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Type:
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Ordinance
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Status:
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Passed
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Title:
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Dedication, opening and vacation of public way(s) in area bounded by E 116th St, S Avenue O, E 122nd St and South Chicago & Southern Railroad
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Topic:
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STREETS - Dedications, - STREETS - Openings, - STREETS - Vacations
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Attachments:
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1. O2020-6017.pdf
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DEDICATION / OPENING / VACATION ORDINANCE WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VII, Section 6 (a) of the 1970 constitution of the State of Illinois and, as such, may exercise any power and perform any function pertaining to its government and affairs; and WHEREAS, the City can enhance public access, support industrial development, strengthen established industrial areas and expand the city's jobs base by encouraging the growth and modernization of existing industrial facilities through opening new rights of way, accepting the dedication of new rights of way, and vacating existing rights of way forreduced compensation; and WHEREAS, many industrial firms adjoin streets and alleys that are no longer required for public use and might more productively be used for plant expansion and modernization, employee parking, improved security, truck loading areas or other industrial uses; and WHEREAS, the properties at 11601-11659 S. Burley Avenue, 11705-11759 S. Burley Avenue, and 11801-12159 S. Burley Avenue, are owned by NP Avenue 0, LLC, a Missouri limited liability company (the "Developer"); and WHEREAS, the Developer proposes to use the small portion of the alley to be vacated herein for inclusion in the overall Avenue O Industrial Park development; and WHEREAS, improved conductivity of the remaining public street grid, and an extended and widened S. Burley Avenue, through the dedication and opening of new right of way, can also serve said industrial park development; and WHEREAS, the City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent of public use and the public interest to be subserved is such as to warrant the acceptance of a private dedication of new public way, the opening of a portion of City owned lots as new public way and the vacation of a portion of a public alley, all as described in this ordinance; now, therefore, Page 1 BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. The Commissioner of the Chicago Department of Transportation (the "Commissioner"), or any of her designees, is each hereby authorized and directed to approve a dedication of certain property owned by the Developer, for use as public way between approximately E. 122nd Street (public) and E. 116h Street (private), as shaded and identified by the words "HEREBY DEDICATED" on the plat hereto attached as Exhibit A, which plat for greater certainty is hereby made a part of this ordinance, and legally described below, as the same is intended for public use and the public interest will be subserved by such dedication: S. BURLEY AVENUE DEDICATION-SOUTH OF 118™ STREET THAT PART OF THE SOUTH EAST QUARTER OF SECTION 19, TOWNSHIP 37NORTH, RANGE 15 EAST, OF THE THIRD PRINCIPAL MERIDIAN, COOK COUNTY, ILLINOIS, BEING BOUND AND DESCRIBED AS FOLLOWS: i COMMENCING AT THE NORTHEAST CORNER OF THE SOUTHEAST QUARTER OF SAID SECTION 19; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST (BASIS OF BEARINGS - ILLINOIS STATE PLANE COORDINATES EAST ZONE (NAD83)) ALONG THE NORTH LINE OF THE SOUTHEAST QUARTER OF SAID SECTION 19, A DISTANCE OF 1,353.18 FEET TO A POINT ON THE NORTHERLY EXTENSION OF THE WESTERN LINE OF THE 80 FOOTWIDE FORMERLY VACATED S. BURLEY AVENUE AND RESERVATION OF EASEMENTTO THE CITY OF CHICAGO, THE METROPOLITAN SANITARY DISTRICT OF GREATER CHICAGO AND ILLINOIS BELL TELEPHONE COMPANY RECORDED MAY 2, 1968, AS DOCUMENT NUMBER 20477960 IN THE OFFICE OF THE COOK COUNTY RECORDER; THENCE SOUTH 01 DEGREES 26 MINUTES 12 SECONDS EAST ALONG THE NORTHERLY EXTENSION OF SAID WESTERN LINE 33.01 FEET TO THE NORTHWEST CORNER OF SAID VACATED S. BURLEY AVENUE AND SAID RESERVATION OF EASEMENTAND BEING THE POINT OF BEGINNING, SAID POINT LYING 33 FEET SOUTHERLY OF (MEASURED PERPENDICULAR TO) THE NORTH LINE OF THE SOUTHEAST QUARTER OF SAID SECTION 19; THENCE CONTINUING SOUTH 01 DEGREES 26 MINUTES 12 SECONDS EASTALONG SAID WESTERN LINE OF VACATED S.BURLEY AVENUE AND RESERVATION OF EASEMENT 2,231.63 FEET TO THE NORTHWESTERN CORNER OF NORTHPOINT'S AVENUE O INDUSTRIAL PARK -SUBDIVISION NO. 1 PER CDOT#19-10-19-3887 PROJECT LEGISLATED AND AWAITING RECORDING AT THE COOK COUNTY RECORDER OF DEEDS; THENCE NORTH 88 DEGREES 33 MINUTES 48 SECONDS EASTALONG THE NORTHERN LINE OF SAID NORTHPOINT'S AVENUE O INDUSTRIAL PARK - SUBDIVISION NO. 1, A DISTANCE OF 80.00 FEET TO A CORNER OF SAID NORTHPOINT'S AVENUE O INDUSTRIAL PARK SUBDIVISION NO. 1, SAID POINT ON THE EAST LINE OF SAID VACATED S. BURLEY AVENUE AND SAID RESERVATION OF EASEMENT; THENCE Page 2 NORTH 01 DEGREES 26 MINUTES 12 SECONDS WEST ALONG THE EAST LINE OF SAID VACATED S. BURLEY AVENUE AND RESERVATION OF EASEMENT, A DISTANCE OF 2,159.92 FEET; THENCE NORTH 44 DEGREES 10 MINUTES 28 SECONDS EAST 97.93 FEETTO A POINTON THE SOUTH RIGHTOF WAY OF E. 118th STREET, SAID POINTLYING 33 FEETSOUTH AND PARALLEL TO SAID NORTH LINE OF THE SOUTHEAST QUARTER OF SAID SECTION 19; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST ALONG SAID PARALLEL LINE A DISTANCE OF 150.02 FEET TO THE POINT OF BEGINNING, ABOVE DESCRIBED PARCEL CONTAINING 180,912 SQUARE FEET OR 4.153 ACRES, MORE OR LESS. S. BURLEY AVENUE DEDICATION -NORTH OF 11 8th STREET TOGETHER WITH: THAT PART OF LOTS 25 THROUGH 33, INCLUSIVE, IN BLOCK 11 OF INDIAN RIDGE SUBDIVISION OF PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDINGTO THE PLATTHEREOF RECORDED SEPTEMBER 23,1869, AS DOCUMENT NUMBER 26596, IN COOK COUNTY, ILLINOIS, BEING BOUND AND DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTHWESTERN CORNEROF SAID LOT 25, SAID POINT BEING THE INTERSECTION OF THE NORTHERN RIGHTOF WAY LINE OF E. 118™STREET AND THE EASTERN RIGHTOF WAY LINE OF S. BURLEY AVENUE; THENCE NORTH 01 DEGREES 03 MINUTES 23 SECONDS WEST (BASIS OF BEARINGS - ILLINOIS STATE PLANE COORDINATES EASTZONE (NAD83)) ALONG THE WESTERN LINES OF SAID LOTS 25 THROUGH 33 IN BLOCK 11, SAID LINE ALSO BEING TH E EASTERN RIGHTOF WAY LINE OF S. BURLEY AVENUE, A DISTANCE OF 222.00 FEET TO THE SOUTHWESTERN CORNER OF AN EAST-WEST 16 FOOT WIDE PUBLIC ALLEY DEDICATED SEPTEMBER 8,1933, AS DOCUMENTNUMBER 11279600,SAID POINT ALSO BEING THE NORTHWESTERN CORNER OF SAID LOT33; THENCE NORTH 89 DEGREES 47 MINUTES 07 SECONDS EASTALONG THE SOUTHERN LINE OF SAID ALLEY AND ALONG THE NORTHERN LINE OF SAID LOT 33, A DISTANCE OF 42.60 FEET; THENCE SOUTH 01 DEGREES 03 MINUTES 23 SECONDS EAST PARALLEL WITH THE WESTERN LINES OF SAID LOTS 25 THROUGH 33 IN BLOCK 11, A DISTANCE OF 152.00 FEET; THENCE SOUTH 45 DEGREES 38 MINUTES 08 SECONDS EAST 99.72 FEETTO A POINTON THE SOUTHERN LINE OF SAID LOT 25, SAID LINE ALSO BEING THE NORTHERN RIGHTOF WAY LINE OF E. 118™STREET; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST ALONG THE SOUTHERN LINE OF SAID LOT 25, SAID LINE ALSO BEING THE NORTHERN RIGHT OF WAY LINE OF E. 118™ STREET, A DISTANCE OF 112.60 FEET TO THE POINT OF BEGINNING, ABOVE DESCRIBED PARCEL CONTAINING 11,907 SQUARE FEET OR 0.273 ACRES, MORE OR LESS. Page 3 S. BURLEY AVENUE DEDICATION - SOUTH OF 11 7th STREET TOGETHER WITH: THAT PART OF LOTS 34 THROUGH 47, INCLUSIVE, IN BLOCK 11 OF INDIAN RIDGE SUBDIVISION OF PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDINGTO THE PLATTHEREOF RECORDED SEPTEMBER 23,1869, AS DOCUMENT NUMBER 26596, IN COOK COUNTY, ILLINOIS, BEING BOUND AND DESCRIBED AS FOLLOWS: COMMENCING ATTHE NORTHWESTERN CORNEROF LOT 48 IN BLOCK 11 OF SAID INDIAN RIDGE SUBDIVISION, SAID POINT IS AT THE INTERSECTION OF THE SOUTHERN RIGHT OF WAY LINE OF E. 117™ STREET AND THE EASTERN RIGHTOF WAY LINE OF S. BURLEY AVENUE; THENCE SOUTH 01 DEGREES 03 MINUTES 23 SECONDS EAST (BASIS OF BEARINGS - ILLINOIS STATE PLANE COORDINATES EAST ZONE (NAD83)) ALONG THE WESTERN LINES OF SAID LOT 48 AND THAT PART OF LOT47 IN BLOCK 11, SAID LINE ALSO BEING THE EASTERN RIGHTOF WAY LINE OF S. BURLEY AVENUE, A DISTANCE OF 34.50 FEET TO THE NORTHWESTERN CORNER OF THE SOUTH HALF OF SAID LOT 47, SAID POINT BEING THE POINT OF BEGINNING; THENCE CONTINUING SOUTH 01 DEGREES 03 MINUTES 23 SECONDS EAST ALONG THE WESTERN LINES OF SAID LOTS 47 THROUGH 34 IN BLOCK 11, SAID LINE ALSO BEING THE EASTERN RIGHT OF WAY LINE OF S. BURLEY AVENUE, A DISTANCE OF 321.50 FEET TO THE NORTHWESTERN CORNER OF AN EAST-WEST 16 FOOT WIDE PUBLIC ALLEY DEDICATED SEPTEMBER 8, 1933, AS DOCUMENT NUMBER 11279600; THENCE NORTH 89 DEGREES47 MINUTES 07 SECONDS EASTALONG THE NORTHERN LINE OF SAID ALLEY 42.60 FEET; THENCE NORTH 01 DEGREES 03 MINUTES 23 SECONDS WEST PARALLEL WITH THE WESTERN LINES OF SAID LOTS 34 THROUGH 47 IN BLOCK 11, A DISTANCE OF 321.50 FEET TO A POINT ON THE NORTHERN LINE OF THE SOUTHERN HALF OF SAID LOT 47; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST ALONG THE NORTHERN LINE OF THE SOUTHERN HALF OF SAID LOT 47 A DISTANCE OF 42.60 FEETTO THE POINT OF BEGINNING, ABOVE DESCRIBED PARCEL CONTAINING 13,696 SQUARE FEET OR 0.314 ACRES, MORE OR LESS. S. BURLEY AVENUE DEDICATION -NORTH OF 117™ STREET TOGETHER WITH: THAT PART OF LOTS 13 THROUGH 24, INCLUSIVE, IN BLOCK 2 OF INDIAN RIDGE SUBDIVISION OF PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDINGTO THE PLATTHEREOF RECORDEDSEPTEMBER23,1869, AS DOCUMENT NUMBER 26596, AND THAT PART OF LOTS 6 AND 7 IN THE DIVISION OF THE NORTH 102 ACRES OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST OF THE THIRD PRINCIPAL MERIDIAN, Page 4 ACCORDING TO THE PLATTHEREOF RECORDED JUNE 26,1872, AS DOCUMENT NUMBER 39470, ALL IN COOK COUNTY, ILLINOIS, BEING BOUND AND DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTHWESTERN CORNER OF SAID LOT 13 IN BLOCK 2, SAID POINT LOCATED AT THE INTERSECTION OF THE NORTHERN RIGHTOF WAY LINE OF E. 117™ STREET AND THE EASTERN RIGHT OF WAY LINE OF S. BURLEY AVENUE; THENCE NORTH 01 DEGREES 03 MINUTES 23 SECONDS WEST (BASISOF BEARINGS - ILLINOIS STATE PLANE COORDINATES EASTZONE (NAD83)) ALONG THE WESTERN LINES OF SAID LOTS 13 THROUGH 24 IN SAID BLOCK 2, SAID LINE ALSO BEING THE EASTERN RIGHT OF WAY LINE OF S. BURLEY AVENUE, A DISTANCE OF 294.00 FEET TO THE NORTHWESTERN CORNER OF SAID LOT 24; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST ALONG THE NORTHERN LINE OF SAID INDIAN RIDGE SUBDIVISION 37.42 FEETTO A POINTON THE SOUTHERLY PROJECTION OF THE EASTERLY BOUNDARY LINE OF PROPERTY CONVEYED AS PARCEL "A" BY REPUBLIC STEEL CORPORATION TO DEFENSE PLANT CORPORATION BY DEED DATED FEBRUARY 17,1943 AND RECORDED AS DOCUMENT NUMBER 13047028 IN THE OFFICE OF THE COOK COUNTY RECORDER, SAID EASTERLY BOUNDARY LINE PROJECTED SOUTHERLY BEING COMMON WITH THE EASTERLY BOUNDARY LINE OF A PARCEL OF LAND CONVEYED BY DEFENSE PLANT CORPORATION TO SOUTH CHICAGO AND SOUTHERN RAILROAD COMPANYBY DEED DATED JUNE 2, 1945 AND RECORDED AS DOCUMENT 13540700 IN THE OFFICE OF THE COOK COUNTY RECORDER; THENCE NORTH 00 DEGREES 40 MINUTES 46 SECONDS WEST ALONG SAID SOUTHERLY PROJECTION LINE 378.41 FEETTO A POINT ON THE SOUTHERN LINE OF A 66 FOOT WIDE INGRESS EGRESS EASEMENTRECORDED DECEMBER 1,1989, AS DOCUMENT89572950 IN THE OFFICE OF THE COOK COUNTY RECORDER,SAID LINE LYING 1,283.00 FEET SOUTHERLY OF (MEASURED PERPENDICULAR TO)THE NORTH LINE OF THE NORTH EAST QUARTER OF SAID SECTION 19;THENCE NORTH 89 DEGREES 39 MINUTES 50 SECONDS EASTALONG SAID SOUTHERN LINE OF INGRESS EGRESS EASEMENT A DISTANCE OF 80.00 FEET; THENCE SOUTH 00 DEGREES 40 MINUTES 46 SECONDS EAST PARALLEL WITH AND 80 FEET EASTERLY OF SAID SOUTHERLY PROJECTION LINE CONVEYED AS PARCEL"A", A DISTANCE OF 374.61 FEET TO THE INTERSECTION WITH A LINE LYING42.60 FEET EASTERLY OF AND PARALLEL WITH THE AFORESAID WESTERN LINES OF LOTS 13 THROUGH 24 IN SAID BLOCK 2; THENCE SOUTH 01 DEGREES 03 MINUTES 23 SECONDS EAST ALONG SAID EASTERLY AND PARALLEL LINE A DISTANCE OF 297.98 FEETTO A POINT ON THE SOUTHERN LINE OF SAID LOT 1 3, SAID LINEALSO BEING THE NORTHERN RIGHT OF WAY LINE OF E. 117™ STREET; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST ALONG THE SOUTHERN LINE OF SAID LOT 13 A DISTANCE OF 42.60 FEET TO THE POINT OF BEGINNING, ABOVE DESCRIBED PARCEL CONTAINING42.804 SQUARE FEET OR 0.983 ACRES, MORE OR LESS. TOTAL AREA DESCRIBED ON PLAT OF DEDICATION CONTAINING 249,319 SQUARE FEET OR 5.724 ACRES, MORE OR LESS. Page 5 SECTION 2.That certain property owned by the City of Chicago, and administered by its Department of Planning and Development, at approximately the southeast corner of E. 117th Street and S. Burley Avenue, as shaded and identified by the words "HEREBY OPENED" on the plat hereto attached as EXHIBIT B and made a part of this ordinance, and legally described below, is hereby opened for public traffic, as the same is intended for public use and the public interest will be subserved by such opening: THAT PART OF LOT 48 AND THAT PART OF THE NORTH HALF OF LOT47 IN BLOCK 11 OF INDIAN RIDGE SUBDIVISION OF PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDINGTO THE PLATTHEREOF RECORDED SEPTEMBER23,1869, AS DOCUMENT NUMBER 26596, IN COOK COUNTY, ILLINOIS, BEING BOUND AND DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWESTERN CORNER OF LOT 48 IN SAID INDIAN RIDGE SUBDIVISION, SAID POINT LOCATED AT THE INTERSECTION OF THE SOUTHERN RIGHT OF WAY LINE OF E. 117th STREET AND THE EASTERN RIGHTOF WAY LINE OF S. BURLEY AVENUE; THENCE NORTH 89 DEGREES 47 MINUTES 07 SECONDS EAST (BASIS OF BEARINGS - ILLINOIS STATE PLANE COORDINATES EAST ZONE (NAD83)) ALONG THE NORTHERN LINE OF SAID LOT 48, SAID LINE ALSO BEING THE SOUTHERN RIGHTOF WAY LINE OF E. 117™ STREET, A DISTANCE OF 42.60 FEET; THENCE SOUTH 01 DEGREES 03 MINUTES 23 SECONDS EAST PARALLEL WITH THE WESTERN LINE OF SAID LOT48, A DISTANCE OF 34.50 FEETTO A POINT ON THE SOUTHERN LINE OF THE NORTH HALF OF SAID LOT 47; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST ALONG THE SOUTHERN LINE OF THE NORTH HALF OF SAID LOT 47, A DISTANCE OF 42.60 FEET TO THE WEST LINE OF SAID LOT 47, SAID POINT BEING THE SOUTHWESTERN CORNER OF THE NORTH HALF OF SAID LOT 47, SAID POINT LYING ON THE EASTERN RIGHT OF WAY LINE OF S. BURLEY AVENUE; THENCE NORTH 01 DEGREES 03 MINUTES 23 SECONDS WEST ALONG THE WEST LINES OF SAID LOTS 47 AND 48, A DISTANCE OF 34.50 FEET TO THE POINT OF BEGINNING, IN COOK COUNTY, ILLINOIS, CONTAINING 1,470 SQUARE FEET OR 0.034 ACRES, MORE OR LESS. SECTION 3. That certain alley portion, as shaded and identified by the words "HEREBY VACATED" on the plat hereto attached as EXHIBIT C and made a part of this ordinance, and legally described below, is hereby vacated and closed, as the same is no longer required for public use and the public interest will be subserved by such vacation: THAT PART OF THE NORTH-SOUTH 14 FOOT WIDE PUBLIC ALLEY WITHIN BLOCK 11 AS DEDICATED WITHIN INDIAN RIDGE SUBDIVISION OF PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15EASTOF THE THIRD PRINCIPALMERIDIAN,ACCORDINGTO THE PLATTHEREOF RECORDED Page 6 SEPTEMBER 23, 1869, AS DOCUMENT NUMBER 26596, IN COOK COUNTY, ILLINOIS, BEING BOUND AND DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTHEASTERN CORNER OF LOT 25 IN BLOCK 11 IN SAID INDIAN RIDGE SUBDIVISION, ALSO BEING ON THE NORTH RIGHT OF WAY OF E. 118th STREET; THENCE NORTH 01 DEGREES 03 MINUTES 23 SECONDS WEST (BASIS OF BEARINGS - ILLINOIS STATE PLANE COORDINATES EAST ZONE (NAD83)) ALONG THE EASTERN LINES OF LOTS 25 THROUGH 28 INCLUSIVE IN SAID BLOCK 11, A DISTANCE OF 97.00 FEETTO THE NORTHEASTERN CORNER OF SAID LOT 28, ALSO BEING AND ABUTTING THE SOUTHERN TERMINUS OF VACATED ALLEY PER CDOT#19-10-20-3937 PROJECT LEGISLATED AN D AWAITING RECORDING AT THE COOK COUNTY RECORDER OF DEEDS; THENCE NORTH 89 DEGREES 47 MINUTES 07 SECONDS EASTALONG SAID SOUTHERN TERMINUS LINE 14.00 FEET TO A POINT ON THE WESTERN LINE OF LOT 5 OF THE RESUBDIVISION OF LOTS 20 TO 24 AND THE SOUTH 8 FEET OF LOT 19 IN BLOCK 11 IN INDIAN RIDGE SUBDIVISION ACCORDINGTO THE PLAT THEREOF RECORDED MAY 23, 1918, AS DOCUMENT NUMBER 6328680; THENCE SOUTH 01 DEGREES 03 MINUTES 23 SECONDS EAST ALONG THE WESTERN LINE OF SAID LOT 5, A DISTANCE OF 97.00 FEETTO THE SOUTHWESTERN CORNER OF SAID LOT 5, ALSO ON SAID NORTH RIGHT OF WAY OF E. 118th STREET; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST ALONG SAID NORTH RIGHT OF WAY 14.00 FEET TO THE POINT OF BEGINNING, ALL IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 1,358 SQUARE FEET OR 0.031 ACRES, MORE OR LESS. SECTION 4. The Commissioner is hereby authorized to accept and approve a restrictive covenant or similar instrument restricting the use and improvement of the public way vacated in Section 3 of this ordinance to industrial uses and for such uses and improvements that are accessory as that term is defined in the Chicago Zoning Ordinance. The restriction on use and improvement in the restrictive covenant or similar instrument shall be for a term of 40 years and upon breach of such restriction the public way herein vacated shall revert to the City and be subject to the terms and conditions of the dedication by which it has been heretofore held by the City. SECTION 5. The dedication herein provided for is accepted upon the express conditions that the Developer is responsible for the installation of any newly required water mains in S. Burley Avenue, that such work is completed at the Developer's sole expense, that such work must be done in compliance with Chicago Department of Water Management - Water Section engineering standards, and that such work is subject to the express written approval of the Chicago Department of Water Management - Water Section prior to the initiation of work, as detailed further in the attached correspondence dated October 20, 2020, hereby attached and made a part of this ordinance as EXHIBIT E. Page 7 SECTION 6. The Developer acknowledges that any private sewers, appurtenances and connections within the area herein dedicated shall be sealed, removed or relocated to private property at the Developer's sole expense, in accordance with the standard procedures of the Department of Water Management - Sewer Section, or established as public pursuant to an ordinance passed by the City Council. In the event that any sewer is abandoned, the abandonment plans must be reviewed, approved and permitted by the Department of Water Management- Sewer Design Section prior to the initiation of work. The Developer also acknowledges its responsibility to provide proper drainage and lay new sewer main and associated structures, at its sole expense in the street herein dedicated, in accordance with plans reviewed, approved and permitted by the Department of Water Management - Sewer Design Section, prior to the initiation of work. Acceptance of new public sewers is contingent upon submittal of as-built drawings, and physical and videotape inspections provided by the Developer to the Department of Water Management, within 30 days of completion. All sewer work in both the public way and on private property must be performed by a Licensed Drainlayer, with the applicable permit, as secured through the Department of Buildings-Sewer Permit Section, all as detailed further in EXHIBIT E. SECTION 7. The dedication, opening and vacation herein provided for are made under the express condition that the Developer, and its successors and assigns, shall hold harmless, indemnify and defend the City of Chicago from all claims related to said dedication, vacation and opening, as depicted in EXHIBITS A, B AND C. SECTION 8. The dedication of public way, opening for public way, and vacation of public way, each as set forth in this ordinance, are approved subject to the express condition that the Developer shall within 180 days after the passage of this ordinance, and prior to recording: 1) deposit in the City Treasury of the City of Chicago, a quoted sum as a security deposit to defray the cost of work for public paving, curbs, and related appurtenances associated with its project, in the event that it defaults on its obligation to construct the directed improvements in accordance with the most current version of the Chicago Department of Transportation's Regulations for Opening. Repair and Construction in the Public Way and its appendices, and in accordance with the executed Duty to Build Agreement attached herein and made a part of this ordinance as Exhibit D; and 2) submit for field inspection and approval of its construction of said improvements, to the CDOT Division of Infrastructure Management, Construction Compliance Unit, Room 905, City Hall, prior to the return ofthe monies deposited there (minus service fee). SECTION 9. The actions herein provided for are made with the express condition that within one hundred eighty (180) days after the passage of this ordinance, the Developer shall file, or cause to be filed for recordation with the Office of the Recorder of Deeds of Cook County, Illinois a certified copy of this ordinance, together with the attached Plat of Dedication, Plat of Opening and Plat of Vacation, each as approved by the Department of Transportation's Superintendent of Maps and Plats, and the fully-executed restrictive covenant or similar instrument referred to in Section 3 as approved by the Department of Law as to form and legality. Page 8 SECTION 10. This ordinance shall take effect and be in force from and after its passage and approval. The dedication, opening and vacation shall take effect and be in force from and after the recording of the ordinance, the three (3) plats and the fully-executed restrictive covenant (or similar instrument). Page 9 AFFECTED PJJU MOLDED LOT * 26-19-200-032 PT OF LOT 6 -"A" 26-19-200-041 PT OF LOT 6 -'A" * PT OF LOT 7 -"A" 26-19-202-024 LOTS 13-24 BL 2 -TJ" 28-19-206-049 PT OF LOT 47 BL 11 -V * LOTS 42-46 BL 11 -"B" 26-19-206-042 LOTS 39-41 8L 11 -"B" 26-19-206-043 PT Of LOT 34 BL 11 -'B" * LOTS 35-38 BL 11 -"B" 26-19-206-048 LOTS 29-33 BL 11 -"B* 26-19-208-018 LOT 28 BL 11 -"B" 26-19-206-019 LOT 27 BL 11 -"B" 26-19-206-020 LOT 20 BL 11 -TB" 26-19-208-021 LOT 25 BL 11 —"B" 26-19-400-013 26-19-400-014 cArtiDi i n PLAT OF DEDICATION OF PART CF THE SOUTHEAST QUARTER AND PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST. OF THE THIRD PRINCIPAL MERIDIAN, COOK COUNTY, ILLINOIS Bvsrwr Wl renr oocn BT. UiTS mPAJBEDt 9ClLff |i' -WISW1K...TOI nr- I hi 1 PLAT OF DEDICATION of i ; PART OF THE SOUTHEAST QUARTER AND PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST, OF THE THIRD PRINCIPAL MERIDIAN, COOK COUNTY. ILLINOIS CAniDi i n PLAT OF DEDICATION OF j JACOB & HEFNER >£3|P|3S*'^ | A9IOCIATB) :.M>3i:ll.r>'.! >. IK f>l.l«sunvr mq.
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DAT* fWWPASO
CDOT#l9-10-20-3945
PART OF THE SOUTHEAST QUARTER AND PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST, OF THE THIRD PRINCIPAL MERIDIAN, COOK COUNTY, ILLINOIS
PLAT OF DEDICATION
OF
PART OF THE SOUTHEAST QUARTER AND PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST, OF THE THIRD PRINCIPAL MERIDIAN, COOK COUNTY, ILLINOIS
LEGAL DESCRIPTION
S, BURLEY AVENUE DEDICATION - SOUTH OF 118th STREET (AS DEPICTFO ON SHFFT 9)
THAT PART Of THE SOUTHEAST QUARTER OF SECTION 19. TOWNSHIP 37 NORTH. RANGE 13 EAST, OF THE THIRD PRINCIPAL MERIDIAN. COOK COUNTY. ILLINOIS. BEING BOUND AND OE SCRIBED AS FOLLOWS:
COMMENCING AT THE NORTHEAST CORNER Of THE SOUTHEAST QUARTER Of SAJO SECTION 19; THENCE SOUTH 89 OEGREES 47 MINUTES 07 SECONOS WEST (BASIS OF
BEARINGS - ILUNOIS STATE PLANE COORDINATES EAST ZONE (NA083)) ALONG THE NORTH UNE OF THE SOUTHEAST QUARTER OF SAID SECTION 19. A DISTANCE OF
1.353.18 FEET TO A POINT ON THE NORTHERLY EXTENSION OF THE WESTERN UNE OF THE 80 FOOT WOE FORMERLY VACATED S. BURLEY AVENUE AND RESERVATION
OF EASEMENT TO THE CITY Of CHICAGO, THE UETROPOUTAN SANITARY DISTRICT OF GREATER CHICAGO AND ILUNOS BELL TELEPHONE COMPANY RECORDED MAY 2
1968. AS DOCUMENT NUMBER 20477960 IN THE OFFICE OF THE COOK COUNTY RECORDER: THENCE SOUTH 01 DECREES 26 MINUTES 12 SECONDS EAST ALONG THE
NORTHERLY EXTENSION Of SAD WESTERN UNE 33.01 FEET TO THE NORTHWEST CORNER OF SAIO VACATED & BURLEY AVENUE ANO SAO RESERVATION OF EASEMENT
AND BEING THE POMT OF BEONNNC SAIO PONT LYING 33 FEET SOUTHERLY OF (MEASURED PERPENDICULAR TO) THE NORTH UNE OF THE SOUTHEAST QUARTER OF
SAID SECTION 19; THENCE CONTINUING SOUTH 01 DEGREES 26 UNUTES 12 SECONOS EAST ALONG SAID WESTERN UNE OF VACATED S. BURLEY AVENUE AND
RESERVATION Of EASEMENT 2,231.63 FEET TO THE NORTHWESTERN CORNER OF NORTHPOINT'S AVENUE 0 INDUSTRIAL PARK - SUBDIVISION NO. 1 PER
CDOT/19-10-19-JB87 PROJECT LEGISLATED AND AWAITING RECORDMG AT THE COOK COUNTY RECORDER OF DEEDS; THENCE NORTH 88 DEGREES 33 UNUTES 48 .'s
^SECONDS EAST ALONG THE NORTHERN UNE OF SAC NORTHPOINT'S AVENUE 0 INDUSTRIAL PARK - SUBDtVISKM NO. 1. A DISTANCE OF 80.00 FEET TO A CORNER OF
'SAID NORTHPOMrS AVENUE 0 INDUSTRIAL PARK SUBDIVSON NO. 1. SAW POINT ON THE EAST UNE OF SAID VACATED S. BURLEY AVENUE AND SAID RESERVATION OF
EASEMENT; THENCE NORTH 01 DEGREES 26 UNUTES 12 SECONDS WEST ALONG THE EAST UNE Cf SAID VACATED S. BURLEY AVENUE AND RESERVATION OF
EASEMENT, A DISTANCE Cf 2.159.92 FEET; THENCE NORTH 44 DEGREES 10 UNUTES 28 SECONOS EAST 97.93 FEET TO A PONT ON THE SOUTH RIGHT OF WAY OF £.
118th STREET. SAC POMT LYWG 33 FEET SOUTH ANO PARALLEL TO SAID NORTH UNE OF THE SOUTHEAST QUARTER OF SAID SECTION 19; THENCE SOUTH 89
DEGREES 47 UNUTES 07 SECONDS WEST ALONG SAID PARALLEL UNE A DISTANCE OF 150.02 FEET TO THE POMT OF BrUITI. ABOVE DESCRIBED PARCEL
CONTAMNG 180,912.SQUARE FEET OR 4.1S3 ACRES. MORE OR LESS ' ,:v '.; ¦: '- ¦
' -j ''Sff: S. BURLEY AVENUE DEDICATION - NORTH OF 118m STREET fAS PFPICTFT) ON SHFFT 3) ,
TOGETHER WTH: THAT PART Of LOTS 25 THROUGH 33, INCLUSIVE, INsBLOCK 11 OF, INDIAN RCGE SUBOIVlSWN OF PART. OF THE NORTHEAST QUARTER Of SECTION 19.
TOWNSHIP 37 NORTH. RANGE 15 EAST OF THE THIRD PRINCIPAL MERIDIAN; ACCCROMC TO THE PLAT THEREOF RECORDED SEPTEMBER 23, 1B69, AS DOCUMENT . "
NUMBER 26596. IN COOK.COUNTY, ILUNOIS, BEING BOUND ANO DESCRBCD AS FOLLOWS: ; , t . , - ' .
HHIBIU AT THE SOUTHWESTERN CORNER OF SAID LOT 25, SAD POINT BEMG THE MTERSECTION Of THE NORTHERN RIGHT Of WAY UNE OF E. 118th STREET AND
THE EASTERN RIGHT OF WAY UNE OF S. BURLEY. AVENUE; THENCE NORTH 01 DEGREES 03 MWUTES 23 SECONDS WEST (BASS OF BEARINGS - ILLINOIS STATE PLANE :
COORDINATES EAST ZONE (NA083)) ALONG THE WESTERN LINES OF SAIO LOTS 25 THROUGH 33 M BLOCK 11, SAJO UNE ALSO BEING THE EASTERN RIGHT Of WAY
UNE OF S. BURLEY AVENUE. A DISTANCE OF 222.00 FEET TO THE SOUTHWESTERN CORNER Of AN EAST-WEST IB FOOT WIOE PUBUC ALLEY DEDICATED SEPTEMBER. 8,
1033. AS DOCUMENT NUMBER 11279600. SAC PONT ALSO BEING THE NORTHWESTERN: CORNER OF SAID LOT 33; THENCE NORTH 89 DECREES 47 UNUTES 07
SECONDS EAST ALONG THE SOUTHERN UNE OF SAID ALLEY AND ALONG THE NORTHERN UNE OF SAIO LOT 33, A DISTANCE OF 42.60 FEET; THENCE SOUTH 01
DECREES 03 UNUTES 23 SECONDS EAST PARALLEL WITH THE WESTERN LINES Of SAIO LOTS 25 THROUGH 33 IN BLOCK 11. A DISTANCE OF 15200 FEET; THENCE
SOUTH 45 DEGREES 38 MMUTES 08 SECONDS EAST 99.72 FEET TO A POINT ON THE SOUTHERN UNE Of SAIO LOT 25, SAID UNE ALSO BEING THE NORTHERN RIGHT
Of WAY UNE OF E. 11801 STREET; THENCE SOUTH 89 DEGREES 47 UNUTES 07 SECONDS WEST ALONG THE SOUTHERN UNE OF SAIO LOT 25, SAD UNE ALSO BEING
THE NORTHERN RIGHT OF WAY UNE OF E. IIBUl STREET, A DISTANCE Cf 112.60 FEET TO THE PONT OF PTOMMMC, ABOVE DESCRIBED PARCEL CONTAMNG 11,907
SOUARE FEET OR 0.273 ACRES, MORE OR LESS. .'. v'-v*
'. ' 'i'^^-^ffifS^.' f^F;':v '' ; '": ¦ "]:- >:\^
':, ;. ^ r' S/BURLEY AVENUE DEDICATION - SOUTH OF 117th STREET fAS DEPICTED ON SHEET 3V 1 ^
TOGETHER WITH: THAT PART OF LOTS 34 THROUGH 47, INCLUSIVE. IN BLOCK 11 OF INDIAN RIDGE SU801VISKM OF PART OF THE NORTHEAST QUARTER OF SECTION 19. TOWNSHP 37 NORTH, RANGE 15 EAST OF THE THRO PRMCIPAL MERIDIAN, ACCORDMG TO THE PLAT THEREOF RECORDED SEPTEMBER 23, 1869, AS DOCUMENT NUMBER 26596. IN COOK COUNTY. HMOS. BONG BOUND AND OESCRBED AS FOLLOWS:
COUMENONG AT THE NORTHWESTERN CORNER OF LOT 48 M BLOCK 11 OF SAD MDIAN RCGE SUBDIVISION. SAD POMT IS AT THE MTERSECTION OF THE SOUTHERN RIGHT OF WAY LINE OF E 117th STREET ANO THE EASTERN RIGHT OF WAY UNE OF S. BURLEY AVENUE; THENCE SOUTH 01 DEGREES 03 UNUTES 23 SECONDS EAST (BASIS OF BEARMGS - ILUNOIS STATE PLANE COORDINATES EAST ZONE (NA083)) ALONG THE WESTERN LINES OF SAC LOT 48 ANO THAT PART OF LOT 47 IN BLOCK II, SAC UNE ALSO BEING THE EASTERN RIGHT Cf WAY UNE Of S. BURLEY AVENUE. A DISTANCE Of 34.50 FEET TO THE NORTHWESTERN CORNER OF THE SOUTH HALF OF SAC LOT 47, SAD POMT BEMG THE POMT OF BBGMMOt THENCE CONTNUMG SOUTH 01 DECREES 03 UNUTES 23 SECONOS EAST ALONG THE WESTERN LINES OF SAIO LOTS 47 THROUGH 34 M BLOCK 11, SAC UNE ALSO KMC THE EASTERN RIGHT OF WAY UNE Of S. BURLEY AVENUE. A CfSTAMCE Cf 321.50 FEET TD IHE NORTHWESTERN CORNER OF AN EAST-WEST 16 FOOT WOE PUBLIC ALLEY DEDICATED SEPTEMBER 8k 1933, AS DOCUMENT NUMBER 11279800: THENCE NORTH 89 DEGREES 47 UNUTES 07 SECONOS EAST ALONG THE NORTHERN UNE OF SAID ALLEY 4260 FEET; THENCE NORTH 01 DECREES 03 UNUTES 23 SECONDS WEST PARALLEL WITH THE WESTERN LINES Cf SAID LOTS 34 THROUGH 47 IN BLOCK 11, A DISTANCE OF 321.50 FEET TO A PONT ON THE NORTHERN UNE Cf THE SOUTHERN HALF OF SAC LOT 47; THENCE SOUTH 89 DEGREES 47 MINUTES 07 SECONDS WEST ALONG THE NORTHERN UNE OF THE SOUTHERN HALF OF SAID LOT 47 A DISTANCE Of 4260 FEET TO THE POMT OF FCCOWIfl, ABOVE DESCRIBED PARCEL CONTAINING 13,696 SQUARE FEET OR 0.314 ACRES, MORE OR LESS.
S. BURLEY AVFNL1F DEDICATION - NORTH OF 117th STREET (AS DEPICTED ON SHFFT 41
TOGETHER WITH: THAT PART OF LOTS 13 THROUGH 24. INCLUSIVE. IN BLOCK 2 Cf INDIAN FJOCE SUBDIVISION Of PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHP 37 NORTH, RANGE 15 EAST OF THE THRO PRINCIPAL MERIDIAN. ACCORDMG TO THE PLAT THEREOF RECORDED SEPTEMBER 23. 1889. AS OOCUUENT NUMBER 26596. ANO THAT PART Of LOTS 6 ANO 7 IN THE DIVISION Of THE NORTH 102 ACRES Cf THE NORTHEAST QUARTER Of SEC110H 19, TOWNSHIP 37 NORTH. RANGE 15 EAST OF THE THRO PRINOPAL MERIDIAN, ACCORDING TO THE PUT THEREOF RECORDEO JUNE 26, 1872. AS DOCUMENT NUMBER 39470. ALL IN COOK COUNTY, ILLINOIS. BEMG BOUND AND OESCRBED AS FOLLOWS:
ABOVE DESCRIBED PARCEL CONTAINING 42804 SQUARE FEET OR 0.983 ACRES, MORE OR M9 SQUARE FLLI OR 5.724 ACRES, MORE OR LESS.
OF SAIO LOT 13 A DISTANCE Of 4260 FEET TO THE POMT OF LESS TOTAL AREA OESCRIBED ON PLAT OF DEDICATION CONTAINING
JACOB & HEFNER
; li.UKIl.in Tip J, >«(>[
Pur_or_juiPCin>fT
CDOT019-10-20-3945
SHEET 5 OF 6
jyiTtjet-jtoto _
nrmmn AT THE SOUTHWESTERN CORNER OF SAD LOT 13 IN block 2 SAIO POINT located at THE INTERSECTION of the NORTHERN RIGHT OF way UNE of e. 117th STREET AND THE EASTERN RIGHT OF WAY UNE OF S. BURLEY AVENUE; THENCE NORTH 01 DEGREES 03 UNUTES 23 SECONDS WEST (BASIS Of BEARWCS -ILUNOIS STATE PLANE COORDINATES EAST ZONE (NA083)) ALONG THE WESTERN LINES OF SAD LOTS 13 THROUGH 24 M SAD BLOCK 2 SAD UNE ALSO BQNC THE EASTERN RIGHT OF WAY UNE Of S. BURLEY AVENUE. A DISTANCE Of 294.00 FEET TO THE NORTHWESTERN CORNER OF SAID LOT 24; THENCE SOUTH BO OCCAEES 47 MINUTES 07 SECONOS WEST ALONG THE NORTHERN UNE OF SAID INDIAN FfflJGE SUBOMSKM 37.42 FEET TO A PONT ON THE SOUTHERLY PROJECTION OF THE EASTERLY BOUNDARY UNE OF PROPERTY CONVEYED AS PARCEL "A" BY REPUBUC STEEL CORPORATION TO DEFENSE PLANT CORPORATION BY DEED DATED FEBRUARY 17 1943 AND RECORDED AS DOCUMENT NUMBER 13047028 IN THE OFFICE OF THE COOK COUNTY RECORDER, SAID EASTERLY BOUNDARY UNE PROJECTED SOUTHERLY BFJNG COMMON WITH THE EASTERLY BOUNDARY UNE OF A PARCEL OF LAND CONVEYED BY DEFENSE PLANT CORPORATION TO SOUTH CHICAGO ANO SOUTHERN RAILROAD COMPANY BY DEED DATED JUNE 2. 1945 ANO RECORDED AS DOCUMENT 13540700 M IK OFFICE Of THE COOK COUNTY RECORDER; THENCE NORTH 00 DEGREES 40 MINUTES 46 SECONDS WEST ALONG SAIO SOUTHERLY PROJECTION UNE 378.41 FEET TO A POINT OH THE SOUTHERN UNE OF A 68 FOOT WIDE INGRESS EGRESS EASEMENT RECORDED DECEM8ER 1. 1989. AS DOCUMENT 89572950 IN THE OFFICE OF THE COOK COUNTY RECORDER, SAID UNE LYING 1,283.00 FEET SOUTHERLY CF (MEASURED PERPENDICULAR TO) THE NORTH UNE OF THE NORTHEAST QUARTER OF SAID SECTION 19; THENCE NORTH 89 DEGREES 39 UNUTES 50 SECONDS EAST ALONG SAID SOUTHERN UNE OF WGRESS EGRESS EASEMENT A DISTANCE Of 80.00 FEET; THENCE SOUTH 00 DECREES 40 UNUTES 46 SECONDS EAST PARALLEL WITH ANO 80 FEET EASTERLY OF SAIO SOUTHERLY PROJECTION UNE CON\«YED AS PARCEL "A-. A DISTANCE Of 374.61 FEET TO THE INTERSECTION WITH A UNE LYING 42 60 FEET EASTERLY Cf AND PARALLEL WITH THE AFORESAID WESTERN UNES OF LOTS 13 THROUGH 24 IN SAID BLOCK 2 THENCE SOUTH 01 DEGREES 03 MINUTES 23 SECONDS EAST ALONG SAID EASTERLY ANO PARALLEL UNE A DISTANCE Of 297.98 FEET TO A POINT ON THE SOUTHERN UNE OF SAIO LOT 13. SAID UNE ALSO BEING THE NORTHERN RIGHT OF WAY UNE OF E 117th STREET; THENCE SOUTH 89 DECREES 47 MINUTES 07 SECONOS WEST ALONG THE SOUTHERN UNE
EXHIBIT "A"
PLAT OF DEDICATION
OF
PART OF THE SOUTHEAST QUARTER ANO PART OF THE NORTHEAST QUARTER OF SECTION 19 TOWNSHIP 37 NORTH, RANGE 15 EAST. OF THE THIRD PRINCIPAL MERIDIAN. COOK COUNTY, ILLINOIS
OWNER'S CERTIFICATE
STATE or )
) SS
COUNTY OF )
NP AVENUE 0. ac, A MISSOURI UUITEO UABIUTY COMPANY. HEREBY CERTIFIES THAT THEY ARE THE OWNER Of THE AREAS SHOWN HEREON AS AREAS HEREBY DEDICATED TOR PUBLIC RIGHT OF WAY. AS DESCRIBED AND DEPICTED ON THE ATTACHED PLAT. AND THAT THEY HAVE CAUSED THE SURVEYOR TO SURVEY AND MAP THE AREAS AS PRESENTED ON THIS PLAT. IN WITNESS THEREOF SAID OWNER HAS SIGNED, OR CAUSED TO BE SIGNED ON ITS BEHALF BY ITS DULY AUTHORIZED AGENT. THIS CERTIFICATE ON
THIS DAY OF , 202 . I
NP AVENUE 0, RC. A MISSOURI UNITED UABIUTY COMPANY c/o NORTHPOINT 4B25 NW 41st STREET SUITE 500
RIVERSCE. MO 64150
BY: PRINTED:
OWNER
NOTARY PUBLIC
STATE OF )
) SS
COUNTY OF )
I. , A NOTARY PUBUC IN ANO FOR THE COUNTY OF
AND THE STATE OF 00 HEREBY
CERTIFY THAT \. PERSONALLY KNOWN TO ME, TO
BE THE SAME PERSON(S) WHOSE NAME(S) IS (ARE) SUBSCRIBED TO THE FORECOMG INSTRUMENT. APPEARED BEFORE ME IHS DAY M PERSON AND DEUWRED SATO MSTRUWENT AM) (SEVERALLY) ACKNOWLEDGED THAT HE (THEY) SIGNED. SEALED AS US (TVER) FREE AND VOLUNTARY ACT FOR THE USES AND PURPOSES KEREN SET FORTH.
OVEN UNDER MY HAND AND NOTARIAL SEAL
THIS DAY Of " A.D. 202
NOTARY PUBLIC COMMISSION EXFWES
CHICAGO DEPARTMENT OF FINANCE
BASS Of BEARINGS IS UJNOIS STATE PLANE COORDINATES EAST ZONE (NADB3) BROUGHT UP TO GROUND COORDINATES
DATE Of COMPLETION Cf FIELD WORK: MARCH 25. 2020.
NO DIMENSIONS SHOULD BE ASSUMED BY SCALE MEASUREMENTS UPON THE PLAT.
THE HEREON DE5CKBED LAND AND A0JONNG LANDS ARE SITUATED WITHIN THE CORPORATE UUITS OF THE CITY OF CHICAGO. ILLINOIS. AND IS ZONED "PLANNED MAMUFACTUF3NC~ PER THE QTY OF O4CAQ0 ZOMNC AND LAND USE MAP AS Of NOVEUBFJt 20. 2020.
WITH THE EXCEPTION OF THE 1 STORY METAL WATER PUMPHOUSE BUILDING ON PIN. 26-19-400-013 (SEE SHEET 2). LAND USE ON THE SUBJECT PROPERTY (AIL OF THE PARCELS DENTFCD WTTH A P.LN. HEREON) ft ADJOINING LAND AT THE TIME OF THE SURVEY WAS Aa VACANT LAND WITH NO BUILDINGS
SURVEYOR'S CERTIFICATE
STATE OF ILUNOIS )
.) ss
COUNTY OF DUPAGE )
I HEREBY CERTIFY THAT. AT THE REQUEST OF THE OWfERS. I HAVE PREPARED THIS PLAT FOR THE PURPOSE Cf DEDICATING RIGHT Cf WAY FOR PUBLIC STREETS DIMENSIONS ARE GIVEN IN FEET AND DECIMALS Of A FOOT.
THIS PROFESSIONAL SERVICE CONFORMS TO THE CURRENT ILLINOIS MINIMUM STANDARDS FOR A BOUNDARY SURVEY
1 HEREBY AUTHORIZE THE OWNER OR THEIR AGENT TO FILE THIS PLAT Of DEDICATION WTH THE COOK COUNTY RECORDER'S OFFICE
GIVEN UNDER MY HAND AND SEAL THIS 23rd DAY Of NOVEMBER. AD. 2020.
1^ . PR
TIMOTHY C. WOLFE l JACOB * HEFNER ASSOCIATES. INC. ILLINOIS PROFESSIONAL LAND SURVEYOR NO. JS-O0J5J5 MY UCENSE EXPIRES NOVEMBER 30. 2022
JS-0O3M5 PROTESSICNAI. ,n"s LAND SURVEYOR ' i - STATE Of IUJNOIS f
SEND TO: OLA PIPER, LLP
444 WEST LAKE STREET. SUITE 900 CHICAGO. IL 60606-0089
CD0T#19-10-20-3945 sheet e of
i
EXHIBIT "B"
PLAT OF OPENING
FOR PUBLIC RIGHT OF WAY OF THAT PART OF LOTS 47 AND 48 IN BLOCK 11 OF INDIAN RIDGE SUBDIVISION OF PART OF THE-NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST. OF THE THIRD PRINCIPAL MERIDIAN. ACCORDING TO THE PLAT THEREOF RECORDED SEPTEMBER 23, 1869. AS DOCUMENT NUMBER 26596. IN COOK COUNTY, ILLINOIS
r rH r
Soalm 1' = 30'
BASIS OF 5EARINGS LUNOIS STATE PLANE EAST ZONE (NAD83) BROUGHT UP TO GROUND COORDINATES
I
-14' PUBUC ALLEY
LOT 12 - BLOCK 2 . (120')
S. BUFFALO AVENUE
(66 FOOT R.O.W.)
BLOCK 1 LOT 12
E. 117th STREET
-(66 FOOT RO.W.)-
HERETOFORE DEDICATED SEPTEMBER 23. 1B69, PER DOC. 26596 (R.O.W. IS NOT IMPROVED)
POINT OF BEGINNING
NW CORNER LOT 48
N89'47'orE 42.60"
(120') LOT 1
(120-) LOT 2 ('2°')
LOT 3
(120')
(120')
LOT 5 (120')
JACOB & HEFNER
ASSOCIATES
iii
I '¦¦fl
EXHIBIT "B*
PLAT OF OPENING
FOR PUBLIC RIGHT OF WAY OF THAT PART OF LOTS 47 AND 48 IN BLOCK 11 OF INDIAN RIDGE SUBDIVISION OF PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH, RANGE 15 EAST. OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT THEREOF RECORDED SEPTEMBER 23, 1869. AS DOCUMENT NUMBER 26596. IN COOK COUNTY, ILLINOIS
DEPARTMENT OF MANNING AND DEVELOPMENT CERTIFICATE
STATE OF ILLINOIS)
) SS
COUNTY OF COOK)
, COMMISSIONER OF
THE DEPARTMENT OF PLANNING AND DEVELOPMENT FOR THE CITY'OF CHICAGO, DO HEREBY CERTIFY THAT I AM THE AUTHORIZED AGENT FOR THE TITLE HELD BY THE CITY Cf CHICAGO, A MUNICIPAL CORPORATION. Of THE PROPERTY DESCRIBED HEREON AND THAT I HAVE CAUSED THE SAID PROPERTY TO BE SURVEYED AND OPENED FOR PUBLIC WAY AS SHOWN HEREON.
THAT PART Of LOT 48 AND THAT PART Of THE NORTH HALF Of LOT 47 IN BLOCK 11 OF INDIAN RIDGE SUBDIVISION OF PART OF THE NORTHEAST QUARTER OF SECTION 19, TOWNSHIP 37 NORTH. RANCE 15 EAST OF THE THIRD PRINCIPAL MERIDIAN. ACCORDING TO THE PLAT THEREOF RECORDED SEPTEMBER 23, 1869, AS DOCUMENT NUMBER 26596, IH COOK COUNTY. ILUNOIS, BEING BOUND AND DESCRIBED AS FOLLOWS:
8EQHNNG AT THE NORTHWESTERN CORNER OF LOT 46 IN SAID INDIAN RIDGE SUBOtUSION, SAIO POINT LOCATED AT THE INTERSECTION OF THE SOUTHERN RIGHT Of WAY UNE OF E 117TH STREET AND THE EASTERN RIGHT Cf WAY UNE OF S. BURLEY AVENUE; THENCE NORTH 69 DEGREES 47 MINUTES 07 SECONDS EAST (BASIS OF BEARINGS - ILLINOIS STATE PLANE COORDINATES EAST ZONE (NAD83)) ALONG THE NORTHERN UNE OF SAID LOT 46. SAID UNE ALSO BEING THE SOUTHERN RIGHT OF WAY UNE OF E. 117TH STREET, A DISTANCE. Cf 42.60 FEET; THENCE SOUTH 01 DECREES 03 MINUTES 23 SECONDS EAST PARALLEL WJTH THE WESTERN UNE CF SAID LOT 48, A DISTANCE OF 34.50 FEET TO A POINT ON THE SOUTHERN UNE OF THE NORTH HALF Cf SAID LOT 47; THENCE SOUTH 89 DECREES 47 MINUTES 07 SECONDS WEST ALONG THE SOUTHERN UNE Cf THE NORTH HALF OF SAID LOT 47. A DISTANCE Cf 42.60 FEET TO THE WEST UNE OF SAIO LOT 47, SAID PONT BEING THE SOUTHWESTERN CORNER OF THE NORTH HALF Cf SAID LOT 47. SAID POINT LYING ON THE EASTERN RIGHT Of WAY UNE Cf S. BURLEY AWNUE; THENCE NORTH 01 DEGREES 03 MINUTES 2] SECONDS WEST ALONG THE WEST UNES Of SAID LOTS 47 ANO 48, A DISTANCE OF 34.50 FEET TO THE POMT OF BEGNNMG, ABOVE DESCRIBED PARCEL CONTAINING 1,470 SQUARE FEET OR 0.034 ACRES, MORE OR LESS.
COMMISSIONER
DEPARTMENT OF PLANNING AND DEVELOPMENT CITY OF CHICAGO
CDOTtfl 9-10-20-3945
EXHIBIT "B*
PLAT OF OPENING
FOR PUBUC RIGHT OF WAY OF THAT PART OF LOTS 47 ANO 46 IN BLOCK 11 OF INDIAN RIDGE SUBDIVISION OF PART OF THE NORTHEAST 0UAR1ER OF SECTION 19. TOWNSHIP 37 NORTH, RANGE 13 EAST, OF THE THIRD PRINCIPAL MERIDIAN. ACCORDING TO THE PLAT THEREOF RECORDED SEPTEMBER 23, 1889. AS DOCUMENT NUMBER 26398. IN COOK COUNTY. ILLINOIS
LEGEND
aOUOr MEASURED DIMENSION (XXX.XX') RECORO DIMENSION TRAFFIC
TT^rnc
TRAFFIC FLOW DIRECTION
SECTION/QUARTER SECTION UNE
BOUNDARY UNE
EASEMENT UNE
TAX PARCEL (PIN) UNE
CHCAOO DEPARTMENT OF TRANSPORTATION
SURVEYOR'S CERTIFICATE
COOK COUNTY
PREPARED FQft
NORTHPOINT DEVELOPMENT
3010 HIGHLAND PARKWAY, SUITE 440
DOWNERS GROVE. «. 60515
CHCAOO DEPARTMENT OF FMANCE
SEND-TO:
OLA PIPER, LLP
444 WEST LAKE STREET, SUITE 900 CHCACO, ILf 60*06-0089
SHEET 3 OF 3
STATE Of IUINOIS )
) SS
COUNTY Of OUPAGE )
I HEREBY CERTIFY THAT. AT THE REQUEST OF THE OWNER, I HAM PREPARED THIS
PLAT FOR THE PURPOSE OF OPENING LAND FOR A PUBUC STREET.
DIMENSIONS ARE GIVEN IN FEET AND DECIMALS Of A FOOT.
THIS PROFESSIONAL SERVICE CONFORMS TO THE CURRENT ILUNOIS MINIMUM
STANOARDS FOR A BOUNDARY SURVEY.
I HEREBY AUTHORIZE THE OVWIER OR THEIR AGENT TO FILE THIS PLAT OF OPEMNG FOR PUBUC STREET WITH THE COOK COUNTY RECORDER'S OFFICE-GIVEN UNDER MY HAND ANO SEAL THIS 20TH DAY OF NOVEMBER, AJ). 202a
TIMOTHY C. I JACOB i HEFNER ASSOCIATES, INC. ILLINOIS PROfESSONAL LAND SURVEYOR NO. 3S-003535 MY UCENSE EXPIRES NOVEMBER 30, 2022
EXHIBIT "C"
AFFECTED P.LN.'S AND CORRESPOMDINfi LOT f&
26-19-205-046 ALL . Of LOTS 1 THRU 5 OF "E"
26-19-206-016 LOT 28 IN BLOCK 11 OF "C" :^
26-19-206-019 LOT 27 IN BLOCK 11 OF "C* V
26-19-206-020 LOT 26 IN BLOCK 11 OF -C"
26-19-206-021 LOT 25 IN BLOCK 11 OF "C"
¦I
(66') "C" —FOUND RAJti?OAD SPIKE
8 23
24
C - INDIAN RIDGE SUBDIVISION OF PART OFTHE NE 1/4' OF SEC. 19-37-15 REC. 09/23/1869 DOC. 26596
"E" - RESUB. OF LOTS 20 TO 24 AND THE
" S. 8 FT. OF LOT 19 IN BLK. 11 IN INDIAN . RIDGE SUB REC. 05/23/1918 DOC. 6328680
"A" VACATED ALLEY PER CDOT019-1C-2O-3937 | PROJECT LEGISLATED AND AWAITING RECORDING AT THE COOK COUNTY RECORDER OF DEEDS
I.P.F. 3/4"
EXHIBIT "C"
PLAT OF VACATION
COOK COUNTY
•LEGEND.
XXX.XX' MEASURED DIMENSION 1 P.F. - IRON PIPE FOUND (XXX XX') RECORD DIMENSION
? FOUND 5/8' IRON ROD WITH CAP
SECHON/OUARTER SECTION UNE
BOUNDARY UNE
_ TAX PARCEL (PIN) UNE
THAT PART OF THE NORTH-SOUTH U FOOT WOE PUBUC ALLEY IBTHH BLOCK 11 AS DEDICATED MTH1N INDIAN . RIDGE SUBDIVISION Cf PART OF THE NORTHEAST QUARTER OF SECTION 19. TOWNSHIP 37 NORTH, BINGE IS EAST Of. THE THIRO PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT THEREOF RECORDED SEPTEMBER 23, IIS9, AS DOCUMENT NUMBER 26596. IN COOK COUNTY, ILUNOIS, BEING BOUND ANO DESCRBEO ¦ AS FOLLOWS:. BC0NN1NC AT THE SOUTHEASTERN CORNER OF LOT 25 IN BLOCK II IN SAIO INDIAN R3XX SUBOIVlSnN. ALSO BUNC ON THE NORTH RIGHT OF WAT OF E. HSIh STREET; THENCE NORIH 01 DEGREES 03 MINUTES 23 SECONOS WEST (BASS OF BEARINGS - UJNOS STATE PLANE COORDINATES EAST ZONE (NAD63)) ALONG THE EASTERN LINES OF LOTS 25 THROUCH 2S INCLUSIVE IN SAIO BLOCK 11, A DISTANCE OF 97.00 FEET TO THE NORTHEASTERN CORNER OF SAID LOT 28. ALSO BONG AND ABUTTING THE SOUTHERN TERMINUS OF VACATED ALLEY PER COOT#U-I0-20-M37 PROJECT LEGISLATED AND AWAITWC RECCROWG AT THE COOK COUNTY RECORDER OF DEEDS; THENCE NORTH 69 DEGREES 47 MINUTES 07 SECONOS CAST ALONG SAID SOUTHERN TERMINUS UNE 14.00 FEET TO A POUT ON IHE WESTERN UNE Cf LOT 5 OF THE RE-SUB0IVI90N CF LOTS 20 TO 24 AND THE SOUTH 6 FEET OF LOT 19 IN BLOCK It IN INDIAN RIDGE SUBDIVISION ACC0RC4NC TD THE FLAT THEREOF RECORDED MAY 23. 1916. AS OOCUUENT NUMBER 6328480; THENCE SOUTH 01 DECREES 03 MINUTES 23 SECOHDS EAST ALONC THE WESTERN UNE CF SAID LOT 3. A DISTANCE OF 97.00 FEET TO THE SOUTHWESTERN CORNER OF SAID LOT 5, ALSO ON SAID NORTH RIGHT OF WAY OF E. 118th STREET; THENCE SOUTH 89 DECREES 47 MINUTES 07 SECONDS VEST ALONG SAID NORTH RIGHT OF WAY 14 00 FEET 10 THE PONT OF BEGINNING, ALL IN COOK COUNTY, ILUNOIS; SAID ABOVE DESCRIBED PARCEL CONTAINING 1,358 SOUARE. FEET OR 0 031 ACRES. MORE OR LESS.
SURVEYOR'S NOTFS:
BASIS OF BEARINGS IS ILLINOIS STATE PLANE COORDMATES EAST ZONE (NA063)
OATI OF COMPLETION OF FIELD "WORK: MARCH 25. 202a
NO DIMENSIONS SHOULD BE ASSUMED BY SCALE MEASUREMENT:! UPON THE PLAT,
ACCORDING 10 INFORMATION FOUND ON THE QTY Cf CHCAOO ZOWKC AND LAND USE HAP. RETRIEVED VIA THOR WEBSITE ON JULY 2, 2020. ALL OF IHE PARCELS lOENTTFTEO OH THIS PLAT Cf VACATION (SHOWN AND LABELED WITH A PJ.N. HEREON) FALL WITHIN ZONING CLASSIFICATION PMDf (PLANNED MANUFACTURING DISTRICT 6)
3) LAND USE ON THE SUBJECT PROPERTY (ALL OF THE PARCELS IDENHFIED WITH A PIN. HEREON) AT IHE TIME OF THE FIELD WORK WRE ALL VACANT LAND WITH NO BUILDINCS.
1 'I HEPEF3Y VACATED
V////A PENDING DEDICATION
SEND TQ;
OLA PIPER. LLP
444 WEST L/KE STREET, SUITE 900 CHICAGO, llJ 40606-0069
SHEET 2
)5S
) .
STATE OF ILUNOS
COUNTY OF OUPAOZ
I, TIMOTHY C. WOFE. AN ILUNQS PROFESSIONAL LAW SURVETTJR, 00 HEREBY CERTFY THAT I HAVE RgPARED IHS PLAT OF VACATION DESCRSED HEREON FOR THE PURPOSE CF VACATHC THE SAW AND THAT H PLAT HEREON DRAWN IS A CORRECT REPRESENTA110N THEREOF AND IHS FROFESStONAL SERVICE COfOSUS ID THE CURRENT UJNOIS HMMUM STANDARDS FOR A BOUNDARY SURVEY. OAIED IHS 2W DAY CF ItOVOQER, 2020,
TNOTHY c ware
¦JACC8 SUR^tOT MO-WY UCEN5E OPIHES NOSGCER X, 2022
NP AVENUE O, LLC 4825 NVV 41st Street, Suite 500 Riverside, MO 64150
DUTY TO BUILD AGREEMENT FOR CREATION OF A NEW STREET
The signatory, an authorized agent of NP Avenue O LLC ("Developer*) agrees to construct the section of S. Burley Avenue between approximately E. 116th Street (private) and E. 122nd Street; S. Burley Avenue being widened by dedication from the Developer in a pending application to the Department of Transportation. The Developer agrees to the below terms of the dedication:
HP Avenue 0,
By : NPD
By:
I am aware that I am responsible for the construction of all new public and private rights of way (streets, alleys, etc) described on the Plat of Subdivision/Dedication.
I further understand that all rights of way (both public and private) must be buil; to Oty specifications as detailed in CDOTs Regulation for Openings, Co^truction and Repair in the Public Way.
Lastly, I understand that construction deposits will be required to assure that the work is done correctly. An inspection will be conducted by the Oty upon completion of the work. The City of Chicago reserves the righ: to require demolition and reinstallation of any facilities that are judged to be sub par or that do not adhere to the City's standards. LLC
orn. Manager SP Avenue O. LLC
4825 NVY 41 st Street Suite 500. Ffr/erstcte. UC Zip. 331-251-31". 1
nt,UC, its manager
/.
64150
Su (his
end sworn to before me day of July 2020.
CITY OF CHICAGO
$ ___
DEPARTMENT OF WATER MANAGEMENT
October 20, 2020 City of Chicago L^partment of Transportation Division of Infratxucnire Management Office of Underground Coordination 30 North LaSaJle Street, 3"1 Floor Chicago, Illinois 60602
Attn: Mr. Jai Kalayil
Coordinator of Street Permits
Re: Proposed Vacation Ordinance 10th Ward
For: NorthPoint Development
Dedication and Opening of S. Burley Avenue from E. 116* Street to IL I22- Street Vacation of alley east of S. Burley Avenue and north of E. 118* Street
OUCFUeNo. VD-105120 M&P Project No. 19-10-20-3945 Water Adas Page 707 & 719 Sewer Atlas Page 37-2-11 & 37-2-12
Dear Mr. Kalayil:
This letter is in response to your inquiry dated July 31, 2020 axxxming the proposed ricdK-atooa, opening and vacation. After reviewing our records, we have aVtennined the foJkmtag
I) The Department of Water Management - Water Section
The following water mains and appurtenances are located within or ad>aon* to the procovxi dedication and opening:
S. Burley Avenue ROW from E. 117* Street to •pproxnotrrj. 30©* t» uW aorta
An 8-inch cast iron water main installed in 1923.
S. Burley Avenue ROW from E. 117lh Street te E. I 18th Street
A 12-inch water main installed in 1899 and a 24 inch metrr mew mttaUoJ n 1*5?
S. Burley Avenue vacated ROW from F_ 118* Street t» E. 1237* Slreet
A 12-inch water main installed in 1899 and a 24-ioch wascr maa tarttalled w i^1
These water mains and appurtenances must he retained. The W«kv Sect** appn«\c« o< «V proposed dedication, opening and vacation. subject »o the fvJkr**^ cor*tex«n
a. The proposed paving plans «rr currently unxtrr rcrrr* vstAn tHK' 1\FP IOV<~t TTfarat proposed paving plans must be rrvtsrwrd and apprm«rd tn the V> sstt S»\wa pnr*
OOirSirUi'-'EHTfJ.
-iwi^w OcCster 20, 2020
b. All water service* no tasgff ts o&e ri»il be pennaasesrily temtsessed m pan of tfe proposed deveiopcaeig by pemoX per DWM Standard*.
Fra (|m^km ccgar&ag w^er fadntics, please contact Andrew Mcf^risad af
The n^rtm^ni of Watgf Vlajweregril ? Sewer Sect&n
1. DedkalfcD^strfpa 2ad teie^^
E 13ft£i S3 and E 122nd §4: Tfeere are 24-tttcb to 27-*ncb Oty «e»m ca S Basrky Ave from E 116th St to appnyxJ^fcet of soatii fee of E 116tb St s&d wTSbssa the proposed area to be deceased. Ttee Sewer Section baa ©o cbjecSkrai to t&e popes^d rff4fk"atpf^, pnnw^jed the following are .part of ihe itodhraatkin orrfrgance"
Private ssnectmes are out aUoe*ed sa the pabfac right of way wtihosi a osvSnace estabbs&ed by tlae City OmsaL EsiMing fmvme egroctures e»st be fefocssesd H£k> prrvzae property, abandoned or oteMwfard through a City Coasted owftia—re.
If and when tfee existing private drainage stractoffeft acd a#aoriaied draara are abandoned, the afeajMScmmeni piaas most meet the Departmeia of Waser Mmm§&mcBL Sewer Design Section's rcqancmef&i.
it is the deveksp**!e«!*s respowibjlity to provide proper drainage is ttee asess to be dedicated- New sewer and drainage CacOitks will be ccsmracsed m tie development's espeaaea. When die final plana a*e availabJe. tbe devdcpHaeni'3 cspaari^ staff mast dascem tteosc plans with Sewer Design Section.
e, pqMtfga sac jaaynred to be obiaiBcd by a 1 termed Drainlayer fsxsm fee [>cg»«a>eaa of Bslkfef»B - Sewer Permit Sectkm for all mdergrces&d sewer »rot ® hush fee pobtoc ©ray Mi oa private property. As-boall piam of the public sewer md KXimbmxd patriae ibem sewers iadkaftag the &xt& location of the racaa sewesfs) ni appmsesances RM^iffit be f'fafpRfil to the )TV ^mff'EK**" of VVsser J^taftagesnest for Record r****y»f* withm 30 *t^>y* of coQAp&etion.
2, Opaofag ef a pSsee of § Barley Aw a£ lhr S«uihesiit corner Barley and 18?&h
Bsstd jasposeaS &m vwc&BBSk. TheaSotc i&e Sewesr Mcskm has at> t%cct»c« lo the propmang
H ^«e§#M ^"l&e «*ey1ls-s«K3fh aOry slab returning to 8 8Sth Slirwi l« Ste 'hte>dk txmtx&^d faf % Wmtef A^sv f& S 87^ Si, § Buffalo A«e, sand £ § l&dh St: ®as*d on erew recon&K gtes w poft^Vc mm^s feafafew viiH i&e fei^s of m pam^amtid few «moa,
OVC FUe Ho. VTM05I20 October 20,2020 Pae*3of3
If there are any questions regarding the sewer facilities, contact Sid Osakada at Sid.Osakada@CityofChicago.org or Anupam Verma al Anupam-Verma@CityofCrucagoxj?g.
Very truly yours.
Randy Conner Commissioner
#1 NP AVENUE O, LLC
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: NP Avenue O, 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 II(B)( I)) State the legal name ofthe entity in which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 4825 NW 41 st Street, Suite 500
Riverside, MO 64150
Telephone: (630) 258-5299 Fax: Email: tgeorge@northpointkc.com
Name of contact person: Tom George
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):
Dedication of right of way for the extension of South Burley Avenue between East 116th Street and East 122n^Street.
Which City agency or department is requesting this EDS? Chicago Department of Transportation
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification ff and Contract #
Vcr.2018-1 Page 1 of 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing
[ ] Person
[ ] Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ ] Limited partnership
[ ] Trust
[x] Limited liability company
[ j 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: 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?
[x] 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
NPD Management, LLC Manager
2. Please provide the following infonnation 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 interest in a partnership or joint venture, interest of a member or manager in a
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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
NH35-FDC Chicago. LLC 6600 France Avenue S Ste. 550. Minneapolis. MN 55435 . 81.7979% (Directs
NP Partners 2018. LLC 4825 NW 41st Street. Suite 550. Minneapolis. MN 55435 12.1730% (Direct)
6600 France Avenue S., Ste. 550,
Richard M. Schulze Revocable Trust u/a dated June 14, 2001 Minneapolis MN 55435 70.67% (Indirect)
Richard M. Schulze (an Individual) 6600 France Avenue S., Ste. 550, Minneapolis, MN 55435 70.67% (Indirect)
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? [JYes [x'JNo
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 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 2-156 ofthe Municipal Code of Chicago ("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 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 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 15
Name (indicate whether retained or anticipated to be retained)
DLA Piper LLP - retained
Jacob & Hefner Associates. Inc.
(retained)
Business Relationship to Disclosing Party Address (subcontractor, attorney, lobbyist, etc.)
Attorney
444 West Lake Street, Suite 900. Chicago. IL 60606
Civil Engineer
1333 Butterfield Rd. Suite 300,
Downers Grove, IL B0515
Fees (indicate whether paid or estimated.! NOTE: "hourly rate" or "t.b.d." is
not an acceptable response.
$20.000.00 - estimated
$20.000.00 - estimated
(Add sheets if necessary)
[ ] Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities.
SECTION V » CERTIFICATIONS
A. 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 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
B. FURTHER CERTIFICATIONS
[This paragraph 1 applies only ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date of this EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance ofany 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 ofany fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) of this EDS:
arc 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;
arc 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 of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The 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 directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5ofl5
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 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 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 ofany 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" [sec 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, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent ofthe City, use any such
Vcr.2018-1 Page 6 of 15
contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. Ifthe Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
None
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively 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, of the City of Chicago (if none, indicate with "N/A" or "none").
None
13. To the best ofthe 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, ofthe 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 Party (check one)
[ ] is [x] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Page 7 of IS
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes [x] No
NOTE: Ifyou checked "Yes" to Item D(l), proceed to Items D(2) and D(3). Ifyou 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 of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ ] Yes [ ] No
If you checked "Yes" to Item D(l), 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 Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of IS
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: Ifthe Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any
person or entity to influence or attempt to influence an officer or employee ofany agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Vcr.2018-1 Page 9 of 15
of a member of Congress, in connection with the award ofany 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) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
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 [ J No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director 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 clause?
[ ] Yes [ ] No
Ifyou checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
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 ofany 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 ofany 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 of this ordinance and a training program is available on line at www.cityofchicago.org/Ethics . and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
Ifthe 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.
Page 11 of 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 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 City.
NP Avenue O, LLC
By: NPD Management, LLC, its Manager
(Print or type exact legal name of Disclosing Party)
(Sign here) Of
ot au
(Print or type name of person signing)
(Print or type title of person signing)
Signed and sworn to before me on (date) hat i£, Z(fl° .
at County, _ fctate)
HEATHER R. PFENOER Notary Public • Notary Seal Clay County - State of Missouri Commission Number 15633521 My Commission Expires Feb 24, 2023
Notary Public Commission expires:
Page 12 of 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 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section 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 of the Disclosing Party, ifthe 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?
[ JYes [xJNo
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.
Page 13 of 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?
[ JYes [ JNo [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.
Page 14 ofl5
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.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.
Page 15 of 15
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected infonnation)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
a dedication of right of way for the extension of South Burley This recertification is being submitted in connection with Avenue between East 116th Street and East 122nd Street
[identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as ofthe date of this recertification, and (3) reaffirms its acknowledgments.
NP Avenue O, LLC
Date: lVl-7LjJ
(Print or type legal name of Disclosing Party)
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(sign here) Print or type name of signatory:
Title of signatory:
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Signed i ItfaJiwi.-. .....,
Notary Public.
Signed and swcpi^^ej^re me on [datej^ ^ \\ f 3 j2- Q
Commission expires:
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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: NP Partners 2018, 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 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: NP Avenue O, LLC
OR
[ ] 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: 4825 NW 41st Street, Suite 500
Riverside, MO 64150
Telephone: (630) 258-5299 Fax: Email: tgeorge@northpointkc.com
Name of contact person: Tom George
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):
Dedication of right of way for the extension of South Burley Avenue between East 116th Street and East 122nd Street.
Which City agency or department is requesting this EDS? Chicago Department of Transportation
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Ver.2018-1 Page 1 of 15
SECTION II -
- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing
[ ] Person
[ ] Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ ] Limited partnership
[ ] Trust
[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: 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?
[ ] Yes [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) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
NPD Management, LLC Manager of the Applicant
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 interest in a partnership or joint venture, interest of a member or manager in a
Page 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
NH35-FDC Chicago, LLC 6600 France Avenue S., Ste. 550, Minneapolis, MN 55435 81.7979% (Direct)
NP Partners 2018, LLC 4825 NW 41st Street, Suite 550, Minneapolis, MN 55435 12.1730% (Direct)
Richard M. Schulze Revocable Trust u/a dated June 14, 2001 70.67% (Indirect)
Richard M. Schulze (an Individual) 6600 France Avenue S., Ste. 550, Minneapolis, MN 55435 70.67% (Indirect)
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 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 of Chicago ("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 intcrcst(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 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Parly's regular payroll. If the Disclosing Parly is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 15
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 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 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
[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 of this EDS, neither the Disclosing Party nor any Affdiated Entity [see definition in (5) below] has engaged, in connection with the performance ofany 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 to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment ofany tax administered by the Illinois Department of Revenue.
Page 4 ofl5
The Disclosing Party and, if the Disclosing Parly is a legal entity, all of those persons or entities identified in Section 11(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 of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The 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 directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acling pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 15
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 of the federal government or ofany 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 I for applicability and defined tenns] 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, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above.and will not, without the prior written consent of the City, use any such
Ver.201 K-1 Page 6 ofl 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 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 of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
None
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, ofthe 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 ofthe City recipient.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [x] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
Page 7 of .15
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes [x] No
NOTE: Ifyou checked "Yes" to Item D(l), proceed to Items D(2) and D(3). Ifyou 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(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of 15
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. Ifthe 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 ofany and all slaves or slaveholders described in those records: .
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: Ifthe Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City arc not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or 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 the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed in paragraph A( 1) above for his or her lobbying activities or to pay any
person or entity to influence or attempt to influence an officer or employee ofany agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Vcr.2018-1 Page 9 ofl 5
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) 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.
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l ) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ 1 No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ]Yes [ ]No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No [ | Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ]Yes [ ]No
Ifyou checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
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 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 of this ordinance and a training program is available on line at www.cityofchicago.oi g/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.
Ifthe 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 infonnation 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. Ifthe 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.
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CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf 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 City.
NP Partners 2018, LLC
By: NPD Management, LLC, its Manager
(Print or type exact legal name of Disclosing Party)
(date) \unL2ll2tylQ
at ftp County,
Notary Public
Commission expires:
Page 12 ofl 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 thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section 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 of the Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[ ]Yes [x]No
If yes, please identify below (I) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAVV/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
Ifthe Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ JYes [ ] 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.
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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.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 -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)(1). If you checked "no" to the above, please explain.
Page 15 oi l 5
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected infonnation)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
a dedication of right of way for the extension of South Burley This recertification is being submitted in connection with Avenue between East 116th Street and East 122nd Street
NP Partners 2018, LLC
By: NPD Management, LLC, its manager
By:
[identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Parry's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.
Nathaniel Hagedwn, Manager
Date: I f - 3 -
Signed and sworn ta before mc on [dafcl-^ fl ~ 3 - T Q , by
JUHVV ft.l^W-fV , at , f h }4<. County. ff)\U ^
Notary Public.
Commission expires:
^ HlTWIWTI **" ~- H IT- ~~ ¦**¦¦**>¦¦ '
HEATHER R. PFENDER Notary Public - Notary Seal Clay County - State of Missouri Commission Number 15633521 My Commission Expires Feb 24, 2023
IMPD MANAGEMENT, LLC
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: NPD Management, LLC
Check ONE of the 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 of the Applicant (see Section TT(B)(1)) State the legal name ofthe entity in which the Disclosing Party holds a right of control:
NP Avenue Q. LLC
Business address ofthe Disclosing Party: 4825 NW 41st Street, Suite 500
Riverside, MO 64150
Telephone: (63°) 258-5299 Fax: Email: tgeorge@northpointkc.com
Name of contact person: Tom George
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):
Dedication of right of way for the extension of South Burley Avenue between East 116th Street and East 122nd Street.
Which City agency or department is requesting this CDS? Chicago Department of Transportation
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification // and Contract tt
Ver.2018-1 Page lot'15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature ofthe Disclosing Party: ¦
[ ] Person [xj Limited liability company
[ ] Publicly registered business corporation [ ] Limited liability partnership
[ ] Privately held business corporation [ ] Joint venture
[ ] Sole proprietorship [ ] Not-for-profit corporation
[ ] General partnership (Is the not-for-profit coiporation also a 501 (c)(3))?
[ ] Limited partnership [ ] Yes [ ] No
[ ] Trust [ ] Other (please specify)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Missouri
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) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title Nathaniel Hagedorn Manager
Chad Meyer 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% of the Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Page 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
NH35-FDC Chicago, LLC 6600 France Avenue S Ste. 550, Minneapolis, MN 55435 81.7979% (Direct)
NP Partners 2018, LLC 4825 NW41st Street, Suite 550, Minneapolis, MN 55435 12.1730% (Direct)
Richard M. Schulze Revocable Trust u/a dated June 14, 2001 70.67% (Indirect)
Richard M. Schulze (an Individual) 6600 France Avenue S., Ste. 550, Minneapolis, MN 55435 70.67% (Indirect)
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? [JYes [xJNo
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? [ J 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 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party?
[]Yes [x] No
If "yes," please identify below the name(s) of such City elected official(s) and/or spousc(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 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
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 ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V -- CERTIFICATIONS
COURT-ORDERRD 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
[This paragraph 1 applies only ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date of this EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance ofany 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 ofany fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment ofany tax administered by the Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section II(B)( 1) of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any 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 ofthe 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 of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The 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 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 the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Pugc5 of 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 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 of the City, the State of Illinois, or any agency of the federal government or ofany 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)(Dcbarment 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 ofany 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 of the City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If MCC Chapter 1-23, Article I applies lo the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent ofthe City, use any such
Ver.20IK-1 Page 6 oi l5
contractor/subcontractor that docs not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. Ifthe Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
None
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively 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 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 ofthe 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, ofthe 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 ofthe City recipient.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [x] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We arc not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
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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):
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best ofthe Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name ofany 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). Ifyou 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
Ifyou checked "Yes" to Item D(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
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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 of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or 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 the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any
person or entity to influence or attempt to influence an officer or employee ofany agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Vcr.2018-1 Page 9 of J 5
of a member of Congress, in connection with the award ofany 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
Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ]No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No [ ] Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ J Yes [ ] No
Ifyou checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
- 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 of this ordinance and a training program is available on line at www.cityofchicago.org/Ethics . and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with 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. Ifthe 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 infonnation provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
Page 11 of 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 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 City.
NPD Management, LLC
(Print or type exact legal name of Disclosing Party)
By:
(Sign here)
(Print of type name of person signing)
mona^r
(Print or type title of person signing)
Signed and sworn to before me on (date) (VI 2£, 20W,
at County, _ mo _ (state).
Notary Public W 1' ¦ „ HEATH£R pfender
* Notary Public -Notary Seal
X
1 Commission Number 1563352"
% b\ Z^> " Commission Expires Feb 24, 2023
Page 12 of 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 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers 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 of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5% 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 [xJNo
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity lo 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.
Page 13 of 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
Ifthe Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] 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.
Page 14 of 15
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.amlcgal.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.
[JYes
[ ] 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.
Page 15 ofl5
(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)
RECERTIFICATION
Generally, for use with City Council matters. Not for City procurements unless requested.
a dedication of right of way for the extension of South Burley This recertification is being submitted in Connection With Avenue between East 116th Street and East 122nd Street
[identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as ofthe date of this recertification, and (3) reaffirms its acknowledgments.
NPD Management, LLC Date: I I
Nathaniel Hagedom, Manager
-Hi n, «¦ -n gg „
HEATHER R. PFENDER Notary Public - Notary Seal Clay County-State of Missouri . commission Number 15633521 I My Commission Expires Feb 24 2023
NH35-FDC CHICAGO, LLC
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: NH35-FDC Chicago, LLC
Check ONE ofthe 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 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: NP Avenue O, LLC
OR
[ ] a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 6600 France Avenue S Ste. 550.
Minneapolis, MN 55435
Telephone: 952-324-8905 Fax: 952-324-8999 Email: kevinb@olvmpusventures.com
Name of contact person: Kevin S. Bergman
Federal Employer Identification No. (ifyou have one):
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
Dedication of right of way for the extension of South Burley Avenue between East 116th Street and East 122nd Street.
Which City agency or department is requesting this EDS? Chicago Department of Transportation
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification // and Contract #
Vcr.20IS-l Paget of 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 [ ] Limited partnership [ ] Trust
[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?
[ ] Yes [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) 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
NPD Management. LLC Manager of the Applicant
Richard M. Schulze President of the Disclosing party
Kevin S Bergman Vice President and Secretary of the Disclosing Party
Joseph S. Langel Vice President and Treasurer of the Disclosing Party
2. Please provide the following infonnation 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 interest in a partnership or joint venture, interest of a member or manager in a
Page 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
NH35-FDC Chicago, LLC 6600 France Avenue S„ Ste. 550, Minneapolis, MN 55435 81.7979% (Direct)
NP Partners 2018, LLC 4825 NW41st Street, Suite 550 Minneapolis, MN 55435 12.1730% (Direct)
6600 France Avenue~ST5f.e7550;
Richard M. Schulze Revocable Trust u/a dated June 14, 2001 Minneapolis, MN 55435 70.67% (Indirect)
Richard M. Schulze (an Individual) 6600 France Avenue S., Ste. 550, Minneapolis, MN 55435 70.67% (Indirect)
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? f ] 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 ofthe Municipal Code of Chicago ("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 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 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 15
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 ifthe 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 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 [ ] No
FURTHER CERTIFICATIONS
i
[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 of this EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance ofany 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 to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 of 15
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) 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 of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The 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 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 of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 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 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 of the 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 ofany 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 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 of the City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent ofthe City, use any such
Ver.2018-1 Page 6 of 15
contractor/subcontractor that docs 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
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
None
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, ofthe 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 ofthe City recipient.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [x] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."
Page 7 of 15
Ifthe Disclosing Party is unable to make this pledge because it or any of its affdiates (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):
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best ofthe Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ]Yes [x]No
NOTE: Ifyou checked "Yes" to Item D(l), proceed to Items D(2) and D(3). Ifyou 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 ofany other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[ ] Yes [ ] 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 of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of IS
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.
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 ofany and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any
person or entity to influence or attempt to influence an officer or employee ofany agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 Page 9 of 15
of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, 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.
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ]Yes [ ]No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ]Yes [ ]No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No [ ] Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [ ] No
Ifyou checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
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 in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution ofany 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 of this 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.
Ifthe 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.
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CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf 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 City.
NH35-FDC Chicago, LLC
(Print or type exact legal name of Disclosing Party)
(Print or type name of person signing)
(Print or type title of person signing)
Signed and sworn to before me on (date)
County,
Notary Public
Commission expires:
Page 12 of 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 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk,, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section II.B.l.a., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, ifthe 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 of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
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CITY OF CHICAGO 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?
[ JYes [x]No
Ifthe Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] 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.
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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.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)(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. 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). Ifyou checked "no" to the above, please explain.
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CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf 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 City.
NH35-FDC Chicago. LLC
(Print or type exact legal name of Disclosing Party)
(Print or type title of person signing)
Signed and sworn to before me on (date) U/3/2020
County,
Notary Public
Commission expires:
Page 12 ofl5
RICHARD M. SCHULZE REVOCABLE TRUST U/A DATED JUNE 14, 2001, AS AMENDED
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: Richard M. Schulze Revocable Trust u/a dated June 14, 2001, as amended
Check ONE of the 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 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:
NP Avenue O. LLC
B. Business address of the Disclosing Party: 6600 France Avenue S., Ste. 550,
Minneapolis, MN 55435
Telephone: 952-324-8900 Fax: 952-324-8999 Email: kevinb@olympusventures.com
Name of contact person: Richard M. Schulze
Federal Employer Identification No. (if you have one):
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
Dedication of right of way for the extension of South Burley Avenue between East 116th Street and East 122"d street.
Which City agency or department is requesting this EDS'? Chicago Department of Transportation
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Vcr.2018-1 Paget of 15
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
[ ] Person
[ ] Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ ] Limited partnership [x] Trust
[ ] 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)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Florida
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 [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) 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.
NOTF2: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
NPD Management. LLC : Manager of the Applicant
Richard M. Schulze Trustee ofthe Disclosing Party
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 interest in a partnership or joint venture, interest of a member or manager in a
Page 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 listedbelow may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
NH35-FDC Chicago. LLC 6600 France Avenue S„ Ste. 550. Minneapolis. MN 55435 81.7979% (Direct)
NP Partners 2018. LLC 4825 NW 41st Street. Suite 550, Minneapolis, MN 55435 12.1730% (Direct)
Richard M. Schulze Revocable Trust u/a dated June 14. 2001 70.67% (Indirect)
Richard M. Schulze (an Individual) 6600 France Avenue S., Ste. 550, Minneapolis, MN 55435 70.67% (Indirect)
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 j 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 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 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party? []Ycs [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 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 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. If the Disclosing Parly is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 of 15
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 ifthe 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 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 agreement?
[ ] 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.] In the 5-year period preceding the date of this EDS, neither the Disclosing Party nor any Affdiated Entity [see definition in (5) below] has engaged, in connection with the performance of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract in progress).
The Disclosing Party and its Affiliated Entities are not delinquent in the payment ofany fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 of .15
3. The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(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 ofthe 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 of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The 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 directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 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 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 of the City, the State of Illinois, or any agency of the federal government or ofany 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 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, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If 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 ONL Y] 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 will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent ofthe City, use any such
Ver.2018-1 Page 6 of 15
contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. 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
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
12. To the best of the 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 ofthe 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, ofthe 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 ofthe City recipient.
None
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is [>] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Page 7 of 15
Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ] Yes [x] No
NOTE: Ifyou checked "Yes" to Item D(l), proceed to Items D(2) and D(3). Ifyou 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(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
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 oft5
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 of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any
person or entity to influence or attempt to influence an officer or employee ofany agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 Page 9 of 15
of a member of Congress, in connection with the award ofany 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( 1) and A(2) above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
Ifthe 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
Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No [ ] Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes L j No
If you checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
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 ofany 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 ofany 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 of this ordinance and a training program is available on line at www.cityofchicago.org/Ethics . and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with 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. Ifthe 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.
Page 11 of 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 City.
(Print or type name of person signing)
Richard M. Schulze Revocable Trust u/a dated June 14, 2001, as amended (Printxfftype exact legal name flfflisclosing Party)
Trustee
(Print or type title of person signing)
Signed and sworn to before me on (date) 11 /3/2020
County,
Notary Public
Commission expires:
Page 12 of 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 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section II.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, ifthe 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 of the 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.
Page 13 of 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
Ifthe Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] 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,
Page 14 of 15
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.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)(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. I also certify that the Applicant has adopted a policy that includes those prohibitions.
[ JYes
[ ]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.
Ver.2018-1 Page 15 of 15
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