OFFICE OF THE MAYOR
CITY OF CHICAGO
RAHM EMANUEL
MAYOR
April 19,2017
TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO
Ladies and Gentlemen:
At the request of the Commissioner of Planning and Development, I transmit herewith ordinances authorizing the sale of city owned property.
Your favorable consideration of these ordinances will be appreciated.
Mayor
Very truly yours,
ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of government by virtue of the provisions of the Constitution of the State of Illinois of 1970, and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the City is the owner of the vacant parcel of property located at 3508 West Flournoy Street, Chicago, Illinois 60624, which is legally described on Exhibit A attached hereto (the "Property"), which Property is located in the Midwest Redevelopment Project Area ("Area"), as amended, established pursuant to ordinances adopted by City Council of the City on May 17, 2000, published in the Journal of Proceedings of the City Council for such date at pages 30775 through 30953.
WHEREAS, JWB, LLC a Delaware Limited Liability Company (the "Grantee"), with a principal business address of 3535 West Harrison Street, Chicago, Illinois 60624, has offered to purchase the Property from the City for the sum of One Thousand Eight Hundred Fifty and 00/100 Dollars ($1,850.00), such amount being the appraised fair market value of the Property, to improve with landscaped open space thereon; and
WHEREAS, pursuant to Resolution No. 16-095-21 adopted on October 20, 2016, by the Plan Commission of the City (the "Commission"), the Commission approved the negotiated sale of the Property to the Grantee; and
WHEREAS, public notice advertising the City's intent to enter into a negotiated sale of the Property with the Grantee and requesting alternative proposals appeared in the Chicago Sun-Times, a newspaper of general circulation, on January 24, 2017, and January 31, 2017; and
WHEREAS, no alternative proposals were received by the deadline indicated in the aforesaid notice; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The City Council of the City hereby approves the sale of the Property to the Grantee for the amount of One Thousand Eight Hundred Fifty and 00/100 Dollars ($1,850.00).
SECTION 2. The Mayor or his proxy is authorized to execute, and the City Clerk or Deputy City Clerk is authorized to attest, a quitclaim deed conveying the Property to the Grantee. Such deed shall include a covenant obligating the Grantee to use the Property only for use consistent with the land uses permitted under the redevelopment plan for the Area. Grantee's acceptance of the City's deed shall constitute Grantee's agreement to such covenant. The quitclaim deed shall also contain language substantially in the following form:
This conveyance is subject to the express condition that: the Property is improved with landscaped open space within six (6) months of the date of this deed. In the event that the condition is not met, the City of Chicago may re-enter the Property and revest title in the City of Chicago. Grantee, at the request of the City of Chicago, covenants to execute and deliver to the City a reconveyance deed to the Property to further evidence such revesting of title. This right of
reverter and re-entry shall terminate upon the issuance of a certificate of completion, release or similar instrument by the City of Chicago.
The Grantee acknowledges that if the Grantee develops the Property with a residential housing project, as defined under and that is subject to Section 2-45-115 of the Municipal Code of the City (the "2015 Affordable Requirements Ordinance"), the Grantee and such project shall be obligated to comply with the 2015 Affordable Requirements Ordinance.
SECTION 3. If any provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such provision shall not affect any of the other provisions of this ordinance.
SECTION 4. All ordinances, resolutions, motions or orders inconsistent with this ordinance are hereby repealed to the extent of such conflict.
SECTION 5. This ordinance shall take effect upon its passage and approval.
EXHIBIT A
Purchaser: JWB, LLC a Delaware Limited Liability Company
Purchaser's Address: 3535 West Harrison Street, Chicago, Illinois 60624
Purchase Amount: $1,850.00
Appraised Value: $1,850.00
Legal Description (Subject to Title Commitment and Survey):
North 29 Feet of the East 14 Feet of Lot 43 and North 29 Feet of Lot 44 (Except the East 7 Feet) in Block 9 in Schoenberger's Subdivision of the West 3A of the North 40 Rods of the Southeast % of Section 14, Township 39 North, Range 13, East of the Third Principal Meridian, in Cook County, Illinois.
Address: 3508 West Flournoy Street
Chicago, Illinois 60624
Property Index Number: 16-14-400-031-0000
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:
J~ny 6 t l-l-c^
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
D^the Applicant
OR
[] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest:
OR
3. [] a legal entity with a right of control (see Section II.B. 1.) State the legal name of the entity in
which the Disclosing Party holds a right of control:
Business address of the Disclosing Party:
Telephone: 5 3.^ '^Sg Fax: sl^3o^ Email: >J ' b ^ £A°SC^
Name of contact person: n! ^ • <5 t/ / ^-
i
E. Federal Employer Identification No. (if you have one):;'
Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Pc^cUaje, ^J2jac^f ^ft^A/"^ 350&vJ. f/au£A)aj
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
I. Indicate the nature of the Disclosing
[ ] Person
[ ] Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ ] Limited partnership
[ ] Trust
arty:
j?^ 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:
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
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
uJ. 6cv/' /c jM^^*Jr±Cl
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.
Percentage Interest in the
Disclosing Party
3513 V £tiLfS-) S^QX Sr~ 7 '
£1
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
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 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) /(J ^^^pbbyte}, etc.) "hourly rate" or "t.b.d." is
St^i-f^xi&D not an acceptable response.
\AAc Ht Ct^; 6ggg3-A~H-/y/ 1/v "g ^ ® ^, -£^£7
(Add sheets if necessary)
[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] 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 [JNo
B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;
have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
3. The certifications in subparts 3, 4 and 5 concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 13
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 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).
A. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify lo 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 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 wilh "N/A" or "none").
/bOlA 6 .
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.
Ay o
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is £4 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 Parly 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 ihc 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 in his or her own name or in the name of any other person or entity in the Matter?
[]Yes ^No
NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. If you checked "No" to Item D.L, proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at 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?
1 . 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
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.
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 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):
aj o la r
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
3. The Disclosing Parly will submit an updated certification al 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.
A. The Disclosing Party certifies that either: (i) it is not an organization described in section 501 (c)(4) of the Internal Revenue Code of 1 986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party (he Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant lo applicable federal regulations? (See 41 CFR Part 60-2.)
[]Yes [JNo
Have you filed wilh 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 [JNo
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [JNo
If you checked "No" to question 1. or 2. above, please provide an explanation:
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicago.orR/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing 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 lo 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 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 thai:
Page 11 of 13
'Oec07 16 01:13p
The Disclosing Party Department of Revenue, noi 'me, fee, lax or other charge :;cwer charges, license
; fees,
7 2 If the Disclosing Pa jsc, nor permit their subcom Parties List System ("EPLS"
F.3 [f the Disclosing Paij; contractors/subcontractors form and substance to those City, use any such contrack Disclosing Party has reason
NOTE: If the Disclosing Pj: explanatory statement must
CERTIFICATION
Under penalty of perjury, this EDS and Appendix A certifications and statemen; and complete as of the dat<
This includes, but is not limited to, all water charges, 73.?, property taxes or sales taxes.
I
ainC ijpd
Iii any facility listed by the U.S. E.i -A- on u jby the U. S. General Services Administration.
.; in i
bplicant the Disclosing Party will obtain from any 1 cSin connects with the Matter certificates equal m ^ Flo ve and will act, without the prior «**™* of the fcorthatdoesnotprovidesuch^ ¦ has not provided or cannot provide truthful certifications. ^
cann
kM certify as to any of the items in F.L, F.2. or F.3- ahove, an attac h c d j to this ED S.
L ' - M^-m warrants that he/she is authorized to execute
t to EDS and Appendix A (if citable) are ««, accurate to the City.
per!) r»
signing)!
igniijll |
t
m on Kpatc) ^^^^' ^
(stale).
OFFICIAL SEAL
Notary Public.
Notify P«W'= - sw1« 01 My CcwwJ«tOO Expiwt PW3.20W
Page 12 of 13
^ » « ¦ < ¦
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS, The purpose of this page la for you to recertify your EDS prior to submission to City Council or an the date of closing. If unable lo recertify touthfully, the Disclosing Parry must complete a now EDS with correct or corrected information)
^CERTIFICATION
Generally, for use with City Council matters. Not for City procurenw&ta unless requested.
This fcceru^catiqn Is being submitted in connection with% yi°^Q*>y ,,, [ioVwtfify the Matter). Under penalty of perjory. toe pewou signing below*. 0) Wi^^ tlwt ie/she Is wrthorited to execute this EDS rcceiiiBcfttioo on behalf of the Dewing Party, (2) vmrant* that all certifications rod statements contajited ia the Disdoiing Party's original EDS m true, accurate and complete us of the date furnished to the City sad (^wUnac to be (rue, jjccu»tc tad complete as of the date of this recettiflcation, «nd (3) ireaffitnts tit
W, IXC D.*: 3/7/2017
(Print or tyj^ teo^fnftme of DiMfl$ing Party)
Print or type name of signatory:
Janes V- Bulk
Title of signatory:
Manager
Signed and sworn to before me on [date] 3*,^<^cV V Dy
Jhihgb .W. Builc r\ . at Cook County, ^J™018 [state).
Notary Public.
Commission expires!^
. OFFICIAL SEAL
JSHANNOMESHEaiE-GORDON
I m Hub,,c"State of Illinois
py Commission Expires 5/15/2019
Dec071601:15p
p.13
Cm'OF CHICAGO CLOSURE STATEMENT AND AFFIDA'STT APPENDIX A
II ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be c| ownership interest in the A; which has only au indirect
Under Municipal Code Sc or any "Applicable Party" or any elected city official or d signed, the Disclosing Party the mayor, any alderman, the partner or as any of the folio niece or nephew, grandparent or stepmother, stepson or sb
tly by (a) the Applicant, and (b) any legal entity which has a direct cecding 7.5 percent. It is not tb be completed by any legal entity interest in the Applicant.
015, the Disclosing Party mustidisclose whether such Disclosing Party or Domestic Partner thereof currently has a "familial relationship" with aji A "familial relationship" exists if, as of the date this EDS is licable Party" or any Spouse or (Domestic Partner thereof is related to
child, brother or sister, aunt or uncle, son-in-law, daughter-in-law, stepfather
[the city treasurer or any city department head as spouse or domestic
stepbrother or stepsister or half-brother or half-sister.
icr by blood or adoption: parent, ij father-in-law, motber-in-law,;
"Applicable Party" ia> Disclosing Party is a corpon partnership; all general pacfr partnership; all managers, ir limited liability company; £ a 7.5 percent ownership int< operating officer, executive exercising similar authority.
Does the Disclosing Part have a "familial relationship
[ ] Yes|10) all :::
cutivc officers of the Disclosing Party listed in Section II.B.La., if the i >a; all Winers of the Disclosing Party, if^he Disclosing Party is a general
any itli ah
and i i; itcd partners of the Disclosing Party, if the Disclosing Party is a limited aging (i rubers and members of the Disclosing Party, if the Disclosing Party is a prir c ball officers of the Disclosing Party; and (3) any person having more than t| in tfc z '. )ikclosingParty. "Principal officers" means the president, chief cctor, c J ief financial officer, treasurer or secretary of a legal entity or any person
i pplicable Party" or any Spouse or Domestic Partner thereof currently e'eted city official or department head?
If yes, please identify beUh (1) i such person is connected; (;| [he na; person has a familial relationship, aii
name and title of such person, (2) the name of the legal entity to which and title of the elected city official or department head to whom such (4) the precise nature of such familial relationship.
Page 13 of 13
Dec0716 01:40p
CITY OF CHICAGO KjjLOSURE STATEMENT AND AFFIDAVIT APPENDIX B
#PFBLAW;PROBLEM LANDLORD CERTIFICATION
JX
cnvti
This Append wliicli has a direct It is not to be complete the Applicant.
to rsl
jorrjpletcd only by (a) flic Applicant, and (b) any legal entity Jest in the Applicant exceeding 7.S percent (an "Owner"). |al entity which has only an indirect ownership interest in
Pursuant to M ini fip£ ] building code pcqffla Code?
Idcitif
[ ]Yes
IfthcAppIicaiitisal
the Applicant
2-92-416 of tfeMun:
No
de Section 2-154-010, is the Applicant or any Owner identified as a priblem landlord pursuant to Section 2-92-416 of the Municipal
r>4
en sal
ivy publicly traded on any exchange, is any officer or director of building code scofflaw or problem landlord pursuant to Section 4l dfpdc?
(J^Not Applicable
bu Id
hich t
Ifyesto(l)od(2j)ab identified as a buildings to u
pi ase identify below the name of the person or legal entity dc jScofflaw or problem landlord and the address of the building or ii cnt code violations apply.
OUT;
FILLING
and agreMe:
THE
REFERENCE IjNT AND THAT SUBJECT Tt> PERJURY ON
Pi ENDIX B CONSTITUTES ACKNOWLEDGMENT HA T THIS APPENDIX B IS INCORPORATED BY [1> MADE A PART OF, THE ASSOCIATED EDS, REjSENTATIONS MADE IN THIS APPENDIX B ARE Rj TFICATION MADE UNDER PENALTY OF lib )F THE ASSOCIATED EDS.
I
Dec0716 01:29p
CITY OF CHICAGO OMIC DISCLOSURE STATEMENT AND AFFIDAVIT
osmg
R
SECTION I - GENERAL A. Legal name of the Disc
Check ONE of the follow
Indicate whether the Disclosing
[] the Applicant
OR
[ ] a legal entity hold Applicant in which tli
OR
[ ] a legal entity witi
Ipg thjrec boxes:
inga i Disc
irtylsubmitting this EDS is:
a right
c ircct or indirect interest in the Applicant. State the legal name of the
losing Party holds an interest:
ofj control (see Section II.B. 1.) State the legal name of the entity in
which the Disclosing.? arty hal js a right of control:
B. Business address of th<
C. Telephone: ¦.
3i:
Name of contact pers
Federal Employer Idemjilficat
c n No. (if you have one):
F. Brief description of crjii ract,
(Inclujc
transaction or other undertaking (referred to below as the "Matter") to
ej project number and location of property, if applicable):
G. Which City agency or
If the Matter is a complete the following
Specification #
ipjent is requesting this EDS?_
i
i
handled by the City's Department of Procurement Services, please
! and Contract #
Page 1 of 13
Dec0716 01:29p
SECTION II - DISCLO A. NATURE OF THE DI 1. Indicate the nature [ ] Person ! [ ] Publicly registered bus [ ] Privately held business [ ] Sole proprietorship i [ ] General partnership ! [ ] Limited partnership PJ- Trust j i 2. For legal entities,|t SURE sclo;; of the i: iness c: oorpo: i-; state j OF OWNERSHIP INTERESTS 1 i i ] MGj PARTY t • isclbsing Party: ; [ ] Limited liability company ¦potation [ ] Limited liability partnership non T1 Joint venture 1 ' ; [ ] Not-for-profit corporation (Is the not-for-profit corporation also a 501 (c)(3))? : [ ] Yes [ ] No j [] Other (please specify) or foreign country) of incorporation or organization, if applicable:
! 3. For legal entities n ; business in the State of IIIi [ ] Yes B. IF THE DISCLOSING 1. List below the fujl t NOTE: For not-for-profTi: there are no such members the legal titleholder(s). If the entity is a general partnership or joint venture manager or any other pen c NOTE: Each legal entity I Name :orga i mis as ;jn«> PAR'' ii.mes a carpoja write [ artnc i { list 1»< norcr s ted V. e zed in the State of Illinois: Has the organization registered to do 3 foreign entity? | ! M N/A if IS A LEGAL ENTITY: nd titles of all executive officers and all directors of the entity. t oris, also list below all members, if any, which are legal entities. If 'no jracmbers." For trusts, estates or other similar entities, list below i siip, limited partnership, limited liability company, limited liability :low the name and title of each general partner, managing member, tity that controls the day-to-day management of the Disclosing Party. 1 aw must submit an EDS on its own behalf.
To I i H - ~
ft/ r- I M
(f
2. Please provide th: f indirect beneficial interc st of such an interest inclu 1: c llowii (includi share ; i 1 g information concerning each person or entity having a direct or :ig;ownership) in excess of 7.5% of the Disclosing Party. Examples ii a! corporation, partnership interest in a partnership or joint venture, Page 2 of 13
Dec 07 16 01:30p
interest of a member or m$o& estate or other similar en Municipal Code ofChicdgc from, any applicant which
is
3 limited liability company, or interest of a beneficiary of a trust, ne, Slate "None." NOTE: Pursuant to Section 2-154-030 of the ircipal Code"), the City may require any such additional information i}< bly intended to achieve full disclosure.
s Address
Percentage Interest in the
¦ Disclosing Party
SECTION III — BUSIN iSS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Code, with any City elect
had offi'dip.
business relationship." as defined in Chapter 2-156 of the M unicipal in1 the 12 months before the date this EDS is signed?
[ ] Yes ^ N
If yes, please identify belbty the: relationship(s):
DF SUBCONTRACTORS AND OTHER RETAINED PARTIES
st di
ltant'
ose the name and business address of each subcontractor, attorney, a|nd any other person or entity whom the Disclosing Party has retained Tvifh the Matter, as well as the nature of the relationship, and the total rnlalted !to be paid. The Disclosing Party is not required to disclose lrough the Disclosing Party's regular payroll.
entity who undertakes to influence any legislative or administrative entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) my person or entity any part of whose duties as an employee of ipJfluence any legislative or administrative action.
If the Disclosing Parr Disclosing Party must ei
3 unce
i
iur as
am whether a disclosure is required under this Section, the the City whether disclosure is required or make the disclosure.
Page 3 of 13
Dec0716 01:30p
Name (indicate whether retained or anticipated to be retained)
lUuttr Ret
sis . Relationship to Disclosing Party |$S (subcontractor, attorney, lobbyist, etc.)
•Hi
V
Fees (indicate whether paid or estimated.) NOTE: "hourly rate" or "t.b.d." is not an acceptable response.
has not retained, nor expects to retain, any such persons or entities.
SECTION V CERTfFICAT
:> JPPORT COMPLIANCE
>-92-415. substantial owners of business entities that contract with \v:ith their child support obligations throughout the contract's term.
Has any person who direct\y or arrearage on any child support <
[]Yes
indirel
ctly owns 10% or more of the Disclosing Party been declared in igations by any Illinois court of competent jurisdiction?
[ ]|no person directly or indirectly owns 10% or more of the Disclosing Party.
witli 11 at
:o a court-approved agreement for payment of all support owed and
agreement?
[]Yes
113
:atic
1. Pursuant to Munj consult for defined termjs submitting this EDS is certifies as follows: (i) r with, or has admitted giji
i!
:e
al CtK'i Chapter 1-23, Article I ("Article I")(which the Applicant should g., 1 c oinjg business") and legal requirements), if the Disclosing Party (< ntjand is doing business with the City, then the Disclosing Party Applicant nor any controlling person is currently indicted or charged
<;ither f i
ill
criminal offense involvii perjury, dishonesty or diep
die:; and
Applicant understands doing business with the timeframe in Article I sU
Erseqc:
of, cr lasjever been convicted of, or placed under supervision for, any actus.1, attempted, or conspiracy to commit bribery, theft, fraud, forgery, :flit ag; inst an officer or employee of the City or any sister agency; and (ii) the acknowledges that compliance with Article I is a continuing requirement for ;}y. l\OTB! If Article I applies to the Applicant, the permanent compliance
jo^ne five-year compliance timeframes in certifications 2 and 3 below.
Page 4 of 13
Dec 07 16 01:31 p
2. The Disclosing Pe identified in Section II.B
:he Disclosing Party is a legal entity, all of those persons or entities EDjS:
arrec
uspended, proposed for debarment, declared ineligible or voluntarily
nslby any federal, state or local unit of government;
:i ii
period preceding the date of this EDS, been convicted of a criminal ad a civil judgment rendered against them in connection with: linj'or performing a public (federal, state or local) transaction or iction; a violation of federal or state antitrust statutes; fraud; ; bribery; falsification or destruction of records; making false ng stbjlen property;
i
or criminally or civilly charged by, a governmental entity (federal, any of the offenses set forth in clause B.2.b. of this Section V;
i
jeriod preceding the date of this EDS, had one or more public statij itt local) terminated for cause or default; and
>eriod preceding the date of this EDS, been convicted, adjudged civil [proceeding, or in any criminal or civil action, including actions
olations, instituted by the City or by the federal government, any 63. The certifications in. subparts 3.J 4 and 5 concern:
the City, using substaju with respect to ContrsitBrs, t[
ly contractor or subcontractor used by the Disclosing Party in udihg but not limited to all persons or legal entities disclosed under jntractors and Other Retained Parties"); e^i ingia person or entity that, directly or indirectly: controls the )7 the Disclosing Party, or is. with the Disclosing Party, under r> >n br entity. Indicia of control include, without limitation: or ownership; identity of interests among family members, shared facilities use o: employees; or organization of a business entity following the entM> o do business with federal or state or local government, including
ielly t < same management, ownership, or principals as the ineligible entity);
indirectly controls the control of another per • any responsible offi other official, agent cj ¦ eijnpio acting pursuant to the < flection Contractor or any Afff iaitcd
erm Affiliated Entity means a person or entity that directly or 2jintra|
Disclosing Party, any Contractor or any Affiliated Entity or any of the Disclosing Party, any Contractor or any Affiliated Entity, or authorization of a responsible official of the Disclosing Party, any tity (collectively "Agents").
I
! Page 5 of 13
Dec0716 01:32p
Neither the Disclosing P or any Contractor nor anj< respect to a Contractor, before the date of such C Matter:
bribed or attempt^ bribe, a public offa government or of; or employee's offij
agreed or collude agreement, or beedi prospective bidde otherwise; or
tyj, noi (atnk' Contractor, nor any Affiliated Entity of either the Disclosing Parly gent;; nave;, during the five years before the date this EDS is signed, or, with ffilifltp i Entity, or an Affiliated Entity of a Contractor during the five years or Affiliated Entity's contract or engagement in connection with the
1 bri ejr or £ stat cap
th oth| cjnvii:t< in re:;:
tractor
or,been convicted or adjudged guilty of bribery or attempting to plo^ee of the City, the State of Illinois, or any agency of the federal local government in the United States of America, in that officer's
'Hi
r bidders or prospective bidders, or been a party to any such
ions of
conduct described in a. or b. above that is a matter of record, but if such conduct; or
4. Neither the Disclo(sjiii|g Paji agents or partners, is banjetc engaging in or being con violation of 720 ILCS 5/ America that contains th
jnicipal Code Section 2-92-610 (Living Wage Ordinance).
from /jilted c 4;
or
same <:
Pai Fors [cjilrity -ie D
"filiated Entity or Contractor, or any of their employees, officials, ontracting with any unit of state or local government as a result of [) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in (3)jjmy similar offense of any state or of the United States of ipei-its as the offense of bid-rigging or bid-rotating.
ldsi:ig
und:
3enor;
nor any Affiliated Entity is listed on any of the following lists Assets Control of the U.S. Department of the Treasury or the :he U.S. Department of Commerce or their successors: the Specially ed Persons List, the Unverified List, the Entity List and the
laifds and shall comply with the applicable requirements of Chapters ), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the
ry is mjmbji: to certify to any of the above statements in this Part B (Further tig Parly must explain below:
Pace 6 of 13
Dec0716 01:33p
1 i If the letters "NA," the w > presumed that the Disclo' 8. To the best of the : complete list of all current I month period preceding t: of the City of Chicago (if i i' i 1 i. jrd "Nc ;r.g Pai ; >is clos enpk e ;xec l3ne,i i: " 5 :e i° P /as lion dica i )r no response appears on the lines above, it will be conclusively fified to the above statements. irty's knowledge after reasonable inquiry, the following is a of the Disclosing Party who were, at any time during the 12-pate of this EDS, an employee, or elected or appointed official, Je with "N/A" or "none"). 1 |109| II
! ¦ ¦
9. To the best of the | : complete list of all gifts fi 12-month period precediii official, of the City of Chi made generally available t course of official City bu; with "N/A" or "none"). \\ ¦ lisclos i at the ] g "he e . cago. : o City : iness c \ s to any 12 P ? il | |109| |
1 C. CERTIFICATION 0 j 1. The Disclosing Pa j a "financial institution" i 2. If the Disclosing I i "We are not and will not i Code. We further pledg: t lender as defined in Cha lender or becoming an a fii business with the City." If the Disclosing Party is j Section 2-32-455(b) of th; 2-32 of the Municipal Gc < I3TATL ty certif lot define: : y IS a (come < jat non er 2-3:, Hate {if rahle l< Muni; e, ex[ 1 i IM Us I in S fin a i | l I prf '? °f oftl 1 n Pr I i ma pal a in ! 1 S FINANCIAL INSTITUTION tat the Disclosing Party (check one) ection 2-32-455(b) of the Municipal Code. ncial institution, then the Disclosing Party pledges: datory lender as defined in Chapter 2-32 of the Municipal our affiliates is, and none of them will become, a predatory e Municipal Code. We understand that becoming a predatory ;datory lender may result in the loss of the privilege of doing ke this pledge because it or any of its affiliates (as defined in Code) is a predatory lender within the meaning of Chapter lere (attach additional pages if necessary):
! i Page 7 of 13
Dec0716 01:34p
If the letters "NA," the w conclusively presumed th
"No he Illi
|
' cr no response appears on the lines above, it will be Closing Party certified to the above statements.
D. CERTIFICATION R
ijc;
Any words or terms that;ijr« meanings when used in tihi$
:
defi Part
NTEREST IN CITY BUSINESS
Chapter 2-156 of the Municipal Code have the same
I. In accordance wit of the City have a financi entity in the Matter?
[] Yes
NOTE: If you checked Item D.l., proceed to Pai
J,'S eerie ¦ i
al nten £ l
i.
h/is" frl
2-1
in
flern
;>6-l 10 of the Municipal Code: Does any official or employee lis or her own name or in the name of any other person or
D.l., proceed to Items D.2. and D.3. If you checked "No" to
ity []
jrocess of competitive bidding, or otherwise permitted, no City lavje a financial interest in his or her own name or in the name of l "chase of any property that (i) belongs to the City, or (ii) is sold ?old by virtue of legal process at the suit of the City (collectively, ion for property taken pursuant to the City's eminent domain power arest within the meaning of this Part D.
r rperty Sale?
No
3. If you checked "Yfc$ officials or employees h;iv
Name
Address
ss
eip D.L, provide the names and business addresses of the City h interest and identify the nature of such interest:
Nature of Interest
4. The Disclosing Pjjiriy fujl be acquired by any City c|fficia
'(GjAREj
E. CERTIFICATION R
er certifies that no prohibited financial interest in the Matter will employee.
SLAVERY ERA BUSINESS
Please check either I] oi disclose below or in an a ,tj
2. be chmc
pw.' If the Disclosing Party checks 2., the Disclosing Party must
to
this EDS all information required by paragraph 2. Failure to Page 8 of 33
Dec0716 01:35p
;ments may make any contract entered into with the City in
ir
reflrr
oid
e bj
the City.
i i
vei: !
and nsut n
comply with these disclo-aujul*: connection with the Matte:
1. The Disclosing P,
air y
pred
:e.
If
the Disclosing Party and from slavery or slaveholdijij issued to slaveholders thai the Disclosing Party has m
2. The Disclosing ptjr
fpes of
es ;that the Disclosing Party has searched any and all records of ecessor entities regarding records of investments or profits olicies during the slavery era (including insurance policies roviuch records.
Ly vei
Disclosing Party has four d lecq'n
policies. The Disclosing! P,a tw yi i
Ml '
records, including the naijrj;e$ of lat, as a result of conducting the search in step 1 above, the
¦ i
investments or profits from slavery or slaveholder insurance ie's' that the following constitutes full disclosure of all such aij'd all slaves or slaveholders described in those records:
I (DNS FOR FEDERALLY FUNDED MATTERS
ifunded, complete this Section VI. If the Matter is not federally or purposes of this Section VI, tax credits allocated by the City dflthe City are not federal funding.
ofu ha'vi
i
ihejeHs.
tfGS|LOBBYING j
ieijsons or entities registered under the federal Lobbying laeje lobbying contacts on behalf of the Disclosing Party with if necessary):
:r
(If no explanation appear: appear, it will be conclusiyj-
registered under the Lob :y Disclosing Party with reis iebt
:to i
i 3 on the lines above, or if the letters "NA" or if the word "None" imbd that the Disclosing Party means that NO persons or entities lo'sure Act of 1995 have made lobbying contacts on behalf of the Matter.)
not
ty has
ii Pa: I
i; Olj
riembi'
spent and wrill not expend any federally appropriated funds to pay rapn A.l. above for his or her lobbying activities or to pay any tlempt to influence an officer or employee of any agency, as defined by f djongress, an officer or employee of Congress, or an employee of a irirjg into any cooperative agreement, or to extend, continue, renew, : x{ ;de|d contract, grant, loan, or cooperative agreement. Page 9 of 13
DecO716 01:36p
en
3. The Disclosing Paj which there occurs any ev forth in paragraphs A.l
at
4. The Disclosing Pa; i 501(c)(4) of the Internal Vjcn 501(c)(4) of the Internal ljtle Activities".
wil lha A.2
i
ccrtj
enu
i
enu
mitt an updated certification at the end of each calendar quarter in iWaterially affects the accuracy of the statements and information set oi.
; that either: (i) it is not an organization described in section ode of 1986; or (ii) it is an organization described in section ode of 1986 but has not engaged and will not engage in "Lobbying
n
5. If the Disclosing P; rt form and substance to para subcontract and the Disci
i
duration of the Matter an
Applicant, the Disclosing Party must obtain certifications equal in 1 ]|through A.4. above from all subcontractors before it awards any v riust maintain all such subcontractors' certifications for the ce such certifications promptly available to the City upon request.
B. CERTIFICATION REG\RT.
If the Matter is federally : ir ded
subcontractors to submit, ti: foil
negotiations ' 1
Is the Disclosing Party th Kppl
[ ] Yes . ! [I N
If "Yes," answer the thre jqtuest:
1. Have you develop d and federal regulations? (Se<: []Yes
3QUAL EMPLOYMENT OPPORTUNITY
ilejal regulations require the Applicant and all proposed ing information with their bids or in writing at the outset of
At?
; below:
ycru have on file affirmative action programs pursuant to applicable
CIR Pail 60-2.)
[]:
l i
2. Have you filed w Contract Compliance Pro under the applicable filir •
[ ] Yes
3. Have you particip p equal opportunity clause [ ] Yes
If you checked "No" to (j
M btlth
D :
eporting Committee, the Director of the Office of Federal t Equal Employment Opportunity Commission all reports due emits?
[]
d in ||ipy previous contracts or subcontracts subject to the []
stiqij \. oij 2. above, please provide an explanation:
Page 10 of 13
Dec07 1601:37p
SECTION VII- ACKTiljOWL COMPLIANCE, PENaIItIES
i)GMENTS, CONTRACT INCORPORATION, ISCLOSURE
The Disclosing Party und'rstanaf jjind
A. The certifications, dis contract or other agreerneft procurement, City assi of any contract or taking it must comply with all
B. The City's Governmei1i|ta the Municipal Code, imp work, business, or transactions line at www.cityofchicagc \c rg/
nc
n f. er
acknowledgments contained in this EDS will become part of any ie Applicant and the City in connection with the Matter, whether ...City action, and are material inducements to the City's execution n :yith respect to the Matter. The Disclosing Party understands that |dma'nces, and regulations on which this EDS is based.
ar i Campaign Financing Ordinances, Chapters 2-156 and 2-164 of duties and obligations on persons or entities seeking City contracts, lie lull text of these ordinances and a training program is available on ibsJ and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, with the applicable ordin
If the City determine-any contract or other agro voidable, and the City m void), at law, or in equity declining to allow the Dijs law for a false statement damages.
It is the City's policy d request. Some or all of tl made available to the pu:jl otherwise. By completir rights or claims which it contained in this EDS ar in this EDS.
L £0610, (312) 744-9660. The Disclosing Party must comply fully
information provided in this EDS is false, incomplete or inaccurate, 'connection with which it is submitted may be rescinded or be void or in* remedies under the contract or agreement (if not rescinded or g terminating the Disclosing Party's participation in the Matter and/or tarty to participate in other transactions with the City. Remedies at al fact may include incarceration and an award to the City of treble
lis, aocument available to the public on its Internet site and/or upon tion provided on this EDS and any attachments to this EDS may be lrijcrnct, in response to a Freedom of Information Act request, or nir4 this EDS, the Disclosing Party waives and releases any possible 'against the City in connection with the public release of information jio.'jizcs the City to verify the accuracy of any information submitted
E. The information provi
Party must supplement t:is
contract being handled tyjthe
update this EDS as the comradt
r 11 l
iproV
23 an,
Chapter 1-23 of the MunfeipaJ1
offenses), the informatio
as required by Chapter 1
is EDS must be kept current. In the event of changes, the Disclosing | the time the City takes action on the Matter. If the Matter is a Department of Procurement Services, the Disclosing Party must res. NOTE: With respect to Matters subject to Article I of e |imposing PERMANENT INELIGIBILITY for certain specified 1 i herein regarding eligibility must be kept current for a longer period, ^ctjion 2-154-020 of the Municipal Code.
The Disclosing Party rep[repenjt^|ajiid! warrants that:
Page 11 of 13
Mil i
Dec0716 01:38p
|1010|
. ]: iLJucnt in the payment of any tax administered by the Illinois
^mparkinj;
] ^losing Party or its Affiliated Entities delinquent m paying any , &ity- This includes, but is not limited to, all water charges, 1 Spelts, property taxes or sales taxes.
^;jd' icant,
w-ui, the Disclosing Party and its Affiliated Entities will not
use,
any facility listed by the U.S. E.P.A. on the federal Excluded by the U. S. General Services Administration.
F.3 If the Disclosing contractors/subcontractors form and substance to thos^ City, use any such c Disclosing Party has reasor
s the d tr
11
F ut be
iwd
be
icant, the Disclosing Parly will obtain from any hired in connection with the Matter certifications equal in 12. above and will not, without the prior written consent of the A that does not provide such certifications or that the « hi k not provided or cannot provide truthful certifications. ^
NOTE: If the Disclosing Ps:{tjj caf explanatory statement mnsl
CERTIFICATION
Jdt certify as to any of the items in. F.l., F.2. or F.3. above, an Jd 16 this EDS.
Under penalty of perjury, thb this EDS and Appendix A f. fljippiijtjyble" certifications and statemen:: cont i i :p ii t and complete as of the date fihpriisflfli
sjigfling below: (I) warrants that he/she is authorized to execute^ ' on behalf of the Disclosing Party, and (2) warrants that all _ this EDS and Appendix A (if applicable) are true, accurate ^ to: me City. x
hem
(Print or type name of Disc lop
(Signh-
perse
(Print or type name of
(Print or type title %l persoji
Signed and sworn to befor; at fo^y County
Commission expires:|10 10|
5 S^c^fr
—; I —i- -= '—
Vvp £5 (state).
Notary Public
ji ¦ ii - 1 ' * -* *
OfHCIW. SEAt
Notary Public - SUta of My Commiaton tyim etc 3,2017
Page 12 of 13
(DO NOT SUBMJXTHIS PAGE \VITH YOUR EDS. The.purposc of this p&ge is for you to rccerflfy.ypvu- EDS prior io subnussion t(t City Council or on the date of closing. If unablo to recertify tmthfiilly, the Disclosing Party must complete a new EDSAVilh correct or corrected tnfortnation)
RECEHTIEICATION
OctKJrtlty, for utts with City Couacil matters. Not for City procurements unless request^ Thai ^certification being submitted in connection with 3S0B w' )?lqu*n°y St>
{identify the Matter). Under penalty of perjury, the person signing below: (1) warrantothai he/she is auuWfcocd to execute this EDS rcocrtifioation oa behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS aro true, accurate end complete as of (he date fimusfced to the CUy and continue to bo true, accurate add complete as of tho date of tills rscertiflcatfofl, and (3) rcaffirins its «ofcnx*wf«dgn.wnt«.
liVIR 1999 FAMILY TXVST
(Print or type' legal name of Disclosing Party) By:
(sign here)
Print or type name of signatory;
Teresa C; Bulk
Title of signatory;
TruBtee
Signed and sworn to before me on [date]
312^/2^7 by
TtyfrP*- c. i^lK. ,a( t-b^Y. County. jr\\vKoi) fatatc].
Notary Public.
QfflCIAl SEAL 8AAMftA L WfL'EVf OIK NQiaryt?ubl|e-9Ut945t Illinois My Commfetlon Empires pec 3,207/
V«r. I t4l-4S
'Dec0716 01:39p
C1TV OF CHICAGO iJSCLOSTJRE STATEMENT AND AFFIDAVIT APPENDIX A
FAMILIAL RELATIONS H IPS NWiTH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
J .pf 1:
jwner:
This Appendix is to be ornership interest in the which lias only an indirect
crfyY
Under Municipal Code S jjcj: on 2\ or any "Applicable Party" 01 any S > any elected city official or di :partm" signed, the Disclosing Party the mayor, any alderman, thi partner or as any of the folio ^yiijig, niece or nephew, grandparer |j or stepmotlier, stepson or ste pd
I I.
I pii
est in tl
"Applicable Party" means (1) a Disclosing Party is a corporc tie i; a partnership; all general partr ers ana partnership; all managers, man's gin
limited liability company; (2) a
a 7.5 percent ownership inte operating officer, executive {liijecto}:, exercising similar authority.
letxc
y by (a) the Applicant, and (b) any legal entity which has a direct jeding 7.5 percent. It is not to be completed by any legal entity interest in the Applicant.
4-< jl5, the Disclosing Party must disclose whether such Disclosing Party seer Domestic Partner thereof currently has a "familial relationship" with |I ea i. A "familial relationship" exists if, as of the date this EDS is
pli sable Party" or any Spouse or Domestic Partner thereof is related to
th; city treasurer or any city department head as spouse or domestic the: |by blood or adoption: parent, child, brother or sister, aunt or uncle,
Id] father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather
stl pbrother or stepsister or half-brother or half-sister.
icx tive officers of the Disclosing Party listed in Section ILB.l.a., if the
rs of the Disclosing Party, if the Disclosing Party is a general ile k partners of the Disclosing Party, if the Disclosing Party is a limited mj iers and members of the Disclosing Party, if the Disclosing Party is a jj>al officers of the Disclosing Party; and (3) any person having more than bis :losing Party. "Principal officers" means the president, chief l ief financial officer, treasurer or secretary of a legal entity or any person
Does the Disclosing Part) have a "familial relationship
[ ] Yes
icable Party" or any Spouse or Domestic Partner thereof currently ed city official or department head?
No
the nai Shm,jrjj}[(;l4)
nan le and title of such person, (2) the name of the legal entity to which j in| title of the elected city official or department head to whom such le precise nature of such familial relationship.
Page 13 of 13
Dec 07 16 01;:15p
P.1
CITY OF CHICAGO JCLOSURE STATEIVfENT AND AFFIDAVIT APPENDIX B
BUILDING C
This Appcndi which has a director It is not to be compk the Applicant.
FJPLAVWPROBLEM LANDLORD CERTIFICATION
) i 1
jqpmpletcd only by (a) the Applicant, and (b) any legal entity tercst in the Applicant exceeding 7.S percent (an "Owner"), legal entity which has only an indirect ownership interest in
1. Pursuant to Mj|itcipal building code Hppfflaw Code?
fie Section 2-154-010, is the Applicant or any Owner identified as a problem landlord pursuant to Section 2-92-416 of the Municipal
[ ]Yes
If the Applica t the Applicant; 2-92-416 oftl
[ JYes
salej;; ' tifie 3 unic
[^No
entity publicly traded on any exchange, is any officer or director of a building code scofflaw or problem landlord pursuant to Section iliCode?
(J^Not Applicable
3. Ifyesto(l)o identified as buildings to
please identify below the name of the person or legal entity
tde scofflaw or problem landlord and the address of the building or
rtinent code violations apply.
FILLING 0 AND AGRE REFEREN AND THA' SUBJECT PERJURY
fjTHljSj APPENDIX B CONSTITUTES ACKNOWLEDGMENT yfEW:' HAT THIS APPENDIX B IS INCORPORATED BY
INTO. VND MADE A PART OF, THE ASSOCIATED EDS, * 'IjIE R £ 'RESENTATIONS MADE IN THIS APPENDIX B ARE
THE ( ERTIPICATION MADE UNDER PENALTY OF IWTAC) IZ'OF THE ASSOCIATED EDS.