Loading...
Joaquin Vargas - 2901 JMH, LLC w 1 /V\I BEACH _.2161-11 Pd eel& 6(.vK, City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami BeachZNE 31 , 9) f l: 53 LOBBYIST REGISTRATION FORM CITY C U T 'S OFF C- C E 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. Vargas Joaquin • NAME OF LOBBYIST: (Last) (First) (M.I) Traf Tech Engineering, Inc. 8400 N. University Drive, Suite 307 Tamarac Florida 33321 BUSINESS NAME AND ADDRESS • (Number and Street) (City) (State) (Zip Code) (954)582-0988 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,ore-mail address. I. LOBBYIST RETAINED BY: ,Jason Halpern NAME OF PRINCIPAL/CLIENT: 2901 JMH, LLC 184 Kent Avenue, C706 Brooklyn New York 12249 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)374-5300 iason.Ca7imhdev.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: Ss ►j 1-6 I p-ern • IDENTIFY ALL PERSONS HOLDING,DIRECTLY,ppR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST INSJCHCORPORATiON, PARTNERSHIP OR TRUST: !iU 11VCh 'c II.SPECIFIC LOBBY ISSUE: - Development Board Approvals for 2901-11 Indian Creek Drive. Miami Beach. Florida Issue to be lobbied(Describe in detail): ill.CITY AGENCIESiINDIVIDUALS 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 monthiOpreceding 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 Staff,PB,HPB,BOA,DRB, Commission None X li 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 i C:IUserslclerhatllAppDatalLocaRMicrosoftlWindowslTemporary Internet Files1Content.Outlook183LGQDDHLLobbyist Registration Formrevised 5-30-2012.doc / IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required):$ 4 a ,o„ , o6 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):$ 2 �Uo,O© ,. (REQUIRED). f 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 Iobbvino on a present or pendinobid for aoolls.eau1onent or services.or on_a Dresent or Pending award for aoods.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 pendlna anniication for a DevelonmentAareement with the City or application for change of zonina map desianatlon or change to the City's Future Land Use Man? 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 reoresentina a not-for-profit corporation or entity without special compensation or reimbursement, V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR,EACH LOBBYIST SHAi ,,SUBMIT TO THE CITY CLERK = SIGNED STATEMENT UNDER OAJH. LISTING LOBBYING EXPENDITURES. AS WELL AS OMPENSATiON RECFIVFD i THE CITY OF MIAMI BEAChl QR ND THE TU 4 " t , 'PRECEDING DING CA ENDAR YEAR. A STATEM t T SHALL BE FILE r FVF'' IF THERE HAVE BEEN NO er.-- , ' SIgna - • obbyist • I do solemnly swear that all of 1:1 e foregoing facts a - . e : d • :ct and that I have read or familiar with the provisions contained in Section 2-482 of the Mia i-ach CittC••.- - :p.. n -.t rements. Signature of Lobbyist: III A Signature of Principal/Clie `�- Olt i VI. LOBBYIST IDEN 'i 1 ATION: PRINCIPAL IDENTIFICATION: I II q' I ffi ic31) '; Produced ID \f 7�-^�''-�" /--� Produced ID I (cr LI c&t, s Q.. ■ Form of Identification , Form of Identification t�ri 4 c n i ; CI. ' 8 , Personally known(Lobbyist) =Personally known(Principal) ;17 o Z E w i VII. SIGNATURE AND STAMP OF NOTARY: ' t4ewyorl< E State of Florida,County of Miami-Dade State of Flecida,County of Miaati-Bedesu <j Sworn to bscrib before me ;,m-'P'',AI� Sworn'arid subscribed before me 2 JOSHANA PATEL J This 27 day of ..4.--A ,2C1,...:,,,,.. ,,; .: MY COMMISSION#FF053408 /This 27 h day of �ri I ,2015 ,„ ,�,� O: / r P`: ••f of��,• EXPIRES September 11.201,�;r '� �/ lure of Public Notary—State of�r"i*E` "53 FloridallotaryService.cc&,g at e of P r c Notary—State of Flerida 1GW)'o rk Notarization of Lobbyist's signature `o • zation o principal's signature TO BE COMPLETED BY CITY CLERK'S ST F ONLY Annual Registration fee: [ ]Yes . No Amount Paid$ V Pr MCR# 'T 0 5 S Date Paid j� Lobbyist Registration Form rem! d and verified by: l v C:1 UserslclerhatllAppDatalLocallMicrosoft\Windows1Temporary Internet Files\Content.Outlook183LGQDDH\Lobbyist Registration Forrnrevised 5-30-2012.doc I F:\CLE istration Form.doc Revised 04/27/2012 I MIAMI BEAC City of Miami Beach, 1700 Convention Center Drive,Miami Beach. Florida 33139, 4 www,minmibeachfl.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk@miamibeachfl.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 '•bbyist, who fails to file the required Statement by April 30th, 2012, shall be auto atically suspended fr•m lobbying until all fines are paid, unless the fine has been appe;•led to the Miami-Dad Co my Commission on Ethics and Public Trust. Zq 15 Si•na ure: Dat ,\ Ii C:1 Usersl clerhatllAppDatalLocallMicrosoft lwindowsvTemporary Internet FileslContent.0utlook183LGQDDH\Lobbyist Registration Formrevlsed 5-30-2012.doc SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in 2901 JMH, LLC Percentage of Interest JHPSB Indian Creek Ventures Investors, LLC 100% 184 Kent Avenue, C706 Brooklyn NY 11249 Interests in JHPSB Indian Creek Ventures Investors, LLC Percentage of Interest JHPSB Indian Creek Ventures, LLC 100% 184 Kent Avenue, C706 Brooklyn NY 11249 Interests in JHPSB Indian Creek Ventures, LLC Percentage of Interest JMH Indian Creek Development, LLC 0% 184 Kent Avenue, C706 Brooklyn NY 11249 PSB Indian Creek, LLC 100% 555 Madison Avenue, Suite 508 New York NY 10022 Interests in JMH Indian Creek Development, LLC Percentage of Interest 295 LNP, LLC 100% 184 Kent Avenue, C706 Brooklyn NY 11249 Interests in 295 LNP, LLC Percentage of Interest The Jason Halpern Life Insurance Trust 90% 184 Kent Avenue, C706 Brooklyn NY 11249 Jason Halpern 10% 184 Kent Avenue, C706 Brooklyn NY 11249 Interests in The Jason Halpern Life Insurance Trust Percentage of Interest Jason Halpern 100% 184 Kent Avenue, C706 Brooklyn NY 11249 Interests in PSB Indian Creek, LLC Percentage of Interest Dhruv Piplani 100% 555 Madison Avenue, Suite 508 New York NY 10022 „3t ;Miscellaneous Cash .Receipt L: : °f; Fi▪9▪ :: CITY.OF MIAMI BEACH s ;( '�'F 1:),,} i l ! _ _ ;R"....,;'''''..k �rL: ) SL., ,), �� ; f( 4 n S,.) / L 1 _ ! al }' 1 _ _ '//� J S /.!” 'O Credit Card - ;Check# .0/ . .) $ -Cash � � ;: S ,r jt !( ' 20• Received of • C `t�� - Iat et fe- .-Address � 1 ti `•'or: r t 1 .�- ) fry€> 'Fir 1 f V - c:d' Ci I�'1_iq"Cu q. `'' .,. t J..e43.- � A` ' . : - - _Tv---.' ---':--7 4ii-ef'- :-..--:-„. .-r .--.1:",-reit_11 ; .F.E;),..,..,:.:_...!,,,,-.,?,..;;;•:;g,:.,•.:..,,r,',',.:'.„i . . .;-..•-•::::. rr. -;,r.' ,:,„. : . ; •- ... . :: , . : ... {THIS INFORMATION'MUST'E COMPLETED) ;:' O ffice of!°i nco Director c) ¢ P :/ .. - ,. Account I�tu�ber 11 . k I t 1 / 1v .�," De t• . ( ( . PreParer. � P - Y i 2901JMHLLC 01035 City of Miami Beach 4/27/2015 Date Type Reference Original Amt. Balance Due Discount Payment 4/27/2015 Bill 04/27/15 350.00 350.00 350.00 Check Amount 350.00 HVB# 5401 Lobbyist registration 350.00 •