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Kobi Karp - Winpol 2020 Trust 6alia, Kit" 15,7 I i i AM ®I BEA H Office of the City Clerk 1700 Convention Center Drive AUG 2020 Miami Beach, FL 33139 305.673.7411 CITY OF MIAMI BEACH OFFICE OF THE CiT`t CLERK 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 "Lobbyist" 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: Karp Kobi NAME OF LOBBYIST (Last) (First) (Middle Name) Kobi Karp Architecture& Interior Design Inc 2915 Biscayne Blvd.#200 Miami, Florida 33137 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)573-1818 kobikarp@kobikarp.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: NAME OF PRINCIPAL (Last) (First) (Middle Name) Winpol 2020 Trust 60 Aray Cresent Toronto Ontario _ Canada M2L 1C7 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (416)483-3409 (561)270-9162 andy@premiumgroup.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS ursuant 4]Gity Code Se'stion 2'4820)01(5): A principal of giv corporation,partne ship,GB other entity who appears m O 156tbyist m behalf of that -ntity,without special compensation ai reimbursement ittMIG appearance, indirect,€p contingent,ODMAGEgi •.• •u t17 0•position to an l l iRG m re.uired l VUI subsection L f3dD p l re.uired t (,fJYew re.istration 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): Andrew Pollack • , 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): Andrew Pollack,Trustee and 100%beneficiary 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. Development Approvals&Permitting Issues, including but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Department, City Commission, and any City Workshop or Committees, if necessary, relating to the property located at 5242 North Bay Road in 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 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 Staff for the Planning&Building Department None X Public Work&City Administration, PB, HPB, BOA None X DRB, City Commission, and Mayor as necessary None 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): 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): 3 6OItv . 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": —YesX_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 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: _YesX 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. —YesX_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: YesX No: If yes, were you promised or did you receive economic consideration in exchange for campaiq co"n's'uTltin'Tseruices?1 --� —�— �— TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ar *� Annual Registration fee: i�jYes[V No Amount Paid$e5 .(""c) MCR# o 4 Date Paid (: ` Lobbyist Registration Form received and verified by: s.) .a.i1/4-) ,i-1r•A F.\C URN ALL\aFORMS\Lgcs'ISr F0RMS\L bbyist Registration Form Revised 03-11-20 REG,doc Revised 03/11/2020 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 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 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 and all reporting requirements. Signature of Lobbyist: Date Signature of Principal: !� ,, Date 241 ' - ± 6, 6-0 VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL rrod State of Florida mate of On472 v;'0 ii e� County of: Miami-Dade nun of: �oronri-0 Sworn to (or affirmed) and subscribed before me, Sworn to (or affi med) and subscribed before me, by means of 0 physical presence by means of Ihysical presence or❑ online notarization, or 0 online notarization, this day of , 20_, by this CtI^ day of A N ,� - , 202-0, by Kobi Karp Andrew Pollack NAME OF LOBBYIST NAME/ OF PRINCIPAL t/ _Produced ID Produced ID jv-i C%f L�cchc� FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Known _Personal) own Signature of Notary Public Signature of Notary Public ,Iho-1— cs 670-91M4 Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped (NOTARY SEAL) (NOTARY SEAL) 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 a's a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensatioh or reimbursement for the appearance. Page 4 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 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 g)13/2c2 Zb I do solemnly swear or affirm that all of the • -going facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with •- : _ ' ions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all rep••••• -quir:ments. J Signature of Lobbyist: Date g/131 Zp2c2 Signature of Principal: / Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of County of: Miami-Dade County of: Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed) and subscribed before me, by means of 0 physical presence by means of 0 physical presence • or 0 onlin&e notarizati n, or 0 online notarization, this 13 day of - , 20 2cby this_day of ,20_, by Kobi Karp Andrew Pollack NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION g _Personally Known Signature of NotaryPublic Signature of Notary Public f'IIV ' . Notary nica n�'P lr1} . ,ped, Printed or Stamped Name of Notary, Typed, Printed or Stamped • Mo • My Commission GG 26601 aw°+A Expires j # Y SEAL) ..aI (NOTARY SEAL) 1 The term"lobbyi 2 etificslly excl. -s the-following persons: Expert witnesses who proVi0 only scientific,technical or other specialized information or testimony in public meetings; any person who only appears as a reliresentative.of-a neighborhood association without compensation or reimbursement for the appearance, whether direct, indirect or contingont, to express suppoit of or opposition to any item; and any person who only appears as a representative of not-for-profit community-based,prganiation�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. Granado, City Clerk • CityClerk@miamibeachfl.gov Tel: 305.673.741 1, Fax: 305.673.7254 NAME OF LOBBYIST: Kobi Karp 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 • - - . year, and the fee for such annual registration shall be $500.00 pursuan . " ection 482 of the Miami Beach City Code. 03/0006 Signature • :• •yist Date F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5of5 . I , Miscellaneous Cash.Receipt CITY OF MIAMI BEACH No. 426348 r=. ©'Cash C1 Credit Card us Check# $ C Res Ivyed of ._ } s� Miscellaneous-sv,GK-zuzu 1., w �`. Payment Amount: » b00.0U - 4 (THIS INFORMATION MUST BE COMPLETED)" Office of Finance Director 1 l ' . �° By Account Number: 0 ��,~� " ; � c « TS() Preparer: t:�"x.�s ...�� _ a' 1 . u -. Dept: � EXT: Miscellaneous Cash Receipt CITY OF MIAMI BEACH r No 426350 El Cash O Credit Card :PChedk# i .$ f' R Vecl Of 1:' t w .jr ::e i f ) z r' u Misceilaneou _MCR.,2020 . r „. Jx'. 20 T7 b �7I J , � hw(7. �`, 7C 1 S 1�4 ! ! !�! Etimti.��a�, A... or2 I20y0 02.o7rm° 1 0 �Payma»t'Amount:,.��- 050 0 � (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director Account Number: Ott c� j �-( c L-1 w,, I 5z') fi ri _, -