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Rory Greenberg - Washington Squared Owner, LLCI Got -6'c5 MIAMI (cF) • r ; City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 20 1 P ; LOBBYIST REGISTRATION FORM ILL 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. Greenberg Rory NAME OF LOBBYIST: (Last) (First) (M.I) Imperial Companies 888 7th Avenue, 27th Floor, Miami FL 10106 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212)894-7085 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address, phone, or e-mail address. I. LOBBYIST RETAINED BY: Washington Squared Owner. LLC (contact: Andrew Joblon) NAME OF PRINCIPAUCLIENT: Same 425 Northwest 26th Street Miami FL 33127 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) ak turnbridaeeauities.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: Andrew Joblon, Manager • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached. Development approvals and permitting issues related to the properties located at 601-685 Washington Avenue. 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 of Planning Department,Building Department,and Public Works Department None. X PB,HPB,BOA,City Commission,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 V./ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 4h h ( 5cIWy r B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION)` (REQUIRED). /Y1A.41 3el,'y 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 X No: : • •; i !•I • .•! • !••• :! .•!11 : 1 : r te_• _ ! !I • • • :1 • ? • 1 !•1 ! 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 X No: Are you Iobbvina on a rending annlication for a DevelonmentAgeement with the City or anolication for chanae of zonina man designation or chanae to the City's Future Land Use Man?, 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 re•resentina a not-for-profit corporation or entity withoutsoeoial 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. USTIN 3 LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVE) IN THE CITY OF MIAMI BEAD( Egg THE PRECEDING CALENDAR YEAR. A STATEMENT SHAD, BE FILED EVEN IF THERE HAVE BEEN NO, EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD, Signature of Lob•' I do solemnly swear that all of the foregoing facts are true and c• t and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all n. requirements. Signature of Lobbyist: Mai Signature of Principal/Client: /, VI. LOBB ST IDENTIFICATION: ' CIPAL IDENTIFICATION: � Produced ID 6/637 '"7 21-i9 0 A. o Produced ID Form of Identification 4 g Form of Identification z ulrq Personally known(Lobbyist) d o w ZPersonally known(Princi r p�•.,�Valentna Ananda Parada Z. �a°' : �sCOMMISSION#FF134267 VII. SIGNATURE AND STAMP OF NOTARY: g ��, ' ..:�a EXPIRES: JUN 19,2018 ■ 0 d' �, '•• •1�S BONDED THRU v X 1st FLORIDA NOTARY,LLC State of Florida,County of Miami-Dade } w State of Florida,County of Miarrf('&t e Sworn to -nd subscribed before me Sworn d subscribe before me 6 This !L_� day of / ,���, , 01_4 :''b T � 201 / , A' /SW tAkCia"P'‘': Signa 1: of Public Not- —State of Florida ":ignature • a' —State of Florida Not ization of Lobb,'st' signature .otarization of Princinal'k signature TO BE COMPLETED BY CITY CLERKISTAFF ONLY Annual Registration fee:. [ J Yes No Amount Paid$ .�)©'G45 # O ` b 3 Date Paid 04-14-I:6 Lobbyist Registration Form received and verified by Revised 01/22/2014 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 4-y)h 1,c.( 4'1(1 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPE ATION):PP (REQUIRED). Mmh )ef' 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 X No: Are you lobbvina on a Present or pendina bid for goods.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 X No: Are you lobbying on a Pendina application for a Development Aareement with the City or application for chanae of zonina map desianation or chanae 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 EQ13 THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO, EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD, Signature of Lob• - I do solemnly swear that all of the foregoing facts are true and cr . t and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all -: n- requirements. Signature of Lobbyist: Signature of Principal/Client: pajeTj VI. LOBB T IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID 676 5 7 20-25?11-191-4 o ° ^ c Produced ID Form of Identification ;55 LL Form of Identification # r Personally known(Lobbyist) z< 0 g Personally known(Principal) a� VII. SIGNATURE AND STAMP OF NOTARY: CC m O i State of Florida, County of Miami-Dade } w State of Florida,County of Miami-Dade Sworn to .nd subscribed before me 2 Sworn and subscribed before me This 1/1—.4 day of if / ,, a 1_4 + •▪ ; F This day of ,201 /,14//% ..- �.a Signa '..1 of Public Not. —State of Florida • ignature of Public Notary—State of Florida Not, ization of Lobb.''st's signature otarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: Revised 01/22/2014 . . 1 M I AM I BEACH 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: Rory Greenberci 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, 2014, 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. q 476 Signature. Date: F:\CLER\$ALL\aFORMS\LOBBYISTFORMS\LobbyistRegistrationForm.doc r 1 aN i o I o - ■0 8 W -- U .Y u 3 c __..: U o° v w U a a .4 o J . I c4 10 v F:2 . -N 3 re; m a 0 4 C 1 0 6 i ,0 p 4 cn .-.1 ^ v' W ' . 0 a�i W o b pa, ``� Va an l 1 o o Q � ° a 3a ��' c 4 Q a o J IS `" ai h 0 C7 �. a Cl. c �'' E o c o n v ~ , J g N 3 oC J J U / 1 a al 0 ^ ti � 'd � c .0 ,t O I i , 1. Washington Squared Owner LLC 7. Michael Fascitelli do Andrew Joblon 888 7th Avenue,27th Floor 1691 Michigan Avenue, Suite 445 New York,NY 10019 Miami Beach,FL 33139 (212)894-7090 2. Washington Squared Partners LLC 8. Washington Squared LLC do Andrew Joblon c/o Andrew Joblon 1691 Michigan Avenue,Suite 445 1691 Michigan Avenue, Suite 445 Miami Beach,FL 33139 Miami Beach,FL 33139 3. IC 601 Washington LLC 9. Turnbridge Miami LLC c/o Alex Bender c/o Andrew Joblon 888 7th Avenue,27th Floor 1691 Michigan Avenue, Suite 445 New York,NY 10019 Miami Beach,FL 33139 (212)894-7090 10. PG Washington Squared LLC 4. IC 601 Washington MGR LLC do Sean Posner do Alex Bender 1691 Michigan Avenue, Suite 445 888 7th Avenue,27th Floor Miami Beach,FL 33139 New York,NY 10019 (212)894-7090 11. Andrew Joblon 1691 Michigan Avenue, Suite 445 5. IC 601 Promote LLC Miami Beach,FL 33139 c/o Alex Bender 888 7th Avenue,27th Floor 12. Sean Posner New York,NY 10019 1691 Michigan Avenue, Suite 445 (212)894-7090 Miami Beach,FL 33139 6. MDF Capital LLC 13. Jarrett Posner c/o Alex Bender 1691 Michigan Avenue, Suite 445 888 7th Avenue,27th Floor Miami Beach,FL 33139 New York,NY 10019 (212)894-7090 -y�: .�q { T:. y. .r ..f i .�f.i- t •;Y�7�7 4, r2 N+� ...„,. '-' - —- - - - - -o� --t.�Y� >...-77.+ -:"Tt-= i ,.Xt- `�'• A`y`r-d t:..q-,-"::!"-':-Y B -. s d : .t ,1 Miscellaneous Cash Receipt ,. . /�-f,y} � �-:s..� �� Y� {€ti 3��,r���'tee:•'�� ''�� ��.,.� ` '�, " r CITY OF MIAMI BEACH . 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