HomeMy WebLinkAboutTAB A.10 Disclosure of Agreement to SupportCITY OFMIAMI
DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
SUPPORT 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: Neisen O. Kasdin
(First Name)
(Middle) (Last Name)
HOME ADDRESS: Akerman Senterfitt
CITY:
(Address Line 1)
One SE Third Avenue, 25th Floor
(Address Line 2)
Miami STATE: Florida "LIP: 33131
HOME PHONE: (305) 982-5629
CELL PHONE: (305) 318-8624 FAX: (305) 374-5095
EMAIL: neisen.kasdin@akerman.com
BUSSINESS or APPLICANT or ENTITY NAME
Brickell CitiCentre East,LLC;Brickell CitiCentre West,LLC;
BUSINESS ADDRESS: Brickell CitiCentre North,LLC;Brickell CitiCentre Plaza,LLC
(Address Line 1)
501 Brickell Key Dr., Suite 600, Miami, FL 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.
Special area plan approval
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 0 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 t e same issue shall be reviewed or
considered by the applicable board(s) until ex ion of a period of one year after the
nullification of the application or order.
PERSON SUBMITTING DISCLOSURE:
Signature
Neisen O. Kasdin
p`a. Notary Public State of Florida
oltAY
a` Ann Condon Print Name
My Commission DD758094
es 03/20120
Expires
Of �0.4.
Sworn to and subscribed before me this t f H ,200 . the foregoing
instrument was acknowledged before me by “>1 e el SOit.1 , who has produced
as identification and/orris personally known to meind who did/did not take an oath.
STATE OF FLORIDA
CITY OF MIAMI 671,"-2d5y-)
MY COMMISSION Notary
EXPIRES: 4A/4/ �� i,
v Al
Print Name
Enclosurc(s)
Doc. No.:86543 Page 2
CITY OFMIAMI
DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
SUPPORT 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 anagreement 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:
HOME ADDRESS:
CITY:
(First ivame)
•
(Middle) (Last Name)
(Address Line 1)
(Address Line 2)
STAt'h: Florida ZIP:
HOME PHONE: CELL PHONE: FAX:
EMAIL:
BUSINESS or APPLICANT or. ENTITY NAME
BUSINESS ADDRESS
C(`c or MiA1
7 ?9 7 f g.tc, 4v E12,t tJ .
(Address Line 1)
(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.
cl!e,1 frbi Ceintr krea, pam
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?
111 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.
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.
b.
c.
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration.
5. Describe what is being requested in exchange for the consideration.
ACKNOWLEDGEMENT
I hereby acknowledge that it is unlawful
Ordinance 12918 and such circumvention
or civil penalties that may be imposed under
disclosure requirement was not fully and
1. the application or order,
effect; and
2. no application from
considered by the applicable
nullification of the application
PERSON SUBMITTING DISCLOSURE:
OF COMPLIANCE
to employ any device, scheme or artifice to circumvent the disclosure requirements of
shall be deemed a violation of the Ordinance; and that in addition to the criminal
the City Code, upon determination by the City Commission that the foregoing
timely satisfied the following may occur:
as applicable, shall be deemed void without further force or
any person or entity for the same issue shall be reviewed or
board(s) until expiration of a period of one year after the
or order.
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ignature
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Print Name
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;.-:^- a EXPIRES: December 10, 2011
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Sworn to an su scri e e ore me
instrumcent was acknowledged before
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its ( day of U , 200 //. The foregoing
me by -66N CRiihq5J,e. , who has produced
as
identification and/or i personally known to me and who did/did not take an oath.
Glj'
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STATE OF FLORIDA
MIAMI-DADE COUNTY
MY COMMISSION
EXPIRES:
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`W \6 Print
Name
Enclosure(s)
Doc. No.:86543 Page 2