HomeMy WebLinkAboutApplication & Supporting DocsGT
GreenbergTraurig
March 18, 2011
Mr. Francisco Garcia
Zoning Department
City of Miami
444 S.W. 2nd Avenue, 4th Floor
Miami, Florida 33128
Iris Escarrh
(305) 579-0737
Direct Fax: (305) 961-5737
E-Mail: escarrai@gtlaw.com
RE: Application for Exception for Public Charter Elementary School - Greater Miami Boys
and Girls Club Foundation, Inc. located at 2805 SW 32 Avenue, Miami, FL.
Dear Mr. Garcia:
The Greater Miami Boys and Girls Club Foundation, Inc., a Florida not -for -profit corporation
("Boys and Girls Club"), along with Mater Academy, Inc., a Florida not -for -profit corporation
("Mater"), are jointly seeking the approval of a Kindergarten thru 8th Grade Public Charter School to
be located in the recently built Alex Rodriguez Educational Facility at the Hank Kline Campus, 2805
SW 32 Avenue, ("Campus"). The Boys and Girls Club has been operating on this Campus for over 50
years, offering excellent programs to children of the City of Miami such as after school care, tutoring,
summer camp, spring camp, teacher work day programs, a variety of sports and extracurricular
activities. Mater Academy is an award winning charter school provider whose key to success is to
develop the intellectual and social skills of its students by facilitating a rigorous college preparatory
curriculum and a wide range of educational resources within a safe learning environment.
In 2007, the Boys and Girls Club received approval from the City of Miami to expanded its
Campus of 28,568 sf with the addition of a new 9,812 sf educational building (for a total of 38,390 sf)
amongst seven buildings by Special Exception and a variance of 25 parking for the additional 9,812 sf.
At this time, the Boys and Girls Club and Mater are requesting an exception in order to expand the
educational programs during hours when the Campus is underutilized. The introduction of a K-8
Charter School into the already existing Alex Rodriguez Educational Building would be an asset to the
community.
Enclosed please find plans for review of an Exception application to allow the use of a K-8
Public Charter School at the Boys and Girls Club Campus. Should you have any questions please feel
free to contact me at (305) 579-0737.
Sincerely,
Iris Escarra
GREENBERG TRAURIG, P.A. • ATTORNEYS AT LAW • WWW.GTLAW.COM
333 Avenue of the Americas • Suite 4400 • Miami, FL 33131-3238 • Tel 305.579.0500 • Fax 305.579.0717
MIA 181,773,843v1 3-17-11
EXCEPTION APPLICATION
MIAMI 21 NPR 21'1 3:`2.
e+deadline to > fakthe}4h le e}.,application with supporting documents is the first five working
ays,ofech:munth.from-8;:00am until 3:00 pm, except on the fifth day, at 12:00 pm. The
;�appf catio'n�`sabmittal" dater is;theWdate stamped by Hearing Boards' staff on this page. The
tres ponseso his^�a lieatiori must�be typed and signed in black ink. All pertinent and accurate
i�p,� pp YP 9
information/documentation, i, ea , theplans, reports, exhibits, shall be presented at the time of filing,
in addition toy the paid reca pt. The applicant is responsible for the accuracy of the information
contamentheappJicationi and allsupporting materials. Should you wish, you could bring the
rriatenafs fiorreiew before .the deadline to ensure completeness.
nito
ou will beNesponsible, if `needed, to bring an interpreter for the English language to any
presentationx berore,,.citya d committees and the city commission. A valid power of attorney
wild be�rirjCiirde if Welded applicant or legal counsel representing the applicant execute the
application ordesire to, make a presentation before city boards, committees and the city
commission All, documents, reports, studies, exhibits (8 '/ x11 ") or other materials submitted
during thispresswill 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 Di;✓e.
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 giver to customers do not constitute action from the City of Miami without plans
review and written comments from the Office of Zoning.
MIA 181,769,009v1 3-15-11
EXCEPTION APPLICATION
Pleaseireferto Article 7.1.2.6 of the Miami 21 Code for Exception information.
r ,
,z�r arj
1, yApplicanfirname(s)� ..Ins ,Escarra; Esquire on behalf of Greater Miami Boys Club Foundation Inc. a
Florldaw no forr profit organization\ Vs owner and Mater Academy, Inc., a Florida not for profit
4
organization;tasLesseer`�,
....9 g 'y„" w?x�.( 4Y�3g e: ' rsY3 `^ " { — y. 't pp
'11
2% Subject property addre.,'ss(es) andfolio number(s): approx. 2805 SW 32 Avenue
Folio Noy 01 411ii6=,O36-001",0 i ,
"Qne (1) originalII survey dated9wiin six (6) months from the date of application prepared by a State
of Florida registered land surveyor.
O'ne ,(v1) original 24x36"' plan? signed and sealed by a State of Florida registered architect or
engineer ineer showin ro ert boundaries and proposed structures , parking, landscaping, etc.;
9 9'�P �p, y p p O g
building`elevations an`ddimensions 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
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 (see pages 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).
violations, unless the
15. For all corporations and partnerships indicated:
a) Articles of Incorporation;
b) Certificate from Tallahassee showing good standing, Tess 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.
MIA 181,769,009v1 3-15-11
EXCEPTION APPLICATION
16 y_1 that is the acreage" of the, project/property site? approx. .91 acres
What s,thec,purppses,ofAts app ication/nature of proposed use? approval for use of an
Elemhe ntaryS.chodl�,,
41 ''''
18/ls, he.tpropertgi.y wit-‘04hhin theme boundaries of arhistoric site, historic district or archeological zone?
Please contactthe tRlanninkg Department on the 3 Floor for information. no
1W9 Is the property withintthe boundaries of an Environmental Preservation District? Please contact the
lk Pla•nning, Departmentron the 3 ? FI'oorfoa information. no
/
Z;V,Cost of processing according7toSection 62-156 of the Miami City Code*:
\\N
a ExcepticrIp rmit of $ 800.00
b. Extension time for#Exceotion $ 500.00
c. Exception -Permit -Requiring City Commission Review $ 2,000.00
$ 3.50
Public hearing and public meeting mail notice fees,
including cost of handling and mailing per notice
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 Ordinance 12719, all planning and zoning fees in excess of $25, 000.00, shall be
paid in the form of a certified check, cashier's check, or money order.
Signature
Name
Telephone 305-579-0737
Iris Escarra, Esq.
Mailing Address 333 Avenue of the Americas
Miami, Florida 33131
E-mail escarraic gtlaw.com
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing was acknowledged before me this
20 1 ( , by Iris Escarra, Esq. .
_ who is a(n) individual/partner/agent/corporation of 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
l� day of
kiSi natL4e_ �, _ _ (, .. _ .
0, °yet MARISOL RODRIGUEZ
'2''1:°"__ Notary Public - State of Florida
, ni : Q? My Comm. Expires Sep 27, 2014 1
�11;'t0 0 Commission # EE 30092
MIA 181,769,009v1 3-15-11
EXCEPTION APPLICATION
Beforeime
zA F el D�4/
ey;uridersgied personally appeared Iris Escarra, Esquire
t , who being by me first deposes and says:
IT 0 F AUTHORITY T 0 ACT
Than he'/she is th`e owne *the,- lI FA
e al representative of the owner, submitting the public hearing
� a � � � � � as , a � �, + ���
application assrequired by the"Code f the City of Miami, Florida, affecting the real property located in
,th.e`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 tdract in his/heir behalf xfo he change or modification of a classification or regulation of zoning
assetout In the,foreg.oi g petition, . X including or 0 not including responses to day to day staff
inquires.
3. That the foregoing and following pages 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.
Iris Escarra, Esquire
Applicant(s) Name Applicant(s) Signature
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE G
The foregoing was acknowledged before me this o day of
20 // , by Iris Escarra, Esquire
who is a(n) individual/partner/agent/corporation of a(n)
individual/partnership/corporation. He/She is personally knowairline or who has produced _
as identification and who did (did not) take an oath.
(Stamp) •
Signature
/o+Pav144> ., MARISOL RODRIGUEZ
1
= Notary Public - State of Florida
, 0,7 My Comm. Expires Sep 27, 2014 I
":7,64u,e,',S Commission # EE 30092
MIA 181,769,009v1 3-15-11
'EXCEPTION APPLICATION
'S;CLOSURE OF O WNERSHIP
List tie owners) 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 orpetition. 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.
Owner's Name(es)
organization
Greater Miami Boys Clubs Foundation, Inc. a Florida not for profit
Percentage of Ownership - See attached Exhibit "B" list of Board Members
Subject Property"Address(es)` approx. 2805 SW 32 Avenue See attached Exhibit "A" for Legal
Description ....:. ........•:.
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):
none
Owner(s) or Attorne Name
Legal Description(s):
,14.
ce-g��— ( of
Owner(s) or Attorda'ey Signatu
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing 'as ac . owledged before e this -2-0 day of AA e-C\
20 i l , by Ce. KK c�.,-. c �1 e le c�
a(n) individual/partne agent corporation of Bo s t 6,'r s Cw a(n)
individual/partnership/corporation. He/She is •ersonally know"o me or who has produced
as identification and who did (did not) take an oath..
(Stamp)
":RY FO94/ ARMANDO RODRIGUEZ-RUG
MY COMMISSION # DD 828603
EXPIRES: October 24, 2012
e �°
�OF FLU 8ondeiThruBodir Notary etNota Swims
who is
MIA 181,769,00903-15-11
Exhibit "B"
Boys & Girls Clubs of Miami -Dade
2011 Board of Directors
Officers
Olga Guilarte — Chiar
Larry Rentz — Vice Chair
Eric Poms — Vice Chair
Robert Kramer — Secretary
Peter Bermont — Treasurer
Barry Stein — Counsel
Executive Board
James Bernhardt
Charles Grey
Bertha Hamilton
Shawn Khosravi
Steve Marin
Raul Marmol
Randall Mckey
C. Fred Rebozo
Richard Sepler
Wendy Poe Whitmire
Directors
Benigno Aguirre
Richard Baker
Alan Berg
Matt Bernhardt
Thomas Bezold
Michael Cabanas
Gary Curry
Lana DeSimone
Joe Fernandez
Edward Gilhuly
Erasmo Guilarte
Clint Gulley
Louis Jolivert
Syd Josepher
Howard Master
Yuni Navarro
Robert Parks
Domenico rabuffo
Alex Rodriguez
Liana Rodriguez
Jeff Samas
Joseph Trabo
Ben Walker
Warren Zimmerman
EXCEPTION APPLICATION
LESSEE
I'S'`C=LOSURE OF OWNERSHIP
1st theowner(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 trusfs .and/or any ;other interested parties, together with their address(es) and
proportionate interestare requiredt ;Please supply additional lists, if necessary.
Qwner's Name(es) Mater,Acadeiy, Inc., a Florida not for profit organization
ercentage of Ownership:
.Subject Property Address(es) approx. 2805 SW 32 Avenue See attached Exhibit "A" for
Legal•Description
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):
none
ea. attached Exhibit "C" list of Board Members
A-db i o L. 2 CA j '& l c�-en4—
Owner(s) or Attorney Name'
iul� ILL Prcad c
Legal Description(s):
Owner(s) or Attorney Signature
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoin wa acknowledge before me this 16 day of
20 �l , by t Vim' a Wd t 1,.r ,
a(n) individual/partner/a��enticorporation of
individual/partnership c1 orN�oratio�n. He/She i
as identification and who did (did not)
GONZq -f'
\����111111
�.
(Stamp) <<.\ \MVssloN' <-'
('L'•
do #DD 965094 ; ,1c
/9�.4''y�876a:::U:dt`.�. t.V.e
�%Iill I1111 � O�\�,
who is
a(n)
r who has produced
MIA 181,769,009v13-'5-11
Exhibit "C"
HATCp._ ADLNU.4 IT C ,-�dl, -0`i1
Board of Directors
Roberto Blanch Chairman
Shanne Sadesky Vice Chair and Secretary
Juan Garcia Director
Elizabeth Nuevo Director
Chris Crousillat Director
, 05-2 06l14/2000 05:30:59pnn
11CA y'q'+NfY AMib
i'agt. I of
HSTrro rate. 0. L la THY HPiT htW. JUHe, FL,
af(I$ Jd1benturt.34ado this Slit day of Ikt7 A 7), 1.9 .
BETWEEN
C. R. WIi103, I5C.
a corporation
existing under the laws of the State of Florida baying ita principal place of
business ha the County of ids and State of Florida
and lawfully autbor.zed to ttsntsatt bt>sinan in the :State of Florida, party of the ii at part, and
MAXI BOYS' C2.41B POURD?_TIOf, a cor2oration not for profit
of the County of Dade _ sed State of 11'larida
porty __ of the aecorui part. WiTNESSET13:
That the said party of the drat, part, for sod In trnaddarsstion of the sum of_Tea.. _dollars
and ativ:r (rood and veylt .ole conei�arp,2_i4tJ$_.......
to it in hand paid by the Auld.part. oe the ee and left, the receipt whereof Ls hereby aclrnowl-
edged, has granted, bargained and cold to the said hart- _... of thesxond partite svcceaaors
tooter and aasigne forever, the lnitosring described hand esituate. tying and being in the County of
De -tie sari Ste.te of Florida, to-Frtt:
All of Block ^lev.e (A1) Gt rrn^^'P'!AI SIL R BT-177F,
a subdivision in the City of Miami, according to the plat
thereof recorded in Plat Book 14, e.t page 59 of the Public
Records of Dade County, Florida, tr.d
All of Blocky Twelre a2), Thirteen (23) and Fourteen
• 04) of COMRRCIAL 3II,v7B M,tl?? TH3RD SEcTIO11, sccordtng to
the plat thereof recorded in Plat Book- 33. at page 3, of the
Ynblic Records of Dade County, Florida.
This deed is given subject to any anti all restric-
tions, reservations, limitations crud etzetsentes of record.
Thi.t> deed iff 41110 given 4tubjeat to any and all out-
atendiht taxce except State ek Couuti which have been paid by
the Grantor to and inoludittg the Tear 1939 and are assumed by
the Grantee elt'Decquent thermto.
clad the aid party of the fast part dotaiaalreby fully warrant Os title to staid lead, sad wsli
doieud the same axabut' iaettl tdiftsss o idi puma 1th n orrer.
IN WM= WUREOP, f.€ila dale party of tbu gut Put but assail these
iatoeifltta to he clime! i:i its ssaass bJ iks juuper
IOW;#n{ fti corpolatat aid to be .affixed, st-
*d»dt tq It* i.tx*tary, the slay and year shore
srZtltl:tRt.
Pug(' 2 of 2
, 5-2 ()()l 14/ 2000 OS:30:59p iss
STATE OY FLORIDA,
MD=
I IfE1103Y CERTIFY, thzt _.2...4-3'4_f/aly Nay A. D. 1.
C. R. 1.4170.03ISOT
bel0415 Penlecsi-R1 appaared
IMO)/ lalifficliCIS
and ..-Psealdtad.- and SanratarY ruTectiv*
12: . R. nvcs,
A corporati= wider the lawn of
Fl o rida
the 8tato of to no baoana to bo We pax 10,o ziirrod tbe foto.
¥o4r in atronacnt an mach cificcra end nostraliy a.airocradagari the corecutIon therm/ to be 'War iron
'• act =I deed an such oiricars fox Ws osta and ra-prory /dwarein. rapadoned tagi. tbAt OUT latAtsa
tbaroto ill* °facial teal of sea corporation. anal that lite Szld inatrament it tbo cd and deal of
aaid corporation..
WITNESS my rianarare and arida) roe at---. VO•tx=1,
in the Coanty of red e ,N1 litcto . Florida,
. ..
WA day rod year lata aforosaid.12 •:... . :?.! ,,,,,,,,,
i-r-
--,/ erilwo.
my cc....46. s- A pira.t__ —.1914.-0 St OA.* of Florida, at
licory % : • ,-- 1,-,a,
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.....;',., I • .1 S
m xyl ral lig 7:
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• • :A.A'.Y.t..>
5
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est • s 1. s'rd •s.r s ss• •
s• 4 A s -.4,iifa'sig.'"4,0D,Pf.' •
• A-7.
`"11
Exhibit "A"
tCC�� GESt't.
'ElOCS Ctua !�5.0.?xi' ucr.otdog Co titc< plot lttcro
acocdttj 111 Mot Bcrc.k S&. FLIc e i) ci LriY
Woo-1i Cade c:Octr1t7, V)ark+a_
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, whetherdirect 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 Name)
(Middle) (Lass Name)
(Address Line 1)
(Address Line 2)
STATE: ZEP:
HOME PHONE: CELL PHONE: FAX:
EMAIL:
BUSSIN,ESS or APPLICANT or ENTITY NAME
Greater Miami Boys Club Foundation, .Inc. a Florida not for profit organization
BUSINESS ADDRESS: 2805 SW 32 Avenue
(Address Line 1)
Miami, Florida
(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.
Approval of an exception for a school for property located at 2805 SW 32 Avenue; Miami, Florida
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 J 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.
Alf
5. Describe what is being requested in exchange for the consideration.
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 SUBMITTING DISCLOSURE: /
Sig y
//X 7?4&'
Pr ame
�f
Sworn to and subscribed before me this 2 0 day of IA k cti‘ , 204 i . The foregoing
instrument was acknowledged before me by Ace)(Tao 'e; v c z - ` , who has produced
as identifrcation and/or i personally known o me and vho
did/did not lake an oath.
STATE OF FLORIDA
CITY OF MIAMI ( 7-----; ''
MIS CD•kI IJS M9NDO RODRIGUEZ-R Notary
E rah; * MY COMMISSION # DD 828603
- Ta
s�, —EXPf EFTS-. October 24, 2012 ‘2/(.4P%A$ 0 0 dam . h
'
,
4'of'Le aors*:ThruliucluitNAIRSWIM Print Name
Enclosure(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 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 giant 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 Name)
(Middle) (Last Name)
(Address Line 1)
HOME PHONE:
EMAIL:
(Address Line 2)
STATE: ZIP:
CELL PHONE: FAX:
BUSSINESS or APPLICANT or ENTITY NAME
Mater Academy, Inc.
BUSINESS ADDRESS:
7901 NW 103 Street
(Address Line 1)
Hialeah Gardens, Florida 33016
(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.
Approval of an exception for a school for property located at 2805 SW 32 Avenue, Miami, Florida
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
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.:865A3
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. i� 1 I
b.
c.
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration. h
5. Describe
what is being requested in exchange for the consideration.
I hereby
Ordinance
or civil penalties
disclosure
PERSON
ACKNOWLEDGEMENT
acknowledge that it is unlawful to employ any device, scheme
12918 and such circumvention shall be deemed a violation
that may be imposed under the City Code, upon
requirement Was not fully and timely satisfied the following
1. the application or order, as applicable, shall
effect; and
2. no application from any person or entity
considered by the applicable board(s) until
nullification of the application o order.
SUBMITTING DISCLOSURE:
OF COMPLIANCE
or artifice to circumvent the disclosure requirements of
of the Ordinance; and that in addition to the criminal
determination by the City Commission that the foregoing
may occur:
be deemed void without further force or
for the same issue shall be reviewed or
expiration of a period of one year after the
A N 1b N t p L.
'�
Signature
_n
RbCc Pf S�Ck-Qi1/l.�" #Teiz A- C A GQ-e ALI,
to and subscribed beJbre me this CO deg: o
rint Name
Sworn
instrument
'_ " , ?0Q__�. The joregoing
was acknowledged heJhre me by �t • . l''_ ,� , who has produced
as identification and/or is
personally known to me and who did/did ttlfilOH ,path.
GYM .tt,�: ����'�1�4 'oj,9 • /.
- 1.) k • Y ?4 0 •: -c
STATE
CITY
MY
EXPIRES:
Doc. No :865A3 Enclosure(s)
OF FLORIDA
OF MIAMI
COMMISSION
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