Ian Bacheikov - PT OPCO, LLC d/b/a Pink Taco /loo
RECEIVED
FEB 2 7 2020
Office of the City Clerk
1700 Convention Center Drive CITY OF MIAMI BEACH
Miami Beach, FL 33139 OFFICE OF THE CITY CLERK
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 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:
Bacheikov Ian
NAME OF LOBBYIST (Last) (First) (Middle Name)
Akerman LLP 98 SE 7th Street, Suite 1100 Miami FL 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-982-5669 305-528-9395 ian.bacheikov@akerman.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
NAME OF PRINCIPAL ( st) (First) �v O (Middle Name)
PT OPCO;LLC d/b/a Pink Taco 5660 Katella Avenue, Suite 200 Cypress California 90630
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
562-346-1200 mike.alasaad@xperiencerg.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
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): Randy Sharpe-Chief Officer
• 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
a
•
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.
Application CUP at 1200 Ocean Drive to add outdoor/open-air entertainment to existing restaurant/bar/entertainment
establishment.
•
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
Planning Board(Public Hearing) X
•
Planning Staff(Meetings) 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 fee is prohibited pursuant to City Code Sec. 2-485.3):
$495.00 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 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 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 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 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
Annual Registration fee: [M Yes[ ]No Amount Paid$ =VC) MCR# .1,1 Z J J, Date Paid ' 01.71-Vi0
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc Revised 01/01/2018
Page3of5
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 COMPEN TION DU ING THE REPORTING PERIOD.'-
Signature of Lobbyist: Date 2—/2--C.
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 an• -.II reportin•Ir:quirements.
Signature of Lobbyist: Date 2-l 2-112,01.-0
Signature of Principaate 2- /2-o/2,0
1 o
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of for J State of
County of: LAI dl h..i - Da.� County of:
Sworn to_(or affirmed) and subscribed before me Sworn to (or affirmed) and subscribed before me
this ZA day of relr y , 2020 by this_day of , 20_, by
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
tPerson-lly Known _Personally Known
I Ii C-
Signature of Notary-;ublic 40 Signature of Notary Public
/Oar i o. anza e.Z
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
rooar Poe�,c MARIA GONZALEZ
(NOTARY SEAL) * * Commission#GG 348492 (NOTARY SEAL)
1'4'
`�I!'. cr Expires October 22,2023
�i op g, Bonded Tin Budget Notary Services
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 requestinga grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
CALIFORNIA.JURAT WITH AFFIANT'STATEMENT - GOVERNMENT CODE§8202
..ilir •.�•_.asp:. �a1...ah-..r/.�N.3Ca- .�i�"se�•.• , �6,K:-'•�cl.�c.aa!f:,!a•:
fri See Attached Document(Notary to,eross out lines.l-6:below)
I 1 See,Statement Below(Lines 1-6 to be completed only;by document signer[s], not Notary)
Signature.of Document Signer No. 1 Signature`of.Document Signer No. 2 (i f an
A notary public or other officer completing this certificate verifies only the identity of the.individual who signed the
document to which this'certificate is:attached,and not the truthfulness,accuracy,or validityof that document.
State of California. Subscribed and sworn to (or affirmed) before me
County of dOLi2/. .
on this day of., -e-/bY rJ 20.E
by Date Month Year
(and (2) ),
Name(s)of Signer(s)
STACIE A.MORN proved to me on the basis, of Satisfactory evidence
Notary Public-California to .be the per.,g j_). who appeared. before: me.
•+,.. Orange County - �'
"Fi.• ` Commission p 2273574
° My Comm.Exprres Dec 30,1022 •
- I
Signature
Signature of Notary Public
Seal
Place Notary.Seal Above
OPTIONAL
Though this,section is optional, completing this'information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document:
Description of Attached.Document
Title or Type of Document: 1b9rj i sf R61• T v- Document Date:. .61
Number of Pages: Signer(s)Other Than Named Above. Y2.01,1
G<•s,• ,•..:ti',�s•a ',a;a�aA•!Av..�✓.•.� A�;ava .. a•,�ea a.'u••rr0..�4eev�.-y• a a•:•..ee '•0. 'zA�G.<?C. • '
02014 National Notary Association •'www.NationalNotary.org• 1-800-US NOTARY(1-800-876-6827) Item#5910
MAMBEACH
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: Ian Bacheikov, Esq.
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.
I1
-!
Signature of Lob syist Date
•
F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc
Page 5 of 5
OWNERSHIP DISCLOSURE AFFIDAVIT
STATE OF FLORIDA )
)ss:
COUNTY OF PALM BEACH )
Before me, the undersigned authority, this day personally appeared James J. Zenni, Jr.,
Manager of PT Opco, LLC, and President and Chief Executive Officer of Z Capital Group, LLC
and Z Capital Partners, LLC, member of Z Capital Partners UGP, L.L.C.,Z Capital Partners GP
II, L.P., the General Partner of Z Capital Partners II-A, LP, Z Capital Partners II-B, LP, and Z
Capital Partners II,LP("Affiant"),who being by me first duly sworn,upon oath,deposes and says:
I. That I am the Manager of PT Opco, LLC ("Pink Taco"), the applicant submitting the
accompanying application for a public hearing before the City's Planning Board("PB")as
required by the City of Miami Beach's ("City") Land Development Regulations for the
Conditional Use Permit to be issued under PB File No. PZ20-0345 affecting the real
property located in the City described in the aforesaid application made a part hereof.
2. That Pink Taco is a wholly owned subsidiary of PT Holdings, LLC ("PT Holdings"), the
ownership interests of which are held in limited partnerships managed by Affiant wherein
no one natural person holds more than a total of Five (5%) Percent of the ownership
interests in the applicant entity.
3. That the facts stated in this Affidavit, and represented in the application and documents
submitted in conjunction with this Affidavit,are true and correct,to the best of the Affiant's
knowledge, information and belief.
Further Affiant sayeth not.
...21■/2
—Ia.. •
Manager o '' g••• C
President of Z Cadita roup, LLC and Z Capital
Partners, LLC
Authorized Signatory of Z Capital Partners UGP,
L.L.C. and Z Capital Partners GP II, L.P., on behalf
of Z Capital Partners II-A, LP,Z Capital Partners II-
B,LP and Z Capital Partners II, LP
The foregoing instrument was sworn and subscribed before me this 5'day of February,
2020, by James J. Zenni, Jr., Manager of PT Opco, LLC, and Authorized Representative of Z
Capital Group,who produced Florida Driver's License Z500-450-55-022-0 as identification.
ARPA ` f
GINAMARIE SC �� I
Notary Public,State of New York
•/
N `P`ub ie
< ' i ii . No.02SC6271033
Not,ry
'AV 4f.' in New York County
4 ^,� � Commission Ex•fires Oct.29,20 4 ,
7 70 7 ea 4,w
Miscellaneous.Cash Receipt ..
CITY OF MIAMI BEACH 5,
425737
N
_4 .
-Cash ❑Credit Card (Check# `I I : $
Rived of t rbc .
Miscellaneous MAGR- .: c• iA2020 , �.. rr ^� V
r* : , : o ' I M 1.-, .r '1
1 F R OPEN•(MCRy- f i .nc<.s, 7 .f �,d`t�( •. -1-71.70 "r'? 'r '
,
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
Account Number. 1 1'1
N C V
( De t. :, - EXT: 1 1,
Prgaparer:� � � ,. �-r�� f. p