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Kevin N. Markow - G200 Exchange LLC iCto 1 ac 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 modiliGatiun of any ordinance, resolution, action or decision of any commissioner; any action,dedsion,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. I , NAME OF LOBBYIST: •(Last) . (nisi) (M.I) _ • G N© POLL Ito BRov1/41*s4) BUSINESS NAME AND ADDRESS (Number and Street) (City) plate) (Zip Code) " • '333 I .35.±:31 - "5 O . 574 79 s-Lo 81 . TELEPHONE NUMBER! FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,ore-mall address. I. LOBBYIST RETAINED BY: Do... eat: L.L.G NAME rLF PRINCiPAU t V NT:T: /U/ .Ueilfl.- ,T/Y' � f!l/���; =- - - 1170/ BUSINESS NAME �_ 0: ODRESS • l�ber and Slre (cm (State) • (Zip Code) •- - '3. . - 0 • TELEpHONE.NUMBER; FAX NUMBER:(Optional) EMAIL:(Optional; Fill out this section if principal Is a Corporation,Partnership or Trust(Section 2482(c)( • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: A/no(J S Lt A4,01 . IDENTIFY ALL PERSONS HOLDING,DIRECTL OR)NDIRECTLY.A 5%OR MORE OWNERSHIP NTEREST IN SUCH CORPORATION. ( PARTNERSHIP OR TRUST: R r r 4,•' ?i.•t I , 1L.2.Ot0 7 1 •lie- II.SPECIFIC LOBBY ISSUE: LDkTNh -: ,. Otto •001 mg• issue to be lobbied(Describe in delail): • iii.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Coda Section 2482(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 cit to the .resent date statin, the,eneral nature of the sub act contractual reiationshi,.. Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of erson to be lobbied N 1S�'D PRE iA Li .__�z".. r k - x I._T Pur scant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional rulationship,or other relationship giving rise to an appearance of an Impropriety,with anycurrent city commissioner or city personnel who is sought to bu lobbied as Identified on tho lobbyist registration form filed. Sec 2.482 ., An Financial Familial or Professional Relationshi. Lz — F;ICLERt$ALL1aFORMSiLOBBYIST FORMS1Lobbyist Registration Form.doc ' 'V IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) "HBUR,1-4 B) PRINCIPAL'S DISCLOSURE(OF LOBIBYII T QO PENSATION): . (REQUIRED). Yeti 1. 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,XNo: Are ou Iobb in• on a 'resent or sendin bid for •oods e•ui•me nt or services or on a 'resent or •endin• 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": xYes—No: Are you lobbying on a pending application for a Development Agreement with the City or application for chan•e of zonin• ma desi•nation or chan•e to the Cit 's Future Land Use Ma.? 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 No: Are you re••resentin•• a not-for-•rofit cor•oration or entit without s•ecial com•ensation 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 COMPENSATIO RECEIVE-DI–IN T ITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED ■ HER a : EN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I de solemnly swear that all of the forego' g f _ - -r- trL- -•. correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beac "I -ode adislerng requirements. Signature of Lobbyist: • Signature of Principal/Client: _- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF 14.,,,,'..",: COLLEEN LAPLANT 7/ . : Commission#EE 880483 State of Florida, County of Miami-Dade a;:, '1 .4 Expires June 16,2017 4 State of Florida, County of Miami-Dade Sworn to and subscribed before me '� Bonded P,,,,,. Sworn and subscribed before me This ,� day of m6- ,n201'_''- ' . ' " " ' _ This day of , 201 Signature of Public Notary–State of Florida Signature of Public Notary–State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature _ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid iLobbyist Registration Form received and verified by: • 1:,Ci.FL\s/.,LI.J:.1=CJitP IS;LQSuYIST FORMS\Lobbyis't Annual Registration Forrn.doc Revised 01/22/2014 • F:ICLER\T;ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) I i B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REOUIRED) /)0V/1• Tho following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement issuer: Yes, No: Are o lobb n• on a 'resent •r •:n•n, bid a .•• .!tit. en o rvi •r•n a ! e=en or •a •in, award for(Dods,eauipment or service? 2) Pursuant to Miami Beach City Code Section 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yos_No: Are you Iobbytnn on a pending application for a Development Agreement with the City or application for 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,shad,-register with the clerk as required by this section but,shall not be required to pay any registration fees. YoNo; Are you representing a not-for-profit corporation or entity without special compensation of 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist l! dc solanmly swear that all of the foregoing facts are true and correct and that t have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: _ aA/4411/ 4,4. VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification Porsonally known(Lobbyist) J'Personally known(Principal) VII, SIGNATURE AND STAMP OF NOTARY: w r..ff Stale of Florida,County of Miami-Dade State of Fide,County of Mierni-Geele-/Ulw Sworn to and subscribed before me Sworn and subscribed before me This day of ,201_ This F Yi day of 1h a : _.,281, ' —--�--! PATRICE lb State of New Ybtt Signature of Public Notary-State of Florida Signature of Public Notary-State of gleiridril4.0444989909 Notarization of Lo,J i_+f st's.signaturo Notarization of Principal's,signature Qualified In New York County Comm.Expires Dec. 16,20 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fog: ( )Yoe[ I No Amount Paid$ MCR# Date Paid Lobbylzt Registration Form received and verified by: j �:i s °,,;�', .'c:rPL.L I vts� rctll:i ;;.ottr,y�_,t 11tcr,c„c�R':c,intattiu:i rorru,ec'c Revised 01/22/2014 F•1CLERtSALL1aFORMSILOBBYIST FORMSILobbyist Registration Form.doc City of Miami Roach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E.Granada,City Clerk CityClerkemiamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Keen i Ac i�,i�ul 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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th of each year,shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the an. ounty Commission on Ethics and Public Trust. Signature: Date: • F.ICLERI$ALL1aFORMSILOBBYISI FORMS\Lobbyist Registration Form.doc t .4 OCL ti 05/1)`(,'..":21:11 mo. Ci01 .1-55 3 Miscellaneous Cash Receipt CITY OF MIAMI BEACH 1:-_ ;: No r a , _ , _ , , . , , , , ss 0 : , • E Cash D Credit Card Check# :$ 2 ' - ' ' ay & 2o I5- Received of ! Qa len i t o me s Address b v4 For (7 n u t reo( ~r 5��' �c l sue api, . )y (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director BY Account Number: zf (71(it i Preperer. �� � Dept: 1 BECKER Colleen LaPlant Phone: (954)987-7550 Fax: (954)985-6814 POLIAIKOFF CLaplant @bplegal.com 1 East Broward Blvd.,Suite 1800 Ft. Lauderdale,Florida 33301 May 5, 2015 Via Federal Express City Clerk Office Attn: Patrick Camm, City Clerk 1700 Convention Center Drive Miami Beach, FL 33139 Re: Lobbyist Registration Dear Patrick: Enclosed please find our Firm's in the amount of $2,550.00, along with the Lobbyist Registration Forms representing lobbyist registration fees for Marcie Nolan, Allen Levine and Kevin Markow on behalf of our client G200 Exchange LLC. Thank you for all your help and assistance. If you need additional information, please feel free to contact me. Sincerely, Colleen LaPlant Executive Assistant Enclosures ACTIVE:5753230_1 www.bplegal.com care @bplegal.com Florida New Jersey New York Virginia Washington, DC Prague S\,,Q. Cl-h l ° c 1 C.o► �,� 4t Salvatore, Jason From: LaPlant, Colleen <CLAPLANT @bplegal.com> Sent: Monday, August 15, 2016 10:58 AM To: Salvatore,Jason Cc: Bailey, Michelle; Chamizo, Roberto Subject: Hi Jason, nice speaking with you... Sorry for the delay. Please see below and let me know if you need any other information from us. G200 Exchange, LLC Hourly Kevin M. Markow$450 per hour Jeremy B Shir$300 per hour Ygrene Energy Fund Florida, LLC Flat Rate $3,000 Jose Bermudez Jose Fuentes Connect Miami Beach Flat Rate $12,500 Jose Fuentes George Burgess Jose Bermudez Thanks again. c Colleen LaPlant Executive Assistant to Bernie Friedman, Esq. and Jeremy Shir, Esq. 1 East Broward Blvd., Suite 1800 I Fort Lauderdale, FL 33301 Tel: 954.985.6804 I Fax: 954.985.6814 I E-Mail Website BECKER&3 POLIAKOFF The Becker & Poliakoff Client CARE Center is here to serve our valued clients. If we can be of assistance in any way, please call us toll-free at 1-844-CAREBP1 (1-844-227-3271) or by email at care @bplegal.com. 1