Jennifer McConney - SRA/Lincoln Theater, LLC MIAMIBEACH
City of Miami Beach Office of the City Clerk
591' �S
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 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 Ordinance 2004 -3435.
McConney Jennifer
NAME OF LOBBYIST: (Last) (First) (M.I)
Kobi Karp Architecture 2915 Biscayne Blvd, Suite 200 Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 573 -1818 (305) 573 -3766 kobikarp@ kobikarp.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
SRA /Lincoln Theater, LLC, Joanna L. Golden, Vice President
NAME OF PRINCIPAL /CLIENT:
SRA /Lincoln Theater, LLC 2301 W. Sample Road, BIdg.3 /1B Pompano Beach Florida 33073
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 979-6730 (954) 979-4951
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: Joanna L. Golden, Vice President
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Clifford M. Stein (20.3 %); Elliott Sutton (25.05 %); William & Sons of Lincoln
Road, LLC (10.10% - George, Andrew & Michael Fakhir each own an equal interest); Stephen Muss (9.90 %).
II. SPECIFIC LOBBY ISSUE:
Floodplain variance and permitting issues associated with redevelopment of 541 -551 Lincoln Road
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner of personnel sought to be lobbied, and whether the lobbyist
has entered into contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding
such person's commencement of service with the city to the present date, stating the general nature of the subject contractual
relationship.
Sec 2482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Planning Department and Building Department None X
Staff
BOA /FPMB* None L X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extenn�f a r L Sief ess f��o�ci�� amilial or
professional relationship, or other relationship giving rise to an appearance of an improprie , with any current city commissioner
or city personnel who is sought to be lobbied as identified on the lobbyist registration form Ogd :Q) WV 8- inr i i of
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
None. (J A id J 38
* Unless an issue is legislative in nature, BOA/FPMB members are not lobbied outside of a public hearing setting.
1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER): / J / h
A) LOBBYIST DISCLOSURE: (Required) $ /Sa / ' I r
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 'Sd 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 X No; Are vou 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 Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues ":
uYes X No: Are vou lobbying on a pending application for a Development Agreement with the City or application
for change of zoning map designation or change to the Citv's Future Land se 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 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 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,
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT
UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF
MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR A STATEMENT SHALL B FILE ■ EVEN IF THERE HAVE BEEN
NO EXPEN • T R OR C • • NSA ION D • ING THE REP • ; _N P ; ° •
Signature of Lo..yist
I do solemnly swear that all of the for -.: ng facts are true and correct and tha I have -.. or am familiar with the
provisions contained in Secti • -' : : • e Mi... - : - .. Ci Code and all reporting req = ents.
Signature of Lobbyist:
Signature of Principa - - ,�" 7 / At A'
VI. LOBBYIST IDENTIFICATION: , PRINCIPAL IDENTIFICATION:
Produced ID __ Produced ID
Form of Identification Form of Identification
Personally known (Lobbyist) Personally known (Principal)
VII, SIGNATU • ANO SIAMPOF.NQTARYI- — . •
� ,, LEVANA COHEN I
�
State of Florida, Cou :, u
. c �atjetary Public - State of Florida 'ate of Florida, County of Miami - -" °" ""`
Sworn to and subscri. �'. My �pmm. Expires Apr 3, 2013 worn and subscribed before me ,,. Ll }VY bEL CARMEN MORALES
This day o rc+ i � °!�oP 20 mission # DO 842824 iS y day of = t� ' COMMISSION # DD7629201
- �'; o'., Bonded Through National Notary Assn. l i , 2 ';• 4 ' EXPIRES February 27, 2012
_,,, ✓ `R , t 407 )398 - 153 FlorideNotaryService.com
Signature of Puy. • . rr_r. ate- offiorida Signature oFP blic Notary - State of Florida
Notarizati. of Lobbyist's signature Notariza n of Principal's signature
FOR L RK J)SE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid `
MCR # 1/ D -te Paid
Lobbyist Registration Form received and verified by: Entered By: 1 • O W)
: /I . AO
Revised 11/11(2011
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) $ is A r
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ / s r
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 X No: Are vou 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 Miami Beach City Code 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 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 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 clerk as required by this section but, shall not be required to pay any registration fees..
❑ Yes X No: Are vou representing a not - for - profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT
UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF
MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN
NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist
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:
Signature of Principal /Clien .: /tom
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
i Produced ID i Produced ID
Form of Identification Form of Identification
Li Personally known (Lobbyist) x known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade State of Florida, County of Miami -D
o i4�"•"r's�•, LUVY DEL CARMEN MORALES
Sworn to and subscribed before me Sworn and subscribed before me ah M1. MY COMMISSION # DD762920
This day of , 20_ This I day of , 20 .��� .>
p • P , c - : EXPIRES February 27, 2012
. ` ,s (407)398 -OVe3 FloridallotarySerwcecom
Signature of Public Notary — State of Florida Signature alp blic Notary — State of Florida
Notarization of Lobbyist's signature Notarize n of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by: Entered By:
Revised 1/11/2011
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.rniarnibeacHtgo
C1T'' CLERK Office CityClerkigimiomibeachfl.gov
Tel: 305.673.741 1 , Fox: 305.673.7254
r
LOBBYIST NAME: ,{1 r,
I understand that no later than February 28th of each year, I must file the following form, 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 and Compensation Forrn
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 on issue I have registered to lobby on has been resolved, 1 am required to
immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
.i /WO
Signature:1W
Date:
•