Joaquin Vargas - TB Purdy Restaurant, LLC 77P (' A .
, (-40 Ave .
l _.
j � ! \.' i f
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 331392015 Di C I 5 PM 3: 24
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.
Varaas Joaauin
NAME OF LOBBYIST: (Last) (First) (M.I)
Traf Tech Engineering, Inc. 8400 N. University Drive, Suite 309 Tamarac Florida 33321
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
954-582-0988 954-582-0989
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Jeff McInnis
NAME OF PRINCIPAUCLIENT:
TB Purdy Restaurant, LLC 200 East 3' Street New York New York 10009
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 746-1105
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
• 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:
2
.euelopment_App_r_ovals-and Pennitting_Issues,,infjuding, but not limited to the Historic Preservation Board, Design Review
Board, Planning Board, Board of Adjustment Land Use Develo meet Committee,Citj Commission, and any City Workshops or
Committees, if necessary. relating to theropertu-orated at 1787 Purdu Avenue,_Miami Beach Florida,.
Issue to be lobbied(Describe irk detail): -
Ill. 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.
1Vone. /
.7 ai
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outiook183LGQDDH\Lobbyist Regis -
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)1 I cs---I tv
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). ( 03 ii
A r
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;ago: • • • • 1 • • 1 - , _ _ 1 1 •.1 • •.• • • •.•;• .• .1 - 1 • - . • - • •1 • � - I • •1- 1 •. •
award for goods-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 Iobbvina on a nendina aoniicationjor a Develooment Agreement with the City or application for,
chanae of zoning man designation or change to the City's Future Land Use Mao?
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 JC No: Are you representina a not-for-profit corporation or entity witho t special compensation or reimbursement,
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO 3 E CITY CLERK A SIGN:s STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES. AS WELL Aal COMPENSATI,)N RECEIVED. IN THE ,ITY OF MIAMI BEACH,
FOR THE PRECEDING CALENDAR YEAR A STATEMENT SHALL E FILED EVEN IF T._E-E HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD., /
...al a/ A
MI" /
Signs re of Lobbyist
I do solemnly swear that all if the foregoing facts are t e d c rrect and t.. :ve read or am familiar with the provisions contained
in Section 2-482 of the Miam Beach ity Codd all epo ' quirement.
Signature of Lobbyist:
t
Signature of Principal/• - r c
VI. LOBBYIST ID, 'ICATIO` PRINCIPAL IDENTIFICATION:
_Produced ID ;I co a_Produced ID d r iure'3 I,Cep4X-_
Form of Identification YONGYI HE
S LL o ' Nota �IbO State E Newyork
Personally known(Lobbyist) ; coo _Pers ;` Prince ■
E H y .02HE6332301
VII. SIGNATU E AND STAMP OF NOTARY: a Qualified Commission E m Newyork County•
$��
Commission Expires October 26,201.. i
State of F F . •da, aunty of Miami-Dade z°a 2 w State of Florida, County of Miami-Dade
Sworn •,:a,d s 'crib- • •-fo •r Sworn and subscribed before me
This ri a ay o / / �y 2015 Dd This day of VGC , 2015
%mo1 ' ' Xe.
11 �.
Signature i�'ublic Notary—State of Florida - Signature of Public No —State of Florida
Notarizati• of Lobbyist's signature Notarization of principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [\Yes[ I No Amount Paid$_35° MCR# "[°0—)0 I it-o i-m Date Paid M.//s//S
Lobbyist Registration Form received and verified by: . ct' S. W6
, , .
MIAMI BEACH
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
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 th Statement or pay the assessed fines after notification.
Any lob`,I list, who fails to file the required Statement by April 30th, 2012, shall be
automat' ally suspended f om lobbying until all fines are paid, unless the fine has been
appeale i to the Miami;Da County Commission on Ethics and Public Trust.
i (•' --/
l Al
Sign I I Date:
C:\Users\clerhatlWppData\LocalWlicrosoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
,
SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in TB Purdy Restaurant, LLC
Percentage of Interest
TB Holdings, LLC 100%
160 Greentree Drive, Suite 101
Dover, DE 19904
Interests in TB Holdings, LLC
Percentage of Interest
Janine Booth 50%
160 Greentree Drive, Suite 101
Dover, DE 19904
Jeff Mclnniss 50%
160 Greentree Drive, Suite 101
Dover, DE 19904
Interests in Purdy Partners 1787, LLC
Percentage of Interest
Purdy Partners 1787 SRC, LLC 50%
230 Fifth Street
Miami Beach, FL 33139
Purdy Partners 1787 PL, LLC 50%
1425 North View Dr.
Miami Beach, FL 33139
Purdy Partners 1787 SRC, LLC
Percentage of Interest
Scott Robins 100%
230 Fifth Street
Miami Beach, FL 33139
..- 3 i• ,'!"-./.1"11!: OW 17
,
Miscellaneous Cash Receipt
CIToFauml BEAcH
Nioo.J.
0 Cash \ redit Card 0 Cheak# $ ob
1
\)e( IC 20 ) C--
Received of ) 0 Cki(A, oi \jai C\C\ s
,-.,-,, ,
Address (A---i t ) , , 1,1 ' \ v C, -,j, 4 kd \--) 1'1.C C>0 I '\ ( ..?....0 61, ji) 1„..,0 r el ,r6
,
For 7 : 7 i-)Lic () \„ A‘.4-0 LA C --- (:til,)i-k,", 1 1C-1)1.Air'- (i r: :
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
. ,
..‘,
. -..• - By
.. ..
‘ /,A 7/a i,,,„ ,
Account Number: u I ' '(: /() - 71- 1 -7 -7'
Preparer: i --)A \Ctt--- -------- 7 ' ] ((e
Dept: L 1 ‘-/ ( ' 1- 1 EXT: t---
/Lit i
i
----- — - — - . .
___ . __ _ _ -,_, 4-, ----..r....O.- ■-•a•-• , ■ .-- .
11
M11ficejlaneous Cash Receipt
CITY OF MIAMI BEACH
.,
No
I t
0 Cash 0 Credit Card loCheok# 1 C) °F-, $ ...7 SO
t.\,‘ 1,;), // 5 20 15
Received of
--, r" ,--' ---, ' 1 - (--
Address C:) (--A 00 f\-) fu)v 0--I n) 4.- i \i7)1- )1.---(_ _) L- I "7,;_,-1,-- (,,--i._ , - L
For I (
- - ,
0 By(THIS INFORMATION MUST BE COMPLETED)
Office of Finance Director
Account Number:,
Preparer: --- 9--' 0 SA-1,v,--7---5r‘.- Dept: ( , `- i (. ii.ric EXT: 74-1 I i