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Andrew Joblon - Washington Squared Owner, LLC. B E. five-, City of Miami Beach Office of the City Clerk 7oc°�� 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. Joblon Andrew NAME OF LOBBYIST: (Last) (First) (M.1) Washington Squared Owner, LLC 425 Northwest 261h Street, Miami Florida 33127 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State.) (Zip Code) a*Pturnbridgeeguities.com TELEPHONE NUMBER: FAX NUMBER: MAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST,RETAINED BY: Washington Squared Owner. LLC (contact: Andrew Joblon) NAME OF PRINCIPAL/CLIENT: Same 425 Northwest 261h Street Miami FL 33127 BUSINE. S NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) ai Luturnbridgeeci uities.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: Andrew Joblon • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 100% Washington Squared, LLC,Managing Member-50%Turnbridge Miami, LLC(47.5%Andrew Joblon, 47.5%Ryan Nelson and 5%Andrew Resnick)&50%PG Washington Squared Owner, LLC(50%Jarrett Posner and 50%Sean Posner) Referendum and Ordinance concerning development regulations for Washington Avenue corridor between 6th and 17" Streets and development approvals and permitting issues for the 600 block on the east side of Washington Avenue 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 Staff of Planning Department,Building Department,and Public Works Department None. X PB,HPB,BOA,City Commission,as necessary None. - I X i 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(8)Any Financial, Familial or Professional Relationship None - _ .t• trq +° � It F:\,C LIE f?1$AI..L\a FORM.S\L0 F,BYiSTFORMS\LohhyistRegistrat ion Form.doc L C., C IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURF=4Required) $ /hour B) PRINCIPAL'S DISCLO E(OF LOBBYIST COMPENSATION): (REQUIRED). /hour 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 eauipment or services or on a present or pendina award for aoods. equipment 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 lobbying on a pending application for a Development Agreement with the City or application for - chanae 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 X No: Are you representing a not-for-profit corporation 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 LQBBYING EXPENDITURES, AS WELL AS COMPENSATION ECE VED CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YE R STATEMENT SHALL IL VE THERE HAYE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoi facts are true and correct and that I have rea am familiar with the provisions contained in Section 2-482 of the Miami Beac ity o e and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Proouced ID Form of Identification Form of Identification 2Personally known (Lobbyist) lZersonally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of , County - State of F oMa, County of Sworn to arW,.subscribed before me - Sworn and subscribed before me This day of J , 201_q This day of , 201_ Si ature of Public Notary—State of Nu Sig ature of Public Notary—State of FiQfiLfid Notarization of Lobbyist's signature iotarization of Principal's signature TO BE COMPLE"cD I31'CITY CLERK'S ST F O .L Annual Registration fee: [ ]Yes[ ]No Amount Paid$ M C R# Date Paid Lobbyist Registration Form received and verified by: Revised 01/22/2014 F—\CLER\$ALL\aFOR"iS\LOBBYiST,�C)RrAS\LobbyistRegistratio!iForm.doc A,�vl�.' B- EACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachll.gov CITY CLERK 0 ffice Rafael E. Granado, City Clerk CityClerkcr.miamibeaclhfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOB BY.IS T NAME Andrew Joblon I understand that no later than February 28 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, 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 $5000 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, 2014, shall be automatically su pe ded from lobbying until all fines Tare paid, unless the fine has been appealed to a is -Dade County Commission on Ethics and Public Trust. Signature: Dat : FACLER\$ALL\aFORMS\LQB BY!STF®RMS\LobbyistRegistration Form.doc ` - 4 Q lu n ui ca SOD r: YJ`l : toms . LL �. LL 0 ca LL L ti � aw Ca tA Ul CL ID Kl' 17 El Z Z := 730 cc V V > - Q U6 v. L