OFFICE OF THE MAYOR
CITY OF CHICAGO
RAHM EMANUEL
MAYOR
December 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 real property commonly known as 2639-59 South Damen Avenue, Chicago, Illinois 60608 (subject to final title commitment and survey, the "Property"), and legally described on Exhibit A attached hereto; and
WHEREAS, pursuant to ordinances adopted by the City Council of the City (the "City Council") on June 10, 1998, and published in the Journal of the Proceedings of the City Council (the "Journal") of such date, (i) a certain redevelopment plan and project (the "Initial Redevelopment Plan") for the Pilsen Industrial Corridor Tax Increment Financing Redevelopment Project Area (the "Redevelopment Area") was approved pursuant to the Illinois Tax Increment Allocation Redevelopment Act, as amended (65 ILCS 5/11-74.4-1 et seq.) (the "Act"); (ii) the Redevelopment Area was designated as a redevelopment project area pursuant to the Act; and (iii) tax increment financing was adopted pursuant to the Act as a means of financing certain Redevelopment Area redevelopment project costs (as defined in the Act) incurred pursuant to the Initial Redevelopment Plan; and
WHEREAS, pursuant to ordinances adopted by the City Council on November 12, 2003, and on September 1, 2004, and published in the Journal for such dates, the City Council adopted amendments to the Initial Redevelopment Plan (the Initial Redevelopment Plan, as amended, the "Redevelopment Plan"); and
WHEREAS, the Property is located in the Redevelopment Area; and
WHEREAS, the appraised fair market value of the Property is Four Hundred Fifty Thousand Dollars ($450,000); and
WHEREAS, Chicago Produce Market Corporation, an Illinois not-for-profit corporation ("Grantee"), with a principal business address of 2404 South Wolcott Avenue, Chicago, Illinois 60608, has offered to purchase the Property from the City for the sum of Four Hundred Fifty Thousand Dollars ($450,000) (the "Purchase Price"), such amount being the appraised fair market value of the Property; and
WHEREAS, SRCI, LLC, an Illinois limited liability corporation (the "Subsequent Purchaser"), with a principal business address of 1816 North Cleveland Avenue, Chicago, Illinois 60614, has offered to acquire the Property from Grantee for the sum of Four Hundred Fifty Thousand Dollars ($450,000), for the purpose of creating an industrial surface parking lot thereon and maintaining such use in perpetuity; and
WHEREAS, Subsequent Purchaser proposes to lease the Property to its affiliate, Banner Wholesale Grocers, Inc., an Illinois for-profit corporation, with a business address of 3000 South Ashland Avenue, Chicago, Illinois 60608, which will use the Property for industrial parking; and
WHEREAS, the use of the Property for industrial parking is consistent with the Redevelopment Plan; and
WHEREAS, the Property contains environmentally impacted and geotechnically unsuitable soils that are too costly to remove and that cannot support the weight of trucks; and
WHEREAS, Grantee has proposed that it deposit Three Hundred Fifty Thousand Dollars ($350,000) from the Purchase Price into escrow for the purpose of reimbursing Grantee for certain environmental remediation and geotechnical costs incurred by Grantee; and
WHEREAS, such an escrow account is acceptable to the City; and
WHEREAS, by Resolution No. 16-098-21, adopted by the Plan Commission of the City (the "Plan Commission") on October 20, 2016, the Plan Commission recommended the sale of the Property; and
WHEREAS, public notices advertising the intent of the City's Department of Planning and Development (the "Department") to enter into a negotiated sale with Grantee and requesting alternative proposals appeared in the Chicago Sun-Times on November 11 and 18, 2016; and
WHEREAS, no alternative proposals have been received by the deadline indicated in the aforesaid notices; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The foregoing recitals are hereby adopted as the findings of the City Council.
SECTION 2. The City Council hereby approves the sale of the Property to Grantee for the amount of Four Hundred Fifty Thousand Dollars ($450,000) (i.e., the Purchase Price). This approval is expressly conditioned upon the City and Grantee entering into a joint order escrow agreement substantially in the form attached hereto as Exhibit B and made a part hereof (the "Joint Order Escrow Agreement"). Three Hundred Fifty Thousand Dollars ($350,000) of the Purchase Price shall be deposited into the escrow account established pursuant to and in accordance with the Joint Order Escrow Agreement. The Commissioner of the Department ("Commissioner") or a designee of the Commissioner is each hereby authorized, with the approval of the City's Corporation Counsel as to form and legality, to negotiate, execute and deliver the Joint Order Escrow Agreement, and such other supporting documents as may be necessary or appropriate to carry out and comply with the provisions of the Joint Order Escrow Agreement, with such changes, deletions and insertions as shall be approved by the persons executing the Joint Order Escrow Agreement. The Commissioner or a designee of the Commissioner is each hereby authorized to consent to the assignment of the Joint Order Escrow Agreement from Grantee to Subsequent Purchaser, upon the conveyance of the Property from Grantee to Subsequent Purchaser, and to negotiate, execute and deliver such assignment, and such other supporting documents as may be necessary or appropriate to carry out and comply with the provisions of such assignment.
SECTION 3. The Mayor or his proxy is authorized to execute, and the City Clerk or the Deputy City Clerk is authorized to attest, one or more quitclaim deeds conveying the Property to Grantee. Without limiting the quitclaim nature of such deed, such conveyance shall be subject to (i) standard exceptions in an ALTA insurance policy; (ii) general real estate taxes and any special assessments or other taxes; (iii) easements, encroachments, covenants, restrictions and
liens of record and not shown of record; (iv) such other title defects as may exist; and (v) any and all exceptions caused by acts of Grantee or its agents.
Such conveyance also shall be subject to the following conditions and covenants, in substantially the form set forth below, which are a part of the consideration for the Property and which are to be taken and construed as running with the land and binding on Grantee and its successors and assigns:
FIRST: Grantee must perform, or cause to be performed, the following work on the Property (all such work, the "Environmental Remediation Work"):
excavation, transport and disposal of approximately 30" (or a depth as determined by a third-party geotechnical engineer) of unsuitable material below expected final grade;
cement stabilize bottom of undercut;
install geofabric at bottom of excavation;
fill undercut with approximately 30" stone compacted or material and depth as determined by a third-party geotechnical engineer). All backfill material must meet the Illinois Environmental Protection Agency Tiered Approach to Corrective Objectives Tier I residential criteria or a letter provided from the quarry stating the material is virgin material;
install an engineered barrier in the form of a concrete or asphalt cap of at least 4" plus compactible fill (in lieu of asphalt and stone) (the "Engineered Barrier");
install a class "A" vapor barrier below pavement;
landscape undercuts to 36" below expected final grade; and
related environmental and geotechnical testing work.
Any soils removed from the Property must be transported to, and disposed of at, a properly permitted landfill in accordance with all applicable laws.
All Environmental Remediation Work must be performed in accordance of Section 13-32-125 of the Municipal Code of Chicago (Construction Site Cleanliness). If unearthing of soils results in noticeable petroleum odors or conditions detrimental to health as determined by the City (Section 7-28-060 of Municipal Code) then the odors must be neutralized and the soils properly tarped or contained to ensure emanation is kept to a minimum.
Grantee must provide, or cause its third-party environmental consultant to provide, a written report to the City (the "Completion Report") that summarizes all of the Environmental Remediation Work performed at the Property. At a minimum, the report must include a summary of field activities, photographs, vapor barrier specifications, manifests, field logs, load tickets, clean backfill documentation and analytical data.
The Environmental Remediation Work must commence not later than six (6) months following the date of the deed and must be completed, as evidenced by the City's issuance of a certificate of completion, release or similar instrument (each, a "Certificate of
Completion"), not later than eighteen (18) months following the date of the deed, unless the Commissioner of the Department or any successor department thereto extends, in writing, such commencement and/or completion dates.
SECOND: Grantee, and its successors and assigns, hereby waive and release, holds harmless and indemnify the City from and against, any claims and liabilities relating to or arising from the structural, physical or environmental condition of the Property and any adjacent property owned by Grantee or owned by any entity that succeeds to the Property, including, without limitation, claims arising under the Comprehensive Environmental Response, Compensation and Liability Act of 1980, as amended ("CERCLA"), and shall undertake and discharge all liabilities of the City arising from any structural, physical or environmental condition that existed on the Property prior to the date of this deed, including, without limitation, liabilities arising under CERCLA. Grantee hereby acknowledges that, in purchasing the Property, Grantee is relying solely upon its own inspection and other due diligence activities and not upon any information (including, without limitation, environmental studies or reports of any kind) provided by or on behalf of the City or its agents or employees with respect thereto. If, after the date of this deed, the structural, physical and environmental condition of the Property is not in all respects entirely suitable for its intended use, it shall be Grantee's sole responsibility and obligation to take such action as is necessary to put the Property in a condition which is suitable for its intended use. Furthermore, Grantee, and its successors and assigns, hereby waive the right to receive the benefits of or to invoke the protection afforded by all maritime statutory limitations of liability, including the Limitation of Vessel Owner's Liability Act, 48 U.S.C. § 183 et seq., that could act to diminish their liability for any harm or damage arising from their performance of the Environmental Remediation Work or for any claims or other costs arising from or occasioned by their operations on any waterways, including the Chicago River. This provision is not intended to avoid or waive federal jurisdiction under the,applicable admiralty laws.
THIRD: The Property must be developed with an industrial surface parking lot within twelve months from the date of this deed and such use as an industrial surface parking lot must be maintained in perpetuity. Grantee shall not construct, develop or erect any buildings or other structures (other than an industrial surface parking lot) on the Property. Grantee shall not apply for any zoning changes or a planned development that is inconsistent with the use restriction set forth in this covenant THIRD.
FOURTH: Grantee, and its successors and assigns, must maintain the integrity of the Engineered Barrier at all times. Grantee must establish and abide by a construction work health and safety plan that will assure that construction workers are protected when any work takes place on the Property.
FIFTH: Grantee, and its successors and assigns, must maintain insurance in accordance with the following:
INSURANCE REQUIRED
Grantee shall provide and maintain, at Grantee's own expense, the insurance coverage and requirements specified below, insuring all work, services and operations related to the Property.
(i) Workers Compensation and Employers Liability. Workers Compensation Insurance as prescribed by applicable law covering all employees ,who are to provide work,
services or operations on the Property and Employers Liability coverage with limits of not less than $100,000 each accident, illness or disease.
(N) Commercial General Liability. (Primary and Umbrella). Commercial General Liability Insurance or equivalent with limits of not less than $1,000,000 per occurrence for bodily injury, personal injury and property damage liability. Coverages must include the following: All premises and operations, products/completed operations, independent contractors, separation of insureds, defense and contractual liability. The City of Chicago is to be names as an additional insured on a primary, non-contributory basis for any liability arising directly or indirectly from the work performed on the Property.
(a) Prior to performing any Environmental Remediation Work or other work, services or operations on the Property, Grantee shall cause its architects, contractors, subcontractors, project managers and other parties performing any Environmental Remediation Work, or other work, services or operations on the Property to procure and maintain the following kinds and amounts of insurance:
Workers Compensation and Employers Liability. Workers Compensation Insurance, as prescribed by applicable law covering all employees who are to provide work, services or operations on the Property and Employers Liability coverage with limits of not less than $ 500,000 each accident, illness or disease. Coverage shall include but not be limited to: United States Long Shore, Harbor Workers and Jones Act when applicable.
Commercial General Liability. (Primary and Umbrella). Commercial General Liability Insurance or equivalent with limits of not less than $2,000,000 per occurrence for bodily injury, personal injury, and property damage liability. Coverages must include the following: All premises and operations, products/completed operations (for a minimum of two (2) years following completion of the Environmental Remediation Work), explosion, collapse, underground, separation of insureds, defense, and contractual liability. The City of Chicago is to be named as an additional insured on a primary, non-contributory basis for any liability arising directly or indirectly from the work.
Automobile Liability. (Primary and Umbrella), When any motor vehicles (owned, non-owned and hired) are used in connection with work to be performed, Automobile Liability Insurance with limits of not less than $2,000,000 per occurrence for bodily injury and property damage. Coverage must include but not be limited to the following: ownership, maintenance, or use of any auto whether owned, leased, non-owned or hired used in the performance of the work, services or operations both on and off the Property including loading and unloading. If applicable, coverage extensions must include an MCS-90 endorsement where required by the Motor Carrier Act of 1980 for transport of Hazardous Waste. The City of Chicago is to be named as an additional insured on a primary, non-contributory basis.
All Risk /Builders Risk. When Grantee undertakes any construction, including improvements, betterments, and/or repairs, Grantee must provide or cause to be provided All Risk Builders Risk Insurance at replacement cost for materials, supplies, equipment, machinery and fixtures that are or will be part of the project. The City of Chicago is to be named as an additional insured and loss payee/mortgagee if applicable.
Professional Liability. When any architects, engineers, construction managers or other professional consultants perform work or services in connection with the Environmental Remediation Work, Professional Liability Insurance covering acts, errors, or
omissions must be maintained with limits of not less than $1,000,000. Coverage must include pollution liability if environmental site assessments will be done. When policies are renewed or replaced, the policy retroactive date must coincide with, or precede, start of work related to the Environmental Remediation Work. A claims-made policy which is not renewed or replaced must have an extended reporting period of two (2) years.
Contractors Pollution Liability. When any work performed involves a potential pollution risk that may arise from the operations of scope of services including Environmental Remediation Work which may cause a pollution exposure, Grantee must cause the remediation contractor to provide Contractor Pollution Liability covering bodily injury, property damage and other losses caused by pollution conditions with limits of not less than $1,000,000 per occurrence. Coverage must include but not be limited to: completed operations, and contractual liability, defense, excavation, environmental cleanup, remediation and disposal and if applicable include transportation and non-owned disposal coverage. When policies are renewed or replaced, the policy retroactive date must coincide with or precede start of work. A claims-made policy which is not renewed or replaced must have an extended reporting period of two (2) years. The City of Chicago is to be named as an additional insured.
Pollution Legal Liability. Pollution Legal Liability Insurance must be provided or cause to be provided by the disposal site/landfill operator, covering bodily, property damage and other losses caused by pollution conditions that arise from the project/disposal site contract scope of work, services or operations with limits of not less than $5,000,000 per occurrence. Coverage must include completed operations, contractual liability, defense, excavation, environmental cleanup, remediation and disposal. When policies are renewed or replaced, the policy retroactive date must coincide with or precede start of work on disposal contract. A claims-made policy which is not renewed or replaced must have an extended reporting period of two (2) years.
Marine Protection & Indemnity (If Applicable). When marine operations are undertaken in connection with the Property, Grantee must provide or cause to be provided, Marine Protections Indemnity coverage with limits of not less than $1,000,000. Coverage must include but not be limited to: Property damage and bodily injury to third parties, injuries to crew members if not provided through other insurance; damage to wharves and other structures, and collision. The City of Chicago is to be named as an additional insured.
(b) Other Requirements:
Grantee shall furnish the City of Chicago, Department of Planning and Development, City Hall, Room 1000, 121 North LaSalle Street, Chicago, IL 60602, original Certificates of Insurance, or such similar evidence, to be in force on the date of this deed, and Renewal Certificates of Insurance, or such similar evidence, if the coverages have an expiration or renewal date occurring prior to the City's issuance of a Certificate of Completion. The receipt of any certificate does not constitute agreement by the City that the insurance requirements in this deed have been fully met or that the insurance policies indicated on the certificate are in compliance with all requirements of this Covenant Fourth. The failure of the City of Chicago to obtain certificates or other insurance evidence from Grantee is not a waiver by the City of any requirements for Grantee to obtain and maintain the specified coverages. Grantee shall advise all insurers of the deed provisions regarding insurance. Non-conforming insurance does not relieve Grantee of the obligation to provide insurance as specified herein. Nonfulfillment of the insurance conditions may constitute a violation of this covenant FIFTH, and the City of Chicago
retains the right to stop work and/or pursue all available remedies in law and in equity until proper evidence of insurance is provided.
The insurance must provide for 30 days prior written notice to be given to the City in the event coverage is substantially changed, canceled, or non-renewed. Any deductibles or self-insured retentions on referenced insurance coverages must be borne by Grantee and contractors. Grantee hereby waives and agrees to require their insurers to waive their rights of subrogation against the City of Chicago, its employees, elected officials, agents, or representatives. The coverages and limits furnished by Grantee in no way limit Grantee's liabilities and responsibilities specified within this deed or by law.
Any insurance or self-insurance programs maintained by the City of Chicago do not contribute with insurance provided by Grantee pursuant to this deed. The required insurance to be carried is not limited by any limitations expressed in the indemnification language in this deed or any limitation placed on the indemnity in this deed given as a matter of law. If Grantee is a joint venture or limited liability company, the insurance policies must name the joint venture or limited liability company as a named insured. Grantee must require its contractors and subcontractors to provide the insurance required herein, or Grantee may provide the coverages for contractors and subcontractors. All contractors and subcontractors are subject to the same insurance requirements as Grantee. If Grantee, any contractor or subcontractor desires additional coverages, the party desiring the additional coverages is responsible for the acquisition and cost.
The City of Chicago Risk Management Department maintains the right to modify, delete, alter or change these requirements.
SIXTH: The City of Chicago makes no covenant, representation or warranty, express or implied, of any kind, as to the structural, physical or environmental condition of the Property or the suitability of the Property for any purpose whatsoever, and Grantee accepts the Property in its "as is," "where is" and "with all faults" condition.
SEVENTH: Grantee, and its successors and assigns, shall not discriminate on the basis of race, color, sex, gender identity, age, religion, disability, national origin, ancestry, sexual orientation, marital status, parental status, military discharge status, or source of income in the sale, lease, rental, use or occupancy of the Property or any part thereof.
EIGHTH: The Property may not be conveyed without the prior written consent of the City, which consent will not be unreasonably withheld or delayed; provided, however, notwithstanding anything set forth above to the contrary, the Grantee, SRCI, LLC or any subsequent owner may convey the Property to any third party purchaser without the City's prior written consent provided said third party purchaser has a minimum net worth of at least ten million dollars ($10,000,000) ("Minimum Net Worth") and is not prohibited from doing business with the City. Further provided, said Minimum Net Worth amount shall increase by three percent (3%) per year commencing January 1, 2018.
The covenant numbered FIRST shall terminate on the date of the City's issuance of a Certificate of Completion. The covenants numbered SECOND, THIRD, FOURTH, SIXTH, SEVENTH and EIGHTH shall have no limitation as to time. The covenant numbered FIFTH shall terminate two years following the date of the City's Certificate of Completion.
If Grantee fails to comply with any of the foregoing covenants and conditions, the City may exercise any and all remedies available to it at law or in equity, including the right to reenter and take possession of the Property, terminate the estate conveyed to Grantee, record ' Grantee's reconveyance deed, and revest title to the Property in the City, and such right, title and interest of Grantee in and to the Property shall revert to the City; provided, however, the City's right of reverter shall be limited by, and shall not defeat, render invalid, or limit in any way the lien of any mortgage encumbering the Property. If title to the Property revests in the City pursuant to the right of reverter, Grantee shall be responsible for all real estate taxes and assessments which accrued during the period the Property was owned by Grantee. Grantee will cooperate with the City to ensure that if the City records the reconveyance deed, such recording is effective for purposes of transferring title to the Property to the City, subject only to those title exceptions that were on title as of the date and time that the City conveyed the Property to Grantee and utility easements. The City's right of reverter shall terminate upon the City's issuance of the Certification of Completion. The City will issue a Certification of Completion upon its receipt, review and approval of the Completion Report, which approval shall not be unreasonably withheld.
SECTION 4. The transfer of title of the Property from the City to Grantee must close on or before June 30, 2017 (the "Outside Closing Date"), unless the Commissioner in his sole discretion extends the Outside Closing Date.
SECTION 5. 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 6. All ordinances, resolutions, motions or orders inconsistent with this ordinance are hereby repealed to the extent of such conflict.
SECTION 7. This ordinance shall take effect upon its passage and approval.
EXHIBIT A
Legal Description
Grantee:
Grantee's Address:
Purchase Amount: Appraised Value:
Chicago Produce Market, Corporation, an Illinois not-for-profit corporation 2404 South Wolcott Avenue Chicago, Illinois 60608 $450,000.00 $450,000.00
Legal Description (subject to final title commitment and survey):
That part of the filled in boat slip formerly known as Canal "D", which adjoins, abuts and runs parallel with the East Line of Lots 19 to 23, in Block 13 in D.J. Walker's Dock Addition to Chicago, being a subdivision of that part of the East V2 of Section 30, Township 39 North, Range 14, East of the Third Principal Meridian, which lies north of the West Branch of the South Branch of the Chicago River, in Cook County, Illinois
Address: 2639-59 South Damen Avenue (rear)
Chicago, Illinois 60608
Property Index Number: The Cook County Assessor has not assigned a P.I.N, to the
Property.
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EXHIBIT B Form of Joint Order Escrow Agreement
[Attached]
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JOINT ORDER ESCROW AGREEMENT
Escrow No. Date:
To: [name of title company] ("Escrowee")
Parties: (a) CHICAGO PRODUCE MARKET CORPORATION, an Illinois not-for-profit corporation ("Grantee"); and
(b) CITY OF CHICAGO, an Illinois municipal corporation and home rule unit of government ("City").
The City and Grantee collectively shall be referred to herein as the "Parties," and individually as a "Party."
The accompanying Three Hundred Fifty Thousand Dollars ($350,000) ("Escrow Amount") is deposited by Grantee with Escrowee and shall be used solely to reimburse Grantee for actual costs incurred at the "Property" by Grantee, as described in Exhibit 1 to this Joint Order Escrow Agreement ("Agreement"). The "Property" is legally described in Exhibit 2 attached hereto and commonly known as 2639-59 S. Damen Avenue, Chicago, Illinois.
The funds shall be disbursed by Escrowee only upon the written joint order of (1)
, in her/his capacity as a of Grantee, or her/his duly
authorized designee and (2) the Commissioner or Deputy Commissioner (Bureau of Environmental, Health and Safety Management) of the Department of Fleet and Facility Management of the City of Chicago. That written order must be substantially in the form of Exhibit 3 attached hereto.
Escrowee is hereby expressly authorized and directed to disregard any and all notices or warnings given by any of the Parties to this Agreement, or by any other person or corporation, but Escrowee is hereby expressly authorized to regard and to comply with and obey any and all orders, judgments or decrees entered or issued by any court with or without jurisdiction, and in case Escrowee obeys or complies with any such order, judgment or decree of any court, it shall not be liable to any of the Parties to this Agreement or any other person, firm or corporation by reason of such compliance, notwithstanding any such order, judgment or decree being entered without jurisdiction or being subsequently reversed, modified, annulled, set aside or vacated. In case of any suit or proceeding regarding this Agreement, to which Escrowee is or may at any time become a party, Escrowee shall have a lien on the escrow funds for any and all costs and attorneys' fees, whether such attorney shall be regularly retained or specifically employed, and any other expenses that Escrowee may have incurred or become liable for on account thereof out of said escrow funds, and the Parties to this Agreement jointly and severally agree to pay Escrowee upon demand all such costs, fees and expenses so incurred.
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In no case shall escrow funds be surrendered except on a joint order signed by Grantee and the City or their respective legal representatives or successors or as directed pursuant to Section 2 above or in obedience of the process or order of court as provided in this Agreement.
If conflicting demands are made upon Escrowee or legal action is brought in connection with this Agreement, Escrowee may withhold all performance without liability therefore, or Escrowee may file suit for interpleader or declaratory relief. If Escrowee is required to respond to any legal summons or proceedings, or if any action of interpleader or declaratory relief is brought by Escrowee, or if conflicting demands or notice by Parties to this Agreement or by others are served upon Escrowee, the Parties jointly and severally agree to pay escrow fees and all costs, expenses, and attorneys' fees expended or incurred by Escrowee as a result of any of the above described events. The undersigned Parties further agree to save Escrowee harmless from all losses and expenses, including reasonable attorneys' fees and court costs incurred by reason of any claim, demand, or action filed with respect to this Agreement. Except for those fees set forth in Section 9 below, the undersigned Parties jointly and severally agree to pay the fees of Escrowee, and reimburse Escrowee for all expenses incurred in connection with this Agreement and direct that all sums due to Escrowee pursuant to this Agreement be deducted from the escrow funds. The undersigned hereby grant Escrowee a lien against the escrow funds to secure all sums due Escrowee. The Escrowee shall not be liable for any act which it may do or omit to do hereunder in good faith and the reasonable exercise of its own best judgment. Any act done or omitted by the Escrowee pursuant to the advice of its legal counsel shall be deemed conclusively to have been performed in good faith by the Escrowee.
This Agreement is not intended to cancel, supersede or modify the terms of any other agreement by and between Grantee and the City. The duties and responsibilities of Escrowee are limited to this Agreement and the Escrowee shall not be subject to nor obligated to recognize any other agreement between the Parties, provided, however, that these escrow instructions may be amended through the mutual agreement of the Parties at any time by an instrument in writing signed by all of the undersigned.
Upon the mutual agreement of the Parties, the escrow may be invested in an interest-bearing account ("Account"), upon separate written instruction with a completed W-9. Any change in the manner of investment shall be requested by a joint written and signed order of Grantee and the City. Escrowee shall, upon written request, furnish information concerning its procedures, rates and fee schedules for investments.
Grantee and the City warrant to and agree with Escrowee that, unless otherwise expressly set forth in this Agreement: (a) there is no security interest in the escrow funds or any part thereof; (b) no financing statement under the Uniform Commercial Code is on file in any jurisdiction claiming a security interest in or describing (whether specifically or generally) the escrow funds or any part thereof; and (c) Escrowee shall have no responsibility at any time to ascertain whether or not any security interest exists
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in the escrow funds or any part thereof or to file any financing statement under the Uniform Commercial Code with respect to the escrow funds or any part thereof.
9. The fee for establishing the escrow is $ , payable solely by Grantee at the time
the escrow funds are deposited. An annual fee of $ will be due solely from
Grantee for each year (or part thereof) the Escrow remains open (with any part of the
deposit not disbursed) after , 20 . Wire transfer or overnight
delivery fees will be assessed at the rate of $ each. All fees relating to this escrow
account shall be billable to and payable solely by Grantee. Funds from the escrow account may not be used to pay such fees.
10. [title company] may resign as Escrowee by giving ten (10)
days' prior written notice by certified mail, return receipt requested, sent to Grantee and the City care of their designated representatives and at the addresses set forth below; and thereafter Escrowee shall deliver all remaining escrow funds to a successor Escrowee named by Grantee and the City in a joint written and signed order. If Grantee and the City do not agree on a successor Escrowee, then Escrowee shall deliver all
remaining escrow funds to ~ [insert name of successor
escrowee], as successor escrowee.
This Agreement shall remain in force for 90 days after the City issues the Certificate of Completion, after which any remainder in the escrow and any accrued interest shall be promptly disbursed to the City without further direction from Grantee.
Any notice which the Parties hereto are required or desire to give hereunder to any of the undersigned shall be in writing and may be given by mailing or delivering the same to the address of the undersigned by certified mail, return receipt requested, overnight courier, or facsimile transmission with confirmation following by first class mail:
Grantee:
Attn:
Chicago, IL 606
FAX:
Copy to:
Attn:
Chicago, IL 606
FAX:
City:
Department of Fleet and Facility Management 30 North LaSalle Street, 3rd Floor Chicago, IL 60602
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Attn: Commissioner FAX: 312-744-6451
Copy to:
Department of Law 121 N. LaSalle Street Room 600
Attn: Real Estate and Land Use Division Chicago, IL 60602 FAX: 312-742-0277
[Signature page follows.]
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the Effective Date.
CITY OF CHICAGO,
an Illinois municipal corporation and home rule unit of government
By:
Commissioner
Department of Fleet and Facility Management
CHICAGO PRODUCE MARKET CORPORATION,
an Illinois not-for-profit corporation
By:.
Name:_ Title:
Approved as to form and legality:
Chief Assistant Corporation Counsel Department of Law
EXHIBIT 1 to Joint Order Escrow Agreement
Allowable Costs Under the Joint Order Escrow
1. Grantee may be reimbursed from the Escrow Fund for: (i) "Geotechnical Costs"; (ii) "Incremental Costs"; and (iii) environmental consultant expenses, reporting costs and project management costs to the extent incurred as a result of the Environmental Remediation Work, without any mark-up by the Grantee.
For purposes of this Agreement:
"Environmental Laws" means any and all Laws relating to the regulation and protection of human health, safety, the environment and natural resources now or hereafter in effect, as amended or supplemented from time to time, including, without limitation, the Comprehensive Environmental Response, Compensation and Liability Act, 42 U.S.C. § 9601 et seq., the Resource Conservation and Recovery Act, 42 U.S.C. § 6901 et seq., the Hazardous Materials Transportation Act, 49 U.S.C. § 5101 et seg,, the Federal Water Pollution Control Act, 33 U.S.C. § 1251 et seq., the Clean Air Act, 42 U.S.C. § 7401 et seq., the Toxic Substances Control Act, 15 U.S.C. § 2601 et seq the Federal Insecticide, Fungicide, and Rodenticide Act, 7 U.S.C. § 136 et seq., the Occupational Safety and Health Act, 29 U.S.C. § 651 et seq any and all regulations promulgated under such Laws, and all analogous state and local counterparts or equivalents of such Laws, including, without limitation, the Illinois Environmental Protection Act, 415 ILCS 5/1 et seq., and the common law, including, without limitation, trespass and nuisance.
"Geotechnical Costs" means Grantee's actual costs for the Geotechnical Work, identified in a contract and verified by actual receipts, with no markup by Grantee.
"Geotechnical Work" means (i) undercut of approximately 30" of unsuitable material below expected final grade as determined by a third-party geotechnical engineer; (ii) cement stabilize bottom of undercut; (iii) install geofabric at bottom of excavation; (iv) fill undercut with approximately 30" stone (compacted) or depth and materials as determined by a third-party geotechnical engineer; (v) install an engineered barrier in the form of a concrete cap of at least 4" plus compactible fill ; (vi) install a class "A" vapor barrier below pavement; and landscape undercuts to 36" below expected final grade.
"Hazardous Substances" means any toxic substance, hazardous substance, hazardous material, hazardous chemical or hazardous, toxic or dangerous waste defined or qualifying as such in (or for the purposes of) any Environmental Laws, or any pollutant, toxic vapor, or contaminant, and shall include, but not be limited to, petroleum (including crude oil or any fraction thereof), any radioactive material or by-product material, polychlorinated biphenyls and asbestos in any form or condition.
"Incremental costs" refers to the difference in costs, if any, between (i) the removal (including, excavation, transportation and disposal), storage, remediation and treatment costs for Special Waste and/or Hazardous Substances (as defined below) that Grantee incurs and (ii) the costs for performing similar work had the Property not contained Special Waste and/or Hazardous Substances. Such costs must be based on Grantee's actual costs, identified in a
ii
contract and verified by actual receipts, with no markup by Grantee for these costs. For example, if the cost for disposing of the Special Waste and/or Hazardous Substances on the Property was $10 and the cost of disposing of the same quantity of material from the Property had it not been Special and/or Hazardous Substances was $8, then the incremental costs for the disposal of such material is $2. "Incremental Costs" specifically excludes any costs relating to investigation, sampling, monitoring and testing related to disposal of potential or actual Special Waste and/or Hazardous Substances and future testing related to environmental remediation approved by city, state or federal environmental agencies.
"Special Waste" shall have the meaning set forth in 415 Illinois Compiled Statutes 5/3.475.
iii
EXHIBIT 2 to Joint Order Escrow Agreement
Legal Description of the Property
That part of the filled in boat slip formerly known as Canal "D", which adjoins, abuts and runs parallel with the East Line of Lots 19 to 23, in Block 13 in D.J. Walker's Dock Addition to Chicago, being a subdivision of that part of the East 1/4 of Section 30, Township 39 North, Range 14, East of the Third Principal Meridian, which lies north of the West Branch of the South Branch of the Chicago River, in Cook County, Illinois
Address: 2639-59 South Damen Avenue (rear)
Chicago, Illinois 60608
Property Index Number: The County has not yet assigned a P.I.N, to the Property.
|1010|
EXHIBIT 3 to Joint Order Escrow Agreement
, the of Grantee, hereby
, Escrowee, under its Escrow Number to
the sum of $ from the cash Deposit
Disbursement Direction
I,
direct
pay to
held in said Escrow
Dated:
By: :
Name:
Its:
I, , [Commissioner or Deputy Commissioner] of the City of
Chicago Department of Fleet and Facility Management, hereby authorize the Disbursement requested above approving its payment as so directed.
Dated: City of Chicago, acting by and through its
Department of Fleet and Facility Management
By:
Name:
Its:
|1010|
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/if applicable:
Check ONE of the following three boxes:
Indicate whether the Disclosing ^
J. £>£jhe Applicant ¦¦ ¦.„ ¦¦ ¦. " ' . '
OR "' '\ ¦' /V . . . ' ¦ -jy', '
2. I ] 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 ¦ ;V:V ' ¦ -' ¦ -. " ¦' ~. '
3. [ ] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: '. . , . : ¦
Business address of the Disclosing Party: cZV&Y 3. H^ocCOTT
Telephone: '773 ^ /Oo° Fax: _„__ Email: TP/3PfWS&PMtfmM"*"*•
Name of contact person: ~~7^&bh fi/A ffft S __.
P. Federal Employer Identification,No. (if you have one); l •
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, inapplicable):
Which City agency or department is requesting this EDS? A^Z/^T". Of t$AiiJ\M~
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # __ and Contract U .
Page .1 of 13
SECTION Ii - DISCLOSURE OE OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
Person
Publicly registered business corporation
Privately held business corporation
Sole proprietorship
General partnership
Limited partnership
Trust
[ ] Limited liability company
[ ] Limited liability partnership
[ ] Joint venture
£(Is the not-for-profit corporation also a 501(c)(3))?
[ ] Yes fXNo [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ] Yes [ ] No p{h
fN/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
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 "ho members." For trusts, estates or other similar entities, list below the legal litleholder(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
CToSiz teO^Z-PrLBZ- ^ ij2dQ,&lx- g H m £LMJf>}¦¦ - Z>frkM A-^KiM -— D t^<=C-r-6j^_
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 oi 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
^4
SECTION III-- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
>
[ ] Yes ^No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom 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 . vRelationsHi'p '^Disclosing Party Fees (indicate wlieth'cr-
^etained;.or;aiuicipaicd- Address (subcontractor; attorney, . .pajdfoV.-cstimatcdVf^oA^V
to be retained) lobbyist, etc.) "hourly rate" orv,t.b.d.;,as
>~ : ' ' ¦ not an acceptable response.,
•__jij^£r^/j^L cnicAeo^ itl (>&>o) ... . ^ ; .
(Add sheets if necessary) -¦"
. [ J-Gheck herorif the Disclosing Party has not retained, nor.expects to retain, any such persori$;ot entities;
SECTION V -r CERTIFICATIONS k^-^"^"^.^'' '' '"'^V ')v'XVv';
Ax pQURT-ORDERED CHILD SUPPORT COMPLIANCE ^ ' 'kh ^S-"
• »• ••^.hijteir^.toicipal-Go.dc Section 2-92-4Insubstantial owncrsof business entitiesihatxohteati-iWith'!
vtheKGity^ throughout the contractus itefhr
Has any person who directly or indirectly owns 10% or.more of thc.pisclbsing Party beerisdcclarcd in :v -arrearagpon any. child support obligations by any Illinois cbur^of competent jurisdiction?;.-
[ ] Yes , f ]No m 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 piprson.in compliance with that agreement? • ; , ; "
{ ].Ycs:' •.' f]No - ".'.I ¦ VV'^':^:--S•;
B. FURTHER CERTIFICATIONS . ' \- v
consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Parly ^submitting this EDS is the Applicant and is doing business wklv the City, then the Disclosing Party, > ccrtificsias follows: (i) neither the Applicant nor any controlling person is currently indicted OTiCharged: with, or lias admitted guilt of, or has ever been convicted of; or placed under supervision for, any criminaloffense involving actual, attempted; or conspiracy to commit bribery, theft, fraud/forgcry, pcrjuryj dishonesty or deceit against an officer or employee of the City or any sister agcncy; and;(ii) the Applicant understands and acknowledges that compliance: with Article Lis a continuing rccjuirernent:for doing;business: with.the .City. NOTE: If Article lappiifjs tq the Applicant,¦¦the permanent compliance : ^ 'timeframe:inyVrticle. 1.supersedes somcfiveryein compIi3ricetimeframes in certifications;^ and i-.below:
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section ILB.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, slate or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City, or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concent:
* the Disclosing Party;
any ''Contractor'' (meaning any contractor or subcontractor used by the Disclosing Party in connection5with 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, withoutlimitation: 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 afty Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any. Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an A ffiliated Entity, or an Affiliated Entity of a Contractor during the fiye years before the date of such Contractor's or Affiliated Entity's contract orengagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded-with other bidders or prospective bidders, or been a party to any such agreement, or been convicted, or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed -price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but ha ve not been prosecuted for such conduct; or
violated the provisions of M unicipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Parly, Affiliated Entity or Contractor, or-any"of their employe^s^officiais. 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 norany Affiliated Entity is listed on any of the following"lists' maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of thc U.S; Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and 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.
7 . 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:
_____ : ^_mo_
Page 6 of 13
If.the letters "NA," the word "None," or no;response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party 's knowledge after reasonable inqiiiry, 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")-
XJOiXj^C
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 haying 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.
. sUO/Pcf , .
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one) [Jis ^isnot
a "financial institution" as defined in Section 2-32-455(b) of the.MunicipafCode.
If the Disclosing,Party IS a financial institution, then the Disclosing Parly pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. Wc further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as;defined in Section 2-32-455(b)*of the .Municipal Code): is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST-IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Does any official Or employee of the City have a financial interest ih his or her own name or in the name of any other person or entity in the Matter?
11 Yes '^No
NOTE: If you checked "Yes" to Item D.! proceed to Items D.2. and D.3. If you checked "No" to Item D.I., 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 taxfes or assessments, or (iii) is sold by virtue of legal process at thesuit 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?
L ] Yes []No
If you checked "Yes" to Item D. I., 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 cither 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X. 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the; Disclosing Party has found no such records.
, 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 hot 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 contactson 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 rriadc lobbying contacts on behalf of the Disclosing Party with respect to the Matter,)
2. The Disclosing Party has not spent and will not expend anyTederally 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
3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set. forth in paragraphs A.l. and A.2. above.
4: 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".
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 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.)
f. 1 Yes f ] No •
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, .or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
L j Yes [ ] No
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page I Oof 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 arid 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking Gity.cpritracts, work, business^ or transactions. The full text of these ordinances and-a training program is available on line at www.citv6fchicaRO:org/Ethics.:ahd 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.
G. If the City determines that any information provided in this EDS is false, incomplete or iniaccuratc, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies, under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining 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.
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 all of the information provided on this EDS and any attachments to-this EDS may be
made available to the public on the Internet, in response to a Freedom of Information Act request, or
otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible
rights or claims which it may have against the City in connection with the public release of information
contained in this EDS and also authorizes the City to verify the accuracy of any information submitted
in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Parly must supplement this EDS up to the time the City takes action on the M atter. 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.l. The Disclosing Party, is not .delinquent in the payment of any tax administeredby tire Illinois* Department of Revenue, nor are the Disclosing Party or its Affiliated Entitiestdclinquent in paying any fine, fee, tax or other charge owed to the City. Fhis includes, hut is not limited to, all water charges, sewer charges,.license fees, parking tickets, property taxes or salesuaxes.
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 Oye.E' ;S.%E:.P; A. on the federal Excluded Parties List System ("EPLS") maintained by the U.S. Genera! Services Adminisnation.
V3 If the Disclosing Party is the Applicant.-thc Disclosing Party' will obtain from any
contractors/subconu^ .connection,with the Matter certifications equal in
form and substance to4hosc in F-1. .and:F.2.,above and will not, without the prior written consent of the City; use any such contractor/subcontractor thai does iioi provide such certifications or that the Disclosing Party has reason^o believe has, ij'of-;provided or cannot provide truthful certifications.
NOTE: If the Disclosing party Cannot ccriilyas to any of the items-in F.l., F,2. or E.3.;abovc^ an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing; bc!ow: (1) warrahtsJhatihe/slic^is'authorizcd to execute this EDS and Appendix A (if applicable) on^behalf of the Disclosing Parfyj and;(^),warrants that all certifications and sUtem.en.ts contained in this; EDS:andAppendix A (if applicable) are true; accurate and complete as of the date furnished to the City.
(Print or type name of,Disclosing Party).
)3y; X - J_*i
(Sign here)
(Print or type name of person signing}
(Print or type title of-person'signing)
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-i 54-015, the Disclosing Parly 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, stepbrotlterpr stepsister or half-brother or half-sister.
¦•'Applicable Patty" means(l) all executive officers of the Disclosing Party listed in Section II.B.I.a., if the Disclosing Party Js a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general.partners arid limited.partncrs 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 DiscJosing Party. "Principalofficers" means the president, chief operating officer, executive director, chief financiafofficer, treasurer or secretary of a legal entity or any person exercising similar authority.
Docs the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[JYes l)^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 "Owiier"). 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 [^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 pursuantto Section 2-92-416 of the Municipal Code?
> [ ] Yes \ ]No jV] 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.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I — GENERAL INFORMATION
Legal name 61" the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
- f£?/otocyjt/ASCheck ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: . , , i ' ¦
( ] the Applicant • - ~~
or ' "'' ¦ ¦
[ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which theDisclosing Party holds an interest: '¦ . ¦ . ¦ ; '
or , ¦'- 'VV:. ,: ¦
3. ^ a-legal entity with a right of control (see Section II-.B.I.) State the legal name of the entity in
which tlfic-Disclosing Party holds a right of control: S'££>Oii'& /Z'/9f^<^Business address of the Disclosing Parly: JZ'/Qtf S, tTelephone: 773 YYI. -/ceo Fax: . , . Email:^%&^^
Name of contact person: "TcPP *~p>fiPP/)^
Federal Employer Identification No. (if you have, one): ^ I
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
fOfiC'A/s&t? 3'i £>/r/n£rM
WhiclvCity agency or- department is requesting-this EDS? QdPf\- -^f ^¦A^'^VC. :
If the Matter is a contract being handled by the City's Department of Procurement Serviccs,;p}ease complete the following:
Specification # _.and Contract tt
Page 1 of 13
SECTION 11 -- DISCLOSURE OF OWNERSHIP INTERESTS 7 .
A. NATURE OF THE DISCI OSING PARTY ' ':'¦> '. "
I. Indicate the nature of the Disclosing Party: ' ' '/•"¦
f) Person , • . .[ ] Limited, liability company
- [) Publicly registered business corporation [] Limited liability partnership • •
[ j Privately held business corporation .. [] Joint venture- -. - - . ;. -
( J Sole proprietorship. -: ' ' ^Not-for-profit corporation -'f' ¦''¦'
[] General partnership . (Is the not-for-profit corporation als6 a 501(c)(3))?
[] Limited partnership [] Yes : ' WNo ' ' V ;
N Trusl ¦: . . .[ ], Other (please^specify) , . .'. . ',.
2; - Fo^icgal entitics;:the state (or foreign country) of incorporation'or bTgam^tio&;Mjf^Ii^ible: :
Foi-^egal entities notorganized in the State of Illinois: Has"the organization registcTfid to .'do '
business in the State of lUinois as a foreign entity? ; £)Ycs (3 No ^n/a '
B. IP THE DISCLOSING PARTY IS A LEGAL ENTITY: "
1. List below the full names and titles of all executive officers and all directors of me entity.
NOTE: For. not-for-profit corporations, also list belovy. all members, if any, which are legal/entitles. If V
there arc no such members, write "no members." For trusts, estates or other similar entities, list below
the legal titleholdcr(s). ! - :l: ¦" :; "¦¦',.: V . . ,
V Jf the entity is.a general partnership, limited partne^hipvlimitediliability cbmpany,limited liability s*'
.partnership or joint venture, list below the iiamcandtitle of each general ;partner, managing member,
manager or any other person or'entity that controls the day-to-day management of the Disposing Party.
NOTE: Each legal entity Hstcd belowmust submit ah.EDS on its own behalf. ¦ V'-
Name
2. -. Please provide the following information,eonccrning each person or entity having a direct or indirect beneficial interest (including owriership);in:cxcesro^
of such an interest: .include shares in a corporation, partnership interest in a partnership or joint venture,
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
/a/ &(C£XJ dF l^A ____ _
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of-thc Municipal Code, with any City elected official in the 12 months before the date this EDS is signed? ¦'¦
I ] Yes [y[No
If yes, please identify below the naroe(s) of such City elected official(s) and describe such relationship(s): >
SECTION IV -DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (I) 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
. Niimc (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address ./(subcontractor, attorney^ " • paid or estimated.) NOTE:
. to be retained) •lobbyist, etc.) . "hourly rate" or "t.b.d." is'
;' ¦-. ? ; : not an acceptable response.
(Add sheets if necessary)
cck.herc if the Disclosing Party has. not retained, nor expects to retain.'any such persons prcntitics. SECTION V — CERTIFICATIONS
A- COURTrORDERED CHILD SUPPORT COMPLIANCE ;j
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 jhc contract's term.
Has any person who'dircctly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage pri any child support obligations by any Illinois court of competent jurisdiction?
: [ ] Yes .¦>:-;; No / * •¦ ^No person directly or indirectly owns-10% or more of the ;
¦¦¦ ,:. Disclosing Party. ¦
If "Yes," ^
is the person in compliance with that agreement? . ¦¦: ¦." ~(v
[] Yes . []No ¦ ¦ '.'
B. FURTHER CERTIFICATIONS " : V
1. Pursuant to Municipal Code Chapter; 1-23, Article I ("Article P)(which the Applicant sliould ;
consult for defined requirements), if the Disclosing Party "
submitting this EDS :is the Applicant and is doingbusincss with the City, then the Disclosing Party
certifies as follows: (i) neither the Applicant nor any controlIing;pers6n is:currcntly/indicted or charged
with, ot has admitted guilt of, or has ever been convicted of, or placed iindcr.:supervisi'qn^foti\any':^-:';.
criminal offense involving actual.'attcinpledior conspiracy to commit bribery, theft, fraud, forgery,
perjury, dishonesty or deceit against an officer or employee Of the*Gity or any sister agency; andi(ii) the
fi^PpUcanttmjIderstands.'an^ with-Articlc I is :a;continuing/cquircmentforf
doing business with the City. NOTE: If Article I applies to the App]ican't;;thc.permane^ timeframe inArticle ! superscdes some five-year compliance timeframes in certificationS'2 and 3 below.
2. The Disclosing Party and, if the Disclosing Party is a legal entity-all of those persons or entities iden tified in Section ll.B. 1. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or slate antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction pf.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
c. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged
guilty, orfound liiblc ip-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 familyimembers, 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 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 ED$ 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 Slate of Illinois, or any agency of the federal government or of any state or local government in ihe United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a; or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2- 92-610 (Living Wage Ordinance). .. -
Neither the Disclosing Party, Affiliated Entity or«Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of Arnerica 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:
_._ ; _ JJO - -
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an: employee, or elected or appointed official, of the City of Chicago (if none, indicate with' "N/A" or "none").
- = /jjOA^-. -¦ ; —
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a : complete list of all gifts mat 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.*
¦ >S-';' ' '.-—— AX)M
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ) is ^ is not
a "f inancial 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 bur affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32,of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege Of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the. Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
In accordance with Section 2-156-110 of the Municipal Code: Docs 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?
I] Yes/
NOTE: If you checked "Yes" to. Item DVl., 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 shallhave a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue-of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
I ] Yes t JNo
If you checked "Yes" to Item D.l., provide the names and business addresses of theCily 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 interest1 in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2., Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
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 Parly verifies that, as a result of conducting the.search in step 1 above, the
Disclosing Party has found records of investments or profits from siavery or slaveholder insurance policies. The Disclosing Party verifies thai 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 M ATTERS
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 REG A RDING 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 Mailer: (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 erriployee 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 J3
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. 1. and A .2. above.
The Disclosing Party certifies that cither: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in scction 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will pot 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.
.' D. 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? v
( ] Yes "r- []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 f ]No
Have you filed with the Joint Reporting Committee, the Director of the Officcof 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 subcontracts subject to the equal opportunity clause?
[]Ycs []No 1
If you checked "No",to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at ww w ciiyofchicaRO.org/Fthics, 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 contrac
void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with theCily. 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-Jo make this document available to the public on its Internet site and/or upon I request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By. completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the. Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect lo Matters subject to Article I of
Chapter 1-23 of the Municipal Co'dc (imposing PERM ANENT 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 lliat:
Page 11 of 13
A >v"v^n» ie«,,[>arkirit-iickols, p:(>pcny lWcs or sales taits; •" as! J^£l^d,e APPl'Cant'DM^^^ not
c^Lr^f ¦IHSCi0SJngP^ * ,iK" ^'^^ posing party w,i! obtain from any
cur,tractors/M^ Matter certifications eo„a< in
J 'SCk Smg 1 a!l-i)aS ^«on to beheve has not provided or cannot provide truthful certifications.
NOTE: IHhc Disclosing Party cannot ccrt.fy as to any of the item, ,„ F 1 F.' or F 3 above an explanatory sinvemenv musf be^ attached lo this EDS. '
CERTIFICATION " .^'r< .j.:
Sm^' ^^^^0" Signi"8 hclOW: Warrail!^ ,hl" hc*"c - authorized to execute /
CCI!,,ICat";nS statements contained ,n this EDS and Appendix A (if amicable are true alcu^c '' '
and complete as of the date furnished to the City. ' e true, accu.au
'Print or type name of Disclosing Party) ' .
(Sign here)
' Print or type name of person signing)'
.. J£t!v!L^<_^_TJ' "V' ¦"'"
(Pririf or type title of person - signing)""
Signed and sworn to before me on (date). JjJ ^ J [ J^
(state).
Notarv:Pubiic.
OFFICIAL SEAL ANGEt MMRINA MARGARIS NOTARY p^ri:;IC ¦ STATE OF ILLINOIS . MYCOMWIS- :V EXPIRES:01Jt»19;
Page J 2 of !3
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 lcgal 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 depaitrncnthead. A'Tamilial 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, fatherTin-law, mbtherrin-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 Secdon ll.B.l .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general. ; ' partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liabiiity 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 airy "Applicable Party" or any Spouse or Domcstic'Partner thereof currently have a "familial relationship''with an elected city official or department head?
[ ] Yes J>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 bead to whom such person has a fami lial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE'STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is fo 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?
iXno
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
3. If yes to (1) or (2) above, please identify below the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
,SRCI, LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: the Applicant OR
2. a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. a legal entity with a right of control (see Section IJ.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
1816 N. Cleveland
Business address of the Disclosing Party:
Chicago, IL 60614
Telephone- 773-755-0600 pax. Email- W.Bakcr@bakcrdevelopmentcorp.com
Name of contact person: Warren Baker
Federal Employer Identification No. (if you have one):
F. 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):
Acquisition of Canal D Parcel
G. Which City agency or department is requesting this EDS?
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 Parly:
Person ^/ Limited liability company
Publicly registered business corporation Limited liability partnership
Privately held business corporation Joint venture
Sole proprietorship Not-for-profit corporation
General partnership (Is the not-for-profit corporation also a 501(c)(3))?
Limited partnership Yes No
Trust " Other (please specify)
2. For legal entities, the slate (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entities not organized in the Stale of Illinois: Has the organization registered lo do business in the State of Illinois as a foreign entity?
"'Yes " " No ,/ N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal litleholder(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 (he day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title Richard Saltzman Manager
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% 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
Richard Sallzman 1816 N. Cleveland, Chicago, IL 60614 /^J
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
Yes j\ No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Parly 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 Parly must cither 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 rale" or "l.b.d." is
not an acceptable response.
(Add sheets if necessary)
y/ Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
Yes y/ No No person directly or indirectly owns 10% or more of the
Disclosing Parly.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
| Yes "" No
FURTHER CERTIFICATIONS
1. Pursuant lo Municipal Code Chapter 1-23, Article I ("Article l")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of 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 Applicanl, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11.13.1. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding (he 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 lo 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 (he offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Parly, or is, with the Disclosing Parly, 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 slate 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 Parly, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting 1o bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of(l) 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 slate 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 Parly is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Parly 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 ,/ is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary):
Page 7 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
1. 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
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power docs not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
""Yes No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
*S 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders thai provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Parly 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 Parly means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Parly 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. 1. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contracl, 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?
" 1 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 I. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Parly understands and agrees lhat:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contracl 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 lo 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.citvofchicago.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 contracl or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article 1 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 M unicipal Code.
The Disclosing Party represents and warrants that:
Page II of 13
F. 1. The Disclosing Parly 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 lo the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, properly taxes or sales taxes.
F.2 If the Disclosing Parly 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, ihe 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 Parly 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: (I) 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) arc true, accurate and complele as of the date furnished to the City.
SRCI, LLC
(Print or typejjame of Disclosing Party)
nere)
Richard Saltzman
(Print or type name of person signing) Manager
(Print or type title of person signing)
Signed and sworn to before me on (date)
at Cook County, Jlhjaisj^" (state).
Notary Public.
Commission expires: yVy\ J?\ >Z.01ft
Page 12 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Parly" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, 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 (I) all executive officers of the Disclosing Party listed in Section II.B.l .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general 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 Parly is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
Yes y/ 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 0No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 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.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. 1 poat name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
_ f?a«Her wtioU*«U 6k(vt*t\, Jrtsc.
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: the Applicant OR
2. a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Parly holds an interest:
OR
3. a legal entity with a right of control (see Section I1.B:1.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
11 go S, ftat^e^ r\Chicago, IL Gf^tsft
Telephone: 773-755-0600 Fax: Email: WBaker@bakerdevelopmentcorp.
Name of contact person: Warren Baker
Federal Employer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") lo
which this EDS pertains. (Include project number and location of property, if applicable):
Acquisition of Canal D Parcel
G. Which City agency or department is requesting this EDS?
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification tt and Contract #
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SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Par Person
Publicly registered business corporation
Privately held business corporation
Sole proprietorship
General partnership
Limited partnership
Trust
Limited liability company Limited liability partnership Joint venture
Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))? Yes No Other (please specify)
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 Slate of Illinois as a foreign entity?
"" Yes " " No y/ 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
Richard Saltzman Y?e±
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 Parly. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
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interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of 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 Parly
Richard Saltzman 1816 N. Cleveland, Chicago, IL 60614
SECTION 111 -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
Yes y| No
If yes, please identify below the name(s) of such City elected official(s) and describe such rclationship(s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Parly is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (I) 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.
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Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) ^ /VJ , lobbyist, etc.) "hourly rate" or "t.b.d." is
(Add sheets if necessary)
*/ Check here if the Disclosing Party has not retained, nor expects to retain, any such persons o; entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
Yes ,/ No No person directly or indirectly owns 10% or more of the
Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
| Yes " No
FURTHER CERTIFICATIONS
I. Pursuant lo Municipal Code Chapter 1 -23, Article I ("Article l")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article 1 is a continuing requirement for doing business with the City. NOTE: If Article 1 applies to the Applicant, the permanent compliance timeframe in Article 1 supersedes some five-year compliance timeframes in certifications 2 and 3 below.
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The Disclosing Parly and, if Ihe Disclosing Party is a legal entily, all of those persons or entities identified in Section 1I.B.1. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection wilh: 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 properly;
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 stale, or any other unit of local government.
The certifications in subparts 3, 4 and 5 concern:
• the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect lo Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, wilh 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 Parly, any Contractor or any Affiliated Entity, acting pursuant lo the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of 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 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 Stale of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a parly lo any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (I) bid-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 Slates of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Parly 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 Elhics) of the Municipal Code.
If the Disclosing Parly is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
None
9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than S20 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 v/ 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 predalory 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 il 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):
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If Ihe letters "N A," the word "None," or no response appears on the lines above, it will be conclusively presumed (hat 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.
1. 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
NOTE: If you checked "Yes" to Item D.l., proceed to Items D.2. and D.3. If you checked "No" to Item D.l., proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
'" Yes No
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
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comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
y/ _1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step I above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If Ihe Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City arc not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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The Disclosing Parly 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 lo 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 lo 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?
"lYes 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:
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SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicaeo.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 Parly must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of materia] fact may include incarceration and an award to the City of treble damages.
It is Ihe City's policy to make this document available lo the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to ihe lime 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:
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F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, properly 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 lo 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 docs 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.I., F.2. or F.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (I) 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 lo Ihe City.
Richard Saltzman
(Print or type name of person signing)
(Print or type title of person signing)
(stale).
Notary Public
Signed and sworn lo before me on (date)
at Cook County, [Hingis^
Commission expires
< My Commission Expires Jul 21, 2018
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
Yes y/ 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.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
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 E
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 f~] No Not Applicable
If yes to (1) or (2) above, please identify below the name of the person or legal entity identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
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