SUBSTITUTE COMMERCIAL VACATION ORDINANCE
WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VII, Section 6 (a) of the 1970 constitution of the State of Illinois and, as such, may exercise any power and perform any function pertaining to its government and affairs; and
WHEREAS, the properties at 4601-4621 W. 46th Street and 4601-4609 S. Knox Avenue are owned by Joseph J. Bertacchi, as trustee of the Joseph J. Bertacchi Living Trust ("South Owner"); and
WHEREAS, the South Owner proposes to use the portion of the street to be vacated herein for a driveway for the adjacent custom metal fabricating shop; and
WHEREAS, the properties at 4600-4620 W. 46th Street and 4551-4559 S. Knox Avenue are owned by S&G Truck Services, Inc. ("North Owner"); and
WHEREAS, the North Owner proposes to use the portion of the street to be vacated herein for commercial truck routing and parking; and
WHEREAS the South Owner and the North Owner (collectively "Owners") wish to divide the area proposed for vacation, such that each will own an approximately equally-sized portion of the vacated right of way adjacent to their respective properties; and
WHEREAS, the City Council of the City, after due investigation and consideration, has determined that the nature and extent of public use and the public interest to be subserved is such as to warrant the vacation of the public street described below; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. Legal Description.
The vacation of: THAT PART OF W. 46TH STREET 66 FOOT WIDE RIGHT OF WAY LYING EAST OF AND ADJOINING THE EAST RIGHT OF WAY OF S. KNOX AVENUE; LYING WEST OF AND ADJOINING THE BELT RAIL ROAD; LYING SOUTH OF AND ADJOINING THAT PART OF LOT 2 IN CIRCUIT COURT PARTITION OF THE SOUTH HALF OF SECTION 3, RECORDED APRIL 29, 1911 AS DOCUMENT NUMBER 2530529 AND LYING NORTH OF AND ADJOINING THAT PART OF LOT 1 IN SAID CIRCUIT COURT PARTITION, ALL IN THE WEST HALF OF THE SOUTHWEST QUARTER OF SECTION 3, TOWNSHIP 38 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS, ABOVE DESCRIBED PARCEL CONTAINING 14,707 SQUARE FEET OR 0.337 ACRES OR LESS, as shaded and legally described by the words "HEREBY VACATED" on the plat hereto attached as Exhibit A. which plat for greater clarity is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacation.
SECTION 2. The vacation herein provided for is made upon the express condition that within 180 days after, the passage of this ordinance, the North Owner and the South Owner shall each pay or cause to be paid to the City of Chicago as compensation for the benefits which will respectively
accrue to the Owners, exactly one half of the sum of Eighty Thousand dollars
($80,000.00 ) which sums in the judgment of this body will be equal to such benefits for the
vacation area specified in SECTION 1.
SECTION 3. The vacation herein provided for is made under the express condition that the North Owner and the South Owner, and each of their successors and assigns, shall hold harmless, indemnify and defend the City of Chicago from all claims related to said vacation.
SECTION 4. The vacation herein provided for is made upon the express condition that within one hundred eighty (180) days after the passage of this ordinance, the South Owner shall file or cause to be filed for recordation in the Office of the Clerk, Recordings Division, of Cook County, Illinois, a certified copy of this ordinance, together with an attached plat as approved by the Department of Transportation's Superintendent of Maps and Plats.
SECTION 5. This ordinance shall take effect and be in force from and after its passage and publication. The vacation shall take effect and be in force from and after the recording of both the ordinance and approved plat.
[SIGNATURE PAGE FOLLOWS]
[Signature page to Substitute Commercial Vacation Ordinance]
Substitute Vacation Approved:
Gia
Commissioner of Transportation
Honorable
Alderman Michael Rodriguez, 22nd Ward
CDOT File Number: 03-22-21-3996
EXHIBIT "A"
PLAT OF VACATION
AFFECTED P.I.N.s:
PART OF LOT 2 PART OF LOT 1
THAT PARI' OF W. H8TH STULLT 66 FOOT'WIDK HI5H7 OF WAY LYING EAST OF AND ADJOINING THE EAST RIGHT OF WAY OF S. KNOX AVENUE: LYING WEST OF AND ADJOINING THE BELT RAIL ROAD; LYING 80UTH OF AND ADJOINMS THAT PART 0FLOT2 IN CIRCUIT COURT PARTITION 01= THE SOUTH H».LK OF SECTION 3, RECORDED APRIL J9.1911 A3 DOCUMENT NUMBER 25JD329 AND LYING NORTH Or AND ADJCOKINS THAT PART OF LOT 11N SAiO CIRCUIT COURT PARTITION, ALL IN THE WEST HALF OF THE SOUTHWEST QUARTER OF SECTION 3, TOWNSHIP 38 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN. IM CCOK COUNTY, ILLINOIS. ABOVE DESCRIBED PARChl. CONTAINING 14.707 SQUARE FEET CR 0.337 ACRES MORE OR I ESS.
¦W. 47th STREET "
(86' PUBLIC ROW)
. SURVEYOR'S NOTES:
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1) SUBJECT PARCEL IS ZONED Ml-1: LIMITED MANUFACTURING/BUSINESS PARK DISTRICT 3) BEARINGS ON THIS PLAT ARE BASED ON AN ASSUMED DATUM 3) THE FIELD WCW FOR THIS PLAT WAS PERFORMED AUGUST S3.7.021 •«) NO MONUMgNTOTlOhl'tfA'S FCUNO N CONJUNdlKW VVlfH THIS PLAT OF VACATION 5) NObfceKSIftNiSSIiiOJilD Dg-ASSUte3 B,Y;"BCALe >:iE*SUREMEIir(S UPON,PLAT;
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CHICACO DEPARTMENT OF TRANSPdRTAIION
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
'jkCheck ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. the Applicant
OR
[ ] a legal entity currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant! State the Applicant's legal
name: ...
OR
[ ] a legal entity with a direct or indirect right of control of the Applicant (see Section n(B)(l)) State the legal name of the entity in which the Disclosing Party holds a right of control:
Business address of the Disclosing Party: MidQ^ ^ , ^Afo/ . JWtif..
Telephone: Hl£-SffA^-^Fax: Email: I 1*
Name of contact person: TTcmr' ^^Vti\l c3\.\
Federal Employer Identification Mo. (if you have one);
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
\/vte#nT Hl/^- l%a.-etJ- ts^^T i«£a/qv m flfrfiL
Which City agency or department is requesting this EDS7. *fW-(-- . Tf^A-rJ $ f>vpWvilc>^
If the Matter is a coutract being handled by the City's Department of Procurement Services, please complete the following:
Specification # . and Contract # . .
Ver.2018-1 Page I of 15
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
I. Indicate the nature of the Disclosing P [ ] Person
[ ] Publicly registered business corporation
( ] Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership
[ j Limited partnership
fxfTrust
[ ] Limited liability company
[ ] Limited liability partnership
[ ] Joint venture
[ j Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
[ ] Yes [ ] No [ ] Other (please specify)
For legal entities, the state (or foreign countrj) of incorporation or organization, if applicable:
: ^4i^/,/, - , , :
For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity'.'
( ] Yes ( ] No [ ] Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles, if applicable, of: 0) 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 entit> 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^ a Title
^syosM^LL . J\ (%<&te.:c£u Tmsmgi--. . .
2. Please pro\ ide 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. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Page 2 of 15
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None,"
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf,
J^ame. a Business Address Percentace Interest in the Applicant
, '^MiMmi^iM . S^tem* M>f
SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or c6.ihpensatiQh;tb any Cjtydecte;d:&ffMa.l diirtngthe
12-month period preceding the date of this EDS? [ ] Ye5 ^|No
Does the Disclosing Party reasonably expect to provide, arty mcom&or corpp,ensatiori;t^a.ny Qw, elected official during the 12-month period following the ike of this IDS'? f ] V8«- pf$o
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 of the Municipal Code of Chicaao ("MCC")) in the Disclosina Partv? [ JYes f^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 interest(s).
SECTION TV - 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 ".sell as the nature of the relationship, and die total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll. If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Part> must either ask the City whether disclosure is required or make the disclosure.
Page 3 of] 5
Name (indicate whether Business Relationship to Disclosing Party Fees (indtcat&whethet
retained or anticipated Address (subcontractor, attorney, paid, of e'stlrhated.) NOTE;
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
(Add sheets if necessary)
fcxfCheck here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes p<£No [ ] No person directly or indirectly owns 10°/o or more of the Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[ ] Yes [ ] No
FURTHER CERTIFICATIONS
[This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-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 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, ull 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 offen603 set forth in oubparagraph (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").
Pagc5ofl5
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 date of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, m 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 oh 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 of the 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").
10. [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 that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
11, If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the 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 of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").
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" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is (>< 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 that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."
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If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined hi 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 that the Disclosing Party certified to the above statements.
D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D,
In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?
[ ]Yes ^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 of any 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 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 [ ] No
If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nature of the financial interest:
Name Business Address Nature of Financial Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
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E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. If the Disclosing Party checks (2), the Disclosing Party must disclose below or in an attachment to this EDS all information required by (2). Failure to comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City,
V 1, The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and 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 VTL For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, 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 if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in paragraph A(l) above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2018-1 Page 9 of 15
of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the 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) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
If the Disclosing Party is the Applicant, tho 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?
[ ] 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 of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
[ ] Yes [ ] No [ ] Reports not required
Have you participated in any previous contracts 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 - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to 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 \vsvw.city6fohicago.prg/Ethics, and may also be obtainod 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 of any information submitted in this EDS.
The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to 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 LNELIGD3ILITY 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
CERTIFICATION
Under penalty of perjury, the person signing below; (1) warrants that he/she is authorized to execute this EDS. and all applicable Appendices, on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as of the date furnished to the City.
(Print or type name of person signing)
(Print or type exac t legal name of Disclosing Party)
(Print or type title of person signing)
Signed and sworn to before me on (date). »"-yYVu/c*-»
at O^ocifs , County, rCLc>iroia (state).
Commission expires:
Page 12 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant.
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 of the 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 IT.B. La., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head?
[JYes t>4>
If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
Page 13 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM 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.
1. 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?
2. 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?
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 IS
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (w^;ainlcgai.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 City money for a license, grant or concession allowing them to conduct a business on City premises.
On behalf of an Applicant that is a contractor pursuant to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)(l) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
[ ] Yes
[ J No
[yO.N/A -1 am not an Applicant that is a "contractor' as defined in MCC Section 2-92-385. This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(l). If you checked "no" to the above, please explain.
Page 15 of IS
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION |
r ;
Legal Dame of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable: £\(t trM $m)M> SMC
Check ONE of the following three boxes:
Indicate-yy^effiei the Disclosing Party submitting this EDS is:
[l/j the Applicauf
OR
[ ] a legd entity^
the contract, transaction" or 0^r-tmtd~OR [ ] al^jgaj-#t|ty;#itli a .direct, or indurectirightipf control of the Applicant (see Section 11(B)(1)) State the legal name of the entity in which the D5jsclps|fig Party holds aright of control:
Business address of the Disclosing Party: S>l;fcTj j
XL M
Telephone:^B^330'QiO^ Fax: •¦ . Email:. _.
Name of contact person: RohiefO $QnCficl> 1
t
Federal Employer Identification No. (if you have cjne): i
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
"Which City agency or department is requesting this EDS? £ t)Q 1
If the Matter is a contract being handled by the City's pepartment of Procurement Services, please complete the following: 1
Specification # j)!)'Ol~7.\ " 2>*\°& and Contract #
Vcr.2018-1 Page 1 of 5 5
[ ] Person
[ V?.^i&^-T9^^ssd^u^es& corporation m J^yatelyh.eld busiriess corporMpn,.
[ ] Sole proprietorship
[ ] General partnership
[ ] Liniited partnership
[ ] Trust
[ ] Lhnited liability company
[ ] Mrnijted liability par_»ship
[ ] Joint venture
[ ] Not-for-profit corporation
(Is th£ 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 IHinpis: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ]Yes [ ]No [l/^ Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGALE^ TTY:
1. List below the full names and titles, if applicable, of: (i) all executive offveers and all directors of
the entity; (ii) for not-for-profit corporations, all rae'mbers, if any, which are legal entities (if there
are no such members, write "no members which are Ielgal entities"); (iii) for trusts, estates or other
similar entities, the trustee, executor, administrator, ox similarly situated party; (iv) for general or
Knitted partnerships, limited UabiUry compaiiies, li nlted liability parfeeXjiiups or joint yetttitfes,
e^6H; gerieM partner/to or legal entity or
indirectly controls the day-to-day management of the Applicant.
].
NOTE: Each legal entity listed below must submit an jEDS on its own behalf.
Title ,
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 (mcluding ownership) in excess of 7.5°/S' of the Applicant Examples ofsaich an interestinchidb 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 35
limited liability company, or interest of a beneficiary |>f a trust, estate or other similar entity. If none, state "None."
NOTE: Each legal entity listed below may be requir^ji to submit an EDS on its own behalf.
Name » Business Address /tkfiW fUX \loob S<*Atto ui Percentage Interest in the Applicant Mil ^ u>ov t
SECTION m ~ INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or Qompehsatibn to any City elected official during the
12-month period preceding the date of this EDS? [ ]Yes MNo
Does the Disclosing Party reasonably expect to provide, any income or compensation to any City elected official dirrmg me 12-rjipnm peirjtod fo.ll6wing)tie date of this EDS? [ ] Yes [/]No
If "yes" to either of the above, please ideW of such City elected officials) and
describe sixch 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 doinestxc partner, have a junaacial interest (as defined in Chapter 2-l56>of the Municipal. Code of Chicago ("Md6'')) in the Disclosing Party? []Yes £<|No
If "yes," please identify below the name(s) of such Ciily elected officials) and/or spouse(s)/domestic partner(s) and describe the financial interest(s).
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and-busikess= address of each subcontractor, attorney,
lobbyist (as defined in MCC Chapter 2r 156), accountant, consultant and any other person or entity
whom the Disclosing Party has retained or expects to ietaitt in connection with the Matter, as well as
the nature of the relationship, and the total amount pfiShq fees paid or estimated to bo paid. The
Disclosing Party is not required to disclose employee's'who are 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 Party must either ask the City-whether disclosure is reqxured or make the
disclosure. 1'
Ver.2018-1
Name (indicate whether Business retained or anticipated Address to be retained)
Disclosing Party
Relationship to (subcontractor, attorney, lobbyist, etc.)
Fees (indicate whetlier paid or estimated:) NOTE: "hourly rate" or "t.b.d." is
not an acceptable response.
M
(Add sheets if necessary)
|, nor expects to retain, any such persons or entities.
[ ] Check here if the Disclosing Party has npttefajn€ SECTION V - CERTIFICATIONS A. COURT-ORDERED CHILD SUPPORT COMP^teCE
Under MCC Section 2-92-415, substantial owners qi remain in. compliance with their child support pbiiga'
Has any person who directly or indirectly owns 10%
msiness. entities that contract with the City must |pns. throughout the contract's term.
f E more of the Disclosing Party been declared in
[JYes [vJNo ['j No person directly or ahdii'e;
If "Yes," lias the person entered into a court-approved is the person in compliance with that agreement?
[ J Yes [ £ No
B. FURTHER CERTIFICATIONS
[This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of Procurement Services.J In the 5-year period precedhjg the date of this EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) Mlowj 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 {fee., 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, '< >r 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
Page 4-otJ>iS
t
$ a legal entity, all of those persons or entities|1010||r. debarment, declared ineligible or voluntarily >r local unit of government;
3. The Disclosing Party and, if the Disclosing Party identified in Section 11(B)(1) of this EDS:
a. are not presently debarred, suspended, proposed,} excluded from any transactions by any federal, state
have not, during the 5 years before the date offbi! EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered¦ agatost them in connection with: obtaining, 1 attempting to obtain, or pejrfprnring a public (federaljltate.' or local) transaction or contract under a public transaction; a violation of federal or state ^fijflSf statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records;-mallirjgfalse statements; or receiving stolen property;
are not presently indicted for, or criminally or civjuly charged by, a governmental entity (federal, state or local) with committing any of the offenses seti forth in subparagraph (b) above;
have not, during the 5 years before the date of this (federal, state or local) terminated for cause or dejiati
have not, during the 5 years before the date of mis" liable in a civil proceeding, or in any criminal or civi environmental violations, instituted by the City or .by. unit of local government.
EDS, had one or more public transactions and
EDS, been convicted, adjudged guilty, or found actipn, including actions concerning
federal government, any state, or any other
4. The Disclosing Party understands and shall cohip Chapters 2-56 (Inspector General) and 2-156 (Gove
5. Certifications (5), (6) and (7) concern: •. the Disclosing Party; .
* any "Contractor" (meaning any contractor or siibepntractor used by the Disclosing Party in connection with the Matter, including but notliinited-to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors a|id Other Retained Parties");
any "Affiliated Entity" (meaning a person or efttitythat, directly or indirectly: controls the Disclosing Parry, is controlled by the Disclosing ^arty, or is, with the Disclosing Party, under common control of another person or entity). Indicia of control include, without limitation: mterlocking management or ownership; identity rif'interests among family members, shared facilities and equipment; common use of employees;-pr organization of a business entity following the ineligibility of a business entity to do busmessl iVvith federal or state or local government,
ahagemcht, ownership, or principals as the ferrii Affiliated Entity means a person or entity is controlled by it, or, with the Contractor, is
including the City, using substantially the same.ity ineligible entity. .Withrespect to Contractors, the that directly or indirectly controls the Contractor, under common control of another person or entity;, any responsible official of the Disclosing Party
jmy Contractor or any Affiliated Entity or any
other official, agent or employee of the Disclosm^jParty, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of ja responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of15
Neither the Disclosing Party, nor any Contractor, no.:'jany Affiliated Entity of either the Disclosing Party or any Contractor, nor any Agents have, Staring the 5 years before the date of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Er$fy's contract or engagement in connection with the Matter.
a. bribed or attempted to bribe, or been convicted pi a public officer or employee of the City, the State P; or of any state or local government in the United $fa' official capacity;
'adjudged guilty of bribery or attempting to bribe, ' inpis, or any agency of the federal government, :es of America, in that officer's or employee's
agreed or colluded with other bidders or prps^eeuv.e bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement c ij collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement: | 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 cpndu< r 5 or
violated the provisions referenced in MCC j^|b^li6^2-92-320(a)(4)(€^tracte Requiring a Base Wage); (a)(5)(Deb,amient Regulations); or (a)(6jj(Mt i|num Wage Ordinance).
te'tfury;; or any successor federal agency.
Neither the Disclosing Party, nor any Affiliated j itiiy' or Contractor, or any of their employees, officials, agents or partners, is barred from CPhtia'C.tif jg 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)Ta% 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 Affilialed.E iity'is listed on a Sanctions List maintained by the
United States Department of Commerce, State, or Tr
8. [FOR APPLICANT ONLY] (i) Neither the AppMkif 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 adrnitted guilt of, or has ever be 3jfc convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or (Ohspiraey to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any "sister agency"; and (ii)
the Applicant understands and acknowledges thai Compliance with Article I is a continuing- requirement for doing business with, the City. NOTE: If MCC Chi pier 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedeso-year compliance timeframes in this Section V.
9. [FOR APPLICANT ONLY] The Applicant and ii subcontractors to use, any facility listed as having ah System for Award Management ("SAM").
10. [FOR APPLICANT ONLY] The Applicant will pbtain from any contractors/subcontractors hired or to be hired in connection with die Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, witfrouikhe prior written consent of the City, use any such
Ver.2018-1
i
contractor/subcontractor that does not provide such believe has not provided or cannot provide trathful
cyrtixicfttions or that the Applicant has reason to certificatiqns.
i>fthe above statements in this Part B (Further
If the Disclosing Party is unable to certify to ail} liifioatipris), the Disclosing Party must explain bel^w.
¦¦¦¦ .,,r,,.,,.„ :„-:,,.-,¦ ,.
If the letters "NA," the word "None," or no response; presumed that the Disclosing Party certified to the
mpears on the lines above, it will be conclusively statements.
Ser reasonable inquiry, the following is a
12. To the best of the Disclosing Party's knowledges;
complete list of all current employees of theBisclpsi i&Party who were, at any time during the 12
pyeef or elected or appointed official, of the City
month period preceding the date of this EDS, an erhp of Chicago (if none, indicate with "N/A" or "none"),
13. To the best of the Disclosing Party's knowledge aifer reasonable inquiry, the following is a
iiven or caused to be given, at any time during his EDS, to an employee, or elected or appointed Statement,, a "gift" does not include: (i) anything general public, or (ii) food or drink provided in vahte of less than $25 per recipient, or (Hi) a edby law (if none, indicate, with "N/A" or
complete list, of all gifts that the Disclosing Party has the 12-month period preceding the execution date of official, of the City of Chicago. For purposes of this made generally available to City employees or to the the course of official City business and having a retail political contrjtotvtipn otherwise; duly reported as regu I "honei"). As to any gift listed below, please also list t \o name of the City recipient.
'Ik
C. CERTIFICATION OF STATUS AS .FINANCIAL
The Disclosing Party certifies that the Disclosing [ ]is [/]is
2-32-455(b). trien the Disclosing Party pledges:
1.
a "financial institution" as defined in MCC Scctioi 2. If the Disclosing Party IS a financial institution,
"We are not and will not become a predatory lender asi 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 tliat becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the.privilegejbf doing business with the City."
Vci.2018-1
If the Disclosing Party is unable to make this pledge D/ac.ans^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. ippeatS on the lines above, it will be conclusively presumed that the Disclosing Party cetftfecd to the above statements.
D. CERTIFICATION REGARDING FINANCIAL JirTERESTlN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-1561 ayjsthe same meanings if used in this PartD
L In accordance with MCC Section 2-156-110: To tpbest of the Disclosing Party's knowledge after reasonable inquiry, does any official or employe < i of the City have a financial interest in his or her own name or hi the name of any other person or el
My' in the Matter?
[/]No
fa Items D(2) and D(3). If you checked "No"
NOTE: If you checked "Yes " to Item D(l), proceed to Item D(l), skip Items D(2) and'D(3) and proceed t^Part E,
ding, or otherwise permitted, no City elected ids- or her own name or in the name of any
|i<
Unless sold pursuant to a process of competitive t{: official or employee shall have a financial interest in
other person or entity in the purchase of any propettyj 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 City (collectively, "City Property Sale"). Compensation for property tal In pursuant to the City's eminent domain power does not constitute a financial interest within t ie meaning of this Part D
Does the Matter involve a City Property Sale?
[ ] Yes [ ] No
If you checked "Yes" to Item D(l), provide the na ines and business addresses of the City officials or employees having such financial interest and ident fy the nature of the financial interest:
Nature of Financial Interest
4. The Disclosing Party further certifies that no preij; acquired by any City official or employee. J
Ver.2018-1
E. CERTIFICATION REGARDING SLAVERY BRA BUSINESS
Disel6|h>g Party checks (2), the Disclosing Party ap information required by (2). Failure to ariy contract entered into with the City in
Please check either (1) or (2) below. If the must disclose below or in an attachment to this EDS comply with these disclosure requirements may rn#| connection with the Matter voidable by the City.
4ingParty has searched any and all records of jfes regarding records of investments or profits ^slavery era (including insurance policies dar$ tge to or injury or death of their slaves), and
t/l. The Disclosing Party verifies that the Discld
the Disclosing Party and any and all predecessor ehti from slavery or slaveholder insurance policies during issued to slaveholders that provided coverage for t the Disclosing Party has found no such records
2. The Disclosing Party verifies that, as a result
Disclosing Party has found records of investments of policies. The Disclosing Party verifies that the folio
of condtfcting the search in step (1) above, the arofits from, slavery or slaveholder insurance eg constitutes full disclosure of all such
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS
;e not federal funding.
NOTE: If the Matter is federally funded, corapletMhis Section VI. If the Matter is not federally funded, proceed to Section VII. For piupbses of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City'.a:
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying
Party with respect to the Matter: (Add sheets if neo'es py):
I
(If no explanation appears or begins on the lines abbvje,, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 199s| 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 npti expend any federally appropriated funds to pay
any person or entity'listed in paragraph A(I) above feu bis or her lobbying activities or to pay arty
person or entity to influence or attempt to influence a i) officer or employee of any agency, as defined
by applicable federal law, a member of Congress, an {xfficer or employee of Congress, or an employee
Ver.2018-1 Page 9 of iS
: of any federally funded contract, making any ipbrative agreement, or to extend, continue, renew, loan, or cooperative agreement,
of a member of Congress, in connection with the :ay federally funded grant or loan, entering into any ooopi amend, or modify any federally funded contract, grab!
not an organization described in section it is an organization described in section but hi&.not engaged and will not engage in "Lobbying closure. Act of 1995, as amended.
3. The Disclosing Party will submit an updated ckttification. at the end of each calendar quarter in which there occurs any event that materially affects accuracy of the statements and inforrnation set forth in paragraphs A(l) and A(2) above.
itte
4. The Disclosing Party certifies that either: (i) 501(c)(4) of the Internal Revenue Code of 1986; or (ft 501 (c)(4) of the Internal Revenue Code of 1986 Activities," as that term is defined in the Lobbying S;
fclosihg Party must obtain certifications equal in 3,d.QV© from all subcontractors before it awards a all such subcontractors' certifications for the W. promptly available to the City upon request.
5. If the Disclosing Party is the Applicant, the Disj form and substance to paragraphs A(l) through A(4) any subcontract, and the Disclosing Party must rnaintM' duration of the Matter and must make such bertifietdif;
B. CERTIFICATION REGARDING EQUAL BMPl &YMENT OPPORTUNITY
j require the Applicant and all proposed :h their bids or in writing at the outset of
If the Matter is federally funded, federal regulatib; i subcontractors to submit the following information-wj; negotiations.
Is the Disclosing Party the Applicant? [JYes []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 of the Office of Federal Contract Compliance Programs, or the Equal Employment Oppjirtujiity Gonunission all reports due under the applicable filing requirements?
[ ]Yes [ ]No [] Reports rj^t-required
subcontracts subject to the
3. Have you participated in any previous contracts m equal opportunity clause?
[ ]Yes [ ]No
If you checked "No" to question (1) or (2) above, please provide an explanation:
Ver.2018-1
SECTION VII - FURTHER ACKNO\VLEDGM$NTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
A. The certifications, disclosures, and aeknowledgrn $u%. contained in this EDS will become part of any contract or other agreement between the Applicant-aM the City in connection with the Matter, whether procurement, City assistance, or other City action, arM are material inducements to the City's execution of any contract or talcing other action with respect to Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and;t;egttfatioiis on which this EDS is based.
Ghaptei'2-156, imposes certain duties and
i work, business, or transactions. The full text i in line atA^^'ci^^Mfea:^o:aa^i3ife% and may ; % Sedgwick St., Suite 500^ Chicago, IL 60610, % with this ordinance.
tn
B. The City's Governmental Ethics Ordinance, MCC obligations on persons or entities seeking City contra $ of this ordinance and a training program is available also be obtained from the City's Board of Ethics, '741 (312) 744-9660. The Disclosing Party must comply^
ifxx with the public release of information y'fei'iif/the accuracy of any infonnation submitted
If the City detennines that any information ptoyii ed in this EDS is false, incomplete or inaccurate, any contract or other agreementin connection with v/hi'bil it is submitted maybe rescinded or be void or voidable, and the City may pursue any remedies md(5t the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the ©isclosiag 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/; ncareeration 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 ihfpM^ ^s EDS ^V De rnade publicly
available on the Internet, in response to at Freedom 6|]to'forfnatipn Act request, or otherwise. By
completing and signing this EDS, the Disclosing Par^-waives and releases any possible rights or
claims which it may have against the City in oonnoct
contained in this EDS and also authorizes the City to
in this EDS.
E. The information provided in this EDS must be kei>; current. In the event of changes, the Disclosing Party mu st supplement this EDS up to the time the <3; vy takes action on the Matter. If the Matter is a contract being handled by the City's Department of P ;bcurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: ^ittt;respect to Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility nlu^t be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020. .
Ver.2018-1
CERTIFICATION
Under penalty of perjury, the person signing below: My warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf o: j tjie Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS,;8ijdfall applicable Appendices, are true, accurate and complete as of the date furnished to the City.
(Print or type exaotlegal name of Disclosing Party) By: AWWf <0^;#5tt.#>>'
or type name of person signing)
^¦mt or type title" of person signing)
Signed and sworn to before me an (date)
at County, (state)
Notary Public Commission expires:
Ver.2018-1
ST. iTEMENT AND AFFIDAVIT
CITY OF
APPE^LXA
' J "
IX ELECTED CITY OFFICIALS HEADS
ECONOMIC DISCLOSURE jS
FAMILIAL RELATIONSHIPS WT
AND DEPATlT&lllENT
This Appendix is to be completed only by (a) the direct ownership interest in the Applicant excee entity which has only an indirect ownership inter,*
Cftjity and (b) any legal entity which has a g 7.5%. It is not to be completed by any legal t in the Applicant.
s Disclosmg;EMy:
must disclose whether such Disclosing Party Parthef thereof currently has a "familial
A "familial relationship" exists if, as of Applicable Party" or any Spouse or Domestic jfKje city clerk, the city treasurer or any city rjiy of the following, whether by blood or
niece or nephew, grandparent, grandchild, ••law, stepfather or stepmother, stepson or ;p^lialfAsister;
Under MCC Section 2-154-015, the or any "Applicable Party" or any Spouse orBohicJstlc relationship* with any elected city official or departs 9n.tb.ead the date this EDS is signed, the Disclosing Party or Partner thereof is related to the mayor, any alde^mait department head as sponse or domestic partner or as! adoption: parent,, child, brother or sister, aunt or tool father-in-law, mother-in-law, son-in4aWi-p^1li^ft'|3 stepdaughter stepbrother or stepsister or half^brothei
"Applicable Party" means (1)' all executive officei s of the Disclosing Party listed in Section
1LB. 1 .a., if the Disclosing Party is a corporation; all partners, of the Disclosing Party, if the Disclosing
Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the
DisclosingParty is a limited partnership; aU raal^ and members of the
Disclosing Party, if the Disclosing Party is a Urnited hhbiiity company; (2) all principal officers of the DisclosingParty; and (3) any person having more.ttaria 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 entiw or any person exercising similar authority.
or any Spouse or Domestic Partner thereof I city official or department head?
Does the Disclosing Party or any "Applicable Bifcri recurrently have a "familial relationship" with an electe?
[/no
[ ]Yes
person, (2) the name of the legal entity to 2! of the elected city official or department head to the precise nature of such familial relationship.
If yes, please identify below (1) the name and titldiof such which such person is connected; (3) the name and titl whom such person has a familial relationship, and (4*
Page 13 of 15
CITY OFCI&CAGO ECONOMIC DISCLOSURE SmTEftTENT'
AND AFFTDAVIT
appendix b
BUILDING CODE S^OEELA^/PROB&l LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Apjmomit^and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% | m "Owner"). It is not to be completed by any legal entity which has only an indirect ownership intc test in the Applicant.
ifitot any Owner identified as a building code Secftin 2-92-416?
1. Pursuant to MCC Section 2-154-010, is the Appli scofflaw or problem landlord pursuant to MCC
[i^No
2. If the Applicant is a legal entity publicly traded on the Applicant identified as abvnlding code scofflaw ci 2-92-416?
ahy^ exchange, is any officer or director of ;problem landlord pursuant to MCC Section
[ ] No [J] The Api -|icant is not publicly traded on any exchange.
name of each person or legal entity identified address of each building or buildings to which
3. If yes to (1) or (2) above, please identify below th: as a building code scofflaw or problem landlord and tnei the pertinent code violations apply.
Ver.2018-1
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
AT$«p£C '
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
as
This Appendix is to he completed only by an Appoint that is completing this EDS as a "contractor defined in MCC Section 2-92-385. That section, which should be consulted (wwwyamle^ generally covers a party to any agreement pursuant t^ which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (mclhding for legal or other professional services), or (ii) pay the City money for a license, grant or cone ession allowing them to conduct a business on City premises.
On behalf of an Applicant that is a contractor pursua; if to MCC Section 2-92-385,1 hereby certify that the Applicant is in compliance with MCC Section '2* &-3 85(b)(1) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, 'dot (ii) seeking job applicants* wage or salary history from current or former employers. I alsb;i5er/dfythat the Applicant has adopted a policy that includes those prohibitions.
llYes
[ ]No
[v/] N/A — I am not an Applicant that is a "contractor'
This certification shall serve as the affidavit required by MCC Section 2-92-385(c)(l). If you checked "no" to the above, please explain.
Page 15 of. 15