Jason Cochran - Foxhole Bar, LLCCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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.
Cochran Jason
NAME OF LOBBYIST: (Last) (First) (M.I)
Foxhole Bar, LLC 524 Woodhaven Court Pittsburgh Pennsylvania 15209
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(310) 569 -6915 N/A jaycen @foxholebar
(Zip Code)
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 1426A ALTON ROAD, MIAMI BEACH, FLORIDA 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(310)569 -6915
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.SPEC.IFIC LOBBY ISSUE:
Application for conditional use approval for a neighborhood impact establishment, consisting of an alcoholic beverage establishment, also
I
operating as an entertainment establishment, with an occupancy of more than 199 persons, at 1426A Alton Road (aka 1218 14th Court).
ul.
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
None
X
City of Miami Beach Planning Director /Staff
None
..� .. ,. a
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 ox 9i,tyners.o gel who is
sought to be lobbied as identified on the lobbyist registration form filed. :11 I I ,_}
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
00 :1 1,1ci
LZ 8VW lin
None
..� .. ,. a
..... .� .... .,.3
5 �
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 Iobbyinq 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 ININo: 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, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
❑ Yes IVNo: 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 SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPE SA • N RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL $ytLE■ /VEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
I do solemnly swear that all of the
in Section 2 -482 of the Miami
Signature of Lobbyist:
Signature of Principal /Clie t:
VI. LOBBYIST IDENTIFICATION
Sig of Lobbyist
cts are true and correct and that I have read or am familiar with the provisions contained
de and all repo ' g requirements.
Produced ID
FD
Form of Identifi
❑ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF N
State of Florida, County of Miami -Dade
Sworn to and subscribed before me
This -k day of 14t)211 , 2012.
Signature of Public Notary — Stat of Florida
Notarization of Lobbyist's si ature
BRAD STEVEN FLEET
MY COMMISSION # DD816769
EXPIRES: August 21, 2012
1.800.3.NOThRY Fl, NOWY Pint Awoc. Co.
PRINCIPAL IDENTIFICATION:
L-I'Produced ID
FPL
Form of Identification
❑ Personally known (Principal)
BRAD STEVEN FLEET
, MY COMMISSION # DD816769
i EXPIRES: August 21, 2012
t- soaa- rv.:O ornRY Ntx fl. rry Oil6bUst Novo. Co.
State of Florida, County of Miami -Dade
Sworn and subscribed before me
This 2feirday o 1142 2012.
Signature of Public Notary — State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ A2S2 • MCR #
Lobbyist Registration Form received and verified by:
\CLERiSALL;a ORIvI5} LOBE YISTFORMS \Lobbyi tAnse?
Registration Fc rm.
Paid
Revised 1/11/2011
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 , Fax: 305.673.7254
CityClerk @miamibeachfl.gov
Jason Cochran
LOBBYIST NAME:
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.
3/26//Z.
Signat , e �- ate:
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 Grutman 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%
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°i 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
50%
100%
100%
100%
49.5%
18.5%
20%
4%
5%
3%
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