OFFICE OF THE MAYOR
CITY Ol- CHICAGO
LORI E. LtGIITFOOT
MAYOR
October 14, 2021
TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO
Ladies and Gentlemen:
At the request of the Commissioner of Planning and Development, 1 transmit here with ordinances authorizing the budget, scope of services and service provider agreements for various Special Service Areas.
Your favorable consideration of these ordinances will be appreciated.
ORDINANCE REGARDING SPECIAL SERVICE AREA #22
WHEREAS, special service areas may be established pursuant to (i) Article VII, Sections 6(1) and 7(6) of the Constitution of the State of Illinois; (ii) the provisions of the Special Service Area Tax Law, 35 ILCS 200/27-5 et seq., as amended from time to time (the "Act"); and (iii) the Property Tax Code, 35 ILCS 200/1-1 et seq., as amended from time to time; and
WHEREAS, the City Council (the "City Council") of the City of Chicago (the "City") has previously enacted a certain ordinance on the date specified on Exhibit A attached hereto and hereby made a part hereof and published in the Journal of Council Proceedings (the "Journal") for such date at the pages specified on Exhibit A hereto, and amended on the date(s) specified on Exhibit A hereto and published in the Journal for such date(s) as specified on Exhibit A hereto (as amended from time to time, the "Establishment Ordinance") which established a certain special service area as indicated therein and as identified on Exhibit A hereto (the "Area") and authorized the levy of certain annual taxes, not to exceed the annual rate (the "Levy Cap") indicated therein and as described on Exhibit A hereto, of the equalized assessed value of the taxable property therein (the "Services Tax") to provide certain special services in and for the Area in addition to the services provided by and to the City generally as specified in the Establishment Ordinance (the "Special Services"); and
WHEREAS, the Establishment Ordinance provided for the appointment of a certain special service area commission for the Area (the "Commission") to advise the City Council regarding the amount of the Services Tax for the Area to be levied and for the purpose of recommending to the City Council for the Area: (i) a yearly budget based upon the costs of providing the Special Services; (ii) an entity to serve as service provider (the "Service Provider"); (iii) an agreement between the City and the Service Provider for the provision of Special Services to the Area (the "Service Provider Agreement"); and (iv) a budget to be included in the Service Provider Agreement (the "Budget") (the aforementioned items (i) through (iv) shall be known collectively herein as the "Recommendations"); and
WHEREAS, the Commission identified on Exhibit A hereto has heretofore prepared and transmitted to the Commissioner of Planning and Development (the "Commissioner") their Recommendations to the City Council, including the Budget attached hereto as Exhibit A; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO AS FOLLOWS:
SECTION 1. Incorporation of Preambles. The preambles of this ordinance are hereby incorporated into this text as if set out herein in full.
SECTION 2. Appropriations. There is hereby appropriated the sum in the amount and for the purposes necessary to provide the Special Services in and for the Area, the estimated amount of miscellaneous income and the amount required to be raised by the levy of the Services Tax indicated on Exhibit A hereto: Collectable Levy, Estimated Loss Collection, Carryover Funds, TIF Rebate Fund, and Estimated Late Collections and interest.
SECTION 3. Levy of Taxes. There is hereby levied pursuant to the provisions of (i) Article
|1010|S \SHARED\Finance\SSA\SSA-2021\Randall - 2, 7, 22, 39, 43, 51\SSA 22\2021 SSA22 Levy Ord docx
VII, Sections 6(a) and 6(l)(2) of the Constitution of the State of Illinois; (ii) the Act, and (iii) the Establishment Ordinance, the sum ofthe "Collectable Levy" indicated on Exhibit A hereto as the amount of the Services Tax for the Area for the tax year 2021.
SECTION 4. Filing. The City Clerk of the City (the "City Clerk") is hereby ordered and directed to file in the Office of the County Clerk of Cook County, Illinois (the "County Clerk") a certified copy of this ordinance on or prior to December 28, 2021, and the County Clerk shall thereafter extend for collection together with all other taxes to be levied by the City , the Services Tax herein provided for, said Services Tax to be extended for collection by the County Clerk for the tax year 2021 against all the taxable property within the Area, the amount of the Services Tax herein levied to be in addition to and in excess of all other taxes to be levied and extended against all taxable property within the Area.
SECTION 5. Service Provider Agreement. The Commissioner, or a designee of the Commissioner (each, an "Authorized Officer"), are each hereby authorized, subject to approval by the Corporation Counsel as to form and legality, to enter into, execute and deliver a Service Provider Agreement as authorized herein with the entity indicated on Exhibit A hereto as the Service Provider, for a one-year term in form acceptable to such Authorized Officer, along with such other supporting documents, if any, as may be necessary to carry out and comply with the provisions of the Service Provider Agreement. The Budget shall be attached to the Service Provider Agreement as an exhibit. Upon the execution of the Service Provider Agreement and the receipt of proper documentation, the Authorized Officer and the City Comptroller are each hereby authorized to disburse the sum appropriated pursuant to Section 2 above to the Service Provider in consideration for the provision of the Special Services described in the Budget. The Department of Planning and Development shall promptly make a copy of the executed Service Provider Agreement (and any amendments thereto) readily available for public inspection. The Authorized Officer is also authorized to sign amendments to the Service Provider Agreement entered into pursuant to this Section 5 so long as such amendments do not alter the identity of the Service Provider and/or the amounts appropriated and/or levied pursuant to Sections 2 and 3 hereof.
SECTION 6. Enforceability. If any section, paragraph or provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such section, paragraph or provision shall not affect any ofthe remaining provisions of this ordinance.
SECTION 7. Conflict. This ordinance shall control over any provision of any other ordinance, resolution, motion or order in conflict with this ordinance, to the extent of such conflict.
SECTION 8. Publication. This ordinance shall be published by the City Clerk, in special pamphlet form, and made available in her office for public inspection and distribution to members of the public who may wish to avail themselves of a copy of this ordinance.
SECTION 9. Effective Date. This ordinance shall take effect 10 days after its passage and publication.
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EXHIBIT A SPECIAL SERVICE AREA #22
Service Provider
Andersonville Chamber of Commerce
Establishment Ordinance Date: November 13, 2002 Journal pages: pages 97169-97241
Amendment(s) to Establishment Ordinance
Date: November 15, 2012
Journal pages: pages 41266-41362
See attached Budget.
|1010|S \SHARED\Finance\SSA\SSA-2021\Randall - 2, 7, 22, 39, 43, 51\SSA 22\2021 SSA22 Levy Ord.docx
Exhibit A Budget
22
Andersonville
Dudget and Services Period- January 1, 2022 through December 31, 2022
Estimated
Late Collections and Interest
$391 $0 $0 $0
$0 $0 $0
$391
Total All Sources
$51,000
$142,302 $4,500 $15,500 $12,000 $21,960 $50,500
$297,762
Estimated 2021 EAV:
; Authorized Tax Rate Cap
Maximum Potential Levy limited by_Rute Cap.
Reciuested 2021 Levy Amount
Estimated Tax Rale to Generate 2020 Levy.
$51,661,720 0.50%
$250,309
$233,930
0.4528%|
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT I
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. the Applicant
OR
(referred to below as the State the Applicant's legal
2. [ ] 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 -
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant,
name:
OR
3. [ ] a legal entity with a direct or indirect right of control ofthe A jplicant (see Section 11(B)(1)) State the legal name of the entity in which the.Disclosing Party holds a r ght of control:
B. Business address of the Disclosing Party: f^V^/if- d\jf\j J^^sfvTflJr A^f-fS
Telephone: W^^lM^&L Fax: Tftg-ffft-^ftfo Email:
Name of contact person: *|^>f^Vl V) Qty£t>S
Federal Employer Identification No. (if you have one):
Brief description ofthe Matter to which this EDS pertains. (Include pproject number and location of
property, if applicable): . , . ,
(li^j-^ruAc^^ pvtMrU- ^Cfjjal SeYWlfJLj Ufo Sfo&
Which City agency or department is requesting this EDS? ^Vi/IA/U^ T \y%^hr^MtA^
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # Ver.2018-1
and Contract #
'age I of 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
[ ] Person
[ ] Publicly registered business corporation
[ ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ ] Limited partnership
[ ] Trust
[ ] Limited liability co mpany [ ] Limited liability pa rtnership [ ] Joint venture
[^Not-for-profit corporation ,N (is the not-for-profit co poration also a(501(c)(3))?/
[ ]Yes -ri>No [ ] 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 [jB. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
officers and all directors of are legal entities (if there for trusts, estates or other party; (iv) for general or tnerships or joint ventures, legal entity that directly or
1. List below the full names and titles, if applicable, of: (i) all executive the entity; (ii) for not-for-profit corporations, all members, if any, which are no such members, write "no members which are legal entities"); (iii similar entities, the trustee, executor, administrator, or similarly situatejd limited partnerships, limited liability companies, limited liability pari each general partner, managing member, manager or any other person qr indirectly controls the day-to-day management ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its Own behalf.
Name
2. Please provide the following information concerning each person or1 legal entity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including ownership) in excess of 7.5% ofthe Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Page 2 of 15
202? Andersonville Chamber of Commerce Board of Directors
"FIRST AND LAST NAME Carol Jonos Dean Hervechon j BOARD TITLE i i PiebidL-nt
Co-Vice President i
Ronna Hotfberg Co-Vice President
Karln Moen Abercrombie j Treasurer I
Lynn Mooney Secretary
Scarab Doysach Director
Stcvo Satok Director
Barbara Janusok Director
Joseph Cranford Director
Ted Fournler Dirsctor
Mia Sakai Director
Mark Liberson Director
Amy Giordano Martin Courrmru.' Diroctor Director
Leni Manaa-Hoppenworth Hallie Borden Director Director
11 nu led !i;;bi In y company, oc mieicsi of a beneficiary ofa I nisi, estate 01 olher similar enlily 11 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
MorvA... _
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-montli period preceding the dale of this EDS? : [,.] Yes ^ No
Docs the Disclosing Party reasonably expect to provide any income or compensation to any City elected official during the 12-month period following the dale of this EDS? [ ] Yes f^C^0
If "yes" to either ofthe above, please identify below the namc(s) of such City elected official(s) and describe such income or compensation:
Does any City elected official or, to the best ofthe Disclosing Party's knowledge after reasonable inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in Chapter 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party? [ ]Ycs ty$Na
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domcstic 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 olher person or entily whom the Disclosing Party lias retained or expects to retain in connection wilh the Matter, as well as the nature of ihe relationship, and the Lo'al amount ol'the fees paid or estimated lo be paid. The Disclosing Parly is not required (o disclose employees who are paid solely through the Disclosing Party's regular payroll. If the Disclosing Parly is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure
Ver ;o;s. I
Kami: (indicate whelhei Business Relationship to Disclosing Patty lees (mdicile whelhei
lelained 01 anticipated Addiess (subcontractor, attorney, paid or estimated.) NOTF,:
to be retained) lobbyist, etc.) "hourly rate" or "i.b d." is
^ a \ \ , /'-i \ ' , not an acceptable response.
(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 COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes [ ] No l^r-^° person directly or indirectly owns 10% or more ofthe Disclosing Parly.
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?
[ ]Ycs [ ]No
FURTHER CERTIFICATIONS
1. [This paragraph I applies only if the Matter is a contract being handled hy the City's Department of Procurement Services.] In the 5-ycar period preceding the date of this EDS, neither the Disclosing Parly nor any Affiliated Entity [sec definition in (5) below] has engaged, in connection with the performance ofany public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entily wilh legal, auditing, investigalive, 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 conlract in progress).
2 The Disclosing Party and its Affiliated Entities are nol delinquent in the payment ofany fine, fee, lax or olher source of indebtedness owed lo the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales Iaxes, nor is the Disclosing Parly delinquent in the payment ofany tax administered by ihc Illinois Department of Revenue.
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3 "f itc Disclosing Pauy and, if ihc Disclosing Paily is ;i legal enlily, all of lliose persons or eniiiies identified m Seciion 11(B)(1) of tins EDS'
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any fedeial, state or local unit of government;
have not, during the 5 years before the date of this EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
c. have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics). :
Certifications (5), (6) and (7) concern:
the Disclosing Party; !
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entily lhat, directly or indirectly: controls the Disclosing Parly, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity). Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization ofa business entity following the ineligibility ofa 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 entily. With respect to Contractors, (he term Affiliated Entity means a person or entity that directly or indirectly controls ihc Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entily;
any responsible official oflhe Disclosing Party, any ("ontractor or any Affiliated Entity or any olher official, agcnl or employee ofthe Disclosing Party, any Conlractor or any Affiliated Entity, acting pursuant io the direction or aulhonzalion ofa responsible official ofthe Disclosing Pan.v. any ( on! racioi or ,mv Affiliated Emily feollecuvelv "Apenls")
v: :oi:•-)
Ncilhei ihe DisciosMu.'. Paiiy. noi any (onlracioi, nor any Affiliated Entity of cither the Disclosing Paity or any Conii.ictor, nor any Agents have, during the 5 years before the dale ol this EDS, or, with lcspect to a Contractor, an Affiliated Entity, or an Affiliated Entily ofa Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection wilh Ihe Matter
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting lo bribe, a public officer or employee of the City, the State of Illinois, or any agency ofthe federal government or ofany stale 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)(Debarmcnt Regulations); or (a)(6)(Minimuni Wage Ordinance).
Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state orjocal 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 ofthe 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.
[EOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] ofthe Applicant is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesly.or deceit against an officer or employee ofthe City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article 1 is a continuing requirement for doing business with the City. NOTE: If MCC Chapter 1 -23, Article I applies to the Applicant, thai Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
9 [FOR APPLICANT ONLYJ The Applicant and its Affiliated Enlities will.'not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U,S. EPA on the federal System lor Award Management ("SAM"). !
10. (FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired oi lo be lured in connection with the Mailer certifications equal in form and substance lo those in Certifications (2) and (9) above and w ill not, wilhoul Ihe prior wnilen consent of ihe Cily. use anv such
\'a /('MS-; I6 of 15
eonlrnclor/subcoiiliaclor dial does nol provide such cci ii llcalions or lhal Ihe Applicani has reason io believe has not provided or cannot provide Inilhlul certifications
1 I. If the Disclosing Party is unable lo certify to any ofthe above statements in this Part U (Furlhei Ccri ideations), Ihe Disclosing Party must explain below:
. j3j£L_ 'z_7.
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 ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the dale of this EDS, an employee, or elected or appointed official, ofthe Cily of Chicago (if none, indicate with "N/A" or "none").
wM" . '.::_ '
I 3. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Parly has given or caused to be given, at any time during the 12-monlh period preceding the execution dale of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies thai the Disclosing Party (check one)
| ] is f)(f\is not
a "financial institution" as defined in MCC Section 2-32-455(b).
Iflhe Disclosing Party IS a financial inslitution, then Ihe Disclosing Party pledges:
"VVc arc not and will nol become a predatory lender as defined in MCC Chapter 2-32. We furl her pledge lhat none: of our affiliates i.s, and none of (hem will become, a predatory lender as defined in MCC Chapiei '.!-32 We understand lhat becoming a predaiory lender oi becoming an affiliate ofa piedaioiy iendei mav result m the loss oflhe privilege of doing business wilh ihe Cily."
l^u'e 7 (il 15
il the Disclosing Parly is unable lo make ihis pledge because il or any of iis affiliates (as defined in MCC Seciion 2-32-'155(b)) is a picdalory lender wilhm Ihc meaning of MCC Chapter 2-32, explain here (attach addition;;! pages if necessary):
ME
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.
' 1. In accordance with MCC Section 2-156-1 10: To the best ofthe Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name ofany other person or entity in the Matter?
KP^o
NOTE: If you checked "Yes" to Hem D(l), proceed to Items D(2) and D(3). If you checked "No" to Hem D(I), 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 inlercst in his or her own name or in the name ofany other person or entity in the purchase ofany property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.:
Does the Matter involve a City Property Sale? ¦
[ ] Yes fyf^Jo
If you checked "Yes" lo Item D(l), provide the names and business addresses ofthe City officials or employees having such financial inleresl and identify the nature oflhe financial inlerest:
Name / Business Address Nature of Financial Inleresl
Mfi __ _____ .
•'1 The Disclosing Party I'm [her certifies ihat no prohibited financial interest in the Mailer will be acquired by any Cily official or employee
\ ci 201| ji of i s
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please cheek either (I ) or (2) below If the Disclosing Party checks (2), the Disclosing Party must disclose below or m an attachment to this EDS all information required by (2). Failure to comply with these disclosure requirements inay make any contract entered into with the City in connection with Ihc Matter voidable by thejcity.
_.)___ ' ¦ Disclosing I'aity verifies that the Disclosing Parly has searched any and all records of Ihc 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 in jury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party veri fies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. rjor purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding. ! ;
!
A. CERTIFICATION REGARDING LOBBYING ;
m.
1. List below the names of all persons of entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf ofthe Disclosing Parly wilh respect to the Matter: (Add sheets' if necessary):
i
(If no explanation appears or begins on the lines above, or if the letters "NA" or iflhe word "None" appear, il will be conclusively presumed thatjlhc Disclosing Party means lhat NO persons or entities registered under ihe Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respeci loj the Matter.)
V
2 The Disclosing Parly has nol spenl and will nol expend any federally appropriated funds lo \y<\any person or entity hslcd in paragraph A(l) above for his or her lobbying activities or lo pay any
person or entity to inlluence or attempt to influence an officer or employee ofany agency, as delincd
by applicable fedeial law. a member of Congress, an officer or employee of Congress, or an employee
Vcr 2<'\y,- ; |:J;„!C y ol 15
I
!
ofa member of Ceng: ess, in ronncchon wiih ihe award ofany federally funded conliacl, making any federally funded grant or loan, entering injto any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
The Disclosing Parly 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 infonnation set lorlh in paragraphs A(l) and A(2) above, j '•
The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code off 1986; or (ii) it is an organization described in section 501(c)(4) of the Infernal Revenue Code off 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.
13. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing- at the outset of negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes [ ] No
If "Yes," answer the three questions below
I. Have you developed and do you have oh file affirmative action programs pursuant to applicable
federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No j
2. 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? |
[ 1 Yes [ ] No ( || Reports not required
3 Have you participated in any previous contracts or subcontracts subject to the
equal opportunity clause? j
|' J Yes f "] No |
If you checked ''No" to question (I) or (2) above, please piovide an explanation:
l\n;v 10 i.-.f 15
i
SECTION VII - Fl.RTIIF.U ACKNOYY'LEl)C.MEN'f'S AND CERTIFICATION
The Disclosing Paily understands and agrejes thai.
A The certifications, disclosures, and acknowledgments contained in this EDS will become pari ofany conlract or other agreement between the Applicani and the City in connection with the Matter, whether procurement, Cily assistance, or other Cilylaclion, and are material inducements to the City's execution ofany conlract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
The City's Governmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of this ordinance and a training program is available on line at w w w. c i t yo I ch i c a go. o i g/ E111 i c s, 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 Parly must comply fully with this ordinance.
i .'
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may:be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other City transactions. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages. j
It is the Cily's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclo'sing Party waives and releases any possible rights or claims which it may have against the City injconnection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the-Disclosing Party must supplement this EDS up to Ihe time the City takes action on the Matter. If (he Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility musl be kept current for a lo'nger period, as required by MCC Chapter 1 -23 and Section 2-154-020. !
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i
CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, 'on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained injthis EDS, and all applicable Appendices, arc true, accurate and complete as of the date furnished to the City.
(Print or type exact legal name of Disclos
By: CMJ^ (Sign here)
nt or type name of person signing)
X0\ AsvA^s
(Print or type title of person signing) j
Signed and sworn to before me on (date) j ^j/1?^^*^)
OfflVL- County, i (state).
at
¦fotary Public Commission expires:
OAKES
OFFICIAL SEAL
DAVID N
NOTARY PUBUC - SjTATE OF ftUNOtS MY COMMISSION EXPIRES 07/36/22
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I
CljTY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
i APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to he completed only by (a) ihe Applicant, and (b) any legal entily 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.
i
Under MCC Section 2-154-015, the Disclosing Party must disclose whether .-such Disclosing Party or any "Applicable Party" or any Spouse orjDomestic 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 Seciion II.B.l.a., if the Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, if the Disclosing Parly is a limited partnership; all! managers, managing members arjd members ofthe Disclosing Party, if the Disclosing Party is a1 limited liability company; (2) all'principal officers ofthe Disclosing Party; and (3) any person havinglmorc 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.
I i 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?
If yes, please identify below (I) the name and title of such person, (2) the name oflhe legal entily lo which such person is connected; (3) the name and title ofthe elected eity official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
_ . i
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND i 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 pot to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
1. Pursuant to MCC Section 2-154-010, is the Applicant or any Owner scofflaw or problem landlord pursuant to MCC Section 2-92-416?
rtfNo
[ ]Yes
the Applicant identified as a building code scofflaw or problem landlord 2-92-416?
C "]No [£] The Applicant is not public
pursuant to MCC Section y traded on any exchange.
or legal entity identified building or buildings to which
3. If yes to (1) or (2) above, please identify below the name of each person as a building code scofflaw or problem landlord and the address of each the pertinent code violations apply.
4k.
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city or Chicago
ECONOMIC DIM l.OSLRF NTA I'KMENT AND AF1T D A\TT
appendix c:
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to be completed only by an Applicant thai is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www^jijjegaj_._cgni), generally covers a party to any agreement pursuant to which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises.
On behalf of an Applicani that is a contractor pursuant to MCC Seciion 2-92-385, I 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.
LXDYes j'' '
| ] No
[ ] N/A - I am not an Applicant that is a "contractor" as defined in MCC Section 2-92-385. This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(l). If you checked "no" to the above, please explain.
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