Carli M. Koshal - 6800 Indian Creek, LLC 67(o —6600
MIAMIBEACH ^Y,,,,,, Cc ee/k--
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
2Oru OV' 'S r. 2. so
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not by a principal who seeks to encourage the`passage;_defeat off:-: , ,�;
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.
Koshal Carli M.
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 ckoshal(aIBRZoninaLaw.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 PRINCIPAUCLIENT:
6800 Indian Creek, LLC 846 Lincoln Road, 5th Floor Miami Beach, Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)200-8740
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:Ricardo Tabet
• 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 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 necessary, relatina to the propertu located at 6790 and 6800 Indian Creek Drive, Miami Beach, Florida.
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
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.
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration C
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)$275.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $275.00 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 pending 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)CNo: Are you lobbvina on a pending application for a Development Agreement with the City or application for
chanae of zoning map desianation 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 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 BEACR
ENIS THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO,
EXPENDITURES OR COMPENSATION DURING THE REPORTING P RI•D
a., it FAa3
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 a d all reporti r • equirements.
Signature of Lobbyist: ' • f .AliaL
Signature of Principal/Clie. '�`
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: :404
• 4.446
Produced ID e4C6 Produced ID 3 v o
Form of Identification .. `� / Form of Identification 1
Personally known(Lobbyist) 1°H Personally known(Principal) zip.
VII. SIGNATURE AND STAMP OF NOTARY: .m °T
g3 N g.
r f %g$ T
a
State of Flonda, ou,ty of Miami-Dade m Stof lorida, County of Miami-Dade
Sworn nd su slcri -• befor�e,m�e o �; worn a rid subscribed bef re me
This , �; y'of .1 I h4 ,2015 a. t is� ,.4 day of �Q�/�°(�, 2015
i
Signature of Pu \■1 otary—State of Florida Signature oi't?b is Notary—State of Florida
Notarization of bvist's signature Notarization'o ' signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[' ]No Amount Paid$ MCR# '4(.)i Date Paid IpL-51----
Lobbyist Registration Form receiv-d and verified by: . CGN^+ `-
I
.
M I AM I BEAC
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachf.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 Carli Koshal
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
Y Y 9
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, 9
or I am no longer
9 Y
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 -
( ) a ity 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.
1 / I < a fts
Signature: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
Exhibit A
Disclosure of Interest
6800 Indian
Creek, LLC
Optimum USA S8 Indian Creek, LLC
Investments 4, LLC Ricardo Tabet
Rodolfo Misitano 846 Licoln Rd, 5th floor
c/o Funaro &Co. P.C. Miami Beach, FL 33139
350 Fifth Avenue,
41st floor, 1 %
New York N.Y. 10118
99%
1
(Ju,"-'
Receipt ti»,.,f.#/wO.1.? 001; 137
► ► t . 0.60
Miscellaneous Cash
CITY OF MIAMI BEACH •
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(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
By
ti Account Number G it s O `( -Z:-c?es.E/ l y�
Prep arer: ;')11:I ( rftvi - Dept: . - t i r EXT..
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City of Miami Beach-Florida
Finance Department
1532913_Ha11
Vied Nov25,2015 5 2015 BR 1 T 137
66 02;47PM Tran #66-66
$1750.00 MCRCLERK
* MCR#: 408331 MCR-City Cler
-
1 ITEM(S): TOTAL;
Check (4021) PAID $1750.00
$1750.00
Have a nice days