Thomas Telesco - 1052 LLC d/b/a Amarillo ( osa cetLeN
MIAMI BEACH
City of Miami Beach Office of the City Clerk 14: `�. , '; ' F. ;
1700 Convention Center Drive, Miami Beach, FL 33139
3 3 1 3 9 2 0 1 6 14H1 1:
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage lthe_passage;,defeat:or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of thetity
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.
Telesco Thomas
NAME OF LOBBYIST: (Last) (First) (M.I)
Telesco Associates Inc., 1111 Kane Concourse, Suite 301, Miami Beach, Florida 33154
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 866-1014 tom(aelescoassociates.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:
Anthonu Arriahi. Manaaina Member
NAME OF PRINCIPAUCLIENT:
1052 LLC d/b/a Amarillo 960 Ocean Drive, Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
ant honu�uceanstensobe.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 HOLD ING DI9TLYY OR N II ECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
S
PARTNERSHIP OR TRUST: � �C
['.SPECIFIC LOBBY ISSUE:
Development Ap rp Duals and Permitting Issues including, but not limited to the Historic Preservation Board, Design Review
Board, Planning Board; and of Adjustmen, Land Use_Develo p m ent Committee, City Commission, and any City Workshops or
committees. if necessaru relatina to the vrovertu located at 1052 Ocean Drive.Miam iBeach. FloridaT1
Issue to be lobbied(Describe in detail):
lll. 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
DRB, 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
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$ c5 o/ h r-
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $ 2 50A r-
(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 Iobbvina on a oresent or nendina bid for goods.eauioment or services.or on a oresent or oendinq
Sward 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 aoolication for a Development Aareement with the City or aoolication for,
ghanae of zonina map 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 X No. _ - • . - • - - 1 '1• . 1 • - • -44 • • •• .1 '• 1 • - 1 . " 1 • ..t- • •11 !' 1 •'1 • '•11 ! .F' II ' I
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL S .:ti • 1 _A : . L '1 1 ID _ u ► k . :
OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS C• PENSATION - • VED. I THE CITY OF MIAMI BEACI-t
Egg THE PRECEDING CALENDAR YEAR. A STATEM ; SHALL BE ED EV- ' IF THERE HAVE BEEN NO
EXPENDITURES OR •ii -._ ► _ • ► 9 : ► . . : -• :AT - ••
''------A e/".1411 KO
Signature of •.••,, ��
I do solemnly swear that all • the foregoir act are true a • Win• hat I have read or am familiar with the provisions contained
in Section 2-482 of the Mi- i Beach Ci.. od- and all r:•orti .17—.4 uirement•.
Signature of Lobbyist: / i' 41_
Signature of Principal/CI"
RI CNCi PPn- La ca+31f i ST
VI. 1..%•:,=.....:1" b NTIFICATION: 4PRtNetPAL IDENTIFICATION:
Produced ID •-Yr(V S 1-1-07.-n.S-t.. _Produced ID il• ,
Form of Identification Form of Identification 01�E'�
Personally known(fit) Pr-VAC-CPU. Personally known (Principal) i c,.E o
VII. SIG TURE AND STAMP OF NOTARY: r"""11 ∎ = 3 m
4. m c m
State of 'lori.7 County of Miami-lade State of Florida, County of Miami-Dade
Sworn • an•r:/ b : 'b:`; bef.re • par PuB Sworn - d subscribed before me # „ cn r-
1 % ELIZABETH CRUZ 4 T ' ^, m y
This i!.//. •' /I_ �L_- ,i20 MY COMMISSION#EE 847730 Thi �da of�7 j 2016 0 c z•_ ,J_ EXPIRES:December 2016 _min _°_�'• a. " n
s L f Bonded Thru Budget Notary Serv■ce.5 L Q, ,�' o
Signature• P l b c Notary-State of'Florida Signature „ P ,'•�I", rotary-State of Florida . ^' ° a }
Notari•-: ion •.f Lobbyist's signature Notarization oTV cioal's signature __
r_
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annu-I Registration fee: [ ]Yes[)Q]No Amount Paid$ 55 c:),O MCR# I Cj U Date Paid 0k-0M-A
Lob• ist Registration Form received and verified by: - N
7
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.*
1052 LLC d/b/a Amarillo. 960 Ocean Drive,Miami Beach. Florida 33139
NAME OF CORPORATE ENTITY
NAME AND ADDRESS % OF OWNERSHIP
Marc Stern 50%
960 Ocean Drive,
Miami Beach, Florida 33139
Anthony Arrighi, Managing Member 40%
960 Ocean Drive,
Miami Beach,Florida 33139
Alejandro Schroeder 10%
960 Ocean Drive, _
Miami Beach, Florida 33139
NAME OF CORPORATE ENTITY
NAME AND ADDRESS %OF OWNERSHIP
IF THERE ARE ADDITIONAL CORPORATE OWNERS, 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.
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeach(l.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerknmiamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LO B B Y IS T NAME Thomas Telesco
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 to the i -Dade County Commission on Ethics and Public Trust.
- %I i(.0
Signature: ate:
•
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
I Miscellaneous Cash Receipt
CITY OF MIAMI BEACH 41 1 9
No.
0 i IN .
0 Cash ❑Credit Card 'f�Check# $ _-,
Q o9 • 20iI,
City of Miarr d@{yed of Th 0006'6 7e"..- i -SC a �/�f ,�
MiseellaneouA 6&201A/ ( I 1� � C��IL.f 1�`�v��`, �o, : / " `1�,tf J�I�i�
0003940053 Maria B.1. 08/ 016 11:42AM
MCR OPEN For _
Payment Amount: 350.00
MCR411906
• - (THIS INFORMATION MUST BE COMPLETED) • - -- Office of Finance Director •':,
By !
'Jl J •0 ° - ..)(" !t-)LJL)-CD- 3o-,' S6;5.- 0)- G° GOB , .,
Account Number: f
j 'I i
Preparer. --SAC N 54'°c- ,AT1'�?C Dept: C EXT: 7�:1
I
.n v....l.c .r l �. �. ....-1. .. -.,.�.ti.. ... �-dJ..rs v.:ry`...�..xw.f -.�a•., ,aL.v.s Lrx ,,. .�...g..,�v.cs.,,.i .-......:vi.,.��1 r.v ....... r��. t..s...�r f� .. .J .�. ,-.� �....-.. .- .•�
a, ^J n G ar
tt a: r W. CD J
" f�d f CD f-. .c^. O n CD rr .. W
eai c ,r
E � z ▪ L.J. -0 a c
_-, o
CT ° c rT1 c a o
—_=-__' N CC • O 3 Q
3 C�
-- .,, ' Ol r-.. W
CE: ' .,i S Le. , , ....0 ca) ,—,- CD
'• '
a. i }i..�x. B
4i g � — • :J7 LT 4% C.3",
IV
r- c; -'
LD c
O O
O 6 C 1 ,c-s. N