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Maria A. Gralia - MC GA Collins Realty LLC ©OO t iid15 haS,. ;73-7 co, 54, Office of the City Clerk 1700 Convention Center Drive Miami Beach, FL 33139 305.6 7 3.7411 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 arty 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: Gralia Maria A. NAME OF LOBBYIST (Last) (First) (Middle Name) 150 W. Flagler Street, Suite 2200, Miami, FL 33130 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-789-3200 305-607-7741 mgraliaostearnsweaver.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Jordan Hylton NAME OF PRINCIPAL (Last) (First) (Middle Name) MC GA Collins Realty LLC 55 East 59 Street, 17th Floor, New York, NY 10022 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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: S • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached 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. • Modification to Conditional Use Permit °tv 'O Co 1105 10S-)-3"1 21 vy - 1.03KC��I�-► , , 1 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 Thomas Mooney x Planning Board 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): $495.00/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_No:x 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_No: x 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 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 }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 COMPENSATION DURING THE REPORTING PERIOD.aa • Signature of Lobbyist: . / ,t �/ /r, // Date ‘// /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 all reporting requirements. Signature of Lobbyist: C'G' ! C� JiQ Date 1//6//7 Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of • County of: Miami-Dade County of: Sworn tq.(or affirmed) and subscribed before me Sworn to (or affirmed)and subscribed before me this (p day of April , 2017, by this day of ,20_, by Maria A. Gralia NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Known . _Personally Known .. ie&fS ' gnat e of otary Public . Signature of Notary Public iv DA- C- iz ,ar). _ N otary, NorditigMed or amped Name of Notary, Typed, Printed or Stamped ,..ti MY COMMISSION II FF 206330 (M14,,.:: -if.IS E/ IpIRES:March 24,2019 (NOTARY SEAL) R(,5�'", Bonded Thru Notary Public Undemiters TO BE COMPLETE BY CITY CLERK'S STAFF ON Annual Registration fee: I I YesNo Amount Paid$ . $(1-02) MCR# S Date Paid "Ot ._ CP--(1 Lobbyist Registration Foram rowdyd and verified by: :\CLEP, $.A L,A,ORMS\LOW6Y1±,`, FORMS,,t.4,Lxt y t Rtvi,,teation Form Revi$ed f1/3-18 1,6 REC'.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. • 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: f t o 1/'# Q, Date X 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 all reporting requirements. Signature of Lobbyist: L./ ! 6 g. too iiQ Date 1/47//7 Signature of Principal: i��. Date GVW/7 VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of C1 P,l)yG I CV . County of: Miami-Dade County of: e)1.-60 10 Sworn tq.(or affirmed)and subscribed before me Sworn to(or affirmed)and subscribed before me this (,' day of April , 2017, by this 10 day of Apra \ ,20_6 by Maria A. Gralia JorAckx-% \\ 0.., NAME OF LOBBYIST NAME OF PRINCIPAL J Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Known X Personally Known / gnat e of otary Public"' Signature of Notary Public ,u DA C, ;z ,sr,.473 Au5o,4 FUSE FZA-r\114. N rm�•Q ,'o ary, yged or amped Name of Notary, TAt rlEilse4n'SR ped kr r., .** MY COMMISSION t FF 206330 (NOTARY SE L ' NOTARY PUBLIC (144,-,„....,•• 2019 48sSI7IRE :M24, ,. Public einftersKalb County, GEORGIA My Comm. Expires 12/13/2020 TO BE COMPLETED BY CITY CLERK'S STAt-r Iv Annual Registration fee: ( 'Yes( I No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: F:ACU,'VW.\aFORMS\LOBBY1i FOR"1S 2.r?i bymt k.f4L.t�atio:a FOtill kwes,z6 Ofi le,1.5 RE§5,tlor 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. 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 CityClerk@miamibeachfl.gov Tel: 305.673.741 1, Fax: 305.673.7254 NAME OF LOBBYIST: Maria Gralia 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 co , • *7//0/7 Signature f Lobbyist Date F:\CLER\BALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc 2000 Collins, Miami Beach Organizational Chart as of August 23, 2016 Richard Wagman- 25.194% The Prudential Insurance J.Joseph Jacobson -3.359% Company of America, David Steinberg-8.398% a New Jersey insurance Jonathan Ratner-0.840/o corporation Jon Cohen-1.680% Jill Grabel Kirby-0.840% Zuckerberg Investment Partner Richard Wagman-80% -59.690% J.Joseph Jacobson -20% 100% GA Collins LLC, MC Collins Investor I LLC, MC Collins Investor II LLC, a Delaware limited a Delaware limited liability a Delaware limited liability liability company company company 90% 9.990/0 0.01% Managing Member MC GA Collins Holdings LLC, a Delaware limited liability company (f/k/a GA/Madcap Collins LLC) 100% MC GA Collins Realty LLC, a Delaware limited liability company 100% 2000 Collins Ave Property, Miami Beach,FL Goodwin Salvatore, Jason From: Linda Christian <Ichristian@stearnsweaver.com> Sent: Wednesday,April 12, 2017 11:40 AM To: Salvatore,Jason Subject: Lobbyist Registration - Maria Gralia Jason: Good speaking with you. The addresses subject to the Modification of the CUP are as follows: 2000 Collins Avenue 205-237 20th Street 221 20th Street; and 2008-2038 Collins Avenue Let me know if you have any further questions. Linda Christian Florida Registered Paralegal Land Development&Zoning Department Stearns Weaver Miller Weissler Alhadeff& Sitterson, P.A. 150 West Flagler Street,Suite 2200 Miami, FL 33130 Direct Number: 305-789-3335 Email: Ichristian @stearnsweaver.com www.stearnsweaver.com tll fJ f IALI I NO[ICE I he information contained in this L inail message is attorney privileged and confidential information intended only for the use of the n mivrdualisi named above.If the reader of this message is not the intended recipientyou are hereby notified that any dissemination,distribution or copy of this >mrnunirrtion is strictly prohibited. If you have received this communication in error.please contact the sender by reply t -mail and destroy all copies of the Thank you. 1 .'A . 5 1. -O�mf 'S! 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