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Record #: O2022-851   
Type: Ordinance Status: Passed
Intro date: 3/23/2022 Current Controlling Legislative Body: Committee on Zoning, Landmarks and Building Standards
Final action: 4/27/2022
Title: Zoning Reclassification Map No. 5-I at 2536 W North Ave - App No. 20986
Sponsors: Misc. Transmittal
Topic: ZONING RECLASSIFICATIONS - Map No. 5-I
Attachments: 1. O2022-851.pdf
ORDINANCE


BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:


SECTION 1: Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all ofthe B3-1 Community Shopping District symbols and indications as shown on Map No. 5-I in the area bounded by

The alley next North of and parallel to West North Avenue; a line of 19.81 feet west of and parallel to North Maplewood Avenue; a line of 60.43 feet North of and parallel to West North Avenue; a line 22.85 feet West of and parallel to North Maplewood Avenue; West North Avenue; And a line 49.45 feet west of and parallel to North Maplewood Avenue




To those of a B3-2 Community Shopping District


SECTION 2: This ordinance shall be in force and effect from and after its passage and due publication.






















2536 W. North Ave, Chicago IL 60647

'X N-7 Rc D/}T£



APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE

ADDRESS ofthe property Applicant is seeking to rezone; 2536 W. North Ave Chicago IL 60647

Ward Number that property is located in 1 st Ward
Blair Rockoff
APPLICANT
ADDRESS »36 W. North Ave CITY
IL 60647 3125053828
STATE ZIP CODE PHONE
blair@rocksolidhealth.net Blair
EMAIL CONTACT PERSON

Is the applicant the owner or the properly? 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 die owner allowing the application to proceed.

OWNER

ADDRESS CITY

STATE ZIP CODE PHONE

EMAIL CONTACT PERSON

If the Applicant/Owner oflhe property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY
ADDRESS
CITY STATE ZIP CODE
PHONE |99|__ _ FAX _ _ _ EMAIL






Payc 1

If iho applicant is a legal entity (Corporation; LLC. Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.

Blair Rockoff
On what date did the owner acquire legal title to the subject property? December 8, 2021.
Has the present owner previously rezoned this property? if yes, when?
No



B3-1 B3-2
Present Zoning District Proposed Zoning District
3300
10. Lot size in square feet (or dimensions)
Existing 1 story building
11. Current Use of the property
To meet the bulk and density of the B3-2 to allow the
Reason for rezoning the property
conversion by adding 3 dwelling units and to constrct a new 2 story addition above the existing story
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)
This property will have an of addition 3 dwelling units after the rezoning. 2 new units on the 2nd floor and 1
on the 3rd floor; existing/proposed. Height of bilding: 37-0". Current building has an attached garage that
cunenily fits 1 car but cualcfpotentiatlyfir-2:


14. The Affordable Requrements Ordinance (ARO) requires on-site affordable housing units and/or a financial contribution for residential housing projects wilh ten or more units that receive a zoning change which, among other triggers, increases the allowable floor area, or, for existing Planned Developments, increases the number of units (sec attached fact sheet or visit www.cityofchicago.org/ARO for more infonnation). Is this project subject to the ARO?

YES NO ^




Psge 2
COUNTY OF COOK STATE OF ILLINOIS


, being first duly sworn on oath, slates that all ofthe above
statements and the statements contained in the documents submitted herewith are true and correct.

VciificrJ l>y pdtFillcr


Signature of Applicant

9-
Subscribed and Swom to before me this
°) day of fe/xv^r/ , 20


"OFFICIAL SEAL" CHRISTINE M PALKOVIC NOTARY PUBLIC, STATE OF ILLINOIS > MY COMMISSION EXPIRES 11/29/2023 >





Date of Introduction:
File Number:_ Ward:
PLAT OF SURVEY
LOT "A" BEING A CONSOLIDATION OF LOTS 19 AND 20 IN BLOCK 2 IN GOTSIORD'S SUBDIVISION OF GLOCK I IN W S JOHNSTON'S SUBDIVISION OF IMF- FAST 1/2 OF THf: SOUTH EAST 1W OF SECTION 36. TOWNSHIP 40 NORTH. RANGE 13 FAST OF THE THIRD PRINCIPAL MERIDIAN. HXCEPTING I HERhFROM THAI PART DESCRIBED AS FOLLOWS
BEGINNING A~ fl IE SOUTH EAST CORNER OF SAID LOT A 1 HENCE WEST Al ONG THE SOUT11 LINE THEREOF 2? 05 FEET TO Tl If CENTER LINE OF A 16 1/2 INCH BRICK WALL AS PRODUCED SOUTH TO THE SOUTH LINE OF SAID LOT A. THENCE NORTH ALONG 1 HE CENTFR LINE OF SAID 16? INCH BRICK WAI I. AND SAID CFNIER LINE AS PRODUCED 60 43 FFET TO ITS INTERSECTION WITH A 16 1/2 INCH BRICK WALL TO THE EAST, THENCE EAST ALONG THE CENTER LINE OF THE LAST DESCRIBED 16 1/2 INCH BRICK WALL 2 64 FEET TO THE LINE OF THE EAST FACE OF A 1 STORY BRICK BUILDING AND PRODUCED SOUTH TO THE CENTER LINE OF SAID 16 1/2 INCH BRICK WALL. THENCE NORTH A^ONG THE LINE OI: THE EAST FACE OF SAID 1 STORY BRICK BUILDING AND SAID LINE AS PRODUCED 59 64 FEET TO THE NORTH LINE OF SAID LOT A THENCE EAST ALONG THE NORTH LINE OF SAID LOT A, 19 81 TEET TO THE NORTH EAST CORNER OF SAID LOI A. THENCE SOUTH ALONG THE EAST LINE OF SAID LOT A, 120.07 FEET TO THE PLACE OF BEGINNING. IN COOK COUNTY, ILLINOIS
LAND TOTAL AREA 3325 SQ FT
COMMONLY KNOWN AS 2536 WEST NORTH AVENUE, Cl HCAGO, ILLINOIS
PIN 1336429023 —
30
16 00 FEET PUBLIC (ASPH PAVED) ALLEY

FOUND CROSS NOTCH J cowc 2.18'S. & ON LINE EXT.
(MEAS & REC.)
29.34'
26.30'
(MEAS. & REC.)

JL
CONC CURB
NORTH AVE.









NO DIMENSIONS SHOULD BE ASSUMED BY SCALE MEASUHMENTS UPON THE PLAT
BOUNDARY DIMENSIONS ARE BASED ON THE PUBLIC RECORDS AND/ OR DESCRIPTION PROVIDED
FOR LEGENDS SEE OTHER SIDE OF THIS PAGE.
THIS PROFESSIONAL SERVICE CONFORMS TO THE CURRENT ILLINOIS MINIMUM STANDARDS FOR A BOUNDARY SURVEY
I. THE UNDERSIGNED, AN ILLINOIS REGISTERED LAND SURVEYOR. HEREBY CERTIFY TO THE ABOVE NAMED PARTY THAT ON THE DATE SHOWN AN INSPECTION OF THE REAL ESTATE DESCRIBED HEREIN WAS MADE AND THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS PLAT REPRESENTS THE FACTS FOUND AT SAID TIME PROPERTY CORNERS ARE SET OR NOT BY CLIENT AGREEMENT SUBJECT PROPERTY HAS NOT BEEN STAKED AND THEREFORE FOR ANY CONSTRUCTION OR ESTABLISHING BOUNDARY OR FENCE UNE SHALL BE STAKED BY A SURVEYOR BEFORE PERFORMING THE TASK

Illinois Land Surveyor Number 035-003349 BEHROOZ MORADI, PhD, P.E . S.E . P L S
II. PROF LAND Sl."RVl:YOR - LICE:NSK GXP DATE NOV JO, I
LMI
m
MORADI MULTI DIMENSIONS CONSULTING ENGINEERS
5804 N WESTERN AVE , SUITE R2. CHI , IL. 60659 | SnEET
^ THE LEGAL DESCRIPTION NOTED ON THIS PLAT WAS PROVIDED BY THE CUENT AND MUST BE COMPARE0 WITH DEED AND/ OR TITLE POLICY BUILDING UNES AND EASEMENTS ARE SHOWN J ONLY WHERE THERE ARE SO RECORDED IN THE MAPS. OTHERWISE FOR BLIt-DlNG HtSTHICilONS 1 AND/OR EASEMENTS RcFEH IO YOUR DEED, CONTRACT. TITLE POLICY. AND/OR ZONING | REGUIATIONS THIS PLAT IS VAUD ONLY IF IT CONTAINS THF ORIGINAL SIGNATURE AND SEAL
"WKi'l TI:N NOTICL'' FORM 01- AFFIDAVIT (Scction 17-13-0107).


March 23, 2022

Honorable Thomas M. Tunney Chairman, Committee on Zoning 121 North LaSalle Street Room 304, City Hall Chicago, Illinois 60602


, being first duly sworn on oath deposes

The undersigned certifies lhat he has complied with the requirements of Section 17-13-0107 ofthe 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 the applicant, and to the owners of all property within 250 feel in each direction ofthe lot line oflhe subject property, exclusive of public roads, streets, alleys and other public ways, or a total distunce limited lo 400 feet. Said "written notice" was sent by First Class U.S. Mail, no more than 30 days before filing the application.
The undersigned certifies lhat tho notice contained the address of the property sought to be rezoned; a statement of the intended use of the property; the name and address of the 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 March 23, 2022
The undersigned certifies that the 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 fect of the subject site is a complete list containing the names and addresses of the people required to be served.




Signature


Subscribed and Sworn to before me this
_18ih day of .March > 20.22.
Notary Public


ntnrv Pnhlir O * ™
f-T^|y\*; Nyl.ii > Public, Stale i>l'To.\as «V,J^>'•>. Comm. l'\j!iK"- ¦:l i -TAii
N.jl.irv II)

March 23, 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 B3-1 to B3-2 on behalf ofthe applicant Blair Rockoff for the property located at 2536 W. North Ave.

The applicant intends to use the subject property for 3 additional dwelling units. To allow for the construction of a 2 story addition over the existing one story building to establish 3 dwelling units.

Applicant and owner Blair Rockoff is located at 2536 W. North Ave. The contact person for this application is Blair Rockoff, 2536 W. North Ave, 312-505-38238.

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 of the property to be rezoned.

Very truly yours,


Cook County, Illinois E1/2 SE1/4 Section 36-40- 13 WEST
2020 Tax Map ¦
Page 1336H
40-13-36H |
-1
STON'S SUB ol tin. E 1/2 of [ho of Sec 36^10 13ark-d by S Johnston | Son An in-fire Rec Doc 0999999599
CU Y OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable: Blair Rockoff

Check ONE ofthe following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:
0 the Applicant
OR
Q a legal entity currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name:
OR
[] a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control:


B. Business address of the Disclosing Party:
Chicago IL 60647

312-505-3828 Fmai|.
Blair@rocksolidhealth.net C. Telephone: Fax: .-.i.e
Blair Rockoff
D. Name of contact person:

E. Federal Employer Identification No. (if you have one):
Brief description ofthe Matter to which this EDS pertains. (Include project number and location of
property, if applicable):
I the applicant/owner seeking a zoning change at 2536 W. North Avenue from B3-1 to B3-2.
Which City agency or department is requesting this EDS? DPD' Burea of zoning and land use

If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:

Specification # and Contract #
Ver.2018-1 Page lof 15

SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY
I. Indicate the nature oflhe Disclosing Person
Publicly registered business corporation Privately held business corporation Sole proprietorship General partnership Limited partnership
Trust
Party:
[ [ Limited liability company | | Limited liability partnership | | Joint venture | [ Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
? Yes ? 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: Flas the organization registered to do business in the State of Illinois as a foreign entity?

[ [ Organized in Illinois

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

1. List below the full names and titles, if applicable, of: (i) all executive officers and all directors of the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management of the Applicant.

NOTE: Each legal entity listed below must submit an EDS on its own behalf.

Name Title Blair Rockoff Owner




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% of the Applicant. Eixamples 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

Ver.2018-1 Page 2 of 15

limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf
Name Business Address Percentage Interest in the Applicant





SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS

Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS? Q] Yes 0 No

Does the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-month period following the date ofthis EDS? Yes 0 No

If "yes" to either of the above, please identify below the name(s) of such City elected official(s) and describe such income or compensation:



Does any City elected official or, to the best of the Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 ofthe Municipal Code of Chicago ("MCC")) in the Disclosing Party?
[] Yes [Tj No
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partner(s) and describe the financial intercst(s).



SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who arc paid solely through the Disclosing Party's regular payroll. If the Disclosing Party is uncertain whether a disclosure is required under-this Section, the Disclosing Parly must either ask the Cily whether disclosure is required or make the disclosure.

Page 3 of IS

Name (indicate whether Business Relationship lo Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not. an acceptable response.





Check here if the Disclosing Party has not retained, nor expects lo 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 £v^No No person directly or indirectly owns 10% or more of the Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?

[J Yes [] No
FURTHER CERTIFICATIONS

[This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date ofthis EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any 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 in 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 the Illinois Department of Revenue.


Page 4 of 15

The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) of this EDS:

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, during the 5 years before the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
Certifications (5), (6) and (7) concern:

the Disclosing Party;
any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, including but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity). Indicia of control include, without limitation: 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 of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity. With respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;
any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 15

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor, nor any Agents have, during the 5 years before the dale of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).

Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of 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 of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] of the Applicant is currently indicted or charged 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) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing 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 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 the prior written consent of the City, use any such
Ver.2018-1 Page 6 of 15

contractor/subcontractor thai does not. provide such certillcations or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.

1 I. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), ihe Disclosing Party must explain below:





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 date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").




13. 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 the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" docs 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 that the Disclosing Party (check one)
[~~| is |7] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
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. We understand t hat becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."

Page 7 of 15

II'the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of .MCC Chapter 2-32, explain here (attach additional pages if necessary):




If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed lhat the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS

Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-110: To the best ofthe Disclosing Party's knowledge 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?

Yes 0 No
NOTE: If you checked "Yes" to Item D(l), 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.
Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase 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 of the Cily (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 ofthis Part D.

Does the Matter involve a City Property Sale?
Yes 0 No
If you checked "Yes" to Item D(l), provide the names and business addresses ofthe City officials or employees having such financial interest and identify the nature oflhe financial interest:

Name Business Address Nature of Financial Interest






4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.

Page 8 of 15

I.-:. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

Please cheek either (1) or (2) below. If the Disclosing Party checks (2), the Disclosing Party must disclose below or in an attachment lo this EDS all information required by (2). Failure to comply with these disclosure requirements may make any contract entered into with the Cily in connection with the Matter voidable by ihe Cily.

_[__[!. The Disclosing Party verifies that the Disclosing Party has searched any and all records of lhe Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:






SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If tho Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes ofthis Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.

A. CERTIFICATION REGARDING LOBBYING

1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):

None


(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means thai NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)

2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entily listed in paragraph A(I) above for his or her lobbying activities or to pay any person or entity 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 Ver.2018-1 Page9of'15

of a member of Congress, in connection with the award ofany federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
The Disclosing Party will submit ah updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A(l) and A(2) above.
The Disclosing Party "certifies that either: (i) it is not an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will nol engage in "Lobbying Activities," as (hat term is defined in the Lobbying Disclosure Act of 1995, as amended.
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?
0 Yes . [JNo

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.)
[J Yes Q No
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
QYes [J No |~"|Reports not required
Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
? Yes ? No

If you checked "No" to question (I) or (2) above, please provide an explanation:




Page 10 of 15

SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION

The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part ofany contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to 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 www.cityofchicaao.org/Ethics , and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance.
If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other City transactions. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing 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 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, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department 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 must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.








Page 11 of 15
C E RTI IT CAT IO N

Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf ofthe Disclosing Party, and (2) warrants that all certifications arid statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as ofthe dale furnished to the City.
(Print or type exact legal name of Di
Vorificci by pdfEilI-jf vt _ *
By:

Blair Rockoff
(Sign'here) Blair Rockoff
(Print or type name of person signing) Applicant/owner
(Print or type title of person signing)

Signed and sworn to before me on (date) 3-/ ^
at Cj^l^ County,

"OFFICIAL SEAL" CHRISTINE M PALKOVIC NOTARY PUBLIC, STATE OF ILLINOIS ! MY COMMISSION EXPIRES 11/29/2023 '

Commission expires:



















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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.

Under MCC Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B. La., 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 Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all 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 of a legal entity or any person exercising similar authority.

Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?

? Yes [vJ'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 to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.










Page 13 of 15

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B

BUILDING CODE SCOFFLAVV/PROBLEM LANDLORD CERTIFICATION

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% (an "Owner"). It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?

QYes QNo
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?

| [ Yes [VjNo fj T'he Applicant is not publicly traded on any exchange.


3. If yes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply.

























Page 14 of 15

CITY OI CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C

PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION

This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (wvvw.amlegal.com ), 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 Cily money for a license, grant or concession allowing them to conduci a business on City premises.

On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(l) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. 1 also certify that the Applicant has adopted a policy that includes those prohibitions.


? No
JvfN/A - I am not an Applicant that is a "contractor" as defuied in MCC Section 2-92-385. This certification shall serve as lhe affidavit required by MCC Section 2-92-385(c)(l). If you checked "no" to the above, please explain.





















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