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Reinaldo Borges - 620 Park Central Partners, LLC /\AIAMIBE H 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. 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 this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: 620 Park Central Partners, LLC NAME OF PRINCIPAUCLIENT: 620 Ocean Drive Miami Beach FL 33154 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 — e.�; r �t _ a • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH COORPORATION, PARTNERSHIP OR TRUST:See attached. - _j ii.SPECIFIC LOBBY ISSUE: `�r, M-- te) Development Board Approvals for Properties located at 620 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 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 Any Financial,Familial or Professional Relationship N/A FACLER\$ALL\aFORMS\LOBBYIST FORMSTobbyist Registration Form.doc 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 bid for goods,equipment or se rvices.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 Noe 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 LQ8BYING EXPEbIJ21TURES, AS AS QQMPENSATIQN RECEIVED. IN THE CIIX OE MIAMI DEACH FQB IHE PRECEDING CALEN12AR YEAR, I SHALL 13E EILED EVEN IF THERE HAVE BEEN WO EXPENDITURES OR Signa ur L b is I do solemnly swear th cts are true d correc and that I have read or am familiar with the provisions contained in Section 2-482 of th Mia Bea repo ing requi ments. Signature of Lobby' Signature of Principal/Clien VI. LOBBYIST IDENTI CATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification MARLENE ALLF r;nE `Personally known(Lobbyist) NOTARy PUf-. Personally known STATE OF FI. (Principal)VII. • CQ W-06.4" SIGNATURE AND STAMP OF NOTARY: EOM 3/2/21.1115 MARLENE ALLENDE State of Florida, County of Miami-Dade NOTARY PU9UC State of Florida, County of Miami-Dade Sworn to and subscribed before me STATE OF(FLORIDA Sworn and subscribed before me This ? day of�� Comm#EEON831 This day of ,2012 ExPkes 3/=15 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 Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR Da,te Paid / Lobbyist Registration Form received and verified by: 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 oendina bid for goods.eauioment or services.or on a present or pending award for aoods.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 lobbvina on a oendina apolication for a Development Agreement with the City or application for change of zoning map desianation or change to the City's Future Land Use Map? 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 corporation or entity without special compensation or reae3humement_ 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/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: -Produced 11�e�s \l \ / d 'tio ID Produced ID � o� f,® Form of Identification Form of Identification r0! C %4.7 Personally known(Lobbyist) Personally known(Principal) m o z X O � 0a H0 VII. SIGNATURE AND STAMP OF NOTARY: °3 o y.3 State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade N= o � Sworn to and subscribed before me Sworn d subscribed bef�rne/me N m y This day of ,2012 Thi" 0 day of !� uQlr"�'��l/ ,2014 N N Signature of Public Notary—State of Florida Sign ure of blic Notary—State of Florida Notarization of List's signature Notarization of Prim al's signature TO BECOMPLETED 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 M is m i Beach, 1700 Convention Center Drive,Mami Beach,Florida 33139,www.miarrnbeachfl.gov CrYCLE KOfl'ice CityClerk©niamibeachfl.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 n LA file the following fom-� pursuant to Section 2-485 of the Mani 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 C le rk'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 ap e led t the Miami-Dade County Commission on Ethics and Public Trust. Sign re: Date: FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Exhibit B Disclosure of Interest r620 Park Central Partners, 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 10 44 i t r LL W , a $s e o Ic Al r . _ -Aw LU . Jal.€ - •tee U. f � JU MOM r •= _ .� _µ 4 _ �. y o a .t3 a U. v •