NOT FOR PROFIT ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VII, Section 6(a) of the 1970 Constitution of the State of Illinois, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the City wishes to support the charitable, educational and philanthropic activities of established Not for Profit Corporations and encourage the continued viability and growth of such activities; and
WHEREAS, many Not For Profit Corporations own property that adjoins streets and alleys that are no longer required for public use and might more productively be used in furtherance of such activities; and
WHEREAS, the City would benefit from the vacation of these streets and alleys by reducing City expenditures on maintenance, repair and replacement; by reducing fly-dumping, vandalism and other criminal activity; and by providing support for such charitable, educational and philanthropic activities; and
WHEREAS, the City can promote strong communities by facilitating services to the public, and increase the City's job base through the vacation of public street(s) and/or alley(s) for no compensation; and
WHEREAS, the properties at 4732-4758 S. Dorchester Avenue, and 1368-1380 E. 48th Street are owned by Chicago Title Land Trust, a Corporation of Illinois as successor trustee ("Land Trustee") to LaSalle Bank National Association, as successor to American National Bank and Trust Company of Chicago, March 2,1994 and known as Trust Number 118087-06 ("Chicago Title Land Trust 118087-06"); and
WHEREAS, the properties at 1356-1364 E. 48th Street, are owned by Southwold Condominium Association which approved a resolution to execute the Consent to Vacation agreement attached as Exhibit A and made a part hereof; and
WHEREAS, the beneficiary of Chicago Title Land Trust 118087-06 is an Illinois Not For Profit Corporation ("Not For Profit Beneficiary") that uses the site as a private school for behaviorally challenged children; and
WHEREAS, beneficiary of Chicago Title Land Trust 118087-06 proposes to use the portion of the public alley to be vacated herein for creation of a secure campus, unification of the campus footprint, expansion of the playground area, and temporary housing of a modular classroom; and
WHEREAS, the City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent ofthe public use and the public interest to be subserved is such as to warrant the vacation of parts of public alley described in the following ordinance; now therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. THAT PART OF THE 14 FOOT WIDE NORTH-SOUTH PUBLIC ALLEY IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION OF BLOCK 2 OF LYMAN, LARNED AND WOODBRIDGE'S
Page 1
SUBDIVISION OF THE EAST 1/2 OF THE NORTHWEST 1/4 AND THE NORTHWEST 1/4 OF THE NORTHEAST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT THEREOF RECORDED MAY 12,1874 AS DOCUMENT 159571, LYING EAST OF AND ADJOINING THE EAST LINE OF LOT 15 IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION AFORESAID, LYING NORTH OF AND ADJOINING THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15, LYING WEST OF AND ADJOINING A PORTION OF LOT 1 AND LOTS 2, 3,4 AND A PORTION OF LOT 5 ALL IN SAID BLOCK 2; AND LYING SOUTH OF AND ADJOINING THE SOUTH LINE OF EAST 47TH PLACE, SAID SOUTH LINE BEING ALSO THE EASTERLY EXTENSION OF THE NORTH LINE OF LOT 15 AFORESAID, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF LOT 15 AFORESAID; THENCE SOUTH, ALONG THE EAST LINE OF SAID LOT 15 (BEING ALSO THE WEST LINE OF SAID NORTH-SOUTH ALLEY), A DISTANCE OF 125.19 FEET (RECORD 125.00 FEET) TO THE SOUTHEAST CORNER THEREOF; THENCE EAST, ALONG THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15, A DISTANCE OF 14.00 FEET TO THE INTERSECTION WITH THE WEST LINE OF LOT 5 AFORESAID; THENCE NORTH, ALONG THE WEST LINE OF LOTS 5,4,3, 2 AND A PORTION OF LOT 1 AFORESAID, (BEING ALSO THE EAST LINE OF SAID NORTH-SOUTH ALLEY) A DISTANCE OF 120.20 FEET (RECORD 120.00 FEET) TO A POINT OF CURVATURE IN THE WEST LINE OF SAID LOT 1; THENCE NORTHEAST ALONG THE CURVED WESTERLY LINE OF SAID LOT 1, (BEING ALSO THE WESTERLY LINE OF SAID NORTH-SOUTH ALLEY) AND BEING THE ARC OF CIRCLE CONVEX TO THE NORTHWEST AND HAVING A RADIUS OF 25.00 FEET, AN ARC DISTANCE OF 5.03 FEET TO THE INTERSECTION WITH THE EASTERLY EXTENSION OF THE NORTH LINE OF LOT 15 AFORESAID; THENCE WEST ALONG SAID EASTERLY EXTENSION, 14.50 FEET TO THE POINT OF BEGINNING, IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 1,751 SQUARE FEET OR 0.0402 ACRES, MORE OR LESS as shaded and legally described by the words "HEREBY VACATED" on the plat hereto attached as Exhibit B, which plat for greater, is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacation.
SECTION 2. The Commissioner of Transportation, or a designee of the Commissioner, is hereby authorized to accept and approve a redevelopment agreement or similar instrument restricting the use and improvement of the public way vacated in Section 1 of this ordinance to social service purposes which include, but shall not be limited to educational purposes and for such use and improvements that are accessory, as that term is defined in the Chicago Zoning Ordinance, to such social service purposes, such uses and improvements to be owned and operated by a non-profit corporation, subject to the approval of the Corporation Counsel as to form and legality. The restriction on use and improvement in the covenant, agreement or instrument shall be for a term of 40 years and upon breach of such restriction the public way herein vacated shall revert to the City and be subject to the terms and conditions of the dedication by which it has been heretofore held by the City.
SECTION 3. The City of Chicago hereby reserves for the benefit of Commonwealth Edison and its successors or assigns, a non-exclusive utility easement to operate, maintain, construct, replace and renew overhead wires, poles, and associated equipment and underground conduit, cables, and associated equipment for the transmission and distribution of electrical energy, telephonic and associated services under, over and along the alley herein vacated, with the right of ingress and egress. The grade of the vacated public way shall not be altered in a manner so as to interfere with the operation and maintenance of Commonwealth Edison facilities. No buildings, permanent structures or obstructions shall be placed over Commonwealth Edison facilities without express written release by the utility. Any future vacation-beneficiary prompted relocation of Commonwealth Edison lying within the area herein vacated will be accomplished by Commonwealth Edison and completed at the expense of beneficiary of the vacation.
Page 2
r
SECTION 4. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Chicago Title Land Trust 118087-06 shall deposit in the City Treasury of the City of Chicago, a sum sufficient to defray the costs of removing paving and curb returns, and constructing sidewalk with the most current version of the Chicago Department of Transportation's Regulations for Opening, Repair and Construction in the Public Way and its appendices.
SECTION 5. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Chicago Title Land Trust 118087-06, shall file or cause to be filed for record in the Office ofthe Recorder of Deeds of Cook County, Illinois, a certified copy of this ordinance, together with a redevelopment agreement complying with Section 2 of this ordinance, and approved by the Corporation Counsel, and the full sized corresponding plat as approved by the Department of Transportation / Superintendent of Maps & Plats.
SECTION 6. This ordinance shall take effect and be in force from and after its passage. The vacation shall take effect and be in force from and after its recording.
Vacation Approved:
/YL
Rebekah Scheinfeld Commissioner of Transportation
Deputy Corporation Counsel
Honorable William Burns Alderman, 4th Ward
Page 3
CONSENT TO VACATION
letlarb prool ol cmncrfhip—Irtit commitment, ittte polio rst.l
The undersigned, irpresems that be/she is the (check one'i
ownei (skip to Season 11.)
beneficiary <*1crp to Season 11.)
__X authorized agem of the owner / beneficiary (CIRCLE ONE) described below:
Name oi owner / beneficinn: Spuibwold Condominium Association
Name ol company (if applicable); _ %
Mailing Address: Jl.5§:64 EL 48th Street tip, ^qr-) 5
Telephonerumibcr: t.773,, 1. ,. ¦ 0T7R ^M^ '^H \ 2_
If Bftm s address is drffeiem fron the owner / beneficiary, complete the followjjjc:
Narncoffirrr ^ _xt\\ )
Mailing Adams:
-«F.
Proprr.- for which cortm: is being given (insert common meet addreisl«)|:
with the »Perr«merH Index Noirsberts): (PIN #t__2Qr11-202-040-0000
(PIN ft)
(prs As ihe owner / beneficiary / d«r> authorized agent of ihe property described above, 1 give consent 10 tht vacation of the public right-of-way decribed as:
TO BE PROVIDED BY THE VACATION A PPL1CANT--1 iwen common iangosae cesorpuon ot wcanon):
The undcm?ned ap*pr»o waiv^sU claims for damages o> compensation arising from such vacation
y ' ' r '1 C\V?^-I k.- printed Li iVPft E? "nj'C^Qr?
sienec
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prime«_
Notary Public:
"t/^A^-7yZmy dai< ^/^-//b primed ,l^dtrj'Lt.fr' J^SlTQ&Q PrS f arc 1-5 dipn number? tftai ufualsyWkf tne lormof l"-?4->67-i'90-(K«i(). Tnt PIN lsauntouc number tor etcr. ptopem ano can be founa on picrvny tat bilis reiatutp to me snectiic propem
PATRICIA A: ERINGT0N OFFICIAL SEAL Notary Public. State ol Illinois My Commission Expires March 09. 2016
SOUTHWOLD CONDOMINIUM ASSOCIATION RESOLUTION
RECITALS
WHEREAS the Southwold Condominium Association is comprised of members owning nine units in the property at 1358-64 E. 48th Street, Chicago, Illinois; and
WHEREAS the Southwold Condominium Association is adjacent to the southern half of the of the north south alley, located to the west of Dorchester Avenue, to the south of 47th Place and to the north of 48th Street (the "North South Alley"); and
WHEREAS the neighboring Ancona School has applied to vacate the northern half of the North South Alley, which is not adjacent to the Southwold^oridominium Association; and
WHEREAS City of Chicago's Department of Transportation asked the Ancona School to obtain a consent letter from the Southwold Condominium Association in order to apply for the vacation of the northern portion ofthe North South Alley; and
WHEREAS on September 7,2014, the Southwold Condominium Association held a meeting to review whether or not to execute the consent to vacation letter; and
WHEREAS on September 7, 2014, the Southwold Condominium Association voted to execute the consent to vacation letter with 6 affinriing votes.
NOW, THEREFORE, BE IT RESOLVED, by the Board ofthe Southwold Condominium Association:
It is resolved that the Southwold Condominium Association consents to the Ancona School's vacation ofthe northern portion of the North South Alley; that Jim Stricklin, Southwold President, has the authority to sign this Resolution; and that Linda Tucker, Board Member, is authorized to execute the consent to vacation letter on behalf of the Southwold Condominium Association.
Subscribed and sworn to before me
re.lCIA A. EfiWGTON^f ' OFFICIAL SEAL ^ -
Notory public. Slate of Illinois; My Commission Expires ' Moich09.2016 fjf
EXHIBIT "A"
PLAT OF VACATION
OF
THAT PART OF THE 14 FOOT WIDC NCRTII-SOUTH PUBLIC ALLEY IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION Or BLOCK 2 OF LYMAN, LARNED AND WOODBRIDGE'S SUBDIVISION OF TH.E EAST 1/2 OF IHE NOK1HWEST 1/4 AND THE NORTHWEST 1/4 OF THE NORTHEAST 1/4 OF 5ECII0N 11, TOWNSHIP 36 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDINC 10 THE PLAT THEREOF RECORDED MAY 12, 1874 AS DOCUMENI 159b/", LVING EAST OF AND ADJOINING THE EAST LINE OF LOT 15 IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION AFORESAID, LYING NORTH OF AND ADJOINING "HE EASTERLY EX~ENSICN OF THE SOUTH LIME OF SAID LOT '5, LYING WEST OF AND ADJOINING A PORTION OF LOT 1 AND LOTS 2. 3. 4 AND A PORTION OF LOT 5 ALL 'N SAID 3L0C< 2; AND LYING SOUTH OF AVID ADJOINING THE SOUTH|109|INF OF EAST 47TH PLACE. SAID SOUTH LINE BEING ALSO IHE EASTERLY EXTENSION OF THE NORT-. L NE OF LOT 15 AFORESAID, BFING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHEAST CORNER OF LOT 15 AFORESAID; THENCE SOUTH. ALONG THE EAST LINE OF SAID LOT 15 (BEING ALSO THE WEST LINE OF SAID NORTH-SOUTH ALLEY), A DISTANCE OF 125.19 FEET (RECORD 125.00 FEET) TO THE SOUTHEAST CORNER THEREOF; THENCE EAST. ALONG THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15, A DISTANCE OF 14 00 FEEI TO THE INTERSECTION WITH THE WEST LINE OF I OT 5 AFORESA'D; THENCE NORTH, ALONG THE WEST LINE OF LOTS 5, 4, 3.|109|AND A PORTION OF LOT 1 AFORESAID. (BEING ALSO THE EAST LINE OF SAID N0RTH-SOU1H A'LEV) A D STANCE OF '20.20 FEET (RECORD 120 00 -~FET) TO A POINT OF CLRVA'JRE IN THE WES1 LINE OF SAID LOT I; "HENCE NORTHEAST ALONG THE CURVED WESIFR.Y JSIE 0- SAID LCT 1, (BEING ALSO THE WES1ERI.Y I NS OF SAO SORTH-SOJTH ALLEY) AND BEING r-E ARC 0- CIRCLE CONVEX TO THE NORTHWEST AND HAV NG A RADIUS OF 25 00 FEET, AN ARC DISTANCE OF 5 03 rEET TO :HK INTERSECTION WITH THE EASTERLY EXTENSION 0" THE NORTH LINE OF LOT 15 AFORESAID; THENCE WEST ALONG SAID EASTERLY EXTENSION, 14.50 FEET TO THE POINT CT BEGINNING, IN COOK COUNTY, ILLINOIS. SAID ABOVE DESCRIBED PARCEL CONTAINING 1,751 SQUARE FEET OR 0 0*02 ACRES, MORE OR LESS.
/-VACATED JULY 1, 1971 ^
/ DOC. 21532023
PUBLIC ALLEY i
L
20'
e S 5
66.00
a o o
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UJ
E. 47TH
TWFIC FLOW PUBUC STREET
TRAFFIC R.OW
H TO BE CUT
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\ \ /^C;«)S5 NOTC-
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-66 00-
OH Ixl I— V) UJ X
o
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a
TRAFFIC FLOW
PUBLIC STREET
TRAFFIC R.OW
(A)
(n)
(M) (CH) (l*AD)
ARC
RECC3D MEASURE.:) CHORD RADIUS
AREA HEREBY VACATED EOUNDARY OF VACATION AREA RiGI-T 0- WAY LINE PARCEL _ NE I OT I INF.
C.D.O.T.:
-ivwp. EDWARD J. MOLLOY Sc. ASSOCIATES, LTD.
LAND * CONSTRUCTION SURVEYORS
L-tM. n*UOMU*ou.Cr>£CM
-S PLAT THE EAST LINE OF LO- 15 IS AT AN ASSJMED
D MESSI3NS ARE S-OWN IN FEET AND DECIMAL PARTS THEREOF
NO DMENSIONS SHOULD BE ASSUMED BY SCALE MEASUREMENTS UPON THE PLAT
All. THF LAND WEST 0- AVD AOJCININC HEREBY VACATED ALLEY FALLS WITHIN ZONE RT-4. RFSnFVTIA "WC-FlAT, TOWNHOUSE AND MULTI-UNT DISTRICT ALL THE LAND EAST OF AND AXO NINO -EREBY VACATED ALLEY FALLS WITHIN ZONE RM-5 RESIDENTIAL MULTI--S 1 SIS-^CT
FIELD WORK WAS CCM=LETT£D ON JANUARY 4, 2D16
PLAT PREPARED FOR-THE ASCOSA SC-COL +770 S DORCHESTER AVENUE OCAGG, IL 606-5
STATE OF ILJNO S )
) SS
COUNTY Or DUPAGE )
I. THOUAS A, MOLLOY, AN ILLINOIS PROFESSION. LAND SURVTYCW AND UANAFJ'.NG AGENT OF EDWARD J MOLLOY AND ASSOCLATE5. LID, HEREBY CERTIFY THAT A PLAT HAS BEEN UADE LSDER UY DIRECIION FOR THE =JRPOSE OF VACATING A PORTION OF AN A-LEY AS S-OWN HLULON AND TIW THE =LAT HEREON DRAWN IS A CORRECT REPRESENT AT OS OF SAID VACATION THIS PRO^ESSONAL SERVICE CONFORMS "0 CURRENT ILL SOS MINIUUU STANDARDS FOR A PJT OF BOUNDARY SURVEY
SIGSEO AT BENSENV LLL, ILLINOIS 1HIS 4TH DAY 0- MARCH , AD. 2016
¦ UCENSE SO 184-002910
$ ,** 30-34OB $ * PROFESSIONAL i
S S LAND -|109|S SURVEYOR r|109|\ STATE OF s»
fHOMAS A. MOLLOY [ THOMAS /
ILLINOIS PROFESSIONAL .AND SURVEYOR NO. 35-^400 (EXPIRES NOVEMBER 30. 2C6 AND IS RENEWABLE)
MANAGING AGENT. ILUNOIS PROFESSIONAL DFSICN FIRM IICFNSE NO 184-002910
v*UD chlt wrm MOSSED SEAL (EXPIRES APRIL 30. 2017 ASP IS RENEWABLE)
EJMA PKOJ NO 23JO/16Q001
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/W if applicable: Chicago Title Land Trust Company, A Corporation of Illinois As Successor Trustee To LaSalle Bank
National Association. As Sucessor Trustee To American National Bank And Trust Company of
Chicago, March 2, 1994 And Known As Trust Number 118087-06. Check ONE of the following three boxes:
Indicate whether tbe Disclosing Party submitting this EDS is:
1. the Applicant
OR
2. [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
. OR
3. [ ]¦ a legal entity with a right of control (see Section II.B. 1.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 10 S. LaSalle Street, Suite 2750, Chicago, IL
60603
Telephone:312-223-Fax:312-223-4136 Email: ?AMp EUFLLA C6{J[
Name of contact person: flA^fliyA/ P^MPBAJELL^
E. Federal Employer Identification No. (if you have one):
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location, of property, if applicable): Vacation of an alley that bisect's school's property. Alley is located west of S. Dorchester
Avenue between E. 47fh PI. and 48th St.
Which City agency or department is requesting this EDS? Department of Transportation
. If the Matier 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
[ ] Person
f ] Publicly registered business corporation [ ] Privately bcld business corporation [] Sole proprietorship [ J General partnership [ ] Limited partnership LJ Trust
[ ] Limited liability company
[] Limited liability partnership
[ ] Joint venture
[ ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501 (c)(3))?
[3Yes []No [ ] 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 [ ] 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 ofthe entity. NOTE: For not-for-profit corporations, also lis! below all members, if any, which are legal entities. If there arc no such members, write "no members." For trusts, estates or other similar entities, list below the legal titlebolder(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 ofthe Disclosing Party. NOTE: Each iegal entity.listed below must submit an EDS on its own behalf.
Name Title
Chicago Title Land Trust iotA^Lfwj Trusts under trust #118087-06 '
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 Interest Ln the
Disclosing Party
Ancona School Society 4770 s. Dorchester 100%
Chicago, IL 60615
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
• Has the Disclosing Party had a "business relationship," as defined in Chapter 2-3 56 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes JO 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 spbeontractor, 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 psrson or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Parry 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 Parry 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)
[xJ 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 roust 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 [JNo
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 Parry submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article 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 or entities identified in Section II.B.l. of this EDS:
a. " are not presently debarred, suspended, proposed for debarment declared ineligible or voluntarily
excluded from any transactions by any federal, stale 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 bad a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
3. The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Parly 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 die Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
* any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Conlractor, 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 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 guihy of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors; the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
To the best of the Disclosing Party's knowledge after reasonable inquiry, no current employee of the Disclosing Party was, 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.
To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the Disclosing Party has not given or caused to be given a gift, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City
Page 6 of 33
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 $10 per recipient.
9. 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: f\|//\ _ Disclosing party is merely land trust which solely holds title to property.
Jf 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.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
(] is fx] is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge fhRf none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory ¦ lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City." •
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) 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):
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed thai 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
Page 7 of 13
meanings when used in this Part D.
1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee cf tbe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[]Yes [xjNo
NOTE: if you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in h:s or bcr own name or in the name of any other person or entity in the purchase of any property Chat (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 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 []No
3. If you checked "Yes" to Item D.I., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in 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 comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X l. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and alt 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.
Page 8 of 13
2. The Disclosing Party verifies that, as a result of conducting the search in step J above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitures full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf 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.
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying
Page 9 of 13
Activities".
5. 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 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?
[JYes [JNo 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.)
[JYes [JNo
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?
[ J Yes I ] 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:
SECTION VIJ — ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any
Page 10 of 13
contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract-or talcing 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.
B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of
the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts,
work, business, or transactions. The full text of these ordinances and a training program is available on
line at www.citvofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
C. 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.
D. 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 Parry waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter J -23 and Section 2-154-020 of the Municipal Code,
The Disclosing Party represents and warrants that:
F.1. 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
Page 11 of 13
F. 1. 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 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 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.1. and F.2. above and will not, without the prior written consent of the 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) 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 ofthe date furnished to the City.
Chicago Title Land Trust Company, as Successor Trustee to LaSalle Bank, as Successor Trustee to American National Bank and Trust Company of Chicago U/T/D 03/02/94 and known
(Sign jfere)
Mario V. Gotanco
as Trust No. 118087-06 and not personally
ffiEIK^ the undersigned Land Trustee,-
not nrsonally to solely as Trustee m the exercise of the poS
(Print or type name of person signing)
Trust Officer (Print or type title of person signing)
VS^ wM«"il«such Trustee
SEES' ?Pr?SCTtaPwK' "vaunts, (mdertakings and ^K1fntsAe,n,nlade ?n «he Part of the Trustee are undertaken by it solely in its capacity as Trustee and'not ''
3feor sha" at *V ,,me be asserted or Waft againstuhe Trustee on account of any wanamv, rteffflST rfflreseftatron/covenantundertaking Trustee in this instrument; ¦ ™
Signed and sworn to before me on (date) August 10, 2015
at Chicago County, Cook (state), of Illinois
: ?
"OFFICIAL SEAL" X
SILVIA MEDINA :
? Notary Public, State of Illinois ?
? My'Commission Expires 06/26/2016?
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 Ca) 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 Parmer 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 of the following, whether by blood or adoption: parent, child, brother or sister, aunr or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section H.B.1 .a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if tbc Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Parry, if the Disclosing Parry 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 ihe Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship'* with an elected city official or department head?
[ ] Yes [x] No
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Undersigned 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 The Ancona School Society [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Undersigned, (2) warrants that all certifications and statements contained in the Undersigned's original EDS are true, accurate and complete as ofthe date furnished to the City and continue to be true, accurate and complete (Mcafo -flfli L§taJerrU3t, ^rr^gf^^ltHbls a9§&c&fcoF$ai§giB its acknowledgments. LaSalle Bank National Association, as successor to American National Bank
and Trust Company of Chicago J^^rch 2,1994 and known as Trust Number
(Print or type name of individual or legbl 8Q87sflbn{llGI5Sa§ur3dtlBPrint or type name of signatory:
Mario V. Gotanco
¦ _ „,:-vi«- certification '^agyof the facts thetein
Title of signatory: Trust Officer
Subscribed to before me on [date] February 26, 2016 , at Cook County,
Illinois [state].
'jLg j ^AJ^Mj^U Notary Public.
Commission expires:*5^^^""^ e™"**^
urn
Ver. 6/23/03
i SILVIA MEDINA •> $ Notary PubSic, Siais of V.iinois
• My Commit irxfriro e*/2Gr5!01S ; Z6
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Parry submitting this EDS. Include d/b/a/ if applicable: The Ancona School Society
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. fc] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: Chicago Title Land Trust, Trust #118087-06
B. Business address of the Disclosing Party: 4770 s Dorchester Avenue
Chicago, Illinois 60615
Telephone: (773) 924-2356 Fax: (773) 924-8905 Emaij. bwishneganconaschool.org
Name of contact person: S Jonathan Silverman, Chair of Facilities Committee
(312) 970-0357
E. Federal Employer Identification No. (if you have one):
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable): Vacation of an alley that bisect's school's property. Alley is
located west of S. Dorchester Ave between E.- 47th Pi. and 48th St.
Which City agency or department is requesting this EDS? Department of Transportation
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 n - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature of the Disclosing Party:
[} Person {]
[ ] Publicly registered business corporation [ ]
[ ] Privately held business corporation [ ]
[ ] Sole proprietorship (?]
[ ] General partnership (Is
[ ] Limited partnership
[ ] Trust [ J
Limited liability company Limited liability partnership Joint venture
Not-for-profit corporation
the not-for-profit corporation also a 501(c)(3))?
[xj Yes [ ] No
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 pg 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
Please see attached list of officers and Trustees
No members.
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
None
SECTION m - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 32 months before the date this EDS is signed?
[ ] Yes |k] 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 ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
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.
(1) Traffic Analysis & Design, Inc., 1898 Waverly Way Montgomery, IL 60538; Consultant (traffic analysis)? $1,000 (est.). (2) National Survey Service, Inc., 30 S. Michigan Avenue
Suite 200, Chicago, IL 60603; Preparation of Survey and Plat of vacation; $2,000 (est.). (3) Neal 6 Leroy, , LLC; 203 N. LaSalle, 203 North LaSalle St., Suite, 2300, Chicago, IL 60601;
(Add Sheets if necessary) Attorneys; Less than $30,000 (est.).
[ ] 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 ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No [X] 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? na
[ ] Yes f ] No|1010|B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 3 -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
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l, of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
3. The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Parry 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 Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33 E-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 of the Treasury or the Bureau of Industry and Security ofthe 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 of the 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 ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
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, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
None.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is . is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
{ 3 Yes W No
NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. If you checked "No" to Item D.L, proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ 3 Yes [ ] No
If you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slaver}' era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
I. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed 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 witb 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 of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) 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 roust 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 ail 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:
1 Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (See 41 CFR Part 60-2.)
t-J 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?
[JYes (JNo
If you checked "No" to question 1. or 2. above, please provide an explanation:
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SECTION VII — ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or othemiae^BjU^idtplutm^ and s^jmii this EDS, the Disclosing Party waives and releases any possible rights i r claims which.it may n^TO inst the City in connection with the public release of information contair sd in. this ED.§;and.als^y^p ?es the City to verify the accuracy of any information submitted in this
:ds.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F. I. 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.1. 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.I., 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.
The Ancona School Society
(Print or type name of Disclosing Party)
(Sign here)
Bonnie L. Wishne (Print or type name of person signing)
Head of School (Print or type title of person signing)
PATRICIA A ERINGTON OFFICIAL SEAL Notary PuDi'C. Slate ot Illinois My Commission Expires Ma'Ch c« 2016
Signed and sworn to before me on (date) *3. .J]. I L
at £ oc k County, J., L (state).
Commission expires:
Page 12 of 13
Trustees of the Ancona School Society As of October, 2012
Terrell Anderson
Chip Bamberger, Treasurer (*)
Keith Bevans, Chair of Committee on Trustees (*)
Amy Ritter Cowen
Lawrence Hill
Kenny Johnson
Kim Morris Lee
Tasha Levy
Sheila Lynch
Renetta McCann, Vice President (*)
Darryl Newell
Todd Neumann
Josh Schwartz, President (*)
S Jonathan Silverman
Lisa Scruggs
Paul Watford
Bonnie Wishne, Head of School
(*) Denotes an officer. All officers are also Trustees.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, 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 JI.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 ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers 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 Parmer thereof currently have a "familial relationship" with an elected city official or department head?
[ 3 Yes jx} No
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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The Ancona School
Board of Trustees March 1, 2015
Ad Frede, Head of School
Ben Smith-Donald
Bonnie Wishne, Ex-Offiao
Dontrev Britt-Hart
Gustavo Bamberger, Treasurer
Henry Wishcampcr
Jill Potter
Joanna Trotter
Keith Bevans, President
Lara Moynihan, Vice President
Lawrence Hill
Lucila Espedido
Paul Watford
Rachel Pernio Waldron
Todd Neumann
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 to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
[ ]Yes [*]No
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 ofthe Municipal Code?
[ ]Yes [ ]No [*] Not Applicable
3. If yes to (1) or (2) above, please identify below, the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address ofthe building or buildings to which the pertinent code violations apply.
FELLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDLX 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.