Jennifer McConney - Miami Beach Resort Owner, LLC M I AM I BEACH $2-,;Cot tin 5Avth14%
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i of Miami Beach Office of the City Clerk vd 40� i
City C ty C .�.
1700 Convention Center Drive, Miami Beach, FL 331'3'9-- ,, /4 `+
LOBBYIST REGISTRATION FORM /,;;. ,g•
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage tlie�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.
McConneu 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)
1305) 573-1818 1305)573-3766 JMcConneunakobikara.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:
Ari Pearl
NAME OF PRINCIPAUCLIENT:
Miami Beach Resort Owner, LLC, 404 Fifth Avenue, 6th Floor, New York NY 10018
BUSINESS NAME AND ADDRESS(Number and Street) (City) (State) (Zip Code)
1305) 747-6408 ari.Dearl(mail.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: Ari Pearl
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See the attached.
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Board, Planning Board, Board
of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 4833
Collins Avenue.Miami Beach.Florida.
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 Department and Building Department Staff None X
PB, 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
Nnne
None
,None
,3
?c_
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required):$ _350
114-t
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $ /4/,c
(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 Iobbvina on a present or pending bid for goods.equipment or services.or on a',resent or
pending award for 000ds.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',ending application for a Development Agreement with the City or application
f,Qa change of zonina map desianation or chance 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 o; Are you representina 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 OMMPENSA,TIO RECEIVED. IN THE CITY OF MIAMI BEACI{
FOR THE PRECEDING CALENDAR YEAR. A S SHAkC FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR • • ► • ► , ►' :. ,: ►r4' :.E, •
Signature • Lobby' t
I do solemnly swear that all - the fir:going fact -re tr a and corr- t and hat I h v read or am familiar with the provisions contained
in Section 2-482 of the Mia i :-a,, C ■ Co•- and I r-•orting req remen .
Signature of Lobbyist:
Signature of Principal/CI -It:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID _Produced ID
Form of Identification Form of Identification
personally known(Lobbyist) ..ersonally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
j�''"►P.Y P'''. OREN DAVID LIEBER
State of Florida, County of Miami-Dade , ,:, MY COMMISSION It FF 058578 State of Florida, County of Miami-Dade
Sworn to and subscribed •efore me ' ^ �.:a EXPIRES:November 29,2017 Sworn and subscribed b�
� •�••4' BondedThru Public _ •�" �>
This f_� day of -� ,20 •-�,ta "�' This I _- DAVIDUEBER
-.r � OREN
�� •.- COMM• FF 058578_ 11'
I:vaU '...ii!
- - -- I •.;•� Bonded Thru�Notary nn�rl�l�l;
re of P.."'is Notary—State of Florida a ure of Public Notary—State '� :.'Tr== _
Notarization of Lobbyist's signature Notarization of principal's,signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONL Lill Annual Registration fee: [VaYes[ ]No Amount Paid$ MCR# `4 61 `i 2- _Date Paid —(/l LO
Lobbyist Registration Forml-received and verified by:
I F:\CLE istration Form.doc Revised 04/27/2012 I
BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachd.gov
CITY CLERK Office
Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 , Fax:305.673.7254
LOBBYIST NAME: Kobi Karp
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 o the Miami-Dade County Commission on Ethics and Public Trust.
‘-'\ `'\ 5
Sign re Date
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, 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
discloses the identity of the individual(s)(natural persons)having the ultimate ownership interest in the entity).*
Miami Beach Resort Owner, a Delaware Company
404 Fifth Avenue, 6th Floor,New York,NY 10018
CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
Miami Beach Resort Mezz,LLC 100%
404 Fifth.Avenue,6th Floor
New York,NY 10018
Miami Beach Resort Mezz,LLC, a Delaware Company
404 Fifth Avenue,6th Floor,New York NY 10018
• CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
MBR Waterview,LLC
404 Fifth Avenue, 6th Floor 10044
New York,NY 10018
MBR Waterview,LLC,a Florida Company
404 Fifth Avenue,6th Floor,New York,NY 10018
CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
Jacob Chetrit
404 Fifth Avenue, 6th Floor 80%
New York,NY 10018
Judo Chetrit
404 Fifth Avenue,6th Floor 20%
New York,_NY 10018
IF THERE ARE ADDI770N4L CORPORATIONS,LIST OTHERS,INCLUDING CORP.Nt4MME(S)AND EACHINDMDUAL''S
NAME,ADDRESS,OFFICE AND PERCENTAGE OFSTOC/ ONA SEPARATE PAGE
NOTE:Notarized signature required on page 8
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