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Michael Llorente - Surterra Holdings m eDt ua v4-j os m AAA BEAcH Office of the City Clerk 1700 Convention Center Drive Miami Beach, FL 33139 • 305.673.7411 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 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: Uor tit (rlIC.i9'L'�l-Q.P NAME OF LOBBYIST (Last) (First) (Middle Name) �I or i. %ti -kr-114u I c-c,r-r� Vd ra j /� LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) L 1/46J w c ,l. kor & ep tloteytie kr2 WO.cam L BBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: IGID )f ciao NAME OF PRINCIPAL (Last) * (First) (Middle Name) Sk r-firra �lY/l� f� b/a(�G fie.361 ,Uiij n . P, L23 30, PRINCIPAL BUSINESS NAME AND ADDRESS .J ` fNumber and Street) ( itNod y) (State) (Zip Code) 11. 0-Lego PRINCIPAL BUSINESS TEL PHONE 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: Jkj(E (4GM41\) • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ,/.//'vim 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. /ekt e4 / cot ki Anil'f 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 Gir i $ , 1 A C! ''if- C I'llJ my' 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. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety: AJCi- 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): 7,- Pt — The following five(5)questions MUST be answered: 1) Pursua to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": —Yes No: 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) Pursua 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 lerk 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 reimbuement 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 shall orally disclose such particular service before lobbying the City Commission at a public meeting. —YesyNo: 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 members)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 FEB-tlARY 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 C9MPENSATION 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 ISN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD,1 Signature of Lobbyist: ' Zr�GGr Date c/ 7 1 I 7 I do solemnly swear or affirm .1 all • he foregoing facts,statements, and disclosures in this form ere 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 reporting requirements. • Signature of Lobbyist: .CI . _ .i( Date br -1 -- t I , Signature of Principal: • ; %�� Date 6-7-2017 ....-- VII. VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of 00 r id/��I State of -Mote-Ida County of: 1M 1 Pm)4(/ak County of:_ 01:3 Sworn • •r affirms.) :nd s •scribed before m Sworn,�o(or affirmed)a..r l>lub;�crIbed before Re this da of ,I ' •2t)4 by this �/ day of J I/l l(.E' ,20 by tNNt••nn11 lrr I , NAME�©FL'B'1 orator e Nicholas Monette NAME OF PRINCIPAL _Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION Sipe :1 ly Known P.:rs•''ally Known A1CAiAIE1 A ; 4 Signat� - oq�otary -I•Iic ( Sign u�req•`No .4 Public RS 6-S Name of No - T t;>d,4�rinted or Stamped Name of N• T - (NOTARY' N. Notary public State o/Florida (NOTARY kit, Notary public State of Florida yr Thais Alexandra Asper Thais Alexandra Asper - :' �mission FF 910371 ,o Expires ExMpCes 08/20/2019 ommission FF 910371 wP : . _ _ t COMP BY CITY CLERK'S ST- 1 •,1__ _ Annual Registration fee: [ I Yee[ w'" MCR F Data Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL`aFORMB\LOBBYIST FORMb1Lobbylst Registration Form Revised 08-18-16 REG.doc Revised 08/18/2016 1 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. t\A v ' ' AIBEACH 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: // I�(��/c.t,r-f' LnrMJ _.. 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. CJi I � Signa re of L st Date F:\CLER\$ALLtaFORMSIOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc Salvatore, Jason From: Thais Asper <tasper@Ilorenteheckler.com> Sent: Thursday,June 08, 2017 2:56 PM To: Salvatore,Jason Subject: Registration for Michael Llorente/Alexander Heckler Hi Jason, Sorry I didn't get back to you yesterday. Information missing is: Jake Bergman, CEO No one owns more than 5% Thank you! Thais Thais Asper P: 305-742-2810 C: 786-457-9636 Llorente & Heckler, P.A. 801 Arthur Godfrey Road, Suite 401 Miami Beach,FL 33140 TAX ADVICE DISCLOSURE: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of(1) avoiding penalties under the Internal Revenue Code or(2) promoting, marketing or recommending to another party any matters addressed herein. NOTICE TO RECIPIENT: This e-mail message is intended only for the individual or entity to which it is addressed and may contain confidential information and/or attachments that are legally privileged. If you are not the intended recipient, any review, use, dissemination, distribution or copying of this e-mail is strictly prohibited. If you have received this e-mail in error, please notify us immediately by return e-mail or by telephone and delete this message. Please note that if this e- mail contains a forwarded message, an attachment, or is in reply to a prior message, some or all of the contents of this message may not have been produced by Llorente & Heckler, P.A. 1 'G �. j N 0 Z V z � �- � { M n a, F 1, ai r a _ �' I .5 .'l A CI n c-, :: `- r n I .•,- m ' g m v ,r - ;..! i C . 3N r O O m J . 0 a y [ t a. o ., 7 � i Q i$