Tracy Slavens - Todd Rosenburg 6.
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M I AM I BEACHo
Office of the City Clerk p 47/4 jj
1700 Convention Center Drive FC�j��
Miami Beach, FL 33139 CMGA/
305.673.7411 R�
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)
LSN Partners 3800 NE 1st Avenue, Suite 200 Miami Fl 33137
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-673-2585 tslavens@lsnlaw.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION: •
Rosenberg Todd
NAME OF PRINCIPAL (Last) (First) (Middle Name)
1501 Collins, LLC 7900 Glades Rd., Ste 540 Boca Raton Fl 33434
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
561-430-3113 1501@pebbcap.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuan Ib City Code - • 2-482(h)(1)(a) • i ®.1(StM corporation, partnersh'p,CB clitr s -••o. !EI lobbyist Clip behalf•Off f
e tityp sp-cial Compensation •Cd KtNiO or ntf l itwl•i&h. r•t•f-1 ()) mdi ect,L•P contingent,fb•• • - ••o d 'o0 position fC
an item shall r.-gister with the Clerk a required by this subsection b t shall not be required to pay any registration ees.
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): \\\b(
• 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 attached.
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.
Development approvals & permitting issues, including, but not limited to Member of City Administration,
Members of City Staff and members of HPB, PB, DRB, and BOA, City Commission and Mayor,
relating to the property located at 1501 Collins Ave for file number HPB22-0559 and PB23-0572
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
Members of Historic Preservation Board (HPB), 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):
•
$750 hr
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":
_YesXNo: 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.
_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 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.
—YesX 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:
_YesXNo: If yes, has it been less han 12 months since he'elected official(s) whom you pro;,ided campaign
consul inq services .orn inf.
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.
—YesX_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:
YesXNo: If yes, were you promised or aid you receimee economic consiaer,ation in exchange for campaign
consuitinq servicesi?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
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 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 COMPE SATI.ON DURIN THE REPORTING PERIOD.1
Signature of Lobbyist: Date
/2y/2
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 Cod an I reportin • ents.
Signature of Lobbyist Date 1/ -e/Z--�
Signature of Principal: Date V I I/ 2 rip
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of toV--\ c\ State of E OC i C�
County of: NWV\ N\y1 County of: ?C I\trl bei,7 C►
Sworn to(or affirmed) and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of 10i physical presence by means of l 'physical presence
or❑ o m e notarization (�,1Q or 0 or]I�'ne notarization,
this IR day of UA\\V�1 ` ,201Sby this /9' aay of 'aq n vary , 20.23 by
Tracy Slavens Todd Rosenberg
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
� FORM OF IDENTIFICATION FORM OF IDENTIFICATION
`�Personally n V Personally Known
Signature of tary Pub is Si ture of Notary Pub is
1._ .V\k \\Q , fl ;it 3
Name of Notary, Typed, Printed or Stamped Name ofQtary,Typed,Cpated or Stamped
(NOTARY SEAL) \ --•- , - (NOTARY SEAL) I D�eG;. MEGHAN DUGGINS
04Vkr, ( ?' � Notary Public-State of°iorica i •
;aRtf i ,. ;'UZBETHBUENO k s`. Commission#HH 240608 ,)
'?'oF P.. •' MyComm.Expires Apr 2.2026
MY COMMISSION#HH 328244 .., p a
'.��-o` , ' BondeC through National Notary Assr.
1 The term'lobbyist'specifi a ' r•;�es tfiginfa tro1&Z028
i �rrr
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
M1AM.LBE .C'H .
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, 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
$50 .00 pursuant to Section 2-482 of the Miami Beach City Code.
•
1/ -(1/1-
Si nature o bbyist Date
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc
Page 5 of 5
1501 COLLINS AVENUE ORG STRUCTURE AS OF 02-08-2022
BENEFIOARIES: BENEFICIARI6: BENEFICIARIES/
Barbara Rosenberg 33.33% Fara Horowitz Todd Rosenberg
Fara Horowitz 33.33%
Todd Rosenberg 33.33%
Eckweltgatl, 8lanwtlsg%b Todd Rosenberg Barbara Rmenbers2016Tsut I fan Mom.2011Tnnt Todd Noaenberg2016Thnt
llnm✓dwll 16,dMdall 00 R.
FIN:3o641113 EIN:636111815 EI%:304655145
1>50,00a 1.110.0a0 1350..000 450,000
75.0% 23.0% 0.0% faint 20.0% 20.0%—
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Managing Member Non Member Manager I
PCM Holden LLC Todd Rosenberg
DE
FIN:87-1390663
2,250,000
100.0% 0.0%
Mena er
No addtlonal members or
Indirect beneficiaries awn 5%
or more of the Property Owner
George Macdmaaa Pebb Capital Management,LLC varlom Fmploleea
(.1.1W) DE llydMduali
El N:46-5680624
3,000,000 2,250,000 250om
100.094 90.0% 10.094
Managing Member
No members or indirect No additional members or
benefidades of RonRuss awns 5% Mdlrect beneficiaries awn 5%
r more of the Property Owner or more of the Property Owner ,
1501 Beach,LLC Roneuss Investments I,LLC Nikea,LLC AR other Limited Members 1501 Beach,LLC 1501 Collins Pebb Manager,LLC
DE FL NV venom NOhna worth DE DE
010187-2165015 EIN:47-2342968 EN:46-4376836 0340201. E10:87-2165015 EIN:87-1697900
2,500,000 2,500,000 3,000,000 1,650,000 2,500,000 2,500,000
50.0% _ 50.0% _ 64.5% 35.5% 50.0% 50.0%
Mafot Decision Member Managing Member r
/ indirect additional membersorr / r
NoNoireR beneficiarieslmmb own 5%
or re of the Property Owner
Ocean Five Beach,LLC 1501 Collins Pref Equity,LLC All other Limped Members 1501 Collbu Manager,LLC
DE FLformed 6/8/2021 yod%s Mph net worth DE
ON:87-1132149 aalduob EIN:137-1431270
5,000,000 4,650,000 7,350,000 5,000,000
22.73% 21.14% 33.41% 22.72%
\ Managing Member
\\\ 1501 Collins Holdings,LLC
DE
EIN:87-1404713
22,000,000
100%
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1501 Collins,LLC
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