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Graham C. Penn - Harding Excalibur, LLC qp0- 1035 ft �IU(oA)€ � City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 3313 ��� Li: LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to'encour`a a the p assa e,'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. Penn Graham C. 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 apennABRZoninaLaw.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: Gabriel Collazo Bodner NAME OF PRINCIPAUCLIENT: Harding Excalibur, LLC 1444 Biscayne Blvd., # 306 Miami Florida 33132 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State). (Zip Code) 305.514.0600 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: Gabriel Collazo Bodner • IDENTIFY ALL PERSONS HOLI I GDIf2ECT' R INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNFRSHIP nR TRUST. JJ L'11 -f II.SPECIFIC LOBBY ISSUE: ;Develop enm t 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(801 5 1-803 Harding A-ven`ue;Miam i B each,Florida. 7 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 rz IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$490.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $490.00 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 lobbying on a present or pending bid for goods, equipment or services, or on a present or pending award for goods,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 XNo: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation 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 BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REP•• ` NG PERIOD. gnatu - _ ...yist I do solemnly swear that all of the for-•oin'; facts are true .•d correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Bea. City 'ode and all re•.rting requirements. Signature of Lobbyist: G' Signature of Principal/Client: / 4.INV VI. LOBBYIST IDENTIFICATION: ° we) PRINCIPAL IDENTIFICATION: 45•4 .r in Produced ID 3a v Produced ID i- § r - m,� - O LL Form of Identification to".2gS Form of Identification I t g , - 2 2.V g. .!2' i / N H Personally known(Lobbyist) N Personally known(Principal) a a V B 8 m- VII. +,SIGNATURE AND STAMP OF NOTARY: , 4 i I' ',I(1_Q 2 4 S(ta a pf Florida, County of Miami-Dade State of Florida, Couty of Miami-Dade •!--",1!a- worq t and subscrib �l re me Sworn a d subscribe. befor me - °�:•;,,;, Nis A ;� day of ,2016 This day of ,4 r , 2016 \l/ \\ Signatu� of Public Notary-State of Florida Signature of Public Notary-State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature yn?oup,- ., �e. P&G ! 10d . OMJI4 -MS: 4 5,o.cV /lick' 'o qL 51f p&p : 01-1-15...I b • a .e I Am I BEAC . City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeach8.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 Graham C. Penn 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 t iami-Dade County Commission on Ethics and Public Trust. • nature: Date: C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc .:\� �1 !f `t .1 P JY ��� C,��`1.�-{'-3 . S. 't-" f� r;3 '? :ti_ 4_-, .;i1—i �p Miscellaneous Cash Recel t :4-'..'...4-- s ;,,Fs 3� ; - JI :, r ,� .: ,y o , ± P ,i... _'; rya w 4 •� •, .� T CITY OF.MIAMI BEACH r j Y x , r k ,'''''''''''''''.'; ''''''''i''.;; ;1-:;.''';'''''..s�� � ew _ -; r,-F t r , J ..N��' ''' a J .D ...r...:',Cash D Credit Card Check# ' '.- ..' ' ,. y ., ,_, '4 .�- . p R F • 4,;(1",""t,'"1 . )P - .eceived of _ a .` r-fib;) #; ; ,C . �i; • ' .Address . ; ; v zFor ,1:''''''''''-'.-' -..::::.' '''' ''''''' (THIS INFORMATION MUST.BE COMPLETED) :Offic oi:Finance Director ‘.,-.::;:.:':, �_" Account Nurcber - � rr ?� wc �r Preparers 1 Dept. 7, �. - rl F i rr r �r , h,',,......=:.,-....,i.:-.,-:';',:,-. c -.0 5:.f ce.�' .q ,_,...:�t –'-•- ,.37= f ,fi:i<.: G ._ _.Y. 11 u k' ,1�_ 2�,..Sy,•W J nT # 3 —. _. TI C"7 Co a J J. �• O rt CD n —1 C7 O C7 = T C'rl 20 ff? D C.O n >y i .3*k C_,, � '< CD —h � I (0))� 000NZ C3 -- CS7 -- O O- — CD co ___I -1=- w E • Q O (.31 •�......... J E. ¢D —I - 0) c co Cr) H .. C7 .A N G I— •- O Efl fTl �' W C31 II T o ° - 4 -z Y= O O o 3 Q ° z - w n 4=b c--I rf• —a ` - C I C-) CD -5 ■ • Detail by Entity Name Page 1 of 3 FLORIDA AxIN OF TAT 441%. 1. '`;, DIVISION OF to t, 1 ,• j r fr Detail by Entity Name Florida Limited Liability Company HARDING EXCALIBUR, LLC Filing Information Document Number L15000108360 FEI/EIN Number NONE Date Filed 06/22/2015 State FL Status ACTIVE Principal Address 1444 BISCAYNE BOULEVARD 306 MIAMI, FL 33132 Mailing Address 1444 BISCAYNE BOULEVARD 306 MIAMI, FL 33132 Registered Agent Name &Address NAUTILUS LEGAL SERVICES, P.A. 1444 BISCAYNE BLVD 306 MIAMI, FL 33132 Authorized Person(s) Detail Name &Address Title MGR ESKENAZI, ALEJANDRO 1444 BISCAYNE BLVD, SUITE 306 MIAMI, FL 33132 Title MGR GOLDENBERG, ANDRES 1444 BISCAYNE BLVD, SUITE 306 MIAMI, FL 33132 Annual Reports No Annual Reports Filed http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/19/2016