Youssef Hachem - 600 Collins, LLC 606-60 f2,5
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M I AM I B E AC H
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 Lv y `::
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.
Hachem Youssef
NAME OF LOBBYIST: (Last) (First) (M.I)
YH Engineering 12151 SW 128th Court, Ste 104 Miami FL 33186
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 969-9423 (305) 969-9453 vh(c�vhenaineerina.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:
Ricardo Tabet
NAME OF PRINCIPAL/CLIENT:
600 Collins, LLC 846 Lincoln Road, 5th floor Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
1786 574 4098 rt(cr�.optimumam.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:see attached
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:see attached
II.SPECIFIC LOBBY ISSUE:
Development Board Approvals for 600-610 &215 6th Street
Issue to be lobbied(Describe in detail):
Ill. 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
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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
13-0/
B) PRINCIPAL'S DISCLOSURE(OF LOBBY T COMPENSATION
(REQUIRED). 4 I SG ) hr
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 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 lobbvina on a pending 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 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 No: Are you reoresentina a not-for-profit corporation or entity without special compensation or reimbursements
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
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. / f
os
Signature of Lobbyist
I do solemnly swear that all of the foregoing fac are true and correct an that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City • :!: d all reporting requirements.
A 1_4.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Yt'ersonally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State • •.- • my of Miami-Dade State of Florida, County of Miami-Dade
S •rn toad subscribe• •_ •re Sworn and subscribed before me
y
his 5 d. •f —1414 ■4'.i me, " Rodriguez g nald R. Rodri This day of ,2014
zCOMMISSION#FF029609
):=';-.':17 EXPIRES:JUN.20,2017
•-- - ofP_*•lic Notary—Sta :,*,s' •rida 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$ 560/c'MCR# 14 C"11%1 Date Paid 61'{f J
Lobbyist Registration Form receive and verified by: "pittfEiw&--�
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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
(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 oendina bid for aoods.eauipment or services. or on a present or pending
award for aoods.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 Iobbvina on a pending application for a Development Aareement with the City or application for
change of zonina map designation 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 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: 6 ��
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) ,Personal) known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY: :iv •
MARILYN ABUD
;': MY COMMISSION 0 FF194693
•
State of Florida, County of Miami-Dade St to of lori • • ofFll is fbFary 01.2019
Sworn to and subscribed before me S ornha d sup - -
This day of ,2014 T is -y of J uqut ,2015
— of Florida Si rfatur of Pu lic t�ta — .tate of Florida
Signature of Public Notary State o o da g ry
Notarization of Lobbyist's signature Notariza 'ono Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[,]No Amount Paid$ v pO MCR# 46413i, Date Paid ke/qjj c
Lobbyist Registration Form receive and verified by: Pak Cc -
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F;\CLE istration Form.doc Revised 04/27/2012 I
A A A 1 rk
v 1"—A, V 1
City of Miami Beach, 1 700 Convention Center Drive. Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Ciranado, City Clerk CityClerkla1miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Youssef Hachem
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
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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.
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Sig natur- �� Dat :
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Exhibit A
Disclosure of Interest
600 Collins
Avenue, LLC
Optimum USA S8 Collins Ave LLC
Investments 2, LLC Ricardo Tabet
Rodolfo Misitano 846 Licoln Rd, 5 th floor
c/o Funaro &Co. P.C. Miami Beach, FL 33139
350 Fifth Avenue,
41St floor, 1 %
New York N.Y. 10118
99%
1
risc llaneous Cash Receipt 4,---" , t.,, t Is r6 , t t
1
CITY OF MIAMI BEACH
404
Cash 0 Credit Card :: Check# $ . , 1
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Received of O 5S c (r LAC. .
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(THIS INFORMATION MUST BE COMPLETED) = Office of.Finance Director
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