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Graham Penn - ARRP Miami, LLC / 1212 Lincoln Road ale,- Y ' `9.....}} Si } IBEAi�`­ eli"C 1-� �. .. r. �,VV// City of Miami Beach Office of the City Clerk iId 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. Penn Graham NAME OF LOBBYIST: (Last) (First) (M.1) Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 (305) 377-6222 aoenn(a-)-brzoning law.com. TELEPHONE NUMBER: FAX NUMBER: EMAIL: s- Please notify this office if your contact information changes: address,phone, or e-mail address..- � I. LOBBYIST RETAINED BY: c.7. David Smith NAME OF PRINCIPAUCLIENT: ro _. ARRP Miami, LLC and Wells Fargo 2200 Biscayne Blvd. Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 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: ._%%7�, _S1z;1/X1r • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5°/ OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ' ii.SPECIFIC. LOBBY ISSUE: Development Board Approvals for 1212 Lincoln Road, 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 Staff, PB, HPB, BOA, DRB, Commission 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 NONE �A C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc '_'_KTS C;q oo'/l-7/Zo 1,6-t IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $460.00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):$460.00 (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 lobbyina on a present or pending bid for goods.eguipment or services.or on a present or pending award for goods,eauil2ment 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 pendina application for a Development Agreement with the City or application for chanae 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. _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 XEAR. EACH LOBBYIST SHALL SUBMIT TO THi CITY CLERK OATH. LISTING g D IN THg CITY OF MIAMI BEACH FHB THE PREC912ING CALENDAR YEAR, A SIAIE E.N7 SHALL BE EILED EMEN IF THERE HAVE BEEN NQ EXPENDITURES OR COMPENSATION QUISING THE PERIW. ignature&Lobbyist I do solemnly swear that all of the foregoing facts 2 re true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami B City Code a d all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: 5 • VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: W Produced ID Produced ID Form of Identification U Form of Identification o wuj'4 / o Personally known(Lobbyist) o.0 o V/Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: a M e o C U' State of Florida, County of Miami-Dade Z o m W State of Florida, C u 'a i- Sworn t d subscri d b fore me •b Sworn and subscr' me N Uo'-, DAYAMI AGUTAR This � day i , 2014 a e This day of x2014 Notary Public-State of Florida '1 0,V•�,' s; My Comm.Expires Mar 16,2015 U r Signa re of Public Notary—State of Florida �' Signatu e o Public ary tat cif,` orida Commission # EE 70292 Notarization of Lobbyist's signatur Notarization of Principal's TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes( ]No Amount Paid$ MCR# ate Pai Lobbyist Registration Form received and verified by: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc istration Forb Aac Revised 04/27/2012 3 City of Miatni Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wNv%v.niiamibeachfl.jzov CITY CLERK Office Rafael E. Granado, City Clerk City Clerk Cam i am i beach fl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: -Graham Penn 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 paid, unless the fine has been appealed to the M' mi-Dade County Commission on Ethics and Public Trust. �1� l Sig lure: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Forrnrevised 5-30-2012.doc i r i ' CV CD %lo ti. W Q LU W CL CL s W ca s = R cs j a t Z Z ' V � _ V © CL i c Q U. D.. q i { J 1 Prieto, Silvia From: Prieto, Silvia Sent: Tuesday, September 16, 2014 10:58 AM To: 'Diana Ramos' Cc: Hatfield, Liliam; Barbou, Regis Subject: RE: Lobbyist Registration Thank you Diana, the below mentioned applications will be amended accordingly. MIAMI BEACH Silvia Prieto,Administrative Aide I CITY CLERK'S OFFICE 1700 Convention Center Drive,Miami Beach,FL 33139 Phone: 305-673-7000 ext.6269/ Fax:305-673-7254 www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community. From: Diana Ramos [ma iltoAramos @brzoning law.com] Sent: Tuesday, September 16, 2014 10:16 AM To: Prieto, Silvia Subject: RE: Lobbyist Registration It is Mr. David Smith. From: Prieto, Silvia [mailto:SilviaPrieto @miamibeachfl.gov] Sent:Tuesday, September 16, 2014 10:04 AM To: Diana Ramos Subject: Lobbyist Registration Dear Diana, I am in-receipt of four(4) Lobbyist Registrations Gelabert-Navia;Jose; Larkin Michael W.; Penn,.Graha_m;Vargas,Joaquin; on "David Smith ARRP Miami, LLC and Wells Fargo" Please provide me with the name of Chief Officer, Partner or Beneficiary(Section 2-482 (c)) Thank you, MIAMI BEACH Silvia Prieto,Administrative Aide I CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Phone:305-673-7000 ext.6269/ Fax:305-673-7254 www.miamibeachfl.qov We are committed to providing excellent public service and safety to all who live,work and play in our vibrant,tropical, historic community. 1