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Monika Entin - 2925 Indian Creek Dr., LLC 9 2S- 1 VIOL , •cit ) tir` ; :A: V 1 . E C ' RECEIVED Office of the City Clerk 1700 Convention:Center Drive FEB 11 2020 Miami Beach, FL 33139 305.673.7411 CITY OF MIAMI BEACH LOBBYIST REGISTRATION FORM OFFICE OF THE CITY CLERK . Lobbyist meansall 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 anycommissioner;'•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. Pleaserefer 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. If youneed more space to corriplete 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/e" 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 throughoutthe: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.&Tapanes, PLLC,200 South Biscayne Boulevard,Suite 850, Miami, FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS ' • ' (Number and:Street). (City): (State)'. ' : '(Zip Code) 305-377-0237 305542-3445 MEritin@BRZoningLaw.com : LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONENUMBER EMAIL ADDRESS II: PRINCIPAL INFORMATION: Bird • Joshua , NAME OF PRINCIPAL . . •(Last)' . (First) '. .•(Middle Name) ' 2925 Indian,Creek Dr., LLC 301.N. Canon Drive, Suite 305 Beverly Hills. CA . 90210 •PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) :(City) (State) (Zip Code) 424=291-5867 . joshua.hird@hawkinsway.:com PRINCIPAL•.BUSINESS TELEPHONE NUMBER' ' CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Purr's ant to City Code StEtion 2v482(h)(1<)(a): A principal of am corporation, partnerhip,ce other entity who appears a3 a lobbyist CE behalf of that. entity special compensation topes for Mg appearance vagagrtfliga indirect cp contingent,ro e a e . ico o•volition to: an item shall register with the Clerk as required by this subsection but shall not be required to'ay any registration fees.. . If:the principal is a .Corporation, Partnership or Trus_t,:the following information. MUST be provided pursuant'to City Code Section 2-482(c): e c 1 • NAME OF CHIEF'OFFICER:.PORTPJ P nR BENEFICIARY(if none,write N/A): `fie A4 , j, 'd- • 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 • III. ISSUE.TO B.E 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,.orpublic:hearing number: Development approvals and permitting issues, including, but not limited to the Historic Preservation Board, Design Review Board; Planning:Board, Board of AdjUstment Land;Use and Sustainability Committee, City:Commission, any City Workshops.or Committees, and City Departments, if necessary relating to the propertylocated at 2925 Indian Creek Drive, 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 tothepresent 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 Department, Building Department . .None. X Public Works, and City Afrninistration,PB,:HPB, BOA None: :X DRB, City Commission,.and Mayor as necessary. None.. X, Pursuant to. City Code Section 2-482(g); everyregistrant'shall: berequired:to state the extent of any : business, financial, familial: orprofessional. relationship;. or :other relationship :giving rise' ,to an' appearance of an impropriety, with any current City Commissioner or City personnel who is sought to r 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 NIA): : • : : : : None. • :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): :$525.00 per hour. 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 r of "lobbyist" as set forth in Section 2-481)Who only appears as a representative of a not-for-profitcorporation.o(entity without special compensation, or reimbursement for:the appearance;whether direct orindirect to.express support or opposition tb any item,shall register with the city clerkas required by this section, but shall not be required to pay any.registration fees. Yes'XNo:. Areyou representinga 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 ortestimony in publicmeetings;•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:onlyappears 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 XNo: Have you provided campaign consulting:services to an'incumbent member of the:City Commission . within the past election cycle?If yes, please:listthe incumbent member(s)of the City Commission: Yet No: :If yes, has it been less than 12 months since the elected official(s) whom you provided campaign consulting sei vices was sworn inr 6) Pursuant to City.Code.Section 2-482(a)(4)a., a lobbyist who has withinthe past:election cycle provided campaignconsulting services to an:incumbent member,of the City Commission (whichlobbying 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 pastelection.cycle?If yes;please list the incumbent member(s)of the City Commission: • • Yes NO: If es were .ou .romised or did .ou receive economic consideration in exchan o e for cam o ai • consulting ser .icesr. . • • • TO BE COMPLETED BY CITY CLERK'S STAFF.ONLAY. Annual Registration fee: [ ]Yes{E1 No Amount Paid$ 35 '-1/4-, MCR# -[j.S 1 A i Date Paid /' (( ' Lobbyist Registration Form received((and verified by: _r .) )=i-LrviVt-Ot'LC • ;1C.I.F?VLL\aur'i}W5,y+ n,Z't3ST FORMS\Lobbyist Registration Form Revd 0-24-18 FIEG,doc Revised 09/20/2018 Page 3'of5 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-) I do solemnly swear.or'affirm that all.of the foregoing ac s., statements; and disclosures.in..this form are.true and.correct,. . and that I have read or:am familiar with the provisio_o.s contained in Chapter 2; Art, VII, Division 3, entitled "Lobbyists" of the.Miami Beach City'Code.and all reportin• re uirements: • / Signature.of.Lobbyist:: •• ,. . : Date: / d/- • Signature of Principal: Date 21 /2ozo VII: ' NOTARY SIGNATURE AND SEAL: LOBBYIST:: PRINCIPAL State of Florida . State of .�� �,� . • County of: Miami-Dade County of:.:Z,ZJS Sworn to(or affirmed)and subscribed before me . Sworn to (or aft •-d)and subscribed before me this day of February ,.20 20 by this /v day of i 202-4 by Monika Entin Joshua'Bird NAME OF LOBBYIST NAME OF PRINCIPAL • Produced'ID. Produced.ID:, FORM.OF IDENTIFICATION FORM OF IDENTIFICATION X 1�ersonally Known //irsonally:Known40I/ 9* .. v ' •. fal; Notary Public . •n-ture of Notary PUblic : , . . Ll Ik AL 4 L( . Name ofNotary;'_.yped,Printed or Sttaa •1eCdp_C�11� Name of Notary,_Typed, Printed or Stamped n--YAketa% SION#.GG 17599(NOTARY SEAL) s:March5,2022 (NOTARY SEAL)Publiclinden/ders : .!'"'' T.CONNERS >t,uY •.� _n-< COMM.#. 2297268• �''�� ° ' ' NOTARY PUBLIC-CALIFORNIA LOS ANGELES'COUNTY I,The term"lobbyist"specifically excludes the following persons: y Comm.Expires JULY 18,2023 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 supportof 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.. P f age 4'0 5 • MIAMI EAC l City;of Miami:Beach,:1700 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: . 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 b:e imposed as provided :Section,2-485:1; a.fine of°$50:00 a. day shall.beassessed. 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,suspende.d from: lobbying until all fines•are paid; unless:the fine has been • appealed to the Miami-Dade°County Commission on.Ethics and Public Trust: hereby acknowledge that:on February 28of'each year,. l•shall.submit to the City Clerk a • signed Statement under oath listing all lobbyist.expenditures, as well as compensation.• received, for thepreceding.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 I. °Leachyear, and the feefor such. annual registration shall .be - $500:00 pursuant to".Section 2-482 of the.Miami.Beach City Code. J • February 1,.I , 2020 Signature of Lobbyist Date • • • :F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc • • 'Page 5of5 Live &Learn Urban Fund LLC FCL Partners,LLC Real.Estate.Fund . Real Estate Fund 50%, . . Live &Learn Urban Fund.JV,LLC 100% 2925 Indian Creek ve,:LLC Fee owner . . . 100% rOf PLTLC7 .Q u Q �� v{ ,.,r 6 � Drive, "AY j q- 2925 INDIAN CREEK DR,LLC 301 N.Canon Drive, Suite 305 Beverly I-Tills,California 90210 February 5,2020 City of Miami Re: 2925 Indian Creek Dr,LLC—Material Members Ladies and Gentlemen: We understand, in connection with the corporate disclosure for 2925 Indian Creek Dr, LLC (the "Company"),that the City of Miami has requested certain information on any individuals who own more than a 5%direct or indirect interest in the Company. In response to such request, this letter serves as confirmation that only the following individuals own a 5%or greater indirect interest in the Company: Name and,Address Percentage Interest Peggy Cherng 12.4% 1120 N Town Center Drive, Suite 150 Las Vegas,NV 89144 Andrew Chemg 12.4% 1120 N Town Center Drive, Suite 150 Las Vegas,NV 89144 Karan Suri 5% 10727 Wilshire Blvd,Suite 306 Los Angeles,CA 90024 Ross Walker 5% 170 Ashdale Avenue Los Angeles,CA 90049 Please let me know if you have any questions. Si cere/ Jc7tli a Bird,Esq. General Counsel for 2925 Indian Creek Dr,LLC cc: Monica Entin,Esq. Salvatore, Jason From: Monika Entin <mentin@brzoninglaw.com> Sent: Tuesday, February 11, 2020 2:12 PM To: Salvatore,Jason Cc: Betty LLerena;Camm, Patrick; Kallergis, Nick Subject: Re: HPB19-0368, 2925 Indian Creek- Disclosure of Interest [THIS MESSAGE COMES FROM AN EXTERNAL EMAIL-USE CAUTION WHEN REPLYING AND OPENING LINKS OR ATTACHMENTS] Of course,whatever we need to do to disclose. Sorry this one has been so complicated. Sent from my iPhone On Feb 11,2020,at 2:10 PM,Salvatore,Jason<JasonSalvatore@miamibeachfl.gov>wrote: Hi Monika, I understand he's an authorized signer, but the Code asks for disclosure of chief officer, partner,or beneficiary to be disclosed along with the 5%ownership interest. With your permission, I can list the owner disclosed in the attachment as the partners of the LLC, but I need your authorization to do so. Thank you, <image001.jpg> Jason Salvatore - Office Associate Ill Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411 www.miamibeachfl.Rov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. From: Monika Entin<mentin@brzoninglaw.com> Sent:Tuesday, February 11, 2020 1:58 PM To:Salvatore,Jason<JasonSalvatore@miamibeachfl.gov> Cc: Betty LLerena<BLLerena@brzoninglaw.com>; Camm, Patrick<PatrickCamm@miamibeachfl.gov>; Kallergis, Nick<NickKallergis@miamibeachfl.gov> Subject: Re: HPB19-0368, 2925 Indian Creek-Disclosure of Interest [THIS MESSAGE COMES FROM AN EXTERNAL EMAIL-USE CAUTION WHEN REPLYING AND OPENING LINKS OR ATTACHMENTS] He is the authorized signatory for the funds. Sent from my iPhone On Feb 11, 2020, at 1:51 PM,Salvatore,Jason<JasonSalvatore@miamibeachfl.gov> wrote: Good afternoon Betty, Josh Bird is listed as the authorized signer of the chief officer, partner, or beneficiary, however I do not see his name listed in the Florida Division of Corporations or on the ownership disclosure. The City Code Sec. 2-482(c)specifically asks for a chief officer, partner,or beneficiary, not an authorized signer. Please confirm the name(s)you wish to be listed as chief officer, partner, or beneficiary of 2925 Indian Creek Dr., LLC. Thank you, <image001.jpg> Jason Salvatore - Office Associate Ill Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Tel:305-673-7411 www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community. From: Betty LLerena<BLLerena@brzoninglaw.com> Sent:Tuesday, February 11, 2020 1:23 PM To:Salvatore,Jason<JasonSalvatore@miamibeachfl.gov>; Camm, Patrick <PatrickCamm@miamibeachfl.gov> Cc: Monika Entin<mentin@brzoninglaw.com> Subject: FW: HPB19-0368, 2925 Indian Creek- Disclosure of Interest Importance: High [THIS MESSAGE COMES FROM AN EXTERNAL EMAIL-USE CAUTION WHEN REPLYING AND OPENING LINKS OR ATTACHMENTS] Good afternoon Jason and Patrick. Please see the email from Nick Kallergis below approving the disclosure for the captioned matter. Best Regards, Betty Llerena Florida Registered Paralegal 2 Bercow Radell Fernandez Larkin &Tapanes 200 S. Biscayne Boulevard, Suite 850, Miami, FL 33131 bllerena@brzoninglaw.com I www.brzoninglaw.com 0:(786)363 2762 I F: (305)377 6222 <image003.jpg> The information contained in this electronic message is privileged and confidential and is intended only for the use of the individual named above and others who have been specifically authorized to receive it.If the recipient is not the intended recipient,you are hereby notified that any dissemination,distribution or duplication of the communication is strictly prohibited.If you have received this communication in error,or if any problems occur with transmission,please immediately notify us by telephone(305)374-5300. From: Monika Entin<mentin@brzoninglaw.com> Sent:Tuesday, February 11, 2020 1:17 PM To: Betty LLerena <BLLerena@brzoninglaw.com> Subject: Fwd: HPB19-0368, 2925 Indian Creek-Disclosure of Interest Sent from my iPhone Begin forwarded message: From: "Kallergis, Nick"<NickKallergis@miamibeachfl.gov> Date: February 10, 2020 at 9:50:42 PM EST To: Monika Entin<mentin@brzoningIaw.com> Cc: "Nunez,Victor" <VictorNunez@miamibeachfl.gov> Subject: Re: HPB19-0368,2925 Indian Creek-Disclosure.of Interest Thanks, Monika.That works for me. Nick Kallergis First Assistant City Attorney City of Miami Beach 1700 Convention Center Drive,4th Floor, Miami Beach, FL 33139 Tel: (305) 673-7470/nickkallergis@miamibeachfl.gov On Feb 10, 2020, at 8:36 PM, Monika Entin <mentin@brzoninglaw.com>wrote: [THIS MESSAGE COMES FROM AN EXTERNAL EMAIL-USE CAUTION WHEN REPLYING AND OPENING LINKS OR ATTACHMENTS] Correct. That is what has been represented to me. Sent from my iPhone On Feb 10,2020, at 4:49 PM, Kallergis, Nick <NickKallergis@miamibeachfl.gov>wrote: 3 Thanks! So,just to be clear,there are no individuals who (1) hold an interest in Live& Learn,AND(2)also hold a 5% or greater interest in 2925 Indian Creek Dr LLC? Nick Kallergis First Assistant City Attorney City of Miami Beach 1700 Convention Center Drive,4th Floor, Miami Beach, FL 33139 Tel: (305) 673-7470/nickkallergis@miamibeachfl.gov On Feb 10,2020, at 3:52 PM, Monika Entin<mentin@brzoninglaw.com> wrote: [THIS MESSAGE COMES FROM AN EXTERNAL EMAIL- USE CAUTION WHEN REPLYING AND OPENING LINKS OR ATTACHMENTS] Hi Nick, Per my client,the individuals listed in the letter have ownership interests in FCL Partners, LLC.Also,they re- confirmed and noted that there was actually an error in the letter. Each, Ross Walker and Karan Suri,only have a 2.5% interest in the fund. Thank you for your help. Regards, Monika Monika H. Entin Bercow Radell Fernandez Larkin &Tapanes 200 S.Biscayne Boulevard, Suite 850, Miami, FL 33131 mentin@brzoninglaw.com I www.brzoninglaw.com 0:(305)377 6237 I c:(305)542 3445 I F: (305)377 6222 Download vCard I View Biography L. L<imageo03.jpg> The information contained in this electronic message is privileged and confidential and is intended only for the use of the individual named above and others who have been specifically authorized to receive it.If the recipient is not the intended recipient,you are hereby notified that any dissemination,distribution or duplication of the communication is strictly prohibited.If you have received this communication in error,or if any problems occur with transmission,please immediately notify us by telephone(305) 374-5300. 4 From: Kallergis, Nick<NickKallergis@miamibeachfl.gov> Sent: Monday, February 10, 2020 3:14 PM To: Monika Entin<mentin@brzoninglaw.com> Cc: Nunez,Victor<VictorNunez@miamibeachfl.gov> Subject: FW: HPB19-0368, 2925 Indian Creek- Disclosure of Interest Hi Monika, Does the attached list include any and all natural persons who hold an interest in either Live& Learn Urban Fund LLC or FCL Partners, LLC? Nick From: Monika Entin<mentin@brzoninglaw.com> Sent:Thursday, February 6, 2020 4:23 PM To: Kallergis, Nick<NickKallergis@miamibeachfl.gov> Cc: Nunez,Victor<VictorNunez@miamibeachfl.gov> Subject: Re: HPB19-0368, 2925 Indian Creek-Disclosure of Interest [THIS MESSAGE COMES FROM AN EXTERNAL EMAIL- USE CAUTION WHEN REPLYING AND OPENING LINKS OR ATTACHMENTS] Hi Nick, My client went back and determined that there are a handful of natural persons with more than 5% ownership. Please let me know if the attached disclosure satisfies the requirement. Thanks for all of your help. Regards, Monika 5 ',. - :,° ..,,,,.2,''i. ,- -& ,. ,Z,',,' ,,, -:,- -, ,--'' „,--,- '• -:-. .„ , ,_ ,-' ,',-- _-' '--.6 c 1 2 , 1 MBF ,,,,,,„ ' 61 . -c ,...-•,,,,,,-, _. • ,'. - 1 y°,, , -az ,- kz,,, s ,, A„ > ; City Hall ., 0, , : Ji .,„.-a, . :+),s. th; - ., Tr.4-.4 - 1 1700 Convention Center Dr. ''-- '' -:z °) --: Miami Beach , FL 33139 305 _•-`.-::.2%°,, .-5D- -- x • • - S ,- ...., I 004323-0055 Maria A. 02/11/2020 01:18PM .' .-1 -: t----,, a ,,,,,- il - . , „: 0,v, ,,,1 ,. y: , 1/4-7., c - - - --,,11----. ,,. ----,: ' a:, MISCELLANEOUS - - -, t.: 4 , . _-:Es .....: ;;-4 , Description: MCR OPEN ,,. • s ). 03 ,IN', ''"•,. '41 ,— ' „ '--"N, Ill ' 1 (MCR) ., ' Reference 1 : 425715 , - ..,-,, 0 NCR OPEN (MCR) , k....,:, c 2020 Item r ,13-., _ ' - -17!" - ) : NCR 1 @ 700.00 ..,,,,, ' , ' F; -m '- , - ,' ''2 NCR OPEN (MCR) 700.00 700.00 . - ' • (Z;'.,- , , ,S.'s* :°. 1- - 1 ' - -• 1 _ Subtotal .. , 700.00 • • - 1 Total 700.00 , , .. , - - . „ - • p-' CHECK 70000. Check Number000115 . Change due 0 00 -4- - - ' ' . ....:- , , :,-g -, - - -- N.:2) Paid by: 2925 INDIAN CREEK 11111111111111111111111111111111111111111111111111 5 CA 1 Thank you for your payment . . . , CUSTOMER COPY . ..