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Bernardo Fort-Brescia - 6800 Indian Creek, LLC IAAA I BEACH 6,2q0 _ p Q t ' Cre��b Ake City of Miami Beach Office of the City Clerk a F 1700 Convention Center Drive, Miami Beach, FL 33139 zo LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passe e,'defeat 6r �- Y P P Y P P g� passage,' 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. Fort-Brescia Bernardo 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 necessaru, relatina to the provertu located at 6790 and 6800 Indian Creek Drive, Miami Beach, Florida. Issue to be lobbied(Describe in detail): lll. 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 p� 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)$400 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $4163per 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.eauioment or services.or on a present or pending award for aoods.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 XNo: Are you lobbvina on a pendina application for a Development Aareement with the City or application for change of zonina map desianation or chanae 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 BEACI( EQR _ ;_C_' ■ C _ '_ _►■_► r._ B _ _N IF THERE HAVE BEEN NO EXPENDITURES OR C•11 ._k c • ► I ► a_ • Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct ant that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Be v ity Code and a eporti • re•, '-- ents. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ° Lfroduced ID r -9r\a_y �‘un� a• Produced ID 3 0 0 Form of Identification Form of Identifcati. 3� R Q g3mi Personally known (Lobbyist) Personally known(Principal) §1.g oT VII. SIGNATURE AND STAMP OF NOTARY: 8 2 N State of Florida, County of Miami-Dade State of Hot da, County of Miami-Dad- t° I Sworn,to :nd s bscribe1d Wore me Swim r l d s bscrib d fpre me This . ' •ay of (Y.UCtotosr, 2015 This' S d y of UL)T ',2015 - . ii ,, I I I Signature oV ublic Notary-State of Florida Signature of Pu;,lir otary-State of Florida Notarizati n of Lobbyist's signature Notarization of•rincipal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY r Annual Registration fee: [ ]Yes[ ]No Amount Paid$ ;So MCR# �U 551 Date Paid (/J2 //5 Lobbyist Registration Form receiv and verified by: p ,.,._ M I AM I BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachf.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 Bernardo Fort-Brescia 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. 0/2--05- Si ature: 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 S8 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 % New York N.Y. 10118 99% 1 t . .. E-. ILL -:1 s'3 s'.+�0 r,00'e a1.:` -4.-.:;' � +� �r -��{ is Miscellaneous Cash Receipt , v 1 CITY OF MIAMI BEACH ` -, 0 Cash- C1 Credit Card Check# U c 1 -�` 1,/50'1 $ a r-7 X50 _ o„ � 20 l 5`- Received of '�;k _� .`, : f;i. xi c t .rI .k, Ca(' 1 ; Jic h I) Csr. /1L1,i/ Address c. '''''''''10 - -(11.-'-'-c-c`' For t7ci0 �,fi 0 1- 1r)f6il IP°; Y_ k i; ir\F` .(c)..cc5UeS - Y i f..x() z...41.25o . . : (THIS INFORMATION MUST SE COMPLETED) Office of Finance:Director .4(:, By Account Number 3't CIO - `1-`1,-/?-1 . ..-. ;, fi� `� , c EXT: f }f Pre' arer: -‘)-(1- (:' #1 ,.r"- - Dept: -, ,- ;/k_.:. , - IOMUIPMOMMOMUMUMMPNW City of Miami Beach-Florida 1F Department 1532913-Ha 11 1 11/25/2015 BR 1 T 137 Ned Nov25,2015 02;47PM Trans#66- 66 $1750.00 MCRCLERK - 66 * MCR#; 408331 NCR-City Cler 1 ITEN(S); TOTAL; Check (4021) PAID $1750.00 $1750.00 Have a nice days 001 tn . 41i,J:::-::.; _t 1 (00,00 Miscellaneous Cash Receipt I BEACH CITY OF MIAMI..,., . 0 No. .lui.-i6.65 0 Cash C3 Credit Card Check# ) C\ °Ric, $ 00 -7--,0 20 /T . i 1 1 I / 1? 4 - ( Received of /0:L- t 'C k ,C k. ; f 1\ ‘e--)i ' ,If.-, 4 6( '-' I f'S If ,. Address Ai A For (? )6 n 0 \ I,y i -1 1 r r 1 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Directo , .4. By I .- Account Number.: a i i-- Fc000-3t fire,tyi \ f) Lyi, , 1 y-N Preparer: ,-- (C1.7rik-----■--- Dept: 4-1,(7-,-( ... EXT: I - . _ . . . , . .. . . , . . . .,_ _.... ... 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!