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Houman Sharif - 5800 North Bay Road LLC 5500 01,4L (A.7 gl:Dtd DocuSign Envelope ID:36528E23-3460-478E-A005-734D5AB4D0D9 RECEIVED 1 11 1 1n �� JUN 28 2021 Office of the City Clerk 1700 Convention Center Drive Miami Beach,FL 33139 CITY OF MIAMI BEACH 305.673.7411 OFFICE O(=T '=Ci`"•' '—'"P' 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: Sharif Houman NAME OF LOBBYIST (Last) (First) (Middle Name) MEM Architecture 601 Montgomery St,Suite 1206 San Francisco CA 94111 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (415)421-9000 hsharif@memarch.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Klopfer Kyle NAME OF PRINCIPAL (Last) (First) (Middle Name) 5800 North Bay Road LLC 5800 North Bay Rd Miami Beach FL 33140 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) finance@gsmcap.com 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 KNI-03 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): • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(If none,write NIA): Kyle Klopfer,Chief Financial Officer • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 6%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): _ Orland Bravo,50%Beneficiary and Kathryn Garrison Bravo,50%Beneficiary. LLth 41° Page 1 of 6 40„,' aRa nso.,o<o .. W ''8C9347643016s ��age1of6 T 1C93476430165 , 1111 F5161%11111 DocuSign Envelope ID:36528E23-3460-478E-A005-734D5AB4D0D9 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 5800 North Bay Road 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 appearance of impropriety(if none,write N/A): None s 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): $295/hr LL LL Page 2 of 6 DocVerify ID:EB7FF409.5823-4A8A-8878-C93476430165 [ page 2 of 6 I 2C93476430165 ,III ,I III www.docverify.com DocuSign Envelope ID:36528E23-3460-478E-A005-734D5AB4D0D9 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 X_No: If yes, has it been less than 12 months since the elected officiai(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 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: —Yes X_No: If yes, were you promised or did you receive economic consideration in exchange for campaign consulting services? Gf U TO BE COMPLETED BY CITY CLERK'S ST`7FF ONLY (6-513 513- MCR# `5( ' `(y�"\ Date Paid ®6'Y6 Annual Registration fee: [�Yes[ ]No Amount Paid$_fy Lobbyist Registration Form received and verified by: Jt) F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 LL LL Page 3 of 6 DocVerify ID:EB7FF409-5823-4A8A-8878-093476430165 Page 3 of 6 30934764301 ,III ,I III i. www.docverify.com — 65 DocuSign Envelope ID:36528E23-3460-478E-A005-734D5AB4D0D9 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 COMPENSArTIGNiO,tdRIING_THE REPORTING PERIOD.1 k-o utv, S&.ai'if 06/24/2021 Signature of Lobbyist: Date s1.338A373114,br4 U/... 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 atl-rL@p rf uire ents. ( usviO.in, Sid' 06/24/2021 Signature of Lobbyist: Date SC330A30DCDC4D7. Signature of Principal: �i��— Date g 110120-Li VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of /f TU r County of: Miami-Dade County of: Mo✓ i" 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 El physical presence or&online notarization, or 0 online notarization, this-24th day of June 2021 ^^ by this !0 day of 5u� ,20 z(by Houman Sharif Kyle Klopfer NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID X Produced ID J 1 J&--O6-i'deal L.c2u.sf, FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally P/r""^ _Personally Known A4-0- - A. Signature of Notary Public Signature of Notary Public Diana Ramos ��., N Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped Diana Ramos (NOTARY SEAL) Commission#GG 308355 Votary Public-State of Florida ICgy Commission Expires Apr 10,2023 1 The t: persons: Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who m 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 th not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 6 DocVerify ID:EB7FF409-5623.4A8A-8878-093476430165 Page 4 of 6 4C93476430165 ,III W01I III Yi www.docverify.com EI • DocuSign Envelope ID:36528E23-3460-478E-A005-734D5AB4D0D9 1 ii JUTl i j i I A notary public or other officer completing this certificate verifies only the identity of 1 i the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. 'i State of California County of Mme''••^ t I >tG Subscribed and sworn to (or affirmed) before me on this i 0 day of """e- 1 20 I\ by \51 Q. KIT-Pee , ! y proved to me on the basis of satisfactory evidence to be the persons)who appeared i i before me. ' i „o,M1 INN HILER ` I - No 1 tary Public California I 3 �c Marin County r j -�.w'„° Commission q 2240650 I °" My Comm.Expires Apr 30,2022 . t Signature a r OPTIONAL INFORMATION INSTRUCTIONS The wording of all Jurats completed in California after January 1,2015 must be in the form as set forth within this Jurat.There are no exceptions.If a Jurat to be completed does not f follow this form,the notary must correct the verbiage by using a jurat stamp containing the 1 correct wording or attaching a separate jurat form such as this one with does contain the • proper wording. In addition, the notary must require an oath or affirmation from the r DESCRIPTION OF THE ATTACHED DOCUMENT document signer regarding the truthfulness of the contents of the document. The document must be signed AFTER the oath or affirmation,If the document was previously j j LI-o y:S-I TzC ;i-l-f`'---1-. .zw signed,it must be re-signed in front of the notary public during the jure,process. I (Title or description of all ed document) • 4r:ori-..-- a State and county Information must be the state and county where the edocument signer(s)personally appeared before the notary public. r (Title or description of attached document continued) o Date of notarization must be the date the signer(s) personally ° • appeared which must also be the same date the jurat process Is o; i S VT`�f°'1' completed. I Number of Pages Document Date o Print the name(s)of the document signer(s)who personally appear at N ! the time of notarization. • 1 o Signature of the notary public must match the signature on file with the o Additional information office of the county clerk. N ; U The notary seal Impression must be clear and photographically 0 reproducible.Impression must not cover text or lines.If seal impression O e smudges, re-seal If a sufficient area permits, otherwise complete a ! different Jurat form. I mt Additional information Is not required but could help I to ensure this jurat is not misused or attached to a ° i different document. m • Indicate title or type of attached document,number of pages and date. i 0 I o Securely attach this document to the signed document with a staple. 1 f a m i 2015 Version www.NotaryClasses.com 800-873-9865 DocVerify ID:EB7FF409-5823-4A8A-8878-C93476430165 I Page 6 of 6 j 6C93476430165 I ,III ,I III www.docverify.com DocuSign Envelope ID:36528E23-3460-478E-A005-734D5AB4D0D9 t t; ,a r..., a I V; E ��...\ i ,,�7� \ i L)L./-1\ \. . City of Miami Reach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeochfl.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: Houman Sharif 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. rDocuSigned by:C(,��,y� b "" ' -f 06/24/2021 m sc330A55eeBe e7... Signature of Lobbyist Date N F:ICLERISALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc LL LL W Page6of6 DocVerify comFF409-5823-4ABA-8878-093476430165 I Page 5 of 6 5C93476430165 I ,III Il1 II I www.doerif S /...._ A � y km �---,.6-.Q\ doo/erify ¢ (. �e ) \:‘,„"y).' , „)�CVE l_ Please_DocuSign_Lobbyist_Registration_Form_- H. Sharif - signed.pdf DocVerify ID: EB7FF409-5823-4A8A-8878-093476430165 Created: June 24, 2021 06:59:24 -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) June 24,2021 07:01:10-8:00[CA7DC676CAA4][162.244.152.118] dramos@brzoninglaw.com I 111116111 1111111111111111111111111111111111111111111111111111111111111111111111 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. 1 DocVerify ID: vrv�w.doerify.EcomFF409-5823.4A6A-8678-093476430165 ,III Fa ,I III Generated Cover Page C93476430165 Miscellaneous Cash Receipt CITY OF MIAMI BEACH No, 428149 C3 Cash O Credit Card cn Check# .- . .: $ I 20 1 1 vod of .�- ,fit """ <� ... , ` { a j- t:- .:, Miscellaneous= ; ~WA'.F.'121-ii A 11 Ofi,2Q1''02'. 10R For- : "t , f; (2 s j ' ,��€ ; , Payment Amount: 2,400.00 (THIS INFORMATION,MUST BE COMPLETED) ° Office of Elnanao Director Account NwtibK' a