HomeMy WebLinkAboutTAB A.10 Disclosure of Agreement to Support or WithholdA.10 DISCLOSURE OF AGREEMENT
TO SUPPORT OR WITHHOLD OBJECTION
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 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
HOME PHONE: (3 0 5) 9 8 2- 5 6 2 9 CELL PHONE: (3 0 5) 318 - 8 6 24
EMAIL: neisen.kasdin@akerman.com
GIP: 33131
FAX: (305) 374-5095
BUSSINESS or APPLICANT or ENTITY NAME
Brickell CitiCentre East,LLC;Brickell CitiCentre West,LLC;
BUS1NESSADDRESS: 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 0. Kasdin
P%, Notary Public State of Florida
o0
i` „ Ann Condon Print Name
y,. My Commission DD758094
OF flo' Expires 03/20/2012
5 Sworn to and subscribed before me this d ��;f
H , ?0lf' . The foregoing
instrument was acknowledged before me by _el.Se-i kri_DI j/1 , who has produced
as identification andiorfis personally known to mejind who did/did not take an oath.
STATE OF FLORIDA
CITY OF MIAMI O'57-7crr->"-7
MY COMMISSION Notary
EXPIRES. / \
Print Name
Enclosure(s)
Doc. No.:86543 Page 2