Office of the City Clerk - Record #: O2011-63

• Record #: O2011-63
• Type: Ordinance
• Status: Passed
• Intro date: 1/13/2011
• Current Controlling Legislative Body: Committee on Transportation and Public Way
• Final action: 2/9/2011
• Title: Vacation of public alley(s) in area bounded by S Baltimore Ave and E 86th St
• Sponsors: Jackson, Sandi
• Topic: ALLEY - Vacation

Date	Journal Page Number	Action By	Action	Result
2/9/2011	112443	City Council
2/7/2011		Committee on Transportation and Public Way	Recommended to Pass	Pass
1/13/2011	111511	City Council	Referred

INDUSTRIAL ORDINANCE

WHEREAS, the City of Chicago ("City") is a home rule unit of local government pursuant to Article VII, Section 6 (a) of the 1970 constitution of the State of Illinois and, as such, may exercise any power and perform any function pertaining to its government and affairs; and

, WHEREAS, the City has experienced a significant loss of industry and jobs in recent years, accompanied by a corresponding erosion of its tax base, due in part to industrial firms' inability to acquire additional property needed for their continued viability and growth; and

WHEREAS, many industrial firms adjoin streets and alleys that are no longer required for public use and might more productively be used for plant expansion and modernization, employee parking, improved security, truck loading areas or other industrial uses; and

WHEREAS, the City can strengthen established industrial areas and expand the city's jobs base by encouraging the growth and modernization of existing industrial facilities through the vacation of public streets and alleys for reduced compensation; and

WHEREAS, the properties at 8463-8571 to 8571 S. Baltimore Avenue are owned by Baltimore Properties, LLC and 8501 Baltimore Properties, LLC; and

WHEREAS, Baltimore Properties, LLC and 8501 Baltimore Properties, LLC employ sixty four (64) full time employees; and

WHEREAS, Baltimore Properties, LLC and 8501 Baltimore Properties, LLC propose to use the portion of the public alley to be vacated herein for the expansion of the storage area, and a driveway for their industrial scrap metal company; and

WHEREAS, The City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent of public use and the public interest to be subserved is such as to warrant the vacation of part of public alley described in the following ordinance; now, therefore,

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

SECTION 1. All that part of the Northwesterly-Southwesterly 14.0 foot wide alley which lies Easterly of Lots 1 through 15 inclusive in Block 16 and lots 1 through 28 inclusive in Block 22 and the vacated Northeasterly-Southwesterly 30.0 foot wide street lying between and adjacent to said Blocks 16 and 22, in the Circuit Court partition of the southeast % of Section 31, Township 38 North, Range 15 East of the Third Principal Meridian (excepting lands belonging to the South Chicago Railroad Company) and which lies Southerly of the Northerly line of said Lot 15 in Block 16 aforesaid extended Easterly to the Easterly line of said 14.0 foot alley, which lies North of the South line of said Lot 28 in Block 22 aforesaid extended East to the East line of said 14.0 foot alley and which lies Westerly of the Easterly line of said 14.0 foot alley, all in Cook County, Illinois as shaded and indicated by the words "TO BE VACATED" on the drawing hereto attached, which drawing for greater, is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacations.

Page 1

SECTION 2. The Commissioner of Transportation is hereby authorized to accept and approve a restrictive covenant or similar instrument restricting the use and improvement of the public way vacated in Section 1 of this ordinance to industrial uses and for such use and improvements that are accessory as that term is defined in the Chicago Zoning Ordinance. The restriction on use and improvement in the covenant agreement or instrument shall be for a term of 40 years and upon breach of such restriction the public way herein vacated shall revert to the City.

SECTION 3. The City of Chicago hereby reserves for the benefit of AT&T-lllinois/SBC, their successors or assigns, an easement to operate, maintain, construct, replace, and renew overhead poles, wires, and associated equipment and underground conduit, cables, and associated equipment for the transmission and distribution of telephonic" and associated services under, over, and along the alley as herein vacated, with the right of ingress and egress.

SECTION 4. The vacation herein provided for is made upon the express condition that within one hundred eighty (180) days after the passage of this ordinance, Baltimore Properties, LLC and 8501 Baltimore Properties, LLC, shall pay or cause to be paid to the City of Chicago as compensation for the for the benefits which will accrue to the owner of the   property   abutting   said   parts   of  public   alley   hereby  vacated   the   sum of

_($. ) which sum on the

judgment of this body will be equal to such benefits, and further shall within one hundred eighty (180) days after passage of this ordinance, deposit in the City Treasury of the City of Chicago a sum sufficient to defray the costs of removing paving and curb returns and constructing sidewalk and curb across the entrance to that part of the public alley hereby vacated, similar to the sidewalk and curb at 8571 S. Baltimore.

SECTION 5. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, Baltimore Properties, LLC and 8501 Baltimore Properties, LLC, shall file or cause to be filed for record in the Office of the Recorder of Deeds of Cook County, Illinois a certified copy of this ordinance, and attached drawing together with a Restrictive Covenant complying with Section 2 of this ordinance, approved by the Corporation Counsel.

Page 2

\

SECTION 6. This ordinance shall take effect and be in force from and after its passage and publication. The vacation shall take effect and be in force from and after its recording.

 

Approved as to Form and Legality Depqty Corporation Counsel

[a nil, /X(L<uhv—

rable San4i \lackson man, 7^th'

 

 

Page 3

 

FILE NO. 31-7-10-3155

TOTAL AREA of ALLEY TO F3E VACATED = 16,225.65 5c\. Ft.

 

. CJTY OF CHI C A GO

ECONOMIC DISCLOSURE STATEMENT ANp AFFIDAVIT

5SfcC1 icb? I - GjE,N-ER AL- )NFORMATJO>'

A. L.eptpmt i^pw'^i1li$'fan^uWi0iing^,-ti.is' EDS., include ftfkxai if ipplictbie:

__Baltimore Propertipc;_f  t.t.p - ■ . -

Chfcfc; O.N£ "<rf ih*; folior.inf ihrre bp?_:«:

J. (d-inc Applicant

Z. I j ^-Je-jsj^trrfvyjvcjffiing c duccirpj inojiec.t uiwyist in,«hc .-.jpjLursnj,. .'Staj* thc;icgaV.;nsTt,»i of 'iH«

Applicant id fv-^^B Disc"}o£jn^:j? 'J³a«y hold* an iriiercsi:. . _■■ _. _

OR

}. J ] .-a iptcififD lt;C£. cr.titv -a-iJ.h.>i rich, cj/conuol i!«.'rSt'cucn 8.-E1 A;} Sra'ic ih'ieMegname of ihc:xnijvy in \yhic"fi p'iic.c,ijT^ _

713/

C. Trlrphont:-. Fax". .,. ⁷73/375-8629   Email:■JeXfgnickelson

demo.com

P. N\*n>e of contact prrJWi:      ,Tpffr_Py a t._?w_

»

f, f racialEmpjovti iocsiii^catipn. No(jfyoyiiBv^ ono: 36. -11 68932

-95Q1—So-—Baltimore Ave. Chicago,  Illinois 60617

EjJfftijpfton °' c'on'tnfct. liirtficrioti'^i after undertaking it* fejj c<3 t&b'clow?as ibt "J^jiio'*);!© svliicnJliTs EDS peiwins. Unciudcrprqj tct numtsj and iocsijtfn W'^pidpcny, If applicable);

■Alloy ViacdLiUli

u. - • .^-^^-»v      Division of Proiect

g. \yjjic3j Citf tgcncVi);aepsnmcm ij irJoxicUmg ft is EDS?-     Povclopmcnf -

if4hc 31*«**-5$S-i«rAJ?ci bring r.sr,ole« by ftr Chy-'s Dcp'Si«ws-nt of FiScwtinetitvS'erVfce^; pleo^e

*feciiicSUOtt:.i N/A

SECTION 1J » DISCLOSURE Of OWNERSHIP INTERESTS

A. NATURE OF DTS^LCSING PARTY

j,   Indicate• the natwe of t)tc Disclqsim; Psrty: ("J Person

£g Public 1 y j eg i.M eje/djki:       c qjpoi ;-;io]y 1 ^ Pn\-itciy-he1d;^U5W^e£' cciporauon [ ] Sole jiTopiieioiship \ J Geneial pajinciship:" [ 3; Lirniied.pann.c 0 Trust

L vmiied 1 iabilnycompany* { } limbed Uabnjtyj?itnci,«h;ip^> [ ] joinl.ventuie* [_:;NjpT^pr-pj ojfi| cqrporavoii iJi the not-f<w-pjofy coippiaiipn also a 5Q3 (Vj(3.))?

'    I] Yet \m° [) Oihet Cp^«ev<pecify$

Note B.Kb below.

'2.   Foi feral eniriiei. lae.s.me tor fcjiicn c<-'.uhuyi ofincoipoiauori o.J bigianizatibn. if 2pplit«b1<T

Illinoi s.

i, Foi legal enniiei 361 otganiKO'.iii'ihr.iSiote of Illinois;' K^s ^ei cr^ flo rusiness jn the Stale of Illinois as .a foirign entity?

\) Yes-B. IF THE DTS

^ N/A

PARTY JS A LEGAL ENTITY:

La. List belpy the full names *r.c* iiil:e'$:-.<(j:6}l.*.x-ecviiye office?* tno-ail piiecjoTS of ibt tnmy.

Foi noi-fpi-pJoTji;coipC'ii:icns. also list be lew all members, j; any. which ate je^ai jrmities;. jfthere ate nonsuch membcj'Si write" "no members-." f <?t trusts, estates pi otbc'i' simiib; entities, list below lhe legal uileh6ldei(s);

"Name

Jeffrey A. Lev

TMJc

. -President

Janice M. Lev

Secretary

Lb.        jf you checked ~GeneI^l.p8ItnVfjKip_f'^, '^,Lirniie3: pBitnei5bip,"**Limtied Babijity company** "Liinitedliibiii^ psnnership."" or "Joint venture" iri-je-sponse to Item•A^...raboyi^j^.fliijr«,«f' Di sc 1 os in g: Ft i <y)V t&.-ke low the name znd title of eacii^enciairpejinei. tnenaginf member, jnanajer pi

Pa$e 2 of 13

onv othej personal entity that conucls.ihe dsviOrdsv mana.cement ofiheDiscicshrg Patty. NOTE; Each lesal entity Vis.ied be tow must sutmn an EDS on its own behalf.

Tismt Tfik

2.  Please piovidc the following {nioimauon ccnceT.ning. cath petson pi entivyhaving a diiectpi inai»e,ci beneficial in iciest {inducing p*ri<i;;hipji in exe-s.s#f Examples of speh an inieiesi include slmcs in a :'c«ipvJ'a:ion. parint-rsirip "pieicst-j.n.«partnership p;:ipiriryentur«j interest of * mcmbej oi.msnagejiri -a limited1 litbiiiiy company/oi interest of a b'cneficjary-of a ijosi. estate or oihet/stonarenvty. Jf>icnejrate;^N'.Gne.*' >\OTEV£uYsuanno Section 2-754-D?0 pf-the NJ unit ip a J C od e o f C^itaSP'^"Nlun-|c']j»ai''t-odc"), Vhc^ity rr»a,y recuiit a ny s uch addiriorialitiToirn at ion from any spplicant which is ieasdnsbty iriieijced.io^v achieve full djsriofvfe.

:^5ante EBusiness; Address Peiremage Jhieiesi in the

£>i«ciosirig Pariv

Jeffrey A. Lev 8501  so. Baltimore        ■       . mna *_

.Chirago,  Illinois 60G17'

SECTION 111 - 13l^;S)>' ESS REL.4TlOJs'-S'H 1 PS WITH CITY ELECTED OFFICIALS

V3as the Disclosing Patty htd* "bussness tclationshipr" as defines io Chaptef 2-156 of the Municipal Code, with any City rlecied^ffjcial in tht 12 month* before the date tthis EDS js signed?

H Ve5

Jfves, p3czse identify below the namet s) of sucfe City elected official!?) snd^desciibeIsucb relationships):

SECTION IV ,r DISCLOSURE OF 5UBC OiNTRACT ORS A>*D OTHER RETAINED PARTIES

"Jlje DiKiojin^^ny nitjif djjscJoVjJre name and%is5neis ssdoitsi of eat^j subedit* ctpj,twoiaev, lobbyist:accouniaiJt. consultant and any other peisbh or emiiy whom the Disclosing Ptrty Jias letatned oreaptcis id ic^ain Connection with theJSj aueiy    ^cllraj the name of ihe idttlonsijp, xnd (he rots)

Page I? of IS

mount of

■the -ft'es ;pa idw^tlmsiwMo be paw. the Disclosing Pmyis not required to disclose

mpio'vte! who aie paid Jolely Thioufih the Disclosing Parly's, icgvtsipayroll

••Lobbvist'"' means aji;y person oj <;n:i;y ;y"np^nGxiixKes to influence snylegisiaiiye; oj adminisuaiivt scticn on behalf of ;anypc:son pj er/«3.ry yihei than: (1) $ i\ot-foj-p3C-vii entity, pn an uhpaid^asis, 91$) hfrf,ie lf, "Lobbyist" s35p; rneans any pe;sen or enrin' cny par: pf w%ostduties as anempkwee. of _3nt-thei includes-undeitskinrS to irulucnce .spy If cjilsiiye oj^Giftiftstraiive actions

Jf:he Disclosing. Paiw '? uncertain whether s disclosure is ttcuiKd undei this -Section, the? Disciosing aPeiw musi e.iiher ask the Ci»y whether disclosure is tecviied oi rnske the disclosure.

Name

findicate whethci-

re if ined or anticipated

to tc letained)

Eusiness Address

Relaiipns Kip lo Disclpting Party Isupcorjti a cior ^ncrney. lobbA'tst, etc.)

Fees'

(indicate whether paid pi estimated)

(Add sheets if necessary).

[ 1 Check here it the Disc lesing party has not refined, nor Y\pects to retain,.any such person's or entities.

SUCTION -V -. CERTJriCy\_:T)0,N£

A. COURT-ORDERED CHILD SUPPORT COMPLlAKjCE

Under Municipal Code "Scciibn f ₄ substantial pw^,ets of business entiiies thai contract with

the Ciivmusi remain in'cornpiiance wnh- their' child ; upport vfciigsiiohs ihiougnout the veirn pf the contract.

Has any person who directly or-indirecTly owns 10% or rrtpre pf the Disclosing Parry been declared in iiieaisje on any child sup^on oDligaiions by any Illinois ccyn of competent jurisdjcUQji?

| ] Yes J^No {j No person owns 10% or more of the Disclosing Party.

If "Yes,** ha? the person enteted imp a coun-appjoved agieemem foi payment of all support owed and is the person in compliance wubihat agreement?

I JYes OT«

Page A of i2

45

- laowen^d^^

^aiexne^ ' c   Sit hot pi«c*rfv inriitacd iorm *Vtrf«<rf«foftf* ^^^^m^^^^

ihjs 5cction;^

d   h*v*tfot^thin* tive-y^ _Pn*#i*c*^ '  jwiisacnom (Tc_:a«aJ, K^ic w^:jpc^rtj«T^na3P^ *0tcause o* oefeuU; sml

_f   biVc ^ ^in * S»e_W prtf^pt* ed$ the iBr ^ma.£K^^^^^ Ut^fc^^^ m^itu.cpbr^rt^ PJ A.yc*p ^dtt^eeihTT«ni,:a^

The; c^tificaiio^^^

 

 

<• anv responsible! official ofite Disclosing, peiiy. ajiy Applicable Psriv qt anv Mfriiaied Emily tn any other^ficia^ ^*nii>i employee pf ihe Pifcjc«ifl| Ja:ty_v?ny A^pplic^bfc Partypt any Affiliated En.my_i.cung psis^lM ^P: vhje ^"jif ciion ai 4yjfcpji;a.tio.q of.a.jeippnjTpic pifrcial of i1it;D3sct6^n$ . Pany,;a.ny .e.p.piitaBTe. Party pi ?.i»y Aftilfaied E'njiJj^/j^^yefy-^^^.

StJifcti-uSt Diieloiine ?>TlVj,npr.any Apfiicsbjfe ferry; norariy^ffiliajed Ejtttty ov<ifntrih« bkc*i;c4ing:_:P^ Party nor. £ny^r.|cnts iaye.uiwlng t&« £i** ?^ai5^ctDit^iht^;56a4'« t£ls

E^S i* signed ^^a^'i^wy.^.i&i-' Applicable Paity jj^W^S^^f?-"- S^e^^yr^^ itffft)ay<!d Entity**

^ppnaa pj. cj>£2.gerocnjf j^ewnecjpawiii ih* Mf.tiet?

a, ;hi.ibcd;pf ajjeffip.ifcd ^aO ^Dijbc, crb:ewcp5i'ijc_iie.d pridlyc^ed $yilwpfibrft^      attempting \t>-cube,:*, public officer to employee df-ibe;^ .t.ijy.agtnpy«f't)jt. federal ^q^ernment pi ^;cif *ny jisie: or iocaT:jovt j-nment m the ^.nise.tf-5.iW£:'.dT'«menca, in.*ha'j pffiper/s :6r e-m^iby:ee^;P#tia1 capacity;

b. ctjeep Or t^iMfl-P^⁰'       9|he_:r ^idc;er.s pfx^^pecH'yt/^figdjet^-p^e^n-i paity^oSaiiy ittefi a^ietrnenA; oj JbiHerh' c^h*«ie.o or adjv8$ed.±vnw pT^;%Je<rn*;i8$»■cp))v.i}p$ among!bidders pi pYospec'iive.fci^ fite'o&m•dre.tj.nⁱ«p'e^i^bn^fc'>ⁱ aj.ieeme.nvnd bid a fixed. ppjt;e^pj. otherwise^©*

c, made •ai»,ac>!i{i«W'0^f^ⁱ?3i *"onauci etijc^ctd in z. or^p above ihaMis;? rna,uer of reeord*but ha ve npi beer, proseet^Mbi such conduct; pr

d. viblajed lhe prpvjiip^j of Municipal Code; S«C4toa£t&'°?6:& fLiSin^ ^jgc>Di\iinancc^.

2. ^eiihe? lhe piiiciotin? Party. Affiliate^ Enjtity QT-A.p^Vicatk Pa^^?; orany pf j\*$0pip\<6&li&l officials^ agents pr^j ai'Reii. k baried from tPMiiciipg *'.«h sjr&^unjl pfiefaie:Oi Ipcalfpvttwnent sssa iestflt of^:"ehgiging rfi pr being convitteibVpftj^ 1LOS ^'5;E-|;jr3$

bid>rPi8Hng in vibteiion-^^ ILCS $£^&xa$i ajy';i^aj.;^jT^E-di^n$ s"»^or'9t ^^^e4; Stales pf Ameiica inaWPn'Mnsihe same<lenirr)U 35 the offense pf brd-rjg£i»g or^ja^otatfnj.

C  "^ttlhejjfhtIJistlcsi'rig" Party nbi anyiAfffl:a'i|e4^ Klied tttnypl tpe#b$pwing }j«|s_:

niainftlne^'pyine ©.flit* pT^prelgn Aisett CPntioVof file J5:S. BepairoTrn^

Designaie^rBatiort-U^ist     D e nie^Pejsonj Lis.;, in* iti^y erjjlecd Lisu tbe Entity lilstand the, Debane^Un.

Jhe ijiscipjih*^ wiih:(1) lhe applicable lepwi^mentt of lhe

Gdyejnraenial Emits ©tdmaBce of "the .Cjty^TiUit 2.<?3>apitei 7-4 $6 pf ^he Wtiriidp^rCodie: «»d (Qfti ^*s^l.«^T>|r'p»vjj*S^ °f Chsptej 2-56 of the Miinicipal C^dt fptfic* ^ofthe inspector Gene»T>i

%tt^f i35

& If. thevDrfecSpf >?£ p2i.Jy r5 UF.tfci? ip certify id any pfiiKe ■above statements inthis Patr;B;:(F«i\Kej Ccrn'nc-iionJl, :hc Disclosing. Parly must opbjn tcjpw:

If. the-le.ii.eJ5 "N'AV- ^:.he ^d^Non*."' of ••np^es.pon.se sppeaxj Gnihe. J-j.n'cs Vpoyejji mjf be conclusively presumed thai, the Disclosing Party certified}^

C. C1 RT1FJC A T J O N OF STATUS .AS FIN¹ A N G3A L JNSTITUT) ON

For puipcsei :pf C;vunp>if£Ju:nicipai^;C^

means a bank. s»vjn.£S"«hd lo^.^ncjari^^

wyst company. {.sVjnc^'T-snk-.inKtimeni harm, ^ecuriueJs tVo^

dealer, municipal securities desfevsecujme<;t»ide^iie^'muhicfpa') s^curjiie¥n4crwT.i;icT^Qycsifne'i>t ;;uf i. verituje capital .c^-mpsny, t-tnk-ho'ding -company, finsrrciat services holding company, or-any lictr.ite under the Consumer inMailrnenvboari Act. the Saies^Jwance Agency Act, or the Residential M cn£ a ge Lic e ns ing AC. However, "financial institution*' specifically .£>.all not include jny entity •whose ptedcrr.-.hant business is thr prbvicih;! pf vax;deJ«reii. defined comT'ibut)Pn.j.pe.n:ipn''P')ans^!-40' public employees in iccoro&ncc with .Siciipns -G3fbt and'.S'S. of the-Internal Revenue Code. rAddiiipnal definitions ma.y^be found in Municipal. Code Section 2^2•4^(b).)

i. CERTIFICATION

the Disc!lp5irig_: P-*ity certifies ihat the Disclosing Pajty (check one)

a *fir<anc-)aVinstuuJionr as defined >n S ea ion ;-?2-42 f4bj pf the Municipal Code.

If the;,Disclciing Parry IS:_a financial insiiiyVjpn, then the Disclosing.;? a»ty pledges.;

"We art not tnd will, not bet o me a p"*e;3aiPrv ttatfer ai dtfin'e^.-inC'hap(er'2^52 Pf lhe MunicipvT Code, Wt^utthej'p)«i?fe 'bat none, of pyi affiliates is* andjhorie oitht'rn will become. epredVipry ltaflej.'jBi.id*fiped-is:CMpU]r      pf the Slunfjtipal £_;e>dc_ Wt i^j^^\m^^9\^i^ni^Ji predatory lender or,b:e<pm?n| tpaffiliatc pf a pfMaipry lender rnay result in the Joss pfl)tiepTiYife|e7 bfdoing businessv*i# ther-feiy "

if lhe ^istipfihgipsrvyis unable to jjislce rhls pied** because iuoi «riyi6:f«s affiliates (a* defined is ■Sti:\iq^^i2-^$:4V)^'^M^nic^a) Coat) ts &.pfe^£TOty:je:ndej within the meaning of Chapter

Paige Ipf 15

-*2 of the Municipal Cede* explain here ttnac'n additional pafes if necessary):

f th«_;le|iq£"N:A," the word "None."or no response upptajj on the lines above, u. will be •OTClusiy^lypjtjumc-d Ihai-lne DliScio?injg Pariy ciiiined^:io'me above statements.

3. CE R^;T 3 F1C A TI O N- R E GA. RD LVXj j.Nt E REST IN CtFt BUSINESS

A'oy: words or terras'that ate defined in Chapter M^odf^Munlti^ meanin15 when ust4M-," W^s, Pan P,

t.   in accordance with Section j- 1 f>6-1.1^ of Lhe .StunicipaJ Code;: Does any. official or employee of lhe Cily hayca financjal imeiesi in his or her pwn.naTnc 6i.,in ihe' name oj any other person pr entity in ihe Mailer?

{'] Yes •DflNo

NOTE: if you checked "Yes*' \o hem D1., pioceed to hems D:2. and £>.?. If you checked "No" to Hen> D.I., proceed tp Pari E.

•2.   Unless sold pursuant. jo.-.a process of competitive biddih^. brvoiherwise perroined, no Chv eletfed official-PI employee <ha.U'ha-ve a j"inanc_sial inteiestin hi$>or her pwn name or i n Ihe ti a me of any other person pi ejytity in the purchase: of any property that (i) belongs to lhe City, or (iij is solo for. taxes or 2iitsimtmi_: ci (iii) ii jold by virtue df iegal process at the suit of the Ciry (collectivelv. "Gity PIcpen:y'S8le.^,,). Compensation for piopcrty iaken pursuant to the City's eminent domain power does not c enstitute a financial interest within ibe-meaning of this Part;D

Does the Matte; involve a Ciiy Property Sale?

U Y es I ] No

v.   If you checked "Yes" to liem P. 1^ provide the n2m.es and business addiesses of iheChv officials or empioyees.bavinj such jnterest and identify-the nature pfjuchJniKTest:

Name Business Address Nature of Interest

«? . The Discjosinf F-wfuithej ceiiiAes thai noprobjbiicd financial inicrest in the Matter will be acpuired byssyCjty df^«l or enipioyeel

Page 8 of if

£. CERTIFICATION REGARDj^G;SL'AVERy ERA. BUSINESS;

Thc^Disclosing Psxiy h>:*f^.f>»fii*a any and fl) .records of the Disciostpje Psny andsnv and ill predecessor yntitice FpJ re c o; o 5 .0 f. invei i me.n is oj profits fromjlavery; tbe;sl?.yc industry, pi ry|sv^hpldtr ipsuianc^ policies ftorh thcVslavery era ttnc1u^^^Ttsjiif9'nce' policies issued to jl3yehp]dtrs;ths!l;pipvidcd/t qamaseyip or irijury prdeath pf ft^

disclosed in jijjs.EDS any and ajlsych records ip the City. |;r> adcii'pn, Oie;TJ%Jbsihj_;J*»ity rousr djsclpjse the •names of iny-Shd all steve's brvslavetipideis described in those records. Failure to cornpjjy with these may make me^alier'tb which this EDS pericins yoidgbW

by the^City.

Please check iimer; l,;or 3i below, if rhe Dis.closmc;Pcrjy^ec)cs 2., ihe'Discrosjhg>Party n?u$l disclose below Pr«*> an aitachme-nt tp this:EDS .all. 1 < auisite information as set forth in thai paragraph 2

_Xhe.;0isclp^jinF Parly verifies thai o j ihe Di?cTo;)ni$orty has searched,any and allre.cpj^sxpf

ibe Disclds')^ profits from

slavery, the slaveiindustry, or slavrholder ras'uranct pcYiiiii. ind (fc) the Disclosing;party'has found no records pfinvestments 01 profits frprn slavery, the slave industry, or ^favthbider insurance policies and[ norrcprds:of flames of any ■s'lbvei or jlavchplders.

2. The Disc losing P?tty ve;ifjes.;hat. as a result of conduci'mr the search in step 1 (a) abpy.e^the

Disclosing party has found records relating to invtun-.ents pt profits from slavery, the slavenndusiTV, :o.r slaveholder insurance policies and/or the names of any slaves or slaveholders. The Dtsclosine Party verifies ihat-thc Ifollo^ing ccnsiiiutes full disclosure of all such records:

S£CTiON^l - C^RTiF^CATjCi^S f OR FE t>XR All YFlWDrD RATTERS

^QTErlf ihe>fiMicr is federally funded, complete this Section VI. If ihe tyaiietis npt;f<4ei«By funded, proceed to Section Vft

A. CERTiFJCATi^\^EGARDJN<5 LOB^JNG

\.  LrsUfctlpw-rhe names of all persons or entities reBiitered under the federal Lobbying Disclosure Act pf      who have made lobbying cdniaos on behalf of the Discloijn;g Pajiv with lespea .10 the ^ffrier: iBtgtniiit here, add Sheets as necessary)".

--—,_„_n/a      . ■    . ._ .__

P»gt 9 of ! •

Is the Disclosing Party the Applicant

■jf*'^*.<s," answer ihip ihiet quejiionj below.:

....... ₍

L  HWe.vou deveipped and do ycu have xin nit iffirmauve ccjioh piccrams p.LMlu.aniHp

applicable federal reciiJaiiwiS? iSee 4,1 CFR Pail 6Dr2.1

:^ve<"""" " rj-No

2.  Hi«e:y6u\-itlerf^vitn^he lotnt Repprting'£cmirtiit.ex. the Director of tbeOffke of Federal Contract Compliance Programs, or the tqua!-Employn-.ent Opponur»ny Commiuicn all reports due under the sppikabic filj^

# Yes I

Have you'participated jn,arry.pj.fvipyj;C«ii.«?a'CJS oj iubcpniiacts/iubiectito the: equal opportunity clause? ■   f^Yes Il^o

If ypu checked "No"' to PuesJiPn .;. 6i *. £hoiee_?:pi«asepjbv.tfie an exptenaitoh:

SECTION VIJ— aCK^O^MLedC^IE^TS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES. PISCLQSI3RE

The piseipjinf .Parfy understands arid agtees rhat:

A. Ey completing anS filing this EPS. the Pise losing-Party acknowledges and agrees* on behalf pf itself and the persons -or entities named innhts EDS. that the City may investigate the creditworthiness of some or all of the persons ot entities named in this EjDS,

B. The certification?;cisclpsuieSvand ac^nbwltjci^ineni's contained jn this EDS will become pan of spy cPa'tract or-ot her egre c rnent be twe en ihe Appfi!c;ar)V.f.r)d the City in c pniiect ion -witbtbe Mattej, ■wWnriprPCorem^^   Ciry is>istance, or other City ac tipp, s.nd;BrCi^aw^ to ihe City's execution of any connect or takrpg- other action with je.speci to the Matter. The Disclosing Party understands ibai Ji rhest comply with *11 statutes, ordihances. arid ief>Jlations ^on. whichthis EDS is based.

C. The City's GovetPTneniaf-Eihics and Campaign F rnancmg Ordinances. Chapters 2-156 end^-lW Of the MiinicrpaJCoofv. oppose.*eriajn dptie^ »nd. dbljf atio^s pr. p;<«ons or entities seeking Cijy c^htfacfti tvpiic. btrsrntss. or trsps^rpn?. 'T&e fbjj teat of ip*« P4:pir*nce5 apd i trarn% pToJiatn b available 08 fine:il^^<li^ftla^^M^ihiti. end ra*y-sL«d be pfct ained from The ^itytrfioard dfffofcs, 5*0l>'. Sedgwick Si„ Spire 2£D, Chicago> IL.pt&J 0, Oii/*<*:-S©£a "Die Drscipsing Party mustcprr.ply fuliy applicable ordrpeflc??.

Pas* li of 15

3- If'ihe Ci[ty w) c i mir>fe^«h at en v jrifprfr.eiiori pi by rocd" lit ih iif'EDS is false.- inGbmpiexepi n£c<«ra.Ae_t any c onnaxi Q» wbeiripterotni in.*Pnriecttdri"%ittfe-whfch ir&lsuomitted rosy pe escinied pi be void    vpidahie; and ihe City may p/ursuesapy temtdiej dndenhe contract pr i«eemc.ntfif not .ics*in3*d.vbid ofvclds'b^^^f Jaw_vpf in epuity^ tntfodiiVg^ifrijhatihg;!!!)*--Disclpsing Party's pa.Ttlcipatidn in the M<iter arid/or declining id allpw the Disclosing Patty' to pariiapate jp other p^aps^     with the Ciiy. Rerpedievai iawfpi s false, siaicmem qf rpaieriaffact. may include ^inc ar ceraiiop Ebb in awaffrjpHh£&w pf treble d^rnig1f$>

E, li isihe Cijy's .pplicy^:^⁰ rhalce :his dbcpmt^ itie^nd/or upon

reGuesj, Some pr jajli^pf 3hetfnTot maiidp prpyidepiri-thi^ any^artSchTnehtird ifc«.ED^imiV^;

bit        ava^lalilje' to'ine" public eh me inie&ei. in;resj3bnse ib>a Freedbra

ci o'theiwts'cy Ey cohipteiihi ^d;sichih| ;h'iS E:DS. ■ht' Disdosing-^ releases apy

pbssihk' ricius or clalrrts ^yhiph i*?nayjhaye 4,giinst:ti*Vti.tv in tpnnf fcVion \y«h Jhe^,pbbiic^, rtlease. Of iniormatipnrcontalned Hti '.his EJP.S and ats.p autiiprijtes the. City lo-yerrfy the accuiacy of;any infpih^atipaiubrnilted ip ihi^EtJS.

Fl.T-h'e ihfPrmaiion provided in ihis'EC.S mystibt'Kipi client;- irrrhe^verivpf changes'; the Disclos'ingVPaity must suppitmcnr this .ED^rS- jip 30?rhe>firi)e. teGtty ta^es^ctidp^ohyihe Matter:. If the Matter 5s:"ahandled by Ihe City's. Department of PrptSiienlePt S'ef.yiceis ihe Disclosing Partymust Upcatcrih.is.^PS ias ihe cpntract re^pireSi

The Disclosing Party represents and^wairants that:

<j. Th'e.Disc losing Party has not withheld or -reserved any disclosures,as to ecpnorritc interests tn ihe Disclosing Panv, or;*? tp 'theXNlaiici.pt inventor matron, data crplan as>to the intended use.or purpose f oi which ihe^pplrcaiVi secksCity CpWcil pir other iCiry ag^iry aciiph.

For purposes iof the cirrrfK'tions in rj.i ,*nd H-2-. teJp^>'*hevt*Tm^ person at

entity thati directly or )T$^eclJy::cpntrpjs ihe; Disclpsing Party, is controlled by the Disclosing Parryj or.is, w'ifb ihe D*seJ^c?jnj Party, uhpej common cpnirotpf snpther person or entity. Indicia of contr ol include., without limitation: mierlbckmg; mo'na^ep>e.pt pjr pw.pers.lnj^ ideritijty of interests anrpn.g. -family members: shared-rfaciiities and equipment; coPiroPJJpse ^ of a

business entity folltiylng the iheiigibrTity^f entity tbjdojliitttjhess S*^;ithtnevJedetSl'

government or ajstaie.pr lpcal government, incjyd?PS the Gity, using jspbstaptially the^atne manijernent, ownership, or$r.ineipafe aS j}ie ^^fl^e,^«jryi

H,j.  "fheiC ii closing, f ^a«y   not dclindueptHn the-.p^vmii-n} of s^jfaxa^

Depar>rneh.t of Revenue; nor arc the Disciesiiig Parry i^j its sf filiates deUhqpent _;in paying ahy-ijpje; fee,ta>i dr_Tpther charge-owed to theiCJcy.       fi)pl«d£s, blrt i$ r»ot ilrniled tp^ alt vtater cltarg^ sewer c'bajges, iicensrfees, parwng ticicei^ptppeny laxcts <n sales uixes:

IL2   if &e':i)!jscJb5i«g ^stiy istheApplifeSii^ ^ Pirty bp6 ttir^ffrliMes wlB n<H usc/tvqi

permit aieii subcpp«*cj^ _;»p use, *   feellji^pr) i^e j^&^IjA^ 14$) of Sicily mfL f acrliiieS.in cennecrion with-iW H#?ter fpr the dpraiien #t in>« liiai sroch fsciti^ temams on%)C^lisi.

Pefc ^2 pf I?

H.3    Jf. ihe: Disclpsing Pwy is the £ppjic*ni, the Piscic'.ing Parly w?>l obtainijbm any comuctpis.'iubcpntJacJDTi hired or ic be bited inrpnnetlienvyiih ihe M?»ei:cejnrKaijons equal b form trio substahcfcrb those in Fi_rI;snn.  .i.ibpvt and will r,oi, wiihout tae:;pTipr™rrutp^ the Ci">:» use^hv such ccnuacvoiysubcpntraGipi "hay cetuftcsuons or'4hat.,the

Disx^;.c'iir»E Party has tcas.cn 10 believe has npi prpyideq 01 csonot pjcvipe truthful cerriTjcatipnt.

NOTE: if the DiscToslng. Pa 1% cannot certify as,^;to. any of the rtcte^in'iH'.I^^vIi br-H.3.> above, an cxpur.ciory staremem-TOV?? bc atiachtd, >o this EDS.

CERTIFICATION

Under ptr.altv of perjury, the personsicriins be.lbwc^i') •.>. airsnts that be she fs authomed toesecute:

this EDS on behalf of -he Discloiing Party, arid" i2>wsii£n« ihei^tc-e':-!^

contained in this ED.S are tr ue, ice ui a te snd-conipieie as cf ihe'date fujnished to the City,

Jeffrey A. Lev

 

(sign netej

Jeffrey A. I,pv

t PrirA c  ype ha«.* orperson^ignine/

President

j Print .01 type title 01 person: signing.*

Date;; May ?1 ,  201 0

Signed and swprn to before me on (-date)_

at,    r^y       Countyy Tl 1 inn is_tstate).

Nowry Public.

Commission "pries:    March 6, 2014

—'Teffroy A« Lev

Paige 13 of is.

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND

DEPARTMENT HEADS

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

Under Municipal Code 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, by blood or adoption, to the mayor, any alderman, the city clerk, the city treasurer or any city department head as 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 corporate officers of the Disclosing Party, if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

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

If yes,please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of

[]Yes

 

such familial relationship.

CERTIFICATION

Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS are true, accurate and complete as of the date furnished to the City.

Jeffrey A. Lev_ _{Date:     Mav} 21. 2010

(Print or type name of Disclosing Party

By:

(Sign

 

Jeffrey A. Lev

(Print or type name of person signing)

President

(Print or type title of person signing)

Signed and sworn to before me on (date)__, by   Jeffrey A. i.&xr ,

at Cook_County,   Tll-innjq (State).

Notary Public.

Commissioner expires:     March 6, 2014

W^t syEH^tHS j^6fc^lTH^>V0©jl^:©3£. The pun^u of*Jtpage is 6w§*c*to i«tlu%voui EESpno^o subjirrsion 10 Ci^Xooncjl^i^a-ihe dale of rtwrnf. Iftmsolcto icttiHfyu^i.h'rv^|tY;: it* Dijclciing^any jhy&<c*9pjete a he** EI3SS^i|'xpn;e«<» cpnected htfonjYaiTdn)

tlTy^ferrule >v^}i<hyC^ciJir4ite^ ^jfoC^pracroerasPlS nnless rewiesod, This rtctnift^^^

 

 

at;ihrt^t^'Ae^n4^^pi^e-w-*«'"''--------------------------------....—

a«yj attend icmp.lctt as cf (tit t^tpf tte j?f er*;firaiiiqn. pnft'f:} je^lfinnJ ickncrwledjnientti

EDS

fFiira xaM'pt ytjpb ^a.iT)t.'pi:Dii<irtiWig Batfyji

 

.Prfnvoi type nan# of licna'tbrV:

■ >WWy /i/^/L/--

Tijl?of:5jgiia«f>»y;

fyf<>(/f<rii~~-_:—

Sjgwd^*wonjiohefwe m« oivfdak) •U" tied '^jjjurv'u^ . »i   Coot^ County."

 

.istatej.

!&>ujTy PobJk.

Commission expoer_

<o-t>//

Vt».JI-M*

-OFMCTAT NEIL D. SCHWARTZ

NOTARY PUBLIC, STATE OF ILLINOIS ^YCOMMBSION EXPIRES 4/24/2011

, CiTY -OF CHICAGG

' ECONOMIC fJISCLOSURE STATEMENT

AND AFFIDAVIT

SJ^CTld.N 1. - GENERAL INTORN1ATIC*'

A. Lt£o\\iimc of Disclosing Fauvfub^.uiing ihis EDS., Include dfbSai if applicable:

8501  Baltimore Prnp_PrH₀c_t LLC_

Check O.N£ "of the following ih ree be? w:

Indicate whether Dv^ J. rfi. fte. Applicant /OR

~. ( j -a Je C£ j e r.t j ty >iC.Jc ing a piject-pi inoiieci :ni£je.s.J in.ihc Ajp.i'ircn:, State the.icgaV:i>£Tne of the Applicant in »vhj£J?i Disclosing Party holds an interest:_ . __t__

""0t ■

'-• 1 } ³ J'pt'ctSeo Itcai entity w.ijh.S light ci' f onttol li.ee Stciioh 3.BlAiJ State thcMefil ninje of ihexntiiv in which pisclc.«gngvP^ __:__

B. Business address of Disclosing^ aity. 8501   So.  R3H-imnr_e Avo._-

Chicaqo.  Illinois fifiM7_

. , ' _r - , _p J,?^{f f} ^nickelsondemojcom C. Telephone_{75 0074} „77?/375 2659 ^Em*^,L---

p. N'irne ofconraet person:     Jeffrey A. Lev_

E. Federal Employer jSer/tfricajipn N^o. fjf.ypu.haA'x one):_ -   ■_^__

F. Briefdesctiptfdrioif itfntroct- ih^ciibn.'pr biber uridertefcmg\Ht«'ferred tbbelbwjBS the ~&'attej^ to .which' rhi'sEDS pe7t«ns> ■Ui>^.de:pjpj*c.t^.mbic3i and iocaticrri W^ioptriy, if applicable):

Alley Vacation

.    . j. . :.......... Division of Project

Ci. NVhiclCi»' feg.encyor.aepanment is requesting this EPS?-    Dov_Ci_opmenL      - ■_

3f jheil^'ttef**.**»fiww being handled by the City"'* Department of PrbcbrcTneht SerVicei> please iCompTefe'lbe folding:

^rificariogf _' ..... N/A     . 2nd Contrari-___

SECTION 11DISCLOSURE OF OWN E.RS ti IP ENTER ESTS

NATURE OJ DISCLOSING PARTY

3.   Indicate' the nature of ihe Disclosing Psrtv:

[1 Person^

|P Publicly regisw^

j J Pri>-iieiy he:ld;bviJ£i:n;esf c-cjppfAcien.-

{ ] Sole pioprietPrsbip

\ j Genera) partnership*

[ \ Limiied-pannersHp"

0 trust.

• >3pic B,l.b below.

L imited liabilky coropanv* f ]; Limited Uabnityjjarineiipip^ [ ] joini.venture* (' ) 'Mpi^pr-pjpjTii cqrporappn rls.ihe noi-fpj-prpfircoippraiipn alspa 5Qlfcj(3))?

'    I) Yes {.ITNp \ I Other Cp^?se;specify5

For legal entities, ;h.t.sr3ie tor fci*isjt tounuyi ofir.c.orpoYaiiori oj big£niza.i.vbti. if applicable?

3, Fox legal eptiiies sc,i orcarviie'd in. iht'.^iiie of Hliriois;' H-a's fhe-cj^aniioiion/re^isiered^o dp business in the S rate of Illinois as.a foreign entity?

{ ) Yes (] N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

La. List be|py>'.the full names*no t iiles of ill *>: coup ^ve officers inp al) directors of the cnutv.

For _:noi-fQj-p;pfii.coipC'istions also list beic*v all members, i; any. "-vhic-h ate leg_:a.l cntit'ies If there arc no .such membcjsi write "ho members-." For trusts, estates pi other simiia; entities, list below the legal t irleb older (s);

TV a me

Jeffrey A». Lev

_ President

Janice M. Lev

Secretary

i:b.        If you checked ^GetierafparnrVr^^ liability company."* "LimitedTribiiity partnership^r or "Joint venture" inures ponse to Item-4tJl._r#bpSrfr&mtutc,4$ Disclosing:Party},- to ielpw? jbe name arid title pf each ^eperalperthei, rnenaging member, manager pr

Psfeiof 13

any other person'or entire shaixoniicisshe oay-vo-Gay rn?j>2Sjprne'nv-of tfteDisclcs n>| Party. NOTE.; Each)e;eal entity listed beiow must submit ?n E DS on its own behalf.

Ts'aroe title

2,   Please provide the fonoting shfQimaiion concerning e3ti;p,e_;t.soflpj/--r.nd.iy;.^B'vinj a direct ot indirect beneficial intcicst (inducing ownership) inexec«^7^'or«H.Disr-losfo£F*ny_t Examples of spcb an interest include "shctcs in a corporation. pattnc'.Tsinb intctcst jn;a panntijhjp pr^oirir^enrute^ vritciest dfa TOcinbci or■m'a.nsy.ej in z limited iitbiiity cbTnpany,*bi interest of a beneficiary of a trust, estaie-or 6iner5jm'na^:r;e.n.tjlY,. Jf none...-state •'None." ."VOTE: Pur suant to Section        -050 of the ^unicipaj Code of C!hf«a^d4^>,Mun>c'ipal'^;C\->d<""), ■."he^City^rr*ay. require any such addition Bl ihTor matton from any applicant which isiteaibnably miene'eato BChie-ve full disclosure.

S?amt Business Address Percentage Interest in the

Jeffrey A a^m  o     „ _n Disclosing Party

^{ey A}- ^{Lev 8501}  So. Baltimore .100% _

_.__Chicago.  Tllinnic ^0617_-_—■__

SECT)ON-11J    BUSINESS ft EL A T10 N S H1P S WITH CITY ELECTEE* O^JTCIALS

lias the Dbclciin? Party had* "business relationship* avp*-fiinTe^:3tf:CTrafpvei 2-lSobf the Municipal Code, with any City elected offjcial in the- 3   months before ihe date shis EDS js sighed?

I 3 Y es ($No

Jfvcs,.please identify G^e'l°^w the namets) of such City eiecttTd official^) ah^describesucb lelationshipts):

SECT-JON JV DISCLOSURE OJF SVBCONTR,A CT OR S .*>*D OTHER R^TAlj^D PARTIES

The. Disc iosincpar'y ^nj05' d is dose ;iji e na m e a nd "biis J«e« address of each supeppttactpj, *)torfiCY. lobbyist;acfduntaw. .consultant, and any other person or entity whom the Disclosing Pem has jet&ined or expects tp regain «n<onnection }Yt%the.M£U^

Page 3 of IS

mount of the ■iits-^:p»id--<}J_:-iiYmtti^.io be paw. the Discloitnc Pitiyis norrequhtdio disclose mpV-vtej who ate paid/solely T'r.iouch the Disclosing Panysiecviarpayioll.

*'Lobbv;st'" Tneans any person oj epjiry ly^ffupgeitcKcs. to kffuence :-nylef isiaiive pr adminisHraiive scti'en onbehalf of any person or er.sjrv-v.Jhej'than^-: (-1) a not-for-profit ehl".}'; PTT an'unpaid/basis, or {2) hfrf.s d£ "Ebbbvist" also; means any person oT-ennty any. par? of *%os.e^vd«uesi'a&'a.n:«mpi^e«,'6i' another- iric]udes."undcr!a:Kin:g ip .^:ruT^.n«.,cny je cjslcUye or/^Gmin^iu-airvc aoiioni

if ;he Disclosing PaHV is uncertain whobt* a disclosure is ttcuired'under this Section, the: Disc icslng" Party must, eiihe; asic the Ciiy whether disc los.ure is recurred or make the disclosure.

Name

(indicate whether retfined or anticipated to be rciainedr

Eusiness .Address

Relat ions hip to,Disclosing Party rsupt on t r a c tor. ;ft nptney. lobbyist, etc.)

Fees

(indicate whether paid pr estimated)

ft

(Add sheets if necessary)

| "i Check here if the Disclosing party has not ictained. not e xpects to rct8in,.any such persons or entities.

SECT) ON -V   CE R T1F1C A T) O >' S

A. CQURT-OROEBED CHILD SUPPORT COMPLIANCE

Under Municipal Code Section!-9.2-4 If ₄ substantial owners of business entities thai contract with the Citvmusi remain imrompiiance ".with- their" child juppcrt obligations throughout the rtrjppf ibe contract.

Has any person who directly of- indirecxly owns 10.% or more of the Drsclpsipg Party been/decl8red in incarage on any child support obligations by any Illinois court of compele.nl jurisdictipp?

[] Yes j^Np .{j No person owns 10% or more of the Disclosing Party.

If "Yes^tos-ibe person entered imp s court-approved agreement for payment of all support pwed and is the perspn in compliance with thai agreement

I Jtes

i

Page *} of H

ioWfied in Section U^L

 

■ t have, ih pffeaSsfis

c   ale hot pr«ctirfv ino'tard fortft p%MiV«fiiftV*# PiA^a lP*«nh>tnX8l^nmy '  ifed<Jj£?^ # k?a$ *    fPWTMisjp.B 04)?.nv p^sVp*f<m«i *rc-fl*S*»#il ittti*ftftB4$. of

this Seeiipn;^.

a   havx^.^«h)_nia nY^yw pcjiP^jr-tec^mj the i*« of :h^iDS:,ha^ne Pi iPoiepoblic. vuaiisa-CiiQUS (Tedcia.L sMc-jpi^jpc^i>j«m;ihaj!cd pjr. cavs? <ade_:feuiU»«d

.   hsvc npuw^in a fcy*£j periodp^cedhtg rfic cite .pith* EHS. t^cn cp_By«:ted_T

jt$tt,ma]^$^ 1. Th>cejtiT»c^^

••the"'bfeeJowi»lfcwQ¹* ' >. _s

^iiv HopJKa&<-y-S^hjSSnaSt     ptf^ p^ the perrpTJnapc^<jTttit: Ma«e»,

D^cJp3ro««f

 

 

1%

 

<• >'zhyresponsible,-qf(lcisJ pfiht.C'ijdosifjs ptiiv. sny Applicable Party pi ■apy Afttiiaied tzirthyw any other c'fficiat ser ni pi employee pf the Difcjcjin^ Jeriy^eny Applicable Partypr any Affiliated Enin^-tciing puls^pj ipJthc,pjiecuon Prtpihpji:c.upo bfa.jesponsiblc p|f^i9i^|''i)ie:;Djscf6ti^. . Ten«,;aj)V-&pp1ic«bJ#. Pfci^! *ny A Orated E^.^^«fo<^--^e«»%

"SttiktrQje Duolpimc ^»ift,!»M-$ijy AppiuabTt fifty: pora^y&tftfctsd fcptity ofrnhtnhe Dtotemg&tt^ Parry/imp-py^eot? have^^ihg the five .ypara$etoi£'^ tfis E£>5 ii s]gptfi,.oj'_y;^^^<%'^V*o^:ap 4pP%*Me P-£iiy.;ap^ ofiliiaed^Bty^pt an ^Wtiaied iinrirypf

^ppiis-chit tmy. cVve^f^

cprmac* pi epga^erncpf ^f crtpecji^n; with ihe M$iieg*

a. iwbed^ot at_;ie^p.'td apbijpe. oi beep ifp.nVKiep pr* drudged 'fp1]l^^;]bj;$be.i^.4Q.r attempting tOt "ciibe,:a public.of^ccif o* employee pf th'eX^^^^^ any agency noftlje. federal f*>xippijfn* dittjTjMJ^ 5isjt- fci iocalippy*f^Hh^sjf fnUws JSni^tf Steresof America, in:4haj pfficerls oi rmplo^fte^^fe'^J capacity;

b. igjeed prcp^i^d.ep &sj?ri' o;.fhe_;: "bid)3ei.-s phpi^speptiye^Si^^-p^e^n.a paiiyjo'ajtjy fttcb agree me^ or-sdjudged^cu^   p$^£<ipV||^f epilation ajppng^jddsrs pi piP5pe*HtVe-psdSe^^'jjrss'faiftr^jf ffrcc^ioT^ a>ie'e^iriH'd.-ljid a fixed; pijjqe,.p.i. otherwise^©!

• c,  mace an.aehnfjifp.n bT-s^.€h vohtfpcid^ic_:*ffced in: a, or^;, above thatyiVa matter of record* but have not been pt63ecpteP*^;foi such conduct; or

d.  vib'iaied the ptp^i?jpns pf Municipa l Code Sec-lion 2=50-610 W^Sirfg ^jt;DJolhapcer).

^either the PMt^'^S P^Jty- Affiliated Ejy:iiy oj.£.ppV».c3^ officials; agents or^a»»ntisVR baited fionj contracting «vitb a^vppti ofs.tateoi local^vttnm.cnt a>a result of'engaging m PJfbtmf comjfteTd of 2^3fEri;^ fcid-iPtaiing in vMtpop M     ItCS 5^1^ 07 f5l ahy simrtai ofTense oJ^'anV statepf^if^^j^ijttned/ grates pf America j^t^ntwrrsroe same elepjerjij as the effitn.se pf brd-iigf inj orbid^otatin£.

*L ^Itherfflbt©«c1<^i^ Party hoi any AiTfliar^Ewl^ jj^ niainftnie^d-by^be Office ctf^pie^gn Assets Control of lhe i2:S; DeparWerit pf ^T;teaiEpj^ or/tb$ Buitav^f Indus^ U.StDepajtineJitJflf C^bhrrneice »t their stfctt^j^ l^e^p^cjaily

Designated OeniediS?e«ons Lwi_f the IJwyeriif&dIjsj, the Etrtiiy List end the.

DeberredLiju

f. The i?isc^ ahdHshall coprply ttjife-fl) the fipplicalHe lepuiremeMs of Ibe

Governmental Ethics I&dlhahce of the Chy,TrUe 2. <?hpprei 2-3 56 of *hr Wunicip»j C₀de;«nd (2)Sll aeipplicabie'pipvisaeifc itf Chapter 2-3b of th^ MunKapsl Cf*de tJOfficc pf the iDspector_: General}^

CtiiTf₍c-ktfony*-ihe Disopsin^; Patty musj. eaplsibbetpw:    ' .[ _A

jf.thc letters: ^A^-ptesunved tba^ittf^

C. CEKTIKIGATJO^ Of STATUSES. F^:A^C^L;^TfT^T10?J

means s bank, savinrs/'firid lbsri/*i;*flc^

VH-st.-tcnjp.any. savin^f-'i-ank-.in^Mmcn'rijahifc. f*c.uiit^

dealei. municipal s*cytitics dealVt;sccuji'jics, undeawiiri. raur.icipaJ sec-'ur'Mes jbMc^ii)et^i[y«sjiin°tDt ij'us'i verituie capita) rfctnpsny,.t^tik--§p:)6^{--e.t^pa"ttt:w financial st/vices holding company^ licensee undcJ-iHc Cc-mumc! InMai.lment boa* &ct_t.tfce Saics^ir.spce Agency Ac^jdrtnc Rtirdtptjal

■'^cit£8^e.'lli«rising-AcL Hp.^ew^

whose piC:dcTr»hahi business is thcpioVfdjiig bi deT*he'dc<mtt1b^

public employees Sna.c:c,b,tds;nce ^yjfb^iciiftK^Ojfbi and:* £3. t»f tbfcjntcjna'l Reverine Cbde.

^Additipnal deOnit'ons-may-bcfound ip. MunicipalCede 5>ctiDP:2^i^k4i5(p^.)

t

1, CERTIFICATION T1ra.^TJ|«<^P5iI^i::i^^.y t^wffcs that the D^losjng.P^fty (clii?V pnel

U »> l^fenor a TinanciaViostttptionr" 'is defined ip5'.e«ion ?*?2k43S$^ ftf- tbc;^vni^il^iHle«

"We,>ft ritft sndifciii^

Cbdei Wfc£w4»#$^^^ ^ff^iiajes fci. al^one b/thera ^^ Wcbm

4ej)d*m;d*^d^ ^f^e^ia.^ .lr^dj:>pj^ tbe lp;sTpf Ihe piiv&|€ ofWppi?

rpsipctf.«*tli iH|^tty ~

 

-32 of ihe Municipal Cede* explain here uusch wdiiiphalpi^tf if necessary):

ffav)t)\a&rVl&i^m 'lb* * bid "None." or no response a^^f^ljrtb'<e|[^^bt>'^,ve_f ii will;bit ^^Vysi^lypt^ih'eiS that-Tnc Disribsinj^Par'ty' ^^'ei9«to1ihr^<6>% staierneptsv

D. C£K5T3FJC ATJ<#N^; REGA RDJJJXj IXTER EST iii Git? fcU&NESS

Any.^bids pj-'1ti7tts'Sih?»-»'« defined in Chapter £^rf:6pf rti#^ meiniS|s ■■>ivrbc*^Sie4;₁fej)M5

3L  -In accordance with Section 2H5^1.3^.pf th.e, .<Junjc-rp8j£pdesany. official or-employee of the C)iy'have.a^ pr her pAv.nj.apve 6S:.in ihe narhe bfahy piher. person or

ewity in the Mirier? . U Y,es ifi$6-

_;NCfrfei Jfyou checic.ed/"y e^-' io JieprD.l,, proceed ,ip-3)e-sj.s.&2, and £?.*, if you checked^v~Nb" id Item D.I., proceed iP-'PaJi E'.

•2.   Unless sold puJiUant.io* pioccss of cornp'etliiye b'icldiht; or^otherwise perroi«ed, hp City cleared: offjcralfpt tjiVp;l^'e«;^ii'Vh8-Ye a.fit.ancial imereivsn: bliS>pj her own frame oi-iti ihe uarrie of any other person pr*mitYin the purchase of any propcjty that |i)'belpnps to-the        oY (iij is soiPV for; taxes or as^essmenisl br (iifivis sold by virtue pf legal process at the suit of the City (collectively,: "C?ity PrcpcrtV-Sale.^ Ccrrjpehsatioli totpjppeit^^futi^p\ii^Sn\. tbfheVpiiys' eminentdomain ppw<| does ajo't c enstttute * ftnaiJci*! werrsr^vjib in ih.e'rneaj»>n|: pf .fltjis Part$)>

Does-the Niauer .inyplve a e^PrbpfXty'Sale? IJYes \$r**

-:»,  1f you. tnecjgifd "Y«* to Item B.^provlde. the parties; and business addr es£_t$ of ibt lThy o/ilcials orerripioyeeshaVihg such interest and. identify the natiQe^plf^chjnteresi:

Narne Business Address; Nawe oTlnlejresi

The DiK}b£jn|^"^Yuirhcr ceniftcs that ho proliibHed ^8ncjaV>picrtsi:iB tbe Matter will be- acquired ^.-0^&i0^^^t^s^}xfyisiL

Page 8 of

4

The sQisclosing, fcarjy h,«.%a>cijeS spy2nd ill;?:ef pros ^.ihjf^^ipi^ilfJix endajjy and all ' prc^tee.ssortcnttti^ profit!* ffpai^layeryj i^$ave u?<3u$\ry^.or:

rjU^jipldet Insurant* policies froin %^3v«.y eis Hnc'luejag Siupjance poHcics is^pcd tp *ia.v«hciJd e is^hfil; jpr p&'i d*djf pVe^e^ fpjr da rr) ije/ip pi injury pr death pfiheii.i|ave^ and has disclosed ^;»n ibijjEJDS; £^#nd ?$?drhi x'e^cs-tp^uevC^ty; b^«d;(^s,^1>%ib.^^|f^ mVSt cijxclpjse; (hepame.3 of tnyahiJ all slaves oiii^ Failure tq

comply widi tiiesei^ rryaymifcc fhe24a*>er -to uchuh ifeV ESS periaSns yoidtfcit:

by vhjetCSiy, -

Please i^pfcil^/l^o^lrhwpw^ ifihej^Mosmg^

disclose beta* pj^ a^sittf fcmrai jp $&E!D;$ .«Ilj<qi?isjii? inXojir^pn as <« fpjihihrhal paragraph 2.

_,Jf_y ¥h&M2<Ws$M- ?^,s*Sf^ttWrtif® ^'HfTptinf^iny'ha? s^virhe^-arry a^d^^etorak^f

lhe, DiS tip sing; F^ir^ profits from:

slavery, the slave::indusirj', er%<i^v^)dje^^;^j9-n£.t' ptfjiiies. .^tid (b^int blscicsihg^arryh^ no t^tifi'0S-0f^nYt^nitjns-rpi pr.dfr'js f^prn slayer^-.rfce s'&se-ro^i^^^^^'h'cildW instance pp'jki« andpprtxpr^

.....2. The Distlosing Imyywfiti^iivu as a^t;u'li:^'^piu»inglihe'»aTcb'3a ^p 1|a) abpv.€^the

E)iscJPSJngJpaiiy:.£]8S fycijdj^ slavery, the tlavenndbjttrv,

.or slaveholder insV?*^ntt The Disclosing *

Partv viei ifreS ihatiihe jpjilo^bg sonsilrptes full ciscJosare oT Sll yucb records:

^PVTErlTJhe;^'^ ifihe: W^.fep^t3ie^a%

ftra^pr^eyW5*^W^' ' '

l tjit^P^f &rati of ifl persons or eptrties ^.egKMsred upde* Metal Lppbrog

;phc)osure pX li?&haAnrrrjadieItf&yipv cpit^irppT*^ ihe |)i>clo'f3pg;^airi ^lt|% K4p^:a>olhe»^

" r ■         ;■      .          . A/r²^  ...... " .

If Tio cipiihaifeTiip^csrs pr brrro.s; o.n. {he; lines sipve, 01 if (hejeners ";NA" m Rihs^XitA^txie? ppear. it! will be conclusively presumed'.hat the Disclosing Party m«*ns.that     persons or entities c-jtisuied under-the i c bpying Disclosure ^.ci of iPS j havc made lobbyinfrconjacis .?.{f v)ciin^lc Party wirb respectcio. ihe.^auet/;

TTie DiStiosihJ Party has npt spent and yill not expend any tederally-appropriated funds.tp jjjgv inyp'tiipn «ti enihv listed in Hats|r2ph A:i. a'oovc fof-fc« or her idfebvinjE activiiits^r jppay apv per5cn'pi entirV-iP influence pritnerr.pno injBbtnce anPfficer Pr empioyee-of spy agerr^j a« defrnied oy.^: Eppiir&bie «o^'ril']a.^^mepS>*r tff}&$pes&;ifr:tiffita~ioi employee pf Congress^ or a n rniployce^pif a Pier7ibcr t^t epfiies&.rirj, rp.nntcjipu-w^h ifct £y?ara Pf spy fedew%/'fpDde"d tbrividi; rnakingVsnyftder'sily: funded grantor 3c-.jan,*ot« iing into, spy cooperative ag> etrnent,- ofr to e^tend^ continue; repjtWj. irocpdY*^{1 m}pdijy epy fepe;isllyr;fcnd^ i«eemtnu

~_:.  TheDrselosipg Pirf-V will jubpiil apupcaiep^rii^ the*nd of each ca Jendaf qparrer

in >y."nich there. .opcuri event that/materially affetfethe acCtiiacy of Ihe statements sand,, informa.iipn set forth .in paragraphs A.l. and &.2 . $1)ov*.

]f the Ma«f^%-lf'd<?.*vi?^d^-srrd anyfunes qtjbe.rM.hanM

will be pa id t.o^apy pt:j chror" erniiy for influepcinj pr ciic-rnpijng-rp influence an officer or; ernployee pfrany Pf.ep.cgjf ^a;s defined bvapplicebiei aVdera 1 law^_fa member of CcpeiesSi an Officer prernplpyee of C c.ngrersvpY an employee .of> member-rof Congress .ih connection with ihe Matter, The' Disclpsing Party must complete, and .«ubmir.$ran.o.8jd Form-LLi. "Discic-sure FormtO ReppnrLobbyirig^;/"ni * accordance ^rtjS jis insauctions. The form _;may oe. obtained online tiprn the; federal-Ofilextof Management and'Eucget rOMB'ii website a'rh"P'^^ww^.^li^ ttnkedpn.;j&epage h'ttp^.'^^v^'hr/cho^

•4 The G iscitsing Partyx^tffies thai ei^.cr;_v0 it is not in ortirtiiation described in «ettidh iOUcyi*) of th.e Internal Revenue Code, of l^eji or tujit^

.^e£l(c-3(4) pf the Internal Revenue Cpue of l¥?6;tuX'hss not engaged end; vy ill ppj ea.gage.in aobbyirtg^ttivifies",

f.  If the Distlosrag Party isrbe„<pp1icaut_t ihe Discicsring Party must pbtain*eitfficatioris equal in form and substance alj subcorW8CtotsT>cfort &

awatp> arry subcorp^

for the GWstipn P^h'e Ma«er srid must rnaVe.suclj ceriHrc*iioi^^^ request.

B. C£RTlflCAT)6Wl*rG.^Dl?«^: Edt^rAl £MpMVmeW OPPQJtTlttilTY

If the"M*^eif^;r>ft4fi^ffon^. federal TepuJauons ut cjuire d«Applicsm^fl ^pttpiiUi s ubcpfljraciprs tpsubtia* ihe FpHpiyiog mfdrrnatiort with their bids or in writinjg at ;hc .cruuetW>f negptiaiidps.

Page JOpf 13

Is ihe disclosimj Paity Jht AppJiciBije tfib ft**

1 iwYf-^dfi dfcveibpeo 2nddo:ycuhwe^&.^ 8tJidh^^a^%p^rs^ii^j!; PppJracX federal i*;giiiM*»S* l$ee*H Cf R.Pan

rt^cT" '    mo ,

2 Hav,_c vbiif&rtfwidjuhe )piw R«p_;or>in|'CcrvWitt.ec. iri<X'i«cioi of.AeOffice ofTedcjar Comraci CompJbJict f wf       «" *he E'qWi$tspipym ail lepbm-due unocjihe s^pjjca.bje Hlih? iequ»j«:tr.c.Dfj.?

iiv-es ' ii**

c. Have vb^B p>«fep?¹?P »ir,3]*y-p^ *pb;cjen9*.««^«bi«!iiii».Tbt: Ifvou cheeked—Xb'^isGVestjon j... £f   t-bbiic_?:pwafrpjeV.iGe an tf.xpjanaiioh:

■"The gkcjpiinl^^ a«jl4Ci*<s jrt>at: .

Av-Ef*^P^W'^-®^il)*^:'^^i? E£$v&e $'«Mm!^^ W>d acjetfSj otobebalfpf

fiieifVrid ifc. p&io&&U»^;#fe EDS, «%J »he City maybiyesi^giu ihfc cieifitwpjibintss iof sTfan* oi alfofthe' pe i*bns pi <jjii,i«s i&nie*f in this'

B. Thecejiific^ sS»hP*0tif^en6 remained in tbis\.EDS/*flt#?cp^

ejection ofonycCT"²^   wKin^dibw action willr lespe*:;i? ?he M.aittt. Tbe Disc|psin£ iMy undeisiancli ^ d1*iaid»es, pipjnaijc^, andi^ion^n. ^bijcfc 4isji&S is

based.

C Tbi QfH's Gio^^{^!}<^{mr1^}^^, ■^^l^*^c$ and Campai^ J inancinj Ordinances. C$*p»ere^J;<$ 8&42>ifc4

6^b< ImS*^ ^^^■'^'^e^!^*^1^iSi^

' cbWac1*i ^ptJc,b^t*a₄ 6r.*ifi j&fcK o^r***** apd *^b^^i:^|^»'

^-fr_rfa ^ ri^iii^ «p4 n>?y- a3?d be <*»e*7>e*j iixsva lb* iei^Boiiia

p^ibSw^

3. tf.'ihc Citv dtie,iinih*$;^«hat anvMptfeation prbyrdctfrTi fhis 'EDS is false.- incomplete or naccuiate, any- cqnpsct or otber.agtt«mehi .to'cenrieetton'which u^s^ubrnHted may be escinoed pj be yoid pr y«i6able; and ihe City may pursue ipy remedies oncer the contract or igjcerncnt iif not icscihded. void or vGida$e)i -z\ law; pi in e^iiit^ inCH>$r>g;Ye^ Disclpsing Party's ppyirc%'ai'ib.n-"in" fheyMfiiei arid/pj decTining to allp>* ib* DtsclpsihgParty id participate in:other; y.aris &pons wjihthtOV; 'RerpcdLevai iaw-fpi a fals^ "slatenieht Gf mate rial fact may iAciudeaneaJcejatipp arid an a^atE^hf'^ty pf lierble fernagi«_:.

E, It is the City's pplicy^'tp mafce^:ft'is ddcpwtpvavfrte^ itJe^and/or upon

que si Som e or jajlipf Ibrinfotmotiop pr^VMepjbri-thfoEDSind i1iy;afl8chrnehtsid ib^ETj^p^y' be rhade; availaciljt torne" public on fbe Intersex. rh;^;ie;.spbijse j&a. FreedbW

or oihyrw^ci Ey cbrhpleiih^ «Kd:sijehih| ihiS EDS. the Disdojirig Paity^aiyes arid releases apy possible rights or clairrts whiph i*:?nsyhaye agafosrihe^ lhe-public release bt

injfotmation.-conta ined % fbrs. EDS andatsp aurocrjies the. C?ty ro^qifY the accuracy ctfany infprmatipjiisub.mitted ?p ibrsjjEpS;,

FI The information'pio'^idep. wihls;£©S touavbe''ia^Te&iefti".- ItrTrie^tte^io.f .c^apjjfcf£pie DiscTesihg: Party must supplement thirEDS- up 3o'^e>irrheVth^:VCity laies^ctrbh^driiilie Ms'tt'er> If the M atter rs.a conitatt being handled by iV.Cpy/s. Department of Ptftturerncpi reryice:* the DkclbsMg PaTry.^mUsippc.ate:ihi?^P-5;-.3S the cpmract requires.

The Disclosing Party represents and'waiiants that:

<j. the. Disc losing Party has not withheld or r eserved any disclosures.as to. ecpnomic interests tn ihe Disclosing Party, pr:a? to 'teeANatiej,.or any infor mation, data, crplan as>to the intended use or purpose for which rhc Apphcahi seieks;City. Cpuhcil pf -other City agitoty action.

For purposes of the cerrificjsijGns ipfij.,*nd       btfJOApvihe^ person or

entity that, directlvTOi indirectly: cpppols the. Disclosing Party. is co.niroile.d by the Disclosing PartVj oris, with the DiscJc^ipg Party, uhper cpmmPp conirot;PT*n.o'her person or entity. Indicia of contr ol include, jviibput limitation: interlocVing management pr ownership; ideJjijJy of interests ernprig. family mernbers: share4d?faciiities aPd eqt%>rhent; conrtnofl use ^f ernployeel; or orgahizafiop of a business entityfpliti»tthg ihe iheligjfeiiity>pf a tfosiheis entity tcidtf:©«ine;& governroent or aistaie.pr local government, including the Ciiy, using spbstaptially theseme management, ownership, pr principals; &&e;^

H.J.  ThtJ^iif Joy¹'! f ⁸*y ir not delintiU^tiw the payrnepl pf apy »

Department of Revenue; nor are ihe bisclesihg Party Jffr its affiliates delrhqpent;in paying,any-Tjn<u fee_f*s* orother cbargt-owed to the^Cltv. Tifcincjtid^ bwisnot limited ibValt^aier charges, sewer e'bargrt, license-fees, parting tieicets, property taxes or sales taxes:

if th<:DiscJosiflg >%tv is theApplifeapt_J,iije^s<k)Smg Parry apd^^fltfiirties Wflj not use* nor permit thdr surxpn«ra.crpj^S! tpuse, ^nv fic||fr^»p r^e US: EPA;!s Usi o^^ia.tini Facriliiet JB ccnrjeciipu t*it|r.irj<^tei .for the dbreiien^time iJiat such facifi^ temams oo%c

Page J2 pf \2-

H.3    Jf ihe- Disclosing Pm* h »Hc .Applicant, the D)sc|o< inj Party will obtain j^brn any contt actqis/subcPnitactor s hired 01 tc be hited in connection with the Manei: ceitificaiions equal b fottn ind substance to those :n H.|.;c-nd H.2. above and ^   npLAyiihou^ the'ptior written consent pf the City;, use ahy such ppnuaciprrsubxpnuatipr^ihat does not piovioe such ceriiftcaYiops pr vhaithe Disclosing Party has reason to believe has not provided ot canr.oi pjovipe truthful certificaiipps^

NOTE: If the Disclosing Patty cshnoi certify as.np any of the iicr^h^H.I^H^ orHabove, ah explanatory statemenvtnv?? be attached to this EDS.

CEFi JIT) CATION

Uhdcr penalty of perjury, ibepersoRs.icfii.ngrheibwj:.!'!:',--.varr-ants .that he-.*h.e- is auvhpiiztdto:e>ecute this EDS on behalf of the Disclosing Party, and rXj^nints vherVsifcrtTtiiVsu^^ cpntairrtd in this £$5 ate ttur,«ccura'.ie ahd<c<mj?IeYe si cime:darc:fu)rTished:to ibeCitV;

Jeffrey ALev

.iPr:ni.oi type name pfpi-vobsirig Partyi fiv:

Date:

May 27, 2010

 

Jeffrey a. Lev

t-Prnrt or type name of person signing.;

President_

jfiini.br type utle of person, signing»

before me on fdatei       cQS ^H^^O/Q^,   Jeffrey A.

Signed and sworn to

at -  Cook f]__, tjO^n^r, iliinnj/^ (state).

Lev

otary Public.

Commission ejphes

 

Page 15 of 13.

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND

DEPARTMENT HEADS

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

Under Municipal Code 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, by blood or adoption, to the mayor, any alderman, the city clerk, the city treasurer or any city department head as 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 corporate officers of the Disclosing Party, if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

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

 

If yes, please identify below (1) the name and title of such person, (2) the name of the legal entity to which such person is connected; (3) the name and title of the elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of

such familial relationship.

CERTIFICATION

Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS on behalf of the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS are true, accurate and complete as of the date furnished to the City.

Jeffrey A. Lev - Date:    _{May 21 2Q1Q}-

(Print or type name of Disclosing Party

 

Jeffrey A. Lev

(Print or type name of person signing) President

(Print or type title of person signing)

Signed and sworn to before me on (date)_ , by  Jeffrey A. Lev ,

at   Cook_County,   lUjnoic (State).

__Notary Public.

Commissioner expires: March fi ?m 4

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SfotaTyPubfic

NEIL D. SCHWARTZ NOTARY PUBLIC, STATE OF ILLINOIS

V«.il4W*

Commission expnet: v/^V/

 

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