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Type:
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Order
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Status:
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Passed
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Title:
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Historical landmark fee waiver for property at 3118 S Prairie Ave
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Topic:
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HISTORICAL LANDMARKS - Permit Fee Waivers
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Attachments:
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1. Or2021-98.pdf
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ORDER WHEREAS, Section 2-120-815 of the Municipal Code provides that the Chicago City Council may by passage of an appropriate order waive any fees charged by the City for any permit for which approval of the Commission on Chicago Landmarks (the "Commission") is required, in accordance with chapter 2-120 of the Municipal Code; and WHEREAS the permits identified below require Commission approval, in accordance with Section 2-120-740 of the Municipal Code; now, therefore, BE IT ORDERED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. The foregoing recitals are hereby adopted as the findings of the City Council. SECTION 2. The Commissioners of the Departments of Buildings, Finance and Fire, and the Zoning Administrator are hereby directed to issue those permits for which approval of the Commission on Chicago Landmarks is required pursuant to Chapter 2-120 of the Municipal Code free of charge, notwithstanding any other ordinances of the City Council to the contrary, for the property at: Address: 3118 S. Prairie Avenue ("Property") District/Building: Calumet-Giles-Prairie Landmark District for work generally described as: A 3,000 square foot, two-story, single-family residence, with an open concept floorplan including five bedrooms, 3.5 bathrooms, a wet bar in the lower level, a rear deck and a 2.5 car detached garage. The facade will have a masonry front with a 14-foot wrap and cement fiber to complete the exterior sides and rear featuring limestone sills and accents. Owner: GraceK Contractors, LLC. C/O Thomas R. Boney Owner's Address: 3400 S. Giles Avenue City, State, Zip: Chicago, Illinois 60616 SECTION 3. The fee waiver authorized by this Order shall be effective from May 15, 2021 through May 15, 2022, and shall not apply to additional developer service fees, stop-work order fees or any fines. SECTION 4. That the permit purchaser for the Property shall be entitled to a refund of city fees for which it has paid and which are exempt pursuant to Section 1 hereof. SECTION 5. This order shall be in force and effect upon its passage. Pat Dowell Alderman, 3rd Ward NOTE: This is NOT a permit, nor does it constitute a Letter of Approval for the above described work. A permit application for the work must be approved by the appropriate City department(s) as well as the Commission on Chicago Landmarks for this permit fee waiver, subject to City Council approval, to be valid. Enhanced Aerial Photograph LEGEND Landmark District I I 3118 S. Prairie Avenue if Department of Planning and Development Proposed Permit Fee Waiver Calumet-Giles-Prairie Landmark District 3118 S. Prairie Avenue BCSHP/HPD 04/09/21 MAR •Enhanced Aerial Photograph LEGEND Y///A LZZI Landmark District ] Landmark District 3118 S. Prairie Avenue Proposed Permit Fee Waiver Calumet-Giles-Prairie Landmark District 3118 S. Prairie Avenue BCSHP/HPD 04/09/21 MAR Site Photograph (Source: Google Earth) i *DPD Site Photograph (Source: Cook County Assessor) Proposed Permit Fee Waiver Calumet-Giles-Prairie Landmark District 3118 S. Prairie Avenue Department of Planning and Development BCSHP/HPD04/09/21 mar South Elevation and Garage Elevations (Source: GraceK Contractors, LLC.) ¦ *DPD Department of Planning and Development Proposed Permit Fee Waiver Calumet-Giles-Prairie Landmark District 3118 S. Prairie Avenue BCSHP/HPD 04/09/21 MAR 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/ ifcapplicfeble: ^GraceK^ontractgrsfLLG Check ONE of the foilowing three boxes : Indicate whether the Disclosing Party submittingithi's ED S is: 1 [Zj the Applicant OR 2. Q; :a;:"le.gal entity/cWentiy holding^or/anticipated to H^lJ iwlhimsi^ on tfaexbntractj^ vyjSich:tjWs EDSpertairis (referred to below as -the "Matter"), a:direc,tor indirect interest in excess of 7.5% in the Applicant. State theiApplicant'sflegal name: . ,„ ,. .... or ~¦:"""" "¦ 3- Q a legal entity with a direct oiiMdiijectn of the. App'liejmt{(seejS;e State the legal name of the entity in ^ bjscjpsing.Party holds ^vright p'f contrplv B; 'Busiftess.add^ 3300SS-. Gi\e%We\. CHicagp, ILBOB^ £¦ Telephone: 312-929-2608: . Fax: Email: J D. Name of contact person: ThomasBbnays Ey federal Employer IdentificationLNo.; (if you haveipne): ; Fi; iBjiefdescrip'tipn of the Matter-to-wMch tfiis; EDjS; peitains; ^Include project number-arid location o'ff' prqpertyUf applicable): ,31-38 S Prairie.Ave. New Goh^nTctic^isi^SfamWHwhe: , G. Which City agency or departmentas-reques^ uiis;EDS7 PEP If the^Mafter^ cqmpJLeteiftg fplUywyhg: Specification U. and Contract #.-. . „.„¦ Ver.2018-1 Paget of 15 SECTION II- DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY L .Indipa'tethe nature of Ihe PJsclpsingjPa^ PjJPerson, (3} Limited liability company ttPubUcty re^tered, b^si^sscprppr^rjpn, Q Lmrit^H^ QJBriJy(aMy;hda Q Joint venture Q] Sole proprietorship Q Not-for-profit corporation: B iGeneralpartaersriip (Is the npl^r-prpfit c^p^ a 501(c)(3))? Limited partnership Q Yes Q No; Q Trust [~J| Other (please.specify) 2 For legal entities, the
ILLINOIS ..
3. For legal entities riot organized in.the State of Illinois: Has the organization registered to do; business in the State of Illinois as a foreign entity?
?J Yes Q No [ZI Organized in Illinois
B. LP THE DISCLOSING PARTY IS A LEGAL ENTITY:
;i... List below the full namesvand'titles, if applicable, x>f: (i) all executive officers. and alUdirectors of
the entity ; (ii) for notefforipW^ members, if any, which are.legal entities (if there
are rio such members, rwrite'''ho; members w (iii)tfpr ^trusts, estates2pr other
simiiar^ntiiieSj'mevtw executor,.administrator, pr;:similarly situated-party; (iv) fprgeneraTor
limited pa rtuersliipsi limitedi liability companies, limited liabiliiry partners^
each general partner, managing^ prjany other person prlegal entity jliat: directly^gr5
iha^^^-confeigis th^day^fo*^
WOTE; E^chflega}4M^il^# ^iovvvmusfesu^ oMts^oyVBlbehatf;,
Name title
Thomas ft Boney; , Owner
;2j; Please provide me Mlbwirig- 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 HabJity/cQjttp bj a ^en#ipiary-!Sfa-ti^ estate/of: other similar entity, Ifnorie,
sMe/'%one|' '
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
T-nomas R Boney 3400 S. Giles Ave., Chicago, IL 60616, 100% ...
SECTION III - INCOME OR COMPENSATION TO, QR OWNERSHIP BY, CITY ELECTED OEFtCIALS
Has me/Disclosing Party provided ariy incomeior^cornpensation to any City elected official during the
I2-rfionth,period preceding the date of tliisEDS? ^Q Yes ©No
Does theiDisclosing Party reasonably expectfe proyide any income.or compensation to, any City elected official during the;l 2-month period;fojlovving:;the date of this EDS? P Yes fZ] No
If''yes" to either of the above, please! dentify$elo\y thename(s) of such City elected ofiicial(s) and describe such income or compensation:
Does any'Gity electedvofficiaLor; tothe bestiof 'the;DiscIbsihg Party's>kripw^^^^
inquiry, any City elected official's spftuse-. oridomessticj.p.artner,; haye^a financial interest:(as: defined in;
Chapter 2-156 of the Municipai.Code of Chicago ("MCC")) in the D isclosing Party?
;0[Yes: (3; 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 mterest(s).
SECTIQNIV^ DISCLOSURE OF SUB^ Al^lQTHE^
'rij| p^cjos'ing Party must discfp|e tljemmne? Mdbusiness address: of each.subcontractor, attorney,
Iqbbyjis^ MCC Chapter: 2-156),. accountant, consultant and&ny other person or eritity
whom the Disclosing.Pai'ty hasTetpned^ retain in connection with the Matter, as well as.
thenature^qf tKe.reiatipnship,, and the total ambuntpf the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who arc paid solely through the Disclosing Party's regular payroll. Ifthe Disclosing Part^is'tthcertain whether a disclosure is required under this Section,;tlie Disclosing Party mustTeither asklthe City/whether disclosure, is required or make the disclosure.
Ver,201.8-1.
Names(ihdicate whether Business Relationship to DisclbsingfPaily Fees (indicate whether
retaiiied oi anticipated Address ^subcontractor, attorney; paid or estimated.') NOTE:
to be retained): lobbyist, etc.) "hourly rate" or "t.b.d." is
hot an acceptable response.
¦See attached
§iM ^eetsrif; neeessaryj
Q Check/here if the Pi^lpsing^Partjy has notjretained,:nor. expects, to;retain;->any such persons or entities. SECTION: V - GERTIFIGATIONS
C01^T-ORX»EREp CHILD SUPPORT COMPLIANCE
Ujnder:MC^Section2 substantial owners .of business entities that contract with the City must .
:remainfe thro.ughoui'lhe contract's term.
Has any person:\yhp dire 1.0J%!pr more:of theiDisClosing Party been declared in
arrearage on any chMsupport obiigations'by- any Illinois court pf eompeterirjurisdictipn?
Q; Yes Q No Q 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?
P Yes QiNo
FURTHER CERTIFICATIONS.
L. ;[Thisparagraph 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 [sje definition ih?(>5): below] has engaged, in connection: with the
perfoiinance of ahypublic contract, the sei-Vices of.ah integrity monitor, independent private sector
inspector general, bi^in^ an individual or entity with legal, auditing,
investigative, PPbthersimilafi skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendbrs:reform' their business practices so they can be considered' for agency contracts in5 the future, or cbhtihue with a contract in progress).
2: ThcjDIscl'b'sihg Part$:arid its Affiliated Entities are nbftd'eiinqUentln the payment of any-firie^fee, tax or bther source of indebtedness .owed to the CUy;;of0iicagb, including, but not limitedto, water ah^si^cFchargeSiiicerise fees, parltihg^tickets, property taxes and sales taxes, nor is the Disclosing; Party.dclinquent in the payment of any tax adniinisteredlby the lllinois Department of.Revenue.
Page 4,of 1'5
NAIV)E: ADDRESS " " relationship: FEES
Preferred'Survey, 7845 W-79th St., Bridgeview.IL 60455 subcontractor <$i;20.o':oo
Three-Sixty Design! 2453:5iArcherAvev.Chi.cagOjjL^OSie: ! architect' $8,000.00
Frv.'&Sbns 11320TimberEdge LaneJOrland.park„IL 60467. subcontractor. :$1;200.00
'DiFoggio"Sewer, 3216 S Shields, Chicago, IL 60616 subcontractor $20,000.00
StoneOrde Concrete: 7653 N Osceola.Niles, IL607i4 * subcontractor -"$28;odo.oo
Meath Masonry. 6351.W.Montrose, Chicago, IL 60534 subcontractor $15,000.00
Peif6rrriatfceTpius;Rbofing " ! 28583 N Washington, Wauconda,;IL60084 subcontractor $12,000.00
Tri State Cut Stone •10333 Vans Dr., Frankfort, IL 60423 supplier. $10,000.00
Forest Lumber: 17280'SCicero, Country Club Hills, IL60478 supplier $so,ooo:pp
Astro Insulation 4418/Rte 31y Ringwood/IL 60072 ; subcontractor $5,000:00
George: Roll &-S6hs; 2258;Vermont St.;;Blue.lslarid, IL 60406 supplier $8,cco;oo
Oamfprt'mate.'Heatihgi&AIr 19137 S Blackhawk'Parkway, Mokena, IL 60448; ? subcontractor $18,000.00
Mank';Plurnblhgi P.O. Box 524 Tinley Park, IL 60477 subcontractor- $22)000.00
Ferguson: l4i0,Butterfield.Rd., Ste 130, Downers Grove; IL'60515 supplier $8>P0O.00
ScKaafWindows- 18445 Thompson:**., Tinley Park, IL 60477 supplier $10;000.00
Northwest Millwork- 455 EJarvis Ave., DesPlaines, IL 60018; supplier $4,'006.00
Pepe's Dryvvall 3 Redwood Ct, Streamwood, IL60107 subcontractor $4,000.00
MT Flooring Source 2211E 67th #3, Chicago, IL 60649: . supplier $7,000.00
Jacpbo'S'Ralritihg "=~ 5730 W 64th St, Chlcagbi IL'60638-" " subcontractor $9,000.00
SStG'Garperitry.' 409 E Prairie, Lombards IL 60148 subcontractor $5,000:00
Andy.O Flooring 424 Farmbrook Ct, Romeovllle, IL 60446. subcontractor $8,000.00
Mehdoza'.tandscapirig; ....... j 5311S Lawndale, Chicago; IU 60632 subcontractor' $2,000:00
UGIW 3555 Normal.Chlcago, IL 60609 supplier 44;000;00
RegibriJrbn'Wprks 223 SLindberg,Griffith,IN 46319. subcontractor "" " ,'. $12,000:00
Gliica'go'Storefrbnt^Glass 2245 S 10tri Ave;, Riverside, IL 60546 subcontractor $4,000;00
Custon^Closefs \ 4032:Bel[ealre:Lane,.DDwnersGrbve;:IL60515 'subcoritra'cto'r' :$2,Q00;00
pbse1dphfl1le;Desighi 505'165th'S^HammWd; IN 46324 supp|ier: $7;ooo:oo
ClasslcHardwpod; 6817 Harlem Ave1., UnifcB:'Bedfof d P.ark; 160.638 supplier $6,000:00
Guco Construction: 15815 Vine St., Harvey, IL 60426? subcontjactor $4,000.00
CHIcago Demolition 4818S LaPorte, Chicago/IL 60638 subcontractor ,$2;O00:op
l(illeen;Electric; 7809 Natchezj.Biirbank, IL 60459 subcontractor $i8;ooo:oo
Alexander Jr Building Services: P.O 5587 Willow Springs, IL 60480 subcontractor $2,000.00
Marfa Cabinets 2050 S'Mt Prospect Rd Suite E, DesPlaines; O0018 subcontractor $16;000.00
MuskerryiBuIlders, 9408 S CIifton Park, Evergreen Park, IL 60805 subcontractor $18,000.00
GraceK Contractors 3400 S Giles Ave, Chicago, IL 60616 general contractor $25,000.00
AMD Construction 1784 EForest Ave., DesPlaines, IL 60018 subcontractor $8,000.00
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:
a. ai'e not presently debarred; suspended; proposed for debarment^ declared ineligible or voluntarily' excluded from any transactions; by any federal, state or. local.unit of government;
bi, havelnot, dui-ihg the 5 years; before the date pf thisEDS, been;eonyicted offense, adjudged^guiltYi, or had a civilijudgment. r.endered;agai.nst them in cpnneptipnwith';' obtaining, attempting to.obtairijJor performing a public (feder.al,.:state; CffJpcjy)|tr.ans.action^ public transaction; a v,iolatiOn;of'federal or state antitrust stamtes;'fraud; .emblez^emen^-lliefi:; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;:
C; are not presently indicted for, or criminallyror civilly charged;by, a governmental entity (federal^ state or local) with-committing any of the; offenses set forth in subparagraph (b) above;
C have;n^t;,duririg me 5. years before the date of this EDS, had one or, more public transactions (federal, state or local) terminated for. cause or default; and
e: have rioti durlhg'theiSjyeaf sbefore thedale. of this EDS, been-convicted, adjudged gui.ltyi,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;goyernmenti,an^ state, or any other iinit 'oi^&^^^WeAt-
,4i. The Disclosing Party understands andishall comply .with the: applicable requirements of MCC Chapters 2-56 (Inspector General)' and'2-156; (Qoverrmiental Ethics).
Si Certifications (5), (6) and (7) concern: m'eTDlsclbsing.Part^;.
••: any" "Contractor'' (meaning any contractor or subcontractor used by the Disclosing Party in Connection withvthe Matter,;including but not limited jp*all persons or legal entities disclosed !urifertSfectib^
any?"A^iated:Entifyv: (meanings person or entity tiiat, directly or indirectly: controls the Disclosing Party, is-controlled by/the Disclosing Party* or is, with the Diseasing Party, under Sommgnicfin^^ :Indicia-;pf
interlbckmg-management oivownership; identityof;^erests among family members, shared
facilities and equipment; cpmrnpn use of employe^ entity following
,the inel igibility of a business entity todb business with federal or state or local government,
including the'CIty, usjng*substantM ownership, or principalsas.the
ineligible entity. With respect to Cpntractprswtheprta Affiliated Entity means a person or entity that directly or indirectly controls ttieJCpnt^tbr,Iis pbntrolied4y it^brvW'imihe: Contractor,, is: under icpmmpfrcpntrql iqf anpther-perspn pfeeh
• any responsible, official .of the bisclosmg^P^ Contractor or any Affiliated Entity or any
pither official, agent oremplpyce^ any Contractor or any Affiliated Entity,
;actmg;pursjuar^ or-authorization of aftespbnsiBle.official'of thC:Dlsciosing;;Party^
any Contractor-or any Affiliated Entity (Cbllect
Rage'5 of 15
Neither the^Disclosing P.artyi 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 Entityj or an Affiliated Entity of a .Coritt-actPr during the 5 years befpre the^ date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
a. bribedior^ttemp^ or-been convicted Pi* adjudgcd.guijry of bribery or attempting to bribe,
a public officer orvemploj^ofjfie^ of any" agency^pf "thefederal government
or ofany state, or local government ihtthe United States pfA^rica^ih pfficiaT capacity;:
b; agreed or colluded^wiUi.odienbidders or prospectiye bidders, or been a party to any such agreement,
or been convicted ofin^i&^&o'Rfifte'dbm. of^inpeU^iohloy ajpeerh^nt^^ ptherjyise; m
c. made an admission of such conduct described-jin sj$paragrap^(^ that is a matter of
record^ bulhave:HPt^rr;prb^ec^
d. . viplafed/'the provisions r^feehced- in MCC Subsection 2-92r3.20(a)(4)(Contracts Requiring a Base
Wage); (a)(5)(Debarmeht R^uiattons)|<^
6;, Neither the Disclosihg^Party, nor any ¦ AffilialcdEntity or Contractor, or any of their employees,
officials,- agents or partners, is barred from>c6hh:#tin local government as a
result of engaging in or being <&nvfcted'of b&nggipgvin violation of 720. ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; of (3) any similar offense of any state or of the United States of America that contains; the' same elemea^aSi'the offense of bid-rigging or bid-rotating.
Ii Neither the.Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, pr; Treasury, or any successor federal agency.
(FOR APPLICANT ONLY] (i) Neither the Applicantnor any "controlling person" Csse.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, of placed under supervision for, any criminal offense involving actual', attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury,' ¦dishonesty pr deceit jagaihstan: officer or employee of the City.or any "sister agency"; and (ii) tlie Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. .NOTEi lf MCC Chapter 1-23, Article I applies to the Applicant, that Article's permancnt compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Eniities wili rnot use, nor permit their subcontractors to use, any facility listed as;fiaving an active exclusion by the U.S. EPA on the federal System for Award Management (,"SAM")[FOR APPLICANT ONLY] TJie Ap^liicant;wi}l ipbtain from any contractors'/subcontractors hired
of :to be hifedoirrcohncctipn with theMat^ equal inform and substahce to those:in
Ceftificatibhs;|2); and (9) :abpvc arid vvilj not, withpufcthe prior, wf itteri ;consent\of tlie City, use any such
:Page;6ofl5'
;cdnji'acTfor7^^ does^hoftpfdvide such certification
Relieve has not;provided'or, carinotprovide truthful ¦cerdficatidns.
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;
Tf .the;:letters.',NA,'1 the word "None," pr.iio response?appeare. pn'thejines above, it;will be conclusively presumed that the Disclosing'PMy certified to the statements.,
;1;2. To the best of ttie.Disclosjng^ thefollowihg is a
complete list of all ^current employees of the Disclosing Party who were, at any time during the 12-mohth 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").
I3jforthc best of the Disciosing Party's knowledge; after reasonable inquiry, melfbUowmp&ta complete list of all gifts thatthe DiKclpsmjg Partyhas given or?caused:to be given, at^y time diirihg, the 12-mpnth period precedingithe execution datefof tKis&DS, to an employee, or elected of )apppihted official, of the City of Chicago. For ;purposes of tliis: statement, a "gift" does hot include: (i) anything made generally available to-City employees or to the general public, or (ii) food or dilhk pfovidlj#ih the. course of official City business and having,a retail 'value of less than $25 per recipient or. (iii) a political contribution otherwise duly reported as required by law (if none, indicate: wimr"N/A'? or "none!'). ;As to any gift listed,b.elow;, please aIso4istthe name.of the City recipient.
C. CERTIFICATION OF STAtUS.AS FINANCIAL INSTITUTflQN
The Disclosing Party certifies that the Disclosing Party:(check one)
? is Q iis not
a "financial institution" as defmed in MCC Section 2=32455,(1?),
If the Disclosing Party IS a financial: institution,'^ pledges?
"Weiare not and will notbecome;a:predatbr$ definedJihjMCC^ We further
'pledgeidiajt none of our affiliates; isvand none of them will become, a predatory lender a&dj$ned in MCCChapter 2-32. We understand that becoming a predatory lender of becoming an affiliate of a predatory lender may result in/the loss of the privilege of doing business with the City."
Page 7 of 15
Ifime.Bisc%slhg fiaEyls^unabie to make thispledgebecause it of any of its.affiliates (as defined.m
;MCC:Se'ctioh] 242*4$^
here^atta^^
If the letters' "NA," the word ,?N6ne," .or no response appears on the. lines above, it will be conclusively presumed that the! Disclosing Party certifiedto the above statements.
D. GERTIFIGATIONREGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined m MCC Chapter 2-156 have.the same meanings if used in this Part D.
1. 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 inlheMatter?
Yes 0%
NOTE:; Ifyou^checked' "Yes" to Item D(l), proceed to:Jiems;,D(2) and.D(3). Tfyou.checked "No" to Item PC'l^sicip Items; D.(2) and D(3) and proceed^to; Part^Ev
'2\- Unless/sold pursuant toia;:prpcess?of epmp £ity elected
official or employee shalljiave a financial mterest in;hisvprl)crpwn^ in tlie name; of any
:pther perspn,pr; entity in the purchase, of anyprpp^ly tp- the Gity,ipr (ii) is sold for
;taxesjspr'assessmenis^or (iii) is sold by virtue of legal process at the suit of the City (collectively, "Gity Property Sale"). Compensation for:prpperty taken pursuant to the City's eminent domain power does not constitute;;a financial interestrwithin the meaning of this f| art D.
Does the Matter involve a City Property Sale?5
Yes rjNo
3. If you checked "Yes" to ItemD(l), provide the names and business addresses of the City officials or employees having such futancialiinterest and identify :the nature of the .financialinterest:
Name BUsiiiessvAddress iNature^of Financial Interest
4; the; LHsdlbsingJSarty\fur&^ prohibited financial jnteres.t;in; the Matter will be
acquiredfty any City official' or employee.-
Vcr;20]8-1 Page 8 of 15
i
:E> CERTIFICATION
Please checkjeither (1) or (2>belbw. If the Disclosing Party checks ;(j2), the Disclosing Party
:mustcdfecXose:betow-pr in an^M^c^meWtb-.this EDS all information required by (2); ^Failure to
cpmply^vyitii diese dlscibs^ make any contract entered into with'the City in.
connection with didMatter voidable by/the" Cityv
x 1. The Disclosing Party verifies that the Disclosing Party has searched5 any and all records of
me^B^clipsing gar^ arid any andajy^re&^ regarding records of;investmentS;Otfproiits
from slayery or slaveholder insurance;
issued to slaveholders that providedcpverage for damage to brlihjury of death of their slaves), and the:Disclbsing Party has fpund.no such records.
% The Disclosing Party verifies that; as^esultbf conducting this search in step' (l) above, the
Disclosing Party has found records of investments or profits, fxpm slavery of slaveholder insurance policies; The Disclosing Party verifies that the following constitutes full disclosure.of ail such records, including the names of any andiall slayes br^slayeKpI^ 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 fcSeetioir'V^; 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., CER'^FICATION REGALING LOBBYING:
I. List belbw/the namesjof all persons or entities registered under the federal Lobbying
Disclosure Actbf1995, as amended, Who have made lobbying contacts on behalf ofthe Disclosing
ijaft^-wM-r^ if necessary):
(If fib explanation'appears of begins on the lihes'abbye, or ifthe letters "NA" or if the^rd "None" appear, it will be conclusively presumed that the Disclosing Pai^means; that NO persphs or entities registered under- the Lobbying Disclosure Act of 1995, as amended, have n^e^lbbbying contacts bh behalf "of me?Disc)bsmg^rt^with:resp^ct to the Matter;)
2. The Disclosing Paityhas not spentand will not expend any federally appropriated funds to pay
"any; person or entity listed in paragraph AO) above for his or hen lobbying activities of to. pay any
person or entity"to :ihfluence:pr;attem as defined
by applicable, federal law, amember of Congress, an; officer'or employee of Congress, of afi employee.
Ver.201S-l Page 9 of 15
ofa-member pftCOngre'sSj, awaMof ahy^
federally funded grantor ioah, eriteringjihto any CQOperatiye agreement, or to extend, continue; renew, amend, or modify any federally-funded contract, grant, loan, or cooperative agreement
3.- The Disclosing Parlylwill submits en&pf. each calendar quarteran
which there occurs any event that materially affects the-accuracy of the statements and;ihformatibh set forth in paragraphs A(l) and A(2) above.
4) TherDiscldsing garjy^ertifies^at either: (i);it is not:afrbrgtmizatibftd^ section. 501(c)(4) ofthe IhternalvRevenue Code of 1986; br(ii) it is an organization described-Sn section 501(c)(4) of the mternal Revenue Code of 1986 but lias not engaged and will not engage in "Lobbying, Activities," as that term is defined in.the.Lobbying Disclosure Act of 1995, as amended.
5. If theDiscIbsmg Party is.the Applicant, the'.Disclosing Party must obtain certificatibhs equal in
form and substance to paragraphs AG) through A(4) above:fr.om 'all subcontractors before it awards
any subcqna/actand the disclosing Parly must maintain all-such" subcontractors' certifications for the
¦dufati^iof .^Matter a such cerUKc;atibns;;promptly available to meiC^uppn request;
B. CERTIFICATION REGARDING' EQUAL EMPLOYMENT OPPORTUNITY
Ifthe Matter is;federa% all proposed
subcontractors to .submit the following information wihYtheir bids or in writing at the outset of negotiations.
Is.the DisclbsingvEarty the; Applicant? QYcis " ' *q}; No
If "YesV answer the three questions below:
1. Have you developed anddo you have on file:affirmative action programs pursuantto applicable federal regulations? (See 41 CFR Part 60-21) QYes pNo
% Have you filed with the Joint Repbrtihg;Cbmmitte^ the/Directqr of thefOffi
Compliance Programs, of the Equal Employment Opportunity. Commission all reports due under the^
applicable filing; requirements?
O ^s D'No QRepbils not required
3 . Have youpartieipated in? any previous contracts or subcontracts subject to the equal opportunity clause?
0;Yes QNo
If ypu checked "No" to question (I ) or (2) above, piease.pfbvide an explanation:
Page 10 of 15
SECTlGN Vll--FURTHER ACKNO\VEED.GMENtS AND CERTIFICATION
The Disclosing- Party understands and agrees, that:
the certifications, diselpsufesvarid acknowledgments containedin this EDS wiil become part of any
contactor other agreement between the .Applicant and the City, in connection with the Matter, whether
procurement, City assistance,/of omefCit^ are material indiicements; to^the City's execution
of any cbntract^of takmg other actioifwrffi^spect tp^me Matter. The Disclosirig Party understands that
it must 'comply with aii,!statutes,fprdh^ices, and regulatipns.pn, which this EDS Vis based.
The Ciry/s wwvv^citvofchicago¦org/Ethics. and. may also. be pbtainedffom; the Gitylsfioard of Ethics, 7AP;;N,vSedgwick.St., Suite 50$ Chicago; IL 606.10, (312) 744-9660. The Disclosing Party must-comply fully with tliis ordinance.
IftKe City determines that any injFqrmah^n.prpyidedi this EDS is falsc, incpmplete-p.r^inaccui-atc,.
any contract or other agreementih; connection with;which it is submitted;may be rescinded or be void
or vbidable^'and the City may pursue any remedies under the contract or agreement (if not rescinded or
void), at law, pr in equity, including;terniinating the Disclbsing Party's participation in the. Matter
¦and/pr^d^ Remedies at
;law for a falseiital^ent of material fact may include incarceration and an award to the City of treble
damages.
;DV;It# the City's: policy to make tliis document available to the-public on its Internet site and/or upon
request. Some or all ofthe information provided in, and appended to,,this EDS may be made publicly
availably Internet, in response to aEreedpm pf^Infprmatipn. Ac^ request, or .otherwise.-. By
:cpmpjetmg Jnd;Signing^this; EDS^^ejpi^ and;reIeases/;any-;D^ or
claims which- U may have against the City in connection with the; public release of information containedin thisiEDS and also authorizes the City to verify the accuracy of any infprmatipnisub.mi in tins EDS.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party must.supplement this EDS up-to the time the City takes action oil the Matter. If the Matter is a
contract being handled by the City's JJepartfncnt 'ofP/rocufeme^ 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?ftereih:reg^ be kept currehtfbfca longer, period, as required
by .MCC: Chapter: 1-23 and Section 2-154-020.
Page 11 of IS
CERTTFICATiON
WilderpenaltyOf perju^the peirson:sigiiing¦;below;:<|)--wJitants that he/she is authprizedto execute, this BD.S, arid-all applicable App^digeSj^on behalf of the-Disclosing P^arty^nd^J warrants thatall certifications Ud^statBSQSiS cqff^iie.d in^this -EDS, and all applicable App'endices, arejtrue, accurate and complete as- of the. date fiXniished to the Gity.
GraceK Contractors-LLC _
(Prmt^
(Sigh-here): ' ~ il>
Thomas RB^oney, 1 ^
(Pr int or typ e iiame of person signing)
Owner
(Print dr type title of person signing)
^g^d}and swpmto befpre^me pnjfdate), ^ Si ii.
Co'mmisstpn expires,;
Page::12 offs;
CITY OF GHICAGD ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APEENDTXA
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS:
TJhis Appendix is to;bc completed only by (a) the Applicant, and (b) any legal entity which/has a
direct ownership Into Applican t 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-J 54r:015,;the Disclosing Party mustdisclose; whether such Dis.closing'Party
or?any "Applicable Party" or/any Spouselor DbMes^^ a "'familial
relationship/' with any elected city offic|al; 6f 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, .fec'ft'^cl'srk, tlie' city treasurer^Or any city
department-head as spouse prdomestic pi^e^ of :a^ whether by blood or
adoption: parent, child, brother or sister^adnt or uncle, niece or nephew, grandparent, grandchild, famer-in-law, mother-inrlaw, son^in^aW* daughterriii--law, stepfather or stepmother, stepson of stepdaughter^ stepj^ stepsisteror h^bj^tiher otf'half-sisteK.
"Applicable Party" means (1) all.executive officers ofthe Disclosing Party listed in Section
ILBVl.a.jif&e D^ all^arlners ofthe Disclosing Party, If the Disclosing
Party is a general partnership; alllgener a): partners and limited partners of the Disclosing Party, Ifthe'
D.isclosing'party is albttifed^partner^ managers, managing members arid members ofthe
Disclosing Party, if the Pisciosing.Par^ Hability compahy; (2) ^il>priricipaL'officersi 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 financiaLpffi
Does the piscIpstng-Pafty or any "Applicable Party" of-any Spdusesbr Domestic Partner thereof currently have.a "fainili'al.felatibnship" with an elected-city official or department head?
? Yes [TjNo
If yes, ple'asesidehtif^ beiow
Page 13 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/MOBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the AppUc^tivand: (b) any legal entity which has,a direct
ownersiup/iinterest^ ''Owher"). It is not to be completed by any
legal entity which has only an indirect ownership interest in, the Applicant.
1. Pursuant/to MCCSectiori 2454r0lij, is the: AppU'cant or any Owner identified as'a{buUdihg code scofflaw or prbblem landlord pursuant to MCC Section 2-92-4,16?
? Yes fv]No
%. If thef Applicant :is>a^egal en|^ any exchange; is any officer ordir.ector'bf
the Applicant identified as a buifdmgbode scofflaw or, problem landlord pursuant to' MCC Section 2-92-41.6?
|~1 Yes flNo 1Z! The Applicant is not publicly traded on any exchange.
:3:.; If yes to (1) or (2),above, please, identify belpwthe name of each person or'legal: entity identified as a buildingxode scofflaw or problem.landlord andUhe address of each building or buildings to/which the pertinent code: vibiatibhs apply.
Page 14 of 15:
CITY OF CHICAGO ECONOMIC DISCL0SIJRE]STATEMENT AND: AFFIDAVIT
AT-PENDIXC
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 dcfinediin'MCC SectionfM That section, which should be consulted (www.amlegal.com ). generally covers a;party to any agreement pursuant to: which they: (!) receive City of^Chicago funds in consideratiortffoivservices, work or goods provided (including for legator other^professionaT services), or.(it) pay the City money for a license, grant or concession allowing them to conduct a business on City premises.
On behalf ;of an Applieahtithat is a:contractor pursuaMto^MCC SectiOfr2-92r385,~I hereby certify that the Applicant is in compliance with MCC Section 2-92-r385(b)(I) and (2)', which prohibit: (i) screening job applicants based on their wage or salar^Histdry^P^ seeking job applicants' wage or salary history from current of former employers'. I also certify that tlie Applicant has adopted a^policy that Jhcludesrfliosepf dhibitioris-.
Yes
No
[7] N/A.-.I arrinot an: Applicant matte""cdhtfactor"'as defined m' MeC Section.2-92-385. This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(1). •ifyduJcheck'ed "ho" to'the abdve,/pielaWexpia1n;:
Page 15 of 15
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