Eduardo Otero - M-4000 Alton Owner, LLC (-(cco Attivt-R L
MIAMI BE B€eta �
Aim �-
City of Miami Beach Office of the City Clerk y
1700 Convention Center Drive, Miami Beach, FL 33139
2015 i
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encou'Fade 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.
Otero Eduardo
NAME OF LOBBYIST: (Last) (First) (M.I)
Mast Capital 119 Washington Avenue, Suite 505 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 531-2426 (305) 675-8447
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Camilo Miguel Jr.
NAME OF PRINCIPAL/CLIENT:
M-4000 Alton Owner, LLC 119 Washington Avenue, Suite 505 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 531-2426 (305) 675-8447
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: or-At
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: CC,Q. g,
II.SPECIFIC LOBBY ISSUE:
Development Board Approvals for 4000 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 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)$ per hour ISO, AAw
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ( /tAdte.
(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 oendina bid for aoods.eauipment 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 lobbvina on a oendina application for a Development Aareement with the City or application for
change of zoning map designation or chance 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 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 BEACU
MR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO,
)(PENDITURES OR, •I/•_., _ • ■ ' :_► ._ •:. k . '_:_• 1
------'= =
Signature . clryist
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 C. Code and all reporting requirements.
%%
Signature of Lobbyist:`
Signature of Principal/Client: --Z -- / .■,
VI. LOBBYIST IDENTIFICATION: . PRINCIPAL IDENTIFICATION:
J 0 •
N.
N A
Produced ID ° ai Produced ID T n
Form of Identification y w Form of Identification N Y
a ' $ °g ` 2.U.
1...Personally known(Lobbyist) "' g Personally known(Principal) ac I tt cc a
VII. SIGNATURE AND STAMP OF NOTARY. j"Ji S Vial
il du E
on; E
State of Florida, County of Miami-Dade .� . ��. State of Florida, County of Miami-Dade :.�°� ���o r
Sworn to and subscribed before me / ,'. Sworn and subscribed bef re me o -, ;
Thy 3/S!' day of 5tSk , 2015 - This 3/s�' of dS� 2015 z 1:
4 \ 7, u&-, , '`�-_
_,Signatur of Public N ry—State of Florida Signature of Public tary—State of Florida
N
(::.otarization of Lobbyist's signature Notarization of Principal's9,signature •.°,� .'s� �'
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ 1 Yes[ ]No Amount Paid$ 47 0 MCR# lip-711 ro Date Paid o/-Sill
Lobbyist Registration Formeceived and verified by: er-_
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Formrevised 5-30-2012.doc
F:\CLE istration Form.doc Revised 04/27/2012
M1AM I AM1 BEAC H
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, 4 www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME Eduardo Otero
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 to the Miami-Dade County Commission on Ethics and Public Trust.
.0711/
Signature: ate:
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Formrevised 5-30-2012.doc
SUPPLEMENTARY DISCLOSURE OF INTEREST
Beneficial Ownership Interests in M-4000 Alton Owner, LLC
Alicia L. Jarrett 73%
100 S Pointe Dr.#3804
Miami Beach, FL 33139
Camilo Miguel, Jr. 24%
119 Washington Avenue, Ste. 505
Miami Beach, FL 33139
Miscellaneous Cash Receipt -..,,,:i._ g 4.19,17 :ter>s f2s 1=:, 00�. a:54
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(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
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