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Graham C. Penn - Crescent Heights MIAMI r- q91 1,a Sin:ns Ac,i, 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. Penn Graham C. NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell&Fernandez, PLLC, 200 South Biscayne Boulevard, Suite 850, Miami, FL.33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-5300 305-377-6222 apenn(ZBRZoninaLaw.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: Russell Galbut NAME OF PRINCIPAUCLIENT: Crescent Heights 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 l J`p c U( • IDENTIFY ALL PERSONS HOLDIf,G,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: /t 1 II.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or Committees. if necessaru. relatina to the propertu located at 947 Washinaton Avenue, Miami Beach.Florida. 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 i 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 Staff for the Planning Department, Building Department, None. X Public Works and City administration, PB, HPB, BOA, None. X City Commission, and Mayor as necessary 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 commissiorier'or city personnel who is,, sought to be lobbied as identified on the lobbyist registration form filed. ``' " p d ' Sec 2-482(g)Any Financial, Familial or Professional Relationship ' ' ` ''-' ,1" 6- ,}AS q 13l None. None. None. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration U Formrevised 5-30-2012.doc I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$475.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $475.00 per hour (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 XNo: Are you lobbying on a present or pending bid for goods.eauioment or services.or on a oresent or°ending — 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 XNo: 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 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 reoresenting 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. Els - : • EXPENDITURES OR •I/ ■ _ • ■ . ■ • . -•:1111771377.1.47° 4 � -' ■ Signature of Lobbyist I do solemnly swear that all of e for-soing fa true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami':-. _jj i d II orting requirements. Signature of Lobbyist: Signature of Principal/Client: /ice" VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: tar ii Produced ID ,.' Produced ID in Q I • Form of Identificati rig _: Form of Identificatio p 2 m ✓Personal) known(Lobbyist ..' Personally known (Principal) o°o s 0 VII. SIGNATURE AND STAMP OF NOT o 9. State of Florida, County of Miami-Dade it l Stoat=of Florida, County of Miami-Dade `° m Sworn o and subscribe,,lefore me Swo d subscrib d bef me Th.. �ii'i day ,• /.�._� ,2015 a 4Tiis day of 1,01-! ,2015 " I kix„,A dr,._ _e. 1 ;... .....,2, Sign atu.riof Pubr- otary-State of Florida o e Signatu ��f Public Notary State of Florida No it riz: ion of Lobbyist's signature . m ff Notariza •n of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ No Amount Paid$ �-i'D MCR# C401 I t-f Date Paid 7 / '/, 'a Lobbyist Registration Form received and verified by: LOA_ M I AM I 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 LO B B Y IS T NAME Graham Penn 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 suspended from lobbying until all fines are paid, unless the fine has been appealed - Miami-Dade County Commission on Ethics and Public Trust. ___- 816 Signature: Da/// e:. C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc Estis,LLC 2235 City of Miami Beach 8/31/2015 Fees ' ..w"'-` ,_-_ " . - - 350.00 waawwwwwwwwwwwww City of Miami Beach-Florida Finance Department SunTrust Bank Checki Lobbist Fee- 1 City Hall 350.00 1524513-1 09/02/2015 BR1 T134 Wed Sep02,2015 09:26AM Trans#5-5 5 $350.00 MCRCLERK - MCR-City Clerk * MCR#: 407143 1 ITEM(S): TOTAL: $350.00 Check (002235) PAID $350.00 Have a nice day! Miscellaneous Cash Receipt i a - 0 ;_p 1,2:015 1:'4 c �tA - � f� CITY.OF MIAMI BEACH -. .4%: -.;-. _ No. : — Q' -2 3 - ' '''"''')'d ''\‘ ''J ' • ' ' 1 0-Cash - 0 Credit Card +_Check# Y ---7- :. ' ' . 6 ., - ,--i- --- 1--- LI.0 - r .:'--- ' -:' :- :':''', Received of .�� t. Address � 6-0,4 �' ] �- ,� �;�,; . For �.,_ ,1 -7- pc,.„,_/11 gr 1 : _.-.:-,,,, MUST BE COMPLETED) Office of Finance Director; ,- (THIS INFORMATION MtlS �� '.+5 r, , ..: , ",,,,, v i c.r}.12) ,\ (; 1 ti Li'ti _ By • Account Number: • f ,- Y p (-- .;./ - (._-x------L . Err- ''_.L'_)'LI. ' ' - Preparers � :t=---n�..- 1 -F -- w....a-....c. = 1 - ac.� .-.n - ..t .. ., ...�- �f.k d.r+.ni•'G^4.1�