RESOLUTION CLASS 6(B) REAL ESTATE TAX INCENTIVE FOR THE BENEFIT OF 4401 WEST KINZIE LLC, AN ILLINOIS LIMITED LIABILITY CORPORATION, AND
REAL ESTATE LOCATED GENERALLY AT
4401-25 WEST KINZIE STREET IN CHICAGO, ILLINOIS
, :; „ PURSUANT TO COOK COUNTY, ILLINOIS
TAX INCENTIVE ORDINANCE, CLASSIFICATION SYSTEM FOR ASSESSMENT
WHEREAS, the Cook County Board of Commissioners has enacted the Cook County Tax Incentive Ordinance Classification System for Assessment, as amended from time to time (the "County Ordinance"), which provides for, among other things, real estate tax incentives to property owners who build, rehabilitate, enhance and occupy property which is located within Cook County, Illinois and which is used primarily for industrial purposes; and
WHEREAS, the City of Chicago (the "City"), consistent with the County Ordinance, wishes to induce industry to locate and expand in the City by supporting financial incentives in the form of property tax relief; and
WHEREAS, 4401 West Kinzie LLC, an Illinois limited liability corporation (the "Applicant") owns certain industrial real estate located generally at 4401-25 West Kinzie Street, Chicago, Illinois 60624 as further described on Exhibit A hereto (the "Subject Property"); and
WHEREAS, the Subject Property is occupied by Why Not Iron, Inc., an Illinois corporation (the "Tenant"), and an industrial metal fabrication business which manufactures, fabricates and installs custom-designed architectural and structural metalwork; and
WHEREAS, the Applicant intends to substantially rehabilitate the approximately 27,664 square foot Subject Property, including tuckpointing, repairing damaged masonry, replacing lintels, replacing windows and doors, repairing the roof and installing ornamental iron grilles; and
WHEREAS, the redevelopment objective of the City in connection with the Subject Property is to encourage industrial investment and job creation and thereby enhance its contribution to the growth and vitality of the area; and
WHEREAS, it is intended that the Applicant will lease the Subject Property to the Tenant for use in its industrial metal fabrication business, which manufactures, fabricates and installs custom-designed architectural and structural metalwork; and
WHEREAS, the Applicant has filed an eligibility application for a Class 6(b) tax incentive under the County Ordinance with the Office of the Assessor of Cook County (the "Assessor") an ,ri eligibility application for a .Class 6(b) tax incentive under the County Ordinance; and
WHEREAS, the Subject Property is located within the" (i) Northwest Industrial Corridor Redevelopment Project Area (created pursuant to the Illinois Tax Increment Allocation Redevelopment Act, 65 iLCS .5/11-74.4-1 et. seq., as amended, and pursuant to ah ordinance enacted by the City Council of the City); (ii) Northwest Industrial Corridor, Industrial Growth|1010|
Zone (created pursuant to an ordinance enacted by the City Council of the City, as amended); and (iii) City of Chicago Enterprise Zone No. 5 (created pursuant to the Illinois Enterprise Zone Act, 20 ILCS 665/1 et seq., as amended, and pursuant to an ordinance enacted by the City Council of the City, as amended), and the purposes of Redevelopment Project Areas and Enterprise Zones are also to provide certain incentives in order to stimulate economic activity and to revitalize depressed areas; and
WHEREAS, it is the responsibility of the Assessor to determine that an application for a Class 6(b) classification or renewal of a Class 6(b) classification is eligible pursuant to the County Ordinance; and
WHEREAS, the County Ordinance requires that, in connection with the filing of a Class 6(b) eligibility application with the Assessor, the applicant must obtain from the municipality in which such real estate that is proposed for Class 6(b) designation is located a resolution expressly stating, among other things, that the municipality has determined that the incentive provided by Class 6(b) is necessary for development to occur on such real estate and that the municipality supports and consents to the Class 6(b) classification by the Assessor; and
WHEREAS, the intended use of the Subject Property will provide significant present and future employment; and
WHEREAS, "notwithstanding the'"Class 6(b) status of the Subject Property, the redevelopment and utilization thereof will generate significant new revenues to the City in the form of additional real estate taxes and other tax revenues; now, therefore,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1: That the City determines that the incentive provided by Class 6(b) is necessary for the development to occur on the Subject Property.
SECTION 2: That the City supports and consents to the Class 6(b) classification by the Assessor with respect to the Subject Property.'
SECTION 3: That the Economic Disclosure Statement, as defined in the County Ordinance, has been received and filed by the City.
SECTION 4: That the Clerk of the City of Chicago is authorized to and shall send a certified copy of this resolution to the Office of the Assessor and a certified copy of this resolution may be included with the Class 6(b) eligibility application filed with the Assessor by the Applicant, as applicant, in accordance with the County Ordinance.
SECTION 5: That this resolution shall be Bjpit^NQ^iT^\^\.i^jJk>^ its passage and
approval. / i ~——
ny/raBte-crason Ervin
Iderman, 28th Ward
EXHIBIT A
Legal Description of Subject Property:
LOTS 1,2,3,4,5,6,7,8,9,10 AND 11 IN THE RESUBDIVISION OF BLOCK 5 IN THE WEST CHICAGO LAND COMPANY'S SUBDIVISION OF THE SOUTH HALF OF SECTION 10, TOWNSHIP 39 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS
COMMONLY KNOWN AS 4401-25 WEST KINZIE STREET, CHICAGO, IL 60624
Permanent Index Number(s): 16-10-304-008-0000
16-10-304-009-0000 16-10-304-010-0000 16-10-304-011-0000 16-10-304-012-0000 16-10-304-013-0000 16-10-304-014-0000
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I--GENERAL INFORMATION
Av Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
. 4401 WeBt Kinzie LLC ' ' '
ChecK ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is: 1. Oft the Applicant OR
•2 [ ] " a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the AppUcani in which the Disclosing Party holds an interest: OR ! •• "
3. [ ] a legal entity wjth a right of control (see Section JJ.B.1.) State the legal name of the entity in
.which the Disclosing Party holds a right of control: : ; '
,v/-*-^:'"- . • .¦•-»« Y'-. ' •' v.*.'-"."-- • .¦ '. ¦ t . •
4425 W. Kinzie
B. Business a&dress of the Disclosing Party:
Chicago, IL 60624
„ T , , . 773-379-07.00 ., „ ' 773-379-0707 „ officemanagerg
C. . Telephone:; Fax: ' Email: whynotiron.com
D. Name of contact person: _t[__i___Z
v
E. Federal Empjoyer 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):
Application for Class 6Ih Status for 4401 W. Kinzie Ave.
Which City agency or department is requesting this EDS? Dept. of Planning & Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Ver. 01-01-12 Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
[] Person Ik] Limited Liability company
[ ] Publicly registered business corporation [ ] Limited liability partnership ,,
[ ] Privately held business corporation [ ] Joint venture
[] Sole proprietorship [] Not-for-profit corporation
[ ] General partnership ' (Is the not-for-profit corporation also a 501 (c)(3))?
[ ] Limited partnership [ ] Yes ' [ ] No
[ ] Trust [ ] Other (please specify) -
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Illinois • ¦ ¦ *
3. For legal entities not organized in the State of Illinois: Has the organization registered to do • business-in the State of Illinois as a foreign entity?
[]Yes ' []No •' ' . :[]N/A ¦¦. ' '"
B. D7 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 b'ability 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'
Sean R. Kelly, Manager' .
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in, a corporation, partnership interest in a partnership or joint venture,
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interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE; Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure. "
Name Business Address Percentage Interest in the "
Disclosing Party -
Sean R. Kelly, A425 W. Kinzie, Chicago 60624 ' lOC/e,.
SECTION HI - 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 . • jxINo
If yes, please identify below the name(s) of such City elected official(s) and.describe such
relationship^): ' V '¦• • • . -' - „
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney,
lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained
or expects to retain in connection with the Matter, as well as the nature, of the relationship, and the total
amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose
employees who are paid solely, through the Disclosing Party's regular payroll. • . ¦
"Lobbyist" means any person or entity, who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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Name (indicate whether retained or anticipated-to be retained)
Business Relationship to Disclosing Party Fees (indicate whether
Address (subcontractor, attorney, . paid or estimated.) NOTE:
lobbyist, etc.) "hourly rate" or "t.b.d." is
71 not: an acceptable response.
tlaw Offices of Terrence Kennedy, Jr. - 180 N. LaSalle, //2650, Chicago, liLL 60601
Attorney for Class 6B Application - $3,000
Has Been Retained ' .
(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
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. •
' ' * • • ' : V ;. • • •/ : .
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [x] No • - [ ] No person directly or mdirectly owns 10% or more of the
' Disclosing Party. '.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that .agreement?
[ ] Yes []No • ¦ ,. ? ; " '
* *
FURTHER CERTIFICATIONS ' • . . ,
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.
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The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B. 1. of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactionsby 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 arcivil judgment rendered against them in connection with:
- " obtaining,'attempting to obtain; dr 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;; . j ¦- •
arenot presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with cornmitting 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 founiiiable in a civil proceeding, or in any criminal or civil action, including actions
concerning'enykonmental violations, instituted by the City or by the. federal government, any
state, or any offierunit of local government' :.' ' "'.-.•/V'
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 DisclosingTarty, any Contractor or anyAffiliated 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 airy Affiliated Entity (collectively "Agents").
Page 5 of 13
Neither the Disclosing- Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party
...or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with
respect to a- Contractor, an- Affiliated Entity, or an Affiliated Entity of a Contractor during the five years
before the date df such Contractor's or Affiliated Entity's contract or engagement in connection with the
Matter: ¦ -
a: 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 brof any state oflcVal government in the United States of •America, in that officer's
. or: employee's official capacity; .; i. ,
b. agreed or colluded with other-bidders or prospective bidders, or been a party to any such -agreement, or-been convicted of 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
c made an admission of such conduct described in a. or b. above that is a matter of record, but have not be.en prosecuted for such conduct; or
d. - violated the provisions of Municipal Code Section 2-92-610 (Living ^age Ordinance).
4-, Neitherthe Disclosing Party, Affiliated,Entity or,Contractor, or any of their employees, officials,, agents or partaers/i?i barred from contacting with any unit of, state or local goverhmpiit as a resiilt of engaging in or tieing convicted of (1.) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 TLCS. 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.
¦ . / ' '•' •'¦*-; j.' ." _•'";• /• -.- •.••'•'iK •;' ;
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 Pjersons List, the Unverified.List, the Entity List and the.
Debarred List. .' '¦/''"• : '\ .'.'•} • V ' "• .
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Not Applicable
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed-that the Disclosing Party certified to the above statements.
8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
None
9. To'the best of the Disclosing Party's knowledge after reasonable inquiry, the following isa. 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'.' 7 ¦
None • ' • ': ' : ¦ ' ' '
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION. / ' . " -1,~-The Disclosing Party certifies that the Disclosmg Party (check-one)
[]is - Fjt]isnot " - =
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
• i .¦ v .'• \,. v -. ; ... ... . . . ; •.-
2. If the Disclosing Party IS a fmancial institution, men the Disclosm^
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable, to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender wititin the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages if necessary): - -
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words.or terms that are defined in Chapter 2-156 of the Municipal Code have the same
meanings when used in this Part D. . 1
•1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes H 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, interestin hisor her own name or in the name of any other person or entity in the purchase of any property.'uiat (i) belongs to'theCity, of (ii) is sold' fortixesi or assessments, of (iii) is sold .by virtue .of legal process at the suit of the City (coUectiyely,-"dity Property Sale")-j Compensation for property taken pursuant to the City's eminent domain power does notconstitute a financial interest within me meaning of this Part D.
. Does the Matter involve a City Property Sale? r
[]Yes irJNo • "
If you checked'IYes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address ' Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1.' or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including.insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has.found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the.
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes .full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTmCATIONSTOR FEDERALLY FUNDED MATTERS
' '-; . '¦ .' . '*' ¦• . ¦ ' ' ' '
NOTE: If the Matter is federally funded, complete this Section VI If the Matter is not federally funded, proceedfo Section .VII. F^r purposes of this Section" VI; tax credits allocated .by. theCity' v : and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None", appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities ' registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has hot 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; urconnection with the award of any federally funded contract, jnaking any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of "each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The Disclosing Party certifies that either: (i) it is not ah organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities": ,
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the-City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed
subcontractors to subnjit the following information with their bids or in writing at the outset of
negotiations. ',' . • ¦ '* • .; , ...
Is the Disclosing Party the Applicant?
I I Yes ' '[' []No' ... '•
If "Yes," answer the three questions below:
¦ Have you developed and do you have on file affirmative, action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.) .
[]Yes - [jNo ' . Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, pr th6 Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
? Yes t|No
3. Have you participated in any previous contracts or subcontracts subject to the
equal opportunity clause?
[] Yes [ | No
If you checked "No" to question 1. or 2. above, please provide an explanation:'
Page 10 of 13
SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and. agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement;, City assistance, or Other .City action, and are material inducements to the City's, execution of any contract or taking other action with respect to the Matter.'- The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicago.ore/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, LL 60610, (312) 744-9660, The Disclosing Party must comply fully
with the applicable ordinances. " " - < • .'''
' -¦ • •.' ¦< .• , ; .,- . '. ' ;v ' -• . -' ¦
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 he rescinded or be' void or
voidable, and me City, may pursue any remedies under the cbnp^ctpt agreement (if not rescinded or
void), at law, or m "equity, including terminating the. Disclosing Party's participation in the Matter and/or
declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at
law for a false statement of material fact may include incarceration and an award to the City of treble
damages. ••„ •'. - . ' ; •' ':
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the-information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives, and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS. '
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 aiqnger period,
as required by-Chapter-1-23 and-Section-2-154-^020 of the Municipal Code
The Disclosing Party represents and warrants that:
Page 11 of 13
The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sever charges, license fees, parking tickets, property taxes lor sales taxes.
F.! t If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not usnor permit their subcontractors to use, any facility listid! by the U.S. E.P.A. on the federal Excluded Ps rties List System ("EPLS") maintained by the U. S. General Services Administration.
F,) If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any
cc ntractors/subcontractors hired or to be hired in connection* with the Matter certifications equal in
form and substance to those in F. 1. and F.2. above and will not, without the prior written consent of the
C ry, use any such contractor/subcontractor that does not provide such certifications or that the
D sclosing Party has reason to believe has not provided or cannot provide truthful certifications.
N
3TE: If the Disclosing Party cannot certify as to any of thl items in F.l., F.2. or F.3. above, an planatory statement must be attached to this EDS. ; I
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute tl is EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate a id complete as (of the date furnished to the City.
C 'rint or type/name of Disclosing Party)
*rint or type name of person signing)
4401 West Kinzie. LLC
fiPrint or type title of person signing)
Signed and sworn to before me on (date) _
lit CcWtC County. ~HU.nJo\^ (state).
A _s ¦///^^-^V_ Notary Public.
J -
Commission expires:_
OFFICIAL SEAL LINDA M NORWICK NOTARY PUBLIC • STATE OF ILLINOIS MY COMMISSION EXPIRES 04.'19n8
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDLX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
„ This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in the^ Applicant exceeding 7.5 percent . It Is not to be completed by any legal entity
which has bnry an indLrecito c '. •! .
Under Municipal Code Section 2:154-015, the Disclosing Party must disclose whether such Disclosing Party
or any "Applicable Party" or any Spouse or Domestic Parmer thereof currently has a "familial relationship" with
any elected city official or department head. A "familial relationship" exists if, as of the' date this EDS is
signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to
the mayor, any alderman, the city clerk, the city treasurer of any city department head as spouse pr domestic
partner of .as any ofv0iefo^o\id^'^e^^py blood or adoption; pareht^cn^ ailnt or uncle,
niece or nephew, grlrndparerit- godchild, father-in-law, mbther^in-law, sbhrin-kw, driugh'tCT-iiWaw, stepfather , or stepmomer, W'b; 's^a^gn^/s^Drbmer or stepsister .or half-brother ox haif$istpr. *-. • ' \ "Applicable Party? means, .(1) all. executive officers of the Disclosing Party hsted. in Section ILB. 1 .a., if the Disclosing Earty^a^
paxmership; all general patbiers arid h^nited^parrners' ojthe pisclpsing Party, if the Disclosing Party is a limited
partnership; aU'managers, managing members and members of the Disclosing Party, if ie.Dis.cl'osing Party is a
limited liability company, _2) all principal officers'.o'f the Disclosing Party; and (3) any per^onhaving more than
a 7.5 percent ownership interest in the ^Disclosing Party. 'Trinripal officers" me^:thepresident, chief,
operating officer, execiitiye director,'cliief financial officer, treasurer or secretary of a. legal entity or any person
exercising similar authority. , " "' ,i - ' • •¦ '• • :
. . Does the Disclosing Party or any "Applicable. Party" or any Spouse or Domestic Partner thereof currently
have a "fanrilial relationship" with an elected city official or department head? I s <
. []Yes . i Vr* ^[^No % ' ": "': ^.
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
GITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
. APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
' This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity
which has a direct ownership interest in ,the Applicant exceeding 7.5 percent (an "Owner").
It is not to be completed by any legal entity which has only an indirect ownership interest in
the Applicant., . ¦. '¦ ' - \:."'
Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes . " ." [ xl No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section
.2>92-416 of the Municipal Code? ' .;; ¦ ' -\ -.; ; •' f -
" [ IYes-. ' ¦ \: ' :^:X'p- [ ]No . : , -vtx]NotAppticabie
3. If yes to (1) or (2) above, please identify below the name of the person or legal entity
' identified as a building code scofflaw or problem landlord and die address of the building or • buildings to which me pertinent code violations apply v
FILLING OUT THIS APPENDIX B CONSTTTUTES ACKNOWLEDGMENT AM) AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I -- GENERAL INFORMATION
Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Why Not Iron Inc.
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
jSj the Applicant
OR
t 3.a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the
Applicant in which the Disclosing Party holds an interest: _ • . -
OR
3. [] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control: ]
Business address of the Disclosing Party: 4425 W. Kinzie Ave Chicago. IL 60624
officemanager@
Telephone:(773)379-0700 Fax: (312)379-0707 Emailwhynottron.com
Name of contact person: Sean Kelly
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):
Application claaa 6B Status - 4401 V. Kinzie Ave., Chicago
Which City agency or department is requesting this EDS? Dept of Planning and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract # '
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
[ ] Person [ ]
[ ] Publicly registered business corporation [ ]
Privately held business corporation [ ]
[ ] Sole proprietorship [ ]
[ ] General partnership (Is
[ ] Limited partnership
[ ] Trust [ ]
Limited liability company Limited liability partnership Joint venture
Not-for-profit corporation
the not-for-profit corporation also a 501(c)(3))?
[ ] Yes [ ] No
Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[]Yes []No PfN/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Patricia Kelly, President
Sean Kelly. Vice President
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,
Page 2 of 13
interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party 1
Patricia Kelly-4225 W. 'Kinzie. Chicago, IL 60624 ":. S/% ¦ :
Sean Kelly -4223 W. Kinzie, Chicago, IL 60624 V97q '
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 fcJNo
If yes, please identify below thename(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: .(l) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 13
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address. (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(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
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes kiNo [] 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 nNo
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
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:
a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from any transactions by any federal, state or local unit of government;
b. have not, within a five-year,period preceding the date of this EDS, been convicted of a criminal
¦ : offense, adjudged guilty, or had a-civil judgment rendered against them in connection with":
obtaining, attempting to 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.
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 either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is-signcd, 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:
. a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officec.or.employee of the City; the State of Illinois, or any agency, of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.
If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further
Certifications), the Disclosing Party must, explain below: . ,. .
Page 6 of 13
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-
monthperiod preceding the execution date of this EDS, an.employee, or elected or appointed official,
of the City of Chicago (if none;;indicate with "N/A" or "none").''" *¦ :ii * "
: H/A - :
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.
~~- n/a ~ ~7T~ . , , Z ' ~ ~~7.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [)!| is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal ' Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in
Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter
2.-32 of the; Municipal Code, explain here (attach additional pages if necessary): - * j
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 H 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?
[]Yes fJNo
If you checked "Yes" to Item D.l., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS * "
Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to
Page 8 of 13
comply with these disclosure requirements may make any contract entered into with the City in connection with the.Matter voidable by the City.
XX 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party-has found no such records. .
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
, 2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l . above for his or her lobbying activities or to pay any ' person or. entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer of employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Page 9 of 13
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
The. Disclosing Party certifies that either: (i) it is not an organization described in section • 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed
subcontractors to submit the following information with their bids or in writing at the outset of
negotiations: " - ... - «
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes ' [ ] No
If you checked-"No" to question 1. or 2. above, please provide an explanation:.
Page 10 of 13
SECTION VII-- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other-agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N.
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
If the City determines that any. information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified
offenses), the information provided, herein regarding eligibility must .be kept, current for.a longer period,
as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.
The Disclosing Party represents and warrants that:
Page 11 of 13
F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by tbe Illinois D:partment of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any flic, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, se wer charges, license fees, parking tickets, property taxes or sales taxes.
F, 2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not u; e, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.
rm and substance to those in F.l. and F.2. above and will pot, without the prior written consent of the ry, use any such contractor/subcontractor that does not provide such certifications or that the
F 3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any cc ntractors/subcontractors hired or to be hired in connection with the Matter certifications equal in fd C
Disclosing Party has reason to believe has not provided or!cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an e; planatory statement must be attached to this EDS. ! j
I
:rtification !
i
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all ce rtifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate ai d complete as of the date furnished to the City.
(P
Sunn RKelly
rint or type name of person signing)
Vice President
(F rint or type title of person signing)
Signed and sworn to before me on (date) at) £TcX>tC County, ^tlf/Oulj (state).
Notary Public.
OFFICIAL SEAL LINDA M .\ORWICK NOTARY PUBLIC ¦ STATE OF ILLINOIS MY COMMISSION EXPIRES 04/19/18
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDLX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section ILB.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ] Yes [X] No
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 13
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
1. Pursuant to Municipal Code S ection 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes [x^No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?
[ ]Yes [ ]No px] Not Applicable
3. If yes to (1) or (2) above, please identify below the name of the person or legal entity
identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.
FELLING OUT THIS APPENDLX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDLX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDLX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.
CITY OF CHICAGO AFFIDAVIT FOR COOK COUNTY CLASS 6b TAX INCENTIVE
On behalf of 4401 West Kinzie, LLC (the "Applicant"), I hereby certify, represent and warrant the
following to the City of Chicago:
Attached as Exhibit 1 hereto and hereby incorporated herein is a true and correct list of all real estate owned in Cook County, Illinois by the Applicant, including all permanent index numbers associated with 'such real estate.
Attached as Exhibit 2 hereto and hereby incorporated herein is a true and correct Disclosure of the Ownership Interests of the Applicant as set forth in Cook County's Code of Ethical Conduct (Cook County, III., Code, Ch. 2, Art. VII, Div. 2, Subdiv. VI, Section 2-610).
The Applicant is not delinquent in the payment of any property taxes administered by Cook County or by a local municipality.
Attached as Exhibit 3 hereto and hereby incorporated herein is a true and correct Cook County Incentives Class Living Wage Ordinance Affidavit ("Living Wage Affidavit") for the Applicant. The Applicant hereby represents and warrants that it shall provide a Living Wage Affidavit to the City for any lessees of the Subject Property (as hereinafter defined) who enter into a lease for the Subject Property on or after July 1,2020.
The Applicant is in compliance with all applicable laws, as required by the Cook County Tax Incentive Ordinance, Classification System for Assessment, as amended from time to time (the 'Tax Incentive Ordinance").
Under penalty of penury, I hereby certify, represent and warrant that I have the knowledge and the authority to provide this Affidavit to the City of Chicago on behalf of the Applicant. This Affidavit shall be deemed to be the Applicant's Economic Disclosure Statement, as defined in the Tax Incentive Ordinance. The Applicant hereby submits this Affidavit to the City of Chicago for purposes of complying with the provisions of the Tax Incentive Ordinance.
I hereby acknowledge that the City of Chicago has not, and will not independently verify the certifications, representations and warranties contained herein. I further acknowledge that the City of Chicago is entitled to and is in fact relying upon the certifications, representations and warranties contained herein in connection with its support and consent for the Class 6b application of the Applicant to the Office of the Assessor of Cook County, Illinois pursuant to the Tax
Incentive Ordinance in connection with property located at 4401-4425 W. Kinzie Avenue , in
Chicago, Illinois (the "Subject Property").
I understand and acknowledge that if the certifications, representations or warranties contained herein arc untrue in any respect, the support and consent of the City of Chicago for the Class 6b classification of the Subject Property may be revoked, and other penalties at law or in equity may apply.
APPLICANT:
Print Title of Signatory: Mjanager /Aoprvt
Signed and sworn before meonC^A^J^"TV1,' 2,QlH (Date)
Go £k- ,. (County) 1 PQjiVvr > ^ (State)
CaO--^- (Notary Public)
lyConun^jon expires on \ <3l_\ - a fl" •
OFFICIAL SEAL-INGR1DLLUNA NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES.12/16/19
EXHIBIT 1
Sec attached list of all real estate owned in Cook County, Illinois by the Applicant, including all permanent
index numbers associated with such real estate.
Property Address Property Index Number
4401 W. Kinzie St. 16-10-304-014-0000
4403 W. Kinzie St; 16-10-304-013-0000
4405 W. Kinzie St. 16-10-034-012-0000
4409 W. Kinzie St. 16-10-304-011-0000
4411 W. Kinzie St. 16-10-304-010-0000
4415 W. Kinzie St. 16-10-304-009-0000
4425 W. Kinzie St. 16-10-304-008-0000
EXHIBIT 2
See attached Cook County Disclosure of Ownership Interests of the Applicant.
CONTRACT #:
COOK COUNTY ECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT INDEX
Section Description Pages
|109|Instructions for Completion of EDS EDS i - ii |109|Certifications EDS 1-2 |109|Economic and Other Disclosures, Affidavit of Child Support Obligations, Disclosure of Ownership Interest and Familial Relationship Disclosure Form EDS 3-12 |109|Cook County Affidavit for Wage Theft Ordinance EDS 13-14 |109|Contract and EDS Execution Page EDS 15-17 |109|Cook County Signature Page EDS 18
CONTRACT #:
SECTION 1 INSTRUCTIONS FOR COMPLETION OF ECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT
This Economic Disclosure Statement and Execution Document ("EDS") is to be completed and executed by every Bidder on a County contract, every Proposer responding to a Request for Proposals, and every Respondent responding to a Request for Qualifications, and others as required by the Chief Procurement Officer. The execution of the EDS shall serve as the execution of a contract awarded by the County. The Chief-Procurement Officer, reserves the right to request that the Bidder or Proposer, or Respondent provide an updated EDS on an annual basis.
Definitions. Terms used in this EDS and not otherwise defined herein shall have the meanings given to such terms in the Instructions to Bidders, General Conditions, Request for Proposals, Request for Qualifications, as applicable.
Affiliate means a person that directly or indirectly through one or more intermediaries, Controls is Controlled by, or is under common Control with the Person specified.
Applicant means a person who executes this EDS.
Bidder means any person who submits a Bid.
Code means the Code of Ordinances, Cook County, Illinois available on municode.com .
Contract shall include any written document to make Procurements by or on behalf of Cook County.
Contractor or Contracting Party means a person that enters into a Contract with the County.
Control means the unfettered authority to directly or indirectly manage governance,-administration, work, and all other aspects of a business.
EDS means this complete Economic Disclosure Statement and Execution Document, including all sections listed in the Index and any attachments.
Joint Venture means an association of two or more Persons proposing to perform a for-profit business enterprise. Joint Ventures must have an agreement in writing specifying the terms and conditions of the relationship between the partners and their relationship and respective responsibility for the Contract
Lobby or lobbying means to, for compensation, attempt to influence a County official or County employee with respect to any County matter.
Lobbyist means any person who lobbies.
Person or Persons means any individual, corporation, partnership, Joint Venture, trust, association, Limited Liability Company, sole proprietorship or other legal entity.
Prohibited Acts means any of the actions or occurrences which form the basis for disqualification under the Code, or under the Certifications hereinafter set forth.
Proposal means a response to an RFP.
Proposer means a person submitting a Proposal.
Response means response to an RFQ.
Respondent means a person responding to an RFQ.
RFP means a Request for Proposals issued pursuant to this Procurement Code.
RFQ means a Request for Qualifications issued to obtain the qualifications of interested parties.
EDS-i
CONTRACT #:
INSTRUCTIONS FOR COMPLETION OF ECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT
Section 1: Instructions. Section 1 sets forth the instructions for completing and executing this EDS.
Section 2: Certifications. Section 2 sets forth certifications that are required for contracting parties under the Code and other applicable laws. Execution of this EDS constitutes a.warranty that all the statements and certifications contained, and all the facts stated, in the Certifications are.true, correct and complete as of the date of execution.
Section 3: Economic and Other Disclosures Statement. Section 3 is the County's required Economic and Other Disclosures Statement form. Execution of this EDS constitutes a warranty that all the information provided in the EDS is true, correct and complete as of the date of execution, and binds the Applicant to the warranties, representations, agreements and acknowledgements contained therein.
Required Updates. The Applicant is required to keep all information provided in this EDS current and accurate. In the event of any change in the information provided, including but not limited to any change which would render inaccurate or incomplete any certification or statement made in this EDS, the Applicant shall supplement this EDS up to the time the County takes action, by filing an amended EDS or such other documentation as is required.
Additional Information. The County's Governmental Ethics and Campaign Financing Ordinances impose certain duties and obligations on persons or entities seeking County contracts, work, business, or transactions, and the Applicant is expected to comply fully with these ordinances. For further information please contact the Director of Ethics at (312) 603-4304 (69 W. Washington St. Suite 3040, Chicago, IL 60602) or visit the web-site at cookcountyil.gov/ethics-board-of .
Authorized Signers of Contract and EDS Execution Page. If the Applicant is a corporation, the President and Secretary must execute the EDS. In the event that this EDS is executed by someone other than the President, attach hereto a certified copy of that section of the Corporate By-Laws or other authorization by the Corporation, satisfactory to the County that permits the person to execute EDS for said corporation. If the corporation is not registered in the State of Illinois, a copy of the Certificate of Good Standing from the state of incorporation must be submitted with this Signature Page.
If the Applicant is a partnership or joint venture, all partners or joint venturers must execute the EDS, unless one partner or joint venture has been authorized to sign for the partnership or joint venture, in which case, the partnership agreement, resolution or evidence of such authority satisfactory to the Office of the Chief Procurement Officer must be submitted with this Signature Page.
If the Applicant is a member-managed LLC all members must execute the EDS, unless otherwise provided in the operating agreement, resolution or other corporate documents. If the Applicant is a manager-managed LLC, the manager(s) must execute the EDS. The Applicant must attach either a certified copy of the operating agreement, resolution or other authorization, satisfactory to the County, demonstrating such person has the authority to execute the EDS on behalf of the LLC. If the LLC is not registered in the State of Illinois, a copy of a current Certificate of Good Standing from the state of incorporation must be submitted with this Signature Page.
If the Applicant is a Sole Proprietorship, the sole proprietor must execute the EDS.
A "Partnership" "Joint Venture" or "Sole Proprietorship" operating under an Assumed Name must be registered with the Illinois county in which it is located, as provided in 805 ILCS 405 (2012), and documentation evidencing registration must be submitted with the EDS.
Effective October t; 2016 all foreign corporations and LLCs must be registered with the Illinois Secretary of State's Office unless a statutory exemption applies to the applicant. Applicants who are exempt from registering must provide a written statement explaining why they are exempt from registering as a foreign entity with the Illinois Secretary of State's Office.
EDS-ii
CONTRACT #:
SECTION 2 CERTIFICATIONS
THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE. THE APPLICANT IS CAUTIONED TO CAREFULLY READ THESE CERTIFICATIONS PRIOR TO SIGNING THE SIGNATURE PAGE. SIGNING THE SIGNATURE PAGE SHALL CONSTITUTE A WARRANTY BY THE APPLICANT THAT ALL THE STATEMENTS. CERTIFICATIONS AND INFORMATION SET FORTH WITHIN THESE CERTIFICATIONS ARE TRUE. COMPLETE AND CORRECT AS OF THE DATE THE SIGNATURE PAGE IS SIGNED; ..THE APPLICANT IS NOTIFIED THAT IF THE COUNTY LEARNS^THAT ANY OF THE, FOLLOWING CERTIFICATIONS WERE FALSELY MADE. THAT ANY CONTRACT ENTERED INTO WITH THE" APPLICANT SHALL BE SUBJECT TO TERMINATION.
PERSONS AND ENTITIES SUBJECT TO DISQUALIFICATION
No person or business entity shall be awarded a contract or sub-contract, for a period of five (5) years from the dale of conviction or entry of a plea or admission of guilt, civil or criminal, if that person or business entity:
Has been convicted of an act committed, within the State of Illinois, of bribery or attempting to bribe an officer or employee of a unit of state, federal or local government or school district in the State of Illinois in that officer's or employee's official capacity;
Has been convicted by federal, state or local government of an act of bid-rigging or attempting to rig bids as defined in the Sherman Anti-Trust Act and Clayton Act. Act. 15 U.S.C. Section 1 et seq.;
Has been convicted of bid-rigging or attempting to rig bids under the laws of federal, state or local government;
Has been convicted of an act committed, within the State, of price-fixing or attempting to fix prices as defined by the Sherman Anti-Trust Act and the Clayton Act. 15 U.S.C. Section 1. er seq.;
Has been convicted of price-fixing or attempting to fix prices under the laws the State;
Has been convicted of defrauding or attempting to defraud any unit of state or local government or school district ' within the State of Illinois;
Has made an admission of guilt of such conduct as set forth in subsections (1) through (6) above which admission is a matter of record, whether or not such person or business entity was subject to prosecution for the offense or
offenses admitted to; or ¦- — - - - -
Has entered a plea of nolo contendere to charge of bribery, price-fixing, bid-rigging, or fraud, as set forth in subparagraphs (1) through (6) above.
In the case of bribery or attempting to bribe, a business entity may not be awarded a contract if an official, agent or employee of such business entity committed the Prohibited Act on behalf of the business entity and pursuant to the direction or authorization of an officer, director or other responsible official of the business entity, and such Prohibited Act occurred within three years prior to the award of the contract. In addition, a business entity shall be disqualified if an owner, partner or shareholder controlling, directly or indirectly, 20% or more of the business entity, or an officer of the business entity has performed any Prohibited Act within five years prior to the award of the Contract.
THE APPUCANT HEREBY CERTIFIES THAT: The Applicant has read the provisions of Section A, Persons and Entities Subject to Disqualification, that the Applicant has not committed any Prohibited Act set forth in Section A, and that award of the Contract to the Applicant would not violate the provisions of such Section or of the Code.
BID-RIGGING OR BID ROTATING
THE APPUCANT HEREBY CERTIFIES THAT: In accordance with 720 ILCS 5/33 E-11. neither the Applicant nor any Affiliated Entity is barred from award of this Contract as a result of a conviction for the violation of State laws prohibiting bid-rigging or bid rotating.
DRUG FREE WORKPLACE ACT
THE APPUCANT HEREBY CERTIFIES THAT: The Applicant will provide a drug free workplace, as required by (30 ILCS 580/3).
EDS-1
CONTRACT #:
D. DELINQUENCY IN PAYMENT OF TAXES
THE APPLICANT HEREBY CERTIFIES THAT: The Applicant is not an owner or a party responsible for the payment of any tax or fee administered by Cook County, such as bar award of a contract or subcontract pursuant io the Code, Chapter 34, Section 34-171.
HUMAN RIGHTS ORDINANCE
1.: !" "
,<-. No person who is-a party to a contract with Cook County ("County") shall ,engage in unlawful discrimination or sexual harassment "againsf any individual in theterms or conditions of. employment, credit, public accommodations, housing;;or provision of County facilities, services or programs (Code Chapter 42, Section 42-30 et seq.).
ILLINOIS HUMAN RIGHTS ACT
THE APPLICANT HEREBY CERTIFIES THAT: It is in compliance with the Illinois Human Rights Act (775 ILCS 5/2-105), and agrees to abide by the requirements of the Act as part of its contractual obligations.
INSPECTOR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTION 34-174 and Section 34-250)
The Applicant has not willfully failed to cooperate in an investigation by the Cook County Independent Inspector General or to report to the Independent Inspector General any and all information concerning conduct which they know to involve corruption, or other criminal activity, by another county employee or official, which concerns his or her office of employment or County related transaction.
The Applicant has reported directly and without any undue delay any suspected or known fraudulent activity in the County's Procurement process to the Office of the Cook County Inspector General.
CAMPAIGN CONTRIBUTIONS (COOK COUNTY CODE, CHAPTER 2, SECTION 2-585) ,
THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County's Ordinance concerning campaign contributions, which is codified at Chapter 2, Division 2, Subdivision II, Section 585, and can be read in its entirety at www.municode.com .
I. GIFT BAN, (COOK COUNTY CODE, CHAPTER 2, SECTION 2-574)
THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County's Ordinance concerning receiving and soliciting gifts and favors, which is codified at Chapter 2, Division 2, Subdivision II, Section 574, and can be read in its entirety at www.municode.com .
J. LIVING WAGE ORDINANCE PREFERENCE (COOK COUNTY CODE, CHAPTER 34, SECTION 34-160;
Unless expressly waived by the Cook County Board of Commissioners, the Code requires that a living wage must be paid lo individuals employed by a Contractor which has a County Contract and by all subcontractors of such Contractor under a County Contract, throughout the duration of such County Contract. The amount of such living wage is annually by the Chief Financial Officer of the County, and shall be posted on the Chief Procurement Officer's website.
The term "Contract" as used in Section 4,1, of this EDS, specifically excludes contracts with the following:
Not-For Profit Organizations (defined as a corporation having tax exempt status under Section 501 (C)(3) of the United State Internal Revenue Code and recognized under the Illinois State not-for -profit law);
Community Development Block Grants;
Cook County Works Department;
Sheriffs Work Alternative Program; and
Department of Correction inmates.
EDS-2
CONTRACT #:
SECTION 3
REQUIRED DISCLOSURES
1. DISCLOSURE OF LOBBYIST CONTACTS
List all persons that have made lobbying contacts on your behalf with respect to this contract: - Namo Address
2. LOCAL BUSINESS PREFERENCE STATEMENT (CODE, CHAPTER 34, SECTION 34-230)
Local business means a Person, including a foreign corporation authorized to transact business in Illinois, having a bona fide establishment located within the County at which it is transacting business on the dale when a Bid is submitted to the County, and which employs the majority of its regular, full-time work force within the County. A Joint Venture shall constitute a Local Business if one or more Persons that qualify as a "Local Business" hold interests totaling over 50 percent in the Joint Venture, even if the Joint Venture does not, at the time of the Bid submittal, have such a bona fide establishment within the County.
a) Is Applicant a "Local Business" as defined above?
Yes: -No:
b) If yes, list business addresses within Cook County: 4425 W. Kinzie St., Chicago
c) Does Applicant employ the majority of its regular full-time workforce within Cook County?
Yes:0 No:[ |
3. THE CHILD SUPPORT ENFORCEMENT ORDINANCE (CODE, CHAPTER 34, SECTION 34-172)
Every Applicant for a County Privilege shall be in full compliance with any child support order before such Applicant is entitled to receive or renew a County Privilege. When delinquent child support exists, the County shall not issue or renew any County Privilege, and may revoke any County Privilege.
All Applicants are required to review the Cook County Affidavit of Child Support Obligations attached to this EDS (EDS-5) and complete the Affidavit, based on the instructions in the Affidavit
EDS-3
CONTRACT #:
REAL ESTATE OWNERSHIP DISCLOSURES.
The Applicant must indicate by checking the appropriate provision below and providing all required information that either
real estate owned by the Applicant in Cook County:
16-10-034-008; -009; -010; -011; -012; -013 &-014
(ATTACH SHEET IF NECESSARY TO LIST ADDITIONAL INDEX NUMBERS)
.The Applicant owns no real estate in Cook County.
5. EXCEPTIONS TO CERTIFICATIONS OR DISCLOSURES.
If the Applicant is unable to certify to any of the Certifications or any other statements contained in this EDS and not explained elsewhere in
.this EDS, the Applicant must explain below:
If the letters, "NA", the word "None" or "No Response" appears above, or if the space is left blank, it will be conclusively presumed that the Applicant certified to all Certifications and other statements contained in this EDS.
EDS-4
CONTRACT*
COOK COUNTY AFFIDAVIT OF CHILD SUPPORT OBLIGATIONS
Effective July 1,1996, every applicant lor a County Privilege shsS be In full compliance wilh any Child Support Order before ouch applicant is enlltlad to receive a County Privilege. When Delinquent Child Support Exists, the County shall not issue or renew any County Privilege, arid may revoke any County Privilege. l>
"AppHcanr moans any parson or business onUtv. Including all 8ub»Umfl8l Owrtars., seeking Issuance of a'County Privilege or-renewal of an existing County Privilege from the County. This term shall not Include any political subdivision ot the federal or state government, including units of local government, and not-for-prott organizations.
'County PrMoga" means any business (cense. Including but not limited to liquor dealers' licenses, packaged goods licenses, tavern licenses, restaurant licenses, and gun licenses; real property license or lease; permit Including but not limited to building permits, zoning permits or approvals; environmental certifies la; County HOME Loan, and contracts exceeding the value of S10,000.00.
"Substantial Owner" moans any person or persons who own or hold a twenty-flve\ percent (26%) or more percentage o( Interest In eny business entity Becking a County Privilege, Including those shareholders, general or limited partners, beneficiaries and principals; except where e business entity Is an Individual or sole proprietorship, Substantial Owner meent unit individual or solo proprietor.
All Appflcanta/Substantlal Owners are required to complete trta affidavit and comply wHh tha Child Support Enforcement Ordinance before any privilege Is granted. Signature of this form constitutes e certlfcoUon the Information provided below [j correct end complete, and that the tndlvWuatta) signing this, form has/have personal knowledge of such Information.
Privilege Information:
Contract #: County Department:
379 0700
City: Chicago Phone ff:-773
. Ml:
Business Entity Information (INCLUDES CORPORATE APPLICANT AND CORPORATE SUBSTANTIAL OWNERS): Business Entity Name: 4401 West Kinzie. LLC Street Address: 4425 W. Kinzie St.
. State: IL , . Zip: 60624
Individual Applicant and Individual Substantial Owner Information (If Applicable):
LB8tnomo: Kelly First Name: jSflan .
SS#(Usl Four Digits):J^C^TS Date of Birth:_
Zln: 60091.
Street Address:. ¦ - ¦
City. .Wilmfll
State: IL
Home Phone: f 773 1 773 - 0700 Driver's Ucense No:_j :
Child Support Obligation Information: ~"
Tho Applicant, botng duly sworn on oath or affirmation hereby stales lhal lo IhB besi of my knowledge (place en "X" nexl to "A", "B", or
/
The Applicant has no judicially or administratively ordered child support obligations.
The Applicant has an outstanding Judicially or administratively ordered obligation, but is paying in accordance with the terms of tho order.
Tha Applicant is delinquent In paying Judicially or administratively ordered child support obligations
The Applicant understands that failure to disclose any Judicially or administratively ordered child support debt owed will be grounds for revoking the privilege.
Name: Signature:
Date: 4/14/17
Subscribed
Subscribed and sworn to before me this __t day of April
^ofijry Public Signature Notary Seal
Not»: TTw abov Information Im aubjeci to rtriffc*//ort prior to th* mward of tho contract.
OFFICIAL SEAL eds-6 INGRID L LUNA
NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES:12/16/19
CONTRACT #:
COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT
The Cook County Code of Ordinances (§2-610 et seq.) requires that any Applicant for any County Action must disclose information concerning ownership interests in the Applicant. This Disclosure of Ownership Interest Statement must be completed with all information current as of the date this Statement is signed. Furthermore, this Statement must be kept current, by filing an amended Statement, until such time as the County Board or County Agency shall take action on the application. The information contained in this Statement will be maintained in a database and made available for public viewing. County reserves the right tp^lrequest additional information to verify veracity of information containted in this statement.
If you are asked to list names, but there are no applicable names to list, you must state NONE. An incomplete Statement will be" returned and any action regarding this contract will be delayed. A failure lo fully comply with the ordinance may result in the action taken by the County Board or County Agency being voided.
"Applicant" means any Entity or person making an application to the County for any County Action.
"County Action" means any action by a County Agency, a County Department, or the County Board regarding an ordinance or ordinance amendment, a County Board approval, or other County agency approval, with respect to contracts, leases, or sale or purchase of real estate.
"Person" "Entity" or "Legal Entity" means a sole proprietorship, corporation, partnership, association, business trust, estate, two or more persons having a joint or common interest, trustee of a land trust, other commercial or legal entity or any beneficiary or beneficiaries thereof.
This Disclosure of Ownership Interest Statement must be submitted by :
An Applicant for County Action and
A Person that holds stock or a beneficial interest in the Applicant and is listed on the Applicant's Statement (a "Holder") must file a Statement and complete #1 only under Ownership Interest Declaration.
o
] Applicant or
Please print or type responses clearly and legibly. Add additional pages if needed, being careful to identify each portion of the form to
which'each additional page refers; — *¦• - ¦•¦ ¦
Stock/Beneficial Interest Holder
This Statement is being made by the [
J ] Original Statement or [j |] Amended Statement
This Statement is an: Identifying Information: Name 4401 West Kinzie, LLC
FEIN # Only:
Street Address:4425 W- Kinize St-
Zip Code: 60624
Fax Number: 77337907070 Email: officemanger@whynoliron.com
Cook County Business Registration Number
(Sole Proprietor, Joint Venture Partnership)
Corporate File Number (if applicable):
Form of Legal Entity:
| | Sole Proprietor ___\ Partnership _ Corporation ___ Trustee of Land Trust
| | Business Trust f~] . Estate ' \_ Association ___ Joint Venture
_ Other (describe) Limited Liability Company
EDS-6
CONTRACT #:
Ownership Interest Declaration:
1. List the name(s), address, and percent ownership of each Person having a legal or beneficial interest (including ownership) of
more than five percent (5%) in the Applicant/Holder.
Name Address Percentage Interest in
Applicant/Holder
Sean Kelly, 4425 W, Kinzie St., Chicago 100%
2. If the interest of any Person listed in (1) above is held as an agent or agents, or a nominee or nominees, list Ihe name and address of the principal on whose behalf the interest is held.
Name of Agent/Nominee Name of Principal Principal's Address
3. Is the Applicant constructively controlled by another person or Legal Entity? [ | | ] Yes [ | | ] No
If yes, state the name, address and percentage of beneficial interest of such person, and the relationship under which such control is being or may be exercised.
Name Address Percentage of Relationship
Beneficial Interest
Corporate Officers, Members and Partners Information:
For all corporations, list the names, addresses, and terms for all corporate officers. For all limited liability companies, list the names, addresses for all members. For all partnerships and joint ventures, list the names, addresses, for each partner or joint venture.
Name Address Title (specify title of Term of Office
Office, or whether manager or partner/joint venture)
Declaration (check the applicable box):
[/] I state under oath that the Applicant has withheld no disclosure as to ownership interest in the Applicant nor reserved
any information, data or plan as to the intended use or purpose for which the Applicant seeks County Board or other County Agency action.
|/1 I state under oath that the Holder has withheld no disclosure as to ownership interest nor reserved any information required to be disclosed.
EDS-7
CONTRACT #:
COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT SIGNATURE PAGE
Signature / /
otTicematTciger@whynotiron.com
E-mail address
Agent
TlUe
4/14/17
Dale
7733790700
Phono Number
Subscribed lo and sworn before me
this J4 day of April . 20 R
NotaryRubllc Signature
OFFICIAL SEAL INGRID L LUNA NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES: 12/16/19
EDS-8
CONTRACT #:
COOK COUNTY BOARD OF ETHICS
69 WWASHINGTON STREET, SUITE 3040 <- CHICAGO, ILLINOIS 60602 312/603-4304 Office 312/603-9988 Fax
FAMILIAL RELATIONSHIP DISCLOSURE PROVISION Nepotism Disclosure Requirement:
Doing a significant amount of business with the County requires that you disclose to the Board of Ethics the existence of any familial relationships with any County employee or any person holding elective office in the State of Illinois, the County, or in any municipality within the County. The Ethics Ordinance defines a significant amount of business for the purpose of this disclosure requirement as more than $25,000 in aggregate County leases, contracts, purchases or sales in any calendar year.
If you are unsure of whether the business you do with the County or a County agency will cross this threshold, err on the side of caution by completing the attached familial disclosure form because, among other potential penalties, any person found guilty of failing to make a required disclosure or knowingly filing a false, misleading, or incomplete disclosure will be prohibited from doing any business with the County for a period of three years. The required disclosure should be filed with the Board of Ethics by January 1 of each calendar year in which you arc doing business with the County and again with each bid/proposal/quotation to do business with Cook County. The Board of Ethics may assess a late filing fee of $100 per day after an initial 30-day grace period.
The person that is doing business with the County must disclose his or her familial relationships. If the person on the County lease or contract or purchasing from or selling to the County is a business entity, then the business entity must disclose the familial relationships of the individuals who are and, during the year prior to doing business with the County, were:
its board of directors,
its officers,
its employees or independent contractors responsible for the general administration of the entity,
its agents authorized to execute documents on behalf of the entity, and
its employees who directly engage or engaged in doing work with the County on behalf of the entity.
Do not hesitate to contact the Board of Ethics at (312) 603-4304 for assistance in determining the scope of any required familial relationship disclosure.
Additional Definitions:
"Familial relationship" means a person who is a spouse, domestic partner or civil union partner of a County employee or State, County or municipal official, or any person who is related to such an employee or official, whether by blood, marriage or adoption, as
a:
Parent
Child ?Brother
Sister ?Aunt
Uncle
Niece
Nephew
?Grandparent
Grandchild
Father-in-law
Mother-in-law
Son-in-law
Daughter-in-law
Brother-in-law
Sister-in-law
| ] Stepfather I ] Stepmother I I Stepson
Stepdaughter
Stepbrother I I Stepsister
Half brother
Halfsister
EDS-9
CONTRACT #:
COOK COUNTY BOARD OF ETHICS FAMILIAL RELATIONSHIP DISCLOSURE FORM
A. PERSON DOING OR SEEKING TO DO BUSINESS WITH THE COUNTY
Name of Person Doing Business with the County: 4401 West Kinzie, LLC ,.
Address of.-Person Doing Business with the County: 4425 W. Kinize St., Chicago'' -
Phone number of Person Doing Business with the County: 773-379-0700 ;
Email address of Person Doing Business with the County: omcemanager@whynotiron.com
If Person Doing Business with the County is a Business Entity, provide the name, title and contact information for the
individual completing this disclosure on behalf of the Person Doing Business with the County:
Sean Kelly, 4425 W. Kinize St., Chicago. IL 60624
B. DESCRIPTION OF BUSINESS WITH THE COUNTY
Append additional pages as needed and for each County lease, contract, purchase or sale sought and/or obtained during the calendar year of this disclosure (or the proceeding calendar year if disclosure is made on January J), identify:
The lease number, contract number, purchase order number, request for proposal number and/or request for qualification
• ¦¦¦ number associated with the business you are doing or seeking to do with the County: ± . ^
The aggregate dollar value of the business you are doing or seeking to do with the County: $
The name, title and contact information for the County official(s) or employee(s) involved in negotiating the business you are
doing or seeking to do with the County:
The name, title and contact information for the County official(s) or employee(s) involved in managing the business you are
doing or seeking to do with the County:
C. DISCLOSURE OF FAMILIAL RELATIONSHIPS WITH COUNTY EMPLOYEES OR STATE. COUNTY OR MUNICIPAL ELECTED OFFICIALS
Check the box that applies and provide related information where needed
? The Person Doing Business with the County is an individual and there is no familial relationship between this individual and any Cook County employee or any person holding elective office in the State of Illinois, Cook County, or any municipality within Cook County.
^ The Person Doing Business with the County is a business entity and there is no familial relationship between any member of this business entity's board of directors, officers, persons responsible for general administration of the business entity, agents authorized to execute documents on behalf of the business-entity or employees directly engaged in contractual work with the County on behalf of the'busiriess entity, and any Cook'County employee or any person holding elective office in the State of Illinois, Cook County, or any municipality within Cook County.
EDS-10
CONTRACT #:
COOK COUNTY BOARD OF ETHICS FAMILIAL RELATIONSHIP DISCLOSURE FORM
? The Person Doing Business with the County is an individual and there is a familial relationship between this individual
and at least one Cook County employee and/or a person or persons holding elective office in the State of Illinois, Cook County, and/or any municipality within Cook County. The familial relationships are as follows:
Name of Individual Doing Name of Related County Title and Position of Related Nature of Familial
Business with the County Employee or State, County or County Employee or State, County Relationship -
<¦ Municipal Elected Official or Municipal Elected Official
If more space is needed, attach an additional sheet following the above format.
? The Person Doing Business with the County is a business entity and there is a familial relationship between at least one
member of this business entity's board of directors, officers, persons responsible for general administration of the business entity, agents authorized to execute documents on behalf of the business entity and/or employees directly engaged in contractual work with the County on behalf of the business entity, on the one hand, and at least one Cook County employee and/or a person holding elective office in the State of Illinois, Cook County, and/or any municipality within Cook County, on the other. The familial relationships are as follows:
Name of Member of Board, of Director for Business Entity Doing Business with the County
Name of Related County Employee or State, County or Municipal Elected Official
Title and Position of Related County Employee or State, County or Municipal Elected Official
Nature of Familial Relationship
Name of Officer for Business Name of Related County
Entity Doing Business with Employee or State, County or
the County Municipal Elected Official
Title and Position of Related Nature of Familial
County Employee or State, County Relationship or Municipal Elected Official
EDS-11
Name of Person Responsible Name of Related County
for the General Employee or State, County or
Administration of the Municipal Elected Official
Business Entity Doing Business with the County
CONTRACT #;
Title and Position of Related Nature of Familial
County Employee or State, Counly Relationship* or Municipal Elected Official
Name of Agent Authorized to Execute Documents for Business Entity Doing Business with the County
Name of Related County Titlo nnd Position of Related Nature of Familial
Employee or State, County or County Employee or Stale, County Relationship' Municipal Elected Official or Municipal Elected Official
Nome of Employee of Name of Related Counly
Business Entity Directly Employee or State, County or
Engaged in Doing Business Municipal Elected Official
with the County
Title snd Position of Related Nature of Familial
County Employee or Slate, County Relationship* or Municipal Elected Official
If more space is needed, attach an additional sheet following the above format.
Date
Cook Counly Board of Ethics
69 West Washington Street, Suite 3040, Chicago, Illinois 60602 Office (312) 603-4304 - Fax (312) 603-9988 CookCounty.Ethics@cookcountyil.gov
" Spouse, domestic partner, civil union partner or parent, child, sibling, aunt, uncle, niece, nephew, grandparent or grandchild by blood, marriage {i.e. in laws and step relations) or adoption.
EDS-12
CONTRACT #:
SECTION 4
COOK COUNTY AFFIDAVIT FOR WAGE THEFT ORDINANCE
Effective May 1, 2015, every Person, including Substantial Owners, seeking a Contract with Cook County must comply with the Cook County Wage Theft Ordinance set forth in Chapter 34, Article IV, Section 179. Any Person/Substantial Owner, who fails to comply with Cook County Wage Theft Ordinance, may request that the Chief Procurement Officer grant a reduction or waiver in accordance with Section 34-179(d).
"Contract' means any written document to make Procurements by or on behalf of Cook County.
¦"Person" means any individual, corporation, partnership, Joint.Venture, trust, association, limited liability company, sole proprietorship or other le^al entity. "Procurement" means obtaining supplies, equipment, goods, or services of any kind.
"Substantial Owner" means any person or persons who own or hold a twenty-five percent (25%) or more percentage of interest in any business entity seeking a County Privilege, including those shareholders, general or limited partners, beneficiaries and principals; except whore a business entity is an individual or sole proprietorship, Substantial Owner means that individual or sole proprietor.
All Persons/Substantial Owners are required to complete this affidavit and comply with the Cook County Wage Theft Ordinance before any Contract is awarded. Signature of this form constitutes a certification the information provided below is correct and complete, and that the individual(s) signing this form has/have personal knowledge of such information. County reserves the right to request additional Information to verify voracity of Information contained In this Affidavit
I. Contract Information:
Contract Number:
County Using Agency (requesting Procurement):
II. Person/Substantial Owner Information:
Person (Corporate Entity Name): 4401 West Kinzie, LLC
Substantial Owner Complete Name: Sean Kelly
FEIN#
Date of Birth: .ail address: officemanager@whynotiron.com
Street Address: 4425 W. Kinzie St.
city: Chicago state.
_ zip: 60624
Home Phone: (773 ) 379 - 0700
III. Compliance with Wage Laws:
Within the past five years has the Person/Substantial Owner, in any judicial or administrative proceeding, been convicted of, entered a plea, made an admission of guilt or liability, or had an administrative finding made for committing a repeated or willful violation of any of the following laws:
No Illinois Wage Payment and Collection Act, 820 ILCS 115/1 et seq No Illinois Minimum Wage Act, 820 ILCS 10511 et seq.,
No Illinois Worker Adjustment and Retraining Notification Act, 820 ILCS 65/1 et seq.,
No Employee Classification Act, 820 ILCS 185/1 et seq., ' .
No Fair Labor Standards Act of 1938, 29 U.S.C. 201, et seq
No Any comparable state statute or regulation of any state, which governs the payment of wages
If the Person/Substantial Owner answered "Yes" to any of the questions above, it is ineligible to enter into a Contract with Cook County, but can request a reduction or waiver under Section IV.
EDS-13
CONTRACT #.
Request for Waiver or Reduction
If Person/Substantial Owner answered "Yes" lo any of lha questions above. It may request a reduction or waiver In accordance with Section 34-179(d), provided thBt the request for reduction of waiver is made on the basis of one or more of the following actions that have taken place;
No Tnere has- bean a bona lida change In ownership or. .Control of the Ineligible'Person or Substantial Owner
No Disciplinary action hae been token against lha Individuals] responsible for the acts giving rise to the violation
No Remedial action has bean taken to prevent a recurrence ot the acts giving rise lo the disqualification or default
No Other factors thai the Person or Substantial Owner believe are relevant.
The Person/Substantial Owner must submit documentation to support the fans/a of ita request for a reduction or waiver. The Chief Procurement Officer reserves the right to make additional Inquiries and request additional documentation.
Affirmation
The Pereon/SubatsnUpl^rffer afflrasjhat a/stalements contained in the Affidavit are true, accurate and complete.
Signature: CM^//^ Dale:4'14'17
Name of Person signing (Print):
^—^ Subscribed and sworn to before mo ih'te day of April , 20_U_
Notsry Public Signature Notary Seal
Note: Tha above Information Is subject to verification prior to tha award of the Contract.
Seari Kelly TOIe. Agent
. OFFICIAL SEAL INGRID L LUNA
NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES: 12/16/19
EDS-14
CONTRACT
SECTION S
CONTRACT AND EOS EXECUTION PAGE PLEASE EXECUTE THREE ORIGINAL PAGES OF COS The Applicant hereby certifies Bnd warrants that all of the statements, cenificatlonB and representations sot forth in this EDS are true, complete and correct; thai the Applicant Is,In full compliance and win continue to bo In compliance throughout the term of the Contract or County^Privilege Issued to the Applicant wilh.lall the policies and requirements set forth in this EDS; end that ell facts and Information provided by the. Applicant in this EDS are true, complete and correct. Tha Applicant agrees lo inform the Chief Procurement Officer In writing if any of such statements, certifications, representations, facts or Information becomes or la found to be :untrue. Incomplete or Incorrect during the term of the Contract or County Privilege.
Execution by Corporation
Corporation's Name President's Printed Name and Signature
Telephone Emell
Secretary Signature Date
Execution by-
4401 West Kinzie, LLC
'¦ ' ¦ ¦ — ¦¦¦¦¦¦ i i ^ ¦¦ i- ' — iii ¦ m ,umm i i j , ,m
LLC Name 'Member/Manager PrinhjfJ Name and Signature
4/14/17 officemanager@whynotiron.com
Date Telephone and Email
Execution by Partnership/Joint Venture
Partnership/Joint Venture Name 'Partner/Joint Venturer Printed Name and Signature
Dsto Telephone and Email
Execution by Sole Proprietorship
Printed Name Signature Assumed Name (If applicable)
?ete Telephone and Email
My commission expires:
h o- \£i - \ t
Notary Public glgpalure Notary Seal
'If the operating agreement, partnershlbaorsement or governing documents requiring execution by multiple members, managers,
parlnerB>or)cWVBfn^m^rB^ execute additional Contract and EDS Execution Pages.
\ OFFICIAL SEAL T
\ INGRID L LUNA \ NOTARY PUBLIC-STATE OF ILLINOIS < \ ^§q^SSIONEXPIRES:iai6f19?
CONTRACTS
SECTION 5
CONTRACT AND EDS EXECUTION PAGE PLEASE EXECUTE THREE ORIGINAL COPIES The Applicant hereby certifies and warranto that all of the statements, certifications end representations set forth In this EDS are true, complete and correct; that the Applicant la in full compliance and will continue to be in compliance throughout the term of the Contract or County Privilege issued to the Applicant wilh all the policies and requirements set forth in Ilia EDS; and that sir facts and Information provided by the Applicant In this EDS are true, complete and corrocl. The Applicant agrees to Inform the Chief Procurement Officer In writing If any of 6uch statements, certifications, representations, facts or Information becomes or Is found to be untrue, Incomplete or Incorrect during the term of Iho Contract or County Privilege.
Execution by Corporation
Corporation's Name President's Printed Name and Signature
Telephone Emoll
Secretary Signature
4401 West Kinzie, LLC _
LUC Namfc'^ *MemberfManager PrintedJjjfeme end Signature
4/14/17 officemanager@whynotiron.com
Date Telephone and Email
Execution by Partnership/Joint Venture
Partnership/Joint Venture Name 'Partner/Joint Venturer Printed Name and Signature
Date Telephone and Email
Execution by Sole Proprietorship
Printed Name end Signature Date
Telephone Email
Subscribed and sworn to before me this
davof,CipAx'Q.20n. ,
My commission expires:
Notary Public Sjghpture Notary Seal
OFFICIAL SEAL INGRID L LUNA NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES.12/16/19
CONTRACT #
SECTION 5
CONTRACT AND EDS EXECUTION PAGE PLEASE EXECUTE THR{;f; ORIGINAL. CQPtEg The Applicant hereby certifies end warrants that ell of the statements, certifications and representations set forth in this EOS are true, , complete and correct; that the Applicant is In full compliance end will continue to be In compliance throughout the term of the Contract or -County Privilege Issued to the'Applicant with' all Jhe policies and requirements' set fbrtrf'in this EDS; and that all'fads and information' * provided by the Applicant In this EDS are true, complete and correcl. The Applicant agrees to Inform the Chief Procurement Officer In writing if eny of such statements, certifications, representations, facts or Information becomes or is found to be untrue, incomplete or Incorrect during the term of the Contract or County Privilege.
Execution by Corporation
Corporation's Name President's Printed Name and Signature
Telephone Email
LLC Name 'Member/Manager Printed .Name and Signature
Secretary Signature
Date Telephone and Email
Execution by Partnarshlp/Jolnt Venture
4401 West Kinzie, LLC
Partnership/Joint Venture Name 'Partner/Joint Venturer Printod Name end Signature
4/14/17 officemanager@whynotiron.com
Date Telephone and Email
Execution by Sole Proprietorship
Printed Name and Signature - Dale
Telephone Email
Subscribed and sworn to before me this
l*frV day oiov;e. 20_n.
My commission expires:
xno
Notary Public Signature Notary Seal
OFFICIAL SEAL INGRID L LUNA NOTARY PUBLIC - STATE OF ILLINOIS MY CEeStf^iON EXPIRES.12/16/19
CONTRACT #:
SECTION 6 COOK COUNTY SIGNATURE PAGE
ON BEHALF OF THE COUNTY OF COOK, A BODY POLITIC AND CORPORATE OF THE STATE OF ILLINOIS, THIS CONTRACT IS HEREBY EXECUTED BY:
COOKCO'UNTY CHIEF PROCUREMENT OFFICER" " "" "
DATED AT CHICAGO, ILLINOIS THIS DAY OF ,20
IN THE CASE OF A BID/ PROPOSAL/RESPONSE, THE COUNTY HEREBY ACCEPTS:
THE FOREGOING BID/PROPOSAL/RESPONSE AS IDENTIFIED IN THE CONTRACT DOCUMENTS FOR CONTRACT NUMBER
OR
ITEM(S), SECTION(S), PART(S):.
TOTAL AMOUNT OF CONTRACT:
(DOLLARS AND CENTS)
FUND CHARGEABLE:
APPROVED AS TO FORM:
ASSISTANT STATE'S ATTORNEY (Required on contracts over $1,000,000.00)
Date
EDS-18
h(tps://\vww.ilsos.gov/corporalellc/CorporateLlcControlIer?comman.
4/14/2017 12:07 PM
EXHIBIT 3
See attached Living Wage Affidavit for the Applicant.
Cook County Assessor's Office
118 Nuktii Ci.ahk STRi-iif, Cilif. vco. IL 60602 ¦PUONIi: 312.443.7550 Wl-HSITIi: WWWXOOKCOUN'IY \SSI-SSOR.COM
Incentives Class Living Wage Ordinance Affidavit
Sean Kelly
as agent for the applicant set forth below, who is seeking a
classification incentive as referenced below, I do hereby state under oath as follows:
As the agent for the applicant set forth below, I have personal knowledge as to the facts stated herein.
The property identified by PIN(s) with commonly known address(es), listed in Exhibit A attached and here|n incorporated, are/is the subject of a pending application/renewal (circle as appropriate) for one of the following development incentives provided by the Code of Ordinances of Cook County, Chapter 74. Article II, Division 2, The Cook County Real Property Assessment Classification Ordinance, Sec.74-60 et seq., as amended:
Class 9
XX Glass 6b
Class 8 (industrial property)
The Cook County Assessor's Office has issued the following control number regarding this
application/renewal (circle as appropriate),
I have reviewed the Code-of Ordinances of Cook County, Chapter 34, Article IV, Division 1 arid The Gook County Uvihg Wage Ordinance, Sec. 34-127 et seq., as amended (the "Ordinance!!), and certify that the applicant is in compliance with the above referenced Cook County Uvihgi Wage Ordinance, due to one of the following options (check as appropriate):
xx Applicant Is currently paying a living wage to its employees, as defined in the Ordinance;
OR
Applicant is not required to pay a living wage, pursuant to the Ordinance.
Agehfs Signature /
4425 W. Kinzie Avenue, Chicago Agent's Mailing Address
4401 West Kinzie, LLC
Applicant's Name
of f iceraanager@wh.ynot iron, com Applicant's e-mail address
Agent's Name & Title (773) 379-0700
Agent's Telephone Number
4425 W. Kinzie Avenue, Chicago Applicant's Mailing Address
Subscribed arj^wom before rpe this t? day of /4psuJ 20 / ?. S^nafure^fef Notary Public
CrriClALSEAL LiiV.^ M NORWICK N0T*.:-> P^SLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES 04/19/18
Exhibit A
(Please type or Print)
; PIN(s) Common Address'
16-10-304-014-0000 4401 W. Kinzie Avenue, Chicago
16-10-304-013-0000 4403 W. Kinzie Avenue, Chicago
16-10-304-012-0000 4405 W. Kinzie Avenue, Chicago
16-10-304-011-0000 4409 W. Kinzie Avenue, Chicago
16-10-304-010-0000 4411 W. Kinzie Avenue, Chicago
16-10-304^009-0000 4415 W. Kinzie Avenue, Chicago1;
4425 W. Kinzie Avenue» Chicago