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Reinaldo Borges - Park Central Partners, LLC MIAMI BE City of Miami Beach Office of the City Clerk ` ,`, -°t 1700 Convention Center Drive, Miami Beach, FL 33139f LOBBYIST REGISTRATION FORM ��'�JAN 7 t 3. r Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to enc'o/u'rage,_tbe passage, defea or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recomrriendatlop fof,the City Manager or any city board or committee; or any action, decision-or recommendation of any city personnel during the time ISeriod 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. Borges Reinaldo NAME OF LOBBYIST: (Last) (First) (M.1) Borges and Associates 1200 Brickell Ave, Suite 1525 Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-9216 rborges(d,)borgesarchitects.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify his office if our contact information changes:address hone or e-mail address. Y Y 9 �P I. LOBBYIST RETAINED BY: Park Central Partners, LLC NAME OF PRINCIPAUCLIENT: 640 Ocean Drive Miami Beach FL 331 3 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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: Ricardo Tabet • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:See attached. II.SPECIFIC LOBBY ISSUE: Development Board Approvals for Properties located at 626-650 Ocean Drive,Miami Beach, FL 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 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 Planning Department and Building Department Staff None PB, HPB, BOA, DRB City Commission, as necessary* None T_ 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 N/A LV F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc "7 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). 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 you lobbying on a present or pending bad oods,eguipment or services.or on a present or pending award for goods,eauiament 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 Develooment 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 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 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 FQB THE ERECEDING CALENDAR YEAR. kit-% ALL BE _EILED EMEN IF THERE HAME BEEN EXPENDITURES OR Signa a of Lob ist I do solemnly swear that all o the f eg in corre and that I have read or am familiar with the provisions contained in Section 2-482 of th Mia d a o ing requi ements. Signature of Lo yist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification V//Personally known Lob_ byist) MARLENE ALLENDE Personally known NOTARY PUBLIC (Principal)VII. STATE OF FLORIDA SIGNATURE AND STAMP OF Comm#EE089831 VlExpltoi;3/212015 NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn Wd subscribed before me Sworn and subscribed before me This tR day of-'Oe��1�201_V This day of ,2012 Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY J f T Annual Registration fee: [ ]Yes[ No Amount Paid$ MCR# . Date Paid Lobbyist Registration Form receive and verified by: IF i i '4 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). 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 vending bid for goods.eauioment or services,or on a present or oendina award for goods,eauioment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes_No: Are you lobbying on a vending application for a Development Agreement with the City or aoplication for change of zoning may designation or change to the Citv's Future Land Use Mav? 3) Pursuant to Miami Beach City Code Section 2-482(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—No: Are you representing a not-for-profit corooration 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 EM 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 VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID ✓ Produced ID f/1'Tyi ff(5 tI COV-11 Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) %4 7 VII. SIGNATURE AND STAMP OF NOTARY: M C 4 0 06 State of Florida,County of Miami-Dade State of Florida, County of Miami-Dade o 3 Sworn to and subscribed before me Thior d subs f b e S a y �jr� g o a �' This day of ,2012 day o ,201 o 9 H I C"M ir o N Signature of Public Notary–State of Florida Sign t e of Nblic Notary–State of Florida T s Notarization of Lobbvist's signature Notarization of Prin=signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[;. ]No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified y: �. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc m /\AIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Nflami Beach,Florida 33139,www.miamibeach1goov MYCLERK Ofi'ice CityClerkQniamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LO B B Y IS T N A M E: Reinaldo Borges I understand that no later than February 28th of each year, I nest file the following fom-4 pursuant to Section 2485 of the Miami Brach City Code, with the City Clerks 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 0 ffic e of lobbyist withdrawal in writing. Pursuant to Section 2 4 8 5 (d), the City Clerk shall notify any lobbyist (or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2 4 8 5 .1 , a fine of $50.00 a day shall be assessed for all Statement(s) filed afterthe 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, 2012, 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. X2120)3 . Si a Date: r F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Exhibit B Disclosure of Interest F rk Central rtners, LLC Optimum USA S8 Park Central, LLC Interfin Holdings, LP Investments 4, LLC Ricardo Tabet Giorgio Borlenghi Rodolfo Misitano 640 Ocean Drive 1400 Post Oak Blvd, 108 Sequoia Tree Lane Miami Beach, FL Ste 150 Irvine, CA 92612 Houston, TX 77156 89% 1% 10% i 10 4i i CY "Zb �_ 3 vs. z a: LU LU vi CL saw V ;s to .v ca Ul 0 r m 9.5 ❑ -� ; cu C 160.