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Jennifer McConney - David Martin MIAMI I BEACH 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 Once 2004-3435. oyp McConnev Jennifer NAME OF LOBBYIST: (Last) (First) (M.I) 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) (786) 523-7675 (305) 573-3766 imcconnev(c�kobikarp.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: to< QI`rGM David Martin gL9 1) NAME OF PRINCIPAL/CLIENT: Terra Group 2675 S. Bayshore Drive Miami Florida 33133 BUSINESS NAME AND ADDRESS /(Number and Street) (City) (State) (Zip Code) (305) 416-4556 (305) 777-3040 DMartin(c�terraaroup.com 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: cc-f till C1/1-e0( • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: . 7f2, Land Development Approvals for 8701 Collins Avenue, Miami Beach, Florida Issue to be lobbied(Describe in detail): Ill. 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 lobby st has-entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months p.r9.QedinL 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) :; DES NO title of person to be lobbied Planning Department and Building Department Staff None X PB, HPB, BOA, City Commission, as necessary* None X 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 2-48,2(g)Any Financial, Familial or Professional Relationship C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc (,," Tr; IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 33s/h B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENS ON): (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 lobbvina on a present or pending bid for aoods.eauipment or services.or on a present or pending 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 lobbying on a pending application for a Development Aareement with the City or application f change 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 representina a not-for-profit corporation Os 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 BEACI-( L Q 1 , -i_C BIB. C• Ek.D,.R __:. i • _u ■ H. L B_ I_ • _ ...' B L• EXPENDITURES OR C• -E I• D k _'• __ i r4w Signature of obby'.:' I do solemnly swear that all oft fa r- - . _ -,,L ect and that I h.-. = read or am familiar with the provisions contained in Section 2-482 of the Miami B ch CI d a reportin• r- :uirements. Signature of Lobbyist: ' Signature of Principal/Client: VI. LOBBYIST IDENTIFICATI N: PRINCIPAL IDENTIFICATION: 415'ko' tefAb Produced ID /r °% Produced ID 4.,�°� Form of Identification ' Form of ldentificatio ,' m c o z a� ev o w•c Personally known (Lobbyist) is o Personally known(Principal)• A 3 dg c» , 0 3 VII. SIGNATURE AND STAMP OF NOTARY: 0 3 w ^>; ° =' c 3.cu g gm 3 5. v,m ep State of Florida, County of Miami-Dade , o m° d State of Florida, County of Miami-Dade N o ~, Sworn to d_ sub rib before_me o o ' `fl•rn a�pd subscri d b pry me n This d y of v1 , 2015 N ;, h s o. day of ILV 1 , 2015 m a a Signs ' e of P. lic Notary–State of Florida Sig :ture\��f Public Notary–State of Florida Notarization o Lobbyist's signature Notarizati.n of Princioal's signature TO BE COMPLETED BY WY CLERK'S STAFF ONLY Annual Registration fee: [ Yes[ No Amount Paid$ ( 11 MCR# (��`1). O 1� Date Paid i_v_V---). , Lobbyist Registration Form received and verified by: LA-- —' C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc l F:\CLE istration Form.doc Revised 04/27/2012 MI AM I BEACH . 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: Jennifer McConney 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 Y 9 Y Y Y 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 appeale. "' Mi , i-Dade County Commission on Ethics and Public Trust. . 3/A/ic' `.'•nature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in 8701 Collins Development, LLC Percentage of Interest 8701 Collins Avenue, LLC 100% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 Interests in 8701 Collins Avenue, LLC Percentage of Interest Terra 8701 Investments, LLC 50% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 8701 Associates 2, LLC 50% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 Interests in Terra 8701 Investments, LLC Percentage of Interest NV Collins, LLC 50% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 Terra 8701 Investments Holdings, LLC 50% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 Interests in NV Collins, LLC Percentage of Interest New Valley, LLC 100% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 New Valley, LLC is 100% owned by Vector Group, Ltd., which is a publicly traded corporation. Interests in Terra 8701 Investments Holdings, LLC Percentage of Interest Terra 8701 IH Holdings, LLC 100% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 Interests in Terra 8701 IH Holdings, LLC Percentage of Interest Pedro Martin 50%� c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 David Martin 50% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 Interests in 8701 Associates, LLC Percentage of Interest 8701 Associates 2, LLC 100% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 Interests in 8701 Associates 2, LLC Percentage of Interest Stephen Della Sala 100% c/o Terra Group 2665 South Bayshore Drive, Suite 1020 Miami FL 33133 . y J^t { City of Miami Beach-Florida Finance Department 1 City Hall 1506213-1 03/03/2015 BR1 1118 Tue Mar03,2015 09:45AM Trans#11-11 11 $350.00 MCRCLERK - MAR-City_ Clerk * MCR#: 402723 1 ITEM(S): TOTAL: $350.00 Check (002060) PAID $350.00 Have a nice day! t,$-L46;21..:.51..- 0 {J: _Miscellaneous Cash Receipt ,s* N q,.4 0 s:n 30 a a� P w r VL CITY OF MIAM I BEACH ti '71:1--7.---t-__i::._; .__-,.,,,-.__;,-:=:,--L---:..:,-..±---•-t-i,.,-.--,:.--:•%•-•::.---.-7:-.-.=-1-...cf 7-..:•-•::"..-',I:" -. - ‘-.--;....-:,•,,- f.:.::::::. -,.-,:-.i.-..:::.. ..;',,,...-,:-' ,-:;..,:---.?-- 2_': ..-_-'..•No:..__-•_-'7,.::::;--,.-...,,,-.-:.':.:,,,ii.:::)...:,r'''':.:'ll' .'r•:;.:'.:, 0f4A., ''..''.:.' 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Y _ t I j,.,,.:,_L'r y F - 1^ , i h: r wikandaffpnzuggravenmwomp City of Miami Beach-Florida Finance Department 1 City Hall 1506213-1 03/03/2015 BR1 T118 Tue Mar03,2015 08:47AM Trans#12-12 12 $500,00 MCRCLERK - MAR--City Clerk * MCR#: 402722 ' 1 ITEM(5): TOTAL: $500.00 Check (002061) PAID $500,00 Have a nice day! • t l� �a ,-1 1.-.q12 ,,-�i� i'Ju9,6�� k Za37 .4�,d _ r°v iscel laneou Cash Receip }3 a :n f } { P� 0 l Q Cash Credit Card Check '6,(i(e i ' . -'-:-='..''' 'S''.5'&°-- - '-':. .--' ' ..---"- ZOO F Received of 1 ` ./ t k .� e. a t3 L.,t-. . Address 0 . (,S ; . 7) •��(6 8 - .- r- , 3 3 2 3 3 ., For `ice i, t�_'1 U- a - �1 i vy` '/w^-° n�' --sue .0 '. 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