City of Chicago

Office of the City Clerk

O2015-7392

Document Tracking Sheet

Meeting Date:

10/14/2015

Sponsor(s):

Emanuel (Mayor)

Type:

Ordinance

Title:

Support of Class 7(b) tax incentive for property at 3440 N

Kedzie Ave
Committee on Economic, Capital and Technology
Development

Committee(s) Assignment:

OFFICE OF THE M A Y O R
C I T Y OF C H I C A G O
RAHM EMANUEL
MAYOR

October 14,2015

TO THE HONORABLE, THE CITY COUNCIL

OF THE CITY OF CHICAGO

Ladies and Gentlemen:

At the request of the Commissioner of Planning and Development, I transmit herewith an
ordinance authorizing a Class 7(b) tax status for 3456 CHI, LLC.
Your favorable consideration of this ordinance will be appreciated.
Very truly yours.

Mayor

ORDINANCE

WHEREAS, the City of Chicago (the "City") is a home rule unit of government under
Section 6(a), Article Vll of the 1970 Constitution of the State of Illinois authorized to exercise
any power and perform any function pertaining to its government and affairs; and
WHEREAS, pursuant to an ordinance adopted by the City Council of the City ("City
Council"), the City established "Enterprise Zone 4" in accordance with the Illinois Enterprise
Zone Act, 20 ILCS 665/1, et seq., finding, among other things, that Enterprise Zone 4 is a
depressed area; and
WHEREAS, certain real estate generally located at 3440 N Kedzie Avenue in the City,
as more precisely described on Exhibit A attached hereto and hereby made a part hereof (the
"Project Site"), is located within the boundaries of Enterprise Zone 4; and
WHEREAS, 3456.CHI, LLC, an Illinois limited liability company ("Applicant"), proposes
to rehabilitate and currently intends to lease the property to Mid City Nissan, Inc., an Illinois
corporation ("Tenant"), and Tenant intends to operate an approximately 134,655 square foot
automobile dealership and service center on the approximately 266,000 square foot Project Site
(the "Project"); and
WHEREAS, the Applicant purchased the Project Site for value; and
WHEREAS, the Project Site has been abandoned for approximately twenty-three
months; and
WHEREAS, the City's Department of Planning and Development ("DPD") has
determined that the property contains numerous depressed conditions that continue to impede
the development of the property, including but not limited to functionally and economically
obsolete buildings and site improvements, deteriorated structures, inadequate utilities,
excessive site coverage and deleterious land use and layout (the "Special Circumstances")
which DPD has determined justify a finding that the Project Site is abandoned for the purpose of
the Class 7b designation; and
WHEREAS, the Project will increase employment opportunities, economic activity in the
area and growth in the real property tax base; and
WHEREAS, the Applicant intends to apply to the Office of the Assessor of Cook County,
Illinois (the "Assessor") for designation of the Project Site as a Class 7b classification eligible for
certain real estate tax incentives; and
WHEREAS, Section 74-65(b) of the Cook County Real Estate Classification Ordinance,
as amended, (the "Classification Ordinance"), provides that prior to filing an eligibility application
with the Assessor, an applicant for Class 7b classification must obtain an ordinance or
resolution from the municipality in which the real estate is located expressly stating that (a) the
municipality has determined that eligibility factors (1) through (5) under Section 74-65(a) of the
Classification Ordinance are present, and (b) the municipality supports and consents to the
Class 7b application to the Assessor; and

WHEREAS, the DPD has reviewed the proposed Project, has determined that it meets
the necessary eligibility requirements for Class 7b designation, and hereby recommends to City
Council that the City expressly determine by ordinance that (a) the required eligibility factors are
present, and (b) the City supports and consents to the Class 7b application to the Assessor by
the Applicant for the Project; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1. The above recitals are hereby expressly incorporated as if fully set forth
herein.
SECTION 2. The City hereby determines that the Project meets eligibility factor (1)
under Section 74-65(a) of the Classification Ordinance in that the Project Site is blighted and is
located in an area in need of commercial development.
SECTION 3. The City hereby determines that the Project meets eligibility factor (2)
under Section 74-65(a) of the Classification Ordinance in that real estate taxes in the area
during the last six years have either declined, remained stagnant and/or potential real estate
taxes are not being fully realized due to the depressed condition of the area.
SECTION 4. The City hereby determines that the Project meets eligibility factor (3)
under Section 74-65(a) of the Classification Ordinance in that there is a reasonable expectation
that the Project is viable and likely to go forward on a reasonably timely basis if granted Class
7b designation and will therefore result in the economic enhancement of the area.
SECTION 5. The City hereby determines that the Project meets eligibility factor (4)
under Section 74-65(a) of the Classification Ordinance in that certification of the Project for
Class 7b designation will materially assist development, redevelopment or rehabilitation of the
area and the Project would not go forward without the full incentive offered under Class 7b.
SECTION 6. The City hereby determines that the Project meets eligibility factor (5)
under Section 74-65(a) of the Classification Ordinance in that certification of the Project for
Class 7b designation is reasonably expected to ultimately result in an increase in real property
tax revenue and employment opportunities within the area.
SECTION 7. The City hereby expressly determines that eligibility factors (1) through (5)
under Section 74-65(a) of the Classification Ordinance are present for the Project, and hereby
expressly supports and consents to the Class 7b application of the Applicant to the Assessor for
Class 7b designation ofthe Project and the Project Site.
SECTION 8. That the City determines that the Special Circumstances justify finding that
the Project Site is deemed "abandoned" for the purpose ofthe Class 7b designation.
SECTION 9. The Commissioner of DPD (the "Commissioner"), or a designee of
Commissioner, are each hereby authorized to deliver a certified copy of this ordinance to
Assessor and to furnish such additional information as may be required in connection with
filing of the application by the Applicant with the Assessor for Class 7b designation of
Project.

the
the
the
the

SECTION 10. This ordinance shall be effective from and after its passage and approval.
2

EXHIBIT A

Legal Description ofthe Project Site:

[see attached]

EXHIBIT A

THAT PART OF THE NORTH 939.19 FEET OF THE NORTHEAST 1/4 OF THE
SOUTHEAST i/4 OF SECTION 23, TOWNSHIP 40 NORTH, RANGE 13 EAST OF THE
THIRD PRINCIPAL MERIDIAN, BOUNDED AND DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT ON THE SOUTH LINE OF SAID TRACT WHICH IS 756.37
FEET EAST OF THE WEST LINE THEREOF; THENCE SOUTH 89 DEGREES 50
MINUTES 30 SECONDS EAST ALONG THE SOUTH LINE OF SAID TRACT A
DISTANCE OF 542.01 FEET TO A LINE 33 FEET WEST OF THE EAST LINE OF THE
SOUTHEAST 'A OF SECTION 23 AFORESAID; THENCE NORTH 0 DEGREES 02
MINUTES 30 SECONDS EAST 241.75 FEET ALONG THE LAST DESCRIBED LINE;
THENCE NORTH 89 DEGREES 50 MINUTES 30 SECONDS WEST 195.27 FEET TO THE
POINT OF TANGENCY OF A CURVED LINE CONVEX TO THE NORTHWEST; THENCE
SOUTHWESTERLY ALONG SAID CURVED LINE WITH A RADIUS OF 359.26 FEET A
DISTANCE OF 328.02 FEET TO AN INTERSECTION WITH A LINE DRAWN THROUGH
THE POINT OF BEGINNING AND FORMING AN ANGLE OF 58 DEGREES 45 MINUTES
45 SECONDS FEET FROM EAST TO NORTHEAST WITH THE SOUTH LINE OF THE
NORTH 939.19 FEET OF THE NORTHEAST 1/4 OF THE SOUTHEAST 1/4 OF SECTION
23 AFORESAID; THENCE SOUTH 32 DEGREES 23 MINUTES 45 SECONDS WEST
119.44 FEET ALONG SAID LINE TO THE PLACE OF BEGINNING.
ALSO
THAT PART OF LOT 7 IN COMMONWEALTH EDISON COMPANY'S RIGHT-OF-WAY
SUBDIVISION, BEING A SUBDIVISION OF PART OF THE SOUTHEAST 1/4 OF
SECTION 23, AND PART OF THE SOUTHEAST 1/4 OF SECTION 24. TOWNSHIP 40
NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN, WHICH LIES EAST
OF THE FOLLOWING DESCRIBED LINE; COMMENCING IN A LINE WHICH IS 906.19
FEET SOUTH OF AND PARALLEL WITH THE SOUTH LINE OF W. ADDISON STREET
(WHICH LINE BEARS SOUTH 89 DEGREES 50 MINUTES 30 SECONDS EAST) AT A
POINT DISTANT 713.97 FEET EAST OF THE EAST LINE OF NORTH. KIMBALL
AVENUE; THENCE SOUTH 26 DEGREES 32 MINUTES 13 SECONDS WEST 59.06 FEET;
THENCE SOUTH 4 DEGREES 20 MINUTES 11 SECONDS EAST, 38.36 FEET THENCE
SOUTHWESTERLY ALONG THE ARC OF A CIRCLE, CONVEX TO THE NORTHWEST,
HAVING A RADIUS OF 347.06 FEET, A DISTANCE OF 59.81 FEET (THE COURSE OF
THE CHORD OF SAID ARC BEING SOUTH 21 DEGREES 17 MINUTES 45 SECONDS
WEST, 59.74 FEET); THENCE SOUTH 16 DEGREES 21 MINUTES 31 SECONDS WEST,
TANGENT TO THE LAST DESCRIBED ARC, A DISTANCE OF 75.20 FEET; THENCE
SOUTHWESTERLY, ALONG THE ARC OF CIRCLE, TANGENT TO THE LAST
DESCRIBED COURSE.CONVEX TO THE SOUTHEAST, HAVING A RADIUS OF 395.26
FEET. A DISTANCE OF 54.15 FEET ( THE COURSE OF THE CHORD OF SAID ARC
BEING SOUTH 20 DEGREES 16 MINUTES 59 SECONDS WEST, 54.11 FEET); THENCE
SOUTH 60 DEGREES 30 MINUTES 41 SECONDS WEST, 33.75 FEET; THENCE
SOUTHWESTERLY, ALONG THE ARC OF A CIRCLE, CONVEX TO THE SOUTHEAST,

HAVING A RADIUS OF 376.26 FEET, A DISTANCE OF 132.28 FEET (THE COURSE OF

THE CHORD OF SAID ARC BEING SOUTH 38 DEGREES 25 MINUTES 33 SECONDS
WEST, 131.58 FEET) TO A POINT IN THE SOUTH LINE OF AFORESAID LOT 7,
DISTANT 517.64 FEET EAST OF THE EAST LINE OF NORTH KIMBALL AVENUE;
EXCEPTING THEREFROM THAT PART LYING SOUTH OF THE FOLLOWING
DESCRIBED LINE; COMMENCING AT A POINT IN THE WEST LINE OF N. KEDZIE
AVENUE (WHICH LINE BEARS NORTH 0 DEGREES 02 MINUTES 34 SECONDS EAST)
172.30 FEET NORTH OF THE SOUTHEAST CORNER OF SAID LOT 7; THENCE NORTH
89 DEGREES 31 MINUTES 12 SECONDS WEST, 12.14 FEET; THENCE WESTERLY,
ALONG THE ARC OF A CIRCLE, TANGENT TO THE LAST DESCRIBED
COURSE,CONVEX TO THE NORTH, HAVING A RADIUS OF 875.43 FEET, A DISTANCE
OF 207.84 FEET (THE COURSE OF THE CHORD OF SAID ARC BEING SOUTH 83
DEGREES 40 MINUTES 42 SECONDS WEST, 207.36 FEET); THENCE SOUTH 76
DEGREES 52 MINUTES 37 SECONDS WEST, TANGENT TO THE LAST DESCRIBED
ARC, A DISTANCE OF 498.82 FEET TO A POINT ON THE ARC OF AFORESAID CIRCLE
HAVING A RADIUS OF 376.26 FEET, SAID POINT BEING 47.65 FEET. AS MEASURED
ALONG SAID ARC, NORTHERLY OF THE POINT OF INTERSECTION OF SAID ARC
WITH THE SOUTH LINE OF SAID LOT 7,
ALSO
THAT PART OF THE NORTHEAST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 23,
TOWNSHIP 40 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL MERIDIAN,
LYING SOUTH OF A LINE WHICH IS 906.19 SOUTH OF AND PARALLEL WITH THE
SOUTH LINE OF W. ADDISON STREET, WEST OF THE WEST UNE OF NORTH
KEDZIE AVENUE, NORTH OF THE NORTH LINE OF THE SOUTH 300 FEET OF THE
SAID NORTHEAST 1/4 OF THE SOUTHEAST 1/4 AND EAST OF THE FOLLOWING
DESCRIBED LINE, COMMENCING IN A LINE, WHICH IS 906.19 FEET SOUTH OF THE
SOUTH LINE OF W. ADDISON STREET(WHICH LINE BEARS SOUTH 89 DEGREES 50
MINUTES 30 SECONDS EAST) AT A POINT DISTANT 721.37 FEET EAST OF THE EAST
LINE OF N, KIMBALL AVENUE; THENCE SOUTH 37 DEGREES 37 MINUTES 25
SECONDS WEST,34.47 FEET; THENCE SOUTH 26 DEGREES 32 MINUTES 13 SECONDS
WEST, 28.52 FEET; THENCE SOUTH 4 DEGREES 20 MINUTES 11 SECONDS EAST,
38.36 FEET; THENCE SOUTHWESTERLY, ALONG THE ARC OF CIRCLE, CONVEX TO
THE NORTHWEST. HAVING A RADIUS OF 347.06 FEET, A DISTANCE OF 59.81 FEET
(THE COURSE OF THE CHORD OF SAID ARC BEING SOUTH 21 DEGREES 17
MINUTES 45 SECONDS WEST. 59.74 FEET); THENCE SOUTH 16 DEGREES 21
MINUTES 31 SECONDS WEST. TANGENT TO THE LAST DESCRIBED ARC, A
DISTANCE OF 75.20 FEET; THENCE SOUTHWESTERLY ALONG THE ARC OF A
CIRCLE TANGENT TO THE LAST DESCRIBED COURSE,
CONVEX TO THE
SOUTHEAST, HAVING A RADIUS OF 395.26 FEET, A DISTANCE OF 54.16 FEET (THE
COURSE OF THE CHORD OF SAID ARC BEING SOUTH 20 DEGREES 16 MINUTES 59
SECONDS WEST, 54.11 FEET); THENCE SOUTH 60 DEGREES 30 MINUTES 4!
SECONDS WEST, 33.75 FEET; THENCE SOUTHWESTERLY, ALONG THE ARC OF A
CIRCLE, CONVEX TO THE SOUTHEAST, HAVING A RADIUS OF 376.26 FEET, A
DISTANCE OF 132.28 FEET (THE COURSE OF THE CHORD OF SAID ARC BEING

SOUTH 38 DEGREES 25 MINUTES 33 SECONDS WEST, 131.58 FEET) TO A POINT IN

THE AFORESAID SOUTH LINE OF SAID NORTHEAST 1/4 OF THE SOUTHEAST 1/4,
DISTANT 517.64 FEET EAST OF THE EAST LINE OF NORTH KIMBALL AVENUE, ALL
IN COOK COUNTY, ILLINOIS.
Address: 3440 N. Kedzie Avenue, Chicago, IL 60618
TaxIdNumber(s): 13-23-402-027-0000, 13-23-402-079-0000, 13-23-402-080-0000. 13-23-402077-0000, 13-23-402-078-0000

CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT
AND A F F I D A V I T
SECTION I - G E N E R A L INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:

Check ONE ofthe following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:
1. ^ ihe Applicant
OR
2. f,.] a legal entity holding a direct or indirect interest in the Applicant. StatR the legal name of the
Applicant in which the Disclosing .Party holds an interest:
.
OR
3. [ ] a legal entity with a right of contj-ol (see Section II.B.l.) State the legal name of the entity in
which the Disclosing Party holds a right of control;
^
B. Business address ofthe Disclosing .Party;

C. Telephone: 0 ^ 3 .
D: Name of contac: person:

MUM^

VjQ ttlK)

fVo^ VoAt'

.^^r^^A.

/ ^ ^ ^ Q Fax: S } l n . r j 5 Z l ^ a < 3 . 3 j ^ F.ma\\-. j d , C i 3 L X - ^ e c i n . < i ^ . ^C>ryi

^'^IA:)^'^"j"

E. Federal Employer Identification No. (if you have one);

F. Brief description orcontract, transaction or other undertaking (referred to below as the "Matter") to
which this EDS pertains. (Include project number and lociilion of property, if applicnbie):

G. Which City agency or department is requesting this E D S ? { ^ ^ r ^ ^ _ e . | ^ j 3 5 . ^ i a i j a ^ _ ^

[f the Matter is a contrtrct being handierJ by the City's Department of Procurement Services, piease
complete the following:
N/A
Specificuioj]

Vci-. ui-oi-12

and Contract tf

Page i of \3

S E C T I O N I I - D I S C L O S U R E O F OWNERSHIP I N T E R E S T S
A. NATURE OF THE DISCLOSING PARTY
1. Indicate the aature of the Disclosing Party:
[ ] Person
[ ] Limited liabihty company
[ ] PubHcly registered business corporation
[ ] Limited liability partnership
^ Privately held business corporation
[ ] Joint venture
[ ] Sole proprietorship
[ ] Not-for-profit corporation
[ ] General partnership
(Is the not-for-profit corporation also a 501(c)(3))?
[ ] Limited partnership
[ ] Yes
[ ] No
[ ] Trust
[ ] Other (please specify)

2.

For legal entities, the state (or foreign country) of incorporation or organization, if applicable;

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?
[JYes

[]No

t/j'N/A

B. IF THE DISCLOSING PARTY IS A L E G A L ENTITY:

1. List below the full names and titles of all executive officers and all directors ofthe entity.
N O T E : For not-for-profit corporations, also list below ail 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 litlcholdcr(s).
If the entity is a gej:eral partnership, limited partnership, limited liability company, limited liability
partnership or Joint venture, list below the name and title of each general partner, managing member,
manager or any other person or entity that controls the day-to-day management of (he Disclosmg P.irty.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name
_Hl.chc.el

,.,.Ekl-a

Title
B-eriruT-^-:.

"-Pr^^idfo^

Se.cy-dz^r^^..lThL^Uj^<sL^

2. Please provide the following information concerning each person or entity having a direct or
indirect :.)cncl'icial interest (including ownership) in excess uf 7 5% ofthe Disclosing I^;;rty. rxamples
ofsuch un interest include ;^hares m a corporalion, partnership interest in a pariiiciship or joint veiiiurc.
Pace 2 of 13

interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust,

estate or other similar entity. I f 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.
Nanie

Business Address

Percentage Interest in the

Disclosing Party

SECTION I I I - BUSINESS RELATIONSHIPS W I T H C I T Y ELECTED OFFICIALS

Has the Disclosing Parly 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

!)4 No

I f yes, please idendfy 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 Parly has retained
or expects to retain in connection with the Matter, as well as the nature of the relationship, aird the total
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 inlluence any legislative or administrative
action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2)
himself. "Lobbyist" also means any person or enlily 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
Disclobing Parly must either ask the City whether disclosru'c is required or make '.he disclosure.

Paac 3 of 1'.

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,) NOTE:
"hourly rate" oi "t.b.d." is
not an acceptable response.

(Add sheets if necessary)

DO 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 contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Pai'ty been declared in
arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes

D(| No

[ ] No person directly or indirectly owns 10% or more ofthe

Disclosing Party.

I f "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?
[]Ycs

[)4,No

B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter I -23, Article 1 ("Article r')(which the Applicant should
consult for defined terms (e.g., "doing business") and legal rcquiremenrs), i f the Disclosing Party
submitting this F,DS is the Applicant and is doing business with the City, then the Disclosing Party
certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged
with, or has admiiied guilt of, or has ever been convicted of, or placed under supervision for, any
criminal offense involving actual, attempted, or conspiracy lo commit bribery, thefi, fraud, forgery,
perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the
Applicant understands and acknowledges thai compliance with Article I is a contmu;ng requirement for
doing bti5)nes,s with the City. NOTE. I f .'Xriicle I applies to the Applicant, the permanent coinphancc
timeframe m Article I supersedes some five-year compliance timeframes m certifications 2 and 3 below.

^agc 4 of 13

2. The Disclosing Party and, i f the Disclosing Party is a legal entity, all of those persons or entities
identified in Section TLB. 1. of this EDS:
a.

are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from any transactions by any federal, stats 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 ihem in connection witl::
obtaining, attempting to obtain, or perfoniiing 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 dcstmction of records; making false
statements; or receiving stolen property;

c.

are not presentiy indicted for, or criminally or civilly charged by, a governmental entity (federal,
state or local) with committing any ofthe offenses set forth in clause B.2.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, stale 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.

3.

The certifications in subparts 3, 4 and 5 concern;

the Disclosing Party;

any "Contractor" (mcajiing any contractor or subcontractor used by the Disclosing Parly in
connection with Ihe Matter, including but not limited lo all 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, oris, with the Disclosing Party, under
common control of another person or entity. Indicia of control inchide, without limitation:
interlocking management or ownership; idc-nlity 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 lo do business with federal or state or local government, including
ihc City, using substantially the same management, ov/ncrship, or principals as the ineligible entity);
with respect lo Contractors, the term Affiliated Entity means a person or entity that direcrly or
indirectly controls the Contractor, is conlroUed by it; or, with the Contractor, is under common
control of another person or entity;
any responsible official of the Di,sclosing Party, any Contractor or any Affiliated Entity oi any
other official, agent or employee ofthe Disclosing Party, any Contractor or any .Affiliated Entity,
acting pursuant to the direction or autliori^atioii of a responsible official ofthe Disclosing Party, any
Contractor or any ft'ilia;ctl EiV-ily (collectively "Agents").

I^aue 5 of"

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclo.sing Party
or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with
respect to a Contraclor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years
before the date of such Contractor'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 ofthe City, the State of Illinois, or any agency ofthe federal
government or of any state or local government in the United States of America, in lliat 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).

4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials,
agents or partners, is barred from contracting with any unit of state or local government as a result of
engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rolaling 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.
5. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists
maintained by the Ofl'icc of Foreign Assets Control of the U.S. Department of the Treasury or llie
Bureau of Industry 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.
6. The Disclosing Party understands and shall coinplywith Ihe applicable requiiements of Chapters
2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Govcrnmcnial Ethics) ofthe
Municipal Code.
7. If the Disclosing Party is unable to certify to any of the above statcnienls m this Part B (Further
Ccitifications), the Disclosing Parly must explain below:

Paoe 6 0f 1 ."i

I f the letters "NA," the word "None," or no response appears on the lines above, it will be co.nclusivcly
presumed that the Disclosing Party certified to the above statemcnls,
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all current employees of the Disclosing Party who were, at any time during the 12month period preceding the execution date of this EDS, an employee, or elected or appointed official,
of the City of Chicago (if none, indicate with "N/A" or "none").

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the
12-month period preceding the execution date of tliis EDS, to an employee, or elected or appointed
official, ofthe City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything
made generally available to City employees or to the general public, or (ii) food or drink provided in the
course of official City business and having a retail value of less than $20 per recipient (if none, indicate
with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient,

fM
C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1.

The Disclosing Party certifies that the Disclosing Party (check one)

[ ] is

is not

a "financial institution" as defined in Section 2-32-455(b) ofthe Municipal Code.

2.

I f the Disclosing Party IS a financial institution, then the Disclosing Party pledges:

"We are not and will not become a predatory lender as defined in Chapter 2-32 of ihc 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 ofthe 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 Ciiy."
I f ihe 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 ihe meaning of Chapter
2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):

Page 7 of 13

If the letters "N A," the word "None," or no response appears on the lines above, it will be
conclusively presumed that the Disclosing Party certified lo the above statements.
D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS
Any words or terms lhat 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 2-156-110 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 or
entity in the Matter?
[ ] Yes
0<] No
NOTE: If you checked "Yes" to Item D . l . , proceed to Items D.2. and D.3. If you checked "No" to
Item D, 1proceed 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 Ihc City, or (ii) is sold
for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively,
"City Property Sale"), Compensation for property taken pursuant to the City's eminent domain power
does not constitute a financial interest within the meaning of this Part D,
Does Uie Matter involve a City Property Sale?
[ ] Yes

[ ] No

3. I f you checked "Yes" to Item D . l . , provide the names and business addresses ofthe City
ofllcials or employees having such inlcrcst and identify the nature ofsuch interest:
Nam.e

Business .Address

Nature of Interest

4, The Disclosmg Parly further certifies that no prohibited financial interest in the Matter will
be acquired by any City official or employee.
E CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either 1, or 2. below. I f the Disclosing Pany checks 2., the Di.sclosing Pajty must
disclose below or in an attachment to th.is EDS nil information required by paragraph 2. rai'.urc lo
Page 8 of 13

comply with these disclosure requirements may make any contract entered into with the City in
connection with the Matter voidable by the City.
1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits
from slavery or slaveholder insurance policies during the slavery era (including insurance policies
issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and
the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search ,in step 1 above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance
policies. The Disclosing Party verifies that the following constitutes full disclosure of all such
records, including the names of any and all slaves or slaveholders described in those records:

S E C T I O N V I ~ C E R T I F I C A T I O N S F O R F E D E R A L L Y FUNDED M A T T E R S
NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally
funded, proceed to Section VII. For purposes of this Section VI, lay. credits allocated by the City
and proceeds of debt obligations ofthe City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying
Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe .Disclosing Party with
respect to the Matter: (Add sheets if necessary);

(If no explanation appears or begins on the lines above, or i f the letters "N A" or i f the word "None"
appear, it w ill 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
Disclo.sing Parly 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 hor lobbying activities or to pay any
person or entity to influence or a:tcn-ipi to influence an off.ccr or employee of any agency, as defined by
applicable federal law, a member of Congress, an officer or employee of Congress, or an eirployec of a
member of Congress, in connection with the award of any federally funded coniract, making any
federally funderl gram or loan, entering into any cooperative agreement, or lo extend, conliiiiic. renev,'.
aniciici, or modify any fedeialJy funded contract, gram, loan, or cooperative agiocment
Page 9 of 13

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.
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. I f the Disclosing Party is tlie 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
sxibcontract 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 die outset of
negotiations.
Is the Disclosing Party the AppHcant?
[]Ycs

[]No

I f "Yes," answer the three questions below:

1. Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (Sec 41 CFR Part 60-2.)
[JYes
;jNo
2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal
Contract Compliance Programs, or the Equal Employment Opportuniiy Commission all reports due
under the applicable filing requirements?
[ ] Yes
[ ] No
3. Have you participated in any previous contracts or s\ibconlracts subject to the
equal opportuniiy clause?
[JYes
[JNo
If you checked "No" to question 1. or 2. above, please provide an explanation:

Pajz'e 10 of 13

SECTION V l l ~ A C K N O W L E D G M E N T S , CONTRACT I N C O R P O R A T I O N ,
C O M P L I A N C E , PENALTIES, DISCLOSURE
The Disclosing Party understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS v.'ill 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.
B. 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.cltvof6fiicag6iOrg/Ethitis. and may also be obtained from the City's Board of Ethics, 740 N .
Sedgwick St., Suite 500, Chicago, I L 60610, (312) 744-9660. The Disclosing Party must comply fully
with the applicable ordinances.
C. I f 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 nol rescinded or
void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or
declining to allow the Disclosing Party to participate in other transactions wilh the City. Remedies at
law for a false statement of material fact may include incarceration and an award lo the City of treble
damages.
D. 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 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 litis 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
m this EDS.
E. The information provided in this EDS must be kepi current. In ihe event of changes, the Disclosing
Parly must supplement this HDS up to the time the City takes action on the Matter. If the M.ittcr is a
contract being handled by Ihc City's Department of Procurement Sei vices, the Disclosing Party iiuist
update this EDS as the coniract requires. N O T E : With respect to Matters subject lo Article 1 of
Chapter 1-23 ofthe Municipal Code (imposing PERMANENT I N E L I G I B I L I T Y for certain specified
offenses), the mlormaiion provided herein regarding eligibiliiy must be kept eurreni for a longer period,
as requited by Chapter 1-23 and Section 2-154-020 of tlie Municipal Code.
The Disclosing Party represents and wairanis that:
Paue 11 of 13

F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois
Deparlmcni of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any
fine, fee, tax or other charge owed to the Ciiy. This includes, but is not limited to, all water charges,
sewer charges, license fees, parking tickets, property taxes or sales taxes.
F.2
If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not
use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded
Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.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 F.l, and F.2. above and will not, without the prior written consent ofthe
City, use any such contractor/subcontractor that does not provide such certifications or that the
Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE; If the Disclosing Party cannot certify as to any ofthe items in F.l., F.2. or F.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 and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all
certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate
and complete as ofthe date furnished to the City.

(Print or type name of person signing)

(Print or type title o\Ci'5on signing)

Signed and sworn lo bel^ore me on (date) CdTQAerz. Bf Zo/C

at
do OK
County,
tj^
(state).

"OmClAL SEAL

Notar>'Pu|,c. ^^^.^ Hovnei

Commission expires:

^/z-frj-t^if
Page 1 2 of 13

CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A

FA.VIILIAL RELATIONSHIPS W I T H ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in the Applicant exceeding 7.5 percent. I t is not to be completed by any legal entity
which has only an indirect ownership interest in the Applicant.
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party
or any "Applicable Pai-ty" or any Spouse or Domestic Partner thereof curraitly has a "familial relationship" with
any elected city official or department head. A "familial relationship" exists if, as of the dale this EDS is
signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to
the mayor, any alderman, the city clerk, tlie city treasurer or any city department head as spouse or domestic
partner or as any ofthe following, whether by blood or adoption; parent, child, brother or sister, aunl or uncle,
niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughtcr-in-lav., stepfather
or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed in Section II.B.l.a., if the
Disclosing Party is a corporation; all partners of the Disclosing Parly, if the Disclosing Parly is a general
partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited
parmership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a
limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than
a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief
operating officer, executive diieclor, chief financial officer, treasurer or secretary of a legal enlily or any person
exercising similar aulhoriiy,
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof cunently
have a "familial relationship" with an elected city official or department head?
[ ] Yes

(XfNo

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

Page 13 of 13

CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity
which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner").
It ij5 not to be completed by any legal entity which has only an indirect ownership interest in
the Applicant.
1. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a
building code scofflaw orproblem landlord pursuant to Section 2-92-416 ofthe Municipal
Code?

[ JYes

l><lNo

2. If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of
the Applicant identified as a building code scofflaw or problem landlord pursuant lo Section
2-92-416 of the Municipal Code?
[ JYes

[ ]No

^ N o t Applicable

3. If yes to (1) or (2) above, please identify below the name ofthe person or legal entity
identified as a building code .scofflaw or problem landlord and the address ofthe building or
buildings lo which the-'pertinent code violations apply.

FILLING OUT THIS APPENDUC B CONSTITUTES ACKNOWLEDGMENT

AND AGI^EEMENT THAT THIS APPENDIX B IS INCORPORATED BY
REFERENCE INTO, AND MADE A PARI' Of, THE ASSOCIATED EDS,
AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE
SUBJEC T TO THE CERTIFICATION MADE UNDER PENALTY OF
PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.

CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT
AND AFFIDAVIT
SECTION I " GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS, Include d/b/a/ if applicable:

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:
1. M the Applicant
OR
2. [ ] a legal entity holding a direcl or indirect interest in the Applicant. State the legal name ofthe
Applicant in which the Disclosing Party holds an interest;
OR
3. [ ] a legal endty with a right of control (see Section II.B.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control;
B, Business address of the Disclosing Party:

C. Telcphone:gyLLL2H3i)5l_

S i S I

UJ . TOLA

Fax;??<4n>S g?-^3-2>M

D. Name of contact person; ^p^j

^*f_

Email: ES^^JLPT

B e.^^^.

coyy\

Y\^. .^^j^-k"

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):

G. Which City agency or deparlmenl is requesting Ihis HL^S'/^prVv I* ^^j^l^tsnYM*^

l'^]^^e.iO^^>fY]0rci'

If the Matter is a contract being handled by the City's Department of Procurement Services, please
complete the following:
Njff
Specification #

\er. oi-ui-i:

'

and Contract ^?

Page 1 of 13

SECTION n ~ DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

]
J
]
]
]
]
]

I . Indicate the nature of tlie Disclosing Party;

Limited liability company
Person
[
]
Limited liability partnership
Publicly registered business corporation
[ ] Joint venture
Privately held business corporation
[ ] Not-for-profit corporation
Sole proprietorship
(Is
the not-for-profit corporation also a 501(c)(3))?
General partnership
Limited partnership
[ ] Yes
[ J No
Trust
[ ] Odier (please specify)

2.

For legal entities, the state (or foreign country) of incorporation or organization, i f applicable:

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

( ] No

0^ N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY;

I . List below the full names and tities of all executive officers and all directors ofthe entity.
N O T E : For not-for-profit corporations, also list below all members, if any, which are legal entities. I f
there are no such members, write "no members." For trusts, estates or other similar entities, list below
the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability
partnership or joint venture, list below the name and title of each general partner, managing member,
manager or any other person or entity tiial controls the day-io-day management ofthe Disclosing Party.
NOTE: Each legal entity listed below must submit an EDS on its own behalf,
. l_LC Name
Title

VP

Todd b&-)iwc^

Membtfv"

Trec^a'-ti

2. Please provide the following information concerning each peison or entity having a dircci or
indirect beneficial intcresi (including ownership) j i i excess of 7.5% of the Disclosing Party. Examples
ofsuch an interest include shares in a corporalion, partnership interest m a partnership or joint vciUurc,
Paac 2 of 13

interest of a member or manager in a limited liability company, or inlerest of a beneficiary of a trust,

estate or other similar entity. I f none, state "None." NOTE; Pursuant to Section 2-154-030 ofthe
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 .\ddiess

M;)i^]ogej; Airman

<S-7^-7 lii.^ti:hy^^/g; Milev^JL.

l&mm
MM

Percentage Interest in the

Disclosing Party

feryiftia

-3 ^

S E C T I O N HI - BUSINESS R E L . 4 T I 0 N S H I P S W I T H C I T Y E L E C T E D O F F I C I A L S
Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of tlie Municipal
Code, with any City elected official in the 12 months before the dale this EDS is signed?
[JYes

^No

If yes, please identify below the name(s) ofsuch 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 ihe nature ofthe relationship, and the total
amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose
employees who arc paid solely through the Disclosing Party's regular payroll.
"Lobbyist" means any person or entity who undertakes to infiuence any legislative or adtninislrative
action on behalf of any person or entity other than; (J) a nol-tor-profit entity, on an unpaid basis, or (2)
himself. "Lobbyist" also means any person or ejitity any pari of whose duties as an employee of
anoiiicr includes undertaking to influence any legislative or administraiive action.
If the Disclosing Party is uncertain whether a disclosure is required under this Section, ihc
Disclosing Party mu.sl either ask the City whether disclosure is required or make the disclosure.

Pat;c 3 of 13

Name (indicate whether

retained or anticipated
to be retained)

Business
Address

Relationship to Disclosing Party Fees (indicate whether

(subcontractor, attorney,
paid or estimated.) NOTE:
lobbyist, etc.)
"hourly rate" or "t.b.d." is
not an acceptable response.

(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 contract's tenii.
Has any person who directly or indirectly owns 10% or more of the Disclosing Parly been declared in
arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ ] Yes

p<^No

[ ] No person directly or indirectiy owns 10"/o or more of the

Disclosing Party.

If "Yes," has the person entered into a court-approved agreement for payment of all support owed and
is the person in compliance with that agreement?[JYes

[JNo

B. FURTHER CERTIFICATIONS
1. Pursuant to Municipal Code Chapter 1-23, Article 1 ("Article l")(v/hich the Applicant should
consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party
submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party
certifies as follows; (i) neither the Applicant nor any controlling person is currently indicted or charged
with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any
criminal offense involving actual, attempted, or conspiracy to commit bribery, ibeft, fraud, forgery,
perjury, dishonesty or deceit against an officer or employee ofthe City or any sister ageiiey; and (ii) the
Applicant understands and acknowledges lhat compliance with Article I is a continuing requirement for
doing busincs.s with the City. NOTE: If Article I applies to the Applicant, the permanent compliance
timeframe in Article I supersedes some five-year complitinee timefrair.cs in certifications 2 i^nd 3 below

Pane 4 of 13

2. The Disclosing Party and, i f the Disclosing Party is a legal entity, all of those persons or entities
identified in Section I I . B . l , of this EDS;
a.

are nol 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 jtidgment 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 stamtes; fraud;
embezzlement; theft; forgery; bribery; falsification or destruction of records; making false
statements; or receiving stolen property;

c.

are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal,
state or local) with committing any ofthe offenses set forth in clause B.2.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,

3.

The certifications in subparts 3, 4 and 5 concern;

the Disclosing Parly;

any "Contraclor" (meaning any contractor or subcontractor used by the Disclosing Party in
connection with the Matter, including but not limited to all 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, wilh 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);
wilh respect to Contractors, the term Affiliated Entity means a person or entity that directly or
indirectly controls the Contractor, is controlled by it, oi', wiih the CJontractor, is under eominon
control of another person or entity;
any responsible official ofthe Disclosing Party, any Contractor or any .Affiliated Entity or any
other official, agent or employee ofthe Disclosing Parly, any Contraclor or any .Affiliated Entity,
acting pursuant lo the direction or authorization of a responsible official of the Disclosing Party, any
Contractor or any A ffiliatcd Entity (collectively "Agents").

Page 5 of

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party
or any Contractor nor any Agents have, during the five years before the dale this EDS is signed, or, with
respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years
before the date ofsuch Contractor'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 ofthe federal
government or of any state or local governmenl in Ihe United Slates 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).

4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials,
agents or partners, is barred from contracting with any unit of stale 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.
5. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists
mainlaiiied by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the
Bureau of Industry 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.
6. 'I'he Disclosing Party understands and shall comply with the applicable requirements of Chapters
2-55 (Legislative Inspector General), 2-56 (Inspector Genera!) and 2-156 (Governmental Ethics) ofthe
Municipal Code.
7. I f the Disclosing Party is unable to certify to any ofthe above statements in this ParlB (Further
Cerfifications), the Disclosing Party must explain below;

Page 6 of 13

If the letters "NA," the word "None," or no response appears on the lines above,,it will be conclusively
presumed that the Disclosing Parly certified to the above statements,
8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all current employees ofthe Disclosing Party who vvere, at any time during the 12month period preceding the execution date of this EDS, an employee, or elected or appointed official,
ofthe City of Chicago (if none, indicate wilh "N/A" or "none").

:MI^

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all gifts that the Disclosing Party has given or caused to be given, at anytimeduring the
12-month period preceding die execution date of this EDS, to an employee, or elected or appoijited
official, of the City of Chicago. For purposes of this statement, a "gift" does not include; (i) anything
made generally available to City employees or to the general public, or (ii) food or drink provided in the
course of official City business and having a retail value of less than S20 per recipient (if none, indicate
with "N/A" or "none"). As to anv gift listed below, please also list the name of the City recipient.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

1.

The Disclosing Party certifies lhat the Disclosing Party (check one)

[ J is

[)4 is not

a "financial institution" as defined in Section 2-32-455(b) ofthe .Vlunicipal Code.

2.

If the Disclosing Party IS afinancialinstitution, then the Disclosing Party pledges;

"Wc are not and v/ill not become o 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. Wc undersland that becoming a predatory
lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing
business with the City."
If the Disclosing Party is unable to make this pledge because it or any of its a [filiates (as defined in
Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter
2-32 ofthe Municipal Code, explain here (attach additional pages if necessary)-

Page 7 of

If the letiers "NA," the word "None," orno response appears on the lines above, it will be
conclusively presumed that the Disclosing Party certified to the above sta'tements.
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 2-156-110 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?
[JYes '
^No
NOTE: If you checked "Yes" to Item D.l,, proceed to Items D.2. and D.3. If you checked "No" to
Item D. 1,, 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 afinancialinterest in his or her own name or in the name of
any other person or entity in the purchase of any properly 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 ofthe City (collectively,
"City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power
docs not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Properly Sale?
[JYes

[JNo

3. [f you checked "Yes" to Item D . l , , provide the names and business addresses ofthe City
officials or employees having such interest and identify the nature ofsuch interest:
Name

Business Address

Nature of Interest

4. The Disclosing Party further ceriifics that no prohibited financial interest in the Matter will
be acc}U!red by any City official or employee.
E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please clieck either 1. or 2. below. I f ihe Disclosing Part>' checks 2., the Disclosing Party nnisc
disclose below or in an attachment to this EDS all information icquiicd by paragraph 2. Faiiiirc to
Paae 8 of 13

comply with these disclosure requirements may inake any contract entered into wilh the City in
connectibn with the Matter voidable by the City.
\. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and all predecessor entities regarding records of investments or profits
from slavery or slaveholder insurance policies during the slavery era (including insurance policies
issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and
the Disclosing Party has found no such records.
2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, die
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance
policies. The Disclosing Party verifies that the following constitutes full disclosure of all such
records, including the names of any and all slaves or slaveholders described in those records:

S E C T I O N V I - C E R T I F I C A T I O N S F O R F E D E R A L L Y FUNDED M A T T E R S
NOTE; If the Matter is federally funded, complete this Section VI. If the Matter is not federally
funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City
and proceeds of debt obligations of the City are not federal funding.

- M/aA. 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 wilh
respect to the Matter: (Add sheets if necessary):

(If no explanation appears or begins on the lines above, or if the letters "N.A" 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 P;irty 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 un employee of a
member of Congress, in connection with the award of any federally funded coiitract, making any
t'ederally funded grant or loan, entering into any cooperative agreement, or to e;<iend, continue, renew,
amend, or modify any federally funded contract, grant, loan, or cooperative agreement.
Pa^e 9 of 13

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.
4. The Disclosing Parly certifies that cither: (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 Ihc Applicant, the Disclosing Party must obtain certifications equal in
form and substance to paragraphs A . l . through A.4. above from all subcontractors before it awards any
subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the
duration ofthe Matter and must make such certifications promptly available to the City upon request.

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.
Is the Disclosing Party the Applicant?
[]Yes

[JNo

If "Yes," answer tiie three qucstion.s 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.)
[JYes
[JNo
2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal
Contract Compliance Programs, or the Equal Employment Opportunity Commiss.ion all reports due
under the applicable filing requirements?
[ J Yes
[ J No
3. Have you i^articipatcd in any previous contracts or subconiracts subject to the
equal opportunity clause?
[ J Yes
[ j No
If you checked "No" to question 1. or 2. above, please provide an explanation-

Patic 10 of 13

SECTION V n - ACKNOWLEDGMENTS, CONTRACT INCORPORATION,

COMPLIANCE, PENALTIES, DISCLOSURE
The Disclo.sing Party understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any
contract or other agreement between the Applicant and the City in connection with the Matter, whether
procurement, City assistance, or other City action, and are material inducements to the City's execution
of any contract or taking other action with respect to the Matter. The Disclosing Party understands that
it must cmriply with all statutes, ordinances, and regulations on which this EDS is based.
B. 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 wwwxitVofchicBgo.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.
C. I f 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 or
void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or
declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at
law for a false statement of material fact may include incarceration and an award to the Ciiy of treble
damages.
D. It is the City's policy to make this docuiuent available to the public on its Internet site and/or upon
request. Some or all of tiie information provided on this EDS and any attachments to this EDS may be
made available to the public on the Tntcrnei, in response to a Freedom of Information Act request, or
otherwise. By completing and signing this EDS, the Disclosing Party v/aives 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.
E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing
Party musi supplement this EDS up to the'time the City takes action on the Matter. I f the .Matter is a
contract being handled by Che City's Deparlmenl of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of
Chapter ! -23 ofthe Municipal Code (imposing PERMANENT I N E L I G I B I L I T Y for certain specified
offenses), the information provided herein regarding eligibility must be kept current for a longer period,
as required by Chajjter i-23 and Section 2-154-020 ofthe Municipal Code,
The Disclosing Party represents and warrants lhat:
Paae 11 of 13

F.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 Affiliated Entities 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.
F.2
If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not
use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A, on the federal Excluded
Parties List System ("EPLS") maintained by the U. S. General Services Administration.
F.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 F.l. and F.2. above and will not, without the prior written consent ofthe
City, use any such contractor/subcontractor that does not provide such certifications or that the
Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.
NOTE; If the Disclosing Party cannot certify as to any ofthe items in F.L, F.2. or F,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 and Appendix A (if applicable) on behalf of the Disclosing Party, and (2) warrants that all
certifications and statements contained in this EDS and Appendix A (if applicable) are true, accurate
and complete as of the date furnished to the City.

(Print or type name qfpisttlosing Party)

B
(Sign here)

(Print or type name of person signing)

(Print or type title of person signing)

Signed and sworn to before me on (date) O i ^ O ^ ^ ^/

^'
<^oo t^
County,
Z^:;
(state).

___iGlHrSEAL'
N,ftw,Pd*cSbtorfHteofa

Notarv Public.
Commission expires:* ^

?
Page 12 of 13

|IJ>J>IIWl*tf'll''^

CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A

FAMILIAL RELATIONSIUPS WITH E L E C T E D CITY OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in tlie Applicant exceeding 7.5 percent. I t Is not to be completed by any legal entity
which has only an Indirect ownership interest in the Applicant.
'
Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party
or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relutionship" with
any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is
signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Parmer thereof is related to
the mayor, any alderman, ihe city clerk, the city treasurer or any city dcparlmciU head as spouse or domestic
partner or as airy of the following, whether by blood or adoption; parent, child, brother or sister, aunt or uncle,
niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather
or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., i f tlic
Disclosing Party is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general
partnership; all general pm'tiiers and limited partners of the Disclosing Party, if the Disclosing Party is a limited
partnership; all managers, managing members and members ofthe Disclosing Party, i f the Disclosing Party is a
limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than
a 7.5 percent ownership inlerest in the Disclosing Party. "Principal officers" means the president, chief
operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person
exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof uunenily
have a "fantilial relationship" with an elected city official or department iicad?
[ J Yes

^ N o

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

Page 13 of

CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX B
BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity
which has a direct ownership interest in the Applicant exceeding 7.5 percent (an "Owner").
It is not to be completed by any legal entity which has only an indirect ownership interest in
the Applicant,
1. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a
building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal
Code?
[ JYes

P><No

2, If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of
the Applicant identified as a building code scofflaw or problem landlord pursuant to Section
2-92-416 of the Municipal Code?
[ J Yes

[ J No

Not Applicable

3. If yes to (1) or (2) above, please identify below the name ofthe per.son or legal entity
identified as a building code scofflaw or problem landlord and the address ofthe building or
buildings to which the pertinent code violations apply.

FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT

AND AGREEMENT THAT THIS APPENDIX B IS INCORl^OIUTED BY
lUSFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS,
AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE
SUBJECT TO THE CERTIFICATION MADE UNDER PENAL FY OF
PER.R,IRY ON PAGE 12 OF THE ASSOCIATED EDS.

u
Q

IS

>