Loading...
Ian Bacheikov - Carillon Hotel, LLC (,go Coll;v►s IV'\I AM I BEACH Office of the City Clerk 1700 Convention Center Drive I FEB iami Beach, FL 33139 HO P LT 1 0 Pf-j 3: 20 305.673.7411 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 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: Bacheikov Ian NAME OF LOBBYIST (Last) (First) (Middle Name) Akerman LLP,Three Brickell City Centre, 98 Southeast 7th Street, Suite 1100, Miami, Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)374-5600 ian.bacheikov @akerman.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Carillon Hotel, LLC NAME OF PRINCIPAL (Last) (First) (Middle Name) The Carillon Hotel, 6801 Collins Avenue, Miami Beach, Florida 33139 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (847) 235-8100 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: See attached. • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST: 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,or public hearing number. Variance to operate and utilize its accessory outdoor bar counter between the hours of 8:00 p.m. and midnight, and all other land use, zoning, development, and licensing matters related to the property commonly known as 6801 Collins Ave. PG 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 _ City of Miami Beach HPB None X Planning Director&Staff 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. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety: None 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): $315/hour 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 A.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 City Code Section 2-490,entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X 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 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 X No 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 X No: 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 X No: 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: 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 COMPENS ION DURING THE REPORTING PERIOD.' Signature of Lobbyist: Date 2-(9- t—7 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 al eporting re.uire ants. _ Signature of Lobbyist: , > Date 2 k -7 Signature of Principal: _∎ Date Z la'//0 1/I//A e- kc..r€/ /Ife0,4fe/ VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Flor;cJo, State of Pw /oi k County of: Mi a.,�.i -Die i County of /1-4G✓ !d/k . Sworn to�(or affirmed) and subscribed before me Sworn to(or affirmed)and subscribed before me this '1 day of FQLLrw.,r y ,2012 by this 3 ltday of f P r?cf7 ,20 , by ,.r„ _Lek, J O C L Q A co V / dog c✓ f(4 --c_ $,, q,`'+..�. 'ME OF LOBBYIST NAME OF PRINCIPAL - Y cb Produced ID _Produced ID z}o c°r m FORM OF IDENTIFICATION FORM OF IDENTIFICATION -Z U N L Pe y K o Personally Known a a0i Q}o v 4 a amN ; m •• "i a. "a ubli' f 0.- ocu, g - f Notary ublic S' nature of ry j ame of Notary, Typed, Printed or Stamped Name of Notary, Typed, Prin;-.1 or Stamped w 9 C 2 E - ZCC 0 V (NOTARY SEAL) (NOTARY SEAL) TO BE COMPLETED BY CITY CLERK'S STAF Y Annual Registration fee: [ ]Yes�]No Amount Paid _36 b MCR#� \\ ?5O) Date Paid 41_04 Lobbyist Registration Form receiv and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registr Form Revised Ot♦-18-16 REG.doc Revised 08/18/2016 1 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. OWNERSHIP DISCLOSURE AFFIDAVIT • / STATE'OF- /Veu )ss: COUNTY OF Mu YU'/ k-- ) Before me, the undersigned authority, this day personally appeared James J. Zenni, Jr., Manager of Carillon Hotel, LLC, f/k/a Z Capital Florida Resort, LLC, and President and Chief Executive Officer of Z Capital Group, LLC and Z Capital Partners, LLC, member of Z Capital Partners UGP, L.L.C., Z Capital Partners GP 11, L.P., the General Partner of Z Capital Partners 1I-A, LP, Z Capital Partners II-B, LP, and Z Capital Partners II, LP ("Affiant"), who being by me first duly sworn, upon oath, deposes and says: 1. That I am the Manager of Carillon Hotel, LLC f/k/a Z Capital Florida Resort, LLC ("Carillon"), the applicant submitting the accompanying application for a public hearing before the City's Historic Preservation Board ("iTPB") as required by the City of Miami Beach's ("City") Land Development Regulations for the Certificates of Appropriateness and Variances to be issued under HPB File No. 7624 affecting the real property located in the City described in the aforesaid application made a part hereof. 2. That Carillon is a wholly owned subsidiary of Z Capital FR Holdings, LLC ("FR Holdings"), the ownership interests of which are held in limited partnerships managed by Affiant wherein no one natural person holds a total of Five Percent (5%) or more of the ownership interests in the applicant entity. 3. That the facts stated in this Affidavit, and represented in the application and documents submitted in conjunction with this Affidavit, are true and correct, to the best of the Affiant's knowledge, information and belief. Further Affiant sayeth not. James J. Zenni Manager of Carillon Hotel, LLC, f/k/a Z Capital Florida Resort, LLC President of Z Capital Group, LLC and Z Capital Partners, LLC Authorized Signatory of Z Capital Partners UGP, L.L.C. and Z Capital Partners GP II, L.P., on behalf of Z Capital Partners II-A, LP, Z Capital Partners II-B, LP, Z Capital Partners II, LP and Z Capital FR Holdings, LLC The foregoing 'instrument was sworn and subscribed before .me this p� day of r, 20If by James J. Zenn.i,.k., Manager of Carillon Hotel, LLC f/k/a Z Capital Florida Resort, LLC, and Authorized Representative of Z Capital Group, who produced Florida Driver's License Z500-450-55-022-0 as identification. MATTHEW DAVID KANE Notary Public 'NOTARY PUBLIC,STATE,OF NEW YORK (40242657;1} NO:02KAB241219 MYGCOAMM SSIO EXPIRES CT 1N2019' MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E. Granado, City Clerk CiyClerk @miamibeachfl.gov Tel: 305.673.741 1, Fax: 305.673.7254 NAME OF LOBBYIST: Ian Bacheikov 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 Sectiop 2-482 of the Miami Beach City Code. I . 2_7:1 /zo I -7 Signature o • • - Date EICLERISALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 08-18-16 REG.doc (' ^� -;xt. 'S --sue L X l L T .-i"�_ r7 O s1 �' O nom' x . 41 s 1 o m c3.; • �� ' L ,, m , - - g 4_ - _, ' -- 3.£' to tii_ — _ �fC �4 j;• _ - •. • - W -d– -� PO___ -_= _ 1 ±- - - — _ •;4 l • . .-- 72.: • • • • •