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Jessica Browdy - Jessica Browdy RECEIVED Office of the City Clerk 0 C T 13 2022 1700 Convention Center Drive Miami Beach, FL 33139 CITY OF MIAMI BEACH 305.673.7411 OFFICE OF THE CITY CLERK 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: • Browdy,Jessica NAME OF LOBBYIST (Last) (First) (Middle Name) XI LLC c/o Jessica Browdy. One SW Third Ave, Suite 2250, Miami FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-877-2884• jessica@jkellyadvisors.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Browdy,Jessica NAN E OF PRINCIPAL (Last) (First) (Middle Name) XI,LLC One SW Third Ave,Suite 2250,Miami,FL 33131 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)• 786-877-2884 jessica@jkellyadvisors.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS • Pursuant in(ft Code Section 2-482(h)(1 Q principal CfilegV corporation, partnership,Cpcag700f2110... m a lobbyist m l 62t ( entity,MOIR compe sationcp reimbursement for Qibi -p,ea - '-,whe er drizi111,indirect,Cp contingent,'Pp ex`resssubdortd2CPobaositionft, an item shall register with the Clerk as required by this subsection but shall not be required to.ay an registration fees. 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): 5�if �' r''''! ' • 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): See organization chart attached Trustee of the Haudenosaunee Trust u/t/d December 18,2017 • • 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. Approvals for 5446 N Bay Rd, Miami Beach, FL DiQ5 ,P; /e, A)a 142- 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 Mayor&Staff N/A X Commissioners&Staff N/A X City Officials&Staff N/A X Design Review Board Members N/A 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): No additional compensation 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 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 yd'esRhaslltibe��le"gsTthan1F12Tmbnth`s7sincelithWieetedro`fci`a1(s)Iwhom 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 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, were you promised ordid you receive economic consideration in exchange for campaiq consulting sencices, �� �� �— - — TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee:>91:es( ]No Amount Paid$ SO'0") // f MCR# {/C7 Date Paid / °08/a: r Lobbyist Registration Form received and verified by: J_e_ J v • r a'4 f.ER .At.L WORMS4r-F7e ST FORMS\LOtrylat Registration Farm Rel.ised c -1t-2O REEVA 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 Signature of Lobbyist: Date FS {15 14:7— 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 C de and all repo "requirements. Signature of Lobbyist: `--" Date 1 15 /2_2-,. Signature of Principal: l Date 8 I 1. 12Z • VII. NOTARY SIGNATURE AND SEAL: • LOBBYIST: • PRINCIPAL State of F Q -1 o P` State of FL L . t O County of: ?A1.M SN- County of: P Aa--I'll g G Q CAA Sworn to(or affirmed)and subscribed before me., Sworn to(or affirmed)and subscribed before me, by means of Lhysical presence by means of❑p ysical presence or 0 online notarization, or El online notarization, • this k 5 day of Pint,LA ST • ;20 22Tby this 25 day of P k-I-O S , 202.2,.by J' 6S1 (-P 1C2J 1 w o`-(' j'ES5\ P. 1?:9 12)W D`{ NAME OF LOBBYIST - NAME OF PRINCIPAL •`� � 'VC Produced ID j( iJ r)\r(A C�'1 Produced ID c( Li Cevi c FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Per nally Known _Pers Ily Known • n ^ / �/ \� Sig ture of Notary Public • Signat of Notary Public ossonwise*Th .--- 111 MC _P 0 "-ohm _iloq.r.pi,,,,-) . •` ...W �t (otary, Typed, Printed or Stamped Name of Notary, Tx4 'PJi or Stamped M9'• o'OP' SF'•, • o to°"r 07A•�ty SEAL) , (NOTARY SE, tt) P�jO 1 A;r.A,s.'�,a . • .7,9 ,e x-ires: . �'•• ^. ▪ •..0 rr9 2S;• ' •• MY Corn O oberm.Expires•; 18 25 • .S . ••N •e •• „ HH 1884190 C "•,tom try lob st specifically excludes the following persons: • • .,�4OU FL0 10Po.•`. �J,•\ • •••. Lixo nlRlesses who provide only scientific,technical or other specialized information oi'.� ip. • etings;any person who only appears as a representative of a neighborhood association without compensation or#% nIiiirspa� .j• 'the appearance,whether direct, indirect or contingent, to express support of or opposition to any item; and any person�IMtniewir%pears 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. , Page4of5 • 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 CityClerkemiamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: J�SS� �-P C wDY • 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 commencing October 1 of each year, and the fee for such annual registration shall be $500.00 pursuant to Section 2-482 of the Miami Beach City Code. SI (SI ()--z Si nature of Lobbyi Date F:ICLERI$ALL1aFORMSILOBBYIST FORMSILobbylst Registration Form Revised 03-11-20 REG.doc • Page5of5 Arturo J.Aballi Hendrik G.:Milne CraigP.:Kalil Joshua D:Poye'r Renee D.Tischle► Shareholders • Aballi Milne Kahl,P.A. a Florida Professional Corporation Sole Member of Sole Admin L.L.C. Sole Admin L:L.C.>'a Florida. Liniiited.Liabili'ty Conipany- :Manager of South Florida Consolidated Holdings LLC SOUTH FLORIDA• CONSOLIDATED HOLDINGS LLC a Florida Limited`Liability. ,Company Sole Admin.L.L.C. Manager of XI LLC XI LLC` .a Florida Limited Liability Company XI LLC, Florida;Limited Liability Company as Trustee.'of the IlAUDENOSAUNEETRUST u/t/d December 18, 2017 1 5466 North BayRd., Miami Beach,FL 331.49. LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,that CRAIG P.KALIL as the Manager of SOLE ADMIN L.L.C., in its capacity as Manager of XI LLC, as Trustee of the Haudenosaunec Trust u/t/d December 18, 2017 (hereinafter referred to as the"Trustee"),and by these presents does hereby make,constitute and appoint,Jessica K.Browdy,President of J Kelly Advisors,Inc.,a Florida corporation,an authorized signatory of the Company for the specific purpose of executing any Land Use Board Applications and associated necessary documents for the purpose of submitting and progressing an application before.the Miami Beach Planning Department, under Pile Number DRB22=0877 seeking a variance for the real property located at 5446 N.Bay Road,Miami Beach,Florida 33140,(the "Property")and in connection specifically therewith appointing her as the true and lawful Authorized Representative of the Company,however this Limited Power of Attorney shall not confer any right to sell,convey,mortgage or otherwise encumber the Property or the assets of the corporation or the Trustee. This Power of Attorney shall remain in full force and effect until such time as expressly revoked by the Trustee or surrendered by the Attorney-in-Fact. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 12th day of August,2022. Signed,sealed and delivered in the presence 9f: , Witn e XI LLC,as Trustee of the Haudenosaunee Trust • u/t/d December 18,2017 Print ime: 1VtaN V O/ By: SOL PMIN L.L.G.,Manager Prim Name: ( a , ger . STATE OF FLORIDA ) )SS: COUNTY OF MIAMI-DADE ) The foregoing instrument was acknowledged before me by means of physical presence,this 12th day of August, 2022 by CRAIG P.KALIL in his capacity as Manager of SOLE ADMIN I .L.C.,Manager of XI LLC,as Trustee of the Haudenosaunee Trust u/t/d December 18,2017,and who is personally known to me. • NOTARY PUBLI ,St to of Florida f. ,1t4 0A1110AD F RtThNDEZ �Y) i aiiisslea0 WN 280M .`m�� Molr0sAugusl11,2028 _ - City Hall ` '' f, a,•. 1700 Convention Center Dr. Miami Beach , FL 33139 o' = " . W.- 305-673-7420 coo �' _ �. Welcome � „ 15738-0001 Carmen V. 10/13/2022 09:26Af�9 - V " �', o c� :SCELLANEOUS • z t, ; =�" o: eference 1 : MCR430760 MCR OPEN (MCR) `* ° 2023 Item: MCR 1 @ 850.00 �. MCR OPEN (NCR) 850,00 ' ''' t c, 850.00 o, . �htatal 850.00 �� � ;, „ Or a .^� atal B50.00 � ,,,�yy IECK 850.00 .� x : ,�. - J „7. Check Number0299 ► „ � t.- `m" " range due 0.00 ': M . {, tid by: J KELLY Y ADVISORS INC s.;�=-' . � r (se) -.� i' *Q L i _ z:- V y' 6 y Q° -v , no s U .". p_V O C ' s_a v," co o a-':, = 0 '' Ff , i ' Qdv `. S , °'. y LL cc, N a d"R-- L.11111111111111111111111111111111111111111 1:1 ".,.. . _ .,. a fz� U Q . a ac Qgk# / : 1) ✓. ,�.a U :, W' ,_ a . t,$ Ihi vto gcaa • g . L . e warCfA o40 F',omi KY/oo—....-/ 2% Z4{ P ': pa■py.41r N d� d Y • 2 49:4416.'t944.Ma, es t Thank you for your paymen CUSTOMER COPY .