SUBSTITUTE ORDINANCE
WHEREAS, the City of Chicago (the "City") \s a home rule unit of government under Section 6(a), Article VII of the 1970 Constitution of the State of Illinois authorized to exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the Cook County Board of Commissioners has enacted the Tax Incentive Ordinance, Classification System for Assessment, as amended from time to time (the "County Ordinance"), which establishes the Class L property tax classification to encourage the preservation and rehabilitation of certain historically and architecturally significant buildings, which will enhance the general character of real estate in the county and contribute to the economic well-being of the county by increasing the level of economic activity, increasing employment opportunities and contributing to the long-term growth ofthe real property tax base; and
WHEREAS, Phoenix 226 Central Loop Owner LLC, an Illinois limited liability company (the "Owner"), is the owner of the historic building (the "Building") located at 226 West Jackson Boulevard in Chicago, Illinois, as more precisely described in Exhibit 1 attached hereto and hereby made a part hereof (the land and improvementslhereon being herein referred to as the "Project Real Estate"); and
WHEREAS, it is expected that the City Council of the City (the "City Council") will adopt an ordinance designating the Building as a Chicago Landmark pursuant to the criteria established in Section 2-120-580 et seq. ofthe Municipal Code ofChicago, and such designation as a Chicago Landmark would meet the definition of Landmark pursuant to the County Ordinance; and
WHEREAS, the Owner proposes to rehabilitate the Building, thereby preserving the historic building, increasing employment opportunities in the area and contributing to the long-term growth ofthe real property tax base (the "Project"); and
WHEREAS, the redevelopment objective of the City in connection with the Project Real Estate is exterior and interior rehabilitation, and
WHEREAS, the Owner intends to use the Building for commercial purposes after the Project is completed by operating the Building as two separate hotels containing, collectively, approximately 350 rooms, associated amenity spaces and approximately 3700 square feet of bar and event space (the "Intended Use"), and ;
WHEREAS, it is anticipated that the Project may require a transfer of a beneficial interest in the Owner to one or more entities who will receive an allocation of federal historic rehabilitation tax credits ("Tax Credit Investors"); and
WHEREAS, the Owner has applied to the Office of the Assessor of Cook County, Illinois (the "Assessor"), for designation of the Project Real Estate as a Class L classification eligible for certain real estate tax incentives pursuant to ihe County Ordinance and
WHEREAS, pursuant to the County Ordinance, the Class I., classification is available to real estate which is to be used for commercial or industrial purposes and which (1) is a Landmark
I
I
(as defined in the County Ordinance); and (2) has undergone Substantial Rehabilitation ,(as defined in the County Ordinance), which constitutes ah investment by the owner of at least 50 percent of the building's full market value as determined by the Assessor in the assessment year prior to the commencement ofthe Substantial Rehabilitation; and the Class l_ incentive shall apply to the building only, except that if the entire building has been vacant and unused for at least 24 continuous months prior to the filing of the eligibility application with the Assessor, the land upon which the building is situated shall be eligible for the incentive; and
WHEREAS, the County Ordinance requires that, in connection with the filing of a Class L eligibility application with the Assessor, an applicant must obtain from the unit of local government in which the real estate is located, an ordinance or resolution which expressly states, among other things, that the local government: 1) has determined that the incentive provided by Class l_ is necessary for the Substantial Rehabilitation of the property; 2) supports and consents to the granting of the incentive; and 3) has reviewed and accepted its Preservation Commission's (as defined in the County Ordinance) written recommendation of the Project for the Class L incentive, specifying the Project budget and proposed scope of; the work, which meets or exceeds the Standards of the United States Department of the Interior for Rehabilitation, Preservation, Restoration, and Reconstruction of historic properties; and
WHEREAS, the City is a Certified Local Government as defined in the County Ordinance and has established the City of Chicago Commission on Chicago Landmarks (the "Landmarks Commission"), and such Landmarks Commission is a Preservation Commission (as defined in the County Ordinance); and
WHEREAS, on January 9, 2020, the Landmarks Commission issued an amended and restated written recommendation ofthe Project to the City Council recommending that the Project be approved by the Assessor for the Class L incentive, a copy of which is attached hereto as Exhibit 2 and hereby made a part hereof; and
WHEREAS, the Project Real Estate shall have been occupied and used for the 24-month period prior to the filing of the Class L eligibility application with the Assessor, making the Class L incentive applicable to the Building only, and
WHEREAS, the Department of Planning and Development of the City ("DPD") has reviewed the proposed Project, has determined that it meets the necessary eligibility requirements for Class L designation, and hereby recommends to City Council that the City expressly determine by ordinance, among other things, that: I) the incentive provided by Class L is necessary for the Substantial Rehabilitation of the Project Real Estate, 2) the City supports and consents to the granting ofthe incentive; and 3) the City has reviewed and accepted the Landmarks Commission's written recommendation of the Project for the Class L incentive, specifying the Project budget and proposed scope of the work, and specifying that the Project meets or exceeds the Standards of the United States Department of the Interior for Rehabilitation, Preservation, Restoration, and Reconstruction of historic properties: now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The above recitals are hereby expressly incorporated as if fully set forth
herein
!
SECTION 2. The City hereby determines that the incentive provided by Class L is necessary for the Substantial Rehabilitation of the Project Real Estate
SECTION 3. The City hereby expressly supports and consents to the granting of the Class L incentive. The City's support and consent to the grant of certification for the Class L incentive for the Project Real Estate is expressly conditioned upon the substantial completion of the Project as proposed by the Owner and approved by the City, both upon completion of the Substantial Rehabilitation ofthe Project Real Estate and during the term ofthe Class L incentive.
SECTION 4. The Project is anticipated to be completed by June 30, 2021. The Commissioner of DPD (the "Commissioner") or a designee of the Commissioner (together with the Commissioner, an "Authorized Officer") shall have discretion to extend the construction completion date by issuing a written extension letter in1 response to a written request from the Owner. To the extent that the Project Real Estate is not rehabilitated, used or maintained during the term ofthe Class L incentive in a manner which is substantially consistent with the approved Project or Intended Use, as determined by the Authorized Officer, the Authorized Officer is hereby authorized to take such steps as may be necessary and appropriate to withdraw the City's support and consent to the Class L incentive, which may cause the Class L certification to be terminated or revoked.
SECTION 5. The City has reviewed and hereby accepts the Landmarks Commission's amended and restated written recommendation of the Project for the Class L incentive, which specifies the Project budget and proposed scope ofthe work, and which specifies that the Project meets or exceeds the Standards of the United States Department of the Interior for Rehabilitation, Preservation, Restoration, and Reconstruction of historic properties, a copy of which is attached hereto as Exhibit 2 and made a part hereof.
SECTION 6. The Economic Disclosure Statement, as defined in the County Ordinance, has been received and filed by the City.
SECTION 7. The Authorized Officer is hereby authorized to deliver a certified copy of this Ordinance to the Assessor and to furnish such additional information as may be required in connection with the filing of the application by the Owner with the Assessor for Class L designation of the Project Real Estate.
SECTION 8. The Authorized Officer is hereby authorized to enter into and execute such instruments and agreements, and perform any and all acts as shall be necessary or advisable in connection with the Project, or such other terms and conditions as may be imposed or approved in connection with the Project by the Authorized Officer.'
SECTION 9. The Authorized Officer is hereby authorized to approve minor changes in the scope of work and budget delineated on Exhibits A and B to Exhibit 2 hereof, provided that changes in the Building conditions warrant such changes and will not change the suitability of the Project Real Estate for the Intended Use (all as determined in the sole discretion of the Authorized Officer) Changes to the Project budget delineated on Exhibit A to Exhibit 7 shall not require prior City approval provided that the Project is substantially completed in accordance with the scope of work defined in Exhibit B to Exhibit 7. and achieves the minimum investment required for Class L
eligibility
SECTION 10. Upon request by the Owner for a final determination of the eligibility of the Project Real Estate for the Class L incentive by the Landmarks Commission pursuant to the County Ordinance upon completion of the Substantial Rehabilitation of the Project Real Estate, the Authorized Officer shall verify that the work performed substantially conforms to the Project approved by the City and that the Project Real Estate is eligible for the Class L incentive (the "Final Determination").
SECTION 11. Any conveyance of all or a portion of the Project Real Estate by the Owner before the Final Determination shall render the support and consent of the City for the Class L incentive set forth hereunder in connection with the Project null and void. Any renewed support and consent of the City for the Class L incentive contemplated -in connection with the Project undertaken by a successor in interest to the Owner of the Project Real Estate prior to the Final Determination shall require additional authorization by the City Council. Any change prior to the Final Determination in the direct owners in excess of 7.5% of the Owner or who constitute the direct or indirect controlling parties ofthe Owner, as determined by the Corporation Counsel (an "Ownership Change"), shall render the support and consent of the City for the Class L incentive set forth hereunder in connection with the Project null and void, unless such Ownership Change is approved by the Authorized Officer in his or her discretion. This Section shall not apply to the transfer of a beneficial interest in the Owner to Tax Credit Investors with respect to the Project, or to the transfer of a leasehold interest in the Project Real Estate to a master tenant entity owned in whole or in part by one or more Tax Credit Investors, provided that such transfers do not involve a change to the direct or indirect controlling parties of the Owner.
SECTION 12. No permit fee waiver(s) pursuant to Section 2-120-815 of the Municipal Code of Chicago from the City related to the Project Real Estate shall be granted to the Owner during the rehabilitation of the Project and prior to the expiration ofthe Class L incentive related to the Project Real Estate.
SECTION 13. To the extent that any ordinance, resolution, order or provision of the Municipal Code of Chicago, or part thereof, is in conflict with the provisions of this Ordinance, the provisions of this Ordinance shall be controlling. If any section, paragraph, clause or provision shall be held invalid, the invalidity of such section, paragraph, clause or provision shall not affect any of the other provisions of this Ordinance.
SECTION 14. This Ordinance shall be effective from and after its passage and approval.
EXHIBIT 1
LEGAL DESCRIPTION
(Subject to final title and survey)
Permanent Index Numbers: 17-16-219-001
Address Commonly known as:
226 West Jackson Boulevard, Chicago
LOTS 23, 24, 25, 26, 27, 28, 29, 30, 31 AND LOT 52 IN THE SUBDIVISION OF BLOCK 92 IN SCHOOL SECTION ADDITION TO CHICAGO IN SECTION 16, TOWNSHIP 39 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
EXHIBIT 2
Commission on Chicago Landmarks Recommendation to the City Council
- see attached
CITY OF CHICAGO COMMISSION ON CHICAGO LANDMARKS January 9, 2020
AMENDED AND RESTATED RECOMMENDATION TO THE CITY COUNCIL THAT A CLASS L REAL ESTATE TAX REDUCTION BE APPROVED FOR
226 W. Jackson Boulevard Chicago & North Western Railway Office Building
To the Mayor and Members of the City Council ofthe City of Chicago:
Whereas., the Commission on Chicago Landmarks (the "Commission") has reviewed an application for the proposed exterior and interior rehabilitation ofthe building at 226 W.Jackson Boulevard (the "Building," and its rehabilitation, the "Project"), pursuant to the Cook County Real Property Assessment Classification Ordinance, as amended (the "County Ordinance"), and its requirements governing the Class L real estate tax incentive (the "Class L"); and
Whereas, the Building was preliminarily recommended as a Chicago Landmark by the Commission on November 7, 2019; and
Whereas, the Commission now desires to amend and restate its November 7, 2019 preliminary recommendation to add an amended Exhibit A and iixhibit C attached hereto; now, therefore
THE COMMISSION ON CHICAGO LANDMARKS HEREBY:
Incorporates the above recitals; and
Finds, based on (he Project's budget and proposed scope of work, incorporated herein and attached as Exhibits A, B and C respectively, that the Project meets or exceeds the Secretary of the Interior's Standards for the Rehabilitation of Historic Building,,-; and
i. Finds that the Project meets the eligibility criteria for the Class L incentive specified in the County Ordinance;
4. Recommends, conditioned upon a final determination by the Commission and the City
Council to designate the building, as a Chicago Landmark, that the Project be approved
for the Class L. incentive. . ^ 7 _ ^
The above recommendation was passed '¦.u_. . . ¦.• effective as ofthe November 7, 201 9 date\>lj the original pVeliminaiy recommendation.
Rafael iVI Leon Chairman
Hated: Q-rt v,, , ^ , £_ C L- O
/ i /- i '
EXHIBIT A PROJECT BUDGET
Category Non-Eligible Cost! Class L Eligible Costs Total Costs
1. Building Acquisition $32,675,000 - $32,675,000
2. Acquisition Closing Costs $82G,750 - $826,750
3. Hard Costs [List Hard Costs Below]
Demolition / Site $4,908,503 $4,908,503
Concrete $740,231 $740,231
Masonry
Granite Repairs $94,6S6 $94,656
Brick Masonry Repairs $384,093 $384,093
Terra Cotta Repairs $302,462 $302,462
Cast Iron Repairs $173,999 $173,999
Wood Component Repairs $7,404 $7,404
Sealant Replacement $565,681 $565,681
Replace Window Glazing Gasket Inc. Above Inc. Above
Prep and Cleaning of Complete Facade $716,704 $716,704
Other Masonry $225,591 $225,591
Metals $2,502,418 $2,502,418
Wood/Plastics $2,112,387 $2,112,387
Thermal/Moisture Protection
Membrane Roofing $1,024,273 , $1,024,273
Green Roof $82,005 $82,005
Other Thermal/Moisture Protection - $986,537 $986,537
Doors/Windows $2,733,165 $2,733,165
Finishes $1,912,680 $11,050,136 . $12,962,816
Specialties $792,468 $792,468
Equipment $1,015,035 $1,015,035
Conveying Systems $1,928,344 $1,928,344
Mechanical $13,910,12S $13,910,125
Electrical $8,213,824 $8,213,824
General Conditions $2,597,442 $2,597,442
Insurance $589,327 $S89,327
Overhead & Fee $1,507,483 $1,507,483
Contractor and Design Contingencies $3,787,536 $373,961 $4,161,497
FRP Cornice $822,768 $822,768
Preliminary Budget Contingency !5%) less Cornice $375,386 $2,063,770 $2,439,156
Total Hard Costs $7,883,105 $60,617,289 $68,500,394
4. Soft Costs
Permit Fees $345,000 $345,000
AfiE $2,264,900 $2,264,900
Consulting $300,000 $1,025,873 $1,325,873
Legal $785,118 $785,118
Insurance $940,065 $940,065
Development Management $3,644,380 $3,644,380
Debt and Equity Construction loan Interest $3,509,967 $3,509,967
Other financing & Closing Costs $¦1,069,325 $4,069,325
Preliminary Budget Contingency (5%) $ 192,45-1 $482,891 $675,345
Other Soft Costs $3,996,872 $3,996,872
Total Soft Costs $8,071,745 $13,485,099 $21,556,845
S. Furniture, Fixtures, & Equipment
Furniture, Fixtures, & Equipment $8,53-1,-123 $8,534,423
Preliminary Bucget Contingency (5%) $-176,721 $426,771
Total Furniture, Fixtures, & Equipment $8,961,1-14 $8,961,144
6. Operator Supplies & Equipment / Technology
Operator Supplies & Equipment / Technology $3,3-10,229 $3,3-10,229
Preliminary Budge; Contingency (5%) $167,011 $167,011
Total Operator Supplies & Equipment / Technology $3,507,240 $3,507,240
l:irn|ccl Totnl Costs $61,924,384 S74,102,388 $136,027,372
EXHIBIT B
CHICAGO & NORTH WESTERN RAILWAY OFFICE BUILDING (226 W. Jackson) SCOPE OF WORK
General, All work affecting the significant historical and architectural features shall be clone in accordance with the following:
The City of Chicago's building permit review procedures and the Landmarks Ordinance, 2-120-
580 et seq. of the Municipal Code of Chicago.
The review and approval of the Commission.
The U.S. Secretary of the Interior's Standards for the Rehabilitation of Historic Buildings (the "Standards") and the Guidelines for Alterations to Historic Buildings and New Construction, adopted by the Commission on March 4, 1992.
Historic photographs, architectural drawings, and any other available archival documentation of the building, unless alteration from the same are agreed to by the Commission, to be investigated and assembled by the property owner.
Drawings prepared by Hartshorne Plunkard Architecture dated August 23^ 2019, revised drawings dated September 18, 2019, with additional updated sheets submitted for permit October 25, 2019, facade condition assessment summary report prepared by Klein & Hoffman dated May 29, 2019 and corresponding repair drawings dated September 18, 2019, and any Commission/PRC conditions of approval.
Required Approvals. All work must be submitted to the Commission staff for prior review and approval. The Commission staff may require as part of its review, as appropriate, material and replacement material samples, paint colors and finishes, shop drawings, specifications, mock-ups, test patches, and control samples.
Required Work.
Exterior.
Work shall include:
Masonry repairs, including tuckpointing. will be performed as necessary to address all condition issues.
All facades will be cleaned using the gentlest means possible.
A stone door surrounds and pediment will be reintroduced based on historic photos at the secondary entrance on Franklin.
At the non-historic south glass facade along Jackson Blvd., two side entries will be removed and a new center entry installed.
A new sill cut will be made on the Quincy facade to allow relocation ofthe loading area currently located on the principle l-'ranklin facade.
The majoiity ofthe existing windows will be retained and repaired and will remain non-operable. Areas of cast-iron mullions, sills, and jambs will be retained and repaired as needed. One bay of windows at the easternmost side of the north (Quincy) elevation will be added from the first floor to the sixth floor for new hotel rooms.
Non-historic infill within select basement window openings will be removed and replaced with
new clerestory windows to match historic conditions.
Brick parapets shall be coaled lo match the sunoundmg stone.
Interior:
Work shall include
.?D(i>i.i ooon! :>;o2:-ir, 12
Demolition of all interior non-load bearing walls and finishes, and select areas of masonry load-bearing masonry walls.
Structural work to include: repair or replacement of clay tile and steel structural elements; replace roof deck and structure 100% with new metal deck with concrete infill. Conversion of building to a hotel use with approximately 350 rooms and associated amenities. The existing bank of five elevators will be retained and divided to service the two separate hotel uses. The existing freight elevator will be retained and reconfigured for use as the elevator to the roof and a new loading elevator will be added to the north side ofthe building (West Quincy Street) serving the basement and first floor.
Historic elevator lobby locations and plan will be retained; and historic finishes will be retained and revealed
The two historic stairs, at the east and north, will be retained. A third stair at the center ofthe building will be removed above the second floor, and remain from the second floor to the basement. Historic stairs will be extended up to the new addition.
All existing obsolete mechanical, electrical, plumbing, and fire protection systems will be removed and new code compliant systems installed in addition to upgrades to bring the building in to conformance with the City's High Rise ordinance - including all life safety, accessibility and energy code requirements.
New mechanical units will be installed primarily in current attic space on the 15'h floor and will not be visible lo the public. Additional individual floor systems, where required, will be concealed and located so as not to damage or compromise significant historic fabric.
Sustainable Features:
Exceed Energy Code by 5% - 20 Points
50% Green Roof- 10 Points Proximity to Transit - 5 Points
CTA Digital Displays - 5 Points
80% Waste Diversion - 10 Points
Work shall occur in accordance with permit drawings for the Project, to be reviewed and approved by the staff ofthe Commission on Chicago Landmarks
Additional work not required by the Class L, but to be undertaken by the owner, includes construction of a one-story rooftop addition and roof deck. Any signage and exterior illumination shall be reviewed and approved by the Commission.
2IK1M2 :;()!)() 1 2'5i)2'i'»v
EXHIBIT C Addition;)I Requirements
The Applicant is proposing to provide an overhanging cornice replication on the building located at 226 W. Jackson Blvd. The overhanging cornice replication would be made of Glass Fiber Reinforced Polyester Resin (FRP) and designed and installed as depicted on the drawings prepared by Martshorne Plunkard Architects dated December 17 and 30, 2019 ("Cornice").
The requirement to provide the Cornice would be subject to the following conditions being met:
It will be necessary to obtain National Park Service ("NPS") approval ofthe Cornice locations, materials and details, and approval to eliminate from the design the replication of the missing vertical parapet above the overhanging cornice, and the elevator machine rooms as depicted. These details will be submitted to the Illinois State Historic Preservation Office via a Part 2 amendment in January 2020.
It will be necessary to obtain approval by the Chicago Building Department and its Committee on Standards and Tests of the use ofthe proposed FRP based on previous similar approvals and any other relevant issues related to the design and installation ofthe Cornice. The details ofthe proposed Cornice will be submitted to the Committee on Standards and Tests for consideration at either its January or February, 2020 hearing.
The cost ofthe Cornice approved by the NPS and the Chicago Department of Buildings does not exceed $822,768.00, the cost identified in the document titled 226 West Jackson - FRP (fiberglass reinforced plastic) cornice dated December 19, 2019 ("Cornice Budget.")
In the event that the final ordinance recommending approval of the Class L Property Tax Incentive, which is approved by the City Council, amends the terms ofthe Amended and Restated Class L Recommendation in such a way to increase the overall Project Budget attached as Exhibit A to the ordinance or is not approved by the City Council by April 22, 2020, the Applicant will not be required to provide the Cornice.
If the above conditions are not met the Applicant will not be required to provide the Cornice. In that event, the Applicant will be required to provide documentation to the staff of the Chicago Landmarks Commission that the conditions have nol been met. Such documentation should include either a copy ofthe written denial by cither the NPS or the Department of Buildings or documentation identifying all line item costs noted in the Cornice Budget demonstrating that the Cornice costs would exceed the amount contained in the Cornice Budget or documentation identifying the increase ofthe overall Project Budget relative to Item 4 above. No further action on the part ofthe Applicant will be required.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Phoenix 226 Central Loop Owner LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[x] the Applicant
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
[ ] a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1)) State the legal name ofthe entity in which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 30 S. Wacker Drive, //2200
Chicago, 11. 60606
Telephone: 847-530-3543 Fax: Email: )mangcl@phocnixdcvelopmcnlpaiincrs com
Name of contact person: John Mangel
Federal Employer Identification No. (if you have one): _
Brief description ofthe Matter lo which this EDS pertains. (Include project number and location of property, if applicable):
Approval of a Class L Property Tax Incentive for 226 W Jackson
Ci. Which City agency oi department is requesting this EDS'7 Depaiimcnt of Planning and Development
If the Matter is a contract being handled by ihe City's Department of Piociiiement Services, please complete the following
Speciflcation /; _ __ __ and Contract ;/
Vci :f!|,X-| Pa-e 1 oi' 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing P<
[ ] Person
[ ] Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ j General partnership
[ ] Limited partnership
[ JTrust
[x j Limited liability company
[ ] Limited liability partnership
[ ] Joint venture
[ ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
[ ] Yes [ ] No [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
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 [ ] 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 ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
226 Jackson SI'E LLC Managing Member
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 owntiship) in excess ol 7 5% of ihe Applicant. Examples ol such an mleiest include share-, in a coiporation, partnership interest in a partnership or |0inl venture, interest of a membei 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: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
Twain HTC Fund 2200 Washington Avenue, St Louis, MO 63102 99%
XXXII, LLC
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? [ ] Yes [x] 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? [ ] Yes [x ] No
If "yes" to either ofthe 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? f ]Yes [x]No
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/do'mestic partner(s) 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, lobbyist (as defined in MCC Chapter 2-1 56), 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 nol required to disclose employees who are paid solely through the Disclosing Party's regulai payroll. If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Parly musl either ask the City whether disclosure is required or make the disclosure.
l\mc 3 of 15
Name (indicate whether Business Relationship to Disclosing Party
retained or anticipated Address (subcontractor, attorney,
to be retained) lobbyist, etc.)
300 S. Wacker, #2200
Daspin & Aunient LLP Chicago, IL 60606 Attorney Retained
i3 w jackson Hiv"a
MacRostie Historic Advisors Chicago. IL 60604 Historic Preservation Consultants Retained Estimated to be in excess of SI 0,000 232 N. Carpenter Street
Hartshornc Plunkard Clncaco 11,60604 Architect Retained Estimated to be in excess of J 10,000
"Klein & Hoffman 1561. Wacker Drive, it 1900 Engineers Retained Estimated lobe in excess of $10,000
(Add sheets if necessaiy)liic;ie<>. iL.r>0606
[ ] 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 MCC 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 ofthe 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 indirectly owns 10% or more of the Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ ] Yes [ ] No
FURTHER CERTIFICATIONS
ff his 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 nor any Affiliated Entity [s_ee 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, fee, tax or olhei source of indebtedness owed to the City ofChicago, including, but nol limited to, water and sewer charges, license lees, parking tickets, property taxes and sales taxes, nor is the Disclosing Parly delinquent in the payment of any tax admimstcied by the Illinois Dcpai Irnenl of Revenue.
Pane 4 ol 15
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identilied in Section 1I(B)( 1) of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, during the 5 years before 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 subparagraph (b) above;
have not, during the 5 years before the date:of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during the 5 years before the date ofthis 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 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");
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 clnectly 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 ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other of ficial, agent or employee of the Disclosing Party, any Conlractoi or any Affiliated Entity, acting puisiiant to the direction or authorization of a responsible official ofthe Disclosing Party, anv C.'i >i ii in c t< it" or any Affiliated Entity (collectively ''Agents'')
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:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
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).
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(l) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Parly nor any Affiliated Entity is listed on 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 aelual, 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 Enlilics will nol use, nor permit their subcontractors to use, any facility listed.as having an active exclusion by the U S. EPA on the federal System for Award Management ("SAM").
iU. | FOR APPLICANT ONLY | The Applicant will obtain from any contractors/subcontractors lined
or to be lured in connection with the Matter certifications equal in form and substance to those in
('er! i' icat ions [?) and (c^) above and will nol. without the prior w i men consent ofthe City, use anv such
contractor/subcontractor that does not provide such certifications or thai the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. 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:
None
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.
12. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe 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, ofthe City of Chicago (if none, indicate with "N/A" or "none").
None
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 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 $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.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Parly (check one)
[ "I is [x ] is nol
a "financial institution" as defined in MCC Section 2-32-455(b).
If the Disclosing Party IS a financial institution, Ihen the Disclosing Parly pledges:
"We are not and will not become a predatory lender as defined m MCC Chanter 2-32 Wc furthei pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chaplei 2-32 We undei stand thai becoming a piedatory lender oi becoming an affiliate of a prcdatoiv lender may result in the loss of the privilege of doing business wuh the City "
Vci V(j I S- I
If the 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):
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 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 ofthe 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 [x] 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), skip Items D(2) and 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 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 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?
[ ] Yes [ ] No
If you checked "Yes" to Item D(I), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature ofthe financial interest:
Name Business Address Nature of Financial Interest
4 The Disclosing Parly further certifies lhat no prohibited financial mierest 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 m 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.
x 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes ofthis Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING N/A
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):
(Tf no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appeal', 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 'I'he Disclosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed m paragraph A( I) above for his or her lobbying activities or to pay any
poison oi entity to inlluence or attempt to influence an officer opemployee ol anv agency, as defined
bv applicable lederal law. a membci cf Congress, an oil ice: ot emplovee of Congress, or an cmolovee
.Va 20 I N-1 l\!!.:o •> oi' 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, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
The Disclosing Party will submit an updated certification at the end o f each calendar quarter in which there occurs any event that materially affects the accuracy ofthe 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) 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 ofthe Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY n/a
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 tbe 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
flave 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 [ | No [] Reports not required
flave you participated in any previous contracts or subcontracts subject to the equal opportunity clause'7
| ] Yes | ] No
If you checked "No" to question (I) or (2) above, please provide an explanation-
SECTION VII -- FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Parly understands and agrees that:
The certifications, disclosures, and acknowledgments contained m 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. 'I"he 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 of the information provided in, and appended to, this EDS may be made publicly available 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 MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the 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.
I I O: I 5
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 of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as ofthe date furnished to the City.
Phoenix 226 Centra! Loop Owner LLC by 226 Jackson SPE LLC, its Managing Member (Print or type exact legal name of Disclosing Party)
By:
John Mangel
(Print or type name of person signing)
Manager
(Print or type title of person signing)
Signed and sworn to before me on (date)
< ,r» lift.-** a
JENNIFER ROBLES
Commission expires:
as'.c 12 nf 15
CTTY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under fvlCC 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 ofthe Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the 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 ofthe 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 Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ I Yes |x | No
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
I'as;c 13 i)l 15
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% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
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 [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 MCC Section 2-92-416?
[ ] Yes [ ] No jx ] 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.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX 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.coin' ), generally covers a party to any agreement pursuant to which they: (1) receive City ofChicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay 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, I 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. 1 also certify that the Applicant has adopted a policy that includes those prohibitions.
[ ] Yes [ ]No
[x] N/A - I 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.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
226 Jackson SPE LLC
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
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
[x ] a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1)) State the legal name ofthe entity in which the Disclosing Party holds a right of control:
Phoenix 226 Central Loop Owner LLC
B. Business address of the Disclosing Party: 30 s wacker Drive, Suite 2200
Chicago, IL 60606
Telephone: 312-466-5700 Fax: Email: jmangcl@phoenixdcvelopmcntpartneis.coiT
Name of contact person: John Mangel
Federal Employer Identification No. (if you have one):,
Brief description ofthe Matter to which this EDS pertains. (Include project number and location of property, if applicable):
Appmval of a Class L Piopcrty Tax Incentive lor 226 W Jackson . _
Which City agency or department is requesting this EDS''' Dcpaumcm of Planum" and Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the loliowmg'
Specification/¦ __ and ('ontract ¦¦
Vo 20IS-1 Paijc 1 ol 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1 Indicate the nature ofthe Disclosing Pc
[ ] Person
[ ] Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ ] Limited partnership
[ ] Trust
ty:
[x ] Limited liability company
[ ] Limited liability partnership
[ ] Joint venture
[ ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
[ ] Yes [ ] No [ ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Delaware
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?
[xj Yes [ ] No [ ] 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 ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
.John Mangel Managing Member
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% ofthe Applicant. Examples of such an interest include shares m a corporation, partneislup intciest in a partneisiup oi jmni venluie, interest ol a member oi manager in a
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest m the Applicant
Phoenix 226 Holding LLC 30 S. Wacker Drive. Suite 2200. Chicago, IL 60606 100%
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? [ ] Yes [x] 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? [ ] 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 ofthe Municipal Code ofChicago ("MCC")) in the Disclosing Party?
[ ] Yes [ x] No
If "yes," please identify below the name(s) of such City elected oflicial(s) and/or spouse(s)/domestic partner(s) 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, lobbyist (as defined in MCC Chapter 2-1 56), 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 lo be paid. The Disclosing Party is not required to disclose employees who aie paid solely through ihe Disclosing Parly's regular payroll. If the Disclosing Parly is uncertain whethei a disclosure is required under this Section, the Disclosing Parly must either ask the Cny whether disclosure is iequirec.1 or make the disclosure
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)
[x] 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 MCC 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 ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ J Yes [xj No [ ] No person directly or indirectly owns 10% or more ofthe 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 [ j No
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 nor any Affiliated Entity [see definition m (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, fee, tax or other source of indebtedness owed lo the Cily ofChicago, including, but not limited to, water and sewer chaigcs. license fees, parking tickets, property taxes and sales laxes, nor is the Disclosing Parly delinquent in the payment of any lax administered by ihe Illinois Department of Revenue.
I'.iL'e -I nl 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 m 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 ofthe offenses set forth in subparagraph (b) above;
have 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
have not, during the 5 years before the date ofthis 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 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 [V, "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 stale 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 ofthe 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 ihe direction or authorization of a responsible official ofthe Disclosing Party, any Contractor oi any Affiliated Entity (collectively "Agents")
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 A ffiliated 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:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe 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 subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct;, or
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).
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 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 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 1 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 1 is a continuing requirement for doing business with the City. NOTE: If MCC Chapter 1-23, Article 1 applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-ycar compliance timeframes in this Section V.
[FOR. APPLICANT ONLY] The Applicant and ils Affiliated Entities will not use, nor permit then" subcontractors lo use, any facility listed as having an active exclusion by the U.S EPA on Ihe federal System for Award Management ("SAM").
jfOR APPLICANT ONLY] The Applicant will obiain from any eontraetors/subconiiaciors lured oi lo be hired in connection wiih the Mattel certifications equal in foim and substance to those in (.'end teat ions (2) and (9) above and will nol, uithoui the piioi uutier consent ol the City, use any such
i',i::c (i ol I 5
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. 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:
None
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.
12. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the date ofthis EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
None
13. To the best ofthe Disclosing Party's knowledge afterreasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused lo be given, at any time during the 12-month period preceding the execution date ofthis 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 iiT the course of official City business and having a retail value of less 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 ofthe City recipient.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is {y. ] 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 no! and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge lhat none of oui affiliates is, and none of them will become, a predate): }' lender as defined in MCC Chapter 2-32. We understand that becoming a piedalory lender or becoming an affiliate of a predatory lender may result m the loss ofthe privilege of doing business with the Cily."
if the 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):
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 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 ofthe 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 [x] 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), skip Items D(2) and 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 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 ofthe City (collectively, "Cily Property Sale"). Compensation for property taken pursuant lo the City's eminent domain power does not constitute a financial interest within the meaning ofthis Part D.
Does the Matter involve a City Property Sale?
[ ] Yes [ ] No
If you checked "Yes" to Item D(l), provide the names and business addresses ofthe City officials or employees having such financial interest and identify the nature ofthe financial interest:
Name Business Address Nature of Financial Interest
A. The Disclosing Party further certifies that no prohibited financial inteiest in ihe Matter will be acquired by any City official oi employee.
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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.
x 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes ofthis Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING n/a
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):
(II no explanation appeais or begins on the lines above, or if the letters "NA1' 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, as amended, have made lobbying contacts on behalf of ihe 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 oi entity listed in paragraph A(l j above for his or her lobbying activities or to pay any person or entity to mlluence or attempt :o influence an ol litei or employee of any agenev. as defined by applicable ledera! law. a menihe: ol (.'ongic^s. an oilicei oi emolovee ol Congicss. 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.
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) 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 ofthe Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY n/a
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 Parly 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.)
[ J Yes [ ] No
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 [ ] No | ] Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause9
| | Yes | '] No
If you checked "\;o" to question ( I) or (2) above, please provide an explanation
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SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
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 m connection with the Matter, whether procurement, Cily 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.cit.vofchicaoo.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 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 MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept currenl for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
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C E R IT FIC A TIO N
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 ofthe date furnished to the City.
226 Jackson SPE LLC
(Print or type exact legal name of Disclosing Party)
John Mangel
(Print or type name of person signing)
Managing Member
(Print or type title of person signing)
Signed and sworn to before me on (date)
Of-rf'PO
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
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 ofthe Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the 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 ofthe 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 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 ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE ST ATEMENT 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% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
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 [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 MCC Section 2-92-416?
[ ] Yes [ ] No [x ] The Applicant is not publicly traded on any exchange.
If yes to (I) 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.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT .
APPENDIX 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 (wwvv.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) pay 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 - I 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.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ i f appl icable-
Twain HTC Rind XXXII, LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR
[x] a legal entity currently holding, or anticipated to hold within six months after Cily action on the contract, transaction or other undertaking to which this EDS pertains (referred lo below as the "Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name: Phoenix 226 Central Loop LLC
~OR ~~
[ ] a legal entity with a direct or indirect right of control of Ihe Applicant (see Section 11(B)(1)) Stale the legal name ofthe entity in which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 2200 Washington Avenue
St. Louis, MO 63103
Telephone: 3 14-300-4 1 70 Fax: Email: _£eplinnic Name of contact person: Stephanie Dctcrding
E Federal Employer Identification No. (if you have one):
-1
Brief description ofthe Matter to which this EDS pertains. (Include project number and location of property, if applicable):
Appiova) of a Class I. Piopcity Tax Incentive for 226 W. Jackson
Which City agency 01" department is requesting this EDS? Dcpaiimeni oH-Mannm]} ami Development
If the Matter is a contract being handled by the City's Department of Procurement Sei vices, please-complete the following.
Specification // _ _ and Contract h
Vci .-018-1 Page I ol 15
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
[ ] Person
[ J Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ j Limited partnership
[ JTrust
[x ] Limited liability company
[ J Limited liability partnership
[ ] Joint venture
[ ] Not-for-profit corporation
(Ts 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:
Missouri
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?
[ JYes [x]No [ ] 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) Cor 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 ofthe Applicant.
Title
100% Mcmbci
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name
StaiKiaid Insurance Company
[ wain HTC, LLC Non-Member Manager
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% ofthe Applicant. Examples of such an interest include shares in a corporation, partnership inteiesi in a partneiship or joint venture, mteiest of a member or manager m a
I'at-c 2 of 15
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity, if none, state "None."
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
Standard Insurance Company 1 100 SW Sixth Ave, Poitland Oiegon 97204 100%
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 of this EDS? [ ] Yes [ x] 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 ofthis EDS? [ ] Yes [x] No
If "yes" to either ofthe 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 of the Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-1 56 ofthe Municipal Code ofChicago ("MCC")) in the Disclosing Party?
[ ] Yes [ x] No
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partner(s) and describe the financial intercst(s).
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OT HER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractoi, attorney, lobbyist (as defined in MCC Chapter 2-1 56), accountant, consultant and any other person or entity whom the Disclosing Parly has retained or expects 10 retain in connection with the Mailer, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is nol required to disclose employees who are paid solely through the Disclosing Party's regular payroll. If the Disclosing Parly is uncertain whethei a disclosure is required under this Section, the Disclosing Party must cither ask the City whether disclosure is required or make the disclosure
\';\'jx } oi' 15
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate v> hether
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)
[x] 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 MCC 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 ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [x] No | J No person directly or indirectly owns 10% or more ofthe 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?
[" j Yes [ ] No
FURTHER CERTIFICATIONS
[This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of Procurement Services.J In the 5-year period preceding the date ofthis EDS, neither the Disclosing Party nor 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 speci fied 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).
'['he Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine, fee, tax oi other source of indebtedness owed to ihe City ofChicago. including, but not limned to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, not is the Disclosing Party delinquent in the payment of any tax admmisleied by the Illinois Department of Revenue
3 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;
c are nol presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in subparagraph (b) above;
have 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
have not, during the 5 years before the date ofthis EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning 1 environmental violations, instituted by the City or by the federal government, any state, or any other unit of local 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 m connection with the Mailer, 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 slate or local government, including the Cily, using substantially the same management, ownership, or pi incipals as the ineligible entity. With lespecl io 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 ofthe Disclosing Parly, any Contractor or any Affiliated Entity or any olhei official, agent or employee of ihe Disclosing Party, any Contractor or any Affiliated Entity, .acting pursuant to the direction or authorization of a icsponsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 cf 15
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor, nor any Agents have, during ihe 5 years before the dale 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:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the Slate of Illinois, or any agency ofthe 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 subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
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).
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 ILCS 5/33E-4; or (3) anysimilar offense of any state or ofthe 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 a Sanctions List, maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
S. [FOR APPLICANT ONLYJ (i) Ncithei the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] of the 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, foigery, 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, lhat 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 System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant wili obtain from any contiactors/subcontiactors lined or lo be lured in connection with Ihe Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, wuhoui the prior written consent ofthe City, use any such
contractor/subcontractor that does not provide such certifications or thai the Applicant has reason to believe has not provided or cannot provide truthful certifications.
II. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
None
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.
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 ofthis EDS, an employee, or elected or appointed official, ofthe City ofChicago (if none, indicate with "N/A" or "none").
None
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 12-month period preceding the execution date ofthis EDS, to an employee, or elected or appointed official, of the City ofChicago. For purposes ofthis 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 S25 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 ofthe City recipient. None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1 The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [x j is not
a "financial institution" as defined in .MCC Section 2-32-455(b).
2. If the Disclosing Party IS a financial institution, then the Disclosing Parly pledges:
"Wc are nol and will not become a predatory lender as defined in MCC Chaplci 2-32. We further pledge thai none of out affiliates is, and none of them wdl become, a predatory lencei as defined in MCC Chapter 2-32. We understand that becoming a predatoiy lender or becoming an affiliate of a piedatory lender may result in the loss ofthe privilege of doing business with the. City "
Page 7 ol" 15
If the Disclosing Party is unable to make this pledge because il or any of its affiliates (as defined in VICC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
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 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.
ln accordance with MCC Section 2-156-110: To the best ofthe Disclosing Party's knowledge after reasonable inquiry, does any official or employee ofthe 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 fx] 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), skip Items D(2) and 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 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 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?
f ] Yes [ | No
If you checked "Yes" lo 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 interest1
Name Business Address Nature of Financial Interest
4. The Disclosing Parly further certifies that no prohibited financial interest in the Mallei will he actumed by any City official or employee
IZ. 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.
_¦_ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step ( I ) above, the
Disclosing Parly 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 VIE For purposes ofthis Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING n/a
1. List, below ihe 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 if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Parly means that NO persons or entities registeied 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 pa any person or entity listed in paragraph A(l) above for his or tier lobbying activities or lo pay any person oi entity to influence or attempt io influence an oflicei or employee of any agency, as defined by applicable fedeial law. a membei ot" Congress, an officer or employee of Congress, or an employe
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.
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 ofthe 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) ofthe 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," 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 n/a
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 ParLy 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
Flave 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 [ ] No [ ] Reports not required
1 lave you participated in any previous contracts or subcontracts subject to the equal opportunity clause'?'
[ j Yes ' I j No
If you checked "No" to question ( 1 ) or (2) above, please provide an explanation:
P:mc 1(1 nl" 15
SECTION VU - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
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 al www.cityofchicago.orij/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 Information Act request, or otherwise. By completing and signing this FDS, 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 lo the time the Cily takes action on Ihe Mailer. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Parly must update this EDS as (he contract requires. NOTE: With respect to Matters subject lo MCC Chapter 1-23, Article 1 (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kepi current for a longer period, as required by MCC Chapter I -23 and Section 2-154-020.
I'a-T I I nf Iri
CEirHFlCATiON
Under penalty ol" perjury, the person signing below. (1) won ants that he/she is authorized to execute this EDS, and u!l applicable Appendices, on behalf of the Disclosing Party, and (2) warrants thai all certifications and statements contained in this EDS, and all applicable Appendices, aie true, accuiate and complete as ofthe date furnished to the City.
Twuin HTC Punil XXXII, LLC
(Print or type exact leual na>ric of Disclosing Party)
(Print or type name of person signing)
Vice Pissitleni of Twain HTC. LLC. the Noii-Memhsr inon.iytr ol Tw.im HTC Fund XXXII. LLC
(Print or type title of person signing)
Signed and sworn to before me on
KELLY A. TROUT
Notary Public, Notary Seal
Stato of Missouri Saint Louis Counly
Commission ft 13447443 My Commission Expiros 12-13-2022
Payc 1/ oi 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-01 5, 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 cily 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 Parly" means (1) all executive officers of the Disclosing Party listed in Section II.B.I.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Parly is a limited liability company; (2) all principal officers ofthe Disclosing Parly; 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 Parly 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 ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city, official oi department head lo whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
I'.i:'.: I .< nl' 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BIJILDING-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% (an "Owner"). Jt is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
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 [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 MCC Section 2-92-416?
[ ] Yes [ ] No [x ] The Applicant is not publicly traded on any exchange.
3. 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.
!>:;-<• 14 of 15
CTTY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX 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.amle.ual com), generally covers a party to any agreement pursuant to which they: (i) receive City ofChicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay 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)(1) 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. 1 also certify that the Applicant has adopted a policy that includes those prohibitions.
[ j Yes
M No
[x] N/A - I 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.
Wi ::ois-[
i
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of Ihe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Standard Insurance Company
Check ONE of tlie following three boxes:
Indicate whether the Disclosing Patty submitting this EDS is:
| ] the Applicant
OR
[x] 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: Phoenix 226 Central Loop Owner LLC
_____
'3. [ ] a legal entity with a direct or indirect right of control of the 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: HOP SW Sixth Avenue
Portland, OR 97204
Telephone: 97l-321-X6:i3_ _ Fax: r;i-321-3037 Email: roh.stackhoiise@standartl.coni
Name of contact person: Rub Si_ickii_____
Federal Employer Identification No. (if you have one): _
Brief description ofthe Matter Lo which this EDS pertains. (Include project number and location of property, if applicable)'
Approv.il of?- Ckiss L !'iopi.rl> Ta\ In-e.-ilive <"[_ 226_\\' Jackson
Which Cily agency 01 depaumcnl is icqucsling this EDS? Depmtmcm_of Pliumins and Development
If the Matter is a contract bcnu; handled by the City's Department of Procurement Services, please complete the follow mo
Specification v _ and Contract //
SECTION II- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing [ ] Person
[ ] Publicly registered business corporation. [X] Privately held business corporation [ ] Sole proprietorship [ ] General partnership [ ] Limited partnership [ JTrust
Parly:
| ] Limited liability company
[ ] Limited liability partnership
f ] Joint venture
[ ] Not-for-profit corporation
(is the not-for-profit coiporation 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:
Oregon
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the Stale of Illinois as a foreign entity?
[ ] Organized in Illinois
B. IF THE DISCLOSING PARTY TS A LEGAL ENTITY:
1. List below the full names and titles, if applicable, of: (i) all executive officers and all directors of the entity; (ij) 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, Ihe Utistee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each geneial partner, managing mcinbci, manager or any other person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title.
Please see page 16 (i.;r ol' Hxecnhve Oificcis and Diiccloiy.
2 Please provide the following mfoi mation concerning each person or legal entity having a direct or indirect, current or prospective d.e within 6 months after City action.) beneficial interest (including ownership) in excess uf 7 5% dl the Applicant Examples of such an mteiest include, shares in a coipuiation pa:tnc!ship inici-.si in
Vci 2CS i Par,; 2 of 15
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in (he Applicant
SlimCorp rinnnn.il Pinup, Inc 1100 SW Sixth Avenue, I'niilnnd, OK 9'PM 100%
SECTION III -- INCOME OR COMPENSA TION 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 of this EDS? [ ] Yes fx] 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 ofthis EDS? [ ] Yes [x ] No
I
If "yes" to either of the above, please identify below the name(s) of such Cily elected official(s) and describe such income or compensation:
Does any City elected official or, to the best of the Disclosing Party's knowledge alter reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 ofthe Municipal Code ofChicago ("MCC")) in the Disclosing Party?
|' ] Yes [ xj No
IT "yes," please identify below Ihe namc(s) of such City elected official (s) and/or spouse(.s)/domesfic partner(s) and describe the financial intcrest(s)
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Pai ty must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MC(' Cliaptci 2-1 56), accountant", consultant and any oilier person or entity whom the Disclosing l'a;ty has letamed or expects to retain in connection with the Matter, as well as the natuie ofthe relationship. ;md the tola! amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required io disclose employees who arc paid solely through the Disclosing Parly's lcgulai payroll if the Disclosing Parly is uncertain whether a disclosure is required undei this Section, ihe Disclosing I'aMy nu.st cither ask (he City whether disclosure is required or make the disclosure
V,;i ?i.n y.
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)
[x] 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 MCC Section 2-92-415, substantial owners of business entities that contract with the Cily must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirccLly owns 10% or more ofthe 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 indirectly owns 10% or more of the Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person'in compliance with that agreement?
[ ] Yes [ ] No-
FURTHER CEP/frFI CATIONS
[This paragraph I applies only if the MatLer is a contract being, handled by the City's Department of Procurement Services, j In Ihe. 5-year period preceding the date ofthis EDS, neither the Disclosing Party nor any Affiliated Entity [sec 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 vendoi s as well as help the vendors reform their business practices so they can be considei cd for agency contracts in-ihe future, or continue with a contract in progress)
The Disclosing Paity and its Affiliated Entities are not delinquent in the payment of any fine, fee, tax or oihei source of indebtedness owud to ihe City of Chicago, including, but not limited to, water and sewer chaijjes. license fees, parking l:ckcls, property (axes and sales taxes, nor is the Disclosing Marty delinquent m the pa> merit of any lax administered by the Illinois Department of Revenue
3. The Disclosing Parly and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section JJ(.!3)(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 of this EDS, been convicted of a criminal offense, adjudged guilty, or bad 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 stale antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen properly;
are not presently indicted for, or ciiminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in subparagraph (b) above;
have 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
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 aclions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
'1. The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
5. 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, "Disclosuie of Subcontractors and Other .Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Pnity, 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 Cily. using substantially (lie same management, ownership, or principals as the ineligible entity Will: respect io Contractors, Ihe term Affiliated Entity means a person or entity that directly oi indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another peison or entity;
any i esponsible official of ihe Disclosing Party, any Contractor or any Affiliated Entity oi any other official, agc.nl or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant io ihe direction or authorization of a responsible official ofthe Disclosing Party, any Connnclo; nr any Al filiated Emily (collectively "Agents").
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Enclosing Party or any Contractor, nor any Agents have, during the 5 years before the dale ofthis EDS, or, with respect lo 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:
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 Uie federal government or of any state or local government in the United Stales 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 subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92~320(a)(4)(ConLracts Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Miniraum Wage Ordinance).
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 ILCS 5/33E-4; or (3) any similar offense of any state or of the United Stales of America thai contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Parly nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, Stale, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controllingperson" [sec 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 thai compliance with Arlicle I is a continuing requirement for doing business with the Ciiy. NOTE: ff MCC Chapter 1-23, Article I applies to the Applicant, thai-Article's pcimaucnt compliance tjmelianie supersedes 5-year compliance timeframes in this Section V.
|FOR APPLICANT ONLY) 'I lie Applicant and its Affiliated Entities will not use, nor permit (heir subcontractors io use. any facility listed as having an active exclusion by the U.S. EPA on the federal System for Awaid Management ("SAM")
|FOR APPLICANT <>M|.Y| The Applicant will obtain from any contractors/subcontractors hired or to be lured in connection wuli the Vl.iuci certifications equal in form and substance lo those in Certifications (2) and (9) above ami v-ill uui. without the pnoi written consent ofthe Ciiy, use any such
contractor/subcontractor lhat docs not provide such certifications or thai the Applicant has reason to believe has not provided or cannot provide truthful certifications.
1 ]. 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: None
If the letters "NA," the word "Mone," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified lo the above statements.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of Ihe Disclosing Party who were, at any time during the 12-monlh period preceding the date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
None
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 12-month period preceding the execution date ofthis EDS, to an employee, or elected or appointed, official, of the City ofChicago. For purposes ofthis statement, a "gift" does not include: (i) anything made generally available lo City employees or to tbe general public, or (ii) food or drink provided in the course of official Ciiy business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate widi "N/A" or "none"). As to any gift listed below, please also list ihe name ofthe City recipient. None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [\ ] is nol ;
j
a "financial institution" as rlelined m MCC Section 2-32-455(b). j
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges: [
"We aic not and will not become a predatoiy lender as defined in MCC Chapter 2-32. We furthei j
pledge that none of our affiliates is. and none of them wul become, a predatory lender as defined in j
MCC Chapter 2-32 We undcisiand that becoming a predatory lenciei or becoming an affiliate of a
picdatory lender may icsidt in ihe loss ofllie pi ivilege of doing business with the City.'' :
\> 7c! 15
If the 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):
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 FINANCIAL INTEREST FN CITY BUSINESS ,
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Pare D.
ln 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 Lhe 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 |x ] 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), skip'Items D(2) and 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 die 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 ofthe City (collectively, "City Property Sale"). Compensation foi properly taken pursuant, to the City's eminent domain power does not constitute a financial interest within the meaning ofthis PartD.
Does the Matter involve a City Property Sale?
[ j Yes 1 | No
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 ofthe financial interest:
"Name . .Business Address Nature of Financial Interest
'I The Disclosing Pauy furiha certifies that no prohibited financial interest in the Matter will he acquit cd by any City oIIkmI m employee
Wi .Nils-1
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check cither (i) or (2) below. If the Disclosing Party checks (2), the Disclosing Parly 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 inLo with the City in connection with the Matter voidable by the City.
x 1. The Disclosing Party verifies that the Disclosing Parly 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 hill 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 ofthis Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING n/a
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 ofthe Disclosing Party with respect to the Mallei. (Add sheets if necessary):
(If no explanation appeal s or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively piesunied that the Disclosing Parly means that NO persons or entities legislercd under the. Lobbying Disclosure Act of I 995, as amended, have made lobbying contacts on behalf of the Disclosing Parly with respect to ihe Mailer.)
2. The Disclosing Party h:v-- nol spent and will not expend any federally appropriated funds to pay any peison or entity lisicc, in. pat.ip.rnph A( i) above for Ins oi her lobbying activities or lo pay any person oi cnlily to influence oi attempt to "iii'lucuce an officer or employee of any agency, as defined by applicable federal law. a mcnibei of ('u-igiess, an officer oj employee of Congress, or an employee
Vci 201 !i-1 I'a.;.,: ') al' 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, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
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 ofthe statement's 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) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of tire Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that lenn 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 n/a
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 fart 60-2.)
[ ] Yes I' | No
Flave you filed with the Joint Reporting Commit tec, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes | | No | ) Reports not required
3 Ilave you participated in any previous eoniiacls oi subcontracts subject to the equal opportunity clause''
[ | Yes | ! No
If you checked "No" lo question (I) oi (2) above, please provide an explanation:
¦X ID ''I' 15
SECTION VII — FURTHER AC'KNOWJEKDGM ENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
Hie 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.cifyofchicago.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 Parly lo 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 of the information provided in. and appended lo, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Parly 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 authoi izes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this TiDS musl be kept currenl. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on Ihe Matter. If the Matter is a contiact being handled by ihe City's Department of Procurement Services, the Disclosing Party must update this EDS as tbe contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein i egarding eligibility musl be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
I':,^: 1 1 ol 15
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 Ci ty.
Standard Insurance Com puny ¦
(PrinLer-4-vpe exact legaLnarne of Disclosing Parly)
(Sign here)
(Print or type name of person signing)
(Print or type title of person signing)
Signed and sworn to before me on (date) _a
Notary Public Commission expires;
OFFICIAL STAMP
mSsM TOMMY A. JONES
VvSJW NOTARY PUBLIC-OREGON K&titi/ COMMISSION NO. 976985
MYCOMMISSION EXPIRES JULY 18, 2022
IV:v I 2 oi I 5
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
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 (hereof 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, tbe 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 U.B. 1 .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 ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Parly; 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 Partner thereof currently have a "familial relationship" with an elected city official or department head?
I ]Yes |;, j No
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) Ihe precise nature of such familial relationship
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFI'XAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is lo be completed only by (a) the Applicant, and (b) any legal entity which lias a direct ownership interest in the Applicant exceeding 7.5% (an "Owner"). Il is not to be completed by any legal entity which has only an indirect ownership interest in Ore Applicant.
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?
[ "J Yes fx] 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 MCC Section 2-92-416?
[ ] Yes [ ] No [x ] 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.
CITY OT CNJ CAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON WAGE & SALAR Y HISTORY SCREENING - CERTHTCATION
This Appendix is Lo 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 fwvw.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) pay 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 cun-ent 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.
Standard Insurance Company
Executive Officers Name
John Gregory Ness Holley Young Franklin, JD Sally Ann Manafi, FSA Robert Michael Erickson, CMA
Directors or Trustees Name
Frederick William Buckman Ranjana Bhnttacharya Clark Elizabeth Ellen Flynn Debora Dyer Elorvalh Akira Kumabe Duane Charles McDongall Helen Elizabeth Mitchell Kevin Masazo Murai John Gregory Ness Mary Frances Sammons Masahani Shiraishi Minoru Wakabayashi Richard Howard Wills Kazimori Yamauchi
Title
Chairman, President & Chief Executive Officer VP, Chief Legal Officer & Corporate Secretary VP, Oorpoiate Actuary & Chief Risk Officer VP, Chief Accounting Officer & Treasurer
CI TV OI1' CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
SlanCorp Financial Group
Check ONE of the following (lu ce boxes:
Indicate whether the Disclosing Party submitting this EDS is:
[ ] the Applicant
OR
[x] 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: Phoenix 226 Central Loop Owner LLC
OR
[ ] a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1)) State Ihe legal name ofthe entity in which the Disclosing Party holds a right of control:
Business address of the Disclosing Party: 1100 SW Sixth Avenue
Portland, OR 97204
Telephone: 971-321-8633 Pax: 971-321-5037 Email: Rob.Stackhouse@slandartl.com
Name of contact person: _Rob Stackhousc....
Federal Employer Identification No. (if you have one)
V. Brief description ofthe Matter lo which this EDS pertains (Include project number and location of property, if applicable):
Appioval of a Clnss L Property 'rax Incentive for '.>.'.'(> W iactcscn _
(!. Which City agency or department is iCqtlCSting illis EDS'? Department ofPjamip^ and Development
I;'the Mallei is a contract being handled by ihe City's Department of Procurement Services, please complete the following.
SECTION n - DISCLOSURE OE OWNERSHIP IN TERESTS
A. NATURE OF THE DISCLOSING PARTY
I. Indicate the nature of the Disclosing Party:
[ ] Person [ ] Limited liability company
[XI Publicly registered business corporation [ ] Limited liability partnership
[ ] Privately held business corporation [ j 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:
Oregon
3. For legal entities not organized in the State of Illinois: Plas the organization registered to do
business in the State of Illinois as a foreign entity?
[ ] Yes [x]No [ ] Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full nanies 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"); (ui) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated parly; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager ty any other person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
"Name Title
Please sec page 16. for list of Executive Officers and Directors
2. Please provide the following information concerning each person or legal entity having a dncct or mdnect, current or prospective (i c. 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 roi pn: al ion, pnrtneiship 'merest n: a pui ir.ei ;.n .p m ;onv venture, mleresi of a member oi manager in a
V::i .'.(US I
j
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
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
Man Yasuda Life 1-1. Mnruncuicli] 2-cliomc, Clriyodn-kn. Tokyo 10Q-000\ Jnpnn 100%
'the Annual Report lor year ended March j I, 2019 (or Mciji Y.isuda l.ile ln.snrar.ee Company (Japan) has been sulmnued separately
SECTION III -- INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
ITas the Disclosing Party provided any income or compensation to any City elected official during the
12-monlh period preceding the date of this EDS? [ ] Yes [x] No
Docs the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-monlh period following the dale ofthis EDS? [ ] Yes jx ] No
If "yes" to either ofthe above, please identify below the name(s) of such City elected official(s) and describe such income or compensation:
Docs any Cily elected official or, to the besl ofthe Disclosing Parly's knowledge afterreasonable
inquiry, any Cily 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?
[ 1 Yes | No
If "yes," please identify below the namc(s) of such City elected official(s) and/or spouse(s)/domestic partner(s) and describe the financial interest(s).
SECTION IV - DISCLOSURE OF SUBCONTRAC TORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (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 weli as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Parly is not required to disclose employees who aie paid solely through the Disclosing Parly's icgular payroll. If the Disclosing Party is uncertain wheiher a disclosure: is required under tins Section, the Disclosing Party must cither ask the City whether disclosure is required or make the disclosure.
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, naid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
[x] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICA TIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC 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 [x] No [ ] No person directly or indirectly owns 10% or more ofthe 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 agreement9
[ | Yes [ ] No
FURTHER CERTIFICATIONS
[This paragraph 1 applies only if the Mallei is a contract being handled by the City's Department of Procurement Services.) In the 5-year period preceding the dale ofthis EDS, neither the Disclosing Parly nor any Affiliated Entity [sec definition in (5) below] has engaged, in connection with the performance of any public contract, the sei vices 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, oi continue with a contract in progress).
I be Disclosing Party and its Affiliated Entities aie not delinquent in the payment of any fine, fee, tax or oihc! source of indebtedness owed to me City ofChicago, including, but. nol limited lo. waler and sewer charges, license fees, parking tickets, propci ty taxes and sales tnxes, nor is the Disclosing Par;y delinquent in (he payment of any lax adm nistci cd by the Illinois Department of Revenue.
The Disclosing Parly and, ii' Ihe Disclosing Parly is a legal entity, all of those persons or entities identified in Section H(B)(.l) of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, stale or local unit of government;
have not, during the 5 years before the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, slate or local) with committing any of Ihe offenses sel forth in subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
c. have not, during the 5 years before the date ofthis 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 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");
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. Willi respect to Contractors, the lei m Alii haled Entity means a person or entity that diiccily or indirectly contiois the Conn actor, is controlled by it, or, with the Contractor, is tindci common control of another person or entity:
any responsible official ofthe Disclosing Party, any Conlracloi or any Affiliated Entity or any other official, agent or employee of the Disclosing Pai ty, any Contractor or any Affiliated Entity, acting pursuant lo the direction or authorization ol a responsible official ofthe Disclosing Party, any Coniiaeioi or any Affiliated luilii} (collectively "Agcnis")
V.;, fl) x
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of cither the Disclosing Party or any Contractor, nor any Agents have, during the 5 years before the date of this 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:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a parly 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
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).
Neither the Disclosing Party, nor any A f[ilialed Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America lhat contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, Slate, or Treasury, or any successor federal agency.
8 [FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [sec MCC Chapter I -23, Article I for applicability and defined terms] of the Applicant is currently indicted or charged with, or has admitted guilt of. or has ever been convicted of, or placed undpr 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 oTlhc City or any "sister agency"; and (ii) the Applicant understands and acknowledges thai compliance with Article I is a continuing requirement for doing business with the Cily. NOTE: If MCC Chapter 1 -23, Article 1 applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
9. [FOP. APPLICANT ONLY] The Applicant and us Affiliated Entities will nol. use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S EPA on tbe federal System foi Awaid Management ("SAM")
I 0. | FOR APPLICANT ONI...Y| The Applicant will obtain from any contractors/subcontractors hired ta to be haed in connection with the Mattel certifications equal in loin; and substance lo (.liose in Certifications (2) and (9) above and will i;o(. wit.amii ihe pnoi wniicn consent of She City, use any sue!:
conn actor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not piovided or cannot provide truthful certifications.
1 1. 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:
None
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.
12. To the best ofthe Disclosing Party's knowledge afterreasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the date ofthis EDS, an employee, or elected or appointed official, ofthe City ofChicago (if none, indicate with "N/A" or "none").
None;
13. 'fo the best ofthe Disclosing Parly'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 ofthis EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes ofthis 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 $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 ofthe City recipient.
None
C CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1. The Disclosing Party certifies lhat tbe Disclosing Party (check one)
[ ] is [x j is not
a "financial institution" as defined in MCC Section 2-32-455(b).
2 If [.he Disclosing Party IS a financial institution, then ihe Disclosing Party pledges:
"We are not and w;!l nol become a predatory lender as defined in MCC Chaplci 2-32. Wc further pledge th;u none of our affiliates is, and none of them will become, a predatory lender as defined in MC,(! Chapter 2-32 We understand ihal becommc a p;ed;iu >ry -em-ei or becoming an al Illi ale of a picdatory lender may result in the loss ofthe privilege of doing business wiih the Ciiy "
If ihe Disclosing Parly is unable lo 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 (at tach additional pages if necessary):
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 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 besl of the Disclosing Parly's knowledge after reasonable inquiry, docs any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ J Yes [xjNo
NOTE: If you checked "Yes" to Item DQ), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and 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 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 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 ofthis Part D.
Does the Matter involve a City Property Sale?
\ ]Ycs [ ]No
If you checked "Yes" to Hem D(l). provide the names and business addiesscs ofthe City officials or employees having such financial interest and identify the nature ofthe financial interest:
Name Business Address Nature of Financial Interest
¦I 'I he Disclosing Party furiher certifies thai no pioluhited financial inteicst in the Matter will be uiquiie.'l by any Cily official or employee.
F, CBRirFICATIONREGARDING SLAVERY ERA BUSINESS
Please check cither (1) or (2) below. If the Disclosing Party cheeks (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 ffie City.
_Ji_J. The Disclosing Party verities 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 VL If the Matter is not federally funded, proceed to Section VII. For purposes ofthis Section Vf, tax credits allocated by the City and proceeds of debt obligation's of the City are not. federal funding.
A. CERTIFICATION REGAINING LOBBYING n/a
I. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have, marie 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 "N A" or if the word "None" appear, il will be conclusively presumed that the Disclosing Parly means thai NO pei sons or entities registered under the Lobbying Disclosure. Act of 1 99\ as amended, have made lobbying contacts on behalf of the Disclosing Party wtlh respect to the Matter)
/ The Disclosing Party lias not spent end will not expend any federally appropriated .funds to pay any pei.vm or entity listed in paragiaph A( 1) above In: ins or hci lobbying aci*vituts oi to pay any peisun oi entity to influence oi attempt lo riiliie.nce an oliicci or employee of any agency, as defined by applicable fodiral iaw a member ol Cutigivs;., an olheei m employee i,\ Corgie:.:;, or an employee
of a member of Congress, in connection with the award of any lederally 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, 01 cooperative agreement.
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 ofthe statements and information set forth in paragraphs A(l) and A(2) above.
The Disclosing Party certifies thai, cither: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in 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 lo 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 n/a
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 (he Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes,' answer the three questions below:
Have you developed and do you have on file affinnative action piograrns pursuant to applicable federal regulations? (Sec 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?
[ JYes [ jNo [ I Reports nol icquircd
I lave you participated in any previous contracts or subcontiacts subject to the canal opportunity clause0
' [ 1 Yes ! ] No
If you checked "No" to question (1) oi (2) above, please provide an explanation
SUCTION VII - FURTHER ACKNOWLKDGMICNTS AND CERTIFICATION
The Disclosing Part)' 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 al 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, (3.12) 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 Jaw for a false statement of material fact may include incarceration and an awatd 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 ail of the information provided in, and appended to, this EDS may be made publicly available 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 in formation provided in this EDS must be kept cm rent, fn the event of changes, tbe 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 Parly must update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the 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.
I'nf.i: 1 I ,. ' I?
CERTIFICATION
Under penally ol'perjury, Ihe person signing below: (1) warrants thai he/she is authorized to execute tins EDS, and ail applicable Appendices, on behalf of the 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 Cily.
SiunCoip Financial Gioup
(Print orlype exact legal name of Disclosing Parly)
By4^^^^^>_
(Sign here)
(Print or type name of person signing) (Print or type title of person signing)
Signed and sworn to before me on (date) at /WrA/Vtd-vf County, Q&tihoA (state).
Notary Public Commission expires
OFFICIAL STAMP TOMMY A JONES
NOTARY PUDLIC OnEGON COMMISSION NO. 976985 MY COMMISSION EXPIRES JULY 18. 2022
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
Tliis 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.
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 (I) all executive officers ofthe Disclosing Party listed in Section Il.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, if the Disclosing Party is a limited partnership; all managers, managing members mid members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Parly. "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?
I. I Yes |x 1 No
If yes, please identify below (.1) the name and title of such pei son, (2) the name ofthe legai entity to which such person is connected;(3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
iJ,is>c I 5 ol i •>
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE S C OFFL AW/PR OB L EM 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% (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 scofllaw or problem landlord pursuant to MCC Section 2-92-4.16?
[ ]Yes [x]No
2 If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
I' J Yes [ ] No [x ] The Applicant is not publicly tiaded on any exchange.
3. If yes to (I) 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.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON VYAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is Lo 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 lo any agreement pursuant lo which they: (i) receive City ofChicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay 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 born current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
[ ]Yes [ ]No
[x] N/A - I 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 tbe above, please explain.
StanCorp Financial Group
Executi ve Ojficars
Name
John Gregory Ness Holley Young Franklin, JD Sally Ann Manafi, FSA Robert Michael Ericlcson, CM A
Title
Chan-man, President & Chief Executive Officer VP, Chief Legal Officer & Corporate Secretary VP, Corporate Actuaiy & Chief Risk Officer VP, Chief Accounting Officer & Treasurer
Directors or Trustees Name
Frederick William Buckman Ranjana Bhattacharya Clark Elizabeth Ellen Flynn Dcbora Dyer Horvath Akira Kumabe Dunne Charles McDougall Helen Elizabeth Mitchell Kevin Masaxo Murai joh.n Gregory "Ness Mary Frances Sammons Masaharu Shiraishi Minoru Wakabayashi Richard Howard Wills Kazunori Yamauchi