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Graham Penn - TCH 500 Alton, LLC 500 - 700 A-urb ro k4kb : IV :n r IV\ BEACH I A n�tl ,I Office of the City Clerk ?Pia 30 Pt3• 05 1700 Convention Center Drive Miami Beach, FL 33139 t; +i`"' 305.673.74111L :i f'1' • E't 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: Penn Graham C. NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez&Larkin,PLLC 200 S. Biscayne Blvd., Suite 850 Miami, Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 gpenn@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Martin David NAME OF PRINCIPAL (Last) (First) (Middle Name) TCH 500 Alton, LLC 2665 South Bayshore Dirve, Suite 1020 Coconut Grove Florida 33133 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 416-4556 david@terragroup.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS tip Mart)Section 2-482(h)1 (a): G1• t o.l dlEgy corporation, partnership,02 CIo a • appears(Ma lobbyist(ii]Eikii1C2 that TEA without special compensation C2 rei sursement for MB appearance, indirect,@J contingent Q)( 7•)su•.ortCQ T o•••sitlon to 9 alb. re•ister with the s3re•uiredl jla • L [3 E:2fbre•uiredin•., a/re•istration¢ 3, 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): SQ-9-. J4 Clnu?-�. • 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): See Attached. • 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. Development Approvals&Permitting Issues, including but not limited to the Historic Preservation Board, Design Review Board,Planning Board, Board of Adjustment,Land Use Development, City Commission, and any City Workshops or Committees, if necessary,relating to the property located at 500-700 Alton Road in Miami Beach,Florida. 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 Staff for the Planning&Building Department None X Public Works &City Administration,PB,HPB, BOA None X DRB, City Commission, and Mayor as necessary 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(if none,write N/A): 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): $530.00 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 XNo: 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 XNo: 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 2-491(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 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: _Yes XNo: f yes, has it been less than 12 months since the elected official(s) whom you provided campaign consulting services was sworn ini 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 X_No: if yes, were you promised or did you receive economic consideration in exchange for campaign mi"..'ultina ticssfl �/ TO BE COMPLETEDCBY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[JI ]No Amount Paid$ J MCR# LI-12.-7v7 v7 Date Paid 0 1 ' '3a-(ri Lobbyist Registration Form received and verified by: ct,'S•9411 Sos,, ..1‘4,61V....„, F:\CLER\$RLL\?FORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-918 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 COMPENSATION DURING THE REPORTING PERIOD.' Signature of Lobbyist: Date 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: Date / Signature of Principal: Date / 70' VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of State of T`DY/ County of: County of: I4/ ,i • Wim. Sworn to(or affirmed)and subscribed before me Sworn to(or affirmed)and subscribed before mg�r this day of ,20_, by this,day of (..1 1tL V ,20 !,/by Graham C. Penn (� NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Known _Personally Known Ir/z i • Signature of Notary Public Si• . u - • otary •ublic Name of Notary, Typed, Printed or Stamped Name of Notary, Typed - t ,8im�ii p ed Q ...8 (NOTARY SEAL) P�oS°0129s . '_ n 16922 me,�O • AFF9 �0aP eve 1 The term"lobbyist"specifically excludes the following persons: %'1'•'•. ro eoiOC;..••O`� T .,�eryPub6°, fL,�� Expert witnesses who provide only scientific, technical or other specialized information or testimony fNity it ngs; any person who only appears as a representative of a neighborhood association without compensation or reimbursement or 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 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 PRECEMG CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGA ED TO"LOBB . AnATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DDR .' - •ORTING P,ERIOD.1 Signature of Lobbyist: � Date iiiii . //2'3/ 7 ,------ ,_ ,_:...___- I do solemnly swear or affirm tha - of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am f- iliar wi h the pro :cions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code a' $ all repo uirements. 1 / 311 7 Signature of Lobbyis •- ____diga! / Date Signature of Principal: Date i VII. NOTARY SIGNATURE AND SEAL: LOBBYIST : PRINCIPAL PRINCIPAL State of f VIA State of County of: mt&u '9mp- County of: Sworn to(or affirmedLand subscribed before me Sworn to(or affirmed)and subscribed before me this S day ofti� ,20B., by this day of ,20_, by Graham C.Penn _ NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF ID'N IFICATION FORM OF IDENTIFICATION x Personally Know 110 _Personally Known • Signature of Notary Public Signature of Notary Public Wim 4616 Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped 4,0 Pu4t'o Notary Public State of Florida (NOTARY SEAL) (NOTARY SEAL Diana Ramos ) My Commission FF 207719 toP 0,oc Expires 04/1012019 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 MIAMIBEACH City of Miami Beach, I MU 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: Graham C. Penn 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 understap.ci-ann I registration of all lobbyists shall be required for each 12-month period comme ing Octo er 1 of each year, and the fee for such annual registration shall be $500. 0 pursuan o Section 2-482 of the Miami Beach City Code. 10011111"/- //7 / Signature of bol byist Date F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page 5 of 5 TCH 500 Alton PEDRO A MARTIN DAVID P MARTIN and/or his Revocable Living and/or his Revocable Living Trust Trust J 50% `\` of 50% , • T 500 ALTON MEMBER PARENT, LLC SONNY KAHN RUSSELL W.GALBUT BRUCE A.MENIN 2004 IRREVOCABLE TRUST 2004 IRREVOCABLE TRUST 2004 IRREVOCABLE TRUST 1 100% 1 T SOO ALTON MEMBER ,• s 16.10/0 /55.60% i 16.10% o � HOLDINGS,LLC �; ; � ' • `• ��'� David Galbut 100% % % /� i 0' ,, i i .,....si / i '12.20% _ ♦ / .• •moi''' - - - T 500 ALTON MEMBER,LLC PARK ON FIFTH,D �e'� AFLORIDALIMTEDLIABILITY ArLORmC LIMITED LIABILTY COMPANY 50%``�s`s.� 50% r TCH 500 ALTON HOLDINGS,LLC A DELAWARE LIMITED LIABILTY COMPANY i 1 100% 1 1 TCH 500 ALTON,LLC - A DELAWARE LIMITED LIABILTY COMPANY (PROPER]YO NEBI Miscellaneous Cash Receipt CITY OF MIAMI BEACI-I (-, —7 0 No. 422787 0 Cash Credit Card1Check# � � $ d r` ' � 20 - 1 ReEgfved of CD g 41A'f�>� c_�.)P�• Plc p�a,C:1v. 4:t i -,10.-10,\) (-1,r4 i,31,i7 Add neous-111Q-k::::/.0)19.) (5;,4t`i' - ;`C)_;tA4(, �t•1i, L :53/">l f,--'.:.�C:0 61Si71,4- , " /'-f ftP;4-1I I 1J'r : Ft03198-0008Adrjan a't«PQM4J W9 :_0(Siv .5 i , ';!„(C: 53 00 7c? ?,.'.'C Tr.IA) MCR OPEN(MCR) :-:' Payment Amount: 1,550.00 1 ( RfS1N ORMATlON MUST BE COMPLETED) Office of Finance Director.; Account Number: °I _). wl ..(Li 1.3L f 0 7• .a•; (i. ) E-y.•)- 5 0 Preparers 1 � (--- �- Dept: C C EXT: q 1 1 I::