jfikrdge 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 whlithe City."

Jf 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 Municipa l Code, explain here (attach additional pages if necessary)::

N/A '

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 arc defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the Cily have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

[JYcs [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 lo 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 lo the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.

Does the Mailer involve a City Property Sale?

L ] Yes [ ] No

If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:

Name Business Address Nature of Interest

4. The Disclosing Parly further certifies thai no prohibited financial interest in the Mailer 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 die Matter voidable by the City

K 1-Tfic: Disclosing Party verifies that the Disclosing Party has searched any and all records of

the pisclosing Party .and any:a»d ill prtiilea'ssor entities regarding records of iiwestinenis or profits from slavery, or slaveholder insurance .policies during the slavery era (including insurance policies issued 10 slaveholders that provided coverage fordamage to or injury or death of their slaves), and the Disclosing Party has found no such records.

3- 'foe Disclosing Party verifies that, ns ;i result of conductingj die search in step 1 -above, 'be

Disclosing Party has.fotmd records of nivestmcnts or profits from slavery or slaveholder in^trance policies. Tbe ;Discl!osing Party .verifies .that ihe.foilov.^;ing constitutes full disclosure of all sudi records, including the names of any and all'slaves or slaveholders described in those recocds:

SECTION VI - - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE:. If-die Matter is fedSeraliy funded, complete this Sqaion VI, If the Matter is nat federally funded, proceed to Sectimi Vff. For puiposes.ofthis Section VI, tax-credits allocated by the City and proceeds of-debt obligations of die City are not federal funding.

A. CERTIFICATION REGARDING LOBBYING

i. List below the names of all persons or entities registered under die federal Lobbying Disclosure Act of 1995.who have made lobbying contacts on behalf of the Disclosing Party with resped to tlie Matter; (Add sheets if necessary):

(If no explanation Appears Or begins on the lines above, or if the letters "NA^W orif the word "None" appear, ii will be conclusively piesiuned that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of have made lobbying contacts on behalf of the Disclosing- Patty 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 fisted jn Paragraph A.L above for his or her lobbying activities or to pay any person or entity.lo influence or attempt lo influence an officer or employee of any agency, as defined by applicable federal; law, a member of Congress, an officer or '"employee of D>ugress, or an employee of a member of Congress, in connection with/the award of any federally funded contract,-making any federally funded grant origan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded eoniract, grant, loan, or .cooperative agreement.

'Page 9.of Li

3: the Disclosing Party will submit an updated certification at the end of each calendar quarter in which there, occurs airy event that notarially affeds the accuracy of (be statements and ■information set forth, in paragraphs A. I. and A.2. above.

4, The Disclosing Party certifies that either: (i) iris not an organization described infection

501(c)(4) of the Internal.Revenue Code of 1986; or (it)J( is an ocganii^tioii described in.section

501(c)(4) of the: Internal Revenue Code oD98G but has not engaged and will not engage in "Lobbying

Activities"!

5. lf the Disclosing Party is the Applicant,, the Disclosing Party roost obusift Certifications equal io

form and substanceto paragraphs A. 1. through A.4. above front all subcontractors before it awards any.

subcontract and the Disclosing Party must maintain all such subcontractors" certifications for the

duration of die Matter and must make such certifications promptly available to the City upon request.

B- CtR11f!CAI10N REGARDING EQUAL EMPLOYMENT OPPORTUNITY

I f the Ma iter is federally- funded, federal regulations require the Applicant and all proposed subcontractors to submit the following 'informal km with Their bids or in writing ai the outset of negotiations.

Ls the Disclosing Party the Applicant?

I [ Yes f j No

If '"Yes," answer the three questions '-below:

1. Have you developed and do you have on file affirmative aciionprograms pursuant to applicable

federal regulations? (See 41 CFR Part 60-2.)

| I Yes [ )No

I Live yon filed with ihe-Joint Reporting Committee, the Director of -the -Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under die applicable filing requirements?

j ] Yes [JNo

Have you porucipaled hi. any previous contracts or subcontracts subject-to the equal opportunity clause?

I 1 Yes * I lNo

If you checked''No'' lr> question i. or 2. above, please provide on explanation:

Page 10 of 13

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

Tjhe Disclosing Patty understands and agrees that:

The certifications, disclosures^ and acknowledgments contained iu this EDS will become pan of any Contract or othci? agimemcait betWoen the AjjjjI icai i t and the City in connection with .the Matte, whether Procurement, City assistance, or other City action, and ere material inducements to the City's execution of any contract or taking omcr action Vrf.fji;respect-tothe Matter The Disdpsing;Party understands that it must comply with all staiutcs, ordinances, and,regulations on which this EDS is based.
The City's Governmental Ethics and-Campaign.'.Financing Ordinances, Chapters 2-156 and 2-164 ol the Municipal Code, impose'ceiiam duties and obligations on persons-or entities seeking City contracts, work, business, orrjarisacuohs. The f ull text of these ortlihances and a training program Is available on line at wi^riryofchic^go.nrp^thtrs.- and tnay also'be. obtained from die City's Board of Ethics, ?40 N.

Sedgwick St., Stiite SW. eiticago, IL 60610/(312) 744-9660: The Disclosing Party must comply fully with the.applicable OFdhiautes.

If die City determines that any. information provided in this EDS is false, incomplete orittaccutate, 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 die contract or agreement (if not rescinded or void), -at law, or. in -equity, including terminating- the Disclosing Partys participation in the Matter and/or declining to allow the Disclosing Parry to participate- in other transactions with the City¹. Remedies at law for a false statement of material fact may include iticajnceration and an award to, the City of treble damages,
It is the City's policy to makethis document available to the public on its Internet siieand/or upon, request. Some or ail of die snforuustiou provided On this .EDS.and any attachments to this EDS may be made available to the public on the Internet, in response io a Freedom of Information Act request, or otherwise. By completing arid signing 'this: EDS,, the Disclosing Party .waives-and releases any possible rights or clairns which it may have against the Cityiit connection with die public release of information contained in this EDS and also authorizes the City to verify, the.accuracy of any information submitted, in this EDS.
llie information provided in this EDS must be kept cuirem. In the event of changes, die Disclosing Party rtuLsi suppjpni.ent. this KDS.up-'to the time the City takes action-on the Matter. If the Matter is a contract being bandied by the City's Department of Procurement Services, the Disclosing Party must update tins EDS as the. contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1 -23 of the Municipal Code (iinposing_;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 2-154-4)20 of the MtuiicipaS Code.

'Ihe Disclosing Party represents and warrants than

Page-ll of-Li

(DO NOT SUBMIT 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 recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)

RECERTIFICATION

Generally, for use with City Council matters. Not for City procurements unless requested.

This recertification is being submitted in connection with Negotiated Sale of 3648 South

Prairie (Rear). Chicago. Under penalty of perjury, the person signing below: (1) warrants that

he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2)

warrants that all certifications and statements contained in the Disclosing Party's original EDS

are true, accurate and complete as of the date furnished to the City and continue to be true,

accurate and complete as of the date of this recertification, and (3) reaffirms its j

acknowledgments. !

Kaitin H. Powell

(Print or type legal name of Disclosing Party)

(sign here)

Print or type name of signatory:

Kaitin H. Powell

Title of signatory:

Owner

[state].

Signed and sworn to before me on [date] £>H / Z Q ( I *> , by kfii Tifil '?C>U)£q _t _at CoO U County,

Commission exi

Notary Public.

Ver. lI-0t-05

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

Iv2. If the Disclosing Party is ihe.Applicani, the Disclosing Party and its Affiliated Entities will hot use, nor permit their subcontractors to use, any facility listed'by the LkS. E.P.A. on the federal Excluded Patties List System ("EPLS") mai ntained by the l.LS. General'Sendees Administration.

F.3. If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contracnors^ulHrontractors hired or to be hired in connection with die Matter certifications equal in fornvand substance to thosem.ET. andE2,above and will not, Without the prior written consent of the City, use any such coruraciOr/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not-.provided or cannot provide fjuthfttl certifications.

1NQ1E: .If-the Disclosing Party cannot certify as io any of die items, in El.;* F.2. or_: F:3. above, an explanatory statement must be attached to tliisEDS-

CE ftTfF i C ATI ON

U nder penalty of perjury, the person signing below: (!) warrants that he/she is authorized to execute this KDS wd Appendijc A (if _;appl.tCHble)'9n.be.lM.!.f'of the Disclosing Party, and (2) warrants tswl 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.

Kaitin H. Powell

(Print orlype nameal'DisdOSing Party)

("Sign here)

(Prjnt or type name of person signing)

Owner

(Print or type tide of person signing)

s ^ (state).

Notarv Pull lie.

Signed and sworn to before me on (date) ^jjJ⁷"¹ ^ , 15

at _.6.^iui County, JJji

Commission-expire:

OFRCIALSEAI-. JENNIFER L ROCCO;

NOT/JW rUEUC - STATE Q? £LUNO!S ' MY OOMWJSaOK- EXP15ES OCTOBEH 6. 3>J6

Page'12 of 13

CITY OF CHICAGO ECEONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHPS WITH ELETED CITY OFFICIALS AND DEIVURTMENT HEADS

Tliis Appendix is to be completed only liy (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 he completed by ahy legal «?rttity which lias only ari indirect ownership interest, mtbe Applicant.

Under Municipal' Code Section 2-154-01 5, ihe Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "jfarfiilial relationship'*- w iti« a ny elected city official or department head. A "fanailial relationship"" exists if, as of ttte date this EDS is

signed, the Disclosing Party or any "Applicable Party'* or any Spouse or Domestic Partner thereof is re lated 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 adopt ton: parent, child, brother or sister, aunt or unde, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law. daughter-in-law, stepfaduT or stepmother, .stepson or stepdaughter, stepbrother or stepsister or half-. brother or half-sister.

"Applicable Parly''' means (l ) ali ex«;mive.officers of the Disclosing Party listed in Section II.B: l.a.; if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Parry* is a limited partnership; all manages, managing members and members of the Disclosing Party/if'tht* Disclosing Party is aliiiiited 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,'''"'Princirwlofficers'"' means the president, chief operating officer,-'executive diiector_ichief financiaf officer; treasurer or secretaiy uf aTegal enUly or a ny person exercising-similar authority

Does die Disclosing Party or any "\Applieable Party" or any Spouse or Domestic Partner .thereof currently have a "familial 'relationship" with" an elected city official or department head?

I-JYes [st No.

ff yes, please identify below (!) the name and title of such person, (2) the name ofthe legal entity to which such'person is connected: (3) che name and Lille of the elected city official or department head to whom such person h^sa-famiiiaErelatiortship, and (4) the precise nature of such familial relationship.

Page 13 of 13

Kaitin H. Powell 3648 S. Prairie Ave.

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 interest in the Applicant exceeding 7.5 percent (an "Owner"). 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 scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?

[ ]Ycs [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 problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?

[ ]Yes [ ]No [_x] Not Applicable

3. If yes to (1) 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 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 REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS M ADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.

CITYOFCHflCAGO EC ON OMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTfON I - GENERAL INFORMATION

A, Legal name of Disdosiujj Parry.submiiting'-ihis EDS. Include d/b/a/ if applicable;

Mares. Powell ^ _ ___

Check ONE of the following three boxes;

iudj.CHie-whether'Disclosing Party submitting this EDS.is': l . fX] the Applicant OR

2. { ] a legal entity holding a direct or indirect interest in the Applicant, State? die legs! name of the Applicant, in which Disclosing Party holds an interest: OR

3.1 ] a leg.^:d entity with a right of control (see Section 11.B. I.) State the legal name of the entity in

which die Disclosing Party holds a right of control: _ _ /

B. Business address of Disclosing Party:- .^: _t

lelephone: I ' Fax: Email: , _mr_
Name of Contact .person: Man: Powell _ _
Federal Employer Identification No. (if you have one): - N/A _
lit-icf descnpiton of contract, irctrisactian or other undertaking (referred to below as the" Matter') to which this EDS pertains, (.include project 'mimber and lm-ation of property, if applicable):

. ,,, Negotiated Sale at 3648 South -Prairie Ave... Chicago _ _ _u

Which C-hy agency or depart menr is;requesting this EDS? Dept. of Planning and 'Development

ff the Matter is a contract being handled by-the City's Department of IVocurement Services, pfease complete the following;

Specification ft N/A and Contract P N/A _m

Ver. OH¹1.-12

Page I of L"J

SECTION Q - DISCLOSURE OE OWNERSHIP INTERESTS A. NATURE OF DISCLOSING PARTY

Indicate the' nature pi ihe Disclosing Party:

[x ] Person [ j.Limited HabiLity company

t ] Publicly registered business corporation [. ] Limited liability partnership

[ ] Privately held, business corporation { ] Joint venture

(j Sole proprietorship 11 Not-for-profitcorporation

I ] General partnership 0$ the not-for-profit corporation also a 501(c)(5))?

1 I Limited partnership [JYes (.1 No

j J Trust I 1 Other (please specify)

For legal entities, the state (or foreign country) of incorporauon or organization, if applicable:

NA .

J.' For legal entities not organised in ihe Stale of Illinois: lias the organization .registered to do business in the Stale of Illinois as a foreign, entity?

j j Yes I [No 1XJN/A

!3. IF THE DISCLOSING PARTY IS A LEGaLENTITY;

1. LLsj below the full .names and tides 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. It there are no such members/write "no members." For trusts, estates or qi her. similar entities, list below the legal tii.Ieholder(s), ;

If the entity is a general partners!tip, limited partnership, limited liability company, .limited UabtWy 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 D.sctostng Party NOTE: Each legal entity, listed below must submit an EDS on its uwii behalf.

Nana- Eitlf

NA _

? Please provide the following information concerning eadi person or entity having a direct or indirect be.HeficialHiUen&i('incrudin_?; ownership) iii excess of 7.5% of the pisclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a. partnership or joint venture,

Page 2 of13

jmcrcsT of a member or manager in-a limiiod liability company, or interest of a beneficiary of a iritsi, c-siateot-other similar entity. If none,'slate'"None." NOTE: Pursuant, to Section-2-154-030 ofthe. Municipal Code oCChicago;C'Munidpal 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

. m _ ~ -

SECTION I II - - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS

lias ihe Disclosing Party nad a ^business relationship," its defined in Chapter 2-3 56 of the Municipal Coda, with any City elected official in the 12 months before the date this EDS is signed"?

f 1 Yes IX] No

If yes, please identify below the name(s) of such City elected ofJicialfs) and describe such relationship^);

N/A ... =

SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

Tlie Disclosing Party must disclose die-naoie and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any. other person or entity whom the Disclosing Party lias retam<*l .or expects to retain in connection with the Matter, as well as the-nature of die relationship, and the total amount of the fees paid orestima.twl to be paid. The Disclosing Party is not required to disclose employees who are paid solely .through-'ihe Disclosing P3rtyVn^ular.payroll-

"Lobbyjsi" means any jK'rsonor entity who undertakes to influeacc.ahy -legislative oradmfostrariy'e action on behalf of any person or entity other than: (lj a not-for-profit entity, on an unpaid. basls,.or (2.) himself. "Lobbyist'" also means any person or entity any part of whose, duties as an employee of another includes undertakmgto 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 wlwther disclosure is required or make the disclosure.

Page 3 «f 13

Narfiefindicate whether Business retained^ anticipated Address to be retained)

Relationship to Disclosing Party Fees (indicate whether

(subcontractor, attorney, paid or estimated.) NOTE:

lobbyist, etc.) "hourly rate" or "t.b.d" is

not an acceptable response.

Kupiec & Assoc., 77 West Washington St. Ste. 1801, Chicago IL 60602 (Attorneys) $7,000 (estimated

(Add sheets if necessary)

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

COURT-ORDERED CHILD SUPPORT COMPLIANCE

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

[ ] Yes [X] No [ ] No person directly or indirectly owns 10% or more 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 1") (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 Certified 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 1 is a continuing requirement for doing business with the City. NOTE: lf 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

2, The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities

identified in Section TLB. 1. 0 f i his EDS:

are not-presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded fronvany transactions by amy federal, state or local unit of govca-iuitent;
have noi, within a five-year period preceding the date of this EDS, been convicted of a criminal offense,adjudged: guilty, or hada civil judgment rendered against thern 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 staiementSr or receiving stolen pMperty;
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) ternlinaied for:cause .or default; and

c. have'nbr, witluh a five-yea.r:penod preccdmgihe date of mis EDS, been convicted, adjudged guilty, or found liable in a civil proceeding,, or in any criminal or civiLa<^qn/uicUKlirig aciidns conoaming environmental violations, instituted by die Cily or by the federal, government, any state, or any other unit of local government,

3. The certifications in subparts 3,4 and 5 concern:

- the Disclosing Party;

any "Contractor" (nu-aningany contractor or subcontractor used by the Disclosing Party in Connection with.tlte Mattel; including but not limited to all persons or legal entities disclosed under SectioniV, "Disclosure of Subcorttraaoi'S and Other Retained Pasties");

# any "Affiliated Entity" (meaning a person.or entity that, directly or indirectly: controls the Disclosing Party, is controlled l>y;pVDisclbsin.g Party- or is, widi the Disclosing Party, under common control of another person or'erUii.y- Indicia of control include, without limitation: interlocking management or ownership; identity of interests, among farnily members, shared facilities and eqiui>uicnt; common use of employees^ .or organization of a business- entity following the

ine iigibiiiiy of a business entity to do business with federal of state or local government, including . the City, using substantially the same niartageuuiii, ownership, or principals as the ineligible entity); with respect to Contractors, the Iran Affiliated Entity means:a person or entity thai directly or indirectly controls the Comraaoi, is controlled by" ii, oi', with the Contractor, is under-common control of another person or entity ;

* any responsible official of the Disclosing Party, any Contract or. or any Affiliated Entity or any oilier official, agent or employee of die 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"),

Neither the Disclosing Party, nor my Con tractor, nor any Affiliated Entity of either ihe Disclosing Party or any Contractor nor any'Agents'have, during the five years before the date this EDS' is signed; or, with respoci 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.engageroe.nl in conueeitors with the Matter:

a. ! bribed or attempted, to bribe, gr been convicted or adjudged, guilty, of bribery or attempting to

bribe, a public officer or employee ofthe City, the Sum⁵ of Illinois, or any agency ofthe federal ., government or of any state or local government in the United States-of America, tn 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 iu a. or b. above thaiis a matter of record, but have not been prosecuted for such conduct; or
violated me provisions of .Mtiuici|ial Code Section 2-32-610 ("Living Wage Ordinance).

A. Neither the Disciokug Patty, Affiliated Emily .dr Coiiiraaoi; oriny 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 cpnvjcted'.of (1) bid-rigging in violation of 720 ILCS. 5/33E-3; (2) bid-roiating 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 pr bid-rotating.

5. Neither the Disclosing Party nor any Affiliated Entity is listed ot* any of the following lists

maintained by the Office of Foreign Assets Control of the U.S. Department of dae Treasury, or the

_: Bureau of Industry and Security of the U.S. Department of Conniierce or their successors: the Specially Desigjiate-d Nationals List, the Denied Persons List, the Unverified .List, the Entity List and the Debarred List.

6. llie Disddsiag' Party understands and shall -comply with (1. ) the applicable requirements of Chapter

{Legislative Inspector■ General), 2-56 (Inspector General) aritl^-1 SS (Governmental Ethics) of the

Municipal Code.

7. If lire Disclosing Party is unable to certify to any of the above statement!; in ibis-Pan B (Further

Certifications), the Disclosing Partv must explain below:

_ .

Page Oof TJ

If the letters "NA," the Word "None," or'no rcsponse^:appeaes on the lines above, it Will be oonclusively-presumed thai ihe Disclosing Party certified to the above statements.

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

9. To the best of lite Disclosing .Pair's knowledge after reasonable inquiry, the following is a; complete list of all gifts that the-Disclosing Party'has given or caused 10 begiven, at any time during the 12-month .period preceding the execution date of diLs EDS, to an employee; or elected or appointed, .official, of the City of Chicago, for purposes of this statement, a '"'gifC do& not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in ihe 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 tlie City recipient. N7A

^:C. CERTIFICATION OF STATUS AS PIN A NCI AL INSIITUTION

J. The -'Disclosing Party certifies that the Disclosing Party (check one)

j ] is |X] is not

aV'Ttnandal institution" as defined in Sect.ion.2-32-4SS(b) of the Municipal C*xie_

2. If tlie Disdixsing Party IS a financial institution, then the Disclosing Party pledges:

"We art-not and will not becotne.ciprcdaioi'y. lender as defined in .Chapter 2-3.2 ot the Municipal ■ Code. We'further pledge that noiieof o«r affiliates is, and none of-litem -wilfbecome, a predatory , lender as defined in Chapter 2-32 of the Municipal Code. We understand thai becoming a predatory

lender or becoming an affiliate of a predatory lender .may result in tlie loss of the. privi lege of doing

business with the Chy."

If the Disclosing Pariy 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 of the Municipal Codci explain -here'(attach additional -pages li liecessary):

N/A

Page / of 13

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

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.

In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

[ ] Yes [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?

[JYes [JNo

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 requirei.ne.ms may make any contract entered into with the City in coiuieaion.whh the Matter voidable by the City

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

die Disclosing Party and any and ail predecessor entities regarding records of invesi.1'1tents or profits 'from slavery^or slaveholder insurance policies during tlie slavery era (includingrnsurattce policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has founrj.no such records.

3. The pisclosing Party'.verifies that, as a result 6f conducting the seaidt in step 1 above, the

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

SECTION VI - - CERTIFICATIONS FOR FEDERALLY FUNDED MATHERS

NOTE: if tlie Matter is feck-rally funded. compleie this Section V1. If tlie Matter is not Merally funded, prbcetxi io Section Vi I. For purposes of this SedionVf, tax credits allocated Uv the City and proceeds of debt obligations of the City are not federal funding.

A. CERT.I Ff CATION REGARDING LOBBYING

L List below the names of all persons or entities registered under the federal-Lobbying Disclosure Act of 19*35 who have made lobbying contacts on behalf ot 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 presuirted diat the Disclosing Party means thai 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.)

it The Disclosing .Party has not spent and.-will not expend any federally appropriated funds to pay any person, or entity listed in Paragraph AJ. 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_Ka member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with die award of any. federally funded Contract, making any federally funded strain or loan, entering into any cooperative agreement, or to extend; continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agmeme.nt.

Page 9 of Vi

Tlie Disclosing'Parry will submit an updated certification at the end of each calendar quarter in which there occurs any event thai materially affects the.accuracy of the statements and information sec forth in paragraphs A. 1. and A2. above,
The Disclosing Party, certilies _:ihat cither: ft) it is not an organization described in section 501(c)(4) of the Internal l<eYe.m.io.Codc of 1986'; : or (ii) it is ail organization described in section 5(M'(c)(4) of die internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities",

5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in

fonu and substance to paragraphs: A.L through AA above from all subcontra.ctors before-it awards any

subcontract and the Disclosing Party must maintain?,!) such subcontractors' certifications lor 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 die Applicant and all proposed subcontractors to submit the 'following infonnaiioa withtheir bids.'or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?

I I Yes I ( No

If "Yes/' answer the three questions below;

L Have you developed and do you have on file affirmative action, programs 'pursuant to applicable

federal regulations?-'(See 4l CfH Part 60-2.)

I 1 Yes 1 ] No

I Lwe 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 r<*|iureaienis?

I; j Yes { J No

Have you participated in any previous conirdCis or subcontracts subjecuo'the equal opportunity clause?

jjYes flNo

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

Page 10 of 13

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

'I"he Disclosing Party undejsiands and agrees that;

A." The certi fi cations, disclosures, a ad acknowledgments contain.^

Contract cir,ot!inr agreei»eiu between die Applicant and the City in connection with the Matte, whether Proeuiement, City assistance, or other City action, and are material-inducements to,die. City's execution of any contract or taking other action with respect lo the Matter The Disclosing Party understands that it must comply with all siatuics, ordinances, and regulations on, which this EDS is based.

B: The City's Governmental Kilties and Campaign Financing Qrdinan^s, CliapteTs 2-lDG and 2-164 of the Municipal Oxie, inij>ose cenain duties and'obligations o« ixasons or entities seeking City contracts., work, business, or Uansactions. "Hie full text of these ordinances and a training program is available on line at'iYWW.cityofrhicfltfn.om/RihicX'aiid/tfiay also be obtained from, the City's Board of Ethics, 740 N.

Sedgwick Sc, Suite 500, Chicago, 11 GOGlp, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.

lf the City determines that any information provided in til is EDS is false, incouiplete or inaccurate, any contract'orMother agreement in connection with which it is submitted, may be rescindtid or be void or voidable; andthe City may pursue any remedies under die contract or'sgrteiifcht (if not rescinded of void), at law, or in equity, including terminating the Disclosing' Party's participation in the Matter and/or declining io allow'the-Disclosing Party u> participate in other transactions with tin: City. Remedies at law for a false statement of material fact may include incarceration and-an award to die 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 oral! of die information provided on this EDS and any attachments to this EDS may be made available tothe public on the Internet, in respouseto a Freedom of Information Act request, or otherwise. By completing and signing this EDS. the Disclosing Party waives and releases any possible-lights or claims whicli it may have against the City in connection with the public release or information cowained ln this EDS and also authorizes the City to verify the accuracy' of any itrforrwatioa submitted iivthis EDS.

E: Tlie information provided in this CDS must be kept current.' In the eventof diaiiges, the Disclosing Party uluSt supplement this EDS up to the time die City takes action on the Matter. If the Matter is a contract being bandied by .the; City *s Department of P'rodwexnent 'Services; die Disclosing Party must update this EDS as the contract requires. NOTE; .With. resjH'Ct to Matters subject to Article f of Chapter 1-23 of the Mimicipa! Code (imposing PERMANENT INELIGIBILITY lor c^rtnin specified offenses), the infomiiuipn provided herein regarding-eligibUity 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 Partyrepresents and warrants that:

Page 11 of 13

(DO NOT SUBMIT THIS PAGE WITH YOUR EDS- The purpose of this page is for you to recertify your EDS prior to submission lo Cily Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)

RECERTIFICATION

Generally, for use with City Council matters. Not Ibr City procurements unless requested.

This recertification is being submitted in connection with Negotiated Sale of 3648 South Prairie (Rear). Chicago. Under penally of perjury, the person signing below: (1) warrants that he/she is authorized lo execute this EDS recertification on behalf ofthe Disclosing Party. (2) warrants thai all certifications and statements contained in ihe Disclosing Parly's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as ofthe date of this recertification. and (3) reaffirms its acknowledgments.

Mare S. Powell Date:

(Print or type legal name of Disclosing Party) Bv:

(sign here)

Print or type name of signatory: Mare S. Powell

Title of signatory: Owner

Signed and sworn to before me on [datcj Q*-t j i2S> [ 1 *Q

[slate].

{Y\&1l(L S . 'TpujRu , al COo^i County, ⁴

n expires:

Comniissio

Jj_jl_ .a ^L-O'v^ Notary Public.

1(^1 lib ,

Ver. JI-OJ-OS

OFFICIAL SEAL AGNIESZKA T PLECKA NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES:04/23/16

F.l. 'flic Disclosing Party is' riot delinquent in fftc^j payment of.aivy tax administered by the Illinois Department of Revenue; nor are. trie Disclosing Party t>r its. Affiliated Entities delinquecrt in trying any fine,, fee, tax or other charge owed lo the City. This includes, but is not limited to;.all. water charges, sewer charg.es, license fees, parking ti ckets, property taxes, or .sales' taxes

R2. If me Disclosing Party is the Applicant, the Disclosing Party and its Affiliated EMities wi'll-noi". use, nor pennit their, subcontractors to-use, any facility listed-by the U.S. E.PA. on the. federal Excluded Parties List System ("RPLS") maintained by die U.S. General Services Administration.

E3; If the Disclosing Party is the Applicant, the Disclosing Party-'will obtain front any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and stibsiaiice to Those in Eland F.2. above and will'not., without the .prior, written consent of the Cily,'"St; any such contractor/subcontractor that does riot pmvide such certifications or that the Disclosing Party has reason to believe lias not provided -or can not provide truthful certifications.

NOTE: If the DisclosingParty''cannot certify as to any of the items in El.', E2, or F-3- above, an explanatory statement triust be attached to (his EDS;

CERTIFICATION

-Under penalty of perjury, the person signingbelow: (1) .warrants that he/she is audiorized to execute this i ;DS and Appendix A (if applicable) on behalf of the Disclusing 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 ii«e City.

MarC S. POWell

(Print or type name of Disclosing Party)

By; MCWoM.

(Sign here)

Fvwell

(Print or type name i>f person signing)

Owner

(Print or type title of person signing)

Signed and sworn tolxTorc mo. on (date) \J Is^- ffij

at. County, ■r%$lXfi~«*S. (state).

^4^-1^- 'ds- A-bilJf'' Nolarv'Public.

V'; 7~T ^ '" ■

Commission expires: (_ .Ma ■ it gvP (

Page 1.2 of! 3

' OFFlGfALSEAL JENNIFER L. ROCCO

NOTARY PU8UD STATf 6? elijnOis Mi CWoilSSON £XRflES OCTOCER Cs a?B-

CITY OF CHICAGO ECEONOMIC DISCLOSURE STATEMENT AMD AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELETED CITY OFFICIALS AND DEPARTMEN T HEADS

This Appendix is lobe completed only by (a) the Applicant, and (b) any legal entity which lias a direct ownership interest in the Applicant exceeding 7-5 pcrceiu. It is not to be completed by any legal entity which has only art indirect ownership interest in the Applicant,

Under Municipal Code Section 2-IS4-015, the Disclosing Party must disclose whether such Disclosing Parry- or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familia! relationship'^ith any elected city official or department head. A'TamiSia! relationship" exists if, as ofthe date dus.EDS is

signed, the Disclosing Party or any "Applicable Party" «>r any Spouse or Domestic Partner thereof is related to

the mayor, any alderman, the city clerk, tfieciiy treasurer or any city depaamenl bead as spouse or domestic partner or as any of llie 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. stepfatlier or stepmother, stepson or stepdaughter stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of ihe Disclosing Party listed hi Section ll.B.Vs , if die Disclosing Party is.a coiporat'ion; all* r^rth'ers-of the' pisclpsing Party,.iftlij? Disposing Party is a general partnership; all'general padrters and limited;part.nejs ofthe Disclosing Party, if the Disclosing Party is aiiimted-partnersliip; ail nuaagers,- managing members and members of the Disclosing Part)', if the Disclosing Party is a limited liability company; (2) al) principal officers of the Disclosing Pa.rty; and (3-) any person haymg more iha'n:a 7.S percent ownership interest'in the Disclosing' Pa rty. 'Tnncipaf officers" means the president, chief operating officer, executive director, chief financial officer, treasurer-or secretary of a legal .entity or any person exercising similar audiority.

Does the? Disclosing Party.or any "Applicable i'arty" or any Spouse or Denriestic Partner tlaereof currently have a "familial n>latiojiship" with an elected city official or department head?

I j Yes- [xj.No

IT yes, please identify below fl) the name and title of such person, (2) the name of the legal entity to which such person is comieaed; (3) die name and title of the elected city official ot-department head to whom such■'person has a familial relationship, and (4) the precise nature of such familial relationship.

Page 13 of 1-5

Marc S. Powell

S. Prairie Ave.

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX B

BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION

Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?

[ ]Yes [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 problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?

[ ]Yes [ ]No [_x] Not Applicable

3. If yes to (1) 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 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 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.

Legislation Text

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