COMMERCIAL ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VI I, 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 properties at 1236-1248 W. Fulton Street are owned by ELA Associates, L.L.C, an Illinois Limited Liability Company; 1224-1234 W. Fulton Street is owned by 1230 West, LLC; 1219-1226 W. Carroll Avenue is owned by Fulton/Racine Property LLC, an Illinois LLC; and 1227-1249 W. Carroll Avenue is owned by Chicago Title Land Trust as successor to North Star Trust Company as trustee under Trust Number 25948 (together the "Developers"); and
WHEREAS, the Developers propose to use the portion of the alley to be vacated herein as a limited access driveway, for which a permit will be secured; and
WHEREAS, the City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent of the public use and the public interest to be subserved is such as to warrant the vacation of the remainder of the 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 EAST-WEST 18-FOOT WIDE PUBLIC ALLEY LYING SOUTH OF AND ADJOINING THE SOUTH LINE OF LOTS 5 THROUGH 16; LYING NORTH OF AND ADJOINING THE NORTH LINE OF LOTS 17 THROUGH 28; LYING EAST OF AND ADJOINING THE EAST RIGHT OF WAY LINE OF N. ELIZABETH ST.; AND LYING WEST OF AND ADJOINING THE WEST LINE OF THAT PORTION OF THE EAST-WEST 18-FOOT WIDE PUBLIC ALLEY VACATED BY ORDINANCE DATED JANUARY 16, 2016 AND RECORDED ON FEBRUARY 26, 2016 AS DOCUMENT NUMBER 1605718052, ALL INCLUSIVE, IN BLOCK 3 IN MAG IE AND HIGH'S ADDITION TO CHICAGO IN THE SOUTHWEST 1A OF SECTION 8, TOWNSHIP 39 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, RECORDED OCTOBER 24, 1855 (ANTE-FIRE), IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 5,524 SQUARE FEET, OR 0.127 ACRE, MORE OR LESS as shaded and legally described by the words "HEREBY VACATED" on the plat hereto attached as Exhibit A, which drawing for greater clarity, 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 City of Chicago hereby reserves for the benefit of
Page 1
Commonwealth Edison and AT&T/SBC, their 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 or AT&T/SBC facilities. No construction, buildings, permanent structures or obstructions shall occur or be placed over the area herein vacated without express written release of easement by the involved utilities. Any future relocation of utility facilities lying within the area being vacated will be accomplished by the involved utility, and be done at the Developers' expense.
SECTION 3. SECTION 3. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the APPLICANT 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 4. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Developers shall pay or cause to be paid to the City of Chicago as compensation for the benefits which will accrue to the owners of the property abutting said part of public alley hereby vacated the sum
dollars ($ ),
which sum in the judgment of this body will be equal to such benefits.
SECTION 5. The vacation herein provided for is made upon the express condition that within one hundred eighty (180) days after the passage of this ordinance, the Developers shall file or cause to be filed for record in the Office of the Recorder of Deeds of Cook County, Illinois a certified copy of this ordinance, together with the associated full sized plat as approved by the Superintendent of Maps and 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.
Page 2
Vacation Approved:
Rebekah-Siheinfeld Commissioner of Transportation
Approved as to Form and Legality
Richard Wendy Deputy Corporation Counsel
Honorable Burnett Alderman, 27th Ward
Page 3
PLAT OF VACATION
THAT TART OF THE BA5T-WBST1WOOT WTJIB TU3UC ALLEY LYING SOUTH GD? AND ADJCLIKINO THB SOUTH LDffi CT? LOTS 3 THBfiUaH^LYMOMXTO
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AHJTDCN TO CHCAOO DJ THE 9UUTHW1S I* OF KHCT1DN t, TUWNIB1? » KOXTH, IMKS.14, BAST CLF THB THIRD FiUNCPAL
ifflMnAHBnrraTi^
aWTAININ054M K^bUUffBHT.OXaitf Af^UDUOfcLESS.
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d
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w LOT 2 <• — H LOT 1 »
i /
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'—: LOT 4 |
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LIST Of OWNUUIHIT:
PULTON RAGNH fSOreRTY, LLC
MX 174MI44M b> 0O7 (Tan of Lots lend 2), 1741-314401 Jl 409 (Lot 3), 174>-3M-a24 A 425 (Lot 4). 174(-314427 (Lot no11741-314^126* (Lot 6) iaBJocl: 10 mC"K!peaterJi Adinioa tD ClocagD Ka. Ao(. 31, I KM (lAti}
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ELAASSOOATCLLC
rXK. 174t-314410(1_ot IT). 174(414411 (Lot II), 1741-314412 (Lot 17). 174U144U (Lot 20) sad I74UI44M(LotII)mBuck3 a Mafiaaodffiglrt AtUnimtoObaeJlocOOH lU5(Aje»-Eit!).
UMWEST.LLC
MX 17-OS-314-OI3(lo<22), n4S-314416(Lot23). 1741-314417 (Lot 24). 174(417428(Lou25tnraojb21 and 174M14422 (Lou 29 ft 30) b MafU aod Eitt AAfcioo toCoi^to Ott.24. 1S53 (Aoto-fm).
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IJhBoii PnriWoLttl Lmd rtoorBjar No. 15-3751 LltEip. ll/M/2014
ACOSTA BTOCl, LLC UDOW.qiiiM Au*.
MM SURVEYING CO., INC.
M12 W. BnXUNB AVENUE rmZAJXX JLUSXSM 006X
CDOT #08-27-16-3747
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Chicago Title Land Trust Company Trust No. 25948
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
jx~j the Applicant
OR
Q] 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 aright of control (sec Section ILB.l.) Stale the legal name of tbe entity in
which the Disclosing Party holds a right of control::
B. Business address ofthe Disclosing Party: 325 N. ELIZABETH STREET
CHICAGO, IL 60607
Telephone: (312) 327-3350 Fax: (312)327-3315 Email. mich38l@3costaezgur.com
Name of contact person: MICHAEL EZGUR
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 alley bounded by North Elizabeth Street; West Carroll Avenue; North Racine Avenue; and West Fulton Street.
G. Which City agency or department is requesting this EDS? CDOT
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
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SECTION II - DISCLOSURE OK OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing | j Person
[ | Publicly registered business corporation | 1 Privately held business corporation j [ Sole proprietorship | | General partnership | 1 Limited partnership [x] Trust
| [ Limited liability company [ 1 Limited liability partnership r~J Joint venture | [ Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
? Yes QNo [ | Other (please specify)
2. For legal entities, the stale (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?
QYes QNo (xj 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 entily. 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 thc 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
Chicago Title Land Trust Company TnJstee
as trustee under trust agreement
dated 12/09/94 unrlpr t-msfr no. 25948
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
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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 tbe 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.
Na7ne Business Address Percentage Interest in the
Disclosing Party
Donald Chaimovitz Declaration of Trust, dated July 25. 1994 325 N. Elizabeth Street. Chicago IL 60607. 100%
Drinalrl nhaimnvit7 snip hpnefiriary wHh 100% nwnpr<-,hip intprp<-T
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes gj 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 thc 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 tlie 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 ar.y person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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Name (indicate whether Business Relationship to Disclosing Parly 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.
Michael Ezgur 1030 W. Chicago Ave., 3rd FL. Chicago IL 60642 Atty $2,500 (est.)
(Add sheets if necessary)
f~~j Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-41 5, substantial owners of business entities lhat 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 [3 No ? No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
Yes ? No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any sister agency; and (ii) the Applicant understands and acknowledges lhat 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 ILB.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 thc City or by the federal government, any state, or any other unit of local government.
3. The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entily means a person or entity that directly cr indirectly controls the Contractor, is controlled by it, or, with thc 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").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before thc date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security 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) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part 3 (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, of thc 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 thc Disclosing Party (check one)
? is (3 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. Wc 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 predator}' lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to. make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing 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 ofthe Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
Yes fx} 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 thc meaning of this Part D.
Does the Matter involve a City Property Sale?
Yes 23 No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
PageS 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.
LU 1. The Disclosing Party verifies that thc 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 thc 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.
I 12. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from 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 thc Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or lo pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federaliy 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 thc 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) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration 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 submil the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes ? No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
Yes rjNo
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes ? No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes ? No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and 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 tbe 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 lo the public on the Internet, in response to a Freedom of Information Act request, or otherwise: By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify tlie 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 Cily's Department of Procurement Services, lhc Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F.l. Tlie Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor arc the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or 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 thc Disclosing Party is the Applicant, tbe Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F. 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 of the date furnished to the City.
Chicago Title Land Trust Company Trust No. 25948 AS TRUSTEE AND NOT PERSONALLY
(Print or type name of Disclosing Party)
(Print or type name of person signi
Nancy A. Carlin
Trust- Qffir-pr
(Print or type title of person signing)
This instrument is executed by the undersigned land Trustee, not personally but solely as Trustee in the exercise of the power-and authority conferred upon and vested in it as such Trustee-It is expressly understood end agreed that all the warranties, indemnities, representations, covenants, undertakings sod-agreements herein made on the part of lhe Trustee arg undertaken by it solely in its capacity as Trustee and not personaiiy. rSio personal liability or . personal rssponsreiiity is assumed by or shall at any time be asserted or'enforceable against the Trusiee on account ot any warrarrtVj indemnity, representation, covenant, undertakihq or agreement of tjJe Trustee in this instrument " ' " " -
Signed and sworn to before me on (date)
at £ook /\ County, Illinois
<
June 16, 2016 _ (state).
_ Notary Public.
"~ contains fn this certification
has been furnished to tf>q land by "
bonsficiarfes of mat m.M&gJTJ£ £ certifiCMibn is mads solsly -m re W tors™
In Its Individual opacity, for Ze trK accuracy or thc facts Groreln statad.
t "OFFICIAL SEAL" ? % HARRIET DENISEWICZ *
Psctp l?*nf hJbtary Public. Stale of Illinois rage ^o^gomnjission Expire5 04/26/19
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 tire date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section ILB.l .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or anyperson 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) tlie name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDLX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) thc 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.
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?
QYes fx] 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 1o Section 2-92^116 ofthe Municipal Code?
QYes [Z|N0 [x~| Not Applicable
If yes to (1) or (2) above, please identify below the name of the person or legal entity identified as a buiiding code scofflaw or problem landlord and the address ofthe building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
Chicago Title Land Trust Company
10 S LaSalle Sued, Suite 2750 . Chicago, IL 60603 . (312) 223-U10 . Fa\ (312) 223-4136 January 21, 2016
Donald Chaimovitz 325 N. Elizabeth Street Chicago, IL 60607
Re: Land Trust No. 2594 S Customer No. BP 25948
Dear Mr Brcnnock:
Pursuant to your request, enclosed please find a certified copy ofthe aforesaid land trust agreement for your records. The trust account will be billed $30.00.1 have also emailed a copy to Michael Ezgw at michaeKajacoslacznur.com.
If 1 can be of any further assistance, please do not hesitate to contact me. I can be reached at (312) 223-4109.
Very truly yours,
Chicago Title Land Trust Company
Trust Officer
Enclosure
Chicago Title Land Trusl Company
Land Trust Review
' Trust number to be used on documents: 25948 Owners of trust (Beneficiaries):
Donald Chaimovitz as trustee of the Donald Chaimovitz Declaration of Trust dated July 25,1994 (100%)
Original signatures needed on direction for the trustee to sign mortgage or deed (Power of Direction): Donald Chaimovitz, as trustee
Lender's signature required on direction to sign documents (Collateral Assignee / Right to Approve): Belmont Bank & Trust Company
*Delinquent Land Trust fees due: $
Other requirements:
*Please note that additional fees will be billed to your account for the signing of mortgage documents or the issuance of a deed. For a quote of these fees, please contact land trust once you know specifically what documents your transaction requires.
Initials: nc
Date: January 21. 2016
Internal account number: BP 25948
COLLATERAL ASSIGNMENT OF BENEFICIAL INTEREST
i,; 8 3 0 G 0 0 3.418-t^l. 2*5 04fcl=J«
Rofcroncca b: Irm boxes obovo ere for lender's U50 ortfj- old (io nol Umll Iho oppllcob|]Il>' of Ihis docutisn! to any DOHiculor loon or riom Anv iloni u'.iovo conlslnfno ' hjs lw«n omlllnd duo lo leixl lanolh limhnlton?;.
Borrower: Donald Chelmuvlu:
Chicago Htl*i Land Trust Company, bi Successor Iru&lcc to North Star Trust Company, ae Successor Trustee lo Banco Popular Norih America, »t Succc«or Trustee to Pioneer Banfc 4\ Trust Company, as TruHco undci Trusl Agreement dated December 9, 19SU nnd known at Truil Number 25940 1820 Clove;dtIt Ava Highland Peik, |L C0015
Grantor.' Doneld Chalmuvltr, as Trustee under the Donald Chnlrnovitx Declaration of Trust under Trust Agreement dated Jury 2S, 1094
ip«ny
Lender: fieimor.t Bank A Trust Company 8250 WEoImont Avo Chkaflo.O. 60634
TnisiNo.^
Wc do hereby certify lhal Ihe wiihln. ccroisi.-si ol _. /o( pace:
rcprcsenls a liu; and cotteel copy ol the original aaoiding lo ms lilts.
CHICAGO TITLE LAND TRUf.T COMPANY
JAN 2 I 20I6
D'.l'e
THIS COLLATERAL ASSIGNMENT OF BENEFICIAL INTEREST dated August 14, 2015. is made and executed between Donald Chaimovitz., as Trustee under lhc Donald Chaimovitz Declaration of Trust under Trust Agreement duted July 25, 1994 ("Grantor") and Belmont Bank & Trust Company ("Lender").
GRANT OP SECURITY INTEREST. For valuable consideration, Gmnfor Jointly and severally gnnb a security Interest In and assigns lo Lender all of Grantor** right, title and beneficial Interest In and to Ihe Truat described ha low lo aecure payment of (ha Indebtedness and agraes -(hat Lender shall hrvr tlie rights slated In this Assignment with respeel to the beneficial Interest In the Trust and the Proporty hold In Hie Trust. In addition to alt clber rights which Lender may have ty law. Grantor hereby waives and releases to Lender all rights and benefits, accruing under and by virtue of eny and et| statutes of lhe Gicte of Illinois providing fur the coemption ot homesteads from iate on execution or otherwise snd al other Inturcslr In Lhe Property held tn tha Trust, Including without limitation sll exompOons Grantor may hove under State of flftnok and laden I bankruptcy and Incofvcncy lrtws In lhe b*neflcJ>.l lnieresl and lhe Proporty held In tha Trust, which said rights and benefits Grantor docs hereby Tckv.e ond waive.
CROSS-COL LATERALIZATION. In odolllon to tho Ncte, this Assignment cocures at obligations, debts and ll&blLhl-ns, plus Interest thereon, of either Grantor or Bom-wor to Lorrfer, or ony one oi more of ihem. es v/oll os all claims by Lender eoalnst Borrower and Grantor of any ono or mom ot them, whether now existing or hereafter arising, wtwlhor relalod or unrelated to Iho purpose of the Nole, whethor voluntary or otherwiie. whether duo or not due. direct or indirect, determined or urdelermined. absolute or contingent, liquidated or unllquldo'ed. whether Borrower n( Grantor may bo liable Indrvtouafly or Jointly with othcia, whether oW-galed os guarantor, surely, accommodation party or otherwise, ond whether recovory upon such amounts may be or hereafter may becomo barred by any statute of limitations, and wtiathar tho obligation io ropay such amounts moy bo or hereafter may becomo o(l-iorwk« unonforceoble
PROPERTY' DESCRIPTION. The word 'Collateral- nc ucod In ihfc Assignment msanc all of Grantor's right, titto and bonaflcJal Interest In and to Iho Tarsi and the following proporty. whetlwr now owned or rxweafier acquired und whether now existing or hereafter arising
[A) AH oddtilons to ond ell replacements of end substitutions tor ony property dosenbed ebove
(B) All products and produce of any of tho property describod tn this CollolerBt section.
fCJ AM accounts, contract rights, general Intangibles, instruments, monies, payments, and ell other rights, arising out of a sfile. lease, or olher deposition ot any of the proporty described In It us Collalorc! section.
AJl proceeds pndudmg Insurance proceeds) from the sale or other disposition of any ol the proporty described in this Cofialorot section.
All records relating to any of the property described In this Collateral cecllon. whether in the form of a writing, microfilm, microfiche, or electronic medio
~Tf7oT^7c7^7op»7lj'',^oTns BlTpmpcrty. Df'7ino~f^7cto,l^ld"l^r"by Che Trust. lndu3^^tKdul"Bmfi11dn Btt"mferasls7~in"!fieT?eaTProperty7-wliotha.' now existing or herrafier Included in flic Trust.
The words "Real Property" mean ttw following duscribed real properly, logelhor with al exiling or subsequently erected or affixed buildings.
Improvamants and fixtures; all caienwils. rights of wny. and appurtenances; all weier. water rights. weie[coursos and dfteh rights (including
stock rn ulllllles with ditch or tiriaahon rirjhls); and aD other rights, royaJtles. and profits relating to tho reel property, including without limitation
all minerals, oil, gas. geothorrnal and simitar matters, located in CooV County, Stela of Illinois:
THE WEST 12 INCHES OF LOT 7 AND ALL OF LOTS ft THROUGH 1S lU 0LOCK 3 IN MAGJE AND HIGH'S ADDITION TO CHICAGO IN THE EAST 1/2 OF THC SOUTHWEST MA OF SECTION B, TOWNSHIP 39 NORTH, RANGE 1-4 EAST OF THE THIRD PRINCIPAL MERIDIAN. IN CCOK COUNTY. ILLINOIS
The Rent Property or its address is commorfy known as 325 H Elizabeth StreoL Chicago. IL 60607. The Real property lax Identification
number 17-05-314-030-0000.
GRANTOR'S WAIVERS. Granlor waives oil requirements of presentment, protest, demand, and notice of dishonor or non-payment to Borrower or Grantor, or any othor party to tho Indebtedness or lhc Collateral. Lender may do any of the tollowino with reaped to ony obligation of any Borrower, without first obtaining the consenl of Grantor (A) gien'. ony extension of time for eny payment (B) grant ony renewal. (C) permit any motfffication of payment terms or other terms, or (O) exchange or rcloosc any Collateiol or olher security. No such ad or tallure lo oct shall affect Lender's rights agartst Granlor or the Cotlaioral.
RIGIfT OF SETOFF. To the extent permitted by epplicoble low. Lender reserves e nght of setoff In all Grantor's accounts with Landor (whothar checking, saving*., cr iCTyj othor account) The? fcidudes a» accents Grentor holds Jointly with someone olso ond all accounts Gnsninr may open tn tho futuro. Hcwovor, this doos not Indudo arrj- IRA or Keogh occounls, or any truct accounts for which colon" would bo prohibited by law. Giantor authorizes Undor, to Inn extent permitted by applicable Jnw, io charge or seloff al aums owing on the Indebtedness against eny and all such accounts, and. at Lander's oplton. to odmlnistratrvdy freoze al such accounts to allow Lendor io protect Lender's charge and setoff rights provided in (his paragraph
COLLATERAL ASSIGNMENT OF BENEFICIAL INTEREST Loan No: 8300003418 (Continued)
POWER OF DIRECTION. The sole nower of rivrirtlon u-der »K- TnJst sV:< b* k-i-* hy
Ri-FRESENTATiONS AND WARRANTIES CONCERNING COLLATERAL Granlor represents, wan-ants and covenants lo Lender al all Hmos while this Assignrnonl k In e fled as follo-vs:
Perfection of Kocurlfy Intorost Grm'or ogroes lo execute and deliver lo Londor such assignments rjnJ Cher documents and lo take whatever olhar arfont ar* requested ty Lender to perfect end continue Lender's assignment ond security lr.t=rcst in the Collateral. Grjnlor shn!t rieTiwnr to Undnr alt original documents croaitng tho Trust, untoc such documonls nro hold by tho Truslaa and are nol nvailablo for del-very to Londer. Upon request of Lender, Grantor will deliver to Lender any end all cf lhe documents evidencing, or constlluilnn the Collateral. u
Transactions Involving Collateral. Grantor makes the following representations and wnrmnV.M with rasped to the Proporty. Additional Lions. Grantor shall not translor. pledge, mortgage, oncumfcer or otherwise permit the Proporty to bo subject to any Hen, socudty Interest, encumbrance, or charge, other than lhc security Interest provldnd for In ihis Assignment, without lhe prior written connonl of Lender. This Includes security Interest ovon If Junior in nghl to tho socunty intorost grantod under this Assignmenl. Grentor expressly authorizes ond directs Truslea nol to eccepL or register upon ita trust records, any subsequent aislgnmanl whllo this Assignment is In force and offect and while any portion or the Indebtedness remains unpaid Granlcr shan not dtroct Trusleo to loose, soil, transfer or encumber any ol lhe Property In lhe Trust (nor surfer or permli anyone else lo do to) without Lender's prior written consont Trustee upon acceptance of thin Assignment eorce* to be bound by the provisions cf thte Assignment and to recognize and honor the power of direction as being solely vested In Lander, except as otherwise may be specified herein.
POSSESSION ANO MAINTENANCE OF THE PROPERTY. Borrower and Granlor ogreo that Borrower's and Grentor's possession and use of Ihe Propnrty sliatl be governed-by tho following provisions:
Possession and Use. Until the occunenco of on Even! of Default. Grantor may (1) remain In possession and control of tho Property, (2) use. operate or mnnarje the Property; ond (3) collect tha Rents from the Property.
Compliance With Environmental Laws. Granlor represents end warrants to Lender Lhat (1) During (he period of Grantor's ownership ot the Property, thorii has been no use, generation, manufacture, storage, treatment, disposal, release or threatened release of any Hazardous Substance by any porson on, under, about or from tho Proporty; (2) Granlor hat no itnowtodgo of. or reason to believe that thore has been, except as previously disclosed to und acknowledged by Lender In writing, (n) nny brooch or violation of ony Environmental Lows, (b) ony use. gannraiion, manufacture, storage, treatment, disposal, release or threatened tolcaso of any Hazardous Substance on. under, about or from tho Property by any prior owners or occupants cf tho Proporty, or (c) any actual or throaloned litigation or claims of any kind by any person relating to such mottois. and (3) Except as previously disclosed to and acknowlodged by Lonflar In writing, (a) neither Grantor nor any tencnl, contractor, agent or olher authorized user of tho Property ahaU use. generate, manufacture, atom, treat, dispose of or relents eny Hazardous Substance on. under, Bbout or from lhc Property; end (a) any such activity shall bo oonductod tn complloneo with ell oppBcablo fodoral, state, and local laws, regulations and ordinance*. Including without limitation all Environmental Laws. Grantor euthortzes Lendor and Us agenTa to enter upon Iho Property lo mako auch rnspecllons ond lasts, ot Grantor's expanse, es Lender may doem appropriate in determine compliance of the Property with lhls section of the Assignment Any inspections or lests made by Lender shall be for Lender*! purposes only nnd shall not be construed lo create any responsibility or liability on the pari of Lendor to Grantor or lo any other person. Tho representations and warranties contained herein are based on Grantor's due dlSgenoa in Investigating Iho Properly for Hazardous Substances. Grantor hereby (1) releases and wolves any future claims against Lender for Indemnity or contnbu'Jon in the event Grentor becomes liable for cleanup or other costs under any such laws; and (2) agrees to Indomnlfy, defend. Bnd hold hermtesi Lender against any and all daims. losses, liabilities, damagoa. penalties, and expenses whtch Londor may d.rectly or Indirectly sustain or suffer resulting from a brooch of this sod Ion of the Assignmenl or os a consoquenco of eny.use, generation, manufacture, storage, disposal, roloosrj or threatened rnloaso occurring prior to Grantor's ownership or Intcrosi in the Property, whether or not the same was or should have been known to Grantor. Thc provisions of this taction of the Assignment, including lhc obligation to Indemnify and defend, shall rurvrvo the payment of tho Indebtedness and the satisfaction and roconvoyonco of the lien of this Assignment ond shall not bo sffectod by Lander's acquisition of any interest in the Proporty. whether by foredosuro or otherwise.
Nuisance, Waste. Granlor shall not cause, conduct or perml! any nultanco nor commit, pormlL or suffer any stripping of or waste on or to tho Properly or any portion of the Proporty. Wllhoul limiting Ihe generality of the foregoing. Grantor will not remove, or granl lo any olhor party the right Io remove, any llmbor. minerals (including oil and gas), coal. day. scoria. r>oD, gravel or rccx products without Lander's prior written consent
Removal of improvements. Granlor shall not demolish or remove any Improvements from tho Ron! Properly without Lander's prior wntton
.consent. _Aj. fl.coridTtlpn Jo .the I$SWW)^.AQyi™prQvp.£tViQt*iX*n$& rnay.«gujra.Qraptorj.o™to
roplnce auch Improvements with Improvements of at loasj equal value
Lender's Right to Enter. Lender ond Lender's agents and represents uvea may enter upon Ihe Real Property at ell reasonable times to attend to Lender's Interests and to Inspect the Real Property for purposes of Grantor's cornplience with the lorms end conditions of this Acslgnmont
Compliance With Laws. Grantor warrants that the Property nnd Grantor's use of the Proporty complies with el! existing nppEcablo Iowa, ordinances, ond regulations of governmental outhonttes.
Duty to Protect Grnnlor agrees neither to abandon or leave unattended the Proporty. Granlor shall do all other ects. in addition to those acts set forth nbove In lhls section, which from the character ond uso of the Proporty orrj reasonably necessary to prolcd ond preserve the Property.
TAXES AND LIENS The following provisions relating to the taxes ond lions on the Property era part ol this Assignment:
Payment. Grantor shell pay when duo (end In all evanis prior to delinquency) all toxes, payroll taxes, special taxes, assessments, water charges end :.awcr service charges levied against or on account of the Properly, and shall pay whon due all claims for worx done on dt for scrVccs rendered or material furnished to tho Property. Grantor shall maintain the Property tree of any lens having prionty over or equal to tho Interest of Lendor under this Assignment, except for thoso liens specifically agreed to In writing by Lendor, ond except lor tho lien of l3xes and assessments not due as further spedflod In thc Right to Conlost paragraph
Right To ContesL Grantor or Buyer nay withhold payment of Bny tax, assessment, or claim In connection with a good forth dispute over the obligation lo pay, so long ea Lender's Intorost m the Property la not Jcoperdlzed. If a tion orises or is filed ca - result of nonpayment, Grantor or Buyer shall within fifteen (15) days after tho lien arises or, If ¦ lion Is nicd, wrthln fifteen (15) days after Granlor or Buyer has notice of tno filing, ssr.ure lhe discharge of Ihe lion, or if requested by Lender, dapctll with t«ndor cash or a sufficlonl corporato surety bond or other security satisfactory lo Londor in an amount suffident to dlschargo the Hen plus any costs and attorneys' fees or other charges that oou'd accrue as a result of e foredosuro or sule under the lien In any contest, Grantor or Buyer shall delend llaell and Lender and shall satisfy any idwuo judgment bo for* enforcement egalm! the Property. Grantor or Buy or aho"! name Lender as an additional
COLLATERAL ASSIGNMENT OF BENEFICIAL INTEREST Loan N'o: 0300003418 (Continued)
oNigcc under eny surely bond (utnlshod In the conlesl orot-ecdlna-i
Evidence of Piymonl Gran'o*" shall upon drmand fumigh io L*jn***>" latis'pctory pvfrJi.npe pi payment of <>? teres c assess ¦¦•¦ep.'* zr.i zr-.z" aulhortio lhc "Pfvopnotc rovcrpminlc' cff!c:e< !c dchvsr 1c Lends* el my tlrr.c a written ciolcncnl e' «he l2«ec cr*d D=;essr^c;-.;s against iho Pioport/
Notltt of Construction Grantor shall noitfy lender a' least fifteen (15) days before eny work is corn me need, any services are furnkhod. or tny mzlorals aro supplied to the Property, if any mechanic's lien, materialmen's lion, or other lien ccuW be escorted on account of the v.-oiW, service&, oi materials Q.'ontor will upon raqunsl of Lender furnish lo Londer advance assuror.ccs salls'sclory to Lender that Grentor can and will pyy the cost of such improvements
PROPERTY DAMAGE INSURANCE. The following provisions rclolliyj to Insuring tho Re ol Proporty aMaintenance of Intunnci. Grentor shal prucuto and maintain policies of firo Insurance with stendord extended coverage endorsements on a lair value bails; lor the 1uD Insurable value covcrk>g oil Improvements on the Rent Property in on amount sulflcier.t to avoid application of nny cotniurunco c-'aueo, and with o standard mortgagoa clause rn favor of Lender. Policies thol bo wrlilon by cuch Incurnnca componlos end In such fo:m es may bo reasonably acceptable lo Lender Grantor shell deliver to Lender certificates of coverage from each Insurer cen:aln:nj o stipulation lhal covcrcge will not be cancelled or diminished without a minimum of Ihlrty (30) deys prior written not'.co to Lender.
Application of Pioceeda. Grentor ehell promptly notify Lender Df any loss or domega to thc Property Lander mny rneka proof of loss If Grantor talis to do co within fifteen (15) deys ol the casualty. Whether or not Lenders security h impaired. Lender may. nt Lender's election, receive and retain the proceeds of any Insurance and apply the proceeds 10 the reduction of the Indebtedness, payment of ony Hon affecting the Property, or the restoration and repoir ol the Property. It Lendci elects lo apply the procoods lo realoratton and repelr, Grentor fihifl repair 01 rerVece the damaged or destroyed Improvements In a manner satisfactory to Lender Lender shall, upon satisfactory proof of liuch expenditure, pay or reimburse Grentor from Iho proceeds lor the reosonaWc cost of repoir or resloretion jf Giontor is not in dofault under this Assignment. Any proceeds which have not boon disbursed within 190 deys after thoir receipt end which Londer has not ccmmtlcd lo Iho repoir or restoration of thc Property chall be used first to pay ony emoun! owing tn LondGr under thlc Asclgnment. ihen to pay accrued Interrjsi ond the remainder, rf any, shall bo applied lo lfw principal belanco ol Ihe Indebtedness if Lender holds any proceeds after paynanl rn full of tho indebtedness, cuch proccods shell bo paid to Grentor as Grantor's Interests may appear.
Unexpired Insurance it Sale. Any unaxpirod Insurance shall triure to tho benefit of. and pose to, tho purchaser of the Proporty covered by this Assignmenl at eny trustee's sale or other sale held undo tho provisions of this Acslgnmenl, or al any foreclosure sole of such Pi o party.
Grantor's Raport on Insuionca. Upon re cue it of Lender, however not more than once a year, Grantor shall lumlsh to Londor a report on each existing policy of Insurance showing- (1) lhe name of Iho Insurer: (7) the risks Insured. (3) tha emoun I of the policy*. (*J) the property Insured, the then amonl replacement valuo of such property, and lhe manner of determining lhal value: end (5) Ihe expiration dblr> cf (he policy. Grentor shall, upon request of Lender, have an Independent epprobor oetlclec'.ory to Lender determine the cash volue teolcccmont cost of Ihe Property.
WARRANTY, DLFENSE OP TITLE. The following previsions rclalhg lo ownership of the Collateral and Property arc a part of this Assignment Title. Gmnloi warrants and covenants that Grantor Is Ihe solo owner oi the beneficial Intcrosl In Lhe Trust, froo and dear of sK Hens, liccuiUy interests, end enomibrancoa, except for those disclosed lo. and accepted by, lender In writing. Grentor also Warrants and covenants lhat it has the right to grant to Lender a securrty Interest In the Collateral and will defend Lender against any end ell claims and demands of oriy person to the CoHalerr-1 end the Properly.
Defense of TIllc. Subject to the exception In the paragraph ebovo. Grantor warrants and will forever delcnd tho title to Iho Collateral ond Property against the lawful claims of ell persons. In the event any action or proceeding is commenced that questions Grantor's title or the IntorCompliance with Governmental Requirements. Grantor shall promptly-comply with all lews, ordlnancoo, end regulations, now or heroalter In cfleci. of ail govcmmoniel ouihortOes applicable to the use or occupancy of the Property, Including without limitation, the Americans With Disabilities Act. Grantor may contain In good fatih any cuch law, ordinance, or regulation end withheld compliance during any proceeding. Including appropriate appeals, so long as Gi unlet has notified lendorjn writing prior to doing so and so long as, in Lender's soJo'opTnxjn. TJS^prTi^reslsninh"e~HToporty affl^6T]eol>ordued~Ccnd& hwy'require Granlor lb "posl odequelo se'cuufy'or a BurclyTaono. " roDsonobry satisfactory lo'Londcr, to protect Lender's InteresL CONDEMNATION Tlie following provisions relating lo condemnation proceedings ere e peri of this Assignment.
Application of Ncl Pioceeda. If all or any port of the Property es condemned by eminent dcmaln proceedings or by any proceeding or purchsso In lieu of condemnation. Lender may at Kb election require that all or sr.y portion of lhe ncl proceeds of Ihe cwsrd ta applied to the Indebtedness or the repair or restoration of the Property. Tho net proceeds of Ihe award shall mean lhe award after payment ol al] roaconoble costs, expensos; end attorneys' foot Incurred by Lendor In connection with the condemnation.
Proceeding. If any proceeding In condemnation is filed. Grantor shell promptly notify Londor ti writing, end Grantor shall promptly take such steps es -ray be necessary ic defend the octlsn and obtain the eword. Granlor mey bo tho nomine1 perty In such proceadlng, but Lender thaP bo entitled to participate In the proceodlng and to bo represented In tho proceeding by counsol of Its own choice, end Grantor will deliver or cause lo be delivered to Lendor such Instrument* ond documentation as mey be rec,uo»lnd by Lendor from lime lo lime 10 permit such pnruapalion.
DEFAULT. E;ich ol ihe following, at Lender's option, shall constitute on Evonl ol Default under this Assignment. Payment Default. Borrower falls to make any payment wtwn due under Ihe Indebtedness.
Other Default.*:. Borrower or Grantor falls to comply with or lo perform Bny other term, obligation, covenant or condition coniBined In this Assignment or tn eny of the Relolod Documents or lo comply with or lo porlorn any term, obligotlon, covcnanl or condition contained In eny other oc-rcemoni between Lender end Borrower or Grantor.
Dofoull In Favor of Third Parties. Borrower, any guarantor or Granlor defeulis undor any loan, extension of credit, security agreement, purchase or aolec agreement, or ony other ogreamont. In favor nf ony othor crodltor or porson iho I mny materially affect ony ol GorioNvora. nny guarantor's or Grentor's property or ebllrty lo perform their respective obligations under ihis Asslcnmenl or any of thc Rotated Documonls
COLLATERAL ASSIGNMENT OF BENEFICIAL INTEREST Loan No: 8300003418 (Continued)
Grantors bc'nalf under (his Assignment or the Kelalco Documents is false or misleading In ony material respect, either now or ai Vno lime matfo or furnished or becomes fa!so cr misleading ol eny lime rharenfier.
Do'ocirvc Cafljitcriit'utlor. Tins Asslgnmonl or any of tno Related Oocumonts ceases to be In full force ond effect (indu-Jing failure ot ony cnihtcrnl ducumonl In create a valid and perfected security Interesl or lien) ot ony tJrre ond for any reosan.
Poaih or lnttil.'cncy. Trie dea:h of Borrower or Grantor, tho insolvency of Borrower or Grantor, lhe appointment of c receiver for any port of Bcn-owerY, or Grantor's prcparty. any asslgnmonl for the benoflt of crerJi'iOTS, any type.of creditor \vcrV:oui, or ihe commencement of nny proceeding under ony bunxnjpicy or Insolvency laws by or egelrot Borrower or Gmntor.
Creditor or Forfeiture Proc*«d!ngs. Commencement of loreclosure or forfeiture proceedings, whether by judicial proceeding, self-help, rcptis: cssicn or any other method, by ony creditor of Borrower ar Granlor or by any gcvemmontol agency against any proporty tccunng tha Indebtedness. This nidudes a garnishment of any of Borrower's or Grentor's occounta, Including dopeslt occounln, wtth Lender. However, this Evonl of Default shall not apply If (here Is a good faith dispute by Borrower or Grantor as lo the validity or reaaonaUonoss of the claim which la the basts of the creditor or forfeiture proceeding und ir Borrower or Grantor gives Londer written notice of the crodltor or forfeiture proceeding and deposits with Lender monies or a suroty bond for the ct editor or forfeiture proceeding. In an o mount determined by Lender, In lis -.olo dlscellan. as balnq an adaqualo roiorve or bond for the dispute.
Event1: Affecting Guarantor Any of the preceding ovents occurs with respect to any Guarantor of any of the Indebtedness or Guarantor die; or becomes Incompetont or rcvoVos or disputes the validity of, or liability under, any Guaranty ol the Indebtedness.
Adverse Chinge. A materiel adverse change occurs In Borrower's or Grantor's financial condition, or Londor bcl-oves the pros pact of pr>)Trv>nl or performance of (ho Indebtedness » Impaired.
Inst-ciinry. Lcndei in good failh believes itself insecure.
Cure Previsions, l( arry default,'clher than a default In payment Is curable and If Grantor has not been given a notice of a breach ot the m.t.u provision of this Assignment wiihln the preceding twcVe (12) months, It may be cured If Grentor, after Lander sends written notice lo Borrower demanding cure of such dolaulL (1) cures the default within ttloen (15) days; or (2) If tho cure requires more than fifteen (15) flays, immediately Initiates steps which Londor dooms In Lender's solo discretion to bo sufficient fo cure the default and thereafter continues and ccniplete* o.1 reasonable ond necessary steps curriclenl to produce compliance ax coon as reasonably practical,
RIGHTS OF 1.CNDER. Upon tlx; occurrence of en Event of Dofouil, Lendor, ot ils option, msy exerdso a.ny one or more of the following rights and rc mod ies in addition lo any olher rights or remedies that may be avallablo ol law, In equity, or otherwise:
Accelerate Indebtedness. Londer may declare lhe entire Indebtedness. Including ony prepayment penalty which Borrower v/ould bo required to pay, immrdlalery due and peysbie.
Assemble Property. Londor may require Grantor to deliver to Lendor ell or ony portion of tho Property and any and ell documents relating to Ihe Proporty. Lender may require Grantor to assomblo tho Proporty and make it available to Lander at a ptaca to bo designated by Lender which Is reasonably convenient lo both pertias. Lender also shall have Ml power lo enter upon the Property to lake possession of and manago tho Property.
Sell (he Collateral. Lender'shod have full power to soil, loasa, trantrfef. or othorv/se doal with tha Collateral or proceeds thereof In its own name or that of Gmntor. Lender may coll tho Collateral at public auction. Unless LSe Collateral threatens to decline cpeodlry in value or Is of a type customarily sold on a recognized market, Lender will give Gmntor reasonable notice of the time efter which any private sele or any other Intended disposition of the Colnlcral is to bo made. Tho requtromonis of reasonable! notice shall be met H such notice Is given at least len (1U) days before the tmo of tho sale of disposition. Ai! expenses relating to lhe dlepooilion of the Collateral, Inducting without limitation tha expenses of taking over the Collateral, In selling tho beneficial Interest, Including reosorub'o attorneys' foes, trustee's tees, advertising coats, maslor'a foes, cost of documentary evidence and oxperts. clenographora1 charges, publication costs, appraisal fees (including cosla ot internal oppralsal), foes for abstracts of title, (Hie coorchos and examinations, guaranty polities, title Insurance policies and sirnilor Items and assurances respecting tills to the Collateral and the retaking, holding, preparing for sole, and selling the Collateral shall become a part of tho Indebtedness secured by tills Agreement, and shall be payobte on demand, with biterest at the Nole rate from date of expenditure until repaid.
Mortgagee In Po-.ses»ion. Lendor shall have tho right lo bo placed es mortgagee in possession or to havo o recetvor appointed to rake possession of ol or any part of thc Property, with tho power to prolect and preservo tho Property, lo operats th* P*opsrty preceding .!°.f.9?,n_?y_rc or sale, and to conocl the Ron's from the Property and apply the_procccds, over and above ihe_cost or the receivership, ogninst th(-7iidebtsclnessV The mortgagee"^ po sTeil; bn"or"recefver rn'ay serve without"benrj If permitted bylaw; LondcrVrtghl tolrie'ap'polnlrrieril of a tecelvor shall exist whether or not the apparent value of the Proporty oxceeds the Indebtedness by e substantial amount. Employment by Lander shall not disqualify a person from serving as a receiver.
ColUct Revenues. Lender mey revoke Grantor's right to manage the Property and to colloct tho renin. Issues and profilo horn tho Collateral, and may, without notice or demand, take possession ol tho Property, OUe to which fs held by the Trusiee. end etlhor tuolfor Ihiough a mce'ver. collect lhe ronts, Issuos and profits therefrom. To facilitate collection, Londor may notify Grantor's occoun: debtors Including any tenants on lhc Property lo moke payments directly to Londor.
Obtain Deficiency. Londer may obtoln a Judgment for any deficiency remaining on the indebtedness duo (o Lender ofior oppilcalton of all amounts received from the exercise of the nghts provided h this Assignment
Content lo Proceedings. Grantor expressly consents end agrees to tho Institution cf any proceedings, by Londor to enforce ihts Agroemom end ILi/tlen agalnii the Ccllateral to eneel a sale thereof, or tu enforce peymont of the Nole end Indebtedness, without previous sale or reduction to poiiecsion of any other property pledged to secure the Nolo or Indebtedness, wllhoul regard to the terms or provisions of the Note or wrilten ins'rumeni porfofnlng to the sale or reduction to poecessten of any such pledged property.
Other Rights and Remedies. Lender shall have end may eicerclso ony or bR of thc rights and remedies of a secured creditor under the provisions ol the Uniform Commercial Code, at law. In equity, or othorwlso
Election of Remedies Except as may be prohibited by applicable law. ell of Lenders rights and remedies, whether avldonced by this Asstgnmcnl or by any other wniing. shall be cumulativo and may be exercised singularly or concurrenHy. Election by Lender to pursue eny remedy shaii nol exclude pursuit of any other remedy, ond an election to moke expendfturas or to lake action to perform an obngntfon of Granlor un:!or Ihis AsslgnmsnL oner Grontor'a failure to porfoim. short not affect Lender's right to declare a default and exorcise its rr.-cdies
INDEfiiNii--|CAT10N Or LENDER. Grantor ugieos to Indomnrfy, lo dofend and to save and hold Lender harmless from any and all claims, sulls. obligntions, dnmegos. losses, eor.ls and oxpunsos (Induding. without limitation, Landofs attomoys' f*e»), o>m«nrJ*. Hablloes. pennltms, finos
Page 5
end lor'eliures oi j»ny nc'ife w*i2irosver ,t,st "ny tc asserted ecsL-sl c: ir-curred by Lendi.', !:s cfficers Cl-cCcs crnplcyocs arte; oyer'* crslr.g nut o(. rclaimy to. or rn any manner occasioned by lhl« AcslgnmonI and lhe oxortlco ot Iho rlghtr and lomedicc granted Lender under this The lorcgeing Indemnity provisions sJiaC survive the cancollalicn of this Assignment es to all matters andng or accruing pner tr» ril,rh canccDa-'on and uV toieccing indemnity tholl survrvc in thc event thol Lender elects to exercise eny o( the remedies es provided under this ^srlnnrrrnl following default hereunder.
LENDER'S EXPENDITURES, f, any acllon or p-occodrng is cornincnced that would materially affect Londor's Interest In tl>e Properly or If Gnsnior fails In cn-npfy with any ptovtlon of this Assignment or any Rnlaled Documenls. Including hut nol limlicd to Grantor's f2lluie to dischargo or pay wher due arry amounts Gianlor Is required to discharge cr pay under this Assignment or ony Reletcd Documents. Lender on Grantor's behal' maj (but sheli nol bo ob!MISCELLANEOUS PROVISIONS. The following rnlsccnaneous previsions ere a perl ot Ilila Assignment1
Amrnrfmenls. This Assignment toge:!*cr with any Rclotod Documents. consUtutcs Hie entire undcrsUnding end agreement of the parties a: lo :hc matters set forth In lhls Assignmenl. No alteration of or umondmcnt lo lhls Assignment shall be effcclrvo unless given In witting ¦nnd r.i^ncd by the party 01 parties sought lo be charged or bound by trie alteration or amendment
Atlnmcys' Frc-:, Expenses. If Lender institutes any aull or action to enforce any of tho lerms of (his Assignmenl. Lender shall be entlllcd to recover such sum as lhe court may adjudge reesonabie as attorneys' fees el trial or.d upon any appeal Whether or not any court action is hvcr-'ed, end lo the cvtenl nol prohibited by lew, oil rcnsonoblo expenses Lender Incuts thai In Lender's opinion ere necessary ot ony time for lhe protection of Ils Interest or the cnio.'ccment of Its nghts shall become e pan of the Indebtedness poyobfo on domond ond shall beoi Interest el tlie Note mte fiom the da'o of tho expenditure until repeld. Gxpences covered by this paragraph Include, wlmou*i limitation, however subject tu any limbs under applicable law. Lender's attorneys' fees end Lenders legal expenses, whether or net there » a lowaiill, including oMximcyi' fees and expenses for bonkruptcy proceedings (including efforts to mcdrfy or vacate ony automatic siey or injunction), cppe.-K. ond any ontlclpelcd post-judgment collection services, the cost of searching records, obtaining tide reports (including foreclosure reports), surveyors' reports, and appraisal Iocs end utlo Insurance, to the extent permitied by applicable law. Granlor also win pay ony court coils. In addition to oD other sums provided by Inw
Caption Headings. Caption headings m this Assignment are for convenience purposes only and are net lo be used lo Interpret or define the prc i'-ons of this Aseignmcnl.
ficvr-ilnj Law. Thlc Assignment wll! be govern ad by fadnral law applicable te Lender and, to tha extent net preempted by federal t;w, Ihe laws of Ihe 5-talc of UDnolc without regard lo Its conflicts of law provisions. This Axiignmenl has been accepted by Lender In lhe Stale ol
Rllnols.
Chf.ir- of Venue If fhero ic a tawsuil. Grantor agrees upon Lender's request to submit to lhe jurisdiction of lhe courts of Cook; County. Stale nf IHInclr.
Mcr-jcr. Thoro shall bo no merger of tho Interest or estate created by this Assignment with any olher Interest or eafnto In the Property ol any Vntc held by or for tho benefit ot Lendor in any copocfly. wllhoul the written consent of Londer.
NotiLf-s. Any notice required lo be given undar Jhls Assignmenl shall be given In writing, and shcD bo oflactrva when ocfuolly delivered, when actually received by telefacsimile (unless otherwise required by low), when deposited wilh a nationally recognized overnight couner, or, il -willed, when deposited in tha Untied Stales man. as first class, certified or registered m»l postage prepaid, directed to tha addresses fihc.'n near Uie beginning of this AssignmonL Any party moy change its address for notices under this Assignment by giving formal writ I "n notice lo the other parties, specifying that the purpose of the notce Is to change tlie party's address. For notice purposes. Granlor agm^ to keep Lender informed al ell Umes of Grantor* current address Unless otherwise prrovidod or rocpirod by law. if there Is more than enc Granlor, eny notice given by Lender to any Grantor is docmod to bo nollcc gh/on to oil Grantors.
Sevc iltlilty. If a court of competent jurisdiction finds any provision of this Assignment to bo Iflogol. Involld. or unenturcceblo as lo any ~circM-^*ta"rKe,^VnTTindirio shuirTioVrnako'Lhe 'dfTShairiCf provision"Dlctfai: lnvfllla; arTfflCTroTTxa^*slo"Bnry_oi^
the .-."ending provision thai! be considered modified ao Lhal It baoomee logol, valid end enforceable, tf tho otfondlng provtelon cannot be co mry.Vd. H shall he considered deleted from this Alignment Unless otherwise lequired by low, the (legality, Invalidity, or unenforce ability ol any provision of this Assignment shall not affect lhe legality, validity or enforceability of ony other piovision of lhls Aasignmenl
Siif. &ort and Assign*. Subject to any limitations statod In this Assignmenl on transfer of Grantors tntoncsl, this Assignment shall be bird -.^ upon and Inure lo the benefit of the parties, their successors ond aseigna. If ownership of lhe Property becomes vesied In a. person ottn:i ihan Grantor, Lender, wlthou: nolice lo Grantor, may doal wilh Grantor's successors with reference to this Assignment and lhe \n-ir* '~inrss by way of forbearance or extension without releasing Grantor from lhe obligations of this Assignment or liability under the Indr*-'-Jress.
Survival of Representations and Warranties. All representations, werrantles. end egreemenls made by Grantor in this Assignmenl shall survfr. lhc execuion and delivery ol ;hls Assignment, shall be continuing hn nature, end shot! remain In full force and effoci until such lime as Bri'TOwers Indehlednes-i shaD be paid in full
Tlmr J< of Itv; Essence. Time Is of tho essence In tho porformanco of thk Artslgnmcnl.
Wit*? Jury All p irtie* to lhls Assignment hereby welvc tho right to nny Jury (rial In any action, proceeding, or counterclaim hrought by sny parly *rj3lns1 any other party.
VJsivz' o( Homestead LxcmpHon. Granioi hereby raleasos and waives 08 rights ond benefits of the hemcstcod exemption laws of the Stole of Illinois 9t io all Ipdoblodnosc secured by this Assignment-No Wnvcr by Lender. Lender sholl no! be deemed IO have worved nny rights under this AcslgnmonI unless such wah/«r Is given tn writing ond .v.:ncd by Lendor. No Oelay or omission un the part of Lender In exercising ony right shell operate as a waiver of such right or Eny olhnr r.nhL A waiver by Lendor of 0 provision of this Assignment shall not prejudice or constitute a waiver of Lenders nghi otherwise to donui- J slrict compliance wilh Uiat provision or any othor provision of lhls Assgnmcnt. No prior werver by Lender, nor ony course of dealing b^rwnen Lender and Grantor, shall constitute n wnlvor ol any of Lendero righLs or of any of Grantor's obttgetlons Qs 10 any future
COLLATERAL ASSIGNMENT OF BENEFICIAL INTEREST Loan No: B30D00341B (Continued)
transections. Whenever the consont of LenUei Is requbed under this Assignmenl, Iho granting of cuch consent by Lender In any instance shall not consiliulo continuing consent In ^uhtnnupr.t lnsbinr.i>* u-h«r ^uch consent Is required and in all cases such consont mny be gi.intnd or withheld in the scle discretion of Lender.
DEF1N.TIONS The following eapUa"ized words and leirns shall havo l^.e following meanings when used tn this Assignment Unless specifically stated to lhc contrary, all references to dollar amounts shall moan amounts in lawful money of tho United Slates of America. Words ond terms used in Iho unguis sh.»!l include lhe plural, arid tlio plural shall include Iho singular, as the context may require. Words and terms not otherwise defined ki this Assignment shell havo the meanings attributed lo such terms rn the Uniform Commercial Code.
Assignment Th*! word 'Assignment* means Ihis Collateral Assignment of Beneficial Inlorest, as this Collateral Assignment of Beneficial Interest may be amended or modlflsd from time to time, logolher with all exhibits and schedules attached to lhls Collateral Assignment of Dencfciol Interest from lime lo time
Borrower. Thc word "Borrower" means Donald Charmovitz; and Chicago Title Land Trusl Company. OS Successor Trustee to North Star Trust Company, :»s Successor Trustee to Banco Pcpulor North Amsnca, es Successor Trustee to Plonocr Bonk 4 Trust Company, as Tru-.tee undrr Trust Agroemont daled December 9, 1994 end known os Trusl Number 25948 and Includes all co-stgnonj ond co-makers r H;ning the Noto ond all tholr successors end assigns.
Collateral. Tho word "Coltolerol* moans all of Grantor's ngm. title and Interest in and lo al the Collateral os described in the Property Descnplion section of this Assignment.
Default. Tho word "Default" moans lite Dofault set forth In this Assignment In the section tilled "Default*.
C-ivtmnmcnlil Laws Tho words "Environmental Lows" mean ony and al stato. Inderal and local alatulos, regulations and ordinances relating to Ihe protection ot human hca'lh or tho environment, Including without limitation lhe Comprehensive Environmental Rosponse, Compensation, and babiaiy Act of 1980, as amended. 42 U.S.C Section GS01, el seq. fCERCLA'). the Superfund Amendments and Renuthoniaiion Act of 1S56. Pub. L. No 9Q-4B9 ("SARA"), the Hazardous Materials Transportation Act. -49 U.S.C. Section 1801. ol aoq., tho Resource Conservation and Recovery Act, 42 USC. Seclwn 6901. et seq or olher applicable stats or foaoral Iowa, ruies, or rrgulntlcns adopted pursuant thereto.
Evmt ol OelaulL The words 'Eveni of Default" mean any of tho evonts of dafiiut; set forth In this Assignment In the default section of this Assignment
Gmntor. Tlio word "Grantor* moans Donald Chaimovitz, as Trustee under tho Donald Chaimovitz Declaration of Trust under Trust Agreement doted July 25,1994.
Gu-irantor. The word "Guarantor" meons ony guarantor, riurety, or ocoommodallon party of ony or all of tho Indoblcdness
Guaranty. The word 'Guaranty" moons the guaranty from Guarantor to Lander, including without limitation a guaranty of aO or port of the
Note.
Hnr.irdous Substances Tho words "Hazardous Substances* mean malanals thai, bocauso of their quonllty, concentration or physical, chemical or infectious characteristics, may cause or pose i presort or pctenLal hazard to human hcalih or the environment when Improperly used, treated, stored, disposed of. generated, manufactured, transported or othorwisa handled. Tho words "Hazardous Substances- arc used In their very broadest sense and Includo without limitation any and oil hnzordous or loxle aubstances, maloriors or wo*in as defined by or listed undor tha Environmental Lows Tho term "Hazardous Substances" olso Includes, without limitation, petroleum and petroleum by-productc or ony fraction thereof and asbestos.
Improvement. The word *lmprovemenl3" meons el' existing and future improvements., fixture*, buildings, etructurea. mobile homoc a".ved on thc Real Property. faculties, additions, replacements and oiher construcllon on the Roal Property.
Indebtedness. The word "Indebtedness" moans efl principal, intereat. and olher omounts. ccsla and oxpenses payable under the Nole or Rclatod Documents, together with all renewals of, extonsbni of, modAcaSons of, consoUdatlons of end substitutions for tho Noto or Rclnicd Dor'.imonts and any amounts expended or advanced by Lendiir to discharge Grantor's obllgalions or expensos Incurred by Lendor to enforce Grantor's obllgallone under this Assignment, togollwr with bitemst on such amounts os provldod In this Assignment. Londor. Th« word "Lender* moans Behnont Bank & Trust Company, its successors and assigns.
Note. Thc word "Note" moans Ihe promissory nolo daled August 14. 201S, In tha original principal amount ol $3,200,000.00 from ?.o*rcwrv to Lender, togothar with el renewals of. extensions of, modifications of. reflnonclngs of, consolldallons of, and substitutions for
. .lhe promissory, nnta pr.agreernenL _ - . . . - - - -
Prnparty. Tho word "Property" moans all of Grantor's righL tWe and Interest In and to on lhe Property os described In tha "Property Dcr-viption* section of this Assignment.
Real Proppny "Pie words "Real Property* mean the feel property. Interests and rights, as further described r» this AsslgnmonL R£ii:id Documents. The v.-crds "Related Dea.'*"en!s" mean oi promissory notos. credit agreements, loan agreements, environmental ogrccmcnlr guaranties, secunly egroemenls, mortgegos. doedt of trust, socurlty deeds, collateral mortgages, and all olher instruments, agreement, and documents, whether now or hereafter existing, executed in connection with the Indebtedness.
Rent* The word "Rcnta* means oil present ond future rente, revenuee. income, latuos. royalties, profits, and other benefits danvad from lhr» Property
Trust. The word "Trust" meons that certain land trust creotcd by o Trust Agreement doted December 9, 1004, Trust Number 25946, and kn i-vn Chicago TiUe Land Trust Company, os Succccsor Trustee to North Star Trust Compony, as Successor Trustee to Banco Popular Moiih Am-i.ca. as Successor Trusleo lo Picnoor Bank & Trust Company, as Trustee, undor Trust Agreement deled December 9, 1994 and knn.-i a: Trust Number 2594A.
Trtrsirc Thc word "Trustee" mcena Chicago Tlllo Land Trust Company, whoso address Is 10 S LaSalle Streot, Sto 2750, Chicago. IL C0/7OJ. and any substitute or successor trustees.
V
COLLATERAL ASSIGNMENT OF BENEFICIAL INTEREST (Continued)
GRANTOR ACKNOWLEDGES MAV'^G P.CAP ALL THE !>o.0VlS'ONS OT TH'S COLLMrp.M ASS'GSMCIJT OF BF.NEFICIAL 1NT£8EST AM GRANTOR ACRCCS TE) ITS TliFLVS. TICS CCLLA7ERAL ASSIGNMENT OF aEKHriClAJ. IN'TCRCST IS DATCO AUGUST 14, 2C15.
Don*Id CXi-a^tmb, as Ttuilcc undet Cliaimovi*7 D*clai3(lon of Trust under Arjfctmcn dated July 25, 159-4
This CoUatcr.iI Assignment of Beneficial Interest prepared by: Robert Sxlremer Uc'-nont Bank A Truct Company 1T2S0 W Delmonl Av. Ch--™, IL G0G34
ACCEPTANCE BY LENDER
In consideroiion of the foregoing Collateral Assignment of Beneficial Intorest for security purposes from Grantor to Lendor end the muluol boncfii.i aix' /-.-Vantages flowing between the parires and othor valuable consBeiolion. Londor hamby accepts the foregoing Assignmenl. subject to all rno icr.ns and provisions of,the Trust Agroemont nurnnorcd 2504S. dated Oecamboi 9, 1994. and known as Chicago Tine Land Trust Company. o* Toccessar Trusloa to Noflh Star Trust Company, as Successor Trusiee to Banco Popular North America, os Successor Trustee to Ptoneor B.in\ j, Trusl Company, as Trusloo under Trust Agreemonl daled Decembor 9, 1994 end known es Trust Number 2534S. but Lender herehy cxprussiy disclaims sny snd aft of the liabilities Imposed by the Trust Atf^morihuporj llie;i|>enelicJary or beneficiaries thereof, unlit such time as Lendij r'tsll exercise-the rights aid pnvileges conferred on h" by (hoy/or«jomg > ilgm
I / LenUo/JWfHvSnl DMA t>uJf/Compuny
wO&fa IOK bv [TO.v
ACCEPTANCE BY TRUSTEE
Chicago Tiiir I nnd Trust Company, not individually, but as Trustee, hereby acknowledges the receipt of the Cotloteral Assignmenl of Beneficial
Interest to i.-"v:or. es sei lorth above, on v^ftx^kaJ' ¦ ont' ncW5P,s ln<: aomo In accordance wtth Iho lormc and
provisions u' 'ie 1 rust Agreemonl numbored 2S940,"ioeted Dooember 9, 1994, ond known es Chicago Tttc Land Trusl Company, as Successor
TnJstoo lo N.iiili Star Trusl Company, as Successor Trusteo 1o Banco Popular North Amenca, as Successor Trustee to Plonoar Bank & Trust
Company, us Trustee under Trusl Agreement daled December 0. 1994 and known os Trust Number 25948 Until the Assignment is released
by Lender. Chirac Title Lend Trutl Company agrees nol to petmll or allow Gn&cr to deol^i^ta^Trust In any manner Inconsistent With Ihe
foregoing A*/ , Trustee/ Chicago TldlLahd/nrsI OotrAny
/ Tmal Officer
• RELEASE-(AFTER PAYMENT) - - -
The foregoing Collateral Assignmenl of Beneficial intcrect from Donald Chaimovitz. oo Tructoo under tho Donald Chaimovitz Declaration of Trust under IrueiAijiecmoni dated Juty2G. 1904 lo Bolmoni Bank & Trusl Company Is hereby cancoltod srtd raloosed
Lender: Belmont Bank & Trust Company
Authorized Officer
NOTIFICATION OF ASSIGNMENT
Chicago Title Land Trust Company 10 S LaSalle Street, Sto 2750 Chicago, IL 60003
D«ar Sir or Madam:
This Notirtcnilon is to advise you ot a proposed collator?' assignment of the beneficial interest In the I snd trust described bclow(rcf erred lo below as lhc Truj;!") to secure the Note. This Notification Is executed and delivered by Donald Chaimovitz, as Irusice under the Donald Chaimovifr Declaration of Trust under Trust Agreement daled July 25, 1994 [individually and collectively referred to below as 'Beneficiary"} lo and lor lhc bench! of Belmont Bank & Trusl Company (referred to bolow at "Lendor").
TRUST DOCUMENT S. Relative lo lha proposed AO I, you aro directed to furnish to Lender, or Lender's designated agent, a certified copy of the Trusl agreement, any amendments thereto, the legal description of all real estate subject lo lhe Trust and all assignments, and to permit Lender, or Lender's designated agent lo examine Ihe Trust file. The above certified copies aro requested for uso In eonnecllor. with a conte-r.plalcd assignment of lhe beneficial interest under the Trust
NO OTHER ASSIGNMENT. You ore therefore hereby directed nol 1c accept or 2ct upon any essignmenl of the benefictol interest under Iho Trusl or lo act upon ony direction lo deal with Irtle to the Trust property until there hns been lodged with you an assignment of lhe beneficial inlercsl in (avor of Lender In tho event that tho proposed transactor is nol consummated, you will be so advised in writing by Lender, but If you have nol rccorved auch odvtco within Ihlrty (30) days Irom Itie dote of this Notification, you may conclusively presume thai tho contemplated assignment transaction will not be consummated and that the reslncimns Imposed by this Notification ore no longer applicable. CERTIFICATIONS TO LKKDEK. You arc a'so directed to certify in writing to Lendor that you have dor.o noihmg lo Creole any liens or encumbrances against ihe llllo to lhe Trusl property and that you havo no knowledge of (A) ony liens or encumbrances against title to ihe Trusl property or thc beneficial interest, (B) threatened or pending litigation regarding the Trust, lhe Trust property, or any beneficial Interest m lhe Truti, (CJ any olher assignment or the beneficial interest in the Trusl. or (0) anything adversely affecting title la lhe Trusl property DEFINITIONS The following capitalized words and terms shall havo Ihe following meanings when used m this Notificotion. Unless apceifically slated io iho contrary, all references lo dollar amounts shall moan amounts in lawful money of the United Slates of America. Words and terms usad in the singular shall include the plural, and lhe plural shall include lhe singular, as the context may require Words ond terms not otherwise defined in 'his Notification shall have the meanings attributed to such lerms in the Uniform Commercial Code
ABI. Tlie word "ABI" means tlie Collateral Assignment of Beneficial Interest doted August 14, 2015 from lhe owners thereof to Londer as
socunly for the Loan
Bo-ioficiary. Thc word "Beneficiary" means Donald Chalmovru, as Trusiee under the Donald Chnimcvitz Declaration of Trust under Trust Agreement dated July 25. 1994. including all Benefldanes signing this Notification
Pon-owcr. Tho word "Borrower' means Donald Choimovitz: and Chicago Title Land Trust Company, as Successor Trusiee to North Star-Trust Company, as Successor Trustee lo Banco Popular North America, as Successor Trustee lo Pioneer Bank & Trust Company, as Trustee under Trusl Agreement dated December 9. 1994 and known as Trust Number 25948 and includes all co-signere and co-makers signing ihe Note and all their successors and assigns.
Lendur The word "Lender" moans Eelmoftt Bank 6\ Trjs'. Company, its successors and assigns
Nole. The word "Note" moans ihe Note doted August 14, 2015 ond executed by Bonuwor In the principal amount of 53.200.000 00. together with all renewals of, extensions of, modificalions of, refinancings of. consolidations of, and substitutions for the ncte or credit agreement
Trust The word "Trust" means that certain land trust created by a Trust Agreement doled Dacambor 9. 1994. Trusl Number 25940, ond known as Chicago Title Land Trust Company, as Successor Trustee to North Stnr Tnj3l Compony, as Successor Trus'leo lo Banco Popular North Amenrj. as Successor Trusiee lo Pioneer Bank A Trust Company, as Trustee under Trust Agreement dated Oocember 9. 1994 and known as Trusl Number 2591B.
Trustee. Trie word "Trustee" meons Chicago Title Land Trusl Company, whose oddross is 10 S LaSaOo Street. Sto 2750. Chicago. IL 60GO3. and any substitute or successor tru5tCC3
NOTIFICATION OF ASSIGNMENT Loan No: 8300003410 (Conlinucd)
!
CUSTOMERNUMUER- BP 2594S
WHEREAS, the Chicago Title Land Trust Company, as Trustee under the terms of a certain agreement dated December 9, 199-1 and known .is Trust Number 25948 is presently holding thc legal and equitable tide to certain real estate;
AND WHEREAS the undersigned party(ics) of the first part hold(s) thc beneficial interest in thc proceeds and avail; of such property in accordance with the terms and provisions of said agreement,
AND WHEREAS said Trust, in accordance with the provisions thereof, terminates twenty years from the date of said agreement or, should said trust have been previously extended, twenty years from thc date from which it was last extended;
AND WHEREAS, it is the desire ofthe parties hereto to extend the terms ofthe trust for an additional twenty years.
NOW THEREFORE for and in consideration of thc sum of One Dollar and olher good and valuable consideration, receipt and sufficiency of which is hereby acknowledged, the parties hereto do hereby agree that llic said trust shall continue under tlie same terms and conditions for an additional twenty years from December 9.2014 except however, that the compensation of the Trustee for signing deeds and otlici instruments shall be its current schedule of charges for such services and S29S.00 per year for continuing to hold title to the real estate, or as adjusted by Lhc Trustee from time to lime.
UJ ^ w
IN WITNESS WHEREOF thc party(ies) of thc first part has (have) set their hand(s) and seal and thc Trustee has caused these presents to be executed by ils Authoiizcd Administrator.
Signature-
Donald Chflimovit7, as trustee ofthe Donftld Chaimovitz Declaration
of Trust dated July 25, 1994
PrintedName:
Telephone Number
noo Ai rs cm ft; m o ia-t
Address, City, Slate, Zip ~ '
Printed Name:
Address, City, Stale, Zip
Printed Name:
Address, City, State, Zip
Printed Name*
Address, City, Slate, Zig
Printed Name
Address, City, State, Zip
Printed Name.
Address. City, Stale, Zip
acknowledged by trustee this
Chicago Title Land Trust Company
By.- -Mm* &&ZAlot<^
AutfiAnzed Administrator
Rev. 10/04
3u*U£ft Sar cement, dated DCCeVilber S, 19 an[i l„own js Trusl Niiinuci 2 5.94 8
IT IS AGREED.
PIONEER EAj:^ i TKu57 COmF'AKY, a corporation cf lUinois. as trustee hereunder, b about to take legal and equitable (ulc io lhe following
described ical estate )n mOfv Count*. !!Jir.c:s:
The West Twelve Inches (W 12") of Lot Seven (7) and all of Lots Eight (8) through Sixteen (16) in Block Three (3) in Nacjle and High's Addition to Chicago in Lhe East Half (E 1/2) of the Southwest Quarter (SW 1/4) of Section Eight (8), Township Thirty-nine North (39 N), Range Fourteen (14), East (E) of the Third (3rd) Principal Meridian, in Cook County, Illinois.
otherwise known as 325 North Elizabeth Street, Chicago, Illinois 6O607
When lhe trusiee has lafcen title to thc leal estate or has accepted in wnunc title lo any other properly conveyed to it is trustee hereunder, thc trustee will hold it for the uses and purposes and on lhc trusts herein stated. Any other property conveyed to the uustce without written acceptance by the truster Thc following na/ned persons (beneficiaries) and their successors in interest shall be entailed lo thc earnings, avails and proceeds of lard real estate according to llic respective interests herein set forth, to wrl.
100% of the beneficial intoreot in DONALD CHAIMOVITZ ao Trustee, or his successors in trust, of the DONALD CHAIMOVITZ DECLARATION o£ TRUST ONDER AN AGREEMENT datod July 25, 1994, with full power to sell, assign or transfer, all or any part of the beneficial interest thereof.
The power of direction icfcrrcd lo on the leverse side hereof shall be in DONALD CHAIMOVITZ, as Trustee, or
his ouccesuors in trust.
THIS AGREEMENT IS SUBJECT TO ADDITIONAL PROVISIONS SET FORTH ON THE REVERSE SIDE HEREOF AND WHICH ARE HEREBY INCORPORATED HEREIN AND MADE A PART HEREOF BY REFERENCE.
n .\Jt\~!-r-K ) (SEAL)
SONALD CJJASMPVITZ, Trustee SSN: 320-46-1891
(SEAL)
Chicago, Illinois 60607
Address, c./.o 3.25 .Npxth.Elizabeth.
Chicago, IL 60607
Beneficlaiy
Address.
Beneficiary
(SEAL)
Beneficiary
.(SEAL)
Beneficiary
.(SEAL)
Dcncfii.i4jy
/^>t^-~'~c':\ PIONEF.B
Assistant ^c^ctajy^^^ftlJRA/A. IitXallES
Signature and nldrcv. of tht person hjvmg a pouci of direction if other lhan a be ncfiu.ny
(SKAU
lhc interest ol every bcneliuary and ol" :iny person who may become cn tl I led to any interest under litis trust
shall consist only ol (I) the power lo dticci the trustee: to deal with ink to lhe property, (2) lite power lo manage,
possess, use and control ihe properly, and (3) lhc right to receive the cuttings, jvuils anil proceeds from leases jnd
other ur.es -and Irom morteases, sales and other dispositions ol' the properly. Such rights and powers shall be person;!
property iti.i m.iy be assignee as such. On the dejtlt of any beneficiary his mtercs!. execpras otherwise specifically
provided, shall pass to his ctccuior or administrator and not to his heirs at law No beneficiary ;i( any tunc shall hjve
any nghi, title or interest tn or to any portion ol' the legal or equitable- title lo the properly Tlie death ol any bene-
ficiary shall not terminate the trust ot affect the rights or powers ol the trustee or ol the bencliciaiics except is pro-
vided by law. H H
No assignment of any beneficial intcrcsl shall be binding, on thc trustee until the original or executed duplicate of ihe assignmenl is delivered to llic trustee and accepted by it tn writing. Every assignment of any beneliciai interest, the original or duplicate of winch shall nol have been so delivered to jnd accepted by the trustee, shall be ineffective as to all subsequent assignees or purchasers without notice.
he trustee shall have no obligation to file any income, profit or other tax reports or returns or pay such or any other taxes. Tin: beneliciaries will nuke all such returns and reporis. and pay general real estate and all olher tjxes or cliatE.cs payable with respeel to lhe piopeny and lo the earnings, avails and proceeds ol' tlie piopeny or based on their interests under this agreement.
If lhe Irustee shall nuke any advances or incur any expenses on account of lliis Irust or the properly or shall incur any expenses by reason of being made a pany io any litigation in conneciion with Ibis Irust or (he property or if the irustee shall be compelled to pay money on accounl of this trusl or the properly, whether for breach of contract, injury lo person or property, fines or penalties under, any law, or otherwise, the beneficiaties jointly and severally on demand shall pay to lhe trustee, with interest at thc highest rale per annum permitted by law [he amount uf all such expenses, advances or payments nude by the trusiee, plus all its expenses.' including attorney's fees. The trusiee sliaJI not be obliged to convey, transfer or otherwise deal with the property or any pan of tl until all of the payments, advance, and expenses made or incurred by H shall have been paid, wilh intcrcsl
The irusice"shall nol be obligated to pay any muney for this (rust or lite properly or to prosccuie'or defend any legal proceeding involving'this trusl or [lie properly unless il shall eleel 10 do so and'be furntshcd-'willi sufficient funds or be indemnified to its satisfaction. II" the trusiee is served Willi process or notice of legal proceedings or of any othei mailer concerning Ihe trust or thc properly, lhe sole duly ol" lhc trusiee shall be to forward lhe process or.notice to the person named herein as lhe person I'o whom inquiries or notices shall be sent, or. in (lie absence bf such designa* lion, lo lhe beneliciaries. The latest address appearing in the records, ol lhe tiustee shall be used lor all mailings.
shall not be (he duty of lhe purchaser ol" llic properly or ol jny pari of it lo sec the application of lhe purchase money, nor shall anyone who nay deal with ihe irustee be required or privileged lo inquire into ihe necessity or expediency of any act ol the trustee, or into the provisions of this agreemenl.
In this agreement the plural includes the singular, and vice vetsa. and the masculine gender includesthe feminine.
The trustee may al any tune resign by sending by registered or certified mail a nolice of such intention to each of the then beneficiaries .at his latest address appealing in the records of the trustee. Such resignation shall become effective twenty days after such mailing. On such resignation a successor may be appointed in writing by the persons ihen cnlitilecl lo direct the trustee in the disposition of lhe properly, and Ihe trustee slull thereupon convey or transfer the properly to such successor. If no successor is named as above provided willnn Iwenly days after the mailing of such notices by the Irustee. the trusiee may convey or transfer lhe irust property lo the beneficiaries in accordance with their interests hereunder, and lhe conveyance may be recorded or registered, as ihe case may be, by Ihe trustee and such recording oi registration shall constitute delivery of die conveyance or transfer io the beneficiaries. The trustee, nt Ms option, may file a complaint for appropriate relief in any court of coinpelent jurisdiction.
Every successor trustee shall become fully vested with all lhe title, csiale, rights, powers, trusts, and shall be subject to the duties-arid.obligations, of its predecessor.
It is agreed by the parties and by any person who may hereafter acquire any interest in this trusuhal the trustee will deal with the trust property including cash or other assets of any kind which may have become subject lo the Irust only when authorised lu do so in writing
On the written direction of the party or parties designated on lhe reverse side hereof as having the power of direction the trusiee will make deeds for, or mortgages or trust deeds (which may include a waiver of the right of redemption from the sale under an order or.decrce of foreclosure) or execute leases or otherwise deal with the title to ihe trust properly including cash or olher assets subject lo ilic.lrusi. The beneficiaries by written instrument delivered
thc trustee m.iy revoke Ihe foregoing power ol" direction and designate the person ihcteai'lct to exercise lhc power. Such instrument slull be signed by all the then beneficiaries. The trustee shall nol be required to inquire inio lhe propriety of any direction.
Thc trustee'shall nut be required to assume any personal obligation or liability in dealing with ihe property or to make iisclf liable for any damages, costs, expenses, lines or penalties, or lo deal wilh title 10 the properly so long as any money is due to it hereunder.
Thc beneficiaries shall have the sole possessionmanagement and control of the selling, renting, repairing, tTuinmning and handling of the properly and the Irustee shall have no right or duty in respect lo any such inaiicrs. Thc beneliciaries shall have the right lo cxecuie leases and colleci rents in their own name or thiough then agents. Thc iruslee shall have no right or duty in respect to lhe payment of taxes or assessments or insurance, litigation or matters relating lo the piopeny. except on written-direction accepted by il as above provided and after the payment lo it of all money necessary in lis opinion lo carry out the directions without liability lo it. The beneficiaries arc not [he agcnls of lhc trustee for any purpose and do not have any authority to conlracl or to execute leases or do any other act for ot in lhc name of lhc irusice or to obligate the trusiee personally or as irusice
The trustee shall nol be required to execute any instrument containing covenants of warranty.
If any properly remains in ihis trust iwenly years from the dale ol" this agreement or any extension thereof.
shall be sold al public sale by lhe trustee on reasonable notice as determined by il and the net proceeds ul" lhe sale
shall be divided .timing those who are then entitled thereto under Ihis agreement in the proportions in which ihey are
then entitled , , . . .
The trustee shall receive lor its services in accepting this trust and tjkmg title hetctindei an acceptance tec, and in addition each year in advance for holding litle after one year from lhe dale liereol an annual lec. each Ice as dcicrmined hy lhe in.sice"s ihen current tate schedule and also its regular scheduled lees for executing deeds, mortgages or olher iiiMnmienis II shall receive reasonable compensation for any special services which may be rendered by it and lor lakmg and holding any. olher properly which may hcicjlier be conveyed lo il hereunder, which Ices, charges and other compensation lhc henel'icuiies jointly and severally agree to pay. II lhe value uf the properly is increased lor any reason after the trusiee has accepted title thereto: lhe m.stee shall be entitled to a reasonable additional annual Ice. in accutdance with us schedule fees lor holding lille lo lhc property.
PiONHEK HANK X TKWST COMPANY JO(II) W. NORTH AVE , CHICAGO. ILL f>t)6.V>
CITY OF CHICAGO ECONOMIC DisCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: 1230 WEST, LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
|xTj the Applicant
OR
? a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest:
OR
3. []a legal entity with a right of control (see Section ll.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 1230 w. FULTON STREET
CHICAGO, IL 60607
Telephone: (312)327-3350 pax: (312) 327-3315 Email: rnichael@acostaezgur.com
Name of contact person: michael ezgur .
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 alley bounded by North Elizabeth St; West Carroll Ave, North Racine Ave; and West Fulton Street
G. Which City agency or department is requesting this EDS'? CDOT
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing | | Person
[~] Publicly registered business corporation H] Privately held business corporation Q Sole proprietorship [ J General partnership | | Limited partnership ? Trust
j~Xj Limited liability company
Q Limited liability partnership
I I Joint venture
| [ Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
? Yes rjNo I | 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 iHNo [xjN/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, 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
DOUGLAS VAN VLYMEN MANAGER
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 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
DOUGLAS VAN VLYMEN 1230 W. FULTON ST., CHICAGO, IL 60607 50%
Corrie Van Vlymen 1230 W. Fulton St., Chicago, IL 60607 50%
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes fx] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes lo 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. MICHAEL EZGUR 1030 W. CHICAGO AVENUE. 3RD FL. CHICAGO IL 60642 ATTORNEY $2,500 (est.)
(Add sheets if necessary)
| j Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.
SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
Yes [X, No fj No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
? Yes []No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1 -23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if thc 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 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
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ILB.l. of this EDS:
I a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Parly, any Contractor or any Affiliated Entity, acting pursuant to thc 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 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of thc U.S. Department ofthe Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
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:
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"). NONE.
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient. NONE.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
? is [xj is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. 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 lo make this pledge because it or any of ils affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
Yes [Xj 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?
Yes [XJ No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify thc 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 cither I. 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.
J=XJ_1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes ? No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
Yes 3No
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
LJ Yes ? No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes n No
If you checked "No" to question 1. or 2. above, please provide an explanation:
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SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1 -23 and Section 2-1 54-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 1 1 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent 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 ofthe items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
Signed and sworn to before me on (date)
at Cook ) County, Illinois
Commission expires:
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or anyperson 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) thc name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) thc precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
1. Pursuant 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 of the Municipal Code?
fx] No
2. If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
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 of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
(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 Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Vacation of alley iDouoded by North Elizabeth St.: West Carroll Ave.; North This recertification is being submitted in connection with Racing Ave; and west Fulton Street
[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 tlie Disclosing Party, (2)
warrants that all certifications and statements contained in the Disclosing Party's original EDS
are true, accurate and complete as of the date furnished to the City and continue to be true,
accurate and complete as of the date of this recertification, and (3) reaffirms its
acknowledgments.
1230 West, LLC
(Print or type legal name of Disclosing Party)
(signliere)
Print or type name of signatory; Douglas Van Vlymen
Title of signatory: Manager
Signed and sworn to before me on [date]
Douglas Van Vlymen , at Cook County, Illinois [state].
Commission expires
otary Public.
Mm ^f^o^o
\ WFICIALsiALr
w MARGARITA BRIZUELA
Ver. 11-01-05
t Notary Public, State of Illinois
i My Commission (Expires 5/14/2020 ;
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION 1 - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Chicago Title Land Trust Company Trust No. 25948
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[Xj the Applicant
OR
rj a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest:
OR
3. [7] a legal entity with a right of control (see Section ILB.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 325 N. ELIZABETH STREET
CHICAGO, IL 60607
Telephone: (312)327-3350 pax: (312)327-3315 Email: michael@acostaezgur.com
Name of contact person: MICHAEL EZGUR
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 alley bounded by North Elizabeth Street; West Carroll Avenue; North Racine Avenue; and West Fulton Street.
G. Which City agency or department is requesting this EDS'? CDOT
If the Matter is a contract being handled by the Cily's Department of Procurement Services, please complete the following:
Specification # and Contract #
Paue 1 of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing [11 Person
?j Publicly registered business corporation ,1 | Privately held business corporation ? Sole proprietorship | j General partnership [? Limited partnership [Xj Trust
Party:
[_] Limited liability company
j | Limited liability partnership
Joint venture
Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
? Yes QNo ? 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?
S 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 Donald Chaimovitz Trustee
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
Donald Chaimovitz Declaration of Trust, dated July 25. 1994 325 N. Elizabeth Street. Chicago IL 60607 100%
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes > [xj 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 thc 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 Parly 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 fo influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
Michael Ezgur 1030 W. Chicago Ave., 3rd FL. Chicago IL 60642 Atty $2,500 (est.)
(Add sheets if necessary)
? Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[j Yes 0 No Q No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
? Yes ? No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of thc 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 thc Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ILB.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not; within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with thc 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 thc 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, thc term Affiliated Entity means a person or entity that directly or indirectly controls thc Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains thc same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of thc following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department of the Treasury or the Bureau of Industry and Security of thc U.S. Department of Commerce or their successors: the Specially Designated Nationals List, thc Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with thc applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, 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, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. NONE.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
? is 0 is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable.to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
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?
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. 1., 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 docs not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
Yes [*j No
If you checked "Yes" to Item D.l., provide the names and business addresses 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_ j 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
dl 2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes ? No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
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?
L'iYes ['"JNo
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
; j Yes : ;No
If you checked "No" to question 1. or 2. above, please provide an explanation:
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SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to thc public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, thc Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. Thc 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 thc City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 1 1 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent 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.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
Chicago Title Land Trust Company Trust No. 25948
(Print or typ& name of Disclosing Party)
Donald Chaimovitz
(Print or type name of person signing)
Trustee of the Donald Chaimovitz Declaration of Trust, dated July 25, 1994, as sole beneficiary
(Print or type title of person signing)
Signed and sworn to before me on (date)
at Cook County, Illinois
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section ILB.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
L7;Ycs [?] 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 ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
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.
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 of the Municipal Code?
QYes [7) No
Tf the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
| | Yes ONo [3Not 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 of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of" 14
(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 Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Vacation of alley bounded by North Elizabeth St.; West Carroll Ave.; North This recertification is being submitted in connection with Racine Ave; and West Fulton Street
[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 Disclosing Party, (2)
warrants that all certifications and statements contained in the Disclosing Party's original EDS
are true, accurate and complete as of the date furnished to the City and continue to be true,
accurate and complete as of the date of this recertification, and (3) reaffirms its
acknowledgments.
Chicago Title Land Trust Company Trust No. 25948 Date: 6-2-16
(Print or type legal name of Disclosing Party)
(sign here) upCA> I-*QS
Title of signatory:
Trust of the Donald Chaimovitz Declaration of Trust, dated July 25, 1994, as sole beneficiary
Signed and sworn to before me on [date] £Mj/k , by
sDonaldI Chaimovitz , at Cook County, Illinois [state].
Notary Public.
Commission expires:
-> - — - - - — . i
< OFFICIAL SEAL i
i SAMUEL BEREZIN »
< Notary Public - State of Illinois '
< My Commission Ixplrea 8/06/2018 >
Ver. 11-01-05
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
ELA Associates, lnc
Check. ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[^j the Applicant
OR
? a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest:
OR
3. ? a legal entity with a right of control (see Section ILB.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 17W635 Butterfield Road
Oakbrook Terrace, IL 80181
Telephone: 312-327-3350 Fax: 312-327-3315 Email: michael@acostaezgur.com
Name of contact person: Michael Ezgur
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 alley bounded by North Elizabeth St.; West Carroll Ave.; North Racine Ave.; and West Fulton Street
Which City agency or department is requesting this EDS? CDOT
If the Matter is a contract being handled by thc City's Department of Procurement Services, please complete the following:
Specification ft and Contract it
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
f ! Person
| j Publicly registered business corporation | j Privately held business corporation
Sole proprietorship } | General partnership r~] Limited partnership ? Trust
[Xj Limited liability company [~1 Limited liability partnership | ] Joint venture [~], Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
? Yes QNo ! | 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 [J No EN/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, 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 ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Carroll Avenue Associates, Ltd. Manager
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
Carroll Avenue Associates, Ltd., 17W635 Butterfield Rd., Oakbrook Terrace, IL 60181 100%
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes £ No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, thc Disclosing Party must either ask the Cily 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.
Michael Ezgur, 1030 W. Chicago Ave., 3rd FL, Chicago, IL 60642 Atty $2,500 (est.)
(Add sheets if necessary)
I | Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
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 fx No ? No person directly or indirectly owns 10% or more ofthe
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
Yes [JNo
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 thc 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 of the City or any sister agency; and (ii) thc Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ILB.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible enlily); with respect to Contractors, thc 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 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 thc City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department ofthe Treasury or the Bureau of Industry and Security of thc 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 Parly understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
None
9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of thc City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
? is [.xis not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Muriicipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
Tf the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
Yes Cx'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?
Yes No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies lhat no prohibited financial interest in thc 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 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.
CZ] 2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that thc Disclosing Party means that NO persons or entities registered under thc Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. Thc Disclosing Party has nol 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 influcnce 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) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes LjNo
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
Yes [jNo
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes GNo
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes ? No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
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.cityofchica.qo.org/Efhics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. Jn the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1 -23 and Section 2-154-020 of the Municipal Code.
Thc Disclosing Party represents and warrants that:
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent 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 ofthe items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf ofthe Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
THOMAS E. COMFORTE
ELA ASSOCIATES. LLC (Print or type name of Disclosing Party)
(Print or type name of person signing)
PRESIDENT OF CARROLL AVENUE ASSOCIATES. LTD., MANAGER
(Print or type title of person signing)
Signed and sworn to before me on (date) at Cook/^yn County, Illinois
Commission expires:
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any 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 ILB.l .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) anyperson 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 entily or any person exercising similar authority.
Docs 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
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.
Pa
ngc 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDLX 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 of the Municipal Code?
0No
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?
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 of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
(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 Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Vacation of alley bounded by North Elizabeth.St.: West Carroll Ave. This recertification is being submitted in connection with Racing Ave; and West Fulton Street
[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 Disclosing Party, (2)
warrants that all certifications and statements contained in the Disclosing Party's original EDS
are true, accurate and complete as ofthe date furnished to the City and continue to be true,
accurate and complete as of the date of this recertification, and (3) reaffirms its
acknowledgments.
ELA Associates, LLC
(Print or type legal name of Disclosing Party) By:
a
Print or type name of signatory:
Thomas E. Comforte
Title of signatory:
President of Manager
Thomas E. Comforte
Signed and swom to before me on [date] _
, at Cook
£,20f&, by
County, Illinois [state].
Notary Public.
Commission expires
OFFICIAL SEAL WNGAKLUC2K1EVWCZ NOTARY PU8UC - STATE OF ILUNOtS MY COMMISSION EXPWES:04/11/18
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable: CARROLL AVENUE ASSOCIATES, LTD.
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
f'J the Applicant
OR
[_x! a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest: ela ASSOCIATES. LLC
OR
3. []j a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 17W635 BUTTERFIELD ROAD, SUITE 220
OAKBROOK TERRACE, IL 60181
Telephone: (312)327-3350 pax: (312)327-3315 Email: michael@acostaezgur.com
Name of contact person: MICHAEL EZGUR
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 alley bounced by North Elizabeth St; West Carroll Ave.; North Racine Ave.; and West Fulton St.
G. Which City agency or department is requesting this EDS? CDOT
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete thc following:
Specification it and Contract #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing Party:
L~j Person LJ1 Limited liability company
[71 Publicly registered business corporation ? Limited liability partnership
fxj Privately held business corporation Q Joint venture
| | Sole proprietorship Q Not-for-profit corporation
? General partnership (Is the not-for-profit corporation also a 501(c)(3))?
[7] Limited partnership [JYes [ZINo
[J Trust Q 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 T] No H 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 titleholdcr(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
THOMAS E. COMFORTE PRESIDENT AND TREASURER
^CTORirCOlvlFORTE"" VTCETRESIUbrTl
JOHN W. COMFORTE VICE PRESIDENT
TMEUrATvTA. COMFORTE STECTfETARY
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 in the
Disclosing Party
THOMAS E. COMFORTE 17W635 BUTTERFIELD ROAD, SUITE 220, OAKBROOK TERRACE, IL 60181 25% VICTOR J. COMFORTE 17W635 BUTTERFIELD ROAD. SUJTE 220, OAKBROOK TERRACE. IL 60181 25%
JOHN W. COMFORTE I7W635 BUTTERFIELD ROAD. SUITE 220. OAKBROOK TERRACE, IL 60181 25%
WILLIAM A COMFORTE, 17W635 BUTTERFIELD ROAD, SUITE 220, OAKBROOK TERRACE, IL 60181 25%
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes [xj No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount 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 thc Disclosing Parly is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make thc disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
[xj Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
Yes [xj 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 [j No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance wilh Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11.B. 1. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any 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 thc City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with thc 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 thc same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contraclor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of thc 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 thc Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of thc U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and thc Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), thc Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official,
of the City of Chicago (if none, indicate with "N/A" or "none"). NONE.
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient. NONE.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
n is [X; is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If thc Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. 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 Cily."
If the Disclosing Parly 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 thc 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?
Yes [Xj 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 thc purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
Yes [X;No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., thc 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 thc Matter voidable by the City.
[X„j 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
[ j 2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on thc 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 thc Disclosing Party with respect to thc Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entily listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that cither: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party thc Applicant?
Yes ? No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
G Yes Li No
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes ? No
Have you participated in any previous coniracts or subcontracts subject to the equal opportunity clause?
LI Yes No
If you checked "No" lo 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.cityofchica.uo.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 thc 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 lo make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, thc 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 thc City's Department of Procurement Services, the Disclosing Parly must
update this EDS as the contract requires. NOTE: With respeel to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page 1 1 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. 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.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, thc 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.
Thomas E. Comforte
Carroll Avenue Associates, Ltd. (Print or type name of Disclosing Party)
(Print or type name of person signing)
President
(Print or type title of person signing)
Signed and sworn to before me on (date) at Cook /^"V-i County, Illinois
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) thc Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister. -
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section ILB.l .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Parly is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
H"]Yes ixjNo
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
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.
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 of the Municipal Code?
QYes |T|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?
QYes QNo Q Not Applicable
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 of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
(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 Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Vacation of alley bounded by North Elizabeth St.; West Carroll Ave.; North This recertification is being submitted in connection with Racine Ave; and west Fulton Street
[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 Disclosing Party, (2)
warrants that all certifications and statements contained in the Disclosing Party's original EDS
are true, accurate and complete as of the date furnished to the City and continue to be true,
accurate and complete as ofthe date of this recertification, and (3) reaffirms its
acknowledgments.
Carroll Avenue Associates, Ltd. Date: 6-2-16
(Print or type legal name of Disclosing Party)
Print or type name of signatory:
Thomas E. Comforte
Title of signatory: President
Signed and sworn to before me on [date] _
Thomas E. Comforte , at Cook
Notary Public.
Commission expires:_
OFFICIAL SEAL KINGAKLUCZWEVWCZ NOTARY PUBUC - STATE Of QiJNOIS MY COMMISSION EXPtftES.OVIIrta
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: FULTON/RACINE PROPERTY, LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
|X~] the Applicant
OR
? a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest:
OR 5
3. Q a legal entity with a right of control (see Section ILB.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 1200W. fulton STREET
CHICAGO, IL 60607
Telephone- (312)327-3350 pax. (312)327-3315 Email- micnael@acostaezgur.com
Name of contact person: MICHAEL EZGUR
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 alley bounded by North Elizabeth St; West Carroll Ave.; North Racine Ave.; and West Fulton St.
G. Which City agency or department is requesting this EDS'? CDOT
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification it and Contract #
Page 1 of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate thc nature of the Disclosing Party:
Ql Person r_Xj Limited liability company
j | Publicly registered business corporation [_j Limited liability partnership
| j Privately held business corporation Q Joint venture
[7] Sole proprietorship [~] Not-for-profit corporation
fjj General partnership (Is the not-for-profit corporation also a 501 (c)(3))?
Q Limited partnership QYes LjNo
Q Trust F] 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 [1 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 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 ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title TIMOTHY JANS MANAGER
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 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
Timothy Jans, 1200 W. Fulton St., Chicago, IL 60607 33.33%
Robert Jans, 1200 W. Fulton St., Chicago, IL 60607 33.33%
David Jans, 1200 W. Fulton St., Chicago, IL 60607 33.33%
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
? Yes [Xj 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
Thc 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. MICHAEL EZGUR 1030 W. CHICAGO AVENUE, 3RD FL. CHICAGO IL 60642 ATTORNEY $2,500 (est.)
(Add sheets if necessary)
I ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
n Yes [Xj No Q No person directly or indirectly owns 10% or more ofthe
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
? Yes ? No
FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or 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 Cily 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 J supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department ofthe Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.
If thc Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further --' Certifications), the Disclosing Party must explain below:
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"). NONE.
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. NONE.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
? is [Xj is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 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 ofthe Municipal Code, explain here (attach additional pages if necessary):
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If thc 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 ofthe Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
? Yes [Xj 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.
Docs the Matter involve a City Property Sale?
[j Yes [Xj No
If you checked "Yes" to Item D.l., provide the names and business addresses ofthe City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matler will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. 1 f the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment lo Ihis 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.
I,XJ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
[_"1J 2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "N A" or if the word "None" appear, il will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under thc Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of thc Disclosing Party with respeel 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 lo extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing 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?
Yes ONo
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
Yes ['.'] No
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 coniracts or subcontracts subject to the equal opportunity clause?
Yes fj No
If you checked "No" to question 1. or 2. above, please provide an explanation:
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SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection wilh the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. Jn the event of changes, the Disclosing
Parly must supplement this EDS up lo the time the City takes action on the Matter. If the Mailer is a
contract being handled by the Cily's Department of Procurement Services, the Disclosing Parly 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 I -23 and Section 2-1 54-020 of the Municipal Code.
Thc Disclosing Party represents and warrants that:
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F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l. and F.2. above and will not, without the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS. 1
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.
(Print or type name of person signing)
MANAGER
(Print or type title of person signing)
Commission expires:
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Parly or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l .a., if the Disclosing Party is a corporation; all partners 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 of the Disclosing Party, if thc 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 thc president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or anyperson 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 fx] 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 ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
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.
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?
QYes
QYes [7] 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?
| [No |~X~~|Not Applicable
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 of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
Page 14 of 14
(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 dale of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
Vacation of alley bounded by North Elizabeth.St.: West Carroll Ave.; North This recertification is being submitted in connection with Racing Ave; and West Fulton Street
[identify thc Matter]. Under penalty of perjury, thc person signing below: (1) warrants that
he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2)
warrants that all certifications and statements contained in the Disclosing Party's original EDS
are true, accurate and complete as of the date furnished to the City and continue to be true,
accurate and complete as of the date of this recertification, and (3) reaffirms its
acknowledgments.
Fulton/Racine Property, LLC Date: 6-2-16
Print or type name of signatory: Timothy Jans
Title of signatory: Manager
Signed and sworn to before me on [date] G6/^Q/^, by
Timothy Jans , at Cook County, Illinois [state].
.Mjold-^lM. Notary Public.
7/
'""Commission expires: Q%/o^> /g^b/y
Ver. 11-01-05