Robert Moehring - 790 Lakeview LLC •
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/V\'iA/V\IBEi ' 'H Office of the City Clerk 2019 FEB —5 r��i 9: 2 I
1700 Convention Center Drive CITY OF MIAMI Bt:.A C
Miami Beach, FL 33139 riFFir. OF THE CITY CLE.( rSS.
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 specificallyincludes 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,withthe applicable fee;to the Office of the City
Clerk. Ifyou 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 requirethat 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:
DID ehrin 6 2.06,0x-i--
NAME OF LOBBYIST . (Las (First) . (Middle Name) .
Oomo S'(wit( o LL , 1,1201Linebi n RoGI I Su4cSo(P ri6rni ge k Pt- 33(3q
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) I" (City) ! (State) Zip Code)
305- -cbo31 305--GISH - 3102 { " robeae, d piroAesignstkdz•
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS e0 An
II. PRINCIPAL INFORMATION:
Remand-es- I-karve y
NAME OF PRINCIPAL . (Last) . (First) (Middle Name)
`7°10 LA k� v1 Q►1 I.LC )W NE )s-± ilvvnvf -eh- 10os-C- {�Y1itlTY)i P, 33132
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) ' / (City), (State) (Zip Code)
(3oS) q SS — 14ernAnde -e:New&A-R17 achy.coin
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER . . EMAIL ADDRESS
If the principalis 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): " -*94 S e'e a l lG vAeoI
• 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): IU /pC
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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.
PevelopcvL* pcvviAIS Gn Perm0001ne� iss l>�s, ilnC Iveli ny b�nf 11D-1- Jinni�.cd-bt�isi�oi
.l
"\VIrfservAlion 1k-eview 'Bo aid 171Anni BoardNsilnkevtiew rot hoard of
Po\A.utSfim\r'4 , Lrindl os-e, I7eV.eiapnen-- Cemmi-H--a and cComm►ssiD, if
c•3Sso►ry� pro 10cA-kof iqo Lak v‘..e, bv11Ae
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 Personto be Lobbied
Plinni n� $(iti Id�ln ?v b1►C wv�rti-s anti Fire N ori
1Mpi:S-�-f-F YE Ra )-1T3 Bc EA C'i h Norm.
C6mmissi on, an L.6 r Ilse. b-eI opme#f No a
/Dm the.t;.as Ccs5.011 N0 YvL
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): .
Mort ;
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):.
25o/hr.
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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 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) 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 toexpress 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 2-491(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.
—YesNo: Have you provided campaign consulting services town 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 bee them 12months since thelelectedt a whom you providedl7cam_pargr
consulting servicarvi swornfin?1
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`"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 oridscl'F.You'irecewe economic consideration.in'exchange,for campaign
consulting services'? -
TO.BE COMPLETED BY CITY CLERK'S STAFF ONLY
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Annual Registration fee: [ ]Yes[ No Amount Paid$ <35 C MCR# l Ji✓� i j Date Paid �• i
Lobbyist Registration.Form received verified by: 1;r.<t .� v'-- 4-0. >
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc ' Revised 01/01/2018 .
Page 3 of 5
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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 1 cI/
.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 oram familiarwith 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: C. T
. - Date . 5II33 fry
Signature of Principal: . AlligillrikW4 Date 0/3/1/1
ap
VII. NOTARY SIGNATURE AND.SEAL:
LOBBYIST: PRINCIPAL
State of no Yid A State of P/al i da. '
County of: A MIC)AG�
)y'% County of: H/�f?7i -ba •P
Sworn to(or affirmed)and subscribed before me Sworn to(or affirmed)and subscribed before me
this 3:701 day of . Tani44Y,l ,2019,by thi*/iSt.dayof /lr.E2.ry ,201 , by
Robert Wto2hn'n� ,' gar y 1ernar,dei-
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID : Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
V Personally Known . Person y Kno ne.. 4.4
OvYY►d- � "
Sign re of Notary Public gnature of N tary Public //��
5ti►utnnt, b. tempi a 4e,374-,r4 Oe 65--htz,
Name of Notary,Typed FF�Jite Name of Notary,Typed,'Printed or Stamped
''li;; i �.LUDWI
MY COMMISSION#FF1994 8 �-
til"u MARIA CRISTINA DE CASTRO
(NOTARY SEAL) •,;,;r••' EXPIRES February t5,2019 (NOTARY SEAL) 4.::4'.'�.'4�z
WU)398-0153 FbrferrNourySa vice.com ': MY COMMISSION#GG069347
-= a;,r EXPIRES April 23,2021
The term"lobbyist"specifically excludes thefollowing 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
M I AM I 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:305.673.7411, Fax:305.673.7254
NAME OF LOBBYIST: Ra bt-... .I'Ylb e
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 paythe
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 longerlobbying 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.
3o/ --
#1fi
Signature of Lobbyist Date
F:\CLER\$ALL1aFORMSLLOBBYIST FORMS\LobbyistRegistration Form Revised 01-01-18 REG.doc_
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+.)WNER AFFIDAVIT FOR INDIVIDUAL OWNER
STATE OF
COUNTY OF
I, , being first duly sworn, depose and certify as follows: (1) I am the owner of
the property that is the subject of this application. (2) This application and all information submitted in support of this
application, including sketches, data, and other supplementary materials, are true and correct to the best of my knowledge
and belief. (3) I acknowledge and agree that, before this application may be publicly noticed and heard by a land
development board, the application must be complete and all information submitted in support thereof must be accurate. (4)
I also hereby authorize the City of Miami Beach to enter my property for the sole purpose of posting a Notice of Public
Hearing on my property, as required by law. (5) I am responsible for remove this notice after the date of the hearing.
SIGNATURE
Sworn to and subscribed before me this day of , 20 . The foregoing instrument was
acknowledged before me by , who has produced as
identification and/or is personally known to me and who did/did not take an oath.
NOTARY SEAL OR STAMP
NOTARY PUBLIC
My Commission Expires:
PRINT NAME
ALTERNATE OWNER AFFIDAVIT FOR CORPORATION, PARTNERSHIP OR LIMITED LIABILITY COMPANY
STATE OF /
COUNTY OF
I, 71a(;:r < P 41,7,+.:<a; „ L.. , being first duly sworn, depose and certify as follows: (1) I am the
��`✓'-/i`ski' (print title) of {f�' `-' c=:a `r={� L41:- (print name of corporate entity). (2) I am
authorized to file this application on behalf of such entity. (3) This application and all information submitted in support of this
application, including sketches, data, and other supplementary materials, are true and correct to the best of my knowledge
and belief. (4) The corporate entity named herein is the owner of the property that is the subject of this application. (5) I
acknowledge and agree that, before this application may be publicly noticed and heard by a land development board, the
application must be complete and all information submitted in support thereof must be accurate. (6) I also hereby authorize
the City of Miami Beach to enter my property for the sole purpose of posting a Notice of Public Hearing on my property, as
required by law. (7) I am responsible for remove this notice after the date of the hearing.,.
' SIGN i\TORE
Sworn to and subscribed before me,thisl y 7-7! day of l f1 r . , 20 /.%;, . The foregoing instrument was
acknowledged before me by /`;F" = A%`i/ af,'d.-"" •, who has produced as
identification and/or is personally known to me and who did/did not take an oath.f
NOTARY SEAL OR STAMP
DE CASTRO �` ITARY PUBLIC
• I o, Y,
My Commission Expires: ° ,I MARIA CRISTINA
J LP i'"K ?G 9MlSSION t*GG069347 ';GC [ L f,j-t f/1C? < ���
r t t " :N.
:aW txoJlRES April 23,2021
We ore committed to providing excellent public service and safety to all who live,work,and play in our vibrant,tropical,historic community.
Page 6 of 8
filed, but prior to the date of a final public hearing, the applicant shall file a supplemental disclosure of interest.
DISCLOSURE OF INTEREST
CORPORATION, PARTNERSHIP OR LIMITED LIABILITY COMPANY
If the property that is the subject of the application is owned or leased by a corporation, partnership or limited liability
company, list ALL of the owners, shareholders, partners, managers and/or members, and the percentage of ownership held
by each. If the owners consist of one or more corporations, partnerships, trusts, partnerships or other corporate entities, the
applicant shallfurther disclose the identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity.
790 LAKEVIEW LLC
NAME OF CORPORATE ENTITY
NAME AND ADDRESS %OF OWNERSHIP
790 LAKEVIEW LLC 100%
14 NE 1st Avenue
Penthouse
MIAMI, FLORIDA 33132
NAME OF CORPORATE ENTITY
NAME AND ADDRESS % OF OWNERSHIP
If there are additional corporate owners, list such owners, including corporate name and the name, address and percentage
of ownership of each additional owner, on a separate page.
We are committed to providing excellent public service and safety to all who live,work,and play in our vibrant,tropical,historic community.
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DISCLOSURE OF INTEREST
TRUSTEE
If the property that is the subject of the application is owned or leased by a trust, list any and all trustees and beneficiaries of
. the trust, and the percentage of interest held by each. If the owners consist of one or more corporations, partnerships, trusts,
partnerships or other corporate entities, the applicant shall further disclose the identity of the individual(s) (natural persons)
having the ultimate ownership interest in the entity.
790 LAKEVIEW LLC
TRUST NAME
NAME AND ADDRESS % INTEREST
790 LAKEVI EW LLC 100%HARVEY HERNANDEZ
14 NE 1st Avenue, Penthouse
MIAMI, FLORIDA 33132
We ore committed to providing excellent public service and safety to all who live,work,and ploy in our vibrant,tropical,historic community.
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
No. 422790
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0 Cash. Credit Card �CP Check# L. $ `'. ` . k r• ,,-'.- �
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(THIS INFORMATION MUST SE COMPLETED) Office of Finance Director
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Account Number. ,!. }. ;' 1 �. c. ,..C r: $� '. • ::� fr.. . (•)"1:"
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