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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.
Entin Monika
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell &Fernandez, P.A., 200 S. Biscayne Blvd., # 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6237 305-377-6222 MEntinABRZoninaLaw.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:
Leonardo B. De Paula Pessoa, MGR
NAME OF PRINCIPAUCLIENT:
CBMIA Restaurant Miami, LLC— 1001 Brickell Bay Drive, Ste. 2406 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
leo(*ocobambu.com
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
C? ^-)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Leonardo B. De Paula Pessoa, MGR
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• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNFRSHIP nR TRl1ST• SEA 4-t9 r cif /� _ - -
II.SPECIFIC LOBBY ISSUE: ' :
Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Review Board,--Planning
Board, Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating the property
located at 955 Alton Road, Miami Beach, FL.
Issue to be lobbied(Describe in detail):
lll. 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 None X
Staff
PB, DRB, HPB, BOA, City Commission, and Land Use None X
Development Committee, as necessary
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
None
None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required): $375.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375.00 per 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 X 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 X No: Are you lobbying on a pending application for a Development Agreement with the City or application
fig change of zoning map designation or change 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 o; 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 COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH
EQB THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE . IF THERE HAVE BEEN NO,
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD,
iiiiikh...
Signature of Lobb i
I do solemnly swear that all of the foregoing facts are true an. orrect and that I have r..d or . : - ' with the provisions contained
in Section 2-482 of the Miami Beach City Code and all rep•.'ing requirements.
Signature of Lobbyist: "•4; ;
Signature of Principal/Client: '4'40 • ,r;.-''
VI. LOBBYIST IDENTIFICATION: ''° '- `'j: PRINCIPAL IDENTIFICATION: ..f o
a= o c,
Produced ID • Produced ID 3 3 ^'
Form of Identification , z Form of Identification o 'X F,'
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Personally known(Lobbyist)
:1 °A 3 3 = • Personally known(Principal) o C o Z
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VII. SIGNATURE AND STAMP OF NOTARY: o'�• ' N c°.
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State of Florida,County of Miami-Dade ,o 1 State of Florida, County of Miami-Dade
Sworn to and subscribed re me �4 0, tx Sworn and subscri fore me xi,
This da of ,28'I'3 This +ay of � � , 1
L., ,% 4
Signati re of -irmot,ry—State of Florida Signature o Public r State of Florida
Notarization of o•byist's signature Notarization of grin •al's signature
r TO BE COMPLET D =Y CITY CLERK'S TAFF •NI( LZIP/1/ I�
Annual RpgJctratinn fpp• [ ]Ypc[ j Nn Amnunt Paid$ P ' l MCRi - b / nlatp Paid
Lobbyist Registration Form received and verified by . __.50 ' / !N'
I F:\CLE istration Form.doc Revised 04/27/2012
MIAMi B EA
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: Monika Entin
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 4': i-'a• - •unty Commission on Ethics and Public Trust.
Signature Da e
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1.CORPORATION
If the property"which is the subject of the application is owned or leased by a CORPORATION, Ilst ALL of the
stockholders,and the percentage of stock owned by.each, Where the stockholders consist of another corperation(s),
trustees), partnership(s)or other similar entity,further disclosure shall be required which discloses the identity of°the-
individual(s)(natural persons)having:the ultimate ownership interest in the entity.*
CBMIA Restaurant,LW
1001 Brickell.Bay Drive, Ste.,2406,Miami,Florida 33131
CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
Refer to Exhibit.B
Hibiscus Alton,.Inc.
1228 Alton Road Miami Beach,FL 33139
CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
James.&Lidia Resnick 33%
1228 Alton Road
Miami Beach,FL 33139
SARP Resnick Familu Trust 33%.
1228 Alton Road
Miami Beach,FL 33139
LR Spousal Access Trust 33%
1228 Alton Road
Miami Beach,FL 33139
IF THERE ARE ADDI77ONAL CORPORATIONS LIST OTHERS,INCLUDING CORP. NAME(S)AND EACH INDIVIDUAL'S
NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK,ON A SEPARATE PAGE.
NOTE'Notarized signature required on page 8
6
•
CITY OF MIAMI. BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2.TRUSTEE
If the property which is the subject of the application is owned or leased by a TRUSTEE, list the beneficiaries of the
trust and the percentage of interest held by each, Where the beneficiary/beneficiaries consist of corporations(s),
another trust(s),partnership(s)or other similar entity,further disclosure shall be required which discloses the identity
of the individual(s)(natural persons)having the ultimate ownership interest In the entity:*
SARP Resnick Family Trust
TRUST NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
James Resnick Beneficiary
50%
1228 Alton Road
Miami Beach, FL 33139
Lionel Resnick,.Beneficiary 50%
1228 Alton Road
Miami Beach,FL 33139
LR Spousal Access Trust
TRUST NAME
NAME;ADDRESS,AND OFFICE %OF STOCK
Fern Resnick,Beneficiary 25%
1228 Alton Road
Miami Beach,FL 33139
Elisabeth Resnick,Beneficiary 25%
1228 Alton Road
Miami Beach,FL 33139
Alexis Resnick,Benefciaru 25%
1228 Alton Road
Miami Beach,FL 3313.9
Adam.Resnick,Beneficiary 25%
1228 Alton Road
Miami Beach,FL 33139
3. PARTNERSHIP/LIMITED PARTNERSHIP
If the property which is the subject of the application is owned or leased by a PARTNERSHIP or LIMITED
PARTNERSHIP, list the principals of the partnership, Including general and limited partners. Where the partner(s)
consist of another partnership(s), corporation(s), trust(s) or other similar entity, further disclosure shall be required
which discloses the identity of the individual(s)(natural persons)having the ultimate ownership interest In the entity,*
NOT APPLICABLE
PARTNERSHIP/LIMITED PARTNERSHIP
NAME,ADDRESS,AND OFFICE %OF STOCK
NOTE'Notarized signature required on page 8
7
Exhibit B
Disclosures
CBMIA Restaurant, LLC
Coco Bambu Investments, LLC 34%
1001 BrickelI Bay Drive, Ste. 2406
Miami, FL 33131
Coco Bambu Holdings, LLC 27%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
FLCB Investments, LLC
12%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
LPCB Investments, LLC
12%
1001 BrickelI Bay Drive, Ste. 2406
Miami, FL 33131
XXCB Investments, LLC
12%
Av. Antonio loaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Ronaldo Parente
3%
11200 SW 8th Street
Modesto A. Maidique, RB 339B
Miami, FL 33199
Coco Bambu Investments, LLC
CB Holdings Oversees, Ltd. 100%
Av. Antonio loaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
CB Holdings Oversees,Ltd.
CBJK Comercio de Alimentos Partners 70.6%
Av. Antonio loaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Rafael Alves de Almendra Freitas 2.1%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Jany Alves Soares Almendra Freitas 1.8%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Daniel Soares Alves de Brito 2.1%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Joao Alberto Ribeiro Pinheiro 2.9%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo - SP Brazil, 04507-000
Alvaro Meireles Jorge de Sousa 2.9%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo - SP Brazil, 04507-000
Igor Fernandes Bezerra de Franca 2.9%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Bruno Lopes Marques
2.9%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Andre Camara Studart Fonseca 2.9%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Felipe Russo Barreira
4.4%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Ticiana Russo Barreira Parente 1.5%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Marconi Nunes Santana 2.9%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
CBJK Comercio De Alimentos
Afranio Barreira Filho 31%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Eugenio Veras Vieira
11%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Idezio Braga Rolim, Jr. 11
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Arthur Souza de Moraes 12%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Hegel Barreira Martinz 3%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Eilson Oliveira Studard Fonseca Filho 3%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Daniell Studart Fonseca Chehab 3%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Andre Rodrigues Parente 2%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Edmar Ronald Frota Aguiar 12%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Leonardo Correa Barros 12%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Coco Bambu Holdings,LLC
CB Enterprise Holdings, Ltd. 100%
CB Enterprise Holdings
Afranio Barreira Filho 100%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil,04507-000
FLCB Investments, LLC
Felipe Luna 100%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
LPCB Investments, LLC
Leonardo Pessoa 100%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
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