JJ Wood - Qriar Island Corp 5L [sly-.. r.
DocuSign Envelope ID:B17C65E3-300D-470A-B731-AC6D11137DEE
RECEIVED
MIAMIBEAC HMAY 032021
Office of the City Clerk
1700 Convention Center Drive CITY OF MIAMI BEACH
Miami Beach, FL 33139 OFFICE OF THE CM(CLERK
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;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:
Wood JJ
NAME OF LOBBYIST (Last) (First) (Middle Name)
Urban Robot Associates 420 Lincoln Road-Suite 600 Miami FL 33139
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786)246-4857 (305)766-0071 jj@urbanrobot.net
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Neiva Silveira Luis Felipe
NAME OF PRINCIPAL (Last) (First) (Middle Name)
Qriar Island Corp 5004 North Bay Road Miami Beach FL 33140
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
9 (305) 324-4700 • luisfelipe@futureholding.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
o m@t119 amp Egtiam 2-482(h)(100 Q principal ea=corporation partnership,CA catar Gat dip.+a F 0 lobbyist CW Cex ill di ffiff
0147„cvlaca spectat co pensation CQ rennbursemen Ctarargi appearance, +C ,indirect Cif contingent CO(11§Lt fl ealtilitoffamfmalimg
• 543RdkEVMDIXMIMagigtfe3ER IraeliGX3 MON + ' o blfilaSILIROMILiM ibl IVEL1'n l.", a ¢jam
• If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
LL pursuant to City Code Section 2-482(c):
W • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): A Ca
• 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):
Please see the attached.
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DocuSign Envelope ID:B17C65E3-300D-470A-B731-AC6D11137DEE
HI. 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 28 Star Island
Drive,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
p 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
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• 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 per hour
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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 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:
Yes XNo: If yes, has i been less than 12 mont s since the elected official(s) whom you provided campaign
consulting services was sworn ini.
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:
0
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LL _Yes X No:• If yes, we a ya.0 promised or did you receive economic consideration in exchange for earrlpaiq
consulting servicest.
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L TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
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Annual Registration fee: [ Yes[ ]`No Amount Paid$ �� MCR# Date Paid S•— - Com(
Lobbyist Registration Form receivedand verified by:
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DocuSign Envelope ID:B17C65E3-300D-470A-B731-AC6D11137DEE
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 COMPENSA N I:4 dNG THE REPORTING PERIOD.1
A A /1A/.1,-,1,Signature of Lobbyist: JJ U'' Date 4-30-2021
U251 H22A3A8U481-...
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 +'e provons ontained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and : -8: ':l'e••/rem: ts.
Signature of Lobbyist: 3). ib. �I. Date 4-30-2021- ---'
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Signature of Principal: `rI Date 01 30, 2.Q2_(
VII. NOTARY SIGN ' URE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
County of: Miami-Dade County of: Miami-Dade
Sworn to(or affirmed)and subscribed before me, Sworn to (or affirme subscribed before me,
by means of 0 physical presence by means of ysical presence
or®online notarization, or❑ online notariza�f`on
this-30th day of April2021 "" by this .LS I L� day of2�` by
JJ Wood Luis Felipe Neiva Silveira
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID `�Produced ID 1\i 42-45bo Com®
FORM OF IDENTIFICATION f FORM OF IDENTIFICATION
X Personally Kno _Per ally Know
0 %ZiI, Uti j
0,
Signature of Notary Public Signat re of Notary Public
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Diana Ramos
N Name of Notary, Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
1 Diana Ramos 1 (NOTARY SEAL)
t; ../��••• ANTONIO GALIC
Commission#GG 308355 O.•Y�•tv
Lu o I Notary Public-State of Florida * -- Commission#GG 936667
liij 1-1 Thel My Commission Expires Apr 10,2023 T.Ig persons: f9 0 F`OQ�`Bonded Expires Decoy Fain Insurance 202 800 385 7019
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bWeary �,w�0 SPS, .SE„
g Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who
wth 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
0 not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
v the appearance.
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DocuSign Envelope ID:B17C65E3-300D-470A-8731-AC6D11137DEE
MIAMI BEACH
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: .1.1 Wood
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.
O
3) ANNUAL LOBBYIST REGISTRATION FEE
Q 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:
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W �� �bb 4-3A /10-2021
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Signature of Lobbyist Date
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DISCLOSURE OF INTEREST
CORPORATION,PARTNERSHIP OR LIMITED LIABILITY COMPANY
If the property that is the subject of the application is owned or leased by a corporation, partnership or limited liability
company, list ALL of the owners, shareholders, partners, managers and/or members,and the percentage of ownership held
by each. If the owners consist of one or more corporations, partnerships, trusts, partnerships or other corporate entities, the
applicant shall further disclose the identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity.
Qriar Island Corp
NAME OF CORPORATE ENTITY
NAME AND ADDRESS %OF OWNERSHIP
BATISTA SILVEIRA,VIVIANNE M 5004 NORTH BAY ROAD MIAMI BEACH,FL 33140 1 00 %
N/A
NAME OF CORPORATE ENTITY
NAME AND ADDRESS %OF OWNERSHIP
If there are additional corporate owners, list such owners, including corporate name and the name,address and percentage
of ownership of each additional owner,on a separate page.
We are committed to providing excellent public service and safety to all who live,work,and play in our vibrant,tropical,historic community.
MBF
City Hall
: '
1700 Convention Center Dr.
+ o o.- Miami Beach , FL 33139
I, . N . 305-673-7420
Welcome
1 N - 1 004770-0029 Maria A. 05/03/2021 03:16PM
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Z . Reference 1: 427904
2021 Item: MCR
I= MCR OPEN (MCR) 2,400,00
.',,, , 2,400.00
1 , Subtotal 2,400.00
Total 2,400.00
:Il
-.) CHECK
,• '1 Check Number6014 1,050.00
i CHECK 850.00
I Check Number6013
ur_ i CHECK 500.00
°^y.., . Check Number000340
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Lobbyist Registration Form - JJ Wood signed.pdf
DocVerify ID: Fl 1CB5CD-AAE6-444C-AE63-E96CE5F9306A
Created: April 30, 2021 06:41 :59 -8:00
Pages: 5
Electronic Notary: Yes /State: FL
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E-Signature Summary
E-Signature Notary:Diana Ramos(dra)
April 30,2021 06:47:46-8:00[A5B77F8B4A8C][162.244.152.118]
dramos@brzoninglaw.com
• .111414
11
1111
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