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This record contains private information, which has been redacted from public viewing.
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Type:
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Ordinance
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Status:
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Passed
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Title:
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Zoning Reclassification Map No. 5-I at 2500-2520 W Cortland St, 1900-1924 N Campbell Ave and 2501-2531 W Homer St - App No. 18580
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Topic:
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ZONING RECLASSIFICATIONS - Map No. 5-I
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FINAL FOR PUBLICATION ORDINANCE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all the current Cl-1 Neighborhood Commercial District and RS3 Residential Single-Unit (Detach House) District symbols and indications as shown on Map No. 5-J in the area bounded by: West Homer Street; North Campbell Street; West Cortland Street; a line 215.50 feet west of North Campbell Street; the public alley next north of West Cortland Street; and a line 311.96 feet west of North Campbell Street to those of a RM4.5 Residential Two-Flat, Townhouse and Multi-Unit District. SECTION 2. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all the current RM4.5 Residential Two-Flat, Townhouse and Multi-Unit District symbols and indications as shown on Map No. 5-1 in the area bounded by: West Homer Street; North Campbell Street; West Cortland Street; a line 215.50 feet west of North Campbell Street; the public alley next north of West Cortland Street; and a line 311.96 feet west of North Campbell Street to those of a Residential Planned Development which is hereby established in the area described above. SECTION 3. This Ordinance shall be in force and effect from and after its passage and due publication. Common Address: 2500 - 20 W. Cortland St./1900 Homer St. FINAL FOR PUBLICATION RESIDENTIAL PLANNED DEVELOPMENT STATEMENTS The area delineated herein as Planned Development Number , ("Planned Development") consists of approximately 65,536 square feet of property which is depicted on the attached Planned Development Boundary and Property Line Map ("Property") and is owned or controlled by the Applicant, Guardian Properties, LLC. The requirements, obligations and conditions contained within this Planned Development shall be binding upon the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. All rights granted hereunder to the Applicant shall inure to the benefit of the Applicant's successors and assigns and, if different than the Applicant, the legal title holder and any ground lessors. Furthermore, pursuant to the requirements of Section 17-8-0400 of the Chicago Zoning Ordinance, the Property, at the time of application for amendments, modifications or changes (administrative, legislative or otherwise) to this Planned Development are made, shall be under single ownership or designated control. Single designated control is defined in Section 17-8-0400 ofthe Zoning Ordinance. All applicable official reviews, approvals or permits are required to be obtained by the Applicant or its successors, assignees or grantees. Any dedication or vacation of streets or alleys or grants of easements or any adjustment of the right-of-way shall require a separate submittal to the Department of Transportation on behalf of the Applicant or its successors, assign or grantees. Any requests for grants of privilege, or any items encroaching on the public way, shall be in compliance with the Plans. Ingress or egress shall be pursuant to the Plans and may be subject to the review and approval of the Departments of Planning and Development and Transportation. Closure of all or any public street or alley during demolition or construction shall be subject to the review and approval of the Department of Transportation. All work proposed in the public way must be designed and constructed in accordance with the Department of Transportation Construction Standards for Work in the Public Way and in compliance with the Municipal Code of the City of Chicago. Prior to the issuance of any Part 11 approval, the submitted plans must be approved by ihe Department of Transportation. 4. This Plan of Development consists of sixteen (16) Statements: a Bulk Regulations Table; an Existing. Zoning Map; a Planned Development Boundary and Property Line.Map; a Site Plan; a Landscape Plan; and Building Elevations submitted herein. In any instance where a provision of this Planned Development conflicts with the Chicago Building Code, the Building Code shall control. This Planned Development conforms to the intent and purpose of the Zoning Ordinance, and all requirements thereto, and satisfies the established criteria for approval as a Planned Development. In case of a conflict between the terms of this Planned Development Ordinance and the Zoning Ordinance, this Planned Development Ordinance shall control. FINAL FOR PUBLICATION The following uses are allowed/permitted in the area delineated herein as a Residential Planned Development: Residential Dwelling Units; parking and accessory uses. On-Premise signs and temporary signs, such as construction and marketing signs, shall be permitted within the Planned Development, subject to the review and approval of the Department of Planning and Development. Off-Premise signs are prohibited within the boundary of the Planned Development. For purposes of height measurement, the definitions in the Zoning Ordinance shall apply. The height of any building shall also be subject to height limitations, if any, established by the Federal Aviation Administration. The maximum permitted Floor Area Ratio ("FAR") for the site shall be in accordance with the attached Bulk Regulations Table. For the purposes of FAR calculations and measurements, the definitions in the Zoning Ordinance shall apply. The permitted Floor Area Ratio identified in the Bulk Regulations Table has been determined using a Net Site Area of 65,536 square feet and a base FAR of 1.7. 9. The Applicant acknowledges and agrees that the rezoning of the Property from Cl-1 and RS-3 to RM-4.5, and then to this Planned Development, triggers the requirements of Section 2-45-115 of the Municipal Code (the "Affordable Requirements Ordinance" or "ARO"). Any developer of a "residential housing project" within the meaning of the ARO must: (i) set aside 10% of the housing units in the residential housing project as affordable units (the "Affordable Units"), or provide the Affordable Units in an approved off-site location; (ii) pay a fee in lieu of the development of the Affordable Units; or (iii) any combination of (i) and (ii); provided, however, in higher income areas, residential housing projects with 20 or more units must provide a minimum of 25% of the Affordable Units on-site or off-site (the "Required Units"). If the developer elects to provide Affordable Units off-site, the off-site Affordable Units must be located within a two-mile radius from the residential housing project and in the same or a different higher income area or downtown district. This Planned Development is located in a "higher income area" within the meaning of the ARO and permits the construction of 49 housing units. As a result, the number of Affordable Units is five (5) and the number of Required Units is one (1), calculated as follows: 49 housing units x 10% = 5 Affordable Units x 25% = 1.25, which is rounded down to one (1) Required Unit pursuant to Section 2-45- 115(R). The Applicant has submitted, and the Department of Planning and Development ("DPD") has approved, a proposal to build the Required Unit and the other four (4) Affordable Units off-site, as set forth in the Affordable Housing Profile Form attached hereto as an Exhibit. The Applicant agrees that the Affordable Units must be affordable to households earning no more than 60% of the median household income for the Chicago Primary Metropolitan Statistical Area ("AMI") in the case of rental units, and 100% of the AMI in the case of owner-occupied units. If the Applicant subsequently reduces (or increases) the number of housing units in the Planned Development, the FINAL FOR PUBLICATION Applicant shall update and resubmit the Affordable Housing Profile Form to DPD for review and approval, and DPD may adjust the number of required Affordable Units without amending the Planned Development. Prior to the issuance of any building permits for any residential building in the Planned Development, including, without limitation, excavation or foundation permits, the Applicant must execute and record an affordable housing agreement in accordance with Section 2-45-115(K)(2). The terms of the affordable housing agreement and any amendments thereto are incorporated herein by this reference. The Applicant acknowledges and agrees that the affordable housing agreement will be recorded against the off-site location(s), or the applicable portions thereof, and will constitute a lien against such property. The Commissioner of DPD may enforce remedies for any breach of this Statement [9], including any breach of any affordable housing agreement, and enter into settlement agreements with respect to any such breach, subject to the approval of the Corporation Counsel, without amending the Planned Development. Upon review and determination, "Part II Review", pursuant to Section 17-13-0610 of the Zoning Ordinance, a Part II Review Fee shall be assessed by the Department of Planning and Development. The fee, as determined by staff at the time, is final and binding on the Applicant and must be paid to the Department of Revenue prior to the issuance of any Part II approval. The Site and Landscape Plans shall be in substantial conformance with the Landscape Ordinance and any other corresponding regulations and guidelines. Final landscape plan review and approval will be by the Department of Planning and Development. Any interim reviews associated with site plan review or Part II reviews, are conditional until final Part II approval. The Applicant shall comply with Rules and Regulations for the Maintenance of Stockpiles promulgated by the Commissioners of the Departments of Streets and Sanitation, Environment and Buildings, under Section 13-32-125 of the Municipal Code, or any other provision of that Code. The terms and conditions of development under this Planned Development ordinance may be modified administratively, pursuant to section 17-13-0611-A of the Zoning Ordinance by the Zoning Administrator upon the application for such a modification by the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. The Applicant acknowledges that it is in the public interest to design, construct and maintain the project in a manner which promotes, enables and maximizes universal access throughout the Property. Plans for all buildings and improvements on the Property shall be reviewed and approved by the Mayor's Office for People with Disabilities to ensure compliance with all applicable laws and regulations related to access for persons with disabilities and to promote the highest standard of accessibility. FINAL FOR PUBLICATION The Applicant acknowledges that it is in the public interest to design, construct, renovate and maintain all buildings in a manner that provides healthier indoor environments, reduces operating costs and conserves energy and natural resources. The applicant has agreed to secure building certification to comply with the City of Chicago's Sustainable Development Policy. This Planned Development shall be governed by Section 17-13-0612 of the Zoning Ordinance. Should this Planned Development ordinance lapse, the Commissioner of the Department of Planning and Development shall initiate a Zoning Map Amendment to rezone the property to a RM4.5 Residential Multi-Unit District. FINAL FOR PUBLICATION RESIDEN TIAL PLANNED DEVELOPMENT PLAN OF DEVELOPMENT BULK REGULATIONS AND DATA TABLE GROSS SITE AREA = Net Site Area + Area remaining in the public right-of-way 97,931 sq. ft. (2.24 acres) = 65,536 sq. ft. (1.50 acres) + 32,395 sq. ft. (0.74 acres) FAR 1.7 SETBACKS FROM PROPERTY LINE: In conformance with the Site Plan MAXIMUM PERCENTAGE OF SITE COVERAGE/COMMON OPEN SPACE In conformance with the Site Plan MAXIMUM NUMBER OF DWELLING UNITS: 49 MINIMUM NUMBER OF OFF-STREET PARKING: Two per dwelling unit MINIMUM NUMBER OF OFF-STREET LOADING None BICYCLY PARKING: One per unit MAXIMUM BUILDING HEIGHT 44' HNAL FOR PUBLICATION | i Applicant: Guardian Properties, LLC Address: 2500 - 20 W. Cortland St./1900 - 24 N. Campbell Avc/2501 - 31 W. Homer St. Intro Date: November 18, 2015 Plan Commission Date: December 17, 2015 FINAL FOR PUBLICATION ; t • ¦ h \ * i»t»H»g .'istonr! ¦¦ . \ 'oy \ ¦ ^.-yp^ COnmwrewl Butting ¦;¦ ¦^¦¦¦v%-- IS 1-Sbwy .-\ ¦ ^ West Homer Street : : Existing 3-Story : RrtWentlal ' Building I Existing 3-Story Residential" •: . Buildings , .f EVliiog^t; ¦': ^p^Resldentia Buildings! fExisting £ ¦^Story: ' .'. Existing .in—IdentW¦¦=. iReskfent.tr
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Intro Date: November 18, 2015
Plan Commission Date: December 17. 2015
FINAL FOR PUBLICATION
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Applicant: Guardian Properties, LLC
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Intro Date: November 18, 2015
Plan Commission Date: December 17, 2015
FINAL FOR PUBLICATION
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Plan Commission Date: December 17, 2015
FINAL FOR PUBLICATION
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Applicant: Guardian Properties, LLC Address: 2500 - 20 W. Cortland St./1900 - 24 N. Campbell Avc/2501 - 31 \V. Homer St. Intro Date: November 18, 2015 Plan Commission Date: December 17, 2015
FINAL FOR PUBLICATION
Applicant: Guardian Properties, LLC
Address: 2500 - 20 W. Cortland St./l 900 - 24 N. Campbell Avc/2501-31 W. Homer St.
Intro Date: November 18, 2015
Plan Commission Date: December 17, 2015
Applicant: Guardian Properties, LLC
Address: 2500 - 20 W. Cortland St./1900 - 24 N. Campbell Ave./2501 - 31 W. Homer St.
Intro Date: November 18, 2015
Plan Commission Date. December 17, 2015
FINAL FOR PUBLICATION
Applicant: Guardian Properties, LLC
Address: 2500 - 20 W. Cortland St./l 900 - 24 N Campbell Avc./2501 - 31 W. Homer St.
Intro Date: November 18, 2015
Plan Commission Date: December 17. 2015
Applicant: Guardian Properties, LLC
Address: 2500 - 20 W. Cortland St./l900 - 24 N Campbell Ave./2501 - 31 W. Homer St.
Intro Date: November 18, 2015
Plan Commission Date: December 17, 2015
Department of Planning and Development
CITY OF CHICAGO
MEMORANDUM
Alderman Daniel S. Solis
Chairman, City Council Committee on Zoning
David L. Reifman Secretary
Chicago Plan Commission
December 18, 2015
RE: Proposed Residential Planned Development for property generally located at 2500-20 West Cortland Street. 1900-24 North Campbell Avenue and 2501-31 West Homer Street.
On December 17, 2015, the Chicago Plan Commission recommended approval ofthe proposed planned development submitted by Guardian Properties, LLC. A copy ofthe proposed planned development is attached. I would very much appreciate your assistance in having this introduced at the next possible City Council Committee on Zoning hearing.
Also enclosed is a copy of the staff report to the Plan Commission which includes the Department of Planning and Development, bureau of Planning and Zoning recommendation and a copy of the Resolution. If you have any questions in this regard, please do not hesitate to contact me at 744-5777.
cc: Steve Valenziano
PD Master File (Original PD, copy of memo)
121 NORTH LASALLE STREET, ROOM 1 000. CHICAGO. ILLINOIS 60602
Chicago Plan Commission
Proposed Residential Planned Development 2500 W. Cortland Street
December 17, 2015
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Landscape Plan
12/17/2015
FINAL
REPORT to the
CHICAGO PLAN COMMISSION from the
DEPARTMENT OF PLANNING AND DEVELOPMENT DECEMBER 17, 2015
FOR APPROVAL: PROPOSED RESIDENTIAL PLANNED DEVELOPMENT
APPLICANT: GUARDIAN PROPERTIES, LLC
LOCATION: 2500-20 WEST CORTLAND STREET; 1900-24 NORTH CAMPBELL
AVENUE; 2501-31 WEST HOMER STREET
Pursuantto the provisions ofthe Chicago Zoning Ordinance, Title 17 of the Municipal Code of Chicago, the Department of Planning and Development hereby submits this report and recommendation regarding a proposed Residential Planned Development for your review and recommendation to the Chicago City Council. The application for the amendment to the Zoning Ordinance was introduced into the City Council on November 18,2015. Proper legal notice of the public hearing on the application was published in the Chicago Sun-Times on December 2, 2015. The Applicant was separately notified of this hearing.
The Applicant, Guardian Properties, LLC is seeking approval for a Residential Planned Development in order to construct a 49 unit townhome project with accessory parking. The property is currently zoned RS-3 and C1-1 and is proposed to be rezoned to RM-4.5, prior to establishing the proposed planned development. This development is being submitted by the Applicant as an elective Planned Development, pursuant to Section 17-8-0600 of the Chicago Zoning Ordinance, because the proposed project includes at least 50% ofthe number of dwelling units that trigger a mandatory planned development.
PROJECT BACKGROUND
The site formerly housed an industrial facility known as the Phoenix Fastener Company. The developer has a contract to purchase the subject property.
SITE AND AREA DESCRIPTION
The subject site is approximately 65,536 square feet and is bounded by West Cortland Street on the south, North Campbell Avenue on the east, West Homer Street on the north and private (residential) property on the west. An east-west public alley runs through the middle of the site between West Cortland Street and West Homer Street. The site is generally level.
The site is currently zoned RS-3(Residential Single Unit (Detached House) District) on the southern half and C1 -1 (Neighborhood Commercial District) on the northern half. The area surrounding the site to the east, south and west consists of a mix of generally residential
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zoning districts, predominantly RS-3, as well as RM-5 (Residential Multi-Unit District), RM-4.5 (Residential Multi-Unit District) and RT-4 (Residential Two-Flat, Townhouse and Multi-Unit District). To the north, the area is zoned C1-1, C2-2 (Motor Vehicle-Related Commercial District) and PD #1247. The residential land uses in the area consists of a mix of single family homes, two and three flats and multi-unit residential buildings. To the north, the land uses include commercial/light industrial buildings that once formed a small cluster of such uses adjacent to Armitage Avenue and the nearby railroad tracks.
The site is not located within either the Lake Michigan and Chicago Lakefront Protection District or a Chicago Landmark District, nor does it contain a designated local or national landmark structure or site. The project does lie within the Fullerton/Milwaukee Tax Increment Financing District and within the Logan Square Community Area.
The site is very well served by the Chicago Transit Authority's Blue Line station at Western Avenue, less than % mile from the subject site. In addition, the site is nearby to the CTA's Western Avenue (#49), Armitage Avenue (#73) and Milwaukee Avenue (#56) buses. Finally, North Milwaukee Avenue is a bike route as well.
PROJECT DESCRIPTION
The project consists of the creation of four rows of townhomes separated into eight buildings, for a total of 49 dwelling units. The site plan consists of two new car courts to be located parallel and to the north and south of the public alley. This will provide for half of the townhomes to front onto West Cortland Street and West Homer Street while the other half of the units will front onto the car courts.
The units will include private outdoor space that includes 10' front yard setbacks on all of the units and individual unit roof decks, totaling approximately 22,000 square feet of private outdoor space. In addition, a 1,283 square foot common open space will be provided in between the two buildings that will front on West Homer Street. Moreover, the car courts themselves will be improved with permeable pavers and will function as an additional common open space, totaling approximately 12,000 additional square feet.
The units themselves are planned to consist predominantly of three bedroom floor plans and are planned to average approximately 2,200 square feet.
DESIGN/LANDSCAPING
The townhomes are planned to be three stories each and approximately 44' in height. The materials on all elevations include fibre cement panels, brick, glass. Wooden pergolas are planned for the roof decks.
10' front setbacks are planned for all of the units either along West Homer Street, West Cortland Avenue or the internal car courts. Side setbacks of 3' are planned along the west side of the site while 5' setbacks are planned along North Campbell Avenue. Parkway trees are planned for West Homer Street, North Campbell Avenue and West Cortland Avenue in compliance with the Chicago Landscape Ordinance. Internal landscaping and trees are also planned for the units that face the internal car courts in accordance with the
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site plan.
ACCESS/CIRCULATION
Vehicular access to the site is planned via the east-west public alley in the middle of the site as well as the planned car courts. The 20' wide car courts will be accessed via North Campbell Avenue via new curb cuts. Attached garage spaces will be provided for all ofthe units, totaling approximately 98 accessory parking spaces.
SUSTA1NABILITY
The project will achieve Building Certification in accordance with the City of Chicago's Sustainable Development Policy. The project will also comply with the Storm Water Management Ordinance, implementing best practices in all storm water management.
BULK/USE/DENSITY
The overall Floor Area Ratio for the project is not to exceed 1.7, which is the maximum allowed under the proposed RM-4.5 (Residential Multi-Unit District) Zoning District. The Minimum Lot Area for the project is 1334, which is well above the minimum required under the RM-4.5 of 700. The planned development will allow for residential dwelling units and accessory parking. The project will trigger the City of Chicago's Affordable Requirements Ordinance and will meet the obligation of the ordinance by providing the five affordable units at off-site locations.
RECOMMENDATION
The Department of Planning and Development has reviewed the project materials submitted by the Applicant and compared this proposal to existing development in the community. The area around this project consists of a mix of generally residential zoning districts and the project represents an opportunity to construct an appropriate residential infill development along West Cortland Street and North Campbell Avenue in Chicago's Logan Square Community Area. In addition, pursuant to Chapter 17-13 ofthe Chicago Zoning Ordinance, the proposed rezoning from RS-3/C1-1 to RM4.5 is appropriate. Specifically, the proposed development is compatible with the character ofthe surrounding area in terms of uses, density and building scale (17-13-0308-C) and the proposed zoning classification is compatible with surrounding zoning (17-13-0308-C).
Based on that analysis, the Department of Planning and Development has concluded that this proposal is appropriate for this site and supports this development for the following reasons:
1. The project meets the purpose and criteria set forth in Chapter 17-8 of the Zoning Ordinance and its adoption would not have any adverse impact on the public's health, safety or welfare. Specifically, this project meets the following provisions of
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Chapter 17-8:
Promotes economically beneficial development patterns that are compatible with the character of existing neighborhoods (per 17-8-0103), as evidenced through the project's design and massing remaining within the context of adjacent structures; and,
Provides that adequate, inviting, usable and accessible open spaces for residents (per 17-8-0909-A-1), as evidenced by the private yards and decks as well as common open space to be located on site; and,
Promotes green design by conserving non-renewable energy and scarce materials (per 17-8-0908-A) as evidenced by the project achieving building certification for the project; and,
All sides and areas of the buildings that are visible to the public are treated with materials, finishes and architectural details that are of high-quality and appropriate for use on primary street-facing facade (17-8-0907-A-4), as evidenced through the material callouts in this report and on the elevations.
2. The project lies within the boundaries ofthe Fullerton/Milwaukee TIF District which was approved by the Chicago Plan Commission in 2000 and is consistent with the land use plan associated with that TIF District.
The public infrastructure facilities and city services will be adequate to serve the proposed development at the time of occupancy. The proposed project has been reviewed by the Mayor's Office for People with Disabilities and the Department of Transportation and all requested changes have been made. Copies of this application have been circulated to other City departments and agencies and no comments have been received which have not been addressed in the application.
The project will comply with the requirements for access in case of fire and other emergencies.
Based on the foregoing, it is the recommendation of the Department of Planning and Development that this application for a Residential Business Planned Development be approved and that the recommendation to the City Council Committee on Zoning, Landmarks and Building Standards be "Passage Recommended".
Bureau of Zoning and Land Use Department of Planning and Development
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DEPARTMENT OF PLANNING AND DEVELOPMENT CITY OF CHICAGO
RESIDENTIAL PLANNED DEVELOPMENT 2500 WEST CORTLAND STREET; 1900-24 NORTH CAMPBELL AVENUE; 2501-31
WEST HOMER STREET
RESOLUTION
WHEREAS, the Applicant Guardian Properties, LLC, has submitted an application seeking approval for a Residential Planned Development; and,
WHEREAS, the Applicant intends to construct 49 dwelling unit/townhomes and accessory parking on an approximately 65,536 square foot site; and,
WHEREAS, the Applicant's request to rezone the property was introduced to the City Council on November 18, 2015; and,
WHEREAS, proper legal notice of the hearing before the Plan Commission was published in the Chicago Sun-Times on December 2, 2015. The Applicant was separately notified of this hearing and the proposed zoning application was considered at a public hearing by this Plan Commission on December 17, 2015; and,
WHEREAS, the Plan Commission has reviewed the application with respect to the provisions of the Zoning Ordinance and finds that the proposal will be consistent with said provisions; and
WHEREAS, the Department of Planning and Development recommended approval ofthe application, with the recommendation and explanation contained in the written report dated December 17, 2015, a copy of which is attached hereto and made a part hereof; and,
WHEREAS, the Plan Commission has fully reviewed the application and all informational submissions associated with the proposed amendment, the report and recommendation of the Commissioner of the Department of Planning and Development and all other testimony presented at the public hearing held on December 17, 2015, giving consideration to the Zoning Ordinance;
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
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NOW, THEREFORE, BE IT RESOLVED BY THE CHICAGO PLAN COMMISSION:
THAT the above-stated recitals to this resolution together with the report of the Commissioner of the Department of Planning and Development be adopted as the findings of fact of the Plan Commission regarding this zoning map amendment application; and,
THAT this Plan Commission recommends approval to the City Council Committee on Zoning, Landmarks and Building Standards ofthe final zoning application dated December 17, 2015, and,
Chicago Plan Commission
RPD No.
Approved: December 17, 2015
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
CITY OF CHICAGO
APPLICATION FOR AN AMENDMENT TO THE CI IICAGO ZONING ORDINANCE
ADDRESS ofthe property Applicant is seeking to rczone:
2500 - 20 W. Cortland St./l 900 - 24 N. Campbell Avc/2501 - 31 W. Homer St.
Ward Number that property is located in:
APPLICANT Guardian Properties. LLC
ADDRESS 17 E. Monroe St., Suite 158 CITY Chicago
STATE IL ZIP CODE 60607 PHONE 312-6.36-6937
EMAIL roianrfo@acosiae.7£.ir.mm CONTACT PERSON Rolando R. Acosta
Is the applicant the owner of the property? YES NO
If the applicant is not the owner of the property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed.
OWN ER Harris Homer, LLC
ADDRESS 2204 Iroquois Road CITY Wilmette
STATE ,L ZIP CODE 60091 PHONE 312-636-6937
EMAIL rolando@acostaezgur.com " CONTACT PERSON Rolando R. Acosta
If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Rolando R. Acosta
ADDRESS Chicago Ave 3rd FL
CITY Chicago STATE IL< ' ZIP CODE 60642
PHONE 312-636-6937 fax EMAIL rolando@acostaezgur.com
If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
Brian Duggan, Stewart A. Harris Living Trust dated 12/4/2002 and Susan Harris Living Trust dated 12/4/2002
On what dale did the owner acquire legal title to the subject property?_
Has the present owner previously rezoned this property? If yes, when?
NO
Present Zoning District C1-1/RS3 Proposed Zoning District RM4.5 then to RPD
Lot size in square feet (or dimensions)_ 65,405 sq. ft.
Current Use ofthe property One story vacant industrial buildings and vacant land
Reason for rezoning the property Development of three-story townhomes with rooftop enclosure and accessory parking
Describe the proposed use of the property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and height ofthe proposed building. (BE SPECIFIC)
Fifty three-story townhomes with rooftop enclosure and two parking spaces per unit and no loading berths.
On May 14", 2007, the Chicago City Council passed the Affordable Requirements Ordinance (ARO) that requires on-site affordable housing units or a financial contribution if residential housing projects receive a zoning change under certain circumstances. Based on the lot size of the project in question and the proposed zoning classification, is this project subject to the Affordable Requirements Ordinance? (See Fact Sheet for more information)
YES
CITY OFCIIICACO ECONOMIC DISCLOSURE STATEMIJNT AND AFFIDAVIT
SUCTION 1 - CENTRAL, INFORM ATION
A. Legal name of the Disclosing Parfy submlttim? this EDS. Include d/b/a/ if applicable: Sswirt A. Harris Uwng Tnjsl dated
Check ONE of the following three, ho>i;s;
Indicate whether the Disclosing Party submitting this F.DS is:
? the Applicant
OR ' _
Ownc
JCf a legal entity holding a direct or indirect interest ia the Appiksst. State the legal name of the
Applicant in which the Disclosini* Party holds an interest: Harris Homer LLC
OR
j. ( | « legal entity with a rijjht of control (see Section U.U.I.) State ihe legal name ofthe entity in
which the Disclosing Party holds a right of control; _
B. Business address of the Disclosing Parly: 22fW Iroquais Road
wamcse n, sxsi
Telephone: 312-635-6937 Fax: Email: robndo@3coslarjzgur.com
Name of contact person: Rol£:tllg_^._A.co&la
II. Federal Eimpioyer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which tliis liDS pertains. (Include project munber and location of property, if applicable):
ftcgpning anS Fteincd fj&veiopmcnt_for 2500 - 20 W. Cortfondl St/l9P0-24 «, CsmpWi AvoJ25OT_-31 W Hxn& St.
O. Which City agency or department is requesting this EDS7 DPP
If the Matter is a contract being handled by the City's Ocpartmcul of Procurement Services, please complete the following:
Specification U _ and Contract W J
Page f of 13
ui.'oncaUur.j j
RECERTIFICATION
GenoalJy, far t-ts wir.li City Council srwsrr!!. >VThis rarcrJricatiiW ii bMUft submitted in. cosiktcion wiib .
(identify ibe J^iuir}- Under paialiyafiKQCay. (he. psfStecijjaing below: (l)«%i3nB Cwn ht'slts ct aatr^ufxnr sw cxretes this EDS icterrifiMBiaa on bcluiirof ifcc DtaARtag ftmy. (2) war«Kttthst a{l ccr.nkslitrss ftrtd sossiuuns; woiaiaed in Use KscfcsjJS tore's anspsal EDS tire uue,a««i=tc nmJ con^lcte 3sofrJ>c
(Priot or type I gal tcznc of Disclaims Party) Sy-
(sign here) Prim or type n&CEcf stgjatary:
TKlc of signer, yr M. <=» r\ c. y
Ctooardsa^a«sacres: i^jltOi^
OfitGOflrcuuTtii rCiM syn
Mi Con a**! fen # xeim stayer. Ktt
SKCMON II DISCI.OSl'RF OK OWNERSHIP INTI-RESTS
A. NATURL OF rill- DISCLOSING PARTY
I. Indicate the nature of the Disclosing Party;
tl Person 11 Limited liability company
[ ] Publicly registered business corporation [ ] Limited liability partnership
i J Privately held business corporation ( ) Joi.oi venture
[ ] Sole proprietorship {) Not-for-profit corporation
f ] General partnership (Is the not-for-prnfjl corporation also a 501(c)(3))?
(J Limited partnership (J Yes [ J No
W Trust f ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organisation, if applicable:
ISinote
3. Foe legal entities not organized in the Stale of Illinois: Has the organization rei'isicred to do
business in the Stale of Illinoi s asia foreign entity?
(1 Yes (] No fc] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
I. List below the full names and titles oral! executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all mcmbcis, jf any, which arc legal entities. If there arc no sueh members, write "no members," For trusts, estates or other similar coliiics, list below (he legal titlcholdcTfs).
If the entity is a genera! partnership, limited partnership, limited liability coQtpany, 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 (hat controls l.hc day-to.
Name Title
Stewart A Harris Trustoe
Sioan Karris Trustee
2. Please provide the fb!lowitjt» information concerning each person or entity having ;i direct or indirect beneficial interest (including ownership) in excess of 7.5% ofthe Disclosing Party. Kxaraples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture.
Paf.c 2 of 13
interest of:* member or manager iii ?i I i rri i it^rJ" 1 i ii |> i 1 i t y cotVi t V; 111 y. or interest of a beneficiary of a trust. CSV:>1c or other similar entity. Ifnifiie., Si;ile "None." NOTE: Puisuant lo Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the. City unity require any such additional information from any applicant which is reasonably intended to achieve frill disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
Stewart A. Hajffe 2294 Iroquois Road, WSimetle, M, GOC01 100%
SECTION IH - BUSINESS RELATIONSHIPS WITH CATV ELECTBD OFFICIALS
Has the Disclosing Patty had a 1)«sirjess relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
l]Yes WNo
If yes, please identify below the numc(s) of such City elected official(s) and describe such ictationslttpfeY.
SECTION IV - DISCLOSUR E OF SUBCONTRACTORS A.NU OTHAR RETAINED PARTIES
Tfie Disclosing Party must disclose the narjxc and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom »hc PisctO£i"Lobbyist" means any person or entity who undertakes lo influence any legislative or administrative action oa behalf of any person or entity other titan: (1) a not-for-profit entity, on an unpaid basis, oi (!) himself. "Lobbyist" also means any person or eulily 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 asli, Ibc City whether disclosure is required or mate rJtc disclosure.
Page-3 of 13
Nairn: (indicate whether business Relationship to Disclosing Parly fees (indicate whether
retained or iinticipatcd Address (subcontractor, attorney, paid or estimated.) NOTE:
'.<> be rciaini-i.1) lobbyist, etc.) "hourly rate" or "t.b.d." is
not ;tn acceptable respon.se .
(Add sheets if necessary)
[X] Check here if the Disclosing Party has not routined, nor expects to retain, any such persons or entities SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under M unicipal Code Section 2-92-4 f 5. 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 aay Illinois court of competent jurisdiction?
[ ] Yes No [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?
I ] Yes 1 J No
FURTHER CERTIFICATIONS
I. Pursuant to Municipal Code Chapter I -23, Article I ("Article r)(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 not' (toy controlling person is currently indicted or charged with, or bus admitted guilt of, or has ever been convicted of, or placed under supervision for, any cmninal offense involving actual, attempted, or conspiracy lo commit bribery, iheJl, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of (he City of any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in ccrtiGcations 2 and 3 below
Page 4 of 13
Tbc Disclosing Party and, ii" the Disclosing Party is a legal entity, nil of those persons or entities denrified in S(;<;iion 11.H.I. of this CDS:
a. arc not presently debarred, suspended, proposed for debarment, declared ineligible or voKwiariiv
e.u".Iudcd-trom any-trynsaeiioris by any federal" star^
have not-, within a five-yesr period preceding the dale of this RDS. 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, stole or local) transaction or contract under a public tiausaction; a violation of federal or stale antitrust statutes; fraud; embezzlement; the ft; forgery; bribery: falsification or destruction of records; making false statements; or receiving stolen property;
arc o*l presently indicted for. or criminally or civilly charged by, a governmental entity {federal, slate 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 liDS, had one or more public transactions (federal, stale or local) terminated for cause or default; and
c. have not, within a five-year period preceding the date of this UDS, been convicted, adjudged guilty, or found liable tn 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 S concern,'
- the Disclosing Party;
* any "Coniractof?* (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 Botfly" (meaning a person ox entity that, directly ox indirectly: controls the Disclosing Patty, is controlled by the Disclosing Party, or is. with the Disclosing Party^ under common control of another person orcntiry. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among farnily mcrobcrs. 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 slate or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, ihe term Affiliated Entity means a person or entity thai directly or indirectly controls the Coalracior, is controlled by it, or, with the Contractor, is cradcj common control of another person or entity;
? nny responsible official ofthe Disclosing Party, uny Contractor or nny Affiliated £nti£y or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Kntlty. acting pursuant to the direction or autltorizatioo of a responsible official ofthe Disclosing Party, nny Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Nciihoi the Disclosing Party, nor any Contractor, iu.u any Affiliated Entity of cither the l^sdosinr; I'-.ixsy or any Contractor nor any Agents have, during the five years before the date this liDS i>? signed, or. with respect to a Contractor, an Affiliated limity, 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 M.'iiter:
bribed or attempted to britx:. or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospec tive bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above thai is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
4. Neither the Disclosing.Party, Afftjijtled linthy ©t Contractor, or any of their employees, officials, agcnls or partners, is barred from contracting with any unit of stale or local government as a result of engaging to or being convicted of (1} bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating io violation of 720 ILCS S/33IS-4: or (3) any similar ofTcnse of any slate or of the United States of America that con to ins the same elements as the offense of bid-rigging or bid-rotatinn-
5- Neither the Disclosing Party nor any Affiliated F.nlity is listed on any of the following jisis maintained by the. Office of Foreign Assets Control t>f the U.S. Department of the Treasury or the Bureau of Industry and Security ofthe U.S. Deportment of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
r>. The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector (iencrnl) and 2-156 (Governmental Ethics) ofthe Municipal Code.
7. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Pageb of 13
If the letters "NA," the word "N'oac," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
complete list ofail current employees of (be Disclosing Patty who were, at any tirac during the 12-rflonth period preceding the execution date of *his EOS, an employee, or elected Or appointed official, of the Cily of Chicago (if none, indicate-with "N/A'or "none").
Non&
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the follow- ing is a complete list of ail gifts that the Disclosing Party bos given ot caused to be given, at any rime during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City ofCbicago. For purposes of this statement, a "gift" docs not include: (i) anything made generally uvatlablc lo City employees or to the general public, oi (uj food or drink provided1 in the course of official City business and Having a retail valve of less than S20 per recipient (if none, indicate v/itb "N/A" or "none"). As to nay gift listed below, please also list ibc name ofthe City recipient.
Mono "
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the OtscJosing-Party (check one)
£ 3 is M is not
a "financial insthutiori" as defined in Section 2-32-455(r» ofthe Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
-Wc arc nni and will not become a predatory lender as defined in Chapler 2-32 ofthe Municipal Code. Wc further pledge that cone of our affiliates Is, and none of them will become, a predatory lender as defined in Chapter 2-32 of Ihe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined sn Section 2-32-455(b) of tbe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None." or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified lo 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 meaning's when used in this PartD.
In accordance with Section 2-156-1 tO ofthe M unicipat Code Docs any officii 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 Mailer'.'
11 Yes fc] No
NOTE: If yott checked "Yes" to Item D.I., proceed to Items t>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 Cily elected official or employee shall have a financial interest in his or her own name or in ihe name of any other person or entity in the purchase of any property that (i) belongs io 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 (collcctiveSy, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power docs not constitute u financial interest within the meaning of this Part D.
Docs the Matter involve a City Property Sale?
[JYes (JNo
If you checked "Yes" to Item D.I„ 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 (he Matter will be acquired by nny City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither I. or 2. below. If the Disclosing Party cheefcs 2 the Disclosing Party must disclose below or in an attachment lo this EDS all information required by paragraph 2. .Failure to
Page 8 of 13
comply wiih these disclosure requirement may inaJte any contract entered ip(o with the City in connection wish the. Matter voidable by the City.
X t. The Disclosing Party verifies that the Disclosing Parly has searched any and all records of
jJiC-Diselosjiig-I-any aij^ ;my-and^ltprcdeees$orrn;irics-regardim^
from slavery or slaveholder insurance policies during (be slavery era (including insurance policies issued to slaveholders thai provided coverage for damage to or injury oi death of their slaves), ynd the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting; the search in step 1 above, che
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies Utut the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOB FEDERALLY FUNDED MATTERS
NOTE: If the. M atter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes Of this Section VI,/ttix credits allocated by the Cily and proceeds of debt obligations ofthe City ure not federal funding.
A. CERTIFICATION REGARDING LOBBYING
I. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts On behalf of the Disclosing Party with respect to the Matter (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed dial the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 199$ have made lobbying contacts on behalf of the: Disclosing Party with respect to die Matter.)
2. The Disclosing Party lias not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.I. 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, s member of Congress, art 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 lean, 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 I'any will submit an updated certification ;n the cad of etich calendar quaiicr in which there occurs any event thnt materially affects the accuracy of the statements and information sc1-fonli ia paragraphs A.l. and A.2. above.
The Disclosing. Party certifies thai either: (i) it is nut ;tr. orgsni/arion described in section 301(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section
501 (c)(4) of the Internal Revenue Code of I9S6 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. I. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Forty must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request,
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If ihe Matier is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at Ibc outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [) No
If '"'Yes,0 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 I J No
Have you 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 the applicable filing requirements?
( ] Yes [ 1 No
Have you participated in any previous contracts or subcontracts subject to ihc equal opponunily clause?
| ] Yes f} No
If you checked "No" to question I. or 2. above, please provide on explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
—Thc-Disclosing-Party iindcretands airdagrecjribTic "
The certifications, disclosures, and acknowledgments contained in ijjis EDS will become part of any contract or other agreement between the Applieani and the City io connection with ihc Matter, whether procurement, Cily assistance, or other City action, and arc material inducements to the City's execution or any contract or wking other action with respect to the Matter, The Disclosing Patty understands that it must comply with all statutes, ordinances, and regulations On which litis COS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-l56awl 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking Cily contracts, worfc, business, or transactions. The full text of these ordinances and a training program is available on line at wvw.ciiyofchicaao.orn/Rihics . and may also be obtained from the City^ Board of Ethics. 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party most comply fuijy wjtfi the applicable ordinances.
If tfte City determines that any inforrnalion provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or bo 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 wit!) 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 (o make this document available (0 the public oil its internet site and/or upon request. Some or oil of the information provided on this EDS and any attachments to this EDS may be made available to the public on Ihc Internet, in response to a Freedom of In formation Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which il may have against the City in connection wfih the public release of information contained to this EDS and also authorizes the City to verify the accuracy of any information submitted in this 60S.
E. The information provided in this EDS must be kept current. In the event of cbtmgcs, the Disclosing
Party must supplement tbis EDS up to the time the City takes action on toe 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 lo Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses). Ihc information provided herein regarding eligibility mast be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F.l. The Disclosing Patty is not delinquent ia tfte payment of any tax administered by the Illinois Department of Revenue, nor arc the Disclosing Party or its Affiliated Entities delinquent in payi::;; :iay fine, fee, sax or outer charge owed to the City. This includes, but is not limited to, all wntcr charges, Si-wcr charge;, license fees, parking tickets, properly taxes or sides uxct.
l\2 If the Disclosing Pony is the Applicani, the Disclosing Party and its Affiliated Entities will not use. nor pirrcnit their subcontractors lo use, any facility listed by the U.S. E.P.A. on die federal Excluded Parties List System CEPES") maintained by the U. S. General Services Administration.
F.3 If titc Disclosing Patty is the Applicant, the Disclosing Party will obtain from any couuactors/subcontntctors hired or to be hitcd in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not. without the prior written consent ofthe City, use any such contractotfsubcontractar that docs not provide- such certifications or that the Disclosing Party has reason ro believe has not provided Oifcsnnot provide truthful certification*.
NOTE: If the Disclosing Party cannot certify as to uny of the items in F.l., F,2. or F-3. above, an explanatory statement must be attached to this EDS,
CERTIFICATION
Under penalty of perjury, the person, signing below: (1) warrants that .he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants thnt all certifications nod staiemcrjis contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
Stewart A. Harris Living Trust dcicd T2i4/2G02 (Print or type name of Disclosing Party)
Stewart A, Harris
(Print or type name of person ingoing)
Trustee
(Print or type title of person signing)
Commission expires:
Page 12 of 1.1
CITY 01 CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
EAMIEIAL RELATIONSHIPS WITH EIECTED CITV'OFFICfA.ES AND DEPARTMENT HEADS
This Appendix is to lie completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any Ic^al cntity whicb lias only an indirect oirncrstttp interest In the Applicant.
Under Municipal Code 'Section 2-154-G15, the Disclosing Party must disclose whether such Disclosing Patty or any "Applicable Part/7 or nny Spouse of Domestic Partner mcrcprctrrrcntty has a "farailiaS relationship" with any elected eily official or departmenthead. A "familial retofionship*" exists if. as of the date this EDS is signed, the Discl^Applicable Party" oKans (1) all executive officers of flic Disclosing Party listed in Section 11.B- l.a„ if the Diselosiiyj Party is a corporation; all partners ofthe Disclosing Party, if the Dbelosin^ Party is a general partnership; ol! general partners and limited partners of tins Disclosing Party, iftbe Disclosing Parry is a litmted partnership; all managers, managing members and members ofthe Disclosing Party, if tbe Disclosing, Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having marc thai* n 7.5 percent ownership interest in the Disclosing Party. "Principal officers'3 means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legai entity or nny 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 on elected cily official or department bead?
( J Yes DO No
If yes. please identify bdow (I) the name and title of sucb person, (2) tbe name ofthe legal entity to which such person is connected; (3) the name and title of the elected city ofOcia! or department head to whom sucb person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CIT Y OP CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX B
BUILDING CODE SCOFHAW/PR08LEM LANDLORD CERTIFICATION
Tin's Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in Ihc Applicant exceeding 7.5 percent («a "Owntrr"). It is oof to be completed by any legal cn tit)'which has only an indirect ownership interest in the Applicant.
Pursuant lo Municipal Code Section 2-154-010, is (lie Applicant or any Owner sderiufied us a building cod>': scofflaw or problem landlord pursuant io Seclion 2-92-416 of th« Municipal Code? '
[ | Yes [XI No
If die Applicant is a Icgpl entiJy publicly traded on any exchange, is any officer or diicclor of the Applicant identified as a building code sonfflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
1 | Yes f J No rXJ Not Applicable
3. If yes to (I) or (2) above, please identify below the name ofthe person or legal cntiiy
identified as a building code scofllaw or problem landlord and the address ofthe building or bnildings 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.
envoi Chicago
FCONOMIC DISCI.OS-OliF. -STATl'.Ml>NT AND AFFIDAVIT
SFCTION I - CliNF.ftAL INFORMATION
A. Legal name ol" ["tie Disclosing Party submitting this CDS. Include ti/b/a/ if applicable: fjuir&i-j Propnlscs. 1.1 ¦<'
Check ONE. of the following throe boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. X *»c Applicant
OR
2. n legal entity holding a direct or indirect interest in Ihc Applicant. State the legal name of tho
Applicant in which ihe Disclosing Party holds an interest:
OR '
3. a Icga! entity with a right of control (see Section 11.8.1.) State the legal name ofthe entity in
which the Disclosing Party holds a righi of control:
ii. Dusincss address of the Disclosing Party: _ 17 Iv KUmrogSuSiritc 138
C^«^IL«060? _
C. Telephone: 312-636-6937 Fax: _ Email: fola:idn@BO05tae^urxain
D. Name of contact person: Rotoriq R. Acosta _
li. Federal Employer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to
which this FDS pertains. (Include project number and location of property, if applicable):
PfenncODj^OfsncmnHW-20_W. CortlandStJI'liX)- 24 N. CampbellA\rs./2S01 -31 W. Homer St
G. Which City agency or department is requesting ibis F-DS?. P_pl) _ .
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification g and Contract» _
Cage 1 of 13
SECTION II --DISCLOSURE OP OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
L Indicate thc_nnuire ofthe Oisdosinft Jnrty;:.
Pcrson x Limited liability company
Publicly registered business corporation Liiniled liability partnership
Privately held business corporation Join! verdure
Sole- proprietorship Not-for-profit corporation
Central partnership (Is the not-for-profit corporation also a 501 (c j{3))?
Limited partnership Yes No
Trust Other (please specify)
2. For legal cnciiire. the slate (or foreign country) of incorporation or organization, if applicable: lllini;.?
3. For legal entities not organized in the Stoic of Illinois: l itis the organization registered to do business in the State of Illinois as n foreign entity?
'" Yes No x N'A
B. II- THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also lis) below all members, if any. which are legal entities. 11" there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal tiilclioldcrfs).
If the entity ts 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 olhcr person or entity (but controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below roust submit an EDS on its own behalf.
Name Title
ntcn ftpRfian Nfact*g
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 intcr^t include shares in a corporation, partnership interest in a partnership or joint venture.
Page 2 of 13
intere.-a of a member or manager in a limned liability company, or interest of a h«pcfkiary of a trust, estate rn- 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 fro ui any applicant which is reasonably intended to achieve full disclosure,
Name Business: Address Percentage Interest in the
Disclosing Party
Uuiin IJa£3Ki 171-:. Monroe St Suits I5S. Chc'caso. II. 60607
SECTION til ~ BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has tbe Disclosing Patty had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
Yes x | No
if yes. please identify below the name(s) of such Cily elected official(s) and describe .such relationship^):
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 bas retained or expects to retain in connection with the Matter, as well as tbe nature ofthe relationship, and ihc total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solety 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 tiny person or entity other than: (I) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or cntiiy any port 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 requited or make the disclosure.
Page 3 of 13
Name (indicate whether Russncss Relationship to Disclosing Party Fees (tndicstcAvjvtioer-""
retained -or anticipated "' Address (subcontractor.,attorney, paid or estimated.) NOTE:
to be regained I lobbyist. etc.) "hourly rale" or "t.fo.il." is
not an acceptable response.-.
1«gafiff>P AiwS'f foO.XV. t%ieac»Are 3nj WU(TiicPffl. It60642 Aiiy. ^.fiOOfciit
(Add shee-is if necessary)
Check hero if tbe Disclosing Party bas not retained, nor expects lo retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415. substantial owners of business entitles that contract with the City must remain in compliance with their child support obligations tbrouglioul the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
Yes x J**'<> No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into n conn-approved agreement for payment of all support owed and is the person in compliance with that agreement?
j Yes No
FURTHER CERTIFICATIONS
I. Pursuant to Municipal Code Chapter I -23, Article I ("Article D(which Iho. Applicant should consult for deflated terms (c,£, "doing business") and legal requirements), if the Disclosing Party submitting tbis EDS is tbe Applicant and is doing business with the City, then the Disclosing Party certifies ns follows: (») 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 arty sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with- tbe City. NOTE; If Article I applies to the Applicant the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications ?, and 3 below.
Page 4 of 13
The Disclosing Parry ana. if iltc Disclosing Party is ft legal entity, all of those persons or entities dentificd in Seciiun ll.fi . I. of this P.DS:
:i. arc no; presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, stiic or local unit of government:
Ii. 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 undent public transaction: a violation of federal ot stale antitrust statutes; fraud: embezzlement; theft; forgery; bribery; falsification or destruction of records; making false .statements; or receiving stolen properly;
arc: 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 13.2 .b. of this Section V;
have not. within a five-year period preceding the date of this F.OS, hod one or more public transactions (federal. Slate or local) terminated for cause or default: and
c. have not. within a five-year period preceding lite dale of this F.DS, 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, arty State, or any other unit of local government.
The certifications \n subparts 3.4 and 5 concern:
the Disclosing Party;
any "Contractor*" (meaning any contractor or subcontractor used by the Disclosing Parly in connection with Ihe Manor, 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 Paiiy, 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 tbe same management ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it. or. with the Contractor, is under common control of another person or entity;
- any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant lo the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated-Entity of cither the Wisclosiag Cany
or any Contractor nor any Agcni,-.; have, during the five years before the date this EDS is signed, or. with
respect io a Contractor, an Affiliated Emily, or ;>n Affiliated Entity of k Contractor daring the five year.*
befojv the dale of such Contractor's or Affiliated Entity's contract or engagement in connection with the
M a Her: . — ¦
bribed or attempted lo bribe, or been convicted or adjudged guilty of bribery or .lUcmpiina. d> bribe. 2 public officer or employee of the City, tins State of Illinois, or nay agency of the federal government or of any state or local government in the United Stales of America, in thai officer's or employee's official capacity;
agrc&d or colluded with other bidders or prospective bidders, or been a party to any s;sch agreement, or been convicted or adjudged guilty of agreement or collusion among bidder? or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a nwttcr of record, btn 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 employee.1;, officials, agents or partners, is barred from contracting with any unit of state of local government as a result of engaging in or being convicted of (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) nny 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-rotniing.
Neither the Disclosing Party nor any Affiliated Entity is listed rib any ofthe following lists maintained by the Office of Foreign Assets Control ofthe U.S. DcpartmcHi 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 Dented Personsi 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 (GovcnuncQtnl Ethics) ofthe Municipal Code.
Page 6 of 13
7. If the Disclosing Party is unable to certify to any ofthe above statements in this Part li < Further Certifications'), the Disclosing Party must explain below:
If the letters "NA," ihc word "None." or no response appears on ihe iinc.;'- above, it will be conclusively presumed thai Ihe Disclosing Party certified to the above statements,
S. To the bcs'. ofthe Disclosing Party's knowledge after
... Norjc_
9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of ail gills that the Disclosing Party has given or caused lo be given, at any time during the 12-month period preceding the execution date of Ibis EDS, to an employee, or elected or appointed official, of the Cily of Chicago. For purposes of this statement, a ""gift" does not include; (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less sban S20 per recipient (if none, indicate with "tit A" or "none""). As to any gift listed below, please also fist the name ofthe City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
'is X is not
a "financial institution" as defined in Section 2-32-4$5(b) of the Municipal Code.
If the Disclosing Party IS o financial institution, then the Disclosing Party pledges:
"Wc are not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. Wc further pledge thai none of our affiliates is. and none of theui will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. Wc understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of ihc privilege of doing business with tbe City."
Page 7 of IJ
If the Disclosing Party is unable to make this pledge because i» or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predator)' lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
If she Ictteis "NA," ihc word "None," or no response appears on the lines above, ii will be conclusively presumed that i.bc Disclosing Parry certified to riic above statements.
OTCiWmC^t ION REGARDING INTEREST IN CITY BUSINESS
Any words or terms ilia: ore defined in Chapter 2-156 of the Municipal Code hove the same meanings when used in this Part 1).
In accordance with Section 2-156-110 ofthe Municipal Code: Does any official or employee ofthe Cily have a financial interest in his Or her own name or in the name of any other person or entity in tbe Matter?
Yes X No " " "
NOTE: If you checked "Yes" to Item D. E, proceed to Hems 0.2. and D.3. If yoa checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no Cicy elected official or employee shall have a financial interest in his or her own name ot tn the name of any other person or entity in the purchase of any property that (a) 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 tbe City (collectively. "City Property Sale"). Compensation for property taken pursuant to the Cily^ eminent domain power docs not constitute a financial interest within the meaning of this Port D.
Does the Matter involve a City Property Sate?
'' Yes * No
If you checked "Yes" to Item D.l., provide the names and business addresses of tbe City officials or employees having such tttlcrcst and identify the nature of such interest:
Nome Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter well be acquired by any City official or employee.
C. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cilher 1. or 2. below. If Ibc 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 * of 13
comply villi these disclosure requirements may make any contract entered X 1. The l)is.::?.osiny Tarty verifies that the Disclosing Parly has searched any and all record-* 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,
? The Disclosing Parly verifies that, as a result of conducting the search in step I above, the Disclosing Party has found records of investments or profit?, from slavery or slaveholder insurance policies. The Disclosing Party verifies that ihe following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: I f the Matter is federally funded, complete ihis Section VL If the Matter is not federally funded, proceed lo 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
I. List below the names of all persons or entities registered under the federal Lohbying 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 Parly means that NO persons or entities registered under the Lobbying Disclosure Act of l°95 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 lo pay any person or entity listed in Paragraph A.l. above for his or bcr lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, ;ss defined by applicable federal law. a member of Congress, an officer or employee of Congress, or art 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 lo extend, continue, renew, amend, (ii modify any federally funded contract, grant, loan, or cooperative agrcemcnu
Po£c9of 13
3. The "Disclosing Parly will submit an updated certification at the end of each eaten da t quarter in which there oecurs any event that materially affects the accuracy ofthe statcrneni.-: and information set forth in pamgruplis A.l, and A,2. above.
4.-—T^eH&hwIraHfjfPa'Ky ccrtiltcs tfmt either: (i) ii is not an organisation described in section
50 f (c){4} ofthe Internal Revenue Code of l%'6;or (it) it is an organization described in section
501 (c)(4) of ihc Internal Revenue Code of 19S6 but has not engaged and will not engage in "Lobbying
Activities".
5. If the Dtsclosing. Party ts. the Applicant? the Disclosing Party mstst oblain ccruftcatintis cqua) in form and substance to paragraphs A.l. through AA. above From all s.wbcniitjticiors: before it awards any subcontract and the Disclosing Party must nunn-ain &U s«cb subcontractors* certifications for (he duration of the Mailer and mus* make such ccrtificalioas promptly available to the City upon request.
ft, CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the AppHcn.nl and all proposed subcontractors to submit the following information will) theif bids or in writing oi tbe outset of negotiations.
Is the Disclosing Party ihe 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? (Sec 41 CER Port 60-2.)
Yes No
I love you filed with Ihc Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
•{Yes No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes *;No
If you checked "No" to .question 1- or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII ACKNOWLEDGE!ENTS. CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing P;>r(,v understands and agiecs slrav.
t\. The certifications, disclosures, and acknowledgments contained in this CDS will become part of nny contract or oilier agreement between the Applicant and the. City in connection with the Matter, whether procurement. City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect so the Walter. The Disclosing Tarty understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
Ii. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-150 and 2-l(>4 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. Tbe full text of these ordinances and a training program is available on line ni www.citvofchiermo.ore/Eiirtcs . and may also be obtained from the City's T3oard of Ethics. 740 N.
Sedgwick St Suite 500, Chicago, IL 60610, (512) 744-9660. The Disclosing Party must comply fatly with the applicable ordinances.
If the City determines thar any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and ihc City may pursue any remedies under ihe contractor agreement (ir not rescinded or void), at law, or in cqnity, including terminating the Disclosing Party's participation in the Mailer 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,
Ii is ibe City's policy to make tbis document available to the public on its Internet site And/or upon request. Some or al) ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which ii may have against the City in connection with the public release of information contained iu this EDS and also authorizes the City to verify Ihc accuracy of any information submitted in this EDS.
The information provided in this EDS roust be kept current. In the e vent of changes, ibe 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 Depnrtmcoi of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the inforntstion provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1 -23 and Section 2-154-020 or the Municipal Code.
The Disclosing Party represents and warrants that:
Page II of 13
r i. The Discbisim; Patty is not delinquent ii! tho payntcns of any las administered by vhe illiiv>is Department of Itevenue, tier arc tliv Disclosing Party or its Affiliated Katiltcv- delinquent in pnytny any Uiitr. ?Ve. of otiu'r ch^r::^- owed in ihc City, i'ltis includes. In:; is not limited tt> ail watei charges. scwcx caar^cs-iiccnsc fccs,.r^tHm^ti<>fevMsri>iorK,rtv-taA!i.-s as s'lttgyiitScT
\.?. II the Disclosing Party is the Anpiicaai. t?ic Disclosing Pariy ami tt.s Affiliated' 'unities v. ill not use. nor permit then subcontractors n> use. any facility listed by ihc U.S. I'.I'.A. on the fcdeml Excluded 5'artivs J.fst System ("liPl-S") maintained by the \J. S. Oatcitit Sep. ices Administration.
K.1* 11'the Disclosing Party is ihc Applicant. Ihc Disclosing, Party will obtain Own any ecMiiraciiii^'subcontraciors hired or iu he hired in connection with Ihe Mnller cct'iifjcations equal in form and substance to those in I' I. anil IK. 2. above aod will not. without the prior written consent ofthe City, nK any such contcstctor/Mibetuttravtor that dovn not provide such ccnittculionsm' tint the Disclosing Purty bas reason to believe has nut provided or ennnot provide truthful certifications
MOTE: If the Disclosing Party cummi 'citify us 5o any of the Hems in 1'. I \ .? or J-'.ji. above, an explnnniory statement must be attached in ibis EDS.
ceutihcation
Under penally of perjury, Ihe person signing below: (1) warrants ibat he/sho. is authorized to execute this I; OS and Appendix A (if applicable! on beF»:tJf of Ihe 'Disclosing Party, and (2) warrants thai all ccrtrlieniinns and statements contained rn this EDS and Appendix A (if appltcstblc) are true, accurate nnd complete as ofthe dale furnished n> the City.
Ciiarclijin Properties. U.C
(Sign here)
U'rini or lypcjiftnic of Disclosinj- Pnrty)
Sarin Dur/s:n
(Print or lype name of person sij.\ninj:j
(I'rini or type tille oI person signing)
Signed and sworn to before me on (date)
I'.-v.'.c Iof 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND A.ITIDA VIT APPENDIX. A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OKElClAl-S AND DEPARTMENT HEADS
Tltis Appendix is lo he completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership intercut in the Applicant exceeding 7.5 percent- It is not to be completed oy any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154*015, the Disclosing Pariy must disclose whether such Disclosing: Party or nny "Applicable Party" or any Spouse or Domestic- Partner thereof atrrently has a "familial relationship'' with JOiy elected city official or department head. A "familial relationship" exists if. as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner ihweof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of tbe following, whether by h'ood or adoption: parent, child, brother or sister, aunt or u:*:Jo. niece or nephew, grandparent, grandchild, father-in-law, mother-in-law. son-in-law, dauglitei-in-rnw, stepfather or stcpniother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (I) all executive officers of the Disclosing Party listed in Section II.B.l jl, if the Disclosing Party is a corporation: all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all genera) partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of lite Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more titan a 7.5 percent ownership interest in (lie Disclosing Purty. 'TrincipaJ officers" means Ute president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or nny person exercising similar authority.
Dots the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected cily official ox department bead?
Yes X No
If yes, please identify below (I) the natoe and title ofsuch person. (2) the nanjc of the legal ctttity to which such person is connected; (3) Che jruuc and title of the elected city ofTtcial or departrtRrtf head to whom such person lias a familial relationship, and (4) the precise nature ofsuch familial relationship.
Page 13 of 13
CITY OF CHICAGO
ECONOMIC DISCIA^^RJL»^^^ —
APPENDIX U
UUILUING CODE SCOFF L AVY7PR0BLEiM LA'SDIjOUD CEKT1F.lCATION
This Appendix is 10 Ik completed only by (a) tbe Applicant, ami (b) nny legal entity which has ;t direct ownership interest in the Applicant, exceeding IS percent (an "Owner5). It isnot to be cotnplctcd by any legal aitifyWilch nas'onJy an Indirect ownership interest in (He Applicant.
I. Ptifsuant tQAlunicipaJ Code Section 2-154-010, is the A ppJicani or any Owner identificd as a building code scofllaw or problcn) landlord ptn?uai« to Section 2»92-4l<> of the Municipal
CodC?
2. If the Applicant i$.t> legal entity publicly traded on any cxdian-jc, is any officer or director of tbe Appitcctni idcnlifted as a building code scofflaw or problem landlord rwrsusnt to Sea ion 2-92-416 of the Municipal Code?
3. If yes to (f) or (2) above, please identify below the nanje ofthe 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 vjolatronsnppSy.
EIL1XVC OUT THIS APPENDIX B CttNSTtTVTJGS ACKNOTi>XED(7MENT AND AGREEMLENT THAT THIS APPENDIX B IS INCORPORATED BY REFBRBNCCINTO, AND MADE A PART OF, THB ASSOCIATED EDS, AND THAT TOE REPRESENTATIONS M ADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OE PERJURY ON PAGE 12 OF THE ASSOCIATED EOS.
tV:r. l
CITY OF CHICAGO FX' 0 N O MIC DIS C L O S V R ES T A T Ii M E N T AND AFFIDAVIT
SECTION I --GENERAL INFORMATION
A. Legal name of ihc Disclosing Parly sub-nicting this EDS. Include d/b.'V if applicable: Susan Harrfe living Trust dated 12M/20O2
Check ONE of Ibe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR ^
Owner
pCJ a legal entity holding a direct or induce: interest in the 'Applicant. State the legal name of the
Applicant in which the Disclosing Parly holds an interest: ifcg-feHorr.gr \XC
OR " ""
X [] i legal entity with a right of control (sec Section ILfJ.l.) Slate the legal name of the entity in
which the Disclosing Party holds: a right of control:
B. Business address of tbe Disclosing Party: 2204 Iroqufe Read
Wrneae. IL 65)091
Telephone: 312-63S-6SQ7 Pax: Email: rol5f»do@acoi.l2e2gur.eo:n
Name of contact person: RotanboR. Acosta
Federal Employer Identification No. (if you have one): ,
Brief description of contract, transaction or other undertaking (referred to below as tho "Matter") to which this EDS pcrtuins. (Include project number and location of property, if applicable):
J^oning end Planned Development for 2300 - 20 W. Cortland Stfl90Q~ 24 M. Campbell Ave.g501 - 3t W. rfomar St
Which Cily agency or department Is requesting this EDS? DPD
If the M aner is a contract being handled by die City's Department of Procurement Services, please complete the following:
Specification 8 and Contract #
Page I of 13
SECTION II ~ DISCLOSURE Ol OWNERSHIP INTERESTS A. NATURE Ol; THE DISCLOSING PARTY
— I" lnffiea^tlieTlaTorc of the DtstI«*ir»g"P-»rty:~
| j Person [ ] Limited liability company
\] Publicly registered business corporation [\ Limited liability partnership
5 J Privately held business corporation (] Joint venture:
[J Sole propriclorsliip f] Noi-for-profi* corporation
[ 1 General partnership (is the nm-for^piofjt corporation, also a 501(c)(3))?
IJ Liiniled partnership {J Yes { J No
W Trust (J Other (please specify)
2. For legal entities, the state (or foreign countty) of incorporation or organization, if applicable: IBiiois
3. For legal entities not organized in the State of Illinois: lias the organization registered to do business in the Slate of UHnois as a foreign entity?
{ ] Yes | ] No fc} N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below tbe full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titlcholder(s).
If the entity is a general partaerfibip. limited partnership, limited liability company, limited liability partnership or joint venture, list below the natno and title of each general partner, managing member, manager or any other person or entity that controls the day-to~day management ofthe Disclosing Party. NOTE: Each legal eritily listed below muss submit an EDS on its own behalf.
Name Title
SterartA. Kafrp Trustee
Sossn karris Tn^tco*
2. Please provide the following informasioa concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 1.5% ofthe Disclosing Party. Examples of Such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
PjiS.se 2 of 13
inicrcs! of a member or manager in a limited liability company, or interest of n beneficiary of a trust, csim.e or other similar entity. If none, state "None." N0TK; Pursuant lo Section 2-151-030 of ihe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information froni any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
Susan Harris 2204 Iroouoi:: Ktiftrt, WihriWC?. IL 603S1
SECTION lit - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Ha*- the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with arty City elected official in the 12 months before the date this EDS is signed'/
11 Yes W No
If yes, please identify below the namc(s) ofsuch Cily elected official(s) and describe such relalionsbip(s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER. RETAINED PARTIES
The Disclosing Party must disdose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
^
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (t) 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 tltc Cily whether disclosure is required Or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or amicipaterj Address (subcontractor, attorney, paid or estimated.) NOTE:
io be retained) lobbyist, etc.) 'hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
1$ Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations, throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes M No [ ] No person directly or indirectly owns 10% or more ofthe
Disclosing Party.
If "Yes" bas the person entered Into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
I JYes [JNo
FURTHER CERTIFICATIONS
I. Pursuant to Municipal Code Chapter 1-23, Article 1 (""Article r)(v/hrch the Applicant should consult for defined ICrtnS (c.g_ "doing business") and legal requirements), if the Disclosing Party submitting this EDS is tbe Applicant and is doing business witfi 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, tbeft, fraud, forgery, perjury, dishonesty or deceit against no officer or employee of flic City or any sister agency; and (if) 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 eniity. zU of those |j:-.rsor.s or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, slate or local unii of if.ovcrnmcnt:
have not. within a five-year period preceding the date of this EDS. been convicted of a criminal offense, adjudged guilty, or bod a civil judgment rendered against thorn iu connection with: obtaining, attempting to obtain, or perforating a public (federal, state or local) transaction or contract under a public transaction: a violation of federal or state antincst statutes: fraud; eroberzlcmcnt; theft; forgery: bribery; falsification or destruction of records: mating false statements; or receiving stolen property;
arc not presently fndieted for, or criminally or civilly charged by, a governmental entity (federal, state or focal) with committing any ofthe offenses set forth in clause B.2.b. of this Section V:
bave not, within a five-year period preceding the date of this EOS. bad one or more public transactions (federal, slate or local) terminated for cause Or default; and
have not. within a five-year period preceding the date of this EDS. been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal governraenrV&ny statc. or any other unit of local government.
Tbe certifications in subparts 3,4 and S concert*:
? the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by tbe Disclosing Party in connection with tbe 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 tbe City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Coo tractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, ort with the Contractor, is under common control of another person or entity;
• any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Patty, any Contractor or any Affiliated Entity, acting pursuant to the direction or euthorreatioo of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither (tie Disclosing Party, nor any Contractor, nor any Affitiafed Entity of cither the Disclosing Party
or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with
respect So a Contractor, an A ffilintcd Eintily, or an Affiliated Emily of a Contractor duriog the. five years
before ihcda:e of such Contractor's or Affiltarod Gr.iiiyj; contract or engagement in connection with the
•Matter:- ¦ _"~~'"
n. bribed or al tempted to bribe, or been convicted or adjudged guilty of briber)' or attempting to bribe, a public officer or employee of the City, the Slate of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission ofsuch 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).
A. Neither tbe Disclosing Parly, 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 ?20 ILCS 5/33E-3; (2) bid-routing 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 tho 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 tbe Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: tlte Specially Designated Nationals List, the Denied Persons LisL the Unverified List, the Dirtily List and the Debarred List.
Tbe Disclosing Party understands and shaJI comply with the applicable requirements of Chapters 2-S5 (Legislative Inspector General). 2-56 (Inspector General) and 2-156 (Governmental Ethics) of Ihc Municipal Code,
If the Disclosing Party is unable to certify to any of the above statements in this Pari B (Further Certifications), the Disclosing Party must explain below;
Page 6 of 13
II the letters "NA," the ward "None." or no response appears on the lines above, it will be conclusively presumed thai ihe Disclosing Party cenified to the above statements.
S. To tbe best ofthe Disclosing Party's knowledge after reasonable inquiry, she. following is a complete list of ail current employees ofthe Disclosing Party who were, at a;;y time during, the 12-month period preceding the execution date of ibis EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
None
9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, tbe following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, of {ii) food or drink, provided in the course of official Cily business and having a retail value of less than S2f> per recipient (if none, indicate with "N/A" or"nonc">. As to any gift listed below, please also list ihc name of the Cily recipient
None ~
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Potty certifies that the Disclosing Parly (check one)
11 is DtJ is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then lite Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2*32 ofthe Municipal Code. Wc 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,"
1 f the Disclosing Party Is unable lo make this pledge because it or any of its affiliates (as defined in Section 2-32-45S(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
Ii ili<: tellers "NA" the- word "None," Or no rcspon.se appears on the lines above, it will be
conclusively presumed that the Disclosing Pariy certified to the above statements.
D. CBRTlflCATlON REGARDING INTEREST IN CITY BUSINESS
Any words or terms (hat are defined in Chapter 2-156 ofthe Municipal Code have ihe same meanings when used in this fan D.
In accordance with Section 2-156-1 JO of the Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matte/?
IJYes WNo
NOTE: If you checked * Yes" to Item D. I., proceed to Items D.2. and D.3. If you checked "No" lo 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 « financial interest in bis or ber own name or in the name of any other person or entity in the purchase of any property thai (j) belongs to the City, or (it) is sold for taxes or assessments, or (Hi) is sold by virtue of legal process at the suit of the Cily (collectively, "City Property Sale"). Compensation for property taken pursuant to the Cit/s eminent domain power docs not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
t ] Yes T 1 No
If you cheeked "Yes" to Item D.l., provide tbe names and business addresses of the City officials Or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. Tbe Disclosing Party further certifies that no prohibited financial interest in ihc Mailer wiJI be acquired by any City official or employee.
fi. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither I. or 2. below. If the Disclosing Patty checks 2 the Disclosing Party musi disclose Ire tow or in an attachment io 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 ihc City in connection with the Matter voidable by ihc City.
X—J- The Disclosing Party verifies thai die Disclosing Party has searched any ;md all records of ihe Disclosing Party and any and all predecessor entities regarding records ol"investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to Slaveholders that provided coverage lor 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 I above, the
Disclosing Party bas found records of investments or profit? from slavery or slaveholder insurance policies. The Disclosing Parly verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described iu those records:
SECTION V! _ CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete Ibis 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
I. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the tenors "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 19° 5 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Parly has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or ailcmpt 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 granl or loan, entering into any cooperative agreement, or to c.Page 9 of 13
3. The Disclosing, Pariy will submit an updated certification ai the end of each calendar quarter tn which (here occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that cither (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986: or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage m "Lobbying Activities".
I f lite Disclosing Party is the Applicant, die Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available lo tbe City upon request.
B, CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require tbe Applicant and all proposed subcontractors to submit tbe following information with thair bids or in writing at the outset of negotiations.
Is the Disclosing Patty tbe Applicant?
[JYes []No If "Yes," answer tbe 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.)
[JYes []No
Hove you fried with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports dac under the applicable filing requirements?
rjYcs (JNo
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[]Ycs []No
If you checked "No" to quest ion 1. or 2. above, please provide an explanation:
Pajjc 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCOItI'OKATIO.V, 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 MaMcr. whether procurement, Cily assistance, or other City action, and arc material inducements to the City's execution of any contract or taking Other action with respect to the Matter. The Disclosing, Pariy 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 aud n training program is available On line at www.ciiyofchiear.o.orft/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 EOS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the Cily may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including lerminaung the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Parly to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in tin's EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
Ii. The information provided in this EDS must be kept current In (he 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 conn-act being handled by tbe 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 1 of Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kepi current for a iongcr period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents ond warrants that:
Page 11 of 13
F. (. The Disclosing Pariy is r.o\ delinquent in ihc payment oi' any tax administered by the Hj'mob: Department of Revenue, nor arc the Disclosing Party or its A lYiliatcd Entities delinquent in paying any -fmc.Tee,-rax-o^oibcr-Ghargc-owe
scwcrcharg.es , license fees, parking, tickets, property taxes or sales taxes.
P.?. If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliate*! entities will not use, nor permit their subcontractors to use, any facility listed by tbe- U.S. E.P.A. On the federal Excluded Parties Lis: System f/EPLS") maintained by the U. S. General Services Administration.
PJ If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with die Master certification!: equal in forei and substance to those La P.I. arid F.2. above and will not, without the prior written consent of the City, use any such contraetor/siibcontractor that docs not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any ofthe items in p. I., F.2. or F.3. above, an explanatory statement must be attached to this BDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (I) warrants that he/she is'authorized to execute this EDS arid Appendix A (if applicable) on behalf bf the Disclosing Party, and (2) warrants that all ccrrificatians and Statements contained in this EDS and Appendix A (if applicable) am true, accurate and complete as of the dc;te furnished to the City.
Susan ttarls Uvlrtfi Trust dated 12/4/2052 (Print or type nftmc, of Disclosing Party)
*r-—^r fffiW
(Sigr/hcre)
StsvmrlA. Hsmc -
(Print or type name of person signing)
Trestee
(Print or type title of person signing)
Signed and sworn to before me on (date) ( et lW>^- "County. Tt( iftai S
Commission expires: Sf' S
, (state). Notary Public.
GAFUCAKDSA WOTWW TOELtt. STtATEOF UliKXS
Page.U of-13
CITY Ol- CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICI ALS AND DEPARTMENT HEADS
Tin's Appendix Is to lie. completed only by (a) ihe Applicant, and (b) any legal entity which has a direct ownership interest f.n the Applicant exceeding 7-5 percent It is not to be. completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, die Disclosing Party must disclose whether such Disclosing Party or any "ApplicableParty" or any Spouse or Domestic Partner thereof cuKcnily hie a ^familial relationship" with any elected city official or department head, A "familial relationship" exists iC as ofthe date Hits EDS is signed, the Disclosing Party or any ^Applicable Party" or any Spouse or Domestic Partner thereof is related to tbe major, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: patent, child, brother or sister, aunt or uncle, aie.ee or nephew, grandparent, gixuidclitldL lalhcr-in-law, mother-in-law, son-in-law, daiighter-m-law, stepfather or stepmother, stcjisoo or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Part}" means (l)all executive officers of the Disclosing Party feted in Section ILB.l-a., if the Discfusmg Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if lite Disclosing Party is a limited liability company; (2) all principal officers of tbe 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 exercisTiTg similar authority.
Does tlw Disclosing Party or any "Applicable Parry" or any Spouse or Domestic Partner thereof currently have a familial relationship" with an elected city official or department head?
[ J Yes DO No
If yes. please identify below (I) the name and title ofsuch person, (2) Ihc name of the legal entity to which such person is connected; (3) the name and title ofthe elected cily official or department head to whom such person has a familial relationship, and (4) the precise nature of such ifamiE.il rt;lalionsbip.
Page 13 of 13
OTY OK CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFl DAVIT """APPENDED B
BUILDING CODE SCX>FFI^W/PR0BL£nf LANDLORD CERTIFICATION
Tin's Appendix: is to be completed only by (a) the Applicant, and (b) any legal entity ^fjjeh.hasadj-r^ovvnershir»tn;tcmtin tbe Applicantexceedin" 7.5 nctfccnt (ah ttCKvner^>. If is.not to Ijc.complete* by any legal ctilUy which has only an indirect ownership, interest in the Applicant.
PttrsuanUo Municipal CodcSSsdton 2-154-010, is the Applicant or any Owner tdeatftfcfi as o. building code scofflaw or problem landlord pursuant to Section 2-92^416 of CflC Muhtdnal Code? 1
I I Yes fXjNo
If the Applicant is a legal entity publicly Iraded on any cxchancic, is any officer or director of the App'icimi identified cs a building code scofflaw or problem landlord pursuant lo Section 2»92-416 of the Municipal Code?
I IYIf yes to (I) or (2) above, please identify below the name ofthe person or legai entity identified ns a bufldrng code scofflaw or problem landlord and the address ofthe building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDS B CONSTITUTES AOCKOVVLEDGMBN1' AND AGREEMENT THAT THIS APPENDIX R IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATTONS MADE EN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OFTHE ASSOCIATED EDS.
CITY or CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Lego) name of ihe Disclosing Party submitting ibis EDS. Include d7b/a.'' if applicable: Karris Momer LLC
Check ONE of the following ibrcc boxes:
Indicate whether the Disclosing Party submitting this EDS is: 1. K) the Applicant; Owner OR
2- (1 a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest;
OR ""
3. [] a legal entity with a right of control (sec Section 11.0.1.) State the legal name of the entity in
which the Disclosing Patty holds a right of control:
I). Business address ofthe Disclosing Party: 22(W Iroquois Rpgd
VWlrneae, IL 60091
Telephone: 3l7.-e38-Sfl37 Fax: Email: re^ndp^j3taeagur.cc»n
Name of contact person: Rot3«fo R. Accsto
Federal Employer Identification No. (if you have one):
Brief description of contract, transaction or other undertaking, (referred lo below as the •Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Ratonifta.and PtanneaOovctonrrientfor 2500 - 20 W Cortland$171900-7A NL CampbellAvc.r25T>1 -31W. Homer St
O. Which Cily agency or department is requesting this EDS? DPP
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification £ and Contract U
Page I of 13
SECTION II - DISCL OSURE OF OWNERSHIP INTERESTS A. NATURE OETHE DISCLOSING PARTS'
-I.—tad ica te-the-on lure-o f-lhe-Disc I usingPartv:
I) Person £j Limited liability company
[] Publicly registered business corporation JJ L united liability partnership
[ ] Privately held business corporation f } Joint venture
[] Sole proprietorship {] Not-for-profit corporation
[ ] General partnership (ts the noi-for-profit corporation also a 501(e)(3))?
[ ] Limited partnership [ ] Yes [ j No
[ 1 Trust [ j Other (please specify)
2. For fegaJ entities, lite Slate (or foreign country) of incorporation or organization, if applicable:
3. Por legal entities not organized in ibe State or Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
UY«s NNo foJN/A
B, IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and lilies of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below alJ members, irany, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list hclow the legal titleboldcr(s).
If the entity is a general partnership, limited partnershjn. limited liability company, limited liability partnership or joint venture, list below the name nod title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of ihc Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
¦Stewart A Harris Manager
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples ofsuch an interest include shares in a corporation, panaership interest in ;i partnership or joint venture,
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interest ol a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), ihc 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
StewartA_ Harris Uvinj Trustdalad 12W2002 2204 Iroquois Rd„ VWlmetie. IL 60091 50% Susan Harris Living Tru£.t dofcc* 12/4/2002 2204 ttoquois Rd Wilmetta, IL 6D091 SO%
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship." as defined in Chapter2-156 ofthe Municipal Code, with any City elected official in the 12 mouths before the date Ibis EDS is signed?
I 1 Yes M No
If ycsr please identify below the name(s) of such City elected official(s) snd describe such relationship^):
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 Of expects to retain in connection with the Matter, as well 3S the nature ofthe relationship, and the total amount ofthe fees paid or estimated lo be paid. The Disclosing Party is not required to disclose employees who arc paid solely through the Disclosing Party's regular payrotL
"Lobbyist" means any person or entity who undertakes io 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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Narnc (indicate- whether Business retained or anticipated Address to he retained)
Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)
Pees (indicate whether paid or estimated.) NOTK: "hourly rale" or "t.b.d." is not an acccpUiblc response.
(Add Sheets if necessary)
[X] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-4 J 5, substantial owners of business entities that contact with the City must remain in compliance with their child support oblivions 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?
C J Ycs Od No IJ No person directly or indirectly owns 10% or more ofthe
Disclosing Party.
If "Ycs.V has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[JYes f JNo
FURTHER CERTIFICATIONS
1. Pursuant to .Municipal Code Chapter 1 -23, Article I ("Article r^whjch the Applicaat should consult for defined tarns (e.g., "doing business") and legal requirements), if the Disclosing Party submitting ibis EDS is the Applicant and is doing business with the City, then rite 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 of deceit against an oftreer 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: If Article f applies to the Applicant, the permanent compliance timeframe in Article 1 supersedes some five-year compliance timeframes in certifications 2 and 3 below.
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The Disclosing Party and. il* the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this liO.S:
arc not presently debarred, suspended, proposed for debarment, declared ineligible-or voluntarily excluded from any transactions by any federal, slate, or local unit of government:
have not, v/ithin a five-year period preceding ihc dale of diis EDS. been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection -with: obtaining, attempting to obtain, or performing a public (federal. Slate or local) transaction or contract under a public transaction: a violation of federal or state antitrust statutes: fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records: making false statements: or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, stale 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 BPS, had one or more public transactions (federal, state or local) terminated for cause or default: and
c. have not, within a five-year period preceding the date of this BOS. 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 lire 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 ihc Disclosing Party, or is, with the Disclosing Parry, tinder 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 iho City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or. with the Contractor, is under common control of another person or entity:
• any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents'*).
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Neither ibo Disclosing Party, nor any Counselor, nor any Affiliated Entity of either Ihc Disclosing forty
or any Contractor »or any Agents have, during the five years before ihe ditto this EDS is signed, or. with
respect to a Contractor, an Affiliated Polity, or an A ffiJiased Entity of a Corttraclur during the five years
before the date ofsuch Contractor's or Affiliated Entity's contraei or engagement in connection with the
-Matter: " ;|99|'
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United Stales of America, io 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 ofsuch conduct described in a. or b. above that is ? matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-5)2-610 (Living Wage Ordinance).'
A. 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 jis a result of engaging in or befog convicted of (I) bid-rigging in violation of 720 iLCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America lhat contains the tame elements as the offense of bid-figging or bid-rotating.
Neither the Disclosing Party nor any Affiliated- Eolity is listed on any of tbe following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department of the Treasury orlhc Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specialty Designated Nationals List, the Denied Persons List; the Unverified List, tbe Entity List attti 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 Patty is unable to certify to any orihe above statements in this Part 13 (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA." the word "None." or no response appears on the lines above, si will be conclusively presumed that ihc Disclosing Purty certified to tin: above statements.
8. To tbe best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a Complete list of all current employees of the Disclosing ('arty who were, at any time during the 12-month period preceding the execution date of this EDS. an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
Mono _ _ "~" ~ ~"~ ~
°. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-rnonth period preceding the execution date of this LiDS. to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" docs not include: (i) anything made generally available lo City employees or to the general public, or (it) food or drink provided in the course of official City business and having a retail value of less than S20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Parly (cheek one)
1] is Dfl is not
a "financial instimtion" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Parry IS a financial institution, then the Disclosing Party pledges:
"Wc arc not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code, Wc further pledge thai none of our affiliates is, and none of them will become, a predatory lender as defined tn Chapter 2-32 of the Municipal Code. Wc understand that becoming a predatory lender or becomiog an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If ihc Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2»32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
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If the letters "NA," the word "None," or no response ap»c;irs on the lines above, it wilt be
conclusively presumed that the Disclosing Party certified to the above statements. .
D. CERTIFICATION REGARDING INTEREST JN CITY BUSINESS
Any words or terms tlirts arc defined in Chapter 2-156 oT the M unicipal Code have the same meanings when used in this Part D.
J ¦ In accordance with Section 2-156-110 of the Municipal Code: Docs any official or employee of tbe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[JYes {<]No
NOTE: If you chcelced "Yes" to Item D.l,, proceed fo Items D.2. and D.3. If yov 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 o 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 lo the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process al the suit of the Cily (collectively, "City Property Sale"). Compensation for property taken pursuantto the City's eminent domain power docs not constitute a financial interest within the meaning of this Part D.
Docs the Matter involve a City Property Sale?
(JYes |]No
if you checked "Yes" to Item D.l provide the names and business addresses of the City officials or employees having such interest and identify (ho nature ofsuch interest:
Name business Address Nature of Interest
4. The Disclosing Party further certifies lhat no prohibited financial interest in the Matter ivjlt 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 cheeks 2., the Disclosing Party must disclose below or in an attachment to diis EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may ncsfce any contract entered into with the City in connection with the Matter voidable by the Cily.
* I- The Disclosing Tarty verifies that the Disclosing I'nrty bas searched any and all records of
the Disclosing Party and any and ail predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery cm (including insurance policies issued lo slaveholders that provided coverage lor damage to or injury or death of their slaves), and the Disclosing Party lias found no such records.
2. Tbe Disclosing forty verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies thai the following constitutes full disclosure of all such records, including the names of any and all sbves or slaveholders described in those record:};
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If Ihe Matter is not federally landed, proceed to Section VII. For purposes of this Section VI. tax credits allocated by the City and proceeds of debt obligations of the City arc not federal funding.
A. CERTIFICATION REGARDING LOBBYING
L List below die 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 Ihe Matter: (Add sheets if necessary):
(If no explanation appears or begins on ihe lines above, or if the letters "NA" or if iho 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. Tbe Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. I . 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 lo extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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3. The l)isclii;;ing P.-irty will submit art updated ecii.il'ication al the cud of each calendar quarter in which there occurs any event that materially affects the accuracy of the stalcmeoss and information se? forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that cither: (i) if is not an organisation described ui section 501 (c)(4) of the Interna) Revenue Code of 19Sf>; or (ii) it is au organization described in section 501(c)(4) of the internal Revenue Code of 1986 hut has not engaged and will not engage in 'Lobbying Activities".
irdie Disclosing Parly is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.1. through A.4. above from all subcontractors be tore'it awards any subcontract and the Disclosing Party must maintain all such subcontractors* certifications for tbe duration of the Matter and musi 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 ihc following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Parry the Applicant?
[ ] Yes [ j No
If "Yes," answer the ihrec questions below:
Have you developed and do you have on file affirmative acttoo programs nuesuajjt to applicable federal regulations? (See 41 CFR Part 60-2.)
[]Ycs [JNo
Have yon filed with the Joint Reporting Committee. Ihc Director of (he Office or Fedcra I Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
(1 Yes [J No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
11 Yes (JNo
If you checked "No"' to question t. or 2. above, please provide an explanation:
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SECTION VII - ACKNOWf.I;"0C';MENTS. CONTRACT INCORPORATION. COMPLIANCE. PENALTIES. DISCLOSURE
The Disclosing Piiriy understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between she Applicant and the City in connection with the Matter, whether procurement. Cily assistance, or other City action, and arc material inducements io 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 2-1 64 of the Municipal Code, impose certain duties and obligations oat 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 wwwxhvofchicago.org/Ethics . and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (31 2) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines thai any information provided in this EDS is false, incomplete or inaccurate, any contract or otber agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Mailer and/or declining to allow the Disclosing Party 10 participate in other transactions with the City. Remedies al law for a false statement of material fact may include incarceration and ao award to the City of treble damages.
Ii 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 he made available 10 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 Mailer is a
contract being handled by ihe City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject lo Article I of
Chapter 1-23 of the Municipal Code (imposing PERMANENT INEUGIBILITV for certain specified
offenses), the information provided herein regarding eligibility must be kepi current for a longer period,
as required by Chapter f-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
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F.l. The Disclosing Party is no I delinquent in the payment of any tax administered by die 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 laxcsor sales tnxes. s
F.2 If the Disclosing Parly is Ihe Applicant, the Disclosing Party and Hs Affiliated entities will not use, nar 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 cny contractors/subcontractor? hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. 1. and F.2. above urn! will not, without the prior written cosscnt of the City, use any such contmctbr/Kubcontrcclor that does not provide such certifications or that the Disclosing Party has reason to believe bas not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.L, F.2. or F.3. above, an explanatory statement must be attached <0 (his EDS-CERTIFICATION"
Under penalty of perjury, the person signing below: (1) warrants thai he/ebe.is authorized to execute this ED S and Appendix A (if app licable) on behalf of the Disclosing Party, and (2) .wacrnnts that oil certifications and statemcats contained in this EDS and Appcfldix A (if applicable) ate true, accurate and complete as of the date furnished to the City.
Hams Keener LLC
(Print or type name ofpisclosing Party)
/
By:_ r/ ^
(Sigiyhcrc)
Stewart A. Hams .5. t-r* 11 ¦ ¦
(Print or type name of person signing)
Manager fJ,j. e qj^.x, V
(Print or type title of person signing)
Signed and sworn tn before me on. (date) r^/pv^lr>^L&
Notary Public. £ GALLC1NDE1A
NOTARY PU33JC - SWTE OF «JHDJS
Commission expires: o ° — / ' .
-- lYije 12 of 13"—"
crry of Chicago
F.CONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICI ALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (t>) any legal entity which bas a direct ownership interest in the Applicant exceeding 7.5 percent. It is not lo be completed by any legal entity which bas only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party most disclose whether such Disclosing Party or any "Applicable Part/' ot any Spouse or Domestic Partner thereof currently has a "familial relationslwp" with any elected city official or department head. A "familial relationship" exists if, as ofthe date diis BDS is signed, ihc Disclosing Party or any "Applicable Party*' or any Spouse or Domestic Partner thereof is related to Ihc mayor, any alderman, the cily clerk, the city treasurer or any city detriment head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law* mother-in-law, sonri*t»luw, daughter-in-law. stcpfalher or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brolher or half-sister.
"Applicable Party" means (I) all executive officers of the Disclosing Party listed in Section ILB.l .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Parly is a general partnership; all general partners and limited partners of the Disclosing Party, if the DiscIosingParty is a limited partnership; all manEgcrs, managing members and members ofthe Disclosing Party, if ihe Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Pony; and (3) any person having more than a 7,5 percent ownership imcrcst in the Disclosing Party. "Principal officers'* means tbo president, chief operating nfficer, executive director, cJiief finnircial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Docs the Disclosing Party or any "Applicable Party*' or any Spouse or Domestic Partner thereof currently have a **rantilia! relationship" with an elected city official ot department head?
[J Yes (XI No
If yes, please identify below (I) the name and title of such person. fJ2) the name of the legal entity to which such person is connected; 0) the name and title of ihe elected city official or deportment head to whom such person has a familial rctotionship, and (4) the precise nature ofsuch familial rcfaiionship.
I'agc 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE .STATEMENT AND AFFIDAVIT APPENDIX B
BUJLDINC CODE SCOFFLAWROBLKM CAjfDLOftD CERTIFICATION
This Appendix is to be completed only by (a) tbe Applicant, and (b) any fcftal cnti completed by any legal en tity which has only an mdereel ownership inrcrc^t in the Applicant.
Pursuant to Municipal Code Section 2-154-010. is the Applicant or any Owircx identified asa building code scoffklw or problem landEofd pursuant to Section 2-92-416 of the Municipal Code?
I I Yes fX}No
If the Applicant is a Icgnl entity publicly traded on any exchange,, is anyoffiOTordlrcctorof I'lK Applicant identified 3S a building code scoffla w or problem landlord purstrant to Section 2-92-416 ofthe Municipal Code?
( J Yes I J No OCIN'ol Applicable. :
If>«su>(l)orf^^tbpv^^
identified as a huildnig code scofllaw or problem landlord and Ihc address of tho btriidfng or buildings to tvftich the pertinent code violations apply.
KILLING OVTTBIS APPKPfDJQt II CONSTITUTES ACKNO WLET>GMEW AND AGREEMENT THAT TIMS APPENDIX It IS INCORPORATED BY REFERENCE 1NT*0, AND MADE A PART OF^ THE ASSOCIATED BUS, AND THAT THE REPRESEiMTATTONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
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