OFFICE OF THE MAYOR
CITY OF CHICAGO
RAHM EMANUEL
MAYOR
September 14, 2016
TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO
Ladies and Gentlemen:
At the request ofthe Comrnissioner of Planning and Development, I transmit herewith ordinances authorizing a budget and service provider agreement for 2017 for various Special Service Areas and an amended 2016 budget for various Special Service Areas.
Your favorable consideration of these ordinances will be appreciated.
Mayor
Very truly yours,
ORDINANCE
WHEREAS, special service areas may be established pursuant to Article VII, Sections 6(1) and 7(6) of the Constitution of the State of Illinois, and pursuant to the provisions of the Special Service Area Tax Law, 35 ILCS 200/27-5 et seq., as amended from time to time (the "Act"), and pursuant to the Property Tax Code, 35 ILCS 200/1-1 et seq., as amended from time to time; and
WHEREAS, on December 7, 2005, the City Council of the City of Chicago (the "City Council") enacted an ordinance (the "Original Ordinance") which established an area known and designated as City of Chicago Special Service Area Number 33 (the "Original Area") and authorized the levy of an annual tax, for the period beginning in tax year 2005 through and including tax year 2014 (the "Original Period"), not to exceed an annual rate of three hundred four thousandths of a percent (0.304%) of the equalized assessed value of the taxable property therein (the "Services Tax") to provide certain special services in and for the Original Area in addition to the services provided by and to the City of Chicago generally (the "Original Special Services"); and
WHEREAS, on December 10, 2014, the City Council enacted an ordinance (the "Enlargement Ordinance") which (i) enlarged the boundaries of the Original Area (as enlarged, the "Area"), (ii) authorized certain special services in the Area distinct from the Original Special Services (the "Special Services"), and (iii) authorized the extension of the time period for which the levy ,of the Services Tax is authorized within the Area from the Original Period to a period from tax year 2014 through and including tax year 2028; and
WHEREAS, the Original Ordinance and the Enlargement Ordinance are herein collectively referred to as the "Establishment Ordinance"; and
WHEREAS, certain funds in Fund A08 ("Fund A08") in the amount of $72 are available for use in connection with the Area; and
WHEREAS, the Establishment Ordinance established the Area consisting of North Ashland from West Division to the Kennedy Expressway; North Damen Avenue from West Schiller to the Kennedy Expressway; North Western Ave. from West Division to West Fullerton (east side only between North and Division); West Division from North Western to the Kennedy Expressway; West North Avenue from North Western Ave. to North Noble and Milwaukee Ave. from North Western Ave to North Haddon; and
WHEREAS, the Special Services authorized in the Establishment Ordinance include but are not limited to: customer attraction, public way aesthetics, sustainability and public place enhancements, economic/business development, safety programs, and other activities to promote commercial and economic development; and
WHEREAS, the Establishment Ordinance provided for the appointment of the Wicker Park and Bucktown Special Service Area Commission (the "Commission") to advise the City Council regarding the amount of the Services Tax to be levied and for the purpose of recommending to the City Council: (1) a yearly budget based upon the cost of providing the Special Services; (2) an entity to serve as a service provider (the "Service Provider"); (3) an agreement between the City and the Service Provider for the provision of Special Services to|1010|2016SSA33Ord-Levy Amendment v2.doc
the Area (the "Service Provider Agreement"); and (4) a budget to be included in the agreement between the City and the Service Provider (the "Budget") (the aforementioned items 1 through 4 shall be known collectively herein as the "Recommendations"); and
WHEREAS, the Commission has been duly appointed and qualified and has heretofore prepared and transmitted to the Commissioner of the Department of Planning and Development (the "Commissioner") its Recommendations to the City Council, including the Budget attached hereto as Exhibit A and hereby made a part hereof; and
WHEREAS, on October 14, 2015 the City Council enacted an ordinance (the "2016 Appropriation, Levy, and Agreement Ordinance"), among other things, appropriating the sums necessary to provide the Special Services in and for the Area for 2016, levying the Services Tax for the tax year 2015, and authorizing an agreement to the 2016 Appropriation, Levy, and Agreement Ordinance) with The Wicker Park & Bucktown Chamber of Commerce d/b/a Wicker Park Bucktown Chamber of Commerce, an Illinois not-for-profit corporation, as the Service Provider (the "2016 Service Provider"), for the provision ofthe Special Services in 2016; and
WHEREAS, pursuant to the 2016 Appropriation, Levy, and Agreement Ordinance the City and the 2016 Service Provider entered into a service provider agreement (the "2016 Service Provider Agreement"); and
WHEREAS, the City desires to increase the budget for Special Services in the Area in 2016 by $184,150; and
WHEREAS, the City therefore desires to amend both the 2016 Appropriation, Levy, and Agreement Ordinance, as set forth below, and the 2016 Service Provider Agreement, pursuant to an amendment in substantially the form attached hereto as Exhibit B; now, therefore
Be It Ordained by the City Council of the City of Chicago:
SECTION 1. Incorporation of Preambles. The preambles of this ordinance are hereby incorporated into this text as if set out herein in full.
SECTION 2. Appropriations. There is hereby appropriated the following sums in the amounts and for the purposes necessary to provide the Special Services in and for the Area, the estimated amounts of miscellaneous income and the amounts required to be raised by the levy of the Services Tax indicated as follows:
WICKER PARK AND BUCKTOWN SPECIAL SERVICE AREA COMMISSION SPECIAL SERVICE AREA BUDGET
For the fiscal year commencing January 1, 2017 and ending December 31, 2017:
EXPENDITURES
Service Provider Agreement for the provision of Special
Services $1,230,977|1010|2016SSA33Ord-Levy Amendment v2.doc
TOTAL BUDGET REQUEST
SOURCE OF FUNDING Tax levy at an annual rate not to exceed an annual rate of three hundred four thousandths of a percent (0.304%) ofthe equalized assessed value, of the taxable property within
Special Service Area Number 33 $1,077,230
Fund A08
Carryover funds currently available from prior tax years
$72
$150,000
Late collections received by the City of Chicago
attributable to the levy of the Services Tax
in prior tax years, along with interest income
thereon, if any $3,675
SECTION 3. Levy of Taxes. There is hereby levied pursuant to the provisions of Article VII, Sections 6(a) and 6(l)(2) of the Constitution of the State of Illinois and pursuant to the provisions of the Act and pursuant to the provisions of the Establishment Ordinance, the sum of $1,077,230 as the amount ofthe Services Tax for the tax year 2016.
SECTION 4. Filing. The City Clerk of the City of Chicago (the "City Clerk") is hereby ordered and directed to file in the Office of the County Clerk of Cook County, Illinois (the "County Clerk") a certified copy of this ordinance on or prior to December 27, 2016, and the County Clerk shall thereafter extend for collection together with all other taxes to be levied by the City, the Services Tax herein provided for, said Services Tax to be extended for collection by the County Clerk for the tax year 2016 against all the taxable property within the Area, the amount of the Services Tax herein levied to be in addition to and in excess of all other taxes to be levied and extended against all taxable property within the Area.
SECTION 5. Service Provider Agreement. The Commissioner, or a designee of the Commissioner (each, an "Authorized Officer"), are each hereby authorized, subject to approval by the Corporation Counsel as to form and legality, to enter into, execute and deliver a Service Provider Agreement as authorized herein with The Wicker Park & Bucktown Chamber of Commerce d/b/a Wicker Park Bucktown Chamber of Commerce, an Illinois not-for-profit corporation, as the Service Provider, for a one-year term in a form acceptable to such Authorized Officer, along with such other supporting documents, if any, as may be necessary to carry out and comply with the provisions of the Service Provider Agreement. The Budget shall be attached to the Service Provider Agreement as an exhibit. Upon the execution of the Service Provider Agreement and the receipt of proper documentation the Authorized Officer and the City Comptroller are each hereby authorized to disburse the sums appropriated in Section 2 above to the Service Provider in consideration for the provision of the Special Services described in the Budget. The Department of Planning and Development shall promptly make a copy of the|1010|2016SSA33Ord-Levy Amendment v2.doc
executed Service Provider Agreement readily available for public inspection
SECTION 6. Amendment of 2016 Appropriation. Levy, and Agreement Ordinance. Section 2 of the 2016 Appropriation, Levy, and Agreement Ordinance is hereby amended by deleting the language indicated by strikeout and adding the underlined language as follows:
"SECTION 2. Appropriations. There is hereby appropriated the following sums in the amounts and for the purposes necessary to provide the Special Services in and for the Area, the estimated amounts of miscellaneous income and the amounts required to be raised by the levy ofthe Services Tax indicated as follows:
WICKER PARK AND BUCKTOWN SPECIAL SERVICE AREA COMMISSION SPECIAL SERVICE AREA BUDGET
For the fiscal year commencing January 1, 2016 and ending December 31, 2016:
EXPENDITURES
Service Provider Agreement for the provision of Special
Services $1,050,554 $1.234,704
TOTAL BUDGET REQUEST $1,050,554 1.234,704
SOURCE OF FUNDING Tax levy at an annual rate not to exceed an annual rate of three hundred four thousandths of a percent (0.304%) of the equalized assessed value, of the taxable property within
Special Service Area Number 33 $1,027,230
FundA08 $1,324
Carryover funds currently available
from prior tax years $12,000 $196,150
Late collections received by the City of Chicago attributable to the levy of the Services Tax in prior tax years, along with interest income
thereon, if any $10,000"
|1010|2016SSA33Ord-Levy Amendment v2.doc
SECTION 7. Amendment to 2016 Service Provider Agreement. The Commissioner, or a designee of the Commissioner, are each hereby authorized, subject to approval by the Corporation Counsel as to form and legality, to enter into, execute and deliver an amendment to the 2016 Service Provider Agreement in substantially the form attached hereto as Exhibit B and hereby made a part hereof (the "2016 Service Provider Agreement Amendment"), and such other supporting documents, if any, as may be necessary to carry out and comply with the provisions of the 2016 Service Provider Agreement Amendment, with such changes, deletions and insertions as shall be approved by the persons executing the 2016 Service Provider Agreement Amendment.
SECTION 8. Enforceability. If any section, paragraph or provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such section, paragraph or provision shall not affect any of the remaining provisions of this ordinance.
SECTION 9. Conflict. This ordinance shall control over any provision of any other ordinance, resolution, motion or order in conflict with this ordinance, to the extent of such conflict.
SECTION 10. Publication. This ordinance shall be published by the City Clerk, in special pamphlet form, and made available in her office for public inspection and distribution to members of the public who may wish to avail themselves of a copy of this ordinance.
SECTION 11. Effective Date. This ordinance shall take effect 10 days after its passage and publication.
|1010|2016SSA33Ord-Levy Amendment v2 doc
EXHIBIT A
Budget
|1010|2016SSA33Ord-Levy Amendment v2.doc
2017 SSA Budgcl Worksheet Chicago Department of Planning and Development
i ; - : ; ; : /;, ^
Service Provider Agency: r,.' "-y:V- V.i'^V- >' vN/ic'RerP^an^
iiiififBiii^
2017 BUDGET SUMMARY
Budget and Services Period: January 1, 2017 through December 31, 2017
2016 Levy
CATEGORY Collectable Levy Estimated Loss Collection Carry Over TIF Rebate: Fund # A08 Estimated Late Collections and Interest 2017 Budget
i.00 Customer Attraction $159,500 $9,134 $10,000 $0 $0 $178,634
2.00 Public Way Aesthetics $556,364 $12,000 $110,000 $72 $3,675 $682,111
3.00 Sustainability and Public Places $9,000 $0 $15,000 $0 $0 $24,000
4.00 Economic/ Business Development $3,000 $0 $10,000 $0 $0 $13,000
5.00 Safety Programs $51,000 $0 $5,000 $0 $0 $56,000
6.00 SSA Management $69,000 $0 $0 $0 $0 $69,000
7.00 Personnel $208,232 $0 $0 $0 $208,232
Sub-total $1,056,096 $21,134 '., . iS,.:Vi '...,':. J' «*»^ ^tfj ¦k :V-t-i'.. :;>-''i.i.,'e -six. '_1_jV_»1.
GRAND TOTALS Levy Total $1,077,230 $150,000 $72 $3,675 $1,230,977
;V.-"V ¦/¦'\\:"} LEVY ANALYSIS
Estimated 2016 EAV: ' $j$37?;252;'730
Authorized Tax Rate Cap. Maximum Potential Levy limited by Rate Cap: 0:304% $1,152,928
Requested 2016 Levy Amount. $1,077,230
Estimated Tax Rate to Generate 2016 Levy: 0.28%
EXHIBIT B
2016 Service Provider Agreement Amendment
|1010|2016SSA33Ord-Levy Amendment v2 doc
AMENDMENT Special Service Area 33
This Amendment ("Amendment") is made and entered into effective as of the day
of , 2016, by and between the CITY OF CHICAGO ("City"), a municipal
corporation and home rule unit of local government existing under the Constitution of the State of Illinois, acting through the Special Service Area Commission at Chicago, Illinois, and The Wicker Park & Bucktown Chamber of Commerce dba Wicker Park Bucktown Chamber of Commerce, an Illinois not-for-profit corporation ("Contractor").
BACKGROUND
WHEREAS, on December 7, 2005, the City Council of the City of Chicago (the "City Council") enacted an ordinance (the "Original Ordinance") which established an area known and designated as City of Chicago Special Service Area Number 33 (the "Original Area") and authorized the levy of an annual tax, for the period beginning in tax year 2005 through and including tax year 2014 (the "Original Period"), not to exceed an annual rate of three hundred four thousandths of a percent (0.304%) of the equalized assessed value of the taxable property therein (the "Services Tax") to provide certain special services in and for the Original Area in addition to the services provided by and to the City of Chicago generally (the "Original Special Services"); and
WHEREAS, on December 10, 2014, the City Council enacted an ordinance (the "Enlargement Ordinance") which (i) enlarged the boundaries of the Original Area (as enlarged, the "Area"), (ii) authorized certain special services in the Area distinct from the Original Special Services (the "Special Services"), and (iii) authorized the extension of the time period for which the levy of the Services Tax is authorized within the Area from the Original Period to a period from tax year 2014 through and including tax year 2028; and
WHEREAS, the Original Ordinance and the Enlargement Ordinance are herein collectively referred to as the "Establishment Ordinance"; and
WHEREAS, On , 2015 the City Council enacted an ordinance (the "2015
Appropriation, Levy, and Agreement Ordinance") which, among other things, appropriated the sums necessary to provide the Special Services in and for Special Service Area Number 33 for 2016, levied the Services Tax for the tax year 2015, and authorized a Service Provider Agreement (the "2016 Service Provider Agreement") with the Contractor as the service provider for the provision ofthe Special Services in 2016; and
WHEREAS, the Contractor and the City have entered into the 2016 Service Provider
Agreement dated , 2016, in which the Contractor is to perform certain Special
Services for Special Service Area Number 33; and
WHEREAS, the amount of the Services Tax for tax year 2015 levied pursuant to the 2016 Ordinance was $1,027,230 (the "Anticipated Amount"); and
WHEREAS, due to cost savings realized by the Contractor in the performance of the Special Services certain surplus funds in the amount of $196,150 (the "Surplus Funds") became available for use to provide Special Services in Special Service Area Number 33; and
WHEREAS, the City desires to ratify and approve the use of the Surplus Funds to
provide Special Services by the Service Provider; and
WHEREAS, the Contractor and the City therefore desire to make certain changes to the Agreement. The Agreement requires that modifications to it must be made in writing and signed by both parties,
NOW THEREFORE, in consideration of the provisions and conditions set forth in the Agreement, the parties do mutually agree to amend the Agreement as set forth below.
It is further agreed by and between the parties that the sole modifications of, changes in, and amendments to the Agreement are as follows:
1. Exhibit 1(A), Amended Budget for 2016, is attached to this Amendment as
Attachment 1 and incorporated by reference.
2. The Agreement-Specific Information is hereby amended by deleting the language
indicated by the strikeout and adding the underlined language as follows:
Maximum compensation amount (see Agreement Section 5.01): $1.050.554 $1.234.704
Maximum amount (see Agreement Section 5.02): $1,050,554 $1.234.704
Surplus Funds amount (see Agreement Section 5.01(b)): $12,000 $196.150
3. Exhibit 2(A), Amended Economic Disclosure Statement and Affidavit, is attached
to this Amendment as Attachment 2 and incorporated by reference.
All terms of the Agreement remain in full force and effect except as modified in this Amendment.
SIGNED:
CITY OF CHICAGO
Commissioner, Department of Planning and Development
CONTRACTOR:
By:_
(Signature)
Its:
(Print Name and Title) Attest:
Its:
(Print Name and Title)
County of State of
Acknowledged on [date] before me by as
[title] of [firm].
Notary Public Commission expires:
Attachment 1 Exhibit 1(A), Amended Budget for 2016
|1010|
2016 Budget and Services Summary Amendment Chicago Department of Planning and Development
Name: Wicker Park Sucktown SSA #33 SSA Chalrperton: Brent Noraman Agency Contact-j Jess tea Wobbekmc"
S«rvica Provider AaeciCY'. Wicker Panx Bucktown Chamber of Commerce Phone Number: Phone Numbtir.t773.384 .2072
SSA Tax Authority Term: 2014-2029 Email: brent@noramanarchitect> com Email.! jssjica Qwickerpa rkbucktnw
Date:
2018 BUDGET SUMMARY Fund ADS ? 2015 Uvy Carry Over Laic Collection* ¦rid intent! income Th»r«on 2016 Budget
CATEGORY
1 00 Customer Attraction * r. ? ? + + S 165,000 $ 9 500 * S • i 174.500
2,00 Ptibfo Way Aesthetics S -.324 S 433.000 s X MS 324
3.00 SustainsbiCty and Public Place* S " S U.C00 S 21.COO $ 10 000 S 45 000
4.00 Economic/Business Development|99| $ 75.000 3 5 500 i eo.5oo
5,00 Safety Programs S 5 1.000 |99|• s S 1.000
6.00 SSA Management s 3 70.400 S 6.15B s S 75.550
7.05 Personnel % $ 193,630. S s S 193 630
8.00 Loss Collection: 7.3% s S 75,000 s s J 75.COO
[ GRAND TOTAL ( J 1,324 $ 1.027,230 5 195,150 5 10.000 J 1.234,704
2019 Budget S 1.23* 701
. LEVY ANALYSIS |109|Estimated Z015EAV S337.934.78C |109|Authorized Tax Rate Cap: 0 304% |109|Est'^ateo" 2015 Levy 51.027.23C |109|Es!.;mate-J Tax Hals to Generate 2015 Levy (Estimated 2D1SLevy + Esirmaied 20!5 EAV" Est Tax Rate; 0 304*
Attachment 2
Exhibit 2(A), Amended Economic Disclosure Statement and Affidavit 2016
3 3- fl-^^X)
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of Ihe Disclosing Puny submitting this EDS. Include d/b/a/ if applicable:
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Parly submitting this EDS is:
N^. the Applicant f OR
[ ] a legal entity holding a direct or indirect interest in the Applicant. State thc legal name of thc
Applicant in which thc Disclosing Parly holds an interest:
OR
3. [ ] a legal entity with a right of control (see Section II.B.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
Business address of the Disclosing Party: } 41 <-j jQ , /^<>U jfl y\^l -)4\>g,. ,
ti^-O^OrJJ^—faoCe>9-3==
Telephone?3je4- 2-L/^X Fax?*! Q-{ .'K'ZC Email^g^iV^ff nVr.fc^^fe
Na.c of soncac, person: Jg^Tfl WgW^ .olg
! i
Federal Employer Identification No. (if you have one) i
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): H^^ltDiO
CA^ca^-o m or-JL^r Ho X)mOi?Q_" Specf^Jp ^uia-s: Mi'VWii^ Si/4 ^23 .
Which City agency or department is requesting this EDSV'J^y^^,^^
If the Matter is a contract being handled by thc City's Department of Procurement Services, please complete the following:
Specification # and Contract tt
Page I of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
[ ] Person
[ ] Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ ] Limited partnership
[] Trust
[ ] Limited liability company [] Limited liability partnership [ ] Joint venture \A Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
[ ] Yes V\ No
[ ] Other (please specify)
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the Stale of Illinois as a foreign entity?
[ J Yes [ ] No J^N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below thc 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 arc legal entities. If there arc no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholdcr(s).
If thc 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
[V/a mamhixs
2. Please provide thc 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
01
u
E
£ o u
4- v>
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> ro O O
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3 rH CQ O jv: ro Q. l— O
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
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 thc date this EDS is signed?
[ ] Yes ^No
If yes, please identify below thc 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 thc relationship, and the total amount of thc 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 Party is uncertain whether a disclosure is required under this Section, thc Disclosing Party must either ask thc City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
[ ] 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?
[ J Yes f ] No aIj^0 Person directly or indirectly owns 10% or more of the
' Disclosing Party.
If "Yes," has thc 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 thc 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 thc 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 guili 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) thc Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with thc City. NOTE: If Article 1 applies to the Applicant, the permanent compliance timeframe in Article 1 supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
Wicker Park & Bucktown Chamber of Commerce Retained Parties 2016
Cleanslate
Retained
1540 South Ashland Avenue Suite 105
Chicago, IL 60608 United States Subcontractor- non MWDBE Fees: $170,000 Estimated
To provide sidewalk cleaning, garbage removal and snow removal services
Christy Webber Landscapes
Retained
2900 W. Ferdinand
Chicago, IL 60612 United States
Subcontractor - MWDBE
Fees: $125,000
Estimated
To provide landscaping and snow removal services
Bartlett Tree Experts
Retained
1960 Old Willow Road Northbrook, IL 60062 United States Subcontractor- non MWDBE Fees: $45,000 Estimated
To provide tree care services
Sassetti, LLC. Retained
6611 W. North Ave.
Oak Park, IL 60302 United States
Subcontractor- non MWDBE
Fees: $8,250
Estimated
To provide accounting services to perform 2015 audit
WHERE Magazine | Morris Visitor Publications
Retained
224 S. Michigan Ave., Suite 370 Chicago, IL 60604 United States Subcontractor- non MWDBE Fees: $25,000 Estimated
To provide editorial and publishing services for a printed guide
HAP Industries
Anticipated to be Retained 7220S200W
Jonesboro, IN 46938 United States Subcontractor- non MWDBE Fees: $63,000 Estimated
To provide holiday decoration installation & removal services
Chicago Event Graphics
Anticipated to be Retained 400 N. Hart St
Chicago, IL 60622 United States Subcontractor- non MWDBE Fees: $5,000 Estimated
To provided banner printing, installation and storage services
The Silverman Group
Retained
213 W Institute Place Suite 8501 Chicago, IL 60610 United States Subcontractor- non MWDBE Fees: $15,000 Estimated
To provide public relations services
The Disclosing Parly 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, slate 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 slate 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 thc 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 slate, or any other unit of local government.
Thc certifications in subparts 3, 4 and 5 concern:
thc 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 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 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 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 thc 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, thc 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 thc 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 thc offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control 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, thc Denied Persons List, thc 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 thc Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Pa lie 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, thc 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").
icate with
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 thc 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.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
Thc Disclosing Party certifies that the Disclosing Party (check one)
[ ] is ^\ is not
a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 ofthe 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 thc 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 thc meaning of Chapter 2-32 of thc Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If thc letters "NA," thc word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of thc 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 Vno
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 [ ] 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 thc 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 thc City in connection with the Matter voidable by the City.
1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and thc 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 thc names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
I. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to thc Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if thc word "None" appear, it will be conclusively presumed that the Disclosing Parly means that NO persons or entities registered under thc Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf ofthe 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 entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with ihe award of any federally funded contracl, making any federally funded granl 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
Thc Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If thc 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 thc 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 thc Disclosing Party the Applicant?
[JYes []No If "Yes," answer thc 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 thc applicable filing requirements?
[ ] Yes [ ] No
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:
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.ww'Vy'.citvofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 M.
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 thc 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 thc 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 thc 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 providcdln 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 thc 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 pjxndded herein regarding eligibility must be kept current for a longer period,
as required by Chap.lopT-23 ancrSe^tion 2-154-020 of the Municipal Code.
'I he Disclosing Party represents and warrants that:
Page I I ol" 13
F.I. The Disclosing Party is not delinquent in the payment of any lax 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 thc City. This includes, but is nol 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 thc 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 thc Matter certifications equal in form and substance to those in F.I. 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 lias not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as lo any of thc 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: (I) 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 th,e date furnished to the City.
t?>^-tS y^^bV-iY^N CLWa.Yvi^^Af- QsdiYiry^srcQ_
(Print or type name of Disclosing Party)
(Sign here)
j^-vu^ Mc iU^L j
(Print or type name of person signing) < Notary Public*6tai»*f Hfowfe
i My -.lommlMkm BqHoM Nov. 12,2019
(Print or type title of person signing)
Signed and sworn to before me on (date) ffjUjS • <^S/). Qoj {^p.
at CtY^Jr County,~7.1(ir\C?<^ Wc).
.^22?0^iw=^!^^ Notary Public.
Co m m i ss i o n exp i res: (5jL J Q v ¦
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, thc Disclosing Party must disclose whether such Disclosing Party or any "Applicable Parly" 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, thc 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, fathcr-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 IT.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 thc 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 thc 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) thc 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 ha.s a familial relationship, and (4) the precise nature of such familial relationship.
Paee 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?
[ ]Yes
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
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.
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:
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: Applicant
2. [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [ ] a legal entity with a right of control (see Section II.B.l.) State the legal name of thc entity in
which thc Disclosing Party holds a right of control:
Disclosing Party: 1^14 h). 4s,Ua frf
Telephone:Z<3^ -2^2- Fax: 3?ti-ISTS Email: j> s^, r ^nV r
Name of contact personC^SS\C<^-
I ]
Federal Employer Identification No. (if you have one): I I
! J
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): -fry 1?^ \-/J
Which City agency or department is requesting this EDS? -H^-^lfV Acj £LVvIf thc Matter is a contract being handled by thc City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page 1 of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
Person
Publicly registered business corporation
Privately held business corporation
Sole proprietorship
General partnership
Limited partnership
Trust
[ ] Limited liability company [ ] Limited liability partnership [ ] Joint venture
Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
[ ] Yes ^ No
[ ] Other (please specify)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
XI lipoid
For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ] Yes [ ] No ^B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If thc 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
K/o m£mhM~-S
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
0)
u
l-CD
E
E o u
OJ u XI (1)
15 u o
i p
> to
o o
3 T—I
CD o rsl
V_
ro
u
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
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 ^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 ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, thc Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business retained or anticipated Address to be retained)
Relationship to Disclosing Party Fees (indicate whether
(subcontractor, attorney, paid or estimated.) NOTE:
lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(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 ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No aTjNo 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 l")(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 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
Wicker Park & Bucktown Chamber of Commerce Proposed Retained Parties 2017
Cleanslate
Anticipated
1540 South Ashland Avenue Suite 105
Chicago, IL 60608 United States Subcontractor- non MWDBE Fees: $200,000 Estimated
To provide sidewalk cleaning, garbage removal and snow removal services
Christy Webber Landscapes
Anticipated
2900 W. Ferdinand
Chicago, IL 60612 United States
Subcontractor - MWDBE
Fees: $125,000
Estimated
To provide landscaping and snow removal services
Bartlett Tree Experts
Anticipated
1960 Old Willow Road
Northbrook, IL 60062 United States
Subcontractor- non MWDBE
Fees: $45,000
Estimated
To provide tree care services
Sassetti, LLC.
Anticipated
6611 W. North Ave.
Oak Park, IL 60302 United States
Subcontractor- non MWDBE
Fees: $8,250
Estimated
To provide accounting services to perform 2016 audit
WHERE Magazine | Morris Visitor Publications
Anticipated
224 S. Michigan Ave., Suite 370 Chicago, IL 60604 United States Subcontractor- non MWDBE Fees: $25,000 Estimated
To provide editorial and publishing services for a printed guide
HAP Industries
Anticipated 7220S200W
Jonesboro, IN 46938 United States Subcontractor- non MWDBE Fees: $63,000 Estimated
To provide holiday decoration installation & removal services
Chicago Event Graphics
Anticipated 400 N. Hart St
Chicago, IL 60622 United States Subcontractor- non MWDBE Fees: $5,000 Estimated
To provided banner printing, installation and storage services
The Silverman Group
Anticipated
213 W Institute Place Suite #501 Chicago, IL 60610 United States Subcontractor- non MWDBE Fees: $15,000 Estimated
To provide public relations services
The Disclosing Party and, if the Disclosing Party .is a legal.entity, all of those persons or entities identified in Section II.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 thc 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 thc 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 thc Disclosing Party, or is, with thc Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affdiated 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 (I) bid-figging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control ofthe 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 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 thc above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all current employees of the Disclosing Party who were, at any time during the 12-
month period preceding the execution date of this EDS, an employee, or elected or appointed official,
of the City of Chicago (if none, indic^^/n^t "N/A" or "none").
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of 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.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is J^j 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 thc 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 thc 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 thc 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 WNo
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 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 thc City.
/\ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and thc 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 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 of the City arc not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe 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 thc word "None" appear, it 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 the Disclosing Party with respect to the Matter.)
2. Thc Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) 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 thc 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 [ ] 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?
[ ] 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.orR/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 arid 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 offensesLjhe information provided herein regarding eligibility must be kept current for a longer period, as required by Chapte/1:i-23 an ion 2-1 54-020 of the Municipal Code.
Thc Disclosing.Party represents ancf warrants that:
Page 11 of 13
F.l. The Disclosing Party is not delinquent in thc payment of any lax 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 thc City. This includes, but is nol 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 thc Matter certifications equal in form and substance to those in F.I. 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 thc items in F.I., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf 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 its of th,e date furnished to the City.
(Print-By:
'Th^^j^^^ d-U^ Wick**
•f^t^ K-^>c-b4-i'u3irA (IWyMo^-Af- G^A^rCc_ int or type name of Disclosing Party)
(Sign here)
p ^ r ^ * m m +. +, + , ;
, Notary FHitfC « «*t* *f UtoOk .
I My nomnilMlon BqHm Nov. 12,2Q1Bm
< iji vi • m 1 •' • '* ¦ ¦ ¦ '
(Print or type name of person signing) (Print or type title of person signing)
at_/X)iC County, ~JL[l
Signed and sworn to before me on (date) /Jl^iS^^^^Qc^J^-ounty, ~T.I|ir\&r<^ V-slate).
Us^dbJ^^'-rj Notary Public.
Commission expires:^_^_0LL-_Ic}_)_QjulQ--
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 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, mothcr-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section H.B.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 ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic 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) thc name ofthe legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) 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?
[ ]Yes
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?
[ JYes
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.