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City of ChicagoOffice of the City Clerk

Legislation Referred to Committees at the Chicago City Council Meeting3/16/2016

Section 3f - Aldermanic Introductions Containing Economic Disclosure Statements

Agreement(s) - Easement

TransportationLong-term easement agreement withChicago Title Land Trust Company, assuccessor trustee to LaSalle Bank, N.A. inarea bounded by S State St and E CongressPkwy (for 4th Ward)

O2016-16761 RedactedRecord

Beale (9)

Dedication of Public Street(s)

TransportationDedication of portion of W 36th St boundedby S California Ave and S Richmond St


Cardenas (12)

Historical Landmark Fee Waiver(s)

ZoningLandmark fee waiver for property at 2047 WThomas St

Or2016-1373 RedactedRecord

Hopkins (2)

Vacation(s) of Public Alley(s)

TransportationVacation of public alley(s) in area boundedby S Kenwood Ave, E 47th Pl, S DorchesterAve and E 48th St (for 4th Ward)


Beale (9)

TransportationVacation of public alley(s) in area boundedby N Sangmon St, W Chicago Ave, NCarpenter St and W Fry St


Burnett (27)

Vacation(s) of Public Way(s)

TransportationVacation of public way(s) in area bounded byW 51st St, Grand Trunk Western Railroad, W53rd St and S. Millard Ave


Zalewski (23)

TitleFile # Committee ReferralSponsor(s)

Created by the Office of the City Clerk, City of Chicago Report Generated on 3/18/2016 at 3:56 PM of 1

City of Chicago

Office of the City Clerk

Document Tracking Sheet

02016-1676

Meeting Date:

Sponsor(s):

Type:

Title:

Committee(s) Assignment:

3/16/2016

Beale (9)

Ordinance

Long-term easement agreement with Chicago Title Land Trust Company, as successor trustee to LaSalle Bank, N.A. in area bounded by S State St and and E Congress Pkwy (For 4th Ward) Committee on Transportation and Public Way

ORDINANCE FOR LONG TERM EASEMENT

WHEREAS, The City of Chicago ("City") is a home rule unit of government by virtue of the provisions of the Constitution of the State of Illinois of 1970 and, as such, may exercise any power and perform any function pertaining to its government and affairs; and

WHEREAS, Chicago Title Land Trust Company as Successor Trustee to LaSalle Bank National Association, Formerly Known as LaSalle National Bank, A National Banking Association, as Trustee under Trust Agreement dated February 1, 1984 and known as Trust 106142 ("Grantee") is the owner of the Leiter II Building, an eight story commercial building and Chicago Landmark property commonly commonly known as 401 South State Street (the "Property"); and

WHEREAS, the Property predates the existence of W. Congress Parkway and protrudes into W. Congress Parkway approximately between the planes of 26.4'CCD/ 11.8' above grade and 149.8' CCD/135.2', and for its support columns supporting same ("Easement Area'); and

WHEREAS, the Easement Area was previously permitted pursuant to a November 21, 1950 Indenture Agreement between the City and the Grantee's predecessor as approved by the Chicago City Council and as recorded with the Office of the Cook County Recorder of Deeds on July 25, 1952 as Document No. 15395845, Book 48135, 72; and

WHEREAS, Grantee seeks to continue its permitted use of the space occupied by its building over the public way, and for its columns supporting same, all in the Easement Area; and

WHEREAS, the Easement Area excludes the area at grade that will continue to serve as part of the public way containing pedestrian sidewalk and curb, and the vaults below grade as more fully described on the Plat of Easement attached hereto and make a part hereof as Exhibit A; and

WHEREAS, the Department of Transportation has determined that a long term easement for the Property will not interfere with the City's traffic infrastructure and will benefit the business; and

WHEREAS, the City is willing to grant Grantee an easement on the same terms and conditions set forth in the Public Way Easement Agreement (the "Public Way Easement Agreement") attached hereto and incorporated herein as Exhibit B; and

WHEREAS, the City Council of the City of Chicago, after due investigation and consideration, has determined that the nature and extent of the public use and the public interest to be subserved is such as to warrant a long term easement for a preexisting, landmark building over the public street described in the following ordinance; now therefore,

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

SECTION 1. LEGAL DESCRIPTION OF EASEMENT AREA THAT PART OF THE SOUTH 16.5 FEET OF LOT 10, LYING BELOW A HORIZONTAL PLANE HAVING A VERTICAL ELEVATION OF +149.8 AND LYING ABOVE THE SIDEWALK, HAVING AN AVERAGE VERTICAL ELEVATION OF +14.6 FEET, ALL CITY OF CHICAGO DATUM, IN BLOCK 10 IN FRACTIONAL SECTION 15, TOWNSHIP 39 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPLE MERIDIAN AS SURVEYED AND SUBDIVIDED BY THE BOARD OF CANAL COMMISSIONERS PURSUANT TO LAW IN THE MONTH OF APRIL, YEAR OF 1836, RECORDED JUNE 13, 1836, ANTE-FIRE, RE-RECORDED SEPTEMBER 24, 1877 AS DOCUMENT NUMBER 151609; EXCEPTING THAT PART OF SAID LOT 10 TAKEN FOR SOUTH STATE STREET AS WIDENED FROM JACKSON STREET TO HARRISON STREET BY ORDER OF POSSESSION JANUARY 24, 1887, ORDINANCE PASSED SEPTEMBER 8, 1878; ALSO EXCEPTING THAT PART OF SAID LOT 10 TAKEN FOR A NORTH-SOUTH 20 FOOT WIDE PUBLIC ALLEY LAID OUT BY AGREEMENT OF OWNERS, ANTE-FIRE; ALSO EXCEPTING THEREFROM THE VERTICAL SPACE OF THE ABOVE-DESCRIBED PROPERTY FROM THE LEVEL OF THE SIDEWALK ON SAID PROPERTY (AVERAGE ELEVATION +14.6, CITY OF CHICAGO DATUM) TO THE LEVEL OF THE BOTTOM OF THE LINTEL OF THE BUILDING PRIMARILY ON SAID PROPERTY (AVERAGE ELEVATION +26.4, CITY OF CHICAGO DATUM); RESERVING TO THE GRANTEES THE SPACE OCCUPIED BY THE EXISTING COLUMNS OF SAID BUILDING, ALL IN COOK COUNTY ILLINOIS. THE EASEMENT MAY BE SUBJECT TO OTHER AGREEMENTS ASSOCIATED WITH THIS AREA, THE TERMS OF WHICH ARE MORE FULLY DESCRIBED IN THE ORDINANCE AUTHORIZING SAID EASEMENT.

SECTION 2. The Commissioner of the Department of Transportation (the "Commissioner") or a designee of the Commissioner is each hereby authorized, along with the approval of the City's Corporation Counsel as to form and legality, to execute and deliver the Public Way Easement Agreement between Grantee and the City, in the form attached thereto as Exhibit B and made a part hereof, and such other supporting documents as may be necessary or appropriate to carry out and comply with the provisions of the Public Way Easement Agreement.

SECTION 3. If any provision of this ordinance shall be held to be invalid or unenforceable for any reason, the invalidity or unenforceability of such provision shall not affect any ofthe other provisions of this ordinance.

SECTION 4. The Public Way Easement Agreement herein provided for is made upon the express condition that within one hundred eighty (180) days after the passage of this ordinance. Grantee shall file or cause to be filed for recording in the Office of the Recorder of Deeds of Cook County, Illinois a copy of the Public Way Easement Agreement, together with its accompanying Plat of Easement as approved by the Department of Transportation's Superintendent of Maps and Plats; as well as a separately recorded full sized copy of the corresponding Plat of Easement for greater clarity.

SECTION 5. This ordinance shall take effect upon its passage and need not be recorded. The Public Way Easement Agreement will take effect upon recording.

Easement approved:

Rebekah Scheinfeld Commissioner of Transportation

Approved aa to form-end legalitvi

Richard Wendy Deputy Corporation Counsel

Honof^bj^Will Burns Alderman 4th Ward

EXHIBIT "A"

FILE PATH: C:\LandProioct9 3\2015\VVE 1-9\9807MiSC\9807B.(lwg

EXHIBIT "A"

PLAT OF EASEMENT THAT PART OF THE SOUTH 16.5 FEET OF LOT 10, LYING BELOW A HORIZONTAL PLANE HAVING A VERTICAL ELEVATION OF +149.8 AND LYING ABOVE THE SIDEWALK, HAVING AN AVERAGE VERTICAL ELEVATION OF +14.6 FEET, ALL CITY OF CHICAGO DATUM, IN BLOCK 10 IN FRACTIONAL SECTION 15, TOWNSHIP 39 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPLE MERIDIAN AS SURVEYED AND SUBDIVIDED BY THE BOARD OF CANAL COMMISSIONERS PURSUANT TO LAW IN THE MONTH OF APRIL, YEAR OF 1836, RECORDED JUNE 13, 1836, ANTE-FIRE, RE-RECORDED SEPTEMBER 24,1877 AS DOCUMENT NUMBER 151609; EXCEPTING THAT PART OF SAID LOT 10 TAKEN FOR SOUTH STATE STREET AS WIDENED FROM JACKSON STREET TO HARRISON STREET BY ORDER OF POSSESSION JANUARY 24, 1887, ORDINANCE PASSED SEPTEMBER 8,1878; ALSO EXCEPTING THAT PART OF SAID LOT 10 TAKEN FOR A NORTH-SOUTH 20 FOOT WIDE PUBLIC ALLEY LAID OUT BY AGREEMENT OF OWNERS, ANTE-FIRE, ALSO EXCEPTING THEREFROM THE VERTICAL SPACE OF THE ABOVE-DESCRIBED PROPERTY FROM THE LEVEL OF THE SIDEWALK ON SAID PROPERTY (AVERAGE ELEVATION +14.6, CITY OF CHICAGO DATUM) TO THE LEVEL OF THE BOTTOM OF THE LINTEL OF THE BUILDING PRIMARILY ON SAID PROPERTY (AVERAGE ELEVATION +26.4, CITY OF CHICAGO DATUM); RESERVING TO THE GRANTEES THE SPACE OCCUPIED BY THE EXISTING COLUMNS OF SAID BUILDING, ALL IN COOK COUNTY ILLINOIS. THE EASEMENT AS SHOWN AND DEPICTED HEREIN MAY BE SUBJECT TO OTHER AGREEMENTS ASSOCIATED WITH THIS AREA, THE TERMS OF WHICH ARE MORE FULLY DESCRIBED IN THE ORDINANCE AUTHORIZING SAID EASEMENT,

East Van Buren Street (66" PUBLIC R/W)

16.50'r—: PROPERTY ACQUIRED FOR WEST ROUTE (DWIGHT E. EISENHOWER EXPRESSWAY) OF COMPREHENSIVE SUPERHIGHWAY SYSTEM GENER/CV ORDINANCE PASSED OCT 31,1941

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EASEMENT HEREBY GRANTED

East Congress Parkway (St.) (PUBLIC R/W - WIDTH VARIES)

PAGE 1 OF 3

CDOT# ^5-02-14-3680 ZARKO SEKEREZ & ASSOCIATES, INC

urveyo no WEBT ClARH STREET. CROWN PCHMT, IN 48307 ILL. PHONE: (312)730-1313 l a . FAX' (312) 23»«50S

VMW.Sa(EREZCOM

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FILE PATH: C:Mancl Projects 3\2015\WE 1-9^9807MISC^9807B.(^W8

EXHIBIT "A"

SURVEYOR'S NOTES:

1) SUBJECT PARCEL P.I.N.: 17-15-108-012-0000, AREA 2,375 SQ. FT 0.055 ACRES ADJOINING APPLICANT OWNED P.I.N. 17-15-108.001-0000

2) THE NORTH LINE OF CONGRESS PARKWAY IS ASSUMED TO BEAR S 89''32'52" W

4) THE FIELD WORK FOR THIS SURVEY WAS PERFORMED ON JANUARY 7. 2015

5) DIMENSIONS ARE SHOWN IN FEET AND DECIMAL PARTS THEREOF

6) NO DIMENSIONS SHOULD BE ASSUMED BY SCALE MEASUREMENTS UPON THE PLAT

7) THE EASEMENT PARCEL AND ALL SURROUNDING PARCELS IN BLOCK 10 ARE ZONED "DX-16, DOWNTOWN MIXED USE."

8) CLIENT CONTACT INFO: TOM GARRITY ANVAN MIDWEST REALTY MANAGEMENT 401 SOUTH STATE STREET CHICAGO, ILLINOIS 312-393-9300

9) BENCHMARK: MARK CUT ON N. SIDE OF STANDARD BM NO. 5675 LOCATED ENTRANCE 228 S. WABASH, 126 FT. N. OF NORTH LINE OF JACKSON AND 1 FT WEST OF WEST LINE OF WABASH. ELEV.=+16.018 ELEVATIONS ARE WITH REFERENCE TO CITY OF CHICAGO DATUM

10) NO CORNERS OF EASEMENT AREA WERE SET

PLAT OF EASEMENT

DEPT. OF FINANCE

COOK CO.

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

(REC) (MEAS)

To: STATE OF ILLINOIS COUNTY OF COOK

This pro] stand:

PROPOSED EASEMENT AREA (AFFECTED BUILDING OVER SAME)

BUILDING ON AFFECTED PROPERTY (NOT PART OF EASEMENT AREA)

EXISTING BUILDING NOT ON AFFECTED AREA

CONCRETE WALK

TRAFFIC DIRECTIONAL ARROW

ADJOINING PROPERTY NOT AFFECTED BY EASEMENT

SUB-LOT DIVISION

RECORD DIMENSION/MEASURED DIMENSION

inktefffSnns to the%im|a| minimum C.D.O.T.

tadu M. S. I r i m e ^ Professional LamfSun SURVEYOR LICEf f tE FIRM REGISTRATldsi

FIRM REGISTRATION

CDOT# 15-0?-T4-S680

I f f r No. o: , ^PJRATION DATi? j t ov^ ibe r 30,

10/2017

PAGE OF 5

ZARKO SEKEREZ & ASSOCIATES, INC Land Surveyors &Land Plannera

11« M S T CLARK STREET. CROVM POINT, IN 46307 ILL. PHONE. (312)728-1513 ILL. FAX. (312)23^9506

VWVW.SEKERE2.COM

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Jan 7,2015

9807

FILE PATH C \Land Projects 3\2015\WE 1-9\9807MISC\9807B (iwg

EXHIBIT B

PUBLIC WAY EASEMENT AGREEMENT

This Instrument Prepared By and After Recording Return to: Karen Bielarz Senior Counsel City of Chicago Department of Law 121 North LaSalle Street, Room 600 Room 600 Chicago, Illinois 60602

(The Above Space For Recorder's Use Only)

Public Way Easement Agreement

This Agreement (the Agreement") entered into as of this day of , 2016, by and between the CITY OF CHICAGO, an Illinois home rule municipal corporation (the "City"), by and through its Department of Transportation , (the "CDOT"), and One Congress Center, LP, an Illinois limited partnership ("Grantee"). City and Grantee together shall collectively be referred to herein from time to time as the "Parties", and individually as a "Party".

Witnesseth:

WHEREAS, Grantee is the owner of the Leiter II Building, an eight story commercial building ("Leiter II Building") and Chicago Landmark commonly known as 401 South State Street, Chicago, Illinois, as legally described on Exhibit A attached hereto and made a part hereof (the "Property"); and

WHEREAS, pursuant to a 1950 City condemnation matter and a prior agreement between the Parties, certain easements and rights for the benefit of the Property were created by and reserved in deed by William Scott Bond, Philip F. W. Peck and Alfred M. Rogers, successor trustees under the last will and testament of Levi Z. Leiter, deceased, to the City of Chicago, in that certain Indenture dated November 21, 1950 and recorded July 25, 1952 as document 15395845 over, upon and under the south 16.5 feet of Lot 10 (except that part lying in South State Street and also except that part taken for 20 foot alley running north and south through Block 10) in Block 10 in Fractional Section 15 Addition to Chicago, Township 39 North Range 14, as set forth therein (the "1950 Indenture"); and

WHEREAS, the 1950 Indenture reserved for the benefit of the Property certain rights and easements to the Grantee above, on, and under the City's public right of way; and WHEREAS, on January 14, 1997, the City designated the Leiter II Building a Chicago Landmark by ordinance recorded in the Journal of the Chicago City Counsel for January 14, 1997, pages 37540-37543, a copy of which is attached hereto as Exhibit B; and

WHEREAS, the easements and rights for the benefit of the Property created by and reserved in the 1950 Indenture have expired; and

WHEREAS, the City has changed the handling of easements and permits above, on, and under the City's public right of way; and

WHEREAS, currently the Leiter II Building occupies certain space above, on and under the City's public way pursuant to public way use permits ("Grants of Privilege") for: (1) two (2) vaulted area under the public sidewalk (Permit No. 1104935 valid until 2018; and Permit No. 1119142 valid until 2020); (2) fire escape on the Leiter II Building (Permit No. 1104934 valid until 2018); (3) a clock on the Leiter II Building (Permit No. 1104914 valid until 2018); (4) a sign on the Leiter II Building (Permit No. 1104913 valid until 2018); and (5) a Leiter II building projection ("Building Projection") over the City public way (Permit No. 1104938 valid until 2018) ("Building Projection Permit"); and

WHEREAS, the Grantee is currently seeking a twenty (20) year long term easement for the Building Projection which building Projection shall be limited to a vertical height limitation of 149.8 feet, as more fully set for the on the Plat of Easement ("Plat") attached hereto as Exhibit C and made a part hereof and

WHEREAS, upon the Parties' execution of this Agreement, the Building Projection Permit will be discontinued and this Agreement shall control over the Building Projection area.

NOW, THEREFORE, in consideration of the above preambles, the mutual covenants herein contained, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

Grant of Easement Area. The City hereby grants to Grantee an easement ("Easement") above and on the public sidewalk adjacent to the Leiter II Building as identified and legally described on the Plat (the "Easement Area"), for the operation, maintenance, use, repair and support of the Leiter II Building at Grantee's sole cost and expense. The Parties hereto may, upon review and approval of the CDOT Commissioner ("Commissioner"), or any successor department, may substitute a revised Easement Area legal description for the Easement Area legal description set forth on the Plat. Terms. The following terms and conditions apply to the Easement:

(a) The Easement is an easement appurtenant in favor of the Grantee's Property.

(b) The Easement is granted for a term of twenty (20) years ("Term") provided that the Grantee pays to the City of Chicago the appraised fair market value of the Easement in the amount of $ . This Easement may be extended for an additional term of 20 years at the request of Grantee and a second payment by Grantee in the amount of the then appraised fair market value of the Easement to the City of Chicago, subject to the consent of the Commissioner of CDOT, and subject to review and approval of the City's Corporation Counsel as to form and legality.

(c) The Easement shall burden the Easement Area as the servient tenement.

(d) Grantee warrants to the City that it is the owner ("Owner") of the Property and also the portion of the Leiter II Building located in the Easement Area and that the Grantee has sufficient title and fee interest to/in the Property to enter into this Agreement.

Final Leiter Building Public Way Easement 030816 2

(e) The Easement above and on the public way granted pursuant to this Agreement constitutes a contemporaneous grant of interest in real property and is not executory in nature.

2. Grantee's Obligations.

(a) Subject to the prior review and approval of CDOT of any exterior construction in the Easement Area, the Grantee shall expressly warrant that any construction in the Easement Area shall be designed and constructed in compliance with all federal, state and local laws and regulations. The Grantee shall expressly warrant that any construction in the Easement Area shall be designed and constructed in compliance with accessibility standards, including, but not limited to: (1) the Americans with Disabilities Act of 1990, 42 U.S.C. 12101, et seq., and the regulations promulgated thereunder; (2) the Illinois Environmental Barriers Act (410 ILCS 25/1 et seq. (1996)); (3) The Illinois Accessibility Code, 71 III. A. Code 400; (4) all local City ordinances, codes, regulations.

(b) The Grantee shall be responsible for obtaining all approvals of and paying for any and all removals, relocations, alterations, additional maintenance and restorations of or to any utility or public service structures or facilities, or any structures or facilities located in or adjacent to the Easement Area which are owned by any third party utility company, and the City, including pavements, bridges, poles, and other facilities and utilities, which are or may be necessary or appropriate to facilitate construction of or work related to any construction in the Easement Area. The Grantee shall be responsible for obtaining the consent of and making suitable arrangements with all entities owning and having an interest in such structures and facilities, including any City department.

(c) The Grantee shall secure all necessary permits, including but not limited to, building permits.

3. Uses Within the Easement Area

(a) The public sidewalk on the south 16.5 feet of Lot 10 (the "Public Sidewalk") shall remain open for use by the public, except for the space occupied by the columns providing support for the Leiter II Building as depicted on the Plat.

(b) The Grantee may not authorize any use above or on the Public Sidewalk for any purpose that will substantially interfere with the use of the Public Sidewalk by the public.

(c) The Grantee may lease the Easement Area above the Public Sidewalk to third parties provided that: (1) all such leases shall require the respective lessees to be bound by and comply with the terms and conditions of this Agreement; and (2) any such use(s) by Grantee or lessees of Grantee shall not substantially interfere with the public's use of the Public Sidewalk.

4. Indemnity. Except with respect to the negligent or wrongful intentional acts of City (to the extent the same are the cause of an injury or loss to a third person). Grantee hereby indemnifies and agrees to hold harmless and defend City from and against any and all claims, demands, damages, lawsuits, legal proceedings, losses, liens.


liabilities, judgments, orders or decrees, and all reasonable costs and expenses (including, without limitation, reasonable attorneys' fees, court costs, and other reasonable expenses related to litigation), arising from or as a result of the death of, or any accident, injury, loss or damage whatsoever caused to the City, any natural person, or the City's property, including but not limited to the Public Sidewalk, Easement Area, and all other impacted City right-of-way areas, the property of any person, arising out of, or occurring as a result of use of the Easement Area by (iSrantee, its officers, employees, and agents. In the event any legal action is taken against City or its agents or any claim is made relating to the Easement Area, the City may elect to tender said defense to Grantee which shall and must defend such action or claim at Grantee's own cost and expense (including reasonable attorneys' fees and costs) and City shall cooperate with Grantee in the defense thereof. Grantor shall have the right to join Grantee as a party defendant in any such legal action. This indemnity shall not be the exclusive remedy of the City, and City shall maintain whatever other right of indemnity it may have under common law, by statute, or by ordinance. This indemnification shall survive any termination or expiration of this Agreement.

5. Grantee's Operation. Maintenance and Security of the Easement Area during the Term of this Agreement.

(a) Grantee shall maintain the Easement Area at its sole cost and expense.

(b) Grantee shall maintain the Easement Area so that the improvement does not unduly interfere with any use ofthe Public Sidewalk by the City, the public, or any person or entity authorized to use or occupy the public way.

(c) Grantee shall conduct regular, documented inspections of the Easement Area and maintain the Easement Area in a structurally sound, clean, aesthetically attractive, and usable condition. All Easement Area maintenance records shall be made available to CDOT upon CDOT's written request for such documentation to Grantee.

(d) Grantee shall cooperate with the City concerning the coordination of uses ofthe Public Sidewalk, including prompt responses to inquiries, attending meetings and site visits, and providing complete disclosure of information concerning the Easement Area and Public Sidewalk.

(e) Grantee shall pay for any and ail utility expenses incurred with respect to the operation, maintenance, repair, and/or replacement of, or security of the Easement Area .

(f) Grantee shall provide security over the Easement Area at its sole cost and expense.

6. City Has No Maintenance and Operational Duties. The Grantee acknowledges that City is not responsible forthe operation, maintenance, repair, and/or replacement of or security of the Easement Area and City has no obligations with respect thereto (other than the provision, through the exercise of the City's right to access the Easement Area for City business purposes and services available to all similarty situated improvements).


7. Insurance.

(a) The Grantee shall procure and maintain, at all times, including but not limited to, all of the types and coverages of insurance and endorsements specified below, with insurance companies authorized to do business in the State of Illinois, covering all operations within the Easement Area under this Agreement, whether performed by the Grantee or any of its lessees or contractors or subcontractors ("Contractor"). Grantee shall procure and maintain, or shall cause any/all Contractors to procure and maintain, all of the types and coverages of insurance specified below, with insurance companies authorized to do business in the State of Illinois, covering all operations within the Easement Area under this Agreement, whether performed by Grantee or any of its Contractors.

(b) The kinds and amounts of insurance required are as follows:

(i) Workers' Compensation and Occupational Disease Insurance. Workers' Compensation and Occupational Disease Insurance, in statutory amounts, covering all employees who are to provide Work under this Agreement. Employers' liability coverage with limits of not less than One Million Dollars ($1,000,000) each accident, illness or disease.

(ii) Commercial Liability Insurance (Primary and Umbrella). Commercial General Liability Insurance, or equivalent, with limits of not less than Five Million Dollars ($5,000,000) per occurrence for bodily injury, personal injury, and property damage liability. All premises and operations, products/completed operations, independent contractors, explosion, collapse, underground, pollution, separation of insureds, defense and contractual liability coverages are to be included. The City is to be named as an additional insured on a primary non-contributory basis for any liability related directly or indirectly to this Agreement.

Contractors performing work for Grantee within the Easement Area must maintain limits of not less than $2,000,000 with the same terms herein.

(iii) Automobile Liability Insurance. (Primary and Umbrella). When any motor vehicles (owned, non-owned and hired) are used in connection with work to be performed within the Easement Area, the Grantee provide or cause to be provided, Automobile Liability Insurance with limits of not less than Two Million Dollars ($2,000,000) per occurrence for bodily injury and property damage. The Grantor is to be named as an additional insured on a primary, non-contributory basis.

Contractor performing work for Grantee within the Easement Area must maintain limits of not less than $1,000,000 with the same terms herein.


(c) Additional Requirements

At least thirty (30) days after the date of this Agreement, the Grantee must provide and cause any of its contractors to provide the City of Chicago, Department of Transportation, 30 North LaSalle Street, Room 500, Chicago, Illinois 60602-2570, original Certificates of Insurance, and endorsements, to be in force on the date of this Agreement, and Renewal Certificates of Insurance, or such similar evidence, if the coverages have an expiration or renewal date occurring during the term of this Agreement. The receipt of any certificate does not constitute agreement by the City that the insurance requirements in the Agreement have been fully met or that the insurance policies indicated on the certificate are in compliance with all Agreement requirements. The failure of the City to obtain certificates or other insurance evidence from Grantee and contractor is not a waiver by the City of any requirements for the Grantee to obtain and maintain the specified coverages. The Grantee and Grantee's contractors must advise all insurers of the Agreement provisions regarding insurance. Non-conforming insurance does not relieve Grantee and contractor of the obligation to provide insurance as specified herein. Non-fulfillment of the insurance conditions may constitute a violation of the Agreement, and the City retains the right to stop work within the Easement Area until proper evidence of insurance is provided.

Grantee agrees to make commercially reasonable efforts to obtain from its insurers, when and if available in the industry, a certificate providing that such coverage shall not be suspended, voided, canceled, non-renewed, or reduced in scope or limits except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to the City.

Any deductibles or self-insured retentions on referenced insurance coverages must be borne by Grantee and Contractor.

The Grantee hereby agrees and will cause its Contractors to agree that insurers waive their rights of subrogation against the City of Chicago, its employees, elected officials, agents, or representatives.

The coverages and limits furnished by Grantee and contractor in no way limit the Grantee's and contractor's liabilities and responsibilities specified within the Agreement or by law.

Any insurance or self-insurance programs maintained by the City of Chicago do not contribute with insurance provided by the Grantee and Contractor under the Agreement.

The required insurance to be carried is not limited by any limitations expressed in the indemnification language in this Agreement or any limitation placed on the indemnity in this Agreement given as a matter of law.

If Grantee or Contractor is a joint venture or limited liability company, the insurance policies must name the joint venture or limited liability company as a named insured.


The Grantee must require the contractor to provide the insurance required herein. All contractors are subject to the same insurance requirements of Grantee unless otherwise specified in this Agreement.

Notwithstanding any provisions in this Agreement to the contrary, the City's Risk Management Department maintains the right to modify, delete, alter or change these requirements, to the extent commercially reasonable.

8. Default. The Grantee shall be in default hereunder in the event of a material breach by Grantee of any term or condition of this Agreement including, but not limited to, a representation or warranty, where Grantee has failed to cure such breach within sixty (60) days after written notice of breach is given to Grantee by City setting forth the nature of such breach. Failure of City to give written notice of breach to Grantee shall not be deemed to be a waiver of the City's right to assert such breach at a later time. If the default is not capable of being cured within the sixty (60) day period, then provided Grantee has commenced to cure the default and is diligently proceeding to cure the default within the sixty (60) day period, and thereafter diligently prosecutes such cure through to completion, then the sixty (60) day period shall be extended for the length of time that is reasonably necessary to cure the default. If the default is not cured in the time period provided for herein, the City may institute such proceedings at law or in equity as may be necessary or desirable to cure and remedy the default, including but not limited to, termination of this Agreement.

9. No Lien. Grantee shall not permit any lien to stand against the Easement Area or any improvement thereon for any labor or material in connection with work of any character performed in the Easement Area at the direction or sufferance of Grantee.

10. Compliance With Lavy. The Grantee agrees that the Easement Area shall be used, and any alterations to the structures located within the Easement Area shall be constructed, installed, used, operated, inspected, maintained, repaired and replaced in complete compliance with all applicable laws, statutes and ordinances.

11. Partial Invalidity. If any clause, sentence or other portion of this Agreement shall become illegal, null or void for any reason, or shall be held by any court of competent jurisdiction to be so, the remaining portion hereof shall remain in full force and effect.

12. Notices. Any and all notices or other communications required or permitted pursuant hereto shall be in writing and shall be deemed to have been given if and when personally delivered or on the next following business day if transmitted by reputable overnight carrier. Notices shall be addressed to Grantee and City at their respective addresses set forth below, or to such substitute address as Grantee or City may have designated by notice in accordance herewith:


If to City:

Commissioner of Transportation 30 North LaSalle Street, Room 500 Chicago, Illinois 60602 Attn: Maps and Plats /Easements

With a copy to:

Department of Law 121 North LaSalle Street, Room 600 Chicago, Illinois 60602 Attn: Deputy Corporation Counsel

Real Estate and Land Use Division

If to Grantee:

One Congress Center, LP 401 S. State Street Chicago, IL 60605 Attn: Thomas L. Garrity

With a copy to:

Drinker Biddle & Reath, LLP 191 N. Wacker Dr., Suite 3700 Chicago, IL 60606 Attn: John A. Simon, Esq.

Addressees may be changed by the Parties by notice given in accordance with the provisions hereof.

13. Illinois Law. This Agreement has been negotiated, executed and delivered at Chicago, Illinois and shall be construed and enforced in accordance with the laws of Illinois.

14. Execution And Recordation of Agreement. The execution and recordation of this Agreement shall be subject to the finalization of utility negotiations, if any, and further provided that the Grantee supplies the City with sufficient proof of ownership of the Property, and any other documents that the City may deem necessary.

15. No Third-Party Beneficiaries. This Agreement shall be binding upon and inure to the benefit solely of Grantee and City and their respective successors, assigns, licensees and legal representatives. This document and the terms hereof are intended solely for the benefit of the parties hereto and their successors, licensee and assigns, as expressly referred to herein. No other person shall have any rights, responsibilities or obligations hereunder nor may such person enforce any of the terms or be entitled to any of the benefits hereof.


16. Authority and Validity. Each party represents and warrants to the other party that (i) this Agreement has been duly authorized, executed and delivered by it and (ii) this Agreement constitutes the legal, valid and binding obligation of it, enforceable against it in accordance with its terms.

17. Miscellaneous.

(a) The terms, benefits, and privileges set forth in this Agreement shall be deemed and taken to be covenants running with the Property and shall be binding upon the Grantee, its successors and assigns having any interest in the Property.

(b) If any provision of this Agreement, or any paragraph, sentence, clause, phrase, or word or the application thereof is held invalid, illegal, null or void for any reason, or shall be held by any court of competent jurisdiction to be so, the remainder of this Agreement shall be construed as if such invalid part were never included and this Agreement shall be and remain valid and enforceable to the fullest extent permitted by law provided that this Agreement, in its entirety as so reconstituted, does not represent a material change to the rights or obligations of either ofthe Parties.

(c) In the event the time for performance hereunder falls on a Saturday, Sunday, or legal holiday, the actual time for performance shall be the next business day.

(d) This Agreement and the accompanying Plat shall be governed by, and construed in accordance with, the internal laws of the State of Illinois. In the event that an adjudication of any kind shall be required in connection with this Agreement, the Parties agree that the venue therefor shall be the state or federal courts located in Cook County, Illinois, whichever may be applicable.

(e) This Agreement constitutes the entire contract between the Parties with respect to the subject matter of this Agreement, and may not be modified except by an instrument in writing signed by all the Parties and dated a date subsequent to the date of this Agreement.

(f) Each Party agrees that it will execute and deliver such other reasonable documents and take such other reasonable actions as may be reasonably requested by the other party to effectuate the purposes and intention of this Agreement.

18. Business Relationships.

The Grantee acknowledges (A) receipt of a copy of Section 2-156-030 (b) of the Municipal Code of Chicago, (B) that it has read such provision and understands that pursuant to such Section 2-156-030 (b) it is illegal for any elected official of the City, or any person acting at the direction of such official, to contact, either orally or in writing, any other City official or employee with respect to any matter involving any person with whom the elected City official or employee has a "Business Relationship" (as defined in Section 2-156-080 of the Municipal Code of Chicago), or to participate in any discussion in any City Council committee hearing or in any City Council meeting or to vote on any matter involving the person with whom an elected official has a Business Relationship, and (c) notwithstanding anything to the contrary contained in this Agreement, that a violation of Section 2-156-030 (b) by an elected official, or any person acting at the direction of such official, with respect to any transaction contemplated by this Agreement


shall be grounds for termination of this Agreement and the transactions contemplated hereby. The Grantee hereby represents and warrants that no violation of Section 2-156-030 (b) has occurred with respect to this Agreement or the transactions contemplated hereby.

19. Patriot Act Certification.

The Grantee represents and warrants that neither the Grantee nor any Affiliate thereof (as defined in the next paragraph) is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury, the Bureau of Industry and Security of the U.S. Department of Commerce or their successors, or on any other list of persons or entities with which the City may not do business under any applicable law, rule, regulation, order or judgment: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.

As used in the above paragraph, an "Affiliate" shall be deemed to be a person or entity related to the Grantee that, directly or indirectly, through one or more intermediaries, controls, is controlled by or is under common control with Grantee, and a person or entity shall be deemed to be controlled by another person or entity, if controlled in any manner whatsoever that results in control in fact by that other person or entity (or that other person or entity and any persons or entities with whom that other person or entity is acting jointly or in concert), whether directly or indirectly and whether through share ownership, a trust, a contract or otherwise.

20. Prohibition on Certain Contributions Mayoral Executive Order 2011-4.

Grantee agrees that Grantee, any person or entity who directly or indirectly has an ownership or beneficial interest in Grantee of more than 7.5 percent ("Owners"), spouses and domestic partners of such Owners, Grantee's contractors (i.e., any person or entity in direct contractual privity with Grantee regarding the subject matter of this Agreement) ("Contractors"), any person or entity who directly or indirectly has an ownership or beneficial interest in any Contractor of more than 7.5 percent ("Sub-owners") and spouses and domestic partners of such Sub-owners (Grantee and all the other preceding classes of persons and entities are together, the "Identified Parties"), shall not make a contribution of any amount to the Mayor of the City of Chicago (the "Mayor") or to his political fundraising committee (i) after execution of this Agreement by Grantee, (ii) while this Agreement or any Other Contract is executory, (iii) during the term of this Agreement or any Other Contract between Grantee and the City, or (iv) during any period while an extension of this Agreement or any Other Contract is being sought or negotiated.

Grantee represents and warrants that from the later to occur of (a) May 16, 2011, and (b) the date the City approached the Grantee or the date the Grantee approached the City, as applicable, regarding the formulation of this Agreement, no Identified Parties have made a contribution of any amount to the Mayor or to his political fundraising committee.

Grantee agrees that it shall not: (a) coerce, compel or intimidate its employees to make a contribution of any amount to the Mayor or to the Mayor's political fundraising committee; (b) reimburse its employees for a contribution of any amount made to the

Final Leiter Building Public Way Easement 030816 1 0

Mayor or to the Mayor's political fundraising committee; or (c) Bundle or solicit others to bundle contributions to the Mayor or to his political fundraising committee.

Grantee agrees that the Identified Parties must not engage in any conduct whatsoever designed to intentionally violate this provision or Mayoral Executive Order No. 2011-4 or to entice, direct or solicit others to intentionally violate this provision or Mayoral Executive Order No. 2011-4.

Grantee agrees that a violation of, non-compliance with, misrepresentation with respect to, or breach of any covenant or warranty under this provision or violation of Mayoral Executive Order No. 2011-4 constitutes a breach and default under this Agreement, and under any Other Contract for which no opportunity to cure will be granted, unless the City, in its sole discretion, elects to grant such an opportunity to cure. Such breach and default entitles the City to all remedies (including without limitation termination for default) under this Agreement, under any Other Contract, at law and in equity. This provision amends any Other Contract and supersedes any inconsistent provision contained therein.

If Grantee intentionally violates this provision or Mayoral Executive Order No. 2011-4 prior to the closing of this Agreement, the City may elect to decline to close the transaction contemplated by this Agreement.

For purposes of this provision:

"Bundle" means to collect contributions from more than one source, which is then delivered by one person to the Mayor or to his political fundraising committee.

"Other Contract" means any other agreement with the City of Chicago to which Grantee is a party that is (i) formed under the authority of chapter 2-92 of the Municipal Code of Chicago; (ii) entered into for the purchase or lease of real or personal property; or (iii) for materials, supplies, equipment or services which are approved or authorized by the City Council of the City of Chicago.

"Contribution" means a "political contribution" as defined in Chapter 2-156 of the Municipal Code of Chicago, as amended.

Individuals are "Domestic Partners" if they satisfy the following criteria:

(A) they are each other's sole domestic partner, responsible for each other's common welfare; and

(B) neither party is married; and (C) the partners are not related by blood closer than would bar marriage in

the State of Illinois; and (D) each partner is at least 18 years of age, and the partners are the same

sex, and the partners reside at the same residence; and (E) two of the following four conditions exist for the partners:

1. The partners have been residing together for at least 12 months. 2. The partners have common or joint ownership of a residence. 3. The partners have at least two of the following arrangements:

a. joint ownership of a motor vehicle; b. a joint credit account;


c. a joint checking account; d. a lease for a residence identifying both domestic partners

as tenants. 4. Each partner identifies the other partner as a primary beneficiary in a will.

"Political fundraising committee" means a "political fundraising committee" as defined in Chapter 2-156 of the Municipal Code of Chicago, as amended.

21. Failure To Maintain Eligibility To Do Business With The City.

Failure by Grantee or any controlling person (as defined in Section 1-23-010 of the Municipal Code of Chicago) thereof to maintain eligibility to do business with the City of Chicago as required by Section 1-23-030 of the Municipal Code of Chicago shall be grounds for termination of the Agreement and the transactions contemplated thereby. Grantee shall at all times comply with Section 2-154-020 ofthe Municipal Code of Chicago.

22. Inspector General and Legislative Inspector General.

It is the duty of every officer, employee, department, agency, contractor, subcontractor. Grantee and licensee of the City, and every applicant for certification of eligibility for a City contract or program, to cooperate with the City's Legislative Inspector General and with the City's Inspector General in any investigation or hearing undertaken pursuant to Chapters 2-55 and 2-56, respectively, of the Municipal Code of Chicago. The Grantee understands and will abide by all provisions of Chapters 2-55 and 2-56 of the Municipal Code of Chicago.

23. Waste Ordinance Provisions.

In accordance with Section 11-4-1600(e) of the Municipal Code of Chicago, Grantee warrants and represents that it, and to the best of its knowledge, its contractors and subcontractors, have not violated and are not in violation of any provisions of Section 7-28 or Section 11-4 of the Municipal Code (the "Waste Sections"). During the period while this Amendment is executory. Grantees, any general contractors or any subcontractors violation of the Waste Sections, whether or not relating to the performance of this Agreement, constitutes a breach of and an event of default under this Agreement, for which the opportunity to cure, if curable, will be granted only at the sole designation of the Chief Procurement Officer. Such breach and default entitles the City to all remedies under the Amendment, at law or in equity. This section does not limit Grantee's, general contractor's and its subcontractor's duty to comply with all applicable federal, state, county and municipal laws, statutes, ordinances and executive orders, in effect now or later, and whether or not they appear in this Amendment. Noncompliance with these terms and conditions may be used by the City as grounds for the termination of this Amendment, and may further affect Grantee's eligibility for future contract awards.

24. Shakman Accord.

(a) The City is subject to the May 31, 2007 Order entitled "Agreed Settlement Order and Accord" (the "Shakman Accord") and the August 16, 2007 "City of Chicago


Hiring Plan" (the "City Hiring Plan") entered in Shakman v. Democratic Organization of Cook County, Case No 69 C 2145 (United States District Court for the Northern District of Illinois). Among other things, the Shakman Accord and the City Hiring Plan prohibit the City from hiring persons as governmental employees in non-exempt positions on the basis of political reasons or factors.

(b) Grantee is aware that City policy prohibits City employees from directing any individual to apply for a position with Grantee, either as an employee or as a subcontractor, and from directing Grantee to hire an individual as an employee or as a subcontractor. Accordingly, Grantee must follow its own hiring and contracting procedures, without being influenced by City employees. Any and all personnel provided by Grantee under this Agreement are employees or subcontractors of Grantee, not employees of the City of Chicago. This Agreement is not intended to and does not constitute, create, give rise to, or otherwise recognize an employer-employee relationship of any kind between the City and any personnel provided by Grantee.

(c) Grantee will not condition, base, or knowingly prejudice or affect any term or aspect to the employment of any personnel provided under this Agreement, or offer employment to any individual to provide services under this Agreement, based upon or because of any political reason or factor, including, without limitation, any individual's political affiliation, membership in a political organization or party, political support or activity, political financial contributions, promises of such political support, activity or financial contributions, or such individual's political sponsorship or recommendation. For purposes of this Agreement, a political organization or party is an identifiable group or entity that has as its primary purpose the support of or opposition to candidates for elected public office. Individual political activities are the activities of individual persons in support of or in opposition to political organizations or parties or candidates for elected public office.

(d) In the event of any communication to Grantee by a City employee or City official in violation of Section 24 (b) above, or advocating a violation of Section 24 (c) above. Grantee will, as soon as is reasonably practicable, report such communication to the Hiring Oversight Section of the City's Office of the Inspector General ("IGO Hiring Oversight"), and also to the head of the relevant City Department utilizing services provided under this Agreement. Grantee will also cooperate with any inquiries by IGO Hiring Oversight or the Shakman Monitor's Office related to the contract.

THE BALANCE OF THIS PAGE IS INTENTIONALLY LEFT BLANK

Signatures appears on the following page


IN WITNESS WHEREOF, Grantee and City have caused this Agreement to be executed by their duly authorized officers, as of the day and year first written above.

ONE CONGRESS CENTER, LP An Illinois limited partnership

By: Anex VI LP, an Illinois limited partnership, its general partner

By: Anex VI LLC, an Illinois limited Liability company, its general partner

By: Vance Antoniou, Manager

CITY OF CHICAGO, a municipal corporation, by and through its Department of Transportation

By:

Name: Rebekah Scheinfeld Title: Commissioner

Approved As To Form And Legality (excluding the Legal Descriptions):

CITY OF CHICAGO Department of Law

By: Name: Karen Bielarz Title: Senior Counsel


STATE OF ILLINOIS ) ) SS.

COUNTY OF COOK )

I, , a Notary Public in and for said County, in the State aforesaid, do hereby certify that Rebekah Scheinfeld personally known to me to be the Commissioner of the Department of Transportation of the City of Chicago, an Illinois municipal corporation, and personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and being first duly sworn by me acknowledged that as the Commissioner, she signed and delivered the instrument pursuant to authority given by the City of Chicago, as her free and voluntary act and as the free and voluntary act and deed of the corporation, for the uses and purposes therein set forth.

GIVEN under my notarial seal this day of , 2016.

NOTARY PUBLIC

STATE OF ILLINOIS ) ) SS.

COUNTY OF COOK )

I, , a Notary Public in and for said County, in the State aforesaid, do hereby certify that Vance Antoniou, personally known to me to be the Manager of the general partner of the general partner of One Congress Center LP, and personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and being first duly sworn by me severally acknowledged that as such Manager, he signed and delivered the instrument pursuant to authority given by organizational documents as his free and voluntary act and as the free and voluntary act and deed of One Congress Center, for the uses and purposes therein set forth.

GIVEN under my notarial seal this day of , 2016.

NOTARY PUBLIC


EXHIBIT A LEGAL DESCRIPTION OF THE PROPERTY

LOTS 2, 3, 6, 7 AND 10 OF BLOCK 10 (ALSO KNOWN AS THE WEST 72 OF BLOCK 10) IN FRACTIONAL SECTION 15 ADDITION TO CHICAGO IN TOWNSHIP 39 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS, EXCEPT THE WEST 27 FEET OF SAID LOTS 2, 3, 6, 7 AND 10 TAKEN FOR WIDENING OF STATE STREET, AND EXCEPT THE SOUTH 16.5 FEET OF LOT 10 AND EXCEPT THAT PART OF SAID LOTS 2, 3, 6, 7 AND 10 TAKEN FOR 20 FOOT ALLEY RUNNING NORTH AND SOUTH THROUGH SAID BLOCK 10.

Commonly known as: 401 South State Street, Chicago, Illinois 60605

Property Index Number:


EXHIBIT B

(LEITER II BUILDING LANDMARK ORDINANCE) (Attached)


EXHIBIT C

PLAT OF EASEMENT (Attached)


EXHIBIT A LEGAL DESCRIPTION OF THE PROPERTY

LOTS 2, 3, 6, 7 AND 10 OF BLOCK 10 (ALSO KNOWN AS THE WEST V-z OF BLOCK 10) IN FRACTIONAL SECTION 15 ADDITION TO CHICAGO IN TOWNSHIP 39 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILLINOIS, EXCEPT THE WEST 27 FEET OF SAID LOTS 2, 3, 6, 7 AND 10 TAKEN FOR WIDENING OF STATE STREET, AND EXCEPT THE SOUTH 16.5 FEET OF LOT 10 AND EXCEPT THAT PART OF SAID LOTS 2, 3, 6, 7 AND 10 TAKEN FOR 20 FOOT ALLEY RUNNING NORTH AND SOUTH THROUGH SAID BLOCK 10.

Commonly known as: 401 South State Street, Chicago, Illinois 60605

Property Index Number:


EXHIBIT B

(LEITER II BUILDING LANDMARK ORDINANCE) (Attached)


37540 JOURNAL-CITY COUNCIL-CHICAGO 1/14/97

Lot 1 in the subdivision of the west half of Block 91 in School Section Addition to Chicago in Section 16, Township 39 North, Range 14 East of the Third Principal Meridian, in Cook County Illinois (Permanent Index Number 17-16-228-001)

is hereby designated as a Chicago landmark. The significant historical and architectural features of the Brooks Building are: the entire north (Jackson Boulevard) and west (Franklin Street) exterior elevations, the marble and terra-cotta cladded returns on the south and east exterior elevations, and all rooflines.

SECTION 2. The Commission on Chicago Landmarks is hereby directed to create a suitable plaque appropriately identifying said landmark and to affix the plaque to the property designated as a Chicago landmark in accordance with the provisions of Section 2-120-700 of the Municipal Code of Chicago.

SECTION 3. The Commission of Chicago Landmarks is directed to comply with provisions of Section 2-120-720 of the Municipal Code of Chicago, regarding notification of said designation.

SECTION 4. This ordinance shall take effect from and after the date of passage.

DESIGNATION OF SECOND LEITER BUILDING AS CHICAGO LANDMARK.

The Committee on Historical Landmark Preservation submitted the following report:

CHICAGO, January 14,1997.

To the President and Members of the City Council:

Your Committee on Historical Landmark Preservation held its meeting on January 13,1997 to consider landmark designation for the Second Leiter Building, and having had the same under advisement, begs leave to report and recommend that Your Honorable Body Pass the proposed substitute ordinance transmitted herewith.

1/14/97 REPORTS OF COMMITTEES 37541

This recommendation was concurred in by a unanimous vote of the members of the committee, with no dissenting votes.

Respectfully submitted,

(Signed) ARENDA TROUTMAN, Chairman.

On motion of Alderman Troutman, the said proposed substitute ordinance transmitted with the foregoing committee report was Passed by yeas and nays as follows:

Yeas — Aldermen Granato, Haithcock, Preckwinkle, Holt, Steele, Beavers, Dixon, Shaw, Buchanan, Huels, Frias, Olivo, Burke , Jones, Coleman, Peterson, Murphy, Rugai, Troutman, Munoz, Zaiewski, Chandler, Solis, Ocasio, Burnett, E. Smith, Wojcik, Suarez, Gabinski, Mell , Austin, Colom, Banks, Giles, Al len , Laurino, O'Connor, Doherty, Natarus, Berna rd in i , Hansen, Levar, Shiller, M . Smith, Moore ~ 45.

Nays — None.

Alderman Natarus moved to reconsider the foregoing vote. The motion was lost.

The following is said ordinance as passed:

WHEREAS, Pursuant to Chapter 2-120, Section 2-120-690 of the Municipal Code of Chicago, the City of Chicago, through its Commission on Chicago Landmarks ("Commission") has determined that the Second Leiter Building, located at 401 South State Street, Chicago, Il l inois, is worthy of designation as a Chicago landmark; and

WHEREAS, The Commission has found that the Second Leiter Bui lding meets certain criteria for landmark designation as set forth in Section 2-120-620 (1), (3), (4), (5), (6) and (7) ofthe Municipal Code of Chicago; and

WHEREAS, The Second Leiter Building is identified wi th Levi Z. Leiter, who in partnership with Potter Palmer and Marshall Field pioneered the city's leading mercantile establishment and, further, wi th his investments in real estate, particularly Loop property, substantially contributed to the commercial development of Chicago during the mid and late nineteenth century; and

W H E R E A S , The Second Lei te r B u i l d i n g is a fundamen ta l and irreplaceable benchmark in Chicago's technical and aesthetic development

37542 JOURNAL-CITY COUNCIL-CHICAGO 1/14/97

in the building arts, as structurally the building incorporates the metal framing that was a major advancement over traditional bearing-wall construction and, aesthetically, the building illustrates the transition from the heavier-looking, historically-inspired forms of conventional masonry construction to the purer profiles of the Chicago commercial style; and

WHEREAS, The Second Leiter Building is a structure whose significance was recognized early on by critics and scholars as one of the premier examples of Chicago's creative and technological advancements in architecture during the late nineteenth century; and

WHEREAS, The architect of the Second Leiter Building, William Le Baron Jenney, was one of the major figures in the development of the Chicago commercial style beginning with his 1884 Home Insurance Building, the first to incorporate skeletal construction in a fireproof commercial building and, further, Jenney's significance is fur ther underscored by the role he played in the architectural education of such major figures as John Root, Louis Sullivan, Daniel Burnham and William Holabird; and

WHEREAS, The Second Leiter Building is listed on the National Register of Historic Places and has the additional distinction of being designated a National Historic Landmark, a program of the federal government that focuses attention on properties of exceptional value to the nation as a whole rather than to a particular state or locality and, further, the Second Leiter Building has been accorded the accolade of being put on the proposed listing for the UNESCO World Heritage List; and

WHEREAS, The Second Leiter Building, initially occupied by the Seigel, Cooper and Company Store and later serving as the flagship Chicago store of Sears, Roebuck and Company, has value as an example of the retailing history of the city and of State Street in particular; and

WHEREAS, The Second Leiter Building is illustrative of the historic identity of State Street as the undisputed retailing thoroughfare in Chicago, a reputation anchored by the location there at one time of such major retailers as Marshall Fields, Carson Pirie Scott & Company, Montgomery Ward and Goldblatt's; and

WHEREAS, The architecture of the new Harold Washington Library, opened to the public in October, 1991, was designed to be compatible with the Second Leiter Building and other landmarks in the library's vicinity, thus recognizing the distinctive physical appearance of the Second Leiter Building as an established and familiar visual feature of the South Loop community; now, therefore.

Be It Ordained by the City Council of the City of Chicago:

1/14/97 REPORTS OF COMMITTEES 37543

SECTION 1. The Second Leiter Building, located at 401 South State Street, Chicago, Illinois, and legally described as:

Lots 1, 2 and 3 (except those portions taken for adjoining streets and alleys) in Assesor's Division of Lots 2 and 3 in Block 10 of the Canal Trustee's Subdivision of lots in Fractional Section 15, Township 39 North, Range 14 East of the Third Principal Meridian; also Lots 6, 7 and 10 (except those portions taken for adjoining streets and alleys) in Block 10 of the Canal Trustee's Subdivision of lots in Fractional Section 15, Township 39 North, Range 14 East of the Third Principal Meridian, all in Cook County, Illinois (Permanent Index Number 17-15-108-001)

is hereby designated as a Chicago landmark. The significant historical and architectural features are: the Van Buren, State and Congress Street exterior elevations, including their rooflines; and the original staircase between the first and second floor, located opposite the central entrance on State Street.

SECTION 2. The Commission on Chicago Landmarks is hereby directed to create a suitable plaque appropriately identifying said landmark and to affix the plaque to the property designated as a Chicago landmark in accordance with the provisionsof Section 2-120-700 of the Municipal Code of Chicago.

SECTION 3. The Commission on Chicago Landmarks is directed to comply with the provisions of Section 2-120-720 of the Municipal Code of Chicago, regarding notification of said designation.

SECTION 4. This ordinance shall take effect from and after the date of its passage, and is passed notwithstanding the provisions of the Municipal Code of the City of Chicago.

DESIGNATION OF WASHINGTON BLOCK AS CHICAGO LANDMARK.

The Committee on Historical Landmark Preservation submitted the following report:

CHICAGO, January 14,1997.

To the President and Members of the City Council:

EXHIBIT C

PLAT OF EASEMENT (Attached)


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PLAT OF EASEMENT

ELEVATION OF BUILDING AT EAST CONGRESS PARKWAY

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EXISTiNG 8-STORY BUILDING

(401 SOUTH STATE STREET)

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LINTEL HEIGHT =11.8'

18.67'

2.95'

18,67' 18.67'

2.95' 2.95' 2 95'

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(PUBLIC RAV- WIDTH VARIES) EASEMENT HEREBY GRANTED

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CDOT# 15-02-14-3680 11 ZARKO SEKEREZ & ASSOCIATES, INC P5 Rl

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" ILL PHONE: (312)720-1313 II.I. FAX'(312) 230.9505 W m v SEKEREZ

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116 WEST CLARK STREET. CSKmH POIHT. IN 40307 " ILL PHONE: (312)720-1313 II.I. FAX'(312) 230.9505

W m v SEKEREZ

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116 WEST CLARK STREET. CSKmH POIHT. IN 40307 " ILL PHONE: (312)720-1313 II.I. FAX'(312) 230.9505

W m v SEKEREZ 9807

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PLAT OF EASEMENT THAT PART OF THE SOUTH 16.5 FEET OF LOT 10, LYING BELOW A HORIZONTAL PLANE HAVING A VERTICAL ELEVATION OF -•-149.8 .AND LYING .ABOVE THE SIDEWALK. HAVING AN AVERAGE VERTICAL ELEVATION OF -H4.6 FEET, ALL CITY OF CHICAGO DATUM, IN BLOCK 10 IN FRACTIONAL SECTION 15, TOWNSHIP 39 NORTH, RANGE 14 EAST OF THE THIRD PRINCIPLE MERIDIAN AS SURVEYED AND SUBDIVIDED BY THE BOARD OF CANAL COMMISSIONERS PURSUANT TO LAW IN THE MONTH OF APRIL, YEAR OF 1836, RECORDED JUNE 13, 1636, ANTE-FIRE, RE-RECORDED SEPTEMBER 24, 1877 AS DOCUMENT NUMBER 151609; EXCEPTING THAT PART OF SAID LOT 10 TAKEN FOR SOUTH STATE STREET AS WIDENED FROM JACKSON STREET TO HARRISON STREET BY ORDER OF POSSESSION JANUARY 24, 1887, ORDINANCE PASSED SEPTEMBER 8, 1878; ALSO EXCEPTING THAT PART OF SAID LOT 10 TAKEN FOR A NORTH-SOUTH 20 FOOT WIDE PUBLIC ALLEY LAID OUT BY AGREEMENT OF OWNERS, ANTE-FIRE, ALSO EXCEPTING THEREFROM THE VERTICAL SPACE OF THE ABOVE-DESCRIBED PROPERTY FROM THE LEVEL OF THE SIDEWALK ON SAID PROPERTY (AVERAGE ELEVATION +14.6, CITY OF CHICAGO DATUM) TO THE LEVEL OF THE BOTTOM OF THE LINTEL OF THE BUILDING PRIMARILY ON SAID PROPERTY (AVERAGE ELEVATION +26.4, CITY OF CHICAGO DATUM); RESERVING TO THE GRANTEES THE SPACE OCCUPIED BY THE EX/STING COLUMNS OF SAID BUILDING, ALL IN COOK COUNTY ILLINOIS. THE EASEMENT AS SHOWN AND DEPICTED HEREIN MAY BE SUBJECT TO OTHER AGREEMENTS ASSOCIATED WITH THIS AREA, THE TERMS OF WHICH ARE MORE FULLY DESCRIBED IN THE ORDINANCE AUTHORIZING SAID EASEMENT.

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EASEMENT HEREBY GRANTED

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CDOT# 15-02-14-3680

scale 1" - 60' PACE 1 OF

II ZARKO SEKEREZ & ASSOCIATES, INC PS II Land Surveyors & Land Planners 11 n6VVESTCU\RKSTREET.CROWNPO(N1.IN<G307 II ILL. PHONE (312)736-1313 ILL FAX (312) 23&*S0C

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PS II Land Surveyors & Land Planners 11 n6VVESTCU\RKSTREET.CROWNPO(N1.IN<G307 II ILL. PHONE (312)736-1313 ILL FAX (312) 23&*S0C

WWW SEKEREZ COM

II Land Surveyors & Land Planners 11 n6VVESTCU\RKSTREET.CROWNPO(N1.IN<G307 II ILL. PHONE (312)736-1313 ILL FAX (312) 23&*S0C

WWW SEKEREZ COM 9307

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SURVEYOR'S NOTES-

1) SUBJECT PARCEL P.I.N • 17-15-108-012-0000, AREA 2.375 SQ FT. 0.055 ACRES ADJOINING APPLICANT 0\A'NED P.I N. 17-15-108-001-0000

2) THE NORTH LINE OF CONGRESS PARKWAY IS ASSUMED TO BEAR S 89°32'52" W

4) THE FIELD WORK FOR THIS SURVEY WAS PERFORMED ON JANUARY?, 2015

5) DIMENSIONS ARE SHOWN IN FEET AND DECIMAL PARTS THEREOF.

6) NO DIMENSIONS SHOULD BE ASSUMED BY SCALE MEASUREMENTS UPON THE PLAT

7) THE EASEMENT PARCEL AND ALL SURROUNDING PARCELS IN BLOCK 10 ARE ZONED "DX-16, DOWNTOWN MIXED USE."

8) CLIENT CONTACT INFO TOM GARRITY ANVAN MIDWEST REALTY MANAGEMENT 401 SOUTH STATE STREET CHICAGO, ILLINOIS 312-393-9300

9) BENCHMARK: MARK CUT ON N SIDE OF STANDARD BM NO. 5675 LOCATED ENTRANCE 228 S. WABASH. 126 FT. N. OF NORTH LINE OF JACKSON AND 1 FT WEST OF WEST LINE OF WABASH ELEV.=-t 16.018 ELEVATIONS ARE WITH REFERENCE TO CITY OF CHICAGO DATUM

10) NO CORNERS OF EASEMENT AREA WERE SET

PLAT OF EASEMENT

DEPT. OF FINANCE

COOK CO.

(REC) (MEAS)

To: STATE OF ILLINOIS COUNTY OF COOK

PROPOSED EASEMENT AREA (AFFECTED BUILDING OVER SAME)

BUILDING ON AFFECTED PROPERTY (NOT PART OF EASEMENT/\REA)

EX/STING BUILDING NOT ON AFFECTED AREA

CONCRETE WALK

TRAFFIC DIRECTIONAL ARROW

ADJOINING PROPERTY NOT AFFECTED BY EASEMENT

SUB-LOT DIVISION

RECORD DIMENSION/MEASURED DIMENSION

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C DOT# 15-0/:- T4-S680

PAGE 3 OF 3

ZARKO SEKEREZ & ASSOCIATES. INC PS Land Surveyors & Land Planners

116 WEST CLARK STREET. CROVyN POim, IN «;307 ILL PHONE. (312)726-1313 ILL. FAX. (312) 236-9506

WVWV SEKEREZ COM

PS Land Surveyors & Land Planners


WVWV SEKEREZ COM

""•.'an?. 2015 Land Surveyors & Land Planners


WVWV SEKEREZ COM 9807

FILE P A T H C Msnd Projects 3\2015U'VE 1-9\9807MlSC\9807B.divg

C I T Y OF C H I C A G O E C O N O M I C D I S C L O S U R E S T A T E M E N T

AND A F F I D A V I T

SECTION I - G E N E R A L INFORMATION

A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ i f applicable:

One Congress Center, an Illinois Limited Partnership

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is: 1. ^ the Applicant

OR 2.1 I a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the

Applicant in which the Disclosing Party holds an interest: -OR

3. a legal entity with a right of control (see Section II .B.I . ) State the legal name of the entity in which the Disclosing Party holds a right of control:

One Congress Center B. Business address of the Disclosing Party:

401 S. State St. Chicago, 1L 60605

./' (312)939-3009 (312)939-3995 [email protected] C. Telephone: Fax: Email:

Thomas L. Garrity D. Name of contact person:

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

F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, i f applicable):

Alley/Street Vacation of Air Rights

CDOT G. Which City agency or department is requesting this EDS?

I f the Matter is a contract being handled by the City's Department of Procurement Services, please complete the following:

Specification # and Contract #

Vcr. 01-01-12 Page 1 of 13

SECTION I I -- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature ofthe Disclosing Party^ Person Publicly registered business corporation Privately held business corporation Sole proprietorship General partnership Limited partnership Trust

Limited liability company Limited liability partnership Joint venture Not-for-profit corporation

(Is'the not-for-profit corporation also a 501(c)(3))? Dves QNO

I |Other (please specify)

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

linois

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?

I IYCS I |NO [/]N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

1. List below the fu l l names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, i f any, which are legal entities. I f there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).

I f the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.

Name Vance T. Antoniou

Title Manager, Anex VI, LLC

General Partner, Anex VI LP

General Partner One Congress Center LP

2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,

Page 2 of 13

interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. I f none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the Disclosing Party

Anthony A. Antoniou One Congress Center 17.7%

Declaration of Trust, dated 3/13/1999 401 S. State St.

Irene Antoniou Trustee Chicago, IL 60605

(FEIN 27-6068520)

S E C T I O N III - BUSINESS RELATIONSHIPS WITH C I T Y E L E C T E D O F F I C I A L S

Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?

/JYCS I |NO

I f yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s): One Congress Center LP has engaged the Honorable Edward M. Burke of Klafter & Burke as tax counsel.

S E C T I O N IV - D I S C L O S U R E OF SUBCONTRACTORS AND O T H E R R E T A I N E D P A R T I E S

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.

"Lobbyist" means any jjerson or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.

I f the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.

Page 3 of 13

Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether retained or anticipated Address (subcontractor, attorney, paid or estimated.) N O T E : to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is

not an acceptable response. Drinker Biddle & Reath LLP 191 N. Wacker Dr. Chicago, 60606 Legal Counsel $8,000-$10,000 (esL)

Zarkeo Sekerez and Associates 116 W. Clark Crown Point, IN 46307 Surveyor $1,850.00 (Paid)

Cohn Reznick 200 S. Wacker Dr. Chicago, IL 60606 Consultant $7,000 (est.)

(Add sheets i f necessary)

j^^Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

S E C T I O N V - C E R T I F I C A T I O N S

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the contract's term.

Has any person who directly or indirectly owns 10% or more ofthe Disclosing Party been declared in arrearage on any child support obligations by any Illinois court of competent jurisdiction?

Q Y C S [/]NO I |NO person directly or indirectly owns 10% or more ofthe Disclosing Party.

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

I^Yes I |NO

B. FURTHER CERTIFICATIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, 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 with the City. NOTE: I f Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Page 4 of 13

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

a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of government;

b. have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;

c. are not presently indicted for, or criminally or civilly charged by, a governmental entity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Section V;

d. have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, state or local) terminated for cause or default; and

e. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.

3. The certifications in subparts 3, 4 and 5 concern:

• the Disclosing 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 of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;

• any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date 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 State of Illinois, or any agency of the federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;

b. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of freedom of competition by agreement to bid a fixed price or otherwise; or

c. made an admission of such conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or

d. violated the provisions of Municipal Code Section 2-92-610 (Living Wage Ordinance).

4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.

5. Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control of the U.S. Department ofthe Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.

6. The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.

7. I f 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

Page 6 of ] 3

I f the letters "NA," the word "None," or no response appears on the lines above, it wi l l be conclusively presumed that the Disclosing Party certified to the above statements.

8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").

None

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

None

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

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

I |is | y lis not

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

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

"We are not and wil l not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them wi l l become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."

I f the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender v/ithin the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages i f necessary):

Page 7 of 13

I f the letters "NA," the word "None," or no response appears on the lines above, it wil l be conclusively presumed that the Disclosing Party certified to the above statements.

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.

1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

P^Yes [ / ] N O

NOTE: I f you checked "Yes" to Item D.L , proceed to Items D.2. and D.3. I f you checked "No" to Item D.L, proceed to Part E.

2. Unless sold pursuant to a process' of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue 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 not constitute a financial interest within the meaning of this Part D.

Does the Matter involve a City Property Sale?

I |Yes I |NO

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

Name Business Address Nature of Interest

4. The Disclosing Party further certifies that no prohibited financial interest in the Matter wi l l be acquired by any City official or employee.

E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

Please check either 1. or 2. below. I f the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to

Page 8 of 13

comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

2^ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes ful l disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:

SECTION VI -- C E R T I F I C A T I O N S F O R F E D E R A L L Y FUNDED M A T T E R S

NOTE: I f the Matter is federally funded, complete this Section V I . I f the Matter is not federally funded, proceed to Section V I I . For purposes of this Section V I , tax credits allocated by the City 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 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets i f necessary):

(If no explanation appears or begins on the lines above, or i f the letters "NA" or i f the word "None" appear, it wil l be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter.)

2. The Disclosing Party has not spent and wi l l not expend any federally appropriated funds to pay any person or entity listed in Paragraph A . l . above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Page 9 of 13

3. The Disclosing Party wil l submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe statem.cnts 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) ofthe Internal Revenue Code of 1986 but has not engaged and wil l not engage in "Lobbying Activities".

5. I f the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A . l . through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.

B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

I f the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors to submit the following information with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant?

QYCS I |NO

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

1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Part 60-2.)

I |Yes I |NO

2. Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?

I |Yes [~]NO

3. Have you participated in any previous contracts or subcontracts subject to the equal opportunity clause?

^Yes I ^0

I f you checked "No" to question 1. or 2. above, please provide an explanation:

Page 10 of 13

S E C T I O N V I I - A C K N O W L E D G M E N T S , C O N T R A C T INCORPORATION, C O M P L I A N C E , P E N A L T I E S , D I S C L O S U R E

The Disclosing Party understands and agrees that;

A. The certifications, disclosures, and acknowledgments contained in this EDS wil l become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement. City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all,statutes, ordinances, and regulations on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The ful l text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N.

Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.

C. I f the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement ( i f not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or . declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.

D. It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.

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 City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT I N E L I G I B I L I T Y for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.

The Disclosing Party represents and warrants that:

Page 11 of 13

Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, lax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated ETitities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 I f the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. l . and F.2. above and will not, v/ithout the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: If the Disclosing Party cannot certify as to any of the items in F. 1., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTTFICATION

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

One Congress Center, an Illinois Limited Partnership

(Print or type name of Disclosing Party)

n By:

(Sign here)

Vance T. Antoniou

(Print or type name o f person signing)

Manager, Anex VI LLC, General Partner Anex Vi LP, General Partner One Congress Center LP

(Print or type title of person signing)

Signed and sworn to before me on (dale) ^^0'^ P^"-at _ ( k l J C _ County,

W^if ^ 1^^^

Commission expires:_

(state).

Notary Pubiic.

"OFFICIAL SEAL" LAURA E. RIVERA

Notary Public, State of Illinois My Commission Expires 10/20/15

Pase 12 of 13

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT

APPENDIX A

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

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

Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof cun ently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city 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 of the Disclosing Party listed in Section II.B.l.a., i f the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, i f the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, i f the Disclosing Party is a limited liabihty company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

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

• Yes / No

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

Page 13 of 13

(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior lo submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)

RECERTIFICATION

Generally, for use with City Council matters. Not for City procurements unless requested.

This recertification is being submitted in connection with Leiter II - Easement Extension [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as of the date fijmished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.

One Congress Center, an Illinois limited partnership (Print or type legal name of Disclosing Party)

By:

Date:

(sign here)

Print or type name of signatory:

Vance T. Antoniou

Title of signatory: Manager, Anex VI LLC General Partner, Anex VI LP

General Partner, One Congress Center LP

i igncd and swom to before mc on [dale] ^^^^ ' ^ ^ l ^ ^ b y Signed a [state].

otary Public.

Commission expires;

Vcr. n-«I-05

.-^^nii^-, ALWA VARGAS LACHAP Ncisrv PiiSlic - Slide Ot H—! . P


APPENDIX B

BUILDING CODE SCOFFLAW/PROBLEM LANDLORD CERTIFICATION

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

1. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?

[ ]Yes / No

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

[ ] Yes [ ] No ^ Not Applicable

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

FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.



SECTION I - G E N E R A L INFORMATION


Anex VI LP, an Illinois limited partnership


Indicate whether the Disclosing Party submitting this EDS is: 1. I I the Applicant

—^OR 2. [ y I a legal entity holding a direct or indirect interest in the Applicant. State the legal name ofthe

Applicant in which the Disclosing Party holds an interest: One Congress Center LP

OR

3. w

a legal entity with a right of control (see Section II .B.I . ) State the legal name ofthe entity in lich the Disclosing Party holds a right of control:


401 S. State St. Chicago, IL 60605

(312)939-3009 (312)939-3995 [email protected] C. Telephone: Fax: Email:


E. Federal Employer Identification No. ( i f you have one):


Alley/Street Vacation of Air Rights




Ver. 01-01-12 Page 1 of 13

S E C T I O N II -- D I S C L O S U R E OF OWNERSHIP I N T E R E S T S


1. Indicate the nature of the Disclosing Party Person Publicly registered business corporation Privately held business corporation Sole proprietorship General partnership Limited partnership Trust

Limited liability company Limited liability partnership Joint venture Not-for-profit corporation

s the not-for-profit corporation also a 501(c)(3))? DYCS Q I O

I pther (please specify)


Illinois


I IYCS • N O / N/A


1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, i f any, which are legal entities. I f there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).

I f the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.


Title Manager, Anex VI, LLC

General Partner, Anex VI LP

2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% ofthe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,

Page 2 of 13

interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. I f none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve ful l disclosure.

Name

Anex VI LLC

Business Address

One Congress Center

Percentage Interest in the Disclosing Party

22.316

Vance T. Antoniou 401 S. State St. 73.56

Chicago, IL 60605

SECTION III ~ BUSINESS RELATIONSHIPS WITH C I T Y E L E C T E D O F F I C I A L S

Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?

• Y es |7]No

I f yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

S E C T I O N IV - D I S C L O S U R E OF SUBCONTRACTORS AND O T H E R R E T A I N E D P A R T I E S


"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.


Page 3 of 13

Name (indicate whether retained or anticipated to be retained)

N/A

Business Relationship to Disclosing Party Fees (indicate whether Address (subcontractor, attorney, paid or estimated.) N O T E :

lobbyist, etc.) "hourly rate" or "t.b.d." is not an acceptable response.


^ Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

SECTION V ~ C E R T I F I C A T I O N S



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?

• Y es | ^ | N O I |NO person directly or indirectly owns 10% or more of the Disclosing Party.


[^Yes I |NO


1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: I f Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Page 4 of 13

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









Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity; • any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any

other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13


a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe federal government or of any slate or local government in the United States of America, in that officer's or employee's official capacity;





5. Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.



N/A

Page 6 of 13


8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").

None

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of 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 City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.

None


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

is not

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


"We are not and wil l not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none of our affiliates is, and none of them wil l become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."

I f the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages i f necessary):

Page 7 of 13




1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee ofthe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

•Yes [/)NO

NOTE: I f you checked "Yes" to Item D . l . , proceed to Items D.2. and D.3. I f you checked "No" to Item D . l . , proceed to Part E.

2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.


•Yes • N O

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

Name " Business Address Nature of Interest

4. The Disclosing Party further certifies that no prohibited financial interest in the Matter wil l be acquired by any City official or employee.


'Please check either 1. or 2. below. I f the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to

Page 8 of 13


_^ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes fu l l disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:

S E C T I O N VI ~ C E R T I F I C A T I O N S FOR F E D E R A L L Y FUNDED M A T T E R S

NOTE: I f the Matter is federally funded, complete this Section V I . I f the Matter is not federally funded, proceed to Section V I I . For purposes of this Section V I , tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.


I . List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter: (Add sheets i f necessary):

(I f no explanation appears or begins on the lines above, or i f the letters "NA" or i f the word "None" appear, it wi l l be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)

2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A . l . above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Page 9 of 13

3. The Disclosing Party wil l 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 . 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 wil l not engage in "Lobbying Activities".

5. I f the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A . l . through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.




I IYCS I |NO



I |Yes I |NO

2. Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements?

I |Yes • N O


^Yes I |NO


Page 10 of 13

S E C T I O N VII - A C K N O W L E D G M E N T S , C O N T R A C T INCORPORATION, C O M P L I A N C E , P E N A L T I E S , D I S C L O S U R E

The Disclosing Party understands and agrees that:

A. The certifications, disclosures, and acknowledgments contained in this EDS wil l become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement. City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N .


C. I f the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement ( i f not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.

D. It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.

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 City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article 1 of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT I N E L I G I B I L I T Y for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.


Page 11 of 13

1 . 1 . i . i l ^ k / 1 - ^ i O W l V / i J I l l ^ 1 U . t t . J l k 7 « . J V . f b V « i > . ' l H J V | ^ » v x A i . . . . . ^ ^ J - - ^ . - -

Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any line, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 I f the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the 13.%. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any i contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. l . and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: If the Disclosing Party cannot certify as to any of the items in F.l . , F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

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

Anex VI LP, an Illinois limited partnership

(Print or tyjje name of Disclosing Party)

By: (Sign here)

Vance T. Antoniou

(Print or type name of person signing)

Manager, Anex VI LLC, General Partner Anex VI LP


Signed and sworn to before me on (dah^) _ at County, " - jHof (state).

Notary Public.

Commission expires:_

| « « « « ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ Page 12 of 13 ^ OFPICIALSEAL" I

LAURA E. RIVERA | Notao PuW/c. State of Illinois |

^ ^ ^ ^ ; ; ; ^ o n Expires 10/20/15 |


APPENDIX A


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

Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Apphcable 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 ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, 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 of the Disclosing Party listed in Section II.B.I .a., i f the Disclosing Party is a corporation; all partners of the Disclosing Party, i f the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, i f the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, i f the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person haying more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.


I I Yes / No

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

Page 13 of 13

(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)

RECERTIFICATION


This recertification is being submitted in connection with Leiter II - Easement Extension • [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as of the date furnished to the City and continue to be true, accurate and complete as ofthe date of this recertification, and (3) reaffirms its acknowledgments.

h) Anex VI LP, an Illinois limited partnership Date: (Print or type legal name of Disclosing Party)

(sign here)


Vance T. Antoniou

Title of signatory; Manager, Anex VI LLC General Partner, Anex VI LP

Signed and sworn loi before me on [date] ^ \ \ ( \ X \ ( f . ' r ' ^ ^ ' M ^ V ^ ftÔ^Wôun^rpr . [state].

I yf J^.J^^'^'^^^^ôtii^ Public.

Commission expires:

Vcr. 11-01-OS

ALMA VARGAS LACHAPtI LE Notary FuhlT. • Slate F'ori;1a

" / ^ J l My Com-'. Espifos Jul 23. ?.017 ] ii - y r ^ r ^ ^ Coniiiiissiu!; # Fh C ri336 <3 '''iVi.ii'i*'''


APPENDIX B


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

1. Pursuant to Municipal Code Section 2-154-010, is the Appl icant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?

[JYes / No

2. If the Applicant is a legal entity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92 A l 6 ofthe Municipal Code?

[ ] Yes [ ] No [ 7 ] Not Applicable

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




S E C T I O N I ~ G E N E R A L INFORMATION


Anex VI LLC


Indicate whether the Disclosing Party submitting this EDS is: 1. I I the Applicant

—^OR 2.1 [ a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the

Applicant in which the Disclosing Party holds an interest: OR

3. a legal entity with a right of control (see Section l l . B . l . ) State the legal name ofthe entity in which the Disclosing Party holds a right of control: Anex Vt LP


401 S. State St., Chicago, IL 60605

(312)939-3009 (312)939-3995 [email protected] C. Telephone: Fax: Email:


E. Federal Employer Identification No. ( i f you have one):'


Petition to Vacate Street Air Rights of One Congress Center LP


I f the Matter is a contract being handled by the City's Department of Procurement Services, please

complete the following:


Vcr. 01-01-12 Page I of 13

SECTION II - D I S C L O S U R E OF OWNERSHIP I N T E R E S T S


1. Indicate the nature of the Disclosing Parly Person Publicly registered business corporation Privately held business corporation Sole proprietorship General partnership Limited partnership Trust

0

Limited liability company Limited liability partnership Joint venture

Not-for-profit coiporation the not-for-profit corporation also a 501(c)(3))?

[]]yes I |NO I jothcr (plca.se specify)



I I Yes • N o / N/A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY;

I . List below the f u l l names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, i f any, which are legal entities.' I f there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).

I f the entity is a general partnership, limited partnership, limited liability company, liinited liabiUty partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party, NOTE: Each legal entity listed below must submit an EDS on its own behalf.


Tit le Manager, Anex VI LLC

Irene Antoniou Manager, Anex VI LLC

2, Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% ofthe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,

Page 2 of 13

interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. I f none; state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the Disc los ing Party

Anthony A. Antoniou One Congress Center 99.9%

Declaration of Trust dated 3/13/1999, 401 S. State St.

Irene D. Antoniou Trustee Chicago, IL 60605

(FEIN 37-6068520)

S E C T I O N III - BUSINESS R E L A T I O N S H I P S WITH C I T Y E L E C T E D O F F I C I A L S


es fTt^" I f yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

S E C T I O N IV -- D I S C L O S U R E OF S U B C O N T R A C T O R S AND O T H E R R E T A I N E D P A R T I E S

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, .lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.


I f the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must cither ask the City whether disclosure is required or make the disclosure.

Page 3 of 13

Name (indicate whether Business retained or anticipated Address to be retained)

Relationship to Disclosing Party Fees (indicate whether (subcontractor, attorney, paid or estimated.) N O T E : lobbyist, etc.) "hourly rate" or "t.b.d." is

not an acceptable response.


^ Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

S E C T I O N V -- C E R T I F I C A T I O N S




es | ^ [ N O I [No person directly or indirectly owns 10% or more of the Disclosing Party.


•[Yes I |NO


1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision .for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article 1 is a continuing requirement for doing business with the City. NOTE: I f Article I applies to the Applicant, the permanent compliance timeframe in Article 1 supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Page 4 of 13

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



c. arc 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 clause B.2.b. of this Section V;






Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business endty to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity;

• any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13







5. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security ofthe U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.

6. The Disclosing Party understands and shall comply wilh the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) of the Municipal Code.

7. I f the Disclosing Parly is unable to certify to any of the above statements in this Part B (Further

Certifications), the Disclosing Party must explain below:

N/A

Page 6 of 13

I f 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.

8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").

None

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

None


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

I [is |»/ | is not



"We are not and wil l not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none of our affiliates is, and none of them wi l l become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."

I f the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages i f necessary):

Page 7 of 13



. Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D.

1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

|~^Yes [ / ]NO

NOTE: I f you checked "Yes" lo Item D.L, proceed to Items D.2. and D.3. I f you checked "No" to Item D . l . , proceed to Part E.

2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue 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 not constitute a financial interest within the meaning of this Part D.

Docs the Matter involve a City Property Sale?

I |Yes I |NO

3. I f you checked "Yes" to Item D . I . , provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:





Page 8 of 13


^ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the

Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes ful l disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:

S E C T I O N VI - C E R T I F I C A T I O N S FOR F E D E R A L L Y FUNDED M A T T E R S

NOTE: I f the Matter is federally funded, complete this Section V I . I f the Matter is not federally funded, proceed to Section V I I . For purposes of this Section V I , tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.



None

(If no explanation appears or begins on the lines above, or i f the letters "NA" or i f the word "None" appear, it wil l be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter.)

2. The Disclosing Party has not spent and wi l l not expend any federally appropriated funds to pay any person or entity listed in Paragraph A . l . above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable-federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Page 9 of 13

3. The Disclosing Party wil l 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 wil l not engage in "Lobbying Activities".

5. I f the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A . l . through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.




Q Y C S I |NO



I |Yes I |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?

I [Yes |~^No


^ Y e s I |NO


Page 10 of 13

S E C T I O N V l l - A C K N O W L E D G M E N T S , C O N T R A C T I N C O R P O R A T I O N , C O M P L I A N C E , P E N A L T I E S , D I S C L O S U R E


A. The certifications, disclosures, and acknowledgments contained in this EDS wi l l become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement. City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The ful l text of these ordinances and a training program is available on line at www.cityofchicago.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 ful ly with the applicable ordinances.


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 of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.

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 City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article 1 of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT I N E L I G I B I L I T Y for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.


Page I I of 13

F. l . The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 I f the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 I f the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. l . and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: I f the Disclosing Party cannot certify as to any of the items in F.l . , F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

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

Anex VI LLC, an Illinois limited liability company


By:_

lype name oi uisciosu

(Sign here)

Vance T. Antoniou


Manager, Anex VI LLC


Signed and sworn to before me on/date) at V j } b l \ County, w U l ) Hi' ' 3 (stiate). ' ~

Notary Public.

Commission expires: f . j^f)^ ^^1^ •

Page 12 of 13

"OF.FICIAL SEAL" LAURA E. RIVERA

Notary Public, State of Illinois My Commission Expires 10/20/15


APPENDIX A


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

Under Municipal Code Section 2-154-015, the Disclosing Party mu.st disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to 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, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section l l .B . l .a., i f the Disclosing Party is a corporation; all partners of the Disclosing Party, i f the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, i f the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, i f the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.


• Yes / No

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

Page 13 of 13

(DO NOT SUBMrr THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)

RECERTIFICATION


This recertification is being submitted in connection with Leiter II - Easement Extension [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf ofthe Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as of the date fumished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reaffirms its acknowledgments.

Anex VI LLC, an Illinois limited

liability company

(Print or type legal name of Disclosing Party)

By: /

7 (sign here)


Vance T. Antoniou

Date:

Title of signatory:

Manager, Anex VI LLC

S,igned and sii;orn to before me on [diUc] — " ^^ii^'^ ^3

(ry Public.

jnimission expires

Ver. 11-01-05

q-t m Q0\ '^LMA VAIiGAS UCIIARtUE »

I tl?=^-? '"I' Expires Jul 29 201? I


APPENDIX B




[-]Yes ( / ] N O

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

[ ]Yes [ ]No [ / ] Not Applicable

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


City of Chicago



O2016-1705

Meeting Date:

Sponsor(s):

Type:

Title:


3/16/2016

Cardenas (12)

Ordinance

Dedication of portion of W 36tli St bounded by S California Ave and S Richmond St Connmittee on Transportation and Public Way

DEDICATION ORDINANCE

Be it Ordained by the City Council ofthe City of Chicago:

SECTION 1. The Commissioner ofthe Chicago Department of Transportation, or her designee, is each hereby authorized and directed to approve a dedication of certain property owned by the Chicago Title Land Trust Company, as successor Trustee ("Land Trustee") to Lakeside Bank, as trustee, under a trust agreement dated May 3, 1985 and known as trust number 10-1037 ("Chicago Title Land Trust 10-1037") along the northern side of W. 36* Street bounded by S. California Avenue and S. Richmond Street, and legally described in the attached plat (Exhibit A. CDOT File: 36-12-15-3725) which, for greater clarity, is hereby made a part of this ordinance.

SECTION 2. The dedication for public way is accepted upon the express condition that funds be deposited into the City Treasury of the City of Chicago sufficient to defray the costs of removing paving and curb returns, and constructing newly dedicated public street according to the current version of the Chicago Department of Transportation Regulations for Opening, Repair and Construction in the Public Way and its appendices, and as agreed to by the beneficial owner of Chicago Title Land Trust 10-1037 ("Beneficial Owner") in the attached Duty to Build Agreement (Exhibit B). hereby made a part of this ordinance.

SECTION 3. The Land Trustee and the Beneficial Owner each acknowledge that all private sewers within the area to be dedicated shall be abandoned or relocated at the expense of the Beneficial Owner. Abandonment plans must be reviewed, approved and permitted by the Chicago Department of Water Management, Sewer Design Section prior to work, with as-built drawings submitted within 45 days of completion, with final acceptance dependent upon physical and video tape inspection by the Chicago Department of Water Management.

SECTION 4. The dedication herein provided for is made upon the express condition that within one hundred eighty (180) days after the passage of this ordinance, the Land Trustee and/or the Beneficial Owner shall file or cause to be filed for record in the Office ofthe Recorder of Deeds of Cook County, Illinois a certified copy of this ordinance, together with the full sized corresponding Plat as approved by the Chicago Department of Transportation / Superintendent of Maps.

SECTION 5. This ordinance shall take effect and be in force from and after its passage. This dedication shall take effect and be in force from and after the recording ofthe plat.

PageT

Dedicatipn Approved:

Rebekah Scheinfeld Commissioner

Approv^ as tc^orr^ an^ Legal i Richard Wtendy

/'6eputy Corporation Counsel

lit Honorable/George Cardenas Alderman/12th Ward

Page 2

..1 . J . a

!i!.yQ!i'lkiii:t- ' " ' i ' ^ bcli.'u dociimeni must he rcpnHiiiccd iMi i!ic anpllciini's knit'iiis.';id, L'XCL-UIOJ,

:inU ( i i ) ! ; i f i^Ci l '

SI nOlVISIO.N / DI :i)K Al ION APPI IC A HON l>UT\ TO BUIl.l) AGRl'KMI'M

(Musi he complclcd by liio applicanl, iioi ihcir uiiiMiiL-y)

In ^.iipp^iii Mi'niy cunx'fii application with the C hicayc Depariinoiii ofTraiispoi'iatioii':-; \hii).s PlaLs unit, jor a subdivision dedicaiion of my private properly, 1 hereby stale tha! I ani liie appiieaiii or ilie conipany agent for the applicant edmpaiiy iii\*»h eil in llie prnjcei. and that I ha\e ilic ,uiil)!.'iiiy to agree lo the below terms ofthe Subdi vision. Plea.sc inilial:

I am aware llial J am responsible fur ilie eonslTnclit.iii i.M"all jniblic and private riulils oTw'ay (sireeti;, alleys, etc) dc.-.(.'iib(;:il on tin.- IMat oi Subiiivision'Dcilicaiion.

I liirtiier imder.sland lhai all rigltm (ilsvay (botlt pubhc and private) miLs! be btiih to Cily specifications as detailed in CDOT'sJ^cgtiltiiion for Opening?. Ct'ii-^iruciion and Repair in the Ptil'iic Way.

i.,.a.stly. 1 utider'iland that coiislrueiieii i,leposi!v> wiU lie letjuircd ;>ssurc that the work i.s done eoiTecily. .An inspcciion will he conducted ivy the Cuy upon Completion ol~thc work. The Ciiy orCiiica2o reserves the right lo require liernolition and reinsiallnlion ofany lacililies tliai aic judged lo be .sub par or shai <lo not ailhcre to the Cilv.s standards.

,Simie(.i;

rimai name; Michael Tadin

1);,!,,. October20, 2015

r;,i.,- Beneficial Owner

(,.ir:j!aniy

Ai l i i r i ,

lione/lax:

t':niaii;

:Volarv:

iyaiion; Chicago Title Land Trust Company as Trustee u/t/a dated 5/3/85 & known as Trust No 10-1037

c/o Michael Tadin, 4450 S. Morgan St. z,,v Chicago, IL 60609

773 254-36445 ,'773 254-7195

mtad i n@mar inacartage .com

Subscribed and sworn to before me this O c j r ^ ^ ^ '2015. OFFICIAL SEAL

? A

^ - . . . . S I . . .jjj -c ?TAr? 'jHJiau vf /--=-f.>/!

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT

AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

A. Legal name of tb . Disclosing Party submitting this EDS. Include d/b/a/ i f applicable:

CHICAGO TITLE LAND TRUST .COMPfiNY AS TRUSTEE t3NDER TRUST NO. 10-1037 DATED 05/03/1985

Check ONE pf the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is: L { ] ftie Applicant

OR <?<bpe/k. 2. [>(] a legal entity holdiag a direct or indirect interest in the AppHcant. State the legal name of the

<p{hM(\et\ Applicant in which the Disclosing Party holds an interest: 3H:bQ 'S, iChi'A^-^a. A^g. ^ OR

3. [ ] alegal entity with aright of control (see Section II.B.I.) State the legal name of the entity in which the Disclosing Party holds a right of control:

B. Business address of the Disclosing Party: IQ s LASALLE SUITE 2750

CHICAGO, I L 60603

C. Telephone: 312-223-2195 fax: 312-223-4139 Email:

D. Name of contact person: TRUST OFFICER

E. Federal Employer Identification No. (if you have one): N/A

F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") lo

which this EDS pertains. (Include project number and location of property, i f applicable); ,

APPLICATION FOR SPECIAL USE FOR PROPERTY AT 3460 S CALIFORNIA AVE. CHICAGO, IL

G. Which City agency or department is requesting this EDS? ZOHING BOARD OF APPEALS

I f the Matter is,a contract being handled by the City's Department of Procurement Services, please complete the following:

Specification # • N/A and Contract § N/A

Ver. 01-01-12 Page 1 of 13

SECTION n - DISCLOSURE OF OV/NSRSHIP INTERESTS


1. Indicate the nature of the Disclosing Party:

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

LAND TRUST AS SELLER OF PROPERTY


ILLINOIS LAND TRtJST

3. For legal entities not organized in the State of Illinois; Has the organization registered to db business in the State of Illinois as a foreign entity?

[ ] Yes [ ] No M N/A


1. List below the full names and titles of all executive officers and all directors of the entity: NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. I f there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).

If the entity is a general partnership, limited partnership, limited liability company, limited liabihty partnership or joint venture, list below the name and title pf each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed belov/ must submit an EDS on its own behalf.

Name MICHAEL A. TADIN 25% BENEFICIAL OWNER OP

Title LAND TRUST

ANTHOOT N. FRATTO 25% BENEFICIAL OWNER OF LAND TRUST

ALBERT BOUMENOT 25% BENEFICIAL OWNER OF LAND TRUST

RONALD MTLRASSO 25% BENEFICIAL OWNER OP LAND TRUST

2. Please provide the following information conceming each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture.

Page 2 of 13

interest.of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. I f none, state "None." NOTE: Pursuant to iSection 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any apphcant which is reasonably intended to achieve full disclosure.

Name , Business Address Percentage Interest in the Disclosing Party

MICHAEL A.- TADIN 4450 S. , MORGAN AVE. CHICAGO, I L 60609 25%

ANTHONY N. FRATTO 2640 s. PRINCETON CHICAGO IL 60616 25%

ALBERT BOUMKNOT 2103 W EVERGREEN CHICAGO, IL 60623 25V

RONALD MASASSO 2907 s CANAL ST. CHICAGO, IL 60616 25%

SECTION III - BUSINESS RELATIONSHIPS WITH CITY E L E C T E D OFFICIALS

Has the Disclosing Party had a "business relationship," as defined in Chapter 2-156 ofthe Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?

[ ] Yes M No

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s); N/A

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attomey, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.



Page 3 of 13


N/A

Business Relationship to Disclosing Party Address (subcontractor, attomey,

lobbyist, etc.)

Fees (indicate whether paid or estimated.) NOTE: "hourly rate" or "tb.d." is not an acceptable response.


] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

SECTION y ~ CERTIFICATIONS


Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with tlieir 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 obtigations by any Illinois court of competent jurisdiction?

[]Yes ^ ] No [ ] No person directly or indirectly owns 10% or more of the Disclosing Party.

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

[JYes [JNo


1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currendy indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criitunal offense involving actual, attempted, or conspiracy to commit bribery, theft, fi-aud, forgery, perjury, dishonesty or deceit 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: I f Article I applies to the Applicant, the pennanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Page 4 of 13

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

a. are not presently debarred, suspended, proposed for debarment, declared, ineligible or voluntarily excluded from any transactions by any federal, state or local unit of govemment;

b. have not, within a five-year period preceding the date of this EDS, been convicted.of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract tinder a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;

c. are not presently indicted for, or criminally or civilly charged by, a govemmental entity (federal, state or local) with committing any of the offenses set forth in clause B .2.b. of this Section V;


e. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, orin any criminal or civil action, including actions conceming environmental violations, instituted by the City or by the federal govemment, any state, or any other unit of local govemment.

3. The certifications in subparts 3, 4 and 5 concem:

• the Disclosing Party; • any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party ia

coimection 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 of control include, without Iknitation: 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 gpvenmient, including the City, using snbstantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity; • any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any

other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction of authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor' any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an AffiUated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:

a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City,.the State of Illinois, or any agency ofthe federal govemment or of any state or local government in the United States of America, in that officer's or employee's official capacity;

b. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders, in restraint of fireedom of competition, by agreement to bid a fixed price or

• otherwise; or

c. made an admission of snch conduct described in a. or b. above that is a matter of record, but have not been prosecuted for such conduct; or •


4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local govemment as a result of eiigaging in or bemg 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 that contains the same elements as the offense of bid-rigging or bid-rotating.

5. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department ofthe Treasury or the Bureau of Industry and Security ofthe U.S. Department of Conmierce or their successors; the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.

6. The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Govemmental Ethics) ofthe Municipal Code.

7. I f the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below: N/A

Page 6 of 13

I f the letters "NA," the word "Nohe," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above-statements.

8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at anytime during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none"). N/A

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



[ ] is [x] is not


2. I f the Disclosing Party IS a financial institution, then the Disclosing Party pledges;

"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Afunicipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."

I f the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-.32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages i f necessary): N/A

Page 7 of 13

I f die letters "N A," the word "None," or ho response appears on-the lines above, it will be conclusively presumed fhat the Disclosing Party certified to the above statements.


Any words or terins that are defined in Chapter 2-156 of the Municipal Code have the same .meanings when used in this Part D,

1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee of the City havie a financial interest in his or her own name or in the name of any other person or entity in the Matter?

[ ] Yes [x] No

NOTE: I f you checked "Yes" to Item D.l . , proceed to Items D.2. and D.3. I f you checked "No" to Itein D.L, proceed to Part E.

2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit of the City (collectively, "City Property Sale"). Compensation for property taken pursuant to die City's eminent domain power does not constitute a financial interest within the meaning of this Part D.


[]YeS [ ] N0 NOT APPLICABLE

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


4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.


Please check either 1. or 2. below. I f the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all mfonhatiou required by paragraph 2. Failure to

Page 8 of 13

comply with these disclosinre requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

-X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and ail 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 foimd no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insutrance 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 V I - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: I f the Matter is federally funded, complete this Section VI . I f theMatteris not federally funded, proceed to Section VH. For purposes of this Section V I , tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.


1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf ofthe Disclosing Party with respect to the Matter: (Add sheets i f necessary): NOT APPLICABLE - THB MATTER IS NOT FEDERALLY FUNDED.

(If no explanation appears or beguis on the lines above, or if the letters "NA" or i f the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)

2, The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A . l . above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Page 9 of 13

3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that'materially affects the accuracy of the statements and information set forth in paragraphs A . l . and A.2. above.

4. The Disclosing Party certifies that either: (i) i t is not an organization described in section S01(c)(4) of the Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Intemal Revenue Code of 1986 but ha:s not engaged and willnot engage in "Lobbying Activities".

5. I f the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and siibs'taijce to paragraphs A , l . through A,4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request. •


If the Matter is federally funded, federal regulations require the Applicant and aU proposed subcontractors to submit the following iiiformation with their bids or in writing at the outset of negotiations.

Is the Disclosing Party the Applicant? NOT APPLICABLE - THE MATTER IS NOT FEDERALLY FUNDED.

[JYes [ ] N o

If "Yes," answer the three questions below:


[}Yes ' [ ] N 0


[ 3 Yes [ 1 No


[ ] Yes [ 3 No

If you checked "No" to question 1. or 2. above, please provide an explanation:

Page 10 of 13

SECTION V n - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE


A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with .respect to the Matter. The Disclosing Party understands that it must comply with all stamtes, ordinances, and regulations on which this EDS is based.

B. The City's Govemmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations oh persons or entities seeking City contracts, work, business, or transactions. The fall text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics. and may also be obtamed from the City's Board of Ethics, 740 N.

Sedgwick SL, Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances.

C. I f the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at lav/ for a false statement of material fact may include incarceration and an award to the City of treble damages.

D. It is the City's policy to make this document available to the public on its Intemet site and/or upon request. Some or all of the information provided on this EDS ahd any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the.Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of infonnation 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 must supplement this EDS up to the time the City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Sendees, the Disclosing Party must update this EDS as the contract requires!. NOTE: With respect to Matters subject to Article I Of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.


Page 11 of 13

F.l . The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 I f die Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in coniiection with the Matter certifications equal in form and substance to those in F, 1. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide tmthful certifications.

NOTE: I f the Disclosing Party cannot certify as to any ofthe items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

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

CHICAGO TITLE LAND TRUST COMPANY AS TRUSTEE UNDER

of Disclosing Party)


Signed and swom to before me on (date) J U L Y ^ 2015 at coo^ County, I L L I N O I S (state).

['^i£.^g>)7^»'g«s>»-^ Notary Public, 3 CommisiSion expires;_

Page 12 of 13

—jbytteofidesip larfJTfUi , |fa$7rusteBintf!8ei(efa«(jfir

a iinnies}'tej s«itatiQn^ C9«aisns,'urid8rta!!i9s heren made on the part of the Trustee

isiifertskeniljy it j felv in its capacity »-Trustee snii ISiTsanaSr. JVo persimai liability or personal iespor^t (miiii^ by or slisS at any tints bs asserted or eiifbrcs snoT ths Tritstse on account of any f 'arranty, 'vksis.

r fGsentaiien. covenant, indertaliing or agreemsnt of TftsteeintfcjnjtfWBSfii

fn Its Ihdimhml cepadiy. for tho mith or sccurtcy of the fs«* thsrsh atsted.

t4.

®8'

m

IF-

CITYOFCHICAGO ECONOmC DISCLOSURE STATEMENT AND AFFIDA.Vrr

APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT MEADS

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

Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "famihal 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 to 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, cMld, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild^ father-in-law, mother-in-law, soit-in-law, daugjiter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stq)sister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers ofthe Disclosing Party listed m Section II.B.1.a,, i f the Disclosing Par^ is a corporation; aU partners of the Disclosmg Party, i f the Disclosing Party is a general partnership; all geneial partners and liinited partners ofthe Disclosing Party, i f the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, i f the Disclosing Party is a liinited liability company; (2) all principal ofiicers of the Disclosing Party; and (3) any prason having more tijan a 7.5 percent ownership interest in the Disclosing Party. 'Trincipal ofBcers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretaiy of a legal entity or any person exercising similar authority.

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

t ] Yes [X] No

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

Page 13 of 13

a T Y OF CHICAGO ECONOMIC DISCLOSURE STATEMENT ATflO AFFIDAVIT

APPENDIX B

BUILDING CODE SCOFFLAW/PROBLEM L/iNDLORD CERTIFICATION

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

1. Pmsuant to Municipal Code Section 2-1 S4-0lb, is the Applicant or any Owner ideritified as a . building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?

• Yes / No

2. I f the Applicant is a legal eiitity publicly traded on any exchange, is any officer or director of the Applicant identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?

QjYes L J ^ ° jy^l Not Applicable

3. If yes to (1) or (2) abo\'e, please identify below the name of the person or legal entity identified as a building code scofflaw or problem landlord and the address of die building or buildings to which the pertinent code violations apply.

Not appScabla.

FILLING OUT THIS APPStJDIX 3 CONSTITUTES ACKI>iO\VLEDGMENT ANB AGREEMENT THAT TECS APPENDIX B IS INCORPORATED BY REFERENCE ir>TO, AND RL'iDE A PART OF, THE ASSOaATED EDS, ANH THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE OTJDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.

Page 14 of 14

(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify tmthfiilly, the Disclosing Party must complete a new EDS with correct or corrected infonnation)

RECERTIFICATION

Generally, for use with City Council matters. Not for City procurements unless requested. A p p l i c a t i o n f o r d e d i c a t i o n f o r widening

This recertification is being submitted in connection with of 35th street (west of California Ave .) [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that ouc File # : he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) 2015-68352 warrants that all certifications and statements contained in the Disclosing Party's original EDS project No • are true, accurate and complete as ofthe date fumished to the City and continue to be true, 36-12-15-3725 accurate and complete as ofthe date of this recertification, and (3) reaffinns its acknowledgments.

C3>'JCAC0 TmE Lf.r.'!> Tfi-j^TT

(Print or type legal name of Disclosing Party)

By:

/ i / V i ' S y Date: January

. V/fyy -p<py ( s i ^ here)


Title of signatory:

^mryy-y- --

2016

This instrument is executed by the unilersigned LaniJ Trustee, not personally but solelv as Trustee in the exercise of the power and authority conferred upon and vested in it as such Trustee, jt is expressly understood and agreed that ail the warraities, indemnities, representations, covenants, undertakings ara agreements herein made on the part of the Trustee are undertaken by it solely in its capacity as Trustee and not personally. No personal iiabiiity or personal responsibility is assumed by or shall at any time be asserted or enforceable against the Trustee on account of any warranty, indeiraiitY, representation, covenant, undertaking or agreement of the Trustee in th.s instrument.

Tlia ;n'crrna;i.?.n ccntrsincci In this csrtiricatlon hr.s bcon -rLrnistifd to ihok'nt ! truates by v.'ia Lcpefioi-'iM!. or -.-iiî r .o. i£. :y£y3^.ZTvi :ha certificat'C'.T i,5 r;..idi, so!g'v' in rclian;;9 tharoon end no .'t>;'ôrisib!/icv i j .loS'imed by ths trustsa In Its ;.'U:;viuii5! csp.ôltv, for tha truth or

Signed and swom to before me on [date] January / • 2016 , by 1 , at Cook County, I l l i n o i s [state].

Notary Public.

Commission expires: •f- ^ « -I- <i-0' < " -i O - ' «•'

T "GFi-lClAL SEAL"

Ver. 11-01-05

SILVIA MEDINA -> Notary Put)lic. Stata of Illinois 1

City of Chicago



Or2016-137

Meeting Date:

Sponsor(s):

Type:

Title:


3/16/2016

Hopkins (2)

Order

Landmark fee waiver for property at 2047 W Thomas St

Committee on Zoning, Landmarks and Building Standards

ORDER

WHEREAS, Section 2-120-815 ofthe Municipal Code provides that the Chicago City Council may by passage of an appropriate order waive any fees charged by the City for any permit for which approval of the Commission on Chicago Landmarks (the "Commission") is required, in accordance with chapter 2-120 of the Municipal Code; and

WHEREAS, the permits identified below require Commission approval, in accordance with Section 2-120-740 of the Municipal Code; now, therefore,

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

SECTION 1. The foregoing recitals are hereby adopted as the findings of the City Council.

SECTION 2. The Commissioner of the Department of Buildings, the Commissioners of the Departments of Environment and Fire, the Director of the Department of Revenue, and the Zoning Administrator are hereby directed to issue those permits for which approval of the Commission on Chicago Landmarks is required pursuant to Chapter 2-120 of the Municipal Code free of charge, notwithstanding any other ordinances of the City Council to the contrary, for the property at:

Address: 2047 West Thomas Street ("Property") District/Building: Ukrainian Village District

for work generally described as: Construction of a new rear porch and a roof replacement, the work will also include tuckpointing and masonry repairs.

Owner: Michael Galvin and Ryan Quirm Owner's Address: 2047 West Thomas Street City, State, Zip: Chicago, Illinois 60622

SECTION 3. The fee waiver authorized by this Order shall be effective from January 1, 2016, through January 1, 2018, and shall not apply to additional developer service fees, stop-work order fees or any fines.

SECTION 4. That the pennit purchaser for the Property shall be entitled to a refimd of city fees for which it has paid and which are exempt pursuant to Section 1 hereof.

SECTION 5. This order shall be in force and effect upon its passage.

Alderman, 2"'' Ward

NOTE: This is NOT a permit nor does it constitute a Letter of Approval for the above described work. A permit application for the work must be approved by the appropriate City department(s) as well as the Commission on Chicago Landmarks for this permit fee waiver, subject to City Council approval, to be valid.


AND AFFIDAVIT

SECTION I -- GENERAL INFORMATION

A. Legal name of the Disclosing Party submitting this EDS. Include d/b/a/ if applicable:

/ t l tCfH^f-i^ ^ ^ k y A /


Indicate whether the Disclosing Party submitting this EDS is: 1. PQ the Applicant

OR 2. [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the


3. [ ] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in which the Disclosing Party holds a right of control:

B. Business address of the Disclosing Party: Zô^y jrj 'TMttÂit f (ZtficJ^ra^ {ôCX %

C. Telephone: : Email:

D. Name of contact person: Al fCfHjhCt- (^dO^r/y



G. Which City agency or department is requesting this EDS? ^'^î>t^&t2'ieL



Ver. 01-01-12 Page 1 of 13

S E C T I O N II - D I S C L O S U R E OF OWNERSHIP I N T E R E S T S


1. Indicate the nature ofthe Disclosing Party: Person [ ] Limited 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 organization, ifapplicable:


[ ] Yes [ ] No [ ] N/A


1. List below the ful l names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, i f any, which are legal entities. I f there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).

I f the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.

Name Title

/Vt /^^^f^£:/i r

2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture,

Page 2 of 13



AJ^6lL

S E C T I O N I I I ~ BUSINESS R E L A T I O N S H I P S W I T H C I T Y E L E C T E D O F F I C I A L S


[ ] Yes i ^ o

I f yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

S E C T I O N IV -- D I S C L O S U R E OF S U B C O N T R A C T O R S AND O T H E R R E T A I N E D P A R T I E S



If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.

Page 3 of 13


Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)

Fees (indicate whether paid or estimated.) NOTE: "hourly rate" or "t.b.d." is not an acceptable response.


^^^^heck here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

S E C T I O N V ~ C E R T I F I C A T I O N S




[ ] Yes J ^ o [ ] No person directly or indirectly owns 10% or more of the Disclosing Party.


[ ] Yes [ ] N o


1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: I f Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Page 4 of 13

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









Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity; • any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any

other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization o fa responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13


a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee of the City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;




4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.

5. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.


7. Ifthe Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Party must explain below:

Page 6 of 13


8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago ( i f none, indicate with "N/A" or "none").

ZMA

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

JZM-



[ ] is ) ^ not



"We are not and wil l not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them wil l become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."

I f the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages i f necessary):

Page 7 of 13,





j W e s [ ] No

NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. If you checked "No" to Item D.l . , proceed to Part E.



[ ] Yes J^^o

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





Page 8 of 13


1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:

SECTION VI ~ CERTIFICATIONS FOR F E D E R A L L Y FUNDED MATTERS

NOTE: I f the Matter is federally funded, complete this Section VI . I f the Matter is not federally funded, proceed to Section VII . For purposes of this Section VI , tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.


1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets if necessary):

/ / f i M / r

(If no explanation appears or begins on the lines above, or ifthe letters "NA" or i f the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)


Page 9 of 13

3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe 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 Intemal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".

5. Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A . l . through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.


Ifthe 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.


J ^ e s [ ] No



[ ] Yes [>fbio


[ ] Yes [>p^o


[ ] Yes EYNO


Page 10 of 13

S E C T I O N V I I -- A C K N O W L E D G M E N T S , C O N T R A C T I N C O R P O R A T I O N , C O M P L I A N C E , P E N A L T I E S , D I S C L O S U R E


A. The certifications, disclosures, and acknowledgments contained in this EDS wi l l become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement. City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The ful l text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N .



D. It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.

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 City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT I N E L I G I B I L I T Y for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.


Page 11 of 13

F. 1. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 Ifthe Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l . and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: I f the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

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


(Sign here)



Signed and sworn to before me on (date) - ^ l o . 10 ^ 1 0 at Cfi>^ /C

Commission expires : 4 h SOh-

(state).

Notary Public. O F F I C I A L S i . JENNIFER L RUSSv

NOTARY PUBUC, STATE OF ILLii,. MY COMMISSION EXPIRES 4/9/201 -

Page 12 of 13


APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS


Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to 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, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section n.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general parmership; all general partners and limited partners of the Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.


[ ] Yes j J ^ o

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

Page 13 of 13


APPENDIX B



I . Pursuant to Municipal Code Section 2-154-010, is the Applicant orany Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 of the Municipal Code?

[ ]Yes No

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

[ ]Yes [ ]No j ^ ^ o t Applicable

Ifyes to (1) or (2) above, please identify below the name of the person or legal entity identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.


interest ofa member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar enfity. If none, state "None." NOTE: Pursuant to Secdon 2-154-030 ofthe Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.


SECTION III - BUSINESS RELATIONSHIPS WITH CITY E L E C T E D OFFICIALS


[ ] Yes ^ N o

Ifyes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

SECTION IV ~ DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total 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 Party's regular payroll.

"Lobbyist" means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative acfion.

If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party must either ask the City whether disclosure is required or make the disclosure.

Page 3 of 13


Relationship to Disclosing Party (subcontractor, attorney, lobbyist, etc.)

Fees (indicate whether paid or estimated.) NOTE: "hourly rate" or "t.b.d." is not an acceptable response.

(Add sheets if necessary)

[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

SECTION V ~ CERTIFICATIONS




[ ] Yes 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 that agreement?

[ ] Yes [JNo


1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article r')(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, 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 with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Page 4 of 13

2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities idenfified in Section II.B. 1. of this EDS:





e. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local govemment.





• any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13


a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public, officer or employee of the City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;




4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (I) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.

5. Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.



Page 6 of 13

If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements.

8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").

:

9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of 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 City business and having a retail value of less than $20 per recipient (if none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name of the City recipient.



[ ] is l^is not



"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."

If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):

Page 7 of 13

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.




,Yes [ ] No

NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. I f you checked "No" to Item D.l . , proceed to Part E.



[]Yes MINo

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

Name ^ Business Address Nature of Interest



Please check either 1. or 2. below. If the Disclosing Party checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to

Page 8 of 13


1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.



NOTE: I f the Matter is federally funded, complete this Section V I . I f the Matter is not federally funded, proceed to Section V I I . For purposes of this Section V I , tax credits allocated by the City and proceeds ofdebt obligations of the City are not federal funding.



(If no explanation appears or begins on the lines above, or i f the letters "NA" or i f the word "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)

2. The Disclosing Party has not spent and wil l not expend any federally appropriated funds to pay any person or entity listed in Paragraph A . l . above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

Page 9 of 13

3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A . l . and A.2. above.

4. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of the Intemal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".

5. Ifthe Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A . l . through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration ofthe Matter and must make such certifications promptly available to the City upon request.


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.


[ ] Yes [ ] No


1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulafions? (See 41 CFR Part 60-2.)

[ ] Yes [ ] No


[ ] Yes [ ] No

3. Have you participated in any previous contracts or subcontracts, subject to the equal opportunity clause?

[ ] Yes [ ] No


Page 10 of 13

S E C T I O N V I I - - A C K N O W L E D G M E N T S , C O N T R A C T I N C O R P O R A T I O N , C O M P L I A N C E , P E N A L T I E S , D I S C L O S U R E


A. The certifications, disclosures, and acknowledgments contained in this EDS wil l become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement. City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The ful l text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N .


C. I f the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement ( i f not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transacfions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.

D. It is the City's policy to make this document available to the pubhc on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.

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 City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT I N E L I G I B I L I T Y for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code.


Page 11 of 13

F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 I f the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 I f the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F.l . and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certificafions or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: I f the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

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

Z ^ ! < ^ ^ j y / A / ^ - ^ < i ^ 7 UZ Ift^ufi-S (Print or type nam«<onDisclosing Party)

^^^^ By: ^ (Sign here]



Signed and sworn to before me on (date) /0 c^^lC/> at Co4< County, -ztr/1 i» oV (state).

, " O F F I C I A L S E A L " Notary Public. 1 JENNIFER L RUSSO

NOTARY PUBUC. STATE OF ILUNOIS ^ / o / ^ ^ , ^ I MY COMMISSION EXPIRES 4/9/2019

Commission expires:"/rvf>/ ca(Q( ; . Crs»s,N<-.,»*>-»-r-»s --« - ^

Page 12 of 13


APPENDIX A



Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to 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, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section Il.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 limited paitners ofthe Disclosing Party, ifthe Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.


[ ] Yes jXf No

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

Page 13 of 13


APPENDIX B




[ ]Yes No

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

[ ]Yes [ ]No [y3 Not Applicable

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


City of Chicago



O2016-1727

Meeting Date:

Sponsor(s):

Type:

Title:


3/16/2016

Beale (9)

Ordinance

Vacation of public alley(s) in area bounded by S Kenwood Ave, E 47th PI, S Dorchester Ave and E 48th St (For 4th Ward) Committee on Transportation and Public Way

NOT FOR PROFIT ORDINANCE

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

WHEREAS, the City wishes to support the charitable, educational and philanthropic activities of established Not for Profit Corporations and encourage the continued viability and growth of such activities; and

WHEREAS, many Not For Profit Corporations own property that adjoins streets and alleys that are no longer required for public use and might more productively be used in furtherance of such activities; and

WHEREAS, the City would benefit from the vacation of these streets and alleys by reducing City expenditures on maintenance, repair and replacement; by reducing fly-dumping, vandalism and other criminal activity; and by providing support for such charitable, educational and philanthropic activities; and

WHEREAS, the City can promote strong communities by facilitating services to the public, and increase the City's job base through the vacation of public street(s) and/or alley(s) for no compensation; and

WHEREAS, the properties at 4732-4758 S. Dorchester Avenue, and 1368-1380 E. 48'^ Street are owned by Chicago Title Land Trust, a Corporation of Illinois as successor trustee ("Land Trustee") to LaSalle Bank National Association, as successor to American National Bank and Trust Company of Chicago, March 2,1994 and known as Trust Number 118087-06 ("Chicago Title Land Trust 118087-06"); and

WHEREAS, the properties at 1356-1364 E. 48* Street, are owned by Southwold Condominium Association which approved a resolution to execute the Consent to Vacation agreement attached as Exhibit A and made a part hereof; and

WHEREAS, the beneficiary of Chicago Title Land Trust 118087-06 is an Illinois Not For Profit Corporation ("Not For Profit Beneficiary") that uses the site as a private school for behaviorally challenged children; and

WHEREAS, beneficiary of Chicago Title Land Trust 118087-06 proposes to use the portion of the public alley to be vacated herein for creation of a secure campus, unification of the campus footprint, expansion of the playground area, and temporary housing of a modular classroom; and

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


SECTION 1. THAT PART OF THE 14 FOOT WIDE NORTH-SOUTH PUBLIC ALLEY IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION OF BLOCK 2 OF LYMAN, LARNED AND WOODBRIDGE'S

Page 1

SUBDIVISION OF THE EAST 1/2 OF THE NORTHWEST 1/4 AND THE NORTHWEST 1/4 OF THE NORTHEAST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT THEREOF RECORDED MAY 12,1874 AS DOCUMENT 159571, LYING EAST OF AND ADJOINING THE EAST LINE OF LOT 15 IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION AFORESAID, LYING NORTH OF AND ADJOINING THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15, LYING WEST OF AND ADJOINING A PORTION OF LOT 1 AND LOTS 2, 3,4 AND A PORTION OF LOT 5 ALL IN SAID BLOCK 2; AND LYING SOUTH OF AND ADJOINING THE SOUTH LINE OF EAST 47TH PLACE, SAID SOUTH LINE BEING ALSO THE EASTERLY EXTENSION OF THE NORTH LINE OF LOT 15 AFORESAID, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF LOT 15 AFORESAID; THENCE SOUTH, ALONG THE EAST LINE OF SAID LOT 15 (BEING ALSO THE WEST LINE OF SAID NORTH-SOUTH ALLEY), A DISTANCE OF 125.19 FEET (RECORD 125.00 FEET) TO THE SOUTHEAST CORNER THEREOF; THENCE EAST, ALONG THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15, A DISTANCE OF 14.00 FEET TO THE INTERSECTION WITH THE WEST LINE OF LOT 5 AFORESAID; THENCE NORTH, ALONG THE WEST LINE OF LOTS 5,4,3, 2 AND A PORTION OF LOT 1 AFORESAID, (BEING ALSO THE EAST LINE OF SAID NORTH-SOUTH ALLEY) A DISTANCE OF 120.20 FEET (RECORD 120.00 FEET) TO A POINT OF CURVATURE IN THE WEST LINE OF SAID LOT 1; THENCE NORTHEAST ALONG THE CURVED WESTERLY LINE OF SAID LOT 1, (BEING ALSO THE WESTERLY LINE OF SAID NORTH-SOUTH ALLEY) AND BEING THE ARC OF CIRCLE CONVEX TO THE NORTHWEST AND HAVING A RADIUS OF 25.00 FEET, AN ARC DISTANCE OF 5.03 FEET TO THE INTERSECTION WITH THE EASTERLY EXTENSION OF THE NORTH LINE OF LOT 15 AFORESAID; THENCE WEST ALONG SAID EASTERLY EXTENSION, 14.50 FEET TO THE POINT OF BEGINNING, IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 1,751 SQUARE FEET OR 0.0402 ACRES, MORE OR LESS as shaded and legally described by the words "HEREBY VACATED" on the plat hereto attached as Exhibit B. which plat for greater, is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacation.

SECTION 2. The Commissioner of Transportation, or a designee of the Commissioner, is hereby authorized to accept and approve a redevelopment agreement or similar instrument restricting the use and improvement of the public way vacated in Section 1 of this ordinance to social service purposes which include, but shall not be limited to educational purposes and for such use and improvements that are accessory, as that term is defined in the Chicago Zoning Ordinance, to such social service purposes, such uses and improvements to be owned and operated by a non-profit corporation, subject to the approval of the Corporation Counsel as to form and legality. The restriction on use and improvement in the covenant, agreement or instrument shall be for a term of 40 years and upon breach of such restriction the public way herein vacated shall revert to the City and be subject to the terms and conditions of the dedication by which it has been heretofore held by the City.

SECTION 3. The City of Chicago hereby reserves for the benefit of Commonwealth Edison and its successors or assigns, a non-exclusive utility easement to operate, maintain, construct, replace and renew overhead wires, poles, and associated equipment and underground conduit, cables, and associated equipment for the transmission and distribution of electrical energy, telephonic and associated services under, over and along the alley herein vacated, with the right of ingress and egress. The grade of the vacated public way shall not be altered in a manner so as to interfere with the operation and maintenance of Commonwealth Edison facilities. No buildings, permanent structures or obstructions shall be placed over Commonwealth Edison facilities without express written release by the utility. Any future vacation-beneficiary prompted relocation of Commonwealth Edison lying within the area herein vacated will be accomplished by Commonwealth Edison and completed at the expense of beneficiary of the vacation.

Page 2

SECTION 4. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Chicago Titie Land Trust 118087-06 shall deposit in the City Treasury of the City of Chicago, a sum sufficient to defray the costs of removing paving and curb returns, and constructing sidewalk with the most current version of the Chicago Department of Transportation's Regulations forOpeninp, Repair and Construction in the Public Way and its appendices.

SECTION 5. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Chicago Title Land Trust 118087-06, shall file or cause to be filed for record in the Office ofthe Recorder of Deeds of Cook County, Illinois, a certified copy of this ordinance, together with a redevelopment agreement complying with Section 2 of this ordinance, and approved by the Corporation Counsel, and the full sized corresponding plat as approved by the Department of Transportation / Superintendent of Maps & Plats.

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

Vacation Approved


Approved as to F

Deputy Corporation Counsel

Honor^e William Burns Alderman, 4"" Ward

Page 3

l i

CONSENT TO VACATION (vrlarb prool ol aHiwrrhip-tille rommitiMnL tMIc poiio' ritO

The undersigned, irpreseins «hai ha'iht is the (check one'i o«-nfi (skip to Sf cijon 11.) beuefKian' (»kjp to Section 11.)

X. tbe duly e«rfjonzed agent of the owner / beneficiary (CIRCLE ONE) described belo -:

Name oi owner / benefjcinn: SpLlthwold Condominium Association

Name ol conq»tiy (if appliczWe);

Mailing Address: J 358;64 48th Street tip. /[{QRI 5

Telephonenfflnbei; t.773,, ..1. ,, -01: • nr>7R ' 'i?' ? 1 2 ,

If Bftnt's tddress is drffeiem fron the owner / be»efic>ar>*. complete the foUowjjjp;

Namcoffirrr- ^ _iel:t )

Mailing Addteis;

ProT' rr.- feu which cnrtf u: is betng gjven iinsert comnwn ftteet addretstes)!:

with the *TeTn»neTW Index Snn**r(t5: (PIN #t_2Dr11-202-040-0000

(PIN tt)

fPTN

])} As the owner / beneficiary / dtjK authorized apeiv of IIK property ccKnbcd above, 1 give consent to th< vacation of the public righi-of-way dc'cr^licd at:

TO BE FROVIDEB EY THE VACATION A PPLiCANT- 1 iwen coronon iangosje eetenptiOA ot wc«>onJ;

Tne understpned 3fi]t to wsiv /aU claims for datm es o> cotnpemtion arismg from such \-ac8iton

sienec

Not«n- Public;

pnme«_

?JS f arc M ci^n Mimiier; IMI utualiytake tne tormof ]*-.^<-}67-!:'ilO-(KKi(>. Tot PIN is* trntouc nuinher toretcr. piOpen> ana can be (ouna en piorvrty tait bilts reiatmp to tne spentic pioptny

PATRICIA A;. ERINGTON-OFFIC IA l SEAL

Notary Public. State ol lllinoil M Y Commission Expires

March 09. 2016

SOUTHWOLD CONDOMINIUM ASSOCIATION RESOLUTION

RECITALS

WHEREAS the Southwold Condominium Association is comprised of members owning nine units in the property at 1358-64 E. 48* Street, Chicago, Illinois; and

WHEREAS the Southwold Condominiiun Association is adjacent to the southern half of the of the north south alley, located to the west of Dorchester Avenue, to the south of 47*** Place and to the north of 48"" Street (the "North South Alley"); and

WHEREAS the neighboring Ancona School has applied to vacate the northern half of the North South Alley, which is not adjacent to the Southwold^ohdominium Association; and

WHEREAS City of Chicago's Department of Transportation asked the Ancona School to obtain a consent letter from the Southwold Condominium Association in order to apply for the vacation of the northern portion ofthe North South Alley; and

WHEREAS on September 7,2014, the Southwold Condommium Association held a meeting to review whether or not to execute the consent to vacation letter; and

WHEREAS on September 7, 2014, the Southwold Condominium Association voted to execute the consent to vacation letter with 6 affirming votes.

NOW, THEREFORE, BE IT RESOLVED, by the Board ofthe Southwold Condominium Association:

It is resolved tliat the Southwold Condominium Association consents to the Ancona School's vacation ofthe northern portion of the North South Alley; that Jim Stricklin, Southwold President, has the authority to sign this Resolution; and that Linda Tucker, Board Member, is authorized to execute the consent to vacation letter on behalf of the Southwold Condominium Association.

SOUTHWQ£;D CONDOIVKNIUM ASSOCIATION

Subscribed and swom to before me

this day o f ^ f A ] , 2015.

PATRICIA A. EfiWGTON^' , , OFFICIAl SEAL %

Noiory Public. Slate of lllinoli My Commrstlon Expires '

Mo(ch09.2016 f j f

EXHIBIT "A"

PU\T OF VACATION

N

OF

THAT PART OF THE H FOOT WIDE NOSTH-SOUTH PUBLIC ALLEY IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION OF BLOCK 2 OF LYMAN, U\RNED ANB WOODBRIDGE'S SUBDIVISION OF TV.E EAST 1/2 OF IH t NOKIHWEST 1/4 AND THE NORTHWEST 1/4 OF THE NORTHEAST 1/4 CF SECTION 11, TOWNSHIP 36 NORTH, RANGE 14, EASF OF THE THIRD PRINCIPAL MERIDIAN. ACCORDING 10 THE PLAT THEREOF RECORDED MAY 12, 1874 AS DOCUMCNI 1 i 9 b / - , L-'ING EAST OF AND ADJOINING THE EAST LINE OF LOT 15 IN BLOCK 2 IN W. B. PIERCE'S SUBDIVISION AFORESAID, LYING NORIH OF AND ADJOINING "HE EASTER_Y EX~ENSICN OF THE SOUTH LIME OF SAID LOT ' 5 , LYING WEST OF AND ADJOINING A PORTION OF LOT 1 AND LOTS 2. 3, 4 AND A PORTION OF LOT 5 AL'. 'N SAID 3L0C< 2; AND LYING SOUTH OF AVID ADJOINING THE SOUTH lINF OF EAST 47TFI PLACE. SAID SOUTH LINE BEING A1.S0 IHE EASTERLY EXTENSION OF THE NORT. LNE OF LOT 15 AFORESAID, BFING MORE PARTICULARLY DESCRIBED AS FOLLOWS:

BEGINNING AT THE NORTHEAST CORNER OF LOT 15 AFORESAID; THENCE SOUTH. ALONG THE EAST LINE OF SAID LOT 15 (BEING ALSO THE WEST LINE OF SAID NORTH-SOUTH ALLEY), A DISTANCE OF 125.19 FEET (RECORD 125.00 FEET) TO THE SOUTHEAST CORNER THEREOF; THENCE EAST, ALONG THE EASTERLY EXTENSION OF THE SOUTH LINE OF SAID LOT 15, A DISTANCE OF 14 00 FEEI TO THE INTERSECTION WITH THE WEST LINE OF 1 OT 5 AFORESA'D; THENCE NORTH, ALONG THE WEST LINE OF LOTS 5, 4, 3, 2 ASD A PORTION OF LOT 1 AFORESAID, (BEING ALSO TTHE EAST LINE OF SAID NORTH-SOUTH K \ . V ) A 0 STANCE OF '20 .20 FEET (RECORD 130 00 - f P ) TO A POINT OF CLRVA'JRE IN THE WEST LINE OF SAID LOT 1; "HENCE NORTHEAST ALONG THE CURVED WESIER..Y ^NE 0 - SAID LOT 1, (BEING ALSO THE WE5IERI.Y I NK OF SAO NORTH-SOUTH ALLEY) AND BEING r-K ARC 0- CIRCLE CONVEX TO THE NORTHWEST AND HAV NG A RADIUS OF 25 00 FEET, AN ARC DISTANCE OF 5 03 ^EET TO 'M-. INTERSECTION WITH THE EASTERLY EXTENSION 0 " THE NORTH LINE OF LOT 15 AFORESAID; THENCE WEST ALONG SAID EASTERLY EXTENSION, 14.50 FEET TO THE POINT OF BEGINNING, IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 1,751 SQUARE ."EET OR 0 0402 ACRES. MORE OR LESS.

PUBUC ALLEY i ; ! ' L

20'

65.00

O o o z l l J

PUBUC ALLEY

10

/-VACATED JULY 1, 1 9 7 1 ^ / DOC. 21532023

c J E. 47TH

S89'53'04X 14-.5I IRON PIPE TO BE SET.

S RIGHT OF WAY UNE OF E. 47TH PL

I W F I C KlOW

PUBUC STREET

TRAFFIC R.OW

(K ^

^ V - fAll

"T 6 S PL in

I H TO BE CLTT

(A)5.03 (RAD)25.00 (CH)S05*46'07"W, 5.03

- P C .

PIN 2 0 - 1 1 - 2 0 2 - 0 2 4 -

, g 2 STORY BRICK BUILDING /...

of- -o o u. •

I r f ' N : 2 0 - 1 1 - 2 0 2 - 0 2 5

-66 00-

Qi 1x1 I -(/) UJ X o a. o a

E. 48TH TlWmC FLOW

PUBLIC STREET

-PAFFIC R.OW

ST.

(*) (H) (u)

CCH)

(l«AD)

ARC

CHORD

RADIUS

A R L A HCREIBY VACATED

BOUNDARY OF VACATION AREA

RiGI-T 0=^ WAY U N t

PA^^CEL _NE

I OT I IN.R:

SURVEYOR'S NOTES. FGR U F PUR^SFS 0 " •LAillNG OF SG3-00'00"E

- S PI.AT THE EAST LINE OF LO" 15 IS AT A« ASSJMED

COOK CO.: C.D.O.T.:

CD0T#11-04-15-3730 "Pt-*it.iY EDWARD J. MOLLOY & ASSOCIATES, LTD.

LAND ft CONSTRUCTION SURVEYORS

l - t M . IMOlOMUMUCnfCM

5" ,»* 3a-34(» \ S f^PnOFESSIOWtL^ S S LMlO -s s suncYOR : 5 \ SUTE OF ;

D ME.SSI3KS A!1E S-OWN IN FEET AND DECIItWL PARTS THEREOF

NO O MENSIONS Sf-OULD BE ASSUMED BY SCALE WEASUBEuENTS UPON THE PLAT

All . THF LAND WES" 0- AVD ADJOINING HEREBY VAGATED ALLEY FALLS WfTHIN ZONE Rr-4. R^sl. F' T^A_ ^^c-FLAT, TOWNHOUSE AND U U L T I - U N T DISTRICT ALL THE LAND EAST OF AND A X O N I N G - E R E B Y VACATED ALLEY FALLS WITHIN ZONE RU-5 RESIDENTIAL MULTi-_s; ::ib-=i.cT

FIELD WORK WAS (:CW=LETED ON JANUARY 4, 2016

PLAT PREPARED FOR-THE ASCOSA SC-OOL •770 S DORCHESTER AVENJE CHCACn, IL 606-5

STATE OF ILJNOS ) ) SS

COLNTY or DLPACL )

I. THOUAS A. MOLLOY, AN ILLINOIS PROFESSIONA!. lANO SURVI:YOH AND UAHAG.NS AGENT OF EDWARD J MOLLOY AND ASSOCttltS, L ID, HERFEJY C£RT1^Y THAI A PLAT HAS BEEN UADE LSDER MY DIREiCIION FOR THE =JRPOSC OF VACATING A PORTION 0^ AN A-LEY AS S-OWN HLULON AND TllAT THE =LAT HEREON DRAWN IS A CORRECT =!EPRESENTATOS OF SAID VACATION THIS PRO^SSONAL SEWCE CONFOR.WS "0 CURRENT ILL SOS MINIUUU STANDARDS FOR A PJk" OF BOUNDARY SURVEY

SIGSEO AT BENSENVU-L, ILLINOIS IHIS 4TH DAY 0- WARCH , A.D. 2016

r t i d lMS A. MOLLOY [ \

• UCENSE .SO 184-002910

THOMfS / _. ILLINOIS PRUI'EJiSIOriAL >N3 SURVEYOR NO. 35-^400 (EXPIRES NOVEMBER 30. 2 0 ' 6 AND IS RCNCWAOLE) MANAGING AGENT. ILUNOIS PRO^SSIOHAl. DFSICN FIRM IICFNSE NO 1S4-002910

WUP OW.Y MIH EWOSSEP S P l (EXPIRES APRIL 30. 2017 ASP IS RENEWABLE)

EJ.yA PROJ HO 23W/160001

. 1


.AND AFFIDAVIT

SECTION i - GENERAL INFORMATION

A. Legal name ofthe Disclosing Party submitting this EDS. Include dfh/eJ if applicable: Chicago Title Land Trust Company, A Corporation of Illinois As Successor Trustee To LaSalle Bank National Association. As Sucessor Trustee To American National Bank And Trust Company of Chicago, March 2, 1994 And Known As Trust Number 118087-06.

Cbeck ONE of the following three boxes;

Indicate whether tbe Disclosing Party submifting tHs EDS is: 1. ^ ] the AppHcant


Applicant in which the Disclosing Party holds an interest: • . OR • •

3. [ ]• a legal entity with a right of control (see Section II.B. 1,) State the legal name of the entity in which the Disclosing Party holds a right of control;

B. Business address ofthe Disclosing Party: 10 S. LaSalle Street, Suite 2750, Chicago, IL

60603

C. Telephone:312-223-^//C> Fax:312-223-4136 Email: ^US-^ d.^ (^~r. C^^^

D. Name of contact person; d ^ f ^ l - Y f ^ ^ p/j^MPBAJ ELL4

E. Federal Employer [dentification No. (if you have one):

F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of propeny, if applicable); Vacation of an alley that bisect's school's property. Alley is located v est of S. Dorchester AvRHUfi between E. 47th PI. and 48th St.

G. Which City agency or depamnent is requesting this EDS? Department of Transportation

. I f the Matter is a contract bemg handled by the Cit)''s Department of Procurement Services, please complete the following. •


Vtr. oi-fli-ii Page 1 of 13

SECTION O - DISCLOSURE OF OWNERSHIP INTERESTS


1. Indicate the nature of the Disclosing Party: [ ] Person [ ] Limited liability company f ] P-ubJicIy registered business corporation [ ] Limited liability partnership [ ] Privately bold business corporation [ ] Joint venture [ ] Sole proprietorship [ ] Not-for-profit corporation [ J General partnership (Is the not-for-profit corporation also a 50] (c)(3))? [ ) Limited partnership [ ] Yes [ ] No ^ ] Trust [ ] Other (please specify)

2. For legal entities, tie state (or foreign country) of incorporation or organization, if applicable

Illinois


[]Yes [ ] N o f ] N / A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY;

1. List below the full names and titles of ail executive officers and all directors ofthe entity. NOTE: For not-for-profit corporations, also lisl below ail members, i f any, which are legal entities. If there arc no such members, write "no members." For trusts, estates or other similar entities, list below the legal titlebolder(s).

If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Partj'. NOTE: Each legal entity listed below must submit an EDS on its own behalf.

Name Title Chicago Title Land Tnjst tDtA^Ltwj S ' Trir.<:;tfiiq under trust #118087-06 '

2. Please provide the following infonnation concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of .'Juch an interest include shares in a corporation, partnership interest in a partnership or joint venture.

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interest of a member or manager in a limited liability company, or interest of a heneficiaiy of a trust, estate or other similar entity. I f none, state "None." NOTE: Pursuant to Section 2-154-030 of the Municipal Code .of Chicago ("Municipal Code"), tbe City may require any such additional informatioii from any applicant which is reasonably intended lo achieve full disclosure.

Name Business Address Percentage Interest in the Disclo.?ing Party

Ancona School Society 4770 s. Dorchester 100% Chicago, IL 60615 .-

SECTION I I I - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS

• Has the Disclosing Party had a "business relationship," as defined in Chapter 2-3 56 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?

[ ] Yes W No

If ycs. please identify below the name(s) of such City elected officiaI(£) and describe such r6lationsh!p(E):

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose tbe name and business address of each spbcontractor, attomey, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as (he nature of the relafionship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.

"Lobbyist" means any person or entity who undertakes to influence any legislative or administrati 'e action on behalf of any person or entity other than: (I) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.

I f the Disclosing Partj' is uncertain whether a disclosure is required under this Section, ihe Disclosing Party .must either ask the City whether disclosure is required or make tlie disclosure.

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None.

Business Relationship to Disclosing Party Address (subcontractor, attomey,

lobbyist, etc.)

Fees (indicate whether paid Or estimated.) NOTE: "hourly rate" or "t.b.d." is not an acceptable response.


Check here i f the Disclosing Party has not retained, nor expects to retain, any such persons or entities,

SECTION V - CERTIFICATIONS




[ ] Yes f(] No ( I N o person directly or indirectly owns 10% or more of the Disclosmg Party.

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

[ ]Ycs [JNo

B, FURTHER CERTIFlCiATIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article r')(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting this EDS is tbe Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervi.sion for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the Cit>' or any sister agency; and (ii) the Applicant understands and acknowledge.'; that compliance with Article I is a continuing requirement for doing business with the City. NOTE: If Article 1 applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

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

a. " are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, stale or local unit of govemment;

b. have not, within a frve-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempting to obtain, or performing a public (federal state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;

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

d. have not, within a five-year period preceding the date of this EDS, had one or more public transactions (federal, stale or local) terminated for cause or default; and

e. h ave not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions concerning environmental violations, instituted by the City or by the federal govemment, any state, or any other unit of local government.


• the Disclosing Party; • any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Parly 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 Enrity" (meaning a person or entity that, directly or indirectly: controls die

Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entify to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity; ' any responsible official of tbe Disclosing Party, any Contractor or any Affiliated Entity or any

other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Enfity, acting pursuant to the direction or autliorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

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Neither the Disclosing Party, nor any Conlractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter: •

a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency of the federal government or of any state or local govemment in the United States of America, in that officer's or employee's official capacity;

b. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement, or been convicted or adjudged guihy 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




5. Neither the Di.sclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors; the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.


7. To the best of the Disclosing Party's knowledge after reasonable inquiry, no current employee of tbe Disclosing Party was, at any time during the 12-month period preceding tbe execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago.

S. To the besJ ofthe Disclosing Party's knowledge after reasonable inquiry, the Disclosing Party has not given or caused to be given a gift, at any time during the 12-month period preceding the execution date of this EDS, fo an employee, or elected or appointed officiaL ofthe City of Chicago. For purposes of this statement, a "gift" does not include; (i) anj^hing made generally available to Cit}'

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employees or to the general public, or (ii) food or drink provided in the course of official City business and having a retail value of less than $10 per recipient.

9. I f the Disclosing Party is unable to certify to any of the above statements in this Part B (Further Certifications), the Disclosing Partj- must explain below;

f\|//\ _ Disclosing par ty i s merely land t r u s t which solely holds t i t l e to property.

Jf 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.


1. The Disclosing Party certifies that the Disclosing Parly (check one)

[ ] is y " '


2. If the Disclosing Party IS a financial institution, then the Disclosing Party pledges:

"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code. We further pledge fhaf none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. Wc 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." •

I f the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined ia Section 2-32-455(b) ofthe Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages i f necessary):

I f the letters "NA," the word "None," or no response appears on tbe lines above, it will be conclusively presumed that the Disclosing Party certified to the above statements,


Any words or terms that are defmed in Chapter 2-156 ofthe Municipal Code have the same

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meanings when used in this Part D.

1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee cf tbe City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

[JY'es ^ N o

NOTE: Lf you checked "Yes" to Item D.l . , proceed to Items D.2. and D.3. I f you checked "No" to Item D.l . , proceed to Part E.

2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or entity in the purchase of any property Chat (i) belongs to ths City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, 'City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.


[]Yes [ ] N o

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


4, The Disclosing Party further certifies that no prohibited financial interest in the Matter will be acquired by any City official or employee.


Please check either 1. or 2. below. I f the Disclosing Party checks 2,, the Disclosing Party must disclose below or in an attachment to this'EDS all information required by paragraph 2. Failure to comply with these disclosure requirements may make any contract entered into with the City in connection with the Matter voidable by the City.

^ 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Di.sclosing Party and any and alt predecessor entities regarding records of investments or profits from slavcrj'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.

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2. The Disclosing Party verifies that, as a result of conducting the search in step J above, the Disclosing Party has found records of mvestments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the foUowing constituics full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:

SECTION V I - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. I f the Matter is not federally funded, proceed to Section VII . For purposes of this Section VI, tax credits allocated by the City and proceeds of debt obligations of the City are not federal funding.


1. List below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to tbe Matter: (Add sheets i f necessary):


2. The Disclosing Party has not spent and v/ill not expend any federally appropriated funds to pay any person or entity listed in Paragraph A . I . above for his or her lobbying activities or to pay any person oi entity to influence or attempt to influence an officer or employee of any agency, as defmed by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally funded contract, grant, loan, or cooperative agreement.

3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and information set forth in paragraphs A . l . and A.2. above.

4. The Disclosing Party certifies that either: (i) it is not an organization described in section 501(c)(4) of tbe 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

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Activities".

5. I f 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 i t awards any subcontract and the Disclosing Party must maintain all such subcontractors' cerfifications for the duration ofthe Matter and must make such certificfltions promptly available to the City upon request.




[ ] Y c s [JNo


1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulations? (See 41 CFR Pan 60-2.)

[JYes [JNo


(J Yes [JNo


[ ] Yes [ ] No

I f you checked "No" to question 1. or 2. above, please provide an explanation;

SECTION V I I - ACKNOWLEDGME.NTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE


A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any Page 10 of 13

contract or other agreement between the Applicant and the Chy in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to tbe City's execution of any contract-or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statates, ordinances, and regulations on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The fiiU text of these ordinances and a training program is available on line af www.ciryofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N.


C. I f the City detennines fhat 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 rhe Cify may pursue any remedies under the contract or agreement (if nof rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at kw for a false statement of material fact may include incarceration and an award to the City of treble damages.

D. It is the City's policy to make this document available to the public on its Internet site and/or upon request. Some or all of the information provided on this EDS and any attachments to tiiis EDS may be made available to the public on the Intemet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS..

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 rime the City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept cunent for a longer period, as required by Chapter J -23 and Section 2-154-020 of the Municipal Code.


F.l . The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 If the Disclosing Party is- the Applicanl, the Disclosing Party and its Affiliated Entities will not

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F.2 I f the Disclosing Party is the Applicant, the Disclosing Parly and its Affiliated Entities w i l l not use, nor permit their subcontractors .to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 I f the Disclosing Party is the Applicant, the Disclosing Party wi l l obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in fonn and substance to those in F . l . and F.2. above and wil l not, without the prior written consent of the Cily, use any such contractor/siibcontraclor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: I f the Disclosing Party cannot certify as to any of the items in F. 1., F.2. or F.3. above, an

explanatory statement must be attached to this EDS.

C E R T I F I C A T I O N

Under penalty o f perjury, the person signing below: (1) warrants that he/she is authorized to execute

this EDS and Appendix A ( i f applicable) on behalf of the Disclosing Party, and (2) warrants that all

certifications and statements contained in this EDS and Appendix A ( i f applicable) are true, accurate

and complete as o f the date furnished to the City.

Chicago T i t l e Land Trus t Company, as Successor Trustee to LaSal le Bank, as Successor Trustee to American N a t i o n a l Bank and Trus t Company of Chicago U/T/D 03/02/94 and known

as Trust No. pe r sona l ly

118087-06 and not

Mario V. Gotanco


Trus t O f f i c e r


n5^Ste?S^'"^i^y the undersigned Cand-Tnisteft IwtsoWv as Trustee m the exercise of the po5;

awaWwntjf conferred uppnM vested in it«suchiTrS

covenwts, undertakings: S ?" 'fie Paft of the Trustee aw-

umteriaken by if solely tn its capacity as Trustee and'nop

Sf.i5yT°^ ^ - ^ Of enforoiS againstuhe Trustee on account of anv.wafrantV/ indmiSv repfeseftalron/covenani,.undertakingo^ Trustee in this instrument: '

Signed and sworn to before me on (date) August 10, 2015

at Chicago County, . Cook (state), o f I l l i n o i s

otary Public.

Commission expires:

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: •

• "OFFICIAL SEAL" t X SILVIA MEDINA : • Notary PuWic. State of Illinois • • My Commission Expires 06/26/20161

CITYOFCHICAGO ECONOMIC DISCLOSURE STATEMEINI' AND AFFlDAVTr

APPENDIX A

FAMILLIL RELATIONSEDGPS WITH ELECTED CITY OFFTCIALS AxND DEPARTMENT HEADS

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

Dnder Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any " Apphcahle Party" or any Spouse or Domestic Partner thereof currently has a "famihal relationship" with any electfld city official or department head. A "familial relationship" exists i t as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party*' or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any citj' department head as spouse or domestic partner or as any of the following, whether by blood or adoption; parent, cJbild, brother or sister, annr or nncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section EB.l .a., if tbe Disclosing Party is a corporation; allpartners ofthe Disclosing Party, if the Disclosing Partyis a general paj-tnci:shipi all general partaers and hmited partners of the Disclosing Partj', i f Ibc Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company, (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Priiicipal officers" means ths president, chief operating ofScer, executive director, chief financial officer, treasm r or secretary of a legal entity or any person exercising similar authority.

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

[ ] Yes [X] No

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

Page 13 of 13

(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Undersigned must complete a new EDS with correct or corrected information)

RECERTIFICATION Generally, for use with City Council matters. Not for City procurements unless

requested.

This recertification Is being submitted in connection with The Ancona School Society [identify the Matter]. Under penalty of perjury, the person signing below; (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Undersigned, (2) warrants that all certifications and statements contained in the Undersigned's original EDS are true, accurate and complete as ofthe date furnished to the City and continue to be true, accurate and complete (Mcaffe itfflg L§teJ^nftt, lTj§rp?ffg§J^ filt'fftlfe a^QQbc ioF ffegTfe its acknowledgments. LaSalle Bank National Association, as successor to American National Bank

and Trust Company of Chicago J/1 rch 2,1994 and known as Tmst Number (Print or type name of individual or legbl 8fi87!flb(i{llGISSa§fE3d{le<laaCHj TrUSt 1 18087-05

• _ ..,„:-vi«- ;i.;c.c6ftltlcation

ftS^b'fseVO* ihe facts thetein5t9t«(J.

Print or type name of signatory;

M a r i o V. Gotanco

Title of signatory:

T r u s t O f f i c e r

Subscribed to before me on [date] February 26, 20I6 , at Cook I I I inois [state].

County,

Notary Public.

Commission expires • ^ ^ T "OFr.CIAL SEAL" t

Ver. 6/23/03

T i m SILVIA MEDINA •>

^ Notary PubSic, Siais of Ciinois ^ ! My Com.rrt:«vrU'r rr/.pi'-r:;} r-n-.'-Gr^Olo I

23


AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

A. Legal name ofthe Disclosing Party submitting this EDS. Include dih/al i f applicable:

The Ancona School Soc i e ty


Indicate whether the Disclosing Party submitting this EDS is: L [ ] the Applicant



3. W a legal entity with a right of control (see Section ILB.l.) State the legal name of the entity in which the Disclosing Party holds a right of control: Chicago Ti t l e Land Trust, Trust *ii8087-06

B. Business address of tbe Disclosing Party: 4770 S Dorchester Avenue

Chicago, I l l i n o i s 60615

C. Telephone: (773) 924-2356 Fax: (773) 924-8905 ^ j ^ ^ i l : bwishneganconaschool.org

D. Name of contact person: S Jonathan Silverman, Chair o f F a c i l i t i e s Committee (312) 970-0357


F. Brief description of contract, transaction or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, i f applicable): Vacat ion o f an a l l e y t h a t b i s e c t ' s school ' s p r o p e r t y . A l l e y i s

l oca t ed west o f S. Dorchester Ave between E.- 47th P i . and 48th St .

G. Which City agency or department is requesting this EDS? Department o f Transpor ta t ion



Vcr. 01-01-12 Page 1 of 13

SECTION n - DISCLOSURE OF OWNERSHIP INTERESTS


1. Indicate the nature of the Disclosing Party: [ ) Person { ] Limited 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 [ j Other (please specify)

2. For legal entities, the state (or foreign country) of incorporation or OTganiz&tion, i f applicable:

I l l i n o i s


[ ] Yes [ ] No M N/A


1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. If there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titlehold6r(s).

If the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entitj' listed below must submit an EDS on its own behalf.

Name Title

Please see attached l i s t of of f i c e r s and Trustees

No members.

2. Please provide the following information conceming each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% ofthe Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture.

Page 2 of 13



None

SECTION m - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS


[ ] Yes M No

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

SECTION IV " D I S C L O S U R E OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total 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 Party's regular payroll.



Page 3 of 13

Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether retained or anticipated - Address (subcontractor, attomey, paid or estimated.) NOTE: to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is

not an acceptable response. (1) T r a f f i c Ana lys i s & Design, I n c . , 1898 Waverly Way Montgomery, I L 60538; Consul tan t

( t r a f f i c ana lys is ) , - $1,000 ( e s t . ) . (2) N a t i o n a l Survey Se rv ice , I n c . , 30 S. Michigan Avenue

S u i t e 200, Chicago, I L 60603; Prepara t ion o f Survey and P l a t o f v a c a t i o n ; $2,000 ( e s t . ) .

(3) Neal 6 Leroy, , LLC; 203 N. LaSal le , 203 Nor th LaSalle S t . , S u i t e , 2300, Chicago, I L 60601;

(Add sheets i f necessary) A t t o r n e y s ; Less than $30,000 ( e s t . ) ,

[ ] Check here if tbe Disclosing Party has not retained, nor expects to retain, any such persons or entities.

SECTION V - CERTIFICATIONS




[ ] Yes [ ] No [X] 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 that agreement? NA

[ ] Yes f 3 No 4


1. Pursuant to Municipal Code Chapter 1 -23, Article I ("Article r')(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supen'isioa 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 l is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Page 4 of 13

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

a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of govemment;




e. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil action, including actions conceming environmental violations, instituted by the City or by the federal govemment, any state, or any other unit of local government.




Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibility of a business entity to do business with federal or state or local govemment, including the City, using substantially the same management, ownership, or principals as the ineligible entity); with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, iscontrolled by it, or, with the Contractor, is under common control of another person or entity; • any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any

other official, agent or employee ofthe Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13






4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local 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 5/33 E-4; or (3) any similar offense of any state or of the United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.

5. Neither the Disclosing Party nor any Affiliated Entity is listed on any ofthe following lists maintained by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the Bureau of Industry and Security ofthe U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.

6. The Disclosing Party imderstands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Governmental Ethics) ofthe Municipal Code.


Page 6 of 13


8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").

None.

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

None.



[ ] is . [}^ is not



"We are not and will not become a predatory lender as defined in Chapter 2-32 of the Municipal Code, We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss ofthe privilege of doing business with the City."

I f tbe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages i f necessary):

Page 7 of 13


D, CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 of the Municipal Code have the same meanings when used in this Part D,


•[ ] Yes No

NOTE: I f you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. I f you checked "No" to Item D.L, proceed to Part E.



[ ] Yes [ ] No

3. I f you checked "Yes" to Item D.L, provide the names and business addresses of the City officials or employees having such interest and identify the nature of such interest:


4. The Disclosing Party further certifies that no prohibited fmancial interest in the Matter will be acquired by any City official or employee.



Page 8 of 13


X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor entities regarding records of investments or profits from slavery or slaveholder insurance policies during the slaver}' era (including insurance policies issued to slaveholders that provided coverage for damage to or injury or death of their slaves), and the Disclosing Party has found no such records.

2. The Disclosing Party verifies that, as a result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:

SECTION VI - CERTIFICATIONS FOR F E D E R A L L Y FUNDED MATTERS

NOTE: I f the Matter is federally funded, complete this Section VI . I f the Matter is not federally funded, proceed to Section VII . For purposes of this Section VI , tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.


1. List below the names of ail persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter: (Add sheets i f necessary):


2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A . l . above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify any federally fiinded contract, grant, loan, or cooperative agreement.

Page 9 of 13

3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy of the statements and infonnation 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) ofthe Internal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Activities".

5. I f the Disclosing Party is the Applicant, tlie 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 roust maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the Cify upon request.




[ ] Yes [ ] No


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


[ ] Yes [ ] No


[JYes (JNo

I f you checked "No" to question 1. or 2. above, please provide an explanation;

Page 10 of 13

SECTION V I I - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE


A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement. City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect fo the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics. and may also be obtained from the City's Board of Ethics, 740 N.

Sedgwick St, Suite 500, Chicago, IL 60610, (312) 744-9660, The Disclosing Party must comply fully with the applicable ordinances.

C. I f the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Part3 s participation in the Matter and/or declining to aUow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.

D. It is the City's policy to make this document available to the public dn its Interact site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Intemet, in response to a Freedom of Information Act request, or otherwiae.->BjU^mplutiHii niitl ^.l^jtihi this EDS, the Disclosing Party waives and releases any possible rights ( r claims which,it may inst the City in connection with the public release of information contair ad^iii^this ED.S'.^iid'j^ls*^ ?es the City to verify the accuracy of any information submitted in this ;DS.

E. The information provided in this EDS must be kept current. In the event of changes, the Disclosing Party must siipplemeht this EDS up to the time the City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 of the Municipal Code (imposing PERMANENT INELIGIBILITY for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 ofthe Municipal Code,


Page I I of 13


F.2 I f the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities wil l not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 I f the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F . l . and F.2. above and will not, without the prior written consent ofthe City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: If the Disclosing Party cannot certify as to any of the items in F.I., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

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

The Ancona School Society


(Sign here)

Bonnie L . Wishne


Head of School


PATRICIA A ERING70N OFFICIAL SEAL

Notary PuDiic, Slate ot Illinois My Commission Expires

Mo'Ct^ C 2016

Signed and sworn to before me on (date) -3. . I L at k County, 17 L

V, L ,f ft.

(state).

Notary Public.

Commission expires:_ 3

Page 12 of 13

Trustees of the Ancona School Societj' As of October, 2012

Terrell Anderson

Chip Bamberger, Treasurer (*)

Keith Bevans, Chair of Committee on Trustees (*)

Amy Ritter Cowen

Lawrence Hill

Kenny Jolinson

Kim Morris Lee

Tasha Levy

Sheila Lynch

Renetta McCann, Vice President (*)

Darryl Newell

Todd Neumann

Josh Schwartz, President (*)

S Jonathan Silverman

Lisa Scruggs

Paul Watford

Bonnie Wishne, Head of School

(*) Denotes an officer. All officers are also Trustees.


APPENDIX A

FAMILL^L RELATIONSHIPS WITH ELECTED CITY OFHCIALS AND DEPARTMENT HEADS

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

Under Municipal Code Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partnes: thereof currently has a "familial relationship" wiUi 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 to 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, aimt or vincle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-ia-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 Party listed in Section E.B.l.a., i f the Disclosing Party is a corporation; all partners ofthe Disclosing Party, i f the Disclosing Party is a general partnership; all general partners and limited partners ofthe Disclosing Party, i f the Disclosing Party is a limited partnership; all managers, managiag members and members ofthe Disclosing Party, i f the Disclosing Party is a limited liability company; (2) all principal officers ofthe Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

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

[ ] Yes Ix} No

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

Page 13 of 13

The Ancona School Board of Trustees

March 1, 2015

An Frede, Head of School

Ben Smirh-Donald

Bonnie Wishne, Ex-f)fficio

Dontrev Britt-Haii

Gustavo Bamberger, Treasurer

Hcnr}' Wishcampcr

Jill Potter

Joanna Trotler

Keith Bevans, President

Lai-a Moynihan, Wee President

Lawrence HiU

Lucila Espedido

Paul Watford

Rachel Pernio Waldron

Todd Neumann


APPENDIX B



1. Pursuant to Municipal Code Section 2-154-010, isthe Applicant or any Owner identified as a building code scofflaw or problem landlord pursuant to Section 2-92-416 ofthe Municipal Code?

[ ]Yes ['<]No

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

[ ]Yes [ ]No [>(] Not Applicable

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

FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDDC B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTIFICATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASSOCIATED EDS.

City of Chicago



02016-1698

Meeting Date:

Sponsor(s):

Type:

Title:


3/16/2016

Burnett (27)

Ordinance

Vacation of public alley(s) in area bounded by N Sangmon St, W Chicago Ave, N Carpenter St and W Fry St Committee on Transportation and Public Way

NOT FOR PROFIT ORDINANCE

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

WHEREAS, the City wishes to support the charitable, educational and philanthropic activities of established Not for Profit Corporations and encourage the continued viability and growth of such activities; and

WHEREAS, many Not For Profit Corporations own property that adjoins streets and alleys that are no longer required for public use and might more productively be used in furtherance of such activities; and

WHEREAS, the City would benefit from the vacation of these streets and alleys by reducing City expenditures on maintenance, repair and replacement; by reducing fly-dumping, vandalism and other criminal activity; and by providing support for such charitable, educational and philanthropic activities; and

WHEREAS, the City can promote strong communities by facilitating services to the public, and increase the City's job base through the vacation of public street(s) and/or alley(s) for no compensation; and

WHEREAS, the properties at 600-808 N. Sangamon Street and 956-960 W. Chicago Avenue, are owned by VGA Real Property Acquisition Corporation, a California corporation, which has quit claimed its interests in the adjacent alley to the Catholic Bishop of Chicago, an Illinois not-for-profit corporation("the Catholic Bishop of Chicago"); and

WHEREAS, the properties at 812-830 N. Sangamon Street, 1001-1041 W. Fry Street and 964-1018 W. Chicago Avenue are owned by the Catholic Bishop of Chicago; and

WHEREAS, the Catholic Bishop of Chicago uses the site ("Site") for secular activities Including food distribution activities, homeless assistance, and hosting neighborhood meetings, and cultural events; and

WHEREAS, the Catholic Bishop of Chicago proposes to use the public alleys herein vacated for improved circulation of vehicles through the Site, and for a use as a through driveway from the adjacent Carpenter Street to Morgan Street; and

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


SECTION 1. ALL OF THE NORTH - SOUTH 20 FOOT WIDE PUBLIC ALLEY LYING SOUTH OF AND ADJACENT TO THAT PART OF LOT 7, LYING WEST OF AND ADJACENT TO LOTS 8 THROUGH 11, LYING SOUTH OF AND ADJACENT TO LOT 7, AND

Page 1

LYING NORTH OF AND ADJACENT TO LOT 18, TOGETHER WITH ALL OF THE EAST - WEST 16 FOOT PUBLIC ALLEY (INCLUDING THE TRIANGLE PORTION OF ALLEY LYING SOUTHWEST AND ADJACENT TO THE SOUTHWEST CORNER OF SAID LOT 11) LYING SOUTH OF AND ADJACENT TO SAID LOT 11, AND LYING NORTH OF AND ADJACENT TO LOTS 12 THROUGH 18, ALL IN BLOCK 9 IN J. A YALES RESUBDIVISION OF LOTS 8, 9 AND 12 IN BLOCK 8 (AND OTHER LOTS AND PARTS THEREOF IN BLOCKS 9,10,11 AND 12) IN WIGHT'S ADDITION TO CHICAGO IN THE EAST HALF OF THE SOUTHEAST QUARTER OF SECTION 5, TOWNSHIP 39 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, RECORDED APRIL 25,1873, DOCUMENT 94836, IN COOK COUNTY, ILLINOIS, SAID PARCEL CONTAINING 4,712 SQ. FT. OR 0.11 ACRES, MORE OR LESS as shaded and legally described by the words "HEREBY VACATED" on the plat hereto attached as Exhibit A, which drawing for greater clarity, is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacation.

SECTION 2. The Commissioner of Transportation is hereby authorized to accept and approve a redevelopment agreement or similar instrument restricting the use and improvement of the public way vacated in Section 1 of this ordinance to social service purposes which include, but shall not be limited to the distribution of groceries, housing assistance and counseling to the needy, hosting public meetings, publically accessible musical/theatrical performances, and for such use and improvements that are accessory, as that term is defined in the Chicago Zoning Ordinance, to such social service purposes, such uses and improvements to be owned and operated by a non-profit corporation, subject to the approval of the Corporation Counsel as to form and legality. The restriction on use and improvement in the covenant, agreement or instrument shall be for a term of 40 years and upon breach of such restriction the public way herein vacated shall revert to the City and be subject to the terms and conditions ofthe dedication by which it has been heretofore held by the City.

SECTION 3. The City of Chicago hereby reserves for the benefit of Commonwealth Edison, AT&T/SBC and Wide Open West ("WOW"), their successors or assigns, a non-exclusive utility easement to operate, maintain, construct, replace and renew overhead wires, poles, and associated equipment and underground conduit, cables, and associated equipment for the transmission and distribution of electrical energy, telephonic and associated services under, over and along the alley herein vacated, with the right of ingress and egress. The grade of the vacated public way shall not be altered in a manner so as to interfere with the operation and maintenance of Commonwealth Edison, AT&T/SBC, or WOW facilities. No buildings, permanent structures or obstructions shall be placed over said facilities without express written release of easement by Commonwealth Edison, AT&T/SBC and/or WOW. Any future vacation-beneficiary prompted relocation of Commonwealth Edison, AT&T/SBC or WOW facilities lying within the area herein vacated will be accomplished by the respective utility, and done at the expense of beneficiary ofthe vacation.

SECTION 4. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Catholic Bishop of Chicago shall deposit in the City Treasury of the City of Chicago, a sum sufficient to defray the costs of removing paving and curb returns, and constructing sidewalk in accordance with the most current version of the Chicago Department of Transportation's Regulations for Opening, Repair and Construction in the Public Way and its appendices.

Page 2

SECTION 5. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, the Catholic Bishop of Chicago, shall file or cause to be filed for record in the Office ofthe Recorder of Deeds of Cook County, Illinois, a certified copy of this ordinance, together with a redevelopment agreement complying with Section 2 of this ordinance, and approved by the Corporation Counsel, and the full sized corresponding plat as approved by the Superintendent of Maps and Plats.

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

Vacation Approved:


Approved as to Form and Legalj :y


)norable Walter Burnett Alderman, 27th Ward

Page 3

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AND AFFIDAVIT

SECTION I -GENERAL INFORMATION

A. Legal name of Disclosing Party submitting this EDS. Include d/b/a/ i f applicable:

The Catholic Bishop of Chicago


Indicate whether Disclosing Party submitting this EDS is: 1. [X] the Applicant


Applicant in which Disclosing Party holds an interest: OR

3. [ ] a specified legal entity with a right of control (see Section Il.B.l.b) Stale the legal name of the entity in which Disclosing Party holds a right of control:

B. Business address of Disclosing Party: 835 N. Rush Street Chicago. IL 60611

C. Telephone: (312) 534-8317 Fax: (312) 534-8392 Email: [email protected]

D. Name of contact person; Kevin J. Marzalik and Carol Mo_rri_s_.


F. Brief description of contract, transition or other undertaking (referred to below as the "Matter") to which this EDS pertains. (Include project number and location of property, i f applicable):

Alley vacation for St. John Cantius Catholic Church

G. Which City agency or department is requesting this EDS? Dept of Transportation

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


Vcr. 01-01-12 Page 1 of 13

SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF DISCLOSING PARTY

1. Indicate the nature of the Disclosing Party: ] Person [ ] Limited 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 corporafion also a 501 (c)(3))? ] Limited partnership* [X] Yes , [ ] No ] Trust [X] Other (please specify) corporafion sole

*NoteB.l.b below

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

Illinois


[ ] Yes [ ] No [X] N/A


1. List below the full names and title of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entifies. If there are no such members, write "no members." For trusts, estates or other similar enfities, list below the legal tifieholder(s).

If the enfity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and tifie of each general partner, managing member, manager or any other person or entity that controls the day-to-day management ofthe Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf

Name Title

The Catholic Bishop of Chicago, a corporation sole, does not have officers and directors by virture of its

corporation sole form of organization. Most Reverend Blase J. Cupich is the Archbishop of Chicago.

Kevin J. Marzalik is the Director for the Archdiocese and he has Power of Attorney to sign contracts on

behalf of The Catholic Bishop of Chicago. A copy of his Power of Attomey is attached as Exhibit A.

2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% ofthe Disclosing Party. Examples of such an interest include shares in a corporafion, partnership interest in a partnership or joint venture,

Page 2 of 13

Interest of a member or manager in a limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none, state "None." NOTE: Pursuant to Secfion 2-154-030 of the Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the Disclosing party

None

SECTION III - BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS

Has the Disclosing Party has a "business relationship." as defined in Chapter 2-156 of the Municipal Code, with any City elected official in the 12 months before the date this EDS is signed?

[ ] Yes [X] No

If,yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

SECTION IV - DISCLOSURE OF SUBCONTRACTORS & OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing party has retained or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.

"Lobbyisf means any person or entity who undertakes to influence any legislative or administrative action on behalf of any person or entity other than: (1) a not-for-profit entity, on an unpaid basis, or (2) himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of another includes undertaking to influence any legislative or administrative action.

If the Disclosing Party is uncertain whether a disclosure is required under this Section, the Disclosing Party, must either ask the City whether disclosure is required or make the disclosure.

Page 3 of 13

Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether retained or anticipated .A.ddress (subcontractor, attorney, paid or esfimated.) NOTE: to be retained) lobbyist, etc) "hourlyrate" or "t.b.d." is

not an acceptable response.

None •


[X] Check here if the Disclosing party has not retained, nor expects to retain, any such persons or entities.

SECTION V -CERTIFICATIONS


Under Municipal Code Section 2-92-415, substantial owners of business entities that contract with the City must remain in compliance with their child support obligations throughout the term ofthe contract.


[ ] Yes [ ] No [X] 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 owned and is the person in compliance with that agreement?

[ ] Yes [ ] No


1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting the EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicated 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 of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Arficle I is a continuing requirement for doing business with the City. NOTE: If Article I applies to the Applicant, the permanent compliance fimeframe in Article I supersedes some five-year compliance timeframes in certification 2 and 3 below.

Page 4 of 13

2. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities idenfified in Secfion II.B.I. of this EDS:

a. are not presenfiy debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any transactions by any federal, state or local unit of govemment;

b. have not, within a five-year period preceding that date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: obtaining, attempfing to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destrucfion of records; making false statements; or receiving stolen property;

c. are not presently indicted for or criminally or civilly charges by, a govemmental enfity (federal, state or local) with committing any of the offenses set forth in clause B.2.b. of this Secfion V;

d. have not, within a five-year period preceding the date of this EDS, had one or more public transacfion (federal, state or local) terminated for cause or default; and

e. have not, within a five-year period preceding the date of this EDS, been convicted, adjudged guilty, or found liable in a civil proceeding, or in any criminal or civil acfion, including actions concerning environmental violations, instituted by the City or by the federal government, any state, or any other unit of local government.


• 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 any persons or legal entities disclosed under Section IV, "Disclosure of Subcontractors and Other Retained Parties"); • any "Affiliated Enfity" (meaning a person or entity that, directly or indirectly: controls the Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under common control of another person or entity. Indicia of control include, without limitation: interlocking management or ownership; identity of interests among family members, shared facilities and equipment; common use of employees; or organization of a business entity following the ineligibiHty of a business entity to do business with federal or state or local government, including the City, using substantially the same management, ownership, or principals as the ineligible entity) with respect to Contractors, the term Affiliated Entity means a person or entity that directly or indirectly controls the Contractor, is controlled by it, or, with the Contractor, is under common control of another person or entity; • any responsible official of the Disclosing Party, any Contractor or any Affiliated Entity 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 of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5'of 13

Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing Party or any Contractor nor any Agents have, during the five years before the date this EDS is signed, or, with respect to a Contractor, an Affiliated Entity, or an Affiliated Enfity of a Contractor during the five years before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the Matter:

a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe federal govemment or of any state or local govemment in the United Stated 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 prospecfive bidders, in restraint of freedom of compefition by agreement to bid a fixed price or otherwise; or



4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracfing with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violafion 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 Stated of America that contains the same elements as the offense of bid-rigging or bid-rotafing.

5. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department ofthe Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons Lists, the Unverified List, the Entity List and the Debarred List.

6. The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (inspector General) and 2-156 (Govemmental Ethics) of the Municipal Code.

7. If the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certificafions), the Disclosing Party must explain below:

The Catholic Bishop of Chicago is and has been a party in various administrative and judicial

proceedings involving municipal code violations of various properties owned by The Catholic Bishop

of Chicago. These cases are generally dismissed after full compliance.

Page 6 of 13


8. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all current employees of the Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, of the City of Chicago (if none, indicate with "N/A" or "none").

N/A

9. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any fime 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 City business and having a retail value of less than $20 per recipient (if non, indicate with a "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient.

N/A



[ ] is [X] is not

a "financial institution" as defined in Secfion 2-32-455(b) of the Municipal Code.

2. If the Disclosing Party IS a financial institution, then the Disclosing party pledges:

"We are not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 of the Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."

If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in Secfion 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 of the Municipal Code, explain here (attach additional pages of necessary):

Page 7 of 13




1. In accordance with Secfion 2-156-110 ofthe Municipal Code: Does any official or employee of the City have a financial interest in his or her own name or in the name of any other person or entity in the Matter?

[ ] Yes [X]No

NOTE: If you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. If you checked "No" to Item D.L, proceed to Part E.

2. Unless sold pursuant to a process of compefitive bidding, or otherwise permitted, no City elected official or employee shall have a financial interest in his or her own name or in the name of any other person or enfity in the purchase of any property that (i) belongs to the City, or (ii) is sold for taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively, "City Property Sale"). Compensation for property taken pursuant to the City's eminent domain power does not constitute a financial interest within the meaning of this Part D.

Does the Matter involve a Cily Property Sale?

[ ] Yes [X] No

3. If you checked "Yes" to Item D. 1., provide the names and business addresses ofthe City officials or employees having such interest and idenfify the nature of such interest:




Please check either 1. or 2. below. If the Disclosing Parly checks 2., the Disclosing Party must disclose below or in an attachment to this EDS all information required by paragraph 2. Failure to

Page 8 of 13


X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of the Disclosing Party and any and all predecessor enfifies regarding records of investments or profits from slavery, or slaveholder insurance policies during the slavery era (including insurance policies issued to slaveholders that provide 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 result of conducting the search in step 1 above, the Disclosing Party has found records of investments or profits from slavery or slaveholder insurance policies. The Disclosing Party verifies that the following constitutes full disclosure of all such records, including the names of any and all slaves or slaveholders described in those records:

SECTION VI -- CERTIFICATIONS FOR FEDERALLY-FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Secfion VI. I f the Matter is not federally funded, proceed lo Section VII. For purposes of this Section VI , tax credits allowed by the Cily and proceeds of debt obligations ofthe City are not federal funding.


1. Lisl below the names of all persons or entities registered under the federal Lobbying Disclosure Act of 1995 who have made lobbying contacts on behalf of the Disclosing Party wilh respect lo the Malter: (Add sheets as necessary):

None

(If no explanation appears or begins on the lines above, or if the letters "NA" or if the work "None" appear, it will be conclusively presumed that the Disclosing Party means that NO persons or enfities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Parly with respect to the Matter.)

2. The Disclosing Party has not spent and will not expend any federally appropriated funds to pay any person or entity listed in Paragraph A . l . above for his or her lobbying activities or to pay any person or entity to influence or attempt to influence an officer or employee of any agency, as defined by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in connection with the award of any federally funded contract, making any federally funded grant or loan, entering into any cooperative agreement, or to extend, continue, renew, amend, or modify and federally funded contract, grant, loan, or cooperative agreement.

Page 9 of 13

3. The Disclosing Party will submil 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 secfion 501(c)(4) ofthe Internal Revenue code of 1986; or (ii) it is an organization described in secfion 501(c)(4) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying Acfivifies".

5. If the Disclosing Party is the applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A . l . through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.


If the Matter is federally funded, federal regulations require the Applicant and all proposed subcontractors lo submit the following information wilh their bids or in writing at the outset of negotiations.


[]Yes [ ] No


1. Have you developed and do you have on file affirmative action programs pursuant to applicable federal regulafions? (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


[ ] Yes [ ] No


Page 10 of 13

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION, COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understand and agrees that:

A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicanl and the City in connection with the Matter, whether procurement, Cily assistance, or other Cily action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply wilh all statutes, ordinances, and regulafions on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City conlracts, work, business, or transaclions. The full text of these ordinances and a training program is available on line al vyww.cilyofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N.

Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully with the applicable ordinances,

C. If the City determines that any informafion provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contracl 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 lo allow the Disclosing Party to parficipate in other transactions wilh the City. Remedies at law for a false statement of material fact may include incarceration and an award to the City of treble damages.

D. It is the City's policy to make this document available to the public on its Intemet site and/or upon request. Some or all of the information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any infomiation submitted in this EDS.

E. The informafion provided in this EDS must be kept current. In the event of changes, the Disclosing Party must supplement this EDS up to the time the City takes action on the Matter. If the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 ofthe Municipal Code (imposing PERMANENT INTELIGIBILITY for certain specified offenses), the infomiation provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1 -23 and Section 2-154-020 of the Municipal Code.


Page I I of 13

F.l. The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2. If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities will not use, nor permit their subcontractors to use, any facility on the U. S. E.P.A. on the federal Excluded Parties List System ("EPLS) maintained by the U.S.,General Services Administrafion.

F.3. If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. 1. and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: If the Disclosing Party cannot certify as to any of the items in F.l., F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

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

The Catholic Bishop of Chicago (Print or typeiname of Disclosing Party)

Kevin J. Marzalik (Print or type name of person signing)

Director (Print or type title of person signing)

Signed and swora to before me on (date)_ at Cook County, Illinois.

cgL^(/K>( J J ^ \ 4 y ^ Notary Public i OFPICIALSEAL 0 „ / , UNDAYMX3ND0

Commission expires: ^ / 1 -^1 \ 7 UNOAYMX3N0ON

NOTMYPUSUC - STATE OF lOINOtS MY COMMSSION EXPnES.-08n2/17

Page 12 of 13


APPENDIX A



Under Municipal Code Secfion 2-154-015, the Disclosing Party must disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as of the date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related, by blood or adoption, to the mayor, any alderman, the city clerk, the city treasurer, or any city department head as parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or stepdaughter, stepbrother or stepsister or half-brother or half-sister.

"Applicable Part" means (1) all corporate officers ofthe Disclosing Party, if the Disclosing Party is a corporafion; all partners of the Disclosing party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and member of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

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

[ ] Yes [ X ] No

If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal entity to which 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.

Page 13 of 13


APPENDIX B


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

1. Pursuant to Municipal Code Section 2-154-010, is the Applicant or any Owner identified as a building code scoffiaw or problem landlord pursuant lo Seclion 2-92-416 ofthe Municipal Code? "

L ]Yes f><lNo

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

[ ]Yes I JNo [>(J Not Applicable

If ycs to (1) or (2) above, please identify below the name ofthe person or legal enfity identified as a building code scofflaw or problem landlord and the address of the building or buildings to which the pertinent code violations apply.


(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recerfify your EDS prior to submission to Cily Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS wilh correct or corrected infomiafion)

RECERTIFICATION

Generally, for use with Cily Council matters. Not for City procurements unless requested.

This recertification is being submitted in connection with/^t^P ft\\^M^ VlacrCHoYX'-~3O\NV>^ [idenfify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that Oxy^o'^ he/she is authorized to execute this EDS recertificafion on behalf ofthe Disclosing Party, (2) warrants that all certificafions and statements contained in the Disclosing Party's original EDS are true, accurate and complete as ofthe date fumished to the City and continue to be true, accurate and complete as ofthe dale of this recertification, and (3) reaffirms its acknowledgments.

T H E : C/VTUot-vc -^\<:>Wo^ Cv\\cA6-T^ Date: ^Aw^ 2-^ Z o l U (Print or type legal name of Disclosing Party)

(sign;


Title of signatory:

Signed and swom lo before me on [date] awocaL<" H ^ , by \dE\oiv-> >;\rj>,'g:z:AuA\c at Cxr oK County, ] LLifpccav^ [state].

( ' j ^ j c . J ^ ^ ^ Notary Public.

Commission expires:

Ver. n-01-05

OFFICIAL SEAL

CAROL A. MORRIS NOTARY PUBLIC, STATE OF ILLINOIS My Commission Expires Sep 3, 2019

City of Chicago



02016-1654

Meeting Date:

Sponsor(s):

Type:

Title:


3/16/2016

Zaiewski (23)

Ordinance

Vacation of public way(s) in area bounded by W 51st SL Grand Trunk Western Railroad, W 53rd St and S. Millard Ave Committee on Transportation and Public Way

INDUSTRIAL ORDINANCE

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

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

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

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

WHEREAS, the properties at 3601-3625 W. 51" ' Street, 5101-5109 S. Millard Avenue, 5113-5171 S. Milliard Avenue and 5213-5231 S. Millard Avenue (collectively, the "Properties") are owned by R.F.M. Properties I, L.P., a Texas Limited Partnership, licensed to transact business in Illinois ("R.F.M. Properties I, L.P."); and

WHEREAS, R.F.M. Properties I, L.P. operates a freezer facility ("Facility") on the Properties and employs one hundred five (105) full time employees at the Facility; and

WHEREAS, R.F.M. Properties I, L.P. proposes to use the portion of the street and alley to be vacated herein for employee parking and future expansion of the Facility; and

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


SECTION 1. THE EAST-WEST 16 FT. WIDE PUBLIC ALLEY LYING SOUTH OF AND ADJOINING THE SOUTH LINE OF LOTS 1 THROUGH 4, ALL INCLUSIVE, IN BLOCK 1 OF ELSDON JOHN G. EARLE'S SUBDIVISION IN THE EAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT RECORDED SEPTEMBER 12, 1888 AS DOCUMENT NUMBER 1003631; LYING WEST OF AND ADJOINING THE SOUTHERLY EXTENSION OF THE EAST LINE OF SAID LOT 1; LYING EAST OF AND ADJOINING THE EAST RIGHT OF WAY LINE OF S. MILLARD AVENUE; AND LYING NORTH OF AND ADJOINING THE NORTH LINE OF LOTS 6, 5, THAT PART OF LOT 4 AND THE EASTERLY EXTENSION THEREOF, ALL INCLUSIVE, IN BLOCK A OF JOHN G. EARLE'S SUBDIVISION IN THE EAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT RECORDED

Page 1

JULY 29, 1892 AS DOCUMENT NUMBER 1708504, ALL IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 1,616 SQUARE FEET OR 0.0371 ACRES, MORE OR LESS.

TOGETHER WITH: THAT PART OF W. 52ND STREET 50 FOOT WIDE RIGHT OF WAY LYING SOUTH OF AND ADJOINING BLOCK C AND LYING NORTH OF AND ADJOINING BLOCK D, BOTH INCLUSIVE, OF JOHN G. EARLE'S SUBDIVISION IN THE EAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT RECORDED JULY 29, 1892 AS DOCUMENT NUMBER 1708504; LYING EAST OF AND ADJOINING THE EAST RIGHT OF WAY LINE OF S. MILLARD AVENUE; AND LYING WEST OF AND ADJOINING THE WEST RIGHT OF WAY LINE OF THE GRAND TRUNK WESTERN RAILROAD, ALL IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 12,554 SQUARE FEET OR 0.2882 ACRES, MORE OR LESS. TOTAL AREA BEING VACATED CONTAINING 14,107 SQUARE FEET OR 0.3253 ACRES, MORE OR LESS as shaded and legally described by the words "HEREBY VACATED" on the drawing hereto attached as Exhibi t A, which drawing for greater clarity is hereby made a part of this ordinance, be and the same is hereby vacated and closed, inasmuch as the same is no longer required for public use and the public interest will be subserved by such vacations.

SECTION 2. The Commissioner of Transportation, or a designee of the Commissioner, is hereby authorized to accept and approve a restnctive covenant or similar instrument restricting the use and improvement of the public way vacated in Section 1 of this ordinance to industrial uses and for such use and improvements that are accessory as that term is defined in the Chicago Zoning Ordinance. The restriction on use and improvement in the covenant agreement or instrument shall be for a term of 40 years and upon breach of such restriction the public way herein vacated shall revert to the City and be subject to the terms and conditions of the dedication by which it has been heretofore held by the City.

SECTION 3. The City of Chicago hereby reserves for the benefit of Commonwealth Edison and AT&T-SBC/LNS their successors or assigns, a non-exclusive utility easement to operate, maintain, construct, replace and renew overhead wires, poles, and associated equipment and underground conduit, cables, and associated equipment for the transmission and distribution of electrical energy, telephonic and associated services under, over and along the street and alley herein vacated, with the right of ingress and egress. The grade of the vacated public way shall not be altered in a manner so as to interfere with the operation and maintenance of Commonwealth Edison, or AT&T-SBC/LNS, facilities. No buildings, permanent structures or obstructions shall be placed over their respective facilities without express written release of easement by Commonwealth Edison or AT&T-SBC/LNS. Any future vacation-beneficiary prompted relocation of Commonwealth Edison or AT&T-SBC/LNS facilities lying within the areas herein vacated will be accomplished by respective utility and be done at the expense of beneficiary of the vacation.

SECTION 4. The vacation herein provided for is made upon the express condition that within 180 days after the passage of this ordinance, R.F.M. Properties I, L.P. shall pay or cause to be filed for record in the Office of the Recorder of Deeds of Cook County, Illinois, a certified copy of this ordinance, together with a restrictive covenant, complying with Section 2 of this ordinance and approved by the Corporation Counsel, and the attached plat approved by the Superintendent of Maps and Plats.

Page 2

SECTION 5. This ordinance shall take effect and be in force from and after its passage and publication. The vacation shall take effect and be in force from and after its recording.

Vacation Approved:

(ebekah Scheinfeld Commissioner

Approved as to Form and Legalif


Hork)rat)le Michael ^aleW Alde>ra4n, 23''' Wan

Page 3

EXHiBrr "A"

PLAT OF VACATION -#.-|S1-ST

HEREBY VACATED ALLEY-SEE PAGE 2 FOR DETAIL

t. PUBLIC ALLEY

= too'

TWFFIC njow

R£C.-23:.00 SIKTSTM-w MEAS.-231.08

-ST-.-

16.00 soawWE I—eeioa-

UMFTS OF PROJECT AREA- / SEE PAGE 2 FOR DETAIL \

1 I TRAFFIC FLOW

-WrfS^ND-ST.-TKAFFIC FLOW •

PLAT PREPARED FOR: AMIGOS FOODS 5251 S. MILUkRD AVENUE CHICAGO. IL 60632

EDWARD J . MOLLOY & ASSOCIATES. LTD. LAND j£ CONSTRUCTION SURVEYORS

1236 W«k STREET. EEMSEtMLLE ILUNOIS S0105 {630)595-2600 FAX(630)595-*700 E-MAIL TTIIOUJOYOEJUOLUJV.COU

.OC.K A!

aisr

.._ J

P L

-W G. r j iRLrl S SUB.

I " " ! " " ! I i I I I I I !

1_ |_J _jLq$K | _ L L J _ ' V A C A T E D ; H n , PUBLIC ALLTr

• r i~i"T T r r T n ~ 11 I 12 I 13jl4!1E|I6I17|ie| :9I20

1 -L .L L VACATEC TSOWESiDCE PL.

lMEAS.'fc251.09 *«»-»4O«:E I I jREC.>2S1.()0 i I • I t

10 I 9 I a I 7 i 6 I 5 i 4 ! 3 I 2 i 1

Pn INCLUDED I I . . . LOdK d i l l

_ L_ I_ . I _L~^_i;?=i_ ! I I . VACATED 16 FT. PLiBLIC ALLEl'

• r n ~r T r r~r-r I I 251.09 is ay54'<!g- E| |

11 112 113 I M • 15 116 117 118 119 i 20

I I I I

^ ^ E R E B Y VACATED W. 52ND S r M f ^

l'^^SEE''PAGE''TTbR'''^^^

I I i ! i I i I I

i ! i I I I M i 10 ' 9 ' 8 ' y ' 6 ' 5 ' 4 ' 3 I 2 ' 1

I I I ^M^l I I ! L - . L . . a M & = t i _ j :

VACATE'!} I f . IT . "UBI.iC Ai.U;Y

" r r i " T T r r - in " I 1 I I I M M

11 19 1 " l i i r , T 7 i a 13

! "I "I I i 'I i 'j 1 -. I_L.J _ i _L J_.. L_I_J ,

VACATTO 52t lD PL.

" [~i"~i"T T r r r n I

I I I I I I VACATED 16 F I . P l M j C AUXY

- r i n "T T r m ! ! i i ! I 1 ! I

111 ,12 , 1 1 , ; 4 . ; 5 1 p , 17 18 ,1S . 20

I I I i { i I i I 1251.10 N scwog- W ^ .a

PAGE: t OF 4 ' I T D I L L H ' CI r u n

-20.00

TTWFIC FljDW

CDOT# 11-23-15-3737 1 r EJMA PROJ. NO 2 1 5 1 / 1 5 0 1 - 4 6 ( 0

EXHIBIT "A"

PLAT OF VACATION

50.00

C5

PLAT PREPARED FOR: AMIGOS FOODS 5251 S. MILLARD AVENUE CHICAGO, IL 60632

LEGEND: (M) MEASURED

(R) RECORD

AREA HEREBY VACATED

BOUNDARY OF VACATION

RIGHT OF WAY LINE/

PARCEL LINE

— LOT LINE

LT PREPARED BY:

EDWARD J. MOLLOY & ASSOCIATES LAND ic CONSTRUCTION SURVEYORS

1230 U W K 5TR£E1. SLNSEMLIE. lUJNOiS 60106 <630)595-Z600 FAX(630)5»-4-700 E-IML- tUOLiDYOEJUOLUCrrCOU

PAGE: 2 OF 4

CDOT# 11-23-15-3737

AREA SURVEYOR'S NOTES: FOR THE PURPOSES OF THIS PLAT THE EAST UNE OF S. MILLARD AVE. IS AT AN ASSUMED BEARING OF SOffOD'OO'E.

NO HELD WORK WAS PERFORMED FOR THE COMPLETION OF THIS SURVEY.

,N0 MONUMENTS FOUND OR SET IN COORDINATION OF THIS SURVEY.

DIMENSIONS ARE SHOWN IN FEET AND DECIMAL PARTS THEREOF.

NO DIMENSIONS SHOULD BE ASSUMED BY SCALE MEASUREUENTS UPON THE PLAT.

HEREBY VACATED PUBUC ALLEY, THE EAST HALF OF S. MILLARD AVE.. THE PROPERTY SOUTH OF AND ADJOINING AND THE PROPERTY EAST OF AND ADJOINING FALLS WITHIN ZONE M1-1 LIMITED MANUFACTURING/BUSINESS PARK DISTRICT; THE PROPERTY NORTH OF AND ADJOINING FALLS WITHIN ZONE RT-4 RESIDENTIAL TWO-FIAT, TOWNHOUSE AND MULTI-UNIT DISTRICT.

EJMA PROJ. NO 2151/150146(2)

EXHIBIT "A"

PLAT OF VACATION

66.00

ti 1 3 2 L. ^

UJ

b 2

_ l O —

' I 2 f -

to

VACATED 16 FT. .ALLEY

(F!)2li,a5 i iP,;.36.0 ! CP.llS 0 I (s;25.& i (P,)25.C! | (MiS.O j (S)J5.0 F <F;K5.!; ! (SJJS.D i p)5» 0

BLOCK C J0I|N G. EARLt'S SUBDIVISION

RECORDED JULY 19, 18921 DOCUM iNT NO. 708504

PIN: 1 9 - 1 1 - 3 0 9 - 0 2 1

11 12 14 15 I 1 e PARKINA LOT

I r S . LINE OF BLOCK C

19 20

(S)26 09

j 1/ i-(M&Rj)251.09 S89'S7'53"|W

v j v : - . : - W . 52ND ST;.;>:;

I:;; HEREBY VACATED iyl;;;;:.:::(12,554 so. FT. OR O.2B82 A C R E S ) : : '

10 I 9

!5 0 j O'lSliCl j (F;)2b.O (5)25 0 j (P)25 0 j {P):f5.0

(M&R)251.b9 N89*57*5i"E ' N. UNE OF BLOCK D 1

0 STORY BR

5 i 4 CK BUILDING

PIN: 1 9 - 1 1 - 3 1 6 - 0 2 2

JOHN G. k D j BLOCl

EARLt'S SiJBDIVISllON RECORDED JULY 29, 1892. DOCUMENT NO. 1708504

I I

(WSe.OS ! ;s>2£.0 j (S;25 0 I {K)2'.j 0 I [;-:)2£ S j ;R;2t.O I (K)2!i.C [ <R;2;-.C I .'=;)25 3 [ (K)23P

VACATED 16 IT. .MXEY

I

r = 40'

50.00

Z

uB L J

LEGENP: (M) MEASURED

(R) RECORD

|: : : I AREA HEREBY VACATED

BOUNDARY OF VACATION AREA

RIGHT OF WAY UNE

PARCEL UNE

LOT UNE PLAT PREPARED FOR: AMIGOS FOODS 5251 S. MILLARD AVENUE CHICAGO, IL 60632

PREPARED Pr-

EDWARD J. MOLLOY <Sc ASSOCIATES. LTD. LAND & CONSTRUCTION SURVEYORS

1239 UMtK S l H t l l . BEMSEWIUX. lUJMOiS 60106 (630)595-2600 F*X(630)S9i-4700 E~LML- TMOLLOrOEJUOLLCn'.COU

PAGE: 3 OF 4

CDOT# 11-23-15-3737

SURVEYOR'S NOTES: FOR THE PURPOSES OF THIS PWT THE EAST UNE OF S. MILLARD AVE, IS AT AN ASSUMED BEARING OF SOffOO'OO'E.

NO FIELD WORK WAS PERFORMED FOR THE COMPLETION OF THIS SURVEY.

NO MONUMENTS FOUND OR SET IN COORDINATION OF THIS SURVEY.

DIMENSIONS ARE SHOWN IN FEET AND DECIMAL PARTS THEREOF.

NO DIMENSIONS SHOULD BE ASSUMED BY SCALE MEASUREMENTS UPON THE PLAT.

HEREBY VACATED W. 52ND ST., THE EAST HALF OF S. MILLARD AVE.. THE PROPERTY NORTH OF AND ADJOINING AND THE PROPERTY SOUTH OF AND ADJOINING FAaS WITHIN ZONE M1-1 LIMITED MANUFACTURING/BUSINESS PARK DISTRICT; THE RAILROAD RIGHT OF WAY TO THE EAST FAaS WITHIN ZONE M2-1 LIGHT INDUSTRY DISTRICT.

EJMA PROJ NO 2151/150146(3)

EXHIBIT "A"

PLAT OF VACATION THE EAST-WEST 16 FT. WIDE PUBLIC ALLEY LYING SOUTH OF AND ADJOINING THE SOUTH LINE OF LOTS 1 THROUGH 4, ALL INCLUSIVE, IN BLOCK 1 OF ELSDON JOHN G. EARLE'S SUBDIVISION IN THE EAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT RECORDED SEPTEMBER 12, 1888 AS DOCUMENT NUMBER 1003631; LYING WEST OF AND ADJOINING THE SOUTHERLY EXTENSION OF THE EAST LINE OF SAID LOT 1; LYING EAST OF AND ADJOINING THE EAST RIGHT OF WAY LINE OF S. MILLARD AVENUE; AND LYING NORTH OF AND ADJOINING THE NORTH LINE OF LOTS 6, 5, THAT PART OF LOT 4 AND THE EASTERLY EXTENSION THEREOF, ALL INCLUSIVE, IN BLOCK A OF JOHN G. EARLE'S SUBDIVISION IN THE EAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 13, EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT RECORDED JULY 29, 1892 AS DOCUMENT NUMBER 1708504, ALL IN COOK COUNTY, ILLINOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 1,616 SQUARE FEET OR 0.0371 ACRES, MORE OR LESS.

TOGETHER WITH

THAT PART OF W. 52ND STREET 50 FOOT WIDE RIGHT OF WAY LYING SOUTH OF AND ADJOINING BLOCK C AND LYING NORTH OF AND ADJOINING BLOCK D, BOTH INCLUSIVE, OF JOHN G. EARLE'S SUBDIVISION IN THE EAST 1/2 OF THE SOUTHWEST 1/4 OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 13. EAST OF THE THIRD PRINCIPAL MERIDIAN, ACCORDING TO THE PLAT RECORDED JULY 29, 1892 AS DOCUMENT NUMBER 1708504; LYING EAST OF AND ADJOINING THE EAST RIGHT OF WAY LINE OF S. MILLARD AVENUE; AND LYING WEST OF AND ADJOINING THE WEST RIGHT OF WAY LINE OF THE GRAND TRUNK WESTERN RAILROAD, ALL IN COOK COUNTY, ILUNOIS, SAID ABOVE DESCRIBED PARCEL CONTAINING 12,554 SQUARE FEET OR 0.2882 ACRES, MORE OR LESS.

TOTAL AREA BEING VACATED CONTAINING 14,107 SQUARE FEET OR 0.3253 ACRES, MORE OR LESS

CITY DEPT. OF FINANCE:

COOK CO. C.D.O.T.;

PLAT PREPARED FOR: AMIGOS FOODS 5251 S. MILLARD AVENUE CHICAGO. IL 60632

PfifPARED BY-

EDWARD J. MOLLOY fic ASSOCIATES LAND Sc CONSTRUCTION SURVEYORS

1236 WKK STRCa. BENSDMU£. ILUNOIS 60106 <630}SSS-2GOO FM<630)565-4700 C-UML TMOLLOVOEJUOLLOY COU

PAGE: 4 OF 4

CDOT# 11-23-15-3737

^ O 35-34OT % 5 J PROFISSIOhM. i 5 I LAND i = : ; SURVEYOR J = 5 1 STATE OF ; = * < & - - , , imNOB

STAlt OF ILLINOIS ) ) SS

COUNTY OF DUPACE )

I. THOMAS A. M0U.OY, AN ILUNOIS PROFESSIONAL LAND SURVEYOR AND UANACINC ACENT OF EDWARD J. UOLLOY AND ASSOCIATES. LTD.. HEREBY CERTIFY THAT A PLAT HAS BEEN MADE UNDER UY DIRECTION FOR THE PURPOSE OF VACATING A PORTION OF A STREET AS SHOWN HEREON AND THAT THE PLAT HEREON DRAWN IS A CORRECT REPRESENTATION OF SAID VACATION. THIS PROFESSIONAL SERVICE CONFORMS TO CURRENT ILUNOIS UINIUUU STANDARDS APPUCA8LE FOR A BOLINLVW SURVEY.

SIGNED AT BENSENVILLE. ILLINOIS THIS 3RD DAY OF _M4B£h_ . AD. 2016

FDWARD J. MOLLOY AND ASS0C1AT7S. LTD. ANJIUNOSJ'ROFESSICNAL DESIGN RRM - UCENSE NO. 1M-002810

THOMAS A. UOaOY ILUNOIS PROFESSIONAL LAND SURVEYOR NO. 35-3409 (EXPIRES NOVEMBER 30. 2016 AND IS RENEWABLE) MANAGING AGENT. ILLINOIS PROFESSIONAL DESIGN RRM UCCNSE NO. 1B4-002910

VAUD OKLY WITH OIB05SQ) SEAL (EXPIRES APRIL 30. 2017 AND IS RENEWABLE)

EJMA PROJ. NO 2151/150146(4)


AND AFFIDAVIT

SECTION I -- GENERAL INFORMATION


?9.oP€;R.T\eg> X , L . ? .


Indicate whether the Disclosing Party submitting this EDS is: 1. the Applicant

OR

2. [ ] a legal entity holding a direct or indirect interest in the Applicant. State the legal name of the Applicant in which the Disclosing Party holds an interest: ;

OR 3. [ ] a legal entity with a right of control (see Section II .B.I . ) State the legal name of the entity in which the Disclosing Party holds a right of control:

B. Business address of the Disclosing Party: So lSV & . tA\u\-WLP-£>

_-CH\CA>(j-& ,_Xl (c£>^2^

C. Telephone: { l 7 ^ _ & 3 & r & i 3 3 _ Fax: ( - j i ^ g>3^-R\ \ ' - \ Email: V A K M N S R € /^VWfaO&FOODS.

D. Name of contact person: tA/\.t^vJtN UjMAG?^\-



_^ / fec^ \^K_^g^Sa^_^g^e^_^Cv^^c .i\jjj^xCJo.Olo--S^S

G. Which City agency or department is requesting this EDS'? l!])^PT- "TRAvrAS^OgrTPCyvoN



Ver. 01-01-12 Page 1 of 13

S E C T I O N II -- DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSmO PARTY

1. Indicate the nature of the Disclosing Party: [ ] Person [ ] Limited 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)


"Xexp g


^ Yes [ ] No [ ] N/A


1. List below the full names and titles of all executive officers and all directors of the entity. NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entities. I f there are no such members, write "no members." For trusts, estates or other similar entities, list below the legal titleholder(s).

I f the entity is a general partnership, limited partnership, limited liability company, limited liability partnership or joint venture, list below the name and title of each general partner, managing member, manager or any other person or entity that controls the day-to-day management of the Disclosing Party. NOTE: Each legal entity listed below must submit an EDS on its own behalf.

Name Title

2. Please provide the following information concerning each person or entity having a direct or indirect beneficial interest (including ownership) in excess of 7.5% of the Disclosing Party. Examples of such an interest include shares in a corporation, partnership interest in a partnership or joint venture.

Page 2 of 13


Name Business Address Percentage Interest in the

0 r r^y r-i Disclosing Pai;t\ /-I I f Disclosing Patty

—y—f \^\^ - 1 J L^i • •^•^^

S E C T I O N III -- BUSINESS RELATIONSHIPS WITH C I T Y E L E C T E D O F F I C I A L S


[ ] Yes IXI No

If yes, please identify below the name(s) of such City elected official(s) and describe such relationship(s):

S E C T I O N IV - DISCLOSURE OF SUBCONTRACTORS AND O T H E R R E T A I N E D P A R T I E S

The Disclosing Party must disclose the name and business address of each subcontractor, attorney, lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The Disclosing Party is not required to disclose employees who are paid solely through the Disclosing Party's regular payroll.



Page 3 of 13

Name (indicate whether Business Relationship to Disclosing Party Fees (indicate whether retained or anticipated Address (subcontractor, attorney, paid or estimated.) N O T E : to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is

_ not an acceptable response.

QllC£LQ^!^^JLl^DLC^


• Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

S E C T I O N V - C E R T I F I C A T I O N S




[ ] Yes ^ N o [ ] No person directly or indirectly owns 10% or more of the Disclosing Party.


[ ] Yes [ ] No


1. Pursuant to Municipal Code Chapter 1 -23, Article 1 ("Article I")(which the Applicant should consult for defined terms (e.g., "doing business") and legal requirements), i f the Disclosing Party submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery, perjury, dishonesty or deceit against an officer or employee of the City or any sister agency; and (ii) the Applicant understands and acknowledges that compliance with Article I is a continuing requirement for doing business with the City. NOTE: I f Article 1 applies to the Applicant, the permanent compliance timeframe in Article I supersedes some five-year compliance timeframes in certifications 2 and 3 below.

Paee 4 of 13

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


b. have not, within a five-year period preceding the date of this EDS, been convicted of a criminal offense, adjudged guilty, or had a civil judgment rendered against them in connection with: ' obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; a violation of federal or state antitrust statutes; fraud; embezzlement; theft; forgery; bribery; falsification or destruction of records; making false statements; or receiving stolen property;

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







• any responsible official ofthe Disclosing Party, any Contractor or any Affiliated Entity or any other official, agent or employee of the Disclosing Party, any Contractor or any Affiliated Entity, acting pursuant to the direction or authorization of a responsible official of the Disclosing Party, any Contractor or any Affiliated Entity (collectively "Agents").

Page 5 of 13


a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe federal government or of any state or local government in the United States of America, in that officer's or employee's official capacity;




4. Neither the Disclosing Party, Affiliated Entity or Contractor, or any of their employees, officials, agents or partners, is barred from contracting with any unit of state or local government as a result of engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in violation of 720 ILCS 5/33E-4; or (3) any similar offense of any state or ofthe United States of America that contains the same elements as the offense of bid-rigging or bid-rotating.

5. Neither the Disclosing Party nor any Affiliated Entity is listed on any of the following lists maintained by the Office of Foreign Assets Control ofthe U.S. Department ofthe Treasury or the Bureau of Industry and Security of the U.S. Department of Commerce or their successors: the Specially Designated Nationals List, the Denied Persons List, the Unverified List, the Entity List and the Debarred List.

6. The Disclosing Party understands and shall comply with the applicable requirements of Chapters 2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Govemmental Ethics) ofthe Municipal Code.

7. I f the Disclosing Party is unable to certify to any ofthe above statements in this Part B (Further Certifications), the Disclosing Party must explain below:

AliPL

Pase 6 of 13

If the letters "NA," the word "None," or no response appears on the lines above, it wi l l be conclusively presumed that the Disclosing Party certified to the above statements.

8. To the best ofthe Disclosing Party's knowledge after reasonable inquiry', the following is a complete list of all current employees ofthe Disclosing Party who were, at any time during the 12-month period preceding the execution date of this EDS, an employee, or elected or appointed official, ofthe City of Chicago (if none, indicate with "N/A" or "none").

R o i s i £

9. To the best ofthe Disclosing Party's knowledge after reasonable inquiry, the following is a complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during the 12-month period preceding the execution date of 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 City business and having a retail value of less than S20 per recipient ( i f none, indicate with "N/A" or "none"). As to any gift listed below, please also list the name ofthe City recipient. _ _ _ _ l ^ i o j ^ E



[ ] is M '



"We are not and will not become a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We further pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in Chapter 2-32 ofthe Municipal Code. We understand that becoming a predatory lender or becoming an affiliate of a predatory lender may result in the loss of the privilege of doing business with the City."

I f the Disclosing -Party is unable to make this pledge because it or any of its affiliates (as defined in Section 2-32-455(b) of the Municipal Code) is a predatory lender within the meaning of Chapter 2-32 ofthe Municipal Code, explain here (attach additional pages i f necessary):

Page 7 of 13





[ ] Yes JKlNo

NOTE: I f you checked "Yes" to Item D.L, proceed to Items D.2. and D.3. I f you checked "No" to Item D. 1., proceed to Part E.



[ ] Y e s ^ N o

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





Page 8 of 13


A L 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.



NOTE: I f the Matter is federally funded, complete this Section V I . I f the Matter is not federally funded, proceed to Section V I I . For purposes of this Section V I , tax credits allocated by the City and proceeds of debt obligations ofthe City are not federal funding.



.HDSI^ ;

(If no explanation appears or begins on the lines above, or if the letters "NA" or i f the word "None" appear, it wil l be conclusively presumed that the Disclosing Party means that NO persons or entities registered under the Lobbying Disclosure Act of 1995 have made lobbying contacts on behalf of the Disclosing Party with respect to the Matter.)


Page 9 of 13

3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in which there occurs any event that materially affects the accuracy ofthe 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 Intemal Revenue Code of 1986; or (ii) it is an organization described in section 501(c)(4) ofthe Intemal Revenue Code of 1986 but has not engaged and wil l not engage in "Lobbying Activities".

5. I f the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in form and substance to paragraphs A . l . through A.4. above from all subcontractors before it awards any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the duration of the Matter and must make such certifications promptly available to the City upon request.




^ Y e s [ ] No



[ ] Y e s ] ^ N o


[ ] Yes ] ^ N o


[ ] Yes ]>4 No


Page 10 of 13

S E C T I O N VII - ACKNOWLEDGMENTS, C O N T R A C T INCORPORATION, C O M P L I A N C E , P E N A L T I E S , DISCLOSURE


A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any contract or other agreement between the Applicant and the City in connection with the Matter, whether procurement, City assistance, or other City action, and are material inducements to the City's execution of any contract or taking other action with respect to the Matter. The Disclosing Party understands that it must comply with all statutes, ordinances, and regulations on which this EDS is based.

B. The City's Governmental Ethics and Campaign Financing Ordinances, Chapters 2-156 and 2-164 of the Municipal Code, impose certain duties and obligations on persons or entities seeking City contracts, work, business, or transactions. The full text of these ordinances and a training program is available on line at www.cityofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N .


C. I f the City determines that any information provided in this EDS is false, incomplete or inaccurate, any contract or other agreement in connection with which it is submitted may be rescinded or be void or voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at law for a false statement of material fact may include incarceration arid an award to the City of treble damages.

D. It is the City's poHcy to make this document available to the public on its Intemet site and/or upon request. Some or all ofthe information provided on this EDS and any attachments to this EDS may be made available to the public on the Internet, in response to a Freedom of Information Act request, or otherwise. By completing and signing this EDS, the Disclosing Party waives and releases any possible rights or claims which it may have against the City in connection with the public release of information contained in this EDS and also authorizes the City to verify the accuracy of any information submitted in this EDS.

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 City takes action on the Matter. I f the Matter is a contract being handled by the City's Department of Procurement Services, the Disclosing Party must update this EDS as the contract requires. NOTE: With respect to Matters subject to Article I of Chapter 1-23 of the Municipal Code (imposing PERMANENT I N E L I G I B I L I T Y for certain specified offenses), the information provided herein regarding eligibility must be kept current for a longer period, as required by Chapter 1-23 and Section 2-154-020 of the Municipal Code.


Page 11 of 13

F.l . The Disclosing Party is not delinquent in the payment of any tax administered by the Illinois Department of Revenue, nor are the Disclosing Party or its Affiliated Entities delinquent in paying any fine, fee', tax or other charge owed to the City. This includes, but is not limited to, all water charges, sewer charges, license fees, parking tickets, property taxes or sales taxes.

F.2 I f the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Entities wi l l not use, nor permit their subcontractors to use, any facility listed by the U.S. E.P.A. on the federal Excluded Parties List System ("EPLS") maintained by the U. S. General Services Administration.

F.3 I f the Disclosing Party is the Applicant, the Disclosing Party will obtain from any contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in form and substance to those in F. l . and F.2. above and will not, without the prior written consent of the City, use any such contractor/subcontractor that does not provide such certifications or that the Disclosing Party has reason to believe has not provided or cannot provide truthful certifications.

NOTE: I f the Disclosing Party cannot certify as to any of the items in F.L, F.2. or F.3. above, an explanatory statement must be attached to this EDS.

CERTIFICATION

Under penalty of perjury, the person signing below: (I) warrants that he/she is authorized to execute this EDS and Appendix A (if applicable) on behalf ofthe Disclosing Party, and (2) warrants that all certifications and statements contained in this EDS and Appendix A (if applicable) are tme, accurate and complete as ofthe date fumished to the City.

?^oPFR-n^^ X L P (Print or type name of Disclosing Party)

^ y . ' ^ ^ ^ Z ^ ^ , ^ ^ & ^ . • XSngn here)


?9^€£>\Cii^ iT


Signed and swom to before me on (date) \ ^ / \ ^ / aov^ at CcsoK County, T.L- (state).

Commission expires: \\ jSL\ /,Q^o\Lr>

Notary Public.

Page 12 of 13 ^ '--^ ~ ~ -*• — OFFICIAL SEAL

MANUEL RANGELJR Notary Public • State of IHinoit

My Commission Expires Nov 21, 2016


APPENDIX A



Under Municipal Code Section 2-154-015, the Disclosing Party mu.st disclose whether such Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial relationship" with any elected city official or department head. A "familial relationship" exists if, as ofthe date this EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic Partner thereof is related to the mayor, any alderman, the city clerk, 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, 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 Part}'" means (1) all executive officers of the Disclosing Party listed in Section II.B.l.a., i f the Disclosing Paity is a corporation; all partners ofthe Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members ofthe Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal )fficcrs of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers'* means the president, chief operating officer, executive director, chief financial officer, treasurer or secretaiy 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 cit>' official or department head?

[ ] Yes ]>iNo

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

Page 13 of 13

(DO NOT SUBMIT THIS PAGE WITH YOUR EDS. The purpose of this page is for you to recertify your EDS prior to submission to City Council or on the date of closing. If unable to recertify truthfully, the Disclosing Party must complete a new EDS with correct or corrected information)

RECERTIFICATION


This recertification is being submitted in connection with aiiRy/street vacation [identify the Matter]. Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute this EDS recertification on behalf of the Disclosing Party, (2) warrants that all certifications and statements contained in the Disclosing Party's original EDS are true, accurate and complete as ofthe date fumished to the City and continue to be true, accurate and complete as of the date of this recertification, and (3) reafiEirms its acknowledgments.

RFM Properties I LP Date: oSL-/j\ta

(Print or typ>e legal name of Disclosing Party)

By:

( s i ^ here)


Maximino Hurtado

Title of signatory:

President

Signed and swom to before me on [date] ( tNP -. >ftPN \9S , by mxiMiKo. WuRTtvJNo , at Coc>K County, T_\JW\^AOV£. [state].

Notary Public.

r* O < l • Commission expires: w JZL\ J\KO

Ver. 11-01-05

OFFICIAL SEAL MANUEL RANGEL JR

Notary Public - Statt of IINnoit My Commisiion Expirtt Nov 21,2016


APPENDIX B


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


[ ]Yes ^No

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

[ ]Yes [ ]No -fy] Not Applicable

3. If yes to (I) or (2) above, please identify below the nartic of the person or legal entity identified as a building code scofHaw or problem landlord and the address ofthe building or buildings to which the pertinent code violations apply.

FILLING OUT THIS APPENDIX B CONSTITUTES ACKNOWLEDGMENT AND AGREEMENT THAT THIS APPENDIX B IS INCORPORATED BY REFERENCE INTO, AND MADE A PART OF, THE ASSOCIATED EDS, AND THAT THE REPRESENTATIONS MADE IN THIS APPENDIX B ARE SUBJECT TO THE CERTmCATION MADE UNDER PENALTY OF PERJURY ON PAGE 12 OF THE ASS0CL4.TED EDS.

city of chicago office of the city clerk chicago, il 60602 · 2019-03-05 · city hall 121 north...

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