Jean-Michel Marie Gathy - 3425 Collins, LLC 342_3 CAII,4S e,
RECEIVED
Nov i ` 2020
n CIT1°OF rVfAM;
Office of the City Clerk OFFIaE
1700 Convention Center Drive
Miami Beach, FL 33139
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;o l 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" lin 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:
Gathy Jean-Michel Marie
NAME OF LOBBYIST (Last) (First) (Middle Name)
Denniston Sdn.Bhd. 26th Floor, UBN Tower, 10,Jalan P. Ramlee, Kuala Lumpur, Malaysia. 50250
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
+603 2031 3418 ea@denniston.com.my
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
3425 Collins, LLC r-i,e,rck � SG&i —
NAME OF PRINCIPAL (Last) I (First) (Middle Name)
3425 Collins, LLC 3201 Collins Avenue Miami Beach FL 33140
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-534-8800 sgeraghty@faena.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
(b M ••- Section 2-482(h)(1)a), A principal CLIEffly corporation, partnership,Cr d n(7�gift din tie• ER)0 lobbyist Oil IIESE111CQ
without special compensation Ci?rei •i,rsement for gig appearance,eflagaorTitaill,indirect,CP contingent,2)C fe •e o CQ07o 0••sition
-Sii anila&gailganzatata®moi Jl:39M • • L• K4isDre•uiredmI S/EII re•istration2
If the principal is a Corporati nn, 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): Leonard Blavatnik
• 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): Leonard Blavatnik
Page 1 of 5
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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 historic Versailles building and construction of new multifamily building at 3425 Collins Avenue
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
Historic Preservation Board Members none
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 Hobbyist 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):
N/A
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 apjcation
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 al 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 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
consuIting ser, ices was sworn ins
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 pastlelection cycle?If yes, please list the incumbent member(s)of the City Commission:
Yes X No: If yes, were you promised or did you receive economic consideration in exchan•e for cam•ai•n
consulting seruices,:
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: �'"e}� �`
g' [�]Yes[ ]No Amount Paid$Q^ MCR# 1 `� Date Paid 0-13.
Lobbyist Registration Form received and verified by: _)..l a' ti 1nNTVA
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist 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.'
I � np
Signature of Lobbyist: Date 5 Na v-L141 RA 2 02 d
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.
f- -1
Signature of Lobbyist: Date 51M2 v'_t n 2._ .,.ZO
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
111
LOBBYIST: PRINCIPAL
State of State of
County of: County of:
Sworn to(or affirmed)and subscribed before me, Sworn to (or affirmed)and subscribed before me,
by means ofg-physical presence by means of 0 physical presence
or 0 online notarization, � � NOV ��— or 0 online notarization,
this dayof 'IlO U by this dayof , 20 by
SEAN-MiCHeL MARIE C, THy
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
[Xer:sonally Known _Personally Known
Signatur otary Public Signature of Notary Public
LEQNG CHIEW KEONG
Name of N. a , Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
r ,A :( iii,h,�� F, (NOTARY SEAL)
1 e„,'er pbbyist°<specif a1I - i.udes the following persons:
,F i KEONCi
E ,witnesses who prz3Vide en y .cientific,technical or other specialized information or testimony in public meetings; any person who
o yap ears als_;ajtep'resenta ' e .. a neighborhood association without compensation or reimbursement for the appearance, whether
dincct, i irett i pntiiigi5rn o e '•ress support of or opposition to any item; and any person who only appears as a representative of
not- r-pro community a.sed rganization for the purpose of requesting a grant without special compensation or reimbursement for
the ail a,anile r‘ ,
`'1 '', :`4 ` 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 PRECEDINGI 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: /_. ..�/% �'/.�1♦ ' Date /7/772,,.. ›,--
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of State of J"Go 21,t,,,o
County of: County of: ilii / I D A t
Sworn to (or affirmed) and subscribed before me, Sworn to (or affirmed) and subscribed before me,
by means of I=1 physical presence by means of Cii(physical presence
or❑ online notarization, or❑ online notarization,
this day of , 20_, by this 3 day of A-k91A-P^bt62 , 20dq by
/
SCO 7r �!°ACJ]'I
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Personally Known VIDersonally Known
Signature of Notary Public ure of Notary Public
XjutteJl /,/r/Pia C iA
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL) (NOTARY SEAL
ryt, Notary Public State of:Florida
W Kenneth H Neidinger
1 4�a My Commission GG 944376
The term"lobbyist"specifically excludes the following persons: o,aP Expires 01/05/2024
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
MIAMHIEACH
EAC H
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: Jean-Michel Marie Gathy
1) LOBBYIST FEE EX'ENDITURE 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 suspe i ded 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 imn ediately 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
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
5 Al0 \/-Phtc 2..e,l 2.02o
Signature of Lobbyist i Date
"',tnj `<`, LEONG CHIEW KEONG
,y '''inn NOTARY PUBLIC riStY �'Ue
F\CLR1$ALLV,7,7 LOBBYIST FORMS\Lobbyist •Registration Form Revised 03-11-20 REG.doc (jF,..t_;!,1 �.�'r";` _! KUALA LUMPUR, MALAYSIAr . Address:Messrs C.K. Leong&NurbayaAIrILumauR
P — Page 5 of 5 Suite 8-9-6,Menara Mutiara Bangsar LEONG CHIEW KEONG
- �,�r, ,a,." ' Jalan Liku,Off Rion WILAYAH
� _ -..�, gr PERS.._i N
1,'r'.1..}A,>''. ] � Bangsar,59100 Kuala Lumpur
P,.dl KU.a 11i�1 Tel:(603)2282 2776, (603)2283 3778 '��LA'(
., W r (603)2284 3778 Fax: (603)2284 4772
777.k :r},� Email:ckleongnurbaya@yahoo.com
MIAMI :BEACH RECEIVED
City of Miami Beach
1700 Convention Center Drive NOV 1 3 2020
Miami Beach, Florida 33139
www.miamibeachfl.gov CITY OF MIAMI BEACH
City Clerk's Office OF�I,;,`Or; -! C rl CLERK
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: Jean Michel Gathy
Business Name: Denniston
Address: 50250 Kuala Lumpur,26th Floor, UBN Tower Kuala Lampur Malaysia 50250
Office Telephone Number: 603 20313418
Cellular Telephone Number:
Email Address: ea@denniston.com.my
If more than one lobbyist,please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#:
Amount paid: Date paid:
Processed by: Date:
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