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David Martin - Alton Mixed Use Investments Holdings, LLC 3l - LI t-k A-44-0A s RECEIVED FEB 21 2020 MIAMI BE.ACF4' Office of the City Clerk CH 1700 Convention Center Drive. C0-r( OF MIAMI BEACH Miami Beach, FL 33139 OFFICE OF THE CIN 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;orany 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: 1114 t) Lel NAME OF LOBBYIST (Last) (First) (Middle Name) /k111m 11NrOS?.latral(l( I S�ldi S U.Ci 21g0‘ .S e shin P(. -*IDV) 33/33 LOBBYIST BUSINESS NAME AND ADDRESS (Ni nber and Street) (City) (State) (Zip Code) 306.► LI-I . -551n - �U,uId m+p LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL A D SS II. PRINCIPAL INFORMATION: Klut4to I DM 14- NAME OF PRINCIPAL (Last) 444 (First) _ (Middle Name) �lf�avl IMiY LI4t I4irtir s Nsl L.1.k Zle tic S shat R. 101 Mit . 33133 P)4INCIPAL BUST ESS NAME AND ADDRESS (Nu er and Street) (City (State) (Zip Code) 4551,0 PRINCIPAL�>�ESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER WV I d EMAIL D R •W'' ' Rfigggaip ©al) o o-I,° e 2-482 h) 1)(4 p principal dam%corporation, partnership,OF ding?ggitiV din appea s 03 O lobbyist ail mallgailka special compensation a011Rtalfrzgilrgaciarilka appearance, r(.AL n ( arcent'ngent,Q7- o 000 p` I?oo oositien 54 WEgaegli o Itrakh subsection l> 011G�'1'I• Co reouired it7o En, Effivoialtagtarb2a 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): 6.U. 06CAtilktik- • 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): I 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. Lease amendment and extension and related matters regarding 300-344 Alton Road, 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): None 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 XNo: Are.:you representing a not-for-profit corporation or entity without special compensation or. reimbursement? 4) Pursuant to City Code Section 2-48t 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 expresssupport 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 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 2 months since the elected official(s) horn vo.0 provided cam akin onsulti,g services was sworn rnr. 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 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: If yes, were you promised or did .o,u receiv, economic consi•eration in e change for campaiq — — cons.ultinq seruieesr TO.BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist.Registration Form Revised 09-20-18;REG.doc Revised 09/20/2018 Page 3of5 •• s 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 CALE D YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED OL BA STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMP S TI RIN EPORTING PERIOD.' - Signature of Lobbyi • Date /S 24.44P I.do solemnly swear or a irm.that all of,the forego 'g fa ts, statements, and disclosures in this form are true and correct, and that I have read or am:familiar with t•- •rov ons j on -d in Chapter 2, Art:VII, Division 3, entitled Lobbyists" of the Miami Beach City Code and all r,op re• • em:� . p' Signature of Lobbyist: A� .� /1 �i Date e 1 0- ��� Signature of Principal: e_����w Date of / a'D 240 • v VII: NOTARY.SIGNATURE , D SEAL: LOBBYIST: PRINCIPAL State of fIoti State of fl D('dA County of: '�1igt1'VLl YGL County of: p(1 GZ�•( ' l►Gt Sworn to(or affirmed and subscribed before me Sworc o (or affi ) and subscribed before me this day of �.Q,�j ,20Lby this day of 20jby . i YY�a vi nU jam �W�/t Y '�/ N E OF LOBBYIST NAME OF PRINCIPAL -hn Produced ID • _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION •• X Personally Known Personally Known We .f otary "u c O , • liii..-A ' Vil/OZ(--/-- . nSignatur=of ,4o ary Publi, anQ.vA YwS . JGJid bet.. ''1 , IS . , Name of Notary, Typed, Printed or Stamped • Name.of Notary, Typed, Printed or Stamped Ma Pue =SANDRA MARIA RAMOS (NOTARY SE j=°; �' Notary Public Stateof Florida (NOTARY SEAL) 'at.p� ` r° SANDRAMARIARAMOSa o i Commission#GG 944633��a` NotaryPublic•State of Florida • I '•-foFA°:• MyComm.Expires r 30;2024 0 p p Commission GG 944633 Bonded through National Notary Assn. OF +. My Comm.Expires Apr 30,2024 Bonded through National Notary Assn. 1 The term"lobbyist"specifically excludes the following persons: • Experwitnesses 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. • Page4of5 • . 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: David Martin 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 $500.10 pursuant to Section -482 of the Miami Beach City Code. Al / I ,. t 8 2-Dou Signat - , Ubyist 1 Date F:\CLER\$ALL\aFORMS\L hBBYIST FORMS\Lobbyist•egistration Form Revised 09-20-18 REG.doc Page 5 of 5 Disclosure of Interest Information Principal:Alton Mixed Use Investments, LLC, 2665 South Bayshore Drive, Suite 1020, Coconut Grove, Florida 33133 Name of Chief Officer, Partner or Beneficiary: Alton Mixed Use Investments Holdings, LLC,as its sole member Name of All Persons Holding, Directly or Indirectly, a 5%or more ownership interest in Alton Mixed Use Investments, LLC: 1. Alton Mixed Use Investments Holdings Member I, LLC 2. RCI MBM Developer, LLC