Loading...
HomeMy WebLinkAboutCC Disclosure to Support or Withhold ObjectionCITY OJMIAMI HISCLOSI R OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO SUPPORT OR wLTHIIoLli 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 en 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 °fits 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: Debra Lee (First Name) (Middle) HOME ADDRESS': 11111 Biscayne Boulevard Sinkle Kolsky (Last Name) (Address Line 1) Unit 1953 (Address Line 2) CITY: Miami STATE: Florida ZIP: 33181 HOME PHONE: 3058938854 CELL PHONE: 9546473545 FAX: 3059810003 EMAIL: dsk@redevco.org BUSSINESS or APPLfCANT or ENTITY NAME Wagner Square 1, LLC BUSINESS ADDRESS: 11098 Biscayne Boulevard, Suite 103 (Address Line t) Miami, FL 33161 (Address Line 2) I. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board, authority, agency, council, or committee. MUSP Approval of Wagner Square project 2. Has any consideration been provided or eonunitted, 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 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, D. No_:56543 3. Please provide the si Or conwaitteds Naomi l'!A c3 address € rtt phone member t f the person(s) or entities to wham consideration has been provided Address Additional names can be placed on a separapage attached tar thi 4, Please describe the nature of the consideration, I4/A 5. describe what is being requested in exchange for the consideration, NjA ACKNOWLEDGEMENT OF COMPLIANCE 1 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 expiration of a period of one year after the nullification of the application or order. PERSON SUBMI l I ING DESCLOSURE: em (f0+ (l l\ o Print Name Sworn to and subscribed before me this / day of � J Er C--'7 ' 200 `7 The foregoing instrument was acknowledged before me by e / r $in l�(' f>.5 /s � {................, s,who has produced f I cfl L ; thrk=9b' is personally known to rate and who ditt"did not take an oath. STATE OF FLOREDA CITY OF MIAMI MY COMMISS ON 1 E YPI €3ES: c.,Q3RRY PU ll iC-STATE OF FLORIDA,/ j l=', Karen S. Watson-. ' 1111., f:�dascar�fs} Cf3 D. Nc:E6543 ��IYCamrc,, Expires: 05/11/2010 mmission # DD551548 77 I ! Nat iy Print Name f SEA Page 2 I CITY QFWANMIi DISCLOSURE OF CONSIDERATION PROVIDED OR CONTIVIITTED FOR AC REEM :NT TO SUPPORT OR WITHHOLD OBJECTION Tare City of Miami requires any person or entity requesting approval relief or other action from the City Commission car 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 assistants: 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 appeasing 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, ar owners' legal representative are not required to fill out this fora:, NAME: Debra Lee Sinkle Kolsky {First Name) (Middle) (Last Name) HOME ADDRESS: 11111 Biscayne Boulevard (Address Line 1) Unit 1953 is Lir.e 2) C!TY: Miami STATE; Florida ZIP: 33181 HOME PHONE: 3058938854 CELL PHONE: 9546473545 FAX: 3059810003 EMAIL: dsk®redevco . org BUSSINESS or APPLICANT or ENTITY NAME Wagner Square LLC BUSINESS ADDRESS: 11098 Biscayne Boulevard, Suite 103 (Address Line 1) Miami, FL 33161 (Address Line 2) t. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board, authority, agency, council, or committee. MUSP Approval for Wagner Square LLC project 2, Has any consideration been provided or committed, directly or on your behalf, to any entity or person for and agreement to support or withhold objection to the requested approval, relief or action? YES ® 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. iDoc. No.:8b343 3, Please provide the name, address and phone number of the person(s) or or committed. b. 1/A Addrcs iti€s to whom consider tfr n hay b r provided Additional cranes can is placed an a separate page attached to ti ffs forfl 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 expiration of a period of one year after the nullification of the application or order. PERSON SUBN I NC DISCL©SUR.E: Debra Sr rikle Kolsky, Manager, KMT Entrp . LLC F � Sworn to and subscribed he bF e me this day ra 2010 . The foreegoing instrument was acknowledged be ©t•e me by t_ficbaL;? ..___. `` who has produced srs identification and/or is personally known to oh and who diikdid not tale an oath. STATE OE FLORIDA CITY OF M € A MI MY COMMISSION EXPIRES: .> J 7� /C} N a-ioswe`j UPI 5 ii\OF FLO Kan S. Commission 5I11.12010 m p eSe otary r Print Name