Monika Entin - Anthony Moonen / q./01 A.,c.i,3 v-,
MIAMI B
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 3313;g ` pi; 2,
02
LOBBYIST REGISTRATION FORM I 1-.Y• ( ' • ,_
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.
Entin Monika
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)
305-377-6237 305-377-6222 u a a aBRZoninnin c ' •u
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Anthonu Moonen
NAME OF PRINCIPAUCLIENT:
1691 Michigan Avenue Investment, LP, 1185 Avenue of the Americas 18th Floor, New York, NY 10036-2601
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 672-6936 305 672-6947 .. .a_
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 Exhibit A
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
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 oropertu located at 1691 Michiaan 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
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 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_
None_
None_
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Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$400.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $400.00 per hour
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes XNo: Are you lobbvina on a present or pendina bid for aoods.eauipment or services.or on a present or pending
award for aoods.equipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes JcNo: Are you lobbvina on a pendina application for a Development Agreement with the City or application for
chanae of zonina map desianation or chanae to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set
forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without
special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or
opposition to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration
fees.
_Yes JIC No: Are you representina a not-for-profit corporation or entity without special compensation or reimbursement
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACIj
FQ$ THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE-FILED-EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD:- .\
Signature of Lobb ' t
I do solemnly swear that all of the foregoing facts are true and,coffect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all repo *Kg requirem ts. \`
Sin- ure of Lobbyist: r�` /
`'
+`s :,. . ure of Principal/Client: -r /
A,� 'art LOBBYIST IDENTIFICATI• PRINCIPAL IDENTIFICATION:
"4;,,;,,?:%* i
3
4.
o Produced ID S Produced ID
3 3 Form of Identification z co c .1-9 •:. :..-,,;..
Hv T a Public State of Florida
a x 5 '.dPersonall known(Lobbyist) a if a 4 to No�ry
Y ( ) eralC�{� clpaq
T = SIGNATURE AND STAMP OF NOTARY: zcam_: v '`'„ono�s
or 1, o a y+ -d'
Al Cif tat- if Florida, County of Miami-Dade �° State of Florida, County of Miami-Dade
" o cwor • and subscri•-d bef• .7. me Sworn and subscribed before me
°D 1• CI 1 .: o • ,2015 r .s► This at1 day of ,2015
111■4 v).76.1•■•■,..1_-___■._. ' A0k(AlVie
Sig i9 - 7, i,: o :ry-State of Florida Signature of Public Notary-State of Florida
No -rizati. • M. I signature Notarization of principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[o]No Amount Paid$ 3 6 ö MCR# MO?Z0 0 Date Paid 4/'5 n/)6---Lobbyist Registration Form receive and verified by ��eaww-,-
. .
M I AM I BEAC H
City of Miami Beach, 1700 Convention Center Drive, Minn Bench; Florida 33I39, www.miamibeachfl.gov
CITY CLERK Office
Rafael L.Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: Monika Entin
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 thiainimDade
N.
County Commission on Ethics and Public Trust.
C- „/////' —) j
Signature: ( ---------,) ate:
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Formrevised 5-30-2012.doc
•
Exhibit A
1691 Michigan Avenue Investment, LP
1185 Avenue of the Americas, 18th Floor,New York, NY 10036-2601
CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
IVG Immobilien AG 100%
Zanderstrasse 5-7
53177 Bonn
Germanu
IVG is publiclu traded the London Stock Exchange under
symbol:IVG:Extra and in other exchanges:IVG
, AGENT AUTHORIZATION LETTER
fi
ii
Parcel Ili: 02.3234-0114-0690
Street Address: 1601 Michigan Avenue,Miami Beach,FL 33139
Property Owner: 1691 Miehigan.Avenue Investments
The undersigned,registered property owner of the above referiPnce-propetty,do herby authorize Anthony,
ill ni n,.pf Colliers International South Florida—L as w....to act on the ownerships behalf and
take all actions necessary for the processing,issuance and acceptance of construction.permits,
4 certifications and any and all standard special conditions.
`Property Owner Address: 1691 Michigan Ave.Investment LP
I 1185 Avenue of the Americas
18th Floor
New York,NY'10036
Attn:
Telephone:
We hereby certify the above information submitted in this application is true,and accurate to the best of
our knowled e.
� ,_
III i
�. . Of r Li?. 'c. .1- n - ,r Se r fPo,ao05
"Ii Signature of Property Owner P Name of P •perty Owner Date
.Yect ti ve:ViLe I V ut t :S;Ch rr�-
State of Pies;di nt
1
County of
The foregoing Instrument was acknowledged before me this_ day of .,2014
By
For 1691 Michigan Ave. Investment LP
Personally Known., or Produced Identification Type of Identification Produced
Signature of Notary
•
No. 375 of the roll of deeds for 2015
I hereby certify the authenticity of the foregoing signatures on the foregoing document of
1, Mrs. Irm and Linker(signature on the left), born g ( g ), on 29 August 1968, reslding in
Bad Homburg v.d.H.,
personally known to me,
and
2. Mr. Nico Brocar(signature on the right), born on 17 August 1980, residing In
Frankfurt am Main,
who identified himself by his valid German.identity card no. 401483386,
which signatures were made on 17 September 2015 in my presence.
Upon request of the persons appearing, I effected the notarization in the offices of TRIUVA
Kapitalverwaltungsgesellschaft mbH, THE SQUAIRE 18, Am Flughafen, 60549 Frankfurt am
Main.
i asked the persons appearing if I or any person professionally associated with me priorly or
rurrently acted or acts in the matter which Is subject of the present notarization, except t as a
i (prior involvement pursuant to Sec. 3 para. 1 no. 7 of the Recording Act (BeurkG)).
The p'kr, appearing answered in the negative.
I hereby explic Ny vise that my responsibility is limited to the certification of the authenticity
of the foregoing signaj and that I have not reviewed the content of the foregoing docu-
ment and thus cannot takearesponsibility whatsoever for such content and/or Its validity.
Frankfurt am MalriNkSeptember 2015
arste: J. An.4 rsbach
Notary
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CITY OF MIAMI BEACH , -.:-�.r,, ► .- ., -, � , ; 7j,-, -_71...„._
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- - . (THIS INFORMATION MUST BE COMPLETED) - Office of Finance Director
B.F..,r�tea-..- _ ` Y.
- Account Number: gO) ii-)q-cf(ici,..,
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., - Pre arer: ►- Dept: �,f tiC, , IN,. EXT: 1 i. _, ,-, • , .
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City of Miami Beach-Florida
Finance Department
1 City Hall
1527320-1 09/30/2015 BR1 T131
Wed Sep30,2015 02:05PM Trans#35-35
35 $700.00 MCRCLERK - MCR-City Clerk
* MCR#: 407200
1 ITEM(S): TOTAL: $700.00
Check (002392) PAID $700.00
Have a nice day!