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Tracy Slavens - Penguin Hotel Development, LLC � 14 as cem.A5 4ve, • AA IAM! BEACH 2046 JUL 13 PM c: 55 CITY CI I City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 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 2004-3436. Slavens Tracy NAME OF LOBBYIST: (Last) (First) (MI) 701 Brickell Avenue,Suite 3300 is •.' FL 33.31 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-8500 305-789-7799 tracy.slavens @hklaw,com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,ore-mall address. I. LOBBYIST RETAINED BY: Penguin Hotel Development,LLC NAME OF PRINCIPALICUENT; Penuiu Hotel Development,LLC 1418 Ocean Drive Miami FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER(Optional) EMAIL(Optional) 3n5.-534- 9534 Fin out this section If principal Is a Corporation,Partnership or Trust[Section 2-482(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Markus Friedli . IDENTIFY ALL PERSONS HOLDINGq DIRECT Y OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 1'` O V- u S �V i'ed t l 5/ �dy'2 – 1*o ►�►e'r 7— A `t p Ii.SPEt;'1F C cOBB'i iSsOt: Develo•ment a••royals for the renovation of and bi e connection's betty Sri hotel build in:s.There are two Issue to be lobbied(Describe In detail): re ate• propert es tot is Matter: rest•enr Vote;nC-:" Z .I ills 'venue. iii.ClT"1` ►t, IO I V P S`TO B.E.LOBSIED: 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 Mayor X Commission X X '— Historic Preservation Board 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 flied. Sec 2-482(g)Any Financial,Familial or Professional Relationship None F:\CLER\$ALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form,doc • • IV. DISCLOSURE OF TERMS AND AMOUNTS-OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLO QI E: Req red) Hourly y Zib B) PRINCIPAL'S DISCLOSUR ,(p OBBYIST COMPENSATION): (REQUIRED). Hourly 113.00 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 lo: 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": _Yes XNo: 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. YesXNo: 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 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. ,- . • Signa re'of Lobbyist Al • nl swear that all of the foregoing facts are true -nd correct and -at I have read or am familiar with the provisions contained I do solemnly s a g g P in Section 2-482 of the Miami Be h City CO .- a • all reporting requirements. • Signature of Lobbyist:- Signature of Principal/Client: # VI. LOBBYIST IDENTIFICATION:.. PRINCIPAL IDENTIFICATION: Produced ID Produced ID f6:31-1-5/3-6L4-Z95-0 Form of Identification Form of Identification • • r!Personally.knowh(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 subscrit tiof„ro mo This 2.B day of u N L ,201 This day of 1 c,,. �"_, 2WANBARA V CREEL s� dvp/':'- '"" PAMELA JACKSON PI„�/ MY COMMISSION#FF171643 Sig ature of Pu.is Not = e : Is�i�ar .: MY COMMISSION t:ture of Public Notary-••t"-- on.. • -IRES October 26 2018 Notarization of Cobb i.is si.nature = •77- .;/ EXPIRES:December 17,2.ONot ` ization of Principal's r.ii::�i,.'53 FloridallotaryService.com — Aci etV Banded Thnr Notary Public Underwriters TO BE CO L E 'S STAFF ONLY Annual Registration fee: [ ]Yes[l No Amount Paid$ 3S: -� MCR# 410 1141 Date Paid 15?-i'7-1‘)Lobbyist Registration Form receive nd verified by: Str'Lv Ft\CLErb\$ALL1aPORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01422/2014 F:\CLER1$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc • 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: Tracy Slavens 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 of each year, 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. er/ S'•nature: ' Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc I . • . . .. , . Miscellaneous Cash Receipt . . • • . - . . . - ' .• . .. CITY OF MIAMI BEACH " . 4 °1074..5 . . . . ... ,• ........ • • No. ,.. .,•:-,:, . • • • ,. • • . . ,.. ...:. . ,.,;'...,,,..-., 771,r,',':_::• . . • .. s —7 •: : 1.Q, 0 Cash 0Credit Card trheok# L i 7 i r r $ 13 • 2O / of i r:,-- City of MiargiagqWed ol " 4'4"C'1 I ri-U LI% C i • MiscellaneotAddifts 2016 0/ il5r CS:( II /I-at c i-e' ?s•co /1-1 fa.7.-1, L _.71Y i 000300-009§.or Jenel F./.07/1312016 02:59PM i .> k,.,k,,r‘,..,,, ,• MCR OPEN r Payment Amount: 350.00 ... • mcr410743 • , -- - . _ _ _ • _ . - - _ _ . . (THIS INFORMATION MUST BE COMPLETED) Office of Finaticii-Director , . . •. ,,, .. ._ By ' '----. ----.--, . Account : 3 --, Number Olt . (-)000 " .) 6'./iititi- 00- ._)07, &5. .0 ta - oc7 -.) 3 ,, , -„, 7 , I ,•,.. ,r"- . . '''C" . Preparer: _.NA`52iv >fi-eki-1-4 "-77(Ze Dept: CT •,. •••!4..,,„••-.. -,,,.---,.....- •• .....-_,A.y, :-..,..,.., ., • , . 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