CITY OF CHICAGO
APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE
ADDRESS of the property Applicant is seeking to rezone:
_1916 West Chicago Avenue_
Ward Number that property is located in: 1_
APPLICANT_BHB &Cafe Management Company LLC_
ADDRESS 2047 West Division Street_
CITY Chicago_STATE Illinois ZIP CODE 60622_
PHONE 773-494-5695_CONTACT PERSON John Fritchey_
Is the applicant the owner of the property? YES_NO X_
If the applicant is not the owner of the property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed.
OWNER Chicago Division Street Restaurants LLC/BHB Real Estate LLC
ADDRESS 2047 West Division Street_
CITY Chicago_STATE Illinois_ZIP CODE 60622
PHONE 773-494-5695 CONTACT PERSON John Fritchey_
If the Applicant/Owner of the property has obtained a lawyer as their representative for the rezoning, please provide the following information:
ATTORNEY John Fritchey_
ADDRESS 2539 North Southport Avenue_CITY Chicago_
CITY Chicago STATE Illinois ZIP CODE 60614 PHONE 773-494-5695 FAX_773-871-4012_
6.
If the applicant is a legal entity (Corporation. LLC, Partnership, etc.) please provide the names of all owners as disclosed on the Economic Disclosure Statements.
See attachment hereto
7. On what date did the owner acquire legal title to the subject property? September 2010
8. Has the present owner previously rezoned this property? If yes. when?
No_
9. Present Zoning District B3-2/RT-4_Proposed Zoning District B3-2
10. Lot size in square feet (or dimensions)_50.25' X 125'_
11. Current Use of the Property_Vacant commercial space_
12. Reason for rezoning the property To allow for establishment of a bakery/restaurant
13. Describe the proposed use of the 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)
Rezoning is sought to allow the establishment of a bakery and restaurant on the first floor of an existing one-story commercial building located at the subject location._
14. On May 14 , 2007, the Chicago City Council passed the Affordable Requirements Ordinance (ARO) that requires on-site affordable housing units or a financial contribution if residential housing projects receive a zoning change under certain circumstances. Based on the lot size of the project in question and the proposed zoning classification, is this project subject to the Affordable Requirements Ordinance? (See Fact Sheet for more information)
NO_X
COUNTY OF COOK STATE OF ILLINOIS
- John Fritchey being first duly sworn on oath, states that all of the above statements and
the statements contained in the documents submitted herewith are true and correct.
A
Signature of Applicant ^te
Subscribed and Sworn to before me this
day of
December 25FF(ECial SEAL JOHN A FRITCHEY
PUBLIC-STATE OF ILLINOIS ' COMMISSION EXPIRES 09/21/13
fary
For Office Use Only
Date oflntroduction:
File Number:_
Ward:
EXHIBIT "A"
BHB & CAFE MANAGEMENT COMPANY LLC OPERATING AGREEMENT
Name and Address of Each Common Member
Gregory R. Mohr
2047 West Division Street
Chicago, Illinois 60622
Capital Contribution
$ 100,000.00
Number of
Membership Interests 14.25%
Scott A. Weiner $ -0- 14.25%
2047 West Division Street Chicago, Illinois 60622
Kevin Cassman $ -0- 1.0%
1624 North Wood Street Unit 4
Chicago, Illinois 60622
Linda Wilson $ -0- 0.50%
1314 Sunrise Lane
Port Byron, Illinois 61275
Robert Wilson $ -0- 0.50%
1314 Sunrise Lane
Port Byron, Illinois 61275
Vinny Garcia $ -0- 15.50%
1856 West Iowa Street Chicago, Illinois 60622
Michelle Garcia $ -0- 15.50%
1856 West Iowa Street Chicago, Illinois 60622
Todd Brook $ -0- 5.0%
1530 South State Street
Unitl5F
Chicago, Illinois 60605
BHB & Cafe Management Company, LLC - Exhibit "A"
Name and Address of Each Preferred Member
Capital Contribution
Number of Preferred Interests
LTHS Revocable Trust c/o TCS Group, LLC 1 North Wacker Drive Suite 4775
Chicago, Illinois 60606 justin Decker
208 West Washington Street Apt 1001
Chicago, Illinois 60606
Scott Berger 1906 Greenview Northbrook, Illinois 60062
Alex James
1690 Tall Grass Lane
Lake Forest, Illinois 60045
Ken jones
910 West Madison Street Apt904E
Chicago, Illinois 60607
Curtis Granderson 20485 Tyler Drive Lynwood, Illinois 60411
Curt Conklin
1942 North Wolcott
Chicago, Illinois 60622
Ronald D. Porte and
Adam R. Porte, as T.I.C. 128 Laurel Avenue Wilmette, Illinois 60091
Matthew & Beth Glaysher 1926 North Winchester Avenue Chicago, Illinois 60622
Grant Lustig
2818 Woodmere Drive
Northbrook, Illinois 60062
$ 275,000.00 12.50%
$ 17,500.00 0.50%
$ 34,000.00 1.0%
$ 34,000.00 1.0%
$ 125,000.00 4.0%
$ 34,000.00 1.0%
$ 34,000.00 1.0%
$ 34,000.00 1.0%
$ 17,500.00 0.50%
$ 187,500.00 7.0%
BH8 & Cafe Management Company, LLC - Exhibit "A"
Name and Address of Each Preferred Member
Capital Contribution
Number of Preferred Interests
Stelios Valavanis 1823 Grant
Evanston, Illinois 60201
Mike Palm
1940 North Wolcott
Chicago, Illinois 60622
Todd Ricketts 510 Laurel Avenue Wilmette, Illinois 60091
Greg Moss
1948Sunnyside
Highland Park, Illinois 60035
Nick Parras
727 East Meadow Lane Palatine, Illinois 60074
$ 17,500.00 0.50%
$ 34,000.00 1.0%
$ 34,000.00 1.0%
$ 17,500.00 0.50%
$ 35,000.00 1.0%
pany, LLC - Exhibit "A"
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 RT-4 Residential Two-Flat, Townhouse and Multi-Unit District symbols and indications as shown on Map No 3-H in an area bounded by:
West Chicago Avenue; a line 50.0 east of and parallel to North Winchester Avenue; the public alley next north of and parallel to West Chicago Avenue; and a line 100.25 east of and parallel to North Winchester Avenue
to those of a B3-2 Community Shopping District, and a corresponding use district is hereby established in the area above described.
SECTION 2. This Ordinance shall be in force and effect from and after its passage and due publication.
Common Address of Property: 1916 West Chicago Avenue
AFFIDAVIT OF COMPLIANCE
January 10,2011
Honorable Daniel S. Solis Chairman, Committee on Zoning 121 North LaSalle Street Room 304 - City Hall Chicago, Illinois 60602
The undersigned. Jolin A. Fritchey, 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 of the Chicago Zoning Ordinance, by sending written notice to such property owners who appear lo be lhe 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 of the lot line oflhe 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 of the property sought to be rezoned; a statement of the intended use of the property; the name and address of the applicant: the name and address of the owner; and a statement that the applicant intends lo file lhe application for a change in zoning on approximately January 11, 201 1.
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 oflhe subject site is a complete list containing the names and addresses of the people required to be served.
John A. Fritchey
Subscribed and Sworn to before me
OFFICIAL SEAL
Notary Public
The Law Office of John A. Fritchey
January 11, 201 1 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 January 11, 2011. this firm will file an application for a change in zoning from a split-zoned B3-2 Community Shopping District and RT-4 Residential Two-Flat, Townhouse and Multi-Unit District to a B3-2 Community Shopping District on behalf of BHB & Cafe Management Company LLC for the properly located at 1916 West Chicago Avenue. The rezoning is sought in order lo allow for the establishment of a bakery and restaurant at the location.
BHB & Cafe Management Company LLC is located at 2047 West Chicago Avenue. Chicago, Illinois 60622.1 am the contact person for the applicant. My address and phone number are set forth at the top of this letter. The property is owned by BHB Real Estate LLC and Chicago Division Street Restaurants LLC, located at 2047 West Chicago Avenue, Chicago, Illinois 60622, the ownership is controlled by Todd Brook. Scott Weiner and Gregory Mohr, of the same address.
PLEASE NOTE THAT THE APPLICANT IS NOT SEEKING TO PURCHASE OR REZONE YOUR PROPERTY, BUT ONLY TO LEGALIZE THE USE OF ITS OWN PROPERTY FOR THE PROPOSED PURPOSE. THE APPLICANT IS REQUIRED BY LAW TO SEND YOU THIS NOTICE BECAUSE YOU ARE LISTED AS THE TAXPAYER OF RECORD OF PROPERTY LOCATED WITHIN 250 FEET OF THE EXISTING PROJECT. NO ACTION IS REQUIRED ON YOUR PART.
Sincerely,
The Law Office of John A. Fritchey
John A. Fritchey
2539 North Southport Avenue Chicago, Illinois 60614
T: 773.494.5695 F: 773.871.4012
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
BHB & Cafe Management Company LLC
Check ONE of the following three boxes:
Indicate whether Disclosing Parts' submitting this EDS is:
1. [X] the Applicant
OR
2. [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name oflhe Applicant in which Disclosing Party holds an interest:
OR
3. f J a specified legal entity with a right of control (see Section ILB. I .b.) State the legal name of lhe entity in which Disclosing Party holds a right of control:
B. Business address of Disclosing Party: 2047 West Chicago Avenue, Chicago, Illinois 60622
D. Name of contact person: John Fritchey
E. Federal Employer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Rezoning for 1916 West Chicago Avenue
G. Which City agency or department is requesting this EDS? Department of Zoning
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
Page 1 of 13
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party: [ J Person
[ ] Publicly registered business corporation [ ] Privately held business corporation ( ] Sole proprietorship [ ] General partnership* [ ] Limited partnership* [ J Trust
* Note B.l.b below.
fX] Limited liability company* f j Limited liability partnership* \ ] Joint venture* [ ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501 (c )(3))?
[ ] Yes f ] No
( ] Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ] Yes [ J No [X] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
fa. List below the full names and titles of all executive officers and all directors of the entity.
For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder( s).
Name Title
Lb. If you checked "General partnership," "Limited partnership," "Limited liability
company," "Limited liability partnership" or "Joint venture" in response to Item A.I. above (Nature of Disclosing Party), list below the name and title of each general partner, managing member, manager or
Page 2 of 13
any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title Gregory R. Mohr Manager .Scott Weiner Manager
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Part}'. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, slate "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
See Exhibit A, attached hereto
SECTION III ~ BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[JYes X No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship( s):
SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total
Page 3 of 13
amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (I) a not-for-profit entity, on an unpaid basis, or (2) himself "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Name
(indicate whether retained or anticipated to be retained)
Business Address
Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)
Fees
(indicate whether paid or estimated)
The Law Office of John A. Fritchey
2539 N. Southport Chicago, IL 60614
Attorney
$6,000
(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
Under Municipal Code 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 term of the contract.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes X No [ ] No person 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?
[]Yes I] No
Page 4 of 13
B. FURTHER CERTIFICATIONS
1. The Disclosing Party and. if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B. I. of this EDS:
a- 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;
b. have not, within a five-year period preceding 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 lo obtain, or performing a public (federal, state or local) transaction or contract under a public transaction: a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements: or receiving stolen property;
c- are not presently indicted lor or otherwise criminally or civilly charged by a governmental entity (federal, stale or local) with commission of any oflhe offenses enumerated in clause B.t.b. of this Section V;
d. have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
e- have not, within a five-year period preceding the dale of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any stale, or any other unit of local government.
2. The certifications in subparts 2, 3 and 4 concern:
the Disclosing Party;
any "Applicable Party" (meaning any party participating in the performance of the Matter, including but not limited to any persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Applicable Parties, the term Affiliated Entity means a person or entity that directly or indirectly controls the Applicable Party, is controlled by it, or, with the Applicable Party, is under common control of another person or entity;
Page 5 of 13
any responsible official of the Disclosing Party, any Applicable Parrs' or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Applicable Part)' or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official oflhe Disclosing Part}', any Applicable Party or any Affiliated Entity (collectively "Agents").
Neither the Disclosing Part}', nor any Applicable Party, nor any Affiliated Entity of either the Disclosing Party or any Applicable Party nor any Agents have, during the five years before the date this EDS is signed, or, with respect to an Applicable Party, an Affiliated Emit}', or an Affiliated Entity of an Applicable Party during the five years before the date of such Applicable Party's or Affiliated Entity's contract or engagement in connection with the Matter:
a- bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency oflhe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
b- agreed or colluded with other bidders or prospective bidders, or been a part}' 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
c- made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
d. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
3. Neither the Disclosing Party, Affiliated Entity or Applicable Party, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
4. Neither the Disclosing Part}' nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the
Bureau oflndustry and Security of the U. S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
5. The Disclosing Party understands and shall comply with (1) the applicable requirements of the Governmental Ethics Ordinance of the City, Title 2, Chapter 2-1 56 of the Municipal Code; and (2) all the applicable provisions of Chapter 2-56 of the Municipal Code (Office of the Inspector General).
Page 6 of 13
6. It' the Disclosing Party is unable lo certify lo any of the above statements in this Pail B (Further Certifications), the Disclosing Party must explain below:
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
For purposes of this Part C, under Municipal Code Section 2-32-455(b), the term "financial institution" means a bank, savings and loan association, thrift, credit union, mortgage banker, mortgage broker, trust company, savings bank, investment bank, securities broker, municipal securities broker, securities dealer, municipal securities dealer, securities underwriter, municipal securities underwriter, investment trust, venture capital company, bank holding company, financial services holding company, or any licensee under the Consumer Installment Loan Act. the Sales Finance Agency Act, or the Residential Mortgage Licensing Act. However, "financial institution" specifically shall not include any entity whose predominant business is the providing of tax deferred, defined contribution, pension plans to public employees in accordance with Sections 403(b) and 457 of the Internal Revenue Code. (Additional definitions may be found in Municipal Code Section 2-32-455(b ).)
1. CERTIFICATION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is X is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
2- If the Disclosing Party IS a financial institution, then the Disclosing Part}' pledges:
"Weare not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. 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."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as .defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter
Page 7 of 13
2-32 oflhe Municipal Code, 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 INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
1. In accordance with Section 2-156-1 10 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter? [' ] Yes [X] No
NOTE: If you checked "Yes" to Item D.I., proceed lo Items D.2. and D.3. If you checked "No" to Item D.I., proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue oflegal process at lhe suit oflhe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale? f ] Yes X No
3. If you checked "Yes" to Item D.I., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of Interest
4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
Page 8 of 13
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
The Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities for records of investments or profits from slavery, the. slave industry, or slaveholder insurance policies from the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves) and has disclosed in this EDS any and all such records to the City. In addition, the Disclosing Party must disclose the names of any and all slaves or slaveholders described in those records. Failure to comply with these disclosure requirements may make the Matter to which this EDS pertains voidable by the City.
Please check either I. or 2. below . If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all requisite information as set forth in that paragraph 2.
X 1. The Disclosing Party verifies that (a) the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities for records of investments or profits from slavery, the slave industry, or slaveholder insurance policies, and (b) the Disclosing Party has found no records of investments or profits from slavery, the slave industry , or slaveholder insurance policies and no records of names of any slaves or slaveholders.
_2. The Disclosing Party verifies that, as a result of conducting the search in step ! (a) above, the Disclosing Party has found records relating to investments or profits from slavery, the slave industry, or slaveholder insurance policies and/or the names of any slaves or slaveholders. The Disclosing Party verifies that the following constitutes full disclosure of all such records:
SECTION VI -- CERTIFICATIONS FOR FEDERALLY-FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Begin list here, add sheets as necessary):
Page 9 of 13
(Mho explanation appears or begins on the lines above, or it" the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or
attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee 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.
3. The Disclosing Part)' will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
If the Matter is federally funded and any funds other than federally appropriated funds have been or will be paid to any person or entity for influencing or attempting 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 of a member of Congress in connection with the Matter, the Disclosing Party must complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The form may be obtained online from the federal Office of Management and Budget (OMB) web site at http:/Avww.whiteliouse.gov/omb/grants/sflllin.pdf. linked on the page http://www.whitehouse.gov/omb/grants/grants_forms.html.
4. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) ot the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in
"Lobbying Activities".
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Page 10 of 13
Is the Disclosing Party the Applicant?
\ "| Yes [ ] No
If "Yes." answer the three questions below:
1. Have you developed and do you have on tile affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.) [ ] Yes [ ] No
2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements? f ] Yes [ | No
3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [ ] No
If you checked "No" to question I. or 2. above, please provide an explanation:
SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENAL TIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. By completing and filing this EDS, the Disclosing Party acknowledges and agrees, on behalf of itself and the persons or entities named in this EDS, that the City may investigate the creditworthiness of some or all of the persons or entities named in this EDS.
B. 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.
C. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicago.org/Ethics. and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
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D. If the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded, void or voidable), 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 transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award lo the City of treble damages.
E. It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.
F. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires.
The Disclosing Party represents and warrants that:
G. The Disclosing Party has not withheld or reserved any disclosures as to economic interests in the Disclosing Party, or as to the Matter, or any information, data or plan as to the intended use or purpose for which the Applicant seeks City Councilor other City agency action.
For purposes of the certifications in H.l. and H.2. below, the term "affiliate" means any person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members; shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with the federal government or a state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity.
H. l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its affiliates delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
H.2 If the Disclosing Party is the Applicant, the Disclosing Party and its affiliates will not use, nor permit their subcontractors to use; any facility on the U.S. EPA's List of Violating Facilities in connection with the Matter for the duration of time that such facility remains on the list.
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H.3 It'the Disclosing Part)' is the Applicant, the Disclosing Party 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 H.l. and H.2. above and will not. .without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: 11" the Disclosing Party cannot certify as to any of the items in H.l., H.2. or H.3. above, an explanatory statement must be attached to this EDS.
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.
BHB & Cafe Management Company LLC
(Print or type n_me of Disclosing Party)
Bv:
Date: December 2, 2010
(sign here)
(Print or type name of person signing)
Signed and sworn to before me on 12/02/2010 at Cook County, Illinois
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EXHIBIT "A"
BHB & CAFE MANAGEMENT COMPANY LLC OPERATING AGREEMENT
Name and Address of Capital Number of
Each Common Member Contribution Membership Interests
Gregory R. Mohr $ 100,000.00 14.25%
2047 West Division Street Chicago, Illinois 60622
Scott A. Weiner $ -0- 14.25%
2047 West Division Street Chicago, Illinois 60622
Kevin Cassman $ -0- 1.0%
1624 North Wood Street Unit 4
Chicago, Illinois 60622
Linda Wilson $ -0- 0.50%
1314 Sunrise Lane
Port Byron, Illinois 61275
Robert Wilson $ -0- 0.50%
1314 Sunrise Lane
Port Byron, Illinois 61275
Vinny Garcia $ -0- 15.50%
1856 West Iowa Street Chicago, Illinois 60622
Michelle Garcia $ -0- 15.50%
1856 West Iowa Street Chicago, Illinois 60622
Todd Brook $ -0- 5.0%
1530 South State Street
Unitl5F
Chicago, Illinois 60605
BHB & Caf£ Management Company, LLC - Exhibit "A"
Name and Address of Each Preferred Member
LTHS Revocable Trust c/o TCS Group, LLC 1 North Wacker Drive Suite 4775
Chicago, Illinois 60606
Capital Contribution
$ 275,000.00
Number of Preferred Interests
12.50%
Justin Decker
208 West Washington Street Apt 1001
Chicago, Illinois 60606
Scott Berger 1906 Greenview Northbrook, Illinois 60062
Alex James
1690 Tall Grass Lane
Lake Forest, Illinois 60045
Ken Jones
910 West Madison Street Apt904E
Chicago, Illinois 60607
Curtis Granderson 20485 Tyler Drive Lynwood, Illinois 60411
Curt Conklin
1942 North Wolcott
Chicago, Illinois 60622
Ronald D. Porte and
Adam R. Porte, as T.I.C. 128 Laurel Avenue Wilmette, Illinois 60091
Matthew & Beth Glaysher 1926 North Winchester Avenue Chicago, Illinois 60622
Grant Lustig
2818 Woodmere Drive
Northbrook, Illinois 60062
$ 17,500.00 0.50%
$ 34,000.00 1.0%
$ 34,000.00 . 1.0%
$ 125,000.00 4.0%
$ 34,000.00 1.0%
$ 34,000.00 1.0%
$ 34,000.00 1.0%
$ 17,500.00 0.50%
$ 187,500.00 7.0%
BHB & Caf6 Management Company, LLC - Exhibit "A"
Name and Address of Each Preferred Member
Capital Contribution
Number of Preferred Interests
Stelios Valavanis $ 17,500.00 0.50%
1823 Grant
Evanston, Illinois 60201
Mike Palm $ 34,000.00 1.0%
1940 North Wolcott Chicago, Illinois 60622
ToddRicketts $ 34,000.00 1.0%
510 Laurel Avenue Wilmette, Illinois 60091
Greg Moss $ 17,500.00 0.50%
1948 Sunnyside
Highland Park, Illinois 60035
NickParras $ 35,000.00 1.0%
727 East Meadow Lane Palatine, Illinois 60074
'.pany, LLC - Exhibit "A"
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION 1 - GENERAL INFORMATION
A. Legal name of Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
BHB Real Estate LLC
Check ONE of the following three boxes:
Indicate whether Disclosing Party submitting this EDS is:
1. [ ] the Applicant
OR
2. f | a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the Applicant in which Disclosing Party holds an interest:
OR
3. fX] a specified legal entity with a right of control (see Section I LB. I .b.) State the legal name of the entity in which Disclosing Party holds a right of control:
B. Business address of Disclosing Party: 2047 West Chicago Avenue, Chicago, Illinois 60622
D. Name of contact person: John Fritchey
E. Federal Employer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Rezoning for 1916 West Chicago Avenue
G. Which City agency or department is requesting this EDS? Department of Zoning
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
Specification # and Contract #
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V
SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF DISCLOSING PARTY
1. Indicate the nature of the Disclosing Party:
[ 1 Person
| ] Publicly registered business corporation
f j Privately held business corporation
[ ] Sole proprietorship
[ ] General partnership*
[ | Limited partnership*
[ J Trust
* Note B.l.b below.
[Xj Limited liability company* [ J Limited liability partnership* [ ] Joint venture* | ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501 (c )(3))?
[ 1 Yes f 1 No
| J Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entities not organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity?
[ ] Yes f 1 No [ X] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
I.a. List below the full names and titles of all executive officers and all directors of the entity.
For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder( s).
Name Title
Lb. If you checked "General partnership," "Limited partnership," "Limited liability
company," "Limited liability partnership" or "Joint venture" in response to Item A.I. above (Nature of Disclosing Party), list below the name and title of each general partner, managing member, manager or
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any oilier person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name Title
Gregory R. Mohr Manager
Scott A. Weiner Manager
Todd Brook Manager
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity . If none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in the
Disclosing Party
See Exhibit A, attached hereto
SECTION III -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes X No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship( s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total
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amount of the fees paid or estimated to be paid. The Disclosing Part}' is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf oi'any person or entity other than: (I) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Name
(indicate whether retained or anticipated to be retained)
Business Address
Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)
Fees
(indicate whether paid or estimated)
The Law Office of John A. Fritchey
2539 N. Southport Chicago, IL 60614
Attorney
$6,000
( 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
Under Municipal Code 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 term of the contract.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes X No [] No person 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?
I ] Yes [ ] No
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B. FURTHER CERTIFICATIONS
1. The Disclosing Party and, if the Disclosing Party is a legal entity, all of" those persons or entities identified in Section ll.B.l. of this EDS:
a- 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;
b. have not, within a five-year period preceding 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 slate antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
c- are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with commission of any of the offenses enumerated in clause B.t.b. of this Section V:
d. have not. within a live-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and
e- have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
2. The certifications in subparts 2. 3 and 4 concern:
the Disclosing Parly;
any "Applicable Party" (meaning any party participating in the performance of the Matter, including but not limited to any persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among'family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Applicable Parties, the term Affiliated Entity means a person or entity that directly or indirectly controls the Applicable Party, is controlled by it, or, with the Applicable Party, is under common control of another person or entity;
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any responsible official of the Disclosing Party, any Applicable Party or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Applicable Party or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Applicable Party or any Affiliated Entity (collectively "Agents").
Neither the Disclosing Part}', nor any Applicable Party, nor any Affiliated Entity of either the Disclosing Party or any Applicable Party nor any Agents have, during the five years before the date this EDS is signed, or. with respect to an Applicable Party, an Affiliated Emit}-, or an Affiliated Entity of an Applicable Party during the five years before the date of such Applicable Party's or Affiliated Entity's contract or engagement in connection with the Matter:
a- bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;
b- 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
c- made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
d. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
3. Neither the Disclosing Party. Affiliated Entity or Applicable Party, 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 (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
4. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the
Bureau oflndustry and Security of the U. S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
5. The Disclosing Party understands and shall comply with (1) the applicable requirements of the Governmental Ethics Ordinance of the City, Title 2, Chapter 2-156 of the Municipal Code; and (2) all the applicable provisions of Chapter 2-56 of the Municipal Code (Office of the Inspector General).
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6. If the Disclosing Party is unable lo certify to any of the above statements in this Pail B (Further Certifications), the Disclosing Parly must explain below:
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
For purposes of this Part C, under Municipal Code Section 2-32-455(b), lhe term "financial institution" means a bank, savings and loan association, thrift, credit union, mortgage banker, mortgage broker, trust company, savings bank, investment bank, securities broker, municipal securities broker, securities dealer, municipal securities dealer, securities underwriter, municipal securities underwriter, investment trust, venture capital company, bank holding company, financial services holding company, or any licensee under the Consumer Installment Loan Act. the Sales Finance Agency Act, or the Residential Mortgage Licensing Act. However, "financial institution" specifically shall not include any entity whose predominant business is the providing of tax deferred, defined contribution, pension plans to public employees in accordance with Sections 403(b) and 457 of the Internal Revenue Code. (Additional definitions may be found in Municipal Code Section 2-32-455(b ).)
I. CERTIFICATION
The Disclosing Party certifies that the Disclosing Part}' (check one)
[ ] is X is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
II the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"Weare not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. 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."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter
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2-32 of"the Municipal Code, explain here (attach additional pages il"necessary):
If the letters "NA," the word "None," or no response appears on the lines above, il will be conclusively presumed that the Disclosing Party certified to lhe above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
1. In accordance with Section 2-156-1 10 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter? [ J Yes |X] No
NOTE: If you checked "Yes" to Item D.I proceed to Items D.2. and D.3. If you checked "No" lo Item D.I., proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs lo the City , or (ii) is sold for taxes or assessments, or (iii) is sold by virtue otlegal process al the suit of the City (collectively. "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale? [ ] Yes X No
3. If you checked "Yes" to Item D.I., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of 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
The Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities for records of investments or profits from slavery', the. slave industry, or slaveholder insurance policies from the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves) and has disclosed in this EDS any and all such records to the City. In addition, the Disclosing Party must disclose the names of any and all slaves or slaveholders described in those records. Failure to comply with these disclosure requirements may make the Matter to which this EDS pertains voidable by the City.
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 requisite information as set forth in that paragraph 2.
X 1. The Disclosing Party verifies that (a) the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities for records of investments or profits from slavery, the slave industry, or slaveholder insurance policies, and (b) the Disclosing Party has found no records of investments or profits from slavery, the slave industry, or slaveholder insurance policies and no records of names of any slaves or slaveholders.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 (a) above, the Disclosing Party has found records relating to investments or profits from slavery, the slave industry, or slaveholder insurance policies and/or the names of any slaves or slaveholders. The Disclosing Party verifies that the following constitutes full disclosure of all such records:
SECTION VI CERTIFICATIONS FOR FEDERALLY-FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Begin list here, add sheets as necessary):
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(Ifno explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act ol" 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for.his or her lobbying activities or to pay any person or entity to influence or
attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee 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.
3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
If the Matter is federally funded and any funds other than federally appropriated funds have been or will be paid to any person or entity for influencing or attempting 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 ol" a member of Congress in connection with the Matter, the Disclosing Party must complete and submit Standard Form-LLL. "Disclosure Form to Report Lobbying," in accordance with its instructions. The form may be obtained online from the federal Office of Management and Budget (OMB) web site at http://www.whitehouse.gov/onib/grants/sflllin.pdf. linked on the page http://www.whitehouse.gov/omb/grants/grants_forms.html.
4. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in
"Lobbying Activities".
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
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Is the Disclosing Party the Applicant?
[) Yes [ ] No
If "Yes," answer the three questions below:
1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.) [ 1 Yes [ ] No
2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements? f 1 Yes [ j No
3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes [ ] No
If you checked "No" to question 1. or 2. above, please provide an explanation:
SECTION VII ~ ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENAL TIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. By completing and filing this EDS, the Disclosing Party acknowledges and agrees, on behalf of itself and the persons or entities named in this EDS. that the City may investigate the creditworthiness of some or all of the persons or entities named in this EDS.
B. 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.
C. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicago.ora/Ethics. and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
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D. If (lie City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract orother agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded, void or voidable), 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 transactions with the City. Remedies at law lor a false statement of material fact may include incarceration and an award to the City of treble damages.
E. lt is the City's policy lo make this document available to the public on its Internet site and/or upon request. Some or all oflhe inlormation provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Part)' waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City lo verify the accuracy of any information submitted in this EDS.
F. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires.
The Disclosing Party represents and warrants that:
G. The Disclosing Party has not withheld or reserved any disclosures as to economic interests in the Disclosing Parly, or as to the Matter, or any information, data or plan as to the intended use or purpose for which the Applicant seeks City Councilor other City agency action.
For purposes of the certifications in H.l. and H.2. below, lhe term "affiliate" means any person or entity thai, directly or indirectly: controls the Disclosing Party, is controlled by lhe Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members; shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with the federal government or a state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity.
H. l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its affiliates delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
H.2 If the Disclosing Party is the Applicant, the Disclosing Party and its affiliates will not use, nor permit their subcontractors to use, any facility on the U.S. EPA's List of Violating Facilities in connection with the Matter for the duration of time that such facility remains, on the list.
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H.3 If the Disclosing Party is the Applicant, the Disclosing Party 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 H. 1. and H.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in H.I., H.2.or H.3. above, an explanatory statement must be attached to this EDS.
CERTIFICATION
Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this EDS on behalf of the Disclosing Part)', 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.
BHB Real Estate LLC ■>,,
Date: December 2, 2010
(Print or type narji£_of Disclosing Party) Bv:
(sign here)
<5>coVV' VaXa r^cf~
(Print or type name of person signing)
Signed and sworn to before me on 12/02/2010 at Cook County, Illinois
Page 13 of 13
EXHIBIT "A"
BHB REAL ESTATE LLC OPERATING AGREEMENT
Name and Address of Each Member
Gregory R. Mohr
2047 West Division Street
Chicago, Illinois 60622
Scott A. Weiner
2047 West Division Street
Chicago, Illinois 60622
LTHS Revocable Trust c/o TCS Group, LLC 1 North Wacker Drive Suite 4775
Chicago, Illinois 60606 Justin Decker
208 West Washington Street Apt 1001
Chicago, Illinois 60606
Scott Berger 1906 Greenview Northbrook, Illinois 60062
Capital Contribution
$ -0-
$ -0-
$ -0-
-0-
-0-
Number of
Membership Interests 14.25%
14.25%
12.50%
0.50%
1.0%
Alex James
1690 Tall Grass Lane
Lake Forest, Illinois 60045
-0-
1.0%
Ken Jones
910 West Madison Street Apt904E
Chicago, Illinois 60607
Curtis Granderson 20485 Tyler Drive Lynwood, Illinois 60411
-0-
-0-
4.0%
1.0%
BHB Real Estate LLC - Exhibit "A"
Name and Address of Capital Number of
Each Member Contribution Membership Interests
CurtConklin $ -0- 1.0%
1942 North Wolcott Chicago, Illinois 60622
Ronald D. Porte and
Adam R. Porte, as T.I.C. $ -0- 1.0% 128 Laurel Avenue Wilmette, Illinois 60091
Matthew & Beth Glaysher $ -0- 0.50%
1926 North Winchester Avenue Chicago, Illinois 60622
Grant Lustig S -0- 7.0%
2818 Woodmere Drive Northbrook, Illinois 60062
Stelios Valavanis $ -0- 0.50%
1823 Grant
Evanston, Illinois 60201
Mike Palm S -0- 1.0%
1940 North Wolcott Chicago, Illinois 60622
Todd Ricketts $ -0- 1.0%
510 Laurel Avenue Wilmette, Illinois 60091
Greg Moss $ -0- 0.50%
1948 Sunnyside
Highland Park, Illinois 60035
NickParras $ -0- 1.0%
727 East Meadow Lane Palatine, Illinois 60074
Kevin Cassman $ -0- 1.0%
1624 North Wood Street Unit 4
Chicago, Illinois 60622
BHB Real Estate LLC - Exhibit "A"
Name and Address of Capital Number of
Each Member Contribution Membership Interests
Linda Wilson $ -0- 0.50%
1314 Sunrise Lane
Port Byron, Illinois 61275
Robert Wilson $ -0- 0.50%
1314 Sunrise Lane
Port Byron, Illinois 61275
Vinny Garcia $ -0- 8.0%
1856 West Iowa Street Chicago, Illinois 60622
Michelle Garcia $ -0- 8.0%
1856 West Iowa Street Chicago, Illinois 60622
Todd Brook $ -0- 20.0%
1530 South State Street
Unitl5F
Chicago, Illinois 60605
BHB Real Estate LLC - Exhibit "A"
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
SECTION I
- GENERAL INFORMATION
A." Legal name of Disclosing Part) submitting this EDS. Include d/b/a/ if applicable:
Chicago Division Street Restaurants LLC
Check ONE of the following three boxes:
Indicate whether Disclosing Party submitting this EDS is:
1. I J the Applicant
OR
2. [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the Applicant in which Disclosing Party holds an interest:
3. [X] a specified legal entity with a right of control (see Section I LB. 1 .b.) State the legal name of the entity in which Disclosing Party holds a right of control:
B. Business address of Disclosing Party: 2047 West Chicago Avenue, Chicago, Illinois 60622
D. Name of contact person: John Fritchey
E. Federal Employer Identification No. (if you have one):
F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, if applicable):
Rezoning for 1916 West Chicago Avenue
G. Which City agency or department is requesting this EDS? Department of Zoning
If the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:
OR
C. Telephone: 773-494-5695
Fax:
Specification tf
and Contract #
Page 1 of 13
SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF DISCLOSING PARTY
1. Indicate lhe nature of the Disclosing Party: [ ] Person
[ ] Publicly registered business corporation [ J Privately held business corporation f ] Sole proprietorship [ ] General partnership* [ ] Limited partnership* [ ] Trust
* Note B. 1 .b below.
[X] Limited liability company* f ] Limited liability partnership* [ ] Joint venture* f ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501 (c )(3))?
[ ] Yes | 1 No
\ ] Other (please specif}')
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable: Illinois
3. For legal entities not organized in the Slate of Illinois: Has the organization registered lo do business in the Slate of Illinois as a foreign entity?
[ 1 Yes [ ] No [X] N/A
B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
I.a. List below the full names and titles of all executive officers and all directors of the entity.
For not-for-profit corporations, also list below all members, if any. which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder( s).
Name Title
l.b. If you checked "General partnership," "Limited partnership," "Limited liability
company," "Limited liability partnership" or "Joint venture" in response to Item A.l. above (Nature of Disclosing Party), list below the name and title of each general partner, managing member, manager or
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any oilier person or entity that controls the day-to-day management of Ihe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on ils own behalf.
Name Title
Gregory R. Mohr Manager
Scott Weiner Manager
Todd Brook Manager
2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, stale "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.
Name Business Address Percentage Interest in lhe
Disclosing Parly
See Exhibit A, attached hereto
SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?
[ ] Yes X No
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship( s):
SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total
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amount of the lees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (I) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.
Name
(indicate whether retained or anticipated to be retained)
Business Address
Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)
Fees
( indicate whether paid or estimated)
The Law Office of John A. Fritchey
2539 N. Southport Chicago, IL 60614
Attorney
$6,000
(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
Under Municipal Code 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 term of the contract.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes X No [ ] No person 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?
[ ] Yes [ ] No
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B. FURTHER CERTIFICATIONS
1. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities identified in Section II.B.l. of this EDS:
a- 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:
b. have not. within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud: embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;
c- are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with commission of any of the offenses enumerated in clause B.t.b. of this Section V:
d. have not. within a five-year period preceding the date of this EDS. had one or more public transactions (federal, state or local) terminated for cause or default; and
e have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.
2. The certifications in subparts 2. 3 and 4 concern:
the Disclosing Party;
any "Applicable Party" (meaning any party participating in the performance of the Matter, including but not limited to any persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
any "Affiliated Entity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Part)', under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Applicable Parties, the term Affiliated Entity means a person or entity that directly or indirectly controls the Applicable Party, is controlled by it, or, with the Applicable Party, is under common control of another person or entity;
Page 5 of 13
any responsible official of the Disclosing Party, any Applicable Party or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Applicable Party or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Applicable Party or any Affiliated Entity (collectively "Agents").
Neither the Disclosing Party, nor any Applicable Party, nor any Affiliated Entity of either the Disclosing Party or any Applicable Party nor any Agents have, during the five years before the date this EDS is signed, or, with respect to an Applicable Party, an Affiliated Entity, or an A fii Mated Entity of an Applicable Party during the live years before the date of such Applicable Party's or Affiliated Entity's contract or engagement in connection with the Matter:
a- bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee oflhe City, the State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity:
f>- agreed or colluded with other bidders or prospective bidders, or been a party lo any such agreement, or been conv icted 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
c- made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or
d. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).
3. Neither the Disclosing Party. Affiliated Entity or Applicable Party: or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4: or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.
4. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the
Bureau oflndustry and Security of the U. S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.
5. The Disclosing Party understands and shall comply with (1) the applicable requirements of the Governmental Ethics Ordinance of the City, Title 2, Chapter 2-156 of the Municipal Code; and (2) all the applicable provisions of Chapter 2-56 of the Municipal Code (Office of the Inspector General).
Page 6 of 13
6. If the Disclosing Party is unable to certify' to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:
If the letters "NA." the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to lhe above statements.
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
For purposes of this Part C, under Municipal Code Section 2-32-455(b). the term "financial institution" means a bank, savings and loan association, thrift, credit union, mortgage banker, mortgage broker, trust company, savings bank, investment bank, securities broker, municipal securities broker, securities dealer, municipal securities dealer, securities underwriter, municipal securities underwriter, investment trust, venture capital company, bank holding company, financial services holding company, or any licensee under the Consumer Installment Loan Act, the Sales Finance Agency Act, or the Residential Mortgage Licensing Act. However, "financial institution" specifically shall not include any entity whose predominant business is the providing of tax deferred, defined contribution, pension plans to public employees in accordance with Sections 403(b) and 457 of the Internal Revenue Code. (Additional definitions may be found in Municipal Code Section 2-32-455(b ).)
1. CERTIFICATION
The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is X is not
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
2- If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:
"Weare not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. 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."
If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter
Page 7 of 13
2-32 of the Municipal Code, 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 INTEREST IN CITY BUSINESS
Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.
1. In accordance with Section 2-156-1 10 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter? f '] Yes fX] No
NOTE: If you checked "Yes" lo Item D.I., proceed to Items D.2. and D.3. If you checked "No" to Item D.I proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue oflegal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant lo the City's eminent domain power does not constitute a financial interest w ithin the meaning of this Part D.
Does the Matter involve a City Property Sale? []Yes XNo
3. If you checked "Yes" to Item D.I., provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:
Name Business Address Nature of 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
The Disclosing Parrs' has searched any and all records of the Disclosing Party and any and all predecessor entities tor records of investments or profits from slavery, the. slave industry, or slaveholder insurance policies from the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves) and has disclosed in this EDS any and all such records to the City. In addition, the Disclosing Party must disclose the names of any and all slaves or slaveholders described in those records. Failure to comply with these disclosure requirements may make the Matter to which this EDS pertains voidable by the City.
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 requisite information as set forth in that paragraph 2.
X I. The Disclosing Party verities that (a) the Disclosing Party has searched any and all records oflhe Disclosing Party and any and all predecessor entities for records of investments or profits from slavery, the slave industry, or slaveholder insurance policies, and (b) the Disclosing Party has found no records of investments or profits from slavery, the slave industry, or slaveholder insurance policies and no records of names of any slaves or slaveholders.
_2. The Disclosing Party verifies that, as a result of conducting the search in step 1 (a) above, the Disclosing Party has found records relating lo investments or profits from slavery, the slave industry, or slaveholder insurance policies and/or the names of any slaves or slaveholders. The Disclosing Party verifies that the following constitutes full disclosure of all such records:
SECTION VI - CERTIFICATIONS FOR FEDERALLY-FUNDED MATTERS
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Begin list here, add sheets as necessary):
Page 9 of 13
(I mo explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)
2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A.l. above for his or her lobbying activities or to pay any person or entity to influence or
attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee 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.
3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A.l. and A.2. above.
If the Matter is federally funded and any funds other than federally appropriated funds have been or will be paid to any person or entity for influencing or attempting 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 ol a member of Congress in connection with the Matter, the Disclosing Party must complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The form may be obtained online from the federal Office of Management and Budget (OMB) web site at http://www.whitehouse.gov/omb/grants/sflllin.pdf. linked on the page hrtp:/Avww. whitehouse.gov/omb/grants/grants_forms. html.
4. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in
"Lobbying Activities".
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A.l. through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.
Page 10 of 13
Is tlie Disclosing Party the Applicant0
[ ] Yes [ ] No
If "Yes." answer the three questions below:
1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations'? (See 4 1 CFR Part 60-2.) [ J Yes [ 1 No
2. Have you tiled with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements? [ ] Yes [ ] No
3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[ ] Yes f ] No
If you checked "No" to question 1. or 2. above, please provide an explanation:
SECTION VII -- ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENAL TIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. By completing and filing this EDS, the Disclosing Party acknowledges and agrees, on behalf of itself and the persons or entities named in this EDS, that the City may investigate the creditworthiness of some or all of the persons or entities named in this EDS.
B. 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 Part}' understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
C. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.citvofchicago.org/Ethics. and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.
Page I 1 of 13
D. IF the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded, void or voidable), 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 transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.
E. It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City lo verify the accuracy of any information submitted in this EDS.
F. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires.
The Disclosing Party represents and warrants that:
G. The Disclosing Party has not withheld or reserved any disclosures as to economic interests in the Disclosing Party, or as to the Matter, or any information, data or plan as to the intended use or purpose for which the Applicant seeks City Councilor other City agency action.
For purposes of the certifications in H.l. and H.2. below, the term "affiliate" means any person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is. with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members; shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with the federal government or a state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity.
H. l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its affiliates delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.
H.2 If the Disclosing Party is "the Applicant, the Disclosing Party and its affiliates will not use, nor permit their subcontractors to use. any facility on the U.S. EPA's List of Violating Facilities in connection with the Matter for the duration of time that such facility remains on the list.
Page 12 of 13
H.3 If the Disclosing Party is the Applicant, the Disclosing Party 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 H. 1. and H.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Part}' has reason to believe has not provided or cannot provide truthful certifications.
NOTE: If the Disclosing Party cannot certify as to any of the items in H.l H.2. or H.3. above, an explanatory statement must be attached lo this EDS.
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.
Chicago Division Street Restaurants LLC
(Print or t}_u£-+«TO<pf Disclosing Party)
By:
Date: December 2, 2010
(sign here)
(Print or type name of person signing)
Signed and sworn to before me on 12/02/2010 at Cook County. Illinois
CcmnvTssion expires
Page 13 of 13
EXHIBIT "A"
CHICAGO DIVISION STREET RESTAURANTS LLC OPERATING AGREEMENT
Name and Address of Capital Number of
Each Member Contribution Membership Interests
Gregory R. Mohr $ -0- 25.25%
2047 West Division Street Chicago, Illinois 60622
Scott A. Weiner $ -0- 25.25%
2047 West Division Street Chicago, Illinois 60622
LTHS Revocable Trust $ -0- 12.50%
c/o TCS Group, LLC 1 North Wacker Drive Suite 4775
Chicago, Illinois 60606
Justin Decker $ -0- 0.50%
208 West Washington Street Apt 1001
Chicago, Illinois 60606
Scott Berger $ -0- 1.0%
1906 Greenvievv Northbrook, Illinois 60062
Alex James $ -0- 1.0%
1690 Tall Grass Lane Lake Forest, Illinois 60045
Ken Jones S -0- 4.0%
910 West Madison Street Apt 904E
Chicago, Illinois 60607
Curtis Granderson $ -0- 1.0%
20485 Tyler Drive Lynwood, Illinois 60411
CurtConklin $ -0- 1.0%
1942 North Wolcott Chicago, Illinois 60622
Chicago Division Street Restaurants LLC - Exhibit "A"
Name and Address of Capital Number of
Each Member Contribution Membership Interests
Ronald D. Porte and
Adam R. Porte, as T.I.C. $ -0- 1.0% 128 Laurel Avenue Wilmette, Illinois 60091
Matthew & Beth Glaysher $ -0- 0.50%
1926 North Winchester Avenue Chicago, Illinois 60622
Grant Lustig $ -0- 7.0%
2818 Woodmere Drive Northbrook, Illinois 60062
Stelios Valavanis $ -0- 0.50%
1823 Grant
Evanston, Illinois 60201
Mike Palm $ -0- 1.0%
1940 North Wolcott Chicago, Illinois 60622
Todd Ricketts $ -0- 1.0%
510 Laurel Avenue Wilmette, Illinois 60091
Michele J. Brook $ -0- 0.33%
3605 Palm Canyon Drive Northbrook, Illinois 60062
Bradley Brook $ -0- 0.17%
3605 Palm Canyon Drive Northbrook, Illinois 60062
Greg Moss $ -0- 0.50%
1948 Sunnyside
Highland Park, Illinois 60035
Bleeding Heart LLC $ -0- 2.50%
1856 West Iowa Street Chicago, Illinois 60622
Chicago Division Street Restaurants LLC - Exhibit "A"
Name and Address of Each Member
Capital Contribution
Number of
Membership Interests
Kevin Cassman $ -0- 1.0%
1624 North Wood Street Unit 4
Chicago, Illinois 60622
Linda Wilson $ -0- 0.50%
1314 Sunrise Lane
Port Byron, Illinois 61275
Robert Wilson $ -0- 0.50%
1314 Sunrise Lane
Port Byron, Illinois 61275
Todd Brook $ -0- 12.0%
1530 South State Street
Unitl5F
Chicago, Illinois 60605
Chicago Division Street Restaurants LLC - Exhibit "A"
Chairman, Zoning Board of Appeals Room 905 - City Hall 121 North LaSalle Street Chicago, Illinois 60602
To Whom It May Concern:
1, Scott Weiner, state that 1 have authorized The Law Office of John Fritchey to file an application identifying Chicago Division Street Restaurants LLC and BHB Real Estate LLC as the entitites holding interest in the land subject to the application for an amendment to the Chicago Zoning Ordinance for the property commonly known as 1916 West Chicago Avenue.
1 depose and say that Chicago Division Street Restaurants LLC and BHB Real Estate LLC hold such interejits^B*4heniselves and no other person, association, or shareholder.
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