OFFICE OF THE MAYOR
CITY OF CHICAGO
LORI E. LIGHTFOOT
September 21, 2022
TO THE HONORABLE, THE CITY COUNCIL OF THE CITY OF CHICAGO
Ladies and Gentlemen:
At the request ofthe Commissioner of Planning and Development, I transmit herewith ordinances authorizing the execution of tax increment financing redevelopment agreements with various entities.
Your favorable consideration of these ordinances will be appreciated.
Very truly yours.
ORDINANCE
WHEREAS, pursuant to ordinances adopted by the City Council (the "City Council") ofthe City of Chicago (the "City"), published in the Journal ofthe Proceedings ofthe City Council ofthe City for such date identified on Exhibit A attached hereto, and under the provisions of the Tax Increment Allocation Redevelopment Act, 65 ILCS 5/11-74.4.1 ef seq., as amended (the "Act"), the City Council: (i) approved and adopted a redevelopment plan and project (the "Plan") for a portion of the City identified on Exhibit A (the "Redevelopment Area"); (ii) designated the Redevelopment Area as a "redevelopment project area" within the requirements of the Act; and (iii) adopted tax increment allocation financing for the Redevelopment Area (items (i)-(iii), each as amended from time to time, collectively the "TIF Ordinance"); and
WHEREAS, the Department of Planning and Development ("DPD") desires to make a grant (the "Grant") to the applicant named in Exhibit A (the "Grantee") for the purpose of wholly or partially funding certain costs (the "TIF-Funded Improvements") of the Project described in Exhibit A (the "Project"), in the amount and under the terms and conditions set forth in Exhibit A; and
WHEREAS, a budget for the Project and a description of the TIF-Funded Improvements are each incorporated into Exhibit A; and
WHEREAS, the Project lies wholly within the boundaries ofthe Redevelopment Area; and
WHEREAS, the Grantee will be obligated to undertake the Project in accordance with the Plan and the terms and conditions set forth in Exhibit A, with the Project to be financed in part by a Grant consisting of certain incremental taxes deposited from time to time in the Special Tax Allocation Fund for the Redevelopment Area (as defined in the TIF Ordinance) pursuant to Section 5/11-74.4-8(b) of the Act; and
WHEREAS, pursuant to Resolution 22-CDC-23 adopted by the Community Development Commission ofthe City (the "Commission") on June 14, 2022, the Commission has recommended that the Grantee and/or its affiliated entities be designated as the developer for the Project and that DPD be authorized to negotiate, execute and deliver on behalf of the City a redevelopment agreement with the Grantee for the Project; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The above recitals are expressly incorporated in and made a part of this ordinance as though fully set forth herein.
SECTION 2. The Grantee is hereby collectively designated as the "Developer" for the Project pursuant to Section 5/11-74.4-4 of the Act.
SECTION 3. The Commissioner and a designee of the Commissioner (collectively, the "Authorized Officer") are each hereby authorized, subject to approval by the City's Corporation Counsel, to negotiate, execute and deliver a redevelopment agreement with the Grantee and to execute such agreements and instruments, and perform any and all acts as shall be necessary
or advisable in connection with the implementation of the Grant. The execution of such agreements and instruments and the performance of such acts shall be conclusive evidence of such approval. The Authorized Officer is hereby authorized, subject to the approval of the Corporation Counsel, to negotiate any and all terms and provisions in connection with the Grant which do not substantially modify the terms described in Exhibit A hereto. Upon the execution and receipt of proper documentation, the Authorized Officer is hereby authorized to disburse the proceeds of the Grant to the Grantee.
SECTION 4. The Mayor, the Chief Financial Officer, the City Clerk, the Commissioner (or his or her designee) and the other officers of the City are authorized to execute and deliver on behalf of the City such other documents, agreements and certificates and to do such other things consistent with the terms of this ordinance as such officers and employees shall deem necessary or appropriate in order to effectuate the intent and purposes of this ordinance.
SECTION 5. To the extent that any ordinance, resolution, rule, order or provision of the Code, or part thereof, is in conflict with the provisions of this ordinance, the provisions of this ordinance shall control. If any section, paragraph, clause or provision of this ordinance shall be held invalid, the invalidity of such section, paragraph, clause or provision shall not affect any other provisions of this ordinance.
SECTION 6. This ordinance shall be effective as of the date of its passage and approval.
EXHIBIT A
Attached
NEIGHBORHOOD OPPORTUNITY FUND
piMUIC^igi
BBS P IB tic
www.NstftiborhootfOpportunllyFuntl.ca |99|
* * * *
July 11, 2022
James Daughrity Policy Kings, LLC 7315 S. Vernon Ave. Chicago, IL 60619
RE: Conditional Commitment of City Funds
Dear James Daughrity,
On behalf ofthe City of Chicago ("City") Department of Planning and Development ("DPD"), congratulations on being selected as a finalist to receive City funds ("Finalist")! Your Project has been evaluated and selected for an award based on the Neighborhood Opportunity Fund ("NOF") program criteria as described in the Program Manual. Pending approval from City Council of the City (the "City Council") and execution of a Redevelopment Agreement ("RDA"), Policy Kings, LLC will be a grantee of City funds ("Grantee").
Policy Kings, LLC has received a conditional commitment of up to $2,150,000 in City funds ("City Grant") to be provided from the 47th/State Tax Increment Financing ("TIF") district. The City Grant includes $1,900,000 for construction costs (the "Base Grant"), a conditional Local Residency Bonus of up to $250,000, (the Base Grant and Local Residency Bonus combined, the "Capital Grant").
The Project was selected for the plan and scope of work presented in the application and summarized below. Any changes to the proposed project plan or scope of work without DPD's prior written approval may result in forfeiture of the City Grant.
PROJECT ADDRESS
353-363 E. 51st Street
20-10-306-003-0000; 20-10-306-004-0000; 20-10-306-005-0000 (The address and PINS collectively, the "Property")
TIF AREA
The Property is located in the 47th/State Redevelopment Project Area (the "TIF Area"). Under ordinances adopted on July 21, 2004, and published in the Journal of Proceedings of the City Council of the City for such date, the City Council: (i) approved a redevelopment plan and project (the "Plan") for the TIF Area; (ii) designated the TIF Area as a "redevelopment project area" within the requirements of the TIF Act; and (iii) adopted tax increment financing for the TIF Area.
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PROJECT PLAN & SCOPE
Renovation of an existing 3-story, 8,986 square foot building (363 E. 51st St.) into two retail suites on the 1st floor and 6 residential units on the 2nd and 3rd floors and renovation of two existing single-story building at 353 E. 51st St. and 357 E. 51st St.
TIF-FUNDED IMPROVEMENTS
TIF-eligible costs include land assembly, demolition, site preparation, environmental remediation, rehabilitation, and other eligible activities under the Tax Increment Allocation Redevelopment Act, 65 ILCS 5/11-74.4.1 et seq. (the "TIF Act"). The TIF-eligible activities for the Project will be listed specifically in the RDA.
PROJECT SOURCES & USES
Anticipated Project Funds (Sources)* Anticipated Project Costs (Uses)
Equity $1,783,771 Acquisition Costs $750,000
Lender Financing $2,250,000 Site Preparation Costs $1,35,458
Other Funds $0 Hard Costs $3,875,504
Base Grant $1,900,000 Soft Costs $1,558,267
Local Residency Bonus $250,000
| Total $6,183,771 Total $6,183,771
*The Local Hiring Funds are available after project completion and therefore cannot be considered part of the Project capital stack.
CAPITAL GRANT PAYMENT
The Capital Grant may be disbursed as progress payments through a project escrow, or as a single, 100% reimbursement upon project completion. The Finalist must select a payment method before executing the RDA.
Project Escrow
Grantees may establish a project escrow account at their own cost, and receive four, incremental disbursements of their Capital Grant during construction. The fourth, and final, disbursement is provided following the completion of the Project and DPD's issuance of a Certificate of Completion ("Certificate"). Each escrow draw requires review and approval of Grantee's documentation by DPD. Grantees who elect to receive their Capital Grant via a project escrow must execute an escrow agreement with DPD and the title company concurrently with the execution of the RDA.
Single Reimbursement
Grantees may receive a one-time disbursement of 100% of their Capital Grant following the completion of the Project and DPD's issuance of the Certificate.
GRANT STRUCTURE
Before the City Grant is disbursed, Grantees will be required to submit evidence of eligible costs under the TIF Act, which may differ from costs eligible under the NOF program.
Base Grant
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Rehabilitation projects are eligible to receive up to 50% of total project costs. New construction projects are eligible to receive up to 30% of total project costs, to the extent that eligible costs such as land acquisition or site preparation are documented.
Local Residency Bonus
Finalists whose officer's or owner's primary residence is located within the Qualified Investment Area ("OJA") are eligible for a funding bonus of up to 25% of the total project cost, but not to exceed a total of $250,000, inclusive of the $2.5M grant limit, to the extent that eligible costs are documented. Finalists who are interested in this bonus must submit two of the following four items as proof of residency by Thursday, August 11, 2022:
Copy of the recorded lease or deed
Driver's license or State ID
Voter's registration card
Utility bill dated within the last 90 days
Local Hiring Funds
Each Grantee hiring at least two or more new employees who maintain their primary residence in the QIA is eligible for up to $75,000 in additional funds, exclusive of their Capital Grant amount. These funds are disbursed following the issuance of the Certificate, for eligible project costs incurred no earlier than three months prior to, and no later than 12 months following, receipt of the Certificate. The amount of Local Hiring Funds available will depend on the total amount of TIF-eligible costs incurred during construction and will be established by DPD upon the issuance of the Certificate. The new, qualifying employees:
Must maintain their primary residence in the QIA
Must work at least 20 hours/week, achieving at least 60 hours/week across all qualifying employees
Must receive at least minimum wage, as defined by the City of Chicago
Must be continually employed for a minimum of 12 weeks
May not include the Grantee's family members (by blood or marriage), persons dwelling at the Grantee's primary residency, or the Grantee themself.
Grantees are advised to keep a separate record of wage expenses for the qualifying employees in an organized file. Requests for reimbursement of project costs can only be submitted once per calendar quarter. Grantees must submit the following documents with their reimbursement requests:
Evidence of eligible project costs incurred and paid by the Grantee
Employee Worksheet Form (included in the RDA) listing all new hires, their primary residences, their hourly wages, and their average weekly hours worked.
Payroll ledgers and/or copies of pay stubs that verify hours worked, hourly wage, and address for employees.
SUMMARY OF GRANT COVENANTS
The following is a summary of important City Grant covenants to which the Grantee must adhere. The RDA will contain a complete list of all City Grant covenants.
Grantees shall not do any of the following without prior, written consent from DPD, for the Term of the Agreement: be a party to any merger, liquidation or consolidation; sell, transfer, convey, lease or otherwise dispose of all or substantially all of their assets or any portion of the project property (including but not limited to any fixtures or equipment now or hereafter attached thereto) except in the ordinary course of business; enter|1010|
into any transaction outside the ordinary course of Grantee's business; assume, guarantee, endorse, or otherwise become liable in connection with the obligations of any other person or entity; or enter into any transaction that would cause a material and detrimental change to Grantee's financial condition.
Operations & Occupancy Covenants
Grantees must continuously own, occupy, and/or operate the entirety of the Project for three years following the issuance of the Certificate. If a Grantee fails to satisfy these requirements, the City shall have the right to cease the payment of the City Grant, terminate the RDA, or place a lien on the Project property in the value of disbursed City Grant.
Annual Compliance Report
Grantees must submit an Annual Compliance Report for at least three years following the issuance of the Certificate. Requirements for the Annual Compliance Reports will be detailed in the RDA.
GRANT CONDITIONS
Issuance of the City Grant is subject to the Finalist's ability to fulfill the following conditions, and City Council approval. Following City Council approval of the City Grant, the Grantee will be required to execute the RDA with the City, through DPD, which details the legal requirements ofthe Project and the process for receiving the City Grant.
Conditions for Submission to City Council for Approval for the City Grant
The following must be submitted to your Project Manager by Click to enter Letter Date + Five Months to prepare for submission to City Council for approval.
Pre-Construction Compliance Meeting: The Finalist, general contractor, and all major subcontractors must meet with Construction Compliance staff to review the Finalist's plan to achieve the City's Construction Compliance obligations (MBE/WBE, City Residency and Prevailing Wage Requirements), as established in the RDA and as mandated by City ordinance and DPD policy.
Final Contractor Estimates: The Finalist must submit at least two, final and comprehensive contractor estimates for the final Project scope of work. All estimates must reflect the same scope of work and final Project Budget, as well as account for the City's M/WBE, Prevailing Wage and City Residency construction compliance requirements.
Final Project Budget: The Finalist must submit a final Project budget. The City Grant amount in this letter will not be increased; therefore, the Finalist must assume the responsibility of any Project cost increases following City Council approval.
Final Design Documents: The Finalist must submit, at a minimum, a final site plan, final renderings, and final elevations for the Project. All DPD comments on the Project design should be addressed prior to seeking City Council approval.
Final Zoning Approval: The Finalist must verify that all proposed Project uses and physical improvements comply with the zoning requirements for the Project location. If the Project uses and/or improvements require a zoning map amendment, licenses, or permits, the Finalist must provide evidence ofthe approved zoning map amendment, secured licenses and/or permits, and Aldermanic input.
Preliminary Project Financing: The Finalist must submit proof of project financing, demonstrating that all sources of funds outside of the City Grant are available and secured, or will be secured by closing. The Finalist must close on all financing sources on or before executing the RDA.
Preliminary Site Control: The Finalist must submit the following proof of site control, demonstrating that the Project location is secured, or will be secured by closing. The Finalist must secure site control on or before executing the RDA.
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Tenant Finalists: Letter of interest or executed lease (for at least three years) for the Project location.
Owner-Occupied Finalists: Deed or Real Estate Purchase Agreement (demonstrating closing within 90 days), for the Project location.
cj Property Owner Finalists: Deed or Real Estate Purchase Agreement (demonstrating closing within 90 days), for the Project location; AND letters of interest or executed tenant leases, for at least three years, for at least 75% of the Project.
Conditions for Executing The RDA
Following City Council's approval, the Grantee must satisfy the conditions below before the City will execute and deliver the RDA, unless the City waives such conditions in writing. The following must be secured within one month of receiving City Council approval to close on the RDA.
Final Project Financing: If not yet submitted, the Grantee must submit proof of project financing, evidencing that all financing sources outside of the Capital Grant have been secured and are available.
Final Site Control: If not yet submitted, the Grantee must submit the following proof of site control, evidencing that the Project location has been secured:
Tenant Grantees: Executed lease for at least three years for the Project location AND written evidence of property owner's consent to record the RDA against the tenant's leasehold interest in the Project location.
Owner-Occupied Grantee: Deed for the Project location.
Property Owner Grantee: Deed for the Project location; AND executed tenant leases, for at least three years, for at least 75% of the Project.
Escrow Agreement: If the Grantee elects to receive the Capital Grant via progress payments (escrow), the escrow agreement between the City, title company and Grantee must be fully executed.
Building Permits: The Grantee must submit proof of all permits required by the City's Municipal Code for work associated with the Project for all corresponding costs to be eligible for reimbursement.
Conditions for Receiving the Certificate
The Grantee must complete project construction and receive a Certificate within the timeframe dictated by the executed RDA, or the Project will be considered in default, the City Grant may be forfeited, and the RDA may be terminated. The Certificate must be issued within two years of the RDA execution date.
MBE/WBE Requirements: The Grantee must fulfill at least 26% Minority Business Enterprise (MBE) and 6% Women Business Enterprise (WBE) participation for all direct and indirect construction costs associated with the Project.
City Residency Requirements: The Grantee must hire City residents to perform 50% of all construction hours.
Prevailing Wage Requirements: The Grantee must adhere to the City's prevailing wage requirement for all construction trades, as established by the Illinois Department of Labor.
Certificate of Occupancy: The Grantee must obtain and submit proof of all permits required by the City's Municipal Code to occupy the Project premises.
Business Licenses: The Grantee must obtain all necessary business licenses.
Documentation: The Grantee must appropriately document all eligible project costs. Documentation includes, but is not limited to, detailed invoices, cancelled checks, sworn owner's statement, sworn statement of contractor and subcontractor to owner and final lien waivers.
PROJECT EXTENSION, WITHDRAWAL AND TERMINATION POLICIES
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Project Deadline Extension
Grantees are allowed to request up to two extensions to satisfy the conditions for all milestones leading to RDA execution. Grantees in need of an extension during this time must submit a written request to DPD justifying the need for the extension. DPD will issue extension approvals and durations, in writing, at its discretion. DPD will withdraw City Grants for Grantees who are unable to satisfy the conditions after exhausting their extensions.
Project Withdrawal
Finalists or Grantees must provide written notification to DPD staff of their intent to rescind their City Grant and withdraw from the program. DPD staff will send the Finalist or Grantee an email confirmation of the Project's withdrawal and the return of the allocated City Grant.
Project Termination
DPD staff will send the Finalist or Grantee notification via email and postal mail to the above address regarding termination of the Project and the return of the allocated City Grant. 1
All questions regarding the conditions outlined in this letter, and general City requirements and procedures, can be addressed to Emmett Morrissey (Emmett.morrissey@cityofchicago.org ) or 312-744-9499.
Tim Jeffries
Deputy Commissioner
Department of Planning and Development
We look forward to supporting your efforts to revitalize the City's South, Southwest and West sides. Sincerely,
|1010|On behalf of Policy Kings, LLC, I accept the above terms and conditions of this Conditional Commitment of City Funds offered by the City of Chicago.
-DocuSigned by
Owner/Devel oper Title
Return one copy of this letter to: City of Chicago
Department of Planning and Development Attention: Emmett Morrissey 121 North LaSalle Street, RM 1003 Chicago, IL 60602
CITY GRANT DELIVERABLE SUMMARY CHECKLIST & SCHEDULE
Milestone #1: Conditional Commitment of Funds (Letter)
.0 Conditions for Next Milestone Time to Next Milestone.
Final Contractor Estimates (2) 5 MONTHS
Final Project Budget
Final Zoning
Final Design Documents
Preliminary (Final acceptable) Project Financing Documentation
Preliminary (Final acceptable) Site Control Documentation
Approval by Community Development Commission
Milestone #2: Council Approval (City Grant Authorization)
0 : Conditions for Next Milestone . . . Time to Next Milestone
Final Project Financing Documentation 1 MONTH
Final Site Control Documentation
Grant Payment Election (executed escrow agreement, if applicable)
Building Permits Secured
Milestone #3: Project Closing (Executed RDA) |10 9|Conditions for Next Milestone Time to Next Milestone
M/WBE Construction Compliance Requirements Fulfilled 24 MONTHS
City Residency Construction Compliance Requirements Fulfilled
Prevailing Wage Construction Compliance Requirements Fulfilled
Occupancy Permits Secured
Business Permits Secured
Business Licenses Secured
Project Cost Documentation (invoices, sworn statements, lien waivers)
Milestone #4: Project Completion (Certificate of Completion)
i
CITY 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:
Policy Kings, LLC
Cheek ONE ofthe following three boxes:
Indicate whether the Disclosing Parly submitting this EDS is:
f ] the Applicant
OR
[ ] a legal entity currently holding, or anticipated to hold within six months alter Ciiy 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. Stale the Applicant=s legal
name: _ _ _
OR " " " " ~ " ~ "
| ] a legal entity with a direct or indirect right of control ofthe Applicanl (sec Section 11(B)(1)) Slate the legal name ofthe entity in which the Disclosing Party holds a right of control:
n o ,., ftl n . • » , 7315 S. Vernon Avenue
13. Business address or the Disclosing Party: __ _
Chicago,II 60619
r , , 773-617-0279 _ r. , 773-617-0279
C. i deplume: _ rax: _ Email: _ _ __
r , James Daughrity
l). Name of contact person: _
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):
353,357,363 E 51st Street Chicago, IL. 60615 - 20-10-306-003-0000. 20-10-306-005-0000, 20-10-306-004
Department of Pianning and Development
Ci. Which City agency or department is requesting this If.DS? __ _
If ihe Matter is a contract being handled by the Cily---s Department of Procurement Services, please complete the following:
Specification // _ and Contract // _ _ _
Ver 20 I 8-1 Pa tie 1 of 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
[ ] Person
[ J Publicly registered business corporation
[ 1 Privately held business corporation
[ j Sole proprietorship
f ] General partnership
[ ] Limited partnership
[ j Trust
|x | Limited liability company [ 1 Limited liability partnership | j Joint venture | j Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
[ | Yes | J No
. [ | Other (please specify)
2. Lor legal entities, the stale (of foreign country) of incorporation or organization, if applicable:
Illinois
3. For legal entities not organized in the Slate of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity9
[ JYes [ | No |x "| 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 ol the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Corey Gilkey Managing Member
James Daughrity Managing Member
2. Please provide the following information concerning each person or legal entity having a direct or indirect, current or prospective (i.e.'within 6 months alter City action) beneficial interest (including ownership) in excess of 7.5% ofthe Applicant. Examples of such an interest include shares in a corporation,-partnership interest in a partnership or joint venture, interest of a member or manager in a
hme 2 >.
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state ANone.@
NOTE: Bach legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
Corey Gilkey 9241 S. Colfax, Chicago, II 60617
James Daughrity 7315 S Vernon Avenue Chicago,II 60619
SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Parly provided any income or compensation to any City elected official during ihe
12-month period preceding the date of this EDS? [ ] Yes |x ] No
Does the Disclosing Party reasonably expect to provide any income or compensation lo any City
elected official during the 12-month period following the date of this EDS? | | Yes |x | No
Tf Ayes@ to cither ofthe above, please identify below the name(s) of such City elected oflicial(s) and describe such income or compensation:
Does any City elected ofllcial or, to the best ofthe Disclosing Party-s knowledge alter reasonable
inquiry, any City elected officials spouse or domestic partner, have a financial interest (as defined in
Chapter 2-1.56 ofthe Municipal Code of Chicago (AMCC@)) in the Disclosing Party?
| | Yes [x | No
If "yes," please identify below the namc(s) of such City elected official(s) and/or spouse(s)/domeslic partner(s) and describe the financial interest(s).
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-1 56), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. Ihe Disclosing Party i.s not required lo disclose employees who are paid solely through the Disclosing Party's regular payroll. If the Disclosing Parly is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
P;mc 3 of 15
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.) Ahourly rate@ or At.b.d.@ is
not an acceptable response.
Nation Builders Construction Group - 22 N Kildare Ave. #403, Chicago, IL 60624 - General Contractor - Paid $65,000 Silvestro Design Operations - 443 East 46th Place Chicago, IL 60653 - Architect - Paid $60,000 The Nascent Group - 6018 South Saint Lawrence Avenue, Chicago, IL 60637 - Estimated $36,000
(Add sheets i f n e c e s s a ry)
[ ] Check here if the Disclosing Party has not retained, nor expects lo retain, any such persons or entities.
SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities lhat contract with the City must remain in compliance with their child support obligations throughout the contract=s term.
I (as any person who directly or indirectly owns 10% or more olThe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ | Yes | ] No |x J No person directly or indirectly owns 10% or more ofthe Disclosing Parly.
If A Yes, g 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
IT FURl'IlER CT-R ITFICATIONS
| 1 his paragraph 1 applies only if the Matter is a contract being handled by the City -s Department of Procurement Services.J ln the 5-year period preceding the date ofihis EDS. neither the Disclosing Parly nor any Affiliated Enlity |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).
T he Disclosing Party and its Affiliated Enlities are nol delinquent in the payment of any fine, fee, lax or other source of indebtedness owed to the City of Chicago, including, but nol limited lo, water and sewer charges, license fees, parking tickets, properly taxes and sales taxes, nor is the Disclosing Parly delinquent in the payment of any tax administered by ihe Illinois Department of Revenue.
Pa-e 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 lederal, 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 (lederal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records: making false statements; or receiving stolen property;
are not presently indicted for. or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any ofthe offenses set forth in subparagraph (b) above;
have not. during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default: and
have not, during the 5 years before the date ofihis 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 2-1 56 (Governmental Ethics).
5. Certifications (5). (6) and ( 7) concern:
5 the Disclosing Party;
3 any AContractorG (meaning any contractor or subcontractor used by the Disclosing Party in connection wilh tlie Matter, including but not limited lo all persons or legal entities disclosed under Section IV, ADisclosurc of Subcontractors and Other Retained Parties?): S any "Affiliated Entily" (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 enlity lo do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity. Wilh respeei to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Conlracior. is controlled by it, or, with the Contractor, is under common control of another person or entity:
$ any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any
other official, agent or employee of the Disclosing Parly, any Contractor or any Affiliated Emily,
acting pursuant lo the direction or authorization of a responsible official ofthe Disclosing Party,
any Contractor or any Affiliated Emily (collectively "Agents").
Ver.20IN-l Pauc 5 ol 15
Neither the Disclosing Parly, 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 tlie 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 ofthe federal government or of any slate 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 mailer of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Conlracts 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 governmeni as a result of engaging in or being convicted of (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rolaiing in violation of 720 ILCS 5/33E-4: or (3) any similar offense of any stale or of the United Slates of America that contains ihe same elements as the offense of bid-rigging or bid-rolaiing.
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 lederal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any Acontrolling person G [see MCC Chapter 1-23, Article I for applicability and defined terms] ofthe Applicant is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any Asister agency (<); and (ii) the Applicanl 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 Arlicle=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 permil their subcontractors to use. any facility listed as having an active exclusion by ihe U.S. EPA on the federal System for Award Management (ASAM?).
10. |FOR APPLICANT ONLY] The Applicanl will obtain from any contractors/subeoniiactors hired
Vci .20 ! 8-1 Page 6 of 15
or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not. without the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful certifications.
1 1. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
N/A
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, ofthe City of Chicago (i f none, indicate with A.N/A@ or Anone@).
N/A
13. To the best ofthe Disclosing Party s knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-monlh period preceding the execution date ofihis EDS, to. an employee, or elected or appointed official, ofthe City of Chicago. For purposes of this statement, a AgiliJ does nol 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 lhan $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law ( if none, indicate wilh AN/A@ or Anone3). As to any gift listed below, please also list the name ofthe City recipient.
N/A
C. CERTIFICATTON OF ST ATUS AS FINANCIAL. INST 1TUTION
The Disclosing Party certifies thai the Disclosing Parly (check one)
f ] is (x ] is not
a "financial institution" as defined in MCC Scciion 2-32-455(h).
If the Disclosing Party IS a financial institution, then the Disclosing Part) pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further pledge thai none of our affiliates is. and none of them will become, a predatory lender as defined in
Vei-.20:S-i
MCC Chapter 2-32. We understand that 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."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
N/A
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 defmed in MCC Chapter 2-1 56 have the same meanings if used in this Part D.
In accordance with MCC Section 2-156-1 10: To the best ofthe Disclosing Party=s knowledge after reasonable inquiry, does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in ihe Matter?
( J Yes [x ] No
NOTE: Ifyou checked "Yes" to Item D( I). proceed to Items D(2) and D(3). Ifyou checked "No" to Item D(l), skip I tems 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 properly lhat (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue oflegal process al ihe suit ofthe City (collectively. "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning ofihis Part D.
Does the Matter involve a City Property Sale'?
[ 1 Vcs [ J No
Ifyou 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 ofthe financial interest:
Name Business Address Nature of Financial Interest
P H o.l 15
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (I) or (2) below. If the Disclosing Parly checks (2), the Disclosing Party must disclose below or in an attachment to this EDS all information required by (2). Failure, lo comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.
* 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 lhat provided coverage for damage to or injury or death of their slaves), and the Disclosing Parly has found no such records.
2. The Disclosing Parly 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 Parly 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 i.s not federally funded, proceed to Section VII. For purposes of this Section VI. tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
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 ihc Matter: (Add sheets if necessary): N/A
(If no explanation appears or begins on tlie lines above, or if the letters "NA" or if the word "None" appeal', il will be conclusively presumed lhal 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 ihe Disclosing Party wilh respect to the Matter.)
2. The Disclosing Pany has nol spent and will nol expend any federally appropriated funds lo pay
Ve: .20 1 S-1 P;ii:e9of 15
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 lo 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 of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A(l) and A(2) above.
The Disclosing Party certifies that either: (i) it is not an organization described in section 501 (c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995. as amended.
If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.
IL CERTIFICATION REGARDING EQUAL EMPLOYMENT' OPPORTUNITY
UThe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information wilh their bids or in writing at the outset of negotiations.
Is the Disclosing Party the Applicant? | ! Yes " ' [] No
If AYes.fei answer the. three questions below:
1 lave you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 4 I CFR Part 60-2.)
| | Yes [ j No
flave you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
| ] Yes | J No | | Reports not required
3 flave you participated in anv previous contracts or subcontracts subject to the equal opportunity clause?
| j Yes ' [" "] No
Ifyou checked ANo@ to question (1) or (2) above, please provide an explanation:
Vci 2018-1 Pa.j., 10 ol 15
SECTION VII -
- FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Parly understands and agrees that:
The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicanl 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, fbe 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 enlities seeking City contracts, work, business, or transactions. The full text of this ordinance and a training program is available on line at w w vv. c i ty o fc 11 i cag o. o rd Ethics, and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St Suite 500, Chicago, IE 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 il 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 io make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided in. and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS. the Disclosing Part) waives and releases any possible rights or claims which it may have against the City in connection with the public release of informaiion contained in this EDS and also authorizes the City to verify the accuracy of any informaiion submitted in this EDS.
The informaiion provided in this EDS must be kept current, ln the event of changes, the Disclosing Party must supplement this EDS up to ihe 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 subjecl to MCC Chapter 1-23, Article 1 (imposing PERMANENT INELIGIBILITY for certain specified offenses), the informaiion provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-\ 54-7)20.
I'a-iC 1 I oi' 15
CERTIFICATION
Under penally 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 ofthe date furnished to the City.
Policy Kings, LLC
(Print or type exact legal name of Disclosing Party)
James Daughrity
(Print or type name of person signing)
Managing Member
(Print or type title of person signing)
See Attached
ftoteiry! Certificate
Commission expires:
P;me 12 of 15
JURAT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Los Angeles
Subscribed and sworn to (or affirmed) before me on this j^S day oftSp/fr&CS'
20SO- by V)c\rY\eS f5. T>avjCjVw. -U^
proved to me on the basis of satisfactory evidence to be the person^ who appeared before me.
LUZM. FLORES - |
Commission No. 2288573 *
NOTARY PUBLIC-CALIFORNIA ^
LOS ANGELES COUNTY E
MyComm Emirm JUNE (0. 2023 i
OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
The wording of all Jurats completed in California after January 1, 2015 must ce in the form as set forth within this Jurat There ure no exceptions If a Jura! to be completed does not follow this form, the notaiy must correct the verbiage by using a jurat stamp containing the correct wording or attaching a separate jurat form such as this one with' does contain Ihe proper wording. In addition, the notary must require an oath or affirmation from the document signer regarding the truthfulness of the contents of the document. The document must be signed AFTER the oath or affirmation. If the document was previously signed, it must be re-signed in front of the notaiy public during the jurat • process.
(Title or description of attached document continued)
^—• State and county information must be the state and county where the document signers) personally appeared before the notary public. Date of notarization must be the date the signer(s) personally appeared which must also be the same date the jurat process is
Q//c/a(y\^ comP|eted
Document Date
'//"«J/iLHWi4. Pijnt the name(s) of the document signer(s) who personally appear at the time of notarization.
• Signature of the notary public must match the signature on file with the
office of the county clerk.
• The notary seal impression must be clear and photographically reproducible Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different jurat form.
Additional information is not required but could help to ensure Ihis jurat is not misused or attached to a different document
Indicate title or type of attached document, number of pages and date.
• Securely attach this document to the signed document with a staple.
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS
AND DEPARTMENT HEADS
Phis 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 AApplicable Party @ or any Spouse or Domestic Partner thereof currently has a Afamilial relationships with any elected city official or department head. A Afamilial relationship? exists if, as ofthe date this F.DS is signed, the Disclosing Party or any AApplicable Parly @ 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 slepmoiher, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
AApplicable Party@ means (1) all executive officers ofthe Disclosing Party listed in Section II.B.l .a., if ihe 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 Parly 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 Parly. APrincipal 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 AApplicable Party £ or any Spouse or Domestic Partner thereof currently have a Afamilial relationship!? with an elected city.official or department head'?
| | Yes [x J 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 electee! city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship.
P;i-e 13 oi 15
IN
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 entily which has only an indirect ownership interest in the Applicant.
Pursuant to MCC Section 2-1 54-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] Yes [x] No
If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416?
[ ] Yes [ ] No |x ] The 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.
!>aue 14 of 15
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX C
PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION
This Appendix is to he completed only hy an Applicant that is completing this EDS as a '"contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (wwvv.amlcgal.com ). generally covers a party to any agreement pursuant to which they: (i) receive City ol"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. I hereby certify that the Applicant is in compliance with MCC Section 2-92-385(b)( 1) and (2). which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants" w age or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions.
I I Yes
I 1 No
|x "| N/A - I am not an Applicanl 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)( 1). If you checked "no" to Ihe above, please explain.
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