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Ian Bacheikov - MME Florida, LLC 1-4,12_&C2 \ CCt✓lrl td,iv\IAmi BEACH � Office of the City Clerk 1700 Convention Center Drive 7019 JAN 16 AM 9: 29 Miami Beach, FL 33139 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 G. NAME OF LOBBYIST (Last) (First) (Middle Name) Akerman LLP 98 SE 7th Street, Suite 1100 Miami FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-982-5669 305-528-9395 ian.bacheikov@akerman.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Edwards Daniel NAME OF PRINCIPAL (Last) (First) (Middle Name) MME Florida, LLC 10115 Jefferson Blvd. Culver City CA 90232 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (323)593-5110 Dan.Edwards@medmen.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS pursuant to City Code Section 2-482(h)(1)(a): A principal of any corporation, partnership, or other entity who,appears as a lobbyist on ben&of that entity,without special compensation or reimbursement for the appearance;whether direct,indirect,or contingent,to express support of or opposition to an item shall register with the Clerk as required by this subsection but shall not be required to pay any registration fees; 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(if none,write N/A): A-Wkble:RAIVId • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): MM Enterprise USA, LLC- a publicly traded company Page 1 of 5 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. Medical Cannabis Treatment Centers and Pharmacy Store Amended Land Use Regulations 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 Mayor x City Commission x Planning Director and Staff 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 (if none,write N/A): N/A 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): $450.00 per hour Page 2 of 5 The following six(6)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 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 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 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services within the past election cycle. See Section 2-491 for more information. _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: Yes xNo: If yes, has it been less than,12 months since the elected official(s)-whom you provided campaign consulting services was sworn in? 6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section 2-491) 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: Yes XNo: f,yes, were you promised or did. you' receive economic consideration in exchange for campaign consulting services? TO BE COMPLETED BY CITY CLERK'S STAFF ONLY a Annual Registration fee: [ ]Yes[6j No Amount Paid$ 0''41MCR# ��i2 1 1 7 Date Paid O( /�I 1 Lobbyist Registration Form received and verified by: - t 3 I Ssvl�..& va, F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 Page 3 of 5 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 COMPEN TION D RI G THE REPORTING PERIOD.1 Signature of Lobbyist: Date if(K( 3f 9' 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 prov'sions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code - l r- T•, r • ements. / p Signature of Lobbyist: ImpA Date / 7/S,/ i atu eIMRTI--=fo- \ )41111..11111 Date 1 ) M I I I VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: -RINCIPAL State of Florida St-te of Countyof: Miami-Dade Cou -y of: Sworn to(or affirmed) and subscribed before me Sworn '• (or affirmed) and subs u before me this IS day of January , 20 1 9 by this_ ,•ay of , 20_, by Ian Bacheikov Qi NAME OF LOBBYIST NAME OF PRI CIPAL _Produced ID _Produced lit FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Known _Personally Kn. n Signature of Nota ublic Signature of Notary P •lic Maria Gonzalez Name of Notary, Typed.Tinted or Stamped Name of Notary, Typed, P 'nted or Stamped 43;•••.,e% MARIA GONZALEZ * ,y * MY COMMISSION#FF 909142 (NOTARY SEAL) s, 10u"' aPIRES:October22,2019 (NOTARY SEAL) grEOF oR�O Bonded Thru Budget Notary Services 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. Page 4 of 5 • CALIFORNIA JURAT _� WW _ �w ._ W w W WWW WAw� _._W 1E , it A notary public or other officer completing this certificate verifies only the identity of ;1 ;l the individual who signed the document to which this certificate is attached,and not ;5 the truthfulness,accuracy,or validity of that document. ( (E State of California ) ii t IE `^ i iL t County of O'S \I-1"\fes ) €f 31E sE Si 1 l Subscribed and sworn to(or affirmed) before me on this 1 I day i€ 1. !E ;! of •-)OWN VlO- , 20 ACI , by Ockh ECiJ J S )1 ii E ., IE 3y IE ly , Ey / „ I€ II 11 0 1 proved to me on the basis of satisfactory evidence to be the person(s) 11 who appeared before me. 1 74lE EE Eg i4 IS , 1; 1i J i MEGAN NICOLE COBB j € li ,i.,:,,,-_-_---„1-4,,,.., / , COMM. #2253747 F 3f 0 . Z E ,; cct,i_- Notary Public•California A . Z ` Los Angeles County o 1 li y,.,�..��, M Comm.Ex fires Au.. 12,2022 ..� I Signature f / (Seal) 1 1, € ' I I. E LIII ® tronat Information _ v_ _ Although the information in this section is not required by law,it could prevent fraudulent removal and reattachment of this jurat to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document p !, Rd"diio>3al lYiforpnaton- . . . ._ This certificate is attached to a document titled/for the purpose of Method of Affiant Identification Proved to me on the basis of satisfactory evidence: 0 form(s)of identification 0 credible witness(es) Notarial event is detailed in notary journal on: Page# Entry# Notary contact: Other containing pages,and dated ❑Affiant(s)Thumbprint(s) ❑ Describe: ©Copyright 2007-2017 Notary Rotary,PO Box 41400,Des Moines,IA 50311-0507. All Rights Reserved. Item Number 101884. Please contact your Authorized Reseller to purchase copies of this form. MIAMI AM B EAC , i 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:305.673.7411,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 Section 2-482 of the Miami Beach City Code. /(01r) Signature of Lo byist Date F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page5of5 Salvatore, Jason From: josefina.castro@akerman.com • Sent: Wednesday,January 16, 2019 9:26 AM To: Salvatore,Jason Cc: ian.bacheikov@akerman.com Subject: MME Florida LLC Chief Officer Good morning, The Chief Officer of MME Florida LLC is Adam Bierman. Thank you, Josefina Castro Legal Administrative Assistant Akerman LLP 198 Southeast Seventh Street,Suite 1100 I Miami, FL 33131 D: 305 679 5449 josefina.castro@akerman.com aker man 700+ Lawyers 24 Offices akerman.com CONFIDENTIALITY NOTE:The information contained in this transmission may be privileged and confidential,and is intended only for the use of the individual or entity named above.If the reader of this message is not the intended recipient,you are hereby notified that any dissemination,distribution or copying of this communication is strictly prohibited.If you have received this transmission in error,please immediately reply to the sender that you have received this communication in error and then delete it.Thank you. 1 Miscellaneous Cash Receipt CITY OF MIAMI BEACH E;- No. 422777 ash Credit Card Check# 5 o• $ ,�0 0 20 t Reeved of �' _ 1`.'n' f�c., , ^E - 7 -•�^� r_ t : :?�,! Biliscellaneous-MCR-2019 —1/-4-t c' r._ AIM' (�-•. f J<3f pit' � Ea""Y ° �' ---5-7,71"a 80-00 f 1 •Lf�li t G�..1, 2 f-2e'13-0-.FeM FCR OPEN(MCR) tel IJ5‘i ,:� �f�8.:: c� ( rrn!•7 . J,,c- fTR�t. r- A , � * Payment Amount:,, 700.00 122777 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director •'s r: By, f'1 • �!• Account Number: �i f 6 ){=`0 1.,`1I Ld LI'L/- (90 -5 "i. 6 r "� '' ` 3 Preparers -,r1. `1::Pj k ` `<=e-c- Dept: _ r: { `_ EXT: ' r'