HomeMy WebLinkAboutDisclosure to Support or Withhold Objection��YOFJ .�
CITY OFMIAMI
DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
"° 4 kmsSUPPORT OR WITHHOLD OBJECTION
The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its
boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the
issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or
withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee,
commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or
implied, or any promise or agreement to provide any of the foregoing in the future.
Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653, and appearing before the City Commission or
any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners'
legal representative are not required to fill out this form.
NAME:
(First Name) (Middle) (Last Name)
HOME ADDRESS:
(Address Line 1)
(Address Line 2)
CITY: Miami STATE: Florida 'LIP:
HOME PHONE: (3 0 5) 3 5 0- 7 2 2 7 CELL PHONE: FAX: (3 0 5) 351-2198
EMAIL: cgimenez@bilgin.com
BUSSINESS or APPLICANT or ENTITY NAME
Carlos J. Gimenez, Attorney on behalf of Applicant
I3USINESSADDRESS: 200 S, Biscayne Boulevard, Ste. 2300
(Address Line 1)
Miami, Florida 33131
(Address Line 2)
1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board,
authority, agency, council, or committee.
Major Use Special Permit Application on behalf of Brickell North Investments, Inc..,
Miami Proarts II, Inc., and Biscayne Arts, LLC in connection with the
1700 Biscayne Blvd. Major Use Special Permit
2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to
support or withhold objection to the requested approval, relief or action?
❑ YES ❑X NO
If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If
your answer to Question.2 is Yes, please answer questions 3, 4 & 5 and read and execute the Acknowledgement.
Doc. No.:86543
3. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided
or committed.
Name Address Phone#
a. N/A
b. N/A
c. N/A
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration.
N/A
5. Describe what is being requested in exchange for the consideration.
N/A
ACKNOWLEDGEMENT OF COMPLIANCE
I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of
Ordinance 12918 and such circumvention shall be deemed a violation of the Ordinance; and that in addition to the criminal
or civil penalties that may be imposed under the City Code, upon determination by the City Commission that the foregoing
disclosure requirement was not fully and timely satisfied the following may occur:
1. the application or order, as applicable, shall be deemed void without further force or
effect; and
2. no application from any person or entity for the same issue shall be reviewed or
considered by the applicable board(s) until e� tion of a period of one year after the
nullification of the application or order.
PERSON SUBMITTING DISCLOSURE: -
-__� i aures
Carlos J. Gimenez, Esq.
Print Name
Sworn to and subscribed before me this ^ ay of ._®C f''p loei ......_...___.._....___. 200 � The foregoing
instrument was acknowledged Before me by --&Yto ...... _.._..... - ...... __, who has produced
as i(lentification and/or is personally knon,n to me and who did did not take an oath.
STATF, OF FLORIDA -.%*py
AVra AlbarraCli
CITY OF MIAMI =Vit. `C0MM1SSi011# DA348962
MY COMMI STONL7
r Notary �� •• .. g,� Aires: AUG, 2, 2008
EXPIRES: $ 2X100) �OPt®iiiie�'' Vt65}V.A.A1iQ!;Np]'ARY,cotu
Print Name
Enclosure(s)
Doc. No.:86543 Page 2