ORDINANCE
BE IT ORDAINED BY CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. Title 17 ofthe Municipal Code of Chicago, the Chicago Zoning Ordinance
Be amended by changing all the B3-1 Community Shopping District Symbols and indications as shown on Map No.32-F in the area bounded by
a line from a point 123 feet south of west 127th Street along south Halsted Street; west 127th Street public alley next east of and parallel to south Halsted Street and south Halsted Street.
to those of a C2-1 Motor Vehicle- Commercial District and corresponding use district is hereby established in the area above described.
SECTION 2. This ordinance shall be in force and effect from and after its passage and due publication.
Common Address of Property:
CHICAGOLAND SURVEY COMPANY INC.
PROFESSIONAL DESIGN FIRU LICENSE NO: 184-005262 EXPIRES 04/30/2017
6501 W. 65TH STREET CHICAGO, ILLINOIS S0638 (773) 2714447 CHICAGOLANDSURVEYeSBCGLOBAL.NET
PLAT OF SURVEY
OF
THAT PART OF THE NORTHWEST FRACTIONAL 1/4 OF SECTION 33, TOWNSHIP 37 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, LYING NORTH OF THE INDIAN BOUNDARY LINE DESCRIBED AS FOLLOWS:
BEGINNING AT THE INTERSECTION OF THE SOUTH EDGE OF THE RIGHT OF WAY OF 127 TH STREET WITH THE EAST EDGE OF THE RIGHT OF WAY OF SOUTH HALSTED STREET, SAID POINT OF INTERSECTION BEING 33 FEET SOUTH OF THE NORTH LINE AND 50 FEET EAST OF THE WEST LINE OF SAID SECTION; THENCE SOUTH ALONG THE EAST EDGE OF THE RIGHT OF WAY OF SOUTH HALSTED STREET AND 50 FEET EAST OF AND PARALLEL TO THE WEST LINE OF SAID SECTION, A DISTANCE OF 123 FEET; THENCE EAST ALONG A LINE PARALLEL TO THE NORTH LINE OF SAID SECTION, A DISTANCE OF 108 FEET; THENCE NORTH ALONG A LINE PARALLEL TO THE WEST LINE OF SAID SECTION, A DISTANCE OF 123 FEET TO THE SOUTH EDGE OF THE RIGHT OF WAY OF 127 TH STREET; THENCE WEST ALONG THE SOUTH EDGE OF THE RIGHT OF WAY OF 127 TH STREET AHD 33 FEET SOUTH OF AND PARALLEL TO THE NORTH LINE OF SAID SECTION, A DISTANCE OF 108 FEET TO THE PLACE OF BEGINNING, IN COOK COUNTY, ILLINOIS.
PROPERTY KNOWN AS: 12701 SOUTH HALSTED STREET, CHICAGO, ILLINOIS
P.I.N. 25-33-100-004-0000
UPDATED 02/03/2016 UPDATED 10/19/2015 FIELD WORK COMPLETED 12/12/2012
FOR EASEMENTS, BUILOMC LHES AND OTHER RESTWCI10HS
NOT SHOWN ON THE ORIGINAL SUSDMSOI PLAT. REFER TO YOUR
TITLE INSURANCE POLICY. DEED, AND LOCAL BUILDING RECULATONS.
CLENT DID NOT REQUEST MONUMENTS TD BE SET AT PROPERTY CORNERS.
STATE OF ILUNOIS
imimiin i
COUNTY OF COOK
SCALE: 1- = 20-
ORDERED BV: IBRAHIM TLAIB
FILE NO.: 10&23VB
/'«iintt»*
LICENSE EXPIRES 11/30/2016
THIS IS TO CERTIFY THAT THIS PLAT AND THE SURVEY ON WHICH IT IS BASED
WERE MADE BY ME, OR BY PERSONS UNDER MY DIRECT SUPERVISION AND
CONTROL THIS PROFESSIONAL SERVICE CONFORMS TO THE CURRENT ILUNOIS
MINIMUM STANDARDS FOR A BOUNDARY SURVEY.
ILLINOIS PROFESSIONAL LAND
DATED THIS 4 TH. DAY OF FEBRUARY 2016.
ilONAL LAND SURVEYOR NO. J3S4
To whom it may concern:
I, Ibrahim Tlaib owner of 12701 South Halsted Street and Applicant concerning the subject property located at 12701 South Halsted Street, Chicago, IL, authorize the Law Offices of Attorney Lewis W. Powell 111 to file a zoning amendment application with the City of Chicago for my property.
Very truly yours,
Applicant
I
Descriptive Statement
Applicant poses to add outdoor auto sales to the existing auto repair shop with three repair bays, at this location. There are also fifteen off-street parking spots including handicap spaces. Days and hours of operation will remain the same. This application is to rezone the property to C2-1; this site contains 13,284 square feet.
Applicant
2nd, 2016
Dear Property Owner,
In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance, specifically Section 17-13-0107, please be informed that on or about February 8, 2016, the undersigned will file an application for a change in zoning from B3-1 Community Shopping District to C2-1 Motor Vehicle Related Commercial District on behalf of Ibrahim Tlaib for the property located at 12701 South Halsted Street.
The applicant intends to use the subject property for out-door auto sales and motor vehicle repair business with 3 repair bays and 15 parking spaces.
Ibrahim Tlaib is the owner and applicant and his address is 6951 158th Place, Oak Forest, Illinois 60452 . The contact person for this application is Ibrahim Tlaib, Ibrahim's phone number is 708-372-1716.
Please note that the applicant is not seeking to rezone or purchase your property. The applicant is required by law to send this notice because you own property within 250 feet of the property to be rezoned.
Very truly yours,
Applicant
FORM OF AFFIDAVIT (S<^on:l7rr3M),07)
Dale
llWorahlc Daniel S. Solis ChairrTi^, Committee on Zoning 121 Northi LaSalle; Street Room 5Q4,!City Halt Chicago. Illinois 60602
Ittc.unocrsignccl, _Z. /) r"/C7 fl I fyj j L a I o ^Injt lursl.dwly sworn on 0*1 K depose*
and states the following: ¦.-¦**¦»'>
The unlets igncd certifies that lie has complied v» ith tbe requfrorttcnts of Ston) 7-13-4M07 ofthe
Chicago Zoning Oiidinanc'c, by smdirig wri^ be the
owners.oTthe property wiUtui die subjert^ not sotety owned r^ me applet, and io the owners of
nit pjripc^wtfim
roads,stree'tsjalleys a^othcrp^^
ww sc^.by.FiTSt Class U|S.,Mai\no more than SO'daji'bcfote filing the applied ton.
The umfcnjijp>cd certifies that the. notice contained the address of the property swght to be rc7xni«d;'ii
siaieinetitof >JieuUeii^rcss"of the 'oimc'n jitdta'»lJitemniL;^'^ <^ie^iMei^;^:f%^a^ii&'«n'for a'chaiigc iri s^irigorjapprp
the panies to be ratified under Soclnin 17-13^0107 of thi Chicaj^Zoir^^^ and that tbe
icoim^y«^-\^^ni^ arid addressesof suriouridjhjg property owners' wtfiW250^fciVd.f the subject site is a complele list oinlainin" the names and addres^ of tl» people n^uired to be served.
Signature
CITY OF CHICAGO APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS ofthe property Applicant is seeking to rezone:
12701 South Halsted Street
Ward Number that property is located in: 34
APPLICANT: IBRAHIM TLAIB
ADDRESS: 6951 156TH PLACE CITY: OAK FOREST
STATE: IL ZIP CODE: _60452 PHONE: 708-372-1718
EMAIL: twinauto@gmail.com CONTACT PERSONIBRAHIM TLAIB
Is the Applicant the owner of the property? YES X 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: __________
ADDRESS: ____ CITY:
STATE: ZIP CODE: PHONE:
EMAIL: CONTACT PERSON:
If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Lewis W. Powell 111
ADDRESS: 53 West Jackson Blvd
CITY: Chicago STATE:IL ZIP CODE: 60604
PHONE: 312-987-9737 FAX:312-987-9093 EMAIL: lwp_law@yahoo.com
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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.
N/A
On what date did the owner acquire legal title to the subject property?
May 2005
Has the present owner previously rezoned this property? If Yes, when?
No
Present Zoning District: B3-1 Proposed Zoning District: C2-1
Lot size in square feet (or dimensions): 13.284 SF
Current Use of the Property: Auto repair garage with three repair bays
Reason for rezoning the property: to allow out-door auto sales
13. Describe the proposed use of the property after the rezoning. Indicate the number of dwelling unit number of parking spaces; approximate square footage of any commercial space; and height of the
proposed building. (BE SPECIFIC) Auto repair garage with three bays and out-door auto sales
with a total of 15 parking spaces
14. 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
COUNTY OP COOK STATE.OF ILUNOIS
statements aad the statements contained in the' doicuiiicats submitted hcrcSvitti'aie uHie and correct:
Signature of Applicant
Subscribed and Sworn >$or
NotaiyfubH
"OFFICIAL SEAL" ELVIARUBIO .
Notary Public, State of "Itnot* My CcW«sionEx_
Date of Introduction:.
Fjte-Njimber.
Ward:.
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: IBRAHIM TLAIB
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[?] the Applicant
OR
[j a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. {"} a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 12701 SOUTH HALSTED
CHICAGO, ILLINOIS 60628
Telephor : Email:
Name of contact person: ibrahimtlaib
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):
REZONING PROPERTY FROM B3-1 TO C2-1 IN ORDER TO ALLOW OUTDOOR AUTO SALES IN CONJUNCTION WITH AUTO REPAIR GARAGE.
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 # n/a and Contract # N/A
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SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
,1. Indicate the nature ofthe Disclosing Party:
; Person P"j
; ~; Publicly registered business corporation PJ
iZ: Privately held business corporation [_}
; ; Sole proprietorship f_i
P'1 General partnership (Is
Pj Limited partnership
P~ Trust FT
Limited liability company Limited liability partnership Joint venture
Not-for-profit corporation
the not-for-profit corporation also a 501(c)(3))?
pi Yes PliNo Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: N/A
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
? Yes ? No
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title N/A
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
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SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
!?! Person [1 Limited liability company
*"Publicly registered business corporation T j Limited liability partnership
Pj Privately held business corporation [ J Joint venture
p Sole proprietorship Not-for-profit corporation
Pi General partnership (Is the not-for-profit corporation also a 501(c)(3))?
p] Limited partnership QYes QNo
P j Trust Pj Other (please specify)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
N/A
For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
? Yes ? No N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title N/A
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% ofthe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
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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
IBRAHIM TLAIB 12701 S HALSTED ST 100%
12701 S HALSTED ST
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?
Pi Yes f_j 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 subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
Lewis w Powell, in (TBR) Attorney $1000.00
(Add sheets if necessary)
_j Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
r 1 Yes !?] No T j No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
LJ Yes M No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
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2. 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.
3. The certifications in subparts 3,4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
NONE
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"). NONE
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. NONE
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
M 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 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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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
? Yes v; No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[j Yes j_J No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
i_J_l- The Disclosing Party verifies that the Disclosing Parly 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): NONE
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section
501 (c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Lj Yes >'_'¦ No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
LJ Yes • j No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Q Yes i2 No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
? Yes ? No
If you checked "No" to question 1. or 2. above, please provide an explanation:
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SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
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!
|
I
J i
F.l. The Disclosing ;Rarty is not delinquent inMhc payment of an^
'De partment of Revenue; nor arc ihc Disclosing Pariy or its Affiliated Entittesdelinqueni in paying any
fine.fee, tax or other charge owed to ihC:Ciiyi.Th&
.'sc'\vcr^hWgcs^:i^ or sales Taxes:'
R3 If the Disclosing Party is the Applicant, the-Oisclosin'sJfaTtyyiirol^in'Trom'any ' coiuraciors/subeonLracibrs hired or to be hired in coiincctioij with the Mailer certifications equal in form antt sub^
City, use any sucli contfactorAubconiKictor thai does nc>'t provide, such certifications or that the;. ¦Disclosing Party has-reaipn tp'rwlieycjias"prn> vt il ctl-^o r? pii nil p t p noyi^rJc.'lrti ijh f ui: c &irt if ica il oris rr
;jNp/TEljIf the Disclosing Pany^^jiot cortUyas to an^'pf thb.iicrns tit; V.V Y2LorFJiaboye^'an: caplariafo
CERTIFICATION-
Lli)der:ocnalty of. perjury, the person &igniQ° below: (I j10 execute this KbS.and Ap^
c&'lifwntifrn*ami'M\6m&is cSrj^ned ih'ft^ and complete as!of ihe tlate furnished,to the City.
.(Prim or type nameof pisclbsing:lJariy>:
(Signbcrc) '(Print or".ixf«?Qa.mcj<)f (jcrsba isignin g).
(Print or'iyhe.iitiev'^rpei^n signing)
(state).
Notary Public.
Pa4¥ l2or i3
"OFFICIAL SEAL"
t ELVIA RUBIO
;; Notory Public, State of Illinois My Commission Expires Sept. 25,2016
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AJVD DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section 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?
ill Yes V: No
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature ofsuch familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
1. Pursuantto Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal
Code?
2. If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
3. If yes to (1) or (2) above, please identify below the name of the person or legal enti ty
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
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