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Emily Balter - Queens Group, LLC 1560Co[(,i) Ave, RECEIVED RECEIVED M IAM•1 •BEN....n AMAR 020 Office of the City Clerk MAR �� 2020 1700 Convention Center Drive CITY OF MIAMVII BEACH Miami Beach, FL 33139 Cli`(OF �� �r AT HCITY CLERK 305.673.7411 OFFICE THE CITY CLERK • 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 willbe 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 soughtto 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 prindpal represented on each specific issue. I. LOBBYIST INFORMATION: Baiter . Emily NAME OF.LOBBYIST (Last) : (First) (Middle Name) • Bercow Radell Fernandez Larkin&Tapanes, PLLC 200 South Biscayne Blvd., Ste. 850 Miami,Florida 33131 LOBBYIST BUSINESS NAMEANDADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 - - ebalter©brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Viso . Christopher NAME OF PRINCIPAL (Last) (First) (Middle Name) Queens Group,LLC 860 Collins Avenue Miami Beach Florida 33139. PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 800-0805 - . - chris@queenshospitality.com PRINCIPAL BUSINESS TELEPHONE NUMBER - -CELLULAR TELEPHONE NUMBER EMAIL ADDRESS REgang{ I Code Section 2-482(h)(11(a): Aprincipal ciremcorporation, partnership,cz `Tt!?G {"rYJappearsmeIobbyista behalf CM - without special compensation CPrei bursementfar(n- appearance,whether direct indirect CQ contingent toexoress su000rt@2(20000sition the @Lei pk)reo- ired WM subsectionsubsectionLIgiaffilliiringreouiredibint-yvreoistration xt- • 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): Christopher Viso . -NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A3%.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 &Planning 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 860 Collins Avenue 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 Mayoras necessary None X Pursuant to City Code Section 2482(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): $250.00 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 director indirect to expresssupport of or opposition to any item, shall register with thecity 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 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 inof any elected official(s) for whom the campaign consultant provided campaignconsulting 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 92 months since the elected officials)whom you provided campaign consulting services,was sworn inr. 6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting services toan incumbent member of the City Commission (whichlobbying 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?!flies,please list the incumbent member(s)of the City Commission: Yes xNo: If yes`were t u prtamrsed°isir drd au receive economic consideration in`exp' an 'e for camosi Y Y9D. - — Marilting1services? TO BE COMPLETED BYCITYCLERK'S.STAFF ONLY f Annual Registration fee: [ ]Yes[ o Amount Paid$ �0•&CR 7 Date Paid ,3�/2/ c:PLO //�� .3 Lobbyist Registration Form received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST'FORM S\LobbyistRegi stration Form Revised 09-20-18 RE CJ c' 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 COMPE ATION DURING THE REPORTING PERIOD.' Signature of Lobbyist: T3LIL�. /1� Date 31.I 0 (ZGZO 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 : d all reporting require -nts. Signature of Lobbyist: . � i _. •. . Date 3 �_ I 0 ZO 20 r 400, 011P'" lg Signature of Principal: • O Date 0 � O VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of ' 6v`c, State of FIback County of; tAi aNll'"DIltUt�/ County of _ a&,ani D 4 of e Sworq tpt(or affirmed nd s bscribed before m%. Sworn to(or affirmed)and subscribed before me this by .day of M OC ,.20 )by this 10 day of. iMurcL .20X,by Emily Salter CA r k,to f,N- VI o NAME OF LOBBYIST NAME OF PRINCIPAL - Products Produced ID 'O' OF IDENTIFICATION FORM OF IDENTIFICATION . X_ Personall \ I, n K Person. ,,i:� � ---- Signature.of Nota ,ublic. Si a of.Notary Public Name of Notary, Typed, Printed ,,oArStamped Name of Notary, Typed, Printed or Stamped .`S;iiii . DIANA RAMOS (NOTARY - J., MY COMMISSION#GG 308355 , ( I 1t. "- EAL`}OI SiON� 1. ..,�.a' EXPIRES:April 10,2023 4 ' t„ MYAt, •GG 300810 %-o'F,QP" Bonded Thru Nofary Public Underwiters t—��y. �, 2023 . . 'V'1;'• Bowled IMrNotary Pt Mk Underseas 1 The term 'lobbyist"specifically excludes the following persons: Expert witnesses who provide onlyscientific, technical or other specialized information ortestimony in public meetings;any person who only appears as a representativeof 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 anyy personwho 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 MIAAAIBEACH City otmiami!moan, I iuu Lonvennon center unve,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: Fm 1y Baiter 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 (orprincipal) to file the Statement or pay the assessed finesafter 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 underoath listing all lobbyist expenditures, as well as compensation received, for the preceding calendar yearwith 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 ori 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 1-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. 11 ° 17-026 atur .of ob 's#. Date FACLERWALLIaFORMSILOBBYIST FORMS‘Lcbbyist Registration Form Revised 09-20-1 REG.doc Page 5 of 5 Electronic Articles of Organization L16000180964 For FILED 8:00 AM September 28, 2016 Florida Limited Liability Company Sec. Of State sgilbert Article I The name of the Limited Liability Company is: QUEENS GROUP, LLC Article II The street address of the principal office of the Limited Liability Company is: 860 COLLINS AVENUE MIAMI BEACH, FL. 33139 The mailing address of the Limited Liability Company is: 860 COLLINS AVENUE MIAMI BEACH, FL. 33139 Article III The name and Florida street address of the registered agent is: CHRISTOPHER VISO 860 COLLINS AVENUE MIAMI BEACH, FL. 33139 Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate, I hereby accept the appointment as registered agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent. Registered Agent Signature: CHRISTOPHER VISO Article IV L16000180964 The name and address of person(s) authorized to manage LLC: FILED 8:00 AM September 28, 2016 Title: MGR Sec. Of State CHRISTOPHER VISO sgilbert 860 COLLINS AVENUE MIAMI BEACH, FL. 33139 Title: MGR CHARLES SCHNEIDER 860 COLLINS AVENUE MIAMI BEACH, FL. 33139 Signature of member or an authorized representative Electronic Signature: CHRISTOPHER VISO I am the member or authorized representative submitting these Articles of Organization and affirm that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January.1st and May 1st in the calendar year following formation of the LLC and every year thereafter to maintain"active" status. MBE ' - City Hall 1 ' • r: : ' ,,...... .,. -Ns 1,.--, ,\„„:,_ 13 , , \i.„,,, ' 1100 Convention Center Or. Miami Beach , FL 33139 1---- 305-613-7420 eco [..- " \ -. "."- ..„L 0 , Wlme ---....., ' ,r- k, ,\'''‘k. ':-.;kl- '''.''-.'.' ' .\.-. 004411-0006 Adrian V 03/12/2020 09:02AM 1C fKI*-i;i ----- 4, \ MISCELLANEOUS i "zr ' c"' Description: MCR OPEN T... o (NCR) Reference 1 : MCR425761 NCR OPEN (NCR) 2020 Item: MCR 1 @ 700.00 1_, MCR OPEN (NCR) 100 00 \.'",...- ,.) . :.';-„,• , \'',... - k ' 10000 '''.--, ' . — ------ * -- Subtotal 700.00 Total 700.00 • kt`''' , — :'-,,t.o, ' .L,,,, - iii, c‘.,,, r,'.- • , i','z-:', ` ' • 1 ' - A.). , 15.;, , t ' ' CHECK 350.00 a I: 11 , ..0 '"......... - i0 N. : Check Number001379 CHECK 350.00 [.. TD :- . 5\C-)... - '''• -• . : Q ..;...., . --..""''.._•,,, _ , a , El, ,,,,,,c Ill s's,--- .• c---., Check Number001380 . Change due 000 Paid by: QUEENS HOSPITALITY CORP. p...) ' . ,. , 0 2 4-, , :.--,,..,, 111111111111111111111111111111111111111111111111 ',''''' a) 5, ,, ,1-1 - c.,, (--- C 2 '' eE2, :' .., .- IA = - 0 w .`s-'--". ' e) ' ........,1‘...,..r. ,.,:g. 44 . .., , , ),. _- ' . (p.. :s (z• 0 ------ w`i'Ltd‘n,I Oft= I ma° * QV dilikfithrsdk cul.•4 M4WMUM1 in 14 x• - triatt=ntitatiteritt===etatt tt".22.4 [- P. UMI « *WORyd. 6ttgr'16 Sam= 1