Ordered, that the Committee on Finance is hereby authorized and directed to issue Charitable Solicitation (Tag Day) Permits to the following organizations
Alzheimer's Association - Greater Illinois Chapter June 2-3 and 9-10, 2017
Citywide
Chicago Firemen's Post 667 - American Legion May 24, 25 & 26, 2017
Citywide
Doctors without Borders/Medecins Sans Frontieres May 21 thru September 2, 2017
Citywide Misericordia Heart of Mercy Center May 6, 7 & 8, 2017
Citywide
Planned Parenthood of America March 31 thru April 30, 2017 Citywide
Polish Legion of American Veterans May 17 thru 20, 2017
Citywide
The Salvation Army Metropolitan Division November 1 thru December 23, 2017 Citywide
The Salvation Army Metropolitan Division June 2 and 3, 2017
Citywide
This Order shall take effect and be in force from and after its passage.
/ofSL_ o^V^;^ Jl___
Edward M. Burke Alderman, 14th Ward
CHICAGO March 29. 2017
To the President and Members of the City Council:
Your Committee on Finance having had under consideration
One (1) order authorizing eight (8) applications for City of Chicago Charitable Solicitation (Tag Day) permits.
Alzheimer's Association - Greater Illinois Chapter June 2-3 and 9- 10, 2017
Citywide
Chicago Firemen's Post 667 - American Legion May 24, 25 & 26, 2017
Citywide
Doctors without Borders/Medecins Sans Frontieres May 21 thru September 2, 2017
Citywide
Misericordia Heart of Mercy Center May 6, 7 & 8, 2017
Citywide
Planned Parenthood of America March 31 thru April 30, 2017 Citywide
Polish Legion of American Veterans May 17 thru 20, 2017
Citywide
The Salvation Army Metropolitan Division November 1 thru December 23, 2017 Citywide
The Salvation Army Metropolitan Division June 2 and 3, 2017
Citywide
Having had the same under advisement, begs leave to report and recommend that your Honorable Body pass the proposed Order Transmitted Herewith.
This recommendation was concurred in by of members of the committee with
(signed)^/
Respectfully submitted
Chairman
PERMIT NO. 2017-09
COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2017-09
Alzheimer's Association
8430 W. Bryn Mawr Avenue, Suite 800, Chicago, IL 60631
ADDRESS:
TELEPHONE NUMBER:
CONTACT PERSON:
DATE WRITTEN REQUEST WAS RECEIVED: February 17, 2017
June2-3 and 9 -10, 2017
CITY COUNCIL DATE:
COMPLETION OF FILE
-DA-T-E:
STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED:
DATE PERMIT LETTER WAS SENT TO ORGANIZATION:
VIOLATION (S)
COMMITTEE LETTER SENT:
COMPLY RECEIVED:
COMMENTS:
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APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
COMMITTEE ON FINANCE
(Please neatly print or type. In ia^W|*ri5^any ^uestion' P,case attach
Name of organization: Alzheimer's Association - Greater Illinois Chapter
Address: 8430 W. Bryn Mawr Avenue, Ste 800, Chicago, Illinois 60631 Telephone Number: 847-933-2413
Use the space below to list names, current positions, residence addresses and telephone numbers of the officers in the organization:
Erna Colborn - President & CEO
Kathleen Bretl - Senior Director, Finance & Administration Sari Eilon - Specialist External Relationships (TAG DAY CONTACT) 847-779-6952 (office); seilon@alz.org
8430 W. Bryn Mawr Avenue, Ste 800, Chicago, Illinois 60631
List the date and approximate location(s) of solicitation:
Dates: June 2 & 3, 2017/ June 9 & 10, 2017 Locations: City-wide
Approximately how many persons will be engaged in the solicitation? Between 150 - 200 people
Explain the methods your organization will use to solicit funds:
Alzheimer's Association volunteers will collect donations in busy areas using Association collection cans. Volunteers will give flower seeds to those who donate as a "thank you".
Has your organization ever been allowed to solicit funds in prior years in the City of Chicago? If so, when?
Yes - The Alzheimer's Association has been soliciting funds since 1987.
Include the following with your application:
A copy of the registration statement filed with the Attorney ^ General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois.
A copy of the tag, badge, emblem or other token (if any) which^ will be distributed as part of the solicitation, or which will be used by your organization in its solicitation.
Please include any other relevant information which would assist the Committee on Finance in reviewing this application.
This solicitation event is part of the Association nation-wide annual Bankers Life Tag Day event.
APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION.
I/WE, THE OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
Signature ^ffi/lA [/V^ Title foWnfll ^*hlT-hflPate 11 1 1 H
Signature JtA Titlc ^ 6AP'r+ H Pate ^ 1 1 ( 1 7
u|99|e^'jcMeS-h 1
Signature
HOLD HARMLESS AGREEMENT
1. The undersigned officer on behalf of the subject organization agrees to
defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations.
2. The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
3. The officer of the subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
Name of organization
Signature of organization officer
Date
OFFICII OF THE ATTORNEY GENERAL STATE OF ILLINOIS
Lisa Madigan
A'iTORNEVCKNF.RAI.
ALZHEIMER'S DISEASE AND RELATED DISORDERS ASSOCIATION,
GREATER ILLINOIS CHAPTER
8430 W. BRYN MAWR SUITE 800 CHICAGO, IL 60631
RE: RE: Status of ALZHEIMER'S DISEASE AND RELATED DISORDERS
-ASSQGIATIONy GREATER ILLINOIS CHAPTER under the Illinois Charitable-Laws
cotf A
Dear Registrant:
This letter is pursuant to your request that the Attorney General confirm the status of ALZHEIMER'S DISEASE AND RELATED DISORDERS ASSOCIATION, GREATER ILLINOIS CHAPTER under the Charitable Organization Laws.
This organization is currently registered with the Attorney General's Charitable Trust and
Solicitations Bureau as CO 71 is current in the filing of its financial reports, having
filed its report for the period ended June 30,2016. Please let us know if you require further information.
Charitable Trusts Bureau 100 West Randolph Street, 11th Floor Chicago, Illinois 60601 Telephone: (312)814-2595
alzheimer's US association
THE BRAINS BEHIND SAVINGYOURS:
1 February 2017
Chicago Committee on Finance 121 N. La Salle St. #302 Chicago, IL 60602
Re: Charitable Solicitation Permit To Whom It May Concern;
On June 2nd, 3rd, 9th & 10th, 2017 the Alzheimer's Association, Greater Illinois Chapter and Bankers Life and Casualty Company will hold our annual Forget Me Not Days® fundraiser to benefit Alzheimer's Association chapters nationwide. We count on the support of local communities to aid in our achieving our mission to eliminate Alzheimer's disease. We are working toward a world without Alzheimer's day in and day out, through the advancement of research; the provision and enhancement of care and support for all affected; and the reduction of the risk of dementia through the promotion of brain health.
During this event, Alzheimer's Association volunteers and their families and friends will collect donations at several locations throughout the 68 counties we serve in Illinois. We would like to request permission for our volunteers to collect contributions in the public way in the city of Chicago. Volunteers will be easily distinguished in green aprons with official Forget Me Not Days collection canisters. In exchange for contributions, our volunteers will hand out packets of Forget-Me-Not flower seeds. The Alzheimer's Association - Greater Illinois Chapter, a 501(c)(3) charitable organization, receives 100 percent of the money collected by our volunteers.
More than 5 million Americans have Alzheimer's disease—including many of our own neighbors. Alzheimer's is the sixth leading cause of death in the United States, and the only one on the list of "Top 10" that cannot be prevented, slowed, or cured. As discouraging as that sounds, it does not take away the significant strides we have made so far in the battle. In fact, it only serves to inspire and motivate us even more, and we truly hope that you will join us in this feat. Forget Me Not Days will raise community awareness for this debilitating disease, and will contribute to the Alzheimer's Association's research, care and support efforts in Greater Illinois.
Thank you in advance for your consideration of our request. Please contact me at 847-779-6952 or seilon@alz.org with any questions or concerns. We look forward to continuing this partnership with the City of Chicago.
Sincerely, Sari Eilon
Carbondale
320 E. Walnut Street, Ste. A, Carbondale, IL 62901
618 9851095 p 618 549 2362 f
Rockford
1111 S. Alpine Road, Ste. 307, Rockford, IL 61108
815 484 1300 p 815 484 9286 f.
Bloomington
207 S. Prospect Road, Ste. 1, Bloomington, IL 61704
309 662 8392 p 309 664 0495 f
217 351 1726 p (Champaign)
Joliet
850 Essington Road, Ste. 200, Joliet, IL 60435
815 744 0804 p 815 773 7340 f
Specialist, External Relationships Greater Illinois Chapter
Chicago
8430 W. Bryn Mawr, Ste. 800, Chicago, IL 60631
847 933 2413 p 773 444 0930 f
Springfield
2309 W. White Oaks Drive, Ste. E, Springfield, IL 6270' 217 726 5184 p 217 726 5185 f
www.alz.org/illinois - 800.272.3900 24-hour helpline
PERMIT NO. 2017- 13
COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2017-13
GROUP NAME: Chicago Firemen's Post 667 American Legion
ADDRESS: 3647 N. Tripp Avenue, Chicago, IL 60641-3038
TELEPHONE NUMBER: 773-283-4305
CONTACT PERSON:
DATE WRITTEN REQUEST WAS RECEIVED: March 14, 2017
SOLICITATION DATE: May 24-26, 2017
CITY COUNCIL DATE: March 29, 2017
COMPLETION OF FILE DATE:
STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED:
DATE PERMIT LETTER WAS SENT TO ORGANIZATION: March 29,2017
VIOLATION (S)
COMMITTEE LETTER SENT:
COMPLY RECEIVED:
COMMENTS:
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APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
(Please neatly print or type. In necessary in answering any question, please attach
additional sheets.)
CHICAGO FIREMEN'S POST 667
Name of organization: AMERICAN LEGION
' Address- 36^7 N. TRIPP AVE.
CHICAGO, IL. 606^1-3038
Telephone Number: 773-283-^305
Use the space below to list names, current positions, residence addresses and telephone numbers of the officers in the organization:
JAMES MINDAK
P0ST_ADJ_UCTANT/FINANCE OFFICER 'j E.
:hicago, il."606^1-3038,,
/ELL)
J
List the date and approximate location(s) of solicitation:
MAY 2k, 25, 26, 2017 VARIOUS LOCATIONS IN CITY
DOWNTOWN, NORTHSIDE, SOUTHSIDE, ETC.
Approximately how many persons will be engaged in the solicitation?
UNKNOWN AT THIS TIME. DEPENDS ON VOLUNTEERS WHO WANT TO HELP
Explain the methods your organization will use to solicit funds:
POST IS ENGAGED IN THE SELLING OF "POPPY'S" TO THE PUBLIC TO HELP VETERANS IN THE AREA VA HOSPITALS AND ALSO THE VA HOME IN MANTENO, IL.
_6, Has your organization ever been allowed to solicit funds in prior years in the
City of Chicago? If so, when?
MAY 25-27, 2016 PERMIT NO. 2016-12
Include the following with your application:
A copy of the registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois.
A copy of the tag, badge, emblem or other token (if any) which will be distributed as part of the solicitation, or which will be used by your organization in its solicitation.
Please include any other relevant information which would assist the Committee on Finance in reviewing this application.
THE POST ALSO USES FUNDS GERE RATED FROM THE SELLING OF POPPY'S TO AID OTHER VETERAN ORGANIZATIONS IN ASSISTING VETERANS.
APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION.
I/WE, THE OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
Title ADJ/FINANCB OFF. Date 8 MAR. 2017
Signature Title Date
Signature
HOLD HARMLESS AGREEMENT
1. The undersigned officer on behalf of the subject organization agrees to
defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations.
2. The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
3. The officer of the subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
CHICAGO FIREMEN'S POST 667 Name of organization
ADJUTANT A'INAN OFFICER
8 MAR. 2017 Date
OFFICE OF THE ATTORNEY GENERAL
March 2, 2017 STATE OF ILLINOIS
CHICAGO FIREMEN'S LEGION POST T .
,,_ Lisa Madigan
ATTORNEY GENERAL
3647 N. TRIPP AVE. CFUCAGO, IL 60641-3038
RE: RE: Status of CHICAGO FIREMEN'S LEGION POST 667 under the Illinois Charitable
Laws
CO*'
Dear Registrant:
This letter is pursuant to your request that the Attorney General confirm the status of CHICAGO FIREMEN'S LEGION POST 667 under the Charitable Organization Laws.
This organization is currently, registered with the Attorney General's Charitable Trust and
Solicitations Bureau as CO#\ J/~~~iIt is current in the filing of its financial reports, having
filed its report for the period ended December 31, 2016. Please let us know if you require further information.
Sincerely,
Ceretha Jackson, Compliance Charitable Trusts Bureau 100 West Randolph Street, 11th Floor Chicago, Illinois 60601 Telephone: (312) 814-2595
PERMIT NO. 2017-12
COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER:
Doctors Without Borders/Medecins Sans Frontieres (MSF)
ADDRESS: 333 7th Avenue, Floor 2, New York, NY 10001
TELEPHONE NUMBER:
CONTACT PERSON:
DATE WRITTEN REQUEST WAS RECEIVED: March 10, 2017
May 21 thru September 2, 2017
CITY COUNCDL DATE:
COMPLETION OF FILE DATE:
STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED:
DATE PERMIT LETTER WAS SENT TO ORGANIZATION:
VIOLATION (S)
COMMITTEE LETTER SENT:
COMPLY RECEIVED:
COMMENTS:
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AFFUCKHOH FOR CHY OF CHICftQO CHARITABLE SOTJCTrftTION PEI3CTT
(Please neatly print or type. If necessary in answering any question, please attach other sheets.)
Name of organization: Doctors Without Borders/Medecins Sans Frontieres (MSF)
Address: 333 7th Ave, Floor 2, New York, NY 10001 Telephone Number: (212) 679-6800
Use the space below to list names, current positions, residence addresses and telephone numbers of the officers in the organization:
Jason Cone, Executive Director, (212) 679-6800
Thomas Kurmann, Director of Development, (212) 679-6800
Andreu Maldonado, Director of Finance, (212) 679-6800
list the date and approximate location(s) of solicitation?
May 21, 2017 - September 2, 2017 in the following approximate locations: The Loop, Wicker Park, Andersonville, near South Side, Logan Square, the Magnificent Mile and Oak Park.
Approximately how many persons will be engaged in the solicitation? Team will consist of anywhere from 6 to 20 people.
Explain the methods your organization will use to solicit funds:
Street canvassing - our team will engage in conversation with people who choose to stop and speak with us about Doctors Without Borders' medical humanitarian work in more than 70 countries, and how they can help.
Was your organization ever allowed to solicit funds in prior years in the City of Chicago? If so, when?
Yes,-in-2010, 2015, and currently (January 14,-2016-to present) -
Include the following with your application:
A copy of the registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois.
A facsimile of the tag, badge, emblem or other token (if any) which will be distributed as part of the solicitation, or which will be used by your organization in its solicitation-
Please include, any other relevant information which would assist the Committee on Finance in reviewing this application.
APPLIC7ATICMS MJST BE RECEIVED BY THE CCfMETTEE ON FINANCE NO LATER THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOTJK3TATION.
3/10/2017
Title
Date
I/WE, OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MOST SIGN AND VERIFY THIS APPLICATION.)
Director of Marketing
Signature
HOLD HARMLESS AGREEMENT
The undersigned officer on behalf of the subject organization agrees to defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for tue purpose ot charitable solicitations.
The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
The officer ot the subject organization has read and voluntarily signs the hold harmless agreement and waiver ot liability and indemnity agreement.
.3d-Q/.2aL7.
Date
Doctors Without Borders/Medecins Sans Frontieres (MSF)
Ssp-OB-15 05:4rpsi F
T-005 P.02/02 F-583
OFFICE OF THE ATTORNEY GENERAL
STATE OF 1LUNOIS
MEDECINS SANS FRONTIERES USA, INC. D/B/A DOCTORS WITHOUT BORDERS 333 7TH AVE 2ND FL NEW YORK, NY 10001
RE: RE: Status of MEDECINS SANS f RONTIERES USA, INC. D/B/A DOCTORS WrrHOUT30RDE_RS_under the Illinois Charitable Laws
Dear Registrant
This Jerter is pursuant to your request that the Attorney General confirm the status of MEDECINS SANS FRONTIERES USA, rNC. D/B/A DOCTORS WITHOUT BORDERS under the Charitable Organization Laws.
This organization is currently refiisrered with the Attorney General's Charitable Trust
and Solicitations Bureau as CO^ ! is current in the filing of its financial reports,
having filed its report for the periou'ended'Deceniber 31,2014. Please let us know if you require further information.
Takiyah Martin Barnes, Compliance Officer
Charitable Trusts Bureau
100 West Randolph Street, 11th Floor
Chicago, Illinois 60601
Telephone: (312)814-2595
PERMIT NO. 2017- 10
COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2017-10
Misericordia Heart of Mercy Center
6300 North Ridge, Chicago, IL 60660-1017
ADDRESS:
TELEPHONE NUMBER:
CONTACT PERSON:
DATE WRITTEN REQUEST WAS RECEIVED: March 3, 2017
SOLICITATION DATE:
CITY COUNCIL DATE:
COMPLETION OF FILE DATE:
STATEMENT OF RECED7TS AND DISTRIBUTION RECEIVED:
DATE PERMIT LETTER WAS SENT TO ORGANIZATION: March 29, 2017
VIOLATION (S)
COMMITTEE LETTER SENT:
COMPLY RECEIVED:
COMMENTS:
APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
(Please neatly print or type. In necessary in answering any question, please attach
additional sheets.)
1. Name of organization:
Misericordia Home 6300 North Ridge Chicago, IL 60660 Tel 773-973-6300
Use the space below to list names, current positions, residence addresses and telephone numbers of the officers in the organization:
Please see attached list/Board of Directors
List the date and approximate location(s) of solicitation:
May 5, 6, 7
Approximately how many persons will be engaged in the solicitation?
We expect approximately 200 volunteers to collect on those dates.
Explain the methods your organization will use to solicit funds:
-Ourvolunteers'wiil-stand^ttke-comers~and~suTTOunding^ soliciting donations and passing out bags ofJelly Belly candy and a tag (sample attached) explaining Misericordia and its mission. Typical donations are coins and dollar bills.
Has your organization ever been allowed to solicit funds in prior years in the City of Chicago? If so, when?
Yes, Misericordia has been conducting Candy Days in the city of Chicago since 1987.
Include the following with your application:
A copy of the registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois.
A copy of the tag, badge, emblem or other token (if any) which will be distributed as part of the solicitation, or which will be used by your organization in its solicitation.
Please include any other relevant information which would assist the Committee on Finance in reviewing this application.
APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION.
I/WE, THE OFFICER(S) OF THE ABOYE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
Title Corporate Secretary Date 2/28/17
HOLD HARMLESS AGREEMENT
1. The undersigned officer on behalf of the subject organization agrees to
defend,. mdenrnify^-sav.e-andiold.harmlessthe
liability, damage or cost which the City may incur dueto the presence ofvolunteers ofthe subject organization on City premises for the purpose of charitable solicitations.
2. The subject organization assumes full responsibility for risk ofbodily injury, death or property damage dueto the negligence ofthe subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way. ,
3. The officer ofthe subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
Misericordia Home
Name of organization
DATE: 2/28/2017
MlSERICORDIA'S BOARD OF DIRECTORS
President
Monsignor Michael Boland The Catholic Charities 721 N. LaSaUe St. Chicago, IL 60625 Phone: 312-655-7460 312-655-7171 (Lana) Appointed in 1996
Treasurer & General Manager
Sister Rosemary Connelly, RSM Misericordia
6300 North Ridge Avenue Chicago, IL 60660 Phone: 773-273-4179 Appointed in 1970
Director
Mrs. Margaret Houlihan Smith United
233 S. Wacker Drive, 10* Floor Chicago, IL 60606
MargarPthouh^ansjium@united.com Phone:'
CeU:3j
Appointed in 2014
Director
Mr. Robert Soudan Lock Up Development 800 Frontage Road Northfield, IL 60093 bobs@thelockup.com
Director
Mr. John L. Dyer
Peter Shannon & Co.
6412 Joliet Rd., Ste. 1
La Grange HigMands,JL^525-4662
Phone:/ nell
Appointed in 2005
Director Mr. Rob Figliulo SPR, Inc.
233 S. Wacker Dr., Ste. 3330
Chicago, IL_60606 .
Cell: \ U3
Appointed in 2005
Director
Dr. Philip R. O'Connor 1318 W. George St.
Chicago, IL 60657_
Phone:y
Phil.oconnof@proactive-strategies.net Appointed in 2015
Director
Mr. Dan Walsh
1130 N. Lake Shore Drive
Chicago, IL 60611
dwalsh@walshgroup.com Appointed in 2015
L
Appointed in 2007 Director
Father Jack Clair, acting secretary
Misericordia
6300 North Ridge
Chicago, IL 60660
Phone: 773-273-4165
frjack@misericordia.com
appointed in 2014
OFFICE OF THE ATTORNEY GENERAL
October 14,2015 STATE OF ILLINOIS
Lisa Madigan
ATTORNEY GENERAL
MISERICORDIA HOME 6300 N. RIDGE ROAD CHICAGO, IL 60660
RE: RE: Status of MISERICORDIA HOME under the Illinois Charitable Laws CO# 01040984 Dear Registrant:
This letter is pursuant to your request that the Attorney General confirm the status of MISERICORDIA HOME under the Charitable Organization Laws.
This organization is currently registered with the Attorney General's Charitable Trust and Solicitations Bureau as CO# 01040984, and has been granted single religious exemption from filing annual financial reports with our office. Please let us know if you require further information.
Sincerely,
Takiyah Martin Barnes, Compliance Officer
___ Charitable Trusts Bureau
100 West Randolph Street, 11th Floor Chicago, Illinois 60601 Telephone: (312) 814-2595
MISERICORDIA
Heart of Mercy Center
6300 North Ridge • Chicago, IL 60660-1017 • 773-973-6300 • fax 773-973-5214
www. misericordia. org
February 28, 2017
Michelle Murphy Committee on Finance City of Chicago - Room 302 121 North LaSalle St. Chicago, IL 60602
Dear Michelle:
Enclosed is the completed 'Application for the City of Chicago Charitable Solicitation Permit'. We hope to collect donations near Wrigley Field on Friday, Saturday and Sunday, May 5, 6, and 7. We truly appreciate the many opportunities we have had to conduct this tag days fundraiser in the past.
Also enclosed is the check for the $20 application fee.
If there are further requirements ore questions, please contact me at 773-273-4163, or tloftus(5)misericordia.com . Thank you very much for your assistance.
"Sincerely,
Therese Loftus
Development Manager Enclosures
PERMIT NO. 2017-11
COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2017-11
GROUP NAME: Planned Parenthood Federation of America
ADDRESS: 123 William Street, 10th floor, New York, NY 1003 8
TELEPHONE NUMBER: 212-541-7800
CONTACT PERSON:
DATE WRITTEN REQUEST WAS RECEIVED: March 10, 2017
SOLICITATION DATE: March 31 thru April 30, 2017
CITY COUNCIL DATE: March 29, 2017
COMPLETION OF FILE DATE:
STATEMENT OF RECED7TS AND DISTRIBUTION RECEIVED:
DATE PERMIT LETTER WAS SENT TO ORGANIZATION: March 29,2017
VIOLATION (S)
COMMITTEE LETTER SENT:
COMPLY RECEIVED:
COMMENTS:
APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
(Please neatly print or type. In necessary in answering any question, please attach
additional sheets.)
Name of organization: Planned Parenthood Federation of America
Address: 123 William Street, 10th Floor, NY, NY 10038 Telephone Number: 212-541-7800
Use the space below to list names, current positions, residence addresses and telephone numbers of the officers in the organization:
Cecile Richards, President: Jethro Miller, Chief Development Officer:
123 William Street, 10th Floor 123 William Street, 10th Floor
New York, NY 10038 New York, NY 10038
212-541-7800 212-541-7800
List the date and approximate locarion(s) of solicitation:
3/5^/? " t/^itft'The Loop, Wicker Park, Andersonville, Near Southstde, Logan Square, Magnificent Mile, and Oak Park
Approximately how many persons will be engaged in the solicitation?
Between 6 and 30
Explain the methods your organization will use to solicit funds:
Planned Parenthood Federation of America has hired Grassroots Campaigns, Inc. to canvass in the city of Chicago.
¦6 Has your-organiiation ever-been allowed tosolidtfundsinpi-ior-yearsin-the
City of Chicago? If so, when? 2016 (Sept 16, 2016 - January 15, 2017)
jOlHianWit/iftJ^H1'"" v 2016 (May 1,2016-August31,2016)
m2015 (October 17, 2015 - December 31,2015)
Include the following with your application:
A copy ofthe registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois.
A copy of the tag, badge, emblem or other token (if any) which will be distributed as part of the solicitation, or which wilt be used by your organization in its solicitation.
No tag or emblem will be distributed
Please include any other relevant information which would assist the Committee on Finance in reviewing this application.
U'i'LK. vi iovs \iiis r nr. Ric. limd by i in com mi i hi on i in \no, no
I.A IK lIlAiN Ul I) \\ S PRIOR TO THL COMM! NCI Ml I.N') Ol 111) SOUC! FA'l ION.
I/WE, THE OFFlCEll(S) OF THE ABOVE NAMED ORGANIZATION* CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TREE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
Title DtpUTi Cf* Date*/*/*"?
Signature Title Date
Sign:iture_ Title Datc_
HOLD HARMLESS A GUT. I MEN I
The undersigned officer on bchii! of the subject oiganixaiion agrees lo defend, indemnify. ,s.:\e and hold harmless the Cny of Chicago for any k s.s. liability, damage or cost which iht; City may incur due lo the presence of volunteers of ihe subject organization on City premises lor the purpose of charitable solicitations.
The subject organization assumes full responsibility for risk of bodily injury, death or property damage due lo the negligence ofthe subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
The officer ofthe subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
natiryd fortm-tood fpdetziticn ofnmetier
Name of organization
Signature of organization officer
Date
Mar-I0-I7 03:11pn From-
OFFICE OF THE ATTORNEY GENERAL
ffXTE OF ILLINOIS
PLANNED PARENTHOOD FEDERATION OF AMERICA, INC.
123 WILLIAM STREET, 10TH FLOOR NEW YORK, NY 10038
RE: RE: Status of PLANNED PARENTHOOD FEDERATION OF AMERICA, INC. under the IllinoisJDharitablc Laws
cod Dear Registrant:
This lerter is pursuant to your r squest that the Attorney General confirm the status of PLANNED PARENTHOOD FEDEF ATION OF AMERICA, INC. under the Charitable Organization Laws.
This organization is currently iegisrered with the Attorney General's Charitable Trust and
Solicitations Bureau as COC j It is current in the filing of its financial reports, having
filed its report for the period ended J in* 30,2015. Please Jet us know if you require further information.
Cfcrciha Jacksoii,Comp^an3i!OTKer^ C haritable Trusts Bureau 1 DO West Randolph Street, 11th Floor Chicago, Illinois 60601 Itflephone; (312)814-2595
Dac-09-16 02:15pm Frw
OFFICE OF THE ATTORNEY GENERAL
December 9,2016 Si ATE OF ILLINOIS
PLANNED PARENTHOOD f . x-
FEDERATION OF AMERlCW, INC. ~LS* M^"^
ATTOWstt GENERAL
123 WILLIAM STREET, 107 H FLOOR NEW YORK. NY 10038
RE: RE: Status of PLANNED PAF ENTHOOD FEDERATION OF AMERICA, INC. under the Ulinois.Chariiab!e_Laws
CO*: ¦
Dear Registrant:
l"his letter is pursuant to your \ tquest that the Attorney General confirm the status of PLANNED PARENTHOOD IEDEEATION OF AMERICA, INC. under the Charitable Organization Laws.
This organization is currently roistered with the Attorney General's Charitable Trust and
Solicitations Bureau as COL It is current in the filing of its financial reports, having
filed its report for the period ended Ji ne 30,2015. Please let us know if you require further information.
Ce -etna Jackson,Complianc Ch iritable Trusts Bureau 10U West Randolph Street. Uth Floor Ch cago, Illinois 60601 Telephone: (312)814-2595
Dac—09-16 02'.1Epn Ff«r
OFFICE OF THE ATTORNEY GENERAL
December 9, 2016 STATE Of ILLINOIS
PLANNED PARENTHOOD .
FEDERATION OF AMERICA, INC. L,!ia Madigan
ATTOhJsfcY CENfKAL
123 WILLIAM STREET, 107H FLOOR NEW YORK. NY 10038
RE: RE: Status of PLANNED PAF ENTHOOD FEDERATION OF AMERICA, INC. under
the Illinois. Charitable Laws
CO# j
Dear Registrant:
litis letter is pursuant to your i squesi that the Attorney General confirm the status of PLANNED PARENTHOOD FEDERATION OF AMERICA, INC. under the Charitable Organization Laws.
This organization is currently^registered with the Attorney General's Charitable Trust and
Solicitations Bureau as CO/ ; ft is current in the filing of its financial reports, having
filed its report for the period ended Jt ne 30,2015. Please let us know if you require further information.
Ce -etha Iackson,Complianc Charitable Trusts Bureau I0(i West Randolph Street. 11th floor Ch cago, Illinois 60601 Telephone: (312)814-2595
-
PERMIT NO. 2017-14
COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER: 2017-14
GROUP NAME: Polish Legion of American Veterans
ADDRESS: 5048 W. Wellington Avenue, Chicago, IL 60641
TELEPHONE NUMBER: 773-545-9159
CONTACT PERSON:
DATE WRITTEN REQUEST WAS RECEIVED: March 14, 2017
SOLICITATION DATE: May 17-20, 2017
CITY COUNCIL DATE: March 29, 2017
COMPLETION OF FILE DATE:
^STATEMENT OF RECEIPTS ~ AND DISTRIBUTION RECEIVED:
DATE PERMIT LETTER WAS SENT TO ORGANIZATION: March 29, 2017
VIOLATION (S)
COMMITTEE LETTER SENT:
COMPLY RECEIVED:
COMMENTS:
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APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
(Please neatly print or type. In necessary in answering any question, please attach
additional sheets.)
Name of organization: foUS^ LcC/o/l) OF AM&filciJ\/6Te*fi#S,a.%ti.
Address: 5f>¥ S id, U) £LL( & $TeP f]^ < Telephone Number: ^ S—9(6^
Use the space below to list names, current positions, residence addresses and telephone numbers of the officers in the organization:
List the date and approximate location(s) of solicitation:
Approximately how many persons will be engaged in the solicitation?
Explain the methods your organization will use to solicit funds:
OffeR(*>G> PopP 1^5 fop. Pi \>0/>ArtOjO Toftfe
Has your organization ever been allowed to solicit funds in prior years in the
City of Chicago? If so, when? - £.0 / £>
7. Include the following with your application:
A copy of the registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General of the State of Illinois.
A copy of the tag, badge, emblem or other token (if any) which will be distributed as part of the solicitation, or which will be used by your organization in its solicitation.
Please include any other relevant information which would assist the Committee on Finance in reviewing this application.
Line 2
__.D_ennis Deisenroth_,_Cpmmander
E. Buenett, - isiand Lake, IL 60042
815-i
Kevin Pomykala, Vice-Commander ^Arrowhead Dr. "Elwood, IL 60421
815-V.
WaJ.ter J. Komarnicki, Treasurer iw. Wellington Ave.
Chicago, IL 60641
'dim
Julianne Viduya, Adjutant j iN. New England Aye. ChTcago, IL 60707
year oi 2016 SECRETARY OF STATE JESSE WHITE PAG1
di e prior to 9-1-2016 STATE OF ILLINOIS corporation fii.k
N 5852-315-1
mling fee is sio. General Not For Profit Corporation Act
IF LA TE, ADD PENALTY OF S3.
ANNUAL REPORT
(Form NFPCAF - Rev. 09/30/2009) * - THIS REPORT CAN BE FILED ON-LINE Vi ww».rvbfrilri\eUttiiob.com WITH AN EXPEDITED FEE. * «
(I'SE BLACK INK)
08-08-03 COOK COUNTY
POLISH LEGION OF AMERICAN VETERANS OF THE USA DEPARTMENT OF % WALTER JOHN KOMARNICKI 5048 W WELLINGTON AVE CHICAGO IL 60641
Item 1. Verify that the corporate name is correct.
Item 2. Verify that the name ofthe registered agent and the address of the registered office are correct. You cannot change the registered agent and/or registered office on the annual report form printed below. In order to change the registered agent and/or registered office, it will be necessary to file with the Secretary of State form NFP 105.10/105.20. Mail the NFP 105.10/105.20. Annual Report and $5 filing fee TOGETHER in the SAME envelope. This form can be downloaded from our internet web site at www.cyberdriveilIinois.com . Click on "Departments", then "Business Services" then "Publications and Forms".
Items 3(a). 3(b). Verify printed information is correct.
Item 4. Must set forth the names and addresses of all
officers and directors of the corporation as of the date of
signing ILLINOIS CORPORATIONS MUST HAVE
AT LEAST THREE (3) DHIECTORS! If there are
additional officers and/or more than three directors, you
must attach a list to this report setting forth all other
name(s). title(s) and address(es). Please write the file
-number-on all-attachments:
Item 5 Please complete this item.
Item 6. Please mark the appropriate box where indicated in response to the following questions
(a) Is this corporation a CONDOMINIUM Association as
established under the Condominium Property Act?
(b) Is this corporation a COOPERATIVE HOUSING
CORPORATION defined in Section 216 of the internal
Revenue Code of 1954?
(c) Is this corporation a HOMEOWNER'S ASSOCIATION
which administers a Common Interest Community as defined
in Subsection (c) of Section 9-102 of the Code of Civil
Procedure?
Item 7. Please complete this item.
Item 8 THIS REPORT MUST BE SIGNED BY A DULY AUTHORIZED OFFICER OF THE CORPORATION!
Please type or print the name and title of the officer signing
this report as well as the date of signing.
DETACH AT PERFORATION - DO NOT SUBMIT A PHOTOCOPY
^TERANS OF THE USA DEPARTMENT OF
}Q t(HCA6t JL- k6?C7
Ditecto' Name/Address
Director NameJAddwss
Director Name/Addjass , , ' „
3^ Brief Description of the corporation's activities, --ri'N'tl f7 \qi££7 T(/ \ . fir t/O
7) Principal Address of the Corporation (Street. City, State. Zip Cede)
2) Registered Agent
% WALTER JOHN KOMARNICKI 08-08-C 5048 W WELLINGTON AVE CHICAGO IL 60641 COOK COUNTY
Under the penalty ct penury and as an auinanzed officer, ! declare mat t'n»s annua? report pursuari to the provisions of the General No* For Prcfit Corporation Act has been examined by
8) Signature
///,
District Hi rector
ivspnrinenL of Llic Treasury
Portion to Contact: * EO;TPA
¦ X-
polish leg10h of american veterans htate depaetheht of illikoig 7.19 s winchester avenue chicago il 60g12
Telephone Nunbcr: . 1-800-029-1040
312-435-1040
Refer Reply Lo: 93-0553
Date: -!**-raa!«T 14, 1992
RE; GROUP EXEHPTiai KIR: [
L _j
Thio letter is to verify exemption under IRC "501{c)(19)-
Dintrit-t Dirwrt-T
Our records indicate that a group ru 1 inp. letter t»«s issued 'to polish Legion o£ Aaerican Veterans National Iv-parU»«»nt and its named subordinate organizations in January. 1940 urn lor group ruling number 1010. Hun-ally a parent organlzation that io covered by a jsroor ruling will automatically add new or additional subordinate units to. the pjroup ruling. We suggest that you contact your ¦parent organization for guidance in this Batter. If you Rant a copy of Lite exemption letter, please contact your parent organisation.
HOLD HARMLESS AGREEMENT
The undersigned officer on behalf of the subject organization agrees to defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations.
2. ' The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject Organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
3. The officer of the subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
Signature oforganization officer
Date
Name of organization
APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION.
I/WE, THE OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
Signature
Signature
"Unity with Heritage"
Commander Robert Swan 530 La Fayette Lane Hoffman Estates, IL 60169 847-322-9874 E-Mail
robert.swan@sbcglobal.net
"Aid to the Blind Program" Adjutant
JUUANNE VlDUYA
2402 N. New England Chicago, IL 60707 773-622-6901
Committee on Finance 3-6-2017 121 N. LaSalle St. Room 22 Chicago, IL 60602
Dear Ms Murphy,
Please find enclosed the application for a Charitable Solicitation Permit, also enclosed is a check for $40
The dates requested are May 17,18,19 and 20 of 2017.
Please mail the permit to:
Walter J. Komarnicki, Treasurer 5048 W. Wellington Ave. Chicago, IL 60641
Sincerely,
lish Legion American Veterans
CHARTERED BY ACT OF CONGRESS
Walter J. Komarnicki
PERMIT NO. 2017 - 15
COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER:
The Salvation Army Metropolitan Division
ADDRESS: 5040 North Pulaski Road, Chicago, IL 60630
TELEPHONE NUMBER:
CONTACT PERSON:
DATE WRITTEN REQUEST WAS RECEIVED: March 10, 2017
November 1 thru December 23, 2017
CITY COUNCIL DATE:
COMPLETION OF FILE DATE:
STXTEM1ENT~0F"RECE1PTS AND DISTRIBUTION RECEIVED:
DATE PERMIT LETTER WAS SENT TO ORGANIZATION:
VIOLATION (S)
COMMITTEE LETTER SENT:
COMPLY RECEIVED:
COMMENTS:
< o W q tu y 22
W EG
APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
(Please neatly print or type. If necessary in answering any question, please attach
additional sheets.)
Name of organization: The Salvation Army Metropolitan Division
Address: 5040 North Pulaski Road, Chicago, IL 60630
Telephone Number: 773.725.1100
Use the space below to list names, current positions, residence addresses and Telephone numbers ofthe officers in the organization:
Scott Justvig, Executive Director of Development and Communications 5040 N. Pulaski Road Chicago, IL 60630 773-725-1100
List the date and approximate location(s) of solicitation:
November 1, 2017 - December 23, 2017 - Sidewalks in the Public Way throughout the City of Chicago (Excluding Sundays)
Approximately how many persons will be engaged in the solicitation? Approximately 85 people/volunteers
Explain the methods your organization will use to solicit funds:
Red Kettles
Has your organization ever been allowed to solicit funds in prior years in the City of Chicago? If so, when?
Yes, we have solicited in the City of Chicago for 80 years.
Include the following with your application:
A copy ofthe registration statement filed with the Attorney General ofthe State of Illinois; or exemption issued by the Attorney General of the State of Illinois.
A copy of the tag, badge, emblem or other token (if any) which will be distributed as part ofthe solicitation, or which will be used by your organization in its solicitation.
Please include any other relevant information which would assist the Committee on Finance in reviewing this application.
APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION.
I/WE, THE OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
y/ ^//d £xff 4WjL^^ TMe 0f De^cp^^ Date 1' V
Signature Title Date_
Signature Title Date_
HOLD HARMLESS AGREEMENT
The undersigned officer on behalf of the subject organization agrees to defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations.
The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
3. The officer ofthe subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
Name of organization
Signature of orgamzation officer
Date
PERMIT NO. 2017-16
COMMITTEE ON FINANCE CHARITABLE SOLICITATION TAG DAY REQUEST FORM AND ROUTE SHEET
PERMIT NUMBER:
The Salvation Army Metropolitan Division
ADDRESS: 5040 North Pulaski Road, Chicago, IL 60630
TELEPHONE NUMBER:
CONTACT PERSON:
DATE WRITTEN REQUEST WAS RECEIVED: March 10, 2017
SOLICITATION DATE:
CITY COUNCIL DATE:
COMPLETION OF FILE DATE:
STATEMENT OF RECEIPTS AND DISTRIBUTION RECEIVED:
DATE PERMIT LETTER WAS SENT TO ORGANIZATION:
VIOLATION (Si
COMMITTEE LETTER SENT:
COMPLY RECEIVED:
COMMENTS:
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APPLICATION FOR CITY OF CHICAGO CHARITABLE SOLICITATION PERMIT
(Please neatly print or type. If necessary in answering any question, please attach
additional sheets.)
Name of organization: The Salvation Army Metropolitan Division
Address: 5040 North Pulaski Road, Chicago, IL 60630
Telephone Number: 773.725.1100
Use the space below to list names, current positions, residence addresses and Telephone numbers ofthe officers in the organization:
Scott Justvig, Executive Director of Development and Communications 5040 N. Pulaski Road Chicago, IL 60630 773-725-1100
List the date and approximate Iocation(s) of solicitation:
June 2-3, 2017 - Sidewalks in the Public Way throughout the City of Chicago
Approximately how many persons will be engaged in the solicitation? Approximately 85 people/volunteers
5. Explain the methods your organization will use to solicit funds:
, y.olunteers-wilLbe-using.marked Donut Day collection boxes
Has your organization ever been allowed to solicit funds in prior years in the City of Chicago? If so, when?
Yes, we have solicited in the City of Chicago for 80 years.
Include the following with your application:
A copy of the registration statement filed with the Attorney General of the State of Illinois; or exemption issued by the Attorney General ofthe State of Illinois.
A copy of the tag, badge, emblem or other token (if any) which will be distributed as part of the solicitation, or which will be used by your organization in its solicitation.
Please include any other relevant information which would assist the Committee on Finance in reviewing this application.
APPLICATIONS MUST BE RECEIVED BY THE COMMITTEE ON FINANCE NO LATE THAN 30 DAYS PRIOR TO THE COMMENCEMENT OF THE SOLICITATION.
I/WE, THE OFFICER(S) OF THE ABOVE NAMED ORGANIZATION, CERTIFY THAT THE INFORMATION FURNISHED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF MY/OUR KNOWLEDGE. (NOTE: AT LEAST ONE OFFICER OF THE ORGANIZATION MUST SIGN AND VERIFY THIS APPLICATION.)
Signature Title Date_
Signature Title Date_
HOLD HARMLESS AGREEMENT
The undersigned officer on behalf of the subject organization agrees to defend, indemnify, save and hold harmless the City of Chicago for any loss, liability, damage or cost which the City may incur due to the presence of volunteers of the subject organization on City premises for the purpose of charitable solicitations.
The subject organization assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of the subject organization or otherwise resulting from conduct or activity related to the participation in charitable solicitation on the public way.
The officer ofthe subject organization has read and voluntarily signs the hold harmless agreement and waiver of liability and indemnity agreement.
Name of organization
Signature of organization officer
Date