Matthew Amster - Baoli Miami, LLC e MIAMIBEACH ,,, v iaC - e ms
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 includes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435.
Amster Matthew
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow, Radell & Fernandez, P.A. 200 S. Biscayne Blvd., Suite 850 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377 -6236 (305) 377 -6222 mamsterCalbrzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Baoli Miami. LLC
NAME OF PRINCIPAL/CLIENT:
999 Brickell Avenue. Suite 600 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 965-7881
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: Paul Jarquin, 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:
Redevelopment and conditional use permit approvals concerning 1908 Collins Avenue
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
J' AJO S, ,;:! 13 A113
03 :11 WV 8- AOW OIOZ
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting. /
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) $ 285.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 285.00 aer 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 ":
ID Yes X No: Are you lobbying on a present or pending bid for goods. equipment or services, or on a
present or pending award for goods, eauioment or service?
2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues ":
pYes X No: 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..
• p Yes X No: Are you representing a not- for -profit corporation or entity without special compensation
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, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. litifer4°C'
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2 -482 of the Miami Beach City Code and all reporting
requirements. ,OFF;7--------
Signature of Lobbyist:
Signature of Principal /Client: -
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
V known (Lobbyist) ersonally known (Princi
? � ° tit Notary Public State of Flonda
Mitchell S Polansky
VII. SIGNATURE AND < My Commission DD770240
?iA CRISTINA D. GONQ�ILQ ov 0 ,o" Expires 04/02/2012
I, ,., = MY COMMISS b DD 960888
State of Florida, County of M - S to of Florida, Cou ty of
: . - g E XPIRES: March a 2014
Sworn to and subscribed bef •e : , � Bonde Thru Notary Public undernriter5S orn and subscrib � • bey
This 2 0-tie, - day of how. s 9 ° \ day of t.:1 ivi7f•! "f
c - wr-lior---
Signature of Public Nota — St a of FeSrida Signature of Public ota — e o lorida
Notarization of Lobbyi' s signature Notarization of P "no > l's r re
FOR CLERK' USE ONLY
Annual Registration fee: [ Yes [ ] No Amount Paid 0 1 - MCR # ;Ac7i2 l Date Paid f ( l f i)
Lobbyist Registration Form received and verified by: .1 - I tered By:
F: \CLER\$ ALL \MARIA -M \Lobbyist \LOBBYIST fORM 05.doc ; n ' ' Revised 12/08/04
fr Nw?
I A i\A B E AC H
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: frl 4h--i ,4yti S-er
Februcoi 2
I understand that no later than eePPober - 1,st of each year, I must file the following
forms, 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 Form
2) Disclosure 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.
/072:?//
Signature: Date:
F:\CLER\LOBBYIST \Lobbyist Registration Form 32708.doc
EXHIBIT B
DISCLOSURE OF INTEREST
for
Baoli Miami, LLC
999 Brickell Avenue, Suite 600
Miami, Florida 33131
NAME OF INTEREST HOLDER % INTEREST
1. Baoli America Group Corp., a Florida Corporation 50%
Christophe Caucino, President
1504 Bay Road, Apt. # 1117
Miami Beach, Florida 33139
a. Christophe Caucino 50%
1504 Bay Road, Apt. # 1117
Miami Beach, Florida 33139
b. Pierre Antoine Navarro ; 50%
27 Blvd Mont Fleury
06400 Cannes - FRANCE
TOTAL for Baoli America Group Corp. 100%
2. JPRE, LLC, a Florida Limited Liability Company 50%
REI Holdings, Manager
999 Brickell Avenue, Suite 600
Miami, Florida 33131
a. REI Holdings, a Florida Fictitious Name 50%
Paul Jarquin, Owner
999 Brickell Avenue, Suite 600
Miami, Florida 33131
i. Paul Jarquin 100% r •
999 Brickell Avenue, Suite 600
Miami, Florida 33131
TOTAL for REI Holdings 100%
b. MIG US, LLC, a Florida Ltd. Liability Company 50%
Mathieu Massa, Manager
1504 Bay Road, Apt. #916
Miami Beach, Florida 33139
i. Mathieu Massa 100%
1504 Bay Road, Apt. #916
Miami Beach, Florida 33139
TOTAL for MIG US, LLC 100%
TOTAL for JPRE, LLC 100%
TOTAL for BAOLI MIAMI, LLC 100%
Y
a; a i TM
X .4 .
04. ID 10
O
m D S .
N
_ n
O r :"
''`s: a fi r , ' a !
. A -. _ '?
2
\ ...'1 .‘ N : "NO :iii Li -. k.,'
5 c �.. •
a p,a ;
• a».
H j i t a .. •
- - : :.9 - - ,,,, ., . ,..5 ; : :1-... ...: _ : ki kil : s4.. 0 .. ,-. 0 . :
1
•