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Monika Entin - Atlantic Princess Condominium Association, Inc. • 3120 poi 1 �'S Aver ' AA ' ch- 1 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. Entin Monika NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell&Fernandez, PLC, 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(a,BRZoningLaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address,phone, or a-mail address. I. LOBBYIST RETAINED BY: Thomas V. Eagan, Vice President NAME OF PRINCIPAL/CLIENT: Atlantic Princess Condominium Association, Inc., 200 S. Biscayne Blvd., Suite 4700, Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 577-2814 c/o thomas.eagan(auisquirepb.com 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. - 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 necessartt, relating to the propertt/located at 3.120 Collins Avenue, 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. '•* �a None. CD C:\Users\clerhatkAppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration ;� j ? Formrevised 5-30-2012.doc Lei � . © ' 1 .s19' i�7 �y6 1 • 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 pending bid for goods. eauioment or services.or on a present or pending award for goods.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_XNo: Are you lobbvina on a pending application for a Development Aareement with the City or application for chance 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 BEACK FQB THE PRECEDING CALENDAR YEAR. A TATEME _....:7,L'1LOW1_�..-_! EVEN IF THERE HAVE BEN NO gXPENDITURES OR C•MP ■ ATI•N D RIN T,_ RE••: ' N PERI•D. ,./- Signatu - • ••• I do solemnly swear that all of the foregoing f..- 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 .de and all reporting requirements. ' Signature of Lobbyist: '. • Signature of Principal/Client: /44)i � �� '�•' /�1l _. i g �� VI. LOBBYIST IDENTIFICATION: "' v ,. !�VielkIN IPAL ITIFICATION: Produced ID ,.r•••• Produced ID "5 � 4 . Form of Identification -.:'t- ;•,mc . Form of Identification t' tx c a y • •„,••• / Q L.L N - LPersonally known (Lobbyist) z d Personally known(Principal) T LL VII. SIGNATURE AND STAMP OF NOTARY: 3 3 ao U•Se u) 2 zE � ,- N. 3 c • ¢ E.a-g State of Florida, County of Miami-Dade o m State of Florida, County of Miami-Dade v w ca Sworn • and subscrib before me a; ' cn c Sworn aqd subscribed before • e This no, of 2015 -. T T Thisr�n1 day • �inV` '015 ;a'•`��_-jp° Sign:ture � i Vii, ary-State of Florida CT; a ignature of Public Not.ry-State o lorida Notarizatio N117 i bbvist's signature oo °' _ _ Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ 'I] No Amount Paid$ 56 MCR# Li G-5`€10LA Date Paid �zj4ri5 9 Lobbyist Registration Form receive and verified by: �jj v--/.....- � 1t I V : F . City of Miami Beach, 1700 Convemion Center Drive, Miami Reach, Florida 33139, www.miamibeachtl.gov CITY CLERK 016cc Rafael E. Granath), City Clerk CityClerk @miamibeachtl.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 $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatical uspended • lobbying until all fines are paid, unless the fine has been appeale• o the Miami-Dade C,•unty Commission on Ethics and Public Trust. //I n te:7 Signature: D C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of the application is owned or leased by a CORPORATION, list ALL of the stockholders, and the percentage of stock owned by each. Where the stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons)having the ultimate ownership interest in the entity.* Atlantic Princess Condominium Association, Inc. CORPORATION NAME NAME AND ADDRESS %OF STOCK The entitu is a not for profit corporation created under Chapter 718 of the Florida Statutes and, as such, does not have anu Stockholders (Please refer to Exhibit B). CORPORATION NAME NAME AND ADDRESS %OF STOCK IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.NAME(S)AND EACH INDIVIDUAL STOCKHOLDER'S NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK ON A SEPARATE PAGE. NOTE:Notarized signature required on page 8 6 Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE 474 DIVISIO\' OF CORPORATIONS ."`kn$'z Detail by Entity Name Florida Not For Profit Corporation ATLANTIC PRINCESS CONDOMINIUM ASSOCIATION, INC. Filing Information Document Number N96000003618 FEI/EIN Number 65-0719095 Date Filed 07/09/1996 State FL Status ACTIVE Principal Address 3120 COLLINS AVENUE MIAMI BEACH, FL 33140 Changed: 07/29/2007 Mailing Address 1430 NW 15 AVE MIAMI, FL 33125 Changed: 08/14/2013 Registered Agent Name&Address EISENGER, BROWN, LEWIS, FRANKEL&CHAIET P.A. 4000 HOLLYWOOD BLVD HOLLYWOOD, FL 33021 Name Changed: 08/14/2013 Address Changed: 08/14/2013 Officer/Director Detail Name&Address Title Secretary Harte, Rory 1430 NW 15 AVE MIAMI, FL 33125 Title President Korallus, Fredrick 1430 NW 15 AVE MIAMI, FL 33125 Title VP Harries, Paul 1430 NW 15 AVE MIAMI, FL 33125 EXHIBIT T http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Enti 1 - Detail by Entity Name Page 2 of 2 Annual Reports Report Year Filed Date 2014 04/30/2014 2015 04/29/2015 2015 06/16/2015 Document Images 06/16/2015--AMENDED ANNUAL REPORT View image in PDF format 04/29/2015--ANNUAL REPORT View image In PDF format 04/30/2014--ANNUAL REPORT • View image in PDF format 09/12/2013--AMENDED ANNUAL REPORT View image in PDF format 08/14/2013--AMENDED ANNUAL REPORT View image in PDF format 04/18/2013--ANNUAL REPORT View image in PDF format 01/09/2012--ANNUAL REPORT View image in PDF format 01/12/2011 --ANNUAL REPORT View image in PDF format 10/27/2010--ANNUAL REPORT View image in PDF format 01/06/2010--ANNUAL REPORT View image in PDF format 08/03/2009--ANNUAL REPORT View image in PDF format 03/30/2009--ANNUAL REPORT View image in PDF format 01/08/2008--ANNUAL REPORT View image in PDF format 07/29/2007--ANNUAL REPORT View image in PDF format 05/09/2007--ANNUAL REPORT View image in PDF format 04/24/2006--ANNUAL REPORT View image in PDF format 04/26/2005--ANNUAL REPORT View image in PDF format 02/19/2004--ANNUAL REPORT View image in PDF format 05/23/2003--ANNUAL REPORT View image in PDF format 05/21/2002--ANNUAL REPORT View image in PDF format 10/04/2001 --Req. Agent Change View image in PDF format 03/12/2001 --ANNUAL REPORT View image in PDF format 07/28/2000--ANNUAL REPORT View image in PDF format 02/08/2000--ANNUAL REPORT View image in PDF format 05/05/1999--ANNUAL REPORT View image in PDF format 09/09/1998--ANNUAL REPORT View image in PDF format 07/16/1998--ANNUAL REPORT View image in PDF format 05/29/1997--ANNUAL REPORT View image in PDF format 07/09/1996-- DOCUMENTS PRIOR TO 1997 View image in PEW format • C:ot_.„.„. ""l and F:tacv Pol c es x "d .. State of Flo:da,Del,talon of Stale htt p://search.sunbiz.org/lnquiry/CorporationSearch/SearchRe sultDetai 1?in ui rY t YP e—Enti tY••• 12/2/2015 . _- - .;i;:`_te: Y; Taisammipiammananancww vulausolglimisisimalleigir illieliiiimateXmlinigr City of Miami Beach-Florida Finance Department 1 City Hall 1534313-1 12/09��54PMRTrans#72-72 Jed Dec09,2015 72 $1050,00 MCRCLERK - MCR-City Cler * MCR#: 43 1 ITEM(S)08: T64 0TAL: $1050.00 Check (001124) PAID $1050,00 Have a nice day! _ - _ ;: Z Y-S 1,3- t:.11'-14 q 1'• 3"-0+1-15. 001' ..per,si '_ �, A :f <.'�.J f'•ten Miscellaneous-Cash _ •-4,4 -CITY OF:MIAMI BEACH '�. 327��,,� - � .. � �' _ ,.. �� _ _ ,• -0-=Cash ®Credit Card, p Check#~ f L $ - USC - ' c ( " . .201C t a , C q Received of . _ u i:- t f r "y i_ c ` ;: , 7 r - Address :f- ;.,/!-, - T r -;- __For 4 r d Y,� ^41 (THIS INFORMATION MUST.BE-COMPLETED . F r ) ()Nice of Finance Director i Account Number:( ( g.. . -.';';,:v4.1/1-,1;,,,,:.--v', - ) ..r - i:_; - - Preparer: ,_ .... 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