!
ORDINANCE
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. Title 17 of the Municipal Code, the Chicago Zoning Ordinance,
be amended by changing all the B3-2 Community Shopping District symbols and
indications as shown on Map No. 3-G in the area bounded by
a line 170 feet northwest of the intersection of West Chicago Avenue and North Milwaukee Avenue, as measured at the easterly right-of-way line of North Milwaukee Avenue and perpendicular thereto; the alley next northeast of and parallel to North Milwaukee Avenue; aline 145.70 feet northwest of the intersection of West Chicago Avenue and North Milwaukee Avenue, as measured at the easterly right-of-way line of North Milwaukee Avenue and perpendicular thereto; and North Milwaukee Avenue,
to those of an B3-3 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
-Hi'.
passage and due publication.
j t
REFERRED TO COMMITTEE ON
ZONING
APR - 6 2005
L/ City Clark_City of Chicago
CITY OF CHICAGO V^r
APPLICATION FOR AN AMENDMENT TO ^f/^ THE CHICAGO ZONING ORDINANCE
ADDRESS of the property Applicant is seeking to rezone: 815 N. Milwaukee
APPLICANT: Jose Rogue c/o James J. Banks, 221 N. LaSalle, Suite 3800. Chicago. IL 60601 ADDRESS: 2316 76th Ct.
CITY: Elmwood Park STATE: IL ZIP CODE: 60707
PHONE: (312) 782-1983 CONTACT PERSON: James J. Banks. Esq.
Attorney for Applicant
Is the Applicant the owner of the property YES X NO_
OWNER: same as above ADDRESS: same as above CITY: STATE: ZIPCODE:
PHONE: (312) 782-1983 CONTACT PERSON: James J. Banks, Esq.
Attorney for Applicant
On what date did the owner acquire legal title to the subject property?
Has the present owner previously rezoned this property? If Yes, when? _ no
Present Zoning: B3-2 Community Shopping District Proposed Zoning: B3-3 Community Shopping District
Current Use of this property: The property is currently improved with a two-story brick building.
Reason for rezoning the subject property: To permit the mixed-use redevelopment of the subject property.
What will be the actual 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) The existing two-story brick building will be raised, and the property will be improved with a new mixed-use building containing commercial space at grade and 3 dwelling units above.
COUNTY OF COOK STATE OF ILLINOIS
Jose Roque, 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.
Signature of Applicant
Subscribed and Sworn to before me this <5A^ day of UiarClfv , 2005.
Notary Public
For Office Use Only
Date of Introduction:
File Number:
OFFICIAL SEAL REGINA M STASCHKE NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES:12/17/07
Ward:
PROFESSIONALS ASSOCIATED SURVEY, INC,
7100 N. TRIPP AVENUE LINCOLNWOOD, ILLINOIS 60712
PROFESSIONAL DESIGN FIRM REGISTRATION NO. 0011129145
PLAT OF SURVEY
OF
LOT 9 (EXCEPT THAT PART IF ANY TAKEN OR USED BY THE CITY OF CHICAGO IN CONNECTION WITH THE SUBWAY CONSTRUCTION UNDERNEATH MILWAUKEE AVENUE) IN BLOCK B IN ELSTON ADDITION TO CHICAGO. A SUBDIVISION IN SECTION 5. TOWNSHIP 39 NORTH, RANGE 14. EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS.
TOTAL NET AREA: 2.506.92 SQ.FT.
COMMONLY KNOWN AS: 815 NORTH MILWAUKEE AVENUE, CHICAGO, ILLINOIS.
TEL: (847) 675-3000 FAX: (847) 675-2167
. "J" Oil
-North Line of W. Chicogo Avenue
THE LEGAL DESCRIPTION SHOWN ON THE PLAT HEREON DRAWN IS A COPY OF THE ORDER, AND FOR ACCURACY SHOULD BE COMPARED WITH THE TITLE OR DEED. DIMENSIONS ARE NOT TO BE ASSUMED FROM SCALING.
BUILDING LINES AND EASEMENTS ARE SHOWN ONLY WHERE THEY ARE SO RECORDED IN THE MAPS, OTHERWISE REFER TO YOUR DEED OR ABSTRACT.
Order No_
Scale: 1 inch = Date:-
98-43Q33
December 23, 2004
Ordered by:
J. ROQUE PLUMBING INC.
THIS PROFESSIONAL SERVICH CONFORMS TO THE ILLINOIS MINIMUM STANDARDS FOR BOUNDARY SURVEY.
THIS SURVEY HAS BEEN ORDERED FOR SURFACE DIMENSIONS ONLY. NOT FOR ELEVATIONS. THIS IS NOT AN ALTA SURVEY.
COMPARE ALL POINTS BEFORB BUILDING BY SAME AND AT ONCE REPORT ANY DIFFERENCE.
State of Illinois County of Cook"'
We. PROFESSIONALS ASSOCIATED SURVEY INC, do hereby certify that we have srjrnwed the abovft descnlied property and that, tothebestofourtaow^eoge, the plat hereon drawn u an accurate representation of said^unrey. 7
IL. PROF. LANDS DRAWN BY: D.B.-
ISB EXP. DATE NOV. 30,2006.
Written Notice, Form of Affidavit: Section 17-13-0107
March 21, 2005
Honorable William J.P. Banks Chairman, Committee on Zoning 121 North LaSalle Street Room 304 - City Hall Chicago, Illinois 60602
To Whom It May Concern:
The undersigned, James J. Banks being first duly sworn on oath, deposes and says the following:
That the undersigned certifies that he has complied with the requirements of Section 17-13-0107 of the Zoning Code of the City of Chicago, by sending written notice to such property owners who appear to be the owners of the property within the subject area not solely owned by the applicant, and on the owners of all property within 250 feet in each direction of the lot line of the subject property, exclusive of the public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. Said written notice was sent by USPS First Class Mail no more than 30 days before filing the application a«d -#tvr-seeeBd-BQtiec-will be sent no tewer than 1U days-after and no morc-fean-i-5-days-afier thr rlntr tlir npplK?aTiTTiTjOt^
The undersigned certifies that the notice contained the address of the property sought to be rezoned is 815 N. Milwaukee, Chicago, IL; a statement of intended use of said property; the name and address of the applicant; the name and address of the owner; and a statement that the applicant intends to file an application for a change in zoning on approximately, March 21, 2005.
The applicant has made a bonafide effort to determine the addresses of the parties to be notified under Section 17-13-0107 of the Zoning Code ofthe City of Chicago; that the applicant certifies that the accompanying list of names and addresses of surrounding property owners within 250 feet is a complete list containing the names and last known addresses ofthe owners of the property required to be served.
Law Offices of Samuel V.P. Banks
VB&af Notice Letter
Via USPS First Class Mail
March 21, 2005
Dear Sir or Madam:
In accordance with Amendment to the Zoning Code enacted by the City Council, Section 17-13-0107-A, please be informed that on or about March 21, 2005, I, the undersigned, will file an application for a change in zoning from a B3-2 Community Shopping District to a B3-3 Community Shopping District on behalf of the Applicant/Owner, Jose Roque, for the property located at 815 N. Milwaukee, Chicago, IL.
The existing two-story brick building will be raised, and the property will be improved with a new mixed-use building containing commercial space at grade and three dwelling units above.
Jose Roque is located at 2316 76th Ct., Elmwood Park, IL.
The contact person for this application is James J. Banks. My address is 221 N. LaSalle Street, Chicago, IL 60601. My telephone number is 312-782-1983.
Please note that the applicant is not seeking to purchase or rezone your property. The applicant is required by law to send this notice because you own property located within 250 feet of the proposed amendment. By law, we are required to send two notice letters to each property owner for each application.
Very truly yours,
LAW OFFICES OF SAMUEL V.P. BANKS
FORM OF AFFIDAVIT - Sec. 11.9-3.2(a)
Chairman, Committee on Zoning Room 304 - City Hall Chicago, IL 60602
To Whom It May Concern:
I, Jose Roque, understand that The Law Offices of Samuel V.P. Banks has filed a sworn affidavit identifying me as Owner and Applicant holding interest in land subject to the proposed zoning amendment for the property identified as 815 North Milwaukee, Chicago, IL.
I, Jose Roque, being first duly sworn oath, depose and say that I hold that interest for myself and no other person, association, or shareholder.
Subscribed and Sworn to before me
this^day of Ua(eU 2005.
Notary Public
Date
To whom it may concern:
I, Jose Roque, owner of property located at 815 North Milwaukee, Chicago, IL, authorize The Law Offices of Samuel V.P. Banks, to file an application for a Zoning Change for my property.
for City us^ affidavit no.__
CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
The City of Chicago (the "City") requires disclosure of the information requested in this Economic Disclosure Statement and Affidavit ("EDS") before any City agency, department or City Council action regarding the matter that is the subject of this EDS. Please fully complete each statement, with all information current as of the date this EDS is signed. If a question is not applicable, answer with "N.A." An incomplete EDS will be returned and any City action will be interrupted.
Please print or type all responses clearly and legibly. Add additional pages if needed, being careful to identify the portion of the EDS to which each additional page refers.
WHO MUST SUBMIT AN EDS:
1. Applicants: Any individual or entity (the" Applicant") making an application to the City for action requiring City Council or other City agency approval must file this EDS.
2. Entities holding an interest in tho Applicant Generally, whenever an ownership interest in the Applicant(for example, shares of stock of the Applicant or a limited partnership interest in the Applicant) is held or owned by a legal entity (for example, a corporation or partnership, rather than an Individual) each such legal entity must also file an EDS on its own behalf, and any parent of that legal entity must do so until individual owners are disclosed. However, if an entity filing an EDS is a corporation whose shares are registered on a national securities exchange pursuant to the Securities Exchange Act of 1934, only those shareholders that own 10% or more of that filing entity's stock must file EDSs on their own behalf.
ACKNOWLEDGMENT OF POSSIBLE CREDIT AND OTHER CHECKS: By completing and filing this EDS, the Undersigned acknowledges and agrees, on behalf of Itself and the entities or individuals named in this EDS, that the City may investigate the creditworthiness of some or all of the_entities or individuals named in this EDS.
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CERTIFYING THIS EDS: Execute the certification on the date of the initial submission of this EDS. You may be asked to re-certify this EDS on the last page as of the date of submission of any related ordinance to the City Council, or as of the date of the closing of your transaction.
PUBLIC DISCLOSURE: It is the City's policy to make this document available to the public on its Internet site and/or upon request.
GENERAL INFORMATION
Date this EDS is completed: M/kfUi ^2 00 S_
A. Who is submitting this EDS? That individual or entity will be the "Undersigned" throughout this EDS. Jf^f , tMj\:\P__
NOTE: The Undersigned is the individual or entity submitting this EDS, whether the Undersigned is an Applicant or is an e ntity holding an interest in the Applicant. This EDS requires certain disclosures and certifications from Applicants that are not required from entities holding an interest In the Applicant. When completing this EDS, please observe whether the section you are completing applies only to Applicants.
X Check here if the Undersigned is filing this EDS as an Applicant.
[ ] Check here if the Undersigned is filing as an entity holding an interest in an Applicant.
Also, please identify the Applicant in which this entity holds an interest:
B. Business address ofthe Undersigned: flK" fO • <uUlMlXb*l
CMua^n {\\, U0.PZ7
C. Telephone: (W^)i6i-flB3 Fax: l*\£)Tth-iHbb Email:__
D. Name of contact person: ^<w\c<> X ftmlt.s, KrVrtyn^-tw fly^,,'*,^ E: Tax identification number (optional): Nlft_■
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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 if applicable): . ,
G. Is the Matter a procurement? [] Yes ^B&0
H. If a procurement, Specification #_and
Contract #__.
I. If not a procurement:
1. City Agency requesting EDS: Df$\ (S^- loi\ I \^
2. City action requested (e.g. loan, grant, sale of property):
3. If property involved, list property location:
SECTION ONE: DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF ENTITY
1. Indicate whether the Undersigned is an individual or legal entity:
Individual, [] Limited Liability Company
[] Business corporation [j Joint venture
[ j Sole proprietorship [ ] Not-for-profit corporation
(Is the not-for-profit corporation also a 501(c)(3))?
[]Yes []No [] General partnership [] Other entity (please specify) [j Limited partnership _____
2. State of incorporation or organization, if applicable: __Nlft _
3. For legal entities not organized in the State of Illinois: Is the organization authorized to do business in the State of Illinois as a foreign entity?
[]Yes (]No j&N/A
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B. ORGANIZATION INFORMATION
1. IF THE UNDERSIGNED IS A CORPORATION:
a. List below the names and titles of all executive officers and all directors of the corporation. For not-for-profit corporations, also list below any executive director of the corporation, and indicate all members, if any, who are legal entities. If there are no such members, write "no members."
Name Title
____________________
b(1). If the Matter is a procurement and the Undersigned is a corporation whose shares are registered on a national securities exchange pursuant to the Securities Exchange Act of 1934, please provide the following information concerning shareholders who own shares equal to or in excess of 7.5% of the corporation's outstanding shares.
Name Business Address Percentage Interest
__________________________________________________________________
b(2). If the Matter is not a procurement, and the Undersigned is a corporation whose shares are registered on a national securities exchange pursuant to the Securities Exchange Act of 1934, please provide the following information concerning shareholders who own shares equal to or in excess of 10% of the corporation's outstanding shares.
Name Business Address Percentage Interest
_________________________——-____________-____________-____
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c. For corporations that are not registered on a national securities exchange pursuant to the Securities Exchange Act of 1934, list below the name, business address and percentage of ownership interest of each shareholder.
Name Business Address , Percentage Interest
_m__
2. IF THE UNDERSIGNED IS A PARTNERSHIP OR JOINT VENTURE: For general or limited partnerships or joint ventures: list below the name, business address and percentage of ownership interest of each partner. For limited partnerships, indicate! whether each partner is a general partner or a limited partner.
Name Business Address Percentage Interest
_m__
3. IF THE UNDERSIGNED IS A LIMITED LIABILITY COMPANY: a. List below the name, business address and percentage of ownership interest of each (I) member and (ii) manager. If there are no managers, write "no managers," and indicate how the company is managed.
Name Business Address Percentage Interest
_m_._
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b. List below the names and titles of all officers, if any. If there are no officers, write "no officers."
Name Title
_m_
4. IF THE UNDERSIGNED IS A LAND TRUST, BUSINESS TRUST, ESTATE OR OTHER SIMILAR ENTITY:
a. List below the name and business address of each individual or legal entity holding legal title to the property that is the subject of the trust.
Name Business Address
__ulfi_:__
b. List below the name, business address and percentage of beneficial interest of each beneficiary on whose behalf title is held.
Name Business Address Percentage Interest
__nJ£_
5. IF THE UNDERSIGNED IS ANY OTHER LEGAL ENTITY, first describe the entity, then provide the name, business address, and the percentage of interest of all individuals or legal entities having an ownership or other beneficial interest in the entity.
Describe the entity:
-^-—__
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Name
Business Address
Percentage Interest
SECTION TWO: BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS
A. DEFINITIONS AND DISCLOSURE REQUIREMENT
1. The Undersigned must indicate whether it had a "business relationship" with a City elected official in the 12 months before the date this EDS is signed.
2. Pursuantto Chapter 2-156 of the Municipal Code of Chicago (the "Municipal Code"), a "business relationship" means any "contractual or other private business dealing" of an official, or his or her spouse, or of any entity in which an official or his or her spouse has a "financial interest," with a person or entity which entitles an official to compensation or payment in the amount of $2,500 or more in a calendar year; but a "financial interest" does not include: (I) any ownership through purchase at fair market value or inheritance of less than 1 % of the shares of a corporation, or any corporate subsidiary, parent or affiliate thereof, regardless of the value of or dividends on such shares, if such shares are registered on a securities exchange pursuant to the Securities Exchange Act of 1934, as amended, (ii) the authorized compensation paid to an official or employee for his office or employment; (iii) any economic benefit provided equally to all residents ofthe City; (iv) a time or demand deposit in a financial institution; or (v) an endowment or insurance policy or annuity contract purchased from an insurance company. A "contractual or other private business dealing" does not include any employment relationship of an official's spouse with an entity when such spouse has no discretion concerning or input relating to the relationship between that entity and the City.
B. CERTIFICATION
1. Has the Undersigned had a "business relationship" with any City elected official in the 12 months before the date this EDS is signed? □ Yes NtfNo
If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s): ^
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SECTION THREE: DISCLOSURE OF RETAINED PARTIES
A. DEFINITIONS AND DISCLOSURE REQUIREMENTS
• 1. The Undersigned must disclose certain information about attorneys, lobbyists, accountants, consultants, subcontractors, and any other person whom the Undersigned has retained or expects to retain in connection with the Matter. In particular, the Undersigned must disclose the name of each such person, his/her business address, the nature of the relationship, and the total amount ofthe fees paid or estimated to be paid. The Undersigned is not required to disclose employees who are paid solely through the Undersigned's regular payroll.
"Lobbyist" means any person (i) who, for compensation or on behalf of any person other than himself, undertakes to influence any legislative or administrative action, or (ii) any part of whose duty as an employee of another includes undertaking to influence any legislative or administrative action.
2. If the Undersigned is uncertain whether a disclosure is required under this Section, the Undersigned must either ask the City whether disclosure is required or make the disclosure.
!
B. CERTIFICATION
Each and every attorney, lobbyist, accountant, consultant, subcontractor, or other person retained or anticipated to be retained directly by the Undersigned with respect to or in connection with the Matter is listed below [begin list here, add sheets as necessary]:
Name Business Relationship to Undersigned Fees (indicate whether
(indicate Address (attorney, lobbyist, etc.) paid or estimated)
whether
retained
or anticipated
to be retained)
Uu) PQi/j of ^amud V.P faints totomJ ZtkHVwL bU
{] Check here if no such individuals have been retained by the U ndersjgned or are antx3patedto
BE RETAINED BY THE U NDERSIGNED.
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B
SECTION FOUR: CERTIFICATIONS
I CERTIFICATION OF COMPLIANCE
For purposes ofthe certifications In A, B, and C below, the term "affiliate" means any individual or entity that, directly or indirectly: controls the Undersigned, is controlled by the Undersigned, or is, with the Undersigned, under common control of another individual 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 witti the federal government or a state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity.
A. The Undersigned is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Undersigned or its affiliates delinquent In paying any fine, fee, tax or other charge owed to the City. This includes all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes. If there are any such delinquencies, note them below: MOM ■_____
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Undersigned certified to the above statements.
B. The Undersigned and its affiliates have not, in the past five years, been found in violation of any City, state or federal environmental law or regulation. If there have been any such violations, note them below:
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Undersigned certified to the above statements.
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C. If the Undersigned Is the Applicant, the Undersigned 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.
D. If the Undersigned is the Applicant, the Undersigned 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 Section Four, I, (A-C) 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 Undersigned has reason to believe has not provided or cannot provide truthful certifications.
If the Undersigned is unable to make the certifications required in Section Four, paragraph I (C) and (D) above, provide an explanation:
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Undersigned certified to the above statements.
H. CHILD SUPPORT OBLIGATIONS - CERTIFICATION REGARDING COURT-ORDERED CHILD SUPPORT COMPLIANCE
For purposes of this part, "Substantial Owner" means any individual who, directly or indirectly, owns or holds a 10% or more interest in the Undersigned. Note: This may include individuals disclosed in Section One (Disclosure of Ownership Interests), and individuals disclosed in an EDS filed by an entity holding an interest in the Applicant.
If the Undersigned's response below is #1 or #2, then all of the Undersigned's Substantial Owners must remain in compliance with any such child support obligations until the Matter is completed. Failure of the Undersigned's Substantial Owners to remain in compliance with their child support obligations in the manner set forth in either #1 or #2 constitutes an event of default.
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Check one:
1. No Substantial Owner has been declared in arrearage on any child support obligations by the Circuit Court of Cook County, Illinois or by another Illinois court of competent jurisdiction^
j,_2, The Circuit Court of Cook County, Illinois or another Illinois court of competent
jurisdiction has issued an order declaring one or more Substantial Owners in arrearage on child support obligations. All such Substantial Owners, however, have entered into court-approved agreements for the payment of all such child support owed, and all such Substantial Owners are in compliance with such agreements.
_3. The Circuit Court of Cook County, Illinois or another Illinois court of competent
jurisdiction has issued an order declaring one or more Substantial Owners in arrearage on child support obligations and (a) at least one such Substantial Owner has not entered into a court-approved agreement for the payment of all such child support owed; or (b) at least one such Substantial Owner is not In compliance with a court-approved agreement for the payment of all such child support owed; or both (a) and (b).
__4. There are no Substantial Owners.
Ill FURTHER CERTIFICATIONS
A. The Undersigned and, if the Undersigned is a legal entity, its principals (officers, directors, partners, members, managers, executive director);
1. 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;
2. 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;
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3. 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 (A)(2) of this section;
4. 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
5. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, in any criminal or civil action instituted by the City or by the federal government, any state, or any other unit of local government.
The certifications in subparts B and D concern:
• the Undersigned;
• any party participating in the performance of the Matter ("an Applicable Party"),
• any "Affiliated Entity" (meaning an individual or entity that, directly or indirectly: controls the Undersigned, is controlled by the Undersigned, or is, with the Undersigned, under common control of another individual 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 an individual 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 individual or entity;
• any responsible official of the Undersigned, any Applicable Party or any Affiliated Entity or any other official, agent or employee of the Undersigned, any Applicable Party or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Undersigned, any Applicable Party or any Affiliated Entity (collectively "Agents").
Neitherthe Undersigned, nor any Applicable Party, nor any Affiliated Entity of either the Undersigned or any Applicable Party nor any Agents have, during the five years before the date this EDS is signedror, with respect to an Applicable Party, an Affiliated Entity, 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:
MV03
12
1. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of 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;
2. 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
3. made an admission of such conduct described in (1) or (2) above that is a matter of record, but have not been prosecuted for such conduct; or
4. violated the provisions of Section 2-92-610 of the Municipal Code (Living Wage Ordinance).
C. The Undersigned understands and shall comply with (1) the applicable requirements of the Governmental Ethics Ordinance of the City, Title 2, Chapter2-156 ofthe Municipal Code; and (2) all the applicable provisions of Chapter 2-56 of the Municipal Code (Office of the Inspector General).
D. Neither the Undersigned, Affiliated Entity or Applicable Party, or any of theiir 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.
E. If the Undersigned is unable to certify to any of the above statements in this Part III, the Undersigned must explain below:
\
If the letters "NA," the word "None," or no response appears on the lines above, it will be condusively presumed that the Undersigned certified to the above statements.
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IV. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
For purposes of this Part IV, under Section 2-32-455(b) of the Municipal Code, 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 Section 2-32-455(b) of the Municipal Code.]
A CERTIFICATION
The Undersigned certifies that the Undersigned [check one]
a "financial institution" as defined in Section 2-32-455(b) of the Municipal Code.
B. If the Undersigned IS a financial institution, then the Undersigned pledges:
"We are not and will not become a predatory lender as defined in Chapter 2-32 ofthe 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 ofthe privilege of doing business with the City."
If the Undersigned is unable to make this pledge because it or any of Its affiliates (as defined in Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages If necessary):
is
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If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Undersigned certified to the above statements.
V. 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 V.
1. In accordance with Section 2-156-110 ofthe 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 in the Matter? [JYes ^o
NOTE: If you answered "No" to Item V(1), you are not required to answer Items V(2) or (3) below. Instead, review the certification in Item V(4) and then proceed to Part VI. If you answered "Yes" to Item V(1), you must first respond to Item V(2) and provide the Information requested in Item V(3). After responding to those items, review the certification In Item V(4) and proceed to Part VI.
2. Unless sold pursuant to a process of competitive bidding, 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 in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power d oes not constitute a financial interest within the meaning of this PartV.
Does the Matter involve a City Property Sale? [JYes pttjjb
3. If you answered "yes" to Item V(1), 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
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4. The Undersigned further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.
yj. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
The Undersigned has searched any and all records of the Undersigned 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 Undersigned 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 pertain;; voidable by the City.
Please check either (1) or (2) below. If the Undersigned checks (2), the Undersigned must disclose below or in an attachment to this EDS all requisite information as set forth in that paragraph (2).
i_1. The Undersigned verifies that (a) the Undersigned has searched any and all records
of the Undersigned and any and all predecessor entities for records of investments or profits from slavery, the slave industry, or slaveholder insurance policies, and (b) the Undersigned 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 Undersigned verifies that, as a result of conducting the search in step (1)(a)
above, the Undersigned 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 Undersigned verifies that the following constitutes full disclosure of all such records:
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SECTION FIVE: CERTIFICATIONS FOR FEDERALLY-FUNDED MATTERS
I. CERTIFICATION REGARDING LOBBYING
A. List below the names of all individuals registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Undersigned with respect to the Matter: [Begin list here, add sheets as necessary]:
__:_:__
pfno explanation appears or begins on the lines above, or if the letters "NA " or if th>* word "None" appear, it will be conclusively presumed that the Undersigned means that NO individuals registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Undersigned with respect to the Matter.]
B. The Undersigned has not spent and will not expend any federally appropriated funds to pay any individual listed in Paragraph (A) above for his or her lobbying activities or to pay any individual 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.
C. The Undersigned 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 l(A) and l(B) above.
If the Matter is federally funded and any funds other than federally appropriated funds have been or will be paid to any individual 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 Undersigned 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.whitehouse,aov/omb/Qrants/sflllin.pdf. linked on the page http://www.whitehouse.QOv/omb/qrante/qrants forms.html.
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D. The Undersigned 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".
E. If the Undersigned Is the Applicant, the Undersigned must obtain certifications equal in form and substance to paragraphs l(A) through l(D) above from all subcontractors before it awards any subcontract and the Undersigned must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.
IL CERTIFICATION REGARDING NONSEGREGATED FACILITIES
A. If the Undersigned is the Applicant, the Undersigned does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and it does not and will not permit its employees to perform their services at any location under its control where segregated facilities are maintained.
"Segregated facilities," as used In this provision, means any waiting rooms, work areas, restrooms, washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing provided for employees, that are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, sex, or national origin because of habit, local or employee custom, or otherwise.
However, separated or single-user restrooms and necessary dressing or sleeping areas must be provided to assure privacy between the sexes.
B. If the Undersigned is the Applicant and the Matter is federally funded, the Undersigned will, before the award of subcontracts (if any), obtain identical certifications from proposed subcontractors under which the subcontractor will be subject to the Equal Opportunity Clause. Contracts and subcontracts exceeding $10,000, or having an aggregate value exceeding $10,000 in any 12-month period, are generally subject to the Equal Opportunity Clause. See 41 CFR Part 60 for further information regarding the Equal Opportunity Clause. The Undersigned must retain the certifications required by this paragraph (B) for the duration of the contract (if any) and must make such certifications promptly available to the City upon request^
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• ■
C. If the Undersigned is the Applicant and the Matter is federally funded, the Applicant will forward the notice set forth below to proposed subcontractors:
NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENTS FOR CERTIFICATIONS OF NONSEGREGATEO FACILITIES
Subcontractors must submit to the Contractor a Certification of Nonsegregated Facilities before the award of any subcontract under which the subcontractor will be subject to the federal Equal Opportunity Clause. The subcontractor may submit such certifications either for each subcontract or for all subcontracts during a period (e.g., quarterly, semiannually, or annually).
Ill CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
Federal regulations require prospective contractors for federally funded Matters (e.g., the Applicant) and proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations. (NOTE: This Part III is to be completed only If the Undersigned is the Applicant.)
A. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)
fJYes []No >KN/A
B. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?
[]Yes []No >fcfN/A
C. Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?
fJYes []No >#ti/A
SECTION SIX: NOTICE AND ACKNOWLEDGMENT REGARDING CITY GOVERNMENTAL ETHICS AND CAMPAIGN FINANCE ORDINANCES
The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156and2-164 ofthe Municipal Code, impose certain duties and obligations on individuals or entities seeking Citycontracts, work, business, or transactions. The Board of Ethics has developed an ethics training program for such individuals and entities. The full text of these ordinances and the training program is available on line at www.citvofchicaqo.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 following is descriptive only and does not purport to cover every
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aspect of Chapters 2-156 and 2-164 of the Municipal Code. The Undersigned must comply fully with the applicable ordinances.
j/^. BY CHECKING THIS BOX THE UNDERSIGNED acknowledges that / the Undersigned understands that the City's Governmental Ethics and Campaign Financing Ordinances, among other things:
1) Provide that any contract negotiated, entered into or performed in violation of the City's ethics laws can be voided by the City.
2) Limit the gifts and favors any individual or entity can give, or offer to give, to any City official, employee, contractor or candidate for elected City office or the spouse or minor child of any of them, including:
a. any cash gift or any anonymous gift; and
b. any gift based on a mutual understanding that the City official's or employee's or City contractor's actions or decisions will be influenced in any way by the gift.
3) Prohibit any City elected official or City employee from having a financial interest, directly or indirectly, in any contract, work, transaction or business ofthe City, if that interest has a cost or present value of $5,000 or more, or if that interest entitles the owner to receive more than $2,500 per year.
4) Prohibit any appointed City official from engaging in any contract, work, transaction or business of the City, unless the matter is wholly unrelated to the appointed official's duties or responsibilities.
5) Provide that City employees and officials, or their spouses or minor children, cannot receive compensation or anything of value in return for advice or assistance on matters concerning the operation or business of the City, unless their services are wholly unrelated to their City duties and responsibilities.
6) Provide that former City employees and officials cannot, for a period of one year after their City employment ceases, assist or represent another on any matter involving the City if, while with the City, they were personally and substantially involved in the same matter.
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7) Provide that former City employees and officials cannot ever assist or represent another on a City contract if, while with the City, they were personally involved in or directly supervised the formulation, negotiation or execution of that contract.
SECTION SEVEN: CONTRACT INCORPORATION. COMPLIANCE. PENALTIES, DISCLOSURE
The Undersigned understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Undersigned understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.
B. 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 Undersigned's participation in he Matter and/or declining to allow the Undersigned to participate in other transactions with the City.
C. Some or all ofthe 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 Undersigned 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.
D. The Undersigned has not withheld or reserved any disclosures as to economic interests In the Undersigned, or as to the Matter, or any information, data or plan as to the intended use or purpose for which the Applicant seeks City Council or other City agency action.
E. The information provided in this EDS must be kept current. In the event of changes, the Undersigned must supplementjhis EDS up to the time the City takes action on the Matter.
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CERTIFICATION
Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS on behalf of the Undersigned, 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.
_:__Date:
(Print or type nama of Individual or lagal entity submitting this EDS) "/
By.
(ilgn hare) ^
Print or type name of signatory:
Title of signatory:
Subscribed to before me on (datellUaK'K 3t\ AQfcfS . at C'fi A_County,
\v)V'^i.^A-^ [state].
LQc-rx.l^\vV ^(WfctC. Notary Public. Commission expires:_
OFFICIAL SEAL REGINA M STASCHKE
NOTARY PUBLIC - STATE OF ILLINOIS MY COMMISSION EXPIRES: 12/17/07
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