Amanda E Jungles - MBeach 1, LLP ` F • Y
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City of Miami Beach Office of the City Clerk b
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1700 Convention Center Dive, Miami Beach, FL 33139 )..(/oe
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LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained,whether paid or not, by a principal who soaks 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 20 04-3435.
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NAME OF LOBBYIST: (I.G st) (First) (M.l)
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SS 130
BUS NESS NAME AND r '..)CRESS (Number and Street) (City) (State) (Zip Code)
(3 0,5 5 -6;i711 3o .1617` r tA�3 Cot d v Q.r-c� 1V44:1(10 tor1tti.c.arV7
EL E HONE NUMBER: FAX NUMBER: EMAIL:
Please. .ofify this o0`_ce.if your contact:i fa naati.on;.`ai a jges:ad }±ess,.ittiones ore-mail add** . -
I. LOBBYIST RETAINED BY:
%
NAME OF PRINCIPAL/CLIENT:
WI Lir c t 11 q d 5--e..%O t-11.CirvIk btaal F L 1Q.9
BUSINE S NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
( 3O$) 333 -93 .
TELEPHONE NUMBER: FAX NUMBER:(Qpticnal) EMAIL:(Optional)
r-115-iit-tiii..s7s-e-ciiiicirprincipilis a Corporation_Rartnc=.ship or Trust(Section 2.432(c)I -
• NAME OF CHIEF OFFICER,PARTNER,GR BENEFICIARY: f�iober+ �6e.�iC.�"-1`
• IDENTIFY ALL PERSONS HOLDING,D1RFl.TLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
..._ PARTNERSHIP OR TRUST: E4E- 4:24..f' chart
it.$PEC1F1 :>1t '_1$S #E1
PIcon;n c)4 zonin�j cproveas r tip. nr f laccrftd Ibt4 Lena,‘ IV ,tlll tinco }�e4-4 lb6S AMtbnkrii
Issue to bdlolibied(Oescriiy in de fail):
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Pursuant to City Code Section 2 48 j(a}(4)include the commissioner or personnel sought to he lobbied.and whether the lobbyist has entered
into any contractual rela.icn3hip (paid or unpaid) with said city commissioner er personnel from 12 months preceding such person's
.:;ominenceinernt of snr-rig 3 with the cityto the present date,stating the general nature of the subject contractual relationship.
i--. Sec 2-4482(.>:<}(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be loh� ied
Ong
e icl r1;$1 aloe LG4t.,1 - r ft
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Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,farri ilal orofessionel
relationship,or other relationship giving ria�:1 to an appearance of an Impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
I
Soy:Z-432(g}4:�a�FinanLiai,Eaa�li3i`9 Or Profesaioral Relationship
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F:iCLERI$ALl_\aFORMS\LOCBYIST FORMSiLobbyisi:Registration t=orm.doc k.'-;
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iV. DISCLOSURE OF TERMS AND AMOUNT`SOILOIEBVISTCQMPENSATtON(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$D
B) PRINCIPAL'S DISCLOSURE(OF LOBBYISTrOc31 PEI<iSATICN):
(REQUIRED).*0
The following information must be answoerE3d:
1) Pursuant to Miami Beach City Corte S,ction 2488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues':
YesXNo: Are You loblayipcs,on a pres.en forrp►erri ood
rlingbird for •• s,equipment or ser°vicAs,or on j resent of nendln_a
award for goods,oquiprnentto is rvice?
2) Pursuant to Miami Beach City Codde Sf�,tionZ-498 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
YesX No: Are you lobPyyinq on a pent t3 oeppliciation for s t vetopment A reamnt with the City or application for
chore of zonin• ma desI r tfionr or chart4e to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code "-„Secntien 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set
forth in Section 2-481 above) wh,o oil' i appears as a representative of a not-for-profit corporation or entity without special
compensation or reimbursement for lies appearance, whether direct, or indirect, to express support of or opposition to any
item, shall register with the clerk a:sru.iirecl by This section but,shall not be required to pay any registration fees.
YesXNo: Aro you ropresenttnq a not-tfor r offic or-.oration or erttit without s•ecial com'cnsation or reimbursement.
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V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, UPC IL.48B MIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDiTUIRES, AS WELL AS COMPENSATION RECEIVED IN ThE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR A ST TWE1MEINT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE EPORT'I Io ERI D.
Signature of Lobbyist t1roondq QL• all 5/eS
I do solemnly swear that all of the foregoing.f 1�a re true 4!.correct and that I have read or ar familiar with the provisions contained
in Section 2-482 of the Miami Beach City CatciE)a.rrntl all reporting requirements.
Signature of Lobbyist: �, ... .". �2•
Signature of Principa:/Clien : -
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LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIrlCATION:
Produced ID \\,_/ Produced ID
Form of Identifc:aIi a Form of Identification
Personally known(3 obbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NCT rY:
State of Florida; County of Miami-Dade. State of Florida,County of Miami-Dade
Sworn to and suhFicribed before me Sworn and subscribed before me
This c.,4 day of_ri__ ,_/ 20.1, Gonztiez This,..,2 Ldav
of 1 1 201 « SOOr IO1�iS G011221111.
Ff1 1 b£ CO O*f FFINCIS / W'
WIRES: Spt. 3. all f�
_ %•- DAMS: Stet. 3.2011
Signature of Public Not Statry Flo'''`'^^ • t1r�Iw.AARONNOTARY.COM Signatur of Public Notary--State • Ibri - � wmr.AR lailoiuwlr."
Notarization of Lob si ure '• Notarization of Principal's si . e
Y9 EE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration Elie::( Yes[ , J Nc$ ;A.in 8141 P$A- 4 tI(fCR{ Date Raid
( Lobbyist Registration:Form received:and ireiiiffll4: t;
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t F:\CLER\SALL\.aFORMS\LOBBViST FORM SSLfxabyisi Registration Form.doc
MBEACH1, LLLP a Delaware limited liability
limited partnership By: MBEACH1 GP, LLC,
its General Partner, By: Urban Investments
Advisors, LLC, its Sole Member, By:
Wellspring Investments Management I, LLC,
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its Managing Member
,
City of Miami Beach, 1700 Convention Center Drive,Miami reach,Florida 33139,www.rniamibeochil,gov
CRY CLERK Office
Rafael E. Granath),City Clerk CityClerk @miamibeachfl.gov
Tel:305.673,7411 , Fax:305.673.7254
LOBBYIST NAME: Aroondci £: 37 Jri j e.S
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.
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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$50,00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to,file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miarri Dade Count Commission on Ethics and Public Trust.
PP ,�. y
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Signature: Date:
F:\CLERI$ALL\aFORMS\I._O13 BYIS7 FORMS\Lobbyist Registration Form,doc
CITY OF MAIMI 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, list the
principal stockholders and the percentage of stock owned by each. Where the principal officers or
stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further
disclosure shall be required which disclosed the identity of the individual9s) (natural persons) having the
ultimate ownership interest in the entity).*
MBEACH1 GP, LLC, a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
URBAN INVESTMENTS ADVISORS, LLC, a Delaware limited liability company, 100%
the Sole Member of MBeachl GP, LLC, a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MBEACH1 INVESTORS GP, LLC. a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
URBAN INVESTMENTS ADVISORS, LLC. a Delaware limited liability company, 100%
the Sole Member of MBeachl Investors GP, LLC.
a Delaware limited liability company
1 111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
URBAN INVESTMENTS ADVISORS, LLC, a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
WELLSPRING INVESTMENTS MANAGEMENT I, LLC. a Delaware limited liability 1%
company, the Managing Member of Urban Investments Advisors, LLC, a Delaware
limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
WELLSPRING INVESTMENTS MANAGEMENT II, LLC, a Delaware limited liability 99%
company, the Managing Member of Urban Investments Advisors, LLC, a Delaware
limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MIAMI 963391.1 7513422013 9
09/23/2014
WELLSPRING INVESTMENTS MANAGEMENT I. LLC,a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
ROBERT S.WENNE i i,TOD ROBERT S.WENNETT REVOCABLE TRUST, 0.5%
the Managing Member of Wellspring Investments Management I, LLC,
a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
ROBERT S.WENNETT REVOCABLE TRUST, the Managing Member of 99.00%
Wellspring Investments Management 1, LLC, a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MARIO CADER-FRECH REVOCABLE TRUST, a Member of 0.5%
Wellspring Investments Management I, LLC, a Delaware limited liability company
1111 Lincoln Road. Suite 760
Miami Beach, Florida 33139
WELLSPRING INVESTMENTS MANAGEMENT II, LLC, a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
ROBERT S. WENNETT,TOD ROBERT S.WENNETT REVOCABLE TRUST, 0.5%
the Managing Member of Wellspring Investments Management I, LLC,
a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
ROBERT S. WENNETT REVOCABLE TRUST, the Managing Member of 99.00%
Wellspring Investments Management 1, LLC, a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MARIO CADER-FRECH REVOCABLE TRUST, a Member of 0.5%
Wellspring Investments Management I, LLC, a Delaware limited liability company
1111 Lincoln Road. Suite 760
Miami Beach, Florida 33139
IF THERE ARE ADDITIONAL 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 13
MIAMI 963391.1 76134220 13 10
09/23/20 14
CITY OF MAIMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATOR
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of the applications 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 corporation(s), another trust(s), partnership(s) or other similar entity, further disclosure shall be
required which discloses the identity of the individual(s) (natural person) having the ultimate ownership
interest in the entity.*
ROBERT S.WENNETT REVOCABLE TRUST
TRUST NAME
NAME,ADDRESS AND OFFICE %OF STOCK
ROBERT S.WENNETT TRUSTEE 76,30711%
1111 LINCOLN ROAD,SUITE 760,MIAMI BEACH, FL 33139 •
MARIO CADER-FRECH REVOCABLE TRUST
TRUST NAME
NAME,ADDRESS AND OFFICE %OF STOCK
MARIO CADER-FRECH TRUSTEE 15.46193%
1111 LINCOLN ROAD.SUITE 760,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
PARTNERESHIP, 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.*
MBEACHI, LLLP, a Delaware limited liability limited oartnershio
PARTNERSHIP or LIMITED PARTNERSIHP NAME
NAME, ADDRESS,AND OFFICE % OF STOCK
MBEACH1 GP, LLC, a Delaware limited liability company, the General Partner 0.5%
of MBeachl, LLLP, a Delaware limited liability limited partnership.
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139 •
MBEACHI INVESTORS, LP, a Delaware limited partnership, a Partner 99.5%
of MBeachl, LLLP, a Delaware limited liability limited partnership
1111 Lincoln Road, Suite 760
Miami Beach,Florida 33139
MIAMI 963391.1 7613422013 1 1
09/23/2014
MBEACHI INVESTORS, LP, a Delaware limited partnership
PARTNERSHIP or LIMITED PARTNERSIHP NAME
NAME,ADDRESS, AND OFFICE % OF STOCK
MBEACHI investors GP, LLC, a Delaware limited liability company. 0.5%
the General Partner of MBeachl Investors, LP, a Delaware limited partnership
ROBERT S.WENNETT REVOCABLE TRUST, a Limited Partner
of MBeachl Investors, LP, a Delaware limited partnership 76.30711%
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MARIO CADER-FRECH REVOCABLE TRUST,a Limited Partner
of MBeachl Investors, LP, a Delaware limited partnership 15.46193%
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
CLAUDE CHANDONNET, a Limited Partner of MBeachl Investors. LP, 7.73096%
a Delaware limited partnership
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
NOTE: Notarized signature required on page 13
4.
5.
6.
7.
a.
MLAMI 963391,1 7613422013 12
09/23/2014
O023 12/02/2014 001 122
Miscellaneous Cash Receipt F.-C•a 362:0 $2,050.00
CITY OF MIAMI BEACH
No. 36230
El Cash red it Card 0 Check# $
20 /cl
Received of Lcp
Address
For Se c r A i 0 A 4,1
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
By
Account Number:alf.Eco 0.,361.'1i j
Proparer7 s r cra Dept: Ic-- Err:7c1 r