City of Chicago
Office of the City Clerk

R2018-680

Document Tracking Sheet

Meeting Date:

6/27/2018

Sponsor(s):

Thompson (11)

Type:

Resolution

Title:

Support of Class 6(b) tax incentive for property at 5000 S
Homan Ave
Committee on Economic, Capital and Technology
Development

Committee(s) Assignment:

 y
RESOLUTION
C L A S S 6(B) REAL ESTATE TAX INCENTIVE FOR THE BENEFIT OF
5000 S. HOMAN L L C , AN ILLINOIS LIMITED LIABILITY COMPANY
AND R E A L ESTATE LOCATED G E N E R A L L Y AT
5000 SOUTH HOMAN AVENUE, IN CHICAGO, ILLINOIS
PURSUANT TO COOK COUNTY, ILLINOIS TAX INCENTIVE ORDINANCE,
CLASSIFICATION SYSTEM FOR ASSESSMENT
WHEREAS, the Cook County Board of Commissioners has enacted the Cook County
Tax Incentive Ordinance, Classification System for Assessment, as amended from time to time
(the "County Ordinance"), which provides for, among other things, real estate tax incentives to
property owners who build, rehabilitate, enhance and occupy property which is located within
Cook County, Illinois and which is used primarily for industrial purposes; and
WHEREAS, the City of Chicago (the "Citv"), consistent with the County Ordinance,
wishes to induce industry to locate and expand in the City by supporting financial incentives in
the form of property tax relief; and
WHEREAS, 5000 8. Homan LLC, an Illinois limited liability company (the "Applicant"),
purchased certain real estate located generally at 5000 South Homan Avenue, Chicago, Illinois
60632, as further described on Exhibit A hereto (the "Subiect Propertv") which contained an
approximately 140,000 square foot industrial building that had been totally vacant for more than
two years prior to the purchase date, and substantially rehabilitated the building; and
WHEREAS, the Applicant has leased the entire Subject Property to its affiliate, Brite
Logistics, Inc., an Illinois corporation, to operate a transportation and warehousing logistics
business; and
WHEREAS, the redevelopment objective ofthe City in connection with the Subject
Property is to support the City's goal of encouraging retention ofthe Applicant's operations
within the City, creating new jobs and attracting investment; and
WHEREAS, the redevelopment objective of the City in connection with the Subject
Property is to support the substantial rehabilitation of an industrial facility, retain existing jobs
and create new jobs; and
WHEREAS, the Applicant has filed an eligibility application for a Class 6(b) tax incentive
under the County Ordinance with the Office of the Assessor of Cook County (the "Assessor");
and
WHEREAS, the Subject Property is located within the City of Chicago Enterprise Zone
No. 2, created pursuant to the Illinois Enterprise Zone'Act, 20 ILCS 665/1 et seq., as amended,
and pursuant to an ordinance enacted by the City Council of the City, as amended, and the
purposes of Enterprise Zones are also to provide certain incentives in order to stimulate
economic activity and to revitalize depressed areas; and
WHEREAS, it is the responsibility of the Assessor to determine that an application for a
Class 6(b) classification or renewal of a Class 6(b) classification is eligible pursuant to the
County Ordinance; and

 WHEREAS, the County Ordinance requires that, in connection with the filing of a Class
6(b) eligibility application with the Assessor, the applicant must obtain from the municipality in
which such real estate that is proposed for Class 6(b) designation is located a resolution
expressly stating, among other things, that the municipality has determined that the incentive
provided by Class 6(b) is necessary for development to occur on such real estate and that the
municipality supports and consents to the Class 6(b) classification by the Assessor; and
WHEREAS, the intended use of fhe Subject Property will provide significant present and
future employment; and
WHEREAS, notwithstanding the Class 6(b) status of the Subject Property, the
redevelopment and utilization thereof will generate significant new revenues to the City in the
form of additional real estate taxes and other tax revenues; now, therefore,
B E IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF CHICAGO:
SECTION 1: That the City determines that the incentive provided by Class 6(b) is
necessary for the development to occur on the Subject Property.
SECTION 2: That the City supports and consents to the Class 6(b) classification by the
Assessor with respect to the Subject Property.
SECTION 3: That the Economic Disclosure Statement, as defined in the County
Ordinance, has been received and filed by the City.
SECTION 4: That the Clerk of the City of Chicago is authorized to and shall send a
certified copy of this resolution to the Assessor, and a certified copy of this resolution may be
included with the Class 6(b) eligibility application filed with the Assessor by the Applicant, as
applicant, in accordance with the County Ordinance.
SECTION 5:
approval.

That this resolution shall be effective immediately upon its passage and

Alderman, 14th Ward

'

 EXHIBIT A

Legal Description of Subiect Propertv:
PARCEL 1:
THAT PART OF BLOCKS 17, 18, 19, 20, 21 AND 22 AND VACATED SPAULDING AVENUE
AND HOMAN AVENUE IN JAMES H. REE'S SUBDIVISON OF THE NORTHEAST QUARTER
OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 13 EAST OF THE THIRD PRINCIPAL
MERIDIAN, ACCORDING TO THE PLAT THEREOF RECORDED SEPTEMBER 5, 1855 AS
DOCUMENT 62421, IN BOOK 85, PAGE 151, IN COOK COUNTY, ILLINOIS, MORE
PARTICULARLY DECRIBED AS FOLLOWS:
BEGINNING AT THE INTERSECTION OF THE SOUTH LINE OF BLOCK 19 WITH A LINE
45.00 FEET WEST OF AND PARALLEL WITH THE EAST LINE OF SPAULDING AVENUE;
THENCE SOUTH 88 DEGREES 32 MINUTES 45 SECONDS WEST A DISTANCE OF 1244.43
FEET ALONG THE SOUTH LINE OF SAID BLOCKS 19, 20, 21, AND 22; THENCE NORTH 01
DEGREES 54 MINUTES 29 SECONDS WEST, A DISTANCE OF 403.78 FEET TO A NONTANGENT CURVE, BEING THE NORTH LINE OF THE PROPERTY DESCRIBED IN
WARRANTY DEED RECORDED NOVEMBER 28,1997 AS DOCUMENT 97892425, IN COOK
COUNTY, ILLINOIS; THENCE 411.94 FEET NORTHEASTERLY ALONG SAID NORTH LINE,
BEING A CURVE CONCAVE TO THE SOUTHEAST, HAVING A RADIUS OF 929.69 FEET,
SUBTENDING A CHORD BEARING NORTH 76 DEGREES 01 MINUTES 00 SECONDS
EAST, A DISTANCE OF 408.58 FEET TO A POINT OF TANGENCY ON THE NORTH LINE OF
THE PROPERTY DESCRIBED IN WARRANTY DEED RECORDED APRIL 27, 1994 AS
DOCUMENT 94380918, IN COOK COUNTY, ILLINOIS; THENCE NORTH 88 DEGREES 42
MINUTES 38 SECONDS EAST, A DISTANCE OF 1355.37 FEET ALONG LAST SAID NORTH
LINE AND THE EASTERLY EXTENSION OF LAST SAID NORTH LINE TO THE
INTERSECTION WITH THE NORTHERLY LINE OF THE PROPERTY DESCRIBED IN QUIT
CLAIM DEED RECORDED JANUARY 29, 2008 AS DOCUMENT 0802933157, IN COOK
COUNTY, ILLINOIS; THENCE SOUTH 73 DEGREES 48 MINUTES 55 SECONDS WEST, A
DISTANCE OF 525.07 FEET ALONG LAST SAID NORTHERLY LINE TO SAID LINE 45.00
FEET WEST OF AND PARALLEL WITH THE EAST LINE OF SPAULDING AVENUE; THENCE
SOUTH 01 DEGREES 39 MINUTES 09 SECONDS EAST, A DISTANCE OF 355.00 FEET
ALONG SAID PARALLEL LINE TO THE POINT OF BEGINNING.
PARCEL 2:
NON-EXCLUSIVE EASEMENT FOR ACCESS TO KEDZIE AVENUE FOR THE BENEFIT OF
PARCEL 1 AND OTHER PROPERTY AS RESERVED IN EASEMENT AND ACCESS
AGREEMENT BY AND BETWEEN K MART CORPORATION AND GRAND TRUCK
WESTERN RAILROAD RECORDED JULY 1, 1985 AS DOCUMENT NUMBER 85084624
OVER THE FOLLOWING DESCRIBED LAND:
A SIXTY FOOT WIDE STRIP OF LAND IN JAMES H. REE'S SUBDIVISION OF THE
NORTHEAST QUARTER OF SECTION 11, TOWNSHIP 38 NORTH, RANGE 13 EAST OF
THE THIRD PRINCIPAL MERIDIAN, CITY OF CHICAGO, COOK COUNTY, ILUNOIS MORE
PARTICULARLY DESCRIBED AS COMMENCING AT THE SOUTHEAST CORNER OF
BLOCK 17; THENCE WESTERLY ALONG THE SOUTHERLY LINE OF BL0CKS.17, 18, AND
19, AS EXTENDED, TO THE NORTHWEST CORNER OF LOT ONE, BLOCK 30 IN PAUL F.
KNEFEL AND COMPANY'S SUBDIVISION OF BLOCKS 29 AND 30 IN THE
3

 AFOREMENTIONED JAMES H. REE'S SUBDIVISION; THENCE NORTHERLY 60 FEET
ALONG THE WESTERLY LINE OF LOT 1 AS EXTENDED; THENCE EASTERLY PARALLEL
WITH THE SOUTHERLY LINE OF LOTS 19, 18 AND 17, AS EXTENDED, TO THE
WESTERLY LINE OF S. KEDZIE AVE.; THENCE SOUTHERLY 60 FEET , ALONG SAID
STREET LINE TO THE POINT OF BEGINNING, CONTAINING 47,640 SQUARE FEET, MORE
OR LESS.
ADDRESS: 5000 SOUTH HOMAN AVENUE, CHICAGO, ILLINOIS 60632
Permanent Real Estate Tax Index Numbers (PINS) for the Subject Propertv:
19-11-202-006-0000
19-11-202-011-0000
19-11-202-012-0000
19-11-202-017-0000
19-11-202-018-0000

 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:
5000 S. Homan, LLC

Check ONE ofthe following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. [x] the Apphcant
OR
2. [ ] a legal enhty currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name:
OR
3. [ ] a legal entity with a direct or indirect right of control of the Applicant (see Section 11(B)(1))
State the legal name of the entity in which the Disclosing Party holds a right of control:
B. Business address of the Disclosing Party:

s ooo s Homan Ava
Chicago, I L 60632

C. Telephone:

312.846.6858

D . Name o f contact person:

Fax:

N/A

Email:

Laurynas M i s i u k e v i c l u s

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

larryabriteloqistic8.com

_ ,

1

F. Brief description of the Matter to which this EDS pertains. (Include project number and location of
property, if applicable):
Application

f o r a 6B t a x i n c e n t i v e

f o r proeprty

located

at

G, W h i c h C i t y agency or department is requesting this EDS? Department

5000 S Homan Ave

o f P l a n n i n g and

Development

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

and Contract #
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 SECTION II - DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY
[
[
[
[
[
[
[

1. Indicate the namre of the Disclosing Party:
] Person
[x] 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
[ JYes
[ ]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

[ ] Organized in Illinois

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles, ifapplicable, of: (i) all executive officers and all directors of
the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there
are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other
similar entities, the trustee, executor, administrator, or similarly simated party; (iv) for general or
limited partnerships, limited Hability companies, limited liabiiity partnerships or joint ventures,
each general partner, managing member, manager or any other person or legal entity that directly or
indirecdy controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf.
Name

Title

Robust Management, Inc.....

Manager

_

_

2. Please provide the following information conceming each person or legal entity having a direct or
indirect, current or prospective (i.e. within 6 months after City action) beneficial interest (including
ownership) in excess of 7.5% of the Applicant. Examples of such an interest include shares in a
corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
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 limited liability company, or interest of a beneficiary of a tmst, estate or other similar entity. If none,
state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf.
Name

Business Address

Andrlua Talandzevicius
Laurynas H l s i u k e v i c l u s

Percentage Interest in the Applicant

5^000 S Homan Avenue, Chicago, II 60632
5000 S Homan Avenue, Chicago, I L 60632

50%
50%.

SECTION m ~ INCOME OR COMPENSATION TO, OR OWNERSfflP BY, CITY ELECTED
OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS?
[JYes
[xJNo
Does the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-month period following the date of this EDS? [ ] Yes
[xJ No
If "yes" to either of the above, please identify below the name(s) of such City elected ofricial(s) and
describe such income or compensation:

Does any City elected official or, to the best of the Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have afinancialinterest (as defined in
Chapter 2-156 ofthe Municipal Code ofChicago ("MCC")) in the Disclosing Party?
[ JYes
[xJNo
Ifyes," please identify below the name(s) of such City elected oflicial(s) and/or spouse(s)/domestic
partner(s) and describe thefinancialinterest(s).

SECTION rv -- DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Party must disclose the name and business address of each subcontractor, attomey,
lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any other person or entity
whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as
the nature ofthe relationship, and the total amount of the fees paid or estimated to be paid. The
Disclosing Party is not required to disclose employees who are paid solely through the Disclosing
Party's regular payroll. 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.
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 Name (indicate whether Business
retained or anticipated
Address
to be retained)

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

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

"Retained" Daley and Georges, L t d . , 20 S C l a r k , #400, Chicago, I L 60603 A t t o r n e y $7,000 {eat)
Michael Synowiecki

(Add sheets if necessary)
[ J Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.
SECTION V - CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substanhal 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?
[ J Yes

[xJ No

[ J 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?
[JYes

[JNo

B. FURTHER CERTIFICATIONS
1. [This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of
Procurement Services.] In the 5-year period preceding the date of this EDS, neither the Disclosing
Party nor any Affiliated Entity [see defmition in (5) below] has engaged, in connection with the
performance of any public contract, the services of an integrity monitor, independent private sector
inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing,
investigative, or other similar skills, designated by a public agency to help the agency monitor the
activity of specified agency vendors as well as help the vendors reform their business practices so they
can be considered for agency contracts in the future, or continue with a contract in progress).
2. The Disclosing Party and its Affiliated Entities are not delinquent in the payment of any fine, fee,
tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water
and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing
Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.

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 3. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those persons or entities
identified in Secdon 11(B)(1) 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, during the 5 years before 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 antitrtist statutes; fraud; embezzlement; theft; forgery;
bribery; falsification or destruction of records; making false statements; or receiving stolen property;
c. are not presently indicted for, or criminally or civilly charged by, a govemmental entity (federal,
state or local) with committing any of the offenses set forth in subparagraph (b) above;
d. have not, during the 5 years before the date of this EDS, had one or more public transactions
(federal, state or local) terminated for cause or default; and
e. have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found
liable in a civil proceeding, or in any criminal or civil action, including actions conceming
environmental violations, instituted by the City or by the federal govemment, any state, or any other
unit of local government.
4. The Disclosing Party understands and shall comply with the applicable requirements of MCC
Chapters 2-56 (Inspector General) and 2-156 (Govemmental Ethics).
5. Certifications (5), (6) and (7) concern:
• the Disclosing Party;
• any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in
comiection with the Matter, including but not limited to all persons or legal entihes disclosed
under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
• any "Affiliated Endty" (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 terai 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 ofthe Disclosing Party,
any Contractor or any Affiliated Entity (collectively "Agents").
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 Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing
Party or any Contractor, nor any Agents have, during the 5 years before the date of this EDS, or, with
respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years
before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the
Matter:
a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe,
a public officer or employee ofthe City, the State of Illinois, or any agency of the 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 afixedprice or otherwise; or
c. made an admission of such conduct described in subparagraph (a) or (b) above that is a matter of
record, but have not been prosecuted for such conduct; or
d. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base
Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
6. Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees,
officials, agents'or partners, is barred from contracting with any unit of 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-rotahng 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.
7. Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the
United States Department of Commerce, State, or Treasury, or any successor federal agency.
8. [FOR APPLICANT ONLY] (i) Neither the Applicant nor any "controlling person" [sec MCC
Chapter 1 -23, Article I for applicability and defined terms] of the Applicant is currendy indicted or
charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for,
any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery,
perjury, dishonesty or deceit against an officer or employee of the City or any "sister agency"; and (ii)
the Applicant understands and acknowledges that compliance with Article I is a continuing requirement
for doing business with the City. NOTE: If MCC Chapter 1-23, Article I applies to the Applicant, that
Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
9. [FOR APPLICANT ONLY] The Applicant and its Affiliated Entities will not use, nor permit their
subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal
System for Award Management ("SAM").
10. [FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired
or to be hired in connection with the Matter certifications equal in forni and substance to those in
Certifications (2) and (9) above and will nol, without the prior written consent of the City, use any such
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 confractor/subcontractor that does not provide such certifications or that the Applicant has reason to
believe has not provided or cannot provide tmthful certifications.
11. If the Disclosing Party is unable to certify to any of the above statements in this Part B (Further
Certifications), the Disclosing Party must explain below:
N/A

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

13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during
the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed
official, of the City of Chicago. For purposes of this statement, a "gift" does not include: (i) anything
made generally available to City employees or to the general public, or (ii) food or drink provided in
the course of official City business and having a retail value of less than $25 per recipient, or (iii) a
political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or
"none"). As to any gift listed below, please also list the name of the City recipient.
H/A

. .

C. CERTIFICATION OF STATUS AS FINANCIAI. INSTITUTION
1. The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is

[xJ is not

a "financial institution" as defined in MCC Section 2-32-455(b).
2. If the Disclosing Party IS a financial institution, then the Disclosirig Party pledges:
"We are not and will not become a predatory lender as defined in MCC Chapter 2-32. We further
pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in
MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a
predatory lender may result in the loss of the privilege of doing business with the City."
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 If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in
MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain
here (attach addidonal pages if necessary):
„

M / 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 FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
1. In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge
after reasonable inquiry, does any official or employee of the City have afinancialinterest in his or
her own name or in the name of any other person or entity in the Matter?
[ JYes

[xJNo

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), skip Items D(2) and D(3) and proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected
official or employee shall have afinancialinterest in his or her own name or in the name of any
other person or entity in the purchase of any 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 afinancialinterest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[JYes

[JNo

3. If you checked "Yes" to Item D(l), provide the names and business addresses of the City officials
or employees having suchfinancialinterest and identify the nature of thefinancialinterest:
Name

Business Address

Nature of Financial Interest

4. The Disclosing Party further certifies that no prohibited fmancial interest in the Matter will be
acquired by any City official or employee.
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 E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. Ifthe Disclosing Party checks (2), the Disclosing Party
must disclose below or in an attachment to this EDS all information required by (2), Failure to
comply with these disclosure requirements may make any contract entered into with the City in
connection with the Matter voidable by the City.
X 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and 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 constimtes full disclosure of all such
records, including the names of any and all slaves or slaveholders described in those records:

SECTION VI -- CERTIFICATIONS FOR F E D E R A L L Y FUNDED MATTERS
NOTE: I f the Matter is federally funded, complete this Section VI. I f the Matter is not
federally funded, proceed to Section VII. For purposes of this Section V I , tax credits allocated by
the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying
Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing
Party with respect to the Matter: (Add sheets i f necessary):

(If no explanation appears or begins on the lines above, or 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, as amended, 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 infiuence or attempt to influence an officer or employee of any agency, as defined
by applicable federal law, a member of Congress, an officer or employee of Congress, or an employee
Ver.2017-1

Page 9 of 14

 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 federallyfiindedcontract, grant, loan, or cooperative agreement.
3. The Disclosing Party will submit an updated certification at the end of each calendar quarter in
which there occurs any event that materially affects the accuracy of the statements and information set
forth in paragraphs A(l) and A(2) above.
4. The Disclosing Party certifies that either: (i) it is not an organization described in section
501 (c)(4) of the 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," as that term is defined in the Lobbying Disclosure Act of 1995, as amended.
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in
form and substance to paragraphs A(l) through A(4) above from all subcontractors before it awards
any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the
duration of the Matter and mu.st make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed
subcontractors to submit the following information with their bids or in writing at the outset of
negotiations.
Is the Disclosing Party the Applicant?
[JYes
[JNo
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.)
[ J Yes .
[ J 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
[ J Mo
[ ] Reports not required
3. Have you participated in any previous contracts or subcontracts subject to the
equal opportunity clause?
[ J Yes
[ ] No
If you checked "No" to question (1) or (2) above, please provide an explanation:

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Page 10 of 14

 SECTION VII ~ FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
A. The certifications, disclosures, and acknowledgments contained in this EDS will become part of any
contract or other agreement between the Applicant and the City in connection with the Matter, whether
procurement, City assistance, or other City action, and are material inducements to the Citys 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 Ordinance, MCC Chapter 2-156, imposes certain duties and
obligations on persons or entities seeking City contracts, work, business, or transactions. The full text
of this ordinance and a training program is available on line at www.citvofchicauo.orjVEthics, and may
also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610,
(312) 744-9660. The Disclosing Party must comply fully with this ordinance.
C. Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate,
any 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 City transactions. 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 in, and appended to, this EDS may be made publicly
available on the Internet, in response to a Freedom of Information Act request, or otherwise. By
completing and signing this EDS, the Disclosing Party waives and releases any possiblerightsor
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 die Matter. If the Matter is a
contract being handled by the Chy's Department of Procurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter
1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the
information provided herein regarding eligibility must be kept current for a longer period, as required
by MCC Chapter 1-23 and Section 2-154-020.

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Page 11 of 14

 CERTIFICATION
Underpenalty of perjury, the person signing below: (1) warrants that he/she is authorized to execute
this EDS, and Appendices A and B (ifapplicable), on behalf of the Disclosing Party, and (2) warrants
that all certifications and statements contained in this EDS, and Appendices A and B (if applicable), are
tme, accurate and complete as of the date fiimished to the City.
5000 S. Homan, LLC

(Print or type exact legal ntiMre^yf Disclosing Party)

By:

(Sign here)

OT^

Laurynas M l s i u l c e v i c i u s

(Print or type name of person signing)
Secretary o f Robust Management, I n c , Manager of 5000 S. Homan, LLC.

(Print or type title of person signing)
Signed and swom to before me on (date) June "2-1 . ?CTT7
at
"

Cook

County,

Illinois

(state).
OFFICIAL SEAL
LAUREN EAVES

Notary Public

'
•

Commission expires:

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Page 12 of 14

NOTMnrnnUC-STATE OF UMOQ
%CamniiNlenEi9i>«Jn«y27.3a2l

 CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CH Y OFFICULS
AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a
direct ownership interest In the Applicant exceeding 7.5%. It is not to be completed by any legal
entity which has only an indirect ownership interest in the Applicant.
Under MCC Section 2-154-015, the Disclosing Party must disclose 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 thi.s EDS is signed, the Disclosing Party or any "Applicable Party" or any Spouse or Domestic
Partner thereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city
department head as spouse or domestic partner or as any of the following, whether by blood or
adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild,
father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or
stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section
II.B.l.a., if the Disclosing Party is a corporation; all partners of the Disclosmg Party, ifthe 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 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% ownership interest in the Disclosing
Party. "Principal officers" means the president, chief operating officer, executive director, chief
financial ofiicer, 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?
[ JYes

[xJNo

Ifyes, 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 namre ofsuch familial relationship.

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Page 13 of 14

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

[x] No

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

[ J No

[xJ The Applicant is not publicly traded on any exchange.

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

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Page 14 of 14

 CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT
AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name ofthe Disclosing Party submitting this EDS. Include d^/a/ if applicable:
Robust Management, I n c .

Check ONE of the following three boxes:
Indicate whether the Disclosing Party submitting this EDS is:
1. [ ] the Applicant
OR
2. [ J a legal entity currently holding, or anticipated to hold within six months after City action on
the contract, transaction or other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name:
OR
3. [xJ a legal entity with a direct or indirect right of control ofthe Applicant (see Section 11(B)(1))
State the legal name of the entity in which the Disclosing Party holds a right of control:
5000 S Homan, LLC

B. Business address of the Disclosing Party:

sooo s Homan Ave
Chicago, I L 60632"

C. Telephone: 312.846.6858
D . N a m e o f contact person:

Fax:

N/A

.

Email: larryQbrlteloqlaticB.com

Laurynas M i s i u l c e v i c l u s

E. Federal Employer Identification No. (if you have one):
F. Brief description of the Matter to which this EDS pertains. (Include project number and location of
property, if applicable):
Application

f o r a 6B t a x i n c e n t i v e

f o r proeprty

located

at

G. W h i c h C i t y agency or department is requesting this EDS? Department

5000 S Homan Ave

o f p l a n n i n g and

Development

If the Matter is a contract being handled by the City's Department ofProcurement Services, please
complete the following:
Specification #
Ver.2017-1

and Contract #
Pagel of 14

 SECTION II ~ DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARTY

,

1. Indicate the namre of the Disclosing Party:
[ J Person
[ J Limited liability company
[ J Publicly registered business corporation
[ J Limited liability partnership
[xJ Privately held business corporation
[ J Joint venmre
[ J Sole proprietorship
[ J Not-for-profit corporation
[ J General partnership
(Is the not-for-profit corporation also a 501(c)(3))?
[ J Limited partnership
[ J Yes
[ J No
[ ] Trust
[ ] Other (please specify)
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

[ J No

[ J Organized in Illinois

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the fiill names and titles, if applicable, of: (i) all executive officers and all directors of
the entity; (ii) for not-for-profit corporations, all members, if any, which are legal entities (if there
are no such members, write "no members which are legal entities"); (iii) for trusts, estates or other
similar entities, the trustee, executor, administrator, or similarly situated party; (iv) for general or
limited partnerships, limited liability companies, limited liability partnerships or joint ventures,
each general partner, managing member, manager or any other person or legal entity that directly or
indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf
Name

Tide

Andrius T a l a n d z e v i c i u s
Laurynas M i s i u k e v i c l u s

Preaident and D i r e c t o r
S e c r e t a r y and D i r e c t o r

2. Please provide the following information conceming each person or legal entity having a direct or
indirect, current or prospective (i.e. within 6'months after City action) beneficial interest (including
ownership) in excess of 7.5% of the Applicant. Examples ofsuch an interest include shares in a
corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
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Page 2 of 14

 limited liability company, or interest of a beneficiary of a tmst, estate or other similar entity. Ifnone,
state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf
Name

Business Address

Andrius Talandzevicius
Laurynas M i s i u k e v i c l u s

Percentage Interest in the Applicant

5000 S Homan Avenue, Chicago, I L 60632
SOOO S iioman Avenue, Chicago, I L 60632

50%
50%

SECTION III -- INCOME OR COMPENSATION TO, OR OWNERSHIP BY, CITY E L E C T E D
OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS?
[JYes
[x] No
Does the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-month period following the date of this EDS? [ ] Yes
[xJ No
If "yes" to either of the above, please identify below the name(s) ofsuch City elected official(s) and
describe such income or compensation:

Does any City elected official or, to the best of the Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 ofthe Municipal Code ofChicago ("MCC")) in the Disclosing Party?
[ JYes
[xJNo
If "yes," please identify below the name(s) of such City elected official(s) and/or spouse(s)/domestic
partner(s) and describe the financial interest(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 (as defined in MCC Chapter 2-156), 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. 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.
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Page 3 of 14

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

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

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

N/A

(Add sheets if necessary)
[xJ Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or entities.
SECTION V ~ CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must
remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in
arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ J Yes

[xJ No

[ J 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?
[ J Yes

[ J No

B. FURTHER CERTIFICATIONS
1. [This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of
Procurement Services.J In the 5-ycar period preceding the date of this EDS, neither the Disclosing
Party nor any Affiliated Entity [see definition in (5) belowj has engaged, in connection with the
performance of any public contract, the services of an integrity monitor, independent private sector
inspector general, or integrity compliance consuhant (i.e., an individual or entity with legal, auditing,
investigative, or other similar skills, designated by a public agency to help the agency monitor the
activity of specified agency vendors as well as help the vendors reform their business practices .so they
can be considered for agency contracts in the future, or continue with a contract in progress).
2. The Disclosing Party and its Affiliated Entities are not delinquent in the payment of anyfine,fee,
tax or other source of indebtedness owed to the City of Chicago, including, but not limited to, water
and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing
Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.

Ver.2017-1

Page4 o f l 4

 3. The Disclosing Party and, ifthe Disclosing Party is a legal entity, all of those persons or entities
identified in Sechon 11(B)(1) of this EDS:
a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from any transactions by any federal, state or local unit of government;
b. have not, during the 5 years before 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 govemmental entity (federal,
state or local) with committmg any of the offenses set forth in subparagraph (b) above;
d. have not, during the 5 years before the date of this EDS, had one or more public transactions
(federal, state or local) terminated for cause or default; and
e. have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found
liable in a civil proceeding, or in any criminal or civil action, including actions conceming
environmental violations, instituted by the City or by the federal govemment, any state, or any other
imit of local government.
4. The Disclosing Party understands and shall comply with the applicable requirements of MCC
Chapters 2-56 (Inspector General) and 2-156 (Governmental Ethics).
5. Certifications (5), (6) and (7) concem:
• the Disclosing Party;
• any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in
cormection 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 sta'te 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 ofthe Disclosing Party,
any Contractor or any Affiliated Entity (collectively "Agents").
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Page 5 of 14

 Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing
Party or any Contractor, nor any Agents have, during the 5 years before the date of this EDS, or, with
respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years
before the date of such Contractor's or Affiliated Entity's contract or engagement in connection with the
Matter:
a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe,
a public officer or employee of the City, the State of Illinois, or any agency of the 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 subparagraph (a) or (b) above that is a matter of
record, but have not been prosecuted for such conduct; or
d. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base
Wage); (a)(5)(Debarment Regulations); or (a)(6)(Minimum Wage Ordinance).
6. Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees,
officials, agents or partners, is barred from contracting with any unit of state orTocal govemment as a
resuh 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.
7. Neither the Disclosing Party nor any Affiliated Entity is listed on a Sanctions List maintained by the
United States Department of Commerce, State, or Treasury, or any successor federal agency.
8. [FOR APPLICANT ONLYJ (i) Neither the Applicant nor any "controlling person" [see MCC
Chapter 1-23, Article I for applicability and defined termsj ofthe Applicant is currently indicted or
charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for,
any criminal offense involving actual, attempted, or conspiracy to commit bribery, theft, fraud, forgery,
perjury, dishonesty or deceit against an officer or employee 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 wilh the City. NOTE: I f MCC Chapter 1-23, Article I applies to the Applicant, that
Article's permanent compliance timeframe supersedes 5-year compliance timeframes in this Section V.
9. [FOR APPLICANT ONLYJ The Applicant and its Affiliated Entities will not use, nor permit their
subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal
System for Award Management ("SAM").
10. [FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired
or to be hired in connection vvith the Matter certifications equal in form and substance to those in
Certifications (2) and (9) above and will not, without the prior written consent of the City, use any such
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Page 6 of 14

 contractor/subcontractor that does not provide such certifications or that the Applicant has reason to
believe has not provided or cannot provide truthful certifications.
11. Ifthe Disclosing Party is unable to certify to any of the above statements in this Part B (Further
Certifications), the Disclosing Party must explain below:
N/A.„_.

;

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

13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all gifts that the Disclosing Party has given or caused to be given, at any time during
the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed
official, of the City ofChicago. For purposes of this statement, a "gift" docs not include: (i) anything
made generally available to City employees or to the general public, or (ii) food or drink provided in
the course of official City business and having a retail value of less than $25 per recipient, or (iii) a
political contribution otherwise duly reported as required by law (if none, indicate with "N/A" or
"none"). As to any gift listed below, please also list the name of the City recipient.
N/A

.

^

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUllON
1. The Disclosing Party certifies that the Disclosing Party (check one)
[ J is

[xJ is not

a "financial institution" as defined in MCC Section 2-32-455(b).
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 MCC Chapter 2-32, We further
pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in
MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a
predatory lender may result in the loss ofthe privilege of doing business with the City."
Vcr.2017-1

Page 7 o f 14

 If the Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in
MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, 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 FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
1. In accordance with MCC Section 2-156-110: To the best of the Disclosing Party's knowledge
after reasonable inquiry, does any official or employee of the City have afinancialinterest in his or
her own name or in the name of any other person or entity in the Matter?
[ J Yes

[x] No

NOTE: If you checked "Yes" to Item D(l), proceed to Items D(2) and D(3). If you checked "No"
to Item D(l), skip Items D(2) and D(3) and proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected
official or employee shall have a financial interest in his or her own name or in the name of any
other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for
taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively,
"City Property Sale"). Compensation for property taken pursuant to the City's eminent domain
power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[JYes

[JNo

3. If you checked "Yes" to Item D(l), provide the names and business addresses ofthe City officials
or employees having suchfinancialinterest and identify the nature ofthefinancialinterest:
Name

Business Address

Nature of Financial Interest

4. The Disclosing Party further certifies that no prohibited financial interest in the Matter will be
acquired by any City official or employee.
Ver.2017-1

Page 8 of 14

 E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (I) or (2) below. Ifthe Disclosing Party checks (2), the Disclosing Party
must disclose below or in an attachment to this EDS all information required by (2). Failure to
comply with these disclosure requirements may make any contract entered into with the City in
connection with the Matter voidable by the City.
x. 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and 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 tliat the following constitutes full disclosure of all such
records, including the names of any and all slaves or slaveholders described in those records:

SECTION VI ~ CERTIFICATIONS FOR F E D E R A L L Y FUNDED MATTERS
NOTE: I f the Matter is federally funded, complete this Section VI. I f the Matter is not
federally funded, proceed to Section VH. For purposes of this Section V I , tax credits allocated by
the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDING LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying
Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf of the Disclosing
Party with respect to the Matter; (Add sheets i f necessary);

(If no explanation appears or begins on the lines above, or if the letters "NA" or if the word "None"
appear, it will be conclusively presumed that the Disclosing Paity means that NO persons or entities
registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on
behalf of the Disclosing 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 activifies 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
Vcr.2017-1

Page 9 of 14

 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 federallyfiindedcontract, 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) of the Internal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying
Activities," as that term is defined in the Lobbjning Disclosure Act of 1995, as amended.
5. Ifthe 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 of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
If the Matter is federally funded, federal regulations require the Applicant and all proposed
subcontractors to submit the following information with their bids or in vmting at the outset of
negotiations.
Is the Disclosing Party the Applicant?
[ ] Yes
[ J 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 regulafions? (See 41 CFR Part 60-2.)
[JYes
[JNo
2. Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract
Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the
applicable filing requirements?
[ J Yes
[ J No
[ J Reports not required
3. Have you participated in any previous contracts or subcontracts subject to the
equal opportunity clause?
[JYes
[JNo
If you checked "No" to question (1) or (2) above, please provide an explanation:

Ve.r.20l7-I

Page 10 of 14

 SECTION VII - FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
A. The certificafions, 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 Ediics Ordinance, MCC Chapter 2-156, imposes certain duties and
obligations on persons or entities seeking City contracts, work, business, or transactions. The frill text
of this ordinance and a training program is available on line at www.citvofchicaijo.or«/Ethics. and may
also be obtained from the City's Board of Ethics, 740 N. Sedgwick St, Suite 500, Chicago, IL 60610,
(312) 744-9660. The Disclosing Party must comply fiilly with this ordinance.
C. Ifthe City determines that any information provided in this EDS is false, incomplete or inaccurate,
any contract or other agreement in coimection 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 City transactions. 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 in, and appended to, this EDS may be made publicly
available 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 possiblerightsor
claims which it may have against the City in connection with the public release of information
contained in this EDS and also authorizes the City to verify the accuracy of any infomiation submitted
in this EDS.
E. The 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 ofProcurement Services, the Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter
1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the
infomiation provided herein regarding eligibility must be kept current for a longer period, as required
by MCC Chapter 1-23 and Secfion 2-154-020.

Ver.2017-1

Page 11 o f N

 CERTIFICATION
Under penalty of perjuiy, the person signing below: (1) warrants that he/she is authorized to execute
this EDS, and Appendices A and B (if applicable), on behalf of the Disclosing Party, and (2) warrants
that all certifications and statements contained in this EDS, and Appendices A and B (ifapplicable), are
tme, accurate and complete as of the date fumished to the City.
Hobust Management, I n c .

(Print or type exact lepal namyofpisclosing Party)
By:
(Sign here)
Laurynas

HisiuJcevlcius

(Print or type name of person signing)
Secretary / Owner

(Print or type title of person signing)

Signed and swom to before me on (date) jrme "2. [
at

Cook

County,

Illinois

,

(state).
OFFICIAL SEAL
LAUREN EAVES

Notary Public
{

Commission expires:

Ver.2017-)

Page 12 of 14

NOTARY PUBUC - STATE OF ILLINOIS
MyCon»niKianExpiiwJanunv27.2021

 CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
FAMILIAL RELATIONSHIPS WITH ELECTED CITY OFFICIALS
AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a
direct ownership interest in the Applicant exceeding 7.5%. It is not to be completed by any legal
entity which has only an indirect ownership interest in the Applicant
Under MCC Secfion 2-154-015, the Disclosing Party must disclose whether such Disclosing Party
or any "Applicable Party" or any Spouse or Domestic Partner thereof currently has a "familial
relationship" with any elected city official or department head. A "familial relationship" exists i f as of
the date tliis 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 parmer or as any of the following, whether by blood or
adoption: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild,
father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or
stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party hsted in Section
II.B. 1 .a., if the Disclosing Party is a corporadon; all partners of the Disclosing Party, if the Disclosing
Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the
Disclosing Party is a limited partnership; all managers, managing members and members of the
Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) all principal officers ofthe
Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing
Party. "Principal officers" means the president, chief operafing 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" witli an elected city official or department head?
[ JYes

[xJNo

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

Ver.2017-1

Page 13 of 14

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

[xJ No

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

[ J No

[xJ The Applicant is not publicly traded on any exchange.

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

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Page 14 of 14

 CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT
AND AFFIDAVIT
SECTION I - GENERAL INFORMATION
A. Legal name of the Disclosing Party submitfing this EDS. include d/b/a/ ifapplicable:
Brite

Logistics,

Inc.

Check ONE of the following three boxes;
Indicate whether the Disclosing Party submitting this EDS is;
1. [xJ the Applicant
OR
2. [ J a legal entity currently holding, or anticipated to hold within six months after City action on
the contract,ti-ansactionor other undertaking to which this EDS pertains (referred to below as the
"Matter"), a direct or indirect interest in excess of 7.5% in the Applicant. State the Applicant's legal
name:
OR
3. [ ] a legal entity with a direct or indirect right of control of the Apphcant (see Section 11(B)(1))
State the legal name of the entity in which the Disclosing Party holds arightofcontrol;

B. Business address of the Disclosing Party;

s ooo s Homan Ave
Chicago, I L 60632

C. Telephone; 312.846.ease
D. Name of contact person;

Fax:

N/A

Email: iarry@briteioqiBtics.com

Larry Misiukevicius

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

\

]

F. Brief description ofthe Matter to which this EDS pertains. (Include project number and location of
property, ifapplicable);
Application

f o r a 6B t a x

incentive

for proeprty

located

at

G . W h i c h C i t y agency or department is requesting this E D S ? D e p a r t m e n t

5000 S Homan Ave

o f p l a n n i n g and

Development

If the Matter is a contract being handled by the City's Department of Procurement Services, please
complete the following;
Specifications
Ver.2017-1

N/A

and Contract # N / ^
Page 1 of 14

 SECTION II ~ DISCLOSURE OF OWNERSHIP INTERESTS
A. NATURE OF THE DISCLOSING PARIT
1. Indicate the nature of the Disclosing Party:
[ J Person
[ J Limited liability company
[ J Publicly registered business corporation
[ J Limited liability partnership
[xJ Privately held business corporation
[ J Joint venture
[ J Sole proprietorship
[ J Not-for-profit corporation
[ J General partnership
(Is the not-for-profit corporafion also a 501(c)(3))?
[ J Limited partnership
[ J Yes
[ ] No
[ ] Trust
[ J Other (please specify)
2. For legal entities, the state (or foreign country) of incorporation or organization, if applicable:
Illinois

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

[ J No

[ J Organized in Illinois

B. IF THE DISCLOSING PARTY IS A LEGAL ENTITY:
1. List below the full names and titles, if applicable, of: (i) all executive officers and all directors of
the entity; (ii) for not-for-profit corporations, all members, if any, which are legal enfifies (if there
are no such members, write "no members which are legal entifies"); (iii) for trusts, estates or other
similar entities, the tmstee, executor, administrator, or similarly simated party; (iv) for general or
limited partnerships, limited liability companies, limited liability partnerships or joint ventures,
each general partner, managing member, manager or any other person or legal entity that directly or
indirectly controls the day-to-day management of the Applicant.
NOTE: Each legal entity listed below must submit an EDS on its own behalf
Name

Tifie

Andrius T a l a n d z e v i c i u s
Laurynas M i s i u k e v i c i u s

P r e s i d e n t and D i r e c t o r
Secretary and D i r e c t o r

2. Please provide the following information concerning each person or legal entity having a direct or
indirect, current or pro.spective (i.e. within 6 months after City action) beneficial interest (including
ownership) in excess of 7.5% ofthe Applicant. E.Kamplcs of .such an interest include shares in a
corporation, partnership interest in a partnership or joint venture, interest of a member or manager in a
Vfr.20l7-1

Page 2 nf 14

 limited liability company, or interest of a beneficiary of a trust, estate or other similar entity. If none,
state "None."
NOTE: Each legal entity listed below may be required to submit an EDS on its own behalf
Name

Business Address

Andrius Taalandzeviciua
Laurynas M i s i u k e v i c i u s

Percentage Interest in the Applicant

5000 S Homan Avenue, Chicago, I I 60632
5000 S Homan Avenue, Chicago, I L 60632

50%
50%

SECTION H I ~ INCOME OR COMPENSAI ION TO, OR OWNERSHIP BY, CITY ELECTED
OFFICIALS
Has the Disclosing Party provided any income or compensation to any City elected official during the
12-month period preceding the date of this EDS?
[ J Yes
[xJ No
Does the Disclosing Party reasonably expect to provide any income or compensation to any City
elected official during the 12-month period following the date of this EDS? [ ] Yes
[x] No
If "yes" to either ofthe above, please identify below the name(s) of such City elected official(s) and
describe such income or compensation;

Does any City elected official or, to the best ofthe Disclosing Party's knowledge after reasonable
inquiry, any City elected official's spouse or domestic partner, have a financial interest (as defined in
Chapter 2-156 ofthe Municipal Code ofChicago ("MCC")) in the Disclosing Party?
[ JYes
[xJNo
If "yes," please identify below the name(s) ofsuch City elected official(s) and/or spouse(s)/domestic
partner(s) and describe the financial interest(s).

SECTION I V - DISCLOSURE OF SUBCONTRACTORS AND OTHER RETAINED PARTIES
The Disclosing Pai1y must disclose the name and business address of each subcontractor, attomey,
lobbyist (as defined in MCC Chapter 2-156), accountant, consultant and any other person or entity
whom the Disclosing Party has retained or expects to retain in connection with the Matter, as well as
the nature ofthe relationship, and the total amount ofthe fees paid or estimated to be paid. The
Disclosing Party is not required to disclose employees who are paid solely through the Di.sclosing
Party's regular payroll. 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.
Vor.20l7-I

Paue .3 of 14

 Name (indicate whether
retained or anticipated
to be retained)

Business
Address

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

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

N/A

(Add sheets i f necessary)
[xJ Check here if the Disclosing Party has not retained, nor expects to retain, any such persons or enfifies.
SECTION V ~ CERTIFICATIONS
A. COURT-ORDERED CHILD SUPPORT COMPLIANCE
Under MCC Section 2-92-415, substantial owners of business entities that contract with the City must
remain in compliance with their child support obligations throughout the contract's term.
Has any person who directly or indirectly owns 10% or more of the Disclosing Party been declared in
arrearage on any child support obligations by any Illinois court of competent jurisdiction?
[ J Yes

[xJ No

[ J 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?

[JYes

[JNo

B. FURTHER CERTIFICATIONS
1. [This paragraph 1 applies only if the Matter is a contract being handled by the City's Department of
Procurement Services.J In the 5-year period precedingthe date of this EDS, neither the Disclosing
Party nor any Affiliated Entity [see definition in (5) below] has engaged, in connection with the
performance of any public contract, fiie services of an integrity monitor, independent private sector
inspector general, or integrity compliance consultant (i.e., an individual or entity with legal, auditing,
investigafive, or other similar skills, designated by a public agency to help the agency monitor the
activity of specified agency vendors as well as help the vendors reform their business practices so they
can be considered for agency contracts in the future, or continue with a contract in progress).
2. The Disclosing Party and its Affiliated Entifies are not delinquent in the payment of any fine, fee,
tax or other source of indebtedness owed to the City ofChicago, including, but not limited to, water
and sewer charges, license fees, parking tickets, property taxes and sales taxes, nor is the Disclosing
Party delinquent in the payment of any tax administered by the Illinois Department of Revenue.

Ver.2017-

Page 4 of 14

 3. The Disclosing Party and, if the Disclosing Party is a legal entity, all of those pensons or entities
idenfified in Secfion 11(B)(1) of this EDS:
a. are not presenfiy debarred, suspended, proposed for debamient, declared ineligible or voluntarily
excluded from any transactions by any federal, state or local unit of govemment;
b. have noL during the 5 years before the date of this EDS, been convicted of a criminal offense,
adjudged guilty, or had a civil judgment rendered 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 destrucfion of records; making false statements; or receiving stolen property;
c. are not presently indicted for, or criminally or civilly charged by, a governmental enfity (federal,
state or local) with committing any ofthe offenses set forth in subparagraph (b) above;
d. have not, during the 5 years before the date of this EDS, had one or more public transactions
(federal, state or local) terminated for cause or default; and
e. have not, during the 5 years before the date of this EDS, been convicted, adjudged guilty, or found
liable in a civil proceeding, or in any criminal or civil action, including actions conceming
environmental violations, instituted by the City or by the federal government, any state, or any other
unit of local govemment.
4. The Disclosing Party understands and shall comply with the applicable requirements of MCC
Chapters 2-56 (Inspector General) and 2-156 (Govemmental Ethics),
5. Certifications (5), (6) and (7) concem:
• the Disclosing Party;
• any "Contractor" (meaning any contractor or subcontractor used by the Disclosing Party in
connection with the MaUer, including but not limited to all persons or legal entifies disclosed
under Section IV, "Disclosure of Subcontractors and Other Retained Parties");
• any " Affiliated Entity" (meaning a person or entily that, directly or indirectly: controls the
Disclosing Party, is controlled by the Disclosing Party, or is, with the Disclosing Party, under
common control of another person or entity). Indicia ofcontrol include, without limitation:
interlocking management or ownership; identity of interests among family members, shared
'
facilities and equipment; common use of employees; or organization 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, (he tenn 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 ofthe Disclosing Party,
any Contractor or any Affiliated Entity (collectively "Agents").
Ver.20rM

P«Ke.Sofl4

 Neither the Disclosing Party, nor any Contractor, nor any Affiliated Entity of either the Disclosing
Party or any Contractor, nor any Agents have, during the 5 years before the date of this EDS, or, with
respect to a Contractor, an Affiliated Entity, or an Affiliated Entity of a Contractor during the 5 years
before the date ofsuch Contractor's or Affiliated Entity's contract or engagement in connecfion with the
Matter:
a. bribed or attempted to bribe, or been convicted or adjudged guilty of bribery or attempting to bribe,
a public officer or employee of the City, the State of Illinois, or any agency of the federal government
or of any state or local government in the United States of America, in that officer's or employee's
official capacity;
b. agreed or colluded with other bidders or prospective bidders, or been a party to any such agreement,
or been convicted or adjudged guilty of agreement or collusion among bidders or prospective bidders,
in restraint offreedomof competition by agreement to bid a fixed price or otherwise; or
c. made an admission ofsuch conduct described in subparagraph (a) or (b) above that is a matter of
record, but have not been prosecuted for such conduct; or
d. violated the provisions referenced in MCC Subsection 2-92-320(a)(4)(Contracts Requiring a Base
Wage); (a)(5)(Debarment Regulations); or (a)(6)(Mininium Wage Ordinance).
6. Neither the Disclosing Party, nor any Affiliated Entity or Contractor, or any of their employees,
officials, agents or partners, is barred from contracting with any unit of state or local government as a
result of engaging in or being convicted of (1) bid-rigging in violafion of 720 ILCS 5/33E-3; (2)
bid-rotafing 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.
7. Neither the Disclosing Party nor any Affiliated Entity is listed on a Sancfions List maintained by the
United Slates Department of Commerce, State, or Treasury, or any successor federal agency.
8. [FOR APPLICANT ONLYJ (i) Neither the Applicanl nor any "controlling person" [see MCC
Chapter 1-23, Article I for applicability and defined temisj ofthe Applicant is currenfiy indicted or
charged with, or has admitted guilt of, or has ever been convicted of, or placed under supervision for,
any criminal ofl'ense involving actual, attempted, or conspiracy to commit bribery, theft,fraud,forgery,
perjury, dishonesty or deceit against an officer or employee of the City or any "sister agency"; and (ii)
the Applicant understands and acknowledges that compliance with Article 1 is a confinuing requirement
for doing business with the City. NOTE; I f MCC Chapter 1-23, Article I applies to the Applicant, that
Article's pemianent compliance timeframe supersedes 5-year compliance timeframes in this Secfion V.
9. [FOR APPLICANT ONLYJ The Applicant and its Affiliated Entities will not use, nor permit their
subcontractors to use, any facility listed as having an active exclusion by the U.S. EPA on the federal
System for Award Management ("SAM").
10. [FOR APPLICANT ONLY] The Applicant will obtain from any contractors/subcontractors hired
or to be hired in connection with the Matter certificalions equal in form and substance to those in
Certifications (2) and (9) above and will not, without the prior written consent ofthe Cily, use any such
Vcr.2017-1

Pagt 6 of 14

 contractor/subcontractor that does not provide such certifications or that the Applicant has reason to
believe has not provided or cannot provide truthfiil certificafions.
11. If the Disclosing Party is unable to certify to any of die above statements in this Part B (Further
Certifications), the Disclosing Party must explain below;
N/A

^

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

13. To the best of the Disclosing Party's knowledge after reasonable inquiry, the following is a
complete list of all gifts that the Disclosing Party has given or caused to be given, at anyfimeduring
the 12-month period preceding the execution date of this EDS, to an employee, or elected or appointed
official, of the City ofChicago. For purposes of this statement, a "gift" does not include: (i) anything
made generally available to City employees or to the general public, or (ii) food or drink provided in
the course of official City business and having a retail value of less than $25 per recipient, or (iii) a
political contribufion otherwise duly reported as required by law (ifnone, indicate with "N/A" or
"none"). As to any giftfistedbelow, please also list the name of the City recipient.
N/A

^

,

C. CERTIFICATION OF STATUS AS FINANCIAL INSTITUTION
1, The Disclosing Party certifies that the Disclosing Party (check one)
[ ] is

[x] is not

a "financial institution" as defined in MCC Section 2-32-455(b).
2. Ifthe Disclosing Party IS afinancialinstitution, then the Disclosing Party pledges:
"We arc not and will not become a predatory lender as defined in MCC Chapter 2-32. We further
pledge that none of our affiliates is, and none of them will become, a predatory lender as defined in
MCC Chapter 2-32. We understand that becoming a predatory lender or becoming an affiliate of a
predatory lender may result in the loss ofthe privilege of doing business with the City."
Vcr,20i7-I

Ptilie7ofi4

 Ifthe Disclosing Party is unable to make this pledge because it or any of its affiliates (as defined in
MCC Section 2-32-455(b)) is a predatory lender within the meaning of MCC Chapter 2-32, explain
here (attach addifional pages i f 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 FINANCIAL INTEREST IN CITY BUSINESS
Any words or terms defined in MCC Chapter 2-156 have the same meanings if used in this Part D.
1. In accordance with MCC Section 2-156-110; To the best ofthe Disclosing Party's knowledge
after reasonable inquiry, does any official or 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?
[ JYes

[xJNo

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), skip Items D(2) and D(3) and proceed to Part E.
2. Unless sold pursuant to a process of competitive bidding, or otherwise permitted, no City elected
official or employee shall have a financial interest in his or her own name or in the name of any
other person or entity in the purchase of any property that (i) belongs to the City, or (ii) is sold for
taxes or assessments, or (iii) is sold by virtue of legal process at the suit ofthe City (collectively,
"City Property Sale"). Compensation for property taken pursuant to the City's eminent domain
power does not constitute a financial interest within the meaning of this Part D.
Does the Matter involve a City Property Sale?
[JYes

[JNo

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

Business Address

Nature of Financial Interest

4. The Disclosing Party further certifies that no prohibited fmancial interest in the Matter will be
acquired by any City official or employee.
Ver.2017-1

'

Page 8 of 14

 E. CERTIFICATION REGARDING SLAVERY ERA BUSINESS
Please check either (1) or (2) below. Ifthe Disclosing Party checks (2), the Disclosing Party
must disclose below or in an attachment to this EDS all information required by (2). Failure to
comply with these disclosure requirements may make any contract entered into with the City in
connection with the Matter voidable by the City.
x 1. The Disclosing Party verifies that the Disclosing Party has searched any and all records of
the Disclosing Party and any and 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 resuh of conducting the search in step (1) above, the
Disclosing Party has found records of investments or profits from slavery or slaveholder insurance
policies. The Disclosing Party verifies that the following constitutes full disclosure of all such
records, including the names of any and all slaves or slaveholders described in those records:

SECTION VI - CERTIFICATIONS FOR F E D E R A L L Y FUNDED MATTERS
NOTE: I f the Matter is federally funded, complete this Secfion V I . I f the Matter is not
federally funded, proceed to Section VII. For purposes of this Secfion V I , tax credits allocated by
the City and proceeds of debt obligations of the City are not federal funding.
A. CERTIFICATION REGARDflMG LOBBYING
1. List below the names of all persons or entities registered under the federal Lobbying
Disclosure Act of 1995, as amended, who have made lobbying contacts on behalf ofthe Disclosing
Paity with respect to the Matter: (Add sheets if necessary):

(If no explanation appears or begins on the lines above, or ifthe letters "NA" or ifthe word "None"
appear, it will be conclusively presumed that the Disclosing Party means that NO persons or enfities
registered under the Lobbying Disclosure Act of 1995, as amended, have made lobbying contacts on
behalf of the Di-sclosing 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
Ver.201 7-1

Page 9 of 14

 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 federallyfijndcdcontract, 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 eidier: (i) it is not an organizafion described in section
501(c)(4) ofthe Internal Revenue Code of 1986; or (ii) h is an organizafion described in section
501 (c)(4) ofthe Intemal Revenue Code of 1986 but has not engaged and will not engage in "Lobbying
Activifies," as tiiat term is defined in the Lobbying Disclosure Act of 1995, as amended.
5. If the Disclosing Party is the Applicant, the Disclosing Party must obtain certifications equal in
form and substance to paragraphs A( 1) through A(4) above from all subcontractors before it awards
any subcontract and the Disclosing Party must maintain all such subcontractors' certifications for the
duration of the Matter and must make such certifications promptly available to the City upon request.
B. CERTIFICATION REGARDING EQUAL EMPLOYMENT OPPORTUNITY
Ifthe Matter is federally funded, federal regulations require the Applicant and all proposed
subcontractors to submit the following information with their bids or in wrifing at the outset of
negofiations.
Is the Disclosing Party the Applicant?
[ J Yes
[ J 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 regulafions? (See 41 CFR Part 60-2.)
[ J Yes
[ J No
2. Have you filed with the Joint Reporting Committee, the Director ofthe Office of Federal Contract
Compliance Programs, or the Equal Employment Opportunity Commission all reports due under the
applicable filing requirements?
[ J Yes
[ J No
[ ] Reports not required
3. Have you participated in any previous contracts or subcontracts subject to the
equal opportunity clause?
[ ] Yes
[ J No
If you checked "No" to question (1) or (2) above, please provide an explanation:

Ver.201 7-1

Paye 10 of 14

 SECTION VII ~ FURTHER ACKNOWLEDGMENTS AND CERTIFICATION
The Disclosing Party understands and agrees that:
A. The certificafions, 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 regulafions on which this EDS is based.
B. The City's Govemmental Ethics Ordinance, MCC Chapter 2-156, imposes certain duties and
obligations on persons or entities seeking City confracts, work, business, or transactions. The full text
of this ordinance and a training program is available on line at www.citvofchicago.org/Ethics. and may
also be obtained from the City's Board of Ethics, 740 N. Sedgwick St., Suite 500, Chicago, IL 60610,
(312) 744-9660. The Disclosing Party must comply fully with this ordinance.
C. Ifthe City determines that any infonnafion provided intiiisEDS 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 tenninating the Disclosing Party's participafion in the Matter
and/or declining to allow the Disclosing Party to participate in other City transacfions. 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 ofthe infonnation provided in, and appended to, this EDS may be made publicly
available on the Internet, in response to a Freedom of Information Act request, or otherwise. By
completing and signing this EDS, the Disclosing Party waives and releases any possible rights or
claims which it may have against the City in connection with the public release of informafion
contained in this EDS and also authorizes the City to verify the accuracy of any informafion submitted
in this EDS.
E. The informafion provided in this EDS must be kept cun ent. 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 ofProcurement Services, die Disclosing Party must
update this EDS as the contract requires. NOTE: With respect to Matters subject to MCC Chapter
1-23, Article I (imposing PERMANENT INELIGIBILITY for certain specified offenses), the
information provided herein regarding eligibility must be kept current for a longer period, as required
by MCC Chapter 1-23 and Section 2-154-020.

Ver.201 7-1

Page 11 of 14

 CERTIFICATION
Under penalty of peijury, the person signing below: (1) warrants that he/she is authorized to execute
this EDS, and Appendices A and B (if applicable), on behalf of the Disclosing Party, and (2) warrants
that all certifications and statements contained in this EDS, and Appendices A and B (if applicable), are
tme, accurate and complete as of the date fumished to the City.
Brite Logistics,

Inc.

(Print or type exact legal narpeypf Disclosing Party)
By:
(Sign heri
Laurynas M i s i u k e v i c i u s

(Print or type name of person signing)
secretary / D \ C ^ \ O Y '

(Print or type fitle of person signing)
Signed and swom to before me on (date) June Z i
at

Cook

County,

Illinois

}**T, «*arr

L ^

(state).
• l*fcM<fcl^ll..>l.

OFFICIAL SEAL
UUREN EAVES

Notary Public

NOTARV PUBUC • STATE OP LUNOIS
% CofflnMan CiipiTM jniKy27,2021

Commission expires: 0(Mf

Ver.2017

7y\,

2.0'^\

Page 12 of 14

 CITY OF CHICAGO
ECONOMIC DISCLOSURE STATEMENT AND AFFIDAVIT
APPENDIX A
F A M I L I A L RELATIONSHIPS WITH E L E C T E D CITY OFFICIALS
AND DEPARTMENT HEADS
This Appendix is to be completed only by (a) the Applicant, and (b) any legal entity which has a
direct ownership interest in the Applicant exceeding 7.5Vo. It is not to be completed by any legal
entity which has only an indirect ownership interest in the Applicant
Under MCC Section 2-154-015, the Disclosing Party must disclose whether such Disclosing Party
or any "Applicable Party" or any Spouse or Domestic Partner thereof cunently has a "familial
relafionship" 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 tiiereof is related to the mayor, any alderman, the city clerk, the city treasurer or any city
department head as spouse or domesfic partner or as any of the following, whether by blood or
adopfion: parent, child, brother or sister, aunt or uncle, niece or nephew, grandparent, grandchild,
father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather or stepmother, stepson or
stepdaughter, stepbrother or stepsister or half-brother or half-sister.
"Applicable Party" means (1) all executive officers of the Disclosing Party listed in Section
II.B. 1 .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 of the Disclosing Party, i f the
Disclosing Party is a limited partnership; all managers, managing members and members of the
Disclosing Party, ifthe Disclosing Party is a limited liability company; (2) all principal officers of the
Disclosing Party; and (3) any person having more than a 7.5% ownership interest in the Disclosing
Party. "Principal officers" means the president, chief operafing officer, executive director, chief
financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.
Does the Disclosing Party or any "Applicable Party" or any Spouse or Domesfic Partner thereof
cunently have a "familial relationship" with an elected city official or department head?
[ JYes

[xJNo

f f yes, please identify below (1) the name and title ofsuch 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 ofsuch familial relationship.

Vcr,2017-1

Page 13 of 14

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

[xJNo

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

[ J No

[xJ The Applicant is not publicly traded on any exchange.

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

Ver.201 7-1

Page 14 of 14

 CITY OF CHICAGO
AFFIDAVIT FOR COOK COUNTY CLASS 6b TAX INCENTIVE
On behalfof ^
S • H^nr^fi^in L l - U
^^^^ "Applicant"), I hereby certify,
represent and warrant the following to the City of Chicago:
1.
Attached as Exhibit 1 hereto and hereby incorporated herein is a tme and correct
Disclosure of the Ownership Interests of the Applicant as set forth in Cook County's Code of
Ethical Conduct (Cook County, III., Code, Ch. 2, Art. VH, Div. 2, Subdiv. VI, Secfion 2-610),
including but not limited to a trae and correct list of all real estate owned in Cook County,
Illinois by the Applicant, including all permanent index numbers associated with such real estate.
2.
Attached as Exhibit 2 hereto and hereby incorporated herein is a true and correct Cook
County Incentives Class Living Wage Ordinance Affidavit ("Living Wage Affidavit") for tbe
Applicant. The Applicant hereby represents and warrants that it shall provide a Living Wage
Affidavit to the City for any lessees of the Subject Property (as hereinafter defmed) who enter
into a lease for the Subject Property on or after July 1, 2020.
3.
The Applicant is not delinquent in the payment of any property taxes administered by
Cook County or by a local municipality.
4.
The Applicant is in compliance with all applicable laws, as required by the Cook County
Real Property Assessment Classification Ordinance, as amended from time to time (the
"Classification Ordinance").
Under penalty of perjury, I hereby certify, represent and warrant that I have the knowledge
and the authority to provide this Affidavit to the City of Chicago on behalfof the Applicant.
This Affidavit shall be deemed to be the Applicant's Economic Disclosurc Statement, as defined
in the Classificafion Ordinance. The Applicant hereby submits this Affidavit to the City of
Chicago for purposes of complying with the provisions of the Classification Ordinance.
I liereby acknowledge that the City of Chicago has not, and will not independently verify the
certifications, representations and warranties contained herein. I fiirther acknowledge that the
City of Chicago is entitled to and is in fact relying upon the certificafions, representations and
warranties contained herein in connection with its support and consent for the Class 6b
applicafion ofthe Applicant to tlie Office ofthe Assessor of Cook County, Illinois pursuant to
the Classification Ordinance in connection with property located at
500 0 S- ) + ' f ^ " ^ ^ J C h i c ^ t j 1/ ^ j i _ (fOLf'h'l— _
_
in Chicago, Illinois (the "Subject Property").

 1 understand and acknowledge that if the certifications, representations or warranties
coniained herein are untrue in any respect, the support and consent ofthe City of Chicago for the
Class 6b classification of the Subject Property may be revoked, and other penalties at law or in
equity may apply.
APPLICANT:
Name of Company:
By:
Print Name of Signatory:
Print Title of Signatory:

/ V i <H.

^ ^J -f-

Signed and swom before me on
at _ ZcOV^.
(County) _illijagLS.
(State) ' ^ y i U / l ^ n <:/_gUl^/\
(Notary Public)
My Commission expires on

(Date)

OFFICIAL SEAL
UUREN EAVES
NOTARY PUBUC • STATE OF ILUNOIS
My Commlseicn Expires January 27,2021

 EXHIBIT '1

See attached Cook County Disclosure of Ownership Interests of the Applicant.

CONTRACT*; N/A

C O O K COUNTY D I S C L O S U R E O F OWNERSHIP I N T E R E S T S T A T E M E N T
The Cook County Code of Ordinances (§2-610 et seq.) requires that any Applicant for any County Action must disclose information
concerning ownership interests in the Applicant. This Disclosure of Ownership Interest Statement must be completed wilh all
Infonnatian current as of Ihe date this Statement is signed. Furthermore, this Statement must be kept current, byfilingan amended
Statement, until such time as the County Board or County Agency shall take action on the application. The information contained
in this Statement will be maintained In a database and made available for public viewing. County reserves the right to request
additional information to verify veracity of Information containted In this statement
If you are asked to list names, but there are no applicable names to list, you must state NONE. An incomplete Statement will be
retumed and any action regarding this contract will be delayed. A failure to fully comply with the ordinance may result In the action
taken by the County Board or County Agency being voided.
"Applicant' means any Entity or person making an appllcatton to the County for any County Aclion.
"County Action" means any action by a County Agency, a County Departmeni, or the Couniy Board regarding an ordinance or
ordinance amendment, a Couniy Board approval, or other County agency approval, wilh respect to contracts, leases, or sale or
purchase of real estate.
"Parson' "Entity" or 'Legal Eniity" means a sole proprietorship, corporation, partnership, association, business trust, estate, two or
more persons having a joinl or common inleresl, trustee of a land trust, olher commercial or legal entily or any beneficiary or
beneficiaries thereof.
This Disclosure of Ownership Interest Statement must be submilted by :
1. An Applicant for Couniy Aclion and
2. A Person lhal holds stock or a beneficial interest in the Applicant and is listed on the Applicant's Statement (a "Holder") muslfilea
Statement and complete #1 only under Ownership Interest Declaration.
Please print or type responses clearly and legibly. Add additional pages if needed, being careful to identify each portion of the form to
which each additional page refers.
This Statement is being made by the [ > ^ ] Applicant

This Statement Is an:

[ ^

or

[

I Original Statement or [

j Stock/Beneficial Interest Holder

] Amended Statement

Identifying Information:

Name 5000 S. Homan. LLC
D/B/A: N/A

FEIN # Only:

Street Address: 5000 S. Homan A v e . ,
Cily: Chicago

Chicago, I L 60632
State:

Phone No.: 312-451-9820

Fax Number;

Zip Code: 60614
N/A

Email: L a r r y f e b r l t e l o q i a t i e a . c o m

Cook County Business Registration Number:
(Sole Proprietor, Joint Venture Partnership)

Corporate File Number (if applicable):

05166691 ( I L S e c r e t a r y o f S t a t e F i l e Number)

Form of Legal Entity:
[ ]

Sole Proprietor

[ ]

Partnership

( ]

Corporation

( ]

Trustee of Land Trust

[ 1"

Business Trust

[ ]

Estate

[ ]

Association

[ ]

Joint Venture

I/]

other tdescribe) I.-imit.Bd r.iabiljt-.y Company

EDS-6

 C O N T R A C T * N/A
Ownership Interest Declaration:
1.

Lisl the name(s), address, and percent ownership of each Person having a legal or beneficial interest (including ownership) of
more than five percent (5%) In the Applicant/Holder.
Percentage Interesl in
Applicant/Holder

Address

Name

Laurvnaa

5000 S. Homan Ave.. Chicaqo. I L 60632

50%

A n d r i u s ("Andrew") T a l a n d z e v l c i u a . 5000 S. Homan Ave.. Chicaqo, I L 60632

50%

2.

("Larry") M i e i u k e v i c i u a .

If the interest of any Person listed in (1) above is held as an agent or agents, or a nominee or nominees, lisl the name and
address of the principal on whose behalf the Interesl is held.
Principal's Address

Name of Principal

Name of Agent/Nominee

1

Is the Applicant constructively controlled by another person or Legal Entity?

/

lYes

(

JNo

Ifyes, state the name, address and percentage of beneficial interest of such person, and the relationship under which such
control Is being or may be exercised.
Name

Percentage of
Beneficiai Interest

Address

R o b u s t Management.

Inc..

5000 S.

Homan A v e .

Chicago.

Relationship
I L 60632

0%

Manager

Corporate Officers, Members and Partners Information:
For all corporations, lisl the names, addresses, and temis for all corporate officers. For all limited liability companies, list the names,
addresses for all members. For all partnerships and joint ventures, lisl the names, addresses, for each partner or joinl venture.
Title (specify title of
Office, or whether manager
or partner/joint venture)

Address

Name

R o b u s t Management-.

Inc.

5000 S. Homan Ave.. Chicaqo. I L 60632

Term of Office

Manager

Declaration (check the applicable box):
r

[/ ]

I Slate under oath that the Applicanl has withheld no disclosure as to ownership Interest in the Applicant nor reserved
any information, data or plan as to the intended use or purpose for which the Applicant seeks County Board or olher County
Agency aclion.

[

I state under oath that the Holder has withheld no disclosure as to ownership interest nor reserved any informalion required to
be disclosed.

1

EDS-7

 CONTRACTS N/A
COOK COUNTY DISCLOSURE OF OWNERSHIP INTEREST STATEMENT SIGNATURE PAGE
Laurynas Mlacukevlciti
Name of Authorized /
Signature

Representative (please print or lype)

Manaqer / Owner
Title
Date

*•

L a r r y O B r l t e l i o g i B t i c a . com
E-mail address

(312)

451-9820

Phone Number
A

Subscribed to and sviforn before me
this 2.)
day of June. 20_18

X )(iuMhA ^M^^
vl I

EDS-8

Notary Public Signature

My commission expires:

^

OFFICIAL SEAL
LAUREN EAVES
I

Notary Seal

A *

NOTARY PUBUC - STATE OF ILUNOIS
Mf CoRimissian Eipires Janua>y27,2021

 EXHIBIT 2

See attached Living Wage Af?davit for the Applicant.

COOK COUNTY ASSESSOR'S OFFICE
118 NORTH CLARK STREET, CHICAGO, IL 60602
PHONE: 312.443.7550 FAX: 312.603.3616
W\A/W.COOKCOUNTYASSESSOR.COM

COOK COUNTY A S S E S S O R
JOSEPH

BERRIOS

INCENTIVES C L A S S LIVING W A G E ORDINANCE AFFIDAVIT
as agent for the applicant set forth below, who is seeking a
Laurynas Mlfliukevlcius
Classification Incentive as referenced below, I do hereby state under oath as follows:
1. As the agent for the applicant set forth below, I have personal knowledge as to the facts stated herein.
2. The property identified by PIN(s) with commonly known address(es), listed in Exhibit A attached and
herein incorporated, are/is the subject of a pending application/renewal (circle as appropriate) for one
ofthe following development incentives provided by the Code of Ordinances of Cook County, Chapter
74, Article II, Division 2, The Cook County Real Property Assessment Classification Ordinance,
Sec.74-60 et seq., as amended:
Class 8 (industrial property)
Class 9
X Class 6b
The Cook County Assessor's Office has issued the following control number regarding this
application/renewal (circle as appropriate). To follow
.
I have reviewed the Code of Ordinances of Cook County, Chapter 34, Article IV, Division 1 and The
Cook County Living Wage Ordinance, Sec. 34-127 et seq., as amended (the "Ordinance"), and certify
that the applicant is in compliance with the above referenced Cook County Living Wage Ordinance,
due to one of the following options (check as appropriate):
X

Applicant is currently paying a living wage to its employees, as defined in the Ordinance.
(No employees)

OR

Applicant is not required to pay a living wage, pursuant to the Ordinance.
Further affiant sayeth not,
L a u r y n a s M i s i u k e v i c i u s , Member/Owner

Agent's Signature

Agent's Name & Title

5000 S. Homan Ave., Chicago, I L 60632
Agent's Mailing Address

Agent's Telephone Number

(312)

451-3820

5000 S. Homan A v e . , Chicago, I L 60632

5000 S. Homan LLC

Applicanf s Mailing Address

Applicant's Name
larry@brlteloqiBticB.com

Applicant's e-mail address
Subscribed and sworn before me this 09 day of
Jiihlif
Signature of Notary Public

7 /7

March

2018

O

1/25/11

•OFFICIAL SEAL'
BEATAjeOBCZAK
Notary PuMo - Stal* of NttnDii
My OommMen ExplrH Augu«t22,20ao

 EXHIBIT A
(Please type or print)

PIN(s)

Common Address

19-11-202-012-0000

5000 S. Homan Ave.

19-11-202-018-0000

4961 S. Spaulding Ave.

19-11-202-006-0000

4931 S. St. Louis Ave.

19-11 -202-011 -OOOO

4960 S. Spaulding Ave.

19-11 -202-017-0000

4963 S. Homan Ave.