Robert Moehring - Harvey Hernandez "7 cf C7 Le.ke_v i e.4,0 60.)L
I V l i' ` B E `C Office of the City Clerk
1700 Convention Center Drive • : .
Miami Beach, FL 33139
305.673.7411 201E OCT 27 Pi; 12: 03
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to•encdurage the passage,1defeat 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 City Code Chapter 2, Article VII, Division 3, entitled"Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
M DER PIN E -0BE12-1
NAME OF LOBBYIST (Last) (First) (Middle Name)
p0M0 STUDIO LLC, 420 UNCOLN P0A01S UIT€SOIQ MIAMI $EA•Crf FL 33139
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
jc) 112;4- SOS (305)9$4- ' 31024 rioge -PMAWS t6NJNDio•CONI
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
I4 P-NRNDEZ }-1-At2-vE`I
NAME OF PRINCIPAL (Last) (First) (Middle Name)
0 LAKEvLEW LL-C, 1300 BOex-ELL BM D¢IvE ,f AATE 11.00 MIAMI FL 33131
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) t (City) (State) (Zip Code)
�3d5) g -5 01- 1414ERNANoE`LANEvi etARLGROUP.COM
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code
Section 2-482(c):
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: SEC frrpQct f&F,
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: S
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for
proposal,_invitation_to_bid,.orpublic hearing_number.-� — _�
• T • • OV if . ►1• • • _ I-_ . _ .r D M• ; • ►r:tTai • . it ! -
FtESEa.vATIoN Q- vIEW 2OA!Lb, PI,ANNtNG goA2Dt DES IGN v1EW floAl2gtIMAM OF ADJ(ATM ENTt
LAND USE DEvEU)PMENT�-CAMMITTEE t�orw) GIN/ COMt4'UION,IF NEassa I �QF.LATIN4 TD iile
%a)
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied,and whether the
lobbyist has entered into any contractual relationship(paid or unpaid)with said City Commissioner or City personnel from 12
months preceding such commencement of service with the City to the present date, stating the general nature of the subject
contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES NO
Title of Person to be Lobbied
PLANNING,PILDIN(1PUPtc Wog11(_& 4 FIR DEPT JTA F NUNS
fig jy242, 14PS,BOA 0.t1"1 COMMiSsioNJ,ANO LAND , onle x
USE DCvELOPMENTCOMMtTTeE As NECgJJAI2
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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of
impropriety:
NdNE
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
2501 hr
The following five(5)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes KNo: 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 City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
_Yes KNo: 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 City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481) 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 city clerk as required by this section, but shall not be required to pay any registration fees.
_Yes iNo: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific, technical or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
_Yes XNo: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-482(a)(4), a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission shall disclose such particular service on his/her lobbyist registration
form and shall orally disclose such particular service before lobbying the City Commission at a public meeting.
_Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes, please list the incumbent member(s)of the City Commission:
NIA
•
If yes, you must also orally disclose such particular service before lobbying the City Commission at a public meeting.
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.1
Signature of Lobbyist: I L' �1 Date /J ,-4'/1 Li
•
I do solemnly swear or affirm that all of the foregoing facts, statements,.and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists"of
the Miami Beach City Code and all re•citing requirements.
Signature of Lobbyist •1 L g� '-` Date /0 ��!
Signature of Principal: Date /D 2(0 /jc•
VII. NOTARY SIGNATURE AND - AL:
LOBBYIST: PRINCIPAL
State of F I O'I d A State of PI O ri d a
County of: NI H 1 -- i
ty County of: I-`I(�� �adQ,
Sworn o(or affirmed)apd subscribed before me Sworn to(or affirmed)and subscribed me
this 2U day of ®(°To b-e,Y ,2016, by this day of o!X scribed be
�
ok .2016, by
ft b-ext M o- h ri n g 14a rve, kin c rd-ez
NAME OF LOBBYIST NAME OF PRINCIPAL
.__Produced ID / Produced ID I(C'enlf-e,
j
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
/Person- _Personally
R / A1
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Signat re i f I!"o ary 'ublic Signature of Iota , blic
are 0 i ocean HaYI a Ionian
Name of Notary,Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
Rifi3 Roman(NOTARY SEAL) �� ` : Commission I GG02Mi'8 (NOTARY SEAL) ' "" I Roman
Commission I GG020916
` '�= Expires:August 14,2020 '"- _. •_,, Expires:August 14,2020
•`p�""",,�`-` Bonded BE Caron Ran
ED BY CITY CLERK'S STAFF ONLY • ��Nolary
Annual Registration fee: [ ]Yes[ No Amount Paid$ 3S°• 00 MDR# i4(2..Q 15 Date Paid 10-2,-1 b
Lobbyist Registration Form recely and verified by: '.A4s&) 544itJftizt- -,
F:WI ER\$/U.LVaFOl+MEII.UfbUY1ST F(fllMS\tobhyisi t:rgistritinn rtirm flttvisca US-18-16 RI?G.tlot: Revised 08/18/2016
'The term"lobbyist"specifically excludes the following persons:
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct, indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
1. i , \ '?� ! tD __ p.t
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E. Granada,City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.741 1, Fax: 305.673.7254
NAME OF LOBBYIST: fAsE .T MoEL WL N(
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
A,'Jiv
Signature of Lobbyist Date
F:ICLERI$ALLI,FORMS1LO68YIST FORMSLLabbyist Registration Form Revised 08-18-16 REG.doc
OWNER AFFIDAVIT FOR INDIVIDUAL OWNER
STATE OF
COUNTY OF
1, 11t 1 E.P,N AIDD E 2 ,being first duty sworn,depose and say that I am the owmerof the property described and which Is the subject
matter of the proposed hearing;that all the answers to the questions in this application and all sketches data and other supplementary matter attached to
and made a part of the application are true and correct to the best of my knowledge and belief.I understand this application must be completed and
accurate before a hearing can be advertised. I also hereby authorize the City of Miami Beach to enter my property for the sole purpose of posting a
NOTICE OF PUBLIC HEARING on my property as required by law and I take the nes '!tty of removing this notice after the date of hearing.
PRINT NAME SIGNATURE
Sworn to and subscribed before me this day of , 20 . The foregoing instrument was acknowledged before me by
_,who has produced as identification and/or Is personally known to me and who did/did not take an
oath.
NOTARY PUBLIC
NOTARY SEAL OR STAMP
PRINT NAME
My Commission Expires:
ALTERNATE OWNER AFFIDAVIT FOR
CORPORATION or PARTNERSHIP
STATE OF. Florida (Circle one)
COUNTY OF Hi a mi -Mt
I, H P P.V / ligNAPAP02, being duly sworn,depose and say that I am the ''PRr rlGt'PA►L of1•810 LAK,Ed1 J
trl:,G and as such,have been authorized by such entity to file this application that all answers to the questions in the
application and all sketches,data and other supplementary matter attached to and made a part of the application are true and correct to the best of our
knowledge and belief,that the corporation is the ownedtenant of the property described herein and Is the subject matter of the proposed hearing.We
understand this application must be completed and accurate before a hearing can be advertised.1 also hereby authorize the City of Muni to enter
the subject property for the sole purpose of posting a NOTICE OF PUBLIC HEARING on the property as required by l'ar and$e the responsibility of
removing this notice after the date of hearing. -7.... ..
Aata-vt Vime-tdivivEz
PRINT NAME !_ i SIGNATURE
Sworn to subbed lore me this 25. day of u u6-t- , 201 .The foregoing Instrument was acmwledged before me by
+10tNe>1 Hernafilez., t ift!i rt2 l laologiNeAtat on .:_,•:f of such entity, who has produced
as Identification and/or Is personally known to me and who did/did not take an oath.
NOTARY SEAL OR STAMP: pi.
Mar;Q ► a� NOTARY PUBLIC
Nia.k Wash sion PRINT NAME
Commission res �! It PM
My E :,; iii
4
A pi POWER OF ATTORNEY AFFIDAVIT
STATE OF F l ar% Lw �p
COUNTY OF 14 1 a 1-1lIA lA tF..
I, ARv 41E A111PE ,being duly sworn and deposed say that I am the owner or representative of the owner of the described
real property that I am aware of Mb nature and effect of the request for 140V4 (0/451124,4C 1104 relative to the subject property,which
request is hereby made by me OR I am hereby authorizing VDMo ittOLH I1'Ir'GfLIR6 • VEbtGxxl to be my representative
before the V ES14P1 px%/1EW Board. I also hereby authorize the City of Miami Beach to enter the subject property for the sole purpose of
posting a NOTICE OF PUBLIC HEARING on the property as required by law and I take the responsibility of removing this . w after th .date of hearing.
-'NSW ty 1401440E7--
PRINT NAME(and Title,if applicable) .. SIGN7RE
to and s bsc ibed let me this day of (d 9 art , 201(0. The forego'm�instrument was admgw�dged-beIOre me by
rug subscribed 1111rZ , 1tilt.'ipa of'1g0 Lela/le hiU. ho has produce !1C°2ll(Q1 as
identification and/or is personally known to me and who did/did not take an oath.
NOTARY SEAL OR STAMP
1 f�
•
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11110118181 .r): hqf>• MINN L I P 1 NOTARY PUBLIC
_ IUI PRINT NAME
My Commission Expires. . : ;:F" MedtttRrlNriaN
CONTRACT FOR PURCHASE
If there is a CONTRACT FOR PURCHASE,whether contingent on this application or not,and whether the purchaser is a corporation,trustee or
partnership,list the names of the contract purchasers below,including the principal officers,stockholders,beneficiaries or partners. Where the principal
officers,stockholders,beneficiaries or partners consist of another corporation,trust,partnership or other similar entity,fuAher disclosure shall be required
which discloses the identity of the individual(s)(natural persons)having the ultimate ownership interest in the entity. If any contingency clause or contract
terms involve additional individuals,corporations,partnerships or trusts,list all individuals and/or complete the appropriate disclosure clause above.'
NAME DATE OF CONTRACT
NAME,ADDRESS,AND OFFICE %OF STOCK
For any changes of ownership or changes in contracts for purchase subsequent to the date of the application,but prior to the dates of final public
hearing,a supplemental disclosure of interest shall be filed.
5
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),partnerships)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.*
1-90 LkWEVIEW
CORPORATION NAME
NAME AND ADDRESS %OF STOCK
-moo
LpfiLEVIVII4 LLG ibb %. -
F M tr M'L
CORPORATION NAME
NAME AND ADDRESS %OF STOCK
IF THERE ARE ADDITIONAL CORPORATIONS,LIST OTHERS,INCLUDING CORP. NAME(S)AND EACH INDIVIDUAL
STOCKHOLDER'S NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK ON A SEPARATE PAGE
NOTE:Notarized signature required on page 8
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