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Kobi Karp - Ari Pearl� . � } A. City of Miami Beach Office of the City Clerk 1700 CODVert|On Center Drive, Miami Be@ch, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist moans all persons employed or retained, whether paid or not, by o principal who seeks to encourage the paooaQn. defeat or _ modification of any o,dmanoe, mao|utiun, action or decision of any commissioner; any oudun, deoioion, recommendation of the City Manager or any city board or committee-, or any ootion, decision or recommendation of any city personnel during the time period of the entire decision-making p,ounoa on such action, decision or recommendation that forooeoab|y will be heard or reviewed by the city commission, or o city boom or committee. The term opooifiuoUy includes the principal as well as any employee engaged in lobbying activities. The term"Lobbyistm" has specific exclusions. Please refer to Ordinance 2UO4'3435. Karp Kobi NAME OF LOBBYIST: (Last) (First) (M.1) bi KaT Architecture Interior BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) L305) 573-1818 (305) 573-3766 kobikaMg TELEPHONE NUMBER: FAX NUMBER: EMAIL: PNoeme notify this office if your contact information changes:address,phone, ore-mail address. | /. LOBBYIST nsnwmsoBY: NAME OF PRINCIPAUCLIENT: � Ari Pearl Miami Beach Res 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: Ari Pearl IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OVVNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See the attached. � x.SPECIFUC LOBBY ISSUE: DevelopmentApprovals and Permitting Issues, including, but not limited to Historic Preservation Board, Planning Board, Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 4833 Collins Avenue,Miami Beach, Florida. 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 e�v contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such commencement of service with m 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 X PB, HPB, BOA, City Commission, and Land Use None X Development Committee, as necessary � Pursuant to CityCodemection 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial o,professional mmummo»kp,or other relationship giving rise to an appearance o,an mmnmp,iety,with any current city commissioner o,city personnel who is nought toue lobbied ou identified on the lobbyist registration form fileSec 2482(g)Any Financial, Familial or Professional Relationship None NJ d. � � IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required): $ �'��O .oo 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 lobbvina on a present or pending bid for goods equipment or services or on a present or ggndjpg award for aoods.eauinment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbAna on a pendina application for a Development Agreement with the City or application JQC change of zoning map designation or change to the City's Future I and Use Man? 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 Xo: Are you representina a not-for-profit corporation or entity without special compensation or reimburs menL V. SIGNATURE UNDER OATH: ON EERRUARY 28 OF EACH YEAR. EACH LOBBYIST cunt L SUBMIT TO THE CITY CLERK A EIGNEp STATEMENT UNDER FOR, THE PRECEDING SH6LLftr_FILEjb FVEN IF THERE HAVE 13ggN No EXPENDITURES OR CO--MPENSAIION DURING THE REPORII Signatur byist 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-P-rincipal%Cliint: VI. LOBBYIST IDENTIFICATION: s" PRINCIPAL IDENTIFICATION: a n' Produced ID Produced ID Form of Identification Form of Identification ay�H0"''`�, C! A Personally known (Lobbyist) 3 LPersonally known (Principal) '- 3 3 VII. SIGNATURE AND STAMP OF NOTARY: M State of Florida, County of Miami-Dade � State of Florida, County of Miami-Dade r" Sworn to and subscribed bef re me ni '^ Swor d subscribed u before me g This _day of ,2014 8 This ay of to A- ,2014 a oo d � or Si nature of Pu lic Notary—State of Florida Signature of Public NotarA State of Florida Notarization of Lobbyist's signature Notarization of Prin=pa=signature TO BE COMP ED BY CITY)CERK' STAFF O LYn Annual Registration fee: )Yes[ )No Am nt Pai R Date Paid ` b Lobbyist Registration Form received and verifie b istration Form.doc Revised 04/27t2012 City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www.miarnibeachfi.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: LOW Karp I understand that no later than February 28 of each year, I must file the following form, pursuant to Section 2485 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, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (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 2-485.1, a fine of $50-00 a day shall be assessed for all Statement(s) filed after the 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. Signature Date -- — - ; - - - Nliscellaneous Cash Receipt F f E >rz�r. F�� , CITY OF MIAMI BEACH, Gash Credit Cb, Check S S Recejved of - 0. For 1 'f._� 1�.�. � s f"" Lh � � t '" °' F!� <° -f `. r'' "t � �''�/`- /1 f - E--1, f - ./�. t� ` -'} .i`fit•_ , `�� Al - (THIS INFORMATION MUST BE COMPLETED) Ofi�ce of F na'np Director. Account_Num�er.: .t De Preparer�' � f = 4 p EXT I