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This record contains private information, which has been redacted from public viewing.
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Type:
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Ordinance
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Status:
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Passed
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Title:
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Zoning Reclassification Map No. 17-H at 1952 W Morse Ave - App No. 20971
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Topic:
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ZONING RECLASSIFICATIONS - Map No. 17-H
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Attachments:
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1. O2022-778.pdf
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ORDINANCE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. Title 17 ofthe Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all ofthe RS-2 Residential Single-Unit (detached house) District symbols and indications as shown on Map No. 17H in the area bounded by The alley next north of and parallel to west Morse Avenue: a line 500 feet west of and parallel to North Wolcott Avenue; West Morse Avenue; and a line 550 feet west of and parallel to North Wolcott Avenue to those of a RS-3 Residential Single-Unit (detached house) District SECTION 2. This ordinance shall be in force and effect from and after its passage and due publication. 1952 W. MORSE AVE CHI CAGO, IL 60626 M/VRC,|) 2~3>,W2Z CITY OF CHICAGO APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE ADDRESS of the property Applicant is seeking to rezone: 1952 W. Morse Ave Ward Number that property is located in: 49th Ward 1952 W.Morse LLC APPLICANT ADDRESS - - - CITY L STATE_ ZIP CODE PHONE_ EMAIL CONTACT PERSON Hya Pisarcnko Is the applicant the owner of the property? YES NO If the applicant is not the owner of the property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed. OWNER ADDRESS CITY STATE ZIP CODE PHONE_ EMAIL CONTACT PERSON If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information: ATTORNEY ADDRESS CITY STATE ZIP CODE PHONE FAX EMAIL Pago 1 If the applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements Ilya Pisarenko On what date did the owner acquire legal title to the subject property'.' June 11, 2018 Has thc present owner previously rezoned this property? 11' yes, when? No n . -7 rv . • . Residential RS-2 n <-/ . Residential RS-3 Present Zoning District K-wiucumi tvo Proposed Zoning District Lot size in square feet (or dimensions) 50 by 171 or 8,550 sq. ft Current Use ofthe property Residential 3 unit building with a coach house Reason for rezoning the property Tomeet ^buLkanddensity ofjhe RS3, to allow a sub-division of one zoning lot measuring 50' a 171' info two 2»nm~gTofs,"wi]l demolish" fhe exisfmg""bulIdTngs and allow the construction of-two single family-homes withaccessory 2 car private garages on two separate zoning lots-Describe the proposed use ofthe property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage ofany commercial space; and height ofthe proposed building. (BE SPECIFIC) To meet the bulk and density of the RS3 to allow a sub-division of one zoning lot measuring 50' X 171' into two zoning lots, will demolish the existing buildings and allow the construction of two single family homes with accessory 2 cat private-garages on twoseparate-zoning-ltrtsr The proposed building height will be 29 Feet 3 inches for each home. Proposing two zoning lots each measuring 25X171=4,275 sq. ft. each. The Affordable Requrements Ordinance (ARO) requires on-site affordable housing units and/or a financial contribution for residential housing projects with ten or more units that receive a zoning change which, among other triggers, increases the allowable floor area, or, for existing Planned Developments, increases thc number of units (see attached fact sheet or visit www.cityofchicago.org/ARO for more information). Is this project subject to the ARO?
YES
COUNTY OF COOK STATE OF ILLINOIS
. being first duly sworn on oath, states thai a!! ofthe above
statements and tlie statements contained in the documents submitted herewith arc true and correct.
signature of Applicant ^1/. //2/?cy~tS^ ^ yc
Subscribed jind Sworn jmiefoiy me this
'of .20
I or Office Use Only
Page 3
CERTIFIED SURVEY, INC.
1440 Renaissance Drive, Suite 140, Park Ridge, IL 60068 Phone 847-296-6900 Fax 847-296-6906
Email :'surveys@certificdsurvcy.com
PLAT OF SURVEY
LOT 24 IN BLOCK 48 IN ROGERS PARK IN SECTION 31. TOWNSHIP 41 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN. IN COOK COUNTY, ILLINOIS
20 FT PUBLIC ALLEY CHAIN LINK FENCE GATE
50.0
NORTH FACE OF FENCE 0 56 SOUTH & WEST FACE 0 58 EAST HAIN LINK FENCE GATE
CONCRETE CURB
W. MORSE AVENUE
DIMENSIONS ARE NOT TO BE ASSUMED FROM SCALING
ORDER No. 180285
DATE: DECEMBER 15. 2021 ORDERED BY: ILYA PISARENKO
BUILDING UNES AND EASEMENTS ARE SHOWN ONLY WHERE THEY ARE SO RECORDED IN THE MAPS OTHERWISE REFER TO YOUR DEED OR ABSTRACT
01=1/8" 02=1/4" 03=3/8" 04=1/2" .05=5/8" 06=3rt"
50=6" 58=7" 67=8" 75=9"
.63=10" 92=11-
1 0=12"
DECIMALS OF FOOT AND TOEIR EQUIVALENT IN INCHES AND FRACTIONS THEREOF.
.17=i2-25=3" 33=4" 42=5"
¦\.-.£-.035-003408: gi : \ PARK RIDGE.; ; -¦•ILLINOIS .•• -
'¦f* of ivaS*!.^
COMPARE Aa POINTS BEFORE BUILDING BY SAME AND AT ONCE REPORT ANY DIFFERENCE
„.„ „ THIS PROFESSIONAL SERVICE CONFORMS TO
?™ «™ ™ q« THE CURRENT ILLINOIS MINIMUM STANDARDS
1 T ur 5,11 FOR A BOUNDARY SURVEY. MONUMENTS NOT
SET PER REQUEST OF CLIENT.
WE CERTIFIED SURVEY, INC DO HEREBY CERTIFY THAT WE HAVE SURVEYED THE ABOVE DESCRIBED PROPERTY AND THAT THE PLAT HEREON DRAWN IS A CORRECT REPRESENTATION OF SAID SURVEY
PROFESSIONAL ILLINOIS LAND SURVEYOR LICENSE EXPIRES NOVEMBER 30. 2022 PROFESSIONAL DESIGN FIRM NO 164-006491
'WRITTEN XOfk.r." FORM OF affidavit (Section i7-!.;-0i()7)
Date March 1, 2022
Honorable Thomas M. Tunney Chairman, Committee on Zoning 121 North LaSalle Street Room 304, City Hall Chicago, Illinois 60602
The undersigned, 1952 W. Morse LLC flya Pisarenko ^ , being first duly sworn on oath deposes and states the following:
The undersigned certifies thai he has complied with the requirements of Section 17-13-0107 of the Chicago Zoning Ordinance, by sending written notice to such property owners who appear to be the owners ofthe property within the subject area not solely owned by tlie applicant, and Lo the owners of all property within 250 feet in each direction ofthe lot line ofthe subject property, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. Said "written notice" was sent by First Class U.S. Mail, no more than 30 days before tiling the applicalion.
The undersigned certifies that the notice contained the address ofthe property sought to be rezoned; a statement of the intended use ofthe property; the name and address ofthe applicant; the name and address ofthe owner; and a statement that the applicant intends to file the application for a change in zoning on approximately {INSERT DATE}.
March 23, 2022
The undersigned certifies that thc applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-0107 ofthe Chicago Zoning Ordinance, and that the accompanying list of names and addresses of surrounding property owners within 250 feet ofthe subject site is a complete list containing the names and addresses of the people required to be served.
March 1, 2022
Dear Property Owner:
In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance,, specifically section 17-13-0107, please be informed that on or about March 23, 2022, the undersigned will file an application for a change in zoning from RS2 to RS3 on behalf of the applicant 1952 W. Morse LLC for the property located at 1952 W. Morse Ave.
The applicant intends to subdivide and demolish existing buildings to build two new single-family homes with a 2-car garage for each home. Each home would be built according to the specifications discussed during our community meetings.
The applicant and owner 1952 W. Mores LLC is located at c/o llya Pisarenko 7300 Cicero Ave Lincolnwood, IL 60172. The contact person for this application is llya Pisarenko 7300 Cicero Ave Lincolnwood, IL 60172 . "
Please note that the applicant is not seeking to rezone or purchase your property. The applicant is required by law to send this notice because you own property within 250 feet ofthe property to be rezoned.
Very truly yours.
ci i v or < iH< \<;o
E C <> N <) MIC I) IS C1 () S11R K S ! A I I: MI N I AND Al FID \V! I
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d-'bv'a/ il applicable: 1952 W. Morse LLC
Check ONE ofthe following three boxes:
indicate whether thc Disclosing Party submitting iiiis EDS is:
(_^J thc Applicant
OR
QJ a legal entity currently holding, or anticipated io hold within six months alter City action on
the contract, transaction or other undertaking to which this EDS pertains (referred lo below as ihe
"Mailer"), a direct or indirect interest in excess of 7.5% in thc Applicant. Slate thc Applicant's legal
name: _ _ _ _
7300 Cicero Ave Lincolnwood, IL 60172
OR~""""""¦
[~] a legal entity with a direct or indirect right ol* control ofthe Applicant (see Section Ii(B)( I')) State the legal name ofthe entity in which thc Disclosing Party holds a tight of control:
B. Business address ofthe Disclosing Party
Telephone: - ¦ • -_ Fax: _ Email: m_
Name of contact person: ^ Pisarenko
H. Federal Employer Identification No. (if you have one): N/A _
F. Brief* description ofthe Matter to which this EDS pertains. (Include project number and location of" property, if applicable):
We are seeking a zoning change for the property located at 1952 W. Morse Ave from RS 2 to RS3.
G. Which City agency or department is requesting this EDS? DPP Bureau ot ^^"g
[fthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification
SECTION II - DISCLOSURE OE OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY I. Indicate the nature of tlie Disclosing Party:
Person Q] Limited liability company
Publicly registered business corporation [~] Limited liability partnership
Privately held business corporation Q| Joint venture
Sole proprietorship [~] Not-for-profit corporation
General partnership (Is the not-for-profit corporation also a 501 (c)(3))'.'
Limited partnership _ Yes No
Trust [~] Other (please specify)
2. For legal entities, thc state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign enlity?
Q] Yes ? No [X] Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
I. 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, ifany, 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 parly; (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.
NOTK: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
llya Pisarenko Managing Member
Aleksandr Kagan Managing Member
2. Please provide the following information concerning each person or legal entity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including ownership) in excess of 7.5% ofthe Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest ofa member or manager in a
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!ist.iled !!ab1111\ eomparr*. or interest oi' :i hetiet':eiary oi a !.r<.is:. estate or other similar entity. 1:' none. Mate "None."
NOTE: Each legal entity listed below may be re qui red to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
llya Pisarenko 7300 Cicero Ave Lincolnwood, IE 60172 " 100 percent
SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Patty provided any income or compensation to any Cily elecled official during the
12-month period preceding the date of this EDS ' j~~J Yes [x] 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 dale oflhis EDS? QJ Yes Q] No
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?
QYes Q] No
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partncr(s) and describe the financial intercst(s).
SECTION IV- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
Thc 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 ofthe relationship, and thc total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who arc paid solely through the Disclosing Party's regular payroll. Iflhe Disclosing Party 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.
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Name (indicate whether Business Relationship to Disclosing Party hoes (indicatc whether
retained or anticipated Address (subcontractor, atiornoy, paid or estimated.) NO TK:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response
(Add sheets if necessary)
fx] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDF.RFD 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.
Mas 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';'
r~J Yes [TJ No QJ 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."
? Yes Q No
FURTHER CERTIFICATIONS
[This paragraph 1 applies only ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date of this EDS, neither the Disclosing Party nor any Affiliated Entity [see 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 entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor thc 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 Entities are not delinquent in the payment ofany 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 thc Disclosing Party delinquent in the payment ofany tax administered by the Illinois Department of Revenue.
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.5 I he Disclosing Party and. ii thc Disclosing Panv :s :i legal entity, ai! oi" those persons or cntiiies. identiHed in Section Il( B){ 1) of this HDS.
a. are not presently debarred, suspended, proposed ior debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unu of government;
b have not, during the 5 years before the date of this HDS, 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, stale 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 tins 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. stale, or any oilier 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 (C jo ven i men ii il Ethics).
Certifications (5), (6) and (7) concern:
• the Disclosing Party;
° any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Parly 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 thc 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 thc same management, ownership, or principals as thc ineligible entity. With respect to Contractors, the term Affiliated Enlity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with thc Contractor, is under common control of another person or entity;
• any responsible official ofthe 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 ofa responsible official ofthe Disclosing Party, any Conlractor or any Affiliated Entity (collectively "Agents").
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Neither the Disclosing Party, nor any (.'oniraetor. nor anv .ASTiiiaieii Entity oi'eitiier ti'.e Disclosing Parly or any Conlractor, nor any Agents ha\e. during the 5 ycais before the date of this 1;DS, 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 Affihaied Entity's contract or engagement m connection with thc Mattel-:
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)(Contract.s 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 from contracting with any unit of state or local government as a result of engaging in or being convicted off I) 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 ofany stale or of thc United States of America thai contains thc same elements as the offense of bid-rigging or bid-rotating.
Neither thc Disclosing Parly nor any Affiliated Entity is listed on a Sanctions List maintained by thc United States Department of Commerce, State, or Treasury, or any successor federal agency.
X. [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 involving actual, attempted, or conspiracy lo 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 understands and acknowledges that compliance with Article I is a continuing requirement fordoing business with the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, that 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 active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors lured 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 ofthe City, use any such
Ver.2018-1 Page 6 of 15
contractor/subcontractor ilia; doe> noi provide such certifications or that iht: Applicant has reason io believe has not provided or cannot provide truthful certification.-!.
I !. Ifthe Disclosing Party is unable to certify to any ofthe above .statements in this Part B (Further Certifications), the Disclosing Party must explain below.
Ifthe letters "NA," the word "None," or no response appears on the hues above, ii. 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 of the Disclosing Party who were, at any time during the 12-month period preceding the date of this FDS. an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").
1.3. To the best of the Disclosing Party 's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during thc 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, ofthe City of Chicago. For purposes oflhis 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 thc 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 below, please also list the name ofthe City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL. INSTITUTION
The Disclosing Party certifies that thc Disclosing Party (check one)
| | is [xj is not
a "financial institution" as defined in MCC Section 2-32-45.")(b).
Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"We arc 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. Wc understand that becoming a predatory lender or becoming an affiliate ofa predatory lender may result: in the loss ofthe privilege of doing business with the City."
Page 7 of 15
if the Disclosing Panv is unable to make this pledge because it or any of its affiliates i;;s def.neu m MCX'.' Section 2-32-455(b)) is a picclatory lender -.vii;;; the meaning of MCC Chapter v explain here (attach additional pages if necessary):
Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified io the above statements.
D. CERTIFICATION REGARDING FINANCIAL IN TEREST IN CITY BUSINESS
Any words or terms defined in VICC Chapter 2-1 56 have the same meanings if used in this Part D.
I. In accordance with MCC Section 2-156-1 10: To the best ofthe Disclosing Parly's knowledge after reasonable inquiry, does any official or employee ofthe City have a financial'interest in his oilier own name or in the name ofany other person or entity in the Matter?
Yes
NOTE: If you cheeked "Yes" to Item D( I), proceed to Items D(2) and D(3). If you checked "No" to Item D( I), skip Items D(2) and D(3) and proceed to Part E.
2. 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 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 intei est within the meaning of this Part D.
Does the Matter involve a City Property Sale?
? Yes
3. If you checked "Yes" to Item D( I), provide the names and business addresses ofthe City officials or employees having such financial interest and identify the nature ofthe financial interest:
Name Business Address Nature of Financial Interest
4 The Disclosing Party further certifies lhat no prohibited financial interest in the Matter will be acquired by any City official or employee.
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!• ("ER I IFiCATlON RK( lARDiNG Sl.,\Vi.;!\Y ERA BUSINESS
Please chock either { ! i or il) below. Iflhe Disclosing Party checks (}. the Disclosing Party must disclose below or in an nitachmen! to this EDS ad information required by (.1) failure to comply with, these diseiosure requirements may make any contract entered into with the City in connection with the Matter voidable by the Cily.
1* 11. The Disclosing Party verities that thc Disclosing Parly lias searched any and all records of thc Disclosing Party and any and all predecessor entities regarding records of investments or pro ills 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
I I 2. The Disclosing Party verities that, as a result of conducting the search in step (I) above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Parly verifies thai the following constitutes full disclosure of all such records, including the names ofany 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. For 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
I. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: ( Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered underthe 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 enlity to influence or attempt to influence an officer or employee ofany agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Vct.ZOIX-I Pago 9 of 15
ofa member of Congress, in coiir.eciior: \>, ;th the award of anv federally (muled contraeL making any federally Ksridetl grant or loan, entering m'o any eooperaiive agreement, oi to extend, continue, renew, amend, or modify any federally funded contract, gram. loan, or cooperative agreement.
The Disclosing Party will submit an updated certification at thc end of each calendar quarter iu which there occurs any event, that materially affects the accuracy ofthe statements and information set forth, in paragraphs A( 1) and Ai 2) above.
The Disclosing Party ecrtilies thai either: (i) i! is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of I c>86; or (ii) il 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 thai term is defined in the Lobbying Disclosure Act of 1995, as amended.
Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs Afi ) lluough A(4) above from all subcontractors before ii awards any subcontract and the Disclosing Parly must maintain all such subcontractors' certifications lor ihe duration ofthe Matter and must make such, certifications promptly available to the City upon request
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
Ifthe 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 thc outset of negotiations.
Is thc Disclosing Partv the Applicant'' QYes ' ' [J No
If "Yes," answer the three questions below:
Have you developed and do you have on fiie affirmative action programs pursuant to applicable federal regulations? (Sec 41 CFR Part 60-2.)
QYes QNo
Have you filed with thc 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 Q^0 i l^cPorts not required
Have you participated in any previous eontraets or subcontracts subject to the equal opportunity clause?
Yes ' ? No
If you checked "No" to question (1) or ( 2) above, please provide an explanation:
Page 10 of 15
SECTION VII - MR 1 HER ACKNOW LEDGMENTS AND CERITI I< A HON
The Disclosing Party undoi stands and agrees that.
'The certifications, disclosures, and ac !•:«\ o w i edgmei t ts contained in this EDS will become pan ofany contract or other agreement between the Anplicani 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 ofany contract or taking other action with respect to the Matter. The Disclosing Parly understands that it must comply with all statutes, ordinances, and regulations on which this HDS 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.cityofchicauo.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N!. Sedgwick St., Suite 500, Chicago, IL. 60610, (3 12) 744-9660. Thc Disclosing Party must comply fully with this ordinance.
Ifthe City determines that any in formal ion 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), al 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.
It is the City's policy to make ibis 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 lo a f reedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which if may have against thc City in connection with thc public release of information contained in this EDS and also authorizes the City to verify the accuracy ofany information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, thc Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. Ifthe 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), thc information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-1.54-020.
hen- 1 1 of 15
C'EKTiriCATION
Under penalty of perjury, inc person signing below ( i) warrants that he/she i>. authorized to execute tins II DS, and til! applicable Appendices, on behalf ofthe Disclosing Party, and (2) warrants that all certifications and statements contained m this HDS. and all applicable Appendices, are true, accurate and complete as ofthe date furnished to tlie Cily.
1952 VV. Morse LLC
(Print or lypcja^t legal name of Disclosing Parly)
'I.Sign here) llya Pisar enko
(Print or type name of person signing)
Managing Member
(Print or type title of person signing)
Signed and sworn to before me an (date),
(state).
NyotaryyP/blic Commission expires: _fflHi
iydllM0^.
LEJLA S1NAN0VIC Official Seal Notary Public ¦ State of Illinois , b | My Commission Expires Aug 30, 2022
Page 12 of 15
cm or chk ago
ECONOMIC DISCLOSURE STATEMENT AND AEEIDAV5T
APPENDIX A
KA.VIII JAI. RELATIONSHIPS WITH ELECTED CU V 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 cily 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 (I) all executive officers ofthe Disclosing Party listed in Section II.B.I.a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Parly, ifthe Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) ail principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president., chief operating officer, executive director, chief financial officer, treasurer or secretary ofa legal enlity or any person exercising similar authority.
Docs the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with un elected city official or department head?
xi No
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 lo whom such person has a familial relationship, and (4) the precise nature of such familial relationship
Page \^ of 15
CITY or CHICAGO EC ONOMIC DISCLOSURE STATEMENT AND AEEIDAY'IT
APPENDIX B
BUILDING CODE SCOFF 1. A \V/ P R O B LEM 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 thc Applicant exceeding 7.5% (tm "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
I. Pursuant lo MCC Section 2-1 54-0i0, is ihe Applicant or any Owner identified as a budding code scofflaw or problem landlord pursuant lo MCC Section 2-92-416?
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?
| j Yes F~j No [xj 1 he Applicant is not publicly traded on any exchange.
If yes to (I) 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.
I'aize 14 of 15
(ii v oi Chicago
ECONOMIC DISC i OS! Rl Si A II MEN I AND A ITT i> A VII
APPENDIX C
PROHIBITION ON WAGE oi SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to be completed only by an Applicant: that is completing this HDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www .am legal, com), generally covers a party to any agreemeiu pursuant to which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (including lor legal or other professional services), or (ii) pay the Cily money for a license, gram, or concession allowing them to conduct a business on City premises.
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-3X5, I hereby certify thai the Applicant is in compliance with MCC Section 2-92-385(b)( I) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (if) seeking job applicants' wage or salary-history from current or former employers 1 also certify that the Applicant has adopted a policy that includes those prohibitions.
Y-
No
[~x| N/A ¦•¦ 1 am not an Applicant that is a "contractor" as defined in MCC Section 2-92-3X5. This certification shall serve as Ihe affidavit required by MCC Section 2-92-385(c)( I). If you cheeked "no" lo the above, please explain.
Page- 15 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND VI I IDA Vi I
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Parly submitting Lhis FDS. Include d/b/a/ if applicable: llya Pisarenko
Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this HDS is.
thc 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 HDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 1.5% in the Applicant. Slate the Applicant's legal
name: _ _ _
or'"~~'
Q a legal entity with a direct or indirect right of control ofthe Applicant (sec Section li(B)( 1)) State the legal name ofthe entity in which the Disclosing Party holds a right of control:
B. Business address ofthe Disclosing Party: 7300 Cicero Ave
Lincolnwood, IL 60172
Telephone: Fax: __ Email:
Name of contact person: "7* Pisarenko
Federal Employer Identification No. (if you have one): ^Jj^
F. Brief description ofthe Matter to which this EDS pertains. (Include project number and location of property, if applicable):
We are seeking a zoning change for the property located at 1952 W. Morse Ave from RS 2 to RS3.
G. Which City agency or department is requesting this EDS? DPP Bureau of Zoning
Ifthe Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification// ._ _ _ and Contract #
Ver.20iS-l Page 1 of 15
SECTION II - DISCLOSURE Ol OWNERSHIP INTERESTS
A. NATURE OF' THE D
I. Indicate the nature of the Disclosing
x Person
Publicly registered business corporation Privately held business corporation
Sole pro p ri e lorsh i p G e n c r;.i I p a rt n e rs 1i p Limited partnership
i j Limited liability company
Limited liability partnership | | Joint venture
Nol-for-profil corporation (Is the not-for-profit corporation also a 50 1 (e)f3))''
[_ j Ves 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
B. IF THE DISCLOSING PAR TY IS A LEGAL ENTITY:
I. 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, ifany, which are legal entities (if there are no such members, write "no members which are legal entities"); (hi) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated parly; (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 thc day-to-day management ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
llya Pisrenko
2. Please provide the following information concerning each person or legal enlity 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 ofa member or manager in a
Page 2 of 15
imi ited habihi \ compa:i v. or m tercel •¦ ¦ '¦' a here •;:ciary o i a trusl. estate -or othei si i: iar cui i tv. ! i' nunc, stale "None ''
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Addiess Percentage interest in the Applicant
llya Pisarenko 7300 Cicero Ave Lincolnwood, IL 60172 100 percent
SEC TION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation lo any Cily elected official during the
12-month period preceding thc date of this EDS'' j Yes jjc] No
Docs the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during thc 12-rnonth period following thc date of this EDS ' Yes jxj No
If "yes" lo either ofthe above, please identify below the name(s) of such City elected offieial(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 elecled 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? -
Yes x No
If "yes," please identify below the name(s) of such City elected official(s) and/or spouses/domestic partncr(s) and describe thc financial interest(s).
SECTION IV- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
Thc 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 ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who arc paid solely through the Disclosing Party's regular payroll. Ifthe Disclosing Party is uncertain whether a disclosure is required tinder thus Section, the Disclosing Parly must either ask the City whether disclosure is required or make the disclosure
Page 3 of 15
(Add sheets if necessary)
[x~[ Cheek here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities SECTION V -- CERTIFICATIONS
A. COUR'I"-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92.-41 5. substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout Ihe 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 obhgaiions by any Illinois court of competent jurisdiction?
i j Yes |Tj No 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'.'
Q Yes Q No
13. FURTHER CERTIFK A'I'lONS
[This paragraph I applies only ifthe 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 thc Disclosing Party nor any Affiliated Entity [sec definition in (5) below] has engaged, in connection with thc performance ofany public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other-similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts m the future, or continue with a contract in progress).
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 thc Illinois Department of Revenue.
3 :1k: Disclosing Parts and, iii;; ! iisciosiiig Parry is a legal cniiiy. all of :!u<>e persons or endues identified m Sec! ion ll(Is)( 1 .'' of in:.-: EDS'
a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded irom any transactions by any iedeiai. state or local unit of government;
b 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 io obtain, or performing ti public (federal, stale or local) transaction or contract under a public transaction, a violation of federal or state antitrust statutes; fraud: embezzlement; theft; forgers: bribery; falsification or deslruction of records: making false statements; or receiving stolen proportv:
are not presently indicted for, or criminally or civilly charged by. a governmental entity l federal, state or local) with committing any ofthe offenses set forth in subparagraph (b) above;
have not, during the 5 years befoie 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 dale of this EDS, been convicted, adjudged guilty, or iounCi 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.
4. The Disclosing Party understands and shall comply with the applicable requirements of MCC
Chapters 2-56 (Inspector Genera!) and 2-156 (Governmental Ethics).
5. Certifications (5), (6) and (7) concern:
«> the Disclosing Party:
o 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 thc 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 of a 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 entity. With respect to Contractors, thc 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 ofthe Disclosing Party, any Contractor or any Affiliated Emily or any other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization ofa responsible official ofthe Disclosing Parly, any Contractor or any Aflilialed Entity (collectively "Agents").
Pas;e 5 nf 15
Neither 'l;e De».'ies;:!:.: faiiv. ¦ anv { om-jceae nor any .-\i'i'iliaiCii Lniev ;•¦! either the Disclosing Parly or any Cera racior, nor aey A "ems have, during the 5 years no I'd re the dale oflhis LDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Lntity of a Contractor during the 5 yctrs before the date of such Contractor's or Affiliated Unhty's contrac: oi engagement in connection with Ihe Mailer.
;i. bribed or attempted to bribe, ov been convicted or adjudged guilty oi 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 iii local government in thc United Slates of America, in that officer's or employee's official capacity:
h 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
e. 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
d. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage); (a)(5)(Dcbarment Regulations); or (a)(6)(Minimum Wage Ordinance).
Neither the Disclosing Pany. nor any Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred f rom contracting with any unit of state or iocal government as a result of engaging in or being convicted of (I) 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 ofany 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 Lntity is listed on a Sanctions List maintained by the United Slates Department of Commerce, State, or Treasury, or any successor federal agency.
S. [FOR APPLICANT ONLY] (i) Neither thc Applicant nor any "controlling person" [sec 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, dishonesty or deceit against an officer or employee ofthe City or any "sister agency"; and (ii) thc Applicant understands and acknowledges that compliance with Article I is a continuing requirement fordoing business with the City. NOTE: If MCC Chapter 1-23, Article I applies to thc Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
[FOR APPLICANT ONLY] Thc Applicant and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain irom any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not. without thc prior written consent ofthe Cily, use any such.
Ver.eOiS-l Page 6 of 15
such CcP ; . icaUo.a
believe has no! provided or eanr.oi provide truthful certifications
uio above statements m tm
I I. ii'the DiseiosiMg Party is enable to eertiiy t;i any of l Certifications), the Disclosing Party must explain below:
Ii'the letters "NA," the word "None," or no response appears on ihe lines above, it wili be conclusively presumed thai 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 of the Disclosing Party who were, al any time during the 1 2-month period preceding the date of this FDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with ''N/A" or "none").
13. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, ihe 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-moiith period preceding the execution date of this FDS, to an employee, or elected or appointee! official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to Cily employees or to the general public, or (ii) food or drink provided in thc 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 iisted below, please also list the name of thc City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
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 Chapter 2-32. Wc understand that becoming a predatory lender or becoming an affiliate ofa predatory lender may result in the loss ofthe privilege of doing business with the City."
V,t ?0! 8-! Page 7 of 15
If thc letters "NA," the word "None," or no response appeal's on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTER ESI" IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
I. In accordance with MCC Section 2-156-i 10: To the best ofthe Disclosing Party's knowledge
after reasonable inquiry, does atty official or employee of die City have a financial interest m his or her own name or in the name ofany other person or enlity in the Matter?
[j Yes 0 No
NOTE: If you checked "Yes" to Item D( I ), proceed to Items D(2) and D(3). If you cheeked "No" to Item 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 interest 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 r£J No
If you checked "Yes" lo Item D( 1), provide the names and business addresses ofthe Cily officials or employees having such financial interest and identify the nature ofthe financial interest:
Name Business Address Nature of Financial Interest
4. Thc Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee
Page 8 of 15
h. CER ! JEiCA "i SUN REX IA Ri.)! :V. I SLA VER V E!-' A BUSINESS
Please check cithci i i ¦ or below if tho Disclosing Party checks ;2). the Disclosing Parly must disclose below or m at; attachment to tins LDS all information required by (?.). failure to comply with these disclosure requirements may make any contract entered into with the City in connection with die Matter voidable by the City
HH I. The Disclosing Party verities that tlie Disclosing Parly has searched any and al! records of the Disclosing Party and any and all predecessor entities regarding records of investments or pro ills Irom 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.
I I 2. The Disclosing Party verifies that, as a result of conducting the search in step i I) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Parly verifies that the following constitutes full disclosure ofailsuch records, including the names ofany 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 VL If the Matter is not federally funded, proceed to Section VIE For 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
I. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to thc Matter: (Add sheets if necessary):
(If no explanation appears or begins on ihe lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means lhat NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of thc Disclosing Party with respect to the Matter.)
2. Thc Disclosing Party has not spent and will not expend any federally appropriated funds to pay
any person or entity listed iii paragraph Ai!) 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
Ver 201,S-1 Page 9 of 15
ofa member of Congress, m ciamec;ion with me award ofany federally funded ooiUrace making any federally funded gran! or loan. cniering m;o ai.y cooperative agreement, or to ox tend. continue, rcr;e\v, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
.3 The Disclosing Party will sebum, an updated certification at the end of each calendar quarter in which there occurs any event thai materially affects the aecuiacy o! the statements and information set forth in paragraphs A(!) and A(2 ) above.
fhe Disclosing Party certifies thai either: (i) il 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 hut. has not engaged and will not engage in "Lobbying Activities," as lhat term is defined in ihe Lobbying Disclosure Act of 1995 as amended.
Ifthe Disclosing Party is the Applicant, the Disclosing Parly must obtain certifications equal in form and substance to paragraphs A( i) through A(4) above from ail 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
Ifthe Matter is federally funded, federal regulations require the Applicant and ail proposed subcontractors to submit tlie following information with their bids or in writing al the outset of negotiations.
Is the Disclosing Party the Applicant?
Q 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 ? No
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 r~j No j~~JReports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
Yes Q No
If you checked "No" to question (1) or (2) above, please provide an explanation.
l'ajjo 10 of 15
SIX HON Vii 1 l it I HER A(' K N O W1. F. IX; :M I-. NT'S AND CHRTU K Al ION
The Disclosing I'ariv understands and agrees lhat:
The certifications, disclosures, and acknowledgments contained m th;> HDS w ill become pan. of am, contract or other agreement between the Applicant and the City in eonneeiiu,: with tlie Matter, whether procurement, City assistance, or other Caty action, and arc material inducements to the City's execution ofany contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, arid regulations on which this EDS is based.
The City's Governmental hthies Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full texl of this ordinance and a training program is available on line at w\yw.cityofchicagp,org/f{tl)i and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago. II. 60610. (312) 744-9660. Thc Disclosing Party must comply,fully with this ordinance.
Ifthe City determines that any information provided in this HDS 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 noi 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 Cily 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. Some or all ofthe information provided in, and appended to, this HDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this HDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this FDS and also authorizes the City to verify the accuracy ofany information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, thc Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If thc Matter is a contract being handled by thc City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTK: 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 must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
Page II of 15
i in i n il a 1ion
Under penalty oi'perjury, the person .signing below: (I} warrants thai heshe is authorized to execute this EDS. and all applicable Appendices, on behalf oi' the Disclosing Party, and [2) warrant's that all certifications tine! statements contained m this {{DS. and all applicable Appendices, are true, accurate and complete as ofthe date Punished to the City.
llya Pisarenko
(Print or type name of person signing) Owner
Page 12 of 15
cn \ or Chicago
I ¦ OVOMK !)ls{ I. OSI RI. SIX) FM! NT AN!) Al l 'IDA VI !
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED C ITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) thc Applicant, and (b) any legal entity which lias a direct ownership interest in the Applicant exceeding 7.5%. It is not lo he completed by anv 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 thc date this HDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is relaied to the mayor, any alderman, the city clerk, the city treasurer or any cily 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 II.B.I.a., iflhe Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Parly, iflhe Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, ifthe Disclosing Parly is a limited liability company; (2) all principal officers ofthe Disclosing Parly; 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 ofa 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?
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 familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 15
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\PIMM);A H
BUI.DING GODi- PROBLEM LANDLORD CEKTIFICYi JON
Tins Appendix is f.ii be completed only by (ai the Applicant, and (hi any legal entity which ha:, a diiv\:! oiv nci'sinp n\o; esi m the Appiicau; exceeding 7.5% (an "Owner"i. U is noi to i:>o eonipi.ei.cd by any legal eiiPiv vs!;io 1: has oni; a;: indirect ownership interest in the Applicant.
1. Pursuant to VK.'C Seeiion : • i 5 ¦¦- 0 i 0, is the Applicant or any Owner identified as a building code scni flaw *.;r problem landlord pursuant to \K'(.' Section 2 - D-4 i 6'.'
2. I f the Applieaiii is a Sega; entity publicly traded oil any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to \1( \ ' Section
2A>2-
? Yes
3. If ves to (F; or (2) above, please identify below thc 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 per'ineiil code viola!ions apply
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APPFNOIX <
PROH1 1>I i SOX ON W KCV & SALARY HISTORY SCRl FMNC CPU i M'iCA i."SON
'fins Appendix Is to be completed only by an Applicant that is completing this FDS a-, a "contractoi" as deilaed in \:Cv Section .'. VAAAA That seciion, uhica should he consumed (syyvyyaunie;.;ai.con;), generally cove: - a pari-. m an.; a-yvepi ai! pursuant to which 'iiey: (i) receive Ciu of Chicago funds in consideration for serv ices, work or goods prov ided (including lor legal or oiher professional services), or (iii pay the City money for a license, gram oi; concession allowing theni to conduct a business on City piepiises.
On behalf id'an Applicant that is a contractor pursuant to MCC Section /" A; AS 5. 1 here by certify thai the Applicant is in compliance with MCC Section 2-92-385(b)( 1) and (2), w hich prohibit: (i) screening job applicant- 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 than includes those prohibitions.
Y™
No
j'xj N A 1 am noi an .Appbeaii! that is a "'contractor" as defined iii MCC Section ! ¦}>':¦ This ceniiicatioi) shall serve as the affidavit required by MCC Section 2-v"2-385(c)( h. if you cheeked "no" to the a :•. w a. piease explain.
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