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Monika Entin - AC 1700 Alton Owner LLCP - N ' - ' - i---k i \ 1 - i EA ...." B \-206A( , v 1 : ., ,,i v i , , • . City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 2.: ' ,._, . _ . v`` i , 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. 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 MEntin(aBRZoninaLaw.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: Adam Verner NAME OF PRINCIPAL/CLIENT: AC 1700 Alton Owner LLC 320 5th Ave., Unit 800, New York NY 10001 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 982-2022 aVi st.3ri:nahot.tsenarf ners.corn 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 the Attached. • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: n.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 nronertu located at 1 700 Alton Road. 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. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc ?L , 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 JrNo: Are you lobbvina on a Present or pendina bid for aoods.eauioment or services.or on a present or pendina award for aoods.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 lobbvina on a pendina application for a Development Aareement with the City or application for chanae of zonina mao desianation or chanae 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 Jr No: Are you reoresentina 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 SUBM CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS OMPENSATION EIVED. IN THE CITY OF MIAMI BEACI( EDE ._. '.: _9... '-- ..B '.:. :. - -It • '-. = I_- ' _ k T _ - = _ .. ,• EXPENDITURES OR •u . ► _ •k 1 : ► . : . •: 'I ■ ' : •D I 7 Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true .•: correct and that ,-.ve read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all rep•rting re•uirements. Signature of Lobbyist: , /�. 00 1:„ , Signature of Principal/Client: �'i • •,�5 • ti•, ` �•`••.A'R.' '�,� .y�� ••4'°j.� VI. LOBBYIST IDENTIFICATION: =°`_ �iv: PRINCIPAL IDENTIFICATION: :•'Np.o1NO6i45997\ • °•o •.. ,0.� - NEyy YORK COUNN� Produced ID �#1�������` Produced ID co EXP• MM• • Y : 018 Form of Identification f o Form of Identificavi tP a)►}� pVB`%G./0 X o nab T Personally known(Lobbyist) y B Ti CO /Personally known(Principal) �'iii�F N�S,�`a. o K ci 111111 , 4 VII. SIGNATURE AND STAMP OF NOTARY: T . „ Now`/�I_ LI I� State of Florida, County of Miami-Dade o d 0 Z State of F-�efiela, County of Miami-Bade Sworn tI r,d subscribed re me CO C” �+ Sworn and subscribed b fore me This • ' 2015 N o . This 36 day of OCAbb-t/ ,2015 4471,004 • Sign�ure • '`%' ota -State of Florida Signature of Public Notary-State of.544Ficia 14 taw 7 0'k 9 � rY g rY Notarizatio • Lobbyist's signature Notarization of princioal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes No Amount P.': 0. WO MCR# SCiO, Date Paid (� Lobbyist Registration Form recei d and verified by: T/4.4 ∎, _ I A tit s_ to Li, " City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachll.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@rniamibeachtl.gov Tel: 305.673.741 I , 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 su • i ded from lobbying until all fines are paid, unless the fine has been appealed t• e Miami-D. •e County Commission on Ethics and Public Trust. Ii '5 Signature:' / Date: C:\Users\clerhatRAppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Form revised 5-30-2012.doc r AC 1700 Alton Owner LLC 1 700 Alton Road Investor List Name S % Address Michael Or love 5750,000 8.8% Mickey Gottlieb S 1 50,000 1.8% Eric Harvitt 8200,000 2.4% Stuart Hescheles 875,000 0.9% Craig Hescheles 875,00( 0.9% Todd Cather S500,000 5.9% Ed Berro 5500,000 5.9% Adam Verner 8512,500 6.0% Ralph Bernstein S500,000 5.9% Aaron Speisman 5450,000 5.3% Scott Hoffman S 100,000 1.2% Steven Bleier S 1 00,000 1.2% Russ Dimini 5100,000 1.2% Zach Papadakis $275,000 3.2% David Schamus 5100.000 1.2% Ross Schuback 5100,000 1.2% Jacob Kohn 5850,000 10.0% Leon Goldstein 8500,000 5.9% Harold Schertz 5200,000 2.4% Motti Hellman $125,000 1.5% Steve Rhodes 5300.000 3.5% Chaim Cahane 5662,500 7.8% Kris Torkan S1,000,000 1 1.8% Yoeli Klein S275,000 3.2% Michael Werner S 100,000 1.2% Total $8,500,000 100.0% r Miscellaneous Cash Receipt - r 4 1-')::-1 ?=p£,.:'.201 c; i '131 CITY OF MIAMI BEACH '1'-'''' '-:-.I. _ -i ate .4 ; yam1 T1, 5.,„oci. No - s . �r��+ .� 0 Cash .:O CreditCard. Check# (6 '- - )O 2 . 20 1 C'S Received of A i C.\' 'CP: Q i q � _ . L. ;k Address I i / For 1)cJ - 'A 1.1u r \< , A ,( rr p J(74 11 (THIS INFORMATION MUST BE COMPLETED) Office of-Finance Director rsii, Account Number O - = ., ' Preparers ' [--�'� -'- De t. ( j Z'(( r e: • City of Miami Beach-Florida Finance Department 1 City Hall 1532713-1 11/23/2015 BRjraps#31-31 Mon Nov23,2015 - MCR-City Cler 31 $1050.00 MCRCLERK * MCR#: 408321 .00_ 1 ITEM(S): TOTAL: $10505.000 Check (001059) PAID $ Have a nice day'.