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Ellen Buckley - MB Mixed Use Investment, LLC (2( : " : ri. g t‘..A Al D.c A .140u; r.: "::t, : V..11 Office of:the.City Clerk - 1700 Convention Center Drive:: .: Miami Beach FL 33139..: 305:673:7411 _ , F : 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, recommendationof.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 al as well as anyem to ee engagedgin 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 f le an amendment to the registration form. • The:lobbyist has: a continuin: dutyto supply information and amend the forms filed throughout the..period that.the lobbying occurs. ... Y g ppY g Y :g. Se arate registration forms shall be required for each principal:represented on each specific issue.. • I. LOBBYIST.INFORMATION: ' • Mickley Ellen NAME OF LOBBYIST (Last) =- j (First) :: • :.(Middle Name) MB Mixed Use Investment, LLC 2665 S. Bayshore Drive Miami FL :_ 33133:: LOBBYIST BUSINESS NAME:AND ADDRESS (Number and Street) (City) (State). Zi p Code) 305-41:6-4556 :: :: :: :: :: ebuckley ar terragroup.com LOBBYIST BUSINESS TELEPHONE NUMBER • CELLULAR TELEPHONE NUMBER II. PRINCIPAL Martin := David . NAME OF PRINCIPAL :: : (Last) (First): : (Middle Name) MB:Mixed Use.Investment, LLC 2665:S. Bayshore Drive Miami FL.: : 33133 : PRINCIPAL BUSINESS NAME AND ADDRESS .:(Number and Street) • (City) :: (State) :(Zip Code) 305-416-4556:: david(a�terragroup:c:om PRINCIPAL BUSINESS TELEPHONE NUMBER • CELLULAR TELEPHONE NUMBER EMAIL ADDRESS :: Pmatm Co 00 mon 2-4820iXIMOD' A pilincdo o cg eorporaalonD o din c [lp©oP mho 5ppeam 5§, krtzka EDGMIN ce tad ozgaoNi o0 0 compensation 00Pambu c IP 619 ea[ 11GKC@ GT dB 00P@D(1 ( C O o @!OoonOO OOH'000.o ©n . p- Pp== o : @Mild RGektLIT wPia ©Mh. difft2 l bsy autvaoililon Lxtt na biwukalo o a la on frtgato If:the principal is:-a Corporation, Partnership or Trust, the following information:M be provided : urspant to Cit Code Section 27482(C):: 1 • :NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): • See attached • NAME OF ALL PERSONS HOLDING:,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH : ir .. CORPORATION,PARTNERSHIP.OR TRUST(if none,:write N/A): .. A 1 . Page 1 of 5AI& , VE;.- • Ill. ISSUE TO BE LOBBIED:: • • . Describe with as much detail as is::practica.l.,-including.but not to.a specific description where. applicable of a:pending:request for proposal, invitation to bid, or public hearing number:: • . Development Approvals and,permitting issues, including but:not limited:to the.Design Review Board,:Planning:: Board,:Board of Adjustment, Historic:Preservation Boa.rd:, Land Use Development,City Commission, and:any any . j:: .City Workshops, Committees.or City Staff, if necessary, relation to the property:located iat:1901 Convention.. CenterDrive. :: ... .: . :.. . IV.:CITY AGENCIES/INDIVIDUA:LS 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 relationshipaid.or unpaid)::with. said City Commissioner:or City personnel from 1:2:months :preceding:such commencemento-:service with the City to the.present date,stating the:general nature-of-the subject contractual relationship. . :. ::: Contractual Relationshiy es, explain) YES:: • NO - F:ull:Name of:Individual and: Title:of Person to be p (If y p . :Lobbied . :Staff for the.Planning&Building Department,Public Works,::: None - • and City Administration,PB,:HPB BOA,DRB,City :. :: ::: None .. ::: '::. ..�::. .. ::. X Commission,:and Mayor as necessary: • - None • X. :Pursuant:to City::Code Section 2-4:82(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 ian impropriety, with any current City Commissioner:oe 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 rie if none-,write N/A ::N/A - • ::::: :: *: . DISCLOSE RATE AND:AMOUNT OF LOBBYIST COMPENSATION:- Be Specific.:(Note that:a contingency fee-is:prohibited pursuant to City Code:Sec. 2,4P5.3): •. • $0/Hour:.. Page:2of5 •- 9 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 X 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 XNo: Are you lobbying on a pending application fora 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--rofit 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 X 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:an 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 X 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 :followingthe swearing in of elected official(s) for-whom the campaign consultantprovided campaign consulting services. 9 any within the past.election cycle:See Section 2-491 for more information. .: .. Yes XNo: Haveyou 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 ommission::: Yes X No: If yes, hg it bee Ek mem 'd2 CdOd 41IOP'kP GlgoaGid © tElliO wiNCEE paDdd9d @empalkin : comaAlltinq agiMicies was @MOTE 6 ....). Pursuant to city Code Section 2-482(a)(4)a., a lobbYyist who:has within the past election:cycle proviOed 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 X No: you"provided youprovided 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 X No: If yes, wieag you pmEi gao 0 OT d6d yon ft @®iWP P@©i©ma@ comPEC;gatiOE M@RERCP gar muipaHon con@uEltiEci servi@Pe : TO.BE COMPLETED.BY CITY CLERK'S STAFF.ONLY •s N b • amu. i/ Annual Registration fee. [ ]Yes[ �No �Arn-o,u'nt Paid,$ MC,R;-#, ,,. - Date Paid Lobb/ist Registration Form received and'ven,ped b -:,,. _ ,,.. ,..�,, . : F:\CLER\SALLN .F94MSX:LOaBrIST FORMS..Lobb'.ist Re istration Form Revised 09.'20-18 REG...dm :. Revised 09/20/2018 , age.3 of 5 - VI.:: -SIGNATURES .UNDER OATH - ri. H -:- - -: :: ON FEBRUARY 28:O:F. 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:1 --- - - -- - Signature of Lobbyist. Date 7//9 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 i e iami peOCh City code an all-.reporting requirements:.:- : : Signature:of Lobbyist: - p.L A Date Cl"- 7 l �. . Signature of Principal: ... 7 -- ::.. :Date :... -/(--)--7/://: :: . : VII:: NOTARY:SIGNATURE AND.SEAL : - - -: -LOBBYIST:: PRINCIPAL . - • . . • • State of. rd .. State of Df-/ a• :- .. ... .. • • • •• ,,, •, • , , • , •• • • • • Di , I •• .h _i• • • • • . •• County of: :.14 / • :)D6( .,(2- :: •. County of: Highli JdL. Sworn to(or affirmed a subscribed before me Sworn t .(or:affirmed).and subscribed before:me . this.d'7day:of: rebizictnjd , 20 :by : this dj day of ,e .7/1' f7 ,-20L by .:: :::, f:.- •• (i)aitht. 14 tilm:L.-_,: : : : : i: : i:-: . I 1 en :A. 1,1& ,1 `/:.::. NAME OF.LOBBYIST . - - • . • NAME OF PRINCIPAL- - - Produced.ID_ Produced ID - FORM OF IDENTIFICATION FORM OF IDENTIFICATION Personally Known - .::: .:personally Known.:: : : :: -::. : .' --:, / : : s .: : -:: : :: : : .: ••,:fif • : •:: .• : ::: --: . :: : . : : :' fr. :7: . l::r .• ::::. 1::: ::Sign=tur.- :•f Notav Public -H. - : : : :: : ign: - of Notary *u lic .. . .ki" .. .. ... .. � � 6""RA ia 11tIi���i�rt44 : nt6,: 1111111, • 1/1 .� �1Q ii . :: - Name of Nota Typed,: •.,• .°� ed -: - - : Name of ota ,.T. ed -:: : .. rY� Yp .•. ... 0 .. • .. ... . .. .::��Co'•. ,�sSiON ��• �. : ::.. ::....: .:.:v0.�a3�'2O9oAe9' .:. .. . c 3O 2 eOi'.:: r. •. : :-N. �Q In• (NOTARY SEAL):. if :a •.. ; �,�-�_ . :: (NOTARY SEAL) ,:: 4.• 22 .:'�` rlc: : . • . • #FF.g�922 ... ... ... .. .. � ; 0.4%9"... ... ... ... ... • . *4.O�••. Bode.'fi`a�,��;'��'� ... ... ... .. .04:". 1:The term lobbyist"specificaf k , g persons: :: :: iii j�$LIC,SI P�o��� -. �� ��,1 ,� x,11 Illi . °°°/iiip eL1C S'�:,\'-`" `• 1.1111 -: Expert witnesses who provide only s iUHtl ! echnical: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 wh:o:-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 . theappearance.. ... .. . Page:4 of 5 ". " . : " IAMIBEACH :: City of Miami Beach,1:700 Convention Center Drive,Miami Beach, Florida 33139,www:miamibeachfl.gov Office of the City Clerk. •. RafCtel E.Grana o,City:Clerk :: ::CityClerk@miamibeachfl.gov Tel:305.673.741 1, Fax:305.673.7254 NAME Ellen Buckley .. 1) LOBBYIST FEE EXPENDITURE AND CO.MPENSATION STATEMENT Pursuantto:: ity Code Section 2-485(d), the:.:City Clerk shall:::notify any lobbyist (or-. • rinci al who fails to file timel a Lobbyist Fee Ex enditure and Com ensation Statement .. p p ):. . y Y p p (Statement). :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 :H due date.:The City Clerk shall notify:the Miami-Dade County Commission Hon Ethics and :Public.Trust of the failure of a lobbyist (or principal) to file the Statement orr 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 ":. : ". . :1'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) . nce an issue i.: ave registered:to o .y .::as concluded or am no:longer onger o. ying on that issue, I sball immediately flipa:Notice o:f Withdrawal with:the Office of the City Clerk. : . :3) ANNUAL:LOBBYIST:REOISTRATION :FEE : : : : understand:annual registration of all lobbyists shall be required for-each 12-month period. .commencing Octolppr 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. .": ."' ":01N- /7' .ig:nature:o : Lobbyist:: :. Date F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc : :: Page5of5 • • • .... . .... . ••• ••• "" •" "• "• .====.... ...,...... .... . . -.. . .. . ... • • • . - -• . .. EXHIBIT • ••: • ••• ... ••• .. ... •. .-• . , .- -.- ... ... .. .. ... .. ••_ . ... ... ••• .•• ... ... ••• •• ... .. .... . -••- - .... . .... . . , --.- . • . . .. . . .. . . .. . . .. . . .. . . .. . ... • • - . ... . ... . ... ... ... . ••-, ... . "• ... ... •• •-- ... .. ... .. ... .. ... .. ... .. ... .. ... •• ••• . . . ••• ••• ... .. ••• :•: ... ... .... . ... .. ... ... .... . ..: ... .... . .. . .... . •••• • • . • • . • . ... . . . .. • . -• . . .. . ... .. ...... „ . ......,.... , . .. .... . • ••• ••- ••• :,i1,-.F.B.....w.tix.ip.:iit..N1,-;,.E.q.I.4EN-.11'0A,,,,t •:•-•..• •- ••• •- ••- .. ... 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MP_141Xl:0-kla Ell ESTE N1i1 4•!S 6 j I4C1 •- PRINCIPALS OF TURNBERRY MEMBER OF MB MIXED USE INVESTMENT HOLDINGS LLC *Members are(I)Jacquelyn Soffer and/or trusts,partnerships or other entities for estate planning purposes of Jacquelyn Soffer Jacquelyn . ry leers* (collectively,"Jackie Soffer"),(ii)one or more of the following Soifer.e relatives of Jacquelyn Soffer;:(x)Rock Soffer,(y)Max Rappaport, and(a)Brooke Soffer,and/or(iii)senior employees of Turnberry _ Associates;provided that(1)Jackie Soffer shall own at least five ... percent (5%) of TB .. Investment � indi •dual will directly or i •dirrectly own more than thirty (2)percent Equity I i�►manager 1003� (30%)of TB M13CC Hotel Investment LI.C. . . TB MBCC HOTEL INVESTIVIENTILC 1 MB MIXED USE INVESTMENT I HOLDINGS MEMBER,LLC , (F 6/6 18) • >:_ f . .. {� 50%Member lf' MB MIXED USE INVESTMENT HOLDINGS,LLC (FL—S/30/18) rr , -',1:::... ' . ..-:,A f r•, - 1 MiscellaneousCashReceipt -.1 t F.::::::s. ciw OF MIAMI BEACH :,....1 t ,:,.. 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INFORMATION ION UST BE COMPLETED) Office of Finance Director ::,,i',,,1 B .. 4y1 i[ir.: . countNumber: (- /y ` ..73(:),:7:,::..) i I''- 468 S y ✓” 0 1;!'"'-'7_ d« ".ek75.:',',.::-.'i n7 ._" rkr": t '. i r :.. ,k ..1 ,-..-,:--- : r : 4" .- Nr . :) r.,..-...-Preiparer: `u,;,,tyT .P= S r i ., q s yEi ni. Dept r 'orr F #y.,. . 1 Fm