Michele Busiri - Vici - Park Central Partners, LLC _ MIAMI BEACH
+
y
City of Miami Beach Office of the pity Clerk ZD
1700 Convention Center Drive, Miami Beach, FL 33139 14.A?y 17 P
LOBBYIST REGISTRATION FORM �,j ( } +
,h.
z...�,� S ul.f f fi
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, d4feat 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.
Busiri -Vici Michele
NAME OF LOBBYIST: (Last) (First) (M.I)
Space 4 Architecture 22 E. 21 Street, Suite 8F New York New York 10010
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 253-7095 mby(cD-space4architecture.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information.changes:.address, phone, ore-mail address.
I. LOBBYIST RETAINED BY:
Park Central Partners, LLC
NAME OF PRINCIPAUCLIENT: CJ
640 Ocean Drive Miami Beach FL 331;j� D
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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:Ricardo Tabet
• 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 Board Approvals for Properties located at 626-650 Ocean Drive,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 None
B, HPB, BOA, DRB City Commission, as necessary* None
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
N/A
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) 4
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 lobbying on a present or pending bid for woods,equipment or services,or on a present or pending
award for goods,equipment 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 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.
Yes X No: Are you representing 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 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.
Vol 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.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID U�-'`V'{ L,��Pc Pj Produced ID
Form of Identification Form of Identification
Personally known(LobbyLs1A(Lobby' Personally known
NElL SCHNEIDER
(Principal)VII. NOTARY PU6uCI S rt-� SIGNATURE AND STAMP OF
`. Registrzhen �E'v YORK
No.O 1 SC6065135
NOTARY: `. • ualified in
Corn Queens Co����
ion Expires Octoeer 9,2017
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to arLd subscribed b fore me Sworn and subscribed before me
This_ day of - l )3 This day of , 2012
-",/ /M,!�
Signatur of P blic Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee:1 ]Yes[ No Amount,Paid$ M C R# 1 Date Paid `
Lobbyist,Regi' ration Form receive and verified by:'
t
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):
RE UIRED
( .Q )
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_NO: Are you IobbXing on a present or pending bid for goods,equipment or services.or on a present or ending
award for aoods.equipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes_No: Are you lobbying on a pending application for a Development Aareement with the City or application for
change of zoning map desianation 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_No: Are you representina 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
EM THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
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.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID y Produced ID ]ft'�Qftj"
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal) $
s
VII. SIGNATURE AND STAMP OF NOTARY:
MZ&)
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade 3 m Q
Sworn to and subscribed before me Sworn a�d subscrM910 ,me A 3 M
This day of ,2012 T ' day of 201 2 y
IM
Signature of Public Notary—State of Florida Sig ture o Public Notary—State of Florida N
Notarization of Lobbvist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF.ONLY
Annual Registration fee:'.[ ]Yes[ ]No._: Amount Paid$ MCR.# Date Paid
Lobbyist Registration Forrn received and verified y:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
OD /\AIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,1Vfiami Beach, Florida 33139,www.mian*eachfl.go,
CITY CLERK Office C ityC le rk @m iamibeachfl.gov
Tel: 305.673.7411 , Fax 305.673.7254
LOBBYIST NAME: Michele Busiri-Vid
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 Clerks
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 County Commission on Ethics and Public Trust.
V N�� I z
Signature: Date:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Exhibit B
Disclosure of Interest
F rk Central
rtners, LLC
Optimum USA S8 Park Central, LLC Interfin Holdings, LP
Investments 4, LLC Ricardo Tabet Giorgio Borlenghi
Rodolfo Misitano 640 Ocean Drive 1400 Post Oak Blvd,
108 Sequoia Tree Lane Miami Beach, FL Ste 150
Irvine, CA 92612 Houston, TX 77156
10
i
- �-- -
E -
"°' .
Tl-
ji
y} f,
IN
v
X-4
$ +
LU
LU
CL
E � .
r. �, :.
ca
L T '� '
ti
yr '�!_
UL
m
ca
��t� Q u. v