City of Chicago 02019-6843 Office of the City Clerk Document Tracking Sheet
Meeting Date: 9/18/2019 Sponsor(s): Misc. Transmittal Type: Ordinance Title: Zoning Reclassification Map No. 2-1 at 731-799 S Washtenaw Ave and 2609-2659 W Harrson St - App No. 20196 Committee(s) Assignment: Committee on Zoning, Landmarks and Building Standards ORDINANCE
JT ORDAINED BY THE CfTY COUNCIL OF THE CITY OF CHICA GO:
SECTION I. Title 17 ofthe Municipal Code ofChicago, the Chicago Zoning Ordinance, is hereby amended by changing all of the Ml-1 Limited Manufacturing/Business Park District and Cl-2 Neighborhood Commercial District symbols and indications as shown on Map. No. 2-1 in the area bounded by:
The centerline of West Harrison Street; the west boundary ofthe Union Pacific Railroad Right of Way; the centerline of West Polk Street; the west boundary ofthe Union Pacific Railroad right of way; the north line of West Taylor Street; a line that is parallel to and 19.50 feel east ofthe west line of vacated South Washtenaw Avenue; the south line ofthe first 16-foot east-west alley south of West Polk Street; the west line of vacated South Washtenaw Avenue; the centerline of West Polk Street; the centerline of South Washtenaw Avenue.
to those of a C3-1 Commercial, Manufacturing and Employment District then to an Institutional Planned Development which is hereby established in the area described.
SECTION 3. I his ordinance takes effect after its passage and publication.
Address of Propcrt>': 731-799 South Washtenaw Ave./2605-59 West Flarrison Street
25838468 1 CHICAGO HOPE ACADLlMY & CHICACO LIONS CHARITABLE ASSOCIATION PROPOSED INSTI rU riONAL PLANNED DLVELOPfVlENT NARRATIVE
1. .\p plica nts
A. Chicago Lions Charitable Association
The Chicago Lions Charitable Association is a 501(c)3 not-for-profit association (the "CLCA"). CLCA lostcrs and promotes rugby sports competition more broadly among the genei'al populations. Through this multi-generational charitable approach, CLCA can promote healthy physical activities in a competitive environment.
li. Chicago Hope Academy
Chicago Hope Academy is a 501 (c)3 Illinois corporation (the "CHA"). CHA is a private Christian academy currently operating at 2189 West Bowler Street, the former home of St. Callistus school, located on the near west side of Chicago. Since 2015, CFIA has provided College Prep curriculum vvith a commitment to small classrooms, as its average classroom size includes 12 students. CHA's existing high school consists of 230 students, 20 teachers and 14 staff members. CFIA's plan for its high school campus CHA/CLCA's plans for its athletic fields are detailed in 111 below.
11. Existing Site Conditions
The subject property is generally bounded by West Harrison Street on the noilh, West 'faylor Street on the south, South Washtenaw Avenue on the west and the elevated portion ofthe Union Pacific Railroad on the east. The subject property consists ofa net silc area of 859,371 square feet and is partially improved with a) existing 2-slory Quest gymnasium and an outdoor running track, b) west athletic field (projected completion August 2019) and c) 112 existing parking spaces, fhe lemainder of the Subject Property is vacant.
The Subject Propeity is located within the Ml-1 District and C3-1 LOistricts.
A. Wcstern/Ogdcn Industrial Corridor
fhe Subject Propeity is located within the Western/Ogdcn Industrial Corridor. The portion ofthe site is in a geographically remote and isolated section ofthe Industrial Corridoi", al lis northern and most westem point and is bordered by residential zoning and open space. The I'aised Union Pacific I'ailroad is localed lo the easl. The properly .soulh of Wcsl Taylor Sireel (and subjecl to the proposed Special l'se), is a large parcel
1
25838318 2 occupied by a vacant industrial building. I'heie is no active industrial use in this seclion ofthe Industrial Corridor or close lo the Subject Property.
fhe paucity of industry in llie area is refiected in cniployment numbers. The study of Industrial Corridors commissioned by the City's Deparlmenl of Planning & Development in 2013 documented a 44.3% employment loss overall in the Weslern/Ogden Industrial Con idor between 2002 and 201 1. Fhe proposed school and community athletic fields complement the nearby homes and Altgeld Park. As such, they aie vei-y good land uses lor transition from the eommercial/manufacturing activities lo the soulh and the residential uses on the west and north.
111. Proposed Institutional Planned Development
•fhe Applicants, CLCA and CHA, are seeking a Planned Development in order to construct an interactive school campus, which will include a private high school, two communily athletic fields, indooi'/outdoor athletic facilities and accessory parking lot(s) for a total of 612 on-site parking spaces, of which 325 off-site accessoi'v parking spaces will seek Special Use approval simultaneously with the proposed Planned Development. As the Subject Property exceeds 2 acres, a Mandatory Planned Development is required in order to establish the proposed school campus. (Section 17- 8-0506 ofChicago Zoning Ordinance).
A. Proposed Athletic Fields
CLCA plans to develop two (2) artificial turf community athletic fields, a fieldhouse (consisting of 11,000 sq. ft.) and accessory parking. The athletic fields, containing a total of 352,052 square feet, will include seating for 6,120 people. Spectator and participant sports will be played on both the east and west athletic fields. Construction ofthe west athletic field is scheduled for completion in August 2019. Adequate lighting vvill be provided at both athletic fields for evening activities. CLCA also plans to possibly seasonally "dome" the eastern athletic field and establish a mid-block crosswalk between the athletic fields lo CIIA's proposed high school described belovv.
1) U.se and Availability of Athletic Fields
CLCA intends lhal the athletic fields be utilized to the fullest extent possible, and vvill be utilized by both CH.A. and CLCA. It is envisioned that olher entities, such as the Noble Chatter schools, CPS schools (elementary, middle and high school) localed vvilhin close pioxiniity ofthe subjecl pioperty vvill also be able lo use the fields.
25838318 2 The athletic fields vvill also be available lo neighborhood based and volunteer driven leagues, eooixlinaled by the CLCA/CHA managers. Youth rugby and soccer leagues ai'e also envisioned in eonjunction vvith Rugby Illinois. Chieago Wapiti Ru In addition lo CH.A sports, the founder of Chicago Hope, Bob Muzikovvski, founded the Near West Little League (NWLL) in 1995, which has culminated inlo the largest urban Little League. NWLL has been continuously operating at Allgeld Park, Livingston Park (Park 510), Skinner Park, Sheridan Park and other west side paiks. NWLL vvill have access to CHA/CLCA alhlelie fields, of which the eastern "domed" field vvill prove useful for practices during the pi'olonged Chicago winter season In addition to actual players, the proposed athletic fields will bring in a large number of spectators. CLCA rugby matches will bring in 60 players and coaches, and approximately 500 spectators. However, the number of spectators vvill inei'ease due to the growth of the Lions for Hope youth academy's rugby events. CHA matches, as well as Noble and other youth matches, will include approximately 40- 50 players and less lhan 50 spectators. CHA/CLCA's athletic fields could also "host" soccer or rugby feslivals. For example, 8 teams playing on the flelds throughout one day could generate up to 250 players and coaches, as well as 750-1000 spectators. 2) Days and Hours of Operation The Applicant is finalizing its Spring, Summer and Fall schedules which will dictate the days and hours of operation specific to each user of its proposed athletic fields. H. Community Amenities CHA and CLCA plans to establish amenities for the neighborhood, as well as CHA students and CLCA I'ugby players and spectators can enjoy. Such amenities include the following: Dog Pai-k: 2,500 sq. It. Community Gaiden: 1,300 sq. ft. Memorial, Flags & Donor Recognition Wall: 650 sq. fl. Enti-y Gathering Tenace: 4,900 sq. ft. Playground: 2,300 sq. ft. Pickleball Courts: 5,700 .sq. fl. Tennis Court: 9,000 sq. fl. Balling Cage: 1,800 .sq. fi. 25838318 2 C. Chieago Hope Academy High School To the noith ofthe athletic fields, CHA proposes lo consiruel a new building (consisting of 148,836 sq. It.) which vvill serve as a private (reduced tuition) high school. With a pedestrian link between its proposed school building and Quest Multiplex (consisting of 55,794 sq. ft. and vvhich vvill continue as a eommeicial lacilily), CHA's overall school facility vvill consist ofa total of approximately 205,000 sq. ft., including indoor basketball courts among other athletic uses. CHA has a projected student enrollment of approximately 600 students. The proposed school vvill include a gymnasium, existing football field and track, and 1,000 bleacher seats. Accessory paiking vvill be provided for use by faculty and staff The high school's proposed hours of operation will be M-F 7:00 a.m. ~ 6:00 p.m., detailed as follows: • School: 7:00 a.m. - 3:00 p.m. • Athletics and Afier School activities: 3:30 p.m. - 5:30 p.m. • Weekends and Summer: 8:00 a.m. - 4:00 p.m. In terms of transportation, 60% of students will take public transportation, 25% of students will be dropped ofi" at the school and 15% ofthe students will walk or ride bikes. CHA does nol offer a bus system and it is against CFIA policy for students to drive to school. D. Proposed parking lot CLCA and CHA are planning on purchasing the city owned property, consisting of 122,397 square feet, located directly .south of West Taylor Street (2601 West Taylor). In addition, CLCA and CHA are in active discussions with American Tower, in regards lo potential lease or sale ofthe area directly east of its cell tower in order to include such property in Applicants proposed development. Although the propo.sed parking loi is part ofthe Applicants' interactive school campus, this propeity soulh of West 'faylor Street will be established as off-site accessory parking through Special Use approval. 25838318 7. K. Proposed PD uses fhe proposed uses include ihe follovving: • Sports and Recreation, Parlieipant, Outdoor & Indoor • Spectator Spoits, Lai'ge Venue (1,000+ capacity) • School • Accessoi'v Pai'king • Communily Centers, Reci"eation Buildings and Similar Assembly Use F. CHA incubator Chicago Hope Academy plans to operate a business incubator within the proposed interactive school campus. The business incubator program(s) vvill focus on providing services to individuals seeking to establish careers in vocational ti'ades, including consti-uction and automotive trades, CFIA's proposed business incubator program vvill be offered not only CHA high school students, but participants in other programs (i.e. Chicago CRED). G. Community outreach A community meeting detailing CLCA & CHA's proposed project was hosted by Alderman Jason Ervin on January 17, 2018, and the Applicants have participated in subsequent meelings with Alderman Ervin. 11. Cit>' Funds or Incentives No public incentives are being sought. Applicants are seeking to purchase City- owned property al 2601 West Taylor through the City's Negotiated Sales process. 1. Sustainable Development Policy Applicants aie awai'e ofthe Cily of Chicago's Sustainable Development Policy lor Planned Development projects. The Applicants will identify the options from the Sustainable Strategies Menu that it vvill utilize during ils proposed phases of development and submil prior to pi'esentation of the pi'oposed Planned Development befoie the Chicago Plan Commission. J. MBE/WBE Hirin*^ Strategy The Applicants are aware of ihe Cily's MBF/WBF policy Ibr Planned Development projects. The City has adopted employment goals of 26% MBE, 6% WL^E, 50% Cily Residency, of which 10% includes lesidents from the 28''^ ward. The Applicants are aware of these goals as they apply nol only due lo the PD, bul also due to ils pi'oposed acquisition of cily-owned properly (2601 West Taylor). 25838318 2 fhe Applicants vvill develop a sli'aiegic plan lor marketing those jobs, and understands lhal il will be required to submit ils plan lo Department of Planning & f)evelopmenl prior to presenlalion of the proposed Planned Development lo the Plan Commission. 25838318 2 STANDARD PLANNED DEVELOPMENT STATEMENTS The Planned Development Statements describe the legal regulations and conditions that vvill control the development ofthe proposed project. The follovving statements shall be included in the ordinance; any proposed changes lo these statements must be discussed and reviewed with the Chieago Department of Planning and Development. 1. The area delineated herein as Institutional Planned Development Number , (Planned Development) consists ofa net site area of approximately 859,371 square feet of propeity which is depicted on the attached Planned Development Boundai-y and Property Line Map (Property) and is owned or controlled by the Applicants, Chicago Hope Academy and Chicago Lions Charitable Association, 2. The lequirements, obligations and conditions contained within this Planned Development shall be binding upon the Applicant, its successors and assigns and, if different than the Applicant, the legal title holders and any ground lessors. All rights granted hereunder to the Applicant shall inure to the benefit ofthe Applicant's successors and assigns and, if difierent than the Applicant, the legal title holder and any ground lessors. Furthermore, pursuant to the requirements of Section 17-8-0400 ofthe Chicago Zoning Ordinance, the Property, at the time of application for amendments, modifications or changes (administi'ative, legislative or otherwise) lo this Planned Development are made, shall be under single ownership or designated control. Single designated control is defined in Section 17-8-0400. 3. All applicable official reviews, approvals or permits are required lo be obtained by the Applicant or its successors, assignees or grantees. Any dedication or vacation of streets or alleys or grants of easements or any adjustment ofthe right-of-way shall lequire a separate submillal to the IDeparlment of Transportation on behalf of the .Applicant or its successors, assigns or gi'antees. Any requests for grants of privilege, or any items encroaching on the publie way, shall be in complianee with ihe Planned Development. Ingress or egress shall be pursuant to the Planned Development and may be subject to the review and appioval of the Departments of Planning and Development and Transporlalion. Closure ofall or any public sli'eet or alley during demolition or constiuclion shall be subjecl lo ihe review and approval ofthe Depaitment of'franspoitalion. Pursuant to a negotiated and executed Perimeter Restoration Agreement ("Agreemenf") by and between the Depaitment of Transportation's Division of InlVastructiii-e Management and the .Applieanl, the .Applicant shall provide improvements and restoration of all publie way adjacent lo the property, vvhich may include, but nol be limited lo, the t'ollovving as shall be reviewed and determined by the Departmenl of Transporlalion's Division of InlVaslrueture Manaiieincnt; A|)|)liceintS' Chicago Hope Acadcrny/Chiciiiio Lions Charitable Associalion .Address 7;i I-799 South Washteiiau,/260.5-.-=i9 Wcsl ILirrison Street DiitiL-t)!'Introdiicticii September IS, 2019 Phiii Comirnssit)n • Full width of streets • Full width of alleys • Curb and gutter • Pavement markings • Sidewalks • ADA crosswalk ramps • Parkway & landscaping 'fhe Perimeter Restoration Agreement must be executed prior to any Department of Transportation and Planned Development Part II review permitting. The Agreement shall refiect that all work must comply with current Rules and Regulations and must be designed and constructed in accordance with the Departnient of Transportation's Construction Standards for work in the Publie Way and in compliance with the Municipal Code of Chicago Chapter 10-20. Design of said improvements should follow the Depaitment of Transportation's Rules and Regulations for Construction in the Public Way as well as The Streei and Site Plan Design Guidelines. Any variation in scope or design of public way improvements and restoration must be approved by the Departmenl of Transpoitation. This Plan of Development consists of 17 Statements: a Bulk Regulations Table; an Existing Zoning Map; an Existing Land-Use Map; a Planned Development Boundary and Property Line Map; ; Overall Site Plan; Proposed Site Plan (North Half); Proposed Site Plan (South Flail); Pedestrian and Vehicular Access Plan; Floor Plans; Landscape Plans and Building Elevations (North, South, East and West) prepared by Team Aj Architecture and dated (date of Plan Commission presentation), submitted herein. Full-sized copies of the Site Plan, Landscape Plan and Building Elevations are on file with the Department of Planning and Development. In any instance where a provision of this Planned Development eonllicts vvith the Chicago Building Code, the Building Code shall control. This Planned Development conforms to the intent and purpose ofthe Chicago Zoning Ordinance, and all requirements thereto, and satisfies the established criteria for approval as a Planned Development. In ease of a confiict between the terms of this Planned Development Ordinance and the Chieago Zoning Ordinance, this Planned Development shall control. The following uses are permitted in the ai'ca delineated herein as a Planned Development TBD: (lisl uses as ihey are defined in the Chieago Zoning Oi'dinance). . • Sports and Recreation, Paiticipant, Outdoor & Indoor • Spectator Sports, Large Venue (1,000+ capacity) • School • Accessory Parking • Comnuiniiv Centers. Recreation Buildinus and Similar Assembly Use Applic;inis: Chicauo l lope Acaclcmy/C'hiciigo Lions Chai itable Association Address: 7!) 1-799 South \Vashtcna\v/26().v59 West Harrison Street Date of Introduction September 18,2019 I'laii C'limmission 6. The exisling 2-story building, in which Quest Mullisport is located, will continue operating as a commercial facility. The Applicants' proposed Planned Development vvill nol impede on Quest's ability to continue lo rent its indoor basketball courts/athletic facilities lor a fee to the general public. 7. The overall development will include a total of 612 parking spaces, including 287 on-site accessory parking spaces and 325 off-site accessory parking spaces. The proposed 325 off- site accessory parking spaces will be .secured through Special Use approval. 8. On-Premise signs and temporary signs, such as construction and marketing signs, shall be permitted within the Planned Development, subject to the review and approval of the Department of Planning and Development. Off-Premise signs are prohibited within the boundary ofthe Planned Development. 9. For puiposes of height measurement, the definitions in the Chicago Zoning Ordinance shall apply. The height of any building shall also be subject to height limitations, if any, established by the Federal Aviation Administrafion. 10. The maximum permitted fioor area ratio (FAR) for the Property shall be in accordance with the attached Bulk Regulafions and Data Table. For the purpose of FAR calculations and measurements, the definitions in the Zoning Ordinance shall apply. The permitted FAR identified in the Bulk Regulations and Data Table has been determined using a net site area of 859,371 squaie feet and a base FAR of 1.2, 11. Upon review and determination, Part II Review, pursuant to Section 17-13-0610, a Part 11 Review Fee shall be assessed by the Depaitment of Planning and Development. The fee, as determined by staff at the time, is final and binding on the Applicanl and must be paid lo the Departmenl of Revenue prior to the issuance of any Part II approval. 12. 'fhe Site and Landscape Plans shall be in substantial conformance with the Landscape Ordinance and any other corresponding I'egulations and guidelines, including Section 17-13- 0800. I'inal landscape plan review and approval will be by the Depaitment of Planning and Development. Any interim reviews associated wilh site plan review or Pari II reviews, are conditional until final Part II approval. 13. The .Applicant shall comply vvith Rules and Regulations for the Maintenance of Stockpiles promulgated by the Commissioners of the Depaitments of Streets and Sanitation, Fleet and Facility Managemenl and Buildings, under Section 13-32-085, or any other provision ofthe Municipal Code ofChicago. Applicants: Chicago 1-lopc .Academy/C'hicauo Lions Charitable Association Address: 7.i 1-799 South \Va.^hlena\v./2605-.')9 West Harrison Street Hate ol" liitiodiiction: September IS. 2019 Plan Commission: 14. The terms and conditions of development under this Planned Developmenl ordinance may be modified administratively, pursuant to Section 17-13-0611-A, by the Zoning Adrninislrator upon the application for such a modification by the Applicant, its successors and assigns and, if dilTcTenl than the Applieanl, the legal title holders and any ground lessors. 15. The Applicant acknowledges that it is in the public interest to design, construct and maintain the project in a manner vvhich promotes, enables and maximizes universal access throughout the Property. Plans for all buildings and improvements on the Property shall be reviewed and approved by the Mayor's Office for People with Disabilities to ensure compliance with all applicable laws and regulations related to access for persons with disabilities and lo promote the highest standard of accessibility. 16. The Applicant acknowledges that it is in the public interest to design, construct, renovate and maintain all buildings in a manner that provides healthier indoor environments, reduces operating costs and conserves energy and natural resources. The Applicant shall obtain the number of points necessary to meet the requirements of the Chicago Sustainable Development Policy, in elTect at the time the Part II review process is initiated for each improvement that is subject to the aforementioned Policy and must provide documentation verifying compliance. 17. The Applicant acknowledges that it is the policy ofthe City to maximize opportunities lor Minority and Women-owned Business Enterprises ("M/WBEs") and city residents to compete for contracts and jobs on construction projects approved through the planned development process, lo assist the city in promoting and tracking such M/WBE and city resident paiticipation, an applicant for planned development approval shall provide infoimation at three points in the city approval process. First, the applicant must submit to DPD, as part of its application for planned development approval, an M/WBE Participation Proposal. The M/WBE Participation Proposal must identify the applicant's goals for paiticipation of certified M/WBE firms in the design, engineering and construction of the project, and of city residents in the construction work. Fhe city encourages goals of (i) 26% MBH and 6% WBE participation (measured againsi the total construclion budget for the project or any phase ihereol), and (ii) 50% city resident hiring (measured againsi the total construclion work hours for the project or any phase thereof). The M/WBE Paiticipation Proposal must include a description of the Applicant's proposed oulreaeh plan designed lo inform M/WBFs and cily residents of job and contracting opportunities. Second, al the time ofthe Applieanrs submission for Pait 11 permit review for the projeel or any phase thereof, the Applieanl musl submil to DPI!) (a) updates (if any) lo the Applieanrs preliminary oulreaeh plan, (b) a description of the Applicant's outreach efibits and evidence of such oulreaeh. including, without liniitalion, copies of certified letters lo M/W13E contractor associations and the ward office ofthe alderman in which the project is located and receipts thereof; (e) responses to the Applicant's outreach efforts, and (d) updates (if any) lo the applieanl's M/WBE and cily residenl participation goals, 't hird, prior to issuance of a Certilieate ot Uceupaney for the project or any phase thereof, the Applicant must jirovide Applicants: Chicago Hope Academy/Chicago Lions Charitable Association ,'\dclrcss: 731-799 South Washteiia\v/26().v.59 West Harrison Street Date ol"liitioduction September IS. 2019 Plan C(immissKiii. DPI!) with the actual level of M/WBE and city resident participation in the projeel or any phase thereof, and evidence of such parlieipalion. In addition to the forgoing, DPD may request such additional informalion as the department deteimines may be necessary or useful in evaluating the extent to which M/WBEs and city residents are informed of and utilized in planned developmenl projects. All .such information will be provided in a form acceptable to the Zoning Administrator. DPD vvill report the data it collects regarding projected and actual employment of M/WBEs and city residents in planned development projects twice yearly lo the Chicago Plan CommLssion and annually to the Chicago City Council and the Mayor. 18. This Planned Developinent shall be governed by Section 17-13-0612. Should this Planned Development ordinance lapse, the Zoning Administrator shall initiate a Zoning Map Amendment to rezone the propeity to C.3-1 Community, Manufacturing and Employment District. Ajiplicanls: Chicago Hope Academy/Chicago Lions Charitable Association Address: 7.') 1-799 South Washtcnaw/26()-5-.59 West Harrison Street Date of Introduction: September 18, 2019 Plan Commission- INS'fI'fUTIONAL PLANNED DEVELOPMENT NO. BULK REGULA'flONS AND DATA TABLE Gross Site Area: 958,340 sq. ft. Area of Public Riuht of Wav: 98,969 .sq. ft. Net Site Area: 859,371 sq. ft. Maximum Floor Area Ratio: 1.2 Allowed Uses: All uses identified in Staiement Number 5 Athletic Field Occupancy: 6.120 bleacher seats No. of Off-street Parking Spaces: 612 spaces (as further defined below) Per PD approval (on-site): • Quest Lot (West) 50 Spaces • Quest Lot (East) 62 Spaces • Hope Lot (South) 91 Spaces • CLCA Lot (North-West) 75 Spaces • CLCA Lot (North-East) 9 Spaces Total: 287 Spaces Per Special Use approval (off-site) • CLCA Lot (Apron Cily) 225 Spaces • CLCA Lot (Apron West) 100 Spaces Total: 325 Spaces Bievele Parkinu: 1 per 10 auto spaces No. of Loadine Berths 1 (school) Maximum Buildiim Ilei Minimum Setbacks: In accordance vvith plans .•'\p|iliciinl> Chic;i!;o II(1|K' .Vciulciiis.'Lliiua^o l.iims Chiinlablc .Association .Atkia'ss V.i 1-7W Soulh Wa^llk•llau Ave /2()(i.^-.^M W csl I larrisoii Sl Dale o! 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IL 60612 hi!F2 t I CLCA ATHLETIC FIELD & PARKING LOT /Ill .t 5? 2637 W POLK STREET Hit mn 'li-Wfl CHICAGO, IL 60612 !!!f5 U ': •liis-it : « PLAT OF SURVEY / PO BOUfCARt WEST HARRISON STREET n*si^ Cl- eFAF!i;jr, i^C^.»*1lo^ :L EAG: roiNT or EKcirMrf- I I li.60'-- ^^a&|^f''|32 33 134 35 I 3G 37 138,39 ..O;-l'l II I I I I I I I WEST ARTHINGION STREtT rv.c.TtO) t I /. WEST TAYLOR STREET, "WRITTEN NOTICE" FORM OF AFFIDAVIT (Section 17-13-0107) September 9, 2019 Honorable Thomas M. Tunney Chairman, Committee on Zoning 121 North LaSalle Street Room 304, City Hall Chicago, Illinois 60602 The undersigned, being first duly sworn on oath deposes and states the following: The undersigned certifies that he has complied with the requirements of Section 17-13-0107 of the Chicago Zoning Ordinance, by sending revised 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 lo the owners ofall property within 250 feet in each direcfion ofthe lot line ofthe subject property, exclusive of public roads, streets, alleys and other public ways, or a total distance limited to 400 feet. Said revised "written notice" was sent by First Class U.S. Mail, no more than 30 days before filing the application. The undersigned certifies that the notice contained the address of the property sought to be rezoned; a statement of the intended use of the property; the name and address of the applicanl; the name and address ofthe owner; and a statement that the applicant intends to file the amended application for a change in zoning on approximately September 9, 2019. The undersigned certifies that the applicant has made a bona fide effort to determine the addresses of the parties to be notified under Secfion 17-13-0107 of the Chicago Zoning Ordinance, and that the accompanying list of names and addresses of surrounding property owners within 250 feet of the subject site is a complete list containing the names and addresses of the people required to be served. Subscribed and Sworn to before rpe this W dayofX^CG^-^ ,20 l i olfTcTXTTEAL^ Notary Public 25838344.1 Via USPS First Clas.s Mail September 9, 2019 Dear Property Owner: In accordance with the requirements for an Amendment to the Chicago Zoning Ordinance, specifically Section 17-13-0107, please be informed that on or about September 9, 2019, the undersigned will file an application for a change in zoning from Ml-1 Limited Manufacturing District and C3-1 Commercial, Manufacturing and Employment District to a C3- 1 Commercial, Manufacturing and Employment District then to a Institufional Planned Development on behalf of Chicago Hope Academy and Chicago Lions Charitable Associafion ("Applicants") for the property located at 731-799 South Washtenaw Avenue/2605-59 West Harrison St.in Chicago, Illinois (refer to attached map) ("Subject Property"). The Applicants and Ringgold Capital IV, LLC collecfively own the Subject Property. The Applicants plan to develop the Subject Propeity into an interactive community and school campus which will include a) new 3-story school building (148,836 sq. ft.) with an indoor gymnasium and will operate as a private (reduced tuition) high school; b) existing 2-story building (consisting of 55,794 sq. ft., and operating as Quest Mullisport), which includes indoor basketball courts/athletic facilities vvhich vvill be made available for use by students and community residents and will also continue to operate as a commercial facility; c) pedestrian link connecting the proposed 3-story school building and existing 2-story building d) existing multi- sport, field and track facilifies; d) two (2) community athletic fields, totaling 352,052 sq. ft., and seating for approximately 6,120 people; and e) a new 2-story fieldhouse (11,000 sq. ft.). The Applicants' interacfive school campus will include a total of 612 parking spaces of which 287 parking spaces will be provided onsite and the remaining 325 parking spaces will be located within the adjacent property located directly south of West Taylor Street. The height of the proposed 3-story school building and fieldhouse are 54 feet and 42 feet, respectively. Chicago Hope Academy is located at 2189 West Bowler Street Chicago. IL. Chicago Lions Charitable Association is located at PO Box 532 Northbrook, IL. Ringgold Capital IV LLC is located at 1045 First Avenue, Suite 120 King of Prussia, PA. Please note that the Applicants are not seeking to rezone or purchase your property. The Applicants are required by law to send this notice because you own property within 250 feet of the property to be rezoned. Any questions regarding this notice may be directed to the undersigned. Applicant's attorney, at Tafl, Stettinius & Holli.sler, 1 1 1 Ea.sl Wacker Drive, Suite 2800, Chicago. IL 60601, (312) 836-4036. Very truly yours. Graham C. Gradv 25838351 4 CHICAGO HOPE ACADEMY/CHICAGO LIONS CHARITABLE ASSOCIATION EXHIBIT A I. Applicants Chicago Hope Academy ("CHA") 2189 West Bowler Street Chicago, IL 60612 Telephone no.: 312-491-1600 Email: bobmuzikowskifO/.chicauohopeacademv.com Contact Person: Robert Muzikowski Chicago Lions Charitable As.sociation ("CLCA"') PO Box 532 Northbrook, IL 60065 Telephone no.: 847-921-0872 Email: clca(5).chicaaolions.com Contact Penson: Jeff Simon II. Property Owners A. Chicago Hope Academy Owner (100%) of property located at 2608-60 W. Lexington Ave; 2661 W. Lexington Ave; 919 S. Fairfield Avenue; 2659 W. Flournoy (identified as Parcel B on attached map) (Acquired 9/2012) Owner (50% Tenants in Common) ofthe propeity located at 2611-61 W. Polk Street; 2611-30 West Arthington St.;2646 West Arthington St.;2636 West Taylor St. (identified as Parcel C on attached map). (Acquired 4/2015) B. Chicago Hope Academy/Chicago Lions Charitable Association Owner (50% 'fenants in Common) ofthe properly located at 2611-61 W. Polk Street; 2611-30 West Arthington St.:2646 West Arthington St.;2636 West Taylor St. (identified as Parcel C on attached map). C. Ringgold Capital IV, LLC Owner ofpropcrty located at 2641 West Harrison Streei Ringgold Capital IV, LLC 1045 First .Avenue. Suite 120 King of Prussia, PA 19406 Contact Person: Robert Fedoris 25838342 2 CHICAGO HOPE ACADEMY/CHICAGO LIONS CHARITABLE ASSOCIATION EXHIBIT B In addition to the description provided in #13 ofthe Zoning Amendment Applicafion firm, Applicant's interactive community and school campus will include a total of 612 parking spaces of which 287 parking spaces will be provided onsite and the remaining 325 parking spaces will be located within the adjacent propeity located directly south of West Taylor Street. The height ofthe proposed 3-story school building and fieldhouse are 54 feet and 42 feet, respectively. 25838342 2 September 5, 2019 Chaimian, Committee on Zoning Room 304 -City Hall Chicago, Illinois 60602 Department of Planning & Development Room 905 - City Hall Chicago, IL 60602 To Whom It May Concern: I, Robert Muzikowski, President ofChicago Hope Academy, understands that Graham C. Grady of Taft, Stettinius and Hollister LLP has filed a sworn affidavit identifying Chicago Hope Academy as a) the Applicant of the property bounded by West Harrison Street on the north; South Washtenaw Avenue on the west; West Taylor Street on the south and the elevated portion of the Union Pacific Railroad on the east (identified as Parcel A on attached map) and b) Owner ofthe property located at 2608-60 W. Lexington Ave; 2661 W. Lexington Ave.; 919 S. Fairfield Avenue; 2659 W. Flournoy (identified as Parcel B on attached map) and c) Owner (50% Tenants in Common) of the property located at 261 1-61 W. Polk Street; 2611-30 West Arthington St.;2646 West Arthington St.;2636 West Taylor St. (identified as Parcel C on attached map). Chieago Hope Academy is seeking an amendment of the zoning for the property bounded by West Harrison Street on the north; South Washtenaw Avenue on the west; West Taylor Street on the south and the elevated portion of the Union Pacific Railroad on the east (identified as Parcel A on attached map) to be changed from the existing C3-1 Commercial, Manufacturing and Employment District and Ml-1 Limited Manufacturing/Business Park District to a C3-1 Commercial, Manufacturing and Employment District then to an Institutional Planned Development. I authorize Graham C. Grady and the law firm of Taft, Stettinius & Hollister LLP to file the Planned Development application. 1, Robert Muzikowski, President of Chicago Hope Academy, being first duly sworn on oath, depose and say that Chicago Hope Academy holds ownership interest in 2608-60 W. Lexington Ave; 2661 W. Lexington Ave.; 919 S. Fairfield Avenue; 2659 W. Flournoy (identified as Parcel B on attached map) and 2611-61 W. Polk Street; 2611-30 West Arthington St.;2646 We§^ Arthington St.;2636 West Taylor St. (identified as Parcel C on attached map) on behalf of itself and no other person, as§p4iatk)n^r member. Robert Muzikowski President Chicago Hope Academy SUBSCRIBED AND SWORN to before me this _2_day of ^ 2019 "OFFICIAL SEAL- FEUCIA BUJANSKI 4 A -P NOTARY PUBLIC. STATE OF ILUNOtS IsTOTARY PUBLIC" ,/ MY COMMISSION EXPIRES 8/3/2023 25780306.5 Septembers, 2019 Chairman, Committee on Zoning Room 304 - City Hall Chicago, Illinois 60602 Department of Planning and Development Room 905 - City Hall Chicago, Illinois 60602 To Whom It May Concern: 1, Jeff Simon, President of Chicago Lions Charitable Associalion, underslaiidii that Graham C. Grady of Taft, Stettinius and Hollister LLP has filed a sworn affidavit identifying Chicago Lions Charitable Association as a) the Applicant of the property bounded by West Harrison Street on the north; South Washtenaw Avenue on the west; West Taylor Street on the south and the elevated portion of the Union Pacific Railroad on the east (identified as Parcel A on attached map) and b) Owner (50% Tenants in Common) of the pioperty located at 2611-61 W. Polk Street; 2611-30 West Arthington St.;2646 West Arthington St.;2636 West Taylor St. (identified as Parcel C on attached map). Chicago Lions Charitable Association is seeking an amendment of the zoning for the property bounded by West Harrison Street on the north; South Washtenaw Avenue on the west; West Taylor Street on the south and the elevated portion of the Union Pacific Railroad on the east (identified as Parcel A on attached map) to be changed from the existing C3-I Commercial, Manufacturing and Employment District & Ml-1 Limited Manufacturing/Business Park District to a C3-1 Commercial, Manufacturing and Employment Distnct then to an Institutional Planned Development. 1 authorize Graham C. Grady and the law firm of Taft, Stettinius & Hollister LLP to file the Planned Development application. I, Jeff Simon, President of Chicago Lions Charitable Association, being first duly sworn on oath, depose and say that Chicago Lions Charitable Association holds ownership interest in 2611-61 W. Polk Street; 261 1-30 West Arthington St.;2646 West Arthington St.;2636 West Taylor St. (identified as Parcel C on attached map). JetT! Preside'nt Chicago Lions Charitable Association SUBSCRIBED AND SWORN to before me this 2Ldayof_3;^ 2()19 P^^^OFTTSTAT S EAL' ~7^/7 \J , , y \ FELICIA BUJANSKI 'vT^C^t:^ ( -j^hr^^f^ \ NOTARY PUBLIC, STATE OF ILUNOIS NOTARY PUBLIC // ?MY COMMISSION EXPIRES 8/3/2023 25830241 1 AFFIDAVIT Re: Quest Mullisport, 2641 W. Harrison St., Chicago, Illinois To WTiom It May Concem at the City of Chicago: This affidavit is to inform that Ringgold Capital IV, LLC, owner ofthe Quest Mullisport and property located at 2641 W. Harrison St., Chicago, Illinois, authorizes attomeys of the law firm of Taft, Stettinius & Hollister, LLP, to file an application for a zoning map amendment to change the zoning district ofthe subject property for inclusion of the subject property in a Planned Developgient. Robert Fedoris Date Manager Ringgold Capital IV, LLC 1045 First Avenue, Suite 120 King of Pmssia, PA 19406 Notary: State of XAWnci^ County of Signed (or attested) before nne on Sfptembef "A ,0<:>t°< (date) by "gL^oef-V V^eAcjf X (name(s) of individual(s)). Signature of notarial officer // ' ^ Stamp Ti 11 e of offi ce »ocV«y/^^ l>vj ft c BROOKBH SCHLICTMAN My commission expires: 3*-';^^"^ .ciO^'iL OFFICIAL SEAL Notary PuWic, State ol Illinois MY Commission Expires July 12. 2022 25471553.1 CITY OF CHICAGO APPLICATION FOR AN AMENDMENT TO THE CHICAGO ZONING ORDINANCE 1. ADDRESS of the propei ty Applicant is seeking to rezone: 731-799 South Washtenaw Ave./2605-59 West Harrison St (see attached Parcel A) 90 2. Ward Number that property is located in: 3. APPLICANT Chicago Hope Academy/Chicago Lions Charitable Organization ADDRESS 2189 West Bowler Street CITY Chicago STATE IL ZIPCODE 6O612 PHONE 312-491-1600 „ [email protected] D U ^ m 1 I EMAIL ^ a K CONTACTPERSON Robert Muzikowski (Please note Exhibit A for complete list of Applicants/Property Owners) „ Is the applicant the owner ot the property? YES ^ NO Ifthe applicant is not the owner ofthe property, please provide the following information regarding the owner and attach written authorization from the owner allowing the application to proceed. OWNER Chicago Hope Academy ADDRESS 2189 West Bowler Street (^jjy Chicago STATE IL ZIP CODE 6O612 PHONE 312-491-1600 [email protected] EMAIL CONTACTPERSON Robert Muzikowski If ihe Applicant/Owner ofthe property has obtained a lawyer as their representative for the rezoning, please piovide the follovving inlormation: ATTORNEY Graham C Grady c/o Taft, Stettinius & Hollister LLP 111 East Wacker Dnve Suite 2800 ADDRESS CITY Chicago STATE IL ZIPCODE 6O6OI PHONE 312-836-4036 FAX EMAIL 9gi'ady@taftlaw com Page 1 Ifthe applieanl is a legal enlily (Corporation, LLC, Partnership, etc.) please provide the names ofall owners as disclosed on ihe Economic Disclosure Statements. Applicants include Chicago Hope Academy and Chicago Lions Charitable Association and are 501(c)(3) not-for-profit corporations 7. On what date did the owner acquire legal title to the subject property? ^^^^^ ^° Exhibit A 8. Has the present owner previously rezoned this property? Ifyes, when? No ManufaX'mg and''^^''*"''"^ ^ ^^"^ Commercial, C3-1 Commercial, Manufactunng and „ „ _ . „. Emolovmpnt District , T • -r^- • Employment District then to Institutional 9. Present Zoning District ^rnp\oymem uisinct Proposed Zoning District piannpd npvpinpmpnt 10. Lot size in square feet (or dimensions) 958,320 sq. ft. (22 acres) The subject property is partially improved with an existing 2-story gymnasium, operated by ,, ^. , Quest Mullisport, outdoor running track, athletic field (located on the westren portion of the 1 I. Current Use of the property_^^^^„p3^rty) and 112 e.xisting parking spa^s. Tiie remainder of the subject property ,s vacant and unimproved I 2. Reason fpr rezonine ihe propertv The Applicants plan to develop the property with an interactive community and school campus, wnich wnl inclStle a rlew 3-stal'y school building wt indoor gymnasium, two (2) community athletic fields, a 2-story fieldhouse, existing multi-sport, field and track facilities and the existing 2-story building, which will continue to operate as Quest Mullisport As the property exceeds"2'acres in size, a mandatory Planned Development is required in order to permit the proposed school campus 13. Describe the proposed use ofthe property after the rezoning. Indicate the number of dwelling units; number of parking spaces; approximate square footage of any commercial space; and height ofthe proposed building. (BE SPECIFIC) The subject property will be developed with an interactive community and school campus which will include a) new 3-story school building (148,836 sq ft) with an indoor gymnasium and operate as a private (reduced tuition) high school, b) existing 2-story building consisting of 55,794 sq. ft. which will continue to operate as Quest Mullisport, which includes indoor basketball courts/ athletic facilities and will be made available for use by students and community residents and continue as a commercial facility, c) a pedestnan link connecting the proposed 3-story school building and existing 2-story Quest Mullisport building, d) existing multi- sport, track and field facilities, d) two (2) community athletic fields containing a total of 352,052 sq ft, with sealing"for 6.120 people and e) a new 2-story fieldhouse (11,000 sq feet) (Refer to Exhibit B for continued description of proposed use of property) 14. The Affordable Requrements Ordinance (ARO) requires on-site affordable housing units and/or a financial coniribulion for residential housing projects vvith len or more units that receive a zoning change which, among olher triggers, increases the allowable fioor area, or, for existing Planned Developments, increases the number of units (see attached fact sheet or visil vvwvv.cilyofchicago.org/ARO for more information). Is this project subject to the ARO? X 13 YES NO Page 2 COUNTY OF COOK STATE OF ILLINOIS I, Robert Muzikowski, as President and on behalf of Chicago Hope Academy being first duly swom on oath, states that all of the above statements and the statements contained in the documents submittedTherewfth arejtate-and correct. Signature of Applicant Subscribed and Swom to before me this 2 day ofSgfkmhl^I--^ ^^-Ifj- "OFFICIAL SEAL" FELICIA BUJANSKI NOTARY PUBUC. STATE OF ILUNOIS Notary Public MY COMMISSION EXPIRES 8/3/2023 For Office Use Only Date of Introducfion: File Number: Ward: 25610537.2 CITYOFCHICAGO ECONOiVllC DISCLOSURE STATEMENT AND AFFIDAVIT SECTION 1 ~ GENERAL INFORMATION A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ ifapplicable: Chicago Hope Academy Check ONE of the following three boxes: Indicate whether the Disclosing Party submitting this EDS is: 1. [x] the Applicanl OR 2. [ ] a legal entity currently holding, or anticipated to hold within six months after City action on the contract, transaction or other undertaking to which this EDS pertains (referred lo below as the "Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. Stale the Applicant's legal name: OR 3. I ] a legal entity with a direct or indirect right ofcontrol ofthe Applicant (see Section 11(B)(1)) Stale the legal name ofthe entiiy in which the Disclosing Party holds a right ofcontrol: B. Business address ofthe Disclosin" Party: 2189 w Bowler street Chicago, IL 60612 C. Telephone: 312-491-1600 p^x: 312-49I-I6I6 Email: bmuzikowski@chicaqohopeacademv org D. Name of contact person: Robert Muzikowski E. Federal Employer Identification No. (ifyou have one): F. Brief description ofthe Matter to which this EDS pertains. (Include project number and location of propeity. if applicable): Planned Development application for the property bounded by West Harrison Street on the north, South Washtenaw Avenue on the east, West -Tayloi^tfeet-en the south and the elevated portion of the Unten-Paetfie-R-atlroad-on-the east (identified as Parcel A on-attaehed-map) G. Which City agency or department is requesting this EDS? Department of Planning & Development Ifthe Matter is a contract being handled by the City's Depaitment of Procurement Services, please complete the follovving: Specification # and Contract # Ver.2018-1 Pauclofl5 SECTION 11 - DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARFY I. Indicate the nature ofthe Disclosing Parly: [ ] Person [ ] Liinited liability company [ ] Publicly registered business corporation [ ] Limited liability paitnership [ ] Privately held business corporation [ ] Joint venture [ ] Sole proprietorship [x] Not-for-profit corporation [ ] General paitnership (Is the not-for-profit corporalion also a 501(c)(3))? [ ] Limited partnership [^ JYes [ ] No [ ] Trust [ ] Other (please specify) 2. For legal entities, the state (or foreign country) of incorporation or organization, ifapplicable: Illinois 3. For legal entities nol organized in the State of Illinois: Has the organization registered to do business in the Slate of Illinois as a foreign entity? [ ] Yes [ ] No I XI Organized in Illinois B. IF TFIE DISCLOSING PARTY IS A LEGAL ENTITY: 1. List below the full names and tilles, ifapplicable, of: (i) all executive officers and all directors of the entiiy; (ii) for not-for-profit corporations, all members, ifany, which are legal entifies (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administralor, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any other person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant. NOTE: Each legal entity listed below must submit an EDS on its own behalf. Name Title See attached list of officers and directors (none are legal entities) 2. Please provide the follovving informalion concerning each person or legal entiiy having a direct or indirecl, current or prospective (i.e. within 6 months alter City action) beneficial interest (including ownership) in excess of 7.5% ofthe Applicant. Examples of such an interest include shares in a corporation, partnership interest in a parinership or joint venture, interest ofa member or manager in a Vfr.2018-1 Pa!ze2ofl5 Chicago Hope Academy BOARD MEMBERS NAME POSITION COMPANY YEARS ON BOARD Robert E. Muzikowski Founder and President Chicago Hope Academy 13 years Jim Sharman Board Secretary COO of Coyote Logistics 9 years Curtis Hart Member Founding Partner, Manna 6 years Capital Alex Moore Member Managing Director at Loop 5 years Capital Markets, LLC Simon Blanks Member Sales Director-The 6 years Enterprise Cloud Company Gregg E. Vann Member Tax and Investment 6 years Consultant at James T. Borello & Co Rev BJ Weber Member Head Pastor at New York 13 years FellowshiD Church Peter Giersch Men^iber The Giersch Group 2 years David Lewis, Atty. Member Darrell & Bailee 1 year Joshua Cauhorn. Atty.' Member Burke. Warren, MacKay & 1 year Sernteila 'taught at Hope 3 years prior to Law school limited liability company, or interest ofa beneficiary ofa trust, estate or other similar entity. If none, state "None." NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf. Name Business Address Percentage Interest in the Applicant None SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS Flas the Disclosing Parly provided any income or compensation to any Cily elected oftlcial during the 12-moiith period preceding the date ofthis EDS? [ ] Yes |x ] No Does the Disclosing Party reasonably expect to provide any income or compensation lo any City elected official during the 12-nionth period following the date ofthis EDS? [ ] Yes [x ] No Ifyes" to either ofthe above, please identify below the name(s) of such City elected official(s) and describe such income or compensation: Does any City elected official or, to the best ofthe f)isclosing Party's knowledge after reasonable inquiry, any Cily elected official's spouse or domestic paitner, have a financial interest (as defined in Chapter 2-156 ofthe Municipal Code ofChicago ("MCC")) in the Disclosing Party? [ ] Yes [X] No If "yes," please identify below the name(s) of such Cily elected official(s) and/or spouse(s)/doiiiestic paitner(s) and describe the financial interest(s). SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES The Disclosing Party musl disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), accounlanl, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relalionship, and the total amount ofthe fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Parly's regular payroll. Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the l!)isclosing Party must either ask the Cily whether disclosure is required or make the disclosure. Ver.2018-1 Pane3ori5 Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether retained or anticipated Address (subcontractor, attorney, paid or estimated.) NOTE: to be retained) lobbyist, etc.) "hourly rate" or "l.b.d." is not an acceptable response. Taft, Stettinius & Hollister (retained) 111 East Wacker Dnve Chicago, IL 60601 Attorney $35,000 (estimated) Team A|Architecture (retained) 405 West Superior St Chicago, IL 60654 Architect $25,000 (estimated) (Add sheets if necessary) [ ] Check here ifthe Disclosing Party has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS A. COURT-ORDERED CHILD SUPPORT COMPLIANCE Under MCC Seclion 2-92-415. substantial owners of business entities that contract wilh the City must remain in compliance wilh their child support obligations throughout the contract's term. Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child suppoit obligations by any Illinois court of competent jurisdiction? [ ] Yes [ ] No [X] No person directly or indirectly owns 10% or more of the Disclosing Parly. If "Yes," has the person entered into a court-approved agreement for paynient ofall support owed and is the person in compliance with lhal agreement? [ ] Ycs [ ] No B. FURTHER CERTIFICATIONS 1. [This paragraph 1 applies only ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the dale ofthis EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) belovv] has engaged, in connection with the performance of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue vvith a contract in progress). 2. I hc Disclosing Party and its Affiliated Eniiiies are not delinquent in the payment of any fine. fee. tax or other source of indebtedness owed to ihe City ofChicago. including, but not limited to, water and sewer charges, license fees, parking tickets, propeity taxes and sales laxes, nor is the Disclosing Party delinquent in the paynient of any tax administered by ihe Illinois Depariment of Revenue. Vei-.201S-1 PaLic4ofl5 3. The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) of this EDS: a. arc not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government; b. have not, during the 5 years before the date ofthis Ef^S. been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting lo obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlemenl; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen propeity; c. are nol presently indicted for, or criminally or civilly charged by, a governmental enlity (lederal, state or local) with committing any ofthe offenses set forth in subparagraph (b) above; d. have not, during the 5 years before the date ofthis EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and e. have nol, during the 5 years before the date ofthis EDS. been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including acfions concerning environmental violations, instituted by the City or by the federal government, any slate, or any other unit of local governnient. 4. The Disclosing Party understands and shall comply vvith the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics). 5. Certifications (5), (6) and (7) concern: • the Disclosing Patty; • any "Contractor" (meaning any conlractor or subcontractor used by the Disclosing Parly in conneclion vvith the Matter, including but not limited to all persons or legal entities disclosed under Seclion IV, "Disclosure of Subcontractors and Other Retained Parties"); • any "Affiliated Entiiy" (meaning a person or enlity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entiiy). Indicia ofcontrol include, without limitation: interlocking inanagement or ownership; identity of interests among family members, shared facilities and equipment: common use of employees: or organization ofa business entiiy following the ineliaibilitv ofa business entitv to do business vviUi 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 Enlity means a person or entity that directly or indirectly controls the Conlraclor. is controlled hy it, or, with the Conlractor, is under common control of another person or enlily: • any responsible official ofthe Disclosing Parly, any Contractor or any Affiliated Entity or any other official, agent or employee ofthe Disclosing Parly, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization ofa responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively ".Agents"). Vcr.2018-1 Pauc5ori5 Neither the Disclosing Party, nor any Conlractor, nor any Affiliated Entiiy of either the Disclosing Parly or any Conlractor, nor any Agents have, during the 5 years before the date ofthis EDS, or, with respect to a Conlraclor, an Aftllialcd Entity, or an Affiliated Entity ofa Conlractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter: a. bribed or aitempted 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 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 agreenient, 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 subparagraph (a) or (b) above lhal is a matter of record, bul have not been prosecuted for such conduct; or d. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracls Requiring a Base Wage); (a)(5)(Debarment Regulafions); or (a)(6)(Minimum Wage Ordinance). 6. Neither the Disclosing Parly, nor any Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is haired 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-rolating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United Stales of America that contains the same elements as the offense of bid-rigging or bid-rotating. 7. Neither the Disclosing Party nor any Affilialed Entity is listed on a Sanctions Lisl maintained by the United States Depaitment of Commerce, State, or Treasury, or any successor federal agency. 8. [FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23. Article I for applicability and defined terms] ofthe Applicant is currently indicted or charged with, or has admitted guilt of. or has ever been convicted of, or placed under supervision for. any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee ofthe City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business vvith the City. NO'fE: If MCC Chapter 1-23. Article I applies lo the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V. 9. [FOR APPLICANT ONLY] The Applicant and its .Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM"). 10. [FOR APPLICANT ONLY] The Applicanl vvill obtain from any contractors/subcontractors hired or to be hired in connection vvith the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and vvill not, without the prior written consent ofthe Cily, use any such Ver.2018-1 Paue6ofl5 contractor/subcontractor that does not provide such ceitifications or that the Applicant has reason to believe has not provided or cannot provide truthful ccrtitieations. 11. Ifthe Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Ceitifications), the Disclosing Party must explain belovv: NA Ifthe letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements. 12. To the best ofthe Disclosing Paity's knowledge alter reasonable inquiry, the following is a complete list ofall current employees ofthe Disclosing Party vvho were, al any time during the 12- nionlh period preceding the date ofthis EDS, an employee, or elected or appointed official, ofthe Cily ofChicago (if none, indicate with "N/A" or "none"). NA 13. To the best ofthe Disclosing Party's knovvledge after reasonable inquiry, the following is a complete list ofall gifts that the Disclosing Party has given or caused to be given, at any fime during the 12-month period preceding the execution date ofthis EDS, to an employee, or elected or appointed official, ofthe City ofChicago. For purposes ofthis statement, a "gift" does not include: (i) anything made generally available lo City employees or to the general public, or (ii) food or drink provided in the course of official Cily business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient. NA C. CERTIFICATION OF STATUS AS FINANCIAL INSl 1 FU flON 1. The Disclosing Party certifies that the Disclosing Party (check one) [ ] is [x] is not a "financial institution" as defined in MCC Section 2-32-455(b). 2. Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges: "Wc arc not and vvill not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our afllliales is. and none oflhem vvill become, a predatory lender as defined in MCC Chapter 2-32. Wc understand that becoming a predatory lender or becoming an affiliate ofa predatory lender may resull in the loss ofthe privilege of doing business vvith the City." Vei-.2018-I Paize7ofl5 Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within ihe meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary): Ifthe letters "NA," the word "None," or no response appears on the lines above, il will be conclusively presumed lhat the Disclosing Party ceitified to the above statements. D. CERTIFICATION REGARDING FINANCIAL INIEREST IN CITY BUSINESS Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D. 1. In accordance with MCC Section 2-156-110: To the best ofthe Disclosing Party's knowledge after reasonable inquiry, does any official or einployee ofthe City have a tinancial interest in his or her own name or in the name of any other person or entity in the Matter? [ ] Yes [x] No NOTE: Ifyou checked "Yes" to Item 0(1), proceed to Items D(2) and .D(3). Ifyou checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E. 2. Unless sold pursuani to a process of competitive bidding, or otherwise permitled, no Cily elected official or einployee shall have a financial interest in his or her own name or in the name of any other person or entiiy in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessinents, or (iii) is sold by virtue of legal process at the suit ofthe City (collecfively, "City Property Sale"). Compensation for propeity taken pursuant to the Cily's eminent domain power does not constitute a financial interest within the meaning ofthis Part D. Does the Matter involve a City Propeity Sale? [ ] Yes [ ] No 3. Ifyou checked "Yes" to Item D( 1). provide the names and business addresses ofthe City officials or employees having such financial interest and identify the nature ofthe tinancial interest: Name Business Address Nature of Financial Interest 4. fhe Disclosing Parly further certifies that no prohibited financial interest in the Matter vvill be acquired by any City official or employee. Ver.2018-1 PaLieSoll? E. CER flFICATION REGARDING SLAVERY ERA BUSINESS Please check cither (1) or (2) below. Ifthe Disclosing Party checks (2). the Disclosing Party must disclose below or in an altachment to this EDS all information required by (2). Failure to coinply wilh these disclosure requirements may make any contract entered into wilh the City in connection wilh the Matter voidable by the City. _x I. The Disclosing Party verifies that the Disclosing Parly 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 Parly verifies that, as a resull of conducting the search in step (1) above, the Disclosing Parly has found records ofinvestments or profits from slavery or slaveholder insurance policies. The Disclosing Party verities that the following constitutes full disclosure ofall such records, including the nanies of any and all slaves or slaveholders described in those records: SECTION VI -- CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS NOTE: Ifthe Matter is federally funded, complete this Section VI. Ifthe Matter is not federally funded, proceed lo Seclion VII. For purposes ofthis Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding. A. CERTIFICATION REGARDING LOBBYING I. List below the names ofall persons or entities registered under the federal Lobbying Disclosure Acl of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary): (If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed lhat the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995. as amended, have made lobbying contacts on behalf of the Disclosing Parly vvith respect to the Matter.) 2. Fhe Disclosing Party has not spent and will nol 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 entiiy to infiuence or attempt to infiuence an officer or einployee of any agency, as defined by applicable lederal law, a inember of Congress, an officer or employee of Congress, or an employee VC1-.20I8-1 Paee 9 of 15 ofa member of Congress, in connection wilh the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreeinent, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement. 3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in vvhich there occurs any event that materially affects ihe accuracy ofthe statements and information set forth in paragraphs A(l) and A(2) above. 4. l he Disclosing Parly certifies that either: (i) it is nol an organization described in seclion 501(c)(4) of Ihe Inlernal Revenue Code of 1986; or (ii) il is an organization described in section 501(c)(4) ofthe Inlernal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended. 5. Ifthe Disclosing Parly is the Applicanl, 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 anv subcontract and the Disclosing Parly must inaintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the Cily upon request. B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY Ifthe Matter is federally funded, federal regulations require the Applicanl and all proposed subcontractors to submit the follovving information with their bids or in writing at the outset of negotiations. Is the Disclosing Parly the Applicant? [ ] Yes ^ [ ] No If "Ycs," answer the three questions below: 1. Flave you developed and do you have on tile affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.) [ 1 Yes [ ] No 2. Flave you filed with the Joint Reporting Commiltee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Oppoitunity Cominission all reports due under the applicable tiling requirements? [ ] Yes [ ] No [ ] Reports not required 3. Flave you participated in any previous contracts or subcontracts subject to the equal opportunity clause? [ ] Yes ' [ 1 No Ifyou checked "No" to question (1) or (2) above, please provide an explanation: Vei-.2018-I PauelOoflS SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION Fhe Disclosing Parly understands and agrees that: A. The ceitifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in conneclion 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 wilh respect to the Matter. The Disclosing Party understands lhat il must coinply wilh all statutes, ordinances, and regulations on which this EDS is based. B. The Cily's Governmental Ethics Ordinance, MCC Chapter 2-156. imposes certain duties and obligations on persons or entifies seeking City contracts, work, business, or transactions. The full text ofthis ordinance and a training program is available on line at w w w. c i tyo fch i cago. org/Eth ics. and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IE 60610, (312) 744-9660. The Disclosing Parly must comply fully with this ordinance. C. Ifthe Cily determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in conneclion 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 Paity's paiticipation in the Matter and/or declining to allow the Disclosing Party to paiticipate in other City transactions. Remedies at law for a false statement of material fact may include incarceration and an award lo the Cily of treble damages. D. It is the City's policy lo make this document available lo the public on its Internet site and/or upon request. Some or all ofthe information provided in, and appended lo, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have againsi 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 musl supplement this EDS up lo the time the City takes action on the Matter. Ifthe Matter is a contract being handled by the City's Depaitment of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter 1-23. Article 1 (imposing PERMANENT INELIGIBILITY for certain specified oflenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by MCC Chapter 1-23 and Secfion 2-154-1)20. Ver.2018-1 Pa^ellofl5 CERTIFICATION Under penalty ofperjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalfof the Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS, and all apphcable Appendices, are true, accurate and complete as ofthe date fumished to the City. Chicago Hope Academy (Print or type 1 name-of Disclosing Party) (Sign here) Robert Muzikowski (Print or type name of person signing) President (Print or type title of person signing) Signed and swom to before me on (date) Cj--,2C-)l9 at ClrCD k County, ZL (l/ilcf 3 (state). Notary Public Commission expires: / 3 Ver.2018-1 Page 12 of 15 CITY OFCHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 1.5"/o. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant. Under MCC Seclion 2-154-015, the Disclosing Parly must disclose whether such Disclosing Parly or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or departinent head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domesfic Partner thereof is related lo the mayor, any alderman, the city clerk, the city treasurer or any cily department head as spouse or domestic partner or as any ofthe following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, fathcr-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 Parly" means (1) all executive officers ofthe Disclosing Parly lisled in Seclion II.B.l.a., ifthe Disclosing Party is a corporation; all partners ofthe Disclosing Party, ifthe Disclosing Party is a general paitnership; all general partners and limited paitners ofthe Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Parly, ifthe Disclosing Party is a limited liability coinpany; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive direclor, chief financial officer, treasurer or secretary ofa legal entity or any person exercising similar authority. Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected cily official or department head? [ ] Yes [X] No Ifyes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to vvhich such person is connected; (3) the name and title ofthe elected city official or department head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship. Vcr.2018-1 Pa^ol3ofl5 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% (an "Owner"). It is not lo be completed by any legal entity which has only an indirect ownership interest in the Applicant. 1. Pursuant to MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scoffiaw or problem landlord pursuant lo MCC Section 2-92-416? [ ] Yes [X] No 2. Ifthe Applicant is a legal enlily publicly traded on any exchange, is any officer or director of the Applicanl identified as a building code scoffiavv or problem landlord pursuant lo MCC Seclion 2-92-416? [ ] Yes [ ] No [ ] The Applicant is not publicly traded on any exchange. 3. Ifyes to (1) or (2) above, please idenfify below the name of each person or legal entiiy identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply. Ver.2018-1 Paiicl4ofl5 CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX C PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION This Appendix is lo be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Secfion 2-92-385. That section, which should be consulted (www.amlegal.com). generally covers a party to any agreement pursuant to which they: (i) receive City ofChicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises. On behalf of an Applicant lhal is a contractor pursuani lo MCC Section 2-92-385,1 hereby certify lhat the Applicant is in compliance with MCC Seclion 2-92-385(b)(l) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy lhal includes those prohibitions. [ ] Yes [ ]No [x] N/A - I am nol an Applicanl that is a "contractor" as defined in MCC Section 2-92-385. I bis certification shall serve as the affidavit required by MCC Section 2-92-385(c)( 1). Ifyou checked "no" to the above, please explain. Ver.20IS-l Paue 15 of 15 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/ ifapplicable: Chicago Lions Charitable Association Check ONE of the following three boxes: Indicate whether the Disclosing Party submitting this EDS is: 1. [x] the Applicanl OR 2. [ ] a legal enlily currently holding, or anticipated to hold vvilhin six months after City action on the contract, transaction or other undertaking to which this EDS pertains (referred to below as the "Matter"), a direct or indirecl inlerest in excess of l.SVo in the Applicant. Stale the Applicant's legal name: OR 3. [ ] a legal entity with a direct or indirecl right ofcontrol ofthe Applicant (see Section 11(B)(1)) State the legal name ofthe entity in which the Disclosing Parly holds a right ofcontrol: B. Business address ofthe Disclosing Party: PO BOX 532 Northbrook. IL 60065 C. telephone: 847-921-O872 p^^. Email: cica@chicagoiionscom D. Name of contact person: Jeff Simon E. Federal Employer Identification No. (ifyou have one): F. Brief description ofthe Matter to vvhich this EDS pertains. (Include project number and location of propeity, ifapplicable): Planned Development application for the property bounded by West Harrison Street on the north, South Washtenaw Avenue on the east. West G. Which City agency or depaitment is requesting this EfJS? Department of Planning & Development Ifthe Mailer is a contract being handled by the City's Department of Procurement Services, please complete ihe following: Specification # and Conlracl # VCI-.20I8-1 Pa-el of 15 SECTION 11 -- DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY I. Indicate the nature ofthe Disclosing Party: [ ] Person [ ] Liinited liabilily company [ ] Publicly registered business corporation [ ] Limited liability paitnership [ ] Privately held business corporation [ ] Joint venture [ ] Sole proprietorship [x] Not-for-profit corporation [ ] General paitnership (Is the not-for-profit corporation also a 501(c)(3))? [ ] Limited partnership [X ] Yes [ | No [ ] Trust [ ] Other (please specify) 2. For legal entities, the slate (or foreign country) of incorporation or organizalion, ifapplicable: Illinois 3. For legal entities nol organized in the State of Illinois: Has the organization registered to do business in the State of Illinois as a foreign entity? [ ] Yes [ ] No [X] Organized in Illinois B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY: 1. List below the full names and titles, ifapplicable, ofi (i) all executive officers and all directors of the entity; (ii) for not-for-profit corporations, all members, ifany, which are legal enfities (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general paitner, managing inember, manager or any olher person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant. NOTE: Each legal entity listed below must submit an EDS on its own behalL Name Tille See attached list of officers and directors (none are legal entities) 2. Please provide the following information concerning each person or legal enlity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including ownership) in excess of 7.5% ofthe Applicant. Examples of such an interest include shares in a corporation, paitnership interest in a partnership or joint venture, interest ofa member or manager in a Vcr.2018-1 Paue2ofl5 limited liability coinpany, or interest ofa beneficiary ofa trust, esiate or other similar entity. If none, state "None." NOTE: 1-ach legal enlity listed belovv may be required to submit an EDS on its own behalf. Name Business Address Percentage Interest in the Applicant None SECTION III - INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS Has the Disclosing Parly provided any income or compensation lo any Cily elected oftlcial during the 12-month period preceding the dale ofthis EDS? [ ] Yes ^ ] No Does the Disclosing Parly reasonably expect to provide any income or compensation to any City elected oftlcial during the 12-nionlh period following the date ofthis EDS? [ ] Yes [x ] No If "yes" lo either ofthe above, please identify below the naine(s) of such Cily elected official(s) and describe such income or compensation: Does any City elected official or, to the best ofthe Disclosing Paity's knowledge after reasonable inquiry, any Cily elected official's spouse or domestic paitner, have a financial interest (as defined in Chapter 2-156 ofthe Municipal Code ofChicago ("MCC")) in the Disclosing Party? [ ] Yes [X] No Ifyes," please identify below the naine(s) of such City elected ofilciaUs) and/or spouse(s)/doiiiestic paitner(s) and describe the financial intcresl(s). SECTION IV - DISCLOSURE OF SUBCOIN I RACTORS AND OTHER RETAINED PARTIES fhe Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist (as defined in MCC Chapter 2-156), accountant, consullanl and any other person or enlity whom the Disclosing Parly has retained or expects lo retain in connecfion vvith the Matter, as well as the nature ofthe relationship, and ihe total amount ofthe fees paid or eslimaled to be paid, 'fhe Disclosing Party is not required to disclose employees vvho are paid solely through the Disclosing Paity's regular payroll. Ifthe Disclosing Parly is uncertain wheiher a disclosure is required under this Seclion, the Disclosing Party must either ask the Cily wheiher disclosure is required or make the disclosure. Vei-.2018-1 Pa^e3ofl5 Cfjitago %ifmi CHARITABLE ASSOCIATION Board members as of 8-12-19: Jeffrey C. Simon - President 2535 Windsor Lane Northbrook, IL 60062 Allie Movrich - Director 4144 N. Sheridan Road Unit 210 Chicago, IL 60613 George Plackmann - Secretary 3011 N Ashland Ave #38 Chicago, IL 60657 Patnck O'Reilly - Director 17715 curry branch Road Louisville, KY 40245 Brian Rooney - Director 2827 N Central Park Ave Chicago, IL 60618 Chicago Lions Charitable Association Mailing Address: PO Box 532 \ Northbrook, IL I 60065 Physical Address: 26Z7 W PolU. | Chicago. IL | 60612 www.chicagolions.com j wvvw.lionsforhopesc.org Name (indicate whether Business Relationship to Disclosing Party Fees (indicate wheiher retained or anticipated Address (subcontractor, attorney, paid or eslimaled.) NOTE: to be retained) lobbvist. etc.) "hourly rale" or "l.b.d." is not an acceptable response. (Add sheets if necessary) [x] Check here ifthe Disclosing Parly has not retained, nor expects to retain, any such persons or entities. SECTION V - CERTIFICATIONS A. COURT-ORDERED CHILD SUPPORT COMPLIANCE Under MCC Section 2-92-415, substantial owners of business entities that contract wilh the Cily musl remain in compliance with their child suppoit obligations throughout the contract's term. Flas any person who directly or indirectly owns 10% or more ofthe Disclosing Parly been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction? [ ] Yes [ ] No [x] No person directly or indirectly owns 10% or more ofthe Disclosing Parly. If "Yes," has the person entered inlo a court-approved agreement for payment ofall support owed and is the person in compliance with that agreement? [ ] Yes [ ] No B. FURTHER CERTIFICA TIONS 1. [This paragraph 1 applies only ifthe Matter is a contract being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date ofthis EDS. neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or conlinue wilh a contract in progress). 2. fhe Disclosing Party and its Affiliated Entifies are not delinquent in the payment of any fine, fee, lax or olher source of indebtedness owed to the City ofChicago. including, but not limited to. water and sewer charges, license fees, parking fickets,propert y taxes and sales laxes, nor is the Disclosing Party delinquent in the payinent of any tax administered by the Illinois Deparlmenl of Revenue. VC1-.2018- Paue4of 15 3. The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities identified in Section 11(B)(1) ofthis 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, during the 5 years beibre the date ofthis EDS, been convicted ofa criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting lo obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false stateinents; or receiving stolen propeity; c. are not presently indicted for, or criminally or civilly charged by, a governmental enlily (federal, state or local) wilh coiiiiiiilting any ofthe offenses set forth in subparagraph (b) above; d. have not, during the 5 years before the date ofthis EDS, had one or more public transactions (federal, stale or local) lerminated for cause or default; and e. have not, during the 5 years before the date ofthis 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 governnient. any stale, or any olher unit of local government. 4. The Disclosing Party understands and shall comply with the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Elhics). 5. Certifications (5), (6) and (7) concern: • the Disclosing Party; • any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in connection with the Matter, 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, with the Disclosing Party, under common control of another person or entity). Indicia ofcontrol include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees: or organization ofa business entity following the ineligibility ofa business entity to do business wilh federal or slate or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity. With respect to Contractors, the term Affiliated Entiiy means a person or entity that directly or indirectly controls the Contractor, is conlrolled by it, or. with the Conlraclor, is under common control of another person or enlily; • any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agenl or einployee ofthe Disclosing Party, any Conlraclor or any Affiliated Enlity. acting pursuant to the direction or authorization ofa responsible official ofthe [)isclosing Party, any Contractor or any Affiliated Enlily (collectively "Agents"). Ver.2018-1 Paue5ofl5 Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor, nor any Agents have, during the 5 years before the date ofthis EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity ofa Conlraclor during the 5 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 lo bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe federal government or of any stale or local government in the United States of America, in that oftlcer'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 subparagraph (a) or (b) above that is a matter of record, bul have not been prosecuted for such conduct; or d. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracls Requiring a Base Wage); (a)(5)(Debariiient Regulations); or (a)(6)(Miniiiiuni Wage Ordinance). 6. Neither the Disclosing Party, nor any Affiliated Entity or Conlraclor, or any of their employees, officials, agents or paitners, 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 ofthe United States of America lhat contains the same elements as the offense of bid-rigging or bid-rotating. 7. Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions Lisl maintained by the United States Department of Commerce, State, or I reasury, or any successor federal agency. 8. [FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] ofthe Applicanl 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 coinmit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or einployee of ihe Cily or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NO'FE: If MCC Chapter 1-23. Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year coinpliance limefranies in this Section V. 9. [FOR APPLICAN F ONLY] The Applicant and its Affiliated Eniiiies vvill nol use, nor permit their subconlraclors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM"). 10. [FOR APPLICANT ONLY] The Applicant vvill obtain from any contractors./subcontractors hired or to be hired in connection vvith the Matter certifications equal in form and substance to those in Certificafions (2) and (9) above and vvill not. without the prior written consent ofthe City, use any such Ver.2018-1 l\'me6ol'15 contractor/subcontractor that does nol provide such certifications or that the Applicant has reason to believe has not provided or cannot provide truthful ceitifications. 11. Ifthe Disclosing Parly is unable to certify to any ofthe above statements in this Part B (Further Ccrtitieations), the Disclosing Party must explain belovv: NA Ifthe letlers "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party ceitified to the above statements. 12. To the best ofthe Disclosing Paity's knowledge after reasonable inquiry, the following is a complete lisl ofall current employees ofthe Disclosing Party who were, at any lime during the 12- monlh period preceding the dale ofthis EDS, an employee, or elected or appointed official, ofthe City ofChicago (if none, indicate with "N/A" or "none"). NA 13. To the best ofthe Disclosing Paity's knowledge after reasonable inquiry, the following is a complete list ofall gifts lhal the Disclosing Party has given or caused lo be given, at any time during the 12-nionth period preceding the execution dale ofthis EDS, to an employee, or elected or appointed official, ofthe City ofChicago. For purposes ofthis statement, a "gift" does not include: (i) anything made generally available to City employees or lo the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or "none"). As lo any gift listed below, please also list the name ofthe Cily recipient. NA C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION 1. The Disclosing Party certifies lhat the Disclosing Parly (check one) [ ] is [x] is not a "financial institution" as defined in MCC Section 2-32-455(b). 2. Ifthe Disclosing Party IS a financial institution, then the Disclosing Party pledges: "We are not and vvill not become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none oflhem will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a prcdalory lender or becoming an affiliate ofa predatory lender may resull in the loss ofthe privilege of doing business vvith the City." Vcr.2018-1 Pa^e7ofI5 Ifthe Disclosing Party is unable to make Uiis pledge because it or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary): Ifthe letlers "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Parly ceitified to the above statements. D. CERTIFICATION REGARDING FINANCIAL INTEREST IN CI 1 Y BUSINESS Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D. 1. In accordance with MCC Section 2-156-110: To the best ofthe Disclosing Paity's knowledge after reasonable inquiry, does any official or einployee ofthe City have a financial interest in his or her own name or in the name of any olher person or entity in the Matter? [ ] Yes [x] No NO'fE: Ifyou checked "Yes" lo Item D(l), proceed to Items D(2) and D(3). Ifyou checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E. 2. Unless sold pursuani lo a process of competitive bidding, or otherwise permitled, no Cily 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 propeity 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 (collecfively, "City Propeity Sale"). Coinpensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning ofthis Part D. Does the Matter involve a City Propeity Sale? [ ] Yes [ ] No 3. Ifyou checked "Yes" to Item D(l). provide the names and business addresses ofthe City officials or employees having such financial interest and identify the nalure ofthe financial interest: Name Business Address Nature of Financial Interest 4. fhe Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee. Vei-.2()18-I Paue8ofl5 E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS Please check either (1) or (2) below. Ifthe Disclosing Party checks (2). the Disclosing Parly musl disclose below or in an attachment to this EDS all information required by (2). Failure to comply with these disclosure requirements may make any contract entered into vvith the Cily in connection vvith the Matter voidable by the City. _x I. 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 shiveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records. 2. 'Fhe Disclosing Party verifies that, as a result of conducting the search in step (1) above, the Disclosing Parly has found records ofinvestments or profits from slavery or slaveholder insurance policies. The Disclosing Parly verifies that the following constitutes full disclosure ofall such records, including the names of any and all slaves or slaveholders described in those records: SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS NOTE: If the Matter is federally funded, complete this Section VI. Ifthe Matter is not federally funded, proceed lo Section VII. For purposes ofthis Section VI, tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding. A. CERTIFICATION REGARDING LOBBYING I. List below the nanies ofall persons or entities registered under the federal Lobbying Disclosure Act of 1995, as ainended, who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary): (If no explanalion appears or begins on ihe lines above, or ifthe letters "NA" or ifthe word "None" appear, it will be conclusively presumed that the Disclosing Party means lhat NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf of the Disclosing Party with respect to the .Matter.) 2. Fhe Disclosing Parly 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 lo 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 einployee of Congress, or an employee Ver.2018-1 Paue9ofl5 ofa member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreeinent. or lo extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreeinent. 3. fhe Disclosing Parly will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statements and information set forth in paragraphs A( 1) and A(2) above. 4. 'Fhe Disclosing Party cerfifies that either: (i) it is not an organization described in seclion 501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) il is an organi/.ation described in seclion 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and vvill not engage in "Lobbying Activities," as that term is defined in the Lobbying Disclosure Act of 1995, as amended. 5. Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain ceitifications 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 musl make such ceititlcations promptly available lo the City upon request. B. CERTIFICAITON REGARDING EQUAL EMPLOYMENT OPPORTUNITY Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors lo submit the following information with their bids or in writing at the outset of negotiations. Is the Disclosing Party the Applicant? [ ] Yes ^ [ J No If "Ycs," answer the three questions below: 1. Flave you developed and do you have on file affirmalive action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.) [ ] Yes [ I No 2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the l-lqual Employment Opportunity Commission all reports due under the applicable filing requirements? [ ] Yes [ ] No [ ] Reports not required 3. Flave you participated in any previous contracts or subcontracts subject to the equal opportunity clause? [ ] Yes ' [ ] No Ifyou checked "No" to question (1) or (2) above, please provide an explanalion: Vcr.2018-1 Pa^cl0ofl5 SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION The Disclosing Party understands and agrees lhat: A. fhe certifications, disclosures, and acknowledgments conlained in this EDS vvill become part of any contract or other agreement between the Applicant and the City in connection vvith the Matter, whether procurement. City assistance, or other Cily action, and are material inducements to the City's execution of any contract or taking other action with respecl to the Matter. 'Fhe Disclosing Party understands that il must comply wilh all statutes, ordinances, and regulations on which this EDS is based. B. The City's Governmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entifies seeking City conlracts, work, business, or transactions. The full text ofthis ordinance and a training program is available on line at www.cityofchicago.org/^Elhics, 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 Parly must comply fully with this ordinance. C. Ifthe 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 Cily may pursue any remedies under the conlract or agreement (if nol rescinded or void), at law, or in equity, including terminafing the Disclosing Paity's participation in the Matter and/or declining to allow the Disclosing Party lo paiticipate in other City transactions. Remedies at law for a false statement of material fact may include incarceration and an award to the Cily 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 in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the Cily in conneclion with ihe public release of information contained in this EDS and also authorizes the City lo verify the accuracy of any information submitted in this EDS. E. The informalion provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up lo the time the City lakes action on ihe Matter. Ifthe Matter is a contract being handled by the City's Depaitment of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: Wilh respect to Matters subject lo MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY Ibr certain specified offenses), the infonnation provided herein regarding eligibility must be kept curreni for a longer period, as required by MCC Chapter 1-23 and Secfion 2-154-020. ' Ver.2018-1 PaucllofLS CERTIFICATION Under penalty ofperjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf ofthe Disclosing Party, and (2) warranls lhal all certifications and statements contained in this EDS, and all applicable Appendices, are true, accurate and complete as of the date fumished lo the Cily. Chicago Lions Charitable Association (Print or type exacl legakiame of Disclosing Party) Jeff Simon (Print or type name of person signing) President (Print or type tifie of person signing) Signed and sworn to before me on (dale) at (' .CT;/^^ County, ^(lihcA S (state). Notary PubTi'ibticc iJ "OFFICIAL SEAL- FEUCIA BUJANSKI NOTARY PUBUC, STATE OF ILUNOIS Commission expires: MYCOMMISSION EXPIRES8/3/2023 Ver.2018-1 Page 12 of 15 CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant. Under MCC Section 2-154-015, the Disclosing Parly must disclose wheiher such Disclosing Party or any "Applicable Party" or any Spouse or Domesfic Paitner thereof currently has a "familial relationship" with any elected cily oftlcial or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Parly" or any Spouse or Domestic Partner thereof is related lo the mayor, any aldennan, the cily clerk, the 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, 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 ofthe Disclosing Parly listed in Seclion ILB.l.a., ifthe Disclosing Party is a corporalion; all paitners ofthe Disclosing Party, ifthe Disclosing Party is a general paitnership; all general partners and liinited partners ofthe Disclosing Parly, ifthe Disclosing Party is a limited paitnership; all managers, managing members and members ofthe Disclosing Party, ifthe Disclosing Party is a fimiled liability coinpany; (2) all principal officers ofthe Disclosing Parly; and (3) any person having more than a 7.5%) ownership interest in the Disclosing Parly. "Principal officers" means the president, chief operating officer, executive director, chief tinancial officer, treasurer or secretary ofa legal entity or any person exercising similar authority. Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or department head? [ ] Yes [X] No Ifyes, please identify below (1) the name and tille of such person, (2) the name ofthe legal entity to vvhich such person is connected; (3) the name and title ofthe elected city official or depaitment head to whom such person has a familial relationship, and (4) the precise nature of such familial relationship. Ver.2018-1 Pauel3ofl5 CITY OFCHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX B BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION Fhis Appendix is to be compieled only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% (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 MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416? [ ] Yes [X] No 2. Ifthe Applicanl is a legal entity publicly traded on any exchange, is any officer or direclor of the Applicant identified as a building code scoftlaw or problem landlord pursuant to MCC Section 2-92-416? [ ] Yes [ ] No [ ] The Applicant is not publicly traded on any exchange. 3. Ifyes to (1) or (2) above, please identify below the name of each person or legal entity identified as a building code scoffiaw or problem landlord and the address of each building or buildings to which the peitinent code violations apply. Ver.2018-1 Paeel4ofl5 CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX C PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION I his Appendix is to be compieled only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That section, which should be consulted (www.amlegal.com), generally covers a party to any agreement pursuani to which they: (i) receive City ofChicago funds in consideration for services, work or goods provided (including for legal or other professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises. On behalf of an Applicanl that is a contractor pursuant lo MCC Section 2-92-385, 1 hereby certify that the Applicant is in compliance with MCC Seclion 2-92-385(b)(l) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicanl has adopted a policy that includes those prohibitions. [ ] Yes [ ]No [x] N/A - I am not an Applicant that is a "conlractor" as defined in MCC Section 2-92-385. This certitlcation shall serve as the affidavit required by MCC Section 2-92-385(c)( 1). Ifyou checked "no" to the above, please explain. Ver.2018-1 Pnue 15 of 15 CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT SECTION I - GENERAL INFORMATION A. Legal name of the Disclosing Party submitfing this EDS. Include d/b/a/ if applicable: Ringgold Capital IV, LLC Check ONE of the following three boxes: Indicate whether the Disclosing Party submitting this EDS is: 1. [X] the Owner of 2641 W. Han-ison St., Chicago, IL 60612 OR 2. [ ] a legal entiiy currently holding, or anticipated to hold within six months after City action on the contract, transacfion or other undertaking to which this EDS pertains (referred to below as the "Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. Slate the Applicant's legal name: OR 3. [ ] a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1)) State the legal name of the entity in which the Disclosing Party holds a right of control: B. Business address of the Disclosing Party: 227 West Monroe St, Suite 5000 Chicago, IL 60606 C. Telephone: (312) 977-4330 Fax: (312) 277-7498 Email: [email protected] D. Name of contact person: Robert Fedoris . , E. Federal Employer Identification No. (if you have one): _, [ F. Brief description of the Matter to which this EDS pertains. (Include project number and location of property, if applicable): Planned Development application for the property bounded by West Harrison on the north. South Washtenaw on the east. West Taylor Street on the south and the elevated portion of the Union Pacific Railroad on the east (identified as Parcel A on the attached map) Please note that Parcel A (attached) is the Sidwell map identifying the properties which will be included in the proposed PD zoning designation. G. Which City agency or department is requesting this EDS? Department of Planning and Development If the Matter is a conlract being handled by the City's Department of Procurement Services, please complete the following: Specification # and Contract # Ver.2018-1 Page lof 15 SECTION II -- DISCLOSURE OF OWNERSHIP INTERESTS A. NATURE OF THE DISCLOSING PARTY 1. Indicate the nature of the Disclosing Party: ] Person [X] Limiled liability company ] Publicly 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 organizalion, if applicable: Delaware 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? [X] Yes [ ] No [ ] Organized in Illinois B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY: 1. List below the full names and titles, ifapplicable, of: (i) all executive officers and all directors of the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entifies (if there are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or limited partnerships, limited liability companies, limited liability partnerships or joint ventures, each general partner, managing member, manager or any olher person or legal entity that directly or indirectly controls the day-to-day management ofthe Applicant. NOTE: Each legal entiiy listed below musl submit an EDS on its own behalf Name Title Robert Fedoris Member/Manager 2. Please provide the following information conceming each person or legal entity having a direct or indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including ownership) in excess of 7.5% of the Applicant. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a Ver.2018-1 Page 2 of 15 limited liability company, or interest of a beneficiary of a trust, estate or olher similar enlity. If none, slate "None." NOTE: Each legal entity listed below may be required lo submit an EDS on ils own behalf. Name Business Address Percentage Interest in the Applicant Robert Fedoris 1045 First Avenue, Suite 120 100% King of Prussia, PA 19406 SECTION III ~ INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY ELECTED OFFICIALS Has the Disclosing Party provided any income or compensation to any City elected official during the 12-month period preceding the date of this EDS? [ ] Yes [X] No Does the Disclosing Party reasonably expect to provide any income or compensation to any City elected official during the 12-month period following the date of this EDS? [ ] Yes [X] No If "yes" to either of the above, please identify below the name(s) of such City elected official(s) and describe such income or compensation: Does any City elected official or, to the best ofthe Disclosing Party's knowledge after reasonable inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in Chapter 2-156 of the Municipal Code of Chicago ("MCC")) in the Disclosing Party? [ ] Yes [X] No If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic partner(s) and describe the fmancial interest(s). SECTION IV -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES The Disclosing Party must disclose the name and business address of each subcontraclor, attomey, lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any olher person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is nol required to disclose employees who are paid solely through the Disclosing Party's regular payroll. Ifthe Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure. Ver.2018-1 Page 3 of 15 Name (indicate whether Business Relationship to Disclosing Party Fees (indicate wheiher retained or anticipated Address (subcontractor, atlorney, paid or estimated.) NOTE: to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is not an acceptable response. (Add sheets if necessary) [x] 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 MCC Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term. Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction? [ ] Yes [X] No [ ] No person directly or indirectly owns 10% or more of the Disclosing Party. If "Yes," has the person entered into a court-approved agreement for payment of all support owed and is the person in compliance with lhat agreement? [ ] Yes [ ] No B. FURTHER CERTIFICATIONS 1. [This paragraph 1 applies only ifthe Matter is a conlracl being handled by the City's Department of Procurement Services.] In the 5-year period preceding the date of this EDS, neither the Disclosing Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the performance of any public contract, the services of an integrity monitor, independent private sector inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing, investigative, or other similar skills, designated by a public agency to help the agency monitor the activity of specified agency vendors as well as help the vendors reform their business practices so they can be considered for agency contracts in the future, or continue with a contract in progress). 2. The Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine, fee, tax or other source of indebtedness owed to the City of Chicago, including, but nol limited to, water and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing Party delinquent in the payment of any tax administered by the Illinois Department of Revenue. Ver.2018-1 Page 4 of 15 3. The Disclosing Party and, if the Disclosing Party is a legal entiiy, all of those persons or entities idenfified in Section 11(B)(1) ofthis EDS: a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unil of government; b. have nol, during the 5 years before the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered againsi them in conneclion 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; thefl; 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 of the offenses set forth in subparagraph (b) above; d. have not, during the 5 years before the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and e. have nol, during the 5 years before the date ofthis 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 govemment, any state, or any olher unit of local govemment. 4. The Disclosing Party understands and shall comply wilh the applicable requirements of MCC Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics). 5. Certificafions (5), (6) and (7) concern: • the Disclosing Party; • any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in conneclion with the Matter, including bul not limited to all persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties"); • any "Affiliated Enlily" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is conlrolled 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 managemenl, ownership, or principals as the ineligible entity. With respect to Contractors, the term Affiliated Entity means a person or entiiy lhal directly or indirectly controls the Contractor, is controlled by it, or, wilh the Contractor, is under common conlrol of another person or entiiy; • any responsible official of the Disclosing Party, any Contractor or any Affiliated Enlity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Enfity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents"). Ver.2018-1 Page 5 of 15 Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entiiy of either the Disclosing Party or any Conlractor, nor any Agents have, during the 5 years before the date of this EDS, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter: 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 Slate of Illinois, or any agency of the federal govemment or of any state or local govemment in the 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 subparagraph (a) or (b) above that is a matter of record, but have not been prosecuted for such conduct; or d. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Conlracts Requiring a Base Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance). 6. Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of slate or local govemment 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 slate or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating. 7. Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the United States Department of Commerce, State, or Treasury, or any successor federal agency. 8. [FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [see MCC Chapter 1-23, Article I for applicability and defined terms] of the Applicant is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy lo commit bribery, theft, fraud, forgery, perjury, dishonesty or deceil against an officer or employee of the City or any "sister agency"; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, that Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V. 9. [FOR APPLICANT ONLY] The Applicanl and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal System for Award Management ("SAM"). 10. [FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired or to be hired in cormection with the Matter certifications equal in form and substance to those in Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such Ver.2018-1 Page 6 of 15 contractor/subcontractor that does not provide such certifications or that the Applicant has reason to believe has not provided or cannot provide tmthful certifications. 11. If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below: N/A If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements. 12. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all curreni employees of the Disclosing Party who were, at any time during the 12- month period preceding the date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"). N/A 13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complele list of all gifts that the Disclosing Party has given or caused to be given, al any lime during the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything made generally available to City employees or to the general public, or (ii) food or drink provided in the course of official Cily business and having a retail value of less than $25 per recipient, or (iii) a political contribution otherwise duly reported as required by law (if none, indicate wilh "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient. N/A C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION 1. The Disclosing Party certifies that the Disclosing Party (check one) [ ] is [X] is not a "financial institution" as defined in MCC Secfion 2-32-455(b). 2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges: "We are not and will nol become a predatory lender as defined in MCC Chapter 2-32. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City." Ver.2018-1 Page 7 of 15 If the Disclosing Party is unable to make this pledge because il or any of its affiliates (as defined in MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain here (attach additional pages if necessary): If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements. D. CERTIFICATION REGARDING FINANCIAL E^TEREST IN CITY BUSINESS Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D. 1. In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge after reasonable inquiry, does any official or employee of the City have a financial inlerest in his or her own name or in the name of any other person or entity in the Matter? [ ] Yes [X] No NOTE: Ifyou checked "Yes" to Item D(]), proceed to Items D(2) and D(3). Ifyou checked "No" to Item D(l), skip Items D(2) and D(3) and proceed to Part E. 2. Unless sold pursuant to a process of competitive bidding, or otherwise permitled, 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 entiiy in the purchase of any property lhat (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 does nol constitute a financial interest within the meaning of this Part D. Does the Matter involve a City Property Sale? [ ] Yes [X] No 3. If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials or employees having such financial interest and identify the nalure of the financial interest: Name Business Address Nature of Financial Interest 4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee. Ver.2018-1 Page 8 of 15 E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS Please check either (1) or (2) below. Ifthe Disclosing Party checks (2), the Disclosing Party must disclose below or in an attachment to this EDS all information required by (2). Failure to comply with these disclosure requirements may make any contract entered into wilh the City in connection with the Matter voidable by the City. X I. 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 resull 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: SECTION VI ~ CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally funded, proceed to Section VII. For purposes of this Seclion VI, lax credits allocated by the Cily and proceeds of debt obligations of the City are not federal funding. A. CERTIFICATION REGARDING LOBBYING 1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing Parly wilh respect to the Matter: (Add sheets if necessary): (If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None" appear, it will be conclusively presumed lhal the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on behalf ofthe Disclosing Party with respect lo 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( 1) above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee Ver.2018-1 Page 9 of 15 of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement. 3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A(l) and A(2) above. 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," as that term is defined in the Lobbying Disclosure Act of 1995, as amended. 5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards any subcontract and the Disclosing Party musl maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the Cily 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 Applicanl? [ ] Yes [ ] No If "Yes," answer the three questions below: 1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.) [ ] Yes [ ] No 2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements? [ ] Yes [ ] No [ ] Reports not required 3. Have you participated in any previous contracts or subcontracts subjecl to the equal opportunity clause? [ ] Yes [ ] No Ifyou checked "No" to question (1) or (2) above, please provide an explanation: Ver.2018-1 PagelOoflS SECTION VII -- FURTHER ACKNOWLEDGMENTS AND CERTIFICATION The Disclosing Party understands and agrees that: A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement. City assistance, or olher City action, and are material inducements to the City's execution of any contract or taking olher action wilh 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 Govemmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and obligations on persons or entities seeking City conlracts, work, business, or transactions. The full text of this ordinance and a training program is available on line at www.citvofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with this ordinance. C. Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate, any conlract or other agreement in connection with which il 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 lo participate in other City transactions. Remedies al law for a false statement of malerial fact may include incarceration and an award to the City of treble damages. D. It is the City's policy lo make this documenl available to the public on its Intemet site and/or upon request. Some or all of the information provided in, and appended to, this EDS may be made publicly available on the Internet, in response to a Freedom of Informalion Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have againsi the City in conneclion with the public release of information contained in this EDS and also authorizes the City lo verify the accuracy of any information submilted in this EDS. E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the Cily lakes action on the Matter. If the Matter is a conlracl being handled by the City's Departmenl of Procurement Services, the Disclosing Party musl update this EDS as the contract requires. NOTE: With respect lo Matters subject to MCC Chapter 1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility musl be kept current for a longer period, as required by MCC Chapter 1-23 and Section 2-154-020. Ver.2018-1 Page 11 of 15 CERTIFICATION Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS, and all applicable Appendices, on behalf of the Disclosing Party, and (2) warranls that all certifications and statements contained in this EDS, and all applicable Appendices, are tme, accurate and complete as of the date fumished to the City. Ringgold Capital IV, LLC (Print o)r lygtyp'e exact legal name of Disclosing Party) By: (Sign here) Robert Fedoris (Print or type name of person signing) Member/Manager (Print or type title of person signing) Signed and swom to before me on (date) ^ptfmV)gY^^ 9^lS at CiXV- County, TU>nc>">S (state). BROOKE H SCHLICTMAN Notary Public OFFICIAL SEAL 1 Notarv Public, State of Illinois My Commission Expires July 12. 2022 Commission expires: JTQI-^ )^^>5L Ver.2018-1 Page 12 of 15 CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX A FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal entity which has only an indirect ownership interest in the Applicant. Under MCC Section 2-154-015, the Disclosing Party must disclose wheiher such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related lo the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domestic partner or as any of the following, whether by blood or adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, falher-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister. "Applicable Party" means (1) all execufive officers of the Disclosing Party listed in Seclion II.B.l.a., ifthe Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limiled partners of the Disclosing Parly, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limiled liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5% ownership inlerest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secrelary of a legal entity or any person exercising similar authority. Does the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently have a "familial relationship" with an elected city official or departmenl head? [ ] Yes [ ] No Ifyes, please identify below (1) the name and title of such person, (2) the name of the legal entity lo which such person is connected; (3) the name and title of the elected city official or department head lo whom such person has a familial relalionship, and (4) the precise nature of such familial relalionship. Ver.2018-1 Page 13 of 15 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 Applicanl, and (b) any legal entity which has a direct ownership interest in the Applicant exceeding 7.5% (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 MCC Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416? [ ] Yes [ ] No 2. If the Applicant is a legal entiiy publicly traded on any exchange, is any officer or direclor of the Applicant identified as a building code scofflaw or problem landlord pursuant to MCC Section 2-92-416? [ ] Yes [ ] No [ ] The Applicant is not publicly traded on any exchange. 3. If yes to (1) or (2) above, please identify below the name of each person or legal enlity identified as a building code scofflaw or problem landlord and the address of each building or buildings to which the pertinent code violations apply. Ver.2018-1 Page 14 of 15 CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT APPENDIX C PROHIBITION ON WAGE & SALARY HISTORY SCREENING - CERTIFICATION This Appendix is to be completed only by an Applicant that is completing this EDS as a "contractor" as defined in MCC Section 2-92-385. That secfion, which should be consulted (www.anilegal.com), generally covers a party to any agreement pursuant to which they: (i) receive City of Chicago funds in consideration for services, work or goods provided (including for legal or olher professional services), or (ii) pay the City money for a license, grant or concession allowing them to conduct a business on City premises. On behalf of an Applicant that is a conlractor pursuani lo MCC Seclion 2-92-385,1 hereby certify lhat the Applicant is in compliance with MCC Seclion 2-92-385(b)(1) and (2), which prohibit: (i) screening job applicants based on their wage or salary history, or (ii) seeking job applicants' wage or salary history from current or former employers. I also certify that the Applicant has adopted a policy that includes those prohibitions. [ ] Yes [ ]No [ ] N/A -1 am nol an Applicanl lhat is a "contractor" as defined in MCC Seclion 2-92-385. This certification shall serve as the affidavit required by MCC Seclion 2-92-385(c)(l). If you checked "no" to the above, please explain. Ver.2018-1 Page 15 of 15