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Gustavo Berenblum - Ophira Cukierman Dot;uSign Envelope ID:FOB4E301-B536-4F9D-A4C6-D097DC392BD4 RECEIVED M I AM I B EAC H Office of the City Clerk JAN 31 2023 1700 Convention Center Drive Miami Beach, FL 33139 305.673.7411 CITY OF MIAMI BEACH 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"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: Berenblum Gustavo NAME OF LOBBYIST (Last) (First) (Middle Name) Berenlum Busch Architects 804 NW 21st Terrace,Suite 222,Miami , Florida 33127 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-200-5251 gb@bbamiami.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Cukierman Ophira NAME OF PRINCIPAL (Last) (First) (Middle Name) 1688 Property Owner,LLC 59 Greenacres Avenue Scarsdale NY 10583 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) - 917-860-0072 ocukierman@gmail.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant lb @ay ..:l 2-482(h)(1r)(a): a principal ct1?g f corporation, partnership, or other entity who appears as a Lobbyist Q behalf of that anti rijs compensation al reimbursem-nt Qe?tDX 1 1,whether direct,indirect,o contingent,to ex.ress su...rt of. o..osition to an iterp shall register with the Clerk as required by this subsection but shall not be required to pay any registration fees. O h 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): O. Cukierman • 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): Please see the attached. Page 1 of 5 DocVerily ID:844CAE81-058C•442E-8429-8977E9DE4D22 L Page 13 of 18 138977E90E4022 ,III 'I II I www docvenfy.com "-- DocuSign Envelope ID:FOB4E301-B536-4F9D-A4C6-D097DC392BD4 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 &Permitting 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 1709 Jefferson Avenue 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 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 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): $ .00 per hour w Page 2 of 5 DDoc er fdocv er ry l .B44CAEB1-058C-442E-8429-6977E9DE4D22 I Page 14 Ll�} of 18 _L 14B977E9DE4D22 'III i3k3e'I HI I DocuSign Envelope ID:FOB4E301-B536-4F9D-A4C6-D097DC392BD4 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 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 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 les then 12 months since the elected official(s)whom you provided campaign MEM consulting services was sworn irn 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 r within the past election cycle?If yes.please list the incumbent member(s)of the City Commission: N O N Yes XNo: If vim. were veu premised or did you receive economic consideration in exchange for campaign r onsui;if servicesI TO BE COMPLETED BY CITY CLERK'S STAFF ONLY v Annual Registration fee: [ ]Yes[ J No Amount Paid$ MCR if Date Paid Lobbyist Registration Form received and verified by: F:\GLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 Page 3 of 5 DocVerify ID:1344CAEB1-058C-442E-8429.8977E9DE4D22 L Page 15 of 18 158977E9DE4D22 j 1111 `r, IA III www docvenfy.com DocuSign Envelope ID:FOB4E301-B536-4F9D-A4C6-D097DC392BD4 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: � f�U' O bGAtM Date 01/30/2023 9 Y E�iKEe„na4ec... 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-araeklibmeiporting req�uiirements. Signature of Lobbyist: austmo - - -" oocuslgned by: Date n1/3n/2023 \--t9natnd1 nb461.... ra �^/�.-,. Signature of Principal: Date 01/30/2023 U1dht1hlt1Ud4t1... 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©online notarization, or Ix7 online notarization, this day of nht3nmma ,20 , by this_day of mt3niwwq ,20_, by Gustavo Berenblum Ophira Cukierman NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Kno --- x Personally Kn — M O Sr.=ti0nvmrozzmam Wm9zdovm.mzm am o Signature of Notary Public Signature of Notary Public Diana Ramos Diana Ramos s 5 Name of Notary,Typed,Printed or Stamped Name of Notary,Typed,Printed or Stamped FA I Jana Ramos Lana Ramos 1 0 1 Commission 0 GG 308355 ♦ gommIsslon#GG 308355 LIJ 1 rotary Public-State of Florida ( Notary Public-State of Florida 1 m ---7 lily Commission Expires Apr 10,2023 1 IVf y Commission Expires Apr 10,2023 1 I 1k o ring persons: o 4 Expert witnesses wno provtae only scientinc,tecnnical or other specializeu uiwnnauuri or iebunwny III Nuuuc niCeunya,any person who b 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 0 the appearance. Page 4 of 5 Doe :do er 44CAE81-058C-442E-8429-6977E9DE4D22 i Page 16 of 18 I 16B977E9DE4D2 1 1111 IN III III I DocuSign Envelope ID:F0B4E301-B536-4F9D-A4C6-D097DC392BD4 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 NAME OF LOBBYIST: Gustavo Berenblum 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. p DocuSigned by: Gust i m "-' -- - 01/30/2023 C971AC03171540C... Signature of Lobbyist Date Q F:\CLERISAWaFORMS\LOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 DocVerify ID: B44CAEB1-058C-442E-8429-B977E9DE4D22 Lpage 17 of 18 1 17B977E9DE4D22 J �QI IS,`-Ell III I DocuSign Envelope ID:FOB4E301-B536-4F9D-A4C6-D097DC392BD4 EX I-I I B I T B ENTITY STRUCTURE Ophira&Joram Cukierman (16.7%) 59 Greenacres Ave Scarsdale, NY 10583 1688 L D Melissa Eidelheit(16.7%) (Asset1010434 Bilsestr 6,Berlin 14193 Germany Alexandra Cukierman (16.7%) Hohmannstrabe 2 1688 Property Meridian 1688 14193 Berlin, Ownero lag ¢1Q0%) Germany 0 Lea Waisberg(16.7%) FasanenstraBe 11,10623 Berlin Germany N Benjamin Skoblo(16.7%) FasanenstraBe 11,10623 Berlin Germany rn Samuel Skoblo(16.7%) a Fasanenstrage 11, 10623 Berlin Germany U DocVerify ID:B44CAEB1-058C-442E-8429-B977E9DE4D22 L Page 18 of 18 I 188977E9DE4D22J ,I i rmig1I III I www docvenfy corn ��R.��� U • Miscellaneous.CashnReceipt CITY OF MIAMI BEACH "P N 431268` ❑Cash ❑CreditCard E3Check#' $ / F , 76; ��1� a � �'' � �r". ,,� � ,;:.. ,� ,.d s • ,�� I' '�.Y �;?;/ Y F\V:x" —. rC b` r - t THIS INFORMATION MUS IC tVTI IAMI B.EAfice !!! 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