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 of the Commissioner 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 July 31, 1996, the City Council ofthe City of Chicago (the "City Council") enacted an ordinance (the "First Ordinance"), as further amended by an ordinance enacted by the City Council on November 20, 1996 and again on October 14, 2015 (collectively, the "Amendment Ordinances") (the First Ordinance and the Amendment Ordinances are collectively referred to herein as the "Original Ordinance") which established an area known and designated as City of Chicago Special Service Area Number 16 (the "Area") and authorized the levy of an annual tax, for the period beginning in tax year 1996 through and including tax year 2016 (the "Original Period"), not to exceed an annual rate of one percent (1%) of the equalized assessed value of the taxable property therein (the "Services Tax") to provide certain special services in and for the 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, City Council enacted an ordinance (the "Levy Extension Ordinance") which (i) authorized certain special services in the Area distinct from the Original Special Services (the "Special Services"), and (ii) authorized the extension of the Original Period and of the levy of the Services Tax for the provision of the Special Services in the Area for a period through and including tax year 2028; and
WHEREAS, the Original Ordinance and the Levy Extension Ordinance are herein collectively referred to as the "Establishment Ordinance;" and
WHEREAS, certain funds in Fund 190 ("Fund 190") in the amount of $84,531 are available for use in connection with the Area; and
WHEREAS, the Establishment Ordinance established the Area as that territory approximately bounded by Madison Street on the north, the John Fitzgerald Kennedy Expressway on the east, Congress Parkway on the south and Green Street on the west; 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 Greektown/Halsted Street 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
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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 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 with West Central Association, Inc., 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 $58,563; 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:
GREEKTOWN/HALSTED STREET SPECIAL SERVICE AREA SPECIAL SERVICE AREA BUDGET
For the fiscal year commencing January 1, 2017 and ending December 31, 2017:
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EXPENDITURES
Service Provider Agreement for the provision of Special
Services $788,201
TOTAL BUDGET REQUEST $788,201
SOURCE OF FUNDING Tax levy at an annual rate not to exceed one percent (1%) ofthe equalized assessed value of taxable property within
Special Service Area Number 16 $703,670 Fund 190 $84,531 Carryover funds currently available
from prior tax years $0
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 $0
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 $703,670 as the amount of the Services Tax for the tax year 2016.
SECTION 4. Filing. The City Clerk of the City (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 of Chicago, 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 West Central Association, Inc., an Illinois not-for-
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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 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:
GREEKTOWN/HALSTED STREET SPECIAL SERVICE AREA 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 $499,311 $557.874
TOTAL BUDGET REQUEST $499,311 $557.874
SOURCE OF FUNDING Tax levy at an annual rate not to exceed one percent (1%) ofthe equalized assessed value of taxable property within
Special Service Area Number 16 $483,460 Fund 190 $6,851
Carryover funds currently available
from prior tax years $58,563
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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 $9,000"
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.
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2016 SSA16 Ord.doc
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EXHIBIT >
Budget
2D17 SSA Budget Worksheet Chicago Department of Planning and Dovclopmtnl
; Special Serw
Service Provider Agency;
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 #190 Estimated Late Collections and Interest 2017 Budget
1.00 Customer Attraction $174,210 $0 $0 $20,000 $0 $194,210
2.00 Public Way Aesthetics $224,760 $17,240 $0 $64,531 $0 $306,531
3.00 Sustainability and Public Places $0 $0 $0 $0 $0 $0
4.00 Economic/ Business Development $140,000 $0 $0 $0 $0 $140,000
5.00 Safety Programs $20,000 $0 $0 $0 $0 $20,000
6.00 SSA Management $37,460 $0 $0 $0 $0 $37,460
7.00 Personnel $90,000 $0 $0 $0 $90,000
Sub-total $686,430 $17,240
GRAND TOTALS Levy Total $703,670 $0 $84,531 $0 $788,201
. LEVY ANALYSIS .;: :'';¦
Estimated 2016 EAV: $70,369,634
Authorized Tax Rate Cap: 1.000%
Maximum Potential Levy limited by Rate Cap: $703,696
Requested 2016 Levy Amount: $703,670
Estimated Tax Rate to Generate I . .-„. 2016 Levy: _ _ j 1-00A
EXHIBIT B
2016 Service Provider Agreement Amendment
AMENDMENT Special Service Area 16
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 West Central Association, Inc., an Illinois not-for-profit corporation ("Contractor").
BACKGROUND
WHEREAS, on July 31, 1996, the City Council ofthe City of Chicago (the "City Council") enacted an ordinance, as further amended by an ordinance enacted by the City Council on November 20, 1996 and again on October 14, 2015 which established an area known and designated as City of Chicago Special Service Area Number 16 (the "Area") and authorized the levy of an annual tax, for the period beginning in tax year 1996 through and including tax year 2016 (the "Original Period"), not to exceed an annual rate of one percent (1%) of the equalized assessed value of the taxable property therein (the "Services Tax") to provide certain special services in and for the 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, City Council enacted an ordinance (the "Levy Extension Ordinance") which (i) authorized certain special services in the Area distinct from the Original Special Services (the "Special Services"), and (ii) authorized the extension of the Original Period and of the levy of the Services Tax for the provision of the Special Services in the Area for a period through and including tax year 2028; and
WHEREAS, on October 14, 2015 the City Council enacted an ordinance (the "2016 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 a Service Provider Agreement (the "2016 Service Provider Agreement") with the Contractor as the service provider for the provision of the Special Services in 2016; and
WHEREAS, the Contractor and the City have entered into the 2016 Service Provider Agreement dated January 1, 2016, in which the Contractor is to perform certain Special Services for Special Service Area Number 16; and
WHEREAS, the amount of the Services Tax for tax year 2015 levied pursuant to the 2016 Ordinance was $483,460; and
WHEREAS, due to cost savings realized by the Contractor in the performance of the Special Services certain surplus funds in the amount of $58,563 (the "Surplus Funds") became available for use to provide Special Services in Special Service Area Number 16; 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:
Exhibit 1(A), Amended Budget for 2016, is attached to this Amendment as Attachment 1 and incorporated by reference.
The Agreement-Specific Information is hereby amended by deleting the language indicated by strikeout and adding the underlined language as follows:
Maximum compensation amount (see Agreement Section 5.01):
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
By:
Commissioner, Department of Planning and Development
CONTRACTOR: WEST CENTRAL ASSOCIATION, INC.
By:
(Signature)
Its:
(Print Name and Title)
Attest:
Its:
(Print Name and Title)
County of
State of
Acknowledged on [date] before me by
[title] of [f
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: SSA016GreeMown SSA Chairperson: Frank Caputo Aoencv Contact Rod Burch
Sen* ic* PnwWtr Atf *nevr Wast Central Asxooabon Phone Number 312.860.M00 Phone Number 31Z.902.4922
5SA Tax Authority Term: 2015 Email: fjcaputoQsbcglobal. net Email: rodgrweacrucago o»g
„ Dale*
2016 BUDGET SUMMARY Fund 190 3015 Levy Carry Over Lata Collection» and Inlmit Inc o ma Tbsraon 2016 BudQtt
CATEGORY
1.00 Customer Attraction * + 141,000 + + + ? + 4 : ? + + + s - 5 141.000
2.W Public Way Aesthetic* . » 0,851 + + 148.000 5 28.000 « 9.000 > 119.131
3.00 Sustainaixliiy ono Puttc Pticcs . t * i S
4.00 Economic/Business Devetepmert ~ ' ¦ » + 70,000 $ 30,5(3 $ '- $ 100,563
5.00 Safety Programs J 20,000 s S 20,000
6.00 SSA Managimenl » • 43.2C0 $ s S 0,260
7.00 Personnel J S 43.200 $ t i 43.200
8.00 Loss Collection: 4.1%|99| S 20.000 ? % i $ 20.000
| GRAND TOTAL $ 483,460 J 58,563 $ 9,000 i 557.S74
2016 Budget J 557.874
!¦¦- LEVY ANALYSIS ¦ ¦ ¦ |109|Estimated 2015 EAV. S40.354.995 |109|Authorized Tax Rate Cap- 1.000% |109|Estimated 201S Levy 5483.460 |109|- 'Estimated Tax Rate to Generate 2015 Levy (Estimated 2015 Levy + Estimated 2015 EAV - Est. Tax Rate). 1.000%
Attachment 2
Exhibit 2(A), Amended Economic Disclosure Statement and Affidavit 2016
|1010|
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;
West Central Association Ihc^
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
(>OR
[ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant,in which the Disclosing Party holds an interest:
OR
3. [ ] a legal entity with a right of control (see Section 1I.B.1.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control: m ,
B. Business address of the ©isclosing Party: 917 W Washington Blvd., #173
Chicago.lL 60607 ,
Telephone: 312.902:4922 Fax: Email: info@wcachicago.org
Name of contact person: Roderick Burch
Federal Employer Identification No. (if you have one): I
L
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):
To allow West Central Association Inc., to amend the 2016 budget specified in the 2016 service provider agreement with the City of Chicago in order to provide special services within SSA #16.
G. Which City agency or department is requesting this EDS? Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification ff and Contract if
Page ] of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature of the Disclosing Party:
Person [ ] Limited liability company
Publicly registered business corporation [ ] Limited liability partnership
Privately held business corporation [ ] Joint venture
Sole proprietorship ^ Not-for-profit corporation
General partnership (Is the not-for-profit corporation also a 501(c)(3))?
Limited partnership [ ] Yes ^ No
Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[]Yes []No ^N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors 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
See q-mciMJ^ USt~
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
^ CENTRAL nSSOCIATi0lv
West Central Association Board of Directors
President
Armando Chacon Treasurer Steve Homrich 1st Vice President Marc Koronkiewi.cz 2nd Vice President Harry Huzenis 3rd Vice President Calvin Gin Secretary Dale Bianco Executive Director Roderick Burch
Larry Adelson Michael Apa Max Bechina Richard Bridgford
Thomas Broderick Marc Bushala Michelle Carrera Thomas E. Comforte Rodrigo d'Escoto Michael Ezgur Calvin Gin Scott Goodman A.G. Hollis Holly Jacobson Tom Moro Mark Nelson John Neurauter Joey Panfil Clint Paton Stephen Ross Jacquie Russell Michael Semenzin John Sochacz Caroline Swinney
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.
Percentage Interest in the Disclosing Party
ey.'v'.-. ¦:
^> .v-
; SECTION HI - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
enfCity elected official(s) and describe such
^ .; Has the ^Disclosing Party had a "b^i^ess^^tionship," as defined in Chapter 2-156 of the Municipal
' * :,'f!Cbde, witfi any City elected ofEci&iui^^ before the date this EDS is signed?
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.
See Attached List
(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 D# 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 tind 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 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 with Article I is a continuing requirement for doing business with thc City. NOTE: If Article I 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
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O. Q. O. Q. Q. Q. Q. Q. O. Ci
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 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 publip 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'goy^r-ri'merit, any state, or any other unit of local government.
Thc 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 the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with'the Matter:
bribed or attempted to< bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a,public officer or employee ofthe City, the State of lilinois, 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 froin contracting with any unit of state or local government as a resultof engaging in or being convicted of.(l) bid-figging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 72.0 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 of the Treasury or the Bureau of industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and'the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all current employees of the Disclosing Party who were, at any time during the 1'2-
month period preceding the execution date of this EDS, an employee, or elected or appointed official,
of the City of Chicago 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;iri the: course .of .official City business and having.a retail value of less than $20 per recipient'(if.rione;;ih'dicate 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 _><5.,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) 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.
I. In accordance with Section 2-156-110 ofthe Municipal Code: Does any official or employee
. of the City have a financial interest in his of her own name or in the name of any other person or
\*T ¦- entity in the Matter? , i , , : •
"Yes «No Ellf,
SfNOTE: If you checked "Yes" to lted^^^ted to Items D.2. and D.3. If you checked "No" to II. ; Item D. 1proceed to Part E. ¦.--^^IM^i
shsiil Ka^e-a^mffi^tinterest in his or her own name or in the name of
m^^t. s 4% Uzdess soU pursuant to a p^g^^^jfetitive bidding, or otherwise permitted, no City
i^Sv&rl^^^^^ «hafrk^ft:afflrSS?^i interest in his or her own name or in the name
'^"^f^^^A^^^^^ica^y in the pjroha|^R^^property that (i) belongs to the City, or (ii) is sold
£$i|f^^^ legal process at the suit ofthe City (collectively,
IfyM names and business addresses of the City
olaffcials^ the nature of such interest:
Nature of Interest
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. The Disclosing Party verifies that thc Disclosing Party has searched any and all records of thc 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 ofany 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 notfederally 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 1.995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "N A" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf 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 ofany 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
3 . 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 ofthe Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the flatter is federally funded, federal regulations require the Applicant and all prop'osed 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 actioti programs pursuant to applicable federal regulations? (See 41 CFR Part 60.-2.)
f]Yes []No
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
f ] Yes f ] No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [ ] No
If you checked "No" to question I. 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.c.ontracts, 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 Ethj'cs, 740 N.
Sedgwick St., Suite 50.0, 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, incompletes 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^arid/or declining to allow the Disclosing-Party to participate in other transactions withthe 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 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 ofany 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 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 1 1 of 13
F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water-charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing 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 ofthe items in F.l., F.2. or F3. 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.
West Central-Association Inc.,
(Print or type name of Disclosing Party)
By:
(grign here)
Roderick J Burch
(Print or type name of person signing)
Executive Director
(Print or type title of person signing)
Signed and sworn to befi/re me on (date) § IjbJZojjb
(Ttate)f
Notary Public.
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 ownershipjihtcrest iinuthc 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 anyV'App'li'caMeiParty'' or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any ejected city official or department head. A "familial relationship" .exists if, as of the date this EDS; is. signed, the ^Disclosing Party pr any "Applicable Party" or any Spouse or Domestic Partner thereof is related'to the mayor,-any:alBerm,an, tine city clerk, the city treasurer or any city department head as spouse of domestic-partner 6r ias .ahy . of the following, whether by blood or adoption: parent, child, brother :or sister,,aunf or uncle, mfecerbr n^hj^^.g^dparent, 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^Paity"'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 of the Disclosing Party; if the Disclosing Party is- a general
partaefship;^ and limited partners of the Disclosing Party, if the Disclosing Party isia/limited
partnership;,:^ and members of the Disclosing Party, if the Disclosing Party'is a
limited liability(c;o'iKpfe^i^)' 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?
[ ] Yes [><] 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 of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAVV/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?
[ J Yes
2. If the/Apphcant is a legal entity publicly traded on any exchange, is any officer or director of me^Ap^licant identified as a building code scofflaw or problem landlord pursuant to Section - 2-&£i^pie$
€ i ;•" [ ]Nf. [XI Not Applicable
^^^^raoovev-f lease identify bel^^me name of me rjerson or legal entity ^a^af^mc^^i^te scofflaw or pn^^m landlord and the address of the building or
CP
CITY OF CHICAGO ECONOMI^?DISCLOSU RE STATEMENT ; AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. LegaLname of me.Disclosing^fta^ this EDS. Include d/b/a/ if applicable:
: ; ..'.„',_ .. *^',
-¦ ' " West Central Assoriatibri)ihc^ 0^.
4Sl ¦
V* '
EDS is:
illegal entity hold^g^^i^^^^^^^p.interest in the Applicant. State the legal name ofthe
interest:
^Section II.B.l.) State the legal name ofthe entity in
^^^^:,^h^K|aie Disclosing Party hofdsLa^gh^f^^tro I:
|917 W Washington Blvd #173
), IL 60607
Email: infoQvi/CTciticagocorg
thefe undertaking (referred!,^^ to
jt^fl^ location of proper^,u||app ;
pfe"^ into a contract with fteTCty
.... Ja^ISS
H?V::^-^^v^^ Department of Procuir^
' ^i. / ¦!.;<.comple^tliej]M -/>^i... ¦^¦¦¦^
.-.Specifi Contract #
••Vc^Ol^I-li'.-:!*
¦'^¦vf.ri!;-.1. :".vv" '
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 p
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[]Yes []No yfN/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
Swee q-mclMJ^ USt~
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% 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
^ CENTRAL
West Central Association Board of Directors
President
Armando Chacon Treasurer Steve Homrich 1st Vice President Marc Koronkiewicz 2nd Vice President Harry Huzenis 3rd Vice President Calvin Gin Secretary Dale Bianco Executive Director Roderick Burch
Larry Adelson Michael Apa Max Bechina Richard Bridgford
Thomas Broderick Marc Bushala Michelle Carrera Thomas E. Comforte Rodrigo d'Escoto Michael Ezgur Calvin Gin Scott Goodman A.G. Hollis Holly Jacobson Tom Moro Mark Nelson John Neurauter Joey Panfil Clint Paton Stephen Ross Jacquie Russell Michael Semenzin John Sochacz Caroline Swinney
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
none
nd business address of each subcontractor, aftoi|riey^ n on
v;.,-
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.
See Attached List
(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 incompliance 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?
[JYes [] N-0 D$ 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 J ("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 thc Cily. 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
Where Morris Publication W.G.N Flag Co. VIRTUS Creative Group Inc Travelers Rummel & Beaugard Risk Services QC Enterprises Inc Michael Roti Maragos & Maragos LTD Idea Kitchen Enosis CWI Strategies, LLC Chicago Trolley Company Chicago Scuplture Exhibit | Chicago Greektown Educational Foundation j Bravos & Associates Anthony Katsulis AMA Marketing Corporation agb Investigative services 2033 95th St, Chicago, IL 60643 Subcontractor - Security Services | | Name
P 0. Box 1584 Augusta GA 30903 7984 S. Chicago Ave Chicago, IL 60617 234 Elm Court Northbrook Illinois 60062 PO Box 660317 Dallas Texas 75266-0317 180 North LaSalle Street Suite 3100 Chicago Illinois 60601 2722 South Hllock Chicago Illinois 60608 715 N Grandview Lake Forest, IL 60045 1 North LaSalle Street Suite 2200 Chicago II 60602 1017 W. Washington Blvd 2ab Chicago.il 60607 733 Less Street Des Plaines Illinois 60016 4920 North Newland Ave Chicago,IL 60656 106 Calendar Ct Suite 134 LaGrange Illinois 60525 c/o Alderman Tom Tunney 3223 N. Sheffield, Suite B Chicago IL 60657 231 S Halsted Ste 201 Chicago,IL 60661 324 Ridgewood Drive Bloomingdale, IL 60108 | Subcontractor - Accounting Services 306 South Halsted Street Chicago Illinois 60661 250 E 167th Street Harvey IL 60426 Business Address
Advertising SubContactor - Banners/Flag Subcontractor - Website Subcontractor - Insurance Subcontractor - Insurance Subcontractor - Decorations Holiday Subcontractor - Bookkeeping services Subcontractor - administrative Services Subcontractor - Branding & Marketing services Advertising Subcontractor - Way Finding/Signage Subcontractor - trolley services Subcontractor - Public Art Advertising j Subcontractor - SSA Office Rent Subcontractor - Sidewalk Cleaning Services Scope of Work \
53,500 $5,000 l 52,000' Anticipated 51,200 53,500 $8,000 $2,400 $13,200 $50,000 $1,200 510,500 550,000 S3.500 510,000 $5,000 $7,200 $8,100 $20,000 Estimated Fee I
Anticipated Anticipated | Anticipated Anticipated Anticipated Anticipated Anticipated Anticipated Anticipated Anticipated ! Anticipated | Anticipated Anticipated Anticipated Anticipated Anticipated , Anticipated Notes |
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribbry; falsification of destruction of records; making false statements; or receiving stolen property;
are not presently indicted foV,v6FcrihmalIy or civilly charged by, a governmental entity (federal, state or local) with committm^ia^Co^^e offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year!penodjpte,c^mg the date of this EDS, had one or more public
the date of this EDS, been convicted, adjudged in any criminal or civil action, including actions the federal government, any
transactions (federal, state or1ocal)iterminated for cause or default; and
Sfi&i; Y-W¥ ^any -edritractor^(meaning anyxontractoHorisubcontractor used by the Disclosing Party in
^w '' >,- ^ to all persons or legal entities disclosed under
¦ ::-;.-y:¦¦ ;'*;.-/¦:; '^UK^Mjii BffliLu i
v^: Sectioh{IV;^Discl6sureiOf Subcontractors^ Retained Parties");
'-'^^ that, directly or indirectly: controls the
^^^^$^^^^0^^^^^^^^- Party» or is, wiA;a&Bisci^^:]^irtyt under
icomm'o^c^ritrol^ of control include, without'limitation:
Ic^kimsmaW^ of interests among famflyvmero
p^|equipraffi^ of a .business ehti^folloWmg .the
hiraigifrli^ federal or state or local government,
Itlije^ ownership, or principals as the^
IfmtiEircsjE^^ means a person or entity tha
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:
a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, 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 conductdeisenbed in a. or b. above that is a matter of record, but
;d. violated the provisions of MuniOTaliGode Section 2-92-610 (Living Wage Ordinance).
M^^.'^"^'"^-. ^P*mi^ m? Disclosing Par^ AjBUia^^Kitity or Contractor, or any of their employees, officials,
P^^^^^^^^%fpffli|n«r^ is barred trom^'cM^crin^^^ any unit of state or local government as a result of
P0M^&^0^0^ i^^or:bemg convicted bf'(lf-r^id^rigging^in violation of 720 ILCS 5/33E-3; (2) bid-rotating in
l^flllf^^ ofany state or ofthe United States of
P%^fjffis^ of the U.S. Department ofthe Treasury or the
1st, the Unverified List, the Entity List and the
Icomply with the applicable requirements of Chapters lector General) and 2-156 (Governmental Ethics) ofthe
So any of the above statemen tsiin this .Part B (Further
@t^||ȣ|^^ of Commerce or their successors: the Specially
If the letters "NA," thc word "None," or no response appears on thc lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"), none
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the
12-month period preceding the execution date of this EDS, to an employee, or elected or appointed
official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything
made generally available to City employees or to the general public, or (ii) food or drink provided in the
course of official City business and having a retail value of less than $20 per recipient (if none, indicate
with "N/A" or "none"). As to any gift-listed below, please also list the name of the City recipient.
none
iff:*:
vm
^ ,;C; ^CERTIFICATION OF STATUS AS FlNANjEIAL INSTITUTION
Code. We understand that becoming a predatory
lender or^beebmmg an aff^ may result in the loss of the privilege of doing
, •: If me 'Disclbsihg^Pai^.is unable foymakeftHlsTplecIge because it or any of its affiliates (as defined i.
iv. -. ¦
^¦'^V^'Vy^^r,^^ ....... .
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 ofthe Municipal Code have the same meanings when used in this Part D.
I. 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?
NOTE Item
[]Yes M No
Items D.2. and D.3. If you checked "No" to
E: If you checked "Yes" to Iten^E^^^eed to D. 1 proceed to Part E. ¦;
>taken pursuant to the City's eminent domain power eaning of this Part D.
- ^2. UnJtaw sold pursuant to a prbc«^|pj^^njaetitive bidding, or otherwise permitted, no City .,-jtf^^-iiJeAAlJf^i^qiiQygg shafl h^^^tmanctal interest in his or her own name or in the name of ittfoEerrtity in the Durcr^s^^^^pxoperty that (i) belongs to the City, or (ii) is sold ^smerit^.or .^^|s4>S^r^^^^^f legal process at the suit of the City (collectively, Stte^k C6nrp%i^^n^j:
ie names and business addresses of the City lentify the nature of such interest:
.„—. nannta
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.
_. 2. The Disclosing Party verifies that, as a result of conducting the search in step I 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:
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 AppUcant, 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;sucli certifications prompdy available to the City upon request.
' ' : ' ¦¦¦¦¦ ""',
• CERTIFICATION REGARDINGiMWAM#MPLOYMENT OPPORTUNITY
:*If me Matter is federally fbnded, fedeiaLregutetipns require the Applicant and all proposed *^^^^gi!^iA^o^,fe submit the foUow^giimfotoa^n with their bids or in writing at the outset of
affirmative action programs pursuant to applicable
-••:/:
toTquwtionlliBO»2$^ provide an explanation: -;' - ^^'i ^ ¦•<¦.
" --¦ '
SECTION VII — ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with thc 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.
B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of
the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts,
work, business, or transactions. The full text of these ordinances and a training program is available on
* line at www.citvofchicaEo.org/Emics^an^ be obtained from the City's Board of Ethics, 740 N.
3:^k ^''
Sedgwick St., Suite 500, Chicago, H; 606|Qi;(3|12) 744-9660. The Disclosing Party must comply fully = :.'.y- -witltthe,applicable ordinances. •w.'l^fvj^.-
©|^I£th^ any uifonnation >proyided in this EDS is false, incomplete or inaccurate,
|^^^i^^P6^^S|j^^^^rjr|go^m^t in cjrjnnectijr^^^^ which it is submitted may be rescinded or be void or
^^^^^^^^t7^^^^M^ PayiPI11^6 ^PRjemedfe^under the contract or agreement (if not rescinded or
te-1^ Disclnsin? Party's participation in the Matter and/or
|£^*iS;decImm^ in other transactions with the City. Remedies at
Wf. • i^i- w; lawifor. a'tal incarceration and an award to the City of treble
^v-.-t v;^-\" «i"ie;Gitvs policy"^fo^ to the public on its Internet site and/or upon
^ ? this EDS and any attachments to this EDS may be
to a Freedom of Information Act request, or
^d^sighirigth^EDSlthc Disclosing Party waives and releases any possible ^^^^^^^^^^^^^^^w^^m^jfe^b,i^^Bragi^r^1j^^^^^^^^^^£^g^^^^^^^^^^^^^g^n connection with the pubjie.rete^
l^ontaineb^irmnis EDS aha( also.OTmorizesim«(KiKCTo veri
-•am
El»ThSrMormati current In the event of changes,^^m&'Disclosmgw sj-
{^MEdalE^ respect taMa^re:s^
SgeUl 6f?l3:^->'^;;:;r>:v ; •:.}, /^ ¦ • y--y^-^:
*^^^^^^^^^^^^^^ffi^^tMANENT INELIGIBKI i;^;
i.*'*Jsia';vE
F. 1. Thc 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.
West Central Association Inc.,
(Print or type name of Disclosing Party)
By:
Roderick J Burch
(Print or type name of person signing)
Executive Director
(Print or type title of person signing)
Notary Public.
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 Parry 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 dry official!or department head. A "familial relationship" exists if, as of the date this EDS is
signed, me DiscIo^gP^ Party" or any Spouse or Domestic Partner thereof is related to
the mayor, any ajtiennan, the; city clerk, the city treasurer or any city department head as spouse or domestic
partner or as my ofoSejlfoU^ by blood or adoption: parent, child, brother or sister, aunt or uncle,
• K ,j„. , niece OTnep^^ father-in-law, mbmer-in-law, son-in-law, daughter-in-law, stepfather
l Parry" or anwSpouse or Domestic Partner thereof currently
S*s33fi9Ki2KhaveVav^fimm offidd^^werarmient head?
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAWVPROBLEM 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 identi fied as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
[ ]Yes
2. If me^Apph'cantis a legal entity publicly traded on any exchange, is any officer or director of ¦' me Applicant identified as a building code scofflaw or problem landlord pursuant to Section
[X] Not Applicable
„ (2) above, please identify below the name of the person or legal entity
&.;<*t'^^ B CONSTITUTES ACKNOWLEDGMENT
w^mS^^^^M^^^oL a EDS,
^*lAl!«ffi^ ARE
o»irigTC»#r>Tii«w»PERJUR^ON'PATSE 12;wi?«
-x£W : i: ;•<¦ ¦ : ¦¦¦<•
ri'^a 'i"^^ ¦=¦'¦«*'' ¦•
WW
or promem landlord and the address of the building or
-ci-;-