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Mark Grant - Louis Taic t `f31 i ! t ! 4; i�ra� 'ta:' e _ City of Miami Beach Office of the City.Clerk 1700 Convention Center Drive, Miami Beach, FL 33139016 Si' 13 4i1 9' 56 LOBBYIST REGISTRATION FORM t✓ir.'11 L;t_'.-:, + S U` I- i; 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. Grant Mark NAME OF LOBBYIST: (Last) (First) (M.I) Greenspoon Marder, 200 East Broward Boulevard, Suite 1800, Ft. Lauderdale, FL 33301 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-527-2404 954-333-4004 Mark.arantaa mlatu.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: Buis Taic Managing Member NAME OF PRINCIPAUCLIENT: South Beach Resort Development, LLC, 58 East 79th Street, Suite 5F, New York, NY 10075 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 360-6030 1212)360-7479 Ltaic(aaol.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: 66E l q-cll#Gf) II.SPECIFIC LOBBY ISSUE: `DeveroprtCent�Approvals and Permitting Issues including, but not limited to the Historic Preservation Board, Design Review Board;Piarcning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or Committees, if necessanl, relating to the nropertu located at.0437 Collins Avenue,7Vliami Bepch;Florida:D Issue to be lobbied(Describe in detail): l 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 DRS, 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 Non P. Nnnr 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)$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": YesXNO: : • . ••• ;1. .1 .,. • -1. • .-1•:1 . • . . ;C _•!11 •1 1 '•• 7 • • F • 1 • 1. 1• 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 chanae of zoning 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 reoresentina 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 - it ME - - _i _ . . gXPENDITURES OR _ • I• ► • • ! ` "!A:1 0M, ► • .► Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained • in Section 2-482 of the Miami'Bea City Code all re•4 ing requirements. Signature of Lobbyist: �� • Signature of Principal/Client: ai• \; VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _Produced ID •oduced ID L 111 t,l' " S' ,.,�:• - . Form of Identification Form of Identification': rn Y O' Personally known(Lobbyist) _Personally known (Principal) 0 s N ° 3 c VII. SIGNATURE AND STAMP OF NOTARY: a z c°, n IVt�1 Ntw R ° N c State of Florida, County of Miarnibeede$5 r`O& r4 State of flur i c,County of i+ i-B 1 '° ENO 3 %, Sworn to a subscrib: •efore me Sworn and su•scribed before me }`j a ' ' This. Z day of_.1'.u-' , 2016 :,:'' -•; UWAN RIVERA T . d:y of 2016 ° •° j £.• r MY COMMISSION#FF 105891 C4 / Y z E • EXPIRES:March 24,2018 " 'nature of Public Notary—State of Flohid '` ��' Borged7hruNotaryPu6lkUnde rqG ;'�='l1WW,1ary—State of •erida f ksrl i,)> r� Notarization of bbyist's signature zat-+n o 1';.•, '. signature J 2 TO BE COMPLETED BY CITY CLERK'S STAF ONLY e•/ -�•<r. Annual Registration fee: es[ ]No Amount Paid$ C CtINCR# �._1 1 et(D D Date Paid 0 Q-I 3"( Lobbyist Registration Fo received and verified by: C&) S, IL-VA-sC-4e MIAMI B C City of Miami Beach, 1700 Convention Center Drive, Miami Beach. Florida 33139, www.miamibeachll.gov CITY CLERK Office Rafael E. Granath), City Clerk CityClerku,miamibcachfl.gov Tel: 305.673.7411 , Fa x: 305.673.7254 LOBBYIST NAME: Mark Grant 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 $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. -'� `�f`n et 4atr' Ia$, v0 / o Signature: Date: C:\Users\clerhatRWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc 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." South Beach Resort Development, LW-58 East 79th Street,Fifth Floor, New York.NY 10075 NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP So. Beach Hotel, LLC 97% 58 East 79th Street,Fifth Floor New York,NY 10075 Oceanfront Equities Corp. 396 58 East 79th Street,Fifth Floor New York, NY 10075 So. Beach Hotel, LLC- 58 East 79th Street, Fifth Floor, New York, NY 10075 NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP Trust for the Children of Louis and Chantal Taic 97%% 58 East 79th Street, Fifth Floor New York,NY 10075 Oceanfront Equities Corp. 3% 58 East 79th Street,Fifth Floor New York,NY 10075 Oceanfront Equities Corp.-58 East 79th Street, Fifth Floor, New York, NY 10075 NAME OF CORPORATE ENTITY NAME AND ADDRESS % OF OWNERSHIP Louis Taic 100% 58 East 79th Street, Fifth Floor New York,NY 10075 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. . . . _ . . ,. Miscellaneous Cash Receipt CITY OF MIAMI BEACH . .. . . ' -• - - ' _ - 960 -:;-- . . , . ..,,. .,:„..,........, No. .- - i- • 7 . • % . . ,Ate 0 Cash 0Credit Card - -1q1Chadk# ,3 7 P .. - , .•;-i.- : . $ 1 So..c ci . . . . 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