Tracy Slavens - 1664 Meridian, LLC RECEIVED
III ACHJUNOffice 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 "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:
Slavens Tracy
NAME OF LOBBYIST (Last) (First) (Middle Name)
Holland and Knight LLP 701 Brickell Ave., Suite 3300 Miami FL 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.789.7642 tracy.slavens@hklaw.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION: • . . ..
Peebles Don
NAME OF PRINCIPAL (Last) (First) ' (Middle Name)
1664 Meridian, LLC 13876 SW 56 ST., #268 Miami FL 33175
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.993.5050 donpeebles@peeblescorp.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER, EMAIL ADDRESS
Pursuant;to City Code,Section42 482(h)(1)(a).>A pnnci pal;of any�corporationpartnership other entity who'appears as a lobbyist,on bebalfiofwahat
entity without„specialcompensation por reimbursem4ent for the appeararice swhetherdlrfeet ,indirect or contingent;to�express support of or,opposition to
arutem`shall reo torwthffie Clerk as re,wr'ed b_,this subsecfion3but shall not be required t_payany;ce'gtstrationfees
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):
• 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): ease_, sce a-H-a ch ed'
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.
Negotiation and approval of development agreement and lease, development and permitting approvals,
including, but not limited to Members of City Administration, Members of City Staff and Members of
Planning Board, Design Review Board, Board of Adjustment, City Commission, and Mayor, relating tei
the RFP for the Lincoln Lane project and development of P27 Parking Lot.
•
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 •
Members of City Administration and Members City Staff X
Planning Board (PB) , Design Review Board (DRB) X
Board of Adjustment (BOA), City Commission and Mayor 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):
$ 780.00 per hour
Page2of5
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 fora 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.
_YesX_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 XIVo: 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.
_YesXNo: 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:
T §l tS a-7 —•-r-_.,..+^.•-
_Yes XNo. If.'yes,',,has it}been less than-12,.months•smce the;electedw official(s) whomyou 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 ZNqgi 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:
:dr • . i 1 i,77:r '.."dt tx
.,c`: `i a. 177,7 n..: Ta C ".^�. '..,:i� m"5::;`
Yes No.• Ifyes,•were.vou promised ordid you receive`economicconsideration.in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
2 7 �/,
Annual Registration fee,:.[ ]Yes�['No Amount,Paid$ 7w� Cam.` MCR#' 4%113 Date Paid `0 r[�I'2 2 -`
Lobbyist Registration,Form received and verified by ;."
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised.03/11/2020
Page 3of5
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 DURI REPORTING PERIOD.'
Signature of Lobbyist: Date [lit 7 20.,E .�
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 t ' ns contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City e d all report r re ents. I
�/
Signature of Lobbyist: Date (a 17 / o _
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of "r1 0 r I d Cf State of
County of:r l luyt Da cLe County of: ..
Sworn to (or affirmed) and subscribed before me, Sworn to(or affirmed) and subscribed before me,
by means of€Q physical presence by means of❑ physical presence
or❑ on ine notarization, or❑ online.notarization,
this l day of dune , 20noy this_day of •20_, by
Tracy Slavens Don Peebles ...
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced •
ID _Produced ID
/ FORM OF IDENTIFICATION FORM OF IDENTIFICATION
/Personally Known _Personally Known
.7/4 24.c.....--,--1._-"C.-- . ., .
Signature Notary Public Signature of Notary Public
rn-rAfLe4 chirt .
Name of Notary, Tyfoed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY - ' ,-...-_.,...M._ (NOTARY SEAL)
IV
ti
e3 MY66MMS iON#Hrl GM. •4_ '
I The term"lobb C , ; �.-r•-(ii.;`; era,:,''',•:" ons: t,
Expert witnesses who provide only scienti ic, ec ni a • • her 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.
1 Page 4 of 5
; °�a�. MERCYARCE
_,. i,k1 MY COMMISSION#HH 054416
;;k -41g EXPIRES:October 18,2024 . ..
•.,OF FV Bonded Thru Notary Public Underwriters
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: c Date (3-- U ^
VII. NOTARY SIGN TUR AND S AL:
LOBBYIST: PRINCIPAL
State of State of Florida
County of: County of: Miami-Dade
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 El physical presence
or 0 online notarization, or 0 online notarization,
this day of .20_, by this 18 day of JUNE . 2022, by
Don Peebles
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID X Produced ID Driver's License
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Personally Known _Personally Known
Signature of Notary Public Signature of Notary Pu
Emile Dominique
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped - ;.
lingarlibrillhAihnemarah
(NOTARY SEAL) (NOTARY SEAL) , ;''�iiii;>'' EMILE DOMINIQUE
_°• �� Notary Public-State of Florida
�; Commission 45
GG 241654
`'••'.`�or r}°' My Comm.Expires Jul 25,2022
'..Bonded through National Notary Msn.
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 requesting a grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
MIAMI 0 oi CH
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: Tracy Slavens
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, [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
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
(l )1 ' Zo Z 2
Signa re of Lobbyi t Date
F:ICLERI$ALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc
Page 5of5 ..
1664 Meridian Avenue, Miami Beach, FL 33139 -Organizational Chart
1664 Meridian Avenue
(Pro erty)
1664 Meridian, LLC (100%)
L22000122140
1
1664 Meridian Ave General
Partner, LLC (100%)
M22000003814
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1664 Meridian Developer,
Meridian Ave Partners LLC
(40%) LLC (60%o)
L22000122137
1664 Meridian Peebles, LLC
SRC Merdian Ave Partners — Baron Meridian Ave (100%)
L22000122132
LLC (100%) Partners LLC (100%)
-! R. Donahue Peebles (100%)
Earl Diversified Holdings
Scott Robins (100%) LLC (DE)(100%)
1
Philip Levine, as Trustee
of the Philip Levine Trust
u/a/d March 24, 2021
Philip Levine (100%) _ _j
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