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Kobi Karp - Beta Epsilon`~. s ~~ Ml~r1~1I BEA~h~ ~ `~`'~ 3~z City 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 inc-udes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Karp Kobi NAME OF LOBBYIST: (Last) (First) (M.I) Kobi Karp Architecture & Interior Design, Inc. 2915 Biscayne Blvd., Suite 200 Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 573-1818 1305) 573-3766 infoCa kobikaro com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Beta Epsilon/Cadillac, LLC, contact: Dan Economos NAME OF PRINCIPAL/CLIENT: Beta Eosilon/Cadillac. LLC 4000 N Federal Hiohwav Suite 206 Boca Raton Florida 33431 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (561) 361-3918 (561)361-3945 TELEPHONE NUMBER: 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: Nicholas Economos, Manager • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit B II. SPECIFIC LOBBY ISSUE: New ground floor addition, including mechanical parking, at the Cadillac Hotel located at 3925 Collins Ave Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Planning Department Staff, HPB, BOA, Planning Board and City Commission* None r ts• , 9~l ~£ ~ - * ~ ~~~e« ~., ~~ I I ~ I sue s egis ative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting. ~~f~ t !II IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, , FLATRATEOROTHERf A) LOBBYIST DISCLOSURE: (Required) $ 500.00 oer hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 500.00 oer hour 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 X No: Are you lobbvina on a present or oendina bid for aoods, eauiament or services, or on a present or oendina award for aoods, eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes X No: Are you lobbying on a pending apulication for a Development Agreement with the City or aaplication for chanae of zoning man designation or chanae to the Citv's Future Land Use Mau? 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 anot-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 X No• Are you representing anot-for-profit corporation or entity without suecial comuensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDI CALENDAR YEAR A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITUR S N DURING THE REPORTING PERIOD. Si ature o obbyist I do solemnly swear that all of the fnrPQOing facts are true d co ect and that I have read or am familiar with the provisio ontained in Sec~1' n 2-482 of the ii Beach ity Code and all reporting requirements. Signature of Lobbyist: Signature of Principa VI. LOBBYIST Produced ID Form of Identification NPer~a known (Lobbyist) ;~~ o,F~o2~~9 5~`e,~$!)~~T AND STAMP OF NOTARY: t~~~aNo ~~~ ounty of mi-Dade ~~"""~~~ ~ subscr be efor me ?~a F~ ~ ~4 •~L ~ - da ' 20L y''a~Nff~i ignatur lic Nota o Floric No ation of Lobbyists signature IDENTIFICATION: ~'~` Ers.bh Ca]•Il~, C, Produced ID For dentification Personally known (Principal) ~°~ARY P~~~ DEBRA A. IIVINGSTON * MY COMMISSION # DD 687826 State of Florida, County of Miami-~ : EXPIRES: May 13, 2011 Sworn and subscribed before me 9~ ~oa~~O BondedihmBudgetNotarpserv~es This ~_da of T~ I y , 2 D~ r ~ vl • D~-/ Signature of Public Notary -State of Flori Notarization of Principal's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid Lobbyist Registration Form received and verified by: Entered By: F:\CLER\$ALL\MARIA-M\Lobbylst\LOBBYIST FORM OS.doc Revised 12/08/04 ~~ m~.rr City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 CityClerk@miamibeachfl.gov Acknowledgement of fines/suspension from lobbying for failure to comply with City of Miami Beach lobbying Laws LOBBYIST NAME: __ ~~~ I l~~P~ I understand that. no later than Oetober 1st of each year, lobbyists subject to lobbyist registration requirements shall submit to the city clerk a signed statement under oath listing all lobbying expenditures, as well as compensation received,. for the preceding calendar year with regard to the specific issue on which the lobbyist has been engaged to lobby. A statement shall be filed even if there have been no expenditures or compensation during the reporting period. The statement shall list, in detail, each expenditure by category, including. food and beverage, entertainment, research, communication, media advertising, publications, travel, lodging and .special events. - FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL -FINES ARE --- PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI-DADS COUNTY COMMISSION ON ETHICS AND PUBLIC TRUST. In the event .a lobbyist fails to either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust. IN ADDITION, ONCE AN ISSUE I HAVE REGISTERED TO LOBBY ON HAS BEEN RESOLVED, I AM REQUIRED TO IMMEDIATELY- NOTIFY THE CITY CLERK'S OFFI WITHDRAWAL IN WRITING. Signature: ~ Y to Date: EXHIBIT B DISCLOSURE OF INTEREST for Beta Epsilon/Cadillac, LLC 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 NAME OF INTEREST HOLDER - % INTEREST - 1. Stanley Daniel Economos 24.75% 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 2. Nicholas Economos 24.75% 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 3. Alexandra Yessios 35.00% 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 4. Chris Yessios 7.50% 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 5. George Bavelis 7,50% 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 6. Beta Epsilon/Cadillac, Inc. a Florida Corporation 0.50% 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 a. Nick Economos 100% 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 I TOTAL for Beta Epsilon/Cadillac, Inc. 100% TOTAL for Beta Epsilon/Cadillac, LLC 100.00%i