The URL can be used to link to this page

Charles Benson - JHPSB Collins Ventures, LLC ?20/-1 3101.1,2o/1)u ml Am I B BEACH ° City of Miami Beach Office of the City Clerk k - 1700 Convention Center Drive, Miami Beach, FL 33139 ZE5 HAY a7 Phi3: 58 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not by a principal who seeks to encourage the passe e,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. Benson Charles NAME OF LOBBYIST: (Last) (First) (M.I) Charles Benson Architecture 1665 Washington Avenue Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 532-6161 Carkitect(c aol.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: Jason Halpern NAME OF PRINCIPAUCLIENT: JHPSB Collins Ventures, LLC 184 Kent Avenue, C706 Brooklyn NY 11249 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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:Jason Halpern • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNFRSHIP OR TRUST.See Attached II.SPECIFIC LOBBY ISSUE: Development Board Approvals for 302/310/320/336 Collins Avenue. Miami Beach. FL 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 Staff, PB, HPB, BOA, DRB, Commission None X None X 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 2-482(g)Any Financial, Familial or Professional Relationship NONE NONE NONE C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc �,L IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$ 245' U U fPi ki7-... B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION)/9 t�) 5•co per �IOc�l (REQUIRED). I 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 pending Award for aoods.eauioment 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 aendina application for a Development Aareement with the City or application for, chanae of zonina map desianation or chanae 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 reoresentina a not-for-profit corporation or entity without special compensation or reimbursement V. SIGNATURE UNDER OATH: ON FEBRUARY 28 •F 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 BEAU{ EQB THE PRECEDING CALENDAR YEAR. _A_ STATEMENT S B Fl EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PE OD Signature of Lobbyist 9 Y I do solemnly swear that all of the foregoing facts ar• ru a r• o - t :nd that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code an• all repi • r_ ?re Signature of Lobbyist: i ' Signature of Principal/Client: ■ VI. LOBBYIST IDENTIFICA , •N: PRINCIPAL IDENTIFICATION: °Produced ID ®Produced ID Form of Identification Form of Identification ,ersonally known(Lobbyist) ''-`-'`" -' °- '' .BROWN Personally known(Principal) 'a C o r g i BRIAN G w Voerk VII. SIGNATURE AND STAMP OF ,OTEItr & urY Publle'.,Bum°of N® N®.01 BR616122pT ` t z .off+ W , S olk COU S_ • � - State of Florida,County of Miami-Dade ., o di QuslHled In fi�Y . a $ � misslon Expires�u9usBtitb. �,-. .., ounty of e Sworn to and subscribed before me a N m Sworn ai subscribed b ore me This _ — d. . •f '.I a. :_ ,2015 Q w .2 " This /r `day of /V ,2015 1i1P, a.....,,,5---afi .1,....,..--.L.., Signature if Public N. : State of Flo '4 a o 8• g Signature of Public Notary g ry- � g ry-State of Florida Notarizati•n of Lobbyist's signature a m Notarization of Principal's signature T • I. �r�,,PI TED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ o rs u_$` 350'°° MCR# qG I Date Paid �� Lobbyist Registration Form received nd v. 7r• : =,7 o- • /J C:\Users\clerhatl\AppData\Local\Microso infi e-v▪ e orary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IF:\CLE istration Form.doc Revised 04/27/2012 I MIAMI 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: Charles Benson 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. Signature: 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 JHPSB Collins Ventures, LLC Percentage of Interest 295 LNP, LLC 15.78% 184 Kent Avenue, C706 Brooklyn NY 11249 PSB Collins, LLC 84.22% 555 Madison Avenue, Suite 508 New York NY 10022 Interests in 295 LNP, LLC Percentage of Interest The Jason Halpern Life Insurance Trust 90% 184 Kent Avenue, C706 Brooklyn NY 11249 Jason Halpern 10% 184 Kent Avenue, C706 Brooklyn NY 11249 Interests in The Jason Halpern Life Insurance Trust Percentage of Interest Jason Halpern 100% 184 Kent Avenue, C706 Brooklyn NY 11249 Interests in PSB Collins, LLC Percentage of Interest Dhruv Piplani 100%o 555 Madison Avenue, Suite 508 New York NY 10022 Mi cellaneous:Cash Re eipt i! 66;f i�g �( �'q �, � a7 k § ,E; t �i � 3 C.t��8 b.r �e��T�LJ�a 4..4� F { f 7 CI'T`('OF MIAMI•BEACH (�� ; No ��l,a� it D C7.,Credit,Card Gheck# $ { . ,Gash � �• h F E �jVI ` t ,60 .,� 1 rri -� S 1 RecPeived of 1 C 9 .J 4(W C 1 a f 15 /Crativ I•,n,en Address p) ri-.. .ai :ac.c. o_u. n.t NUrrlbe.1 r•.- � . ST � ....i � .ZiD) [Dep.t.• - . I .:;::".'-.1"."''''' r-'';:i.".r7,,-:.,'''::::.''''..''.:fl 'I-7)'":1-...55.-w.c," '--,'-.1 -'''-:---''.....1-'"'-'-'g o•. •••...•.• . •,,..... ..,• •• ..,•,. .•....„, :' rII irector` 'bi ! ®f bona r '®Dof Off! E E E COMPLET O MATION MUB �� ,I (THIS INF / l;; �{ EXT•� £ ! / If V P � �� ;, ..e:�.1.-e, },.a} v. . tPre P aer: Y . . . •_r.L...T f�a.e e Pr t L . _ -iz_,- ! F i ro ti . ..i a _.` , ' •L�? I�.t. ,1 .'1, .'.0':-f .1i,- 4 q. ti �.�- •