Kobi Karp - H&M Hennes & Mauritz L.P. H & ,M Hennes & Mauritz, LLP, 47 W 34 Street, 3rd Floor, New York, NY 10001 eR
iV\I Ami BEAc H r-1
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 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.
Karp Kobi
NAME OF LOBBYIST (Last) (First) (M.I)
Kobi Karp Architecture & Interior Design, Inc., 2915 Biscayne Blvd, Suite 200, Miami, FL 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.
H & M Hennes & Mauritz L.P
NAME OF PRINCIPAL/CLIENT
H & M Hennes & Mauritz L.P., 47 W 34 Street, 3rd Floor, New York, NY 10001
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
212- 287 -1974 212- 287 -1990 brlan. rowanahm. 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 Daniel Kulle, Country Manager, Domestic CEO
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST Publicly Traded Corporation
II.SPECIFIC LOBBY ISSUE:
Partial Demolition, Renovation and Restoration of Lincoln Theater - 551 Lincoln Road, Miami Beach, FL
Issue to be lobbied (Describe in detail):
lll. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any 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 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Historic Preservation Board
William Cary, Asst Dir, Planning and Zoning Dept
City Planners - Michael Belush, Deborah Tackett 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.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
None 3313.40 S,4f313 A I In
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07- 11 -'11 17:37 FROM- Pathrnan & lewis 3053792420 T -301 P0002/0004 F -964
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). -_ w. =
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`'
0 Yes rl No Are ou Iobb in • on a •resent or endin bid for oods, 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 @ No: Are you lobbying on a pending application fora Development Agreement with the City or application for .:
chap;a ofzonin. ma desi•nation or than•a to the Cit. 's Future Land Use Ma.?
3) Pursuant to Miami Beach City Code 2 - 484 (h) Any person (except those exempt from the definition of "iubt)yisr as set forth in
Section 2 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 10 any s
item, shall register with the clerk as required by this section hut, shall not bc• required to pay any ii gistration fees ' :x`
❑ Yes 0 No: Are you representing a not- for - profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH SHALL SUBMIT 10 THE CITY CLERK A SIGNED STATEMENT UNDER „ ,
OATH, LISTING LOBBYI G 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. _ )
- ----\--"" ---
$ignsluro of Lobbyist )'
I do solemnly swear that all of the foregoing facts are true and correct that I have read or am familiar with the provisions contained
in Section 2 - 482 of the Miami Beach City Code and 311 uire E - -
Signature of Lobbyist: ,_ _
Signature of Principal /Client: _.,_ r IZ —,C ... -.--,. 0
t'�M ( V c rIge,o- -r,(
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION. y
r
❑ Produced ID I 1 Produced ID -
Form of Identification Form of Identification '-'
jJ Personally known (Lobbyist) 0 Personally known (Principal) aa a � WQ
V3 N A.
�
VII. SIGNATURE AND STAMP OF NOTARY. ra v 'r. •
;:ri Sd x -
State of Florida, County of Miami.Oade Stat€ of•Eleri uu.0 c>,
4a, County of t llaalo a =r Is :N ,
worn o and subscribed efore me Sworn and subscribed before me
Thi es day a. .. , le_ , 2011 I ni., V" ?ay of ' 5"ti ,1 1 , 2011
- s • tture of Public Not ry - State offiofl 70 ! ignaturs o( li tdotary State of FLocfid , 1.)1.)0-) .e O /I .
/No arlzation of Lobbvi St's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERKS STAFF ONLY
Annual Registration fee: ( ] Yos [ ] No Amount Pald $ ...... MCR 1► Dale Paid
Lobbyist Roglstratlon Form received and verified by:
F :IC t •^ FO 1S LOBBYIST FORhfS \lobbyist Anneal Regimtation Fw,u.doc Revised 1/11/2011 J
AA, `;t;t+: S :•. JEAN C.14CLEOO _^
:4 MY COMMISSION a DO 8$ 229 ,
;; EXP:RCS: Novambe.r 11, 2012 1 0.
• `gip r'„F . 00 oo Thar Notary Public Undorenas '
S -
t\A I A NI\ 1 BEAC
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305 673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Kobi Karp
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 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 of lobbyist withdrawal in writing.
AV/ D ate: