William A. Lai - Mokai Lounge.~ __ _
~~'~
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 bond 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 Ordinance 2004-3435.
Lai William A.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Dynamics Architecture + interior Design Corp. 888 Biscayne Boulevard, Suite 101 Miami,
Florida 33132
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(305) 376-8889 (305) 328-9688 wlai dynamicastudio.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Mokai Lounge, LLC
NAME OF PRINCIPAUCLIENT:
Mokai Lounge 690 Lincoln Road, Suite 201 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 695-8411 (786) 507-3449 hassan theopium roup com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust (Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Roman Jones, as Manager of
Mokai Lounge, LLC
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°/ O~VIORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUS~. `o -~
-° : c._.
See attached Disclosures of Interest. ~ ; G
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~~. srecll=lc LOBBY ISSUE: ~ .o
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Modification to a Modified Conditional Use Permit for an existing Neighborhood Impact Establishmentd~a ally~, an'„`_~`,
outdoor cafe without entertainment and without dancing in the adjacent existing surface parking lot undue' Fife~Vo. `~w--~'
1764 for the property located at 219 23rd Street - 235 23rd Street (a/k/a 233 23rd Street). f--~ ~
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual/Title B) An Financial, Familial or Professional Retationshi
City of Miami Beach Planning Board None
City of Miami Beach Planning Staff None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
see
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: Re wired Flat Rate ~ 6 ~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $6,000.00 ~r ~ ~'j' rLA~TZr
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^Yes ®No: Are you lobbvina on a present or pendinq bid for aoods, equipment or services or on a
present or pendina award for aoods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues°:
^Yes 6d No: Are you lobbvina on a pendinq application for a Development Agreement with the City or
application for change of zoning map designation or change to the Citv's Future Land Use Map?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of snot-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 clerk as required by this
section but, shall not be required to pay any registration fees..
^Yes ®No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist: ~~jji
-~
Signature of Principal/Client:
Roman Jones, as Manager of Mokai Lounge, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
[Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, Cgupty of Miami-Dade
tip ~rv c = - --l -- --
STATE OF~ ,,
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^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2010
Signature of Public Notary -State of Florida
Notarization of Principal's signature
CO
Fonn received and verified by:
~byist Registration Form 32708.d
Signature of Lobbyist -William A. Lai
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: (Required) $ 10io0c~ ~L'+'T Ia~TS
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $ t'i~ Oo0 Ft,aT a?~4•~
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^Yes ®No: Are you lobbvinq on a present or pending bid for aoods, equipment or services or on a
present or pending award for aoods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ®No• Are you lobbvinq on a pending application for a Development Agreement with the City or_
application for chance of zoning map designation or chance to the Citv's Future Land Use Man?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of snot-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 clerk as required by this
section but, shall not be required to pay any registration fees..
QYes ®No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. "'
V. SIGNATURE UNDER OATH:
Signature of Lobbyist - Wiliam A. Lai
1 do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach Cit~Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2010
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
IPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
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'~'• i D(FIRES: JULY 29 2012
State of Florida, County of Miami-Dade%;>'a•~,d~,~
SWO,rJ~ t0 and SU~s/c~ri~b~ed before me ~"'a"~~ w~'~ONNOTARY.Cpm
This L~ day of ~/ y L.7~. , 2010
S a li N - e of Florida
No zation r ci I's signature
Manager of Mokai Lounge, LLC
Roman Jones,
TO BE COMPLETE BY,CI Y CLERK'S USE ONLY
Annual Registration fee: Yes [ ] No Amount Pald $ MCR # $ Date Pald
Lobbyist Registration received and verified by:
F:\CLER\LOBBYIST\L byist Registration Form 32708.doc Revised 03/27/2008
~~ ril~u tvtrv ~r i htrtt riAVe BEEN Nv EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD.
~ MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office Ci~ClerkCcilmiamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
William A. Lai
LOBBYIST NAME:
I understand that no later than October 1St of each vear, I must file the following forms, pursuant to Section 2-485 of
the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County
Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
~~~'~~ ~- 7/Z Z/ Zo / o
Signature: William A. Lai Date: ___
NAME AND ADDRESS
MOKAILOUNGE,LLC
Mokai lounge Manager, LLC
690 Lincoln Road, Suite
Miami Beach, Florida 33139
MOKAI LOUNGE MANAGER. LLC
Roman Jones Companies, Inc.
3165 Pine Tree Drive
Miami Beach, Florida 33139
Mokai Investors, LLC
7901 SW 6th Ct.
Plantation, Florida 33324
Mokai 23, LLC
1137 Biscayne Point Road
Miami Beach, Florida 33141
Nomade Investments, Inc.
230 N.E. 107th Street
Miami Shores, Florida 33161
JL Club Holdings, LLC
14500 Ocean Bluff Drive
Fort Meyers, Florida 33908
Haute Investments, Inc.
P.O. Box 190754
Miami Beach, Florida 33119
ROMAN JONES COMPANIES. INC.
Roman Jones
3165 Pine Tree Drive
.Miami Beach, Florida 33139
MOKAI INVESTORS. LLC
Mitchell Rubinson
7901 SW 6th Ct.
Plantation, Florida 33324
ANV Investment Group, LLC
3801 Collins Avenue, Apt. 1404
Miami Beach, Florida 33140
EXHIBIT "B"
DISCLOSURE OF INTEREST
Page 1 of 2
OFINTEREST
100
55.118
11.811
11.811
5.906
11.811
3.543
100
50
50
NAME AND ADDRESS % OF INTEREST
MOKAI 23, LLC
Francis Milon 66.5
1137 Biscayne Point Road
Miami Beach, Florida 33141
Eric Milon 33.5
1137 Biscayne Point Road
Miami Beach, Florida 33141
NOMADE INVESTMENTS. INC.
Hassan Benjelloun 100
230 N.E. 107th Street .
Miami Shores, Florida 33161
HAUTE INVESTMENTS. INC.
Jaime Rubinson 100
P.O.Box190754
Miami Beach, Florida 33139
JL CLUB HOLDINGS. LLC
Justin Levine 100
14500 Ocean Bluff Drive
Fort Meyers, Florida 33908
ANV INVESTMENT GROUP. LLC
Dev D Dabas
3801 Collins Avenue, Apt. 1404 50
Miami Beach, Florida 33140
Sumedha Dabas
3801 Collins Avenue, Apt. 1404 50
Miami Beach, Florida 33140
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