HomeMy WebLinkAboutDisclosure to Support or Withhold Objection•
CI'FY OFMIAMI
• DISCLOSI.,'RE&» CONSIDERATION PROVWEI) OR COMMITTED F(1R AGREEMENT T()
SUPPORT OR WITHHOLD OBJECTION
- •
The City el- iMiarrii requires any person or entity requesting approval relief or other action from the City Commission or any of its
hoards, authorities, os,encies, councils or comm hie, to disclose at the COIMIlenC,Mleili (or continuance) or the bearinvls) on the
issue, any consideration provided or committed, directly or on .its hentrJr, to any entity or person for an agreement to support •or
nvithhoId objection to the requested approval, relic!or action. "Consideration' includes anyi gift, payment, contribution. donation,
commission, promise. or grant of any inoney. property, service, credit or financial as of any kind or value, vtibather threctigr
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implied. or any promise or agreement o provide any of the lOregoing in the futurr.
tntlividuals retained or employed by a principat as a Jobhyist as defined hi Sec, 2-653„ and appenrinat beiore the City Commission (.if
any °hits boards, authorities, atencies, councils or committees solely in the capacity ofa iobittyt and not as the applicant, o oners'
IrOalrepresentative are no1 required to till out this form,
Ben John Fernandez
..,„
(First Name) (Middle) (Last Name)
Ic./NIE ADDRESS: 1837 SW 23rd Street
(Address Line 1)
(Address Line2)
Miami Florida /JP: 33145
IlUMiPHONEll (305) 857-0337
CEU,PHONF• (305) 978-2866 FAN: (305) 377-6222
EmAu BFernandez@brzoninglaw.com
IWSSINTSS .,APPLicANli or ENTIT).' NAMF
Arks Development, LLC
BU.SINESSADDRES 4949 $W 75th Avenue
(Address Line 1)
Miami, FL 33155
(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.
Comp plan amendment and rezoning.
2. Has any consideration been provided or committed, directly ar on your behalf, to any entity or person for an agreement to
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support or withhold objection to the requested approval, relief Or action?
F-1 YES • FR'l 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 Iles, please answer questions 3, 4 & 5 and read and execute the Acknowledgement.
]ix,.. r,;',:86543
3, t'1ca3c provide the mime,
or comm
di!JOr r Oat is 1t
4. Please des
and the perscIM
€}�e ,.. �i1.t chcCi d.._1 tiT-5 corm.
Qature of the consideration,
bcea roam€ed
Phoneiit
S. Describe what is being requested in exchange for the consideration.
ACK`!(>\4'1., DCEMENT OFCOMPLIANCE
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 is a shall be reviewed or
considered by the applicable be' until expiraatio of a p rriod of one year after the
nullification of the applicatio
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;Doc N ..786543
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Ben Fernandez
Print Name
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