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Kobi Karp - Meir Srebernik ',�P�a% NiEw MIAMI 16 0-a /a 3 1- S 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 Boulevard, Suite 200 Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 573 -1818 (305) 573 -3766 kobikarpOkobikarp.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Meir Srebemik NAME OF PRINCIPAL/CLIENT: Palau Sunset Harbor, LLC 900 Biscayne Blvd., #2802 Miami Florida 33132 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ' (Zip Code) 305 514 0818 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: C") Zoning Memorandum Involving Development of the Property at 1201, 1225, and 1237 20 Street, Miami Beach, Florida-4 o Issue to be lobbied (Describe in detail): Z Cy III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: � N .7 - A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relaibnsl3 �= c Cl1 1 L yA-se. rrt tT * Unless an Issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting. 11/22/2011 09:55 3053776222 BERCOW RADELL PAGE 04/05 Mil\A I AMfBEAC ; -.4 • ECO COPY 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 pnndpal. seeks to encourage the passage, defeat or modification or 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 dedslon- making process on such action, decision or recommendation that foreseeably will be heard or reviewe.d by the city commission, or a city board or committee. The term specifically includes the principal as well as any employee engape In lobbying activities. The term " Lobbyists' ?has specific exclusions. Please refer to Ordinance 2004-3435. Karp Kobi NAME OF LOBBYIST: (Last) (First) Kobi Karp Architecture & Interior Design, Inc. 291S Biscayne Boulevard, Suite 200 Miami Florida 3 3137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (state) (Zip Code) - C3.051573-1818 f3Q5):573 -37 6, : ; . s k obikDla�koblk<�re:cem TELEPHONE NUMBER: FAX NUMBER: ar EMAIL: I. LOBBYIST RETAINED BY: Melr Srebemlk j NAME OF PRINCIPAL/CLIENT. i , Belau Sunset Harbor. LL 900 Biscayne .B vd..'2S02 Miami i lorioa 3313? BUSINESS NAME AND ADDRESS (Number and Street) (Gty) -• - -• (State) (Zip Code) 305 514 0518 , , 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, • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST :. ... _ _ .. _ II. SPECIFIC LOBBY ISSUE: - _ Zoning Memorandum Involving Development of the Property at 1201, 1225, and 147,20 Street, Miami Beach, Forlaa Issue to be Lobbied (Describe in detail): r.1 r III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: _ _ s• T r � 4. A) Full Name of Individual/Title I t — "" B) Any Financial, Familial or Professional Relation tifb - 'I Iafl n iiiG• / / eOA , t• - - z b., /it6il %1G' , , •niF1- /I //t - _ rn T • Unless an ue is IeQislative In nature. HPB. 80A, Planning Boara, anc City Commission memoers are not lobbleo outside of a ruby hersrin�; s ertlro ' ' t H 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). $ 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 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 Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues ": [Wes 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 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 OCTOBER 1 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDIT • -, S COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRE • ING CALENDAR YEA • A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEN • URES OR COM • ATI • N DURING THE REPORTING PERIOD. Signature • Lobbyist I do solemnly swear that all of the foregoing facts ar- true and c rect and that I have read or am familiar with the provisions - - 17, ea in e • - 2 -482 of the i Beach City Code and all reporting requirements. - Signature of Lobbyist: Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: ( PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification Form of Identification [ ` 'ersonally known (Lobbyist) X known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: Co ) i - Dade LEVAN State of Florida, County of Miami -Dade State of H Sworn�taand sub G yp, SwoSworn an• _ Florida, ida, Cb -rida ��-- av2 o, - • o L VANA COHEN .,� This �`da rs f - State of Florida - lic Th omm. ry Expi res Apr 3, 2013 ,� ommissioPubiic n # State DD 8 4282 �� r • om . Expires Apr 3, 2013 , = DD 842824 Throu Na tional CO N otar y EN Assn. Signature • Pu. , r4 , ist;ttueditifi6VOINational Notary Assn. Signature of Pu • otary — S Notarization of Notarization of Principal's signature FOR CLE 'S USE ONLY 5 - � Y' r1 3,lI) Annual Registration fee: [ Yes [ ] No Amount Paid MCR # 3' r02 Date Paid 1/ r?' /1 Lobbyist Registration Form received and verified by: . ...Jr' ; .l Entered By: s y�I / ll I • ;zh, F• \CLER \$ ALL \MARIA -M \ Lobbyist \LOBBYIST fORM 05.doc Revised 12/08/04 EA MIAMIBEACH 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. itL lit Signature: Date: