Ira Sussman - S.F. Land, LLC t, 565 C>Dl ;.,s 41,,e)
X DocuSign Envelope ID:9F0829D3-A52E-4233-BBA8-E527DED577FB
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M I AM I BEACH Office of the City Clerk JUN 17 2022
1700 Convention Center Drive
Miami
Beach,FL 33139 ®PPi e��MI AMI s .
C17y C�RK
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:
Sussman Ira
NAME OF LOBBYIST (Last) (First) (Middle Name)
S.F. Land, LLC 6565 Collins Avenue Miami Beach FL 33141
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-866-8855 irasussman@the-beach.net
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Sussman Ira
NAME OF PRINCIPAL (Last) (First) (Middle Name)
S.F. Land, LLC 6565 Collins Avenue Miami Beach FL 33141
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
S 305-866-8855 irasussman@the-beach.net
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuant t1+3 .-ity Gode Section 2"48211)(1')(5): A principal of etiiv corporation partnershi a CF other enti who .s. .rb OM a lobb is CM I Gfl that
entity �; co p-ns-t-onCO - , for Sirg appearance, a- t (ems direst Cifcont'ngent (O m 3ec,fjcpOaoo itlonto
an item shall re.gis erwith the®Jerk as required b, his suosection but shall hot be required to pa any registration fees.
0
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
0 pursuant to City Code Section 2-482(c):
•
NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): See attached
Q
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): �1�.-�_, CCG IA_J
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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.
Development approvals and permitting issues, including, but not limited to the Historic Preservation Board, Design
Review Board, Planning Board, Board of Adjustment, Land Use and Sustainability Committee, City Commission,
any City Workshops or Committees, and City Departments, if necessary relating to the property located at
� 6 � � Oft vv) I ol c h f1:3 3 If
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 Department, Building Department
None. X
Public Works, and 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.
6
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
a appearance of impropriety(if none,write N/A):
N
O
None.
0 None.
z
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):
$0.00
N
M
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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 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 jNo: 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_No: If yes, has it been less than 12 months since the elected official si whom you provided campaign
consulting services was sworn inr
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 past election cycle?If yes,please list the incumbent member(s)of the City Commission:
N
0
N
Yes No: If yes, were you pro ised or did you receive economic consideration in e change for camtaign
In --
cow SUltin NEI:,iCe ISil
0
0
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8 TO BE COMPLETED BY CITY CLERK'S STAFF ONNLLY
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Annual Registration fee: .[ ]Yes[•lIo Amount Paid$ MCR# pI(A
Alt_ Date Paid
a Lobbyist Registration Form received and verified by: JS
F<\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018
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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.'
Si nature of Lobby ist: IPa �IASSwtatn Date 6/17/2022
g y co5Cer2C05734CD...
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 CoetertliditIteitivorting requirements.
Signature of Lobbyist: lra S.MSKialn. 6/17/2022
Date
6/17/2022
Signature of Principal: lrtL S.U.SSwtatn, Date
`—C85E6F2CB57346D...
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 0 physical presence by means of 0 physical presence
or 0 online notarizati9g,1712022 or®online notarization,
this day of ,20_, by this_day of 06/17/2022 ,20_, by
Ira Sussman Ira Sussman
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
X
X Personally Know "`"°' _Personally Urn �...
0
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_6 Signature of Notary Public Signature of Notary Public
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Ben Fernandez ,
Ben Fernandez
_ _lu ar I. d Name of Notary,Typed, Printed or Stamped
!lefty etty Llerena
w Commission#HH 221018 Betty Lierena
N ICLotary Public-State of Florida 1 Commission#HH 221018
a My Commission Expires Mar 05,2026 a Kfotary Public State of Florida
a, 0 � P y Commission Expires Mar 05,2026
a,M a 0
m 1 Theas?}`Jr 'urz7�f1T>7 .4'ic7Ccifi7��1T,ilsochmc�in.b-fnmeaAti g persons: _ _ _ _ _ _ - _
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Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who
O only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
c direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
N not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
m the appearance.
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MIAMI 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: 305.673.7411, Fax: 305.673.7254
Ira Sussman
NAME OF LOBBYIST:
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
N 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.
N Imo, DocuSigned by:
o I lVa SIASSKAN . 6/17/2022
C85E6F2CB573460...
Signature of Lobbyist Date
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CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION,list ALL of the stockholders,and
the percentage of stock owned by each. Where the stockholders consist of another corporation(s),trustee(s),partnership(s)or
other similar entity,further disclosure shall be required which discloses the identity of the individual(s)(natural persons)having
the ultimate ownership interest in the entity.*
S.F. Land, LLC.
CORPORATION NAME
NAME AND ADDRESS %OF STOCK
S.F. Land Trust f/b/o Joel.Sussman Family 40%
6565 Collins Avenue
Miami Beach, FL 33141
S.F. Land Trust f/b/o Ira Sussman Family 50%
6565 Collins Avenue
Miami Beach, FL 33141
S.F. Land Trust f/b/o Perri Stern Familmm 10%
6565 Collins Avenue
Miami Beach, FL 33141
CORPORATION NAME
NAME AND ADDRESS %OF STOCK
IF THERE ARE ADDITIONAL CORPORATIONS,LIST OTHERS,INCLUDING CORP.NAME(S)AND EACH INDIVIDUAL
STOCKHOLDER'S NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK ON A SEPARATE PAGE.
NOTE:Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2.TRUSTEE
If the property which is the subject of the application is owned or leased by a TRUSTEE,list the beneficiaries of the trust and the
percentage of interest held by each. Where the beneficiary/beneficiaries consist of corporations(s), another trust(s),
partnership(s)or other similar entity,further disclosure shall be required which discloses the identity of the individual(s)(natural
persons)having the ultimate ownership interest in the entity.*
S.F. Land Trust f/b/o Joel Sussman Family
TRUST NAME
NAME AND ADDRESS %OF STOCK
Matthew Sussman 10%
6565 Collins Avenue, Miami Beach, FL 33141
Elizabeth Sussman 10%
6565 Collins Avenue, Miami Beach, FL 33141
Benjamin Sussman 10%
6565 Collins Avenue, Miami Beach, FL 33141
Stephanie Sussman 10%
6565 Collins Avenue, Miami Beach, FL 33141
S.F. Land Trust f/b/o Ira Sussman Family
TRUST NAME
NAME AND ADDRESS %OF STOCK
Mollie Sussman Davis 10%
6565 Collins Avenue, Miami Beach, FL 33141
Paige Sussman Danowit 10%
6565 Collins Avenue, Miami Beach, FL 33141
Max Sussman 10%
6565 Collins Avenue, Miami Beach, FL 33141
Rachel Sussman 10%
6565 Collins Avenue, Miami Beach, FL 33141
Miriam Sussman 10%
6565 Collins Avenue, Miami Beach, FL 33141
S.F. Land Trust f/b/o Perri Stern Family
TRUST NAME
NAME AND ADDRESS %OF STOCK
Meredith Rishty 10%
6565 Collins Avenue, Miami Beach, FL 33141
3. PARTNERSHIP/LIMITED PARTNERSHIP
If the property which is the subject of the application is owned or leased by a PARTNERSHIP or LIMITED PARTNERSHIP, list
the principals of the partnership, including general and limited partners. Where the partner(s)consist of another partnership(s),
corporation(s),trust(s)or other similar entity,further disclosure shall be required which discloses the identity of the individual(s)
(natural persons)having the ultimate ownership interest in the entity.*
PARTNERSHIP or LIMITED PARTNERSHIP NAME
NAME AND ADDRESS %OF STOCK
NOTE:Notarized signature required on page 8
7