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Alyssa Kriplen - Jamestown Premier 755 Washington LLC -7 143 / 15 S W A4.,,,5i , AAI/ \I h I B EAC RECEIVED AA� Office of the City Clerk 1700 Convention Center Drive SEP 09 2019 Miami Beach, FL 33139 305.673.7411 LOBBYIST REGISTRATION FORM CITY OF MIAMI BEACH hFFIC;l=(1F THE CITY CLERK 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: Kriplen Alyssa NAME OF LOBBYIST (Last) (First) (Middle Name) 2455 SW 27th Avenue Miami Florida 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: Bohn Frances NAME OF PRINCIPAL (Last) (First) (Middle Name) Jamestown Premier 755 Washington LLC 675 Ponce de Leon Ave,NE 7th Floor Atlanta GA 30308 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to City Code Section 2-482(h)(1)(a): A principal of any corporation, partnership, or other entity who appears as a lobbyist on behalf of that entity,without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to express support of or opposition to an 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): Frances Bohn • 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 Exhibit "B" 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. Renovation of the exterior facade of the 743 Washington Avenue Building(part of 755 Washington Ave.)including removal of tiles and new opening.Removing old renovation. 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 Mayor & Commission x City Manager and all City Staff x Planning Department and Staff x Parking Department and Staff 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): N/A V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a contingency f e is prohibited pursuant to City Code Sec. 2-485.3): fi age . 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": _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. _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. _Yes X 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 X 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 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 promised or did you receive economic consideration in exchange for campaign consulting services? TO BE COMPLETED BY CITY CLERK'S STAFF ONLY y� �i Annual Registration fee: [ )Yes[' No Amount Paid$ 35"'nom MCR# `21 3 D b Date Paid a 7-©'/- /t) Lobbyist Registration Form received and verified by: -PrePA) SAL r&l.!Z F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 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 E GAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR CO NSATION DURING THE REPORTING PERIOD.' Signature of Lobbyist: Date q.--1 4 - / 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 -miliar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Cod: :'d all reporting requirement C� C� 1 Signature of Lobbyist: Alci, Date / _ 1 — 9 9 Y - , Signature of Principal: /pA:� Date 9 9 J 1 1 -4-0,,-- •VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of Florida County of: Miami-Dade County of: Miami-Dade Sworn to (or affirmed) and subscribed before me Sworn to(or affirmed) and subscribed before me this day of , 20_, by this day of , 20_, by Alyssa Kriplen Frances Bohn NAMES F LOBBYIST NAME,MEOF PRINCIPAL Produced ID 1 c` L ' Produced ID 6/-- p L- FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Known _Personally Known Si ture of Notary Public . nature of Notary Public _]/T(-)-'J v. 3z.c:e -_\9Sa,v S/44-4/ ' Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped ,•'�7°Z.. JASON SALVATORE (NOTARY "= MY COMMISSION#GG 030527 (NOTARY SEA I ;Ute '• JASON E " ar; ':' MY COMMISSION#GG 030527 .�•�,: EXPIRES:September 14,2020 c► %,-;;,;.: E; t°� Bonded Thru Notary Public Underwriters `:±F!��P EXPIRES:September 14,2020 '•4,`,. ' Bonded TIhru NotaryPublic Underwriters 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 M AMIBEACH City of Miami Beach, I/00 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov Tel:305.673.741 1, Fax:305.673.7254 NAME OF LOBBYIST: Alyssa Kriplen, RA 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. c1- 9 - 11 Si. .. ur of Lobbyist Date F\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page 5 of 5 EXHIBIT'13" JAMESTOWN Premier Property Fund 755 Washington 6/2012019 Public and Private Penalon Funds 80%,of which throe pubic pentons hinds(Kansas Public Enlpioyeos Retirement System Mtth 6.65%,New Medco Mato Inwatmcnt Council with 6.89%and the CcrLUler or tho State of Now York o s Trustee of the Coffman Rattromcnl Fend v411113.33%)ore morn than 5% Foundattons7Endowmants 4.3% ILO Nat Worth IrdMQucb 1.2% Eoonamk 0avatopnunt Fonda 2.3% Smerslcn Wealth Fumes 1.2% Fwd of Funds 1.8% JPPF Co-Investment LP. JPPF Management Co-Investment.L.P. a Dolavrarollmltad partnership a Delaware larded partnerohlp EIN;45-3830526 ESN:453833558 08.6% 2.7% 0.7% JAMESTOWN Premlor Property Fund,LP. JAMESTOWN Premier Properly Fund a Delaware Iimitod pannerehlp (Damian Feeder),LP. EIN:45-3263193 a Delaware limited par nerohip EIN:46.1827117 98.62% 3.38% JPPF REIT,IrtC JAMESTOWN Premier Property Fund a Delaware corporation (OP Feed*,LP. EIN:45-3951638 a Delaware Merited partnership EIN:48-1815621 98.316 LP 1.7% LP JPPF Operating Pa tnenhlp,L.P. a Delaware limited partnership EIN:46.1062874 100% JPPF TRS Holdings,LLC a Delaware limited Ilahllly company EIN:47.4890412 i 100% I Jamestown Preneer755 Washington Avenue.LLC a Delaware Raked liability company EIN:47.5522592 Miscellaneous Cash Receipt CITY OF MIAMI BEACH No. 424380 El Cash InCredit Card 0 Check# $ 20 Rived of A ),153-.-, if ,' Miscellaneous-MCR-201-9 f9-2 m AMEMIC104 6SWAr • 2 tAl FROPEN(MCR) / t4 4-q3/7 55 Payment Amount: 350.00 424380 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By tic Account Number: Preparer: Dept: EXT: •