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Thomas Webber - Villa Seis LLC DocuSign Envelope ID:557F3920-B2A1-46D0-9F62-CE4CB291229B 'SO/ Co 1(ivs 4Ut? RECEIVED t„, A A i\ tp L21 \in EG►8VED K'r Office of the City Clerk APR 30 2021 1700 Convention Center Drive Miami Beach, FL 33139• CITY OF MIAMI BEACH 305.673.7411 OFFICE OF 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 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: Weber Thomas NAME OF LOBBYIST (Last) (First) (Middle Name) Weber Studio,LLC 104 Crandon Boulevard,Suite 414 Key Biscayne FL 33149 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)361-9935 tweber@weberstudiomiami.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS • II. PRINCIPAL INFORMATION: Aguera Gimeno Jose Luis NAME OF PRINCIPAL (Last) (First) (Middle Name) Villa Seis LLC, 1506 Collins Avenue Miami Beach FL 33139 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)331-4707 jlaguera@surinvest.cl r- PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to City Code Section 2-482(h)(1)(a): A principal of any corporation, partnership, or other entity who appears as a lobbyist on behalf of that entity,without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to express support of or opposition to an item shall register with the Clerk as required by this subsection but shall not be required to pay any registration fees. W 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): Tose Luis Aguera Gimeno • 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): Ari' d, M iL Page 1 of 5 4 �, 'Rpz:eeoe 103-E341760AEE05 Page[__. 1__of 6 1E341760AEE05 1111 @ r _-P411111 k • DocuSign Envelope ID:557F3920-B2A1-46D0-9F62-CE4CB291229B 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 Sr 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 1506 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 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 0-appearance of impropriety(if none,write N/A): None W W M 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): U Page 2 of 5 DocVerify ID:398F23D7-3CE9-457A-ADD3-E341760AEE05 Page 2 of 6 1 2E341760AEE05 ,III @{fig ,I III vnvw.docverify.com DocuSign Envelope ID:557F3920-B2A1-46D0-9F62-CE4CB291229B 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 x 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 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 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, has it been less than 12 months since the elected official(s) whom you provided campaign consulting services was 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 lobbvina the City Commissionat 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: W _Yes XNo: If yes, were you promised or did you receive economic consideration in exchange for campaign consulting services? W O TO BE COMPLETED BY CITY CLERK'S STAFF(- T(A,�FF ONLY Annual Registration fee: [�]Yes[ ]No Amount Paid$ �V o .0) MCR# `���O" C, Date Paid 0 f+"30'71 Lobbyist Registration Form received and verified by: Fa\CLERWALL\aFt9RMS\LOBBYIST FORMS\Lobbyist Registration Forma Revised 09-2048 REG.doe Revised 09/20/2018 LL 2 Page 3 of 5 DocVerify ID:398F23D7-3CE9-457A-ADD3-E341760AEE05 www.docverify.com Page 3 of 6 ,III 3E341760AEE05 I 7R tt;�'t,I I -, DocuSign Envelope ID:557F3920-B2A1-46D0-9F62-CE4CB291229B 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 COMPENSfig-faNsfALLRING THE REPORTING PERIOD.' Signature of Lobbyist: IV Date 4/29/2021 -C5470EA323FB419... 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 anderVfl Ytequirements. ___rki4/29/2021 Signature of Lobbyist: c547ocn323roa,9... Date Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of County of: Miami-Dade County of: Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of 0 physical presence by means of 0 physical presence or Il online notarization, or 0 online notarization, this 29 day of April ,20 21, by this_day of ,20_, by Thomas Weber Jose Luis Aguera Gimeno NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally KnT.„....... _Personally Known N Signature of Notary Public Signature of Notary Public N Diana Ramos N Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped w 1 Diana Ramos ► (NOTARY SEAL) < 1 Commission#GG 308355 1 rotary Public-State of Florida 1 My Commission Expires Apr 10,2023 1 0 1 Thel o tg persons: ,- Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who 'T: 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 o not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. O Page 4 of 5 DocVerify ID:398F23D7.3CE9-457A-ADD3-E341760AEE05 Page 5 of 6 5E341760AEE05 ,III IY pryer psCh�4 'I III LL p www.docverify.com DocuSign Envelope ID:557F3920-B2A1-46D0-9F62-CE4CB291229B 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: r Date Signature of Principal: - I ' DateCO l 1 1Jc0_ VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of l01-. County of: Miami-Dade County of: Vy Ipsy,Alr Dtro • Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of 0 physical presence by means of rgphysical presence or 0 online notarization, or❑ online notarization, this day of , 20_, by this 04tlay of Alp wk.- , 2021, by Thomas Weber Jose Luis Aguera Gimeno NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID X Produced ID tk,tVb7—'" kV}-O FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Known _Per onally Know, m � � 0 Signature of Notary Public ignature of Not•'ry P • is Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, rinted or Stamped wa (NOTARY SEAL) (NOTARY S' Ap " Notary PLuCblaicrpSetate o f Florida 44 ' . My Commission GG 298039 Expires 0210412023 W an • '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 DocVerify ID:398F23D7-3CE9-457A-ADD3-E341760AEE05 Page 4 of 6 I 4E341760AEE05 J ,III@�gy ,I III a www.docverify.com - C'.V� — DocuSign Envelope ID:557F3920-B2A1-46D0-9F62-CE4CB291229B 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: 305.673.741 1, Fax: 305.673.7254 NAME OF LOBBYIST: Thomas Weber 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. co 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. DocuSigned by: 4/29/2021 CWOEA323F8v i9... Signature of Lobbyist Date Ui w U F:\CLER1$ALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 DocVerify ID:398F2307-3CE9-457A-ADD3-E341760AEE05 Page 6 of 6 6E341760AEE05 www.docverify.com — C.hi�ROc Er1s"�;f L aa��E;V E r? , Exhibit A APR 30 K: 1 Ownership of Villa Seis, LLC: CITY 7i= in,ti; • 100%of Ownership of Villa Seis, LLC is held by Florda Casa LLC OFFICE OF l j o Florida Casa, LLC is owned 50%by Montesur Investments, LLC • Montesur Investments, LLC is owned 10%by Oviedo Investments LLC, • Oviedo Investments LLC is owned 100%by Inversiones Oviedo USA Spa. o 65%of Inversiones Oviedo Spa is owned by Jose Luis Aguera Gimeno. • Address: 1300 S Miami ave,STE. 3604, MIAMI, FL 33130 o 35%of Inversiones Oviedo Spa is owned by Maria Teresa Gimeno. • Address: 1300 S Miami ave,STE. 3604, MIAMI, FL 33130 • Montesur Investments, LLC is owned 90%by HPDM USA, which is owned 100% by Inmobiliaria • Inversiones Pie de Monte Ltda. • Inmobiliaria e Inversiones Pie de Monte Ltda is owned 93.93%by Inversiones San Luis S.A. o Inversiones San Luis S.A. is owned 98.72%by Tooshi Shintaku Co. • Tooshi Shintaku Co. is owned 100%by Zetaeme Fundacion Inc. • 33%of Zetaeme Fundacion Inc. is owned by Pilar Zabala. o Address:AVENIDA PRESIDENTE RIESCO NO. 5711 SANTIAGO, CHILE • 33%of Zetaeme Fundacion Inc. is owned by Mariela Zabala. o Address:AVENIDA PRESIDENTE RIESCO NO. 5711 SANTIAGO, CHILE • 34%of Zetaeme Fundacion Inc. is owned by Maite Zabala. o Address:AVENIDA PRESIDENTE RIESCO NO.5711 SANTIAGO, CHILE o Florida Casa, LLC is owned 25%by SounHonor Ltd. ■' Sound Honor Ltd. is owned 100%by Amicitia Investments Corp. • 51.98%of Amicitia Investments Corp. is owned by Enrique Hasbun o Address: Kennedy 7900 of. 301,Vitacura,Santiago, Chile • 22.02%of Amicitia Investments Corp. is owned by ELTA SpA held by Enzo Lubiano o Address: Del Inca 4421 dp. 161, Las Condes,Santiago, Chile • 25.99%of Amicitia Investments Co. is owned by lunctus SpA., o 50% lunctus SpA. is owned by Marisa Lubiano • Address: Camino La Vina 12.025 CASA 4, Las Condes,Santiago, o 50% Iunctus SpA. is owned by Juan Fernando Lafuente • Address: Camino La Vina 12.025 CASA 4, Las Condes, Santiago, Chile o Florida Casa, LLC is owned 25%by Sasep Overseas Ltd. • Sasep Overseas Ltd. is owned 100%by Jorge Selume Zaror • Address: Kennedy 5454 of. 1701,Vitacura, Santiago, Chile • f I C -- 0 1 ti MBFi ti City Hall $ 1700 Convention Center Dr. Miami Beach , FL 33139 o_u �' 305-673-7420 Z H. '* Welcome c. • 004769-0033 Maria A. 04/30/202.1 11 :14AM r . s r - : - MISCELLANEOUS 1 _ Reference 1 : 427902 2021 item: MCR MCR OPEN (MCR) 1,900.00 1,900.00 Subtotal 1,900.00 Total 1,900.00 1 , `� � c �. = CHECK 1,.100,00 Check Number000107 ^r.,z 4, y Change due 0.00 g. V . o •- °'-. gym„ 5 r .— Paid by: villa seis p'.2 .. v . . q pq_ - - ,. _ - � it!1T19A U = �., .... .,. . . _ Thank you for your payment CUSTOMER COPY docv'erify3 ` 7 ocv.„ Lobbyist Registration Villa Seis - T. Weber -fully executed.pdf DocVerify ID: 398F23D7-3CE9-457A-ADD3-E341760AEE05 Created: April 29, 2021 12:27:58 -8:00 Pages: 6 Electronic Notary: Yes / State: FL This document is a DocVerify VeriVaulted protected version of the document named above.It was created by a notary or on the behalf of a notary,and it is also a DocVerify E-Sign document,which means this document was created for the purposes of Electronic Signatures and/or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to www.docverify.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. E-Signature Summary E-Signature Notary:Diana Ramos(dra) April 29,2021 12:28:46-8:00[A77A041 EC19D][162.244.152.118] dramos@brzoninglaw.com t ti r r ti 11 111111111111111111111111111 11111 11111111111011101111111 111111 I I I I l l i • DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. I DocVerify www.do eIf3A8P23D7.3CE9-457A-ADD3•E341760AEE05 Generated Cover Page E341760AEE05 ,III ,I III