Angel Fabres - Foxhole Bar, LLCA `�¢r f I)
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
110Pri tiAig 1014
2012 ifiv? 27 ,‘af
4
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Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City
Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time period of the
entire decision - making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city
commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435.
Fabres Angel
NAME OF LOBBYIST: (Last) (First) (M.I)
Foxhole Bar, LLC 5151 Collins Avenue, Suite 321, Miami Beach, Florida 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 851-1525
N/A a @smacent.com
TELEPHONE NUMBER:
FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
LOBBYIST RETAINED BY:
FOXHOLE BAR, LLC
NAME OF PRINCIPAL /CLIENT:
FOXHOLE BAR, LLC 1426AALTON ROAD, MIAMI BEACH, FLORIDA 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(305) 851-1525
TELEPHONE NUMBER:
(State)
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2 -482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Jason Cochran, Manager
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See Attached Exhibit "B"
ii.SPECIFIC LOBBY ISSUE:
Application for conditional use approval for a neighborhood impact establishment, consisting of an alcoholic beverage establishment, also
operating as an entertainment establishment, with an occupancy of more than 199 persons, at 1426A Alton Road aka 1218 14th Court).
in. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of Individual and
title of person to be lobbied
Contractual Relationship (Explain)
YES
NO
City of Miami Beach Planning Board
None
X
City of Miami Beach Planning Director /Staff
None
X
City of Miami Beach Mayor and Commissioners
None
X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)
No additional compensation for lobbying
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): No additional compensation for lobbying
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2 -488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
Issues".
❑ Yes No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or pending
award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues ":
❑ Yes INo: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code 2 -484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481 above) who only appears as a representative of a not - for - profit corporation or entity without special
compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
item, s all register with the clerk as required by this section but, shall not be required to pay any registration fees.
❑ Yes No: Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUB
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPE
THE PRECEDING CALENDAR YEAR. A STATEMENT Sb1ALL BE F
COMPENSATION DURING THE REPORTING PERIOD.
TO THE CITY CLERK A SIGNED STATEMENT UNDER
TION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
Signati of Lob yist
I do solemnly swear that all of the foregoing fa are true and correc and that I have read or am familiar with the provisions contained
in Section 2 -482 of the Miami B City Cod d all reporting requirements.
Signature of Lobbyist:
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION:
`1
r
roduced ID f LtTiZelp t% ✓g5 C.tc
(((((( Form of Identification
❑ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade
Sworn to and subscribed efore e
This 197 yay of j ee'C4 , 2019
Signature Public Not - — State of Florida
Notarizat•n of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
/115Produced ID �G
Form of Identification
❑ Personally known (Principal)
State of Florida, County of Miami -Dade
Sworn and subscribed efor e
lies (27 da of _ 4 I 201?—
Signa re of Publ'' NNt6ry — State of Florida
Nota ization of ° rincipal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ }'Yes [ ] No Amount Paid $___}757).O?) MCR #
Lobbyist Registration Form received and verified by: 7:5)46 '21(
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WI ?•al'ORiIS� LO aST'OR S\LobbyistAnnualRegiistratio For.€i,do t i
Date Paid C3 P" 2-
Revised 1/11/2011
=orm.doc Revised 1/11/2011
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME:
L5& Czie)05
I understand that no later than February 28th of each year, I must file the following
form, pursuant to Section 2 -485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure and Compensation Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami -Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2 -485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addition to any other penalties which may be imposed as
provided in Section 2- 485.1, a fine of $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami -Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically sus- . -nded from lobbying until all fines are paid, unless the fine has been
appealed to th -•mi -Dade County Commission on Ethics and Public Trust.
3Z
Signat V : date:
F: \CLER \$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
o Cash
0, Credit .Card
Received of
Address
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Tick i ., t,, t . E' `7 . 3t5403 c b4.,,:... wv;'-5•13 „.00. •
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HIS INFORMATION MUST BE COMPLETED)'
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Preparers Lr. A.� ; r ' Dept:
ffice of Finance Director`
EXHIBIT `B"
DISCLOSURE OF INTEREST
FOXHOLE BAR, LLC
Name and Address % of Ownership
5151 Entertainment, Inc.
5151 Collins Avenue, Suite 321
Miami Beach, Florida 33140
Angel Fabres 50%
5151 Collins Avenue, Suite 321
Miami Beach, Florida 33140
Conrad Gomez 50%
5151 Collins Avenue, Suite 321
Miami Beach, Florida 33140
BD Equity, LLC
1000 Lincoln Road, Suite 200
Miami Beach, Florida 33139
Brian I. Gordon 50%
1000 Lincoln Road, Suite 200
Miami Beach, Florida 33139
David Gartman 50%
1000 Lincoln Road, Suite 200
Miami Beach, Florida 33139
Black and Yellow Management Group, LLC
524 Woodhaven Court
Pittsburgh, Pennsylvania 15209
Joe Lopez 50 °/u
524 Woodhaven Court
Pittsburgh, Pennsylvania 15209
Jason Cochran
524 Woodhaven Court
Pittsburgh, Pennsylvania 15209
Jay Coc Entertainment, LLC
524 Woodhaven Court
Pittsburgh, Pennsylvania 15209
Jason Cochran
524 Woodhaven Court
Pittsburgh, Pennsylvania 15209
Chatani Ventures, Inc.
401 W 30 '' Street
Miami Beach, Florida 33140
Navin Chatani
401 W 30°i Street
Miami Beach, Florida 33140
Fortune 51, LLC
2799 NW Boca Raton Boulevard, Suite 203
Boca Raton, Florida 33431
Jonathan Vilma
2799 NW Boca Raton Boulevard, Suite 203
Boca Raton, Florida 33431
L
50%
100%
100%
100%
49.5%
18.5%
20%
4%
5%
3%