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Monika Entin - Texas Taco Factory Express, Inc. Lto - 'V tit 15 'P e�- b�L �,S City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 2 � � ��;� l I LOBBYIST REGISTRATION FORM ; r ,., Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the assa e,'defeat'o� C;' Y P P Y P P 9 p 9 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(a)BRZoninaLaw.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: Texas Taco Factors Express. Inc. NAME OF PRINCIPAUCLIENT: Texas Taco Factory Express, Inc., 1608 Alton Road, Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-498-6318 neallmi(atbellsouth.net 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:Leland Neal • 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_an_d Permitting_Issues,7including, but not limited to the Historic Preservation Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or Committees, if necessary. relatina to the vronertu located at 409-411 15th Street.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 cityto 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 1Lobbyist Registration 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)$425.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $425.00 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 aCNo: • . • I s • • • =6 • • - ■ ✓••. • • ••y• - • ;•• - 8 • - • • • _:- ,1 • • Award for aoods.eayiipment 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 Agreement with the City or application for chanae of zonina 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 JC 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 CLERKA SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS CQMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACI{ mg THE PRECEDING CALENDAR YEAR A STATEMENT SHALL BE FILED EVEN IF THERE HAVE JIEEN NO EXPENDITURES OR • • • : '• ,a��= Signature of Lobbyist I do solemnly swear that all of the foregoing f. - - r' ue&I`d-co ect and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City •i de -n• all reporting requi ments. Signature of Lobbyist: -. Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: s "" PRINCIPAL IDENTIFICATION: Produced ID -1• 2(_Produced ID do Form of Identification ;,;,; a•• Form of Identification „7 �;� <_ I / Z.Personally known(Lobbyist) ' o g .E„.• Personally known(Principal) ' a 3 m �c o VII. SIGNATURE AND STAMP OF NOTARY: 7 o I 0 State of Florida, County of Miami-Dade It a m j ty (7" m m ty State of Florida, Coun of Miami-Dade P Sworn t•. nd subscribe before me N `° z Sworn and subscrib d before me _ This Ail . of ,2016 This �� •a of ,2016 .• ;, /�/ Qf N O a / • T o T O p n Sign.'ur= • .4 b c Notary—State of Florida ignatur- of Pu% f • ary—State of Florida \ 01 N ° N O =• Notarizat Lobbyist's signature Notarization • incipal'%signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ SO, MCR# i Date Paid 05-It-1 t Lobbyist Registration Form receive verified by: TTEZZIE t_ e ' C. M I AM I BEAC City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E.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 •,thirMiami=Dade County Commission on Ethics and Public Trust. 40,Signatur-: ate: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc 10 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION,PARTNERSHIP,OR LIMITED LIABILITY COMPANY If the property that is the subject of the application is owned or leased by a corporation, partnership, or limited liability company, list ALL of the owners, shareholders, partners, managers, and/or members, and the percentage of ownership held by each. If the owners consist of one or more corporations, partnerships, trusts, partnerships, or other corporate entities, the applicant shall further disclose the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* Texas Taco Factory Express, Inc. NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP Leland Neal 27% 8507 Franio Road, Miami, FL 33189 James Ross 27% 14370 SW 98 Terrace, Miami, FL 33186 Javier Cervera 22% 502.5 SW 62 Avenue, Miami, FL 33155 Milagros Diaz 12% 1608 Alton Road, Miami Beach, FL 33139 Marlon Palmer 12% 1608 Alton Road, Miami Beach, FL 33139 1500 Washington, LLC NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP Michael Comras 50% 1261 20th Street, Miami Beach, FL 33139 JTC 2006 Trust FBO Michael Comras 16.6796 1261 20th Street, Miami Beach, FL 33139 JTC 2006 Trust FBO Richard Comras 16.67% 401 E. Rivo Alto Dr., Miami Beach, FL 33139 JTC 2006 Trust FAO Ashler'&Bryan Comras 16.66% 246 E. 4th ST, Apt. 3, New York, NY 10009 IF THERE ARE ADDITIONAL CORPORATE OWN ERS, LIST ALL SUCH OWNERS, INCLUNG CORPORATE NAMES AND THE NAME,ADDRESS,AND PERCENTAGE OF OWNERSHIP OF EACH ADDITIONAL OWNER, ON A SEPARATE PAGE. NOTE:Notarized signature required on page 9 FILE NO. - . Miscellaneous Cash Receipt . : - . , y ' --.., .-.,: ... • . -.-r, . :--,, • CITY OF MIAMI BEACH - , . - - . . ; . ., , .-., . 0-Q 9 0 No ‘. 1 - . . . . - "'''' ' •- ' . --". , . ? -,4„. 0 , , . . -..- . : - . . ,. . . . 0 ----;,-.,--;;...-'' . o - Card Check# 53 33 $ ' -I-0'c''' 'c''' ,., . D Cash Credit ard , ec . ..,: ',,. ...-,-- , . „ C)5-':-/ 1 ..::----*--- -':::-'-'..2 0-'; f . . ,... r.„. , • r-,, 1 • i , 1 ,,f __ . .1 City of N iamNtretAved of r,e L ---,',-.€*'ti(-1 , ..,,- CA i It 1 f Pt,CarC,, /tin el ,r,,--i , .. :, . .•I, Miscell eouAdirgesig Lfir 0 1 6;-,, i-6 ,,,,L A)vd. 5;c€ -73L-)9., A4 ( L 331 3ik'. 000055- 066 Jenel F... Ct5ti1y2016 5:35vA,,, 171 i Syr- 'T:5`45 id A- Ci MCR OPEN FC)r - ‘, -i• , ,"-----i./tr•if.z " \,..;cr-, , - i , „ , •/ ,,-.... 3 -3/-1r i Payment Amount: . 3 MCR409910 ' . • . .. . , . ,.. s r - •-•. r : ' r.' . (THIS INFORMATION MUST BE COMPLETED) ' : - . -Office of Finance Director By ' ' C.)//- OC.00 - 369, 0149- 00- 30."- .„:.-. 65-'7 ,./:', -t1.a.:-.Q 0:-' ,'•: i: Account Number-. - • - : - .... , '..Prepaier: -'7.-.1 4:50,4 j4:7 ti.AT,--"-9 0- ' -' '1. . - Dept: Ci.)-f. CL 6,4'4 te :. 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