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Juan Espinosa - 120 Ocean Drive, LLC �b MIAMIBEACH r City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 3313 AM 10� Z I LOBBYIST REGISTRATION FORM C I T .t, C L L `r" U F F = 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. Espinosa Juan NAME OF LOBBYIST: (Last) (First) (M.I) David Plummer&Associates 1750 Ponce de Leon Blvd., Coral Gables Florida 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)447-0900 (305)444-4986 Juan.EspinosaCa�dplummer.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: I. LOBBYIST RETAINED BY: 120 Ocean Drive, LLC . NAME OF PRINCIPAUCLIENT: 120 Ocean Drive, LLC-2675 S. Bayshore Drive, Coconut Grove, FL 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)416-4556 (305) 377-3040 DMartin @terragroup.com 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:David Martin • 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,including,but not limited to Historic Preservation Board and Planning Board approvals for modifications to design and robotic/mechanical parking for the property located at 120 Ocean Drive,Miami Beach,FL Issue to be lobbied(Describe in detail): Ill. 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 relationshi . Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Tanning Department and Building Department Staff None PB, DRB, HPB, BOA, FP, City Commission, as None ecessary* Pursuant to City Code Section 2-482(g) Every registrant shall be required Pursuant to City Code Section 2-482(8) 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 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc / S IV. 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): (Required). 1 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 pendina bid for goods,ea ant or services.or on a present or pending award for goods.eauipment or service? 2) Pursuant to Miami each City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes X Noe Are you lobbying on a pendina application for a Development Agreement with the City or application for change of: . map desianation or chanae 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 X No: Are you renresentina 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 COMPENS THE CITY OF MIAMI BEACH EM THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyis 1 do solemnly swear that all of the foregoi acts tr a and correct and tha/have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach Ci C de tl reporting requirements. Signature of Lobbyist: �- Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification Personally known obbyist) Personally known (Principal)VII. ROSARIO R.BERUVIDES " " SANDRA RAMOS NOTARY: Notary Publk'State of Florida ``` •g MY COMM.Expires Nov 21,2015 _* � Commission#EE 178548 Commission#EE 137323 My Commission Expires State of Florida, County f t d�ondedTAtougAltattionslNotxyAssn '��70;�� to of FJ�p ,3�u»t�lo6 Miami ade Sworn t and subscribe This O `1 2012 - T ' 3d , 2oa�13 Sin ure of Public Notary–State of Florida atu e f P =signature State of Florida Nota ization of Lobbyist's signature No ari ation of TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [V/1 Yes[ ]No Amount Paid$ MCR# fZl ate Said 9/ 10 1/7 Lobbyist Registration Form received and verified by: ® 101 AAA IBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139.www.miamibeachfl.gov CITY CLERK Office CityClerk emmiam1beachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Juan Espinosa 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 suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade C my Commission on Ethics and Public Trust. Signature- Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1.CORPO TION If the property which is the subject of the application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s)(natural persons)having the ultimate ownership interest in the entity).* 120 Ocean Drive,LLC 2675 South Bayshore Drive Coconut Grove FI.33133 CORPORATION NAME and ADDRESS NAME,ADDRESS,AND OFFICE %OF STOCK Terra 120 Ocean Drive Investments LLC 100% 2665 S.Bayshore Drive Suite 1020 _ Coconut Groue,FL 33133 Terra 120 Ocean Drive Investments LLC 2665 South Bayshore Drive Ste 101OCoconut Grove FL 33133 NAME,ADDRESS,AND OFFICE %OF STOCK Terra 120 Ocean Drive LLC 100% 2665 S.Bayshore Drive Suite 1020 _ Coconut Grove,FL 33133 Terra 120 Ocean Drive.LLC 2675 South Bayshore Drive Coconut Grove,FL 33133 CORPORATION NAME and ADDRESS Pedro Martin Managing Member 50% 2675 S.Bayshore Drive Coconut Grove,FL 33133 David Martin,Member 50•� 2675 S.Bayshore Drive „ Coconut Grove FL 33133 IF THEREAREADD177ONAL CORPORATIONS,LIST OTHERS,INCLUDING CORP.NAMES)AND EACH IND V DUAL'S NAME,ADDRESS,OFFICEAND PERCENTAGE OFSTOCK,ON A SEPARATE PAGE. NOTE,Notarized signature required on page 8 6