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Kobi Karp - Gianfranco Rondon MIAMI VC r 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. Kara Kobi NAME OF LOBBYIST: (Last) (First) (M.1) Kobi Karp Architecture&Interior Design, Inc., 2915 Biscayne Blvd, Suite 200, Miami, Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 573-1818 (305) 573-3766 kobikarP&&obikarv.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: Gianfranco Rondon NAME OF PRINCIPAUCLIENT: RG Michigan 2014 11251 NW 20th Street, Suite 106, Miami FL 33172 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 497-4521 c/o a.rondon(a_)aroup-ra.cont 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: Gianfranco Rondon 99% -� _71 i • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH Cb_IPORATION, PARTNERSHIP OR TRUST: II.SPECIF'IC LOBBY ISSUE: � r Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Board, Plannii-pBoard, Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the propertZlocated at 419 Michigan Avenue, 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,Building, Public Works and Fire Department Staff None. B, DRB, HPB, BOA, City Commission, and Land Use None. Development Committee, as necessary Pursuant to City Code Section 2-482(8)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 co mmissioner or city personnel who is sought to be lobbied as Identified on the lobbyist registration form filed. 't a Sec 2-482(g)Any Financial, Familial or Professional Relationship rt N ,.✓ ,t_a ... tl 4 `y C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration .� Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$ :[ /hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $ lr /hour (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 XNo: Are You lobbying on a present or nendina bid for goods,equipment or services.or on a present or uendina 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 lobbvina on a pending application 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 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 EXEgbIJ21TURgS. AS WELL AS QQWPEbj D. IbI THE CITY OF MIAMI BEACH EM THE PRECEDING CALEbjj2AR YEAR, A SJAJEJOENT SHAI l5djgalL�D-' EVEN IF THERE 1JAME BEEN NO EXPENDITURES OR It Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct an h ead or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reportin ents. Signature of Lobbyist: _ { Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID •',5�'������ Form of Identificatior�o•'°f'��"�°�'�. Form of Identification ?� fir' � �<e :r • Personally known(Lobbyist) XPersonally known(Principal) x]11419 �� 3 7_ VII. SIGNATURE AND STAMP OF NOTA45j ° o Cr m State of Florida, County of Miami-Dade S j, Mn State of Florida, County of Miami-Dade X Sworn to_and subscribe -b.efore me 0 o m rn Sworn subscribed bef re me CA This ✓ day of , 2014 r") o This day of ,2014 T 3 T fL Sig ature of P`ubli.o-Notary—State of Florida Si gnat re A P i otary�—State of Florida ° o a Not -ization of Lobbwst s signature Notarization o signature TO BE COMPLETED BY CITY CLERK'S STAFF QJWLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ / MCR# Date Paid Lobbyist Re Istration Form received and verified by: b /\AIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, Nv%v-,v.m i am i beach fl.gov CCfy CLERK Office Rafael E. Grdnado, City Clerk CityClerk@ rniamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Kobi Karp 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 $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 aid, unless the fine has been Y P Y 9 P appealed to the Mia de County Commission on Ethics and Public Trust. Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc f �^ I i. 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