Charles H Benson - JHPSB Collins Ventures, LLC � � o v
BEACH
ill I Affil I I
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.
Benson Charles H.
NAME OF LOBBYIST: Last) (First) (M.I)
Charles Benson&Associates,
Architects,P.A. 1665 Washin gt on Avenue,2nd Floor, Miami Beach,FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 532-6161 (305) 532-6161 carkitect3 @aol.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:
JHPSB Collins Ventures, LLC
NAME OF PRINCIPAUCLIENT:
184 Kent Avenue, C706,Brooklyn,NY 11249
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212)687-3444 _jason(ajmhdev.com
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
out s section ff principal Is a Corporation.Partnership or Trust[Section c
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• o OR MORE OWNERSHIP 114TEREST IN SUCH CORPORATION,
II.SPECIFIC LOBBY ISSUE: Seeking Board of Adjustment and Planning Board approvals on matters for the
properties located at 302/310/320/336 Collins Avenue,Miami Beach, FL 33139
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 eneral 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 Board members, staff None X
Board of Adjustment members, staff None X
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 Relationshiprte,
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) f ~ 00j kve
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":
_YesX_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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
—Yes XNo: 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 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.
—YesXNo: 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 LOBBYING EXPENDITURES AS WELL AS COMP S TIO CEIVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL B FIL 1EVEN IF HERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist Charles H. Benson
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 Bpltyo nd all reporting requirements.
Signature of Lobbyist:
Charles H. enson
Signature of Principal/Client:
Jason Halpern Vj
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
A
Produced ID o Produced ID
Form of Identification ° `- Form of Identification
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Personally known(Lobbyist) C � y W o _/ Personally known(Principal) a "
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VII. SIGNATURE AND STAMP OF NOTARY: a 2- LZ
EE E se Qtw yori� SN1ffojK
M IL State of Florida, County of Miami-Dade cc E State of Flerids,County of AAiai-Dmade 310'�. a c
Sworn to and subscribed before me o ,. Sworn a d subscribed before me sA N
This y o � ,201! � g This 3'� day of SePteK4bfr.,201A c `+ �
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Signature of Public No State of Florida us Sign ure of Public otary–State of Florida
Notarization of Lobbyist's signature -,�o� 1;:�' Notarization of Principal's signature
TO BE C C CLERK'S&TAFF N Y
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date aid
Lobbyist Registration Form received and verified by: `
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MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachf.gov
CITY CLERK Office
Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.741 1 , Fax:305.673.7254
LOBBYIST NAME: Charles H. Benson
I understand that no later than February 23 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$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 30'of each year, shall be
automatically suspende from lobbying until all fines are paid, unless the fine has been
appealed to th MINI -Da a County Commission on Ethics and Public Trust.
Signature: Charles"ens-on- Date:
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SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in JHPSB Collins Ventures, LLC
Percentage of Interest
295 LN P, LLC 15.78%
184 Kent Avenue, C706
Brooklyn NY 11249
PSB Collins, LLC 84.22%
555 Madison Avenue, Suite 508
New York NY 10022
Interests in 295 LNP, LLC
Percentage of Interest
The Jason Halpern Life Insurance Trust 90%
184 Kent Avenue, C706
Brooklyn NY 11249
Jason Halpern 10%
184 Kent Avenue, C706
Brooklyn NY 11249
Interests in The Jason Halpern Life Insurance Trust
Percentage of Interest
Jason Halpern 100%
184 Kent Avenue, C706
Brooklyn NY 11249
-- --_-._ -----_ --- __ -- . Interests in PSB Collins, LLC
Percentage of Interest
Dhruv Piplani 100%
555 Madison Avenue, Suite 508
New York NY 10022