CITY Of CHICAGO
MICHELLE A. HARRIS. ALDERMAN. 8TH WARD CHAIRMAN-COMMITTEE ON COMMITTEES AND RULES CITY MALL. RM-200. OFFICE *4 • 121 NORTH I.ASALI.P. STREET, CHICAGO IL C0G02 PHONE; 312-744-3075 • FAX* 31 2-71 4-5007
City Council Meeting June 23, 2021
To the President and Members of the City Council:
Your Committee on Committees and Rules, considered all the following Report, Ordinances and Orders which met June 22, 2021:
The approval of the May, 2021 Monthly Rule 45 Report for the Committee on Committees and Rules
Your Committee on Committee and Rules, recommends "do pass" ofthe following items:
Recommendation to refer proposed item 2 to the Committee on Budget & Government Operations:
(O2021-1995)Transfer of funds within City Council Committee on Housing and Real Estate for Year 2021 for personnel services and contract service
Recommendation to refer proposed items 3-9 to Committee on License and Consumer Protection
(02121-1842) Amendment of Municipal Code Section 4-60-023 (30.4) to allow additional package goods licenses on portion (s) of N Milwaukee Ave.
(02021-1998) Amendment of Municipal Code Section 4-60-023 (37.15) to allow additional package goods licenses on portion (s) of W North Ave.
(02021-1843) Amendment of.Municipal Code Section 4-60-023 (45.40) to allow additional package goods licenses on portion (s) of N Lipps Ave
(02121-2138) Designation of 6th Precinct of 23rd Ward as Restricted Residential Zone prohibiting additional shared housing units and vacation rentals
(02021-2135) Designation of 14th Precinct of 41st Ward as Restricted Residential Zone prohibiting additional shared housing units and vacation rentals
(02021-2136) Designation of 22nd Precinct of 41st Ward as Restricted Residential Zone prohibiting additional shared housing units and vacation
, rentals
(02021-2028) Amendment of Municipal Code Chapters 9-114 and 9-115 to further regulate regular fare rates for transportation network providers
Recommendation to refer proposed items 10-13 to Committee on Transportation and Public Way
(02021-2139) Dedication of public way (s) in area by W 33rd St, Sanitary Ship Canal and S Pulaski Rd
(02021-1877) Dedication of public way (s) in area bounded by W Irving Park Rd, N Kenneth Ave, W Byron St and N Kilbourn Ave
(02021-2142) Approval of plat of Lincoln Yards South Resubdivision
(02021-2141) Vacation of N Throop St bounded by W Wabansia Ave, W Concord PI and N Ada St
Recommendation to refer proposed item 14 to Committee on Workforce Development
(02021-2058) Amendment of form of Certified Service Provider License Agreement adopted by City Council September 6, 2017
Recommendation to refer proposed items 15-25 to Committee on Zoning, ndmarks & Building Standards
(Or2021-116) Historical landmark fee waiver for property at 2115 W Evergreen
(02021-1997) Amendment of Municipal Code Section 17-3-0503-D by modifying certain pedestrian retail street designations on portions of N Lincoln Ave
(Or2021-97) Issuance of permits for sign(s)/signboard(s) at 5400 W Belmont Ave
(Or2021-109) Issuance of permits for sign(s)/signboard(s) at 9 W Washington St
(Or2021-110) Issuance of permits for sign(s)/signboard(s) at 625 W Madison St
(Or2021-111) Issuance of permits for sign(s)/signboard(s) at 555 W Madison St
(Or2021-112) Issuance of permits for sign(s)/signboard(s) at 320 S Canal St-west elevation
(Or2021-113) Issuance of permits for sign(s)/signboard(s) at 320 S Canal St-south elevation
(Or2021-89) Issuance of permits for sign(s)/signboard(s) at 2844 N Broadway
(Or2021-115) Issuance of permits for sign(s)/signboard(s) at 6250 N Sheridan Rd
(02021-2131) Amendment of Municipal Code Chapters 17-3 and 17-9 by modifying Section 17-3-0304-A and adding new Section 17-9-0131 regarding general district standards for indoor and outdoor operations and use standards for outdoor walk-up service windows
This recommendation of each item was concurred in by the Committee on Committees and Rules.
Michelle Harris, Chairman Committee on Committees and Rules
Sincerely,
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 ofthe City Council to the contrary, for the property at:
Address: 2115 W. Evergreen Avenue ("Property")
District/Building: Wicker Park Landmark District
for work generally described as: The construction of a new two-story rear addition and a one-story
side addition to an existing masonry residence; the demolition of a rear one-story brick garage; and the replacement with a new one-story rear brick garage with a roof deck.
Owner: Bradley Barnes Suster and Hector T. Hernandez
Owner's Address: 2115 W. Evergreen Avenue City, State, Zip: Chicago, Illinois 60622
SECTION 3. The fee waiver authorized by this Order shall be effective from May 15, 2021 through November 31, 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.
Brian Hopkins Alderman, 2nd 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 2115 W. Evergreen Avenue
H^DPD
Department of Planning and Development
Proposed Permit Fee Waiver
Wicker Park Landmark District 2115 W. Evergreen Avenue
BCSHP/HPD 04/09/21 MAR
Enhanced Aerial Photograph
LEGEND
Y////A Landmark District \m-& Landmark District I I 2115 W. Evergreen Avenue
Proposed Permit Fee Waiver
Wicker Park Landmark District
n „ , ._. 2115 W. Evergreen Avenue
Department of Planning 3
and Development BCSHP/HPD 04/09/21 MAR
Site Photograph (Source: Google Earth)
Site Photograph (Source: Cook County Assessor)
^cDPD
Proposed Permit Fee Waiver
IIUII Wicker Park Landmark District
***** f fc# ¦ 2115 W. Evergreen Avenue
Department of Planning
and Development bcshp/hpd 04/09/21 mar
Site Plan (Source: JOMX Architecture)
East Elevation (Source: JOMX Architecture)
mm
North and South Elevations (Source: JOMX Architecture)
^cDPD
Department of Planning and Development
Proposed Permit Fee Waiver
Wicker Park Landmark District 2115 W. Evergreen 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/ if applicable:
Bradley Barnes Suster • . " .
Check ONE of the following three boxes:
Indicate whether the DisclosingJParty submitting this EDS is:
prj the Applicant
OR
f~J a legal entity currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name:,-, ... • .,.....,.„ ...... ¦ ¦ .....„„:,... i,. .¦. -
or - " - - : ¦ ;" ' ¦
? a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:
< B. Business address of the Disclosing Party: 2115 W Evergreen Ave, Chicago, IL 60622
Telephone: 773-87V5050_ Fax: 773-442-0142 :, Email: :
Name of contact person: Bradley Barnes Suster j
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): -
. ¦• 1
Seeking Permit Fee Waiver For Landmark Buildings for an addition to.our home at 2115,W Evergreen Ave,TChicago IL 60622.
G. Which City agency or department is requesting this EDS? Department otPianning & Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # .2. . • and Contract # ', ,„,.,.,,. ¦ ,..
Ver.2018-1 Page 1 of 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
¦ ¦ ¦ - .... . . q
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
Q Person PI Limited liability company
?J Publicly registeTed^busmess corporation Q Limited liability partnership
? Privately held business corporation Q Joint venture
Q Sole proprietorship ? Not-for-profit corporation
QJ General partnership (Is the not-for-profit corporation also a 501 (c)(3))?
P Limited partnership ? Yes Q No
Q Trust "* Q Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
?J Yes ? No Q Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles, if applicable, of: (i) all executive officers and all directors of the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities* the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
2. Please provide the following information concerning each person or legal entity having a direct or
indirect, current, pi* prosp^ctiye ;(i;ei witr^d m^ interest {including
ownership) in excess of 7.5% of the Applicant. Examples ojlsuch .an', mter-est .include shares in a
corporation, partnershipjnterestrm or^int veh^e,^interest of ^member or managerjh a
Ver.2018-1 . *' ¦ ^^2Jpf\5
i
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS? ? Yes El No
Does me Disclosing Party reasonably'expect to proyid^any income or compensation to any City
elected official during the 12-month period following the date of this EDS? ? Yes pij No
If "yes" to either ofthe above, please identify below the name(s) of such City elected official(s) and describe such income or compensation: :
Does any City elected official or, to the best of the Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a[ financial interesti(as defined in
Chapter 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party?
P Yes [7] No
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partner(s) arid describe trie fi^
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must^disclose the name and business M o.|feach subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), accountant, consultant'and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as, the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. If the Disclosing Party is uncertain whether a disclosure is required under tliis Section, the DiscIosing.Party must either ask jiie^yiwhether disclosure is required or make the disclosure.
¦ ¦ - ¦ . ¦ -.
Ver.2018-1 Page 3 of 15 ¦ .
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
regained or anticipated Address (subjconjb^ctQr, attorney,."'• paidlbr esjimatM.) NOTE:
to be retained) ' ' lobSyist,:etcO :; ''Tiburlyjrate^^
not an acceptable response. John Joyce (Retained) - 1658 N Milwaukee Ave #335, Chicago IL 60647 - Architect - $57,000(Estimated)
(Add sheets if necessary)
? Check here-if the Disclosing Party:has not retained, nor expects to retain, any such persons or entities. SECTION VW CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party, been declared in arrearage on.any child supporlsobligations by^
Q Yes (TJ No Q No person directly or indirectly owns 10% or more ofthe Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
?I Yes DNo
FURTHER CERTIFICATIONS 1
[This paragraph I applies only if the Matter is a contract being handled by the City's Department of Procurernent^
Party norVanv-A%il^ connection with:the
performance of any public contract, the services of an integrity monitotrmdependent 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 caribe"cbns^
The Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 of IS
The Disclosing Party and, if the Disclosing Parry is a legal entity, all of those persons or entities identified in Section 11(B)(1) of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, during the 5 years before the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding,.or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-5^
5. Certifications (5), (6) and (7) concern: -
, • the Disclosing Party; any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "A^ffiH
DisclosmgiiParty,4S ^controlled by &e Disclosing^
common control of another person or entity). Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common^ following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity. Withirespect to Contractors, the termAffiliated Entity means a person or entity that directly or indirectly controls the Contractor,,-is contfdUed b^ it, of, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant tO:the>direcdon or
anyContractoror any Affi^
Page 5 of 15
Neither the DisclosiihgTarty, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor, nor any Agents have, during the 5 years before the date of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of the federal government or of^any.state or local.government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
Neither the.Disclosing Party, nor any Affiliated Entity or Contractor, or any of thekremployees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America &
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal^agency:
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC
Chapter 1-23, Article I for applicability and defined terms] ofthe Applicant is currently indicted or
charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for,
any criminal offense mvblving actual, attempted, or conspiracy to commit bribery', theft, fraud, forgery,
perjury, dishonesty or deceit against an officer or employee of the City or any "sister agency"; and (ii)
the Applicant;u^ Article I is a continuing requirement
.fbr&H^ Chap^i|p-^ .
Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an actrye exclusion:$y the lifsT: EPA on the federal System for Aw^dManagement*(''SAM
[FOR, APPLICANT ONLY] The Applicant will obtain from.any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (
Ver.20I8-1 Page 6 of 15
contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications)* theDisclosing Party must explain below:
NA ' '' ""
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
N/A
13.To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete, list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than S25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). Asjaany gift:listed';beto^
N/A ' '¦¦ " """ . V T . ,. ¦ 1 ... .........
C. CERTMCATIONOF^^^
The Disclosing Party certifies that the Disclosing Party (check one)
? is (7) is not
a "financial institution" as defined in MCC Section 2-32-455(b).
If theiDisclosing Party IS a fihandallnstimtibi^
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
Page 7 of 15
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional
If the letters "NA," the word ;"N6ne," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFY
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D,
In accordance with MCC Section 2-156-110: To the best ofthe Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
Yes rZJNo ' '
NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected
official or employee shall have a financial interest in his or her own name or in the name of any
other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for
taxes or assessments, or (iii) is spldiby virtue of^egalprocess atthe suit;6f.the City^cbllectively,
"City Property Sale"). Compensation for property taken pursuant to the City's eminent domain
power^es'h^tjcpristi^ within the meaning of this Part D.
Does the Matter involve a City Property Sale?
Yes (?] No
If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials ;or employees haying suchj^
Name Business Address , Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of15
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. If the Disclosing Party checks (2), the Disclosing Party must disclose below or in an attachment to this EDS; all information required by (2). Failure to cpmply with these: disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
x_ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued lo slaveholders that provided coverage for damage to or injury or death of their slaves), and me Disclosingf|yrjty^
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, p^eej to? Section VII. For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obl igations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING 1. List below the names of all persons or entities registered under: the federal Lobbying: Disclosure Act of 1995, as amended, whd'havj^maae lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary): NA
(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word^None"
appear, i|will bei conclusively presumed that^^ or entities
registered under: the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect lo the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any persoii.pr. entity to Influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, ari^officer'pr''employee-of Congress,-.or an employee
Ver.2018-1 Page 9 of 15 ' 'j'
of a member of Congress, in connection with the award of any federally; funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A(l) and A(2) above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed -subcontractors to submit the following information with ^eir bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant? i ' QYes ' QNo
If "Yes," answer the three questions below: ¦
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
Yes ~ '¦¦ ' Q No i
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes I I No ?Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes QNo
[f you checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of IS
SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands,and agrees that::
The certificatior^ acknowledgments .contained in^ part of any
contract or other agreement between the Applicant and the City in connection with the Matter, whether
procurement, City assistance, or other City action, and are material inducements to the City's execution
of any contract or taking other action with respect to die Matter. The Disclosing Party understands that
it muit comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of this ordinance and a training program is available on line at www.citvofchicago.org/Ethics . and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate,
any contract or other agreement in connection with which it is submitted may be rescinded or be void
or voidable, and the City may.pursue any remedies under the contract or agreement (if not rescinded or
void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter
and/or declining to allow the Disclosing Party to participate in other City transactions. Remedies at
law, for a-fajse s|ate^ fact may include incarcerate an awardLto -the City of &eble
damages!" *""" ~ i ' '
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Parry waives and releases any possible rights or claims which it may have against the City in connection wit^
contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party;mu^supplement Ais:EDS|up,^
contract being handled by the City's Department of Procurement Services, the Disclosing Party must
update;ftis:!ED NOTE: Wim respjccttplM Chapter
I-23^rticpr(imposing PERMAIVENT INELIGIBH.iT^fo^ specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section2-154-020. \'
Page 11 of 13
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 ofthe Disclosing Party, and (2) warrants that all certifications arid statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as of the date furnished to the City.
Bradley Barnes Suster
(Print or type exact legal name of Disclosing Party) By: j^c-*JO^f -friU***.
Bradley Barnes Suster
(Print or type name of person signing)
Applicant \ (Print or type title of person signing) " j
Signed and sworn to before me on (date) / at doiJC-. . Mm^ (state).
¦ "if ~ - v *". * " * mtm'
Commission expires:
TERRY L FARMER
'i Official Seal
Notary Public - State of Illinois I My Commission Expires Mar 12. 1023
Page 12 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APP^NDIXA'
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant
Under MCC Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section ILB.i.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Jarty,jifthe Dispiosing Party is a h
Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing
Party. |P^ihcipal^6fficers"im president, chief operating officer, executive director, chief
financial ofJicer,:treasurer or secretary of a legal entity or ariy person exercising similar authority.
TJoes th%Disclo Spouse or Pomesfic:
currently have a "familial relationship" with an elected city official or department head?
? Yes (7] No .
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is Connected; (3) the h^ejnd title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE^ SCOFFLAW/PROBLEM LA>fDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and.(b) any legal entity which has a direct ownership interest in the Applicant exceeding7.5% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
? Yes [7]No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of
the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section
2-92-416? ' ' i
I I Yes | | No 17] The Applicant is not publicly traded on any exchange.
If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.
Page 14 of 15
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
" APPENDIX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as
defined in MCC Section 2-92-385. That section,;which should be consulted (www>amlegalxotn).
generally covers a party to any agreement pursuant to which they: (i) receive City of Chicago funds in
consideration for slices, work-or g (including for legal or other professional services),
or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises.
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(l) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
Yes
No '
0 N/A -1 am not an Applicant that is a "contractor" as defined in MCC Section 2-92-385. This certification shall ser^e asftthe affidavit roqu^ed-bjy|vICC Section 2-92-l85#(c)( 1). If you checked "no" to the above, please explain.
Page 15 of 15
GITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Hector Thomas Hernandez
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
£Zj me Applicant
OR
? a legal entity currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name: „,„,.,. " ; ¦-.
or ~ t "" V
Q a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 21.15 W Evergreen Ave, Chicago, IL 60622
Telephone: 773-844-0562 Fax: 773-442-0142 Email:
Name of contact person: Hector Thomas Hernandez
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):
Seeking Permit Fee Waiver For Landmark Buildings for an addition to our home;at 2115 W Evergreen Ave, Chicago IL 60622.
Which City agency or department is requesting this EDS?pepartment of Planning & Development.
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification# ...,,.> ,a.....and;Contract^. ..... ¦.,„,.„¦
Ver.2018-1 Paget of 15
SECTION U - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE ^
h; Indicate the nature of the Disclosing Party:
(ZJ Person (ZJ Limited liability company
P] Publicly registered business corporation Q Limited liability partnership
? Privately held business corporation Qf Joint venture¦/"
Q| Sole proprietorship fl Not-for-profit corporation
B
General partnership (Is the not-for-profit corporation also a 501(c)(3))?
Limited partnership Q Yes Q No
Q Trust :r_T Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization^ if applicable:
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
?] Yes ? No Q Organized in Illinois
B; IF THE DISCLOSING PARTY IS A LEGAL ENTITY: .,
T. List below thefu^ ff.aprilibj^^6f:'(i) all executive officers arid all directprs;of
the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there
are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other
similar entities, the trustee, executor, ad^ party; (iv) for general or
limited partnerships^ limited liability com pan
each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
2. Please provide the following information concerning each person or legal entity having a direct or indirect^ current of prospective (i.e. wimiri^
ownership) in excess of 7.5% of the Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Page 2 of 15
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name . Business Address Percentage Interest in the Applicant
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
12j£npnt& ? Yes B.No
Does the Disclosing Party reasonably expect to provide any income or compensation to any City elected official during the 12-month period following the date of this EDS? Q Yes HNo
If "yes" to either ofthe above, please identify below the name(s) of such City elected pfficial(s) and describe such income or compensation:
Does any City elected official or, to the best of the Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party?
P Ves (3 No.
If "yes," .please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partners) and describe the financial interest(s).
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Partys; regular payjro
Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Page 3 qfIS
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response. John Joyce (Retained) -1658 N Milwaukee Ave #335, Chicago IL 60647 - Architect - $57,000(Estimated)
(Add sheets if necessary)
Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COIvMSaNCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain inrcompliance with their child support obligations throughout the contract's, term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Winois court of competent jurisdiction?
Q Yes {ZJ 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?
Yes ? No
FURTHER CERTIFICATIONS
[This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-ycar period preceding the date of this EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any public c^n]^t,thejserv;ices of an integrity monitor, independent private^sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract in progress).
The Disclosing Party and its Affiliated Ent^s^are^
tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identifie^m
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excludedjfrpm^^
have not, during the 5 yearsbefore the date of this EDS, been convicted of a criminal offense,
adjudged guiltyv or had a civil ji^gment-rendered against them ; in; connection wite obtaining,
attemprjhg^to dbtiuh (feder^^state prjc^aiy rrahsacti a
public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery;
bribery; falsification or destruction of records; making false statements; or receiving stolen property;
e. are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found liable in a civil^rpceedihg,ipr in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government^ any state, or any other unit of local government.
The Disclosing Parry understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
Certifications (5), (6) and (7) concern:
the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity). Indicia of control include, without limitation: mteriockih&:maha|em ^ facilities and equipment; common usejbfjmplpyees; pr organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity. With respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of 15
Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor, nor any Agents have, during the -S/years^befo^
respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted, to bribe, .or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct-described in subparagraph (a) or (b) above that is. a matter of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees,
officials, agents or partners, is barred frpm"pon^ any unit of state or local government as a
result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2)
bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United .
States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] of the Applicant is currently indicted or :.charged^ith;:;orlls' admitted guilt of, or has e;^^
any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery,
¦p^ury, dishone^y^r^deceit ^ainstar^ of theCrty or any "'sister ageiaey^and (ii) ,
the Applicant -uhderstandV and;acknpwicdges'that:compliance;with Article I is a'continuing requirement for doing business wittthejCity] NOTE: If MCC Chapterl-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in;thissSeJtion:y^;
[FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their
subcontractprstouse, any facility listea^ EB$$n the federal
System for Award Management ("SAM").
'10, [FOR APPLICANT OM^] The App cpntractors/subeom -
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 15 ;
j
i
contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not prpyided^ricarmo
11. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
NA" . . . .
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
N/A ' ' . . "
13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a comjpjet^
the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed
official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include:, (i) anything
made generally available to City employees or to the general public, or (ii) food or drink provided in
the course of official City business and having a retail , value of less than S25 per recipient, or (iii) a
political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or
"none"). As to any gift listed belpw, please also list the name of the City recipient.
n/a.' "' . v J'X'/ . .
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1. The Disclosing Party certifies that the Disclosing Party (check one)
? is (7) is not '
a "financial institution" as defined in MCC Section 2-32-455(b).
;2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
" We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter2;3^
prefatory lender may result in me joss of the p^
Page 7 of 15
If the Disclosing Part}' is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2.32455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best ofthe Disclosing Party's knowledge alter reasonable inquiry, does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
Yes EINo
NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any o^enperson or^eM
taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively,
"City Property Sale"). Compensation^ eminent domain
power does not constitute aMnan^
Does the Matter involve a City Property Sale?
Yes [7] No
If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 ofIS
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. If the Disclosing Party checks (2), the Disclosing Party
must disclose below orjin an a^techm Failure to
comply with these disclosure requirements may make any contract entered into with the Gity in connection with the Matter voidable by the City.
x 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery, or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and;ajl slaves or: slayehQldersA described in those records:
SECTION VI - CERTIFICATIONS FOR FJEDERALLYi^
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not
federally funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by
the City andproceeds,pfJiebt;pbl^^ not federal funding. .
A. CERTIFICATION REGARDING LOBBYING
1, Xist below thejnames of aH .persons prehtitie^ Disclosure: Acfof 1995, as amended, who have made/lofi^^ Disclosing Party with respect to the Matter: (Add sheets if necessary):
na . . ..._/:;¦ .......... „
(If no explanation appears or begins on the lines above, or if the letters¦ vl|A"¦"dr.;if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Vcr.2018-1 Page 9 of 15
of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A(l ) and A(2) above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant arid all proposed • subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant?
Yes ? No
If "Yes," answer the three questions below:
Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
Yes * QNo
Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
Yes ? No ? Reports not required
3^Hawy.ou,particjp equal opportunity clause?
Yes? No
If you checked "No" to question (1) or (2) above, please provide an explanation:
Page 10 of 15
SECTION VTI - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Parly understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contractor other agreement^
prbcurement;City assistalice^br ouSer City acu^,;and are materia13hduceme|&> the City's execution of any contract or taking other action with respect tq/the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on whi^-ilhis EDS,is.b$$ed. w
The City's Governmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and
obligations on persons or entities seeking City contracts, work, business, or transactions. The full text
of this ordinance ant a training program fe-:|^liabie;;pnline at w\vw.city6fffi and may
also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610,
(312) 744-9660. The Disclosing Party must comply fully with this ordinance.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or ypid), atlawj prin e^
ahdfcr declining to aliow%ei)isclpsing Party ^participate in other City^ irxansactions. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon
request. ^Sotrieor all of the information provided in, and appended to, this EDS may be made publicly
available"onjmVlhternet, i^ of Information Act request, or otherwise. By
completing and signing this EDS, the Disclosing Party waives and ^releases any possible rights or
claims which^may have against the C
contained iri' W City .to venf^&e accural
in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the. time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department pfjPljCwement Services, the Disclosing Party must update this EDS as the contract requires. ;NOTE:^^wMi respect to Matters subject to MCC Chapter l-23VAriicle1|i^osing!PERMA^ the. information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1 -23 and Section 2-154-020. r-
Page 11 of IS
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and ail applicable A^
certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and^complete as of merdate furnished to the City.
Hector Thomas Hernandez
(Print or type exact ly Party)
By: lL,hx- Mv^Jfl / ¦.¦^rr ¦ (Sign here) X
Hector Thomas Hernandez
(Print or type name of person signing)
Applicant
(Print or type title of person signing)
Commission expires: 3//c2/lc?z]>
Signed and sworn to before me on (date) at Gy^lC County, ~LU^\N<} & (state)
Page 12 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS1 AND DEPARTMENT HEADS
This Appendix i$ to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7;5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or. any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner^hereofis relatedJto the mayor, any alderman,--the city clerk, the city rxeasurer or any>city departmenthead apspouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece dr 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]^^^
-Ap^licableJParty" means (10 ^11 executive b
n.B.l.a.VifAe Disclosing P if the Disclosing
Party is a general partnership;^ of UieDisclose
Djsclosing^^^ liability company; (2) all principal officers of the
Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
? Yes rjTJNo
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a-f ami Hal rejation^ip»^^4)^:I?rTO^? nirture of such familial relationship.
Page 13 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant. - -
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
? Yes [7] No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416? .
I I Yes Q No [TJ The Applicant is not publicly traded on any exchange.
If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.
Page 14 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This; Appendix is to be completed only by an Applicant that is completing this EDS as a^'cohtxactor'^as
defined in MCC Section 2-92-385. That section, which should be consulted (www.amlegal.corrT ).
generally covers a party to any agreement pursuant to which they: (i) receive City of Chicago funds in
consideration for services, work or goods provided (including for legal or other professional services),
or(iij|pay.thejGity:rnlmey^fw:a license, grant or concession allowing them to conduct a business on
City premises. - .
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(1) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants-' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
Yes
No
0 N/A -1 am not an Applicantithat is,a "contractor" as defined in MCC Section 2-92-385. This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(l). If you checked "no" to the above, please explain.
Page 15 of 15