Alyssa Kriplen - 530 Lincoln Owner, LLC MIAMI BEACH
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.
Kriplen Alyssa
NAME OF LOBBYIST: (Last) (First) (M.I)
Shulman and Associates 100 NE 38th Street, Space 2, Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)438-0609 (305)438-0170
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
530 Lincoln Owner. LLC—David Edelstein, Manager
NAME OF PRINCIPAL/CLIENT:
Same 590 Madison Avenue,21St Floor, New York NY 10022
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212)521-4488 (212)521 4489
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: David Edelstein,Manager and Authorized Signatory
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST: David Edelstein—60%;Jackie Mansfield—20%;Robert Futterman—20%.
II.SPECIFIC LOBBY SSUE:
Development approvals and permitting issues for 530 Lincoln Road
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,s ting 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 None
Denartment
B,HPB,BOA,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(g)Any Financial,Familial or Professional Relationship �\
A
None
7
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$ n eN
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPEN ATION):
(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":
yer. X gg, Are you lobbying an a nr sent or pending bid for goods eauipment or seLyices or on gdpresent acne_nnd_
agia[d Lgr ago d -_gaulpMen or selXiceZ
2) Pursuant to Miami Beach City Code 2490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes X No Are you lobbying on a pending appllcation for a Develonm®en_Aareement with the Gity or application for
gbanue of zoning man designation ar gbanpe to the Citv's Future La d Use Man?
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.
yeses XrMob re you representing a not for profit corporation or gnt ty Nithout specal op�oensation or reimbursement
V. SIGNATURE UNDER OATH:
-EIJPENDIJURES, AS M1 BdREN,5AjIQN_H9GEI9EQ- IN Itir NO
FM
EXPENDITURES OR
Sre o bb i t
I do solemnly swear that all of t e fo qo ng facts are d correct d that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami B c Code and al
Signature of Lobbyist:
Signature of PrincipaUClient: Z
:•"Isl .�� PRINCIPAL IDENTIFICATION:
Vl. LOBBYIST IDENTIFICATION: ;�;�..ao;; O
Produced ID :;r,G4 4•�`a;; Produced ID m o W 3
dentifcation Form of Identification m a r
sonally known(Lot g o
�rso rincipal)VII. T z o z
STAMP OF NOTARY. ® m
-D m ~ D N N
to C r ]3 Q� Q
State of Florida,County of Miami-Dade a m State o ,County of n Z cc
Sworn to and subscribed before me c, Sworn an�subscribed b f re me 0C m
This day of ,2014 ? c This L�d y of f9 2014 0 O
N X
Signature of Pu i ry-ota State of Florida � a Signature of Public N ary-State of Florida
Notarization of signature °° Notarization of Principal's signature
TO BE COMPLETIJD BY CITY CLERK'S STAFF O LY
Annual Registration fee: es �
No Amount Paid$ b' OZ)MCR#_-.41D 13 314 Date Paid /v �
Lobbyist Registration Form received and verified by:
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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). /t
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-eauinment or services-or on a present or pending
award for goods.eauipment 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 Gity 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 representina 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 CLERIC 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_
S�nr CA4e.-- P!W--C
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:
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VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ® D
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Produced ID Produced ID ® o
o ic
Form of Identification Form of Identification a • y
Personally known(Lobbyist) ersonall k own rincipal)VII.
Z 4z
SIGNATURE AND STAMP OF NOTARY: 0
NY mr-
w � N �
State of Florida, County of Miami-Dade State offFbrfda•,'County of'P�V o CA
Sworn to and subscribed before me Sworn an subscribed b f re me o O° m
This day of , 2014 This=d of cv !2014 '_
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Signature of Public Notary—State of Florida Signature of Public N ary—State of Florida x
Notarization of Lobbyist's signature Notarization of Prince 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 by:
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www-mianxibeaclifl.gov
CITY CLERK Office CityClerk@mianiibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: &ssaKtiplen
I understand that no later than February 28th 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, 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 to ist, who fails to file the required ' Statement by April 30th, 2014, shall be
u t or m
a I A I fly suspended from lobbying until all fines are paid, unless the fine has been
3
app e he Miami-Dade County Commission on Ethics and Public Trust.
S;94/e: Date-
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CITY OF MIAMI BEACH
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