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 ofthe 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: 3324-3334 S. Prairie Avenue ("Property")
District/Building: Calumet-Giles-Prairie Landmark District
for work generally described as: Construction of six, two-story masonry and limestone attached row
houses; each with a raised basement, five bedrooms, 3.5 bathrooms, a rear deck, a yard, and a detached rear two-car garage.
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 June 15, 2021 through June 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.
Proposed Permit Fee Waiver
Calumet-Giles-Prairie Landmark District
Department of Planning 3324-34 S. Prairie Avenue
and Development ' BCSHP/HPD 04/09/21 MAR
'Enhanced Aerial Photograph
LEGEND
Landmark District Landmark District
] 3324-34 S. Prairie Avenue
Proposed Permit Fee Waiver
Calumet-Giles-Prairie Landmark District
Department of Planning 3324-34 S. Prairie Avenue
and Development BCSHP/HPD 04/09/21 MAR
Site Photographs (Source: Google Earth)
DPD
Department of Planning and Development
Proposed Permit Fee Waiver
Calumet-Giles-Prairie Landmark District 3324-34 S. Prairie Avenue
BCSHP/HPD 04/09/21 MAR
SOUTH PMRC AEW.C
Site Plan (Source: GraceK Contractors, LLC.)
Proposed Permit Fee Waiver
Calumet-Giles-Prairie Landmark District 3324-34 S. Prairie Avenue
Department of Planning
and Development BCSHP/HPD04/09/21 MAR
Renderings (Source: GraceK Contractors, LLC.)
Proposed Permit Fee Waiver
Department of Planning and Development
Calumet-Giles-Prairie Landmark District 3324-34 S. Prairie Avenue
BCSHP/HPD04/09/21 MAR
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legalnauie ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
GraceK Contractors LLC
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting tliis EDS is:
Q the Applicant
OR
Qi a legal entity currently holding, or anticipated to hold within six months after City action on
me 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. Stale the-Applicant's legal
name: _ . _______ ."., ... .
" or
? a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1)) State the legal name ofthe entity ih: which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party: 3400 S. Giles Ave.
Chicago, IL 60616
Telephone: 312-929-260B Fax: _ Email:;
Name Of COlltactpersOn: Thomas Boney
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):
3322-34 S Prairie Avo.New Construction 6 unit rowhomB development ____
Which City agency or department is requesting this EDS? DPD _
If the Matter is a contract being handled by the Gity'sTJepartment of Procurenienl'Services, please complete the following:
Specification # . and Contract .# ___
Ver.2018-1 Page 1 of IS
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY
3y :ilndicate;the:nature ofthe Disclosing-Party:
Person rjl] Limited- liability:company
PI Publicly registered business corporation Q Limited liability partnership
PI Privately held business corporation PJ Joint venture
O Sole proprietorship Q Not-for-profit coiporation
Q General partnership (Is the not-fpr-profit corporation also a 501 (c
P] Limited partnership Q Yes QNo
Trust P Other (please specify)
2, For legal CrititieSy the state (or foreign country) Of incorporation or organization, if applicable:
ILLINOIS .. , ,. .
3. For legal!entities;not organized in the State of Illinois: Has' the organization registered to do
business inthe State of Illinois asra foreignjentity?
?] Yes CD No pO Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:5
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, iif any, which-are legal entities (if there
afe:no such;memjbers,-, write "no members which are legal entities"); (iii) for trusts-estates or other,
similarientitie^, me trpstee, executo^ similar^ for general or
limited partnerships, limited liability companies, limited.liability partnerships of joint ventures,
eaci^geheralfpaf^ manager or any o&er, person or legal entity that directly or
indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entitylisted below must submit an EPvS-.on its'own behalf.
Name Title
ThomasRBoney .. Owner . . ,„ , .
.2. Please provide the following information concerning each person or legal entity having a direct or Indirect, current pi: prospective (i.ei within 6 months after, City action) beneficial intefest (iricluding .ownership) in excess o f 7.5% Of the Applicant. Examples of such an interest 'include sh'afesyfi a corporation, partnership interest in a partnership of joint venture, interest of a member or manager in,a
Page-2 of IS
limited UabilitY;company, ovinterest 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 Eusiness Address Percentage Interest in the Applicant
Thomas R Boney , 3400. S. Giles Aye./;Criica'gb, tV- 60616 100% , , ;.
SECTION III- INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS? Q Yes pp No
Db'^
elected officia^ 12-month period following thedate of this EDS? P Yes p3:No
If "yes" to eitlier of tlie above, please identify below the.name(s) of siich City elected official(s) arid describe such income or compensation::
Does any City elected official or, to the best of the Disclosing Parry's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have .a financial interest (as defined in
Chapter 2-156 ;of Uie,Municipal: Code of Chicago (''MGC")) in the Disclosing Party?
;'P3 Yes [vJ No
If "yesi" please identify below the name(s) of such City elected pfficial(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 me,DiscIosirig .Party has retained br.expects to retmn.ih;cpnnectibh w
the. nature bf .the relationship,, arid the 'total amount of the fees paid or :estimated to be paid. The
Disclosing Party is notirequireci to disclose employees who arc paid solely through the/Disclosing
Party's regular payroll. If the disclosmg P-arty- is;uncertain whetfer^a disclosure islrequiredunder this
Se6tio%tlie.Disclbsing^^ required of.make the.
disclosure.
Page 3 of 15
Name (indicate whethcr Business Relationship to Disclosing-Party Fees'(indicate whether
retained or anticipated .Address, (subcontractor, ^attorney, paid or estimated-) NOTE:
to $e,retained)- lobbyist, etc.) "hourlyrate''or "t.b:d." is
not an acceptab Ie response.
See attached
(Add sheets if necessary)
Q 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
Under MCC. Section 2-^92-415, substaritiai owners of business entities that contract with the City must remain m compliance with their jchild'support obligations throughout the contract's term.
Has^any person-who directly of indirectly owns. 10% or more of the Disclo;sing:Party been declared in , arrearage
Q Vei" 'l^'No Q -No person directly or mdifectly owns 10% of more of :thc:'Disclosing Party.
If "Yes," has the person entefed into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
P| Yes P No
B. /FURTHERCERTIFICATIONS
[This paragraph I Applies only ifthe Matter is a contract ^being handled by the City's'Department of ProcurementServices.] In the. 5-year period preceding,tlie date of this EDS, ricimier,the Disclosing Party nor any Affiliated Entity f see definition in (5) belowj has engaged, in connection with the performance of . any public contract, the services of .an iritegrity.monitor, independent private sector inspectorgeneral, or integrity compliance-consultant (i.e., an individual-or entity with legal, auditing, investigative, or other similar skills, designatedby 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 Disciosing Party and its Affdiate
taxior other source of indebtedness owed to the City of Chicago, including, butnot limited to, .water and sewcr 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 Departmenrof Revenue.
Page 4 of 15
3324^3334 SPra'lrle
NAME ADDRESS RELATIONSHIP FEES
Preferred Survey 7845 W79th St.,BrldgevIew, IL 60455 subcontractor ,$2,500.00
Alexander Rolich'uk Architects 3330 Dundee Rd.'Nb'rthbrook, IL 60062 architect $50,000.00
Fry & Sons .-. ¦" 11920 Timber Edge Lane, Orland Park, IL 60467 subcontractor $4,000.00
DIFogglo.Sewer 3216 SjShlelds,. Chicago, IL 60616 subcontractor $90,000.00
StbneOrcle'Concrete 7653 N.Osceola, NllesJL 60714 "'. subcontractor '$223;400.00
Me'ath'Mas'onry . 6351W Montrose, Chicago, It 60634 subcontractor $345,000.00
Stone Circle Concrete 7653 N.Osceola, Nlles.IL 60714 .:. subcontractor $74,000.00
Performance Plus Roofing 28583 N Washington,'Wauconda, IL 60084 subcontractor. ' $61,547.00
Til State CutStorie 10333 Vans Dr., Frankfdrt,.IL 60423 supplier .'$200-000.00
Forest Lumber, 17280 S Cicero, Country Club Hills; IL 60478 supplier ' ^$25o;ooo.oo
RlchcoiStr.uctures W989'County Rd" FF, Sheboygan; Wl 53083 supplier . $98)315.00
Astro-Insulation 4418 Rte:3'l, Rlngwood,-IL 60072 subcontractor .. $40;000.00
George Rolls'Sons i 2258 VermontSt., Bluelsland, IL 60406 supplier $30,000.00
Ferguson . 1410 Butterfleld Rd., Ste 130, Downers Grove, IL 60515 supplier $75,000.00
Scha'af. Windows 18445.Thompson Ct, Tl'nley Park; IL 60477 supplier $70,000.00
Northwest'Mlllwork . 455.E Jarvls Ave., DesPlalnes.lL 60018 supplier ... $40,000.00
Repe's^Orywall' 3 Redwood Ct., Sffeamw6bd, IL'60107' subcontractor- .$40,000.00
MT: Flooring Source 2211E 67th #3, Chicago,. IL 60649, supplier . $35,000:00
Jacobo's Painting 5730 W 64tti St., Chicago; IL '60638 subcontractor $45,000.00
S&.G Carpentry 409 E.RralrieH'ombard, IL 60148 subcontractor $36,000.00
BeverlyAsphalt 1514 W Pershing Rd., Chlcagb.lL 60609 . subcontractor '".' !$40,000.00
Marfa'Cablnets; 2050 5 Mt Prospect Rd 5ulte £, DesPlaines, IL 60018, - supplier' :$90,ooo;oo
Andy!QFIb?6flng 424-FarmbrobkCt, Romeovllle, lL'60446 subcontractor :$45,C00.'C0
MeridbzVLa'ndscaplng 5311'S:LawndaleChicag6,IL 60632 ., subcontractor ¦:$lo,ooo.oo
UGM 3555'NormaLChlcago, IL 60609 supplier $25,000.00
Region'Iron Works 223 S Undberg; Griffith, IN 46319 subcontractor $35,000.00.
Chicago Storefront,St Glass 2245 SlOth Ave;; Riverside, IL 60546 subcontractor $15,000.00
Custom Closets 4032Bellealre Lane, Downers Grove, IL 6051S: subcontractor $18,000.00
Poseidon Tile Pesigri'. 505165th St,'Harnrriond, IN 46324' supplier -'. $50,000.00
Ciasslc'Hardwood 6817^ Harlem Ave.> Unit B-Bedford Park; IL 60638: supplier " $30,000:00
BR'bevelopmeht 1845 N Blssell St, Chicago, IL 60614 subcontractor '' $150,000.00
Cucd.Cpnstructioti 15815 Vine St; Harvey, IL 60426 subcontractor. .. $40,000.00
Chicago Demolition 4818 SLaPorte, Chicago, IL 60638 subcontractor $10,000.00
Kilteen Electric-. 7809'Natchez,-Burbank, IL 60459. subcontractor . $17,200.00
Alexander Jr Building Services P.O 558; Willow Springs; It 60480 subcontractor $20,000.00
Dee.Plumblng' 3828 W 128th PI., Atslp, IL 60803 , . subcontractor- ¦$120,000.00
RMB Heating a.Cobllhg. 205 Mldway.'Dr.,.Willbwbrook; IL.; : subcontractor $112,000;00
Musketry Builders . ' 9408 S Clifton Park, Evergreen Park; IL 60805 subcoritractor - $75';000.00
3 The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in-Section II(B)(i) of this EDS:
m'e.nptvpresently rfebarred,; 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 cruninal offense, adjudged guilty^ or had ^a civiijudgment rendered against thenvin connection wim: obtaining, attempting to obtain, oivperforming a public (federal, state or local) transaction or contract under a public)tfansactio^ av^bjatiphvbf^federallor^stateyantitrust stamtcs;;fiaud;
bribery! f^^
;are not presently indicted for, or criminaIly:or;civillycharged %, -a goveirnmental .entilyX^deral, state or local) with committing any of the'offenses set forth in subparagraph (b) aboye;
have not, during, the 5 years before the date ofthis EDS, had one or mofe public transactions (federal, state or local) terminated.for cause ordefault; and
& 'haye.tipt, during the 5._year^.:b^fpre"the"date?6fithls.'EDS, been convicted, adjudged;guilty,or found .liable:-iri a.civilproceedlng, oi; in any cfiminai Or;civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other imit of local gpyemfnent.
The Disclosing Party understands ahd.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 ¦'Cpht^actpf,, (meaning any cohtfactor of subcontractor used by the Disclosing Party in connection with the Matter,-including but not;limited to iall persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors- and Other. Retained Parties");
iiahy- "Affiliated" Entity" (meaning a perspnrpf'entity thatj directly or indirectly: contrOls'the
Disclosing Party, is controlled by the Disclosing Party, or is, with tlie Disclosing Party, under
common cphtrol^ Indicia of control include, without^ imitation:
interlocidngrmanagement or ownership;3dfacilities and equipm ent; common use of employees; or organization of a business entity following
the ineligibility of a.busine ;dp business with federal or state :or local government,
including the City, using substantially the same management, ownership, or principals as the,
ineligible entity. Witfi respect to Contractors, the term Affiliated Entity means a person or entity
that directly or. indirectly controls the Contractor, is .controlled by> it, or, ;v#th 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, agentor^cmployce of the^Disciosing Party, any Contractor or any Affiliated Entity, acting .pursuant; to the1'direction of authorization ,of a responsible official of the bisclosingParty,-any Conlracior or any Affiliated Entity (collectively "Agents").
PageS oflS
N"eitherithe:Disclosing Party, nor anyiCpnlractbr, nor any Affiliated Entity;of either the Disclosing;
Party or any Contractor, nor any Agents :h^^ the 5 years before the dale of this EDSi oiy With
respect te a Contractor, an Affiliated;Entity, or an Affiliated Entity Of a Contractor during'Qie 5 years before thedate ofsuch Contractor's orAffiliated Entity's contract or engagement in connec Matter:
a, bribed^of attemp^ or been convicted or adjudged guilty of bribery or attempting to bribe,
a public officer br employee. of tlie City,:the State of Iliinpis,;brfany agency;of tlie federal:government
or ofahy state otvlocalgoyernmentinfe
official capacity; • .
b. agreed or.colluded with:other bidders or prospective bidders, or been a party to any such agreement,
or'bcenoonvicted; c^
in resu'airit of freedom of competition by agreement to bid a fixed price orotherwise; or
c; made an admission of-such,conduct;descfibedjih subparagraph (a) or '(b) above that.is a matter of record, but have hot been, prosecuted'for such conduct; or
d. violated the.provisions referenced in MGC .Subsectiori52^2-320(a)(4)(Gontracts Reqiiivihg^a Base Wage);; (a)(5)(pebarment,Regulatiohs); or. (a)(6)(Miriimum Wage Drdihahce);
'6v Neither the Disclosing Party,.npr an^Affiliat^ :dfficials;^
result of engaging in or being convicted of (1) bid-rigging iri violation of720 ILCS 5/33E-3; (2) bid-fotadng in violation of 720/ILCS 5/33E-4; or (3) soiy similar offense of any state or of the United !ST^es,pf^merica^mat cphl^ns:the same}ielem^s;as;the offense of bid^f igging .of bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is; listed on aiSarirtibns List maintained by the United States Department 6f Commerce,.State, or Treasury, of any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant-nor any "controlling person" [aeeMCC Chapter 1723,: Aj^icle 1 for\appiicability and defined termsT pf the;Applicant is currently indicted or ch^gedvyith, 6f;^
any criminal offense involving actual, attempted, or conspiracy to commit bribery, dieft, fraud, forgery, perjury, dishonesty or^ce^_a^^i:\i^9fRc0t or>mployeerbf*me;City or any "sister agency"; and (ii) me-X^
for doing business with the City. NOTEi - If MCC' Chaptcr 1^23, Article I applies to the Applicant'that Article's permanent compliance;timeframe supersedes"5-y|ajr4ftmpltance timeframes1 in ihls Section yr
[FOR APPLICANT ONL^ The Applic^t;ahd.its Affiliated Entities will not use,.n0r;pefmit theif subconlfactprs to use, any facility listed as having an active exclusion'by tlie U.S. EPA on the federal System for i^ard^
[FOR- APPLICANT ONLY] The Applicants any cOhtractbfs/subcbntractOrs-hired
or to .be hired in Oonnectiorii.with the;Matter certifications equaiin form and substance to those in
Certifications (2) and (?) above and will not, without the prior written consent .of the City-; use any such
Ver:20;iji.;i vRage^ibn5
.contractof/subcontractpr that does not provide\such;certi;^ that the Applicant has reason to believe has not provided of-icanhotprp^ certifications.
ill If tlie Disclosing JParty^ above statements in tliis Pail B (Further
Certification^
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. Tp the best of the Disclosing Party's knowledge after reaspnabie inquiry, the following is a complete list of all cwrent employees of thb Disclosing Party who were, at any .time, during the; 12-mohth period preceding tlie date of diis EDSi an employeei or elected or appointed official, of the City Of Chicago (if hone, indicate with :"N/Ah 6r:"hbrie!'j.
13.:To.&c^ after reasonable inqui'i7, the^,^
complete list.of all gifts, that the;DiscIosing Party has given or caused to be given, at any time during
fheil^rmqntteperiod;^ the;executi6nof ficial; of the City of Chicago. .For purposes "of mis slatement,;a "gift" .does not include: (i) anything
made;generally available to City employees or to the generai'public, or?(ii) fbOdpf drink provided in
the-cpurscpf official City business, and^iayirig a retail value of less thaiv$25 per recipient, or (iii) a
p6iitical;c6ntfibution;^ (if none, indicate with "N/A'>'or
""hone"). As to any gift listed below, please also list the name ofthe City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
? is 0 is not
a "financial institution" as defined in MCC-Sect.ion,2-32--455(b).
If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
;,,We;are
Page;? of 15
If the Disclosing Party is unable to make this; pledge because it of any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within die meaning of MCC Chapter 2-32, explain here (a'ttachadditional p'ages.if necessary):
If the letters "NA," fee word "None,"'or n be conclusively presumed'tiiattiw
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.
1. In accordance with MCC. Section: 2-156-11,0': To thebest of the Disclosing Party's'knowledge
afterreasp^ any'official or einployee ofme Cir^ have a financial interest in. h
her own>name or in the; name of aiiy/otrlef. person of entity in die.Matter?
Yes [ZINo
NOTE: If you;.Qhecked ',Yes'1 to Item D(l)i proceed to Items; D(2) and D(3). If you checked "No" to Item D(il;),. skip Items Dj(2) and;.D(3) and proceed to Part E.
;2i Unlessisdld pursuantto.a process of cphlpetifiye bidding,-of otherwise perm'itted^no City elected
official or employee shall have a financial interest in his or her own name or in tlie 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 sPld by- vif tue of legal process attlte suitvpf the'City. (cbllecliyelyi.
"Gi^^foperly Sale"). Cj6mperis^ion:f^ eminent domain ,
power does not cbtis&utea frnan^^ D.
Does the Matter involve a City Property Sale?-
Yes 'CJNo
3. If you. checked "Yes" toltem D(l), providethe names and business addresses of tlie City-.officials or employees having such.financial mterestand identify the na!Uirc 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, byany City official or employee.
Ver.2018-1 Page?8tof 15
¦ i
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS'
:P^ase.xhepk^eitiieiv(l;) or (2) below. Ifthe Disclosing Party checks (2), the Disclosing Party must:disciose beiow^pr in an attachment to .this EDS all informalion.required by (2). .Failure; to comply; witiiithese disojbs^ coDheCtioh:witH the Matter voidable ;by the City.
x 1-.; The Disclosihg'Paf ty verifies that the Disclosing Party has searched any and all records of the DisipIosingParty 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 coveragefoiVdamage 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 resultof conducting1 the search in step (1) above, the
Disclosing P.arjy hasfound records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that me following cbnsdtutes,full disclosiu-e' of alisuch 'records, including the names of any and all slaves or-slaveholders, described in those records:
SECTION VI- CERTIFIGATIONS FOR FEDER^IJL^FUNDED MATTERS
NOTE:; If the.Matter is federally funded, coniplete this|Section VL If the Matter is not
federally pri For purposes of this Section VI, tax credits allocated by
the. City andproceeds of debt obligations of the City 'a^ :
A. CERTIFICATION REGARDING LOBBYING
I. List below die names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995,;as amended, who-have made lobbying contacts on behalf ofthe Disclosing 'Party with respect to the Matter: (Add sheets if necessary):
(If no explanation.appears or begins on the lines above, or if the letters '!NA" or if the word "None" appear, it.will-.bc conclusively.presumed that the.Disclosirig Party means 'that NO persons of lerititics registered under the Lobbyirig.bisclosurc Act of;l'9-9'5, as amended,;have made lobbying contacts on beKW^pf me'-p.isc|psirig- PJrty'wim-respectto the^Ma&er.)-
2. The' biscidsihg?Paiiy has.not spent and will not cxpciidvany federally appropriated funds; to pay
any persort of entity listed in paragraph A(I) above fof his or her lobbying activities or to pay any
person or entity to influence or-attempt'to influences officer or employee, of anyagency^ as defined
by applicable federal law,-a member of Congressman officer or employee of Congress, or an employee
Ver.2018-1 Page ? of IS
of .a ¦member of Gtiotf with .'the; award-of any federally funded contract, making- any federally funded^grantor. loan, entering into any cooperative agreement, or to extend, continue; renew, ;amerid, -,or modify any federally funded contract, grant, loan,, or cooperative agreement.
3. TheDisclosing Party will siibrhit ah updated certification at the end.pf 'each calehdajV.quarter. in .whfcivth^^^^ forth in pa^graphs;A^
. .4. The p'is'cl^ either: (i) itis not an organization described in section
5d.l.(cX4j:.of?ttie^ of .198.6; or (ii) it is an organization described in section
501(c)(4) of the Internal Revenue Code of 1986 but has not engagedand will not engage in "Lobbying Activities," as tliat term is defined .in the Lobbying Disclosure Act .of 1995, as amended.
5. If the Disclosing Party is the Applicant', the .Disclosing Party must obtain certifications equal in form and substance to paragraphs A(t) 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 Matterand must make such certifications promptly available to tlie City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If tiie^al^r.;.'isjfederal.ly funded, federal regulations require the Applicant and all proposed subcpntractorS:to%ubmit the following information with their bids of in writing at the outset of negotiations.
is the Disclosing Party flie.Applicant?
Yes ONo
If "Y'eSj"iansWw-]tlVe" 1^1©^ questions below:
1. Haye-you developed; and" do you" have dn.file:;affittnative action programs .pursuanttb applicable federal?feguiatibns?^ (See 4.1 CFR Part<60-2;) PYes: ?No:
2 Have-you file'd With the Joint.Reporting Committee, the Director of the Office of Federal Contract: €bJap^Jn.^:;jPripgr^s, or the Equal Employment Opportunity ^Gommission all reports due under trie applicable; fil ing requirements?
Yes ? .No |~] Reports not required
3. Have.yo'u participated imany 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 VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party Understands and agrees that:.
the certifications, disclosures, and acknowledgments contained contact or pthcr agreementibetween
procurement.sGity assistance,;pr-,other-City action, and.are>mater-fel indu^nients- teethe; Gi^sve*ecu1i6r} of ^ny cbhtTacjtfor taking P^er^action y^ith respect to-the Mattel The Disclosing.Party understands that it must c^rnplyhvith all,smtutes,,ordihances, arid regulations oh which ihis 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. Tjhe full text of this ordinance and a training program is.available on line at:www.citYofchIcag^^
also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9.66.0. The Disclosing Party must comply fully with tliis ordinance.
.Ifthe City determines that airy information provided in this. EDS is false;, Incomplete or inaccurate, ariycontractor other.agreement in connection with which it is submitted may be rescinded or ;besvoid Orvoidable- and me)City::may pursue any'remedies under the contract or agreement (if hot rescmded;pr vbid)tat IaWj/pr in.equilyi including terminating the Disclosing Party's participation irfithe Matter ahd/of declining to aliow'thefbisblosing Party to participate In other. City transactions. Remedies at law for a fidse.statement of m aterial fact'may ; include incarceration and an award to the City.Pf treble damages.
Itis the;City's pdlicy to make.this.documeht available to the public on itsilntefnet site and/orupbh
request. S6me.:br all;ofthe information-provided in, and appended to, tiiis EDS may be madepubli'cly
available'^ request, or othWwise. By
completing-and'signi^ andvreleases any-possible fights of
clainVs whic^ have against the City iri connection with the.public release of information1,
containedin th'is-ED'S arid also authorizes theiC-ity to verify me.accuracy of any information submitted1
in this EDS.
E:. The mfprmationVpi'ovided:4n this FJDS .must be kept current; In the eve^Pf changes, die Disclosing
Party must supplement this EDS up to the time the City takes actipn on^.the Matter. If.the;Matter is a
cbnttactbeing h^ meDisclbsmg Party !mu^^
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"'
:infbimation :p^ regarding ;eli^bility must be kept current for a longer period, as required
by MCCChapter 1^23 and Section 2-154-020.
Page li of IS
CERTIFICATION
Under^ (ij warrants ma^
mis all applicable A>pendicesi on behalf of me"bisclo'sirig Party, and (2).warrants that all
certifications and statements contained in this EDS, ahd.all applicable Appendices, are .true, accurate arid complete astof the date furnished to the City,
GraceK Contractors Lie
(Print ortiffiipxact legal name of Disclosing Party)
By-
(Sign here) Thpmas.R?Bpney
(Print or type name of person signing)
Owner
(Print- or type title of person signing)
Signed and sworn to befpre>rae on (date) fitf&is *
at . WW— County, _ (state).
QFEIGIAL SEAL
¦DIANA;LPHILBlKl \¦ NOTARY PUBLIC- STATE OF ILLINOIS I
¦ MyCOMMISSIOp^|RCS:OoS *
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.
UnderMCC Section 2-154-015, me D or any "Applicable Party" or any Spouse or Domestic Partn
relationships with any'elected:;c1ty official or department head. A "familial relationship" Exists if, as of
the date this EDS is signed, tlie Disclosing Party of any "Applicable Patty" or any Spouse or Domestic
jPartner-die clerk, the .ciiy treasurer or,:ahy city
department head;as spouse of- domestic pailner of.as any of the fbliowmg^whetiief hyibipqd or adp^ibni^renti, child, bfomerw^
father-in-law, mo.ther-inrlaw, sbririn-rlaw, daughter-invlaw, stepfather orstepmother, stepson or stepdaughter, stepbrother or stepsister' or half-brother dr half-sister;
"Applicable Party" means (1) allfexecutive;oXfi'cers of the Disclosing Party listed in Section TLB;! ra.yi if: the1 DiscIosihgiPafty is a;corpprationj all! partners of the Disclosing Party, if the Disclosing .jRartyls age^ral/pjrt^^
Disclosing Party is a limited partnershipj'all mahagers,;ntanagihg members and'membersi.pf die Disc]fein^Parly, ifthe Discl6sin£Paxtyis alirnjtediliabihfyo^
Disclosing ownership interest in the Disclosing
Fafty. "Principal^ the president, phie£pperating officer, executive director, chief
financial officer;, to of a legal entity or any person exercising similar authority.
PpeSjtiiejDisClpsi anySpousevprjDbrnesti^ cmtently;haye! a^"fjTO.ilial relationship" wim^an^electeidjcity official or'-department head?
? Yes [7J.No
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to
which; sucl^ere (3) the name;and&tie of the'elected city official or department head to
whom such person has a familial relationship, ah'di(4)-the precise nature of such fami lial 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 legai.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 inithe 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 tZJNo
If tlie Applicant is a legal'entity publicly traded on any exchange, is any officer or-director of the> Applicahtidehtifted as a^^b
2-9241.6?
QYes. 1 | No. [7] The Applicant;isr not publicly traded: on any^chailge.
if yesTlo (1) of (2): above, please identify below th6 name of each persontor 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
Thjls^pOTdiMs tojbe completed only by an AppIicant that is completing this EDS as a "contractor" as
defined in MCC Section 2-92-385. That section., which should be consulted (www.amlcgal.conv ).
generally covers a paiiy to-any agreement pursuant- id-which they:: (i) receive City of Chicago funds in
consideration ^ work or goods provided: 0nciudingfor legal of other professional services),
or (ii) pay trie.City money for a license, grant or concession allowing them to conduct a business on City premises.
ph:belialf .ofan Applicant that is ajconU-ac^^^^ I hereby certify that
the Applicant-is in compliance with MCC Section 2r92-385(b)(l) and (2), which prohibit: © screening
jph;appUcahts;:based^ or salary history, or (ii) seeking job applicants' wage or salary
hisfp^frotn^uitent orformeivemployers. Lalso certijfy|hat thej-App Ueaht has adopted*a?policy*hat inch$esj^
,? Yes
?:No
,13 N/A - l am not ah'Applicant that is a "contractofv-as defined in MCC Section 2-92-385. This;;w^
If you checked "no" to the above, .please explain.
Page 15 of IS