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Office of Chicago City Clerk

02011-2264
Office of the City Clerk
Tracking Sheet

Meeting Date: 4/13/2011


Sponsor(s): Clerk Del Valle
Type: Ordinance
Title: Zoning Reclassification App. No. 17233
Committee(s) Assignment: Committee on Zoning
ORDINANCE

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

SECTION 1. That the Chicago Zoning Ordinance be amended by changing all the
Institutional Planned Development No. 60 symbols and indications as shown on Map 11 -H in the
area bounded by:

West Wilson Avenue; the public alley next east of and parallel to
North Winchester Avenue; West Sunnyside Avenue; North Damen
Avenue;

to those of the B2-2 Neighborhood Mixed-Use District.

SECTION 2. That the Chicago Zoning Ordinance be amended by changing all the B2-2
Neighborhood Mixed-Use District symbols and indications as shown on Map 11-H in the area
bounded by:

West Wilson Avenue; the public alley next east of and parallel to
North Winchester Avenue; West Sunnyside Avenue; North Damen
Avenue;

to those of Institutional-Residential-Business Planned Development 60, as amended.

SECTION 3. This Ordinance shall be in force and effect from and after its passage and
publication.

EAST\44429168.1
CITY OF CHICAGO

AMENDED APPLICATION FOR A N AMENDMENT TO


THE CHICAGO ZONING ORDINANCE \

ADDRESS of the property Applicant is seeking to rezone:

4550 N . Winchester Avenue

2. Ward Number that property is located in: 47th Ward

3. APPLICANT Lycee Franpais de Chicago

ADDRESS 613 West Bittersweet Place

CITY Chicago STATE IL ZIP CODE 60613;

PHONE 773-665-0066 CONTACT PERSON Robert Nauert

Is the applicant the owner of the property? YES NO X


If the applicant is not the owner of the property, please provide the following information
regarding the owner and attach written authorization from the owner allowing the applicant to
proceed.

OWNER Chicago Title Land Trust Company. Trustee u/t/a dated May 1. 2002. No. 1110819*

ADDRESS rOF AGENT/ATT0RNEY1 111 West Washington Street. Suite 855

CITY Chicago STATEJOL ZIP CODE 60602

PHONE (312) 726-9060 CONTACT PERSON James Sulzer. Esq.

5. If the Applicant/Owner of the property has obtained a lawyer as their representative for the
rezoning, please provide the following information:

ATTORNEY DLA Piper LLP. Attn: Ted Novak

ADDRESS 203 N . LaSalle St.. Ste. 1900 CITY Chicago

PHONE 312-368-4037 FAX 312-630-7398

*Other owners of parcels within PD are identified on attached table.

EAST\44429474.3
6. If the applicant is a corporation please provide the names of all shareholders as disclosed on the
Economic Disclosure Statements:
The Applicant is a not-for-profit corporation and has no shareholders.

7. On what date did the owner acquire legal title to the subject property? Unknown

8. Has the present owner previously rezoned this property? If yes, when?

According to City records, the last rezoning occurred on or around August 3, 1976.

9. Present Zoning District Institutional Planned Development No. 60

Proposed Zoning District B2-2 and then to Institutional-Residential-Business Planned

Development No. 60. as amended

10. Lot size in square feet (or dimensions) +312.101 net square feet (7.16 acres)

11. Current Use of the Property Medical and related uses / parking

12. Reason for rezoning the property To allow construction of a school facility as described in

the enclosed statements and depicted on the enclosed project plans.

13. Describe the proposed use of the property after the rezoning. Indicate the number of dwelling
units; number of parking spaces; approximate square footage of any commercial space; and
height ofthe proposed building. (BE SPECIFIC)
See proposed planned development statements, bulk regulations and data table and plans.

14. On May 14'*', 2007, the Chicago City Council passed the Affordable Requirements Ordinance
(ARO) that requires on-site affordable housing units or a financial contribution if residential
housing projects receive a zoning change under certain circumstances. Based on the lot size of
the project in question and the proposed zoning classification, is this project subject to the
Affordable Requirements Ordinance? (See fact Sheet for more information)

YES NO X

EAST\44429474.3
COUNTY OF COOK
STATE OF ILLINOIS

Lycee Fran9ais de Chicago, being first duly sworn on oath, states that all of the above statements and the
statements contained in the documents submitted herewith are true and correct.

L Y C E E FRANCAIS DM CHICAGO

By:

Name: fH-A\Kj Wgfegg.

Its: Pg^^i&eKj-r

Subscribed and Sworn to before me this


i ^ d a y of i L p \ J L 2011.

% "OFFICIAL SEAL" |
Notary Public I PATRICIA A. DILLMAN *
• Notary Public, State of Illinois «
« My Commission Expires 04/25/2014 %

For Office Use Only

Date of Introduction:

File Number:

Ward:

CENTRAL\31310345.1
Subarea Owner Contact Information Form of Authorization

A,E Ravenswood Associates, LLC Bob Levinson Declaration of Covenants, Conditions and
Ravenswood Associates Restrictions, etc. dated October 3, 2007,
401 N . Franklin Doc. No. 0727839130
Suite 5 South
Chicago, IL 60654
(312) 649-6835
B/C Chicago Title Land Trust Company, as James Sulzer Written owner's authorization attached.
Trustee under Trust Agreement dated May SULZER & SHOPIRO, LTD.
1,2002, Trust No. 1110819 111 West Washington Street, Suite 855
(Contract Seller) Chicago, Illinois 60602
(312) 726-9060
D HCRI Illinois Properties, LLC Christopher A. DiSalle Zoning Rights Agreement dated
Vice President — Medical Facilities Group December 20, 2002, Doc. No. 0021432126
Health Care REIT, Inc.
4500 Dorr Street
Toledo, OH 43615-4040
(419) 247-5253

F 4501 North Damen Parking Garage Each of the above are also contacts for this Zoning Rights Agreement dated
Condominium Association owner as members of the association. December 20, 2002, Doc. No. 0021432126
and Declaration of Covenants, Conditions
and Restrictions, etc. dated October 3,
2007,'Doc. No. 0727839130
AUTHORIZATION

Chicago Title Land Trust Company, as Trustee under Trust Agreement dated May 1,
2002, Trust No. 1110819 ("Ovraer"), being a record owner of part of the Ravenswood Hospital
site, which hospital site is bounded by West Wilson Avenue on the north, the public alley next
east of and parallel to North Winchester Avenue on the east, West Sunnyside Avenue on the
south and North Damen Avenue on the west, West Sunnyside Avenue on the south, and North
Damen Avenue on the west, hereby authorizes Lycee Fran9ais de Chicago ("Lycee") to file an
application to amend Plarmed Development No. 60 and to seek such other permits and land use
approvals as may be necessary or desirable to allow construction of a school facility on a portion
ofthe hospital site. Such authorization is subject to the terms of a Purchase and Sale Agreement
between Owner and Developer dated January 6, 2011. No such amendments, permits or
approvals shall take effect or bind Owner or Owner's property until Lycee acquires Owner's
property.

CHICAGO TITLE LAND TRUST COMPANY, as Trustee


under Trust Agreement dated May 1, 2002, Trust No. 1110819,
by its beneficiares:

4720 NORTH RA

Name: p<^u
Its: gey
Date: yi, - OS)-Q-Ofl

4550 NORTH Wir

Name: T^^u^^dP L
Its: kAg*.<vj<?^^
Date: ^ 3 ^ X 9 - ^ / /

DWS OWNERSHIP, LLC

By:_
Name:
Its:
Date:

EASTA44094268.2
AUTHORIZATION

Chicago Title Land Trust Company, as Trustee under Trust Agreement dated May 1,
2002, Trust No. 1110819 ("Owner"), being a record owner of part of the Ravenswood Hospital
site, which hospital site is bounded by West Wilson Avenue on the north, the public alley next
east of and parallel to North Winchester Avenue on the east. West Sunnyside Avenue on the
south and North Damen Avenue on the west, West Sunnyside Avenue on the south, and North
Damen Avenue on the west, hereby authorizes Lycee Frangais de Chicago ("Lycee") to file an
application to amend Planned Development No. 60 and to seek such other permits and land use
approvals as may be necessary or desirable to allow construction of a school facility on a portion
of the hospital site. Such authorization is subject to the terms of a Purchase and Sale Agreement
between Owner and Developer dated January 6, 2011. No such amendments, permits or
approvals shall take effect or bind Owner or Owner's property until Lycee acquires Owner's
property.

CHICAGO TITLE LAND TRUST COMPANY, as Trustee


under Trust Agreement dated May 1, 2002, Trust No. 1110819,
by its beneficiares:

4720 NORTH RACINE, LLC

By:
Name:
Its:
Date:

4550 NORTH WINCHESTER, LLC

By:
Name:.
Its:
Date:

DWS OWNERSHIP, LLC

Name:
Its: l ^ ^ ^ f - ^ r / ^ ' V
Date:

EAST\44094268.2
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in the Applicant exceeding 7.5 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 "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 ofthe Disclosing Party listed in Section n.B.l.a., if the
Disclosing Party 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 UabiUty 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, chieffinancialofficer, 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 [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
10/10

Lycee Fran^ais de Chicago


Board of Trustees 2010-2011

Miles McKie, Chair

Fernando Assens

Patrick Balson

David Berten

Tim Calkins

Hugues Delannoy

Diane Saltoun, Vice Chair

Zachary Egan

Bruce Gehnan

Sharon Langshur, M.D., Treasurer

Nancy Lemer-Frej

John JefEry Louis

Douglas W. Lyons

Susan Malisch

Marianne Markowitz

Jean-Fran9ois Masson

Denise Olsen

Etienne Veber

Alain Weber, President

Gwen Rose, Secretary


CITY O F C H I C A G O
E C O N O M I C DISCLOSURE S T A T E M E N T
AND AFFIDAVIT

SECTION I - G E N ] | : R A L I N F O R M A T I O N

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

•(7:20 A/A^c/^Cy LLC: ^^^OM (A)iio'Qk<L^^r, U~C; DOO^ Oc^i^^ArvU^h.LL


LC)
Check ONE of the fdllowina three boxes:

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 wh|ich the Disclosing Party holds an interest:
OR
3. [ ] a legal entity with a right of control (see Section II.B.l.) State the legal name of the entity in
which the Disclosjing Party holds a right of control:

B. Business address 6f the Disclosing Party:

C. Telepho

D. Name of contact person: X ^ ^ V i ^ L , - c \ \ M.'^/v>

E. Federal Employer [identification No, (if you have one):

F. Brief description qf contract, transaction or other undertaking (referred to below as the "Matter") to
which this EDS perta'ins. (Include project number and location of property, if applicable):

G. Which City agencjy or department is requesting this EDS? O \ ^^0/\l / A / ^

If the Matter, is a cjontract being handled by the City's Department of Procurement Services, please
complete the foUojwing:

Specification # and Contract #

Ver. 09-01-10 Page 1 of 13


SECTION II ~ DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature of the Disclosing Party:


[ ] Person I [] 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, if applicable:

3. For legal entiti'es not organized in the State of Illinois: Has the organization registered to do
business in the State of Illinois as a foreign entity?

[]Yes []No ^ N / A

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

1. List below theifull names and titles of all executive officers and all directors of the entity.
N O T E : For not-for-profit corporations, also list below all members, if any, which are legal entities. If
there are no such metribers, write "no members." For trusts, estates or other similar entities, list below
the legal titleholder(sj).
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 eriitity listed below must submit an EDS on its own behalf.

Name , o , / , . Ti.tle ~ 1 J
/D><=?u)^ L^\Ah\afj^. Kio\Na(^\t^^ H / T-O K). I^J^^^CIM^. LX-C

Aw
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 inblude 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. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the
Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information
from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the


A i 1 Disclosiiig Party ^
O^mM Lei^^^^^J 'SBX M. War^Y A\.^^ ^\^-^., Oak P^IC. 1^ /O- ^OlS/^

SECTION m -- BUSINESS RELATIONSHIPS WITH CITY ELECTED OFFICIALS

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

[ ] Yes y4^.
No

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

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

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

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

: ^ — —

(Add sheets if necessary)

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

SECTION V - CERTIFICATIONS

A. C O U R T - O R D E R E D C H I L D SUPPORT C O M P L I A N C E

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

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

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


Disclosing Party.

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

[ ] Yes [ ] No

B. F U R T H E R C E R t l F I C A T I O N S

1. Pursuant to Mbnicipal 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 dojng.busmessjAi'it^^^ City,Jhen 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 o f 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. N O T E : If Article I applies to the Applicant, the permanent compliance
timeframe in Article il 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 E D S :

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 E D S , 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 govemmental 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 E D S , 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 concem:

• 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; co!mmon use of employees; or organization of a business entity following the
inejigibilityjjXa business entity to do business with federal or state or local government, including
the City, using substantially the same management, ownership, or principals^as~th~e"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").

Pages 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 E D S 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 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 govemment as a result of
engaging in or being convicted of (1) bid-rigging in violation of 720 I L C S 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 of the Treasury or the
Bureau of Industry arid 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
Munidpal Code.

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

Page 6 of 13
If the letters " N A , " the word "None," or no response appears on the lines above, it will be conclusively
presumed that the Disclosing Party certified to the above statements.

C. C E R T I F I C A T I O N OF S T A T U S A S F I N A N C I A L INSTITUTION

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

[ ] is

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

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 of the Municipal Code, explain here (attach additional pages i f necessary):

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

D. C E R T I F I C A T I O N R E G A R D I N G INTEREST IN C I T Y B U S I N E S S

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?
[ ] Yes ^ N o

N O T E : 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.

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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 .

Does the Matter involve a City Property Sale?

[ ] Yes X.No

3. If you checked "Yes" to Item D.I., provide the names and business addresses 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 will
be acquired by any City official or employee.

E. C E R T I F I C A T I O N R E G A R D I N G S L A V E R Y E R A BUSINESS

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

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

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

Page 8 of 13
SECTION VI ~ CERTIFICATIONS FOR F E D E R A L L Y FUNDED M A T T E R S

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

A. CERTIFICATION REGARDING L O B B Y I N G

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):

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

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

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

5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in
form and substance to paragraphs A . I . 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.

Page 9 of 13
B. C E R T I F I C A T I O N R E G A R D I N G E Q U A L E M P L O Y M E N T O P P O R T U N I T Y

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

Is the Disclosing Party the Applicant?

[ ] Yes [ ] No

If "Yes," answer the three questions below:

1. Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (See 41 C F R 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

3. Have you participated in any previous contracts or subcontracts subject to the


equal opportunity clause?
[]Yes []No

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

SECTION VII - 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 , PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

A. The certifications, disclosures, and acknowledgments contained in this E D S 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 E D S 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 .

Page 10 of 13
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 information provided in this EDS is false, incomplete or inaccurate,
any contract or other agreement in connection with which it is submitted may be rescinded or be void or
voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or
void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or
declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at
law for a false statement of material fact may include incarceration and an award to the City of treble
damages.

D. It is the City's policy to make this document available to the pubUc 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 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 E D S 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. N O T E : With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing P E R M A N E N T 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.

The Disclosing Party represents and warrants that:

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

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

F.3 If the Disclosing Party is the Applicant, the Disclosing Party will obtain from any
contractors/subcontractors hired or to be hired in connection with the Matter certifications equal in
form and substance to those in F . l . and F.2. above and will not, without the prior written consent 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.

Page 11 of 13
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.

(Print orwype name of Disclosing Party)

(Sign here)

(Print or type name of person signing)

(Print or type title of person signing)

Signed and sworn to before me on (date) o /( ,


at CLOo County, ~P- ( l {i^oi5 (state).
OFFICIAL SEAL
9.1? Notary Public. FRAN E BABLONKAY
Notary Public - State of Illinois
My Commission Expires Jul 21. 2014
Commission expires: \ ^^"^ / ^ •

Page 12 of 13
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in the Applicant exceeding 7.5 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 "familial relationship" exists i f 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, daugliter-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 Usted 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
partnership; all general partners and limited partners ofthe Disclosmg Party, if the Disclosmg Party is a limited
partaership; all managers, managing members and members ofthe 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 Domestic Partner thereof currently
have a "familial relationship" with an elected city official or department head?

[ ] Yes j><iNo
If yes, please identify below (1) the name and title of such person, (2) the name ofthe legal enfity 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
DLA Piper LLP (US)
203 North LaSalle Street, Suite 1900
Chicago, Illinois 60601-1263
www.dlapiper.com

Theodore J. Novak
theodore.novak@dlapiper.com
T 312.368.4037
F 312.630.7398

April 6, 2011

The Honorable Daniel Solis, Chairman Linda Searl, Chairman


City of Chicago Committee on Zoning City of Chicago Plan Commission
Room 304, City Hall Room 1000, City Hall
121 North LaSalle Street 121 North LaSalle Street
Chicago, Illinois 60602 Chicago, Illinois 60602

Re: Lycee FranQais de Chicago / 4550 N. Winchester Avenue /


Application for Amendment to Institutional Planned Development No. 60

Dear Chairman Solis and Chairman Searl:


The undersigned, Theodore J. Novak, a partner with the law firm of DLA Piper LLP (US), which firm
represents Lyc6e Frangais de Chicago, the applicant for an amendment to the Chicago Zoning Ordinance for the
property located at 4550 N. Winchester Avenue, being first duly sworn on oath, deposes and says the following:
(1) That, to his knowledge, the undersigned certifies that he has complied with, or caused compliance
with, the requirements of Section 17-13-0107 of the Municipal Code of the City of Chicago, by:
(a) Sending the attached letter by U.S. Mail to such property owners who appear to be the owners
of real property within 250 feet in each direction of the lot line of the property referenced within
said letter, exclusive of public roads, streets, alleys and other public ways; and
(b) Including in said letter a statement of the intended use of said property, the names and
addresses of the applicant, and a statement that the applicant intends to file an application for
an amendment to the Chicago Zoning Ordinance on approximately April 13, 2011.
(2) That the undersigned has made, or caused to be made, a bona fide effort to determine the
addresses ofthe parties to be notified under Section 17-13-0107 ofthe Municipal Code ofthe City of Chicago; and
(3) That the undersigned certifies that, to his knowledge, the accompanying list of names and
addresses of surrounding property owners within 250 feet, recognizing the above limits, is a complete list containing
the names and last known addresses of the owners of the property required to be served and the persons so served
as they appear in the Cook County tax records as the taxpayers of record.

Very truly yours,


DLA Piper LLP (US)

Theodore J. Novak

Subscribed and sworn to before me


This 6th day of April, 2011.
• "OFFICIAL SEAL" %
% PATRICIA A. DILLfv'LAW %
Notary Public • Notary Public. State of 1 lliroi:. •;
CENTRAL\31313070.1 % My Commission Expires W"&\''.'<'' %
DLA Piper LLP (US)
QL/\ P I P E P 203 North LaSalle Street, Suite 1900
Chicago, Illinois 60601-1293
www.dlapiper.com

Theodore J. Novak
theodore.novak@dlapiper.com
T 312.368.4037
F 312.630.7398

Aprils, 2011

FIRST CLASS MAIL

To the Party Addressed:

In accordance with the requirements of Section 17-13-0107 of the Municipal Code of the
City of Chicago, please be informed that on or about April 13, 2011, the undersigned, on behalf
of Lycee Frangais de Chicago (the "Applicant"), will file an application with the City of Chicago to
amend the Chicago Zoning Ordinance and Institutional Planned Development No. 60 ("IPD 60").

IPD 60 applies to the Ravenswood Hospital site, bounded by West Wilson Avenue, the
public alley next east of and parallel to North Winchester Avenue, West Sunnyside Avenue, and
North Damen Avenue. The proposed change of zoning does not apply to your property. You
are receiving this notice because Cook County tax records indicate that you own property within
250 feet (more or less) of the above-described property.

The application seeks to amend IPD 60 in a two-step process including a rezoning to the
B2-2 Neighborhood Mixed-Use District and then to Institutional-Residential-Business Planned
Development No. 60, as amended. The application, if approved, will facilitate the construction
of a new school facility on part of the site, located at 4550 North Winchester Avenue and
fronting on the south side of West Wilson Avenue. The Applicant intends to replace several
existing, large, vacant hospital structures with a school, recreational uses, open space and other
uses.

The Applicant is the contract purchaser of part of the Ravenswood Hospital site. The
Applicant's address is 613 West Bittersweet Place, Chicago, Illinois 60613. I am an authorized
representative of the Applicant and my address is 203 North LaSalle Street, Suite 1900,
Chicago, IL 60601.

Please contact me at 312-368-4037 with questions or to obtain additional information.

Very truly yours,

DLA Piper LLP (US)

Theodore J. Novak
INSTITUTIONAL-RESIDENTIAL-BUSINESS PLANNED DEVELOPMENT
NUMBER 60, AS AMENDED

Plan of Development Statements

1. The area delineated as Institutional-Residential-Business Planned Development


Number 60, as amended, consists of approximately three hundred twelve thousand one
hundred one (312,101) net square feet (7.16 acres) of property bounded by West Wilson
Avenue; the public alley next east of and parallel to North Winchester Avenue; West
Sunnyside Avenue; and North Damen Avenue (the "Property"). The Applicant, Lycee
Fran9ais de Chicago (the "Applicant") has filed this application with the authorization of
the owners of the Property.

2. All applicable official reviews, approvals or permits are required to be obtained by the
Applicant. Any dedication or vacation of streets, alleys or easements or any adjustments
of rights-of-way shall require a separate submittal on behalf of the Applicant, its
successors, assigriees or grantees and approval by the City Council.

3. This Planned Development shall not shall take effect or bind the owners or the owners'
property until the Applicant acquires Subarea B/C. Subject to the foregoing, the
requirements, obligations and conditions contained within this Planned Development
shall be binding upon the Applicant, its successors and assigns and, if different than the
Applicant, the legal title holders and any grotmd lessees. All rights granted hereunder to
the Applicant shall inure to the benefit of the Applicant's successors and assigns and, if
different than the Applicant, the legal title holder and any groimd lessees (including any
condominium or homeovmers' association which may be formed). Furthermore, pursuant
to the requirements of Section 17-8-0400 of the Chicago Zoning Ordinance, the Property,
at the time of applications for amendments, modifications or changes (administrative,
legislative or otherwise) to this Planned Development are made, shall be under single
ownership or under single designated control. Where portions of the improvements
located on the Property have been submitted to the Illinois Condominium Property Act,
the term "owner" shall be deemed to refer solely to the condominium association of the
owners of such portions of the improvements and not to the individual unit owners
therein. Nothing herein shall prohibit or in any way restrict the alienation, sale or any
other transfer of all or any portion of the Property or any rights, interests or obligations
therein. An agreement among different ovraers of the Property or a covenant binding
upon owTiers of the Property may designate the parties authorized to apply for future
amendments, modifications or other changes to this Planned Development.

4. This plarmed development consists of these Fifteen (15) statements, a Bulk Regulations
and Data Table, an Existing Zoning Map, an Existing Land Use Map, a Planned
Development Boundary and Property Line Map, a Subarea Map, a Site/Landscape Plan
and Building Elevations, all prepared by Krueck & Sexton Architects, dated April 13,
2011. Full-sized copies of these plans and elevations are on file with the Department of
Housing and Econonlic Development (with its successors, the "Department"). These and
no other zoning controls shall apply to the Property. This planned development conforms

APPLICANT: Lyc6e Fran9ais de Chicago


ADDRESS: 4550 N. Winchester Avenue
DATE: April 13,2011
CPC DATE:
EAST\44429290.2
to the intent and purpose of the Chicago Zoning Ordinance, Title 17 of the Municipal
Code of Chicago, and all requirements thereof, and satisfies the established criteria for
approval as a planned development.

5. The uses of the Property permitted pursuant to this planned development shall include:

Subarea A: Business and professional offices; off-street parking and related and
accessory uses; health club facility; hospital, research, medical, doctors' offices, housing,
and related and accessory uses.

Subarea B/C: A school and related and accessory uses including, without limitation,
participant sports and recreation (indoor and outdoor), small and medium entertainment
and spectator sports venues, and incidental student and staff housing; all uses permitted in
the B2-2 Neighborhood Mixed-Use District; hospital, research, medical, doctors' offices,
housing, and related and accessory uses.

Subarea D: Hospital, research, medical, doctors' offices, housing, and related uses.

Subarea E: Residential uses, day care facilities and related and accessory uses; senior
housing, assisted living and nursing home uses; hospital, research, medical, doctors'
offices, housing, and related and accessory uses.

Subarea F: Accessory and non-accessory parking.

6. Business identification signs and temporary signs such as construction and marketing
signs shall be permitted subject to the review and approval of the Department. All other
on-premise signs shall be permitted within the planned development subject to the review
and approval of the Department, consistent with the provisions of Section 17-12-010, et
seq., of the Chicago Municipal Code. Off-Premise Signs shall not be permitted in the
planned development.

7. Closure of all or part of any public streets or alleys during demolition or construction
shall be subject to the review and approval of the Chicago Department of Transportation.
All work proposed in the Public Way must be designed and constructed in accordance
with the Chicago Department of Transportation Construction Standards for Work in the
Public Way and in compliance with the Mimicipal Code of the City of Chicago.

8. The maximum height of improvements on the Property shall be as designated on the


Building Elevations and in the Bulk Regulations and Data Table attached hereto.. In
addition to the maximum heights of the buildings and any appurtenances attached thereto
prescribed in this planned development, the height of any improvements also shall be
subject, if applicable, to height limitations as approved by the Federal Aviation
Administration.

9. For purposes of floor area ratio ("F.A.R.") calculations, the definitions in the Chicago
Zoning Ordinance shall apply.

APPLICANT: Lyc6e Franfais de Chicago


ADDRESS: 4550 N. Winchester Avenue
DATE: Aprill3,2011
CPC DATE:
EAST\44429290.2
10. The improvements described on the plans identified in Statement Number 4 shall be
designed, constructed and maintained in substantial conformance with, in accordance
with the parkway tree and parking lot landscaping provisions of the Chicago Zoning
Ordinance (to the extent the same are not inconsistent with such plans) and corresponding
regulations and guidelines.

11. The City of Chicago established a Part II Review Fee per square foot for the total
buildable square feet (floor area). The Part II Review Fee will be assessed by the
Department during the actual Part II Review. The fee as determined by the Department
staff at that time is final and binding on the Applicant and must be paid to the Department
prior to the issuance of any Part II approval.

12. The terms, conditions and exhibits of this plarmed development may be modified
administratively by the Commissioner of the Department upon the application for such a
modification by the owner or ground lessee of the Property and a determination by the
Commissioner of the Department that such modification is minor, appropriate and
consistent with the nature of the improvements contemplated by this planned
development. Any such modification of the requirements of the plarmed development by
the Commissioner of the Department shall be deemed to be a minor change in the
planned development as contemplated by Section 17-13-0611 ofthe Chicago Zoning
Ordinance.

13. Per City Code, all work proposed in the public way must be designed and constructed in
accordance with the Chicago Department of Transportation Construction Standards for
Work in the Public Way and in compliance with the Municipal Code of the Citv of
Chicago. Any changes to ingress and egress as depicted in the plans shall be subject to
the review and approval of the Department of Transportation and the Department. Off-
street parking and loading facilities shall be provided in compliance with this plarmed
development.

14. The Applicant will comply with City Rules and Regulations For the Maintenance of
Stockpiles promulgated by the Commissioner of the Streets and Sanitation, the
Commissioner of the Environment and the Commissioner of Buildings under Section 13-
32-125 of the Municipal Code of Chicago or any other provision of that Code.

15. Unless substantial construction or renovation has commenced within six (6) years of the
effective date of this Plarmed Development, this amended Planned Development shall
expire upon the sixth anniversary of the effective date hereof If this amended Planned
Development expires pursuant to the foregoing provision, the zoning ofthe Property shall
automatically revert to the Residential Plaimed Development No. 84 in effect
immediately prior to this amendment. Such reversion shall not render any building
existing at the time to be non-conforming. The six year period may be extended for up to
one additional year if, before expiration, the Commissioner determines that good cause
for an extension is shovra.

APPLICANT: Lyc6e Fran(;ais de Chicago


ADDRESS: 4550 N. Winchester Avenue
DATE: April 13,2011
CPC DATE:
EAST\44429290.2
CITY OF C H I C A G O
E C O N O M I C DISCLOSURE S T A T E M E N T
AND AFFIDAVIT

SECTION I ~ G E N E R A L I N F O R M A T I O N

A. Legal name ofthe Disclosing Party submitting this EDS. Include d/b/a/ if applicable:
Lycee F r a n c a i s de Chicago, I n c .

Check ONE of the following three boxes:

Indicate whether the Disclosing Party submitting this EDS is:


1. 50 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.l.) State the legal name ofthe entity in
which the Disclosing Party holds a right of control:

B. Business address ofthe Disclosing Party:

C. Telephone! Emai

D. Name of contact person: Robert Nauert

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

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

Approval of r e z o n i n g and planned development . f o r p r o p e r t y g e n e r a l l y l o c a t e d


at 4550 N o r t h Winchester Avenue
G. Which City agency or department is requesting this EDS?Department of Housing and
Economic Development
If the Matter is a contract being handled by the City's Department of Procurement Services, please
complete the following:

Specification # and Contract # N / A

Ver. 09-01-10 Page 1 of 13


SECTION II ~ DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE 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 y Not-for-profit corporation
General partnership (Is the not-for-profit corporation also a 501(c)(3))?
Limited partnership [ ] Yes [ ] No
Trust [ ] Other (please specify)

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

Illinois

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

[]Yes []No yN/A

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

1. List below the full names and titles of all executive officers and all directors of the entity.
N O T E : For not-for-profit corporations, also list below all members, if any, which are legal entities. If
there are no such members, write "no members." For trusts, estates or other similar entities, list below
the legal titleholder(s).
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 entity listed below must submit an EDS on its own behalf.

Name Title
See attached l i s t o f Board o f Trustees

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. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe
Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information
from any applicant which is reasonably intended to achieve fiill disclosure.

Name Business Address Percentage Interest in the


Disclosing Party
None

SECTION III ~ BUSINESS RELATIONSHIPS WITH CITY ELECTED 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 MNo

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

SECTION IV ~ DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, attorney,
lobbyist, accountant, consultant and any other person or entity whom the Disclosing Party has retained
or expects to retain in connection with the Matter, as well as the nature of the relationship, and the total
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, oh 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 Address (subcontractor, attorney, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.
Jones Lang L a S a l l e 200 E . R a n d o l p h Broker $10,000 (est.)

DLA P i p e r L L P (US) 203 N . LaSalle, Ste. 1900 Attorney $45,000 (est.)

Krueck & Sexton 221 W. E r i e Architect $40,000 (est.)


P r o j e c t Management
Advisors 150 S. Wacker Or . , Ste. 670 P r o j e c t Management $40,000 (est.)

(Add sheets if necessary)


KLOA 9750 W. H i g g i n s R d . , Ste. 400, Rosemont, IL T r a f f i c Consultant $20,000 (est.)
[ ] Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.

SECTION V ~ CERTIFICATIONS

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

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

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

[ ] Yes [ ] No [x] No person directly or indirectly owns 10% or more of the


Disclosing Party.

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

[ ] Yes [ ] No

B. FURTHER CERTIFICATIONS

1. Pursuant to Municipal Code Chapter 1-23, Article I ("Article r')(which the Apphcant should
consult for defined terms (e.g., "doing business") and legal requirements), if the Disclosing Party
submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party
certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted Or charged
with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any
criminal offense involving actual, attempted, or conspiracy to commit bribery, 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
identified in Section II.B.l. of this EDS:

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

b. have not, within afive-yearperiod 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 afive-yearperiod 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 afive-yearperiod 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 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 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 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, 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
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 Affihated Entity, or an Affiliated Entity of a Contractor during the five years
before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the
Matter:

a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to


bribe, a public officer or employee ofthe City, the State of Illinois, or any agency ofthe federal
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 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 (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 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 of the U.S. Department ofthe 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 with the applicable requirements of Chapters
2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Govemmental Ethics) ofthe
Municipal Code.

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

N/A

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.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

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

[ ] is is not

a "financial institution" as defined in Section 2-32-455(b) 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 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) ofthe Municipal Code) is a predatory lender within the meaning of Chapter
2-32 of the Municipal Code, explain here (attach additional pages if necessary):

N/A

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

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

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

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

Page 7 of 13
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City
elected official or employee shall have a financial interest iii 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.

Does the Matter involve a City Property Sale?

[]Yes []No N/A

3. If 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 will
be acquired by any City official or employee.

E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

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

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

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

Page 8 of 13
SECTION VI ~ CERTIFICATIONS FOR F E D E R A L L Y FUNDED M A T T E R S

N O T E : If the Matter is federally funded, complete this Section VI. If the Matter is not federally
funded, proceed to Section VII. For purposes of this Section VI, tax credits allocated by the City
and proceeds of debt obligations of the City are not federal funding.

A. CERTIFICATION REGARDING L O B B Y I N G

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):
N/A - This Matter i s not f e d e r a l l y funded.

(If no explanation appears or begins on the lines above, or i f the letters " N A " or i f the word "None"
appear, it will be conclusively presumed that the Disclosing Party means that N O 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 will not expend any federally appropriated funds to pay
any person or entity listed in Paragraph A . 1. above for his or her lobbying activities or to pay any
person or entity to influence or attempt to influence an officer or employee of any agency, as defined by
applicable federal law, a member of Congress, an officer or employee of Congress, or an employee 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 infonnation set
forth in paragraphs A . 1. 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 Intemal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying
Activities".

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

Page 9 of 13
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

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

Is the Disclosing Party the Applicant?

[]Yes • []No N/A '

If "Yes," answer the three questions below:

1. Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No N/A

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 N/A

3. Have you participated in any previous contracts or subcontracts subject to the


equal opportunity clause?
[]Yes []No N/A

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

N/A - This Matter i s not f e d e r a l l y funded.

SECTION VII ~ ACKNOWLEDGMENTS, CONTRACT INCORPORATION,


COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any
contract or other agreement between the Applicant and the City in connection with the Matter, whether
procurement. City assistance, or 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 Govemmental 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 .

Page 10 of 13
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 information provided in this EDS is false, incomplete or inaccurate,
any contract or other agreement in connection with which it is submitted may be rescinded or be void or
voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or
void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or
declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at
law for a false statement of material fact may include incarceration and an award to the City of treble
damages.

D. It is the City's policy to make this document available to the pubhc 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 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 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. N O T E : With respect to Matters subject to Article I of
Chapter 1-23 ofthe Municipal Code (imposing P E R M A N E N T 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.

The Disclosing Party represents and warrants that:

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

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

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

Page 11 of 13
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 tme, accurate
and complete as of the date furnished to the City.

Lycee F r a n c a i s de Chicago, I n c .

(Print or type name of Disclosing Party)

B y : _
(Sign here)

A l a i n Weber
(Print or type name of person signing)

President
(Print or type title of person signing)

Signed ^ d sworn to before me on (date) ( X p ^ j J ^ U . I^


at L ^ t ^ County, S j i j y T u i o (state).

{ff^iAitULj /yj . { A d t n L O ^ Notary

Commission expires:_
Public, r^^^hrm^^^ii^
iMotary Public, State of Illinois
%JffSIT!!*'""
•* PATRICIA^"^P'f"
A. DILLMAN •
04/25/20141

Page 12 of 13
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT
AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

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

AJ l^r.aN^, L L C COM^. ^>fl..^ L L C ^ o ^ A ^ C U c ^ ^ ^ k


Check ONE of the following three boxes:

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.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:

C. Telepho

D. Name of contact person: r ^ a t \ j \ ^ L ^ ( A /Wt^/O

E. Federal Employer Idenfification 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 locatij)n of property, if applicable):

MSSO Mov^^ WiACV>cs>ier Avenue T , ^ r -7


G. Which City agency or department is requesting this EDS? U ^ ^ ^ n t r T u ^ ? / ^ ZL.O^)l^/^

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

Specification # and Contract # hi

Ver. 09-01-10 Page 1 of 13


SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature of the Disclosing Party:


Person Limited Uability company^'! D
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
Tmst [] Other (please specify)

C o L L C Tc o f 11^^ 4 ^ - ^ U ^ A j ^ o a r ^ ^ - o P 4 t v ^ OooN^AC
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:

(llAJQl^

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

[ ] Yes [ ] No ^ N / A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY;

1. List below the full names and titles of all executive officers and all directors of the entity.
N O T E : For not-for-profit corporations, also list below all members, if any, which are legal entities. If
there are no such members, write "no members." For trusts, estates or other similar entities, list below
the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, lirnited 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 /] , j I i \ '^^^^^
0^\,\M LgUM^^J• f\A^/sj<g>^)M<j IA^KMGY M7ao K].'RAC/N>^, U L C

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 tmst,
estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 ofthe
Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information
from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the


, Disclosing Party .

ooUo o^-^A> /^©•^•^ 4-UA)O T'- 5*/^ /,o -f Lcrf bcM" 4(\aN 7,5*'X'^P4tve pro feet oou
SECTION III ~ BUSINESS RELATIONSHIPS W I T H CITY E L E C T E D OFFICIALS ^

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

[ ] Yes ' ^ N o

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

SECTION IV ~ DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, 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 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 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 Address (subcontractor, attomey, paid or estimated.) NOTE:
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
I not an acceptable response.

(Add sheets if necessary)

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

SECTION V - CERTIFICATIONS

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

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

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

[ ] Yes "^MC^^O [ ] No person directly or indirectly owns 10% or more ofthe


Disclosing Party.

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

[ ] Yes [ ] No

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), if the Disclosing Party
submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party
certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged
with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any
criminal offense involving actual, attempted, or conspiracy to commit bribery, 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
identified in Section II.B.l. of this EDS:

a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from any transactions by any federal, state or local unit of 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 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 E D S , 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 E D S , 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 concem:

• 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 equiprrient; 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, 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 ofthe 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 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 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 govemment as a result of
engaging in or being convicted of (1) bid-rigging in violation of 720 ILCS 5/33E-3; (2) bid-rotating in
violation of 720 ILCS 5/33E-4; or (3) any similar offense of any 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 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 (Govemmental Ethics) ofthe
Municipal Code.

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

Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively
presumed that the Disclosing Party certified to the above statements.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

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

[ ] is /^^^

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

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

"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."

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) ofthe Municipal Code) is a predatory lender within the meaning of Chapter
2-32 ofthe Municipal Code, explain here (attach additional pages if necessary):

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

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

Any words or terms that are defined in Chapter 2-156 ofthe 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?
[ ] Yes ^ X N O

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.

Page 7 of 13
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?

[ ] Yes ~^No

3. If 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 will
be acquired by any City official or employee.

E. C E R T I F I C A T I O N R E G A R D I N G S L A V E R Y E R A BUSINESS

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

' ^ ^ ^ 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.

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:

Page 8 of 13
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally
funded, proceed to Section VII. For purposes of this Section VI, 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 if necessary):

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

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

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

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 Intemal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying
Activities".

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

Page 9 of 13
B. C E R T I F I C A T I O N R E G A R D I N G E Q U A L E M P L O Y M E N T O P P O R T U N I T Y

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

Is the Disclosing Party the Applicant?

[ ] Yes [ ] No

If "Yes," answer the three questions below:

1. Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (See 41 C F R 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

3. Have you participated in any previous contracts or subcontracts subject to the


equal opportunity clause?
[ ] Yes [ ] No

If you checked " N o " to question 1. or 2. above, please provide an explanation:

SECTION 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 , PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

A. The certifications, disclosures, and acknowledgments contained in this E D S 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 E D S 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 .

Page 10 of 13
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 information provided in this EDS is false, incomplete or inaccurate,
any contract or other agreement in connection with which it is submitted may be rescinded or be void or
voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or
void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or
declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at
law for a false statement of material fact may include incarceration and an award to the 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 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. 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 of the Municipal Code (imposing P E R M A N E N T 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.

The Disclosing Party represents and warrants that:

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 If the Disclosing Party is the Applicant, the Disclosing Party and its Affiliated Enfities will not
use, nor permit their subcontractors to use, any facility Usted by 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 certificafions equal in
form and substance to those in F. 1. and F.2. above and wiU 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.

Page 11 of 13
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.

(Print or type name of Disclosing Party)

(Sign here)

(Print or type name of person signing)

(Print or type title of person signing)

Signed and sworn to before me on (date) l \ p V \ [ ^ J ? o t / ,


at C Q g K County, T L L i K o i S (state).
OFFICIAL SEAL
FRAN E BABLONKAY
_ Notary Public. Notary Public - State of Illinois
My Commission Expires Jul 21, 2014

Commission expires: S mi ti^'X ^ Gi I H •

Page 12 of 13
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in the Applicant exceeding 7.5 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 "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 ofthe Disclosing Party listed in Section n.B.l.a., if the
Disclosing Party is a corporation; all partaers of the Disclosing Party, if the Disclosing Party is a general
partnership; all general partaers and limited partners of the Disclosing Party, if the Disclosing Party is a Umited
partnership; all managers, managing members and members of the Disclosmg 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, chieffinancialofficer, 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 Partaer thereof currently
have a "familial relationship" with an elected city official or department head?

[ ] Yes ^"^^4^°
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
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT
AND AFFIDAVIT

SECTION I - GENERAL INFORMATION

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

t^ao AJ. M/^Aesi^^ LLC/^A>^.nf-fiy^^ ^L.Cs uA^ "^-^^


La^Ji^hcxft
Check ONE of the following three boxes:

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.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:

C. Teleph

D. Name of contact person: " \ ^ ( ^ u \ ^ | jg^tyN/st^^tO

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

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

G. Which City agency or department is requesfing this EDS?LJg^nu.^ijr O^^ ji-Or^l(^<A

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

Specification # and Contract #

Ver. 09-01-10 Page 1 of 13


SECTION II ~ DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature of the Disclosing Party:


Person •p^ Limited liability companyC/"^
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, if applicable:

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

[]Yes []No ^CfN/A

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

1. List below the full names and titles of all executive officers and all directors of the entity.
NOTE: For not-for-profit corporations, also list below all members, if any, which are legal entiUes. If
there are no such members, write "no members." For tmsts, estates or other similar entities, list below
the legal titleholder(s).
If the entity is a general partnership, limited partnership, limited liability company, limited liability
partnership or joint venture, list below the name and title of each general partner, managing member,
manager or any other person or entity 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
L^aiiic n I I I I ''"itle ^ , j

2. Please provide the following information concerning each person or entity having a direct or
indirect beneficial interest (including ownership) in excess of 1.5% 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 tmst,
estate or other similar entity. If none, state "None." NOTE: Pursuant to Section 2-154-030 of the
Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information
from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the


Disclosing Party

kJjt^- "TIAX-T p€<ng^<g>.<T^ lArV^/lryit -fi(r VMKCX(K ;^epv<:feAs -VUei- 4flW(

^ SC TE? /C T I O N III ~ DBUSINESS


-<'T'T/-k1VT T T T
RELATIONSHIPS W I T H CITY E L E C T E D OFFICIALS
T T C TIVTIT C C T> IT T A T ^ T / - k VT C T T T l S C X i Z T T T T / - " T H T V T? T I T / - " T I T r » r » T r i 7 T / - ' T A T ' C >J

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 ^ 1No

If yes, please identify beiow the name(s) of such City elected official(s) and describe such
relationship(s):.

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND O T H E R R E T A I N E D 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 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: (I) a not-for-profit entity, on an unpaid basis, or (2)
himself. "Lobbyist" also means any person or entity any part of whose duties as an employee of
another includes undertaking to influence any legislative or administrative action.

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

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.

9^

(Add sheets if necessary)

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

SECTION V ~ CERTIFICATIONS

A. COURT-ORDERED CHILD SUPPORT COMPLIANCE

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

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

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


Disclosing Party.

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

[] Yes []No

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), if the Disclosing Party
submitting this EDS is the Applicant and is doing business with the City, then the Disclosing Party
certifies as follows: (i) neither the Applicant nor any controlling person is currently indicted or charged
with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for, any
criminal offense involving actual, attempted, or conspiracy to commit bribery, 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 somefive-yearcompliance 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 II.B.l. of this EDS:

a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from any transactions by any federal, state or local unit of 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 pubUc (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 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 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 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, 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
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 ofthe City, the State of Illinois, or any agency of the 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 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 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 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) ofthe
Municipal Code.

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

Page 6 of 13
If the letters "NA," the word "None," or no response appears on the lines above, it will be conclusively
presumed that the Disclosing Party certified to the above statements.

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION

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

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

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

"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):

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

D. CERTIFICATION REGARDING INTEREST IN CITY BUSINESS

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

1. In accordance with Secfion 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: 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.

Page 7 of 13
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.

Does the Matter involve a City Property Sale?

[ ] Yes J^No

3. If 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 will
be acquired by any City official or employee.

E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

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

^ 1 ^ 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:

Page 8 of 13
SECTION VI - CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

NOTE: If the Matter is federally funded, complete this Section VI. If the Matter is not federally
funded, proceed to Section VII. For purposes of this Section VI, 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 if necessary):

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

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

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

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 Intemal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying
Activities".

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

Page 9 of 13
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

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

Is the Disclosing Party the Applicant?

[ ] Yes [ ] No

If "Yes," answer the three questions below:

1. Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No

2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal
Contract Compliance Programs, or the Equal Employment Opportunity Commission all reports due
under the applicable filing requirements?
[ ] Yes [ ] No "

3. Have you participated in any previous contracts or subcontracts subject to the


equal opportunity clause?
[ ] Yes [ ] No

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

SECTION VII ~ ACKNOWLEDGMENTS, CONTRACT INCORPORATION,


COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any
contract or other agreement between the Applicant and the City in connection with the Matter, whether
procurement, City assistance, or 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 .

Page 10 of 13
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 information provided in this EDS is false, incomplete or inaccurate,
any contract or other agreement in connection with which it is submitted may be rescinded or be void or
voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or
void), at law, or in equity, including terminating the Disclosing Party's participation in the Matter and/or
declining to allow the Disclosing Party to participate in other transactions with the City. Remedies at
law for a false statement of material fact may include incarceration and an award to the City of treble
damages.

D. It is the City's policy to make this document available to the pubUc 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. 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 P E R M A N E N T 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:

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 Enfifies delinquent in paying any
fine, fee, tax or other charge owed to the City. This includes, but is not limited to, all water charges,
sewer charges, license fees, parking tickets, property taxes or sales taxes.

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

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

Page 11 of 13
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 appUcable) are true, accurate
and complete as of the date fumished to the City.

(Print or type name of Disclosing Party)

(Sign here)

(Print or type name of person signing)

(Print or type title of person signing)

Signed and sworn to before me on (date) ^^LAAXJ^ I ^ 2 QI (


at ( ^ o o ^ County, Z T r , ( /(state).
~ ~ ~ - -
OFFICIAL SEAL
Notary Public. FRAN E BABLONKAY
Notary Public - State of Illinois
My Commission Expires Jul 21, 2014
Commission expires: txi^-u^ 0- ^^ Xcy I ^ .

Page 12 of 13
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AIVD AFFIDAVIT
APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in the Applicant exceeding 7.5 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 Partaer 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 Partaertaereofis related to
the mayor, any alderman, the city clerk, the city treasurer or any city department head as spouse or domesUc
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 ofthe Disclosing Party listed m 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
partnership; all general partaers and limited partaers of the Disclosing Party, if the Disclosing Party is a limited
partaership; 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. "Principal officers" means the president, chief
operating officer, executive director, chief fmancial 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 ^y<(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 of the elected city official or department head to whom such
person has a familial relaUonship, and (4) the precise natare of such familial relationship.

Page 13 of 13
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT
AND AFFIDAVIT

SECTION I ~ GENERAL INFORMATION

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

Check ONE ofthe following three boxes:

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.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:

C. Telepho

D. Name of contact person: |^6^l^h> MrAtt40l

E. Federal Employer Identification No. (if you have onl

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

|z^f:bg>^t>Jb X^^dA^jtM^ffg) 'C&wrio crjf^A-^n^ \o


G. Which City agency or department is requesting this EDS? ^iO^i^

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

Specification # f j | ^ and Contract #

Ver. 09-01-10 Page I of 13


SECTION II ~ DISCLOSURE OF OWNERSHIP INTERESTS

A. NATURE OF THE DISCLOSING PARTY

1. Indicate the nature of the Disclosing Party:


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

2. For legal entities, the state (or foreign country) of mcorporation or organization, if appUcable:

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

[]Yes []No f ^ / A

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:

1. List below the full names and titles of all executive officers and all directors ofthe 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 tmsts, estates or other similar entities, list below
the legal titleholder(s).
If the entity is a general partnership, limited partaership, 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.

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 tmst,
estate or other similar entity. If none, state "None." N O T E : Pursuant to Section 2-154-030 ofthe
Municipal Code of Chicago ("Municipal Code"), the City may require any such additional information
from any applicant which is reasonably intended to achieve full disclosure.

Name Business Address Percentage Interest in the

It. 1
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 of the Municipal
Code, with any City elected official in the 12 months before the date this EDS is signed?

[] Yes ^f^o

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

SECTION IV - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES

The Disclosing Party must disclose the name and business address of each subcontractor, 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 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 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 Address (subcontractor, attomey, paid or estimated.) N O T E :
to be retained) lobbyist, etc.) "hourly rate" or "t.b.d." is
not an acceptable response.

(Add sheets if necessary)

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

SECTION V ~ CERTIFICATIONS

A . C O U R T - O R D E R E D C H I L D SUPPORT C O M P L I A N C E

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?

[] Yes [If^o [ ] 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 []No

B . F U R T H E R 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 actaal, 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. N O T E : 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 II.B.l. of this EDS:

a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from any transactions by any federal, state or local unit of 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 under a public transaction; a violation of federal or state antitmst statates; fraud;
embezzlement; theft; forgery; bribery; falsification or destmction 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 ofthe offenses set forth in clause B.2.b. of this Section V ;

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

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

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 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 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, 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 ofthe 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 ofthe City, the State of Illinois, or any agency ofthe federal
govemment 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 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 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 with the applicable requirements of Chapters
2-55 (Legislative Inspector General), 2-56 (Inspector General) and 2-156 (Govemmental Ethics) ofthe
Municipal Code.

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

Page 6 of 13
If the letters " N A , " the word "None," or no response appears on the lines above, it will be conclusively
presumed that the Disclosing Party certified to the above statements.

C. CERTIFICATION OF STATUS AS F I N A N C I A L INSTITUTION

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

[ ] is Jl/^s not

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

2. If the Disclosing Party IS a financial institation, 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 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."

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):

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

D. CERTIFICATION R E G A R D I N G INTEREST IN CITY BUSINESS

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

1. In accordance with Section 2-156-110 of the Municipal Code: Does any official or employee
of the City have a financial interest in his or her own name or in the name of any other person or
entity in the Matter?
[ ] Yes j^No

N O T E : 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.

Page 7 of 13
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City
elected official or employee shall have afinancialinterest in his or her own name or in the name of
any other person or entity in the purchase of any 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 constitate a financial interest within the meaning of this Part D.

Does the Matter involve a City Property Sale?

[ ] Yes M^o

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

Name Business Address Natare of Interest

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

E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS

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

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

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

Page 8 of 13
SECTION VI ~ CERTIFICATIONS FOR FEDERALLY FUNDED MATTERS

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

A. CERTIFICATION REGARDING LOBBYING

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

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

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

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

4. The Disclosing Party certifies that either: (i) it is not an organization described in section
501(c)(4) ofthe 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 will not engage in "Lobbying
Activities".

5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in
form and substance to paragraphs A . l . through A.4. above from aU 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.

Page 9 of 13
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY

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

Is the Disclosing Party the Applicant?

[ ] Yes [ ] No

If "Yes," answer the three questions below:

1. Have you developed and do you have on file affirmative action programs pursuant to applicable
federal regulations? (See 41 CFR Part 60-2.)
[ ] Yes [ ] No

2. Have you filed with the Joint Reporting Committee, the Director of the Office of Federal
Contract Compliance Programs, or the Equal Employment Opportanity Commission all reports due
under the applicable filing requirements?
[ ] Yes [ ] No

3. Have you participated in any previous contracts or subcontracts subject to the


equal opportanity clause?
[ ] Yes [ ] No

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

SECTION VII - ACKNOWLEDGMENTS, CONTRACT INCORPORATION,


COMPLIANCE, PENALTIES, DISCLOSURE

The Disclosing Party understands and agrees that:

A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any
contract or other agreement between the Applicant and the City in connection with the Matter, whether
procurement. City assistance, or 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 statates, 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 on persons or entities seeking City contracts,
work, business, or transactions. The full text of these ordinances and a training program is available on
line at www.citvofchicago.org/Ethics, and may also be obtained from the City's Board of Ethics, 740 N .

Page 10 of 13
Sedgwick St., Suite 500, Chicago, IL 60610, (312) 744-9660. The Disclosing Party must comply fully
with the appUcable ordinances.

C. If the City determines that any information provided in this EDS is false, incomplete or inaccurate,
any contract or other agreement in connection with which it is submitted may be rescinded or be void or
voidable, and the City may pursue any remedies under the contract or agreement (if not rescinded or
void), at law, or in equity, mcluding terminating the Disclosing Party's participation in tae Matter and/or
declining to allow tae 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 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 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 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 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.

The Disclosing Party represents and warrants that:

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

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

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

Page 11 of 13
NOTE: If the Disclosing Party cannot certify as to any ofthe items in F.L, F.2. or F.3. above, an
explanatory statement must be attached to this EDS.

CERTIFICATION

Under penalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute
this EDS and Appendix A (if applicable) on behalf 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 of the date fumished to the City. ^

"out, gW^gi^gM? t^t.^ - 0^*- ^ 3 W - * / ^ *-t


(Print or type name of Disclosing Party)

(Sign here)

(Print or type name of person signing)

(Print or tj^e title Cf person signing)

Signed and swom to before me on (date) ( 1 ^ ^ ^ ^ ^/


at Ccpo^L- County, /L.L-//*<?f^ (state).

otary Public.

Commissitm ^pu-es:"OFFlC|^{_ SEAL^


* ^iJ^'^^ M SuJzer

Page 12 of 13
CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A

FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS AND DEPARTMENT HEADS

This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a direct
ownership interest in the Applicant exceeding 7.5 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 Partaer 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 Partaer thereof is related to
the mayor, any alderman, tae city clerk, tae city treasurer or any city department head as spouse or domestic
partaer 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-m-law, daughter-in-law, stepfather
or stepmother, stepson or stepdaughter, stepbrotaer or stepsister or half-brotaer or half-sister.

"Applicable Party" means (1) all executive ofiScers of the Disclosing Party listed in Section n.B.l.a., if the
Disclosing Party is a corporation; all partaers of tae Disclosing Party, if the Disclosing Party is a general
partaership; all general partaers and limited partaers of the Disclosing Party, if tae Disclosing Party is a limited
partaership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a
limited Uability 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 tae 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 Partaer thereof currently
have a "familial relationship" with an elected city official or department head?

[ ] Yes . [I

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) tae name and title ofthe elected city official or department head to whom such
person has a familial relationship, and (4) tae precise nature of such familial relationship.

Page 13 of 13
INSTITUTIONAL-RESIDENTIAL-BUSINESS PLANNED DEVELOPMENT
NUMBER 60, AS AMENDED

Plan of Development
Bulk Regulations And Data Table

Gross Site Area = Net Site Area + Area Remaining in Public Right-of-Way: + 405,275 gross square feet (9.30
acres) = + 312,101 net square feet (7.16 acres) + 93,174 square feet (2.14 acres) in public right-of-way.

Maximum Overall F.A.R.: 2.20


Minimum Accessory Parking Spaces: 348
Subarea A (net site area + 40,627 sf):
Minimum setbacks: Lesser of: (i) existing structures, or (ii) as required by the B2-2 District.
Maximum building height: Greater of: (i) existing structures, or (ii) as required by the B2-2 District.
Subarea B/C (net site area + 165,233 sf):
Minimum setbacks; Per Site/Landscape Plan.
Maximum building height: Per Building Elevations.
Subarea D (net site area + 52,632 sf):
Minimum setbacks: Lesser of: (i) existing structures, or (ii) as required by the B2-2 District.
Maximum building height: Greater of: (i) existing structure, or (ii) as required by the B2-2 District.
Subarea E (net site area + 15,415 sf):
Minimum setbacks: Lesser of: (i) existing structures, or (ii) as required by the B2-2 District.
Maximum building height: Greater of: (i) existing structure, or (ii) as required by the B2-2 District.
Subarea F (net site area + 36,354 sf):
Minimum setbacks: Lesser of: (i) existing structures, or (ii) as required by the B2-2 District.
Maximum building height: Greater of: (i) existing structure, or (ii) as required by the B2-2 District.

APPLICANT: Lyc^e Franpais de Chicago


ADDRESS; 4550 N. Winchester Avenue
DATE; April 13,2011
CPC DATE;
EAST\44429290.2
B1-1 Neighborhood Shopping District PD-60 Planned Development LETTER#-#
B1-2 Neighborhood Shopping District PD-613 Planned Development
B3-1 Community Shopping District RM-4.5 Residential Multi-unit Buildings
B3-2 Community Shopping District RS-3 Residential Single-unit (Detached House) District density
Ml-2 . Limited Manufacturing/Business Park District RT-4 Residential Two Flat, Townhouses and Multl Unit Districts
district type
SUBJECT PREMISES
Applicant: Lycee Francais de Chicago Scale: NTS Date-April 13, 2011

Address:4550 NoFth Winchester Avenue


EXISTING ZONING MAP Krueck & Sexton Architects
221 WesI EriB Streel, Chicago lU, 60610
BOB N Oeattxxn Slieel Chicago Bttnas 60610
7312644S85D F312 644 9846
I U U U
a •_•

p a

DM —,
1
• • R/4

1 1 a 1
•a •! R/4 1
CZl • j1 1 \vi-i

I. SUNNYSIDE AVENUE

R/2|

1/1
^ , 'D

p
r—1 •!

LEGEND
I INSTITUTIONAL R/2 SUBJECT PREMISES
C BUSINESS/COMMERCIAL
M MANUFACTURING I no. of stories
R RESIDENTIAL
P PARKING building type

Applicant: Lycee Francais de Chicago Scale: NTS Date-ApriMS, 2011


Address:4550 NoTth Winchester Avenue
EXISTING LAND USE MAP Krueck & Sexton Architects
221 West Erie Streel, Chicago IL, 60610 BC6 N Deartxxn Streel C h i c ^ . IkroG 6D610
T 312 644 9650 F 312644 9B46
II II 11 IL

LI7
W.WILSON AVENUE S;

W. SUNNYSIDE AVENUE

"n rn
"in n
LEGEND n ni +
PLANNED DEVELOPMENT (P.D.) BOUNDARY

— PROPERTY LINE (P.L.)

Applicant: Lycee Francais de Chicago Scale: 1"=100'-00" Date-April 13, 2011

Address:4550 North Winchester Avenue


P.D. BOUNDARY & PROPERTY LINE MAP Krueck & Sexton Architects 221 West Erie Slreel, Chicago IL. 60610 BOB N Deartxxn Slrae( Chicago DbncMS 60610
T3I2644 9S5D F312644 9a46
Jl 11 IL
Ul LI7
W.WILSON AVENUE 2;

W. SUNNYSIDE AVENUE

(1
nn n h -[ r

LEGEND

PLANNED DEVELOPMENT (P.D.) BOUNDARY SUBAREA A SKe Area: 40, 420 sf


Building Footprint 11,650sf
SUBAREA
+
E site Area: 15,347 sf
Building Footprint 7,736 sf
Built Floor Area: 93,200 sf Built Floor Area: 92,832 sf
PROPERTY LINE (P.L.) FAR: 2.3 FAR: 6.0

PARCEL BOUNDARY S U B A R E A B/C site Area: 165,245 sf SUBAREA F Site Area: 36,165 sf
Building Footprint 61,418 sf Building Footprint 31,961 sf
BuiS Floor Area: 118,398 sf Built Floor Area: 111,664 sf
FAR: 0.7 FAR: 3.1
SUBAREA D site Area: 48,420 sf
Building Footprint 33,604 sf
Built Floor Area: 156,081 sf
Applicant: Lycee Francais de Chicago Scale: 1"=100'-00" FAR: 3.2 Date-April 13, 2011
Address:4550 North Winchester Avenue
SUBAREA MAP Krueck & Sexton Architects
221 West Erie Streel, Chicago IL. 60610 BOB N Deartxim Stiaei Chicago. Unas 60610
1312644 9650 F312G44 9646
J| I

17 ^
W. WILSON AVENUE
45'.6' SIDE SETBACK

W. SUNNYSIDE AVENUE

"O
] 9
LEGEND

— — PLANNED DEVELOPMENT (P.D.) BOUNDARY


+
PROPERTY LINE (P.L.)
m m ^ GREEN ROOF
I - . I VEGETATED LANDSCAPE

Applicant: Lycee Francais de Chicago Scale: 1"=100'-0" Date-April 13,2011


Address:4550 N o r t h W i n c h e s t e r Avenue
SITE AND LANDSCAPE PLAN Krueck & Sexton Architects
221 WesI Erie Street, Chicago IL. 60610 sti
e08 N Doartnm Stmt. CNcago •
T3)2,644,M50 F 312.644.9846
359--10* TOTAL BUILDING LENGTH

Applicant: Lycee Francais de Chicago Scale: 1"=50'-0" Date-April 13, 2011

Address:4550 N0Fth W l n c h e s t e T Avenue


FIRST FLOOR PLAN Krueck & Sexton Architects
221 West Erie StieeL Chicago IL, 60610
Sti.
BOB N Deartnn Shoe:, Owasi). (SrntaGOeiO
T3I2644BB50 F 3)2644SMS
PRECAST CONCRETE- WETAL' PANEL CLEAR INSULATED- PAINTED . STEEL-
KNEE WALL GLASS WINDOW ... COLUMN COVERS
WALL SYSrEM

Applicant: Lycee Francais de Chicago Scale: 1"=50'-0" Date-April 13, 2011

Address:4550 North Winchester Avenue


NORTH ELEVATION Kmeck & Sexton Arctiitects
221 WesI Erte Street Chicago IL. 6O610
BOS N Dewborn SITMI. U i a g o Oroh EC
T31Z644.9850 F312E44gS4B
PERFORATEL .
METAL SCREEN \ [
T/ SCREEN
EL 79.92'
T/ ROOF PARAPET yfc
tL. >2.o6' —

T/ FIFTH FLOOR A
EL. 58.00'

T/ FOURTH FLOOR >>•


EL. 44.00' ^

T/ THIRD FLOOR
EL. 30.00'

T/ SECOND FLOOR fV
EL- 16.00'

T/ FIRST FinOR A _

PAINTED STEEL CLEAR INSULATED CLEAR INSULATED


COLUMN COVERS CLASS :WINDOWi' GLASS WINDOW
WALL SYSTEM^ WALL SYSTEM..

Applicant: Lycee Francais de Chicago Scale: 1"=50'-0" Date-April 13, 2011

Address:4550 North Winchester Avenue


WEST ELEVATION Krueck & Sexton Architects
221 West Erie Street Chicago IL, 60610 808 N Dcartwm SITMI. Chtcago. ERnob 60610
T 3 i ; 6*4,9850 F 312.644.9846
PERFORATED
METAL SCREEN
BEYOND

PAINTED SIEEl CLEAR INSULATED PRECAST CONCRETE- -PRECAST CONCRETE


COLUMN COVERS GLASS WINDOW •. PANELS ENCLOSURE AROUND
WALL SYSTEM COM-ED TRANSFORMERS

Applicant: Lycee Francais de Chicago Scale: 1"=50'-0" Date-April 13, 2011

Address: 4550 North Winchester Avenue


SOUTH ELEVATION Krueck & Sexton Architects
221 West Erie Street Chicago IL. 60610
'808 N0e3ibomStrM(.Chkaeo Snob 60610
T 312.6445850 F 312.644S846
PERFORATED
METAL SCREEN
BEYOND

II SCREEN,
NA.
EL-79.92' HJ
\ l ROOF PARAPET
EL 72.00' '
T/ FIFTH FLOORS
EL- 58-00' ^

T/ FOURTH F L O O R ^
EL. 44.00'

M THIRD FLOOR,
EL- 30.00' ^

T/ SECOND FLOOR
EL. 16.00'

T/ FIRST FLOOR ^
EL. 0.00'

PAINTED METAL PRECAST CONCRETE CLEAR INSULATED-


• ACCESS DOORS s PANELS GLASS WINDOW
COM-ED TRANSFORMERS SYSTEM

Applicant: Lycee Francais de Chicago Scale: r=50'-0" Date-April 13, 2011

Address:4550 North Winchester Avenue


EAST ELEVATION Krueck & Sexton Architects
221 West Erie Street, Chicago IL, 60610 d
BOS N OBstom S h c t Chicago, nnoii 606 to
T 312.644 9850 F 112.644JS4S
® storm MH.
@ Storm CB
® Storm (niet
™ Storm Inlet
© Son IvtH
® Son Storm Combo MH
y San Clean Out
H Water Valve Vault
® Water MH
^ Water Buffalo Box
*4 Water Hand Hole
H Water Meter
5^ Water Fire Hydrant
(5 Telephone MH
(H Telephone Voult
O Telephone Pedestal
Public Telephone
fi} Combination Pedestal
qQj utility Pole
® Guy Anchor
|£] Electric Manhole
© Electric MH
. B Electric Vault
*<& Electric Hand Hole
[p] Electric Pod
® Electric Meter
® Electric Pedestal
Electric Light Pole
© Electric Traffic Signal
^ Electric Light Pole with Traffic Signal
CSl Electric Traffic Control Box
.121 Electric Traffic Vault
Electric Ground Light
3^ Electric Mounted Wall Light
% Gas Buffalo Box
% Gas Hand Hole
® Gas Meter
M Gas Valve
© . Gas MH
El Gas Vault
ffn Cnhip T V PpH(»<5tnl
GREMLEY & A DIVISI-

PLCSCol
LiCHBE NO. 1

PROFESSIONAL U
4505 NORTH ELSTON AVEI
TELEPHONE: (773) 685-5102 FAX: (773) 2

ALTA/ ACSM U
PARCEL 1: LOTS 1. 2 AND 3 OF SAMUEL BROWN JR'S SUBDIVI
SUBDIVISION OF PART OF THE NORTHEAST QUARTER AND TH
SECTION 18 AND PART OF SECTION 17, TOWNSHIP 40 NORTH
COUNTY, ILLINOIS.

PARCEL 2: LOTS 1 AND 2 IN FELIX J . CANDA'S RESUBDIVISIOf


COUNTY, ILLINOIS.

PARCEL 3: LOTS 16 THROUGH 24, BOTH INCLUSIVE, IN BLOC!

PARCEL 4: LOTS 1 THROUGH 10, BOTH INCLUSIVE, AND LOTS


AFORESAID, IN COOK COUNTY, ILLINOIS.

PARCEL 5: ALL THAT PART OF NORTH WINCHESTER AVENUE


BOTH INCLUSIVE, IN BLOCK 14; LYING EAST OF AND ADJOINI^
AND LYING NORTH OF AND ADJOINING A LINE DRAWN FROM
SOUTHEAST CORNER OF SAID LOT 8 IN BLOCK 15, ALL IN RAN
FURTHER DESCRIBED AS ALL THAT PART OF NORTH WINCHEi
DFfAWN 392 FEET, MORE OR LESS. SOUTH OF AND PARALLEL

PARCEL 6: THAT PART OF THE NORTH AND SOUTH VACATEC


LOTS 1 TO 10 AND LYING EAST OF AND ADJOINING LOTS 15 T
OF A LINE DRAWN FROM THE SOUTHWEST CORNER OF LOT
ALSO
THAT PART OF THE WEST HALF OF THE NORTH AND SOUTH'
ADJOINING LOTS 13 TO 14 IN BLOCK 15 IN RAVENSWOOD AF<
SOUTHWEST CORNER OF LOT 10 TO THE SOUTHEAST CORN

PARCEL 7: LOTS 11 AND 12 IN BLOCK 15 IN RAVENSWOOD Bi


NORTHEAST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 18, AN[
THE THIRD PRINCIPAL MERIDIAN, IN COOK COUNTY, ILUNOIS.

PARCEL 8: THAT PART OF THE EAST 1/2 OF THE NORTH AND


AND ADJOINING LOTS 11 AND 12 IN BLOCK 15 IN RAVENSWQi
SOUTHWEST CORNER OF LOT 10 TO THE SOUTHEAST CORN

AMERITECH UNE
A
EY & BlEDERIVIANN
A DIVISION OF

LCS Corporation
LICENSE No. 184-005322

PROFESSIONAL LAND SURVEYORS


I NORTH ELSTON AVENUE, CHICAGO, IL 60630
5102 FAX: (773) 286-4184 EMAIL: INF0@PLCS-SURVEY.COM

SM Land Title Survey


tOWN JR'S SUBDIVISION OF LOTS 13 AND 14 IN BLOCK 14 IN RAVENSWOOD, BEING A
• QUARTER AND THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF
WNSHIP 40 NORTH, RANGE 14, EAST OF THE THIRD PRINCIPAL MERIDIAN, IN COOK

A'S RESUBDIVISION OF LOT 15 IN BLOCK 14 IN RAVENSWOOD AFORESAID, IN COOK

CLUSIVE. IN BLOCK 14 IN RAVENSWOOD AFORESAID, IN COOK COUNTY, ILLINOIS.

;LUS1VE, AND LOTS 13 THROUGH 24, BOTH INCLUSIVE. IN BLOCK 15 IN RAVENSWOOD

CHESTER AVENUE LYING WEST OF AND ADJOINING THE WEST LINE OF LOTS 17 TO 24,
r OF AND ADJOINING THE EAST UNE OF LOTS 1 TO 8, BOTH INCLUSIVE, IN BLOCK 15;
INE DRAWN FROM THE SOUTHWEST CORNER OF SAID LOT 17 IN BLOCK 14 TO THE
OCK15, ALL IN RAVENSWOOD AFORESAID, SAID PART OF PUBLIC STREET BEING
)F NORTH WINCHESTER AVENUE LYING BETWEEN WEST WILSON AVENUE AND A LINE
OF AND PARALLEL THERETO, IN COOK COUNTY, ILLINOIS,

3 SOUTH VACATED ALLEY PER DOCUMENT 24015075, LYING WEST OF AND ADJOINING
JOINING LOTS 15 TO 24, IN BLOCK 15 IN RAVENSWOOD AFORESAID AND LYING NORTH
" CORNER OF LOT 10 TO THE SOUTHEAST CORNER OF LOT 15 AFORESAID;

)RTH AND SOUTH VACATED AUEY PER DOCUMENT 24015075 LYING EAST OF AND
W E N S W O O D AFORESAID AND LYING SOUTH OF A LINE DRAWN FROM THE
SOUTHEAST CORNER OF LOT 15 AFORESAID, ALL IN COOK COUNTY, ILLINOIS. LAND AREA
AREA (ACRES) AREA (SQ.FT.)
I RAVENSWOOD BEING A SUBDIVISION OF PART OF THE NORTHEAST 1/4 AND THE
F SECTION 18, AND PART OF SECTION 17, TOWNSHIP 40 NORTH, RANGE 14, EAST OF
COUNTY, ILUNOIS.

F THE NORTH AND SOUTH VACATED ALLEY PER DOCUMENT 24015075, LYING WEST OF
15 IN RAVENSWOOD AFORESAID AND LYING SOUTH OF A LINE DRAWN FROM THE
WUTHEAST CORNER OF LOT 15 AFORESAID, ALL IN COOK COUNTY, ILUNOIS. 312101.48 SQ-FT.
TOTAL LAND AREA 7.16 ACRES

WILSON
VICINITY MAP
1

1
V
lENC : Avc 1

1 u ON >VE.

B AVE.
i

AVE.
s Ik e AV \
i •A
o \
i 1a rao!'. AV

— -AV \

ID w1 PA

12101.48 SQ.FT.

I F I ^ T R i r I IWC
o Parking Meter 'CITE BENCHMARK EI£V-18143^^
Parking Pay Box
Sign Post
Mail Box
® Bumper Post
irrrmi Bike Rack
Soil Boring
@ Unclassified Manhole
Auto Sprinkler
Hose Connection
Fire Alarm
— Flag Pole

CONCRETE DRIVEWAY *>


1 •* C O N C R Q T E PARKING S P A C E ;

^^•J' PIN 14-1 a


\CONCRETE DRIVEW

=?ETE D R I V E W A V ,A 1?
/RAISED •^^
ISLAND WITW-?''
-GAUL Xo-<iii_
12 0 WATER MAIN
w
Bo
So
in 4' SEVCR UNE
DAMEN
(RECORD 80 FT. PUBLIC Sf^M
S r;
!" — •>? 5^ ^ '.ImSim

- E -OE -^SJ-
53
AIN DEPBESSED G 4;^? ttv G 'IT,"
COMCeETE
. ~ RTSzSgO"
V» -

->*- s V
2' SEWER LINE

30" GAS MAIN

CHICAGO CITY BENCHMARK #2599


ELEVAT10N= 18.442

LOCATION: MONTROSE AVENUE & NORTH DAMEN AVENUE

ON SOUTH MONTROSE AVENUE, 35.5 FT. EAST OF THE EAST UNE OF NORTH DAMEN
AVENUE. MARK CUT NEAR WEST END OF STONE DOORSIU ON NORTH SIDE OF 2-STORY
BRICK BUILDING.

SURVEY NOTES:
This survey vi/as prepared without the Iwnafit of, and is subject to. all restrictions and matters appearing
as might tie disclosed by a current title commitmenl

Surveyors license expires November 30,2012.

UTILITY WARNING

The underground utilities shovm have been located from field survey Information and existing drawings,
surveyor makes NO guarantee Uiat the underground utilities shourn comprise aD such utilities in the area,
service or abandoned. The surveyor further does not warrant that the underground utilities shown are h
exact location indicated although he does certify that they are located.as accurately as possiblefixMnM o
available. Tlie surveyor has not physically located the urKlerground utilities.

Call DIGGER - (312) 744-7000 within the City of Chicago.

Outside of the City of Chicago call J.U.L.I.E. (800) 892-0123 prior to construction or excavation. -

RECERTIFIED 3/31/11 #2011-15005 (BB)


PROPERTY APPEARS IN "OTHER AREAS" ZONE X. AREAS DETERMil^ED TO BE OUTSIDE^flE-oS
ORDERED BY: LYCEE FRANCAIS DE CHICAGO CHECKED: DRAWN: ANNUAL CHANCE FLOODPLAIN. PER FLOOD INSURANCE RATE MAP COOK COUI<TY ItillNOISl'il
ADDRESS: 1945 W. WILSON AVENUE BB 17031C0410J. EFFECTIVE DATE AUGUST 19, 2008. ;> 1

^ GREMLEY & BE
l DERMANN < Note R. & M. denotes Record and Measured distances respectively.
I PLCS, CORPORATION
T LICENSE NO. mmiiz Distances are marked in feet and decimal parts thereof. Compare all points BEFORE biiikllng by same E
PnoFessiim. LAW SmeroRS once report any differences BEFORE damage Is done. . i « <''-•
A505 NORTH ELSTON AVENIK, CHICAGO. IL 60630
TELEPHONE: (773) 685-5102 FAX: (773) 286-4184 EMAIL: INFOePLCS-SuRVEY.
COH For easements, building Ones and other restrictions not shown on survey plat refers i > jr d. Jr ua. d
contract, title policy and tocal tmllding line reguiatkjns.
DATE PAGE NO.
JANUARY 19. 2011 NO dimenstons shall be assumed by scale measurement upon this plat

2011-14729-001 SCALE:
1 INCH = 25 FEET
IOFI Unless othenwise noted hereon the Bearing Basis, Elevation Datum and Coordlnai D umrfuodrjA

G: \CAD\2011\2011-14729\dwg\2011 -14729-001 .dv»g - '-^i 1^ e W


COPYRIGHT GREMLEY & BlEDERMANN. INC. 2011 "All R^hfs Reserved"
CONCRETE
^:<t?

50" GAS MAIN

HMNHOLE TYPE RIM ELEVATION INVERT ELCVATON TTl

1 CATf^H BASIN 19.16 SEALED. FLOODED 47 CATCH


2 STORM 20.12 W.=8.66. E.=8.72 48 UNCLAi
.3 CATCH RASIN NE:.=13.9I. S.=12.57 49 ELECTR
OF NORTH DAMEN 4 CATCH 8ASIN 18.85 SEALED. FLOODED 50 ELECTR
IRTHSIDEOF2-5TORY 5 UNCLASSIFIED 18.97 DEBRIS FILLE:0 51 ELECTR
6 CATCH BASIN 13.^7 W.= C A P P E b . e . = l 7 . 0 - ^ 52 ELECTR
7 STORM 18.94 W.=8.44. E . = 8 . 4 9 . S.=8.71 53 ElECTR
8 STORM W.=8.08. E:.=fl.04 54 ELECTR
9 WATFR 18.59 TOP OF PlPe=13.47 55 CATCH
Ictlons arid mattars appearing of record 10 STORM 18.48 N.=-?.60. S . = 7 . 6 9 56 CATCH
11 CATCH BASIN 17.44 TOP OP WAVEft= 13.09 57 ELECTR
12 CATCH pASIN 17.33 CAR OVER 58
13 STORM 18.38 N.=7.95. S.=7.84 59 ELECTR
14 CATCH BASIN 19.41 SEALED 60 UNCIA<
15 SANITARY 19.71 S . = 1 6 . 9 8 . E.=17.01 61 UNCLAi
16 STORM 18.34 SEALED 62 UNCLAi.
17 STORM 19.71 N . = 1 4 . 9 9 . S.= 14.66 63 TELEPH
mation and existing drawlrtgs. The 18 CATCH BASIN 17.34 CAft OVEF! 64 CATCH
rise all such utilities In the area, either in 19 yNCIJLSSIFIED 18.93 NW.= 1 2 . 4 3 . N. = 1 1 . 0 9 . S. = 11.13 65 CATCH
?o t)NClA.SSinED 19.01 66
lerground utilities shown are in the 21 UNCLASSIFIED 20.23 w.=i3.23:
E . = 1 6 . 3 3 e;=i3.ie. s.=i3.3i 67
CATCH
CATCH
accurately as possible fmm Infonnation 22 VVATFR 19.46 TAP OF" PIPe=13.47 68 CATCH
s. 23 1JNCIA,SS1F1ED 19.15 M.=11.fi2. S.=H.50 69 UNCLAI
24 CATCH BASIN ia.34 DEBRIS FILLED 70
75 IJNCIASSIFIED 19.22 N.=11.97. S.=l2.67 71 _a££IE
CATCH
26 INIFT 20.34 DEBRIS FILLED 72 CATCH
97 l,JNCI ASSIFIED 20.24 S.=17.14 73 UNC1.A"
ruction or excavation. 28 -pNCLASSIFIED 50.2S W,= 12.12. e.=12.1';. NE.=16.d2. 74 UNCLA'
3 6 " = 12.27 75 INLEf
29 l^NCLASSIRED 20.12 N.=10.97 ? e . = 1 l . 6 9 , N E . = 1 1 . 8 7 76 STORM
30 DNCLASSIRED 20.05 77
NED TO BE OUTSIDE THE 0.2%
.31 STORM 19.9§
Ne.=-I2.4^:'
SEALED
'?.=12.30. S.=12.45 78
CATCH
INLET
> COOK COUNTY, ILLINOIS, MAP NO.
32 STORM 18.37 N.=7.22. S.=7.12 79 ELECTF.
33 .STORM 18.09 \Y.=7.B7. E.=xe5 80 WATER
34 UNCLASSIFIED 18.42 t^.=12.92. E . = 1 2 , 4 2 81 WATE!^
35 UNCI ASSIRED 16.45 T0(^ OF \l/ATe«=9.96 82 WATER
36 STORM 18.12 W.=8.32. E.=8.1'7. S E . = 9 . 4 2 83 WATER
37 CATCH BASIN 18.42 FLOODED 84 INLET
s BEFORE bulkling by same and at 38 STORM 19.09 N . = 9 . 2 9 . E . = 8 . 3 9 . S . = 9 . 2 9 , W.=a 45 85 UNCLA'
39 UNCLASSIFIED 19.13 N . = 9 . 6 3 . VV.=8.84. E . = 8 . 8 0 86 CATCH
40 UNCLASSIRED 20.70 N.=12.05. E.=13.20. S.=11.80. W 87 WATER
41 UNCLASSIFIED 23.30 N.=16.O0. £.=16.30 88 YARD 1
ilat refer to your abstract, deed, 42 INLET 19.72 NW=17.78 = 13.30 89 UNCLA'
43 ?TORM 20.2? W.=9.06. E.=9.10 90 CATCH
44 WATER 17.66 TOP OF' PlPK=lC>.16 91 SEWER
45 STORM 18.33 N . = 1 0 . 0 9 . S . = 9 . 5 8 . W.=»9.86. E.=' 92 WATER
45 CATCH BASIN 18.56 FLOODED
oordlnate Datum if used Is ASSUMED, 1.74

ed"
-COT
tSbDEPRESSEO^o ' t S ^ ^ ^ ^ d ' ^ ,^ CONCRETE
CURB M W 4^
r • W •
^ s -X- s
SEWER LINE

AVENUE

MANHOLE TYPE RIM ELEVATION INVERT ELEVATIOU


47 CATCH BASIN 18.29 TOP OF WATER= 14.55
48 UNCUSSIFIED 19.41 DEBRIS FILLED THE Cmr OF CHICAGO BOARD OF UNDERGROUND INVOLVEMENT HAS
49 ELECTRIC 20.18 N/A BEEN REQUESTED FOR YOUR SURVEY. THE RESULTS TO DATE ARE
50 ELFCTRIC 19.67 N/A INDICATED BELOW. AS A CONVENIENCE TO YOU THE UnUTY DATA IS
51 ELECTRIC 19.76 N/A
52 ELECTRIC 19.84 N/A REVIEWED AND ADDED TO THIS PLAT AS IT IS RECEIVED. THESE
53 ELECTRIC 18.91 RECORDS ARE THEN FORWARDED TO YOU. PLEASE BE AWARE THAT
54 ELECTRIC 18.38 NO OTHER COPY OF THIS INFORMATION IS RETAINED.
55 CATCH BASIN i8.To OUC# 4 7 8 3 9
56 CATCH BASIN 18.60 SEALED
57 ELFCTRIC 18.44 N/A X-INVOLVED. N-NOTlNVaVEO. BLANK-NOT RECEVED.
58 ELECTRIC 18.33 N/A
59 ELECTRIC 18.15 N/A J< 1.AT&T-IUIN01S/SBC
60 UNCLASSIFIED 19.99 SfeALED
61 UNCLASSIFIED 20.11 SEALED J 2. AT«T LOCAL NETWORK SERVICES
62 UNCUSSIFIEP 20.27 JC 3. BUREAU OF ELECTRICITY
63 TELEPHONE 18.62
imib N. 4. CDOT - PROJECT DEVaOPMENT
N/A
64 CATCH BASIN 20.00 SEALED J ! 5. CDOT mFRASTRUCTURE IMNAGEMEHT
65 CATCH BASIN 18.35 SKLE5 J ! 6. BUREAU OF FORESTRY
65 CATCH BASIN l8i39 J l 7. CDOT ENGINEERING
67 CATCH BASIN 18.S7 FLOODED J i 8. CTA-TRAFFIC
68 CATCH BASIN 18.66 FLOODED J l 9. CTA-ENGINEERING
69 UNCLASSIFIED ' 19.22 k= 14.39 SW= 14.32 E= 14.57 J l 10. RON METRO OPTICAL NETWORKS - CHICAGO
70 ELECTRIC 19.66 N/A
71 CATCH BASIN J ! 11. CHICAGO PARK DISTRICT
18.57 FL6ODE0 J{ 12. COMEO TRANSMISSION
72 CAJCH BASIN 18.87 FLOODED
73 UNCLASSIFIED 19.S3 SEALED JK13. DEPARTMENT OF WATER t^ANAGEMENT - SEWER SECTION
74 UNCLASSIFIED 18.78 CAR OV J( 14. CDMW WATER SECTION CONSULTANT
75 INLET 18.73 CAR OV JCW.MO
76 STORM 19.45 DEBRIS FILLED J116.M.W.R.D.
77 CATCH BASIN 18.28 SEALED JL 17. PEOPLES GAS
78 INLET 26.54 SEALED J l 18. ABOVENET COMMUNICATIONS
79 ELECTRIC 25.58 N/A J l 19. COMCAST
80 WATER • 19.83 t6P OF PIPE=15.43
81 WATER 19.63 TOP OF PIPE=l5.18 jN 20. JCDECAUX NORTH AMERICA
8? WATER 19.30 Ww=15.16 W=12.00 NE=i5.7A S== 12.05 J i 21. DIGITAL REALTY TRUST (LAKESIDE TECHNa.OGY CENTER)
83 WATER 19.16 CAR OVER ' ^ J l 22. LEVEL 3 COMMUNICATIONS / LGN
84 INLET 20.05 SEALEO J1.23. MDEmiERMAL CHICAGO CORPORATION
UNCLASSIFIED 19.64 NW.=17.24. Ne.= 15.24 K. 24. COMED - DISTRIBUDON
_ 86 CATCH BASIN 18.99 DEBRIS FILLED j< 25. CDOT - DIVISION OF ELECTRICAL OPERATIONS
—_S7 WATER 19.40 SW=13.Q5 S=12.75 E=13.80 E=1 5.87
. 88 YARD DRAIN 19.02 FLOdDEb
89 UNCLASSIFIED 21.27 SEALED
90 CATCH BASIN l7.g3 SEALED
-—ai_ SEWER .i8,«y,, 8.27
WATER SEALED
92
^^cP S"" WATER MAlNp.y^-'^

— G
30" GAS MAIN

rHAS
\RE
TAIS

THAT

This is to certify that this map or plat and the survey on which it is based were made in
accordance with the 2011 Minimum Standard Detail Requirements for ALTA/ACSM l^nd Title
Surveys, jointly established and adopted by ALTA and NSPS, and includes Items 1, 2, 3,4, 7(a),
7(b)(1), 8,9, and 11(a) of Table A thereof.

Thefieldwork was completed on March 31, 2011.

Date Of P X a i ^ p r t ( 2g>// .

Robert G. Biedennann
Professional Illinois Land Surveyor No. 2802

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