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Jennifer McConney - CG Sunny Isles, LLC MIAMI BEACH 6 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. McConnev Jennifer NAME OF LOBBYIST: (Last) (First) (M.1) Kobi Karp Architecture 2915 Biscayne Blvd, Suite 200, Miami FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 573-1818 (305) 573-3766 info(a)kobikaro.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: CG Sunny Isles, LLC, CG Sunny Isles I. LLC. & CG Sunny Isles II. LLC—Joseoh Chetrit& Meyer Chetrit, Managers NAME OF PRINCIPAUCLIENT: Same 2915 Biscayne Blvd, Suite 300, Miami FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)747-6408 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: Joseph Chetrit and Meyer Chetrit,Managers and Authorized Signatories • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached. II.SPECIFIC LOBBY ISSUE: Development approvals and permitting issues for one hotel project located at 2000 &2030 Park Ave, 2035 Washington Ave. 425 &43520` Street. and 430 21st Street Issue to be lobbied(Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2482(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 relationshi . Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES I NO title of person to be lobbied Staff of Planning Department, Building Department,and Public Works None X Department PB, HPB, BOA,City Commission,as necessary* None X Pursuant to City Code Section 2482(g)Every registrant shall be required to state the extent of,aPy.tiy s financilaI far�►ilial or professional relationship,or other relationship giving rise to an appearance of an impropriety,with any curreNt�city�--co?nmrssionli- city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. r Sec 2-482(g)Any Financial, Familial or Professional Relationship None d . d *Unless an Issue Is legislative in nature,PB,HPB,BOA,&City Commission members are not lobbied outside of a public hearing setting. r/ C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): n- / (REQUIRED). per /%—U pr The following Information must be answered: 1) Pursuant to Miami Beach City Code Section 2488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes X No: Are You lobbvina on a present or pending bid for goods.eauloment or services,or on a present or pending award for goods.eauloment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled'Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbvina on a bending application for a Development Agreement with the City or anplication for change of zoning man designation or chance to the CitVs Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482(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 X No; Are you representing a not for profit corporation or entity without special compensation or reimbursement V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 gEpOgTINp r nature of Lobby t 1 do solemnly swear that all of n fac are true an orrec nd tha have�rad/or/m familiar with the provisions contained in Section 2-482 of the Miami Beach Ci nd all re orting regwremenis Signature of Lobbyis �Ignature of PdncipaUCll VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _Produced ID Notary Puaic state of Florida Produced ID .Form of Identifi t' MI C Mamues Form of Identification ��o�ir�iotstsetas Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF n. .". State of Florida,Coun of Miami-Dade JEANINE RODRIGUEZ Swom subscribed befor me tale of Florida,County of Miami-Dade otary Public-State of Florida wo and subscribed b fore me This y u 2012 yCammiss oo#sDD 85176213 is_day of X2012 Signat e o u is Nota —State of Florida Signature Public No ary—State o •lorida Notarization o signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S TAFF ONLY Annual Registration fee: Yes I I No Amount Paid$ ]-LO MCR It S Date Paid Lobbyist eg s ra on Form received and verified y: C:1 UserslclerhaUXAppDatalLocaiNicrosoft\Windows\Temporary Internet Files\Content.Outlook183LGQDDH1Lobbyist Registration Formrevised 5-30-2012.doc EE ii Istration Form.doc Revised 04/27/2012 MIAMBEACH City of Miami Beach, 1760 Convention Ccntcr Drive,Miami 13cack Florida 33139, %%�v%v.miambeach0.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerkCmiamibeachfl.sov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Jennifer McConney I -understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, 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 Statements) 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 suspended from lobbying until all fines are paid, unless the fine has been appealed mi a County Commission on Ethics and Public Trust. " L' 2-7 / 2__ igrlature: ate: CA Users1derhatKAppData lLoca1W,1crosoft\Windows\Temporary Internet Fllesl Content:Outlook183LGQDDH1Lobbyist Registration Forrnrevised 5-30-2012.doc EXHIBIT B DISCLOSURE OF-INTEREST NAME OF INTEREST HOLDER % INTEREST 1. CG Sunny Isles,LLC,a Florida Limited Liability Corporation 51% 3200 Stirling Rd Hollywood,FL 33021 Judah Chetrit,Manager 100% 3200 Stirling Rd Hollywood,FL 33021 2. CG Sunny Isles I,LLC,a Florida Limited Liability Corporation 20% 3200 Stirling Rd Hollywood, FL 33021 Joseph Chetrit,Manager 100% 3200 Stirling Rd Hollywood, FL 33021 3. CG Sunny Isles H,LLC,a Florida Limited Liability Corporation 29% 3200 Stirling Rd Hollywood,FL 33021 Meyer Chetrit,Manager 100% 3200 Stirling Rd Hollywood,FL 33021 TOTAL for Applicant 100% e