This record contains private information, which has been redacted from public viewing.
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Type:
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Order
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Status:
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Passed
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Title:
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Tag day permit(s) for Salvation Army Metropolitan Division, The; Blue Cap; State Department of Illinois Polish Legion of American Veterans, U.S.A.; ChildFund International; and Chicago Firemen's Post 667
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CHICAGO April 13. 2016 To the President and Members of the City Council: Your Committee on Finance having had under consideration one (1) order authorizing five (5) applications for City of Chicago Charitable Solicitation (Tag Day) permits. A. The Salvation Army Metropolitan Division / June 3-4, 2016; November 1, 2016 - December 24, 2016 (excluding Sundays) Citywide Blue Cap August 19-20, 2016 Citywide State Department of Illinois Polish Legion of American Veterans, U.S.A. May 19-22, 2016 Citywide ChildFund International April 14,2016- December 31,2016 Citywide Chicago Firemen's Post 667 May 25-27, 2016 , Citywide having had the same under advisement, begs leave to report and recommend that your Honorable Body pass the ordinance(s)/order(s) transmitted herewith. This recommendation was concurred in by fa vjYa^"*p vote of the members of the committee with dissenting vote(s)). Respectfully submitted (signed)^> q^^V^ X6>. JL Chairman Ordered, that the Committee on Finance is hereby authorized and directed to issue charitable solicitation (tag day) permits to the following organizations: The Salvation Army Metropolitan Division June 3-4, 2016; November 1, 2016 - December 24, 2016 (excluding Sundays) Citywide Blue Cap August 19-20, 2016 Citywide State Department of Illinois Polish Legion of American Veterans, U.S.A. May 19-22,2016 Citywide ChildFund International April 14, 2016 - December 31,2016 Citywide Chicago Firemen's Post 667 May 25-27, 2016 Citywide 0—L Edward M. Burke Alderman, 14th Ward i PERMIT NO. 2016-07 COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET PERMIT NUMBER: 2016-07 GROUP NAME: The Salvation Army Metropolitan Division ADDRESS: 5040 N. Pulask .i Road, Chicago, IL 60630 TELEPHONE NUMBER: 312-205-3537 CONTACT PERSON: Shanell Allen DATE WRITTEN REQUEST WAS RECEIVED: March 8, 2016 SOLICITATION DATE: June 3-4, 2016 November 1, 2016 - December 24, 2016 (Except Sundays) CITY COUNCIL DATE: April 13,2016 COMPLETION OF FILE DATE: STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED: DATE PERMIT LETTER WAS SENT TO ORGANIZATION: April 13, 2016 VIOLATION fS) COMMITTEE LETTER SENT: COMPLY RECEIVED: COMMENTS: APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT (Please neatly print or type. If necessary in answering any question, please attach additional sheets.) Name of organization: The Salvation Army Metropolitan Division Address: 5040 N. Pulaski Road, Chicago, IL 60630 Telephone Number: 773-725-1100 Use the space below to list names, current positions, residence addresses and Telephone numbers of the officers in the organization: Lt. Colonel Charles Smith : 5040 N. Pulaski Road Chicago, IL 60630 List the date and approximate location(s) of solicitation: June 3-4, 2016 and November 1 thru December 24, 2016 Sidewalks in the Public Way throughout the City of Chicago Approximately how many persons will be engaged in the solicitation? Approximately 75 people/volunteers Explain the methods your organization will use to solicit funds: Volunteers will be using marked Donut Day collection boxes and Red Kettles Has your organization ever been allowed to solicit funds in prior years in the City of Chicago? If so, when? Yes, we have solicited in the City of Chicago for 75 years. Include the following with your application: A copy of the registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois. A copy of the tag, badge, emblem or other token (if any) which will be distributed as part of the solicitation, or which will be used by your organization in its solicitation. Please include any other relevant information which would assist the Committee on Finance in reviewing this application. APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION. I/WE, THE OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.) of Pev&L-opneNjr Signature Title Date_ Signature Title Date_ HOLD HARMLESS AGREEMENT The undersigned officer on behalf of the subject organization agrees to defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations. The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way. The officer of the subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement. Name of organization Signature of organization officer 3 ib Date Mar-08-16 05:29pm From- OFFICE OF THE ATTORNEY GENERAL March 8, 2016 STaTK oh ILLINOIS THE SALVATION ARM Y 10 W ALGONQUIN RD Lisa Madigan DES PLAINES, IL 60016 *riurnky ckneuai. RE: RE: Status of.THE SALYATK iN ARMY under the Illinois Charitable Laws CO# Dear Registrant: This letter i& pursuant to yo xr request that the Attorney General confirm the siaius of THE SALVATION ARMY under ih«, Charitable Organization Laws. This organization is.cuirenily regisrered wilh the Attorney General's Charitable Trust and Solicitations Bureau as i . and has been granted single religious exemption from filing annual financiafrepons w .iti our office. Please let us know if you require further information. Sii cerely, Taiiyah Martin Barnes, Compliance Officer Ch writable Trusts Bureau 1 Oi) West Randolph Street, 11th Floor Ch cago, Illinois 60601 Teephone: (312)814-2595 I i I Founded n 1S65 by Wi,:^n ^ri;l Catherine Booth Metropolitan Division P&ul R Seller territorial Commander Charios H Smith l.T Co:onei D i v i s i o n 11! C o ¦¦ t. m a i1 d e i Andre Cox Gonoral March 8,2016 Mr. David Espinoza Committee on Finance City of Chicago 121 N. LaSalle Street Room 302 Chicago, IL 60602 Dear Mr. Espinoza, Enclosed you will find an application from The Salvation Army requesting approval to conduct a charitable solicitation in support of our upcoming Donut Day fundraising event and Kettle Campaign. The dates of this year's event are June 3-4, 2016 and November 1 thru December 24, 2016. Funding from this event will help to support The Salvation Army's program and services for people in need throughout the city. We thank you for your past support and assistance in securing these permits and approvals. If you have any questions or need additional information, please do not hesitate to contact me at 773-205-3537 or Shanell_Alleni@usc.salvationarmy.org .
Best regards,
Shanell Allen
p. 773 72R 1100 I f 773 725 282? ! www Ra:amiych:eago org
PERMIT NO. 2016-08 COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2016-08 GROUP NAME: Blue Cap ADDRESS: 2155 Broadway, Chicago, IL 60406 TELEPHONE NUMBER: 708-389-8137 CONTACT PERSON: Sheryl Germany DATE WRITTEN REQUEST WAS RECEIVED: March 1,2016 SOLICITATION DATE: August 19-20, 2016 CITY COUNCIL DATE: April 13,2016 COMPLETION OF FILE DATE: STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED: DATE PERMIT LETTER WAS SENT TO ORGANIZATION: April 13,2016 VIOLATION (S) COMMITTEE LETTER SENT: COMPLY RECEIVED: COMMENTS:
APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
(Please neatly print or type. In necessary in answering any question, please attach additional sheets.) Name of organization: i *a <£. Cc\ ^ Address: vXttffT R^^^cy Telephonc Number: 7o* - 3' - */ J 7 Use the space below to list names, current positions, residence addresses and telephone numbers of the officers in ._the_organization: . .
_ „ . .... r~- -~" " "X <= List rne aare ami approximate Iocation(s) of solicitation: Approximately how many persons will be engaged in the solicitation?
/So Explain the methods your organization will use to solicit funds:
V\o^a cuV Co,n Si y' %c <± crxxKcs nS Has your organization ever been allowed to solicit funds in prior years in the City of Chicago? IT so, when? Include the following with your application:
A copy of the registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois. A copy of the tag, badge, emblem or other token (if any) which will be distributed as part of the solicitation, or which will be used by your organization in its solicitation. Please include any other relevant information which would assist the Committee on Finance in reviewing this application.
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Chicago Locations
Rock Island RR- 103 and Longwood* Rock Island RR - 107th and Longwood* Rock Island RR - IIIth and Longwood* 95th & Western - East/West/North/South 99th & Western - East/West/North/South 103rd & Western- East/West/North/South IIIth & Western -East/West/North/South IIIth & Kedzie - East/West/North/South 95th & Ashland -East/West/North/South 119th & Western (Walgreens with their permission) A few Loop locations Union Station* LaSalle Street Station*
*Blue Cap Foundation will obtain permission from Metra for all train stations I
i APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION.
I/WE, THE OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE, (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
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Signature .-V. {\(VyT_ Title 5>^e ... s p.h.
Signatured, j/u.^JJ^ S/(/Jl/I^oi^. Title Vj < \?
HOLD HARMLESS AGREEMENT
The undersigned officer on behalf of the subject organization agrees to defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations.
The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
The officer of the subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
\'5'x, ^. Ccx'^ Name of organization
Signature of .organization officer
Date
Mar-17-16 12:33pn From-
OFFICE OF THE ATTORNEY GENERAL March 17, 2016 STATf; of ILLINOIS BLUE CAP FOUNDATION, INC. M „ 2155 BROADWAY *,?2«eJ2SS BLUE ISLAND. IL 60406 RE: RE: Status ot" BLUE CAP FO( JNDaTION, INC. under the Illinois Charitable Laws COff " | Dear Registrant: This letter is pursuant to your j equesi thai the Attorney General confirm the status of BLUE CAP FOUNDATION, INC. under the Charitable Organization Laws.
This organization is currently jegistered with the Attorney General's Charitable Trust and Solicitations Bureau as CO " It is current in the filing of its financial reports, having filed its report for the period ended J me 30,2015. Please lei us know if you require further information.
Siicerely,
Tikiyah Martin Bames,Compliance Officer Charitable Trusts Bureau 1 C O West Randolph Street, 11th Floor Cliicago, Illinois 60601 Telephone: (312)814-2595
CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER \rVr\ur J. Gallagher Risk Management Services, Inc. Two Pierce Place tasca IL 60143 CONTACT n«l« name: Ryan Doyle (A/C,NNn, FYt): 630-285-3678 | (A/C. No): aSKress-. Ryan_doyle@ajg.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A Great American Alliance Insurance C 26832 INSURED Blue Island Citizens 2155 Broadway Street Blue Island IL 60406-3050 INSURER B Great American Insurance Company 16691 INSURER C INSURER D INSURER E INSURER F COVERAGES x i COMMERCIAL GENERAL LIABILITY CLAIMS-MADE i X ' OCCUR ¦7/1/2015 REVISION NUMBER: EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY
$2,000,000 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG , $2,000,000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) ALL OWNED AUTOS ? SCHEDULED AUTOS I | NON-OWNED HIRED AUTOS I AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident)
B X I UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE
PEP i RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y , N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED7 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below OTH-_ER PER STATUTE E L EACH ACCIDENT E L. DISEASE - EA EMPLOYEE- $ E L DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) \u\o Deductibles: Comprehensive $500 / Collision $1,000 Evidence of Insurance for: fag Day Events: August 19, 2016 and August 20, 2016
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD V1// JLjCCkS Internal Revenue Service-P . 0. Box 2508 Cincinnati OH
BLUE ISLAND CI7IZEN5S FOR PERSONS WITH DEVELOPMENTAL DISABILITIES 2155 BROADWAY ST BLUE ISLAND IL 6G406-3Q5D
bmploysr Identification Numbers '. ,¦- Person to Contacts "MS INKLE R Toll Free Telephone Number; 1-877-829-5500 Dear TAXPAYER; This is in response to your request of Feb, 27,- 2009, regarding your tax-exempt status.
Our records indicate that a determination letter was issued in MAY 1965, that recognized you as exempt from Federal income tax? and discloses that you are currently exempt under section 501Cc)(3) of the Internal Revenue Code.,
Our records also indicate you are not a private foundation within th meaning of section 509Ca) of the Cade because you are described in sectionCs) 509(a)(1) and 170 Cb) CD C A3 (iv) . Donors may deduct contributions to you as provided in. section 170 of the Code. Bequests , legacies.- devises, transfers; or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions- of sections 2055,, 21G6^ and 2522 of the Code.
If you have any questions, please call us at the telephone number shown in the heading of this letter, Michele M. Sullivan, Qper. Mgr. Accounts Management Operations I
Sincerely yours.
i i BLUE CAP Mission Statement Blue Cap is an organization dedicated to the discovery, pursuit and achievement of personal growth and dignity for individuals of all ages having or at risk for developmental disabilities. Blue Island Citizens for Persons with Developmental Disabilities
Blue Cap is a 501(c)(3) non-profit organization. Youth Services School Program is an Illinois State Board of Education approved program serving students with intellectual disabilities ages 3 through 21 years of age with a diagnosis of autism, physical impairment, cognitive delay or other health impairments. We provide educational, therapeutic, self-help and pre-vocational services to students, 3 to 21 years of age, diagnosed with severe developmental disabilities and/or autism. Early Intervention An early intervention records management and billing service which allows therapists the time to focus on providing the best therapy for children age birth to 3. Adult Services Adult Day Services offers individualized support and education to persons with developmental disabilities, 18 years and older, with an emphasis on vocational training and teaching of daily living skills. A Workshop facility provides a supervised work environment in which adults with developmental disabilities are trained to do a variety of jobs contracted from local industries. Supported Employment offers individualized support to adults with developmental disabilities who are interested in community job placement, while providing businesses with quality employees Senior Program offers older individuals living with developmental disabilities the opportunity to retain their current life skills while embracing their golden years. Residential offers a variety of supportive living arrangements in the community for adults with developmental disabilities. Specialized Services offers a facilitator to support families receiving services for adults with intellectual and developmental disabilities who are living at home.
Overview of Services In 1967, Blue Cap responded to the needs of the community by providing a school program that served 28 students with developmental disabilities. Today, Blue Cap offers seven different programs which provide educational, vocational, therapeutic and residential services to nearly 200 infants, children and adults. Blue Cap serves the south side of Chicago and more than 30 suburban communities. Adult Services Building Main Office 2155 Broadway Blue Island, IL 60406 708.389.6578 708.389.5086 fax
Instructional Center 1962 Broadway Blue Island, IL 60406 708.389.8137 708.389.3669 fax
Visit us at: www.bluc-cap.org j^j Like us on 4tj^-j*jtv Facebook HA™
Blue Island Citizens for Persons with Developmental Disabilities 1962 Broadway Blue Island, IL 60406 Phone: (708) 389-8137 Fax: (708) 389-3669 www.Blue-Cap.org Like us on Facebook
Coming up on Blue Cap's Calendar: Blue Cap Foundation 22nd Charity Invitational Silver Lakes Country Club Wednesday June 15,2016
Attention: CU \)\& A< p 1 f] A Company: ? V^- 4^ 'Z-iXy1 (¦> vs. ^ f ^ «-»a „-) <¦
From: Date: ^/aZ/flflM Number of Pages (including cover sheet): Q_ Message: K)c\ 0 i Ql
Mission Statement Blue Cap is an agency dedicated to the discovery, pursuit and achievement of personal growth and dignity for individuals of all ages having or at risk developmental disabilities.
This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged or confidential. You are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by telephone and return the original message to us at the above address via the United States Mail. |1010|Blue Cap, located in Blue Island, is a 501(c)(3) non-profit organization that has been providing services for people of all ages with developmental disabilities since 1967. Sponsored by: Ferrara Candy Co. Thank you for supporting Blue Cap! Blue Cap has been offering support to children and adults with developmental disabilities since 1967. We touch the lives of nearly 250 people each year through one of our 9 distinct programs. We currently serve families from the City of Chicago and over 30 suburban communities. Our Workshop contracts with 5 different businesses, offering valuable job training to over 100 adults with developmental disabilities. Blue Cap operates 8 community-centered homes for adults with developmental disabilities. Our school program provides educational and therapeutic services to students diagnosed with severe developmental disabilities and/or autism. Of each dollar donated to Blue Cap, 88 cents goes directly to the programs and services. Your tax deductible contribution to Blue Cap Tag Days helps make all of this possible. Thank you!
BLUE CAP Contact us to learn more: 708.389.6578 or [j\ www.blue-cap.org ™——^Q@23BTr3s^ BlueCap ,_, L^^xJJ^=Cii--/" 21 55 Broadway \mBlue Island, IL 60406 I PERMIT NO. 2016-09 COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2015-09 GROUP NAME: State Department of Illinois - Polish Legion of American Veterans ADDRESS: 5048 W. Wellington Avenue, Chicago, IL 60641 TELEPHONE NUMBER: 773-545-9159 CONTACT PERSON: Mr. Walter Komarnicki DATE WRITTEN REQUEST WAS RECEIVED: March 18, 2016 SOLICITATION DATE: May 19-22, 2016 CITY COUNCIL DATE: April 13,2016 COMPLETION OF FILE DATE: STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED: DATE PERMIT LETTER WAS SENT TO ORGANIZATION: April 13,2016 VIOLATION (S) COMMITTEE LETTER SENT: COMPLY RECEIVED: COMMENTS:
wkDmarnicki@sbcglobal.net- att.net Mail
APPLICATION FOR C.ITV OF C'lllCAMi CHARITABLE SOLICITA TION I'EIOIIT
t'PIenic neatly print or type. In necessary in answering any t|uestiun, pk-use :ilt:ich additional sheets.) sntfe bGMtotf&n or ImtJoi?
Telephone ;NDmber: -jy ^ tfcf^Cf [ g C( I'm- Ihe space liclotv to list names, eurrenl pnsilinns, rwitlentf aililrro.<9> anil telephone numbers of the olTicers in (lie or^niii/nt'iuii: 5ggt /Writeteb Steer
List the date a nt I approximate locntionf.*) tifsolit tit* n: 2 S 4* A|i)irnximalcK- how manv persons will be engaged »» 'he &oiivilntior>? O* «3* 3d 5 5 E»pliiiiithri7ietliuibyouror^»iii«ili«n«illiiScinsn^ (fVtvSC^T <^£i SftfWc, toAOgfiz bit ipT6r\SecT(0VHuj your or£ani/.afion e>er been alluned lo solicit funds in prior yeiirs in tin' Cily »f Chicago? If so,«lien? "*/^"fj V 5> /v^r^e/r, iyxay w>t*) Mayoic/j. May te>\£yuM^y o Ineltidcjhc follmvmg with your :ipp)ii:uliou: (^A.y' A fnjiy uf the registration Mutirniciir filed with the AUnrncy OcncruJ of thcStiitc ot Illinois: or exemption ukuciJ by iIil- Attorney Ccnenil of Ihe Sinle ui Illinuiv a t\ n w ,* Qty A copy ol the n»p„ badge, emblem or othw fokun (il any) whirh /^M r*U f*1^ will be di.Ytrihiiteri as part of the snlicitiition, or which will be osrd by your organization in ils sobril-.ition. S. IMcasc inrlmlc any other rclevnnr information which would nssist the Coinmiilce on Fsnrmrc in reviewing this nppheatiou.
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APPLICATIONS MUST BE RECEIVED UV IHE COMMITTEE OiS' FINANCE NO I.ATE THAN 3U IMYS PKIOK TO THE COMMENCEiMF.NT OK THE SOLICITATION.
( lAvF THE OKl-TCCK(S) OF T1IT. ABOVE NAMED OKGAM/.A ITON, CERTIFY I'll AT THE INFORMATION IT UMSIIEI7 IN THIS STATEiVIKN "I AND AM, ATTACHED SHEETS IS TRUE AM) CORRECT TO THE BEST Or iVIY/OLU K.NOWI.EDCE. (NOTE: AT LEAST ONE OFFICER OK THE OKG A NIDATION MUST SIGN AND VEItlFT THIS A1TLICA HON.)
'UteAtUfc/L Dale ^/\bjl^
Siyn:ilui-e_ tirtps ://us- mg 5. mail .yatioo. corrVneo/1 aunch?. partner=sbc&. rand= 5fecbavl p2of3#mail I "Unity with Heritage"
Commander Robert Swan 530 LaFayette Lane Hoffman Estates, IL 60169 847-322-9874 E-Mail robert.swan@sbcglobal.net
DEPARTMENT OF ILLINOIS CHARTERED BY ACT OF CONGRESS ILLINOIS CHARTERED APRIL 14, 1921 "Aid to the Blind Program "
Adjutant Julianne Viduya 2402 N. New England Chicago, IL 60707 773-622-6901
State Department Officers
Commander Robert Swan, \ Sr. Vice-Commander: penriis Deisenroth, Jr. Vice-Commander: Kevin Pomykala,^ Treasurer: Walter J. ko.marnickV'l__
Adjutant: Julianne Viduja,.
\ Hoffman Estates, IL 60167 Island Lake, IL 60042 „ Elwood, IL 60421 \ Chicago, IL 60641 I, Chicago, IL 60707
f/O Beginning 01 & Ending. 12 Federal ID # ;_. Are contributions to the organization tax deductible? (Zl Yes D No I/O 01 l-onn AG990-1L Revised 3/05 /Ol ,21 LEGAL NAME MAIL ADDRESS CITY, STATE ZIP CODE
POLISH LEGION OF AMERICAN VETERANS - STATE DEPT OF IL 5048 WEST WELLINGTON AVENUE CHICAGO, ILLINOIS 60641-5045 Year-end amounts ASSETS LIABILITIES NET ASSETS
SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:
PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV (GROSS AMTS GOVERNMENT GRANTS & MEMBERSHIP DUES OTHER REVENUES TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E, & F) SUMMARY OF ALL EXPENDITURES DURING THE YEAR: H) OPERATING CHARITABLE PROGRAM EXPENSE i) EDUCATION PROGRAM SERVICE EXPENSE J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I) Ji) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J). $ K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) M) MANAGEMENT AND GENERAL EXPENSE N) FUNDRAISING EXPENSE 0) TOTAL EXPENDITURES THIS PERIOD (ADD L, WI, & N) SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES: (Attach Attorney General Report of Individual Fundraisirsg Campaign- Form IFC One 'cr each FFR.1, PROFESSIONAL FUNDRAISERS: P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS AMOUNT 18.510 4,105 LSI 5 24,430
23,134
23,134
23,134 5,659
28.793 Q) TOTAL FUNDRAISERS FEES AND EXPENSES R) NET RECEIVED 3Y THE CHARITY (P MINUS Q = R) PROFESSIONAL FUNDRAISING CONSULTANTS: S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR: T) NAME, TITLE WALTER KOMARMICKI - TREASURER U) NAME. TITLE- JULIANNE VIDUYA - DIRECTOR V) NAME, TITLE R SWAN - DIRECTOR V. CHARITABLE PROGRAM DESCRIPTI0N:ch/9W7able program p highest by s expended) code categories W) DESCRIPTION COMFORT AND AID TO VETERANS IN HOSPITALS List on back side of instructions CODE W)# 127 XJ DESCRIPTION Y) DESCRIPTION.
IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:
! WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT'' i HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF EVER BEEN CONVICTED 3Y ANY COURT OF ANY M ID S D EM E AN 0 R INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY' .. 2 DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST. OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION'' 3
i HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER. DIRECTOR OR TRUSTEE OWNS MORE THAN 1 0% OF THE OUTSTANDING SHARES? 4 IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? . 5. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER''! ATTACH FORM IFC ) 6
7a j ID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, HAILING. ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? . 7
7b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS £ i(n) THE AMOUNT ALLOCATED TO PROGRAM SERVICES S (in) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL S AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING S 3 DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? B HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY'' 9 WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS'? 10
11 LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS. ATHENE ANNUITY & LIFE ASSURANCE CO #0040099504; AMERICAN GENERAL LIFE SERVICES CO #MN034810; MCHENRY BANK AND TRUST #2650002077
i 2 N AME AND TELEPHONE NUMBER OF CONTACT PERSON: WALTER KOMARN1CK1 BE SURE TO INCLUDE ALL FEES DUE: ) REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END ) FOR FEES DUE SEE INSTRUCTIONS 3 ) REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A S100 00 PENALTY.
DATE SIGNATURE NT name! Q 7/r- 'SJONATURE DA/tE' / int name) SIGNATURE DATE
- ^egtcn American Veterans TEEEP BY ACT OF CONGRESS fcf^O?
PERMIT NO. 2016-11 COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2016-11 GROUP NAME: ChildFund International ADDRESS: 2821 Emerywood Parkway, Richmond, VA 23294 TELEPHONE NUMBER: 703-556-0411 CONTACT PERSON: Hailey Render DATE W RITTEN REQUEST WAS RECEIVED: March 10,2016 SOLICITATION DATE: April 14,2016- December 31,2016 CITY COUNCIL DATE: April 13,2016 COMPLETION OF FILE DATE: STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED: DATE PERMIT LETTER WAS SENT TO ORGANIZATION: April 13,2016 VIOLATION (S) COMMITTEE LETTER SENT: COMPLY RECEIVED: COMMENTS:
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ii'. Exnbfo the methods vonr orgBnfctatfam win use to casidft State "Face tb'Face Fundraising campaign on the street. Our agent, DialogueDirect will generate commitments and increase the public awareness of the charitable efforts of ChildFund International 6„ Htat) yowv oirgaiaiamtiittri osvor tosoEi allowed! to oeSfjeofi fitadDc itm prSor yeare fm Abe CiJy of Cfalefflgo? IV w, Tjh tarn 7 _
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APPLICATIONS MUST BE RECEIVE© BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATJION.
I/WE, THE ©FFICER(S) OF THE ABOVE NAME© ORGANIZATION, CERTIFY THAT THE HNPORMATION FURNISHED IN THUS STATEMENT AND ALL ATTACHED SHEETS SS TRUE AND CORRECT TO THE BEST Off MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
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HOLD HARMLESS AGREEMENT
The undersigned officer on behalf of the subject organization agrees to defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations.
The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
The officer of the subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
Signature of organization officer
Name of organization i
I I i i I I I Feb-24-16 03:20pm From-
OFFICE OF THE ATTORNEY GENERAL STATE OF ILLINOIS CHILDFUND INTERNATIONAL, USA 2S21 HMERYWOOD PARKWAY RICHMOND, VA 23261 RE: RE: Status of CHILDFUND INTERNATIONAL, USA under the Illinois Charitable Laws CO# Dear Registrant: This letter is pursuant to your request that the Attorney General confirm the status of CHILDFUND INTERNATIONAL, USA under the Charitable Organization Laws.
This organization is currently registered with the Attorney General's Charitable Trust and Solicitations Bureau as CO*' ,is current in the filing of its financial reports, having filed its report for the period ended June 30, 2014, and having received an extension of time until February 29, 2016 to file its report for the period ended June 30, 2015. Please let us know if you require further information.
Sincerely,
Takiyah Martin Barnes, Compliance Officer Charitable Trusts Bureau 100 West Randolph Street, 11th Floor Chicago, Illinois 60601 Telephone: (312)814-2595
Chairman Marilyn F. Grist Vice Chairman John L. Lewis IV Secretary Nancy Hill Chair, Audit CommSttee Sarah G. Green (Sally) Board Members John B. Adams Austin Brockenbrough IV Jane D. Brown Thomas C. Deline Elizabeth Flanagan (Betsy) Shailendra Ghorpade Ed Grier Ayesha Khanna Jill E. Korbin Tushar Makhija Lyn McDermid Geremie Sawadogo Daniel Silva Anne Waleski
President & CEO Anne Lynam Goddard Vice President, Finance & Operations/CFO James Tuite Chief Development & Marketing Officer Aki Temiseva
Address for all:
ChildFund International 2821 Emerywood Parkway Richmond, VA 23294 i
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Fax Transmission Charitable Trusts and Solicitations Bureau 100 W. Randolph Street, 11* Floor Chicago, IL 60601-3175 Phone: (312) 814-2595 Fax: (312) 814-2596
To: Haiiev Render Date: 02/24/2016
Fax #; ,88-222-6807 Pages: (2) including cover page
From: Takiyah Manin-Barrws Compliant: Officer Direct: 312-814-5840 s«bjcct: Letter of Good Standing Request CQ# 01QQ439S COMMENTS:
*Forms can be downloaded at www.illinoisattorneygenerai.gov under "Building Better Charities."* This FAX may contain attorney-client, attorney work product or other privileged and/or confidential information. This FAX is intended only for the use uf the individual for v»horn or entity to which it is addressed If you have received this FAX in error, please notify the sender at the above telephone number and destroy his FaX. If you are not the intended recipient, you are hereby notified that any retention or dissemination of this FAX and/or the information it contains is strictly prohibited. ORIGINAL (check one) X WILL
GENERAL COUNSEL
ATTORNEYS AT LA W 6849 Old Dominion Drive, Suite 220, McLean, Virginia 22101 (Main) 703-556-0411 (Fax) 888-222-6807 WW.GENE RALCOUNSELLAW.COM
Hailey b. render EMAIL: HRI-NDER@GCPC.COM DIRECT DIAL: (703)226-1874 March 10, 2016 SENT VIA FEDEX
David Espinoza City of Chicago - Committee on Finance City Hall, Room 302 121 North LaSalle Street Chicago, IL 60602 Re: Application for Charitable Solicitation Permit To David: I wanted to thank for all of your guidance and support thus far, it is greatly appreciated. Enclosed you will find the following documents for a Charitable Solicitation Permit for Dialogue Direct and ChildFund International: Application for City of Chicago Charitable Solicitation permit along with the attachments. The requisite fee amount of S910.00 (in the form of a check) Letter of Good Standing issued by the Charitable Trust and Solicitation Bureau.
Please let me know if you have any questions regarding this application.
PERMIT NO. 2016- 12 COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2016-12 GROUP NAME: Chicago Firemen's Post 667 ADDRESS: 3647 N. Tripp Avenue , Chicago, IL 60641-3038 TELEPHONE NUMBER: 773-283-4305 CONTACT PERSON: James Mindak DATE WRITTEN REQUEST WAS RECEIVED: March 13, 2016 SOLICITATION DATE: May 25-27, 2016 CITY COUNCIL DATE: April 13,2016 COMPLETION OF FILE DATE: STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED: DATE PERMIT LETTER WAS SENT TO ORGANIZATION: April 13,2016 VIOLATION (S) COMMITTEE LETTER SENT: COMPLY RECEIVED: COMMENTS: j OFFICE OF THE ATTORNEY GENERAL STATE OF ILLINOIS CHICAGO FIREMEN'S LEGION POST 667 3647 N. TRIPP AVE. CHICAGO, IL 60641-3038 RE: RE: Status of CHICAGO FIREMEN'S LEGION POST 667 under the Illinois Charitable LawsCO#| Dear Registrant: This letter is pursuant to your request that the Attorney General confirm the status of CHICAGO FIREMEN'S LEGION POST 667 under the Charitable Organization Laws.
This organization is currently registered with the Attorney General's Charitable Trust and Solicitations Bureau as CO# ¦ ] It is current in the filing of its financial reports, having filed its report for the period ended December 31, 2015. Please let us know if you require further information.
Sincerely,
Takiyah Martin Barnes, Compliance Officer Charitable Trusts Bureau 100 West Randolph Street, 11th Floor Chicago, Illinois 60601 Telephone: (312) 814-2595 APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
(Please neatly print or type. In necessary in answering any question, please attach additional sheets.)
L Name of organization: CHICAGO FIREMEN'S POSS 66? AMERICAN LEGION Address- 36^7 N. TRIPF AVE. CHICAGO, IL. 606^1-3038 Telephone Number: 77; 2. Use the space below to list names, current positions, residence addresses and telephone numbers of the officers in the organization: JAMES MINDAK A DJ U TAN T /F IN A N GE OFFICER AVE. CHICAGO , " ILY 606*1-1-3038 List the date and approximate location(s) of solicitation: MAY 25, 26, 27, 2016 VARIOUS LOCATIONS WITHIN CITY OF CHICAGO LIMITS Approximately how many persons will be engaged in the solicitation? APPROX. 5-8
Explain the methods your organization will use to solicit funds: STREET SALS OF POPPY'S TO AID VETERANS IN VARIOUS VA HOSPITALS AND HOMES. Has your organization ever been allowed to solicit funds in prior years in the City of Chicago? If so, when? YES, MAY 20-22, 2015 PERMIT NO. 2015-05
Include the following with your application: A. A copy of the registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois. B. ^^jLjio^M^tferfa^ token (if any) or which wi will be distributed as part of the solicit' used by your organization in its solicit
Please include any other relevant information which on Finance in reviewing this application. REGISTRATION WITH ATTORNEY GENERA.7 DEPT. OF ILLINOIS AMERICAN LEGION APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION.
I/WE, THE OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
Signature_
Signatnre_ HOLD HARMLESS AGREEMENT
The undersigned officer on behalf of the subject organization agrees to defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations.
The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
The officer of the subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
CHICAGO FIREMEN'S POST 667 AMERICAN LEGION Name of organization
13 MAR. 2016 Date I
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