Jose L. Gomez - CBMIA Restaurant Miami, LLC I BEA@H V,,-/r
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 Ordinance 2004-3435.
Gomez Jose L.
NAME OF LOBBYIST: (Last) (First) (M.l)
Belinson Gomez Architects, P.A. 8101 Biscayne Blvd., # 309 Miami FL 33138
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 559-1250 (305) 551-1740 jg(a4,beilinsonarchitectspa.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:
Leonardo B. De Paula Pessoa, MGR
NAME OF PRINCIPAL/CLIENT:
CBMIA Restaurant Miami, LLC— 1001 Brickell Bay Drive, Ste. 2406 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
leo %► ocobambu.com C.'
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
3
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] t "'
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Leonardo B. De Paula Pessoa, MGR
. ' 1
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR_IyORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNFRSHIP OR TRl1ST• SEA l _ P--.- 9-
• 47
II.SPECIFIC LOBBY ISSUE: _.. `~•
Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Review Board, Planning
Board, Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property
located at 955 Alton Road, 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, Building, Public Works and Fire Department None X
Staff
PB, DRB, 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
None
G
0 •
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOB YIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) L9 BAS-T-DISGLOSURE:(Required): $
E9,PR1NCIPACS-DISCLOSURE(OF LOB YIST COMPENSATION): $
(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 lobbying on a present or pending bid for goods.equipment or services.or on a present or
pending award for goods.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 lobbying on a pending application for a Development Agreement with the City or application
fgC change of zoning man designation or change to the City's Future Land Use Mao?
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 representing 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 COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACI-t
EQB THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE : - _P I .D
Signatur• of Lobbyist
I do solemnly swear that all of th- •re• • ' is re true and correct and tha I have r-:d or am familiar with the provisions contained
in Section 2-482 of the Mi.•- :eac► Cod• . II reportin• requirements.
1
Signature of Lobbyis — 11 .
'11.-- --- -2
Signature of Princip. /Client: _�
9 P
VI. LOBBYIST ID NTIFIC.TION: PRINCIPAL IDENTIFICATION:
L.
<:Produced ID •5 "ti'••, Produced ID t •.••,m;=
Form of Identification ,' 1.17 Et�'�'1= Form of Identification
• ° • Z
'Personally known(Lobbyist) e! �4�%•..° 1 Personally known(Principal) 3 o.�
' Cz 3 3 Sao
VII. SIGNATURE AND STAMP OF NOTARY: `} c c d o i „
.. .n rn Cr -�
State of Florida, County of Miami-Dade H R,�.T 51 /km cn 4, `" .. o
ty Q State of Florida, County of Miami-Dade
Sworn toad subscrib efore me = a Sworn d subscri B efore me c.9 • g a
This i •-y of L ,2913(�I`I T H d m This �da •f J"'�l ,28'x3 o
-n ee m NZ
I O d
Si nature Hof P �• °' °
g ig N tary—State of Florida N o .Signature of P •is ry—State of Florida
Notarization o bbyist's signature CO d
Notarization of Princ-•al's signature
TO BE COMPLET,,F� Y CITY CLERK'S T F ONL • J r
Annual Rpgi_ctratinn fPe• [ j YPC[ ]Nn Amount Paid � MCR o )12 ' , 0 nati aid/ / / 5'
Lobbyist Registration Form received and verified by. wow I
•
• istration Form.doc Revised 04/27/2012
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: Jose L. Gomez
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 suspen•ed from lobbying until all fines are paid, unless the fine has been
appealed • iami-►,ade County Commission on Ethics and Public Trust.
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•
CITY OF MIAMI EACH
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, I1st ALL of the
stockholders, and the percentage of stock owned by.each. Where the 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.*
CBMIA Restaurant,.LLC
1001 Brickell.Bau Drive, Ste.2406,Miami,Florida 33131
CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
Refer to Exhibit B
Hibiscus Aiton,Inc.
1228 Alton Road Miami Beach,FL 33139
CORPORATION NAME and ADDRESS
NAME,ADDRESS,ADDRESS AND OFFICE %OF STOCK
Jam_es&Lidia Resnick ... . 33%
1228 Alton Road
Miami Beach,FL 331,.39
SARP Resnick Family Trust 33%.
1228 Alton Road
Miami Beach,FL 33139
LR Spousal Access Trust 33%
1228 Alton Road
Miami Beach,FL 33139
IF THEREAREADDITIONAL 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 8
6
410 •
CITE OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2.TRtSTEIEz
If the property which is the subject of the application is 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 corporations(s),
another trust(s),partnership(s)or other similar entity,further disclosure shall be required which discloses the identity
of the individuals)(natural persons)having the ultimate ownership interest in the entity.*
SARP Resnick Familu Trust
TRUST NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
James Resnick,Beneficiary 50%
1228 Alton Road
Miami Beach, FL 33139
Lionel Resnick,.Benefrciarii 50%
1228 Alton Road
Miami Beach,FL 33139
LR Spousal Access Trust
TRUST NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
Ferri,Resnick Benefzciaru 25%
1228 Alton Road
Miami Beach,FL 33139
Elisabeth Resnick,Beneficiary 25%
1228 Alton Road
Miami Beach,FL 33139
Alexis Resnick,Beneficiarq 25%
1228 Alton Road
Miami Beach,FL 33139
Adam Resnick,Beneficiary 25%
1228 Alton Road
• Miami Beach,FL 33139
I PARTNERSHIP/ILIMITED PARTNERSHIP
If the property which is the subject of the application is owned or leased by a PARTNERSHIP or LIMITED
PARTNERSHIP, 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.*
NOT APPLICABLE
PARTNERSHIP/LIMITED PARTNERSHIP
NAME,ADDRESS,AND OFFICE %OF STOCK
NOTE:Notarized signature required on page 8
7
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Exhibit B
Disclosures
CBMIA Restaurant, LLC
Coco Bambu Investments, LLC 34%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
Coco Bambu Holdings, LLC 27%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
FLCB Investments, LLC 12%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
LPCB Investments, LLC 12%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
XXCB Investments, LLC 12%
Av. Antonio Toaquim de Moura Andrade,737
Sao Paulo -SP Brazil, 04507-000
Ronaldo Parente 3%
11200 SW 8th Street
Modesto A. Maidique, RB 339B
Miami, FL 33199
Coco Bambu Investments, LLC
CB Holdings Oversees, Ltd. 100%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
CB Holdings Oversees,Ltd.
CBTK Comercio de Alimentos Partners 70.6%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil,04507-000
Rafael Alves de Almendra Freitas 2.1%
Av. Antonio Joaquim de Moura Andrade,737
Sao Paulo -SP Brazil,04507-000
Jany Alves Soares Almendra Freitas 1.8%
Av. Antonio Joaquim de Moura Andrade,737
Sao Paulo -SP Brazil, 04507-000
Daniel Soares Alves de Brito 2.1%
Av. Antonio Toaquim de Moura Andrade,737
Sao Paulo -SP Brazil, 04507-000
Joao Alberto Ribeiro Pinheiro 2.9%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo - SP Brazil, 04507-000
Alvaro Meireles Torge de Sousa 2.9%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo - SP Brazil, 04507-000
Igor Fernandes Bezerra de Franca 2.9%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Bruno Lopes Marques 2.9%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Andre Camara Studart Fonseca 2.9%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Felipe Russo Barreira 4.4%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil,04507-000
Ticiana Russo Barreira Parente 1.5%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Marconi Nunes Santana 2.9%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
CBTK Comercio De Alimentos
Afranio Barreira Filho 31%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Eugenio Veras Vieira 11%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Idezio Braga Rolim, Tr. 11%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil,04507-000
Arthur Souza de Moraes 12%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Hegel Barreira Martin 3%
•
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Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Eilson Oliveira Studard Fonseca Filho 3%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Daniell Studart Fonseca Chehab 3%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Andre Rodrigues Parente 2%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Edmar Ronald Frota Aguiar 12%
Av. Antonio Toaquim de Moura Andrade,737
Sao Paulo -SP Brazil, 04507-000
Leonardo Correa Barros 12%
Av. Antonio Toaquim de Moura Andrade, 737
Sao Paulo -SP Brazil, 04507-000
Coco Bambu Holdings,LLC
CB Enterprise Holdings, Ltd. 100%
CB Enterprise Holdings
Afranio Barreira Filho 100%
Av. Antonio Joaquim de Moura Andrade, 737
Sao Paulo -SP Brazil,04507-000
FLCB Investments, LLC
Felipe Luna 100%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
LPCB Investments,LLC
Leonardo Pessoa 100%
1001 Brickell Bay Drive, Ste. 2406
Miami, FL 33131
Camm, Patrick
From: Mary-Eve <mev @beilinsonarchitectspa.com>
Sent: Thursday, May 28, 2015 4:50 PM
To: Camm, Patrick
Subject: Lobbyist Disclosure Info
Good Afternoon Mr. Camm,
In response to a call we received from Alcene,following is the information she requested:
A) LOBBYIST DISCLOSURE:$250.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):$250.00 per hour
Please let me know if you need any additional information.
Thank you,
Mary-Eve Vendryes
Office Manager
BE 11L I:NSON
1 1 1 1 1G° 1E1 1
MARY-EVE VENDRYES, CPS
FAO,BISCAYNE BLVD'.S E ZIIS-11Q
MIAMI FI mac(c( A3 NP..-4 84
to.IL,ri*ONARei I Lc is pA cOM
www.bgarchitectspa.com
mev @beilinsonarchitectspa.com
Tel.305-559-1250 x.201
Statement of Infringements.The enclosed documents/computer data files are instruments of service and shall remain the property of Beilinson_Gomez Architects,
PA,whether the project for which they were prepared is executed or not.They are not to be used in any manner on other projects or extensions to this project
except by agreement in writing and with the appropriate compensation to Beilinson_GOmez Architects PA.Reproduction or distribution,in any manner to a third
party,of documents/computer data files,without the written consent of Beilinson_GOmez Architects PA are prohibited.Use of these files,including modifications is
at the sole risk and liability of the user.The user shall to the fullest extend of the law hold Beilinson_GOmez Architects PA harmless from any claims,liabilities,
damages,losses,judgments,cost and expenses including legal fees that may be incurred by Beilinson_GOmez Architects PA as a result of the document/computer
data file including but not limited to,any alterations,modifications,deviations from additions to the document/computer data file.Failure to adhere to these
conditions is grounds for legal action by Beilinson_GOmez Architects PA.All printed and/or published versions of these documents/computer files must contain the
corporate logo of Beilinson_GOmez Architects PA.
Statement of Confidentiality.The contents of this e-mail message and any attachments are confidential and privileged,intended solely for the addressee. The
information may also be legally privileged. This transmission is sent in trust,for the sole purpose of delivery to the intended recipient. If you have received this
transmission in error,any use,reproduction or dissemination of this transmission is strictly prohibited. If you are not the intended recipient,please immediately
notify the sender by telephone(305)559.1250,fax(305)551.1740 or electronic mail jg@beilinsonarchitectspa.com and delete this message and its attachments,if
any.
1
S5 M AZPII Rfi>
BE I ILI I IN:SONI
1 1 GOEZI
August 18, 2016
Via Email to JasonSalvatore @miamibeachfl.gov
Mr. Jason Salvatore
Associate, Office of the City Clerk
I!P City of Miami Beach
1700 Convention Center Drive
Miami Beach, FL 33139
Re: Update of Lobbyist Registration Information
955 Alton Road
Principal: Leonardo B. De Paula Pessoa, MGR/CBMIA Restaurant Miami LLC
Mr. Salvatore:
Pursuant to your request, the purpose of this letter is to clarify the terms and amount of
compensation to be paid by each principal to the lobbyist pursuant to the Miami Beach City
Code Sec. 2-482(a)(6).
For the specific issue on which I was engaged to lobby, the compensation to be paid by the
client is$250.00 per hour.
Please give us a call if you have any questions or need additional information.
Respectfully,
(75.
Jose L. Gomez,AIA
President
Beilinson_Gomez Architects P.A.
JLG/mev
8101 Biscayne Blvd.,Suite 309-310
Miami, Florida 33138—4664
Tel 305-559-1250/Fax 305-551-1740
www.beilinsonarchitectspa.com
AAC001062 AR-15416 ID-6091