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 the sale of city-owned property.
Your favorable consideration of these ordinances will be appreciated.
Mayor
Very truly yours,
ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of government by virtue of the provisions of the Constitution of the State of Illinois of 1970, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the City is the owner of the vacant parcel of property located at 1144 North Waller Avenue, Chicago, Illinois 60651, which is legally described on Exhibit A attached hereto (the "Property"); and
WHEREAS, Channing's Childcare Academy (the "Grantee"), with a principal business address of 5701 West Division Street, Chicago, Illinois 60651 has offered to purchase the Property from the City for the sum of Two Thousand Four Hundred and 00/100 Dollars ($2,400.00), such amount being the appraised fair market value of the Property, to improve with landscaped open space thereon; and
WHEREAS, pursuant to Resolution No. 16-058-21 adopted on July 21, 2016, by the Plan Commission ofthe City (the "Commission"), the Commission approved the negotiated sale of the Property to the Grantee; and
WHEREAS, public notice advertising the City's intent to enter into a negotiated sale of the Property with the Grantee and requesting alternative proposals appeared in the Chicago Sun-Times, a newspaper of general circulation, on June 10 and June 17, 2016; and
WHEREAS, no alternative proposals were received by the deadline indicated in the aforesaid notice; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The City Council ofthe City hereby approves the sale ofthe Property to the Grantee for the amount of Two Thousand Four Hundred and 00/100 Dollars ($2,400.00),
SECTION 2. The Mayor or his proxy is authorized to execute, and the City Clerk or Deputy City Clerk is authorized to attest, a quitclaim deed conveying the Property to the Grantee. The quitclaim deed shall also contain language substantially in the following form:
This conveyance is subject to the express condition that: the Property is improved with landscaped open space within six (6) months ofthe date of this deed. In the event that the condition is not met, the City of Chicago may re-enter the Property and revest title in the City of Chicago. Grantee, at the request of the City of Chicago, covenants to execute and deliver to the City a reconveyance deed to the Property to further evidence such revesting of title. This right of reverter and re-entry shall terminate upon the issuance of a certificate of completion, release or similar instrument by the City of Chicago.
The Grantee acknowledges that if the Grantee develops the Property with a residential housing project, as defined under and that is subject to Section 2-45-115 of the Municipal Code of the City (the "2015 Affordable Requirements Ordinance"), the Grantee and such project shall be obligated to comply with the 2015 Affordable
Requirements Ordinance.
SECTION 3. If any provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such provision shall not affect any of the other provisions of this ordinance.
SECTION 4. All ordinances, resolutions, motions or orders inconsistent with this ordinance are hereby repealed to the extent of such conflict.
SECTION 5. This ordinance shall take effect upon its passage and approval.
EXHIBIT A
Purchaser:
Purchaser's Address: Purchase Amount: Appraised Value:
Channing's Childcare Academy
5701 West Division Street, Chicago, Illinois 60651
$2,400.00
$2,400.00
Legal Description (Subject to Title Commitment and Survey):
Lot 2 and the South 2 Feet of Lot 1 in Block 3 in Martin Anderson's Resubdivision of Lots 1 to 9, both inclusive, and Lots 30 to 39, both inclusive, in Block 3 and Lots 1 to 48, both inclusive, in Block 5 all in Hood's Subdivision of Blocks 1 to 6, 8 and 18 in Salisbury's Subdivision of the East 1/4 of the Southeast % of Section 5, Township 39 North, Range 13, East of the Third Principal Meridian, in Cook County, Illinois.
Address: 1144 North Waller Avenue
Chicago, Illinois 60651
Property Index Numbers:
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Parly submitting this EDS. Include d/b/a/ if applicable*.
C.i^''^^'^ (L- kJ!^-A+4->. c^4<36^^'
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
h/ the Applicant
OR
[ ] a legal entity holding a direct or indirect interest in thc Applicant State the legal name ofthe
Applicant in which thc Disclosing Party holds an interest:
OK
3. [ ] a legal entity with a right of control (see Section Il.B.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: / /0.
C. Telephone:!
D. Name of contact person: / /tiLJ
r'r
E. Federal Einployet Identification No. (if you have one): /
V. 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 properly, if applicable):
/l^ ^ ^cUA^u
G. Which Cily agency or department is requesting this EDS? jQL^dSlJ . Z1 ArA^t^k&^...'"J". ~J^*^bjj-
If ihe Ma tier is a contract being handled by thc City's Department of Procurement Services, please complete the following;
Ver. 01-01-12 pAl'C 1 of 13
Specification # /)'J /} and Contraci H
SECTION U - DISCLOSURE OL" OWNERSHIP INTERESTS
A. NATURE OF THF DISCLOSING TARTY
1. Indicate the nature ofthe Disclosing Party:
[j Person [] Limited liability company
[ ] Publicly registered business corporation [ ] Limited liability partnership
[ ] Privately held business corporation [ ] Joint venture
| ] Sole proprietorship ^Not-for-profit corporation
[ j General partnership (Is the not-for-profit corporation also a 501(c)(3)):
[] Limited partnership [y]Yes l]No
[ ] Trust [] Other (please specify)
2. For legal entities, the stale (or foreign country) of incorporation or organization, if applicable:
_jSX^5£. Jt^.sdJl^At^,
r
3. For legal entities not organised in the Slate of Illinois: Has (he organization registered to do
business in the Stale of Illinois as a foreign entity?
I. ] Yes r ] No ryfN/A
IL IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
3. List below the full names and titles of all executive officers and all. directors ofthe entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titlcholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Patty,, NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name / ^ Title
iJUC^p /^^£j>>L> ^.(LJ(-^-0 .. _
U. <*s>r.L> ^&Ln^L&Ls. ..£& C^v-vt-
,/->• (lA^
2. Please provide the following information concerning each person or entity having a direct or indirect bcocficial interest (including ownership) in excess of 7.i>% ofthe Disclosing Parly. Examples ol such an interest include shares in. a coiporalion, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. IT 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 thc
{/y Disclosing Party
fLlr-A.^ _ _
SECTION III- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe. Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
f ] Yes
If yes, please identify below thc namc(s) cf such City elected officials) and describe such reiationship(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 lelalionship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who arc paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative, action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party musl either ask the City whether disclosure is required o: make the disclosure.
Page 3 of 13
Name (indicate whether retained or r::iticip.iCcr: .0 be retained")
Business Add less
Relationship ic Disclosing Parly 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)
[vf Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415. substantial owners of business entities that contract wilh the City must remain in compliance with (heir child support obligations throughout thc 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
Disclosing Party.
If "Yes," has the person enlrrcd into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
: j yes
B. FURTHER CERTIFICATIONS
]. Pursuant to Municipal Code Chapter 1-23, Article 1 ("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 Parly 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, oi 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 cr any sister agency; and (ii) the .Applicant understands and acknowledges that compliance with Article 3 is a continuing requirement for doing business wilh the City. NOTE: If .Article I applies to the Applicant, thc permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
psgir n of j.3
2. The Disclosing Part}' and. if the Disclosing Pany is a legal entity, all of those persons or cutitiex identified n\ Section II.B.l. of this EDS:
arc not presently debarred, suspended, proposed fot 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;
e. are not presently indicted for, oi criminally or civilly charged by, a governmental entity (federal, state or locai) with committing any of the offenses set forth in clause B.2.b. of this Section V;
d. have no'., within a livc-yeai period preceding the date of this EDS. had one or more public transactions (federal, slate or local) terminated for cause or default; and
c. have not, within a five-year period preceding the date, of this EDS. been convicted, adjudged guiJty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
3. The certifications in subparts 3. 4 and 5 concern:
- the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with rhc 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, oi 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 thc Contractor, is controlled by it, or, with the. Contractor, is under common control of another person or entity;
• any responsible official ofthe Disclosing Parly, any Contractor or r.ny Affiliated Entity or any other official, agent or employee of the. Disclosing Party, any Contractor or any Affiliated Entity, acting puisnanl to thc direction or authorization of a responsible official cf the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents")
Neither die Disclosing Parly, nor any Contractor, nor any Affiliated Entity of cither 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 thc five years before thc dale of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of the federal government or ofany 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 ag: cement 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 pr osecuted 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 contr acting with any unit of state or local government as a result of engaging in cr being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3: (2) bid-rotating in violation of 720 ILCS 5/33 E-4; or (3) any similar offense ofany state or ofthe United States of America that contains thc same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department ofthe Treasury or the Bureau of Industiy and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List the Unverified List, thc 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) ofthe Municipal Code.
If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Cert.fieations), the Disclosing Party must explain below:
Page: 6 of 13
If (he letters .'"NA" the word "None." or no response appears on thc lines above, it will be conclusively presumed that thc Disclosing Party certified to the above statements
8. To the best of the Disclosing Parly'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, ofthe Citv of Chicago (if none, indicate with "N/A" or "none").
A'/ # _
9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. Eor purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, cr (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
/J/.a . _ _
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
{ ] is [t/is not
a "financial institution" as defined in Section 2-3?.-455(b) ofthe Municipal Code.
IT the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"Wc are net and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. Wc further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatoiy lender or becoming an affiliate .of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
H"the letters "NA," thc word "None," or no response appears on the lines above, it will be conclusively presumed that thc Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Anv words or terms that arc defined in Chapter 2-156 ofthe Municipal Code have thc same meanings when used in this Part D.
) _ In accordance with Section 2-156-110 of the Municipal Code: Does airy official or employee ofthe City have a financial interest in his or her own name or in the name; ofany other person or entity in the Matter? y
[) Yes fc/No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you cheeked "No" to Hem D.l., proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase ofany property that (i) belongs to thc 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 pr operty taken pursuant io the City's eminent domain power docs not constitute a financial interest within the meaning of this PartD.
Does the Matter involve a City Property Sale?
[ ] Yes [ ] No
3. 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. Thc Disclosing Party further certifies that no prohibited financial interest in thc Matter will be acquired by any Cily official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither I. or 2. below. If the. Disclosing Party checks 2., thc Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the Cily in connection with the Matter voidable by the City.
^J!. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
ihe Disclosing Parly and any and a!) predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during thc slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. Thc 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 ali slaves oi slaveholders described in those records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter it? federally funded, complete this Section VI. If (.he 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 arc not federal funding.
A. CERTIFICATION REGARDING LOBBYING
i. List below thc names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if 1hc letters "NA" or if the word "None" appear, if 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. Thc 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 thc 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 av.y federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 1.3
3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which ihcrc occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A.I. and A.2. above
A. The Disclosing Party certifies that cither: (i) it is not an otganization described in section 501(e)(4) ofthe Internal Revenue Code of 19?<5; or (ii) it is an organization described in section 501 (c)(4) of the Interna! Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
5. If the Disclosing Party is thc Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A4. 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.
13. 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 thc three questions below:
Have you developed and do yon have on file affirmative action piograrns pursuant to applicable federal regulations? (See 41 CFR. Part 60-2.)
f ] Yes f J No
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract. Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes []No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[]Yes []No
If you checked "No" to question J. or 2. above, please provide an explanation:
Page JO of 13
SECTION VT1 - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES. DISCLOSURE
The Disclosing Parly understands and agiccs that.
A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between tlx Applicant and the City in connection with thc Matter, whether procurement, City assistance, or other City action, and arc matciial inducements to the City's execution ofany contract cr 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.
33. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of thc Municipal Code, impose certain duties and obligations on persons cr entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line ai www.citvQfchicaeo.org/Elhics , and may also be obtained from the City's Board of Ethics. 740 N.
Sedgwick St., Suite 500. Chicago, IL 606)0, (312) 744-9660. The Disclosing Party must comply fully with thc applicable ordinances.
If thc 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 thc contract or agreement (if not rescinded oi void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining lo allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available, to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom, of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives ar.d releases any possible rights or claims which it may have against thc City in connection with the public release of information contained in this EDS and also authorizes thc City to verify (he accuracy ofany information submitted in this EDS.
K. Thc information provided in this EDS must be kept cunenl. In thc. event of changes, the Disclosing Party must supplement this EDS up to (he time thc City takes action on ihe Matter. 3f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as thc contract tcquires. NOTE: Wilh respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the infoimation 'provided herein regarding eligibility must be kept current for a longer period, as rcquhed by Chapter 1 -23 and Section 2-154-020 ofthe Municipal Code.
The Disclosing Party represents and warrants that:
Page i I of 1.3
F. 1. The Disclosing Party is not delinquent in (he payment ofany tax administered by the Illinois Department of Revenue, nor are thc Disclosing Party or its Affiliated Entities delinquent in paying aiiy fine, fee, tax or other charge owed to the Chy. This includes, but is not limited to, al! water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If thc Disclosing Party is thc Applicant, thc 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 fedeial Excluded Parlies List System ("EPLS") maintained by the U. S. General Services Administration.
F.3 If the Disclosing Party is the Applicant, thc 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 thc prior written consent, ofthe City, use any such eonlraclor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot pjovide tiuthful certifications.
NOTE: If the Disclosing Party cannot certify as to any ofthe items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, thc person signing below: (1) warrants thai he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of thc Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) arc true, accurate and complete as ofthe date furnished to the City.
(Print or type narfjc of Disclosing Party) (j
By: i^.A:iz^LJ^±^A~-T^:^
(Sign here)
(Print or type name of person signing)
(Print or type title of person signing)
Signed and sworn to before ;ne on (date) _J -^tt'/k (
a* ._CO.O'K- County, -r.|{ l(X0 >V C^'te)
Notaiy Public.
Commission expires
OFFICIAL SEAL b Page 12 of 13
RENEE DIXON Notaiy Public - State of Illinois My Commission expires Sep 6. 201C
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) (he Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party'' or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, thc Disclosing Parly or any "Applicable Part)'" or any Spouse or Domestic Partner thereof is related to the mayor', any alderman, the city clerk, thc city treasurer or any cily department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section IIB, 1 .a., if thc Disclosing Party is a corporation; all partners of thc Disclosing Party, if the Disclosing Party is a general partnership; all genera! partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5 -percent ownership interest in the. Disclosing Party. "Principal officers" means thc president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or 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?
1. ] Yes
If yes, plaase 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 rclationshipVand (-1) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is (o 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.
I. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
[ ]Yes [/[No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?
[ ]Yes [ JNo M Not Applicable
3. If yes to (1) or (2) above, please identify below the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address ofthe building or buildings to which the pertinent code violations apply.
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.