Alyssa Kriplen - IVY MBT Property, LLC (3) MlAMLEAcH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 2016 SEP 28 AM iii: 7
LOBBYIST REGISTRATION FORM C 1-r Y
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.
Kriplen Alyssa
NAME OF LOBBYIST: (Last) (First) (M.I)
Shulman +Associates 100 NE 38th St#2, Miami, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(305) 438-0609 alyssa @shulman-design.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:
IVY MBT Property, LLC C/O Ivy Realty
NAME OF PRINCIPAUCLIENT:
IVY MBT Property, LLC CIO Ivy Realty 102 Chestnut Ridge Road, Suite 204, Montvale, NJ 07645
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(201) 264-6093 jcosenza@lvy-Realty.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: Anthony P. DiTommaso Jr., Manager
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Please see attached.
ii.SPECIFIC LOBBY ISSUE:1
De■elopment-approvals-and permitting issues related to the properties located at-T6 88 Meridian Avenue
Issue to be lol)bled-(DeSOrit)ein 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 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 Staff, City Commission, Development None. X
Boards, Land Use Development Committee None. X
and 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
N/A
OCT 032016
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc C n n d
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) t 22-5'OD / k r
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): r
(REQUIRED). 2
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,fou 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.
_YesXNo: 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 S • SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER •
OATH, LISTING LOBBYING EXPENDITURES,AS WELL A'. • PENSATION RECEIVED. IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SH' :: FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
-1
Signatuf of Lob 4 ist
I do solemnly swear that all of • • 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 :- A City Code and all reporting requirements.
Signature of Lobbyist: ,11 /
r
Signature of Principal/Client: /_; //��
r9/T/1v)ny P. ) I
....,r,,. , . /9.24,-A fe/'
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID ? K` r v, �
Produced ID
_ —
Form of Identification ';4,4••°-'" P Form of Identification
ersonally known(Lobbyist) n F o F >4'Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:, r
o r Q n /✓t7�: RSt�/ iOc/eGe
State of Florida,County of Miami-Dade = , , m # State of Florida,County of Miami-13ade
Sworn to and subscrib"_ bet. e me ti —1 I Sworn and subscrib d before me
T H y 2
This day of - .� ,201 ; , A n // ThiisL_2y'`(day of /.0a-ST ,201 (o
Signature of Public Notary State of Florida . a' ° . Signature of Public Notary-State ofFloride•/`�:"'''cos`/
Notarization of Lobb ist'; signature ., . Notarization of Principal's signature PATRI(�AA.
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY . �� P�-(C OF
Annual Registration fee: [ j Yes[ j No Amount Pald$ O■ ' MCR# I. Da
Lobbyist Registration Form received and verified by: —WA!) S1444/444 014--;15,41‘,
F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\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) 1 „�,0 J /
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): S ' /" Op I kr.
(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 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.
YesXNo: 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. C�
'Ge (�ttv tour a54 -1
Signature of Lobbyist e
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 Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: V�
A/Wh'h O
VI. LOBBYIST IDENTIFICATION' PRINCIPAL IDENTIFICATION:
_Produced ID _Produced ID
Form of Identification Form of Identification
_Personally known(Lobbyist) >'Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
Ntz✓.&g sE / at7266rd
State of Florida,County of Miami-Dade State of Etude,County of Miami-Bede
Sworn to and subscribed before me Sworn and subscrib d before me
This day of ,201_ This 2/'`1(day of Ga.ST ,201 •
aI_- N ,�ErrsEy
Signature of Public Notary—State of Florida Signature of Public Notary—State of d
Notarization of Lobbyist's signature Notarization of Principal's signature PA A.
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY NOTARY PUBLIC OF NEw Amy
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Datirar$9"IRESIIRM2018
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
A t BE law f
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeochfl.gov
CITY CLERK Office
Rafael E.Granado,City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: Alyssa Kriplen
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 CO t,PENSATIONI FORE
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 Eli fines are paid, unless the fine has been
appe=t.ed to the `,'iami-Dade County Commission on Ethics and Public Trust.
1 I4714,
Sig a'ui
r Date:
F:ICLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
ivy F.11 BT Pro erty, LLC
Ownership Chart fJ
As of August 25, 2016
Ivy Realty Fund IV, L.P. 10%+Owners of Ivy Realty Fund IV,L.P.
102 Chestnut Ridge Road Ellipse Holdings,LLC-20 Horseneck Lane,
Montvale,NJ 07645 Greenwich,CT 06830 42.7% (1)
Texas Christian University-2800 S.
University Drive, Fort Worth,TX 76129 11.4% (2)
Federal Insurance Company- 15 Mountain
100% View Road, Warren, NJ 07059 22.8% (3)
Total 10%+Owners 76.8%
Ivy MBT Holdings, LLC 76 Various Individuals,Trusts and LLCs 23.2%
102 Chestnut Ridge Road
Montvale, NJ 07645 Total 100.0%
100%
Ivy MBT Property, LLC
102 Chestnut Ridge Road
Montvale, NJ 07645
1
1688 Meridian Avenue, Miami Beach, Florida
(1) Ellipse Holdings, LLC is a pass-thru investment holding company. Majority owners are Stephen
Friedman (35%) of NY, NY and Charles Davis (35%) of Greenwich,CT.
(2) TCU is a 501(C)(3)Tax Exempt Organization
(3) Federal Insurance Company is a 100%wholly owned subsidiary of Chubb Ltd(NYSE:CB)
S:\E\EVP Construction\]688 Meridian Avenue\Exhibit B to Application 8/26/2016
. Miscellaneous Cash-.Receipt •
CITY OF MIAMI BEACH ` 9
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. . 0 Cash 0 Credit Card Check#. •�?1 -� $
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Payment Amount: 2,800.00 '76 s'
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(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
Account Number "t i F. ,�,r , ° .I-)�I•,t{ - '�0 . !'` - :�5- U r r7�__ CC:•r .A;..�rCi
Preparers Dept: t ..: EXT: `ii t-I
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