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Kobi Karp - Hans Bhojwani All AM I B,EAC H lb Vol 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. Karp Kobi NAME OF LOBBYIST: (Last) (First) (M.1) Kobi Karp Architecture&Interior Design, Inc., 2915 Biscayne Blvd, Suite 200, Miami, Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 573-1818 (305) 573-3766 kobikarn(k:obikarx�.corm. TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify his office if our contact information changes:address hone or e-mail address. Y Y 9 �P I. LOBBYIST RETAINED BY: Hans Bhoiwani NAME OF PRINCIPAUCLIENT: Manhattan House, Inc., 1655 Washington Avenue, Miami Beach FL 33139 BUSINESS NAME AND ADDRESS(Number and Street) (City) (State) (Zip Code) 786-216-2161 h.a.nsbhoiwani aama.i.l.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: Hans Bhojwani • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See the attached. II.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Review Board, Planning Board, Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 1651 Washington Avenue, Miami Beach, Florida. 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 Planning Department and Building Department Staff None PB, HPB, BOA, City Commission, and Land Use None Development Committee, as necessary 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 Rgrsonnel ho Is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial, Familial or Professional Relationship i_iy None %is V1 J None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required): �s1-I�p,DD 11F h�r- B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): _ -126— �F �v l ��J1•( (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 en nding bid for goods,equipment or services.or on a present or 22nd=award for goods.eaui0ment 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 lobbydpg on a pending a®plication for a Development Aareement with the City or a012lication 12L change of zoning ma0 designation or chance 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 X o: Are you representing a not-for-0rofit corgoration or entity without s0ecial com0ensation 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, Signatu I do solemnly swear that all of the foregoing facts are true and correct and that a read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Cod met#' equirements. Signature of Lobbyist: Signature of Principal/Client: I 4�a VI. LOBBYIST IDENTIFICATIO PRINCIPAL IDENTIFICATION: r° N 3 q f0 Produced ID Produced ID z o Form of.Identification Form of Identification Q Personally known(Lobbyist) a Z" Personally known(Principal) a Uj m d C VII. SIGNATURE AND STAMP OF NOTARY: = fix ' State of Florida, County of Miami-Dade > State of Florida, County of Miami-Dade Sworn to and subscribed before me 2 Sworn and subscribed before me This a-"T' day of , 2014 •°°:�: ;, This day of ,2014 nature of Public Notary–State of Florida . '�� Signatu a of a – tate of Florida Notarization of Lobbyist's signature Notarization signature TO BE COMPLETED BY CITf_.CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# C� �7 Date Paid / Lobbyist Registration Form received and verified by: istration Form.doc Revised 04/27/ Cityof Miami Beach, 1700 Convention Center Drive, Miami Beach., Floi-ida33139,lvvr"lw.mi�iniibeachfl.govI CF1'Y CLERK Office Rafael E. Granado, City Clerk CiIyClerk wmiami eac=htLoy Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Kobi Karp 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 lobbyist, who falls 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 a County Commission on Ethics and Public Trust. --S-ignature Date i JGB BANK V5973 BISCAYNE BRANCH 1920 BISCAYNE BOULEVARD MANHATTAN HOUSE, INC. MIAMI,FLORIDA 33132 63-634/660 1001 1655 WASHINGTON AVENUE MIAMI BEACH,FL 33139-3106 03/26/14 PAY TO THE CITY OF MIAMI BEACH DRDER OF I a� **700.00 s Seven Hundred and DOLLARS ` CITY OF MIAMI BEACH 1700 Convention Center Drive . Miami Beach FL 33139 4 4EMO ff c u�OOS973110 '406E0063491:003 LSqS3406Ijl L CD ` N m i ML LLI 0 t CL LL, ti ' U �t. J i ++ ` CL ' CL .0 2 .r �IZ Cf .; W 0! V o ` v d O ca m to , ❑ ,ovL c o u. Q a`