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Adrienne R. Grandolfo - Senor Frogs Miami, LLC J Wt.ri ail be q-CALeeci era tv 1AM BEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 y 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. Grandolfo Adrienne R. NAME OF LOBBYIST: (Last) (First) (M.I) Greenspoon Marder, P.A. 1601 Washington Avenue, Suite 300 Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)602-8245 adrienne.grandolfo @gmlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Senor Frogs Miami, LLC NAME OF PRINCIPAL/CLIENT: Senor Frogs Miami, LLC 1450 Collins Avenue, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (407)414-2974 N/A rana @andermail.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: Renato Alvarado Chavez • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached Exhibit"B" ILS,,, _ CIFIC LOBBY ISSUE: Variance to Exceed the Maximum Square Footage Permitted for Signage for the Building on Both Collins Avenue and Espanola Way. 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 City of Miami Beach Historic Preservation Board None X Planning Director and Staff None X Mayor and Commissioners 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 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $375 / hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375 / 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 © No: Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending award for goods,equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ❑Yes © No: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code 2-484(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. CI Yes © No: Are you representing a not-for-profit corp_oration or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. 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 City Code and all reporting.requirements. Signature of Lobbyist: •of Principal/Client: �� • VI. LOBBYIST IDENTIFICATION: PRINC "AL IDENTIFITIQN:, 1--(37 ❑ Produced ID Produced ID Form of Identification Form of Identification /L-/ ❑ Personally known(Lobbyist) ❑ Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade Sworn to and subscribed before me Sworn and subscribe This day of ,201_ This t day of ....• ROSEMARIE TRUJILLO .,$ o`'- Notary Public-State of Florida,: _• •- My Comm.Expires Jul 29;201 T, Signature of Public Notary-State of Florida Signa ure •f ubl'• ot -S ;'.�� Commission#FF 40708 Notarization of Lobbyist's signature Nota rz- • Prpal's sii naft� pio, r ���• Bonded Through National Notary Assn: TO BE COMPLETED BY CITY CLER 'S ST FF ONLY Annual Registration fee: V Yes[ ]No Amount Paid$ 500. 00 MCR#\ Date Paid 1'I C�'-I Lobbyist Registration For received and verified by: -1A-SON S-V 1ZE. F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 1/11/2011 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $375 / hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375 / 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 , © No: Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending award for goods,equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": El Yes © No: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code 2-484(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 © No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. KA,i,Ju 'LAN i ; 1 _ 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 City Code and all reporting requirements. Signature of Lobbyist: kl,K0100 VI tA4.44 Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: . . - PRINCIPAL IDENTIFICATION: * , '4 ❑ Produced ID 1- , , ❑ Produced ID Form of Identification �A°f4�;,?(,.��' Form of Identification I/ Personally known(Lobbyist) e' 3 = CI Personally known(Principal) in- VII. SIGNATURE AND STAMP OF NOTARY: 4 g.m � Z State of Florida, County of Miami-Dade -1% State of Florida, County of Miami-Dade Sworn toad subscribed before me - '' Sworn and subscribed before me This "7� day of iiM. , 2016 o-Z This day of , 201_ 722404/6 iee. 11/1"tee, -- . • Signature of Public Notary-State of Florida Signature of Public Notary-State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [Ng Yes[ ]No Amou nt`:Paid$ S 00 03 MCR#' O' b l I '" Date Paid I-/�-.16 Lobbyist Registration Form received and verified by .; 50 ti 5fr -ice. 9a F:\CLIERt Val\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration For .doc Revised 1/11/2011 V # 3_, e # $'•.» rr,.3:fir' '1 City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Adrienne R. Grandolfo I understand that no later than February 28th 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 o'n Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. 6:0,4.14 'January 0i, 16%V Signature: Date: EXHIBIT"B" DISCLOSURE OF INTEREST SENOR FROGS MIAMI,LLC CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1.CORPORATION If the property which is the subject of the application is owned or leased by a CORPORATION, list ALL of the stockholders, and the percentage of stock owned by each. Where the stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* Senor Fro's Miami LLC CORPORATION NAME Name and Address %of Ownership Senor Frogs Miami,LLC GH10 USA, LLC 100% 1000 5th Street,Suite 1311 Miami Beach, FL 33139 GH10 USA, LLC GH9,S.De R.L. 100% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello,Cancun,Quintana Roo 77533 GH9,S.De R.L. Janleah, S.A. De C.V. 30.06% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun,Quintana Roo 77533 Las De Lalo, S.A. De C.V. 11.26% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello,Cancun,Quintana Roo 77533 Anarpa Compagnie, S.A. De C.V. 10.53% Acanceh MZA 3 LT 3 LOC 22 PH SM 15 A Quintana Roo 77500 Holding Villarox, S.A. De C.V. 10.53% Avenida Bonampak Manzana 1 Lote 3 Local 202 Super Manzana 3,Cancun,Quintana Roo 77500 Son Del Primo, S.A. De C.V. 6.08% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun, Quintana Roo 77533 EXHIBIT"B" DISCLOSURE OF INTEREST SENOR FROGS MIAMI,LLC Page 2 of 4 Akatan, S.A. De C.V. 2.96% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello,Cancun,Quintana Roo 77533 Grupo Holding GTZ,S. De R.L. De C.V. 2.42% Bonampak 3 Manzana 1 SM 3 Cancun Benito Juarez,Quintana Roo 77500 Ranaca, S.A. De C.V. 2.39% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello,Cancun,Quintana Roo 77533 Taniseb, S. De R.L. De C.V. 0.87% AV Acanceh Lote 3 Manzana 2 Local 202 Supermanzana 11, Cancun Benito Juarez, Quintana Roo 77504 Grupo Restaurantero Shamdas, S.A. De C.V. 17.20% Avenida Vasco De Quiroga 3900 Piso 21 Torre a Lomas de Santa Fe, Distrito Federal 01219 Cuatro Por Ciento, S.A. De C.V. 5.70% Avenida Vasco De Quiroga 3900 Piso 21 Torre a Lomas de Santa Fe, Distrito Federal 01219 Janleah,S.A. De C.V. David Leonardo Krouham Litchi 99% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun,Quintana Roo 77533 Jorge Eduardo Lizarraga Flores 1% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello,Cancun,Quintana Roo 77533 Las De Lalo, S.A. De C.V. Eduardo Beaven Magana 99% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun,Quintana Roo 77533 Alejandro Beaven Magana 1% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun, Quintana Roo 77533 Anarpa Compagnie, S.A.De C.V. Adrian Gomez Oyanguren 98% Acanceh MZA 3 LT 3 LOC 22 PH SM 15 A Quintana Roo 77500 Miram Rodriguez Cardenas 2% Acanceh MZA 3 LT 3 LOC 22 PH SM 15 A Quintana Roo 77500 • EXHIBIT"B" DISCLOSURE OF INTEREST SENOR FROGS MIAMI,LLC Page 3 of 4 Holding Villarox,S.A.De C.V. Rodrigo Villanueva Aguirre 98% Avenida Bonampak Manzana 1 Lote 3 Local 202 Super Manzana 3, Cancun,Quintana Roo 77500 Ana Belen Aquino Alcalde 2% Avenida Bonampak Manzana 1 Lote 3 Local 202 Super Manzana 3,Cancun,Quintana Roo 77500 Son Del Primo,S.A. De C.V. Alejandro Schoer Diestel 99% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello,Cancun,Quintana Roo 77533 Norma Gabriela Graf de Shoer 1% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun,Quintana Roo 77533 Akatan,S.A.De C.V. I.Tan Investments, Inc. 99% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun,Quintana Roo 77533 Kristel Andrea Camino 1% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun,Quintana Roo 77533 Grupo Holding GTZ, S. De R.L. De C.V. Alejandro Gutierrez Robles 99% Bonampak 3 Manzana 1 SM 3 Cancun Benito Juarez, Quintana Roo 77500 Daniel Alejandro Gutierrez Romero 1% Bonampak 3 Manzana 1 SM 3 Cancun Benito Juarez, Quintana Roo 77500 Ranaca, S.A. De C.V. Janleah,S.A. De C.V. 50% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun,Quintana Roo 77533 Akatan, S.A. De C.V. 50% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello, Cancun,Quintana Roo 77533 EXHIBIT"B" DISCLOSURE OF INTEREST SENOR FROGS MIAMI,LLC Page 4 of 4 Taniseb, S.De R.L. De C.V. Marion Angelika Speck Hever 99% AV Acanceh Lote 3 Manzana 2 Local 202 Supermanzana 11,Cancun Benito Juarez, Quintana Roo 77504 Fernando Dobaldo Rueda 1% AV Acanceh Lote 3 Manzana 2 Local 202 Supermanzana 11,Cancun Benito Juarez, Quintana Roo 77504 Grupo Restaurantero Shamdas, S.A. De C.V. David Shamosh Helfon 30% Avenida Vasco De Quiroga 3900 Piso 21 Torre a Lomas de Santa Fe,Distrito Federal 01219 Daniel Shamosh Helfon 30% Avenida Vasco De Quiroga 3900 Piso 21 Torre a Lomas de Santa Fe,Distrito Federal 01219 Salomon Shamosh Helfon 30% Avenida Vasco De Quiroga 3900 Piso 21 Torre a Lomas de Santa Fe,Distrito Federal 01219 Abdo Shamosh Helfon 10% Avenida Vasco De Quiroga 3900 Piso 21 Torre a Lomas de Santa Fe,Distrito Federal 01219 Cuatro Por Ciento, S.A. De C.V. Simon Shamosh Charabati 50% Avenida Vasco De Quiroga 3900 Piso 21 Torre a Lomas de Santa Fe,Distrito Federal 01219 Robert Shamosh Charabati 50% Avenida Vasco De Quiroga 3900 Piso 21 Torre a Lomas de Santa Fe,Distrito Federal 01219 I.Tan Investments, Inc. Jorge A. Camino 50% Calle Porto Liguria 13 Manzana 15 Lote 2 SM 55 Fracc Porto Bello,Cancun, Quintana Roo 77533 Kristel A. 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