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Monika Entin - 6800 Indian Creek, LLC • C 7 6$c ' kippkAA G ‘cDr� MIAMI BEACH ' F Office of the City Clerk 1700 Convention Center Drive f_' —" �i7: 146 Miami Beach, FL 33139 }� ; , 305.673.7411c\rr I• 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: Entin Monika NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez&Larkin,PLLC 200 South Biscayne Blvd.,Suite 850 Miami,Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 mentin@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Tabet Ricardo NAME OF PRINCIPAL (Last) (First) (Middle Name) 6800 Indian Creek, LLC 846 Lincoln Road,5th Floor Miami Beach Florida 33139 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 200-8740 PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant fp gIV(g002@tigillii 2-482(h)(1 . Q principal(T +'+ p+ _ + partnership,CL?Cil - W^"np appears m a lobbyist t ( i G1t entity,dinEigl special compensation CFiaiellffEEIMER for ing appearance,c2=r2pdtGa indirect,CP contingent (taai.:i o++ diCR+.•_ + jan item shall register with the Clerk as required by this subsection but shall not be required to pay any registration fees. 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): R. Tabet • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST'(if none,write N/A): See Attached. Page 1 of 5 s #2$ 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 &Planning Issues,including but not limited to the Historic Preservation Board, Design Review Board,Planning Board,Board of Adjustment,Land Use Development, City Commission, and any City Workshops or Committees,if necessary,relating to the property located at 6790 &6800 Indian Creek Drive in Miami Beach,Florida 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 Staff for the Planning&Building Department None X Public Works &City Administration,PB,HPB,BOA None X DRB,City Commission, and Mayor 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): $500.00 per hour Page 2 of 5 L 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": _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 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 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 XNo: 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. _YesX 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 2-491(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. —Yes XNo: 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 XNo: 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 2-482(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 lobbying the City Commission at a public meeting. _Yes XNo: 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 XNo: if yes, were you romised or did you receive economic consideration in exchange for campaign; �co�uItir is ices. TO BE COMPLETED BY CITY CLERK'S STAFF ONLY y� Annual Registration fee: [ ]Yes[']No Amount Paid$ 3 S3 ' MCR# 1112-1 61 Date Paid 07 -0 cl- \\ Lobbyist Registration Form received and verified by: F:\CLER\OIL\aFORMS\LOHi3Y%ST FORMS\Lobbyist Registration Form Revised 09-20-15 REG-dot Revised 09/20/2018 Page 3 of 5 1 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.LOB STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSA DURING THE REP TING PERIOD.' Signature of Lobbyist: Date a i l t 61 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 wi . •: - ' ions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code an. : reporting require -nts. LI I G Signature of Lobbyist: Date 67 I 14 ` l Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of I(tG4G State of County of: A.A1 0.t.41 bad-2 County of: Sworn to(or affirme4arld subscribed before me Sworn to(or affirmed)and subscribed before me this ,1..4 day of rC.brUGVIj ,20.9_, by this day of ,20 , by Monika Entin NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID A _Produced ID FORM OF IDE ATION FORM OF IDENTIFICATION X Personally Known 1 _Personally Known • Signature of Notary Publi, Signature of Notary Public Dia/1G 124.wl Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped (NOTARY SE )dao 'PVe Notary Public State of Florida (NOTARY SEAL) #7. Diana Ramos My Commission FF 207719 'oet�o�c Expires 04/10/2019 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. 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: Date 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 reporting requirements. Signature of Lobbyist: Date Signature of Pri• ncip t� 2 Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST:. PRINCIPAL [oirj,a, State of State of County of: County of: '\totifYll 1.) te Sworn to (or affirmed) and subscribed before me Swor (or affir ed) and subscribed before me this day of , 20_, by this day of u 2014, by Monika Entin l"fie c NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM • IDENTIFICATIO X Personally Known v Persona ly KI own IJ I A Signature of Notary Public Signature o Not.: ��uibli "' bfk 63(S Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped (NOTARY SEAL) (NOT L) MARILYN ABUD MY COM ' MISSION#FF194693 �Q EXPIRES February 01,2019 - - - --- ---- e9-3_lP S Floridalloro Serv,cecon• 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. Page 4 of 5 MIAMI BEACH City of Miami Beach, I/W Convention Center Dnve,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov Tel:305.673.7411, Fax:305.673.7254 • NAME OF LOBBYIST: Monika Entin 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 $500.01 _• suant to Section 2:482-of the Miami Beach City Code. 14 `\ Signature of Lobbyist Date F:ICLERI$ALL\aFORMSILOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page 5 of 5 Exhibit B Disclosure of Interest 6800 Indian Creek 6800 Indian Creek,LLC 846 Lincoln Rd,5th floor Miami Beach,FL 33139 100% Optimum USA Investments 4,LLC S8 Indian Creek,LLC c/o Funaro&Co.P.C. 846 Licoln Rd,5th floor 350 Fifth Avenue,41st floor, New York N.Y.10118 Miami Beach,FL 33139 99% (, 1% I I Rodolfo Misitano Ricardo Tabet Ricardo Tabet 350 Fifth Avenue,4lst floor, 846 Licoln Rd,5th floor 846 Licoln Rd,5th floor New York N.Y.10118 Miami Beach,FL 33139 Miami Beach,FL 33139 50% 50% 100% 1 . ' . . MBF City Hall 1700 Convention Center Dr. Miami Beach , FL 33139 305-673-7420 ' ' Cr) tqf ° C>7' Welcome 003202-0054 Adrian V 82/04/20l9 02:51PH MISCELLANEOUS Description: MCR OPEN (MCR) Reference 1 : HCR422789 ' NCR OPEN (NCR) 2019 Item: NCR 1 @ ]5O.0O NCR OPEN (NCR) 350.00 0. 350.00 Subtotal 350.00 Total 350.00 CHECK 350.00 Check NUmb8[4688 __ _ _ __ Change due 0.00 Paid by: 6800 INDIAN CREEK LLC ' o� ~- (.9 jT N|0UNU�1UBUUU�N8�U�/HHU|�U�l/ NKNU�|U���UU���3����UU��! __ Thank you for your payment CUSTOMER COPY . * . .