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Adrienne R. Grandolfo - DOA Miami Beach, LLC 02,60cmo C_,,o1kt'.,5 4ve, iv■ AN\1 BEAC \ • City of Miami Beach Office of the City Clerk Zei6 SFr i 3 ) N 8: ti 1700 Convention Center Drive, Miami Beach, FL 33139 1'IT y �;; L •;i'S C}r HL. LOBBYIST REGISTRATION FORM 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. C;RANDOT,FO AT�RTF.NNF. R NAME OF LOBBYIST: (Last) (First) (M.I) GREENSPOON MARDER, P.A. 1601 WASHINGTON AVENUE, SUITE 300,MIAMI BEACH, FLORIDA 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 309-602-8245 ADRTFNNR GRANDOT,FOoCMT,AW CQM TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: DOA MIAMI BEACH, LLC NAME OF PRINCIPAUCLIENT: DOA MTAMT REACH. T,T,C' 8950 S .W. 74TH COURT, SUITE 1704, MIAMI, FL 33156 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-670-7645 305-670-7647 JEFF@CTCORPOFFICE 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: JEFFREY S . BOERNER, DIRECTOR • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE EXHIBIT "B" n.SPECIFIC LOBBY ISSUE: ANY AND ALL LAND USE, ZONING,AND LICENSURE ISSUES RELATING TO THE PROPERTY T,OrATF.D AT f)nin—rn-11 TTTN:F A\7RNTTR MT AMT RRAC'H—FT-CSR"' n —T-11-3-4-7 Issue to be lobbied(Describe in detail): _-_ - - - nl.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 PLANNING/PARKING DIRECTOR AND STAFF X PLANNING BOARD X MAYOR AND COMMISSIONERS 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 F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $375/HOUR B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $3 7 51 HOUR 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. _YesX 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 REPORTING PERIOD. �Am- eLi4 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 iami Beach City Code and all reporting requirements. t 1 / Signature of Lobbyist: A 1,i,l .. I �,,;,1_•,_, Signature of Principal/Client: 1.4 kb VI. LOBBYIST IDENTIFICATION: i PRINCIPAL IDENTIFICATION: _Produced ID —Produced ID Form of Identification . Form of Identification Personally known(Lobbyist) /Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade Sworn to a d subscribed befo e me //� Sworn and subscri d before me Thiscp!)a. day of • ,201(0 This)I'+day of i )( j - ,201 )1_91064 IL_II . .J • • .4 _ 10 Signature of Public Notary-State of Florida Signature of Public.Notary-State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes���t1'1 No Amount Paid$ SO .•0 MCR# tot tl qS e1 Date Paid D4' -13- 1.6 Lobbyist Registration Form received and verified by: C. PLC-. F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 :Qfil ,,,$A {gpek WYIST F(RMS1Lobbyist Registration Form.doc 4V'' CHRISTINA NI. LLOYD fir c• :: Commission#FF 929437 =F '=' `= MY COMMISSION#GG001813 ��- Expires October 20,2019 P �±±�r . .- EXPIRES June 13,2020 9 - A',fq� Bandsd Nu Troy Fein Inure=B00385-7019 :, (107)388-0153 FlOridaNOtaryservrce.com /\/\ IA/V\ I E .CH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachH.gov CITY CLERK Office Rafael E. Granada, City Clerk CityClerk @miamibeochfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST N AVM ADP TRNNR R C;RANDOT,FO 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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th of each year,shall be • automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. • 09/01/ L0113 Signature: Date: • F:\CLERI$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc EXHIBIT "B" DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of the application is owned or leased by a CORPORATION, list ALL of the stockholders, and the percentage of stock owned by each. Where the stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* DOA MIAMI BEACH, LLC CORPORATION NAME NAME AND ADDRESS % OF STOCK DOA MIAMI BEACH, LLC A.C. Waney 28.8% Flat 16 46 Lowndes Square London SWIX9J, United Kingdom Linia 2 I.1% 8950 Southwest 74th Court, Suite 1704 Miami, Florida 33156 Nahita International Inc. 34.2% 874 Walker Road City of Dover City of Kent Delaware 19904 Karl Waney 5.3% 8950 Southwest 74`h Court, Suite 1704 Miami, Florida 33156 Tom Mur 5.3% Flat 4 Arundel Court Jubilee Place London SW3 3TJ, United Kingdom 27618669v1 Exhibit"B" Page 2 of 4 Arman Naqi 5.3% 8950 Southwest 74th Court, Suite 1704 Miami, Florida 33156 LINIA,LLC Arun K. Puri 68.320% 8950 Southwest 74th Court, Suite 1704 Miami, Florida 33156 Yoshina R. Puri 10.0% 8950 Southwest 74`h Court, Suite 1704 Miami, Florida 33156 Jaz Krishan Puri 21.680% 8950 Southwest 74th Court, Suite 1704 Miami, Florida 33156 NAHITA INTERNATIONAL INC. Nahita UK Ltd. 100% c/o Cooley Services Limited Dashwood 69 Old Broad Street London Ec2M 1 QS, United Kingdom NAHITA UK LTD. Dream International BV 100% Oranje Nassaulaan 12 1075 AN Amsterdam The Netherlands DREAM INTERNATIONAL BV Dream International Corp. 100% Oranje Nassaulaan 12 1075 AN Amsterdam The Netherlands DREAM INTERNATIONAL CORP. Nahita Restoran Isletmeciligi ve Yatirim A.S. 100% Dream Buyukhanli Plaza Dikilitas Mahallesi Uzengi Sokak No. 8 Besiktas/Instanbul 27618669v1 Exhibit"B" Page 3 of 4 NAHITA RESTORAN ISLETMECILIGI VE YATIRIM A.S. Dogus Holding 100% Maslak Ayazaga Cad. No: 2 Sariyer/Istanbul DOGUS HOLDING Deniz Sahenk 17.296% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul Ferit F. Sahenk 32.520% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul Filiz Sahenk 30.435% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul Dogus Arastirma Gelistirme Ve Mus Hizm 10.265% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul Dogus Otom Servis Tic A.S. 3.689% Maskal Ayazaga Cad.No:2 Sariyer/lstanbul Antur Turizm A.S. 0.450% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul Dogus Sigorta 0.539% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul Garanti Turizm 4.684% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul Dogus Turizm Sag. Yat. Ve Is' 0.090% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul Dogus Oto Pazarlama Ve Tic A S 0.031% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul 27618669v1 Exhibit"B" Page 4 of 4 Dogus Nakliyat Ve Tic A S 0.001% Maskal Ayazaga Cad.No:2 Sariyer/Istanbul 27618669v1 , • . . .. Miscellaneous Cash Receipt • . . - CITY OF MIAMI BEACH - . 4 1 1 9 59 . . .,.. . , . . .- No. - . • ..„. , L ) c:.I <-,,i _ .., -'''',-;,.;,-2.- 0 Cash Credit Card E.c.I Cheok# .1-) 1) : .-- . - . . $ 20 , A i City of mianfitlilfa* et/of MiscellaneouAddfiss201167 6 1 1„\)1.c,e,IA ( ) /1\ c, '- oc , r-A C i 000526-0002 Irma Ro... 09/.13/2016 08:3BAM , For I I > •%.°- e - , cr-{-,7) C c1 11,, .. . , MCR OPEN Payment Amount: 350.00 ' . 411959 .,,. (THIS INFORMATION MUST BE COMPLETED) Offide of Finance Director : .. . By _ . 3 G-ci t..1 t itl _ CO - 3 . :,1,7(-g. 9:_)- 0 0- D e-• ' . , Account Number 0.1 I ' 0 CI o o - ,.. , .. 1 it Preparer: --SA c'tS -', 513.L vt;7?-3(4--E '" " Dept r C_- - •• EXT: , „ . ' . C) • C1• , — - PI C•" 57, , , Ilz --' Z ,_....--' H.? 3.1. -T• CZ- ci.'. -,, ..., --• CV 3: (T., CID .."---- ..72... .. .,,'-'' 3 .-7'. —.. CD n's r... •S.+ '< ..'-' rr 2., .- 0- - .-- 0, - ,---i ii' — u, = .! __, "0 • M.': CD ,.. C'' -. 71, CD, ,--a = :,.,:', •••-.1 5. 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