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Eric Holland - FG 801 Arthur Godfrey Owner, LLC '50( c) .141 DocuSign Envelope ID:57BDEDA6-2933-4AC1-987C-BF5090620877 RECEIVED IV\I/A1V\I BEACH' MAR —12022 Office of the City Clerk 1700 Convention Center Drive CI-I " OF MIAMI BEc ER Miami Beach, FL 33139 OFFICE(jr THE CITY 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: Holland Eric NAME OF LOBBYIST (Last) (First) (Middle Name) OTJ Architects 169 East Flagler Street,Suite 727 Miami Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-598-7260 holland@otj.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Sanders* Mark NAME OF PRINCIPAL (Last) (First) (Middle Name) *Authorized Signatory of FG 801 Arthur Godfrey Owner LLC FG 801 Arthur Godfrey Owner,LLC 47 NE 36 Street Miami Florida 33137 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 0. 305-938-4321 msanders@fifteengroup.com N PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS o0 0 Pursuant(bi Code/§Mgrim 2-482 mo,Q principal CQM corporation Iartnersh p, MN Glialy appears p3 lobb ist CM bag CO that enti owitikcat special com a ensa ion Cll'allinftEME1=for IRO appearance Zitiligi0102a,indirect Cs • tl g-j1 (D e e pTCO o 0.osrtion(E n item shall register wit he Slerk as required by this subsec ion but shall not be required to pay any registra ion fees. O If the principal is a Corporation, Partnership or Trust, the following information MUST be provided st pursuant to City Code Section 2-482(c): • o • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): M. Sanders as authorized signatory a • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH m CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): Please see the attached. N a Page 1 of 5 • • � aRamos /oba� J yCA-D04C83035649 Page 1 of 6 1D04C83035649 ,III 'I III . DocuSign Envelope ID:57BDEDA6-2933-4AC1-987C-BF5090620877 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 &Planning Issues,including but not limited to the Historic Preservation Board, Design Review Board,Planning Board,Board of Adjustment,Land Use Development,City Commission, and any City Workshops or Committees,if necessary,relating to the property located at 801 W 41 Street 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) I YES NO Title of Person to be Lobbied Staff for the Planning&Building Department None X Public Works &City Administration,PB,HPB,BOA None X DRB,City Commission,and Mayor as necessary None X Land Use &Sustainability Committee 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. iV List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety(if none,write N/A): None U 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): $220.00 per hour Page 2 of 5 Dwww.doc e'rfy.comBDE5D-B92B-0C75-A9CA-D04C83035649 Page 2 of 6 2D04C83035649 J 1111 IMIttall 111 DocuSign Envelope ID:57BDEDA6-2933-4AC1-987C-BF5090620877 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 x No: 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 x 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 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 1 months since the elected official(s)whom you provided campaign consulting sen►iGes 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 N within the past election cycle?If yes, please list the incumbent member(s)of the City Commission: N N O —Yes XNo: If yes, were you promised or did you receive economic consideration in exchange for campaiq 0 consuttng servicesi TO BE COMPLETED BY CITY CLERK'S STAFFTA ONLY S Annual Registration fee: [p]Yes[ ]No Amount Paid'$ U)0- CIO` MCR# -1 2-/ i J 5 Date Paid o3'0 ` o Lobbyist Registration Form received and verified by: �S w F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised,09/20/2018 0 Page 3 of 5 DocVerify ID:14IBDE5D.D92B-4C75•A9CA-D04C83035649 Page 3 of 6 3D04C83035649 I ,III �I III L www.docverify.com t11K DocuSign Envelope ID:57BDEDA6-2933-4AC1-987C-BF5090620877 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 COMPENS KDl DARING THE REPORTING PERIOD.1 Signature of Lobbyist: Date 02/28/2022 9040691DDo213436... 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 aH g 'requirements. • Signature of Lobbyist: lkbU�n Date 02/28/2022 90400910D0213436... Signature of Principal: Date 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, by means of❑ physical presence by means of 0 physical presence or Ilonline notarization, or❑online notarization, this 28 day of February ,2022, by this_day of February ,2022, by Eric Holland Mark Sanders* NAME OF LOBBYIST NAME OF PRINCIPAL *Authorized Signatory of FG 801 Arthur Godfrey Owner LLC _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally KnoLi •N-� _Personally Known I N Signature of Notary Public Signature of Notary Public Diana Ramos Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped 1 Diana Ramos / (NOTARY SEAL) commission#GG 308355 Notary Public-State of Florida 1 Icy Commission Expires Apr 10,2023 I They ci — _- - - ---- - - - - -- ----.�Rg persons: PST 488221018992 0 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 • DocVerify ID:141BDE5D-B926-4C75-A9CA-D04C83035649 Page 4 of 6 4D04C83035649 ,III @ � ,I III www.docverify.com li', DpcuSidn Envelope ID:A80026BC-6042-47C5-A383-EDICE6EE0D52 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.1 Signature of Lobbyist: _ Date • I do solemnly swear or affirm that all of the foregoi facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the pro 'sions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reportin quirements. Signature of Lobbyist: Date /1.411_ Signature of Principal: * Date 01'f2"1* Signatory of FG 801 Arthur Godfrey Owner LLC 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 affymed)and subscribed before me, by means of 0 physical presence by means of Q physical presence or 0 online notarization, or 0 online notarization, this day of February , 2022 by this 11 day of February . , 2022, by Eric Holland Mark Sanders* NAME OF LOBBYIST NAME OF PRINCIPAL *Authorized Signatory of FG 801 Arthur•Godfrey Owner LLC Produced ID Prot uced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Known P: sonally Known it Signature of Notary Public 'f. S e of Notary Public Diana Ramos tiltvos Wander Name of Notary, T ed Printed or Stamped dme of Notary,Typed,'Printed or Stamped Typed, P rY� YP � P (NOTARY SEAL) (NOTARY SEAL) <AN Notary Public State of Florida Marcus Wander My Commission GG 950909 W Expiros 01/28/2024 I 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 DocuSign Envelope ID:57BDEDA6-2933-4AC1-987C-BF5090620877 MIAMIBEACH 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: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: Eric Holland 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 fV 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. DocuSlgned by: • r� MAMA.", �/� �� o `t:►'`(. koLLOla/I. 02/28/2022 v —3C40631DD020430... Signature of Lobbyist Date m F:\CLERI$ALL1aFORMS\LOBBYIST FORMSLLobbyist Registration Form Revised 03-11-20 REG.doc 0 Page 5 of 5 DocVderief ��BDESD-6926-0C75-A9CA-D04C83035649 Page 5 of 6 5D04C83035649 ,III EMI' III DocuSign Envelope ID:57BDEDA6-2933-4AC1-987C-BF5090620877 Exhibit B Disclosure of Interest Interests in FG 801 Arthur Godfrey Owner LLC Percentage of Interest FG 801 Arthur Godfrey JV LLC 100% 47 NE 36th Street—2nd Floor Miami FL 33137 • Interests in FG 801 Arthur Godfrey JV LLC Percentage of Interest FG 801 Arthur Godfrey Investors LLC 100% 47 NE 36th Street—2"d Floor Miami FL 33137 • Interests in FG 801 Arthur Godfrey Investors LLC Percentage of Interest Mark Sanders 48.75% Ian Sanders 48.75% • Justin Toal 2.5% 0 0 N ai PiN • rn M M U 0 U rn U v m N m 0 W Co Co DwocVerify ID:ww.docvenfy.00mBDE5D-B926-0C75-A9CA-D04C83035649 Page 6 of 6 6D04C83035649 1111 B 'I III :: Miscellaneous Cash Receipt CITY OF MIAMI BEACH No,429758 I Cash I Credit Card ' CI Check'# $ {i�._. . x C . 0 ? • C e(.. 20 . 7 • P of i a f(C, it) f J''��'f" � ��•, rt fir,s, ) f— r;c 1�r r t r;„1z� Miscellaneous=;CK 202 r ) dr d F rfvn n 02/01/2022 C'A 3rM° f f p 1 For v a , x .4S s _ iOs> r 9 Payment Amount: 2,050.00 • • (THIS INFORMATION MUST BE'COMPLETED) Offlco of Flnan*Director �' �. By • Aunt Number: rD'1 non r> J c. t,� , ;) >�1 -4 ! • :)�� «_: prepare,: "' :p:!r.,. f r 1. Dept .!'-• • • • •