CHICAGO, June 17,2015
To the President and Members of the City Council:
Your Committee on the Budget and Government Operations, having had under consideration an Ordinance authorizing the execution of a fuel and maintenance agreement with Growing Power, Inc. necessary for the implementation of a Mobile Food Market Program; and having had the same under advisement, begs leave to report and recommend that Your Honorable Body pass the Ordinance transmitted herewith.
This recommendation was concurred in by a viva voce vote of the members of the Committee.
(Signed).
Carrie M. Austin Chairman
|1010|
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 Fleet and Facility Management, I transmit herewith an ordinance authorizing the execution of a fuel and maintenance agreement with Growing Power for the mobile produce bus program.
Your favorable consideration of this ordinance will be appreciated.
Very truly yours,
ORDINANCE
WHEREAS, by virtue of Section 6(a) of Article VII of the 1970 Constitution of the State of Illinois, the City of Chicago (the "City") is a home rule unit of local government and as such may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the City is committed to continuing efforts to increase access to affordable healthy food options in underserved areas within the City; and
WHEREAS, Growing Power, Inc., a Wisconsin not-for-profit company ("Growing Power") has been providing safe, affordable, and healthy food for metropolitan communities for over two decades, and for City residents for more than twelve years; and
WHEREAS, Growing Power will repurpose two out-of-service former governmental buses into fully operational mobile produce markets (the "Mobile Markets") to sell locally grown produce to create and expand markets for local and regional farmers and provide affordable healthy food options for purchase in underserved areas; and
WHEREAS, the Mobile Markets will make designated stops at specified locations such as health clinics, schools, daycare centers, farmers' markets and parks throughout underserved neighborhoods on the west and south sides of Chicago to make available fresh food options from farms within a 200-mile radius of the City (the "Mobile Food Program"); and
WHEREAS, it is anticipated that the Mobile Food Program would create 20 jobs, provide 44 market expansions for food producers and sell approximately 50,000 pounds of produce in making approximately 2,200 community stops over the course of 50 weeks; and
WHEREAS, Growing Power has received federal funding to implement the Mobile Food Program for a period of one year; and
WHEREAS, the Department of Fleet and Facility Management ("2FM") wishes to assist Growing Power in implementation of the Mobile Food Program by providing one bus no longer needed in its fleet to be used as one of the Mobile Markets (the "2FM Bus"), and fuel and maintenance services for both Mobile Markets on an as-needed basis; and
WHEREAS, 2FM seeks authorization from the City Council of the City to donate the 2FM Bus and enter into a fuel and maintenance agreement with Growing Power in furtherance of the Mobile Food Program; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The above recitals are incorporated herein and made a part hereof.
SECTION 2. The Commissioner of 2FM (the "Commissioner") or a designee of the Commissioner is each hereby authorized, with the approval of the Corporation Counsel, to transfer title of the 2FM Bus to Growing Power, and negotiate, execute and deliver a fuel and maintenance agreement between the City and Growing Power for a term of one year to provide for a total donation of (a) fuel for the Mobile Markets in an amount not to exceed $50,000, and (b) repair work to the Mobile Markets, the value of which shall not exceed $60,000, which agreement shall contain usual and customary terms for City donation of goods and services,
l
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting, this EDS is:
"^fthe Applicant
QR
[ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant iii which the Disclosing Party holds ah interest: .....
OR
3. [ ] a legal entity with a right of control (see Section II.B. 1.) State the legal name of the entity in
which the.Disclosmg PaTty holds'a.right ofcontrol: ./ . .
Business address of the Disclosing Party: ^ ¦
Telephone: IL'. ^Mf^ tH'^j j^U^I Email: C\>Cl^($A(Div'> M pOu)$A
Name of contact person: £Q,-\\L^ AUs&AJ
Federal Employer Identification No. (if you have one): 1
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):
Which City agency or department is requesting this EDS? C,\/V\
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # /[/ and Contract # l\J^\ .
Page 1 of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
] Person
] Publicly registered business corporation
] Privately held business corporation
] Sole proprietorship
] General partnership
] Limited partnership
j Trust
[ ] Limited liability company
[ ] Limited liability partnership
[ ] Joint venture
^\1^ot-fbr-proflt corporation
(is 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:
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?
T^es []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 "ho 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
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.
Pa^e 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
jOJJLi
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 t^Wo
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, arid 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 cither 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)
"pJ^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 pode 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 oh any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes "p^yNo [ 1 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
I. Pursuant to Municipal Code Chapter 1-23, Article I ("Article l")(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 1 supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B. 1. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud-eta hezzlemeht; theft; forgery; bribery; falsification or destruction of records;, making.'false statements; or receiving stolen property;
are hot presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any oT 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. of more, public transactions (federal, state;or local) terminated for cause or default; and
have hot, 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 tQ bribe, a public officer or employee of the City, the, State of Illinois, or any agency of the federal government of 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'Of prospective bidders, in restraint of freedom of competition by agreement to bid a fixediprice or otherwise; or
made ah admission of such conduct described in a> or b. above that is a matter of record, but have hQt been prosecuted for such conduct; or
violated the provisions Of Municipal Code S ection 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:
iO(K^
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" of "hone").
, : a.) j a ^ ,
9. To' the best of the Disclosing Party's,knowledge after reasonable inquiry, the following, isa complete list of all gifts that the. Disclosing Party has giye;n or Caused to be given, at any time during; the 12-month; period preceding the execution date of this BBS, 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 Qf OfficjalCity business and.;haying a retail value^of less than $20 per recipient (if npne^ indicate with "N/A" of "hone"). As to any. gift listed below, please also list the name of the City recipient.
C. CERTIFICATION QF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is ]>^Ts 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 pfctfo
NOTE: If you checked "Yes" to Item D.I., 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 ofcompetitive 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 \y$o
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
fV(^
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 F.DS 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.
?Kj^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 Discj.QsmgiParty verifies:that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in thoserecords:
SECTION VI « CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For. purposes of this Section VI, tax credits allocated by the City and proceeds, of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary): .
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing: Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance.to paragraphs A. t. through A.4. above firom all subcontractors before it awards any subcontract and the Disclosing Party must maintain alLsuch'Subcbntractors' 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 [ 1 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, of 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 of inaccurate, any contract Or other agreement in connection with which it is submitted may be rescinded of. 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.
E. 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 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1 -23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
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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 iii connection with: the Matter certifications equal in form and substance to those in F. l . and F.2. above and will riot, without the prior written consent of the City, use any such contractor/subGontrattor that does hoCpro.vide such certifications or that ¦the-Disclosing Party has reasonto believe has not provided of cannot provide tmthfui 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
(Print or type name of Disclosing Party)
(Print or type name of person signing)
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.
Signed and sworn to before me on (date) March ^ , o?o/^T
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.Appllcaht, 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 m
Under Municipal Coxie ;Secti6n 2-154i015,. the-DisclosingvParty. must disclose whether such DisclosingiParty
or any "AppUcabje Party'' Or any Spouse* or Domestic Partner thereof currently has a "familial relationship" with
any elected'city official or department head. A "famili al relationship*' exists i f* as of the date this. EDS is
signed, the Disclosing Party or any "Applicable Party" Of any Spouse or Domestic Partner thereof is related to
me njaybr.any aldermahVthe city clerk, the city spouse of domestic
partner or as any of the following, whetherbyblood or adoptibn: parent, child, brother or sister^ aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law,; mother-in-law, sOn-rin-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; .ah parmers of the Disclosing Party, if the Disclosing Party isa.general partnership; all general partners and limited partners of me;Disclosing:Partyy 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
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
Hl§§pES
'9
lite
5500 W. Silver Spring Dr. Milwaukee Wl 53218 Phone: (414) 527.-1546 Fax:(414)527-1908
Welfbrd Sanders, President Executive Director
MLK Economic FAvelppnwnt Corporatjbn 2745 N Martin; Luther King Dr Rm 203 Milwaukee Wl 53212 Work: 414.264^000 Cell: 414.704.9117 welford@uwm.edu
Oliver Plunkoti, Treasurer Certified Public Accountant 2973 N; Ha&ett Avenue-Milwaukee. Vyi 53211.3443 Worki 414:908,9130 Fax 4^906.9*40 oii»ahapiun>iettopaiCbrn
Matthew L Cain, Secretary Milwaukee Public Schools Teacher 2157 N. 55th Street Milwaukee, Wl 53208 Home: 414!871.8082 rpattthewci^boglobaihei
Clyde I,. M&tth'ews Electrician
Mitwauke'e. Department of Public Works
i^So'/rfc 32hdStreet
Miforaukee, Wl 53208
Homiar4.t4:342.1048^
Cell: 414.405,4037
or^dm1^ptrnall.com
Ariel Kaufman
1126 Jenifer Street #2 Madison, Wl 53703 cfell: 608.235.4812
alkaufm2(aftivisc-edu
Don Richards Retired City Alderman 9301 N. 76th Street Milwaukee; Wl 53223 Cell: 414.232.5360 donrichards(S>wi.fr.com
Larry. Adams
Co-Fburider of Walnut Way Conservation Corp
2240 N. 17th Street
Milwaukee, Wl 53205
Work: 414.267.2326
Home: 414.264.2243
larrv(S>walnutwav.orQ
Don Austin
Elementary School Principal, Retired 2359 N 72nd St Wauwatosa Wl 53213 Home: 414.771.6175 idaustin2@earthlink.net
Sharon Adams
Cc-Founder of Walnut Way Conservation Corp
2240 N. 17th Street
Milwaukee, Wl 53205
Work: 414.264.2326
Home: 414.264.2243
sharon(5)walnutwav.orq
staff
Will Allen. CEO Growing Power 5500 W Silver Spring Dr Milwaukee Wl 53218 Office. 414.527 1546 Cell- 414.793 7083 vviil|S)ai uwinqpower.org
Tammy Mclntyre, Associate Director/Finance Mgr
Growing Power
5500 W Siiver Spring Dr
Milwaukee Wl 53218
Office: 414.527.1546
Karen Parker, Director Growing Power 5500 W Silver Spring Dr Milwaukee Wl 53216 Cell: 414.698.7381 karenCQ)qrowinqcow6i oiq