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This record contains private information, which has been redacted from public viewing.
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Type:
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Ordinance
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Status:
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Passed
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Title:
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Zoning Reclassification Map No. 9-F at 3901 N Broadway - App No. 18706
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Topic:
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ZONING RECLASSIFICATIONS - Map No. 9-F
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FINAL FOR PUBLICATION ORDINANCE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the B3-2, Community Shopping District symbols shown on Map 9-F. in the area generally bounded by: A line beginning at a point 206.10 feet north of West Sheridan Rd. extended east 100 feet to a point 200.56 feet north of West Sheridan Rd.; a line 100 feet east of North Broadway Street; West Sheridan Rd.; and North Broadway Street 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 9-F in the area generally bounded by: A line beginning at a point 206.10 feet north of West Sheridan Rd. extended east 100 feet to a point 200.56 feet north of West Sheridan Rd.; a line 100 feet east of North Broadway Street; West Sheridan Rd.; and North Broadway Street to those of a Residential-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: 3901 North Broadway FINAL FOR PUBLICATION RESIDENTIAL-BUSINESS PLANNED DEVELOPMENT No. Plan of Development Statements The area delineated herein as Residential-Business Planned Development No. ("Planned Development"), consists of approximately 20,307 square feet (0.466 acres) of property located at 3901 North Broadway 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 of the Applicant, Vermilion Acquisitions, LLC. The requirements, obligations and conditions contained within this Planned Development shall be binding upon the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. All rights granted hereunder to the Applicant shall inure to the benefit of the Applicant's successors and assigns and, if different than the Applicant, the legal title holder and any ground lessors. Furthermore, pursuant to the requirements of Section 17-8-0400 of the Chicago Zoning Ordinance, the , Property, at the time of application for 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 and approval by the City Council. 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 ("DPD") and Transportation. Closure of all or any public street or alley during demolition or construction shali be subject to the review and approval ofthe 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. . 4. This Plan of Development consists of Sixteen Statements; a Bulk Regulations and Data Table; an Existing Zoning Map; an Existing Use Map; a Planned Development Property Line & Boundary Map; Site Plan; Level 2 Plan; Ground Floor/Landscape Plan; Applicant: Vermilion Acquisitions. LLC Address- .3901 North Broadway Street Date Introduced- March 16,2016 Plan Commission: June 16.2016 FINAL FOR PUBLICATION Landscape/Green Roof Plan; Level 3 Landscape Plan; and Building Elevations prepared by Hirsch Associates LLC dated June 16, 2016. 5. The following uses are permitted in the area delineated herein as a Residential-Business Planned Development: Residential dwelling units (located above the ground floor); financial services; office; retail sales; food and beverage retail sales; eating and drinking establishments (excluding drive-thru facilities); personal service establishments; accessory parking: and accessory uses. .6 On-Preniise signs and temporary signs, such as construction and marketing signs, shall be permitted within the Planned Development subject tothe review and approval of the Department of Planning and Development. Off-Premise signs are prohibited within the boundary ofthe Planned Development. For puiposes 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 Property shall be 5.0 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 20,307 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 II 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 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- . 13-0611-A ofthe Zoning Ordinance, upon written application by the Applicant, its Applicant: Vermilion Acquisitions, LLC Address: 3901 North Broadway Street Date Introduced March 16,2016 Plan Commission: June 16,2016 FINAL FOR PUBLICATION 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. Applicant shall achieve basic L.E.E.D. Certification under the Leadership in Energy and Environmental Design ("L.E.E.D.") Green Building Rating System and provide a minimum 50% green roof over the net roof area of approximately 6,259 square feet. The Applicant acknowledges and agrees that the rezoning of the Property from B3-2 to B3-5, and then to this Planned Development triggers the requirements of Section 2-45-115 of the Municipal Code (the "Affordable Requirements Ordinance" or "ARO"). Any developer of a "residential housing project" within the meaning ofthe ARO must: (i) set aside 10% ofthe housing units in the residential housing project (the "Required Units") as affordable units, or provide the Required Units in an approved off-site location; (ii) pay a fee in lieu of the development of Required Units; or (iii) any combination of (i) and (ii), provided, however, that residential housing projects with 20 or more units must provide at least 25% of the Required Units on-site. The Properly is located in a higher income area within the meaning of the ARO, and the Applicant has agreed to satisfy its affordable housing obligation by making a cash payment to the Affordable Housing Opportunity Fund in the amount of $125,000 per unit ("Cash Payment") and providing three (3) affordable units in the rental building to be constructed in the Planned Development, as set forth in the Affordable Housing Profile Form attached hereto as Exhibit A. The Applicant agrees mat the affordable rental units must be affordable to households earning no more than 60% of the Chicago Primary Metropolitan Statistical Area Median Income ("AMI"), as updated annually by the City of Chicago. If the Applicant subsequently reduces (or increases) the number of housing units in the Planned Development, the Applicant shall update and resubmit the Affordable Housing Profile Form to the Department of Planning and Development ("DPD")-for review and approval, and DPD may adjust the number of required Affordable Units without amending the Planned Development. Prior to the issuance of any building permits for any residential building in the Planned Development, including without limitation, excavation or foundation permits, the Applicant must make the required Cash Payment and execute and record an affordable housing agreement in accordance with Section 2-45-115(L). The terms of the affordable housing agreement and any amendments thereto are incorporated herein by this reference. The Applicant acknowledges and agrees that the affordable Applicant: Vermilion Acquisitions. LLC Address: 3901 North Broadway Street Dale Introduced: March 16,2016 Plan Commission: June 16. 2016 FINAL FOR PUBLICATION housing agreement will be recorded against the Planned Development, or the applicable portion thereof, and will constitute a lien against such property. The Commissioner of DPD may enforce remedies for breach of this Statement 15, including any breach of any affordable housing agreement, and enter into settlement agreements with respect to any such breach, subject to the approval of the Corporation Counsel, without amending the Planned Development. 16. 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 ZoningMap. Amendment to rezone the property to B3-5, Community Shopping District. "' Applicant' Vermilion Acquisitions, LLC Address: 390! North Broadway Street Date Introduced: March 16, 2016 Plan Commission: June 16, 2016 FINAL FOR PUBLICATION PLANNED DEVELOPMENT NO. BULK REGULATIONS TABLE Gross Site Area: 32,454 Square Feet Area in Public Right-of-Way: 12,147 Square Feet Net Site Area: 20,307 Square Feet Maximum Floor Area Ratio: 5.0 Maximum Building Height: 105' Minimum Number of Parking Spaces: 57 Minimum Number of Bicycle Parking Spaces: 93 Minimum Number of Loading Berths: 0* Maximum Number of Dwelling Units: 100 Minimum Setbacks: In accordance with the Site Plan * One 25' loading zone will be provided on Broadway Street Applicant: "Vermilion Acquisitions, LLC Address: 3901 North Broadway Street Dale Introduced: March 16, 2016 Plan Commission: June 16,2036 m FINAL FOR PUBLICATION FINAL FOR "U o ~t> id" % O ~ O £T o ^ m cr - ¦ yi r> to O a o cr> o ^ o> oi ^ 3 S |1010|o o|1010|m o o rn < m i— o m co —i m|1010| 2: i O ' ; H CD yO O > • > -< f CO ! H - 73 .v rn m ¦ H •\.r - • r~... 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^&e7^Affordable Housing Profile Form (Rental)
Submit this form to the Department of Planning & Development (DPD) for projects that are subject to the 2007 ARO. Projects submitted after October 13, 2015 - or that do not receive City Council approval by July 13, 2016 - will be subject to the 2015 ARO. More information is online at www.cityofchicaqo.org/ARO .
This completed form should be returned to: Kara Breems, DPD, 121 N. LaSalle Street, Chicago, IL 60602. E-mail: kara.breems@cityofchlcago.org Telephone: (312) 744-6476
Date: May 19,2016
SECTION 1: DEVELOPMENT INFORMATION
Development Name: TBD
Development Address: TBD (closed pas station at 3901 North Broadway) Ward: 46th
If you are working with a Planner atthe City, what is his/her name? Noah Szafraniec Type of City Involvement: Q City Land
(check all that apply) ,i—i Financial Assistance (IftfeceWMj TIF assistance, will TIF funds be
I J used for housing construction? | j*) *lf yes, please provide copy
. . of the TIF Eligible Expenses I—J
[y/j Zoning increase and/or PD
SECTION 2: DEVELOPER INFORMATION
Developer Name: Vermilion Development Developer Contact (Project Coordinator): Kerry Dickson Developer Address: 401 North Franklin, Suite 4 South; (ft Email address: kerrv.dickson@vermliiondevelopment.c0 Telephone Number: (312) 525.8808
SECTION 3: DEVELOPMENT INFORMATION
a) Affordable units required
For ARO projects: wo x 10%* = jo i_ (always round up)
Total units total affordable units required
*20% if TIF assistance is provided
For Density Bonus projects: X 25% =
Bonus Square Footage* Affordable sq. footage required
*Note that the maximum allowed bonus is 20% of base FAR in dash-5; 25% in dash-7 or -10; and
30% of base FAR in dash-12 or -16 (wwwxUyojcJ^cajga^ for zoning info).
b) building details
Each apartment has individual electric meler for lights, power and heat. In addition to water, which of the following utilities will be included in the rent (circle applicable):
3 ? ? ? ?
Cooking gas electric gas heat electric heat • • other (describe on back)
?ca ? \zIs parking included in the rent for the: affordable units? yes no market-rate units? yes no
If parking is not included, what is the monthly cost per space? $200
Estimated date for the commencement of marketing: pa!' 2017
Estimated date for completion of construction ofthe affordable units: Spring 2018
Unit Type* Number of Units Number of Bedroo ms/Unit Total Square Footage/Unit Expected Market Rent Proposed :• Affordable Rent* Proposed Level of Affordability (60% or less of AMI) Unit Mix OK to proceed?
Example 1 bed/1 both|999|800 $1000 769 80%
Affordable Units 1 bod/1 bulh|999|570 nnd 729 $787 60% Ef'
2 bed/2 bnlh|999|1,016 $2,700 $944 60%
?
Market Rate Units 1 bad/1 balh «6|99|670 (o 744 $1,650 lo«,100 N/A N/A ?
2 bud/2 balh 23|99|1,012 to 1,149 12,700 lo $2,900 N/A N/A ?
3 bdd'2 bath|9 9|a 1,284 S3.400 N/A N/A ?
SECTION 4: PAYMENT IN LIEU OF UNITS
When do you expect to make the payment -in-lleu?
(typically corresponds with issuance of building permits)
December 2016 Month/Year
For ARO projects, use |he followiiui.formula to calculate naymehtovved:
$
Amicwittratiapjrnent
™ X10%=1°IO5s3"n3lt8Un"S = 7 X $125.000= $875'°(
(round up to nearest
Number of total units
whole number)
For Density Bonus projects, use Ihe following formula to calculate payment owed:
N/A
x 80% x $_
Bonus Floor Area (sq ft) median price per base FAR foot Amount owed
Submarkat (Table for use with the Density Bonus fees-ln-lieu calculations) Mfldlan Land Price per Ba9e FAR Foot
Loop: Chicago River on north/west; Congress on south; Lake Shore Dr on east $31
North: Division on north; Chicago River cn south/west; Lake Shore Dr. on east $43
South: Congress on north; Stevenson on south; Chicago River on west; Lrtke Shore Dr. on east $22
Wosl: Lake'on'north; Congress on south; Chicago River on east; Racine on west $29
Kara Br'cfefns, DPD // Dsvclc-per/projecl M.-ioaycV
Authorization to Proceed (to be completed hv Developer & DPD)
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Department of Planning and Development
CITY OF CHICAGO
MEMORANDUM
Alderman Daniel S. Solis
Chairman, City Council Committee on Zoning
David T_. Reifman Secretary
Chicago Plan Commission
DATE: June 17, 2016
RE: Proposed Planned Development for property generally located at 3901 North Broadway.
On June 16, 2016, the Chicago Plan Commission recommended approval ofthe proposed planned development submitted by Vermillion Acquisition LLC. A copy of the 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)
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FINAL
REPORT to the
CHICAGO PLAN COMMISSION from the
DEPARTMENT OF PLANNING AND DEVELOPMENT
JUNE 16, 2016
PROPOSED PLANNED
DEVELOPMENT (APPLICATION NO. 18706)
VERMILION ACQUISITIONS, LLC.
3901 NORTH BROADWAY
Pursuant to the provisions of the Chicago Zoning Ordinance, Title 17 of the Municipal Code of Chicago, the Department of Planning and Development hereby submits this report and recommendation on a proposed Planned Development for your review and recommendation to the Chicago City Council. The application was introduced to the Chicago City Council on March 16, 2016. Notice of this public hearing was published in the Chicago Sun-Times on June 1, 2016. The Applicant was separately notified of this public hearing.
The property is identified as 3901 N. Broadway and is generally located at the northeast corner of North Broadway and West Sheridan Road. The applicant, Vermilion Acquisitions LLC, proposes to construct a ten-story mixed-use building with retail use at the ground floor and 100 dwelling units on the floors above.
This request is being submitted as a mandatory planned development, pursuant to Section 17-08-0512-A, due to the fact that the proposed project exceeds 8O'-0" in height in an underlying B3-5 zoning designation.
PROJECT BACKGROUND AND DESCRIPTION
The site consists of approximately 20,000 square feet and is currently improved with a vacant gas station. The applicant proposes to demolish the building and proposes to construct a ten-story mixed use building on the site. The proposed building will have retail and commercial use on the first floor, 57 parking spaces dedicated to the residential units on the ground floor and second floor, and 100 dwelling units on floors 3 through 10. Inside the building space will be dedicated for 93 bicycle parking stalls.
T^p7o~posed project will be primarily finished with metal and glass panels along [he ShePr°dan and Broadway elevations, the remainder of the bu.lding will be finhhed in brick. Typical accents in the form of cast stone copings, door and Endows systems Z louvered openings to vent the parking garage w.l. be
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provided. The building proposes to locate active uses immediately adjacent to the street edge along both Broadway and Sheridan Road. The proposed color palette includes red and brown brick tones, light brown, gray and white metal panel tones, and blue tinted glazing.
LANDSCAPING AND SUSTAINABILITY
The entire planned development will be compliant with the requirements of the Chicago Landscape Ordinance specifically in terms of parkway trees,
The subject site will be designed to be in compliance with the current City of Chicago Sustainable Development policy and will provide a vegetated roof equivalent to a minimum of 50% of the net roof area which equates to 6,259 square feet of area. Additionally, the subject building will obtain LEED certification.
ACCESS / CIRCULATION
Access to the site is provided by way of two driveways both located along North Broadway; these driveways each lead to a separate level of the interior parking provided for the tenants of the building. Trucks providing service to the building will use a loading area provided parallel to the Broadway curb, an ordinance for the location will be obtained by the property owner and renewed on an annual basis. The bicycle parking for the building uses is provided at various locations within the parking garage and will totai 93 spaces. All vehicle parking, bicycle
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parking/storage and loading docks will be designed to be compliant with Chapter 10 ofthe Chicago Zoning Ordinance.
BULK / USE / DENSITY
The current maximum allowable Floor Area Ratio (FAR) for the proposed underlying zoning district (B3-5) is 5.0; the proposed planned development is designed for and will be limited to a maximum FAR of 5.0. The proposed planned development will maintain setbacks that are in compliance with the requirements of the B3-5 zoning designation. All remaining bulk, use and density items will be in substantial compliance. with the stipulations of Section 17-3-0400 for B3-5 zoning districts.
RECOMMENDATION
The Department of Planning and Development has reviewed the project materials submitted by the Applicant and compared this proposal to the requirements of the Chicago Zoning Ordinance and existing development in the community. The area around this project is composed of manufacturing uses and is accessible from public transit. Based on that analysis, DPD has concluded that this proposal is appropriate for this site and supports this development for the following reasons:
Promotes economically beneficial development patterns that are compatible with the character of existing neighborhood (per 17-8-0103), as evidenced by the design of the project, and the fact that the proposed uses are in context with the character of the adjacent properties and also meet the needs of the immediate community;
Promotes transit, pedestrian and bicycle use, ensures accessibility for persons with disabilities and minimizes conflicts with existing traffic patterns in the vicinity (per 17-8-0904-1-2, 3 & 4), as evidenced by the site's close proximity to public transit in the form of various CTA bus lines as well as the Sheridan Road station situated along the CTA red and CTA purple line; the accessibility accommodations made on-site for the building users; pedestrian and bicycle ingress and egress options provided to the building users in the form of 93 bicycle parking stalls and lastly ensuring that the design of the site works within the confines of the current existing traffic patterns at the site and creates little or no adverse impact to those patterns.
Building Orientation and Massing (per 17-8-0906-B), as evidenced by the project design which brings the edge of the building up to the street frontage and provides large transparent store front windows to create an active building wall;
. 4. All sides and areas of the buildings that are visible to the public should be treated with materials, finishes, and architectural details that are of high-quality and appropriate for use on primary public-right-of-way-facing facade (per 17-8-0907-A-4), as evidenced through the information contained within this report, the proposed material is to be metal panel and glazing along Broadway and Sheridan and brick
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along the north and east elevations. Aluminum window systems, glass garage doors and standard storefront system, as shown on the elevations, are also provided. The design should be consistent with the exhibits for this planned development, and the corresponding proposal renderings.
The project meets the purpose and criteria set forth in the Chicago Zoning Ordinance and its adoption would not have any adverse impact on the public's health, safety or welfare:
Per 17-13-0308-C, the proposed development is compatible with surrounding commercial, retail, and residential developments in terms of land use, as well as, the density and scale of the physical structure.
Per 17-13-0308-D, the proposed underlying zoning for this planned development (B3-5) and is consistent with other zoning districts, both adjacent to this site and in the immediate area.
Per 17-13-0308-E, the public infrastructure facilities and City services will be adequate to serve the proposed development at the time of occupancy and the project will comply with the requirements for access in case of fire and other emergencies. The proposed project has been reviewed by the Mayor's Office for People with Disabilities and the Department of Transportation and all requested changes have been made. Copies of this application have been circulated to other City departments and agencies and no comments have been received which have not been addressed in the application.
Based on the foregoing, it is the recommendation of the Department of Planning and Development that this application for the establishment of a Planned Development be approved and that the recommendation to the City Council Committee on Zoning Landmarks and Building Standards be "Passage Recommended".
Bureau of Zoning and Land Use Department of Planning and Development
Department of Planning and Development city of chicago
3901 NORTH BROADWAY PROPOSED RESIDENTIAL BUSINESS PLANNED DEVELOPMENT
(APPLICATION NO. 18706)
RESOLUTION
WHEREAS, the applicant, Vermilion Acquisitions LLC, has submitted an application to establish a planned development; and,
WHEREAS, the Applicant is proposing to construct a ten-story mixed use building with commercial, retail and parking uses on the ground floor and 100 dwelling units on the floors above, the applicant will provide 57 vehicular parking stalls and 93 bicycle parking stalls; and,
WHEREAS, the Applicant is proposing to rezone the property from B3-2 (Community Shopping District) to B3-5 (Community Shopping District) and then to a Residential Business Planned Development; and,
WHEREAS, the Applicant's request to rezone the property was introduced to the City Council on March 16, 2016; and,
WHEREAS, proper legal notice of the hearing for this application before the Plan Commission was published in the Chicago Sun-Times on June 1, 2016 and the Applicant was separately notified of this hearing; and,
WHEREAS, the proposed zoning application was considered at a public hearing by this Plan Commission on June 16, 2016; and,
WHEREAS, the Department of Planning and Development recommended approval of the application, with the recommendation and explanation contained in the written report dated June 16, 2016, a copy of which is attached hereto and made a part hereof; and,
WHEREAS, the Plan Commission has fully reviewed the application and all associated-informational submissions, the report and recommendation of the Department of Planning Development and all other testimony presented at the public hearing held on June 16, 2016, giving consideration to the applicable provisions ofthe Zoning Ordinance.
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
1— I * I A I
NOW, THEREFORE, BE IT RESOLVED BY THE CHICAGO PLAN COMMISSION:
1. THAT the final application dated June 16, 2016 be approved as being in conformance with the provisions, terms and conditions ofthe corresponding zoning application; and,
THAT the above-stated recitals to this resolution together with the report of the Department of Planning and Development be adopted as the findings of fact of the Plan Commission regarding this zoning map amendment application; and,
THAT this Plan Commission recommends approval to the City Council Committee on Zoning, Landmarks and Building Standards ofthe final zoning map amendment application dated June 16, 2016, as being in conformance with the provisions, terms and conditions of the Zoning Ordinance
Martin Cabrera, Jr. Chairman
Chicago Plan Commissio
PD No.:
Approved: June 16. 2016
121 NORTH LASALLE STREET, ROOM 1000, CHICAGO, ILLINOIS 60602
a 4 1$
CITY OF CHICAGO
REVISED APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
2. 3.
1. ADDRESS of the. property Applicant is seeking to rezone:
3901 North Broadway
APPLICANT Vermilion Acquisitions, LLC ADDRESS
Ward Number that property is located in: 46
STATE Illinois
PHONE 312.525.8808
401 North Franklin Street - 4 South CITY _Chicago_ ZIP CODE 60654
EMAIL . Keny.dickson@verniiirondcveioj»- CONTACT PERSON Kerry Dickson
ment.com
NO
X
4. Is the applicant the owner of the Property? YES
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 FOG BS, LLC
ADDRESS 420 East Waterside - #4410
PHONE 312.505.3900
EMAIL jmintzer@saxonycap.cora CONTACT PERSON Joshua A. Mintzer
If the Applicant/Owner ofthe property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY Edward J. Kus / Taft Stettinius & Hoi lister LLP
ADDRESS 111 East Wacker Drive - Suite 2800
STATE Illinois ZIP CODE 60601
EMAIL ekus@taftlaw.com
6. Jf the applicant is a legal entity (Corporation. LLC, Partnership, etc) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
Dave Cocapne
7. On what date did the owner acquire legal title to the subject property? unk
Has the present owner previously rezoncd this property? If Yes, when?
NO
Proposed Zoning District B3-5 then to RBPD
Lot size in square feet (or dimensions) 20,307 square feet
Current-'Use of the property Abandoned gas station ,
Reason for rezoning the property Proposed height of new mixed-use building exceeds 80'
and requires a planned development. ; ;
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)
Mixed-use building will contain 100 dwelling units with ground floor retail; there w_ilj_be_57
on-site parking spaces; ground floor will contain approximately 3,260 square feet of ret_ailj_ _
Height of building will be 105' to the top ofthe tallest roof structure.
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.cilvorchicauo.oru/ARQ for more information). Is this project subject to the ARO?
YES
application for broadway. sheridan
COUNTY OF COOK STATE OF ILLINOIS
Kerry Dickson, being first duly sworn on oath, states that all of the above statements and the statements contained in the documents submitted herewith are true and correct.
/,
igr^tftire of Applicant
Subscribed and Sworn to before me this /J£ day of June. 2016.
Notary Public
.SEEN
CLAYTON LGHEEN OFFICIAL SEAL Not'ory Public, Slato of illin.ois My Commission Expires a february 10, Z020
Date of Introduction:,
File Number:
Ward:
application for broadv/?.y_sherldan
CITY OF CHICAGO KCONOMTC DISCLOSURE STATEMENT AND AFFIDAVIT
SUCTION i -- GENERAL INI''ORMA'tTON
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ i.f applicahle:
rocv \l} in
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Parly submitting this EDS is: •i. {'"'i 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 ari'inte/est: fob (V; , Ltkl.
OR ~3. { ,!a legal entity with a right of control (see ScctiontL'B.l.) State the .legal name ofthe entity in
which the Disclosing Party holds a right of control: . .
Business address of the Disclosing Party: ^00¦ Wl A/Tfcfc,T"H\A£ ft\h&&
mmm/}^
Telephone: (f-Q'(p.^ (fPfa .Fax: . ^- . Email: Off/K
:Narne:o^cojhtactp 0T\(\t\C . 0:, t4^fr)g/#fe& .
Fe'derKl EriVplpyer Id.ea^ (if ydu haveotie): ' P'f'~ •^f'-'** H L -
Brief description of contract, transaction-or^^ to below as.the "M atter") to
which this EDS pertains. (Include project numb.er.w^o^ail^'h.' of property, if applicable):
.jfe rVPf.M^n.QNJ rcCL . ^ ifkiomuj/^ .
G. Which City .agency or department is requesting this.EDS? ^plQ .
If tlte Matter is a contracl bcing-hah'dlcd by'the'Cily's Department of Procurement Services, please complete the following-:
Specification V' . and Contract^. . , -. .
Page 1 of 13
SKCTION II -- IHSCLONURK Ot1' O WNKRNI 1111 IN I KRESTS
A. NATUKE 01- Till-. DISCLOSING PARTY
I. Indicate 11»e nature ol" the Disclosing Party:
Person Limited liability company
: Publicly registered business corporation ; Limited liability partnership
Privately held business corporation ; Joihi'von'tiiie
f Sole-proprietorship, f T Not-for-profit corporation
f : General .partnership (Is the jiot.-fQivprofit corporation also a 501(c)(3)")?
[ 5 Limited partnership OYe's ;']}No
i Trust. ; Other (please specify)
2. For legal entities, the state for foreign country) of incorporation or organization, inapplicable: &#/s.LV I/} ty ; & "
3. For legal entities noi organized in the State of Illinois: Has the organization registered io do busihess-in' life State of Illinois as'a'foteigri entity?
fl Yes ^No p N/A
B. IF THE DISCLOSING -PARTYiS A LEGAL ENTITY:
I. List below the fu 11 nanies and- titles of all executive officers and all directors of the eniity. IS 0'JCE":''ft'.bP- iidt^.fb'i^c.C'jRt •cp'ftjoratiifna- aIsoTi'st:bclbw .-a;ij^nernib.eFs,: if any, w'hich^arc legafentiljes. If there afe;rio such members/write "no members." For ItT-isfsj estates or other sitriilar entilies, list below thty c'gal> ti tl olio i d.cr(s). '
^Ifitii^ehtjtyXi$^siv.gcnc;raLpattt.nefsl^rp.,.Ijjintted partnership, limited-liability cpmpany, iimijcd;liability
paftri&fcsi^ lisrcbptpy^t^ ahcbtifi&Ofc^
manager pr any other, pefson or, enti^ Patty.
NOTEfEach lcgaL^^ mtist sjib>n
Name Title
f.^'C o>. U rVC-p.r ; _ .
2. Please provide the following-infoftnatiOiVconcernifii; each person or.cii.tily haying a direct or indirect beneficial interest (including ownership) i.h-'excess.of 7.5% of (he Disclbsitig Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership dr joint venture,
Page 2 of 13
int.ei c.sl of a member or manager in a limited liability company, or interest, of a beneficiary of a trust, cstale or oilier similar entity. If none, state "None." NOTE: Pursuant to Section 2-1 54-030 of the Municipal Code of Chicago ("M unicipal Code"), the City may require any such additional information from any applicant which is reasonably intended lo achieve full disclosure.
Name Business Address Percentage interest in the
Disclosing Party
$L,h& RnrTntr/j tap' Q<\vd Ui tr r&g r/.y- n g, ftiQff- x. S L
'fjo QTtioO ££ np,A,-o il'S'j-
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
._ j Yes ^fTNo
If yes, please identify below the namc(s) of such City elected officials) and describe such rclationship(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
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) ' lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
X Check here if the Disclosing Party has not retained, nor expects tb 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 Cily must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
. ' Yes ^No No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment-of all support owed and is the person in compliance with that agreement?
_. Yes No
FURTHER CERTIFICATIONS
I. Pursuant to Municipal Code Chapter1-23, 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 businessAvith theCity, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty ;or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledgesthat 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 T supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Parly is a legal entity,'all of those persons or entities identified in Section ILB. 1. 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 n 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;
arc not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause 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 lo 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 Patty, 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
Neither tlie Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the live years before the date this IiDS 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 Matler:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe 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 iu 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 stale 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.thc Disclosing Parly nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of lhc'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 InspectorGencral), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe 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:
Page 6 of 13
IT (be 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 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").
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 Cliicago. 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.
jfl/A.a/k : :
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
is ^isnot
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. Wc further pledge that none ofour affiliates iSj 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):
<^ f)ML\ _
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Parly certified to the above statements.
D. CERT IF IC A TI ON REGARDING INTEREST IN CITY BUSINESS
Any words or terms that arc defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-1 10 of the Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
Yes >
NOTE: Ifyou checked "Yes" to Item D.L, proceed to Items D.2. and D.3. Ifyou 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.
Docs the Matter involve a City Property Sale? "Yes XNo
Ifyou checked "Yes" to Item D.L, provide the names and business addresses of tlte City officials or employees having sxich 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 tlie Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered inlo with the City in connection wilh the Matter voidable by the City.
1. The Disclosing Party verifies that the Disclosing Parly 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 Parly has found.no 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, 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 purposcs 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 "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 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 lo 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
Tlie 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 ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that cither: (i) it is not an organization described iu section 501(c)(4) ofthe internal Revenue Code-of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Parly is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs AT . .through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.
R. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes No If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (Sec 41 CFR Part 60-2.)
: ; 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?
Yes _ No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
I.;Ycs "No
If you checked "No" to question 1. or 2. above, please provide an explanation :
Page 10 of 13
SECTION VII -- ACKNOWLEDGMENTS, CONTRA CT INCORPORATION, CO M PLIANCE, 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 Cily action, and arc 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 Cily contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cilyofchicag6;6rg/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, incomplctc 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 hot'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 Parry to participate in other transactions with tlie 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 tlie City's policy to make diis 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 niformation submitted in litis EDS.
E. The infonnation provided in this EDS must be kepi 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 II of 13
F.l. The Disclosing Party is not delinquent in Ihe payment of any tax administered by the Illinois Department of Revenue, nor arc the Disclosing Parly or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, properly taxes or sales tnxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will noi use, nor permit their subcontractors lo use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or lo be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent, ofthe City, use-any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any ofthe items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
CLO,
(Print or. type.riamcrof Disclosing Party)
(Sitai.herc)
(Print or type name of person signing)
.
(Print or type title of person signing)
Signed and sworn to/before me on (date) F~'S/br-y\ t\rr\- I^T-^ , 'Z Oi i
J^+J^^ 1 (state). &
^^~"a^^^F%:
Page 12 of 13
''''wnitO^
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to he 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 ahy.Spousc or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familialTelatiorisliip" exists if, as of the date this EDS is signed, die 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 TLB. 1 .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 of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal; officer- of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the-Disclosing Parly. "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 ^Uo
Page 13 of 13
If yes, please identify below (I) the name andtille of such person, (2) the name of the legal entity to which such person is connected; (3) the name andltitle ofthe elected city'official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAVV/PROBLEM LANDLORD CERTIFICATION
(he Applicant.
.1 J?m^ui)_ntvto^^ as a
ibuilding^^
Cocie?i;'T— • - '-;
Yes
No
2. llUhc&pp^j^^
&e.A^^ Section
j^Yc'g. f^N'p llfoQ Not Appiicable
^ ; or
buil&ngs^
¦;FiLLIN;¦;A%D AGT^EME^ BY REFERENCE INTO, AND M ADF/A*P ART-OF, THE ASSOCIATED EDS, ANi^ATTHF/^ ^UBlffep^THMER^
Prigc J4 of 14
(DO MOT SIMM IT THIS J'ACili WJTT1 YOUR l.iDS. The purpose oiTliii.; pngo is for you if. recertify, your IIDS j>rfor lo .submission lo City Council or on ilie datv uicldsin^. ft'unable n> receitify tinthfully, the Disclosing Party must complete: a new HDS witli. correct or corrected information)
Ii ECEUT1FIC ATTON
Gencinlly, for usowith City Council malices. ¦Not*foi\'City_.procurcinciits milOKS requested.
Tliis record ficntion is bciivg submitted in connection with PD at 3901 N. .Broadway
[identify (hc jviallerf. Under penally of perjiiry, ,^ below:' (1) wamiuts that
he/she is autlutri/.cd to execxile this F.DS rceci iiticoition .on .lH-linlf of tlie J'>isclo'singT'uri.y,- (2)
warrants that iii 1 cerufieaiiohiKahd statements coi^ original-EDS
are tine, aceuniio and complete os;of ihe. dnio funiislicd k» Ihe City :\n und;(3) ieafliriiis'ils ackiiowleatyiYeins.,
FQ6;,14,LLC D'fltc-. MpV^S.ioi^
(Print or'type legal :na\nft'6f5;Disclbsing Parly)
By:
(sigiv'hcfl;|:^'^', Print of ryp._
Tide'of signatory;
Notary-Piiblic.
Comjul:ssion''^^^jg^£_-
... i~~mmm» -
Vri-. ll-(il-W
CITY OF CHICAGO RCONOM IC DISCLOSU R E STATEMEN I' AND Al'TTDAVIT
SECTION 1 - GENERAL INFORMATION
A. Legal name ofthe Disclosing Parly submitting this EDS. Include d/b/a/ if applicable: FOG BS, LLC
Cheek ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: 1. the. jVprrtiaaflt 0\>J^£rK ^f" 3^MJ .GxCufi&wfifj OR
2- (._] a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest: .
OR
3. []a legal entity with a right of control (sec Section Il.B.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 420 E. Waterside Unit 4410 _
Chicago, IL 60601
Telephone: 312-505-3900 Fax: Emaii: jmintzer@saxonycap.com
Name of contact person: Joshua A. Mihtzer
Federal Employer Identification No. (if you have one): v ^
Brief description of contract, transaction or other undertaking (referred to below as the "M atter") to which this EDS pertains. (Include project number and location of property, if applicable):
Planned Development Application for 3901 N. Broadway
G. Which City agency or department is requesting this EDS? DePl °f Planning and Development
If the M atter is a contract: being handled by the City's Department of Procurement Services, please complete the following:
Specification it and Contract V .
Page I of 13
SECTION I'I -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF TI IE DISCLOSING PA RT'Y
I. Indicate ('lie nature ofthe Disclosing Party: /
! j Person \\ /I, itnilcd liability company
j Publicly registered business corporation ; Limited liability partnership
j Privately held business corporation I j Joint venture
: Sole proprietorship j j Not-for-profit corporation
' General partnership (Is the not-for-profit corporation also a 501 (c)(3))?
' i Limited partnership f jYes i No
f i Trust ! I Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
_ ' _ _
3. For legal entities not organized in the State of Illinois: H as the organization registered to do
business in the State of Illinois as a foreign entity?
? Yes []No ]*QN/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 ofthe entity. NOTE: For not-for-profit corporations, also list below all members, ifany, which are legal entities. If there arc no such members, write "no members." For trusts, estates or other similar entities, list below the legal titlcholder(s).
If the entity is a general 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 tlie day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
. aw-^i^
city? W {AAPh^ _ ^%r^::
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,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None.'" NOTE: Pursuant to Section 2-154-030 of the Municipal-Code of Chicago ('-Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
- - - ' /.Disclosing Party
vXy\ i,:u.A. frt.fovy l?o(pn, l\\\Ur^ . f o.&
MM^S^^ - ¦__ ...
jot£^.i4 i -Styfi^¦cA^<&&{$$&\_ j2_.:_
¦ > >-,> 4^<&^ - \ ;..:..„
;¦. S15CT ION ;! IT-- B USiNKS S RM< ATIO JN S111 fsjiV!^ - . . ,.v. ,.
x; I-ta's\tlv^ ¦.:
¦: G i> d e, w'i tli .a.ny;C it ye 1 ec t cd io f f iei a 1 iir:;iheil2 nionthsibefpi'e
y.[ -Ifycsjlrilcas^^
xmplbycesXwh^^ V'
;.iii:V-.: \^f\-.-.xlji*:- •. .V.v&V: :'.' -: •. ~;rv-"V;:.:?;^^
;?*.f' .iicti^ (2,)f;
;v atrbtber incm ."j;.'.- ~" 7r:
•".¦•" > ;I&ffip?Discl6|ing;^a ¦'' '¦.
[.'i''. -jpjscjpj{.iiig;\l^trty' lTiiist eith tlie^Jisql.osiirc. •"¦
Name (indicate whether Business Relationship to Disclosing Party Pecs (indicate, whether
retained or anticipated Address (subcontractor, attorney. paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rale" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that: contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court, of competent jurisdiction?
Yes
[]No person directly or indirectly owns 10% or more ofthe Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
? Yes ? No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article 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 lias admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: .If Article J applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons in entities
identified in Section 11.13.1. 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 dale 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;
arc not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause 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 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 ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Parly, nor any Contractor, nor any Affiliated Emily of either the Disclosing Parly or any Contractor nor any Agents have, during the five years before the date this IiDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during tlie 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 lo bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of the federal government or of any state or local government in the United Slates 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 ofthe 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 ofthe 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, tlie-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 tlie Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
. ~J$^F ~ ~~~ ¦ ~
Pane 6 of 13
If (lie letters "NA," tlte.word "None,1' 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 ofthe Disclosing Parly who were, at any time during the 12-ruonth period preceding the execution date of this IiDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
jvO}JU_
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" 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 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.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1. The Disclosing Party certifies that the Disclosing Party (check one)
? is ed-Tsnot a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"Wc arc not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that hone 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) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
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 to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that arc defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-1 56-110 of the Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
Yes
NOTE: Ifyou checked "Yes" to Item D.l., proceed to Ttems D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant lo 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 ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant lo the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
Yes ^jNo
Ifyou 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 Cily official or employee.
sl. i^iiK I J.r'iu./A 1 Kjjn lvb(jA\.J.VL>.inO ,M./v v rirv 1 iiK/a. o ij ^ i.-.t>.S
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
ic Disclosing Party has searched any and all records of
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matler voidable by the City.
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 die Disclosing Party has found no such records.
J l_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 fuuded, 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 tlie 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 tlte 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
Tin; Disclosing Parly will submit an updated certification at the end of each calendar quarter in winch there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that cither: (i) it is not an organization described in section 501(e)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an. organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
I f the Disclosing'-Party is the Appjicanl, the Disclosing Party must obtain certification's equal .in form and substance to paragraphs'A.l. thrb'ugh A.4. above from all subcontractors ''before if awards anj subcontract and the Disclosing Party mustmaihta'ih all such subcontractors' certifications for the duration ofthe- Matter and •must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQU AL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal.regulations rcquire.the Applicant and all proposed subcontractors to submit: the'¦ following information with their bids or in writing at tlie outset of negotiations.
Is the Disclosing Party flic Applicant?
? Yes
If "Yes," answer the three questions below:
1. Have you devciopedsand^ file affirmative action programs putsuaiit'tp applicable
federal regulations? (See 4"LC^§^art>6b-2.)
? Yes.
3. Have you participated Tn any'previous contracts or subcontracts subject to the equal opportunity clause?
If you checked "N6" to questional\: or 2. above, please provide an e'xplahatidn:
Page 10 of 1.3
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PEN ALTIES, J)ISCLOSDRK
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 oilier Cily action, and arc material inducements to the City's execution of any contract or taking other action with respect to the M atter. 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.cityofchicaKO.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 lo 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 thai:
Page 11 of 13
F. 1. The Disclosing Parly is not: delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor arc the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or olher charge owed to the Cily. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickels, property taxes or sales taxes.
F.2 If the Disclosing Parly is the Applicant, the Disclosing Parly and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Parly will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2.above and will not, without the prior written consent ofthe City, use any.such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F. 1., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) dhfbehalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as ofthe date furnished to the City.
(Print or type name of Disclosing Party)
(Print of type name of person signing)
fi{i^wy(Print or type title of person signing)
Signed and sworn to before-me omjdatc)
at &<>&J\ County, ^- ^~
3/
(state). _ Notary Public.
Co mm h&jon expires:
CITY OK 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 (h) 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 (I) all executive officers ofthe 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 Parly, 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 tlie Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secrelaiy of a legal entity or any person exercising similar authority.
Docs tlie 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?
["'jYes ?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 arid 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.
Page 13 of 13
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. Pursuant lo Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
Yes
?
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 tlie Municipal Code? /
| J'Yes | jNo ;qjNot Applicable
If yes to (1) or (2) above, please identify below 'the .name ofthe person or legal entity identified as a building code scofflaw or problem'landlord and the address of the building or buildings to which tlie pertinent code violationsyapply.
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.
Page 14 of 14
(DO NOT SUBMIT THIS PAGE WITH YOUR. BUS. The purpose olThis pane id for you m recertify your EDS prior- lo submission to City Council or on the dale of closing: Tl'unablc to recertify.truth fully, the Disclosing'Party must complete n new EDS wilh correct or corrected informal ion)
RKClvR-riFJCAriO.N
Generally, for use with Cily Gfaunejl'matters. Not fo); City procurements unless requested.
This .rccejli.rtcation is:bcing;subn'i.ilicd in cbti'n'cotiou with :PD.aC3.90"V-N. Broadway ._
[identify the Matter]. Uiidcr;pe;nal^
hc/slic j's.authorized to execute.this J.-1DS rceciti(ieniioj) on bdiolfof die Disclosing Patty; (2)
warrant*-ihaf.all cortiticatioiis iVid stuteinchis-cpnUiii'icd in iheDisclosing Parly's orijjuiaLEDs
aretnic, ac'otintto and'completc its bf (he dale furbished to the Cily iind.continue to be (riic,
Hccur^t^i^'cb.iitplctc as;6^thc;daie of th reaffirms .its
acjiifowlctl^meiils.
Fbousri-uc Date: M'?y.K6. zoic
(Print or type legal name of Disclosing Party)
(sfgri"jv6i
Tiljo'^igiiatibry:
j ^
#>^^'W^I^^§4r. Notary Public, eonitnisiioii ^^&&uA^&^r*«
Vcr. 1 i:-0lJ)S
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:
: , .; , MARS, BS, LLC
Check ON E of the foljqwing three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1 • O tnP Applicant _
OR
2. [Yj a Jegal entitydioldmg a:direct;or indirect .interest .in the Applicant State the¦ legal nainerbf the
Applicant in which'tiie5bisc{osing Party holds ah interest: fo6bs.llc. ..' :.
3'. |31 a;legal entityvyitlvja"-riglVt/dfl/coiit'rp" 1 ¦.Cs*?'e- SectionI-^B') State the legal name.;of tiie entity in
Avhicirtfc control: _^ ' ".^-.--¦¦J, .'-•:-:. .
B^ui^ ¦ '^35 North Michigan Avenue, Ste.:2Dp9"; % . \,.,\:.'/jV ¦.
G; /Tclephoife: 630-954:7354. X;r:.:. . ,, ¦¦ -;F.aX:.. . . Emaill .pbryant@m|dafnericagrp,com .
D. Namc.dfcohtact pefson.-.Paui.^ / ¦ .V,|;....... ;.j¦¦^-¦'¦l
; E, ^Federal Employer. I ii ^.jrl t i'fi c a t i v.lij;^ j C i ^ c» H Y>9 9'$^)': ¦' , ,',.^y^ ¦ /
F^Brief^escnpn^
which this EDS[-pertains. '(Incju^-jprpjtect.iiumBer an'd;-local ion'- of property, if gppTitiabii;):
Piajiped.deivelop.ment-applicat]6'n.»rpj3^.p.1:.I^^Br<«(|yray.>._• ... ¦ . ,,.' .„, ,. ,;
.G:-Mhich-Gity:^ . :
If the M.atter:is.a cohtfact:b^ the City's; Department of Prooureineht §01^008.^16350,
complete the following:
Specification,^ : ¦ ¦ .j- and Contract // ¦¦ ¦" • ¦-.=¦'¦;... ,-'
Vi.T.ot-oi:i2 Page 1 of, 13
SECTION II -- DISCLOSURE OL OWNERSHIP INTERESTS
A. NA T U R E O F THE DISCED SING P A R T Y
1. Indicate the nature oi' the Disclosing Party:
i "' Person ^ Limited liability company
; Publicly registered business corporation Limited liability partnership
I' _] Privately .lielidbusiness corporation ^ j Jointventure
fl Sole^opfiotorship' D Not-for-profit corporation-
I: General:partnership (Is the not-for-profit corporation also a 501(c)(3))?
[" r Limited-ipartncrsliip f^-jYes :|„|No
fl-Trust- ' [HI Other (please specify) : '•
2. P.dr^e^VF^i^'s, the state (or foreign country) of incorporation or organization; if,applicable: •
3 . For legai;^ntitiesmpt tfr^:ah'ized:iri--.thc- Stale 'of Illinois:: H'a'sj-the orgahfzatioh registefed;to do
•busjir^s^^ '"¦' V. ¦ . ;
-;'v. . ~) N'o |/]:N/A. ¦
B: I F - -^ :
;1.
-l^O^I^Eo^^ 'lisfbclp/w.;-^ If
¦'thei&a'^ writer"no members:" -E-britfusjts;' estates-cm othehsimilar^ -bclb'w
.:thelle|;^ ''0'^; Xr ¦ 7 ¦¦yy^-f ::7;77;:^
'Name^'o ' \ ... • r: ; . 'Title ': : );—]:,
Paui:RV:Bryant • - : , • • . Manager bY*M^^
2. :¦ PIcase provide the fo 11 qwing information concerning each person or entity having a direct or
indirect beneficial ownership) in excess.of 7:5'%Vpf, the Disclosing-Party. -Examples
of suclvah 4h'iei:estinfc:iude;share's in a corporation,-partnership.'interest in aparliiershipor joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-1 54-030 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
Paul R. Bryant 435 Michigan Avonuo Sin 2009 Chicago IL 606011 |
, Dan TaUSk 435 N. Michigan Avenue Sic 2009 Chicago IL 606011
SECTION III— BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
T las the Disclosing .Party, had a "business .relationship;" as defincd in Chapter 2-156 of4he Municipal; Code, with ahy;Gity elected
.::il);ycs,;,. ... .j&Np ; .. ../, r. -,;h,. ,.'..... .¦ v.v:;;:.>:,^
'•If^y.esiipleXiej^ £ '¦:
feiatibriship^ ,! ' . ,:;;;v; .;.-^;;: }%^;^\A^(::.r u -L ¦ ¦ ¦ ':^;v
SECTION IV,-- DJS CEO SURE: OFY S UBCONTiRACTORSAND OTI1ER RETAINED PARTIES
r :;Tlie,;b.is;cl^
lobbyist, accountant, consultant and ariy o
* br^xpectis pSYrefairi in x^MectibmSy it o f Ithe^clatibhsb^
amifAufitiof
empilqyees^wl^ 'V.
"LoHb.^isf phadmin
. aetioff^qn^ or:pnfit^'6tbef than
ano.therlnclud.es undert^
. Tf!tHe.l^iscIp.sing_Paity;ls ii'ncertaiii -Wheithcr.';aXdisc'losure is.required under tbis Section|;the; DisclosingvParty niust:-either'.ask the .Qity:^Iiethcrdisclo'sure is required or.make the disclosure. .
Page 3. of. 13
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.cl." is
not an acceptable response.
(Add sheets if necessary)
£^Check- here if the Disclosing Party .has not retained, nor expects to fetainV any siich .persdhs or entities SECTION V — C E R T IF IC A T IONS A. GOURT-ORbM
rTjnderMurii^^ of bitsiness;entities%^
th'e.^ijty-must:remain iri!.'Gonipliancc with thejr chilcf s
¦ Has'any p'e ofpic Disciosit^
Vai^'^ ¦¦¦
: ^-yes . • .'• ®f;N:p. .jQNqp^
pX^;X - Disci o si n g'Par ty!
iTjfc^e^
iSv'tHe-peVso'n inxbnipliarice - with ;thatiakgreeiiieht?':;;':.
fl "Yes' ?' Flfe^*'-'7' " " ' '' ':V'• -r" ^V^^*':-- - -¦¦¦¦:'*>¦< :^'r-v-:.
b; furtMi^ s 7.': r^. 3,' ' \4r'' ::Jix ^
1. Pursu^M Iv23.;vA;fj-i'(cl'e;l ("Article l?90wlM
cbnsulffqr^efi^ rsttbmittjngfthisiB^
certifies a%;|oliojys.: •(i)'Jfld*Uh"e.r.lthe'-Applic"ant--nor anyconl to11 i ng^persbri is cdirrentlyyndicted;oi' charged
with, br:his%dmitted,lg^ placed•imdei " .
criminai "offense"'invo.IyStVg actiiai, attejriptcd, or conspiracy to committbribeYyi':ih^
peijufy,.dirslfohe/t^ bfficfer' orr£m.£loyee of tlie. City onatfy'isisteV^
Appiicahf'tind'efste that compliance with ATticie'TMs a^.W
do.ing business vv-ith tire City., ;;NOTE: If Article I [applies-to. the Applicant, th'Cr.perma.nc
timeframe¦iii. Article I" siip.ers;edes some five-year compliance timeframes ih.^
Page 4 of .13
The- Disclosing Party and. if the Disclosing Party is a legal entity, all ol'those persons or entities entitled in Section ll.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 apublic 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-n;ot.presen.tly.hidicted'tpr,,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 afiye-yearperipd preceding -the datcofihis -EDS, had one.or .more .public transactions; (federal, ,
e: ha^'eTfbt/^ been cpriyicted,vadjudged .
;guilfy£^ any[:criminy;pr civil action, including actions
ppticef™ gpyernrnentj-any
;;:;sb^^ ^ ; ¦¦',.,¦>-¦ '¦ : ^ -:.
T^ejcgrt^ v :'.
^•.•tKe;Dis^lps'ing•-•P.arty; ; vany-^emtractpr" xOiiheetipti^
• any;:"AMlia^ pr entity tiVat; dir ec 11 y pr indircc11 y:•' c q n tr oIs the
^DisciM^
cemmpme^ ancther person or entity. Indicia pf control include, withqut limitatipn:
interim
:&ndritie'ligiftih withvfedcrai or state or local government, including^
-theiG.i^iusing^ub
with^sppcfti^ Affiliated^Ehtity means a^perspn pf entity that directly Or
ihdirectiycc^ntfpls the -CQntractor;- is -controlled :by it^pn:w:ith.;tlic .Cpntrac^ common cctitrol pf aripther pcrspn or entity;
• any fesjSphsible official pf the; Disclosing Party, ,any;.Gohtractor or any Affiliated Entity or any other; official;agentpr employee ofthe Disclosing Party, any .Contractor or any Affiliated Entity, acting pursuant "to the directiprior authorization of a responsible official of the Disclosing Party, any Contractpfionahy Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Eniity, 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:
a. 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, of any agency ofthe federal
government or of any state or local government in the United States of America, in that officer's
of employee's official capacity; :\ -:
agreed :br 'co 11 uded vyith-pther bidders or prospective bidders, pf becri a party to any suclv-
agreement, or been convicted or adjudged guilty of agreement or collusion among1 bidders or
^pjQ^'pepliyfe^i'd'ders; tmrestrair^ of/competition by agreement
dtnerwise; Of' :
rhad'e an'Sdriiissibri 6f sti iii a. or b. above that is%:m'aFt'cr-'b'frecbfSi-but'
baye;nqf:,bbe^ ¦' ¦-' ' :'¦¦>:'''' -¦^¦>k
d. " yioiji|ej^ . ( Li vi n'g ;W agfe;0 J'd 1 n an.cb^ -
¦4; ^.mtoer'th^
ageiYtsprfparniers &r^ulf bf
engaging^ (;2)j.bjd^^a'tm'g;;in
vip'latioh^ '
America,that dbntairis the same elb^ • ;;
"S.¦¦: N/either/t^ ¦¦ma'inMn^
;B,4feauvpf^ su^cesso*s;:;th'^^ -'D:e§ign&^ "
DebarrediList. ; : :':'-'y-'^ 4¦¦|99|¦ '"•:'v? " :'W':
'jS. Td\e D j s c^ 2^5;S: (Le|^
M^nicipaLCpdpv .J;;^ Xi ' - :-7';- - r'X} :'\t:\^ '• ''
7 ILthc Disclosing Party ismnable|:p certify tojany of the a^by'e-stateni'ehts'in!fliis\tP,artB^'Fufltber
Certifications)'^ ...*:ih-:-\s.-r ,.>xv •
'.'; ' t-v:~^yW
Page-6 of 13
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. Tor purposes of this statement, a "gift" does not include: (i) anything m.ade gencraiiy^ayaijabTe'tp City employees or to the general public, or (ii) f6;$d^fcdrinfc'providediiHhe course pf official City business and haying a retail value of less than $20 pcr^fecipient (if none, indicate with "N/A" pr "nprie"), :Xs to any.gift listed below, please also list the name;'pf flre.Crty recipient.
G. CERTIFICATION CT STATUS; AS 0NANCIAE INST1TUTI0;N •-¦¦^ : 'l . TTIe Disclosing^
¦ .' LJ>S ' ¦ F^;ts n'pf. \:\,'- '-::"-
a ''firianciai institiit ,
2. If the Disclpsing^ar^ then' the^isclcsingiMrty
"Wc arc not and will hpfbecorite-^ predatpry lender as'defined4mCM^
Code:-W ncrie pf thcm)wi 1 1$ecpme;^a pf edat ory
lender as defined in Ch^ .We understand that becoming a;predatpry
leffjdlefji)ivb.e.cpmitig;aii:a.ffi result in'the lo^
business wjtli-tiie-Cityf"'i ; v ? ,: •
If tlie Disclosing Party.is"':m^ because if of any of its affiliates r(as defined in
Section 2-32-,455(b) of tlie Municipal Cede) is ,a. predatory lender withiii'thelffleahifig pf Chapter 2-32 ofthe Municipal Cpde, explain here (attach additional pages if necessary):
Page 7 of 13
if-the letters "NA," the word ''None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms .that are defined in Chapter 2-1 56 of the Municipal Code have the same meanings when used in this Part D.
1. .In-accordant 2-156-110! of tlie.Municipal: Code: ;Dbes any official or employee
of the:Gity hav.e, aTinahcifilJnterest in his or her Own.name or-in/theinain^pf-any.other persoif or cntity in the Matter?
•^.^es,. [/]''No
NOTE:;:^^^ Item D.l .,¦ proceed to. Items ID.2. and D.3. If .ydmcheeked /Iko", to
itemtl^ r ;-,V ¦ ¦-¦'« , ¦¦ -. ."!.:-:-;:'--
.- y&TsU
reject^ -havea :fin£nciafinfe name;:or :in^
any other person" or^entityan thb purcha^ •••':
;^f^:;t^^
"jGityfProperty Sale"); Compensation for property Taken pursuantto'the City's eminent domain pbwe
^be's1'^
DbesstjfeMatte"™ 7
officials b'f^suc^in'terest;:'
Name' 7.-,;-¦"=.'. .: ;B,us.iness; Address .ir:, ¦ .^LHature of Interest ¦¦¦>¦.< ,
4. /sThe;TJ|isc;lbs.ifig^R^ finanpiahinterest in the-Matter vyill
be acquircalby^^ or employee: ¦' / ; ¦.;'¦<:
E. CE-RTlE lC A TfON REGARDING SLAVERY ERA; BUSINESS
Pieiise check-either 1. or 2rbelow. If the Disclosing Party chcck.s'2., the Disclosing Party1 miisf disclose below or in an attachment to this EDS all information required by paragraph 2. Failure, to
Page.8 of .13
comply with these disclosure requirements may make any contract entered into wilh 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.
|109|1 2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
DisclosingrPartythas foundrrecords of investments or profits from slavery or slaveholder insurance policies.- The Disclosing'Parly.verifies that the following constitutes full disclosure of alLsuch records, including-the.names of. any .-and: all slaves or slaveholders describcd.;in. those records:;;
SECTION VI - CERTIFICAT;IQJ\S FORFED E RALLV FUNDED MATTjERS , r ;u;
NOTE: If the Matter is federally^ Section VI. If the .Matter'is;iiot^fed_eraliy_
fundedi proceed to Section VII. Fof. purpo ses o f this Section VI, tax;crediIs a 11ocated;:by the City arid proceeds of debt obligations b
A. CERTIFICATION REGARDING LOBBYING
, . List/below the names of;alLperspns;o registered under the federal Lobbyirig.
i. DisclbSQW^^
; respect to thc.Matter: (Add sheets if necessary): • ' :""::v:-:;i-:?-
(lf.no explanation appears or begins '-'on :the-line's above, or if the letters ."NA" of if the word •¦l^jbne,-' r
appear?;it wiil be conchisivcly pfesu Disclosing Party means that'-NO persons or.entities
r.egi ste'r.e'd Tiride r_th e;.Lob.b-yjii g.D j s closu rp^A c UbfU 9A5ih a yre„m a de.J o b.b.y.i ng xpnt.acts^qh^beh.alf.bfTli e T
Disclosing Party with respect to.the.^Matter.) > i- v. V :. - ;> > •;..<¦
2. The.Disclosing Party has nob spenfand.will not expend any federally appropriated funds to pay
any person or entity listed in- Paragraph A: 1.: above.for his orTier lobbying activities or to pay any
person or entity to influence or atfeippt to influence or employee of any agency,- as defined by
applicablcfederal law, a member of Congress, an officer or ctnplOyce of Congress, or an employee of a member of '.Congress', in' connection '.with-tlfe'award of any federally funded' con'ffa'cff'iMkiti'g'an"yl federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend,.or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe 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) ofthe 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. 1. 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 Disclosiug Party the Applicant?
Yes ? No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (Sec 41 CFR Part 60-2.)
Yes ? No
Have you filed-With the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes ? No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes ? No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECT ION 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 connecliemwith the Matter, whether procurement, City assistance, or other City action, aiufare material inducements to the.City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party underslands that it must comply with all statutes,.o.rdinances, and regulations, on whiclvthis ED.S is;basep.T%-6i.ty!s>GbVcriiniental Ethics and Campaign, Financing Ordinances, Chapters 2-156 and 2-1^4; of : the MunicipaliGode, impose certain dutics.-and o.biigatiqns'pn persons or ehtities;sceking«City,0ntrac^ work, business,- or transactions. . .The full text of these brdinances-and a; training.pro.graniis/-availab^e^on-line at w w w^ cj tyofch' icago. org/E th ics, andmay also be bbtaiiicdfrom the City's Board of Ethics, 740 N.
Sedgwick^St:, Suite'500,;Chicago, IL:606tty, (312) 744-9660. The Disclosing Tarty must comply fully with the ap.pli6tabie;prdinanccs.
;:G;iilf the*Gity?deieririineS:thatariyirifbrmatiph.prpvidejdihTiiis EDS isfalse--:ihcpriiplete,pr inaccurate, *•
;ahy?bbritra^ orMe void . br;i
(iypidable^abdjjt^
•Mid), at;pv^
'decimipg^tP'a tciipafticipa'tbW^ iReme^ies|at:;
la w^foiVa falser an' award to the City of treble
.damages; ; .-'.;: ;;.K-v " 7::;.7-v';' ^^^^.^/^^f^-Al'V ':'• ;•'•:
reqiibsf:;j Spmew^ prpylded^pn fj^
vniznd&ays^
ptirerwise. By;pPiTi^ ariy^ippssible
:rign% br^claim iaga irisj? .tJjfe -}.^f iftfoipi^a%bn;ii;
cpitfaine^iii tjiis EDS-an^alsp authorizesfheC^ information ^bniitjed
-innSi^EfiS; ¦ ;%:!.';::^ _ ' ¦¦ '¦''"'¦¦;\ ' ''"^^ \ ''. W::-^-^^r'-
^:£he4in^ .ih*this-EDS-miist4^^
iPaf^mVist supplbmfentThis EDS up tc theTime;;tlVe.City-:take'sacti'pn onthe Matter./ If theVMafter js;ia:
xqSirac^ City's TJ'epaftfh^
up'date.'th'isE'D^/as^^Iie.xpntract'requircsv^p.TE-: W.ith-respectTp^Mattcrs subject tciA-rticlefipf. ChaiHcf-:l^23.pf the Milnicipal Code (impbsing:TER^
pffpbses'^ must-be -.kept-current fpr-a.kmger.peried,
as required by^C^
Tlie Disp.ldsing'P'afty.Teprpse^ warrants tliat:
Page 1 1 of 13
F. 1. The Disclosing Party is hot delinquent in the payment of any (ax administered by the Illinois Department of Revenue, nor arc the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes:
F;2 If the Disclosing Party.is the Applicant, the Disclosing Party and,its A ffiliatedTintilies'w.ill not' use, nor permit their ¦''subcontractors to.use^-any facility listed.by the U.S. E.P:A. on the/federal Excluded 'P'artie's'.List S.ystem ("EPLS")'maintaihed by the :U." S. General Services; Administration1.
E.-3 if>.die;Disclosing?Pm will;obtain ffonV-ahy- -;•
contra^ with ¦the Matte recertification
feniiriabd'-'Substance-to'-W^ F?i-.>-'aW*:F;2vabo.ve-aiYd'w,il Gjtyvusea^
Discibsing(P-aTty has^rcason t0-be'|.ievfe5has;'n'dt;p^rovi.ded or- cartifotiproyide/1
explanatory stat^ ™.,A?t attachb.d to.this EDS: ¦ ':\77.;7> . \\...¦
C E RT1.1^1'jC A T10 N
..... ... ...... . -
'i^tifiba^
¦ and? cbmtifef e^as ¦b^.tlie;da'te^fu;rn i shedf to^thelC i ty:-.> <-:r'S-*
(Prin'tj'br ^ p'et\son;sigmhg^: •'
(•Print or type fi ':'•' ¦ -. ^ '
Sfghedfan^'swprn 'toVb^fore Ypc pn'(da'tc) l^flfojAffi}''
at; V^^H^:--, .C.bunty,1"^7^;^^j:/>J .¦';• /{state}.: - ]!C$fec. ¦j^t4^4''7r~ N-otaiw-Ptiblic.
Commission expires:
HOTARY PUtSJC - STATE Cf IUI?WIS
my onfisssibN exmES^owisiiT.
Paiic.l'2of 13
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you lo recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct-or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
This recertification-is being submitted in connection with PD at 390,1 N. Broadway
[identify the Matter]; Under penally of perjury; the person signing beloW: (1) wan-ants that ' he/she is .authorized- to execute this EDS recertification on behalf of theDisciosi.ng:Party,,(2) warrants that all certifications and statements contained i'n thc DisclosingT.arty's original EDS are true, accurate and complete as of the .date furnished to the. City and continue to-be-true, accurate and complete as ofthe datc;of this recertification, and (3) reaffirms its acknowledgments.
mars bs. mc
ig Party)
(sign here) \ Printer typc;iiarVjc
Date: May 25.-2016'
Title.of signatory;
yi%/^v .
Signed and sworn to before.me on:[dale] M^> V. ^*>^ L» , by
(^A^^i*. LYfi*46.c. ... -at -PhfL County, /ko/jJoU . [state].
-/K^^-—-^---- Notary Public.
Commission expires; "cK't'iy .T£* t-c- I'? ¦
OFFICIAL SEAL CAROLYN MHRONEC NOTW PUft.lC - STATE Of ILLINOIS' MY'«JM^SIOf<.EXPlRES.-07n'5/17
Vr.r. 11-01-05
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) aiiy 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 Avhich 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:"Appj|cab.le;F "familial rel at ion ship" with
aiiy elecTed city bffiCial'pr departmehthead; A 'Tam'ilial relationship" exists if, asfoTthe"date"Ufis-'EDS.is
signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Parkier thereof to
the mayor, any^ai^ city cleric, the city treasurer or any city department head as s^us|V'd?W^'ti.9.
partner "dr. as any oftlie follpwirig, whether by blbod-or adoption: pa'i;eriti:child; bfb^ niece'drmephewy^
or stepmotherj;.;steps^ stepbrpther pf:
. <;Appjibapl^ Disclpsih£:;P!^ parttiefsh;$^
par^reliip^aif^ members cf the Disclcsing Party, ifthe Party is a
Hrnitedimbii^
a 75 ;pgrcj^tp^n'er|lMp "Principal; <^eejrs"jmeansil thjyp^id ipliief.;
operati ngjpffi^ pfil cer^jLTeasurer, pr. ^ret^jipf a r leg^ticntity pr;any> perspn
exCfcisihg:'sirpilar?au^ ¦' : ¦ :^'<-:<-= ¦ ¦ -.^ v^.';.';
Dcesi^:Di01^ihgfPa^ pr any "Applicable Party" of any Spou^ Or|Dprries.tic Partner -thereof- currently have a "lamilial'r^
r~] Yes "V:: fi^No
If -.yes^ple^se idehtify belpw-f|10th^name and1-title;of such»p&s^ such person is connected; (3) tiie'na'me and title bf meelecf^
persbn.ha£.:aTa^ ii.:
Page 13.of 13
C0NOM»C^OS0>^8 *********
rOBt SCO* ttvc A^^vr^^ftoSttpss--
CITY Ol- CHICAGO ECONOMIC I.)ISCLOSHUE S'J'ATEM1CNT AN 13 ATEIDAVIT
SECTION I - GENERAL INFORMATION
Legal name of'(ho Disclosing Parly .submitting this EDS. Include d/h/a/ if applicable;
ycQg fV^ftpg, -LcLp :
Check ONE ofthe following (luce boxes;
Indicate whether the Disclosing Party submitting (his EDS is: L ' "¦ the Applicant OR
2. ^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: f^O^ LL-C^
OR
3, *:• a legal entity with a right of control (sec Section II.B.l.) State the lcgnl name ofthe entity in
which the Disclosing Party holds a right of control:
Business address ofthe. Disclosing Party: S °[0 0- u/lft/7 &CrijtA fl. ftlftfifr
Telephone: Cfllf -ri'^° ¦¦ Fax: Email: Name of contact person: I^P\R.)C (>¦ 1-1 /-) C E. b/ P R
Federal Employer Identification No. (if you have one): ^ • M .
Brief description of contract; jt.rarisaction or other uiidertaking (referred to below as,the "Matter1-') to which this EDS pertains. (Include project number arid location of properly, if applicable):
G. Which City agency or department is rccpicsling this EDS? }^P/)
If the Matter is a conlracl being handled by the City's Department of Procurement- Services, please complete the-following:
Specification # _. and Contract // .
Page lot' 13
SECTION II -- DISCLOSURE OF OWNEKSII11' INTERESTS
A. N ATI IR F. OF TH \l DISCI -OSING TARTY I. Indicate the nature ofthe Disclosing Party:
Person : Limited liability company
. Publicly registered business corporation Limited liability partnership
Privately held business corporation ; Joint venture
: Sole proprietorship ; Not-for-profit corporation
General partnership (Is the not-for-profit corporation also a 501(c)(3))?
Limited parlncrship [ .Yes [No
' Trust • • Other (plenscspccify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
0>r-/r-;
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business iu the State of Illinois 'as a foreign, entity?
* Yes JX.No • N/A
B. IF THE DISCLOSING PARTY IS A LEGALTiNTITY:
1. List below the full namesand titles of all executive officers and nil directors of the entity. NOTE: For liol-Jbr-piofitcorporations, also list below all members, ifany, which arc legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal litlcholder(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, managor or;any other person or eniity (lint controls the day-to-day management of die Disclosing Party. NOTE: EachTcgal entity listed below must submit an;EpS/6n its own'behalf.
Name Title
nft jjg 0 . |T. A f J^/VfcR. |)^1'.0^
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,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." .NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Inlcicsl in the
Disclosing Party
¦^TftO/ 6,ltftpc CitciC, >ft/npq,Pi 3jblc,
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the dale this EDS is signed?
.jYes X'No
If yes, please identify below the namc(s) of such City elected official(s) and describe such rclationship(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
Name (indicate whethej business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
lo be retained) lobbyist, c(c.) "hourly rate'' or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
.X Check here if the Disclosing Parly 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% ormore ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
j Yes ^No 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?
/.Yes No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter .1-23, Article 1 ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosiug 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 lias admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency" and (ii) the Applicant understands and acknowledges that compliance with Article 1 is a continuing requirement for doing business with ihe City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes sonic five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 1.5
The Disclosing Pany and. ii" tho Disclosing Party is a legal entity, all ol" those persons <>; entities identified in Section ll.fS.l. of this RDS:
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, slate or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
arc not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, Stale or local) wilh committing any of ihe offenses set forth in clause D.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 Eniity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Parly, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of.intercsts 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 tlie City, using substantially the same management, ownership, or principals as-the ineligible entity); with respect to Contractors, ihe term Affiliated Entity means a person or entity 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 ofthe Disclosing Party, any Contractor or any Affiliated imtily (collectively "Agents").
Page 5 of 13
Neither the Disclosing Paily, nor any Contractor, nor ;my Affiliated F.ntUy of either the Disclosing Party or any Coniractor nor any Agents have, during the five years before the dale thin F.DS is signed, or, wilh respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before Ihe date of such Contractor's or Affiliated Entity's contract or engagement in connection wilh the Matter:
bribed or ailempled to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the Cily, the Stale 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 olher 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 coil duct described in a. orb. 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 (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States .of America 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 ofthe 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.
Page 6 of 13
7. If the Disclosing Parly is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Parly must explain below:
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 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").
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 IiDS, 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.
A/0ikG .
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one) is
a "financial institution" as defined in Section 2-32-4 55(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 ofthe Municipal Code. Wc understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
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):
M4/ir „ -
Page 7 of 13
If (lie letters "NA.," die word "None." or no response appears on the lines above, it will be conclusively presumed that tlie Disclosing Party certified to the above statements.
D. .CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2.-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 ofthe Municipal Code: Docs 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 XNo
NOTE: Ifyou checked "Yes" to Item D.L, proceed to Items D.2. and D.3. Ifyou 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 iu 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 diis Part D.
Does the Matter involve a City Property Sale?
""Yes XN°
Ifyou checked "Yes" lo Item D;l., provide the names and business addresses of the City officials or employees having such, interest and identify tlie nature of such interest:
Name y.- 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 cither 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply will) ihcsc disclosure requirements may make any contracl entered into witli the City in connection with the Mailer voidable by the City.
^X^ 1. The Disclosing Parly verifies that the Disclosing Party lias searched any and all records of the Disclosing Parly and any and all prcdeccssoi 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 Parly verifies that, as a result of conducting the search in step 1 above, ihe
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, 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 arc 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 tlie 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 ihe award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Paity will submit an updated certification at the end of each calendar quarter in which there occurs any event thai materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
Tlie Disclosing Party certifies that either: (i) it is not an organization described in section 501 (c)(4) of the Internal Revenue Code of ! 986: or (ii) it is an organization described in sect ion
501 (c)(4) of the Infernal Revenue Code of I 986 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.J. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
• Yes No
If "Yes," answer the three questions below:
' I. Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (Sec 41 CFR Part 60-2.)
L: Yes ¦ _ No
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable'filing requirements?
Yes , No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
.(V Yes '" No
Ifyou checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
O
SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, C O M P LI A N CE, PEN A LT] ES, D1S CLOSURE
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 Matler, 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 Parly 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.cityofchicaRo.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 auy information provided iu 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 tlie City of treble damages.
It is the City's policy to make this document available to the public oh 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 Infonnation 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 Parly 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 1,1 of 13
F.l. The Disclosi.uu Parly is not delinquent in the payinenl of any lux administered by the Illinois Department of Revenue, nor arc the Disclosing Parly or its Affiliated Entities delinquent in paying miy fine, Ice, lax or oilier charge owed to the City. This includes, but. is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not. use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPFS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is (he Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with, the Matler certifications equal in form and substance to those in FT. and F.2. above and will not, without the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in FT., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf ofthe Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
SLb& PfltTAVfrfu?, U>P
(Print or type name of person signing)
(Print or type title of person signing)
(Print or type namcjaf.Disclosing Party)
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 -1.54-015, die Disclosing Party must disclose whether such Disclosing Patty 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 die date this EDS is signed, die 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, raothcr-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 tlie Disclosing Party listed in Section II.B. 1 .a., if die 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, managi ng 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 diereof currently have a. "familial relationship" with an elected city official or department head?
Yes
If yes, please identify below (1) the name and title of such person, (2) tlie name ofthe legal entity to wluch 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, mid (4) tlie precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO KCONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX K
BUILDING CODE SCOF.ITAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be conipliitedonly by (a) (lie Applicant, and (Ii) any legal entity whiclr lias a direct ownership iiKcix-si iu-(iie Applicaii^cxcceding-7.5;p ."O.wncr"). It is hot to be completed hy any legal'cujfity^vhich;has-oniy^aiiJiidjt:l!C.(owJiersliip interestTn the Applicant.
1. Pursuant toMunicipaFCfldc-SecUgin 2f 154-010, is;thc.Applfcant or any Owner idenlificcl as a
•building code scofflaw or.pToWcm'jatfd'lord^ 2-92-4.16 ofthe Municipal
Code? ""' :"""
If the' Applicant is n lcgalcnlily.publiclyTraded bivanycx^ the Appiicuhbidcntifi
2-92-416 of the Mimicipnl Gode?.'
[~] Yes- :@'No j^j.Not Applicable
,lf yes to fd).Qr/(2)^ entity icienlificdaf a biiildingxp^ or buildiugs to which the pertinent cbdc'violations apply.
/_ - :
lULLINGiOUT THIS^^
and agreement ^eh^ .refei^-^
ANTi/FHAT'rini.REPIU?Si^ ARE SUBJECT TO THE ^CERTIFICATION; MADE UNDER PFINAt/rY OF PEIUUllY ON PAGE 12 OF TJ1E ASSb CIATED EDS.
Pajjc 14 of 14
(DO NOT SUBMIT THIS PAGE WITH YOUR 'CDS. Tho purpose, of (his page is lor you to recertify your BDS prior io submission (o Hiiy Council or on Ihedmcof closing, ll."unable- to recertify tnnlifully, the Disclosing Parly mu>a complete u n«:w BDS wivh correct or corrected information)
RKCKin'U'lCA'JTON
Generally, for use wilh City Council-matters. "Not; for City procurements unlosd.rcc|ui:sn:This rectification is ¦¦being subniUtcdiin coiiticctiori with PD;nt'-3'90i N. Broadway
[identity'tlie" Mailer). IJiider-pctinlfy of perjury} the poison sijuiihg bclow::(:l) war'tarifc that, he/she" is' authorized tb execute this .CDS reccrti ficatiou ¦on'bena'if of .the' D.isciosiiig'Parly, (2j wnrraiils thVtt.ii.il certifications find {italcmciits' cbiitamcd iirilic'Diaclosiu.!.! P-urty's.origiuid EDS aru<(ruc, accurate .ahd-coiiiplo'lc as of "the dale fun'usiicd to the Giiy iihd continue ib be true, accurate and complete as of ihe dale of this recertification, and (3) rcaffimis .its ackuoWiedpinciit?.
SLDQ Pihiiefs/ilLP
(1,'rihtortype, legal.name of Disclosing-Patty)
(sign-here) •• .print ortypG.naiue bftsignatpry:
Title.of MgonHjiy:
Vcr. 11-01-1)5
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: Vermilion Acquisitions, LLC
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 of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [3J 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 ofthe Disclosing Party: 401 North Franklin, Suite 4 South
Chicago, IL 60654
Telephone: (312)239-3534 Fax: Email: dave.cocagne@vermiliondevelopment.com
Name of contact person: £avecocagne
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-3901 North Broadway
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
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing ?i | j Person
[ ] Publicly registered business corporation • _ j Privately held business corporation ;""! Sole proprietorship i j General partnership j ! Limited partnership i| Trust
[7'j Limited liability company
[ J Limited liability partnership
i~ j Joint venture
[""] Not-for-profit corporation
(Is the not-for-profit corporation also a 501 (c)(3))?
? Yes riNo [ J Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Illinois
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 0 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 Dave Cocagne, Managing Member
2. Please provide the following information concerning each person or eniity 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,
Page 2 of 13,
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 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
Dave Cocagne 401 N. Franklin, Suite 4 South, Chicago
401 N. Franklin, Suite 4 South, Chicago
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
LJ Yes 0 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.
Page 3 of 13
Name (indicate whether Business retained or anticipated Address to be retained)
Relationship to Disclosing Party Fees (indicate whether
(subcontractor, attorney, paid or estimated.) NOTE:
lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
$25,000
225 W Hubbard, Fiflh Floor, Chicago
(Add sheets if necessary)
I Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[. j Yes [/] No Q] No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
? Yes
B. 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.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.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;
arc not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause 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 ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe 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. orb. 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 ofthe following lists maintained by the Office of Foreign Assets Control of the U.S. Department ofthe 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) ofthe Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official,
of the City of Chicago (if none, indicate with "N/A" 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)
[" j is (7j 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 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 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13.
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee ofthe 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 [7] No
NOTE: Ifyou 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?
Yes [J No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13 -
comply with these disclosure 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 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 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 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 -
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 ofthe 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) ofthe Internal Revenue Code of 1986;'or (ii) it is an organization described in section 501(c)(4) ofthe 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?
Yes rjNo :
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
Yes ? No
Flave you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes ? No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes : ] No
Ifyou checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII-- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and arc material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing 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 1 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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F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
Vermilion Acquisitions, LLC
(Print or type name of Disclosing Party)
By: iQ^AJ^
(Sign here) Dave Cocagne
(Print or type name of person signing) Managing Member
(Print or type title of person signing)
Signed and sworn to before me on (date) • *3 j [ ji/
at_fclK 2. County, lluvimS (state).
F3 A) ~ ft fit)
(
Commission expires:
UUSjiAM. _"',( Notary Public.
OFFICIAL SEAL
NOTARY PUBLIC • STATE OF HUfcOiS MY COftOflSSlON E&m£S:03mnB
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the 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 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 ofthe 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 tlie 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?
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 ofthe 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
fl'
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this pane is lor you to recertify your HDS prior to submission to Cily Council or on the elate of closing. If nimble to recertify truth fully, the Disclosing Pnrly must complete o now IiDS with correct or correctctl information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
This rcccrtification is bohuj submitted hi connection with PD at 3901N13 roadway
Date: May 25,201c
Votmliloii Acquisitions, LLC
[identify thc.Maller]. Under penalty of perjury, the person sign tnu, below: (1) warrants lhat he/she is authorized to execute Ibis. EDS reccrtlficatipii on.behalf of the Disclosing Parly, (2) warrants that all -certifications and statements contained in Ihe. DisclbsingTarly'.s original P.DS nro True, accurate and complete ns of diediilcTurnisUed to tho City and continue to ho true, accurate and complete ns of the dale of this rcccrtification, and (3);rcaffirnvs its acknowledgments.
(sig'iuicre) Print or type name of signatory:
DovoCocauno
(Print of typo legal name bf Disclosing Party) e'luicre)
Title of signatory: Managing Mombor
at .Cjx^
Signed and sworn to before mc=o».fdnto] /%uy ZQlj ,,hy
County, jfcV-,
Notary Public.
Commissioiv cxphes:_
V'tf. II-0L05
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