Alyssa Kriplen - IVY MBT Property, LLC (MK f .ct,ot&v
r VC r,
MIAMI BEACH Office of the City Clerk n111 Jill AM 11: 27
1700 Convention Center Drive ?EA CI,
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 'hone' 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:
Kriplen Alyssa
NAME OF LOBBYIST (Last) (First) (Middle Name)
MAK Work 1251 SW 20th Street, Miami, FL 33145
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 310-2602 alyssa@makwork.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
IVY MBT Property, LLC c/o IVY Realty
NAME OF PRINCIPAL (Last) (First) (Middle Name)
35 Field Point Road, Greenwich, CT 06830
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(203) 301-5336 alyssa@makwork.com
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(if none,write N/A):
Russell F. Warren, Jr. Manager of Ivy MBT Property, LLC
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write NIA): See Exhibit A.
Page 1 of 5
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.
Development approvals and permitting issues related to the property located at 1674 Meridian avenue.
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
Planning Staff, City Development Boards, None X
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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety(if none,write N/A):
None,
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):
oo7 ttXRO f-Fs_
Page 2 of 5
•
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_YesXNo: 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":
_YesXNo: 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.
_YesXNo: 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 XNo: 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 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the past election cycle.See Section 2-491 for more information.
_YesXNo: 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:
_Yes_No: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign
consulting services was sworn In?
6) Pursuant to City Code Section 2482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service before lobbvina 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:
_Yes)No: If yes, were you promised or did you receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
_, .
Annual Registration fee: [ ]Yes[y]No Amount Paid$ 2 r MCR R
- ) Date Paid t �Y
Lobbyist Registration Form received and verified by: A 1"1 "
F:\CLER\GALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc Revised 01/01/2018
Page 3 of 5
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 COM- SATION DURING THE REPORTING PERIOD.'-
Signature of Lobbyist: Date 'D 6. (e9
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 ammiliar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code --`r• all reporting requirements. /�r,,t
Signature of Lobbyist: At Date 06. c4 . �t
Signature of Principal: Sec itey4-- A Q`Q- Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of R-o"-1 O 0- State of
County of: f4i fr-i QAC— County of:
Sworn (or affirmed)arkd subscribed before me Sworn to (or affirmed)and subscribed before me
this
^ I day of// wWG 2O/ ', by this_day of 20 , by
{.V�VSSA 12/LE N)
N
NAO.
LOBBYIST NAME OF PRINCIPAL
I_//Produced ID FT_ 'D 1, _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Personally Known Personally Known
ature of Notary Public Signature of Notary Public
Name of N Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
R` ,kik.y- JASON SALVATORE
(NOTARY S6tl�) MY coMrnlssioNxcc 030527 NOTARY SEAL)
S•y EXPIRES.September 14.2020
(
�p r.Bonded Tan Notary Pudic UmlerxMeis
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
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: O.0 [N10:250C2-0e✓IDQI � Date
I do solemnly swear or affirm that all of the1foregoing 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 reporting requirements.
Signature of LobbyistDate
Signature of Principal: ice--- —
(-/-7-7-
Date l�
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
Stateof Stateof LOrIn2C1-iNT
County of: County of: Fill fi e1c-i
Sworn to (or affirmed)and subscribed before me Sworn to(or affirmed) and subscribed before me
this day of 20_, by this 444'day of -3 c) P 201}L, by
€vctef( F1Jamen rJr
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION / FORM OF IDENTIFICATION
_Personally Known /Personally Known
Signature of Notary Public Signature of Notary Public
Cara SCtulo
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL) (NOTARY SE r y Public
%D l
My Commission Expires Math 3/,2022)
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
1 C _
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.mlomlbeochfl.gov
Office of the Ciy Clerk
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
,, ,�
NAME OF LOBBYIST: * I S'A
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.
of off-. 7M3
Si nat e f Lobbyist Date
F:rGLER\SALLUFORMSLLOBBYIST FORMOLodbrst Registration Form Revised o L01-I REG doe
Page 5 of 5
•
•
EXHIBIT B
Ivy MBT Property, LLC
Ownership Chart
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)
v Total 10%+Owners 76.8%
Ivy MBT Holdings, LLC 76 Various Individuals,Trusts and LLCs 23.2% (4)
102 Chestnut Ridge Road
Montvale, INJ 07645 Total 100.0%
1 100%
Ivy MBT Property, LLC
102 Chestnut Ridge Road
Montvale, NJ 07645
1
-1674 Meridian Avenue, Miami Beach, Florida
Ellipse Holdings, LLC is a pass-thru investment holding company. Majority owners are Stephen
(1) Friedman (35%)of NY, NY and Charles Davis(35%)of Greenwich,CT. No other investors own more
than 5%of that entity.
(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)
(4) None own more than 5%of that entity.
s\e\EVP ConvrvmonUan Meridian Avenue\Zeta On a ModinnWn\E•MBU B-w.MBT.Disclosure.of Me rid Ian Ave 3/14/2018
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
No. 421155
Cash Credit Card O Check# $ '350
Smarr_ J 20 i g
MBF
ROQiiika4aau=-RA?1 k054s4 ' r plc e
AMA1/0oale@knI..1efitp /2o19261k'm5} p) a rf L 2, 2>i9<
MCR OPEN(MQ ) ;-.,
F A,.,,,,,,„W rl 4$6 „ a A
MCR421155 I i) Voip
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
6 ( I-WOO- 644{ci LA _0c -2.C7-2'll1-G C)-00-60 By
Account Number:
Preparer: A ,-\ I. , r r'•-- Dept: 6+. (I�. )_ Ex-17c)//
i
0 — ca
Q a^ 3
3Ay
— coT x d O 3 /R i A,,, ,, ^.
— N.
p .. N _ -. A La Cry r ar
3
TCi ? an T b M2 0
p
Cl �- rri a.r- Z N 3 -. o C f 3 C
'” 3 Zl 3 3 v d a C�
3 — 3 �.. C
_ CC A
`_G - y V < c Co d N C7
C rt .
Z a C Ui Z o S_.`G T
O
C \ m N-, t at
r O
CJ .-o-
,:::
C b-'
m
C O N
O r C C
O O oo c n
3