George Khoury - 600 Collins, LLC hv�
MI AMI BEACH 6 C
:t)
City of Miami Beach Office of the City Clerk o
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.
Khoury George
NAME OF LOBBYIST: (Last) (First) (M.I)
BNI Engineers 800 Douglas Road, Suite 300, Coral Gables, Florida 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-442-7086 a-khourvebnienaineers.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:
Ricardo Tabet
NAME OF PRINCIPAUCLIENT:
600 Collins, LLC 846 Lincoln Road, 5th floor Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
1.K0 712-7133 rtaoptimumusa.us
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:see attached
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: see attached
ILSPECIFIC LOBBY ISSUE:
Development Board Approvals for 600 Collins Avenue—600 Collins. LLC
Issue to be lobbied(Describe in detail):
m. 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 X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familialior 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 "° ri
NONE
c)
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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) ✓n,,- p0
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):41. o,�
(REQUIRED). � J.
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 oendina bid for goods„eauioment or services.or on a present or oendinq
award for aoods.eauipment 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 lobbvina on a oendina application for a Develo mentAareement with the City or application for
chanae of zonina man desianation or chanae to the City's Future Land Use Mao?
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 CLERKA SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACFt
EQB THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD,
Signature • �fst
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 Cod- and all reporti • requir nt
—
Signature of Lobbyist: An/
1i�11�r
Signature of Principal/Clye :
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID ..11:3,c( 00 ø0 '0 LProduced ID T -120 -�
Form of Identification Form of Identification
co
Personally known(Lobbyist) Personally known(Principal)
CO N o
VII. SIGNATURE AND STAMP OF MARY: ® ± N
4'p..O•,••.. L
County of Miami-Dade `':CRISTINA DIANA GONZALEZ County y a Z cJ
State of Florida, •; �!► �; ate of Florida, ount of Miami-Dade z o
_ MY COMMISSION#FF08312 Q cn
Sworn to and subscribed before me ::•. worn and subscribed before me cn 2
This l ST day of VFt.ErNea?,2014 ‘7 a; EXPIRES March 23,2018r •1is IST day of" eZrBBe&,2014 n
(407)391.0153 FloridallotaryService.corn rr
:: C
Signature of Public Not –St e of rida Signature of Public Notary– ate Florid v W
Notarization of Lobbyist's signature Notarization of Principal's signature 2
TO BE COMPLETED B CITY CLERK'S STAFF ONLY • • . \ 9
Annual Registration fee: [ .]Yes[ ].No Amount Paid MCR# :�fo 2 Co Date Paid 12- t o
Lobbyist Registration Form received and verified by .•,a..*..5��:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
IF:\CLE istration Form.doc Revised 04/27/2012 I
MIAMI BEI BEA H
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: George Khoury
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 Miami-Dade County Commission on Ethics and Public Trust.
Signa,, -. Da e:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
Exhibit A
Disclosure of Interest
600 Collins
Avenue, LLC
I I
Optimum USA � S8 Collins Ave, LLC
Investments 2, LLC Ricardo Tabet
Rodolfo Misitano 846 Licoln Rd, 5th floor
c/o Funaro &Co. P.C. Miami Beach, FL 33139
350 Fifth Avenue,
41st floor, 1 %
New York N.Y. 10118
99%
1
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CITY OF MIAMI BEACH - -
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