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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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Approval of plat of Park One Resubdivision
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Topic:
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PROPERTY - Plats - Resubdivision
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Attachments:
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1. O2021-1031.pdf
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( \3:ll:T RESUBoivisioNordinance ;,^^.;jV";;; [ 1 - ' BeIt'drdairitedby,theCityCouhcijofi E. , . rSECTION ,1. The v Comrriiasloner^ ofcthe^; Chicago^: Depart S ' trahsportatioh ,r: v'J* ¦:'v ^ approve a proposed Park:One Resubdivision be'^ owned j'\ ^ by Wabash-Van/Buren Park. One, LLC. ("Developer') in the block , bounded by W. ./ . Grenshaw Street, W; De KovenI Street, S. Jeffersori Street ahdsS. Clinton Street and ; legally described in ^ ~* * - > ¦ V Boater certainty, is hereby made a part of.this ordinance,, ;. .C- K- v , :i SECTION ^ , ;V ^ ;:" ' \, K harmless, indemnify and defend the City of Chicago from ;all. claims, related to' the; i > V tNjJ . .resubdivision y;%.;rr*. .::¦¦„;-. s's-==- -•- 4 -• -,: V SECTiON l The resub^ ;. A - i." ^,,, ordinance, the Developer shall file or cause to be filed.for recordation with the Office of ...¦¦.¦¦^;;;t;:;| ';.>*^-; "V' v the Recorder of Deeds ;of Cook County, lll^ . <: :'v •tpgether*.with, the fuli-sizedVcprtespondlng - plat approved by 'the Department of;, y.: >:f* ,,; ,r * T rahsportatioh's Superintendent of Maps and Plate. . JM . ^ , *t ;>l'r;: SECTION 4; ^ ¦, ,;. fer y : ^> .vft, after its'passage ari^^ ' introduced by: vHdhbrable LBy rpn Sigcho-Lopez. Alderman 25th Ward ) ; i ¦ ^ s CITY OF CHIC AGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT SECnONI 4-GENJERA^ A. Legal name of die Disclosing Parry submitting dus EDS. Include d/b/a/ if applicable: Vyahash>VanBuren Park One, LLC. '-r-^zV.^^.^ ; . Check ONE or the following three boies. V f 4/ " '"\ ' "" " 'r'\ ] Indicate whether die Disclosing Party submitting this EDS is: 1. 0 the Applicant :¦- OR - .... .... ^ - ;-v. . -., ip ¦... ,¦.».:...,, e ¦ * V-^,- " 2- Q 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>clirect™^ State the Applicant's leg- name: : . : ... . :¦ — 3. ? a legal entity with a direct or indirect right of control of the Applicant (see Section II(BX1)) State the legal name ofthe entity in which the Disclosing Party holds a right of control: B. FnTirrrr H*-^ "f rwi^rip l^rtf 65 E. Harrison Street, <217 ¦ 'r;y
G Telephone:, D. Name of contact person: -r^™;
Etyo^-E^oyerlQ^
Brief description of the Matter to which this EDS pertains. (Include project number and location of
property, if applicable): , ,
Appflc^tlsseeta^ approval of
Which City agency or a^partment is requesnngtim EDS? ct"c^oPopartren!— if the Matter is acont^^
and Contract #.
page liof 15
r&mplete-m^^ Z-\0:::':¦ ¦V::}..^'
Specification # - f Vcr2018-1
section n - disclosure of ownership interests
A. NATURE OF THE DISCLOSING PARTY 3^-
1. Indicate the nature.of the Disclosing Partyi ^ : . ¦ * ^
Person 0 Limitedliabilitycompany
Publicly registered business corporation P Limited habilityparm
Privately held business corporation j_ Joint venture
Sole proprietorship ' ? Not-for-profit corporation . "
General partaership the not-for-profit corporation also a 501(c)(3))?
_Luiutedpartnership .¦ : wv. ; ¦ QYes ONo :
?Trust [_ Other (please specify)
2;^o7legai entities, me^stote or organization; if applicable:
3. For legal entities not organized in the State of Illinois: Has me organization registered to do
business in theState of nimois as a foreign entity? • .r-.0n * ¦
f~Yes QNo ["Organizedin Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1; List below the fall names and tides, if applicable, of: (i) all executive officers and all directors of the entity; (ti) 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, Umited liability companies, limited liability partnerships or joint ventures, each gene^partaer, managuig member, manager or any other person or legal entity that directly or indirectly controls the day-to-o^y management of the Applicant
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
AndriyousP.Voulchana. ¦¦ ¦;¦ . .Manager
2. Please provide the following Mormation 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 - ^n0^
state "None." ... •. ?-Xr** ' y, .:rj ¦ ¦ ¦¦ ¦
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address , Percentage faterert m ^
AndriyousP.Youkhana - 65 E. Harrison St. #217, Chicago, tt. 60605 « 10°* __„-/ ; " .-
SECTION in - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CriY ElJ:CTED OFFICIALS ,, 4^.-
j .ji. * -
Has the Ittwlo^ Parry proyid™
12-month period preceding die date of this EDS? D Yes —»
Does the Disclosing Party reasonably expect to;p^
elected official during die 12-month period following the date of this EDS? "JYes g No
If "yes" to either of the above, please identify below die namefs) of such City elected official(s) and describe such income or compensation::
Does any City elected official ot. to the best of die Disclosing Party's knowledge after reasonable mquiry.any City elected official's spouse or domestic partner, have a financial interest (as defined in Chapter 2-156 of die Municipal Code of Chicago ("MCC")) in me Disclosing Party? QYes 0No
If "yes," please wienhTy below the name(s) of such City elected official(s) and/or snou^sydomestic
partners) and describe die. financial interests). ... vv,- ¦¦¦ -v.-,,
^ECTIONW - DI^^
Ibe i^c!o)dj^ Party musttfsclose^ ofieach subcontractor, attorney,
lobbyist (as defined in MCC Chapter 2-156), accountant consultant and any other person or entity * whom me Disclosing Parry has retained or expects to retain in connection with the Matter, as well as the nature of die relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who ore paid solely through the Disclosing 'Paity^s
Section, the DisclosingI'Pariyinust either ask die City Whether disclosure is required or make the disclosure.
Page 3 of15
Name (indicate whether Business Relationship tDlpw^^^^v.^M'g^!!^^
retained or anticipated Address (subcontractor, attorney, B8UMttJa^P^i^.:e
to be retained) ^ f ; - lobbyist, etc.) " "hourly rate* or ?tb;aV is
not an acceptable response.
(Add sheets if necessary) .... ¦ :r''0 Check here if the Disclosing Party has not retained; nor expects to retain, any such persons or entities.
SECTION V — CERTIFICATIONS ¦.- ¦ ^
A COURT ^ORDERED CHILD SUPPORT COMPLIANCE
- • ," ' ' '- .: - ¦.,W v -0--: :^ i- ; " Under MCC Section 2-92-415, substantial owners of busmess entities mat 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 cliud support obligations by any Illinois court of competent jurisdiction? *"s: S: ;: '
?Yes |i7|No QNo person directly or indirectly owns 10% or more of the Disdos^ 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?
B. FURTHER CERTIFICATIONS
L pThis 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 mis EDS, neither the Disclosing Party nor any Affiliated Entity [$££ definition in (5) below] has engaged, in connection with the performance of any public contract, die 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).
2. The Disclosing Party and its Affiliated Entities are hot delinquent in the payment of any fine, fee, tax orptiiersource of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, U
Page 4 of 15
3, The Disclosing Parry 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 metigible or voluntary excluded from any transactions by any federal, state or local unit of government;
ha^ve not, during the S years before the date of this EDS, been convicted of a.£^n^*SC' [adjudged guUty, or had a civu judgrn^
atimptmg to obtain. W performing public (federal, state «^^TZSSi^^
pubtic transaction; a violation of federal or state antitrust statutes; fraud; emliezzlement
bribery; falsification or destruction of records; making false statements; or receiving stolen propc. y,
are not presently indicted for. or criminally or civilly charged by, a governmental entity (federal, state or local) with comnutting any of me offenses set form in subparagraph (b) above,
d have not. during the 5 years before the date of this EDS. had one or more public transactions -(federal, state or local) terniinated for cause or default; and
e. have not; during the 5 years before the date of this EDS, been convicted, adjudged guflty, 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 anyotner
unit of local government - ^.i . ¦¦• ¦ /. --^v-o^ ¦¦¦ ¦ ¦ ¦ }px -v ¦'
The Disclosing Party: undeisnmds and shall comply with the applicable requirements of MCC
Chapters 2-56 (Inspector'General) and 2-156 (Govenunmtal Ethics). ? ?
Certifications (5), (6) and (7) concern:
¦¦ .• the Disclosing Party-,. ;,.-," y ^^./^ .' ¦
any^ntractor" (meaning any contractor or subwntractor used by the Disclosing Party in ejection with the Matter, including but not limited to all persons or legal entities disclosed under Section TV, "Disclosure of Subcontractors and Other Retained Parties"); , m ^
any "Afliliated Entity" (meamng a person or entity thai, direcdy or indirectly: controls the Disclosing Party, is amtrolled by me Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity), mcucia of control mclu^
interiocking management or ownership; identity of interests among family members, shared, -x;> facilities and eo^pment; common use of employees; or organizati on of a business entity foUowing
the ineligftilhV ' j
- ^ncludmg 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/
v thaidirectiy or mclirectly controls .the C^nfractpr, is controlled by it, or, with the Contractor, is
under common control of another person or entity; -^ .Virrr-i-„ -,v'.¦,>¦; .'.;*?:/;¦
any responsible official.of the Disclosing Party, any Contractor or any Affiliated Entity or any omer official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, ac^g pursuant to^
any Contractor or any Affiliated Entity (collectively "Agents"). ^ ».
"¦ >¦,...!.•. . ¦ ¦ ';y. V. Z .' .. i^:.
Vcr.201841 Page 5 of 15
Neither Disciosiog Party, nor any Contractor, nor ^^^^e date of this EDS, or, with
Party or any Contractor, nor^ ^ 5 years
Matter-a.
respect to a Contractor, an Affiliated Entity, or «^at^SSor^i2eS before the date of such Contractor's or Affiliated Entity's contract or engagement in co
bribed^auenmtedtobrme.or^^^
a public officer or employee of the City, the Stetepf Illinois, or any ^yee's. -
or ofahy state or local governm .
official capacity, - -1 ^- ~,^i':--^r-'
agreed or cbUuded with other bidders or prospective bidders, or ^^^^^ISSS orbeenconvicted or adjudged ipulty of agreement or ^ -
m restraint of freedom of competition by agreement to bid a fixed price or otherwise, or ^ ^
mate anadntission of such conduct described m subparagraph (a) or (b) above that is a matter of
record, but have not been prosecuted for such conduct; or . *»
4 viblatedthe provisions referenced m MCC SU^
Wage);t>X5)(Debarment Regulations); or 6^NeimernKT3isclosingP^
officials, agents or parSs, is Wfron^contmctrng wn^
result of engaging in or being convicted b£(l)bi*n^
bid^otati^in^lation of720 ILCS 5/33E-4; or (3) any stouter offense of any **«^UWed States of America that cen^ same elements as me offense of bid-nggmg or bid^otating.
V NrimertherJisdosmgT^
United Slates Department of Commerce, State, or Treasury, or any successor federal agency. _
8 rFOR APPLICANT ONLY] (i) Neither the Appticanf nor any "annulling person" ISfi^MCC Chapter 1-23 Article I for applicability and defined terms] of the Applicant is currently indicted or chareedwhW or has admitted guilt of, or has ever been convicted of, or placed under supervision for, anv 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 (u) Ac Applicant understands and acknowledges that compliance with Article l is a continuing requirement , for domg business wrth the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, mat Article's permanent compliance timeframe supersedes 5-year compliance timeframes m this Section V.
^93 {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"). • v
10. [FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
Ver.2018-1 > ; Page 6 of IS
brieve |u»s not pro^ \1 v, ¦"
U. If the Disclosing Party is unable to certify to any of the above statmcntsm this Part B (Further CernficationsX the Disclosing Party must explain below: s:: ^ . f , ,j ;;Vii^ ,
None " "' " > ¦ ": .
If the letters "NA," me word "None," or no response appears on thelines !abwe,;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 timednring *»*l2~ 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:Tb me best of toe rjisclosh^ fa^i&foSfa^-is*
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, 'toaii employee, or elected or appointed
officiaL of the City of Chicago. For purposes of this statement, a "gift" does hot include: (i) anything
made generally available to City employees or to me general public, or Oi) food or drink provided m
the course of official City business and having a retail value of less man $25 per recipient, or (iii) a
poMcal coipb^ with "N/A" or
"none"). As to any grft^^
None. ^. ' ¦¦'' ' - -.' : ... ¦ ^—
G. CERTIFICATIGN OF STATUS AS FINANCIAL INSTITUTION 1 the^isciosme Party
Ifa^fina^ ^
2. if the Disclosing Party IS a financial institution, then me 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 pred«ory lender as defined in MCC Chapter 2-32.' We understand that becoming a predatory lender or becoinmg an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Ver.2018-1 ¦ f^J^P.f ¦
If the Disclosing Party is unable to make this pledgebecause ^^j^^J^Z MCC Section 2Ws(b)) is a predatory lender within me meaning of MCC Chapter * c*P here (attach additional pages if necessary):
Ifmelettetsm-thewoni^^
exclusively presumed that me ^ D^t3ERTlHCAT» ? ^ K
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D
1. In accordance withMCC Section 2-156-110: ™^0^
after reasonable kquiry, does any official or employee of the City have a financial interest in ms
her own name or in the name of any other person or entity in the Matter? s r «
QYes
NOTE: If you checked *Yes" to Item D(1X proceed to Items D(2) and D(3). If you checked "No" to Item DO), skip Items D(2) and D(3) and proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or omerwise permftM no ^f0^
offidalorenmtoyeeshaUhaveafina^^
other perso^ entity m me purchase of any property o^(i)b^
taxesora^ents,or(iii)is soldby virtue of legal process at tire ^^2^'^^'
"City Property Sale"): Compensation for property taken pursuant to the City's emment domain
power dc« not consth^ afinancM meaning of this Part D.
Does the Matter involve a C% Property Sale? ¦ ;
' QYes .' ' ¦ : ' - 0No - ¦¦¦<¦ '•'
3 If vbuchecked "Yes" to Item D(l), provide the names andbusiness addresses of the City official or employees having such financial'interest and identify the nature of the financial interest
Nature of Financial Interest
.¦^/¦ ¦/HY
4. The Disclosing Party further certifies that no prohibited financial interest mJhe:Kta^ will be
acquired by any City'official or employee. . : .j- ¦ -. .¦¦>¦ :;'
Page 8 of15
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
" Please check either (1) or (2) below If the Disclosing Party cieeks (2), the Disclosing Parry must disclose below or in an attachment to this EDS all information required V (2). Fdlure to comply with these disclosure reqrnuemenb may make any cralract^tered into with the City in ' connection with the Matter voidable by die City. ^ ^ 1 x-*¦ -----
The Disclosing Party verifies that lhe Disclosing Party has searched any and all records of
tile Disclosing Party and any and all predecessor entities regarding records of myestments or profits
from slavery or slaveholder insurance policies during the slavery era (including msurance policies .
issued to slaveholders that provided coverage for damage to or mjury or deattt of their slaves), and
the Disclosing Party has found no such records. ' "
XZL.2. The Disclosing Party verifies that, as a result of condMting the search in step (1) above, the Disclosing Party has found records of investments or. profits from slavery or slavebxilder msurance policies. The Disclosing Party verifies that the following constitutes foil disclosure of all such ' records, including the names of any and all slaves or slaveholders described in n^ose records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VL If the Matter is not federally funded, proceed to Section VEL For purposes of this Section VL tax credits allocated by the City and proceeds of debt obligations of me Chy are not federal funding.
A. CERTTFICATION REGARDING LOBBYING ^ ^ ^
1. List below the names of all persons or entities registered under tile federal Lobbying
Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of tile Disclosing
P^arty whltrespert ^ ; _ , ^ , ^
(If no explanation appears or begins on the lines above, or if the letters TNA" 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 me DisclosingParty 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(I) above for bis or. her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 P4ge9ofl5
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 federaUy 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 organization1 described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section
5P l(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage m "Ubbymg Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended ' y
Y 5. If tire Disclosing Party is the Applicant, tile Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from afi subMntiactors before it awards any subcontract and the Disclosing :P^uty must maintam
duration ofthe Matter and must make such certifications promptly available to the City upon request.:
B. CERTTJFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY m -
• If the Matter is federallyfunded federal regulation require tine Applicant and all proposed ^ subcontractors to submit the following information with their bids or m writing at the outset of negotiations.
Is the Disclosing Party the Applicant? ' iv^u'vfc f:^--^ s^'YU > - v^'' ¦¦tv**-.--
QYes QNo «^ - -,^;A/.Y-; -:, > yW* ¦¦^¦¦V ^rS^^^'
If "Yes," answer the three questions below: ¦ ¦„¦. v- . 'V--;
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
QYes ON0
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract
Compliance Programs, or die Equal Employment Opportunity Commission all reports due under the
appficablefilmgrequirements? . .- > y;;--. ¦ . ' >2yf
£]Yes . . TJNo |^epcrts not required . •;r^-^K ; 0 ,s-
Have you participated in any. previous contracts or subcontracts subject to the equal opportunity clause?
? Yes QNo
If you checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
SECTION Vfl - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
TheDisdosing Party understands and agrees that: '
The ratifications, disclosures, and acknowledgments contained in dus EDS will become part of any contract or other agreement between the Applicant and the City in connection with die Matter, whether procurement, Ghy assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action widi respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations oh 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; bmmess, or transactions, tte full text
1 of this ordinance and a training program is available on line atwww.citvbfclu'^ *°d may
also be obtained from die City's Board of Ethics, 740 N. Sedgwick St; Suite 500, Chicago, LL 60610, (312) 744-9660. The Disclosing Party must comply fully with this onlinance.
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 !k rescinded or be void or voidable, and die City niaypuraue any remedies under die
voidX at law, or in equity, mcluding tcnninating die Disclosing Party's participation in the Matter and/or dectining to allow die Disclosing Party to participate in other Chy 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 tius document available to the public on its Internet site and/or upon request Some or all of die information provided in, and appended to, this EDS may be made pubticry available on die 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 daims wMcft it may ha^
lebnteinedI'm this EDS and also authorizes the City to verify the accuracy of any infonnation 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. If the Matter is a contract being handled by die City's Department of Procurement Services, theDisdosing Party must update this EDS as die contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offensesX tiie 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.
PagetloftS
CERTIFICATION
Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf of the Disclosing Party, and (2) warrants mat all certifications and statements contained in this EDS, and au applicable Appendices, are true, accurate and complete as ofthe date furnished to the City. ^ >1%0
Wabash-Van Buren Park One, LLC.
AndriyousP. Ybukhana
(Print or type name of person signing) Manager
(Print or type ti tle of pmon'signing)
Signed and sworn to before me on (date)>Y&WW 17»2021
OFFICIAL SEAL LUBMAYOUKHANA '-]. NOTARY runic: STATE OF kuMowh . M»Caffimg>lenEi»»n7fl7a4
Page 12 of 15
CITY OF CHICAGO " ¦? -^v^"-^
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED.CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix b 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 b not to be completed by any legal entity which has only an indirect ownership interest in the Applicant
r^ Under MCC Section 2-154-015, the Disclosing Party, most 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 to D^dosmg Party or any "Applicable Party" or any Spouse or Domestic Parmer thereof is related to the mayor, any alderman, the dry clerk, the city treasurer or any dty 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.
"Apphrable Party" means (1) all executive officers of me Disclosing Party listed in Section D.B. l a., if tile Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all generalipartners and limited partners ofthe Disdosing Party, if tile. Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party isa limited liability company, (2) all priridpal 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 orierating officer, executive director, chief: financial officer, treasurer or secretary of a legal entity or any person excrdsing similar authority.
¦ Does the Disclosing Party or any "Apphcable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
?Yes 0No ; :
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) tile name and title ofthe elected city official or department head to whom such person has a familid relationship, and (4). the precise nature of such fanund relationship.
ycr.20t8ii 'U[ Page 13of 15
TWs 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
IT 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?
, 2KItme Applicant is a legal entity publicly traded on any exchange, is anyofficer¦¦or dfrrctorofi
the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC; Section <•
2r92-416? ¦ . -^.^i-'J.r jv'^
QYes QNo 0TheAppKcahtisnotr>ub
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. ,
^ 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. Hurt section, which should be consulted (www.amlegai.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 foi'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. ¦" >''-'" : i '"' '
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that
flie Applicant is in compliance with MCC Section 2-92-385(b)(l) and (2), which prohibit: (i);sca^eeiring
job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary *-<
lnstory from current or former employers. I also certify that the Applicant has adopted a policy that
includesthose prohibitions. <** >•'//••- *•• ,;
?no ^ . ,. — ;. ; ';. ' • j J ^
N/A — I am not an Applicant that is a "contractor" as de^ned:m:M^-Sedion2:92-3^. ;
This certification shall serve as me affidavit required by MCG Section 2-92-385(c)(l).";
If you checked "no" to die above, please explain ;* «-V. " s —'"'-
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