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Julio Pulido - Avi Kramer e,01 �e 4 MIAMI BEACH • '• r City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 2016 JUL 12 AN 9; 0 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat 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. PULIA2 JULIO NAME OF LOBBYIST: (Last) (First) (M.I) mows .4/2Gaie rXPR Ll.G 122/ S.v AV Aev l PC- 3919- BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305 505 - (710 Juli0 140vasaer,4-eipee. cow TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Avi kramev' NAM OF PRINCIPAUCLIENT: LGG 210 -1 lib SU/fl 90 MI4item 5'k4cH FL- 33/4-1 �v�e�lc� ftofe/ , BUSINESS NAME AND ADDRESS (Number and Street) (City) (State (Zip Code)/ 746;6— 230 -$569 G�N/I m2Y iaboO . cem 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: see Q'/1 2c S hikt 4 • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: IL-SPECIFIC LOBBY ISSUE: Me Aca1 666 -fD Ve ie�ga., /We-7 Issue to be lobbied(Describe in detail): ul.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 /D r( • tie5ecV4170,-i 1 2c r/ AVA- Cc CO r)-)i 9S1O l 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 N/A F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc \-) IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION((DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) /' ` /' r7 0T D,1 c/r// �Gk (_`�j og 5. w/'h '. B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST CO` sATI N): - n �� -��►1 �(REQUIRED). ` " <-s- Qi 10 e1 i 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": —YesD•lo: 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 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. —YesF lo: Are you representing 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 TH - `%L RK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATIO -EC D, I THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED E N IF/ RE •AVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the .regoi I s -re true and correct and tha I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City/ -nd all reporting requirements. Signature of Lobbyist: A:i; - II ip / �- - Signature of Principal/Client: / ' I. VI. LOBBYIST IDENTIFIC TION: ) PRINCIPAL IDENTIFICATION: Produced ID 17/ D ire✓mac J c _Produced ID Form of Identification Form of Identification Personally nown(Lobbyist) Personally known , r Y ( y1 ) Y '; � '� STACY OSKOLSKI 1., Notary Public-State of Florida VII. SIGNATURE AND STAMP OF NOTARY: o- ��, V My Comm.Expires Apr 11.2017 `'"Y P�� EDGARD()R.MATTA % ;<<;°°'•'• Commission# FF 007332 State of Florida, -•.Ity of Miami-Dade �' ° State of Florida,Count - •• !- Sworn to d - bscribed bef re me * '�_ * MY COMMISSION#FF 179847 Rh:'..• EXPIRES:February 14,2019 Sw. • ,d subs, • • •-fore This (l day of S ,201 s.;. �r Bonded Thru Budget Notary Service �_ day k. 01 FOF F�� IF Signature of Public Notary-State of Florida '' ' of Public • agitate of Florida Notarization of Lobbyist's signature Notarization of Princ pal's,signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY r� Annual Registration fee: Yes[ ]No Amount Paid$ 5� MCR# 410 7" '4. Date Paid //IL/1(0 Lobbyist Registration Fo eceived and verified by: 145(- Sk1 uci-low F:\CLER\SALL\aFORMS\LOB MIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 F:ICLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc iY 1 / 1 M I B E C H 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: J(A/( &/id) 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 t• ,. the required Statement by April 30th of each year, shall be automatically suspe • : fro lobbying until all fines are paid, unless the fine has been appealed to the M =mi ade ounty Commission on Ethics and Public Trust. �,,i a�/1/ D'( Signature: - ate: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc EXHIBIT A Disclosure of Interest VENEZIA HOTEL. LLC Name % of Ownership G&A Miami, LLC 42.5% Shareholders: • Abraham Karmer • 50% • Gidon Goeta • 50% Led Trust, LLC 42.5% Shareholders: • Erik Yehezkel • 33% • David Yehezkel • 33% • Lara Yehezkel • 33% • Haim Yehezkel • 1% Uri Fouad Mussaffi 15% MIAMI BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.gov City Clerk's Office Tel: 305-673-7411 Fax: 305-673-7254 Office Use Only ANNUAL LOBBYIST REGISTRATION FORM Name: IC' A4C) ? Business Name: `kvas. ifecid e, Address: /2 Z/ SW 30 />1 m is 3�' �'� 33/ L 5 Office Telephone Number: 305" 5c2C-6.`S10 Cellular Telephone Number: 3055--5°500 --(11 505-6, 10 Email Email Address: jUii0 �o�&ISav�cf yi 2e . cow If more than one lobbyist, please list: ��/j 1) 2) 3) ---- 4) 5) 6) 7) Submit this form to the Office of the City Clerk, along with a check for $500 for each lobbyist. Please make the check(s) payable to the City of Miami Beach. For City Clerk's Office Use Only MCR#: Amount paid: 500 % cr) Date paid: _ 71 Processed by: 3C SOA S 4 k k k r Z Date: 7/ ! Z/ I b F:CLER\SALL\aFORMS\LOBBYIST FORMS\ANNUAL LOBBYIST REGISTRATION FORM reg.doc Miscellaneous Cash Receipt . • CITY OF MIAMI BEACH 410734 r.- f - ❑ Cash El Credit Card ICheck# I )3 1 $ S o c 0.7 - 1 . 20 /k City of Mianiit® Ned Of .3 V ■ O %DC , MiscellaneoLAd s2ci1 z: i '3w -3 bra jtA IA-0 I t ..L -II 1 -2 .5 000294-0012 Jenel T... 07/12/2016 09:05A 1 For I A &Ju �-1 ( 6, 4-"' I !5S(.• f MCROPEN . Payment Amount: 850.00 mcr410734 (THIS INFORMATION MUST BE COMPLETED)_ _ Office of Finance Director By ,c, Account Number: O// • C.00(.7- . 69 & ig- C0 • 30-2 g4,5- ao - GryroJ t it ■ ` C C_- ma.: 7 G1 i l ' Preparer• --.JAS.'.r;, --5A•Lki. 61A.C. Dept: --0 = = 0 C H C) , ` C. cD a 3 4, z1 CD T O CO-- U'7 •'p = a O —I - 4 = CD z 0 mC� z o 037 r 9 m - 5--1 Z CD a N o .: E- ;i m co zcID -- rc w o c-, s ie n: ---• '• Cj (JD • a C 2 O f 3 0 0 < i w a rr{_ p _ a i CD O =r'i CD al C) rt. : 3 o m C-I C 0 _ On CD .A T C7 -j.IV r- CD cio -< � c n I n . , w co o z O �,I i § I m Ln COD m -- • 3' O o 00 C O O b 3 - • o O O O p co 3 •