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BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the Bl-2 Neighborhood Shopping District symbols and indications as shown on Map No. 1-G in the area bounded by
West Chicago Avenue; a line 96 feet west of and parallel to North Nobel Street; The alley next south of and parallel to West Chicago Avenue; a line 72 feet west of and parallel to North Noble Street.
to those of a Bl-3 Neighborhood Shopping District.
SECTION 2. This ordinance shall be in force and effect from and after its passage and due publication.
|1010|
Common Address of Property: 1367 West Chicago Ave. Chicago IL 60642
N
I
PLAT OF SURVEY
Residential . . Topographical
Commercial Studnicka and Associates, Ltd. Condominium
ALTA studnicka2000@gmail.com Site PUds
Tel. 815 485-0445 17901 Haas Road
Fax 815 485-0528 Mokena, Illinois 60448
LOT 6 IN BLOCK 5 IN TAYLOR'S SUBDIVISION OF BLOCK 1 IN THE ASSESSOR'S DIVISION OF THE EAST 1/2 OF THE NORTHWEST 1/4 OF SECTION 8, TOWNSHIP 39 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
CHICAGO AVE.
Scale: i" = 20 feet
Distances are marked in feet and decimals. Ordered by: Ali llanesb Order No.: 20-1-198
Compare all points before building by
same and at once report any difference.
For building lines, restrictions, or easements not
shorn hereon, refer to abstract, deed or ordinance.
Field work completed: 2/6/20 Drawn by: P.D. Proofed by: T.S.
Design Firm Registration § 164-002791
STATE OF ILUNOIS COUNTY OF WILL
2020
Studnicka and Associates. Ltd., an Illinois Land Surveying Corporation does hereby certify that this professional service conforms to the current Illinois standards for boundary survey.
Mokena, IL February 7, A.D.
License No. 3304 Expires 11/30/20
"WRITTEN NOTICE" FORM OF AFFIDAVIT (Section 17-13-0107)
February 4,2020
Honorable Thomas M. Tunney Chairman, Committee on Zoning 121 North LaSalle Street Room 304, City Hall Chicago, Illinois 60602
The undersigned, Ali Manesh. being first duly sworn on oath deposes and states the following:
The undersigned certifies that he has complied with the requirements of Section 17-13-0107 of the Chicago Zoning Ordinance, by sending written notice to such property owners who appear to be the owners ofthe property within the subject area not solely owned by the applicant, and to the owners of all property within 250 feet in each direction ofthe lot line of the subject property, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. Said "written notice" was sent by First Class U.S. Mail, no more than 30 days before filing the application.
The undersigned certifies that the notice contained the address ofthe property sought to be rezoned; a statement of the intended use of the property; the name and address of the applicant; the name and address of the owner; and a statement that the applicant intends to file the application for a change in zoning on approximately 02-07-2020.
The undersigned certifies that the applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-0107 of the Chicago Zoning Ordinance, and that the accompanying list of names and addresses of surrounding property owners within 250 feet ofthe subject site is a complete list containing the names and addresses of the people required to be served. 0
CHRIS BIELAT Official Seal Notary Public - State of IlHnois My Commission Expires Oct 6, 2023
PUBLIC NOTICE
Dear Property Owner:
In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance, specifically Section 17-13-0107, please be informed that on or about February 7, 2020,1, the undersigned, will file an application for a change in zoning from Bl-2 Neighborhood Shopping District to proposed Bl-3 Neighborhood Shopping District on behalf of myself, Ali Manesh, for the property located at 1367 West Chicago Ave. Chicago IL 60642.
I intend to use the subject property for a four story mixed used building with a proposed 48' height including a 1200 sft commercial space on the first floor, four residential dwelling units on floors 2, 3 and 4, two parking spots using (TOD) Transit Oriented Development Ordinance, and garbage / recycling bin spaces on the back.
I, Ali Manesh, am the property owner, the applicant and the contact person, and my address is 1367 West Chicago Ave. Chicago IL 60642, my phone number is 312-898-3333 and my email address is ali@manesh.org .
Please note that the applicant is not seeking to rezone or purchase your property. The applicant is required by law to send this notice because you own property within 250 feet ofthe property to be rezoned.
Ali Manesh, Ph.D, P.E.
X
Very truly yours,
CITY OF CHICAGO s
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS ofthe property Applicant is seeking to rezone:
1367 West Chicago Ave. Chicago IL 60642
Ward Number that property is located in: 27
APPLICANT Ali Manesh
ADDRESS 1367 West Chicago Ave. CITY Chicag°
STATE il ZIP CODE_60642 PHONE 312-898-3333
EMAIL aU@manesh.org CONTACT PERSON Ah Manesh '_
Is the applicant the owner of the property? YES x NO
If the applicant is not the owner of the property, please provide the following infonnation regarding the owner and attach written authorization from the owner allowing the application to proceed.
OWNER
ADDRESS CITY
STATE ZIP CODE PHONE
EMAIL CONTACT PERSON
Ifthe Applicant/Owner ofthe property has obtained a lawyer as their representative for the rezoning, please provide the following information: '
ATTORNEY
ADDRESS
CITY STATE ZIP CODE
PHONE FAX EMAIL
Page 1
6. If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
7. On what date did the owner acquire legal title to the subject property?_
8. Has the present owner previously rezoned this property? If yes, when?
No
Present Zoning District B1-2 Proposed Zoning District 813
Lot size in square feet (or dimensions) 2>19» sft
Current Use Of the property Mixed Use, one commercial and one residential
Reason for rezoning the property New construction of a 4 story building,
with an office on the ground floor and 4 dwelling units above.
Describe the proposed use of the property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and .' height ofthe proposed building. (BE SPECIFIC) lS
To construct a 4 story building with proposed height of 48', including one 1200 sft commercial space on the first floor, 2 residential spaces on the second floor, one residential space on the third floor and one residential space on the fourth floor, two on site
parking spaces (seeking Transit Oriented Development ordinance TOD to reduce parking requirements) and necessary space for recycling and trash bins on the back, and will apply for variance to reduce the required set back.
The Affordable Requrements Ordinance (ARO) requires on-site affordable housing units and/or
a financial contribution for residential housing projects with ten or more units that receive a zoning change which, among other triggers, increases the allowable floor area, or, for existing Planned Developments, increases the number of units (see attached fact sheet or visit www.cityofchicago.org/ARO for more information). Is this project subject to the ARO?
YES NO x
Page 2
COUNTY OF COOK STATE OF ILLINOIS
Ali Manesh
being first duly sworn on oath, states that all of the above
statements and the statements contained in the documents submitted herewith are true and correct.
Sfgnature of Applicant
Subscribed and Sworn to before me this
Notary Public
5 ^y of fek/ltt/v. 20_^_
CHRIS BIELAT Official Seal Notary Public - State of Illinois My Commission Expires Oct 6, 2023
Date of Introduction:
FileNumber:_ Ward:
CITY OF CHICAGO t
ECONOMIC DISCLOSURE STATEMENT
t AND AFFIDAVIT i
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Ali Manesh i
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[x] the Applicant
c OR
[]a legal entity currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name: ,
- OR
(PJ a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 1367 West Chicago Ave. Chicago il 60642
Telephone: 3122-898-3333 Fax: Email: ak@manesh.oig
Name of contact person: Mi Manesh
Federal Employer Identification No. (if you have one): n/a
Brief description ofthe Matter to which this EDS pertains. (Include project number and location of property, if applicable):
Rezoning application for my property on 1367 West Chicago Ave. Chicago IL 60642
Which City agency or department is requesting this EDS?
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract # .
Ver.2018-1 Page 1 of 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. ^Indicate the nature of the Disclosing Party:
fv Person Q Limited liability company
Publicly registered business corporation Q Limited liability partnership ;
Privately held business corporation Q Joint venture
Sole proprietorship Q Not-for-profit corporation
General partnership (Is the not-for-profit corporation also a 501(c)(3))?
Limited partnership | | Yes | |No
Trust Q Other (please specify)
2. Foff legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For; legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
QYes LZl^0 | | Organized in Illinois .
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles, if applicable, of: (i) all executive officers and all directors of the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited'partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
2. Please provide the following information concerning each person or legal entity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including ownership) in excess of 7.5% of the Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest ofa member or manager in a
Ver.2018-1 Page 2 of 15
r-1 1
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
i'i NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name« Business Address Percentage Interest in the Applicant
None V
SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date ofthis EDS? QJ Yes H No
Does the Disclosing Party reasonably expect to provide any income or compensation to any City
elected: official during the 12-month period following the date of this EDS? JQ] Yes £x] No
If "yes" to either of the above, please identify below the name(s) of such City elected official(s) and describe such income or compensation:
Does any City elected official or, to the best ofthe Disclosing Party's knowledge after reasonable
inquiry^ any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 of the Municipal Code of Chicago ("MCC")) in the Disclosing Party? '}
p] Yes [7] No
If "yes/' please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partners) and describe the financial interest(s).
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney,
lobbyisi (as defined in MCC Chapter 2-156), 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 ofthe relationship, and the total amount ofthe 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. 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 of15
>!
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)
fx] 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
UndenMCC 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.
ij
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? i
s 1 QYes [JNo [7] No person directly or indirectly owns 10% or more of the Disclosing Party.
1 ¦
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?
[JYes; [JNo
FURTHER CERTIFICATIONS
[This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date ofthis EDS, neither the Disclosing Party rior any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity/of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract in progress).
The Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine,j fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment ofany tax administered by the Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) ofthis EDS:
are, not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions :by any federal, state or local unit of government;
have not, during the 5 years before the date ofthis 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;
arejnot 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 subparagraph (b) above; r
i. I
haye not, during the 5 years before the date ofthis EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
i_ ;
have not, during the 5 years before 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 ilocal government.
The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
Certifications (5), (6) and (7) 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");
airy "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 undier 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 ofthe 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"). -
Ver.2018-1 Page 5 of 15
'¦¦T
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 5 years before the date ofthis EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before] the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
V
'¦*
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity; 5
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 subparagraph (a) or (b) above that is a matter of record^ but have not been prosecuted for such conduct; or
P.
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage)'; (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
'¦ fc
6. Neither the Disclosing Party, nor any 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 LLCS 5/33E-4; or (3) any similar offense ofany state or of the United States 0f America that contains the same elements as the offense of bid-rigging or bid-rotating, t.
1. Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United^States Department of Commerce, State, or Treasury, or any successor federal agency. [FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] ofthe Applicant 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 ofthe 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 MCC Chapter 1-23, Article I applies to the Applicant that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal Systemfor Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
Ver.2018-1 Page 6 of 15
contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. Ifthe Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
None;";;
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presutned that the Disclosing Party certified to the above statements.
12. To/the best ofthe 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 date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
N/A . .
r'. ' ;
13. 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 12Tlnonth 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 ofless than $25 per recipient, or (iii) a
political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or
"none"?). As to any gift listed below, please also list the name of the City recipient. j
h r|910|N/Aa p
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION >
ThejDisclosing Party certifies that the Disclosing Party (check one)
I~] is 0 is not
a "financial institution" as defined in MCC Section 2-32-455(b).
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 MCC Chapter 2-32. We further pledge|that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate ofa predatory lender may result in the loss of the privilege of doing business with the City." t;
V.i f.
Ver.2018-1 Page 7 of 15 s
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
^ ' v
Ifthe 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 FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her owh name or in the name of any other person or entity in the Matter?
?'Yes [x] No
NOTE^ If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "tio" to Item D(l), skip Items D(2) arid D(3) and 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 ofany 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 ofthe 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?
?lYes QNo
If you checked "Yes" to Item D(l), provide the names and business addresses ofthe City officials or employees having such financial interest and identify the nature of the financial interest: i
Name?- Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Ver.2018-1 Page 8 of 15
II
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 (2). Failure to comply with these disclosure requirements may make any contract entered into with the City in' connection with the Matter voidable by the City.
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^ slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2i 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 insurarice 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
NOTF£ Ifthe Matter is federally funded, complete this Section VI. Ifthe 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, as amended, 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 ifthe letters "NA" or ifthe 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, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any
person Or entity to influence or attempt to influence an officer or employee of any agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 Page 9 of 15
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,crenew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
iThe Disclosing Party will submit an updated certification at the end of each calendar quarter in whichjjhere occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A(l) and A(2) above.
vThe 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) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
,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 I
i \ ¦ ».
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?
¦jYes []No
i
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federalregulations? (See 41 CFR Part 60-2.)
QXes DNo
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements? ;
[ | Yes U No [""[Reports not required
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 15
SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTD7ICATION
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 Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text ofthis ordinance and a training program is available on line at www.citvofchicago.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N, Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
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 City transactions. 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 ofthe information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Infonnation 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 ti-. contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
i . i. t'
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 MCC Chapter 1-23, Article I (imposing PERMANENT INELIGffilLITY for certain specified offenses), the H information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1 -23 and Section 2-154-020.
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CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf ofthe Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as of the date furnished to the City.
Ali Manesh
(Print or type exact legal name of Disclosing Party)
Ali Manesh
(Print or type name ofperson signing)
Owner / Applicant
(Print or type title of person signing)
Signed and sworn to before me on (date) £ \^ylO/t^C)
CHRIS B1ELAT Official Seal Notary Public - State of Illinois My Commission Expires Oct 6, 2023
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if CITY OF CHICAGO
n ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT|10 9|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%. It is not to be completed by any legal entity >which has only an indirect ownership interest in the Applicant.
s ¦ Under MCC 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 ofthe 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 i II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members ofthe 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% 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 Parmer 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.
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CITY OF CHICAGO 1 ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT r
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
i
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% (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 MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
? Yes g
Ifthe 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 MCC Section 2-92-416? f;
[ [ Yes [J No £xj The Applicant is not publicly traded on any exchange.
If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.
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r CITY OF CFJICAGO
y, ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
t APPENDLX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www.amlegal.com' ), generally covers a party to any agreement pursuant to which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii)tpay the City money for a license, grant or concession allowing them to conduct a business on City premises.
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(l) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
Yes
No"
£x| N/A -1 am not an Applicant that is a "contractor" as defined in MCC Section 2-92-385. This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(l). If you checked "no" to the above, please explain.
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