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Chad Oppenheim - ARRP Miami, LLC Ia( 41eiRôq1 AA opli 6auliii FL_ 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. Oppenheim Chad NAME OF LOBBYIST: (Last) (First) (M.I) Oppenheim Architecture and Design 243 NE 37 Street Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 576-8404 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,or e-mail address. I. LOBBYIST RETAINED BY: David B Smith NAME OF PRINCIPAUCLIENT: ARRP Miami, LLC and Wells Fargo Bank 2200 Biscayne Blvd. Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 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: David Smith C : t`-J — e • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORATION, PARTNFRSHIP OR TRUST. See Attached `- II SPECIFIC LOBBY ISSUE: Development Board Approvals for 1901 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-Iobb ist 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 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 . C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc -)C IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): I5.4:)C) f 2 (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.eauipment or services.or on anresent or pending award for goods.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 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 - - - corporation r n i without forth in Section 2 481 above) who only appears as a representative of a not for profit or entity ty Y 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 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 SUBM1 lr0 E CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPE SATI• RECEIVED. IN THE CITY OF MIAMI BEACI-( FQB THE PRECEDING CALENDAR YEAR. A STATEMENT S ALL :'� ,D EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PE-IOD, /r�� a Signature of Lobby.t 1A. I do solemnly swear that all of t - fo going facts are true and correct an• - hA- read or am familiar with the provisions contained in Section 2-482 of the Miami :-ach u, Code a • : reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID D L_ . Produced ID Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOY:, •',`" Y XIMENA GONZALEZ '' to of Florida,County of Florida, County of Miami-Dade ;�*• •.�;-,, y of Miami-Dade Sworn to and subscribed before me (• ■ ._ Notary Public-pawn orn and subscribe ,bef°'e me his ' . - d. , 2015 4 MY Comm.Expire Mar 24,tot_ is 7 day of Iv IA'-1 , 2015 . s f�•.' Commission ommission I FF 000129 S'.nat► e of Public o - -Stat•. of Florida Signature of Public Notary-State of Florida otariz.-ion of Lobbvist's s' nature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: ]Yes[ ]No Amount Paid$ MCR# 4-(t)41," ' _Date Paid Zf,• Lobbyist Registration Form received and verified by C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Form revised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) G,L 50.0/ IA- B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 500 4-\ (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.eauiament or services. or on a present or pending award for goods.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 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, 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 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 BEACH E$ 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 I do solemnly swear that all of the foregoing facts are true and correct and that I 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: 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 NOTARY: State of Florida,County of Miami-Dade State of Florida, C• Sworn to and subscribed before me Sworn grad subscri•- : : me DAYAMV AGUTAR This day of ,2015 This - :y of ,,� , ` Miry Public.goo of Florida ' '�' Commission of FF 196144 �.. TTIAL. � Na' mom Expires Mar 16,2019 Signature of Public Notary—State of Florida Sign:tur f f Public N!ary-.Stai��o orilinlOtiougliftion0NotiryAssn. Notarization of Lobbyist's signature No .riza ion of Principal's,sign TO BE COMPLETED BY.CITY CLERK'S STAFF ONLY Annual Registration fee: [aces[ ]No =Amount Paid S13 MCR#. 40 Li t S Date Paid 5- 1 lr Lobbyist Registration Form received and verified by: �'i t „ n - C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F:\CLE istration Form.doc Revised 04/27/2012 I A M 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: Chad Oppenheim 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 automatic spended from lobbying until all fines are paid, unless the fine has been appealed o t ' iami-►ade County Commission on Ethics and Public Trust.5� 6 . Signature: w�� Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Form revised 5-30-2012.doc • SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in ARRP Miami III, LLC Percentage of Interest KGM Equities 2, LLC 95% 2200 Biscayne Blvd. Miami FL 33137 Beach R Holdings, LLC 5% 2200 Biscayne Blvd. -- - Miami FL 33137 Interests in KGM Equities 2, LLC Percentage of Interest Sonny Kahn 2004 Irrevocable Trust 45% 2200 Biscayne Blvd. Miami FL 33137 Russell W. Galbut 2004 Irrevocable Trust 45% 2200 Biscayne Blvd. Miami FL 33137 Bruce A. Menin 2004 Irrevocable Trust 10% 2200 Biscayne Blvd. Miami FL 33137 Beneficiaries of Sonny Kahn 2004 Irrevocable Trust Percentage of Interest Child of Sonny Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Child of Sonny Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Child of Sonny Kahn _ _ 20% 2200 Biscayne Blvd. Miami FL 33137 Child of Sonny Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Child of Sonny Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Beneficiaries of Russell W. Galbut 2004 Irrevocable Trust Percentage of Interest Child of Russell Galbut 50% 2200 Biscayne Blvd. Miami FL 33137 50% Child of Russell Galbut 50/O 2200 Biscayne Blvd. Miami FL 33137 Beneficiaries of Bruce A. Menin 2004 Irrevocable Trust Percentage of Interest Child of Bruce Menin 33.33% 2200 Biscayne Blvd. — — - -Miami FL 33137 Child of Bruce Menin 33.33% 2200 Biscayne Blvd. Miami FL 33137 Child of Bruce Menin 33.33% 2200 Biscayne Blvd. Miami FL 33137 Interests in Beach R Holdings, LLC Percentage of Interest • Tourer Bitton .: • - 100% -2200 Biscayne Blvd. Miami•FL 33137 • • • • • ej: , City of Miami Beach-Florida Finance Department 1 City Hall 1514620-1 05/26/2015 BR1 T131 Tue May26,2015 12:46PM Trans#41-41 41 $850.00 MCRCLERK - NCR-City Clerk * MCR#: 404154 1 ITEM(S): TOTAL: $850.00 Check (00579) PAID $850.00 Have a nice day! 13. t L4 l 1..)5/26120' 1, A 31 Miscellaneous Cash Receipt ; .,. �.k : - 0 CITY OF MIAMI BEACH - " g5O'l--) '' .. ' - i, .. ::: . No 4 rik,41 i„5 4 . :-, 0 Cash Credit Card Check# 7 - Si �31a6 201 = Received of (Z P P/ CA�'" 1 L 1 . Addresses, 0 0 J_u-, ,,-t, 1 J , ' cam) , ' 3" l 1-1 For A A A..l^-c Le 1 to :' l'{ Z{. , + v c. .� •.,- . 0 °N 4 , ...._4(r. I C(THIS INFORMATION MUST.BE COMPLETED) ' Office of Finance Director -, :-:.:'..-,---,-4,- By -Account Number f f. 4 . ; _ 10 . + -1 - : , . Preparers (I ' - ---- "4-- Dept: .(---61--'-'4.-- ' 1