Silvia S. Coltrane - Collins And 72nd Developers LLC 7tCoRltn3 4Ye '.&t
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MIAMI BEACH7010APt 19 PH 3: 22
Office of the City Clerk _
1700 Convention Center Drive _C
Miami Beach, FL 33139 FFiC -F THC CITY CLERX
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 tens 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,Divisnn 3,entitled"Lobbyists,"
for additional information.
instructions: Please complete all sections of this form and submit the completed tor),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 'Na" 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:
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NAME OF LOBBYIST (Last) (First) (Middle Name)
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LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
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NAME OF PRINCIPAL (Last) (First) (Middle Name)
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PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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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): C ,1 L _,.
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(R none,write N/A): J 11 u L q 5 L. W ITgpw
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
u •
CORPORATION,PARTNERSHIP OR TRUST(If none,write N/A): See. LLVYaC Stab
Page tof5 / `J
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.
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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
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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(if none,write N/A): Ay"
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):
'l/44
Page 2 of 5
The following six(6)questions MUST be answered:
1) Pursuant t ity Code Section 2-488,entitled Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
Yes_No: Are you lobbying on a present or pentlina 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 f_NNo: Are you lobbying on a pentlina application for a Development Aareement with the CRY or application
for change of zoning map designation or chanae 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
reimburserrry9lent 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-pro community based organization for the purpose of requesting a grant without special compensation or
reimburs ent for the appearance.
_Ves_No: Are you providing only scientific. technical or other specialized Information: aopearina 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 arant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following tl)'swearing in of any elected official(s)for whom the campaign consultant provided campaign consulting services
within the✓,bast election cycle.See Section 2-491 for more information.
—Yes_No: Have you provided campaign consulting services to an incumbent member of the City Commission
within the oast election cycle?If Yes,please list the Incumbent memberlsl of the City Commission'
_Yes_"No: )f yes. has It been less than 12 months since the elected *Malaita) whom You provided camoalart
consulting services was sworn In?
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an 'ncumbent member of the City Commission(which lobbying activity is not otherwise prohibited by Code section
2-491) shall isclose such particular service on his/her lobbyist registration form nd shall orally disclose such particular
service be re lobbvina the City Commission at a public meeting.
_Yes_ o: Have you provided campaign consulting services to an Incumbent member of the City Commission
within the oast election cycle?R yes,please list the incumbent memberts)of the City Commission:
_Yes_Rio: if yes, were you promised or did you receive economic consideration In exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERKS STAFF ONLY ,,/
Annual Registration fee: o f Yes l I No Amount Paid$ OS\D-U^,.' eMCR N i4 L002 a Dale Paid O` l t l
Lobbyist Registration Form received and verified by: \ C ' JL4'Lvii-V5.4-E'
F:\CLER\$PLL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG-doc Revised 01/01/2018
Page 3 of 6
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 COMPENSA ON DURINGIN/ THE
REPORTING PERIOD.1 / /�
Signature of Lobbyist: ✓ =v1 /lGGP/.d�_ Date "Y/// / t
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 a reporting requirements.
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Signature of Lobbyist: J T� Date ///$"// / e
Signature of Principal: ' //}GLeLG t Date ilia/ /C.
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of ?Z c' V i ,AA State of r/0/C /..2)A
County of: JlA-d4a- County of: Z)A..0t
Sworn tojor affirmed)and subscribed before me Sworn to(or affirmed)and subscribed before it:Le
this pr day of /-P/Pi / 20fby this/91 day of /¢-/'R/ / 20 (by
,52/yi4 Ccv7%,4A-/% s./v7/ C-0/7,"i, , -fl/ •
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
✓ Personally Known li Personally Known
Signa a of Notary Public Signatur of Notary Public
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Name el Notary,Tid Printed or Stamped Name ofrNotary,Typed, Printed or Stamped
"'' i ...... OLGA CASTILLO
Notary Public-Slate of Florida OLGACASTILLO
(NOTARY SEAL) 1 Commission sGG 159336 (NOTARY SEAL) Notary Pudic-State of Ronda
My Comm.Expire Nav 12,2021 Canmissian aGG 159036
�"" Bonded Inmen xeuaui xolayum. Amy My Comm.Expires Nov 12,2021
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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.
Page 4 of 5
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E. Granada,City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.741 1, Fax: 305.673.7254
NAME OF LOBBYIST: 3-1-1Q f q S. Co L.n.q N
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 300" 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 totoSection 2-482- of the Miami Beach City Code.'
� �/! 1. �1ar�- y-/i,t'/�C
3331 nature of Lobbyist Date/
F:ICLemsew.FORMBLLOEBYIET FORMSLobbpa Reyav,tlon corm Revised 0101IBREG doc
Page 5 of 6
Qscoka of Owne ho for taEinand 22nd Deyekoen.l Lr
%Interned %MemtdCOYM•
Member NAME brdMdual Member 72nd Developers LLC
Transact.72nd,LLC,9357 Harding Ave,Surfside,FL 33154 Silvia Sabates Coltrane,Manager 100.00% 36.59%
ADMA Investments,LLC(Delaware LLCI,130 5th Avenue,20M Alex Blavatnik,Manager 103.00% 4.02%
Floor,New York,NY 10019
Silvia Sabates Coltrane,Manager 83.37%
Collins and 72nd Holdings,LLC,9357 Harding Ave,Surfside,FL Raquel Bender Rabinovkh as Co- 5.545%
33154 Trustee 24.44%
Jacob Bender grays..as Co-imsne 5.545%
Cynthia A.MacPherson 2.72%
Derek and Ashley Norred 2.77%
Contemporary Hotel Partners,LLC.(Delaware LLQ,18305 Jacques eessoudo,Manager 50.00%
•
Biscyane Blvd,Suite 402,Aventura,Fl.33160 31.51%
Jordan Kavana,Manager 50.00%
Gold Bird Road Properties,LLC(Florida LLC),1177 Kane Salam0n Gold,Manager 50.00%
3.39%
Concourse, Suite 21g,Bay Harbor Islands,FL 33154 David Gold,Manager So.OD%
TOTAL 100% 100%
MIAMI BEACH RECEIVE ,
City of Miami Beach
2018 APR I Q PM 3 22
1700 Convention Center Drive
Miami Beach, Florida 33139 OIl Y CF 11131:11 BEACH
www.miamibeachfl.gov PEKEtir THE CITY
City Clerk's Office
Tel: 305-673-7411
Far 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: 51IUia 5, Co t-1-rtRn)/=
Business Name: Co 1,1 ius f1ND 77 un "bait lopev s
Address: R 5 31 &a talk Out-
Office Telephone Number: 305- g67- 63 i4:11
Cellular Telephone Number: 205-N 9/i - Ret 4 F
Email Address: S i t A/ i A a7 2 all /Vl I Rrf i- CDMA
If more than one lobbyist,please list
1)
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#:
Amount paid: Sou. 00 Date paid: OW, iq" I
Processed by: ic›,,-, Date: 04- 1(h- 16
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