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 ofthe B1-3, Neighborhood Shopping District symbols shown on Map 12-D in the area generally bounded by:
East 53rd Street; a line 140.45 feet east of and parallel to South Dorchester Avenue; a line 150.59 feet south of and parallel to East 53rd Street extended west to a point 150.56 feet South of East 53rd Street; South Dorchester Avenue
to the designation of B3-5, Community Shopping District.
SECTION 2. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the B3-5, Community Shopping District symbols shown on Map 12-D in the area described in Section 1 above, to those of a Business Planned Development, subject to the use and bulk regulations set forth in the Plan of Development attached hereto and made a part hereof.
SECTION 3. This ordinance takes effect after its passage and approval
Common Address: 140I-1411 East 53rd Street
BUSINESS PLANNED DEVELOPMENT NO.
Plan of Development Statements
The area delineated herein as a Business Planned Development ("Planned Development") consists of approximately 21,148 square feet (0.49 acres) of property located at 1401-1411 East 53rd Street (the "Property"), as more fully depicted on the attached Planned Development Boundary and Property Line Map. The Property is under the single designated control ofthe Applicant, Smart/Olympia Illinois 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 ofthe Chicago Zoning Ordinance, the Property, at the time of application for an amendment, modification or change (administrative, legislative or otherwise) to this Planned Development is made, shall be under single ownership or single designated control. Single designated control is defined in Section 17-8-0400 of the 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, assigns 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 II approval, the submitted plans must be approved by the Department of Transportation.
Applicant: Smart/Olympia Illinois LLC
Address: 1401 -1411 East 53rd Street
Dale Introduced: January 13, 2016 Plan Commission: May 19, 2016
FINAL FOR
This Plan of Development consists of Fifteen Statements; a Bulk Regulations fable; an Existing Land Use Map; a Zoning Map; a Planned Development Boundary and Property Line Map; a Site/Ground Floor Plan; a Landscape and Green Roof Plan; Building Elevations (North, East, South, and West) prepared by G|R|E|C Architects dated May 19, 2016.
In any instance where a provision of this Planned Development conflicts with the Chicago Building Code, the Building Code shall govern. 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 shall control.
The following uses are permitted in the area delineated herein as a Business Planned Development: hotel; retail sales; eating and drinking establishments: outdoor patio at grade; accessory 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 purposes of FAR calculations and measurements, the definitions in the Zoning Ordinance shall apply. The permitted FAR identified in the Bulk Regulations Table has been determined using a Net Site Area of 21,148 square feet.
Upon review and determination ("Part II Review"), and 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 review associated with the site plan review or Part 11 reviews are conditional until final Part II approval.
The Applicant shall comply with the Rules and Regulations for the Maintenance of Stockpiles promulgated by the Commissioners of the Departments of Streets and
Applicant: Smart/Olympia Illinois LLC
Address: 1401-1411 East 53rd Street
Date Introduced: January 13, 2016 Plan Commission: May 19, 2016
Sanitation and Fleet and Facility Management and Buildings, pursuant to Section 13-32-125 ofthe Municipal Code, or any other provision of that Code.
The terms and conditions of development under this Planned Development Ordinance may be modified administratively by the Zoning Administrator, pursuant to Section 17-13-061 1-A ofthe Zoning Ordinance, upon written application 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.
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. At the time of a hearing before the Chicago Plan Commission, all developments must be in substantial compliance with the current City of Chicago Sustainable Development Policy set forth by the Department of Planning and Development. Applicant shall achieve L.E.E.D. Certification under the Leadership in Energy and Environmental Design ("L.E.E.D.") Green Building Rating System for the proposed building and a 50% Green Roof over the Net Roof Area of approximately 4,300 square feet.
This Planned Development shall be governed by Section 17-13-0612 of the Zoning Ordinance. Should this Planned Development Ordinance lapse, the Zoning Administrator shall initiate a Zoning Map Amendment to rezone the property lo a B3-5, Community Shopping District.
Applicant: Smart/Olympia Illinois LLC
Address: 1401-1411 East 53rd Street
Date Introduced: January 13, 2016 Plan Commission: May 19, 2016
BUSINESS PLANNED DEVELOPMENT NO.
BULK REGULATIONS TABLE
Gross Sifc Area:
Area in Public Right-of-Way:
Net Site Area:
Maximum Floor Area Ratio: Maximum Building Height: Minimum Number of Parking Spaces: Minimum Number of Loading Berths: Maximum Number of Hotel Keys: Minimum Setbacks:
33,044 Square Feet 11,896 Square Feet 21,148 Square Feet
3.5
90"
15
(10'x25')
100
In accordance with the Site Plan
Applicant: Smart/Olympia LLC
Address: 1401-1411 East 53rd Street
Date Introduced: January 16, 2016
Plan Commission: May 19, 2016
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Department of Planning and Development
CITY OF CHICAGO
MEMORANDUM
Alderman Daniel S. Solis
Chairman, City Council Committee on Zoning
David L.lReifman Secretary
Chicago Plan Commission
May 20, 2016
RE: Proposed Planned Development for property generally located at 1401-11 East 53rj Street.
On May 19, 2016, the Chicago Plan Commission recommended approval ofthe proposed planned development submitted by Smart/Olympia Illinois, 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 ofthe Resolution. Ifyou 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 1000, CHICAGO, ILLINOIS G0G02
REPORT TO THE
CHICAGO PLAN COMMISSION FROM
THE DEPARTMENT OF PLANNING AND DEVELOPMENT
MAY 19, 2016
BUSINESS PLANNED DEVELOPMENT
SMART/OLYMPIA ILLINOIS, LLC
1401-1411 EAST 53 STREET
Pursuant to the provisions of the Chicago Zoning Ordinance, Title 17 of the Municipal Code of Chicago, the Department of Planning and Development hereby submit this report and recommendation on a proposed Business Planned Development for your review and recommendation to the Chicago City Council. The application for the amendment to the Chicago Zoning Ordinance was introduced into the City Council on January 13, 2016. Proper legal notice of the public hearing on the application was published in the Chicago Sun Times on May 4, 2016. The Applicant was separately notified of this hearing.
This application is submitted as a mandatory planned development pursuant to section 17-8-0512-B (Tall Buildings) which requires planned development review and approval for any building in a B3-5 Zoning District that meets or exceeds 80 feet.
SITE AND AREA DESCRIPTION
The project consists of two rectangular shaped lots containing a total of 21,148 square feet and is bounded on the north by East 53rd Street, on the east by an existing drive-way, on the south by an existing 2-story masonry building and on the west by South Dorchester Avenue.
Planned Development Boundary Map
PROJECT DESCRIPTION AND BUILDING DESIGN
The site is currently zoned B1-3 (Neighborhood Shopping District) and the applicant proposes to rezone the site to a B3-5 (Community Shopping District) prior to establishing the Business Planned Development. The proposal will allow a seven-story, 100-room hotel, accessory parking and accessory and related uses.
3. Rendering - Northwest Perspective
ACCESS/CIRCULATION
/s**7». " , | _
4. Site / Ground Floor Plan
Access for vehicular traffic is provided via an existing curb cut along East 53rd Street and leads to an accessory parking lot with 15-accessory parking spaces. The egress from the parking lot is from a proposed curb cut along South Dorchester Avenue and leads directly to the street Loading will occur internal to the site and is provided by a 10'x 25' loading berth/space located along the east side of the building. Access for pedestrians to the hotel and restaurant occurs through a hotel entry lobby located along East 53rd Street.
LANDSCAPING and SUSTAINABILITY
The applicant must comply with the City of Chicago's Landscape Ordinance. In addition the proposed building is required to achieve LEED certification and provide a 50% green roof as defined by the City of Chicago Sustainable Matrix.
5. Landscape Plan 6. Green Roof Plan
BULK/USE/DENSITY
Reference attached Bulk and Data Table Exhibit. RECOMMENDATION
The Department of Planning and Development has reviewed the project materials submitted by the Applicant and have concluded that the proposed development would be appropriate for the site for the following reasons:
The project complies with the Standards and Guidelines for Planned Developments in the Zoning Ordinance (Section 17-8-0900).
1. 17-3-0400 Bulk and Density standards. The proposed Planned Development would not increase the maximum Floor Area Ratio (F.A.R.) stipulated under the B3-5 District but would be restricted to a 3.5 FAR and will be consistent with the surrounding area. This project will have similar uses as the surrounding areas, which include lodging, commercial and retail uses, and accessory parking spaces.
17-8-0908 Green Design: The proposed hotel building shall be required to achieve L.E.E.D certification and provide a 50% Green Roof over the net roof area to satisfy the requirements of the City of Chicago's Sustainable Guidelines.
17-8-0905 Pedestrian Orientation: Primary pedestrian entrances are located at the sidewalk level and allow unimpeded pedestrian flow along East 53rd Street. Furthermore the entire street frontage of the building along South Dorchester Avenue and East 53rd Street is enlivened by an architectural window system looking directly onto the street frontage.
17-8-0904 Transportation, Traffic, Circulation and Parking: Motor vehicle parking would be accessed from East 53rd Street and loading will occur internal to the site.
17-8-0901 Use, Bulk, Density and Intensity: The proposed development is compatible with the character of the surrounding area in terms of uses, density, and building scale. The proposed Planned Development would be consistent in bulk, density, and Floor Area Ratio (F.A.R.) with the surrounding area. The proposed project will be limited to a maximum Floor Area Ratio (F.A.R.) to 3.5. The height ofthe proposed 7-story (90') hotel building will be consistent and is within the context of the surrounding area.
Based on the foregoing, it is the recommendation of the Department of Planning and Development that the revised application submitted by Smart/ Olympia Illinois, LLC for a Business Planned Development be approved and that the recommendation to the City Council Committee on Zoning, Landmarks and Building Standards is: "As Amended, Passage Recommended."
Department of Planning and Development
FINAL
DEPARTMENT of PLANNING and DEVELOPMENT CITY OF CHICAGO
RESOLUTION BUSINESSS PLANNED DEVELOPMENT
1401-1411 EAST 53rd STREET
WHEREAS, the applicant, SMART/OLYMPIA ILLINOIS, LLC, proposes to establish a Planned Development. The applicant proposes to rezone the site from a B1-3 (Neighborhood Shopping District) to a B3-5 (Community Shopping District) prior to establishing a Business Planned Development. The proposal will allow a seven-story, 100-room hotel, accessory parking and accessory and related uses; and
WHEREAS, this application is being submitted by the applicant as a mandatory planned development application pursuant to section 17-8-0512-B (Tall Buildings); and
WHEREAS, the application for the amendment to the Chicago Zoning Ordinance was introduced into the City Council on January 13, 2016. Proper legal notice ofthe public hearing on the application was published in the Chicago Sun Times on May 4, 2016. The Applicant was separately notified of this hearing; and
WHEREAS, the Plan Commission has reviewed the applications with respect to the provisions of the Chicago Zoning Ordinance and finds that the proposal will be consistent with said provisions; and
WHEREAS, the Department of Planning and Development recommended approval of the application, with the recommendation and explanation contained in the written report dated May 19, 2016, a copy of which is attached hereto and made a part hereof; and
WHEREAS, the Chicago 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 May 19, 2016 giving due and proper consideration to the Chicago Zoning Ordinance; and
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO ILLINOIS 60602
FINAL
NOW, THEREFORE, BE IT RESOLVED BY THE CHICAGO PLAN COMMISSION:
THAT the final application dated May 19, 2016 be approved as being in conformance with the provisions, terms and conditions of the corresponding Zoning application; and
THAT this Plan Commission recommends approval to the City Council Committee on Zoning, Landmarks and Building Standards of the final zoning application dated May 19, 2016; and
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 Chicago Plan Commission regarding the zoning map amendment for a Business Planned Development application.
Martin Cabrera, Jr. / y Chairman {^y Chicago Plan Commission
Approved:
May 19, 2016 BPD No.
^ECEIVEO
JAN 21 7m
CITY OF CHICAGO
APPLICATION FOR AN AMENDMENT TO RECEIVED
THE CHICAGO ZONING ORDINANCE ^ ^ ^ ^j-
1. ADDRESS of the property Applicant is seeking to rezone: Initial." \~" VJ^Vft^- "^-^D
1401-1411 East 53rd Street
Ward Number that property is located in:
APPLICANT Smart/Olympia Illinois LLC
ADDRESS 20600 Chagrin Blvd. - Suite 705 CITY Shaker Heights
STATE Ohio ZIP CODE 44122 PHONE 216.485.2311
EMAIL csmall@smarthotelsgroup.com CONTACT PERSON Ed Small
4. 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.
OWNER The University of Chicago ("UofC") / Lake Park Associates, Inc. ("LPA")
ADDRESS 5801 S. Ellis Ave. - Suite 619 _ CITY Chicago
STATE Illinois ZIP CODE 60637 PHONE 773.702.1976
EMAIL rhrush@uchicago.edu CONTACT PERSON Robert Rush
If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Edward J. Kus / Taft Stettinius & Holiistcr LLP
ADDRESS 111 East Wacker Drive - Suite 2800
CITY Chicago STATE Illinois ZIP CODE 60601
PHONE 312.836.4080 FAX 312.275.7586 EMAIL ekus@taftlaw.com
6. 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.
Olympia Boutique LLC _
The Olympia Companies
Smart Hotels Five Three LLC
SHG University Chicago LLC
UofC (1401)- 1997
On what date did the owner acquire legal title to the subject property? LPA (1411) - 2013
Has the present owner previously rezoned this property? If Yes, when?
NO
9. Present Zoning District Bl-3 Proposed Zoning District B3-5 then to BPD
Lot size in square feet (or dimensions) 21,148 square feet
Current Use of the property Surface parking and 2-story commercial building
Reason for rezoning the property Planned development is required because proposed
building height exceeds 80'. .
Describe the proposed use ofthe 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)
A new hotel building containing approximately 99 guestrooms with accessory food and
beverage. There will be 17 on-site parking spaces. The height ofthe building will be 90'
(measured to the top ofthe highest rooftop structure).
The Affordable Requirements Ordinance (ARO) requires on-site affordable housing units and/or a financial contribution for residential housing projects with ten or more units that receive a zoning change which, among other triggers, increases the allowable floor area, or, for existing Planned Developments, increases the number of units (see attached fact sheet or visit www.cityofchicago.org/ARO for more information). Is this project subject to the ARO?'
YES NO X
15008214_1
(DO NOT SUBMIT THIS PAGH WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new PTJS with correct or corrected information)
REC ERTIFICATI ON
Generally, for use with City Council matters. Not for City procurements unless requested.
This rcccrtification is being submitted in connection with PD at 1401-1411 E. 53rd Street [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS rcccrtification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as ofthe date furnished to the City and continue to be true, accurate and complete as ofthe dale of this rcccrtification, and (3) reaffirms its acknowledgments.
The University of Chicago
(Print or type legal name of Disclosing Party) By:
n
Date; May g. 2016
(sign here)
Print or type name of signatory: Kim Taylor
Title of signatory:
Vcr. 11-01-05
VP and General Counsel
(DO NOT SUBMIT THIS PAGE WITH YQIJR EDS. The purpose oi' this pagc.is lor you to recertify your EDS prior to submission lo City Council or on iiic.datci of cldsiug;. ]f unabie to recertify truthfully, the Disclosing Party must complete a new EDS with coirccVbr :cpm;c.te^ infonnation)
RECERTrFICX'fTON'
'W.afr^fits that all ccrjifi ¦afe.lrue,: accurate and:^
accurate and;c^ !'aci<6ip\yie4gmrerits.
.Generally; for use with CityCmmcil'nT^ ¦;. This rcccrtification
4Prin.t ,pr t Pjafiy}& J' " -
(sign .here) ^Prinfcr^t^K n^^ ^evjin P_.^.MahaneY,,.:
'iSigiieid;atfj _ ,by ,¦ :; J > ;^S^'
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.\^binmission>cxpTrcs:--. • t&y^/fZ^l:.; V
•My Commission Expires'October -10,2021; " ¦ " s':':.j&^*y^
(DO NOT SUI3M1T TH1S PAGE WITH YOUR EDS. Tho purpose of this page is for you to recertify your EDS prior to submission to City Council or on tho date of closing. If unable to recertify truthfully, the Disclosing Party must complete a now BDS with correct or corrected Infonnation)
RECERTIFICATION
Generally, for use with City Council mattera. Not for City procurements unlc&s requested.
This rcccrtificalion is being submitted in connection with PI) at 1401-1411 Iv. 53rd Sttcct (identify the Matter], Underpenalty of perjury, the poi son signing below: (1) warrants that he/she is authorized to execute this EDS rccertlficatlon on behalf of the Disclosing Party, (2) warrants that all certifications and statements eontulnod in tho Disolosing Parly's original EDS are true, accurate und complete us ofthe date furnished lo the City and continue to be true, accurate and complete as of the dato of this rcccrtification, and (3) reaffirms its acknowledgments.
SHG Unlvarclty Chicago LLC ; Dutc: May 3.2018
(Print or type legal numo of Disclosing Party)
(sign here)
Print .or typo name of signatory:
£bcofi(Zb Small.
Shyicd and ewbiu jo before rnc on [(Into] -
Vvr. ll-OI-OJ
(DO NOT SUBM1T:TH1S PAG%WITH YOUR EDS, The purpose oi" this page'is for you lo recertify your EDS prior to;subini$sloYh to City Councilor oh :rwcHify trutiiuaily; t|Vc:b information)
RECERTIFICATION
Generally, for use with Gity,GoUi^i('mttttcrs. Mtfxtt-Citypw
/I^is^f^ertificatipn'is PD:aH4Qi'1411 :E.;S,^_S^cct;
[iddntii'ytho Mattb^
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:^can^t^ahd conipiot^ --^ acknowledgments.
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(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this pugc is for you u> recertify your EDS prior to submission to Gity Council or on the date of closing, If unable to recertify truthfully, the Disclosing Parly must complete'a now EDS with correct or corrected infonnation)
RECERTlFICATfON
Generally, for use-with Cily Council huiltbrs.-.Not for Cily procurements unless requested.-
This rccertificaliqu jsbcihg submittcdh'n^coiiheciion with PD at 1401-1411 E. 53rd Street
[identify thcMattb^ (1) warrants thai •
He/she is ¦aulhorizc'd.to/c^ behalf of ife
warrants tlwfdil ocrtif^
arctr:uci;«icciiratc;^iid:c.^ the/Gily.and^cojft
accurate ahdtannp^^
acknowledgments.
Lake Hark Aosoclatos;-Inc.;
(Print or lype legal.hathe of Disclosing P.jii^y) By:
(sign here)
Print or type naine;bf sigriatory; kiiii taylo.p ^
Title ofr^i ghatpfyV VP -and ;s^cre^|^.
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-'|ci}VK - ¦¦ . at f :^::rC^o^l^^;Cot>nty¦ [state]
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OFFICIAL SEALrn." '. . TtS • v:;TAMBRAABLAGKi/. -
' .NOTARY PUBLIC -.STATE OF ILLINOIS -* ; .''WCOAllSStOfJ DCPIRESir/M/ia'-;-
•Ver. JI-U1-0S
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Lake Park Associates, Inc.
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
;/ ; the Applicant— Owner of the Property . OR
i "I 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 (see Section II.B.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 5601 S. Ellis Avenue, Suite 619
Chicago, IL 60637
Telephone: 773-702-1976 Fax: 773-702-0934 Email: rhmsh@uchicago.edu
Name of contact person: Robert Rush -
E. Federal Employer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Planned Development Application for 1401-1411 E. 53rd St.
G. Which City agency or department is requesting this EDS? Department of Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page 1 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. Tf none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
The University of Chicago 5801 S. Ellis Ave 100%
Chicago, IL 60637
SECTION UI -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[JYes i/INo
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section U.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
N/A
9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
I i is |/j is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none ofour affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
N/A
Page 7 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
/ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
j _2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED M ATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying
Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with
respect to the Matter: (Add sheets if necessary): N/A
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
Yes v^No
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
OTY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
SHG University Chicago LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR
[X] a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe Applicant in which the Disclosing Party holds an interest: Smart/Olympia Illinois LLC
OR
3. [ ] a legal entity with a right of control (see Section Ii.B.l.) Stale the legal name of the entity in
which the Disclosing Party holds a right of control:
Business address of the Disclosing Party: 20600 Chagrin Blvd., Suite 705
Shaker Heights. OH 44122
Telephone: (216) 485-2311 Fax: N/A Email: esmall(S>,smarthotelsgroup.corn
Name of contact person: Ed Small
E. Federal Employer Identification No. (if you have one): (
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Planned Development Application for 1401-1411 E. 53rd Street, Chicago
Which Cily agency or department is requesting this EDS? Planning and Development
If the Matter, is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page 1 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional infonnation from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in
the Disclosing Party
Jonathan D. Adams 20600 Chagrin Blvd., #705. Shaker Hts, O. 44122 50%
Ed Small 20600 Chagrin Blvd #705. Shaker Hts. O. 44122 50%
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes [X] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Parly is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or,entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or amy Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
N/A .
9. To the best of the Disclosing Parly's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As lo any gift listed below, please also list the name ofthe City recipient.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [X] is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none ofour affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory-lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
comply wilh llicse disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or lo extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicago.org/Ethics . and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the infonnation provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period, as
required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughteivin-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section H.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes [X] No
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entityto which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I.-- GENERAL INFORMA TION
A. Legal name ofthe Disclosing Party submittingthis CDS. Include d/b/a/ if applicable:
Smart Hotels Five Three.LLC _
Check ONE ofthe following three boxes;
Indicate whether the.Disclosing Party submitting this EDS is:
[ ] the Applicant1
OR
[X] 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: Smart/Olympia Illinois LLC
OR
3. | ] a legal entity with a right of control (see Section II.B.l .) State the legal name of the entity: in
which the Disclosing Parly holds a right of control:
B. Business address of the Disclosing Party: 20600 Chagrin Blvd Suite 705
Shaker Heights. OH 44122 1 .. ....
C. Telephone-: (216") 485-_3-l-l Fax: N/A Email: csma 11 (3),smaribdie 1 s gro up;'com
..... - ? i -¦ ¦ ¦ ¦'¦ ¦"¦ ¦
D. Name of contact person: Ed Small _
Federal-Employ^ ypu.hayc one): ¦ :.-.... . ...
.Brief description 0f contTa^ other undertaking (referreittOib^
which this EDS pertains, (htelude project;hiimber and location of property, if *appHcai)le):
Planned Development Applicatioh for 1401-1411 E. 53rd Street. Chicago
G. Which City agency or department is requesting this EDS? Planning and -Development
If the Mailer is a contract being handled by the City's Department of Procurement/Services, please complete the following:
Specification # i and Contract # _ . -
Ve-. oi-oi-ii Page .1 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, stale "None." NO'lTi: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in
the Disclosing Party
Jonathan P. Adams 20600 Chagrin Hjvd tf7QS. Shaker Hts. O. 44122 100% _
SECTION 111 -- BUSINESS RELATIONSHIPS WITH CITY ELECTED'OFFICIALS.
Mas the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with-any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes |XJ No
If yes, please identify below the namc(s) of siich-Gily^eleeted official(s) and describe such relationship(s):
SECTION IV r- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name arid business address of each .subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects .to retain in connection with the Matter, as well as the nature of die relationship, mid the total amount of the fees paid or estimated .tp he-paid, llic Disclosing Party isaiol. required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means anyjperson or .entity iwjio 'QnderCafcps to influence, any legislative or. adriiihistfatiye action on behalf of any person or «itity--pjlicr-:trfe"n>'j(l) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means anyt,pcrsph.,p,f entity, any part of whose duties as an employee of another includes undertaking tb .influence .any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing;Party must either ask (he City whether disclosure is required.or make the disclosure.
Page 3 of 13
The Disclosing Parly and, if the Disclosing Parly is a legal entity, all oflho.se persons or entities identified in Section II.B.I. of this EDS:
arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within, a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged-guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting-to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or stale antitrust statutes; fraud; embezzlement; theft ; forgery; bribery; falsification or destruction of records; making false statements- or receiving.stolen property:
are:not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period prcceding the date of this EDS.; had one or more public transactions (federal, state or local) terminated for cause of 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 violations, instituted: by the City or by the federal government, any
state, or^any other imitpf local government.
The certifications in subparts 3, 4 and 5 concern:
• the.Disclosing Party;
any •¦Cpjritractpr" in connection with the Matter-, mcluding'butnot limited:to,all perspns or legal entifies--d)sclos6d:ufldcf Section IV, disclosure 6f; Subcontractors and Other detained Parties");
'-any "AffjlMed^ or ¦eiititytt^ the
Disdjosifrg^ "rider
common cbntrol of another person or entity. .Indicia of- control .>i delude j .Withput limitation:
intcrlpcking;m^ 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;fhe sa'riie management, ownership, or principaislas the ineligible-entity);
with fespefefc^ Affiliated Entity means a.perspn or eniityy that directly or
indirectly controls 'tire Contractor, is controlled by it, of, with the Contractor, is under common control of another person or entity;
any responsible, official of the Disclosing. Parly, any Contractor or any Affiliated Entity or any other officialy agent:or employee of the Disclosing Parly, any Contractor oriany Affiliated Entity, acting pursuant.tothe direction or authorization of a responsible official ofthe Disclosing Party, any Contractor Or any Affiliated Entity (collectively "Agents").
Page 5 of 13
IfUie letters "NA," (lie word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, (he following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed'official, of the City of Chicago (if none, indicate with "N/A." or "none").
N/A : .
9. To the:best-of the Disclosing Party's knowledge after reasonable inquiry, the following is - a; complete list of all gifts that the DiscIosing Party has given or caused to be given, at any time during the 12-mohth period,preceding the execution elate of this EDS, to an employee, or elected or appointed official; ofthe City of Chicago. Forpurposcs of this statement.; a "gift" docs not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the co.urse of official City business and having a retail value of less than $20 :pcr recipient (if none, indicate with "N/A" or "none")! As'to any gi.fi4ist;edv.belo\y, please also.list the.naine ofthe Gity.recipient;
N/A _ . : - ,
C. CERTIFICATION OF STATUS AS TINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check One)
[ J is [X] is not '
a "financial institution"/^ -Code.
If th'e/D.iscibsiiijg Party IS aMhanciai:ihstiiu.tion, then t he; Dj sc losing Party pledges:
"We arc not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal
Gode. ^cit\itfYcey\p\6f\g^ ;iha.t non& Ci^pXirjiaftiJih.le's is, and none of them will become,: a predatory
lender as dcfihcd: ih-Cliapter Code. We •understand that becbniifig&p^
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.iniake/tJiis^pJedge because it or ahyibf its affiliStesttas d Section 2-32^-455(b) of the Municipal Code) is-.a.predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (altaeh-additional pages if necessary):
Page 7 of 13
comply wild these disclosure requirements may make any contract entered into wilh the City in connection with the Matter"voidable by the City.
X_l. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance ^policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found lio such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Parly has found records of investments or profits from slavery or slaveholder •insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of.all such records, includirig:thc~names:of any and all slaves or slaveholders described inthosc records:
SECTION VI CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VT. If the Matter is'-noi {federally funded, proceed to Section VII. For purposes of this Section VI, tax credits-allocated; by the City and proceeds of debt obligatibiis ofthe City arc not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the-namesijb'fall personsor.eritities registered under thc~fcderal Lobbying Disclosure Act ofT9§5 ^hp^ay.C'.i]r)adc' •io'.bbyiiig. contacts: on behalf of the Disclosing Pja'riy with respect:'to theMatter:(Add sheets if necessary):
(If: no explanation appears pr>b§gins onthe lines above, or if the- letters "NA;"or if. :U)ot-.wpr': - ..... . ... \v^).' : ¦
registered under the Lobbying ^Disclosure Act of 1995 have made lobbying contacts on behalf ibfthe Disclosing Party with respect-to the Matter.)
2. The Disclosing.P/artyljiS's;Ari'ot:s^ent and wilj not expend any federallyiapprPpfiaiedTurid"s;tp^p:ay
any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any
person or entity to influcnce.iprisattenipt to.:.infiuence,^n pfficer or einployee,-:bf'aiiy,-ag^ncyias defined by
applicable federal law, amembcrof or employee of "Co crhpjpyceof-a
member of Congress, in coiinection with the award of any federally funded contract,,.makihg any federally funded grant or loah; 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
SECTION Vll -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands: and agrees that:
The certification's, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and. the City in connection with the Matter, .whether procurement, Cily assistance, or other City action, and are.material inducements to the City's execution of any contract or taking other action \vith respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations OiV 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^ahd obligations on persons or entities seeking-City contracts, work, business,, of transactions.- The .full.; text •;of.:thesC/%Qrdinanc;cs and a. training program' is^ayaila^le^'Qit line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board-of .Ethics; 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (3.12) 744-966.0. The Disclosing Party must comply fully with tlie applicable ordinances.
If tlie City determines that any information provided in this EDS is false, incomplete or inaccurate,
any contract Or other agreement in connection with which itiis:. submitted may be rescinded .or be void or
voidable, and void)^at lav/i dfein. equity, incLud.ing<;te^ participation, iulhei^^ter^and/or.
declining to allow the Disclosing'Party to participate in other:.lransacti6ns with th.e:Gity^JR'cn1cdies:„ at
law'for a false statement of material fact may include incarceration and an award to the City of treble
damages.
ItiS ithc City'sjpolicy to make this-docun^cht ayaiiablcito-thc\public on its Internet;site :and/!pr upon
request. 'S^nte;pj.all;of:tlve ihfprm&ionjprp^ attachments tpithis^F^vWayphe
made avaiiablc:itb the public Oh;the Internet, m;fcspbnsc tb;aj"rccdom of Information; Acf^
otherwise. By cb.inpletirig and signii^ the DisclOsiiigvParty waives and relcascs^any|$^
rights or claims which it may-have agaiiist-the City in connection with the .public release oOhformatipn
contained :iin':tlfisBD$ and also'authorizes;the-City.to,verify-the,accu^
ih-this EDS.
E. The information provided in.this EDS must be kept current. In the event of changes* the. Disclosing
Party must-supplement thisiEDSuip to the tinie .tlie Cily takes action on the Matter. If the Matter is a
ebntfacfbem bythe'Giiy^ the .Disclosing Party must
iipdate'this;ED5 ; , t>
Chap'tcr 1 -2>bfJtie 'Mum (i mposi iig P E RM AN EN'P IN E Li G IBILTT Y for certaih- spccificd.
offenses), the in'fbrmalibn provided herein regarding eligibility must be kept current for a/longer period, as
required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants (Hat:
Page II of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FA Ml LIA L -RELATION SB I PS'. VY ITU ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appchdix.is loybe completed only by (a) the Applicant, and (b)any legal. eii(ity:niuch has a
ownership interest ih^ not .fo be complete^
whicli lias ¦•only aninilirc^ in the Applicant.
UndcrjlvI.Unic'i^ 2-1.54^0.15. the Disclosing Party inust disclose whethersuch Djsclosing Party
or any 'V\ppjic^lc^r^ thereof currcntly.has a f^iHi|ifU;rclatioriship'' with
any elecred-eity'pffi A "familial relationship" exists if; as of'tn'e^g^^i's.cE^iS is
sighedylhc^ DiscloisingiParty or any applicable Party" or any Spouse or Domestic PartneHhefepf:is related to the mayor, any alderman, the'eity clerk, the city treasurer or any city department head as spouse or domestic, partner or as any':6lPih0;?fo'U6wifog* whether by blood or adoption: parent, child, brother or-sister, aunt or uncle, niece or nephew*son-in-law, daughler^n-lavv, stepfather or stepmother,, stepson or. stepdaughter, stepbrother or stepsister or half-brother or half-sisterv
'^pplicabic^ (j) all executive officers of the Disclosirig Party listed1in Sedtiob Il^B-La., if the
Disclbsi^^ Disclosing^ Party^is a gcneral
parfoership;^ pisclosingrPafty.i a limited
partnership^ members and members of th6 Disclosing Party; if the disclosing Party lis a
liniitSdfliabii ofthe ^Disclosing Party;; air^^(3j)^ toy|p5^s^|ft^iiig more than
a7:£|>er^
pp^ftrip^&r^ bhief 4^nciai-©iTj^ any person
exereisihg'sirmi;^
Db^thk>E>^
l^ypt$:-^^^ii^^j^^^ioj£$^]>*; withian^cl'ccled city pfficial.pr dep^Me^H^a|(?. [;]Yes [X]No
lfycs^pleaseici^ which
such person is icbn^ city'oTficial 6^ such
person lia^ of such'familial'^ •' "
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/if applicable:
The Olympia Companies, LLC
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. : the Applicant
OR
2. x a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest: Olympia Chicago Boutique LLC
OR
3. a legal entity with a right of control (see Section II.B. 1.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: J__^^5ilJL^!i£2_?^££.®E
Portland, ME 04101
Telephone: 207-874-9990 Fax: 207-874-9993 Email: kmahaney@theocos.com
Name of contact person: Kevin P. Mahaney ¦
Federal Employer Identification No. (ifyou have one): [
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Planned Development Application for 1401-1411 E. 53rd Street
G. Which City agency or department is requesting this EDS? Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # _ and Contract it
Page 1 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
Kevin P. Mahaney 7 Custom House St. Portland, Maine 04101 99%
OEl Management Corp 7 Custom House St. Portland, Maine 04101 1%
7 Custom House St. Portland, Maine 04101
SECTION III-- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
QYes gNo
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, stale or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Parly;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
If Ihe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"). N/A
9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient. N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
'" I is xj is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none ofour affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
j i_2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including teiminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the cily treasurer or any city department head as spouse Or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
;'lYes j*:no
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I --GENERAL INFORMATION
A. Legal name of the Disclosing Parly submitting this EDS. Include d/b/a/ if applicable:
Olympia Chicago Boutique, LLC
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
; i the Applicant
OR
i'x | a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the Applicant in which the Disclosing Party holds an interest: Smart Olympia Illinois, LLC
OR
3. ; j a legal entity with a right of control (sec Section 11.3.1.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 7 Custom House Street
Portland, ME 04101
Telephone: 207-874-9990 Fax: 207-874-9993 Email: kmahaney@theocos.com
Name of contact person: Kevin P . Mahaney ;
Federal Employer Identification No. (if you have one): j
F. Brief descript ion of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Planned Development Application for 1401-1411 E. 53rd Street
G. Which City agency or department is requesting this EDSVj^J^i^
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract ft
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interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
The Oly.upia Companies, LLC 7 Custom House Street 100%
Portland, ME 04101
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes L*No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any. legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section Il.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) tenninated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents"):
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none"). N/A
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
' is *} is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none ofour affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss 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 in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
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comply wilh these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
_2L_1- The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Parly 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.
J 2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or i f the letters "N A" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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SECTION VII-- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Parly's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the cily clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
LJ Yes 1x; No
Tf yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
SHG Chicago II LLC
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR
[] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [X ] a legal entity wilh a right of control (see Section II.B.l.) State the legal .name of the entity in
which the Disclosing Party holds a right of control: Smart/Olympia Illinois LLC
Business address of the Disclosing Party: 20600 Chagrin Blvd., Suite 705
Shaker Heights, OH 44122
Telephone: (2161 485-2311 Fax: N/A Email: esmall@smarthotelsgroup.com
Name of contact person: Ed Small
Federal Employer Identification No. (if you have one):
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Planned Development Application for 1401-1411 E. 53rd Street, Chicago
Which Cily agency or department is requesting this EDS? Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract # _
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interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in
the Disclosing Party
SHG University Chicago LLC 20600 Chagrin Blvd #705. Shaker Hts. O. 44122 50%
OEl Management Corp. 7 Custom House St Portland. ME 0410) 50%
SECTION 111 - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes [X] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity olher 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 Parly is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13'
The Disclosing Parly and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section I1.B.1. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors arid Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
N/A
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
N/A .
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [X] is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or. any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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SECTION VII --ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Parly understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject lo Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period, as
required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILI AL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, tlie city treasurer or any city department head as spouse or domestic partner or as any of tlie following, whether by blood or adoption: parent, child, brother Or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section H.B.I.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes' [X] No
If yes, please identify below (1) the name and title of such person. (2) the name of the legal entity to which such person is connected; (3) the name and title of tlie elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO E CONOMIC DISCLOSU RE S TATE MEN T AND A FITDAVIT
SECTION 1 - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/fr/a/ if appiicabie:
The University.^ Chicago . . . ^_ ¦,, . . ¦ ¦ ¦... ,. . ,,.
Gluick^rSE bf^
Indicate wTiether the Disclosing;^ tiiisjjD'S.%: 1 1'Bie Af>pl4tMHi4- Owner of Uie iVojKrty
OR; ' " '
.2. ^[a;jlcgalfentity iioW interest'invtHe;^
. App'licant.invwlu lioldsi:an.interest::].!^ , - ¦.
ORK ¦.¦¦¦¦.¦,;y...:.:. . . :: -v ¦ .:^K,;;v»
];:a4cgaletitity witli a right qfyconlrbl (see SccHqhilTB.l;^/State^the ;16gal nam
>whifalftti^ of control: .-.:>¦.¦,:¦¦¦¦ • •¦¦•w^;. ¦¦¦¦^^•f< ¦.
13. ^B^jk^s^ddr^ ^^:dHs:^yen%:-" :: " tifegdriLSoffir •¦c,*,'i*.:' -'^ff ¦•
C. dj.clcph.bnc':^ -.7';. Fax: 77^-702-0334 . " , . .,, ...
D/Namey^coniactpersb
Fcdcral;Employcr IdentificationN haycipne);^ ¦¦¦ ¦^^¦:>;r^v-^r;-i^:- -.-
BniSftt^riptib^
whi.chnb^ lo.c^aition^^
Plahnod DeyeloprhentVApplicalion-for 1401 -141 -I^E.'53r"d;St.
G. Which^Gitv^ IT^heVrvi&^
complci^^ ¦' ¦¦ ;^:\:V;;^ • -
Specification ft.;- , ...,. .:.......-'¦ ¦¦¦¦¦x. : . ;;ahd-Cbhtraci#
Ver: 01 01-12 ' l';lgC. ) .of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state ''None." NOTE: Pursuant lo Section 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), (be City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
None
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined ln Chapter 2-. 156,of.the Municipal Code, with any City elected official in the 12 months before the dale this EDS is sighed?
; j Yes No
If yes, please identify below the name(s) of .such City elected official(s) and describe such
relationship(s):
N/A
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and. business address "of each sub'&oiittactQr; '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.we.U:as;thc. hature-6f»flic •r^latiir>tit'hi(>?-and-the total amount of the fees paid or estimated to be paid. The Disclosing Party isi not reqiiifed^to disclose employees who are paid solely through the Disclosing Party's regular;payroll.
"Lobbyist" means any.perspn or entity who undertakes to influence any legislative or administrative action on behalf of any person Or"entity other than.:' (I) a .npt-^or-proTi't^tityj on ah iThp$id;hasis, or (2) himself: "Lobbyist" also means any person or entity any part of w^bs'c^auti°cs;Ss an employee of anomer includes, .undertaking to. mfluence any' Icgis'lSitivc 'or adifitinisttUtiy
If the Disclosing Party is uncertain whether a disclosure isrequiied under .this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ll.B.l. of this EDS:
a. arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
.b. have not, within a five-year period preceding tlie 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 apublic (federal,.state or.local) transaction or contract under a public 'transaction; a violation of federal or state-antitrust:-statutes j.-fr.au;dj; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or.receiving. stolen property;.
are not presently indicted for, or ciiininallytOr. civilly charged by, a governmental entity,(federal, state or local) with committing any of the offenses set forth in clause B.2.b. of-.this .Section:V;
have notj within a:fivc-year.period-preccding-the -date; of thisEiXS; had one or;more public transactions (federal^ state or local) terminatbd.for cause ordpfault; and
have not, within a-fiverycar-ipcriqd'prece^ \th^ate.-of^is.-EI>'S, been convictedadjudged
guilty, or found liable in a civil proceeding, or in:any criminal Or civil action, including;actions
concerning environmental violatibhSj. irist^ federal gp^"Criijpaeii^'ahy
state, or any other unit of local gov
3; T4ie'-certifications. in .sjubp^ai-ts'' 3f A eaiidf 5:-cpncprn.:-
•the Disclosing Party;
any 'IGontractpr!' (meaning any cpntr actor:Pr;sube used by the Disclpsing^P^n-ty m;i
connection with the Matter; jiiciuding;but;not limited to' all persons or legal cntitics-discloscd^undcr
: Sejejtipiic^ . ,„
• any " Affiliated,Eritityl,;:(iheari a person or entityj;thati;,dircctly:or indirectly: cpntrplsthc
Disbursing Party, is controiled;'b^:M or is, with tbc^Disclosing ^rty;i|\m|lbri
coniitioh control of another^ lhpi'cia of control include, withQutli^Ua3^h: _
'interlocking^ membei^sifiarc^
andiCquipment common use-bf ^mplbyccSj prsprgamza^^ enti^^ljta^
ineligibility of a business entity 10 doibusihbss with federal or state or local gbyerriincnt;;inclu
the City, using substantially the sam& ownership; or principals asv.the iiapli^ible/ciit-ity);
with respect to Contractors,;^ entity that directly pf
'iuWircciiy controls the Contractor,-is coritrolle&by i^ control of another person or entity;
any responsible official of the Disclosing Party, any Contra or any Affiliated Entity or.'any
• otlicr official}-agent or eiripToye.e/of ^ or a'fly^Afn^
acting-, pursuaftt to the dircctipn or authprizatiOh.pf a rcspphsible official of thy DisclosingParty,,any Contractor or any Affiliated Entity (collectively'"Agents").
Page 5 ot; 13.
If the letters "NA," the word "None," or no response, appears on the lines above, il will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, ah employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none'.').
N/A
9 To the best bf the Disclosing Party's k n o w ledge a fter reasonable inquiry, the-following is a complete list of all gifts that the Disclosing Party has given>or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, fo an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" docs not include: (i) anything made generally available to City employees Or to the general public, or (ii) food or drink provided in the course'ofofficial City business and having a retail value of less than; $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
is V is not
a "financial institution" as defined in Section 2-32-455(1?) of the Munjcjpai Code.
If-tlie Disclosing Tarty IS. a financial institution,;^
"Wc are notand will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. Wc further pledge that none of our affiliates is, and nOne bf them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. Wc understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in theloss ofthe privilege of doing business with the City."
If^c'-Diselbsihg^Party'js uriableto make mis'-piedge'5^ Section .2-'32-455(b) of the Municipal Code) is a'prcdaloryflcn'd^ 2-32 of the Municipal Code, explain here (attach addiliohai pagcsif necessary):
n/a ¦ - '." -" ¦
Page 7 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
J / 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era,(including insurance policies issued to slaveholders that provided coverage for damage lo or injury or death of their slaves); and the Disclosing Party has found no such records.
• .12. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from::s!ayery.o.r;slaveho.lder;insurance
policies. The Disclosing Party verifies that, the following constitutes Xui!-d^cldiSure.-or all such
records, including the names of any and all slaves or slaveholders, described in those records: M/A
SECTION VI — 'CERT FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is.Tcdcrajly funded, complete this Section VI. If the Matter is not federally funded, proceed to Section: VII. For purposes of this Section VI, tax credits allocated by the.City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below thenames of all persons or entities registered under me^ Disclosure Act of 1995 who:have made lobbying contacts on behalf pf the Disclosing Party with respect to the Matter: (Add shbets^iftn^cessafy):
N/A
(If no expland ti on appears of-heginsloii the lines above, or if the letters appear, it will be condlusively presuined that the Disclosing Party means jM^
registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. Thc.DisclpsuigPariy Jbas not spent.and will not expend any federally:apprppriated;funds to pay
any pCrspn-6rc;htit^ilis.tediir,Pa for lhs .or^hcr lpbp^ pay any
person or cntity to iiiflucncc or attempt to influence an officer or employeep£^^any:a'gcncy,.as'defined: by applicable federal lavvj a member pf,Gpngrcss, an officer or employee of'0Pn'gicss.i.;6r;an pmploycc of a member of Gongxess^in connection-with .'tlic< a ward of any federally-funded any federally funded grarit or loan; entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or coopc'rative.agrecmcnt.
Page 9 of 13-
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures.; and acknowledgments contained in this-.EDS will become part of any contractor other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, op,other City action, and are inaicriaH
of any contract or taking other action with respect to the-Matter. The Disclosing Parly understands that it must comply with all statutes. Ordinances, and rcguiatiohsipn which this EDS isvbased.
The-City's Governmental Ethics and CampaignFinancing Ordinances, Chaptcrs?^^
the Municipal' Code, impose certain .dutics,:and:pbligatipns on persons or entities seeking-^ity.cpntracts,
work, business, or transactions. vThe.full text of these, ordinances and a training program; is
line at www.cityofchicago.org/Ethics , arid may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500. Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If.the City determines that any.information provided in this EDS is false, incomplete or inSc'cui;atc; ahy contract-or other agreement vhicpnu^
voidable,, and the City may pursuka^^
void),#1aw., or in equity, including :tcrmi^ parlicipatibri itljje Matter and/or
declining to allow the Disclosing Party to participate in PthcMransactions with the Cily. Remedies at law for a false statement of material fact may include incarceration and an award to tlie City of treble damages.
P. It is'the City's policy to make:ti^ public on.its; Internet si^tfn^o^uijpn'
•request. /Some or.all oftheMnfprrhati^ attachments^ -.
m0i-%aUable to the public' oil tlipllntemp^ of Infprrn^tipir^
pt|icw*:ise. By completing and^s'igiiing thls^ED waives and,r^i^ses^ny^ps^ible
rights 6t claims which it mayTiiiy£;ag^ cbhhectipn with tlie public rclcys^
coft3Mh$d:'in this EDS and also authpn
in this EDS.
E. Tlie information provided in this EDS: mUst be-kept current. In the eventpf cha'nge^
Party must'supplement this EDS up tprthe\tlme ^heyCityltakes^actibh on the Matter. ¦'ifjthe^Mat^
contract being handled;by the Sity's'iD'cpa^ Disclosi^
update-thisiEDS as;tlie'cPntracT;r&qm^ ^
Chapter-1-2-3 ofthe Municipal;CodcPffchses), the information provided herein;^
as-Tequired'by Chapter 1-23 ahd^Sec
The Disclosing Party represents.and warrants that:
Page 11 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OTTTCIALS.AND DEPARTMENT HEADS
Tliis Appendix is,to be completed only by (a) the^ AppHcant, and^(b).any«Iega|.ci»ti.ty which has a direct ownership interest in the Applicant exceeding 715 percent. Itis-hbtto be coinpietcd by any legal eiitity which has only an indirect ownership interest in the Applicant.
Under Municipal .Gpde Section 2-154-015, the Disclosing Paity-iniisrdisclose w such Disclosing Party or any "Applicable Party" or any Spouse or Domeslic;Pai:tner. .to^ with any elected city official or department head. A "familial relationship" exists'if, asof the date this EDS is signed, the DisclosingrParty or any "Applicable Party" or any Spouse or DomesticTaither tlicrcof is related to the mayor, any alderman, the city clerk, the city treasurer-or any city department.head as spouse or domestic partner or as any of the following, whether by blood or adoption: parertt^dh^d, brother or sistcr, aunt or uncle, niece or ncplyewiigi'andparcht; grandchild, father-in-law; jtibdierHn^ stepfather or stepniOtherJtstepson:pr slcpdaughtery stepbrother O^stepsist^^
"AppUcable'PartyV means (1) all executive officers of the Disclosing Party lisited in. Section ILB.l.a., i.fthc DisclosingPartyis aico1rp]braU6
parinersrii'p) ali generai:partners -and :limited:pai'mers of theDis^
parthcrship-ral!'managers'; .inanaging members and members: of^^ tiie^Disclosing'Partyi'if the Disclosing Party is-a
limit'e'd4ia]&li^
a 7;5^pefccnt;ownershij^
operating''pfficer;.exebStive director, chief.financial offi^ person exercising siihilar/authority.
Does-the Disciosih&Paxty or any "Applicable Party" orany Spouse or .'Domestic i-Partncr thereof cuiTently have a "familial rciationship" with an elected city official or department bead?
I f yes, please identify -below fl) the name and fide pf;such^ entity to which
such person:iskcpnMcfed;;(3) the name arid title of the elpcfed City:gffj^^^^^^i^^ad I'd .whom such
person hfe:a:ftmilial:^ and :(4f die precise-M
Page. 13.of 13
Disclosing Patty's Executive Officer!;
President: Robert J. Zimmcr J'rovost: Brie D. Isaacs Executive VI': David B. Fitluan
Executive VI* for McdicRl Affairs; Dean, Biological Sciences Division and the Prif/.ker School of Medicine Kenneth S. Polonsky
VP for Campus Life and Student Services: Karen Warren Coleman
VP for Civic'Engagement: Derek R.B. Douglas
VP for Research and foe National Laboratories: Donald f I. Levy
VP for Communications: John Longbrakc.
VP for Alumni Relations and Development: Ken Manoiu
VP for Operation? and Chief Financial Officer: Rowan A. Miranda
VP for Enrollment and Student Advancement & Dean of College Admissions and Financial Aid: James G Nondorf
VP and Secretary of the University: Darrcivlleisberg VP and Chief Investment Officer: Mark A. Schmid VP for Global Engagement: Ian H. Solomon VP and General Counsel: Kim Taylor
Disclosing Patty's Tnistcet)
Byron D. Xrotr. John A; Edwardson Charles; A • Lewis Marshall ll \Vais James S. Frank John Liew Gregory W.: Weiidt Jack'W: Fuller Pctcx^May. D6nal5;R;.^ilson,Jr. Timo'riiyfMifGcorge J pscpfcN cubaucr Paula Wolff " Rodney L. Goldstein )7-mily'N icklin Paiil''G. Yovovich Maiy. Louise Gotno Michael P.^T.oisky Francis £F,F/ Yuen fieiinetb ,.Cr. Go ftw Myrdc'sYPottcr Robert J. Zimmcr
Andrew-M. Alpcr Sanfoid J. Grossman Thomas J. Pi.itzker David G. Booth King \V. Harris John W. Rogers, Jr. David B. Brooks Kenneth; M. Jacobs Emmanuel Roman Debra A. Cafaro Karen L. Katen Andrew M. Roscnfield ThomasA. Cole Dennis J. Keller David M. Rubcnstetn E. David Goolidgc III Steven A. Kcrs ten Alyaro.J. Saieh James S. Grown Janics M.- Kilts Nassef O. Sawiris Katharine P. Diurrow Kathatinc P. Dsurrow Michael J. Klingciismtt Steve. G. Stcvanoyich Daniel :1 ,.;Doctoroff Michael L. Klowden Elizabeth .M.' Thompsc Brady W. Dou'gan Rachel D. Kohlcr Maty A. Tolau Craig J. Dudiossois Robert W. Lane
H
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I — GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Smart/Olympia Illinois LLC
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[XJ the Applicant
OR
[ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [ j a legal entity with a right of control (see Section ll.B.l.) State the legal name ofthe entity in
which the Disclosing Parly holds a right of control:
Business address of the Disclosing Party: 20600 Chagrin Blvd Suite 705
Shaker Heights. OH 44122
Telephone: (216) 485-2311 Fax: N/A Email: esinall@smarthotelsgroup.com
Name of contact person: Ed Small
Federal Employer Identification No. (ifyou have one):; ;
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to
which this EDS pertains. (Include project number and location of property, if applicable):
Planned Development Application for 1401-1411 E. 53rd Street. Chicago
G. Which City agency or department is requesting this EDS? Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please, complete the following:
Specification # _ and Contract #
Page 1 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or olher similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe ¦ Municipal Code of Chicago ("Municipal Code"), the Cily 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
Smart Hotels Five Three LLC 20600 Chagrin Blvd #705. Shaker Hts, O. 44122 40%
SHG University Chicago LLC 20600 Chagrin Blvd #705. Shaker Hts. O. 44122 8%
Olympia Chicago Boutique LLC 7 Custom House St Portland. ME 04101 40%
The Olympia Companies LLC 7 Custom House St Portland. ME 04101 8%
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes [X] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV-- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II. 13.1. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, .state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any
- Contractor or any Affiliated Entity (collectively "Agents").
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Parly certified lo the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
N/A
9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during tlie 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [X] is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of tlie Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 oi the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity j including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period, as
required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTM ENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section Il.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ J Yes [X] No
If yes, please identify below (1) tlie name and title of such person, (2) the name of the legal entityto which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name ofthe Disclosing Parly submitting this EDS. Include d/b/a/ if applicable:
OEl Management Corp.
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
: , the Applicant
OR
' a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest:
OR
3. ;X a legal entity with a right of control (see Section Il.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: Olympia Chicago Boutique LLC
B, Business address of the Disclosing Party: 7 Custom House Street
Portland, ME 04101
Telephone: 207-874-9990 Fax: 207-874-9993 Email: kmahaney@theocos . com
Name of contact person: Kevin P. Mahaney •
E. Federal Employer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to
which this EDS pertains. (Include project number and location of property, if applicable):
_Planned Development Application for 1401-1411 E. 53_rd Street
G. Which City agency or department is requesting this EDS? Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
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Percentage Interest in the Disclosing Party
55%
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address
Kevin Mahaney 7 Custom House St, Portland, ME 04101
Christopher Mahaney 7 Custom House St, Portland, ME 04101 15%
David Mahaney 7 custom House st. Portland, me 04101 15%
Nicholas Mahaney 7 Custom House St. Portland, ME 04101 15%
SECTION HI -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
} J Yes :x; No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 1I.B.I. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly'or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"). N/A
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. N/A
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
J is 13j is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
j *1 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
j_2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer Or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-inrlaw, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
j Yes fx] No
If yes, please identify below (1) the name and title of such person, (2) tlie name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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