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Mercy Arce - Alton Road Owner LLC (671Gt,6 M I AMI B EACH RECEIVED Office of the City Clerk 1700 Convention Center Drive AUG -8 2019 Miami Beach, FL 33139 305.673.7411 CITY OF MIAMI BEACH LOBBYIST REGISTRATION FORM OFFICE OF THE CITY CLERK 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: Arce Mercy NAME OF LOBBYIST (Last) (First) .33ld Fl (Middle Name) Holland and Knight LLP 701 Brickell Ave Miami FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-349-2178 mercy.arce@hklaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS • II. PRINCIPAL INFORMATION: Colmer Bradley NAME OF PRINCIPAL (Last) (First) (Middle Name) Alton Road Owner LLC 1691 Michigan Avenue, Suite 510 Miami Beach FL 33139 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-749-0921 brad ley.colmber@decocapital.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS ursuant to City Code Section 2T482(hj(1R: A princip'al of em corporation, partne'rsfiip,co other entity who -•+ m D l65157ist CW behalf of that entity,without special compensation tap reimbursement for MID ttigt rotxa aa:22kIlm,indirect,co contingent,tiDaTim Eaugnac2co 0++osition 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): rr,, • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A)?W. t` .1(e . C • 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): 52_.e / t 1' ee Page 1 of 5 0 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 and permitting approvals for property located at 1671 Alton Road, Miami Beach, Florida 33139. 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 Members of City Administration and Members of City Staff X Members of Design Review 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(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): $225.00 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)(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 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 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: .J, �.:, .' Yes No.• loves has itlbeen lessIthani1f2rmonths.since:the electedfofficial(s) whom yoWprovided campaign consulting services`w 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: � '�,.�•� .,�; s_amu:�. -. r ,� r_..- �..- +..a '• .11r::�tzn?.,�:�w°�a :tiy' +�ksa'.>�..[� , ?'s�=Ccucu`�"x; Yes No: If..ves,, .were you§promised��of�=drd�vouiireceive._economicaconsiderat►on mchange forxwcampaign, consultinq.•se iry ec s TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[y1 No Amount Paid$ yy _ MCR#r Date.Paid • Lobbyist Registration Form received and verified by: c r;- F.\CLER\ ALL\aFORMS\LO88YIST FORMS\Lobbyist Registration Ferns 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 COMPENSATIONMPDURING THE REPORTING PERIOD.' Signature of Lobbyist: /(i `rf .-t .tom Date 611 / i Jr 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: "174 Date 8 A it J 1 Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: I PRINCIPAL State of r-1•0 rt.�t State of County of: C CJIV1 l ' County of: Sworn to(or affirmed) @nd subscribed before me Sworn to(or affirmed) and subscribed before me this 1 Sr day of c . , 2010, by this_day of , 20_, by NAME F LOBBY! T NAME OF PRINCIPAL _Produced ID _Produced ID /Personally FORM OF IDENTIFICATION FORM OF IDENTIFICATION Known _Personally Known Signature of Notary Public. Signature of Notary Public Yv 1 11 lG /lS Name of Notar ,Tied Printed or Stam•ed Name of Notary,Typed, Printed or Stamped I .., MY � ION8808X480 (NOTARY SEAL) (NOTA'i mama won �Iv Bondldlto Pibbtlndaw n 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 representativ&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 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: 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:::: Date 1 q Signature Date 2,1 L l VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of State of c O hOC County of: County of: Miami - Sworn to(or affirmed)and subscribed before me Sworn.o(or affirmed)and subscribed before me this day of , 20_, by this 17- day of TO(i , 20jI, by .�rr�lt i (11)1 rrrc r NAME OF LOBBYIST NAME OF PRPNCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION Personally KnownPersonally l Signature of Notary Public Signature of Notary Pu• rn0.14k-C11IS -w ►'� Name of Notary, Typed, Printed or Stamped Name of Notary,TyNtoilNititliy/k�Stamped (NOTARY SEAL) (NOTARY SEA .��° 011'24,,Z •. :die 6:5d) • * 61.414D •: •r: "Z• • •yam #GG 293975 • 1 The term"lobbyist"specifically excludes the following persons: 4 � •'•'ye'nded t�� �` • tint• Expert witnesses who provide only scientific,technical or other specialized information or tes' ings; any person who only appears as a representative of a neighborhood association without compensation or ream dfim4•.� �p1i���e 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, 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: Mercy Arce 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. f w 71 4,1 Signature/of Lobbyist Date / / F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page 5 of 5 DISCLOSURE OF INTEREST APPLICANT: ALTON ROAD OWNER LLC • Alton Road Owner LLC is 100% owned by Alton Road Ventures LLC o Alton Road Ventures LLC is 85.50% owned by RWNIH-REP III Alton Road LLC, and 14.50% owned by Deco Capital Investment Alton Road LLC ■ RWNIH-REP III Alton Road LLC is owned by the following individuals: Marc Rowan 97.851% Joshua Shapiro 0.921% Ari M. Shalam 0.614% Alex Rabin 0.614% 100% ■ Deco Capital Investment Alton Road LLC ownership is as follows: Dan Marinberg 8.99% Bradley & Olivia Colmer, 13.44% as Husband and Wife Alex Gellman 17.997% Bernard Borghei 17.997% Max Leifer 3.599% Brady Leifer 1.799% Richard May 17.997% Christine Routhier 8.998% Linda Worton Jackson 8.998% DCP Sunset Harbor LLC 0.186% 100% • • DCP Sunset Harbor LLC is 100% owned by Bradley Colmer #69550504_v1 • [ , [ i Miscellaneous Cash Receipt CITY OF MIAMI BEACH1 ,I No,424335 , , i , r Cash 'El, Credit Card 0 Check# $ 11°5(7)- c",,., ob- o t-) 20 —n i. mBFlt , . Mr., i tgVer.,IAL- CR-2019 ' I Q-4 -7 "J.11- —'- • i'''( / 11)i '-. "1? ) ..r., U'4 V ,`•7.).'1 A et'4 4-(4 , --,-,, 1,,f i} --- -- AddIMS5)014 Maria A. 08/08/2019 1C0'.44AM ,(, . Ii 4k-(.. 5 '5 , ' f.,T1 11 :::? ?,I ? ! iM1, ,.!CR OPEN(MCR) /1 5 I I, FCR OPEN ':,,,,,ir - I i • c.., 7 1 / I`i<;,,1 (C`CI '41 Payment Amount. 1,050:00 1 424335 1 1 1 r I 1 1 , (THIS INFORMATION PAUST BE COMPLETED) 1 1 Office of Finance Director ! 1 By 'I Account Number: (1)" '.-3 a --1' - - 4=1-I I-.1 e,- - ._,.) / J Cf _ ,,.., _y „,,• , ,_ __ •i 1 \ 1 i ' ) arer Prep : ----)/3'-''''':"'"1/ '‘/1 L', ' ''!"''''''' ( 4.----- [ Dept fEXT: i i t 1 r, 1_. . .._ . . .