ORDINANCE
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. Title 17 of the Municipal Code of Chicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the RS 3 Residential Single-Unit (Detached House) District symbols and indications as shown on Map No. 9-J in the area bounded by
A line 190.36 feet North of and parallel to West Grace Street; the public alley next East of and parallel too North Hamlin Avenue; a line 157.07 feet North of and parallel to West Grace Street; North Hamlin Avenue
To those of an RT 3.5 Residential Two-Flat Town House and Multi-Unit District.
Section 2. This Ordinance shall be in force and effect from and after its passage and due publication.
Common Address of Property: 3817 N. Hamlin Avenue
CJTY OF CFTfCAGD
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING: ORDINANCE
ADDRESS of the proparty Applicant is seeking to rezbhe:
3817 N. HAMLIN AVENUE
WardNumher to
APPLICANT RICARDO AND BERNICE A. LOZADA
ADDRESS . .'. . , , CITY
STATE. ZIP CODE PHONE;
EMAIL CONTACT PERSON
Is the applicant the ownfer of the property? YES X NO_
If theapplicant-isnpt the owner ofthe property, please provide the fbflowinj£i^ regafdingthe owner and attach -wntoniauthorization from the owner allowing the application to proceed.
OWNER
ADDRESS
STATE ZIP CODE PHONE
EMAIL CONTACT PERSON
Ifthe Appiicant/Owner pf the property has obtained a lawyer as their representative for the rezoning,-please:provide the following inibirnatibn:
ATTORNEY LISA DUARTE
ADDRESS 180 N. LASALLE ST. #2750
CiTY CHICAGO STATE IL ZIP CODE 60601
PHONE (517) 980-5896 FAX EMAIL.
Page 1
Ifthe applicant is a legal entity (Corporation, LLC, Partnership, etc.) please provide the names of all owners as disclosed on uje Ecanonuc Disclosure-Statements.
N/A
On what date did the owner acquire legal titieto the subject property? MARCH 4, 2022
Has the present owner previously r^ned mis property? If yes, when?
NO
RS 3 RESIDENTIAL RT 3.5 RESIDENTIAL
SINGLE-UNrTJDETACHED TWO-FLAT TOWN HOUSE
Present Zoning DistrictHOUSEi district Proposed Zoning District and multuunit district
Lot size in square feet (or dimensions) 33' X 125.7'
Current Use of the property RESIDENTIAL 2 DWELLING UNITS ^_
Reason forrezoning the property TO MEET THE BULK REQUIREMENTS OF THE RT 3.5 DISTRICT
TO ALLOW THE CONVERSION OP THE EXISTING 2 DWELLING UNIT BUILDING TO A 3 DWELLING UNIT BUILDING. THE THIRD DWELLING UNIT WILL BE ON THE LOWER LEVEL OF THE EXISJTING 3 STORY BUILDING.
Describe the proposed use ofthe property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and height of the proposed building. (BE SPECIFIC)
3 DWELLING UNITS. 3 PARKING SPACES. EXISTING 3 STORY BUILDING LOWER LEVEL TO BE EXCAVATED APPROXIMATELY 8" NO CHANGE IN EXTERIOR BUILDING HEIGHT
14. The Affordable Requrements Ordinance .(ARO) requires on-site affordable housing units and/or a financial contribution for residential housing projects with ten or more units that receive a zoning change which, among other triggers, increases the allowable floor area, or, for existing Planned Developments, increases the number of units (see attached fact: Sheet or visit www.cityofchicago.org/ARO for more infonnation). Is uus project subject to the ARO?
YES NO X
Page 2
COUNTY OF COOK STATE OF ILLINOIS
RICARDO AND BERNICE A. LOZADA , being first duly sworn on oath, states that all ofthe above statements and the statements contained in the documents submitted herewith are true and correct.
Signature of Applicant RICARDO LOZADA
Subscribed and Sworn to before nie this
\2-VK day of OqVW , 20 *-2-
Notary Public
"~ - fc>
Signature of Applicant BERNICE A. LOZADA
LISA DUARTE Official Seal , Notary Public-State of Illinois I My Commission Expires Nov 16, 2025
Date of Introduction:
File Number:
Ward:
?
^EXACTA
Land Surveyors, LLC
www-exactaland com | office: T73.305-4011
PROPERTY ADDRESS: 3817 N HAMLIN AVENUE, CHICAGO, ILLINOIS 60618
2210.2206
BOUNDARY SURVEY COOK COUNTY
FND CRG55 _2_00'_W . ¦
HD Cp.OS5 2 00' w <
-2 I £)' -2 I S'
-I 7 O1-¦ CONC
.CONC
if>|
T
REMAINDER OF
LOT 17
BLK 6 (NOT INCLUDED)
2.5 STORY BRICK RES. ,
LOT 17 BLK 6
EXCEPT THEN 8 1/3' THEREOF ft
1$ S89°24V9'E 125.58'(Cj
-r
2:5 STORY¦¦50.'2.5 STORY BRICK RES.
:o"c ¦
THEN 16 2/3'OF LOT 18
BLK 6
REMAINDER OF
LOT 18
BLK 6 (NOT INCLUDED)
2 STORY BRICK RES.
THE N R/W LINE OF
GRACE STREET
LINE TABLE-LI 33.33'(R)
NO'ITO'E 33 25'(C) L2 S0"02'16"E 33.31'(C) L3 N89°22'41-W 125.77'(C)
TOTAL AREA OF PROPERTY SURVEYED 4182 SQ.FT.±
GRAPHIC SCALE (In Feet) 1 inch = 30' ft.
STATE OF ILLINOIS "Ice COUNTY OF GRUNDYj THIS IS 10 CERTIFY THAT THIS PROFESSIONAL SERVICE CONFORMS TO THE CURRENT ILLINOIS VIN'MUM STANDARDS =OR A BOUNDARY SURVEY GIVEN UNDER MY HAND AND SEAL THIS DATE HEREON 4*2/ '44 ^/ 1 |7 BSO03CS \\ S\JV>A/tl4A\ /ftr^WlJin 1 # 1 PROFESSIONAL 11 w ^11 LAND SURVEYOR I f All MORRIS. IL # # ILLINOIS PROFESSIONAL LAND SURVEYOR No ""^^?.F LICENSE EXPIRES 11/30/2022 EXACTA LAND SURVEYORS, LLC PROFESSIONAL DESIGN FIRM 184008059-0008 POINTS OF INTEREST: NONE VISIBLE
A m\X~"\tW /V ExactaUndSurveyors,LLC L»nd Surveyor*. ULC 0:773.305 4011 316 East Jackson Street | Morris, IL 60450
A SurveySTARS
DATE OF SURVEY: 10/17/22 FIELD WORK DATE: 10/17/2022 REVISION DATE(S): (REVO 10/17/2022) SEE PAGE 2 OF 2 FOR LEGAL DESCRIPTION PAGE 1 OF 2 - NOT VALID WITHOUT ALL PAGES
PROPERTY ADDRESS: 3817 N HAMLIN AVENUE, CHICAGO, ILLINOIS 60618 SURVEY NUMBER: 2210.2206
JOB SPECIFIC SURVEYOR NOTES:
LEGAL DESCRIPTION:
LOT 17 {EXCEPT THE NORTH 6 1/3 FEET THEREOF) AND THE NORTH 16 2/3 FEET OF LOT 18 IN BLOCK 6 IN MASONS SUBDIVISION OF THE EAST HALF OF THE NORTHWEST QUARTER (EXCEPT RAILROAD) OF SECTION 23, TOWNSHIP 40 NORTH, RANGE 13, FAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
GENERAL SURVEYOR NOTES:
The Legal Descr ptic-. used lo reform I his survey was supplied by others This survey dues noi determine nor imply ownership of lhe lands or any fences shown hereon Unless otherwise noted, an examination of the abstract of Mle was NOT performed by lhe signing surveyor lo determine which instrument!, if any, are affecting this property
The purpose of this survey is to establish the boundary of the lands described by lhe legal description provided and to depict the visible improvements thereon for a pending financial transaction Underground footings, utilities, or other service lines, including roof eave overhangs were not located as part of this survey Unless specifically stated otherwise the purpose and intent of this survey is not for any construction activities or future planning
If thnre is a septic tank or dram field siown on i*iis survey, fie location deo.cied hereon was either shown to the surveyor by a third party or it was estimated by visual aboveground impel lion No excavation was performed to determine its
This survey is exclusively for a pendng financal tiansaction and only to he i;jed by the parties to whom it is certified
b Alterations to this survey map and report by other than the
signing surveyor arc prohibited 6 Dimensions are in feet and decimals thereof
'/ i\".y FlMA flood zone da;a cu-.ta ncd on this suivey ¦! for
informal.onal purposes oily Research to obtain saic cata was por for Tied at www fema gcv and may not reflect t"e most recent information
Unless otherwise noted "SIR* indicates a set iron rebar, 5/8 inch in diameter and twenty-four inches long
The symbols reflected in the legend and on this suivey may have been enlarged or reduced for clarity The symbols have been plotted at the approximate center ol the field location and may not represent the actual shape or size of thefeaiure
Poinis of Interest (POI's) are select above-ground improvements, which may appear In conflict with boundary, b-Jldmg setback or easement lines, as denned by the parameters of this survey These POI's may not represent
al! items of interest lo lhe viewer There may be additional PO-'s which are not shewn or ca'led-out as POI's, or wn:ch are otherwise unknown lo the surveyor
Utilities siown on the subject property may or may not indicate the existence of recorded or unrecorded utility easements
The information contained on this survey has been performed exclusively by and is the sole responsibility of Exacta Land Surveyors, LLC Additional logos or references to third party firms are for informational purposes only
13 Due lo varying contt ruction Man da res. bu. ding c.mensions are approximate and are not intenced to be used for new construction or planning
1^ Surveyor bearings are used for angular reference and a;e used lo show angular relationships of lines only and are not relaled oi orientated lo true or magnetic north Bearings are shown as surveyor bearings, and when shown as matching those on the subdivision plats on which this survey is based, they are to be deemed no more accurate as the deteirmnation of a north orientation made on and for those original subdivision plats North 00 degrees East is assumed and upon preparation of this plat, lhe resulting bearing between found points as shown on this survey is the basis of said surveyor bearings as defined and icquired lo be noted by Illinois Admmstralwe Code Title 68, Chapter Vll. Sub-Chapter B, Pari 12/0, Section 1270 56, Parag-aoh 3. Sub-Paragraph 6, Item k
15 THIS SURVEY IS A PROFESSIONAL SERVICE IN COMPLIAfSCt WITH THE MINIMUM STANDARDS OF THE STATE OF ILLINOIS NO IMPROVEMENTS SHOULD BE MADE ON THE BASIS OF THIS PLAT ALONE PLEASE REFER ALSO TO YOUR DEED, TITLE POLICY AND LOCAL ORDINANCES COPYRIGHT BY EXACTA ILLINOIS SURVEYORS THIS DOCUMENT MAY ONLY BE USED BY THE PARTIES TO WHICH IT IS CERTIFIED PLEASE DIRECT QUESTIONS OR COMMENTS TO EXACTA ILLINOIS SUHVEYORS, INC AT THt PHONE NUMBER SHOWN HEREON
SURVEYOR'S LEGEND
UNETYPES
"j Boundary Line
Centerline
« ««« + ChainLinkorWire |Fence
Easement
Edge of Water
-O—O— Iron Fence
—OHL—| Overhead Lines
¦ ¦ j Structure
Survey Tie Line
Vinyl Fence
| WallorPartyWall
*•* Wood Fence
SURFACETYPES
Asphalt
Brick orTile
Concrete
> < Covered Area
'/m Water
Wood
SYMBOLS
Benchmark
Center Line
A Central Angle or Delia
Common Ownership
Control Point
Catch Basin
Elevation
XT Fire Hydrant
• Find or Set Monument
£— Guy wire or Anchor
Manhole
© Tree
Utility or Light Pole
® Well
ABBREVIATIONS
(O-Calculated
{D)-Deed
IF}-Field
(M) - Measured
(P)-Flat
(R) - Record
IS)-Survey
A/C-Air Conoilionmg
AE-Access Easement
ANE - Anchor Easement
ASBL - Accessory Setback Line
B/W-Bay/Box Window
BC- Block Corner
BFP-fiacVilowr'ievtnK.'i
BLDG-Building
BLK - Block
BM - Benchmark
BR - Bearing Reference
BRL - Building Restriction Line
BSMT-!l.wr.i>M
OC.: ¦*¦<>
C/L-Centei Line
C/P- Covered Porch
C/S-Concrete Slab
CATV-Cable TV Riser
CB-Concrete Block
CH-Chord Bearing
CHIM-Chimney
CLF-Cham Link Fence
CME - Canal Mamtenance
Easement
CO-Clean Out
CONC - Concrete
COR-Comer
CS/W-Concrele Sidewalk
CUE ¦ Control Utility Easement
CVG - Concrete Valley Gutter
D/W-Driveway
DE - Drainage Easement
DF-DramFieic:
OH-Drill Hole
ELEV- Elevation
EM-Electric Meter
ENCL-Enclosure
ENT-Entrance
EOP - Edge of Pavement
EOW-EdgeofWaler
ESMT- Easement
EUB - Electric Utility Box
F/DH - Found Drill Hole
FCM - round Concrete
Monument
FF-Finished Fluor
FIP-"ou-:c!lron Pipe
FIPC - -nii-d Iron Pipe 6, Cap
FIR-Found Iron Rod FIRC-Found Iron Rod & Cap FN - Found Nail FN&D-FoundNail&Disc FRRSPK - Found Rail Road Spike
GAR-Garage
GM -Gai Meter
ID-ldentiScanon
IE/EE - Ingress/Egress Easement
ILL-Illegible
INST-Instrument
INT-Intersection
IRRE - Irrigation Eascmenl
L- Length
LAE-Limned Access Easement LB# - License No (Business) LBE - ¦.im ted Buffer Easement LE - Landscape Easement LME-Lake/Landscape Maintenance Easemeri LSd - License No (Surveyor) MB - Map Book ME-Maintenance Easement MES-Milered End Section MF-Meial Fence MH-Manhole
1929
MHWL - Mean High Water Line NR - Non-Radial NTS-Not to Scale NAVD88- North Amern an Vertical Datum 1988 NGVD29 - Nat ona! Geodetic
Vertical Datum OG-OnGroun
ORB - O'ficial Recoids Book ORV - Official Recoid Volume O/A-Overall O/S-Offset
OFF - Outside Subject Property
OH - Overhang
OHL - Overhead Utility Lines
OHWL-Ordinary High Water
Line
ON - Inside Subject Property
P/E-Pool Equipment
PB - Plat Book
PC - Poinl of Curvature
PCC - Point of Compound
Curvature
PCP - Permanent Control Point
PI - Point of Intersection
PLS - Professional Land
Surveyor
PLT-Planter
POB-Point of Beginning
POC - Point of Comment ement
PRC-Point of Reverse
Curvature
PRM - Permanent Reference Monument
PSM - Professional Surveyor & Mapper
PT - Point of Tangcncy PUE-Public Utility Easement R-Radius or Radial R/W-Right of Way RES - Residential RGE - Rii'igc
ROE - Roof Overi-any Easement RP-Hbcl.s Po.-.t
S/W-Sidewalk
SBL-Seiback Line
SCL - Survey Closure Line
SCR - Screen
SEC-Section
SEP - Septic Tank
SEW-Sewer
SIRC - Set Iron Hod & Cap
SMWE-Stoim Water
Management Easement
SN&D-Sel Nail arid Disc
SQFT-Square Feet
STl. - Survey Tie Line
STY-Slory
SV - Sewer Valve
SWE - Sidewalk Easement
TBM - Temporary Beich Mark
TEL-7e!e:i7-o".e Facilities
TOB-Toi) of Hank
lUliI
TUE-Technologic Easement TWP * Township TX - Transformer TYP-Typical UE- Utility Easement UG - Underground UP-Utility Pole UR-UiihlyRiser Vr-V::!yrre:iL« W/O Witless Corner W/F-Water Filter WF-Wood Fence WM - Water rV.eler/V,i vt- = WV-Wnti-'Viilvt
FLOOD ZONE INFORMATION:
DATE SIGNED: 10/17/22
BUYER: BERNICE LOZADA
LENDER:
TITLE COMPANY:
CLIENT FILE NO:
COMMITMENT DATE:
SEE PAGE 1 OF 2 FOR MAP OF PROPERTY PAGE 2 OF 2 - NOT VALID WITHOUT ALL PAGES
^EXACTA
Land Surveyors. LLC
Exacta Land Surveyors, LLC PHI 1840M059 0:773 305.4011 316 East Jackson Street | Morns, IL 60450
"WRITTEN NOTICE" FORM OF AFFIDAVIT (Section 17-13-0107)
Date October 12, 2022
Honorable Thomas M. Tunney Chairman, Committee on Zoning 121 North LaSalle Street Room 304, City Hall Chicago, Illinois 60602
The undersigned, Li S3 Duarte , being first duly sworn on oath deposes
and states the following:
The undersigned certifies that he has complied with the requirements of Section 17-13-0107 ofthe Chicago Zoning Ordinance, by sending written notice to such property owners who appear to be the owners of the property within the subject area not solely owned by the applicant, and to the owners of all property within 250 feet in each direction ofthe lot line ofthe subject property, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. Said "written notice" was sent by First Class U.S. Mail, no more than 30 days before filing the application.
The undersigned certifies that the notice contained the address ofthe property sought to be rezoned; a statement of the intended use ofthe property; the name and address of the applicant; the name and address of the owner; and a statement that the applicant intends to file the application for a change in zoning on approximatelyOctober 26, 2022.
The undersigned certifies that the applicant has made a bona fide effort to determine the addresses of the parties to be notified under Section 17-13-0107 of the Chicago Zoning Ordinance, and that the accompanying list of names and addresses of surrounding property owners within 250 feet ofthe subject site is a complete list containing the names and addresses of the people required to be served.
Signature
Subscribed and Sworn
October 12, 2022
LETTER TO SURROUNDING PROPERTY OWNERS
Dear Property Owner:
In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance, specifically Section 17-13-0107, please be informed that on or about October 26, 2022 the undersigned will file an application for a change in zoning from RS 3 Residential Single-Unit (Detached House) District to RT 3.5 Residential Two-Flat, Town House and Multi-Unit District on behalf of Ricardo and Bernice A. Lozada the owner and applicant for the property located at 3817 N. Hamlin Avenue Chicago, Illinois.
The applicant intends to meet the bulk requirements of the RT 3.5 district to allow the conversion of existing the 2 dwelling units to a 3 dwelling unit building; the third dwelling unit would be on the lower level of the existing 3 story building.
Ricardo and Bernice A. Lozada are located at _ _ „- - I
am the attorney contact person for this application. My name is Lisa Duarte and my telephone number is (517) 980-5896.
Signature
Lisa Duarte Attorney
Please note that the applicant is not seeking to rezone or purchase your property. The applicant is required by law to send this notice because you own property within 250 feet of the property to be rezoned.
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:
RICARDO AND BERNICE A. LOZADA
Check ONE of the following three boxes;
Indicate whether the Disclosing Party submitting this EDS is:
^ the Applicant
OR
[~] a legal entity currently holding, or anticipated to hold withjLn six 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
j~j a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1)) State the: legal name of the entity in which the Disclosing. Party holds a right of control:
B. Business address ofthe Disclosing Party:
Telephone: Fax: Email:
Name of contact person:
Federal Employer Identification No. (if you have one):
Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable):
ZONING AMENDMENT 3817 N. HAMLIN AVENUE
G. Which City agency or department is requesting this EPS?PEPARTMENT OF PLANNING/ ZONING BUREAU
If the Matter is a contract being handled by the City 's; Department of Procurement Services, please complete the following:
Specification # and Contract #
Ver.2018-1 Page 1 of 15
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
Person
Publicly registered business corporation Privately held business corporation Sole proprietorship General partnership Limited partnership Trust
O Limited liability company
S
Limited liability partnership Joint venture Q Not-for-profit corporation (Is the not-for-profit corporation also a 501(c)(3))?
? Yes QNo j j Other (please specify)
For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
A/A- : : _ '
For legal entities not organized in the State of Illinois: Has the organization registered to do business in fee State of Illinois as a foreign entity?
QYes QNp ¦-¦ ? Organized in Illinois
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1- List below the full names and titles, if applicable, of: (i) all executive officers and all directors of the. entity ; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
2. Please provide the following infonnation concerning each person or legal entity having a director 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, parmership interest m a partnership or joint venture, interest of a member or manager in a
Ver.2018-1
limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If hone, state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name Business Address Percentage Interest in the Applicant
SECTION HI - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS? ["""jYes [~|No
Does the Disclosing Party reasonably expect to provide any income or compensation to any Ciry
elected official during the 12-month period following the date of this EDS? Q Yes j~j No
If "yes" to either of the abo ve, please identify below the name(s) of such City elected orjficial(s) and describe such income or compensation:
Does any City elected official or, to the best of the Disclosing Parry'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 Chicago ("MCC")) in the Disclosing Party? QYes QNo
If "yes," please identify below the narae(s) of such City elected officials) and/or spbuse(s)/domestic partner^) and describe the financial interests).
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with me Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Parry 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 Party must either ask theCity whether disclosure is required or make the disclosure.
Page 3 of 15
Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether
retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
i iqa ni iaptp 180 n. lasalle attornfy not an acceptable response.
USA DUARTE CHICAGO, IL 60601 ATTORNEY "zLCVO
ZC^WIC?C^C^SL^TANT, INC. ch'cAGQ^^^^ CONSULTANT/LOBBYIST $2,000 PLUS COST ESTIMATED
(Add sheets if necessary)
| | Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE N/A
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
| | Yes No No person directly or indirectly owns 10% or more of the Disclosing Party.
If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with that agreement?
[JYes []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.] 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 lo help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract in progress).
The Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.
Page 4 of 15
The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) of this EDS:
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;
have not, during the 5 years before the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embe2zlement; theft; forgery; bribery; falsificationor destruction of records; making false statements; or receiving stolen property;
are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in subparagraph (b) above;
have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found liable ina civil proceeding, or in any criminal or civil action, mcluding 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 (Gwenunental 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, mcluding but not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Omer Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosmg Parry, is controlled by me Disclosing
common control of another person or entity). Indicia of control include, without limitation: . mterlocking 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 tiie Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").
Page 5 of IS
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 mis EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:
bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of lhe federal government or of any state or local government in the United States of America, in that officer's or employee's official edacity;
agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or
made an admission of such conduct described in subparagraph (a) or (b) above that is a matter, of record, but have not been prosecuted for such conduct; or
violated the provisions referenced in MCC Subsection 2-92-320(aX4)(Contracts Requiring a Base Wage); (aX5)(Debannent 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 of720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency.
[FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [s§e 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, mat 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 die federal System for Award Management ("SAM").
[FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
Ver.2018-1 Page 6 of 15
contractor/subcontractor; that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide trumfiil certifications.
11. Ifthe Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
Ifthe letters "NA," the word "None," or no response appears on the 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 knowledgeafter reasonable inquiry, the following is a complete list of ail 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 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-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: © anything made generally available to City employees or to the general public, or(ii) food or drink provided in the course of official City business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
The Disclosing Party certifies that the Disclosing Party (check one)
[j| is |H] is not
a "financial institution" as defined in MCC Section 2-32-455(b).
If the Disclosing Party IS a financial institution, men me 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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Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary):
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed 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 ofthe Disclosing Party's knowledge after reasonable mquiry, does any official or employee of the City have a fiiiancial interest in his or her own name or in the name of any other person or entity in the Matter?
Yes QNo
NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No" to Item D(l), 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 m the name of any other person or entity in the purchase of any property that (i) belongs to the Chy, 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 Cit/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 >Q.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 disclosurareqmrementema connection with the Matter voidable by the City.
2. The Disclosing Party verifies that, as a result of conducting the search in step (1) above, the
_ HI* • 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.
n
Disclosing Party has found records of investments orprofits 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. Ifthe Matter is not federally funded, proceed to Section VEL 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 19^5, as amended, who Party with respect to the Matter: (Add sheets if necessary):
(If no explanation appears or begins on the lines above, or ifthe letters "NA" or 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 die 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( I) above for his or her lobbying activities or to pay any
person or entity to influence or attempt to influence an officer or employee of any agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
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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 i&formatioh set forth in paragraphs A( 1) and A(2) above.
The Disclosing Party certifies mat eime
501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described m 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, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractorstosubmit me foUowmg infonnati negotiations.
Is the Disclosing Party the Applicant? QYes QNo
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.)
QYes QNo
Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Coirimission all reports due under the applicable.filing requirements?
QYes QNo QReports not required
Have you participated in any previous contracts or subcontracts subject to the equalopportumty clause?
? Yes QNo
If you checked "No" to question (1) or (2) above, please provide an explanation:
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SECTION VH - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
A . 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 www.cn^ofchicago.ore/Emics . and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St, Suite 500, Chicago, BL 60610, (312) 744-9660. The Disclosing Party must comply fully wim this ordinance.
Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement^mwrmection wim 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 ail of the infonnation provided in, and appended to, this EDS may be made publicly available on the Internet, m 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 infonnation contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
The'infonnation provided in this EDS must be kept current In the event of changes, the Disclosing Parry must supplement this EDS up to the time the City takes action oh the Matter. Ifthe Matter is a contract being handled by the City's Department of Procurement Services, the Discibsing Party must update this EDS as the contract requires. NOTE: Wim respect to Matters subject to MCC Chapter
1 -23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020.
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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.
BERNICE A. LOZADA
By:
(Sign here) RICARDO LOZADA
(Print or type name of person signing)
OWNER INDIVIDUAL
(Print or type title of person signing)
(Sign Here) BERNICE A. LOZADA
(Print or type name of person signing) OWNER INDIVIDUAL
(Print or type title of person signing)
Signed and sworn to before mc on (date) 10/12/22.
at County, instate).
Notary Public Commission expires:
LISA DUARTE Official Seal Notary Public - State of Illinois My Commission Expires Nov 16, 2025
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDDX A
FAJWTLIAL 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 chy 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 execufive'officers of the Disclosing Party listed in Section II.B. 1 .a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, ifthe Disclosing Party is a general partnership; all general parmers and limited partners ofthe 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 ofthe Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising siinilar 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?
QYes dlNo
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 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.
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CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAWPROBLEM 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 die Applicant exceeding 7 .5% (an "Owner"). It is not to be completed by any legal entity which has only ah indirect ownership interest in the Applicant
Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scoffiaw or problem landlord pursuant to MCC Section 2-92-416?
? Yes
Ifthe Applicant is a legatentity 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 ~-gJNo ?'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 .
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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 (www.amlegal.com >. generally covers a party to any agreement pursuant to which they; (i) receive City of Chicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay the 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)(1) and (2), which prohibit: (i) screening job applicants based On their wage or salary history, or (ii) seeking job applicants! wage or salary history from current or former employers'. I also certify that the Applicant has adopted a policy that includes those prohibitions.
QYes
? No
^£N/A -1 am not an Applicant that is a "contractor" as defined in MCC Section 2-92-385. This certification shall serve as me affidavit required by MCC Section 2-92-385(cXl). If you checked "no" to the above, please explain.
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