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Amit Khurana - 411 Michigan SOFI Owner, LLC I I H I ci M(CAAky,,,, DocuSign Envelope ID:691323AD-31 E5-48CC-807E-814DAF71156A O Li L1 SK MIAMI BEACH RECEIVED Office of the City Clerk 1700 Convention Center Drive NOV 2 4 2021 Miami Beach, FL 33139 305.673.7411 LOBBYIST REGISTRATION FORM CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK 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: Khurana Amit NAME OF LOBBYIST (Last) (First) (Middle Name) 411 Michigan SOFI Owner, LLC 55 E 59 Street, 24 Floor New York NY 10022 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 917-370-7467 amit@sumaidakhurana.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Pallaoro Alessandro NAME OF PRINCIPAL (Last) (First) (Middle Name) 411 Michigan SOFI Owner, LLC 55 E 59 Street, 24 Floor New York NY 10022 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 917-370-7467 pallaoro@bizzipartners.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS nt to r (a}: A corporatiotirpartnefflirMirter entity who a entity,without special compensation or reimbursement for the appearance,whether direct, indirect,or contingent,to ilk item shaRgagister with the Clericailaigiliby this subsection but shall not be required to p 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): A. Pallaoro • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH N a CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): Please see the attached co LL LL Page 1 of 5 Dt0114ROMOS 6-34E 00C 016 E E 2 Page 1 of 5 134E00C016EE2 1111 ,I III DocuSign Envelope ID:691323AD-31 E5-48CC-807E-814DAF71156A 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. Code Amendment, 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 properties located at 411-419 Michigan Avenue, and 944 5th 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) 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 8 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 W W 0 U 0 0 w v in • 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): LL O co $ 0.00 per hour LL Page 2 of 5 ' DocVerify corn 486-FBA6-0Ft2-929634EOOc016EE2 Page 2 of 5 234E00C016EE2 1111 1I III ' DocuSign Envelope ID:691323AD-31 E5-48CC-807E-814DAF71156A 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 X No: 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 X No: 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 X_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. —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: 0 N W — Yes X_No: If yes, were you promised or did you receive economic consideration in exchange for campaign o consulting services? w w a N TO BE COMPLETED BY CITY CLERK'S STAFF ONLY n Annual Registration fee: [ ]Yes[ ] No Amount Paid$ MCR# VI"''t 5 L ik- I` ' Date Paid m Lobbyist Registration Form received and verified by: 03 - Olt.: Revised 09/20/2018 I LL n o Page 3 of 5 DocVerify ID: 'F486-FBA6-4F12-9296-34EO00016i'- ' wwww docverify corn ,III H.�6�,I II Page 3 of 5 334EO00016EE2 DocuSign Envelope ID:691323AD-31E5-48CC-807E-814DAF71156A 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 COMRENSA1d@NyDURING THE REPORTING PERIOD.' Qwtt{ ArALtA. 11/12/2021 Signature of Lobbyist: ',--sozaaAeraaoz�er_ 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 ree(UIP8111@ V.by Signature of Lobbyist: DocuSignedby: limit & Date 11/12/2021 062AA4cr34524Cr_ Signature of Principal: �� Date 11/12/2021 36070AD713C340C_. 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❑ physical presence or M online notarization, or E online notarization, this 12 day of November , 2021 , by ' this 12 day of November , 2021 , by Amit Khurana Alessandro Pallaoro NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Kno x Personally K Signature of Notary Public Signature of Notary Public Diana Ramos Diana Ramos Name of Notary,Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped 1 Diana Ramos ` Diana Ramos 1 Commission#GG 308355 1 Commission#GG 308355 0 1 Notary Public-State of Florida 1 Notary Public-State of Florida My Commission Expires Apr 10,2023 ► 1 My Commission Expires Apr 10,2023 1 Th9 Fig 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 m 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:52C7F48B-FBA6-4F12-9296-34E00C016EE2 www.docverify.com Page 4 of 5 434E00C016EE2 'III gyY�{��'I III 1 DocuSign Envelope ID:691323AD-31 E5-48CC-807E-814DAF71156A M AMBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov Office of the City Clerk Rafael E. Granada, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: Amit Khurana 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. 0 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. a / DocuSigned by: U IAI n 1 MIIWA,tAralut, 11/12/2021 rn ` f:Ca2AA4t i4.,2.�r Signature of Lobbyist Date LL m LL m F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc v LL r cq Page 5 of 5 DocVeriiy ID:52C7F48B-FBA6-4F12-9296-34E00C016EE2 44��+ p' +. www.docverify.com Page 5 of 5 534EO00016EE2 ,III p'ggy� 'I II EXHIBIT B Disclosure of Interest for 411 Michigan SOFI Owner LLC 411 Michigan SOFT Owner LLC 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 411 Michigan JV LLC 100% 411 Michigan JV LLC 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 SREI SOFI LLC 88% Lauren Pressman 2% 411 Michigan Sponsor LLC 10% SREI SOFT LLC 500 Winstead Building 2728 N. Harwood Street Dallas, TX 75201 Eric and Wendy Schmidt 100% 555 Bryant Street, #347 Palo Alto, CA 94301 411 Michigan Sponsor LLC 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 SK 411 Michigan LLC 50% 411 Michigan BP LLC 50% SK 411 Michigan LLC 520 West 27th Street, Suite N° 302 New York, NY 10001 Sumaida + Khurana SS 411 Michigan LLC 50% EXHIBIT B Disclosure of Interest for 411 Michigan SOFT Owner LLC AK 411 Michigan LLC 50% 411 Michigan BP LLC 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 Bizzi & Partners Realty LLC 50% Alessandro Pallaoro 50% SS 411 Michigan LLC 5 Park Lane, West Harrison, NY 10604 Saif Sumaida 100% AK 411 Michigan LLC Amit Khurana 50% 520 West 27th Street, Suite N° 302 New York, NY 10001 Attn: Amit Khurana Sumaida + Khurana Paramdeep Singh 50% 7 Roads End Brookville, NY 11545 Bizzi & Partners Realty LLC 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 Davide Bizzi 100% 2 Kohtu Street Apt. #3 Tallinn, 10130 Estonia 11/19/21, 3:31 PM Detail by Entity Name r • DIVISION OF CORPORATIONS '1 � I I r_gA ri;partment of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Foreign Limited Liability Company 411 MICHIGAN SOFI OWNER LLC Filing Information Document Number M21000006942 FEI/EIN Number NONE Date Filed 06/08/2021 State DE Status ACTIVE Principal Address 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 Mailing Address 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 Registered Agent Name&Address INCORPORATING SERVICES, LTD. 1540 GLENWAY DR. TALLAHASSEE, FL 32301 Authorized Person(s)Detail Name &Address Title MGR PALLAORO, ALESSANDRO 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 Title MGR BIZZI, DAVIDE 55 E. 59TH ST., 24TH FLOOR NEW YORK, NY 10022 Title MGR SUMAIDA, SAIF https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=411 MICHI... 1/2 11/19/21, 3:31 PM Detail by Entity Name W 27TH ST. NEW YORK, NY 10001 Title MGR KHURANA, AMIT 520 W. 27TH ST. NEW YORK, NY 10001 Annual Reports No Annual Reports Filed Document Images 06i08/2021 --Foreign Limited View image In PDF format https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inguirytype=EntityName&directionType=Initial&searchNameOrder=411 MICHI... 2/2 (-,--,--A L F Ni ....,,,, erif 5-j:: : 8 ' 1 OCCVER�� Lobbyist Registration Form - A. Khurana - executed.pdf DocVerify ID: 52C7F48B-FBA6-4F12-9296-34E00C016EE2 Created: November 12, 2021 11:12:34 -8:00 Pages: . 5 Electronic Notary: Yes / State: FL This document is a DocVerify VeriVaulted protected version of the document named above. It was created by a notary or on the behalf of a notary,and it is also a DocVerify E-Sign document,which means this document was created for the purposes of Electronic Signatures and/or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to www.docverify.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. l E-Signature Summary ESignature Notary:Diana Ramos(dra) November 12,2021 11:15:22-8:00[9FCD5D563D39][162.244.152.118] dramos@brzoninglaw.com I .7 '41.11,ii.,J, ..,,.i.i.,1 ' 7 '"C : . ' I I; "1 F I ' id I111111111111IIIIIIIIIIIIII111111IIII1111111111IIIIIIIIIIIIIIIIIIIIIII DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. I DocvVbeofyeDy5m7F488-FBA8-4F12.9298.34EO00018EE2 ,III MERE'I ■ Generated Cover Page 34E00C018EE2