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Allan T. Shulman - PPF MBL Portfolio, LLC i $01 LivIc61iRoa MIAMIBEACH , .."" - City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139Oi5 JUN -9 Ail : 1( 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. Shulman Allan T. NAME OF LOBBYIST: (Last) (First) (M.I) Shulman +Assoc. 100 NE 38th St.# 1+2 Miami FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 438-0609 (305) 438-0170 allan @shulman-design.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: Stephen H. Bittel ,as Manager of Lincoln Road MM,LLC,a Florida limited liability company,acting as manager of PPF Lincoln Road Ventures,LLC,a Delaware limited liability company being the sole member NAME OF PRINCIPAL/CLIENT: PPF MBL Portfolio,LLC 801 W 41st Street, Suite 600 Miami Beach, FL 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 695-8700 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] PPF MBL Portfolio,LLC is the owner of the property.The membership interest in PPF MBL • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Portfolio,LLC are indirectly owned by:(a)Prime Property Fund,with Morgan Stanley Real Estate Advisor,Inc.as the Fund's investment advisor and(b)Lincoln Road MM,LLC and Lincoln Road IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY, Investors VI,LLC,which are controlled by Stephen H.Bittel and which represent less than a 5% • A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, interest.As of March 31,2015,there are no investors in Prime Property Fund that own more than 5% of the interests in Prime Property Fund,other than a large pens ion fund which owns more than 5% PARTNERSHIP OR TRUST: but less than 10096.The pension plan has more than 5,000 beneficiaries,for which State Street Bank acts as Trustee. °.SPECIFIC LOBBY ISSUE:. Modification of Final Order,Variance and Certificate of Appropriateness for 801 Lincoln Road 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 City Staff X City Commissioners X City Manager 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 n/a F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc QL , IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) no additional compensation over current agreement (REQUIRED)IPPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): no additional compensation over current agreement 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 you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending 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": _YesX_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 XWo: 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 .0 PENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SH' :E FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Sig ature oYfbbyist I do solemnly swear that all of th oregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami B: a ity Code and all reporting requirements. Signature of Lobbyist: A ._ Signature of Principal/Client: , ../.-'--- Manager of Lincoln Road MM,LL da VI. LOBBYIST IDENTIFICATION: lisnitedliabilitycompany,actiagasmanagerof PRINCIPAL IDENTIFICATION: PPF Lincoln Road Ventures,LLC a Delaware limited liability company being the sole member of PPF MBL : ° t,' Produced ID ,,,.5��:��-ti,, Produced ID Form of Identification _,,, ••°°••°p Form of Identification Personally known (Lobbyist) ��'0,•,�.``;,0' Personally known (Principal q'0-.10svoNa"•. �� F, £ e ac�Q 13,2p� '•, VII. SIGNATURE AND STAMP OF NOTARY: • o; ° :��` s •; State of Florida, County of Miami-Dade H 3 Q l- State of Florida, Cou t o iarrr� #EE101909 H _ N Y � �� o Sworn to and subscribe• before me 6 x a m t. Sworn -, su•.cr._... •efore mel%°. �s4o.an:S.s'te' ti ••za This S •- of / ;a , 2016 „ This / d.! o _ t ,20 'P._ . P„- `o��° �� Nv o X , %I ��/lli0Bl1 111od�`� Dow 1 i— %111 Signature of Public Notary—S : e of Florida A N s Signature of Pu• • ;-.� ” —Stat- of Florida Notarization of Lobbyist's s.•nature °' ° a Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY t 7 u Lc- Annual Registration fee: [ ]Yes[ No Amount Paid$ 2751)s MCR# (AO Ig j Date Paid iJ Lobbyist Registration Form receive and verified by: ,l d _ F:\CLER\$ALL\aFORMS\LOBBYIST FO MS\Lobbyist Annual Registratmon Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MAM B 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: Allan T. Shulman 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 Miami-Dade County Commission on Ethics and Public Trust. Signature: ate: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ( _ J lt) �:3T;-a ia' '.. 7fc.3,3I d„:f it #1 f,-;t tJ 4 4'E' L3!'' 7 � , e aneous Cash Receipt ; ,, ~_ 1:.;� ��,ti .1, !_ ��,,.3 ..• t CITY OF MIAMI .BEACH ,,�t Y ; J :J J J No .. ,,? 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