HomeMy WebLinkAboutApplication & Supporting Documents-11
so
BGRCOW RADELL & FERNAN DEZ
ZONING, LAND USE AND, ENVIRONMENTAL LAW ;':�
Direct (305) 377-6235
E-Mail: Bfernandez ac brzonincilaw.com
VIA HAND DELIVERY
November 2, 2011
Mr. Anel Rodriguez
Public Hearing Section
City of Miami Riverside Center
444 SW 21,d Avenue, 7th Floor
Miami, Florida 33130
RE: Exception for 55 NE 24th Street, Miami, Florida
Dear Mr. Rodriguez:
This law firm represents Rosenthal, LLC ("Applicant"), and Slim s
Universal Holding Company, LLC (the "Operator"), in connection with the
above referenced property, located at 55 NE 24t1 Street ("Property"). This letter
shall serve as the supplemental letter of intent with respect to the application for
an exception in connection with the establishment of Automatic Slims on
Property.
In response to the Planning Department's request, please be advised of the
following additional facts concerning the operation of the proposed supperclub
on the property:
Occupancy. The maximum occupancy is approximately 280
persons.
2) Operation Plan. The Club will operate seven (7) days a week.
There will initially be employees including bartenders, a cook, and
security personnel. The goal of the business is to provide a
neighborhood serving drinking establishment that is characteristic
of the Wynwood Arts District.
WACHOVIA FINANCIAL CENTER • 200 SOUTH BISCAYNE BOULEVARD, SUITE 850 • MIAMI, FLORIDA 33131
PHONE. 305.374.5300 • FAX. 305.377.6222 • WWW.BRZONINGLAW.COM
Mr. Anel Rodriguez
November 2, 2011
Page 2
3) Traffic. The property is located on a dead-end street in an entirely
industrial area along Miami Avenue. The roadway impacts
associated with patrons arriving by car will be minimal as there is
no traffic congestion at any time along in the immediate area.
4) Noise. The applicant will not be generating sound that will be
appreciable from a residential area since the club will be located
within an entirely enclosed building and the nearest residential
area is located more than 200 feet from the property.
5) Human Security Detail. Automatic Slim's will being employing its
own security guards/bouncers as needed, and as reasonably
determined to be needed depending upon how busy the
establishment is on any given evening. It is the general policy to
have both one man, and one woman, each of which operates as a
host at the front door. Typically the security guard/bouncer-is an
individual who mans the emergency door, and who also serves as a
bouncer if, as and when needed within the operation. Typically,
various roving managers, door men and woinen and the security
details throughout the establishment will have constant
communication links to one another via radio frequency devices
attached to ear sets each will be wearing. This will ensure a
constant communications at all access points and elsewhere within
the establishment in order to be alerted to any emergency
situations.
6) Video Surveillance. In addition to the onsite security personnel, the
establishment will be fitted with state of the art video surveillance
apparatus through the interior and exterior of the establishment.
These video devices will run on a 24 hour seven day basis, and will
be looped to both closed-circuit monitors within the building
management office, as well as, video recording/storage devices
enabling playback at any time.
7) Proximity to Residential. The property is not located within two
hundred feet (200') of a residential property.
Parking. The Applicant intends to lease the abutting property to
provide all of the required parking spaces for each phase of the
project. Although the parking provided will be technically off -site,
BERCOW RADELL & FERNANDEZ
ZONING. LAN ID USE ANC ENVIRONMENTAL LAW
Mr, Anel Rodriguez
November 2, 2011
Page 3
the parking will be just steps away from the proposed
entertainment establishment. The parking area is indicated on the
plan.
9) Sanitation. Sanitation will be provided by a private hauler on an
as -needed basis. At a minimum, we anticipate daily garbage pick-
ups.
Based on the above described operation plan, the supperclub will be
compatible • with the surrounding area. Should you have any' questions
regarding this Application, please do not hesitate to contact me.
Sincer
Ben Fernandez
BF/bl
Enclosures
cc: Ron Bloomberg
27
BERCOW RADELL & FERNANDEZ
ZONING, LANE, USE ANO ENVIRONMENTAL LAW
APPLICATION
MIAMI 21
e 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. All pertinent and accurate';'
l.I
'information/documentation; i.e.; the plans, reports, exhibits, shall be presented at the time of filing, .�;�i
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 for review'beforethe deadline to ensure completeness.
ou 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 'h x11") or other materials submitted
during this process will be kept as part of the record.
An additional fee to record resolutions will be charged, and it is determined contingent upon fees
charged at the time of recordation by the Miami -Dade County Recorder's Office at 22 NW First
Street, First Floor. Upon arrival, ask for a certified copy of the resolution. They will keep the
original, but please have them mail it to us, and bring the certified copy to our office. Copies of
City Commission resolutions/ordinances can be obtained at our website through the "Legislative
Hub", or for certified copies, please contact the Office of the City Clerk at 305-250-5360 or at 3500
Pan American Drive.
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.
Applications given to customers do not constitute action from the City of Miami without plans
review and written comments from the Office of Zoning.
Revised May 2010
CITY OF MIAMI
Hearing B o a r d s
Pb: 305-416-2030
444 SW 2' d Ave 701 Floor Miami, FL 33130
www.miamigov.com/hearing_boards
3
EXCEPTION APPLICATION
Please 'refer to Article 7.1.2.6 of the Miami 21 Code for Exception information. ry,;f
Applicant name(s) Ben Fernandez, Esq. on behalf of Rosenthal, LLC and Slim's Universal
Holdmqs;>`Co: LLC. (lessee) ,:
Subject property addresses) and folio number(s): 55 NE 24'h Street, Miami, Florida (Folio Number
01-3125-010-0170)
One (1) original survey dated within six (6) months from the date of application prepared by a State
'of Florida registered land°'surveyor;.
One (1) ,original , 24x36" ; plan, signed and sealed by a State of Florida registered architect or
engineer showing; property '`boundaries and proposed structure(s), parking, landscaping, etc.;
building elevations and dimensions and computations of lot area and building spacing.
5. After all departments initial and date the plans, two (2) 11x17" and one (1) 8'/x11" copies of the
original plan, in addition to the survey.
6. Original and current Zoning Write -Up signed by Office of Zoning designee.
7. The subject property(ies) cannot have any open code enforcement/lien violations, unless the
request, if granted, would remedy the violation.
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 (seepages 4 and 5).
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 6 and 7).
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.
Revised May 2010
CITY OF MIAMI
Hearing B o a r d s
Ph: 305-416-2030
444 SW 2nd Ave 7d' Floor Miami, FL 33130
www.miamigov.com/hearing_boards
4
EXCEPTION APPLICATION
What` is the acreage of the,project/property site? 0.33 acres
What,is:,the purpose of -,this application/nature of proposed use? A supperclub to be operated
between'the hours of300 prn and 5:00 a.m.
e,:.'prppertSifkwithirOheboundaries of a historic site, historic district or archeological zone?
Pleaseicontact the` Planning Department on the 3rd Floor for information. No.
0 Is the property within,the boundaries of an Environmental Preservation District? Please contact the
PlanningDepartment on the 3rd Floor for information. No.
Cost of processing according to/Section 62-156 of the Miami City Code*:
Exception l ermi
b Extension of time for Exception $ 500.00
c. Exception Permit Requiring City Commission Review $ 2,000.00
Public hearing and public meeting mail notice fees,
including cost of handling and mailing per notice
$ 800.00
$ 3.50
Surcharge equal to applicable fee from item above, not to exceed eight hundred dollars
($800.00) except from agencies of the city; such surcharge to be refunded to the applicant if
there is no appeal from the applicant or a property owner within five hundred (500) feet of the
subject property.
*Pursuant to 0 •riance 12719, all planning and zoning fees in excess of $25, 000.00, shall be
paid in the f rm o a certified ec` cashier's check, or money order.
Signature
Name
Ben Fernandez, Esq.
Mailing Address 200 South Biscayne Blvd. # 850
Miami, FL 33131
Telephone 305-377-6235 E-mail BFernandez(BRZoningLaw.com
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing was acknowledged before me this J 1 day of September, 2011, by Ben
Fernandez, Esq. who is a(n) individual/partner/agent/corporation of Bercow Radell & Fernandez,
P.A. a(n) individual/partnership/corporation. He/She is peilsonally known to me or who has
produced as identification and who. did (did yt) t ke ari1oath.
(Stamp) 8ErrYLLERENA
I-4'1A MY COMMISSION 0OD660413
c i st.$'' Bend Haim tl s
S I..,� nlll{, KariT"' Y OF M I A M I
Hearing Boards
Ph: 305-416-2030
444 SW 2nd Ave 7'h Flcor Miami, FL 33130
Revised May 2010 www.miamigov.com/hearing_boards
Si
5
EXCEPTION APPLICATION
I'DAVIT OF AUTHORITY TO ACT
Before me thiday, the undersigned personally appeared Ben Fernandez, Esq., who being by me
first deposes;`and;says
That =he/she is,,the owner or, the legal representative of the owner, submitting the public hearing
applications asrequired;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,'I] including or 0 not including responses to day to day staff
inquires``z
That the foregoing,. and„followingpages 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'
Appliant(s) Signature
The foregoing was acknowledged before me this day of September, 2011, 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 who did (did nuke an oath.
(Stamp) Sing` natur,
Revised May 2010
BETTY LIJERENA
14 14yC014116510NNDD060413
E (P ES: Marsh 5, 2014
Uro5 Thru Notay Public Underwriters
CITY OF MIAMI
Hearing B o a r d s
Ph: 305-416-2030
444 SW 2nd Ave 7r1i Floor Miami, FL 33130
www.miamigov.com/hearing_boards
6
EXCEPTION APPLICATION
;CLOSURE OF OWNERSHIP
es,ubjedt'pi'op.erty and percentage of ownership. Note: The Miami City Code
all partiesiiaving a financial interest, either direct or indirect, with respect to a
of petition:;J,'Accordingly, disclosure of shareholders of corporations, beneficiaries
:other interested \patties, together with their address(es) and proportionate interest
ate required. Please supply additional:;lsts, if necessary.
owner's,Name(es
or; an
Rosenthal, LLC
Percentageof Ownership 98% Raphael Adouth, 2 NE 25th Street, Miami, FL 33137; and
2 % Daisy Adouth Gross,42•NE 25th Street, Miami, FL 33137
Subject.,P bperty.:Address(es)
55 NE 24th Street, Miami, FL (Folio No. 01-3125-010-0170)
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):
42 NE 25th Street
Owner(s) or Attorney Name
Legal Description(s):
See Exhibit B
Owner(s) or Attorney Signatur
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foreoi�ng was acknowledged before me this ` day of 2011, by
1'Y' A tf-e rAotin who is a(n)
individual!partner/agent/corporafon of Rosenthal, LLC a(n) individual/partnership/corporation.
He/She is personally known to me or who has produced as identification and who
did (did not) take an oath.
(Stamp)
Revised May 2010
CITY OF MIA.MI
Haring Boards
Ph: 305-416-2030
444 SW 2'd Ave 7th FIoor Miami, FL. 33130
www.m iamigov.com/hearing_boards
7
EXCEPTION APPLICATION
ISCLOSURE OF OWNERSHIP
ist.,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.
Slim's Universal Holding Co. LLC.
100% Ron Bloomberg, 309 23`d Street, # 203, Miami Beach,
Florida, 33139
Subject Property Address(es) 55 NE 24th Street Miami, FL (Folio No. 01-3125-010-0170)
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):
N/A
N/A
N/A
Owner(s) or Attorney Name
Legal Description(s):
N/A
N/A
N/�
rti
0 ner(s) or Attorney Si • nat F
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE,
The foregoing was acknowledged before me this al-0 day of October, 2011, 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 who did (did not) take oath.
(Stamp)
Revised May 2010
Signat
ITY OF MIAMI
Hearing Boards
Ph: 305-416-2030
444 SW 2„d Ave 70, Floor Miami, FL 33130
www.miamigov.com/hearing_boards
8
Exhibit A
LEGAL. DESCRIPTION:
LOT 10, BLOCK 2, ROSEWIN PARK, ACCORDING TO THE PLAT
THEREOF, AS RECORDED IN PLAT BOOK 3, AT PAGE 52, OF THE
PUBLIC RECORDS OF.MIAMI-DADE COUNTY, FLORIDA; LESS THE
SOUTHEASTERN 15.00 FEET OF SAID LOT 10, BLOCK 2, OF
ROSEWIN PARK, NEXT ADJOINING THE. RIGHT-OF-WAY OF THE
FLORIDA EAST COAST RAILWAY COMPANY, AND LOT 11, BLOCK
2, OF SAID ROSEWIN PARK, LESS THAT PORTION OF LOT 11
BEGINNING AT THE SOUTHEAST CORNER OF LOT 12, IN BLOCK 2,
• OF SAID ROSEWIN PARK, PROCEED IN AN EASTERLY DIRECTION
8.60 FEET; THENCE NORTH 140.55 FEET; THENCE WEST 8.63
FEET; THENCE SOUTH 140.55 FEET TO THE POINT OF BEGINNING.
LYING IN SECTION 25, TOWNSHIP 53 SOUTH, RANGE 41 EAST,
PROPERTY ADDRESS 55 NE 24th STREET FOLIO 01-3125-010-0170
CITY OF MIAMI,
MIAMI-DADE COUNTY, FLORIDA
See Exhibit B
Lot 6, 7, 8, and 5 in Block 2, Rosewin Park, according to the Plat thereof as recorded in
Plat Book 3, at Page 52 of the Public Records of Miami -Dade County, Florida; LESS and
excepting therefrom the right-of-way of the Florida East Coast Railway Company.
Tble document prepared by! •
Jeffrey E. Levey, rEL: 1.8919E3800'
Jen'rry E. Lamy, P.A.
1665 South Bayeben brier
Suite 1004
99R652451 1999 DEC 27 08155
Coconut Grove. Florida 33133 DDCSTPDEE 44300.00 SURTX •• 3►600.00
HARVEY RUVIHr CLERK DADE COUNTY, FL
WARRANTY DEED' • .
• THIS,WARRANTY DEED, executed this 7"day of December,.1999, between ROYAL WEST, INC., -
a Florida corporation, whose address is 2516 Sunset Dr„ Miami Beach, Florida 33140 (the "Grantor") '
and Rosenthal LLC, a Florida limited liability company, whose post office address is 42 N.E. 25 rn Street, •
Miami, Florida 33137 (collectively, the "Grantee"): •
• WiTNESSETH, that Grantor, for and in consideration of the sum of 510.00 and other good and •
valuable consideration paid to an Accomodator pursuant to. an I.R.C. 1031 Exchange, the receipt and
adequacy of which is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases,
conveys and confirms unto the Grantee and Grantee's heirs, successors and assigns all that certain land
situate, lying and being in the County of Miami -Dade, State of Florida, to -wit (the "Property'):
PARCEL ONE: Folios: 01-3125-010-0130 & 01-3125-010-0140
Lots 8, 7, 8, end 9, Block 2, ROSEWIN PARK, according to the Plat thereof, recorded In•Plat
Book 3, Page 52, of the Public Records of Mlenii-Dade County, Florida, •
•
less and excepting therefrom the following: the Southeasterly 15 feet of Lot
9, Block 2, of ROSEWIN PARK, next adjoining the right-of-way of the Florida
East Coast Raltway Company.
PARCEL TWO: Folio: 01-3125.010-0170
Lot 10, Block 2, of ROSEWIN PARK, according to the Plat thereof, as recorded in Plat Book
3, Page 52, in the Public Records of Mlaml-Dade County, Florida,
less the Southeastern 15 feet of said Lot 10, next adjoining the right-of-way
of the Florida East Coast Railway Company; and •
Lot 11, Block 2, of seld'ROSEWIN PARK,
less that portion of said Lot 11, beginning at the Sotitheast comer of Lot 12,
. In Block 2, of said ROSEWIN PARK, proceed in an Easterly direction 8.6
feet; thence North 140.55 feet thence West 8.63 feet; thence South 140.55
feet to the Point of Beginning..
Subject to the -following: '
' 1. • Taxes for the year 2000 and all subsequent years; and
2. Toning, restrictions, prohibitions and other requirements imposed by governmental
authority; rgstr1ctidns and matters appearing on the plat or otherwise common to the
subdtvlsion;•public utility easements of record. .
TOGETHER with all,the tenements, hereditaments and appurtenances belonging or appertaining
thereto.
' TO HAVE AND TO HOLD the same In fee simple forever.
• AND Grantor does hereby fully covenant with Grantee that Grantor is lawfully seized of said
property in fee simple; that Grantor has good right and lawful'authority'to set and convey said property; that
Grantor hereby fully warrants the title to said property and will defend the same against the lawful claims of
all persons whomsoever. .
"Grantor" and "Grantee" are used for singular orplural, as context requires:
. IN WITNESS WHEREOF, the Grantor has signed and sealed these presents the'day and year first .
tibove written.
WITNESSES as to both signatures :
(e
GRANTOR:
ROYAL WEST, INC., a Florida corporation
ARY ROBINSO •, President
Address: 2516 Sunset Dr.
Miami Beach, Florida 33140
NEC: 18919P63gp;M1
STATE OF FLORIDA )
) ss: .
COUNTY OF MIAMI-DADE )
•
The foregoing Instrument was acknowledged before me this 7 °i d o
Robinson as President of Royal West, Inc.,* Florida corporation, who
has produced as identification and he did take an
Notary Public
State of Florida
• My commission expires: (p
Carmen Robles
ILI, Balms 2002
Con nit bn C'�CC� MIMI •
LADED hu
AnMmceoNorracaVW.
N,° ogoseorc
REComo VER lED
HARVEY'RUVMN
c.tERKarmorcougt •
, IASetiers lRoya Wet hDocslWs mnryDeed.wpd
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: Ben J. Fernandez
(First Name)
(Middle) (Last Name)
I-IOME ADDRESS: 200 S.. Biscayne Boulevard
CITY:
(Address Line 1)
Suite 850
(Address Line 2)
Miami STATE:
HOME PHONE: (305) 377-6235
Florida
ZIP: 33131
CELL PHONE: `- (305) 978-2866 FAX: (305) 377-6222
EMAIL: BFernandez@BRZoningLaw.com
BOSSINESS or APPLICANT or ENTITY NAME
Rosenthal, LLC
BUSINESS 145 East Flagier Street, # B5
(Address Line 1)
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.
Miscellaneous land use, zoning and permitting matters.
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?
El 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
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
N/A
N/A
5. Describe what is being requested in exchange for the consideration.
N/A
N/A
N/A
I hereby acknowledge
Ordinance 12918 and
or civil penalties that
disclosure requirement
1. the
effect;
2. no
considered
nullification
PERSON SUBMITTING
ACKNOWLEDGEMENT OF COMPLIANCE
that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of
such circumvention shall be deemed a violation of the Ordinance; and that in addition to the criminal
may be imposed under the City Code, upon determination by the City Commission that the foregoing
was not fully and timely satisfied the following may occur:
application or order, as applicable, shall be deemed void without further force or
and
application from any person or tity for the same 'ssue s all be reviewed or
.by the applicable bo (s) ntil expiration of eriod f one year after the
of the application o orde .
DISCLOSURE:
Si nature
Ben J. Fernandez
before me this e%� •clay of�"i
Print Name
Sworn to and subscribed
insh•lnnent YVcis
, 2t' The foregoing
acknowledged before 171e by
as identification cind
, who has produced
or is personally known to me and who did/did not take an oath.
*�
STATE OF FLORIDA
CITY OF MIAMI
MY COMM! 1pp
EXPIRES:
11, p
`'(
J^
Notary,
`/ -eiri p�/� a
Enclosure(s)
Doc. No.:86543
�Y{(i!sY Pp�;4 BETTY LLERENA
"""It(
',r MYCOMMON NDD00A413
';bay: _, OMB: fart 5, 2014
` :+ " ®ondedihru Notary P4 lolluiar wkers
Print Name
Page 2
: 6,
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: Ben J. Fernandez
(First Name)
(Middle) (Last Name)
I -TOME ADDRESS: 200 S. ` Biscayne Boulevard
(Address Line 1)
Suite 850
(Address Line 2)
CITY: Miami STATE: Florida ZIP: 33131
HOME PHONE: (3 05) 377-6235
CELL PHONE:' (305) 978-2866 FAX: (305) 377-6222
EMAIL: BFernandez@BRZoningLaw.com
BUSSINESS or APPLICANT or ENTITY NAME
Slim's Universal Holding Co. LLC
BUSINESS ADDRESS: 309'23rd street, # 203
(Address Line 1)
Miami Beach, FL 33139
(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.
Miscellaneous land use, zoning and permitting matters.
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 Q 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
N/A
N/A
5. Describe what is being requested in exchange for the consideration.
N/A
N/A
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 entit the same issue h • 1 be reviewed or
considered by the applicable board(s) itil ex ration of a pe • d one year after the
nullification of the application or ord r.
PERSON SUBMITTING DISCLOSURE:
Signature
Ben J. Ferna dez
Print Name
Sworn to and subscribed before me this 9�� day 0 VA W9✓A- --7,, ii The foregoing
instrument was acknowledged before me by F"�(r,�' `— _
( `ynC`c 11w/io has produced
cis identification and/or is personally known t0 me and who ll]d/di l not take an oath
STATE OF FLORIDA
CITY OF MIAMI L
MY COMMIS
EXPIRES: ��
ION`��
c —1
Notary
�V--ea
`
1
Enclosure(s)
Doc. No.:86543
dt�,Pi y BETTYLLERENA
x: , :a? MY COMMISSION # 9D 660413
= j. EXPAES: Mai*6, 14
int Name
Page 2
. •��::r LIZIPArniraivecerieuricunisaniab