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Joaquin E. Vargas - 2912 Collins Avenue, LLC (—MIAMI BE H � ► �� City of Miami Beach Office of the City Clerk l� 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. Varaas Joaauin E. NAME OF LOBBYIST: (Last) (First) (M.I) Traf Tech Engineering 8400 N. University Drive, Suite 307 Tamarac Florida 33321 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-582-0988 954-58g2-0289 ioa i r ec b' TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. - I. LOBBYIST RETAINED BY: 5 2912 Collins Avenue, LLC NAME OF PRINCIPAL/CLIENT: 1065 Kane Concourse, Suite 201 Bay Harbor Islands FL 33154 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) X305) 866-7555 (305) 866-7515 robertnafinvarb.corn 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: Robert Finvarb • 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 approvals for the p. opertu located at 2912 Collins Avenue,Miami Beach. FL Issue to be lobbied(Describe in detail): III. 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 Contractual Relationship(Explain) YES NO title of person to be lobbied Tanning Department and Building Department Staff one B, DRB, HPB, BOA, City Commission, Land Use None Development Committee, as necessary Fyone 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 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 None A None 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required):_$ ©�1 v B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (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 X No: Are you lobbvina on a present or pending bid for goods,eauioment or services.or on a present or gig award for goods,eauioment 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 lobbying on a pending application for a Development Agreement with the City or application f2E change of zoning map designation or change to the City's 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 Xo• not-for-profit co r ent8ly without special compensation or reembursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SH SUBMIT TO THE CITY CL Lf A Qlt%_K1C MNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS COMPENSATION R TY OF MIAMI BEACH EM THE PRECEDING CALENDAR YEAR, A%STA iNT SHALL BE FI �EN Ir THERE H"E BEEN No EXPENDITURES OR Signat a of kirements. I do solemnly swear that all of th foregoing facts are tru a hat I have read In familiar with the provisions contained in Section 2-482 of the Miami B ch City Co de II r po n r Signature of Lobbyist: 1 Signature of Principal/Client: VI. LOBBYIST IDENTIF I ATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID co Form of Iden _.__ L Form of Identification `.�1fY PLC i vV3,` H,f.I\:1 . Wjj T-- }r 1:� .� , .li SW Personally known(Lobbyist) =*�: "��:` �; ;.,�.�:r-, :_;,:_, Personally known(Principal) ''�,°fr.•' 6;.nc��l,n,Pl o�:,,yFu1;��cUrr!:;n.r''�ra-1 ���4. VII. SIGNATURE AND STAMP OF State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade , Sworn to and subscribed before me Sworn��n,,d�subscri ed bef re a This _day of Jv/ 013 This -"bay of ,2013 Sig "ureublic N t -State of Florida Signature of Public Notary-State of Florida No rization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Anmal Renestrateon fee- E I Yes E I No Amount Paid S MCR 9 Date Paid Lobbyist Registration Form received and verified by: F:\CLE istration Form.doc Revised 04/27/2012 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerknmiamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME Joaquin Vargas 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 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 to yist, who fails to file the required Statement by April 30th, 2012, shall be automa cally suspended from fobbying until all fines are paid, unless the fine has been appeale to the Miami-Da e C Commission on Ethics and Public Trust. Sig atur Ofate r CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1.CORPORATION 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).* 2912 Collins Avenue,LLC, a Delaware Company 1065 Kane Concourse,Suite 201,Bau Harbor Islands.FL 33154 CORPORATION NAME and ADDRESS NAME,ADDRESS,AND OFFICE %OF STOCK RIF 2912,LLC 100% 1065 Kane Concourse,Suite 201 Bau Harbor Islands,FL 33154 RIF 2912 LLC 1065 Kane Concourse,Suite 201,Bau Harbor Islands,FL 33154 Robert F nvarb Family Investments 100% 1065 Kane Concourse,Suite 201 Bau Harbor Islands,FL 33154 Robert Flinvarb Family Investments 1065 Kane Concourse,Suite 201,Bau Harbor Islands,FL 33154 Robert and Rochelle Finvarb.Manaoina Members 100%as 1065 Kane Concourse,Suite 201 tenants bu the entiretu Bay Harbor Islands,FL 33154 Seville Acquisition,LLC 10400 Fernwood Road,Bethesda,Maruland 20817 Courtuard Marriott Corporation 100% 10400 Fernwood Road Bethesda,MD 20817 Courtuard Marriott Corporation Marriott International.Inc. 100% 10400 Femwood Road Bethesda,MD 20817 Marriott International,Inc. Marriott Intemational,Inc. 100% Marriott Intemational.Inc,is a publiclu traded companu under the symbol MAR on the New York Stock Exchange. If THERE ARE ADDIITONAL CORPORATIONS,LIST OTHERS,INCLUDING CORP.NAMES)AND EACH BVDMDUAL S NAME,ADDRESS, OFFICEAND PERCFNTAGEOFSTOCK, ON SEPARATE PAGE. NOTE.•Notarized signature required on page 8 6 -.g - j Z — _ l+ - +.� �i•-f �w "yam - - �1 'R,? J — st lu ca Li-