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Michelle Cintron - 6800 Indian Creek, LLCr MI/6\MI BEAC H G7,10-6.goc, n d.xr�CcezdG City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 2015 NOV 25 P " 2: 50 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the.passage?defeat'of-- 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. Cintron Michelle NAME OF LOBBYIST: (Last) (First) (M.I) Arquitectonica 2900 Oak Avenue Miami Florida 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-372-1812 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Ricardo Tabet NAME OF PRINCIPAUCLIENT: 6800 Indian Creek, LLC 846 Lincoln Road, 5th Floor Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)200-8740 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 Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or Committees. if necessary, relating to the property located at 6790 and 6800 Indian Creek Drive, Miami Beach. Florida. Issue to be lobbied(Describe in detail): nl. 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 Staff for the Planning Department, Building Department, None. X Public Works and City administration, PB, HPB, BOA, None. X City Commission, and Mayor as necessary None. X 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. None. None. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc (F(./ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)ScP?Co per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Sp/00 per hour (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 XNo: Are you lobbvina on a present or pending bid for goods.equipment or services. or on a present or pending award for goods.eauipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes.CNo: Are you lobbvina on a pending application for a Development Agreement with the City or application for change of zonina 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 X 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 EQB THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE F ED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTp1G PERIOD, uJC &t_L _ i_ r- 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 Ci Code and all reporti requirements. I. / / / ` / Signature of Lobbyist: ( .e "'ram!! •ts.4b Signature of Principal/Clie • w_ 2 � %A.." VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: 3 z qb m.f iv v o 4 Produced ID Produced ID i g °1.2 Form of Identification Form of Identification y °' s I/ c0 ,' ��Z N7 N if Personally known(Lobbyist) 1 Personally known(Principal) wm g T VII. SIGN T RE AND STAMP OF NOTARY: WI) . g8. a• . .-n State of Flori qa, �'ounty of Miami-Dade `°o a State 9 'lorida, County of Miami-Dade Sworn •• subscribe efore me 1 a wor� . subscri forces me This `�/ •'ay •.f ei'�'' 2015 m 'hi`s err day of ilrU 9',2015 elk \ / Signature • 'P�hlic Notary—State of Florida - Signatur. ti '' blic Notary—State of Florida Notarization Lobbyists signature Notarizati n if Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ �5o MCR# Lt D$v-jl Date Paid t 1/2 WC- Lobbyist Registration Form receive and verified by: ' { vim' - M I AM I BEAC City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673 7254 LO B B Y IS T NAME Michelle Cintron 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 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. (4( d'Ufj)&76,;1,-"' ll Jig/z ST Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc Exhibit A Disclosure of Interest 6800 Indian Creek, LLC Optimum USA 1S8 Indian Creek, LLC Investments 4, LLC Ricardo Tabet Rodolfo Misitano 846 Licoln Rd, 5th floor c/o Funaro &Co. P.C. Miami Beach, FL 33139 350 Fifth Avenue, 41st floor, 1 /o o New York N.Y. 10118 99% 1 Miscellaneous Cash Receipt 4003.3 "": _ ' CITY OF MIAMI BEACH _•y 4 'V� N0. 0 Cash 0 Credit Card Check# 4 02.\ --°' l`56 $ I , 7 a U AJ0v1c 20. IS E C F M - ..°� . C k 1ti h c~I C ie,. Received of ''%` ..-j,.f . . !I C 6 - , I 1 ,- i f ' I - 'Address r�, F �< - • v . 1- For 13.7C10 � -:1Jr6 i,}ia-)F 11 f ;IL LL i)ir\.)` • (SN) i r, r (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director r - 74‘:.• By - .Account N umber: ' ,- —: " `._�1 - --( I J1 l ,f .r{: Preparers -s 0-'1 4 it f��i$�'-�: Dept._; . 'Y k-. jr r z EXT: . • ir:iC/ '--'�-.i��t^`:...;.t:l ri-i.t.h.. -.L. _-,,:i t'.r:" Y. - -w-'v4=-, s.- _-.v. ..- - ">�}. - _ -r ..•t. `.. ..\_!' .... _.v. .-— .. -S .r4 .. -i t ..c_S5�✓':�s.�� .. � ..r City of Miami Beach-Florida Finance Depart ment 1532913-Hall 4{Jed Nov21 11/25/2015 BR 1 T 137 ,2015 02:47PM Trans#66- 66 $1750,00 MCRCLERK - 66 * MCR#: 408331 MCR-City C1er 1 ITEM(S): TOTAL; Check (4021) PAID $1750.00 $1750,00 Have a nice day, AI/20 Jill 17.",t • 4 4 ,000,00 Miscellaneous Cash Receipt CITY OF MIAMI BEACH • No. ..- .“) 635 Cash Credit Card Cheak# 6\ OcC(- $ 00-- \ • X (XX), o ) 2)0 20 /T - Received of /10:LA ( IC ç .)(- )'(•i • 6( 1 5 Address A/A For • - (THIS INFORMATION MUST BE COMPLETED) - Office of Finance Directo By Account Number.: of 1 ao0.- • t/ f-V/47 Preparer: • 1 1( Dep t . EXT: City of Miami Beach-Florida Finance Department 1 City Hall 1533420-1 11/30/2015 BR1 T131 • Mon Nov30,2015 10:55AM Trans#30-30 30 $1000.00 MCRCLERK - MCR-City Cler * MCR#: 408335 1 ITEM(S): TOTAL: $1000.00 Check (019096) PAID $1000.00 Have a nice day!