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Alejandro Perez - TCH 500 Alton, LLC 00 )00 Av-a -oj • a r) rrtr ;s Office of the City Clerk JAN P,, , 1700 Convention Center Drive 2019 9 c�1i� 29 PM 2' 09 Miami Beach, FL 33139 CITY 305.673.7411 07FaC.;. i? T CITY CLLf <<: LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paidor 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: Perez Alejandro NAME OF LOBBYIST (Last) (First) (Middle Name) Arquitectonica 2900 Oak Avenue Miami Florida 33133 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 372-1812 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 i?u scant to City code Sediort 2-<t,2(l}(1)(a) i0.pnnccpat of an corporation partnership or other:,entity who appears%as a lobb}nst on behalf of=that entity without special;compensation;Or reimbursement for the•appearance whether.direct,Indirect,orcontingent to express supporf odor opposition to art-dein:shall register with the,Clerk as requ►red°by this subsection but shatinot be,required to payany registratron 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 NIA): 5la , AirkcW, • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST(if none,write NIA): See Attached. Pagel of 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): o 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 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 2-491(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 x No: if yes, has it been less than 12 months"since the elected-=-officialfs)whom you:provided campaign cansultine services was swore 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 x No: If yes,:were.You.promised ordid you receive=economic consideration in,exchange for"campaian consulting`services? TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee [ ]Yes[ ],No Amount Paid$915°'mac' "MCR"# 22 U Date Paid CI/.'x �( 1q Lobbyist"Registration Form received and verified by:' p`''4)1 "5 G. Vrc, F:\CLER\$!LL\aFORP'IS\LO88YIST FORM1IS\LOIS gist Registration Form Revised 09-2048 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: iIII‘-- / Date of""eT- 'Z ( 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 provisio contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reportin, -quirements. q �r� Signature of Lobbyist: �� i,r/� Date Date of— ' s ---2- 1', � Signature of Principal: 1/2-11/1 1 VII. NOTARY SIGNATURE AND 'EAL: LOBBYIST: ,,,_ J ,, PRINCIPAL State of ,Ql�i cam-• State of 1"f a riw{a County of: Clore- County of: M tan ' 'Dai o Sw9g_to(or affirm_ec) nd subscribed before me Sworn (or affi ed and subsc•ibed before this C.�7 day of'- , el4 LCA , 20L�by this? day of O artaa,r i , 20( by Alejandro Perez �-OAi Lot Oa Jr-1 v1 NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _ _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION ersonally . •- , n /Personally Known "11! . / 1, ' Signature of • - Pub 1 '..t : r- o'Notary Pu•lic u aid x r<cullW . Name of Notary,Typed, Printed or Stamped Name of Notary, Typed, P`Oul,Aiptamped ��0,i;P RAM0S/�i/i (NOTARY SEAL) , A?.•"'�°" . DAMARIS MEDINA (NOTARY SEAL) * cor.ma SIO A:.. i• • = MY COMMISSION#GG 212338 0,2 i a: . .*: - .. Qua ?p �� °' ''. .- $ EXPIRES:August 27,2022 , — •g _ •* ''� :!:1 da'Y Bonded Thru Notary Public Underwriters 5.k: �' :p • 5 go.- 'The term"lobbyist"specifically excludes the following persons: >p�.*•. d�.e•a; M1AMIBEACH 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: Alejandro Perez 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 - - Zoll. Sig* c. Le -:-i' Date F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page 5 of 5 - Miscellaneous Cash Receipt CITY OF MIAMI BEACH 6 t` -7 � k 3 i �: t. No. 422782 166 (, .,) El in Credit Card Check# $ /0.( `)0 r 0` ... ff MBF 1----7% - .( i 20 -i „` E 9 Received of * ,H217-1--.. - Ce-;RT• P f i'`T t A , A . )(23.-.Q Z, { ),`a,;�tu,. L 1, k \01t r.A f� ~�tl J1J7 '1 Miscellaneous- MCK-ZU7 e I Address :t{ � �' j P ti ' /�'t.I `�.t `'i1 i eFor3i 86-Ou58 Marian ../G1/29/2019 82i'v / ii -1. 1<.£ 6 S j S. cx (t ':::,-.DO- '7,7'd I C77-.)pJ f MOR OPEN(MCR) Payment Amount: 4,1b07DD .., MCR422782 C (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director ,r By 1'Account Number: 01 i• 'S UC C . 36c:11-1 1 (/, 0(3- 0-7• 3 ';N..') r) ). t°-)0 (L)O - I Prepares: ---)07,0",, _ (d•- vfY .,t Dept- i ";.._. OCT: N ( ' •E • Salvatore, Jason From: - Alice Ramos <aramos@arquitectonica.com> Sent: Tuesday,January 29, 2019 9:58 AM To: Salvatore,Jason Cc: Isis M. Mojicar-Hunt Subject: Arquitectonica Lobbyist Forms -City of Miami Beach - 500 Alton - Missing Information Attachments: Copy of TCH 500 Alton Org Chart 1 25 2019.pdf Good morning Jason, Thank you for holding onto the forms while I gathered the missing information. Attached is the supporting document for page 1,Section II, including the persons holding Ownership in the Corporation. Regarding page 2,Section V, please use$250 as the hourly fee for each applicant. If you need anything further please do not hesitate to contact me. Thank you for your help and time. Regards, Alice ALICE RAMOS Administration aramosarquitectonica.com cx P +1 (305) 372-1812 Ext. 1126 290ARQUITECTONICA Mia i,Fl Avenue V Miami,Florida 33133,United States www.arouitectonica.com•AAC000465 This message and all attachments are intended only for the addressee containing confidential information exempt from disclosure.If you are not the intended recipient, any disclosure,copying,distribution,use,or any action or reliance on this communication is prohibited.We do not accept liability for any loss or damage due to this message or its attachments. 1