Meagan A. Sippel - Rock Soffer 17**-- Ave
t\/\ I Am I B E 1C ' Office of the City Clerk
1700 Convention Center Drive _ T
Miami Beach, FL 33139
305.673.7411 Z(J 11 F D -o Vi i- 8: c j
LOBBYIST REGISTRATION FORM
L:jYc;
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage;-defeatior._.
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 City Code Chapter 2,Article VII, Division 3, entitled"Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form, with the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
BSIPPEL MEAGA I MILE
NAME OF LOBBYIST (Last) (First) (Middle Name
ST,4-ITC I14 zcH/1crotom, I JJC. 2 S'. Pi1SCANE 13Lub SuITEILQ 1O M iAFIUI F- ' 1
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
LOBBYIST B1LL TELEPHONE NUMBER -7 E CELLULAR 1b-03 NUMBER`agar . i" �I0 ADDRESS C.CDrn
II. PRINCIPAL INFORMATION:
SDFFEIe GIG
NAME OF PRINCIPAL (Last) (First) (Middle Name)
ESS E J I2 S JG5OI iSCA- E ✓•V o 3u L[DV ,UENtu 41 FL 33180
PRINCIPAL BUSINESS N N AND ADDRESS ( r ) (City) (State)
(Zip Code)
?i0-r2-914- X201
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code
Section 2-482(c): '
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Gk_ San-tar
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical,including but not limited to a specific description where applicable of a pending request for
proposal, invitation to bid,or public hearing number.
20I■I IiJ C�, LA-KP I)SE A-191912LV,a LS 1 1-1 MId7 W EST AM U E. rEpk1L�-
•
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IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied,and whether the
lobbyist has entered into any contractual relationship(paid or unpaid)with said City Commissioner or City personnel from 12
months preceding such commencement of service with the City to the present date, stating the general nature of the subject
contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES NO
Title of Person to be Lobbied
V70kD°FAQ)usrmenrs HP13/ RN/Lib
WAS I LAIAMI f EA-c-H C/AUmis of ErS
T`�M4Nv -, C I YY'�Armes, PI J t/0\16 130 , • X
mS Go Wo t City CodSec n 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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of
impropriety:
NO
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
3501 000/( 14-
The following five(5)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
Yes 4No: 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 City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real.Estate Development
Issues":
_Yes./No: 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 City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481)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 city clerk as required by this section, but shall not be required to pay any registration fees.
_Yes /No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific, technical or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
_Yes ✓No: Are you providing only scientific, technical or other specialized information: appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-482(a)(4), a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission shall disclose such particular service on his/her lobbyist registration
form and'hall orally disclose such particular service before lobbying the City Commission at a public meeting.
_Yes No: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes, please list the incumbent member(s)of the City Commission:
If yes,you must also orally disclose such particular service before lobbying the City Commission at a public meeting.
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.'-
Signature of Lobbyist: rte— ' Date 12' (2. 20 l(Q
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all repo • requirements.
411
Signature of Lobb ist: �• Date 12 1 2 .201(0
Signature of Principal: Date ( Z-( Z -Z 016
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIS : PRINCIPAL
State o State of
County of: County • i��i ^ 14' /
Sworn ttj(or affirme and subs rib before me Sworn (or affi d and s •sc '•ed before me
thi day o , 2016, by this ay of,. 2016, by
h1kdQ4A) �
NAME OF LOBBYIST NAM
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
V Personally Known VPersonally Known
Signature of Notary Pu Ic Signature of Notary P lic
/ //
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped •
! 8b"""L1, :ERCEDES GUASCH I (
Notary Public-State of Florida °:"„B,, MERCEDES GUASCH
=
• ' •, :.1 My Commission Expires Feb 22 2019 - : Notary Public•State of Florida
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• °i Cnnvrksinn+eFF t71945 TO ek COMPLETED BY CITY CLER .SAY €litNitovinission Expires Feb 22,2019
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Lobb „y: : , Bonded through National Notary Assn. 0
F:\CLER\BALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08,18489kE e 1 08/18/2016
The term"lobbyist”specifically excludes the following persons:
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether
direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
MAMBAC 'H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1, Fax: 305.673.7254
NAME OF LOBBYIST: MEA6A • StPPE�--
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
12. 12-WI CP
Signature of o• ► ist Date
F:ICLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
FEB
-
Miami Beach, Florida 33139 2 1 �.L
ki 8: 5 7
www.miamibeachfl.gov ` I'LL Out:
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: MEAGA-14 S1pPla-
Business Name: SrAMTEC AleCl- tT C TOR . l rUC•
Address: 2 SOUni 1�ISCA'TIiE 13wLE.-1/Ar--12 MIAMI, PL 33131
Office Telephone Number: 47O'S-Wee.- `5131
Cellular Telephone Number: 11 G-301- l(OS3
Email Address: IMeagan • sip @ s-tc n-re.G• corn
If more than one lobbyist, please list:
1) SCOTT 1300T1-E
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#: H3T) '
• Amount paid: 500.-a##aa\ S5d -i 5.5C a Date paid: F4 61 25 1?
Processed by: 244--now' Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS.ANNUAL LOBBYIST REGISTRATION FORM reg.docx. •
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Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
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No. 413871
❑ Cash o Credit Card /Check# -1 ' ' $ �- =
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Received of - . i_,
Address - ', , 1 <. `
City of Miami Beach
MiscellaneosQ '.R-9n17
000993-0009 Adrian ...0210612017 09:O1AM -
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Payment Amount: 1,700.00
MCR413871 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
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Account Number: i
Preparer: Dept: EXT:
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1681 Ventures, LLC Structure Chart
Officers:
Shlomo Khoudari,Sylvain Argy
Jack Azout,Juan R.DeAngulo
111~-
Elton III Real Estate Elton III West Avenue Elion III Real Estate
Fund Ill,LP Holdings,Inc, Aggregator,LLC
(DE) (DE) (DE)
Class A Class A 82.36% Class B
17.64%
(Promote)
Managers:
Shlomo Khoudari Elion III Trip S West Ave,LLC
Sylvain Argy West Avenue,l.0 Managers:
(FL) Erwin
Jack Azout (DE)
Juan R.DeAngulo Jonatan Sredni
50% 50% Manager:
Rock Soffer
1681 N Member, 1681 RS Holding, LLC ,/
Member Managed ------ LLC (FL)
(DE)
43.18% 56.82%
Managed by Executive Commktee: 1681 Ventures,LLC
Jack Azout,Erwin Sredni,Rock Soffer,Jeff Soffer (FL)
(Administrative Manager:Rock Soffer)
10096 10096
1681 West Ventures, 1698 Alton Road
LLC Ventures,LLC
(FL) (FL)
Asset:
aAsset:1681-1683 West Ave.Miami Beach,FL