NOT FOR PROFIT ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VII, Section 6(a) of the 1970 Constitution of the State of Illinois, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the City wishes to support the charitable, educational and philanthropic activities of established Not for Profit Corporations and encourage the continued viability and growth of such activities; and
WHEREAS, many Not For Profit Corporations own property that adjoins streets and alleys that are no longer required for public use and might more productively be used in furtherance of such activities; and
WHEREAS, the City would benefit from the vacation of these streets and alleys by reducing City expenditures on maintenance, repair and replacement; by reducing fly-dumping, vandalism and other criminal activity; and by providing support for such charitable, educational and philanthropic activities; and
WHEREAS, the City can promote strong communities by facilitating services to the public, and increase the City's job base through the vacation of public street(s) and/or alley(s) for no compensation; and
WHEREAS, the properties at 4732-4758 S. Dorchester Avenue, and 1368-1380 E. 48th Street are owned by Chicago Title Land Trust, a Corporation of Illinois as successor trustee ("Land Trustee") to LaSalle Bank National Association, as successor to American National Bank and Trust Company of Chicago, March 2, 1994 and known as Trust Number 118087-06 ("Chicago Title Land Trust 118087-06"); and
WHEREAS, the properties at 1356-1364 E. 48th Street, are owned by Southwold Condominium Association which approved a resolution to execute the Consent to Vacation agreement attached as Exhibit A and made a part hereof; and
WHEREAS, the beneficiary of Chicago Title Land Trust 118087-06 is an Illinois Not For Profit Corporation ("Not For Profit Beneficiary") that uses the site as a private Montessori school ("School") for children from preschool through 8th grade; and
WHEREAS, the Not For Profit Beneficiary of Chicago Title Land Trust 118087-06 proposes to use the portion of the public alley to be vacated herein for creation of a secure campus, unification of the campus footprint, expansion of the playground area, and temporary housing of a modular classroom for the School; and
Page 1
WHEREAS, the City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent of the public use and the public interest to be subserved is such as to warrant the vacation of parts of public alley described in the following ordinance; now therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. THAT PART OF THE 14 FOOT WIDE NORTH-SOUTH PUBLIC ALLEY IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION OF BLOCK 2 OF LYMAN, LARNED AND WOODBRIDGE'S SUBDIVISION OF THE EAST 1/2 OF THE NORTHWEST 1/4 AND THE NORTHWEST 1/4 OF THE NORTHEAST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT THEREOF RECORDED MAY 12,1874 AS DOCUMENT 159571, LYING EAST OF AND ADJOINING THE EAST LINE OF LOT 15 IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION AFORESAID, LYING NORTH OF AND ADJOINING THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15, LYING WEST OF AND ADJOINING A PORTION OF LOT 1 AND LOTS 2, 3,4 AND A PORTION OF LOT 5 ALL IN SAID BLOCK 2; AND LYING SOUTH OF AND ADJOINING THE SOUTH LINE OF EAST 47TH PLACE, SAID SOUTH LINE BEING ALSO THE EASTERLY EXTENSION OF THE NORTH LINE OF LOT 15 AFORESAID, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF LOT 15 AFORESAID; THENCE SOUTH, ALONG THE EAST LINE OF SAID LOT 15 (BEING ALSO THE WEST LINE OF SAID NORTH-SOUTH ALLEY), A DISTANCE OF 125.19 FEET (RECORD 125.00 FEET) TO THE SOUTHEAST CORNER THEREOF; THENCE EAST, ALONG THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15, A DISTANCE OF 14.00 FEET TO THE INTERSECTION WITH THE WEST LINE OF LOT 5 AFORESAID; THENCE NORTH, ALONG THE WEST LINE OF LOTS 5,4, 3, 2 AND A PORTION OF LOT 1 AFORESAID, (BEING ALSO THE EAST LINE OF SAID NORTH-SOUTH ALLEY) A DISTANCE OF 120.20 FEET (RECORD 120.00 FEET) TO A POINT OF CURVATURE IN THE WEST LINE OF SAID LOT 1; THENCE NORTHEAST ALONG THE CURVED WESTERLY LINE OF SAID LOT 1, (BEING ALSO THE WESTERLY LINE OF SAID NORTH-SOUTH ALLEY) AND BEING THE ARC OF CIRCLE CONVEX TO THE NORTHWEST AND HAVING A RADIUS OF 25.00 FEET, AN ARC DISTANCE OF 5.03 FEET TO THE INTERSECTION WITH THE EASTERLY EXTENSION OF THE NORTH LINE OF LOT 15 AFORESAID; THENCE WEST ALONG SAID EASTERLY EXTENSION, 14.50 FEET TO THE POINT OF BEGINNING, IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 1,751 SQUARE FEET OR 0.0402 ACRES, MORE OR LESS as shaded and legally described by the words "HEREBY VACATED" on the plat hereto attached as Exhibit B, which plat for greater clarity, is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacation.
SECTION 2. The Commissioner of Transportation, or a designee of the Commissioner, is hereby authorized to accept and approve a redevelopment agreement or similar instrument restricting the use and improvement of the public way vacated in Section 1 of this ordinance to social service purposes which include, but shall not be limited to educational purposes and for such use and improvements that are accessory, as that term is defined in the Chicago Zoning Ordinance, to such social service purposes, such uses and improvements to be owned and operated by the not for profit corporation, subject to the approval of the Corporation Counsel as to form and legality. The restriction on use and improvement in the covenant, agreement or instrument shall be for a term of 40 years and upon breach of such restriction the public way herein vacated shall revert to the City and be subject to the terms and conditions of the dedication by which it has been heretofore held by the City.
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SECTION 3. The City of Chicago hereby reserves for the benefit of Commonwealth Edison and its successors or assigns, a non-exclusive utility easement to operate, maintain, construct, replace and renew overhead wires, poles, and associated equipment and underground conduit, cables, and associated equipment for the transmission and distribution of electrical energy, telephonic and associated services under, over and along the alley herein vacated, with the right of ingress and egress. The grade of the vacated public way shall not be altered in a manner so as to interfere with the operation and maintenance of Commonwealth Edison facilities. No buildings, permanent structures or obstructions shall be placed over Commonwealth Edison facilities without express written release by the utility. Any future vacation-beneficiary prompted relocation of Commonwealth Edison lying within the area herein vacated will be accomplished by Commonwealth Edison, and completed at the expense of the beneficiary of the vacation.
SECTION 4. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Not For Profit Beneficiary shall or shall cause the Chicago Title Land Trust 118087-06 to deposit in the City Treasury of the City of Chicago, a sum sufficient to defray the costs of removing paving and curb returns, and constructing sidewalk with the most current version of the Chicago Department of Transportation's Regulations for Opening, Repair and Construction in the Public Way and its appendices.
SECTION 5. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Not For Profit Beneficiary shall or shall cause the Chicago Title Land Trust 118087-06 to file or cause to be filed for record in the Office of the Recorder of Deeds of Cook County, Illinois, a certified copy of this ordinance, together with a redevelopment agreement complying with Section 2 of this ordinance, and approved by the Corporation Counsel, and the full sized corresponding plat as approved by the Department of Transportation / Superintendent of Maps & Plats.
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SECTION 6. This ordinance shall take effect and be in force from and after its passage. The vacation shall take effect and be in force from and after its recording.
CONSENT TO VACATION
(grtacb proci oi o«ucrs/hip—titit commitment. lUfc polio- r!t.]
The undersigned. :rpresejns that he/she is the (check one'i
o»ne: f skip to Section II.)
beneficiary (skip io Scnion II.)
___X _ the duly authorized a gem of the owner / beneficiary (CIRCLE ONE) described below:
N=me of owner / benef)ci?.n-: Soujhwold Condominium Association
Name 01 conpasyfjf eppliwble); ,
Miiiinc Address: J 358^&4 48th Street 2iF j=;ngi5
Telephone number: < . 712—L... ^1^ f)?,7R ~?> " >?7 I 2_
Jf stem's address jj different from the owner / oene/iaary. complete the followinc:
Nameoffra- _ td:( )
Mailme Address
ProrTTv for tvhieb caw-.;,', if betng jjven linger, common t»«t addresses) I:
with the *Fenmanem Index N'uroberUi: (PIN H i__20r 11.-202J:04i):QQOjO_
(PTN tfl _
f PIN
3Ij As the owner / beneficiary' duh authorized apent of the property def-cribed above, 3 give consent to the vacation of the public rigJti-of-».ay described as:
TO BE PROVIDED BY THE VACATION APPLICANT-- nnsen common iansuaM ceseriwon ol vacation):
<2
The undcrsiened agrresio waivp^aJt claims for damages or compensation arising fiom such vacation
sienrc
Not* ry Public:
r
detr.'J^r^'i^-' Prrnirc
dai* printed
fie/tec ^j&ZiCt/<(>'^rf&Acndfct'ont l/^Z/O priwee M^'S j.'ISAJ?'C<
PIN f arc K diett numbers (Mi usually :z« tne lorm of ir-?<-5fr"'-iy ana r«5 he foano on piorvny ia* biiis re'itimp io tne sntcoic property
SOUTHWOLD CONDOMINIUM ASSOCIATION RESOLUTION
RECITALS
WHEREAS the Southwold Condominium Association is comprised of members owning nine units in the property at 1358-64 E. 48th Street, Chicago, Illinois; and
WHEREAS the Southwold Condominium Association is adjacent to the southern half of the of the north south alley, located to the west of Dorchester Avenue, to the south of 47th Place and to the north of 48,h Street (the "North South Alley"); and
WHEREAS the neighboring Ancona School has applied to vacate the northern half of the North South Alley, which is not adjacent to the Southwold Condominium Association; and
WHEREAS City of Chicago's Department of Transportation asked the Ancona School to obtain a consent letter from the Southwold Condominium Association in order to apply for the vacation of the northern portion of the North South Alley; and
WHEREAS on September 7, 2014, the Southwold Condominium Association held a meeting to review whether or not to execute the consent to vacation letter; and
WHEREAS on September 7, 2014, the Southwold Condominium Association voted to execute the consent to vacation letter with 6 affirming votes.
NOW, THEREFORE, BE IT RESOLVED, by the Board of the Southwold Condominium Association:
It is resolved that the Southwold Condominium Association consents to the Ancona School's vacation of the northern portion of the North South Alley; that Jim Stricklin, Southwold President, has the authority to sign this Resolution; and that Linda Tucker, Board Member, is authorized to execute the consent to vacation letter on behalf of the Southwold Condominium Association.
Subscribed and sworn to before me
this ^7 day of fa I , 2015.
EXHIBIT 'B
PLAT OF VACATION
OF
THAT PART Or TIE H TOOT WiDE NORTH-SOUTH PUBLIC ALLEY IN BLOCK 2 IN W. B PIERCE'S SUBDIVISION OF BLOCK 2 OF LYMAN, LARNED AND WOODBRIDGE'S SUBCIViSION OF THE EAST 1/2 OF THE NORTHWEST 1/4 AND THE NORTHWEST 1/4 OF THE NOKTHEAST 1/4 OF SECTION 11. TOWS'SHIP 38 NORTH', RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE Pt-AT THEREOF RECORDED MAY 12, 1874 AS DOCUMENT 159171. LYING CAST OF AND ADJOINING THE EAST LINE OF LOT 15 IN BLOCK 2 IN W B. PIERCE'S SUBDIVISION AFORESAID, LYING NORTH OF AND ADJOINING THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15. LYING WEST OF AND ADJOINING A PORTION Or LOT 1 AND LOTS 2. 3, 4 AND A PORTION OT LOT 5 ALL IN SAID BLOCK 2; AND LYING SOUTH OF AND AOJOINING THE SOUTH LINE OF EAST 47TH PLACE. SAID SOUTH LINE BEING Al SO THE EASTERLY EXTENSION OF THE NORTH LiNE OF LOT 15 AFORESAID, EEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHEAST CORNER OF LOT 15 AFORESAID, THENCE SOUTH, ALONG THE EAST LINE OF SAID LOT 15 (BEING ALSO THE WEST LINE OF SAID NORTH-SOUTH ALLEY), A DISTANCE OF 125.19 FEET (RECORD 125 00 FEET) TO THE SOUTHEAST CORNER THEREOF; THENCE EAST, ALONG THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15. A DISTANCE OF 14.00 FEE I TO THE INTERSECTION WITH THE WEST LINE OF LOT 5 AFORESAID. THENCE NORTH, ALONG THE WEST LINE OF LOTS 5, 4, 3, 2 AND A PORTION OF LOT 1 AFORESAID, (BEING ALSO THE EAST LINE OF SAID NORTH-SOUTH ALLEY) A DISTANCE OF 120 20 FELT (RECORD 120 00 FEET) TO A POINT OF CURVATURE IN THE WEST LINE OF SAID LOT 1, THENCE NORTHEAST ALONG THE CURVED WESTERLY LINE OF SAID LOT 1, (H-ING ALSO THE WESTERLY LINE OF SAID NORTH-SOUTH ALLEY) AND BEING THE ARC OF CIRCLE CONVEX TO THE NORTHWEST AND HAVING A RADIUS OF 25.00 FEET, AN ARC DISTANCE OF 5 03 FEET TO THE INTERSECTION WITH THE EASTERLY EXTENSION OF THE NORTH LINE Or LOT 15 AFORESAID; THENCE WEST ALONG SA!D EASTERLY EXTENSION, 14 50 FEET TO THE POINT OF BEGINNING, IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 1.751 SQUARE FEET OR 0 0402 ACRES, MORE OR LESS.
/-VACATED JULY 1, 197 / DOC. 21532023
PUBLIC ALLEY f$
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S89*53'04"W, 14.51
RON PIPE TO BE SET RIGHT Of WAY LINE Or E. *7TH PL -in i
IRAFHC ri_OW PUBLIC STREET
TRAFFIC FLOW
^CROSS NOTCH TO BE CUT
(A)5.03 (RAD)25.00
(CH)S05-46'07X 5.03
-PC
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TRAFFIC now PUBLIC STREET
TRATTIC FLOW
(*) W (M) (CH) (RAO)
l£Gf_N£tL_
ARC
RECORD MEASURED CHORD RADIUS
ARCA HEREBY VACATED UOUNDAKY Of" VACATION A3EA RIGHT OF WAY LINE PARCEL UNE LOT UNE
C.D.O.T.:
EDWARD J. MOLLOY tc ASSOCIATES,
LAND & CONSTRUCTION SURVEYORS
SURVEYOR'S NOTES.
FOR THE PURPOSES Or THIS PLAT THE EAST LlNF. OF LOT 15 IS AT AN ASSUMED PEA RING OT SCCTOO'OG'L"
DIMENSIONS ARE SHOWN IN H'ET AJO DECIMAL "AR1S IHEHKOF
NO DIMENSIONS SHOULD BE ASSUMED BY SCALE MEASUREMENTS UPON THE PLAT
ALL THE LAND WrST 0" AND ADJOINiNC HEREBY VACATED ALLEY FALLS WfTHIN ?0KE RT-4 RESIDENT!*: "WC-FLAT, TOWNHOUSE AND MULTI—UNIT DISTRICT ALL THE LAND EAST OF AND ADjO.NINC HEREBY VACATED ALLEY FALLS WITHIN ZONE RU-5 RESIDENTIAL MULTI-UNIT DISTRICT
FIE1D WORK WAS COMPLETED ON JANUARY 4. 2C16
PLAT PREPARED FOR' THE ANCONA SCHOOL 4770 S. DORCHLSTCR AVENUE CHICAGO, II. £0615
STATE OF ILUNO-S )
) SS
county or" Dupage )
^lUH'I'lii,, 4!&»s ». la '-',.
/v>
i- 35-34O0 **, i
: j PROFESSIONAL \|910|: : land • -
: - surveyor : :|109|\ state of * s
IUJN0IS
%V* -V/
''•HJIIIlH**
I. THOMAS A. MOLLOY. AN ILLINOIS PROFESSIONAL LAND SURVEYOR AND MANAGING AGENT OF EDWARD J MOL10Y AND ASSOCIATES, LTD. HEREBY CERTIFY THAT A PLAT •IAS [Jf.EN MADE UNDER MY DIRECTION FOR THE PURPOSE OF VACATING A PORTION Of AN ALLEY AS SHOWN HEREON AND TIIAT THE PLAT HEREON DRAWN rS A CCHREC1 HEPRESEN1AI10N OK SAID VACATION TH15 PROFESSIONAL SERVICE CONFORMS TO CURRENT ILLINOIS UINIUUM STANDARDS TOR A PLAT OF BOUNDARY SURVEY
SIGNED AT BtNStNVILLE. ILL'NOIS THIS 4TH DAY Or MARCH . AD 2C.0
THOMAS A. MOLLOY
ILLINOIS PROCESS ONAL LAND SURVEYOR NO 35-* _ (DCP:RES NOVEMBER 30. 2016 AND 'S RENEWABLE) MANACINC AGENT, ILLINOIS PROFESSIONAL DESIGN FIRM LICENSE NO
VAUP ONLY wnw E»COES£D SE*. (EXPIRES APRIL 30. 2017 AND IS RENEWABLE)
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/if applicable: Chicago Title Land Trust Company., A'Corporation of Illinois As Successor Trustee To LaSalle Bank National Association. As Sucessor Trustee To American National Bank And Trust Company of
Chicago, March 2, 1994 And Known As Trust Number 118087-06. Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
y the Applicant
OR
f] a legal entity holding a direct or indirect interest in the. Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest: ^
" . OR
3. [ ] a legal entity with a right of control (see Section II, B.l.) Stats the legal name of the entity in
which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 10 S. LaSalle Street, Suite 2750. Chicago, IL
60603
Teiepbone:312-223-^//g Fax:312-223-4136 Email; MM* EUITc,LA £.& (LTT.
Name of contact person: WU)L>flJ pfi-MPEtiELLfi
E. Federal Employer Identification No. (if you have one):
Brief description of contract, transaction or other undertaking (referred to below as (he "Matter") to which this EDS pertains. (Include project number and location of property, if applicable): Vacation of an alley that bisect's school's property. Alley is located west of S. Dorchester
.A^mugJbfitween F, 47th PI, and 48th St,
Which City agency or department is requesting this EDS? Department of Transportation
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page 3 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
I. Indicate the nature of the Disclosing Party:
[ ] Person [ ] Limited liability company
[] Publicly registered business corporation [) Limited liability partnership
[J Privately held business corporation f] Joint venture
[J Sole proprietorship [] Not-for-profit corporation
[ ] General partnership (Is the not-for-profit corporation also a 501 (c)(3))?
[ ] Limited partnership (] Yes [ ] No
LJ Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable Illinois
3. For legal entities not organized in the State of Illinois; Has fbe organization registered to do business id 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 fuli names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also lisi below ail members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other shnihr entities, list below the legal titlebolder(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 thafcontrols the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Chicago Title Land Trust iOnn^lLtwf £S Trustee under trust #118087-06 '
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares m a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a "beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant (o Section 2-154-030 of the Municipal Code .of Chicago ("Municipal Code"), the City may require any such additional uiformarjoD from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address . Percentage Interest in (he
Disclosing Party
Ancona School Society 4770 s. Dorchester 100%
Chicago, IL 60615
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with 3ny City elected official in the 12 months before the date this EDS is signed?
f ] Yes ft] No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address cf each spbeoritractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an tmpaid 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 Parly mast either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Parry Fees (indicate whether
retained or anticipated Addres6 (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable resnonse.
None.
(Add sheets if necessary)
[x| 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 2-92-4] 5, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes f<] N° [ ] ^° person directly or indirectly owns 10% or more of die
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?
[J Yes []No
B. 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 (i:) the Applicant understands and acknowledges that compliance with Article 1 is a continuing requirement for doing business with the City. NOTE; If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ll.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;
b. 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 obrain, or performing a public (federal, state or local) transaction or
contractunder a public transaction; a violation of federal or state antitrust statutes; fraud;
embezzlement; theft; forgery; bribery; falsification or destruction of records; making false
statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-yearperiod preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
3. The certifications in subparts 3, 4 and 5 concern:
• the Disclosing Party;
* any "Conn-actor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to ail persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
? any "Affiliated Entity" (meaning a person or entity that, directly or indirectly controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation; interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
• any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Parry, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any staie or local government in the United States of America, in that officer's or employee1? 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).
4. Neither the Disclosing Party, Affiliated Entity or Contractor:, or any of their employees, officials,
agents or'partners, is barred from contracting with any unit of state or local government as a result of
engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in
violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of
America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of 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 Parry 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.
To the best of the Disclosing Party's knowledge after reasonable inquiry, no current employee of the Disclosing Party was, 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.
S. To the best of the Disclosing Party's knowledge after reasonable inquiry, the Disclosing Party-has not given or caused to be given a gift, 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
Page 6 of 13
I
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 $ 10 per recipient. '
9. If the Disclosing Party is unable to certify to any of the above statements in this Part 3 (Further Certifications), the Disclosing Party roust explain below:
- Disclosing party is merely land trust vhich solely holds title to prope
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.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
I ] is rx) js not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory ¦ lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Jf the Disclosing Party 16 unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
If the letters "N A," 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 ha Chapter 2-156 of the Municipal Code have the same
Page 7 of 13
meanings when used in this Part D.
I. In accordance with Section 2-156-310 of the Municipal Code: Does any official or employee of the City have g financial interest in his or her own name or in the name of any other person or entity in tbe Matter?
[JVes (tfNo ¦
NOTE: If you checked "Yes" to Item D.3., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E-
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City ejected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Fait D.
Docs the Matter involve a City Property Sale?
[]Yes []No
3. If you checked "Yes" to Item D.l., provide tbe names and business addresses of the City officials or employees having such interest and identify tbe nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below, If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this'EDS all information required by paragraph 2. Failure to comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X l. 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 ot 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 Pajty has found no such records.
Page 8 of 13
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. Tbe Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. Forpurposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding,
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to :be Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to tbe 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 defmedby applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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 1 986: 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
Page 9 of 13
Activities".
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party (he Applicant?
[]Yes []No If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[jYes []No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[J Yes []No
Have you participated in any previous contracts or subconlracts subject to the equal opportunity clause?
[] Yes fJ No
If you checked "No" to question 1. or 2. above, please provide an explanation:
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 pan of any
Page 10 of 13
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.
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 th«se ordinances and a training program is available on
line at www.cirvofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
C. If tbe City determines that any information provided in this EDS is false, incomplete or inaccurate,
any contract or other agreement in connection with which it is submitted may be rescinded or be void or
voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or
void), at law, or in equity, including terminating the Disclosing Party's participation in the MarteT and/or
declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at
law for a false statement of material fact may include incarceration and an award to tbe City of treble
damages.
D. It is the City's policy to make this document available to the public on its Internet site and/or upon
request. Some or ail of the information provided on this EDS and any attachments to this EDS may be
made available to the public on the Internet, in response to a Freedom of Information Act request, or
otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible
rights or claims which it may have against the City in connection with the public release of information
contained in this EDS and also authorizes the City to verify the accuracy of any information submitted
in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the rime 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 tbe contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 of the 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:
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities dclinquen! in paying any fine, fee, tax or other charge owed to tbe 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
Page 11 of 13
F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parlies 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. 1., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate and complete as of the date furnished to the City.
Chicago Title Land Trust Company, as Successor Trustee to LaSalle Bank, as Successor Trustee to American National Bank and Trust Company of Chicago'u/T/D 03/02/94 and known
as Trust No. 118087-06 and not personally
(Priat4rtypeMme of penon signing) SgKSW1 ff* «* <™'»' m
(Print or type title of person signing
Signed and sworn to before me on (date) August 10, 2015
at Chicago County, Cook (state). Df Illinois
AU jj /_ I ft , V'^lM^L Notary Public. • "OFFICIAL SEAL" t
. ., • SILVIA MEDINA %
rnmmi«iin rxnires- ( ((? • Notary P"Wlc, Stale Of IHIrxtf* %
Commission expires. )£_ L£_. J My Commission Expire 06/26/2016 ?
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND APFEDAVTT 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 rc 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 Parry or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister,
"Applicable Party" means (1) all executive officers of tbe Disclosing Party listed in Section ILB.l.a., if tbe Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partacrs and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disalusing'Tarty. "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 W No
If yes, please identify below (1) the name and title of such person, (2) tbe name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
1. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes I No
.2. If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes [ ]No [ ] Not Applicable
3. If yes to (I) or (2) above, please identify below the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
(DO NOT SUBMiT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Undersigned must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless
requested.
This recertification is being submitted in connection with The Ancona School Society
[identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Undersigned, (2) warrants that all certifications and statements contained in the Undersigned's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete (ajc^o th§ Latafariftt, ^rp^Sfft^Wrftfife a§eda&tarefflf&i& *ts acknowledgments. LaSalle Bank National Association, as successor to American National Bank
and Trust Company of Chicago JMarch 2,1994 and known as Trust Number isStiedaaftd.Trust' 11"&
The Information contained In this certification has been fumt«h«l to the lawJ^jjHao by trw beneftdtrtea of truM t^J£i£4L£#mi the oertif ieation la m#de witty In reliance thereon and no reaponstbHItv to etcumed by the trust** in lis lR*vld«8i 6$)#sity, tm &§ *yff? Sf aeouraey of the facts therein «at«l
lt8087=OT
//Print or type name of signatory: Title of signatory:
scriDea to Dejore me on Jfe/tf&& [state].
.Via,
Subscribed to before me on [date] O^T' *>h 7o& , at QA&fer? ^^CCountv.
Notary Public.
Commission expires:
Ver. 6/23/03 ¦«**«.,. ¦ ,
I OFFICIAL SEAL" % 23 % ki GRACE MARIN t . Notary Public, State of Illinois % ; fey ^ommiesion Expires 07/01/2017*
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
The Ancona School Society
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
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 hoids an interest: _
OR
3. fc] a legal entity with a right of control (see Section ILB.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: Chicago Title Land Trust, Trust #118087-06
B. Business address of the Disclosing Party: 4770 S Dorchester Avenue
Chicago, Illinois 60615
Telephone: (773) 924-2356 Fax: (773) 924-8905 Email: bwishneGanconaschool¦ org
Name of contact person" S Jonathan Silverman, Chair of Facilities Committee
(312) 970-0357
Federal Employer Identification No. (if you have one):
«
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable): Vacation of an alley that bisect's school's property. Alley is
located west of S. Dorchester Ave between E. 47th Pi. and 48th St.
Which City agency or department is requesting this EDS? Department of Transportation
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # '" and Contract #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
] Person f ] Limited liability company
] Publicly registered business corporation [ ] Limited liability partnership
] Privately held business corporation [ ] Joint venture
] Sole proprietorship £J Not-for-profit corporation
] General partnership (Is the not-for-profit corporation also a 501(c)(3))?
] Limited partnership [x| Yes [ ] No
] Trust [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ] Yes [ ] No m 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
Please see attached list of officers and Trustees No members.
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
None
SECTION m -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Parry had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes jk] No
If yes, please identify below the name(s) of such City elected official(s) and describe such reiationship(s):
SECTION TV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on. an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated -Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response. (1) Traffic Analysis & Design, Inc., 1898 Waverly Way Montgomery, IL 60538; Consultant
(traffic analysis); SI,000 (est.). (2) National Survey Service, Inc., 30 S. Michigan Avenue
Suite 200, Chicago, IL 60603; Preparation of Survey and Plat of vacation; $2,000 (est.). (3) Meal i Leroy, , LLC; 203 N. LaSalle, 203 North LaSalle St., Suite, 2300, Chicago, IL 606C1;
(Add sheets if necessary) Attorneys; Less than $30, 000 (est.).
[ ] 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 with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No [X] 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? na
[ ] Yes [ ] No
B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article F')(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 the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated' Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any slate 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 hid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of 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
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:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted,, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
3. The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes M No
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at tbe suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ J Yes [ ] No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
None .
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
None.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is W is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
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 the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI ~ CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[.] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[JYes [J No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [ ] No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Parry's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or nfhftrwjfip. By^ujiiiplnlirH^ viiul Blff'niTi'3 this EDS, the Disclosing Party waives and releases any possible rights < r claims wfiich.it may n"a^^ inst the City in connection with the public release of information contair sd in this EDS, and.,als^%.u^ri zes the City to verify the accuracy of any information submitted in this
fcDS.'-v:
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 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F. 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 of the Cily, 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.
The Ancona School Society
(Print or type name of Disclosing Party)
(Sign here)
Bonnie L. Wishne
(Print or type name of person signing)
Head of School (Print or type title of person signing)
PAfRICIA A. ERJNGTON ' OFFICIAL SEAL Notary Public. Stale of lllinplj My Commission Expires March 09, 2016
Signed and sworn to before me on (date) ^?, / 7*. /5~
at Cnok- County, XL (state).
Notary Public.
Commission expires: JS- .
Pase 12 of 13
the
ANCONA school
POWERED by the GENIUS of C H 11. D RE N
TRUSTEES OF THE ANCONA SCHOOL As of June 1,2015
Chip Bamberger, Treasurer Keith Bevans, President Dontrey Britt-Hart Lawrence Hill
Lara Moynihan, Vice President Darryl Newell Todd Neumann Jill Potter
Joanna Shaan Trotter
Benjamin Smith-Donald
Paul Watford
Henry Wishcamper
Ari Frede, Head of School
Bonnie L. Wishne, Head of School
The Ancona School 4770 South Dorchester Avenue Chicago, Illinois 60615-2023
ph 773.924.2356 fx 773.924.8905 info@anconaschool.com
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT-APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section ILB.l.a., if the Disclosing Party is a corporation; all partners of tbe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes fcj No
If yes, please identify below (1) the name and title of such person. (2) the name of the legal entity to which such person is connected; (3) the name and title 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 SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes f^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 of the Municipal Code?
[ ]Yes !XfNo I ] Not Applicable
3. If yes to (1) or (2) above, please identify below the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Undersigned must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless
requested.
This recertification is being submitted in connection with The Ancona School Society [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Undersigned, (2) warrants that all certifications and statements contained in the Undersigned's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledg ments.
The Ancona School Society
(Print or type name of individual or legal entity submitting this recertification)
By:
(sign here)
Print or type name of signatory:
Title of signatory:
Subscribed to before me on [date] *f /jk> J/(*> at Oock
ITU [state]. 7
Notary Public.
Coinmission expires:
Ver. 6/23/03
OFFICIAL SEAL PATRICIA A. ERINGTON Notary Public - State of Illinois |My Commission Expires 4/21/2020 >