HomeMy WebLinkAboutApplication & Supporting DocsOFFICIAL VACATION AND CLOSURE OF A PUBLIC FIGHT -OF -WAY
Welcome to Hearing Boards! This application is intended to serve as a guide in assisting you with our
public hearing process. Please feel free to contact us at the number above, should you have any
questions.
The deadline to file the complete application with supporting documents is the first five working days
of each month from 8:00 am until 3:00 pm, except on the fifth day, at 12.00 pm The application
submittal date is the date stamped by Hearing Boards' staff on this page The responses to this
application must be typed and signed in black ink. Please note that pursuant to Section 1304.2.2 of
the Miami Zoning Ordinance, no application shall be deemed to have been filed unless and until the
application shall have been completed. All pertinent and accurate information/documentation; i.e., the
plans, reports, exhibits, shall be presented at the time of filing, in addition to the paid receipt. The
applicant is responsible for the accuracy of the information contained in the application and all
supporting materials. Should you wish, you could bring the materials to our office for review before the
deadline to ensure completeness.
You will be responsible, if needed, to bring an interpreter for the English language to any presentation
before city boards, committees and the city commission. A valid power of attorney will be required if
neither applicant or legal counsel representing the applicant execute the application or desire to make a
presentation before city boards, committees and the city commission. All documents, reports, studies,
exhibits (8 1/2 x11 ") or other materials submitted during this process will be kept as part of the record.
ORDINANCE NO. 11469, CODIFIED IN CHAPTER 2, ARTICLE VI OF THE CITY CODE STATES
THAT ANY PERSON WHO RECEIVES COMPENSATION, REMUNERATION OR EXPENSES FOR
CONDUCTING LOBBYING ACTIVITIES TO REGISTER AS A LOBBYIST WITH THE CITY CLERK,
PRIOR TO ENGAGING IN LOBBYING ACTIVITIES BEFORE CITY STAFF, BOARDS, COMMITTEES
AND THE CITY COMMISSION. A COPY OF SAID ORDINANCE IS AVAILABLE IN THE OFFICE OF
THE CITY CLERK (MIAMI CITY HALL), LOCATED AT 3500 PAN AMERICAN DRIVE, MIAMI,
FLORIDA, 33133.
Ordinance No. 12918 states that each person or entity requesting approval, relief or other action from
the City Commission or any of its boards, authorities, agencies, councils or committees regarding any
issue, shall disclose at the commencement (or continuance) of the public hearing(s) on the issue, any
consideration provided or committed, directly or on its behalf, for an agreement to support or withhold
objection to the requested approval, relief or action. The Disclosure of Consideration Provided or
Committed for Agreement to Support or Withhold Objection Affidavit included in this package must be
submitted with the application. The applicant must, at the commencement of any public hearing on the
issue, if there is any disclosure to report, read the disclosure into the record. Also, the applicant must
supplement the affidavit if there is any new information or additional information to disclose.
Copies of City Commission resolutions and ordinances can be obtained at our website through the
"Legislative Hub", or for certified copies, contact the City Clerk's Office at 305-250-5360.
Rev. 12-16-08
4 �y4110411 ORATE
HEARING BOARDS
444 SW 2nd Avenue, 7th Floors Miami, Florida 33130
Telephone 305-416-2030. Fax 305-416-2035
file Ip
www.miamigov.com/hearing boards
f®- ®0eW4C,
OFFICIAL VACATION AND CLOSURE OF A PUBLIC FIGHT -OF -WAY
Welcome to Hearing Boards! This application is intended to serve as a guide in assisting you with our
public hearing process. Please feel free to contact us at the number above, should you have any
questions.
The deadline to file the complete application with supporting documents is the first five working days
of each month from 8:00 am until 3:00 pm, except on the fifth day, at 12.00 pm The application
submittal date is the date stamped by Hearing Boards' staff on this page The responses to this
application must be typed and signed in black ink. Please note that pursuant to Section 1304.2.2 of
the Miami Zoning Ordinance, no application shall be deemed to have been filed unless and until the
application shall have been completed. All pertinent and accurate information/documentation; i.e., the
plans, reports, exhibits, shall be presented at the time of filing, in addition to the paid receipt. The
applicant is responsible for the accuracy of the information contained in the application and all
supporting materials. Should you wish, you could bring the materials to our office for review before the
deadline to ensure completeness.
You will be responsible, if needed, to bring an interpreter for the English language to any presentation
before city boards, committees and the city commission. A valid power of attorney will be required if
neither applicant or legal counsel representing the applicant execute the application or desire to make a
presentation before city boards, committees and the city commission. All documents, reports, studies,
exhibits (8 1/2 x11 ") or other materials submitted during this process will be kept as part of the record.
ORDINANCE NO. 11469, CODIFIED IN CHAPTER 2, ARTICLE VI OF THE CITY CODE STATES
THAT ANY PERSON WHO RECEIVES COMPENSATION, REMUNERATION OR EXPENSES FOR
CONDUCTING LOBBYING ACTIVITIES TO REGISTER AS A LOBBYIST WITH THE CITY CLERK,
PRIOR TO ENGAGING IN LOBBYING ACTIVITIES BEFORE CITY STAFF, BOARDS, COMMITTEES
AND THE CITY COMMISSION. A COPY OF SAID ORDINANCE IS AVAILABLE IN THE OFFICE OF
THE CITY CLERK (MIAMI CITY HALL), LOCATED AT 3500 PAN AMERICAN DRIVE, MIAMI,
FLORIDA, 33133.
Ordinance No. 12918 states that each person or entity requesting approval, relief or other action from
the City Commission or any of its boards, authorities, agencies, councils or committees regarding any
issue, shall disclose at the commencement (or continuance) of the public hearing(s) on the issue, any
consideration provided or committed, directly or on its behalf, for an agreement to support or withhold
objection to the requested approval, relief or action. The Disclosure of Consideration Provided or
Committed for Agreement to Support or Withhold Objection Affidavit included in this package must be
submitted with the application. The applicant must, at the commencement of any public hearing on the
issue, if there is any disclosure to report, read the disclosure into the record. Also, the applicant must
supplement the affidavit if there is any new information or additional information to disclose.
Copies of City Commission resolutions and ordinances can be obtained at our website through the
"Legislative Hub", or for certified copies, contact the City Clerk's Office at 305-250-5360.
Rev. 12-16-08
Please refer to Chapter 55 of the Miami City Code for Vacation and Closure information.
1. Applicant name(s): Ben Fernandez, Esq. on behalf of Prince Albert, LLC
2. Two (2) copies of the Tentative Plat: One (1) 24 x 36" and one (1) 8 1/2 x 11" prepared by a
State of Florida registered land surveyor.
3, Two (2) original sketch of surveys: One (1) 24 x 36" and one (1) 8 1/2x 11", prepared by a State
of Florida Registered Land Surveyor showing only the area to be vacated or closed and the
pertinent legal description of the area, within one year from the date of application.
4, Two (2) 11x17" original and one (1) 8 1/2x 11 copy of the survey of the property prepared by a
State of Florida registered land surveyor within six (6) months from the date of the application.
5. Opinion of Title addressing the reversionary rights, if any. Note: An update is required if more
than three (3) months elapse before Zoning Board or City Commission, approval.
6. Signed Tentative Plat letter from Public Works indicating Plat & Street recommendation.
7. The subject property(ies) cannot have any open code enforcement/lien violations.
8. Copy of the lobbyist registration processed by the Office of the City Clerk, if applicable.
9. At least two photographs showing the entire property showing land and improvements.
10. A clear and legible copy of the recorded warranty deed and tax forms of the most current year
showing the present owner(s) and legal description of the property.
11. A clear and legible copy of the subject property address(es) and legal description(s) on a
separate sheet, labeled as "Exhibit A", to match with the current survey's legal description.
12. Affidavit of Authority to Act and the Disclosure of Ownership of all owners and contract
purchasers, if applicable, of the subject property (see pages 5 and 6).
13. Original Disclosure of Consideration Provided or Committed for Agreement to Support or
Withhold Objection Affidavit.
14. Certified list of owners of real estate within 500 feet of the subject property (see pages 7 and 8).
2 Rev. 12-16-08
15. For all corporations and partnerships indicated:
a) Articles of Incorporation;
b) Certificate from Tallahassee showing good standing, less than one (1) year old;
c) Corporate Resolution or a Power of Attorney signed by the secretary of the Corporation
authorizing the person who signed the application to do so;
d) Non-profit organizations: A list of Board of Directors less than one (1) year old.
16. What is the acreage of the project/property site? Approximately 0.059 acres
17. What is the purpose of this application/nature of proposed use? Adaptive re -use of existing
structures.
18. Is the property within the boundaries of a historic site, historic district or archeological zone?
Please contact the Planning Department on the 3rd Floor for information. No.
19. Is the property within the boundaries of an Environmental Preservation District? Please contact
the Planning Department on the 3rd Floor for information. No.
20. Cost of processing according to Section 62-156 of the Miami City Code*:
Vacation of public right-of-way:
a. Original submittal:
1. Per square foot of right-of-way $ .90
2. Minimum $ 1,200.00
b. Re -submittals:
1. Per square foot of right-of-way $ .90
2. Minimum $ 1,200.00
3. Maximum $ 1,700.00
Public hearing and public meeting mail notice fees,
including cost of handling and mailing per notice $ 3.50
*Pursuant to Ordinance 12719, all planning and zoning fees in excess of $25,000,00,
shall be paid ' he form of a rtified check, cashier's check, or money order.
Signature Mailing Address 200 S. Biscayne Blvd., # 850
Name Ben Fernandez, Esq. Miami, FL 33131
Telephone 305-377-6235 E-mail BFernandez(cr..BRZoningLaw. com
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing was acknowledged before me this day of March 2010, by Ben
Fernandez. Esq., who is a(n) individual/partner/agent/corporation of Berc- Radell &
Fernandez, P.A. a(n) individual/partnership/corporation. He/She is personally known to me
or who has produced as identification and w id (did not) take an oath.
�2" /'W'� I
(Stamp)
N p of F1000 Si natur
o Betty Llemna
My Coinmisbn DD514988
ov Expires 0310512010 3
Rev. 12-16-08
AFFIDAVIT OF AUTHORITY TO ACT
Before me this day, the undersigned personally appeared Ben Fernandez, Esq., who
being by me first deposes and says:
1. That he/she is the owner or the legal representative of the owner, submitting the public
hearing application as required by the Code of the City of Miami, Florida, affecting the
real property located in the City of Miami, as listed on the foregoing pages.
2. That all owners who he/she represents, if any, have given his/her full and complete
permission for him/her to act in his/her behalf for the change or modification of a
classification or regulation of zoning as set out in the foregoing petition, ® including or
❑ not including responses to day to day staff inquires.
3. That the foregoing and following pages are part of this affidavit and contain the current
names, mailing addresses, telephone numbers and legal descriptions of the real
property of which he/she is the owner or legal representative.
4. That the facts, as represented in the application and documents submitted in
conjunction with this affidavit, are true and correct.
Further Affiant sayeth not.
Ben Fernandez, Esq.
Applicant(s) Name
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
'M
The foregoing was acknowledged before me this day of March 2010, by Ben
Fernandez, Esq., who is a(n) individual/partner/agent/corporation of Bercow Radell &
Fernandez, P.A. a(n) individual/partnership/corporation. He/She is personally known to me
or who has produced as identification and wh d (did not) take an oath.
(Stamp) 4W %wpsOn
�orroo S'gnatur
Betty Ll"I
'mc v4 Bxplres 03 01 D524388
4 Rev. 12-16-08
DISCLOSURE OF OWNERSHIP
1. List the owner(s) of the subject property and percentage of ownership. Note: The
Miami City Code requires disclosure of all parties having a financial interest, either
direct or indirect, with respect to a presentation, request or petition. Accordingly,
disclosure of shareholders of corporations, beneficiaries of trusts, and/or any other
interested parties, together with their address(es) and proportionate interest are
required. Please supply additional lists, if necessary.
Owner's Name(es)
Percentage of Ownership
Subject Property Address(es)
Prince Albert, LLC is owned 100% by Kluger
Family Limited Partnership.
Kluger Family Limited Partnership is owned b
Jeffrey Kluger (33% limited partnership
interest), Gary Kluger (33% limited partnership
interest), Jennifer Kluger (33% limited
partnership interest), Kluger Family
Corporation (1 % general partnership interest).
Kluger Familv Corporation is 100% owned by
Jeffrey Kluger, Gary Kluger, Jennifer Kluger.
2. List all street address(es) and legal description(s) of any property located within 500 feet
of the subject property owned by any and all parties listed in question #1 above. Please
supply additional lists, if necessary.
Street Address(es): Legal Description(s):
N/A
N/A
Ben Fernandez, Esq.
Owner(s) or Attorney Name 1 Owner(s) or Attorne Sign
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing was acknowledged before me this day of March 2010, by Ben
Fernandez. Esq., who is a(n) individual/partner/agent/corporation of Bercow Radell &
Fernandez, P.A. a(n) individual/partnership/corporation. He/She is personally known to me
or who has produced as identification and whq d,!q,(did not) take an oath.
(Stamp) Si aty r,
,v Votary Public State of Florida
Betty llerena
F pi�ras 03/05llOOMMIsslon 1) 4988
5 Rev. 12-16-08
OR K 2Z39!7----2 F -G 4-2,04,
LAST PAGE
Exhibil,
'rhe Soh 267 fee, of Block 5� less the South 10 feet, ft Uresa I a feet grd less East 110
feet offthe North 1315 Gf the. South 2,457 feel, Block 5� of ROSBINIS-GRAHANI AND
CHILLINOSNNIORIFH� according to the Pkt thereof, as recorded. in Plat Book "'-A-, at
Pagge 49 Ir, ofibePubric girds off. Dade County, Florida,
The East 110 feerof Narth 133.5 feet of South '247 feet in Block 5, of RORMNS AND
C SW , according to the Plat thereof, n r=rdcd in Plat Book. 'A", at
Page 49-,k oft Public Records of Dadc Courxy,,Florida.
ZK5 f4d of ft So"h, 267 feet Offthe West, 90 fed 4W. the Sou*, 6 5: feet of'
the Wea- in Less the South 10 hea it Block 5, of ROB.9NS-GRMAM &,..
CRRI� �; 9=digg W 6e Netthereof, as morded in #W;#Ook.A,, at Pap 4-9
La, of ihtPRwcor& of Mimni-Dade, Cowty, VloddL
'Me Nonh W5 feet oft e South 131S *d of the We IrZ in Sly 5- =4 its included
alley, IMACNVCst. 100 ems dw=f, tOS9TNmanqcm
Io tho Plat thcrreconied. fi,% Pie, Book A, at Page 49 V2, ofthe Pvbft
Rwar&-dMww-we Cv jqOr,&.
(Property addressw: 31 NT,*17 Sfttc,,Mia W, Mod&
1 MI Wort Nftni Av n, ue, Miami. Florida
172-9-31 North Miami Awnuci Mami, FW*
State of Florida
Department of State
I certify from the records of this office that PRINCE ALBERT, LLC is a
limited liability company organized under the laws of the State of
Florida, filed on September 27, 2005.
The document number of this limited liability company is
L05000095133.
I further certify that said limited liability company has paid all fees due
this office through December 31, 2009, that its most recent annual report
was filed on March 27, 2009, and its status is active.
I further certify that said limited liability company has not filed Articles
of Dissolution.
Given under my hand and the Great Seal of
Florida, at Tallahassee, the Capital, this the Third
day of February, 2010
i
Secretary o, f State
Authentication ID: 500167901105-020310-LO5000095133
To authenticate this certificate,visit the following site, enter this
ID, and then follow the instructions displayed.
https:Hefile.sunbiz.org/certauthver.html
Rifkin, Esq.
IN -4 -arch 3 2010
Tw, City of 'h4hinli
LAW OFFICE'S
ELIOT. W RIMIN, P. A.
D'Idelaud'fbwem South, Suite 6M)
94(X)- Sout'a Dadeland flkuttluvud
Hand., Sarkis 33156
301670 -4330-I'dephone
It'd .231 1. Runan v
Opinjan of TMe
()wner:' Prince filbert,:: X, a Florida Hinit ed HaMty company
Addre&&?�-. 31 Nrf"' 171� Sweet, Miaml,.Flo rubt; 1,103 North, Miami Aven tiUaw4.. orida
1729-31 North Miami Avenues Miami., Florida
Leg IR See Exhibit A. attached
With the undefstanding that this oginion of title is Puruisbed xis request by the City oflkliami,Morida. , 111
C iance with its regrrrt rrr rrt toreview the 'Alley Nvuy; located inside the, boundaries of thestibject
pl'Operty., I hereby Certi fy that I have examined the emupletv Abstruct of ' fle or compiarable title as
pursuant to the rNui ents 01"Attomeys' Title. Fund Services, LLC
Bw 11 opiniorl'an said oomplete abstrar,,t or cot opiniort that asof.Tebruary
15,2010, the &e -Mruple title to the Irl; doscribed real propeny was wined in-,
Prince Albert,. LIX, a Florida fintitedliability colupa.a.'y
Subje-clt to tile.JI)i 1 oxwiing encumbrMwe'si, fien&,, and other exec - tk -i
1. Alt taxes for the year in vihich flifis opinion is ren- dere and sAgequent (hrreto,
2, Faots diatwould be disclosed upon accurate survey,
I Zonift and cit ermstrictiotis imposed by govenmentalauft
4Any liv.i. provided Qg1rity or City OTdimincc or kv Chapter 159, Florida -Statutes.
Purthermo.re, I aurtofthe opinion that. Prinev is the owner of all reversiotiaryrights to the Alley
Way rtain wrth & south as per the Plat reemded M Plat Book A at pagro 49'.1/2, of tim Public. Ree of
Mkimi-Dade t knuit y, Floric
- of '10ji
y I practice ire state u 1 " da,
and am i naxmber in good snandiiag of the Florida Bar,
-RCSI)CCI.Oully subuvItted, this 3' day of March, 2010.
Euar W. RIFKN, P—A.,
t's
:art, -zsquire
Anachmeal Alit. A-.Legi7i.De.scri,.ption asi-eot)rde.din fficial Rmords Book 23952, Page 0804 o t—
Put)fic Retards of Mhuni-Dade Coullty, Florida.
Ai
OR SK 2ZIP542
UAST PAGE
Tho South 267 feet of Block .5, less the South 10 feet, 0 "to West 10 feet and less East 11 G
feet of the North 133.5 :of the South 267 feet, Block 5, of ROBBINS-GRAHANT AND
C.11ILLINGSWORTH, according to the Plat thereof, as recorded in Plat Book "AtIp at:
Pa go 49 1/2 of the Public Records of Dade County, Florida,
The East 110 feet of North 133.5 f6et of South 267 feet in Block 5,of BOBBIN S AND
CHILLINGSWORTH, accordina to the Plat thereof, as recorded in Plat Book "A."t at
Page 49-A, of the Public Records of Dade County, Florida.
The North 200.5 root of the South -26-7 feet of rho West 90 fbd -and the Soudi 66.75 feet of
the West 1/2 Less the -South 10 feet in Block 5, of ROBBINS-GRA14AM &
CHILLINGSWORTH, according to the Plat thereof, as recorded ia Plat Book A, at Page, 49
1/2, of the Public RecoWs ofMiami-Dade- County, *Florida..
The North 66,75 fiat of the. South 132,E feat or the West 1/2 tri B look 5, And its included
alley, less the West 100 feet : thereof, of ROBINS -GRAHAM & CHILLINGSWORTH,
according to the Plat thereof, as recorded in Plat Book A, At Page. 40 112, of the Public
Records ofMiarni-Dade County, Florida.
(Property addresses: 31 NE 17 Street, Miami, Florida
1703 North Mianit Avenue, Miami, Florida
1729-31 North Miami Avenue, Miami, Flooda)
a. 3'.'08959-V2
S
.arNl
Prepared by and return to:
Christopher W. Boyett, Esq.
Holland & Knight LLP
701 Brickell Avenue, Suite 3000
Miami, Florida 33131
Folio Nos.: 01-3136-005-0150
01-3136-005-0160
01-3136-005-0170
WARRANTY DEED
111111111111 Hill 111111111111111111111 fill fill
C.FN 2005R1 175779
OR Bk 23452 'Pss 4872 _ 004; (3pss)
RECORDED 11/14/2005 08:3001
DEED DOC TAX 0.60
HARVEY RUVINr CLERK OF COURT
MIAMI-DADE COUNTY► FLORIDA
This Warranty Deed is made by Kluger Family Limited Partnership, a Nevada limited
partnership (the "Grantor"), whose address is 6600 NW 74 Avenue, Miami, Florida 33166, to Prince
Albert, LLC, a Florida limited liability company (the "Grantee"), whose address is 6600 NW 74
Avenue, Miami, Florida 33166.
The Grantor, for and in consideration of the sum of Ten And No/] 00 Dollars ($10.00) and
other good and valuable consideration paid to the Grantor by the Grantee, the receipt and
sufficiency of which are hereby acknowledged, grants, bargains, sells and conveys to Grantee the
following described real property situate, lying and being in Miami -Dade County, Florida
(collectively, the "Property"):
See Exhibit "A"
Together With all easements, tenements, hereditaments and appurtenances belonging to or
in any way appertaining to the Property and all buildings and other improvements now or hereafter
located on the Property.
To Have and To Hold the same in fee simple forever.
This conveyance is made free and clear of all liens: and encumbrances except:
(a) Taxes and assessments for the year 2005 and all subsequent years;
(b) Applicable zoning ordinances; and
(c) Restrictions, reservations, easements and :limitations of record, if any, provided that
this shall not serve to reimpose same.
The Grantor warrants to the Grantee that: the Grantor lawfully owns the Property in fee
simple; the Grantor has the lawful authority to sell and convey the Property; the Grantor fully
warrants the title to the Property and will defend the Property against the lawful claims and
demands of all persons whomsoever.
Book23952/Page4802 CFN#20051175779
Page 1 of 3
Grantor has signed this Warranty Deed in the presence of the witnesses signing below on
this 7 day of &y )2005.
WITNESSES:
�_
�.. ■ a. G �_ . .
1�_ f:• , . �, tay.
MMOO= Q+ r�+
STATE OF FLORIDA
COUNTY OF MIAMI -DADS
GRANTOR:
Kluger Family Limited Partnership, a Nevada
limited partnership
Kluger Family Corporation, a Florida
corporation, as general partner
By:
Print Name:
Its: President UZ
The foregoing instrument was acknowledged before me this 1—) day of
_C � IK , 2005, by :P gr Pu , on behalf of Kluger
Family Corporation, a Florida corporation, as g n re a al partner of Kluger Family Limited
Partnership, a Nevada limited partnership, who- is eor has produced
as Identification.
Notary Public, State of Flo
Print Name: V-0,6,
My commission expires:
Book23952/Page4803 CFN#20051175779
ro,Nw pus,KW MATUS-GOMEZ
* MY COMMISSION r DD 137789
* EXPIRES: August 4,2006
sf�ffOFF`i;" BindedTmuBudget HOWYServiue
Page 2 of 3
OR BK 23952 PG 4804
LAST PAGE
Exhibit A
The South 267 feet of Block 5, less the South 10 feet, the West 10 feet and less East 110
feet of the North 133.5 of the South 267 feet, Block 5, of ROBBINS-GRAHAM AND
CHILLINGSWORTH, according to the Plat thereof, as recorded in Plat Book "A", at
Page 49 1/2 of the Public Records of Dade County, Florida.
The East 110 feet of North 133.5 feet of South 267 feet in Block 5, of ROBBINS AND
CHILLINGSWORTH, according to the Plat thereof, as recorded in Plat Book "A", at
Page 49-A, of the Public Records of Dade County, Florida.
The North 200.5 feet of the South 267 feet of the West 90 feet and the South 66.75 feet of
the West 1/2 Less the South 10 feet in :Block 5, of ROBBINS-GRAHAM &
CHILLINGSWORTH, according to the Plat thereof, as recorded in Plat Book A, at Page 49
1/2, of the Public Records of Miami -Dade County, Florida.
The North 66.75 feet of the South 133.5 feet of the West 1/2 in Block 5, and its included
alley, less the West 100 feet thereof, of ROBBINS-GRAHAM & CHILLINGSWORTH,
according to the Plat thereof, as recorded in Plat Book A, at Page 49 1/2, of the Public
Records of Miami -Dade County, Florida.
(Property addresses; 31 NE 17 Street, Miami, Florida
1703 North Miami Avenue, Miami, Florida
1729-31 North Miami Avenue, Miami, Florida)
# 3208959_v2
Book23952/Page4804 CFN#20051175779 Page 3 of 3
�Y OSx <�
'` CITY OFMIAMI
DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
e r aauie,
G";i SUPPORT OR WITHHOLD OBJECTION
., r C 0•, Fi ;.,�;
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: Ben Fernandez
(First Name) (Middle) (Last Name)
HOME ADDRESS: 200 South Biscayne Boulevard, Suite 850
(Address Line 1)
CITY: Miami
HOME PHONE: 305-377-6235
(Address Line 2)
STATE: Florida El zIP: 33131
CELLPHONE: 305-978-2866 FAX: 305-377-6222
EMAIL,: BFernandez@BRZoningLaw.com
BUSSINESS or APPLICANT or ENTITY NAME
Prince Albert, LLC
BUSINESS ADDRESS: 6600 NW 74th Avenue
Miam
(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.
Alley closure.
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
h.
c.
* 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 sli 11 be reviewed or
considered by the applicable board(s) until expiration of a period f o e year after the
nullification of the application or order.
PERSON SUBMITTING DISCLOSURE: "rte
igna ure
Ben Fernandez
Print Name
Sworn to and subscribed before ire this day of March 2010 The foregoing
instrument was acknowledged be/ore me b)' RP Fernancle7 who has produced
as identification and/or is personally known. to me and who did/did not take an oath.
STATE OF FLORIDA
CITY OF MIAMI
MY COMMIS 'ION &#L
Notary
EXPIRI S:% 5 1 Bettya
Print Name
Enclosure(s) N Natary Public State of Florida
Betty Lierena
Doc. No.:8G543 ()57(� Page 2
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