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JJ Wood - Luis Felipe Neiva Silveira DocuSign Envelope ID:AB793D5A-62D1-4A5B-A342-4D6DD93BF549 RECEIVED APR 04 2023 MLAM I B EAC H Office of the City Clerk CITY OF MIAMI BEACH 1'700 Convention Center Drive OFFICF nP Ti4E CITY CLERK Miami Beach, FL 33139 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"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: Wood JJ NAME OF LOBBYIST (Last) (First) (Middle Name) Urban Robot Associates 420 Lincoln Road-Suite 600 Miami FL 33139 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786)246-4857 (305)766-0071 jj@urbanrobot.net LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Neiva Silveira Luis Felipe NAME OF PRINCIPAL (Last) (First) (Middle Name) Qriar Island Corp 5004 North Bay Road. Miami Beach FL 33140 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 324-4700 luisfelipe@futureholding.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant 11)( ..- - . 2-482( 1110Q•rincipal CQI i cor.oration,paiDgidaiL ce2g Cowl s appea s E 3 a lobb is Cfnl o- l od!that e tityoUtikEil spe 'ra o pe s.tion Cgaiegiggi= or Rci appearan e gigingaii01 indirect CRi contingent,in afgamum.. dap 0ica o 0 o an item shall register with the Oje a required b this subsection but shall not be required to pay y;eglstration fees If the principal is a Corporation, Partnership or Trust, the following information MUST be provided a pursuant to City Code Section 2-482(c): 0 LL • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): Luis Felipe Neiva Silveira 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. Pagel of5 �1 ?. DocVerify ID:0637B73D-E910-4548-9A45-EBF4DFD46C8B Page 1 of 5 I 1EBF4DFD46C8B I ,III �1I III www.docverify.com F{C„T.1 DocuSign Envelope ID:AB793D5A-62D1-4A5B-A342-4D6DD93BF549 ti 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 &Planning 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 28 Star Island Drive,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 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 8 appearance of an impropriety, with any current City Commissioner or City personnel who is sought to co be lobbied as identified on the lobbyist registration form filed. co List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety(if none,write N/A): None ❑ LL LL 07 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): $350 per hour Page 2 of 5 Doc,V�eo fy ID:0637B73D-E910-4548-9A45-EBF4DFD46C8B I Page 2 of 5 I 2EBF4DFD46C8B I 'III �'I II I DocuSign Envelope ID:AB793D5A-62D1-4A5B-A342-4D6DD93BF549 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 x No: 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 X No: 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 X No: If yes, has it been less than 1fr2 months since the elected official(s) whom you provided campaign co sultin_ services was sworn ini 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: O a _Yes X No: If yes, were you promised or did .ou receive economic consideration in exchange for campaiq o LL sonsulti eservicesi m TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 01, Annual Registration fee: [ ]Yes,[ ]No Amount Paid$ - MCR# Date Paid Lobbyist,Registration Form received and verified by:, CLER\OLL\aFO'RMS'\iO8BYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REGaiac Revised 09/20/2018 m Page 3 of 5 DocVerify ID:0637B73D•E9104548-9A45-EBF4DFD46C8B [ Page 3 of 5 3EBF4DFD46C8B I ,III �tl II I www.docverify.com GsS DocuSign Envelope ID:AB793D5A-62D1-4A5B-A342-4D6DD93BF549 ,) 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.1 DocuSigned by:. ^h Signature of Lobbyist: JJ 046/ Date 3/31/c2023 B251B22A3A8D48F... 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 ocu g arilne allby:reporting requirements. Signature of Lobbyist: E) (N61, Date 3/31/2023 DocuSigned b 6251822A3ABD48F... 3/31/2023 Signature of Principal: Date 8EBDD4915777419... 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 ll online notarization, or ll online notarization, this 31 day of March ,2023, by this 31 day of March ,20 23, by JJ Wood Luis Felipe Neiva Silveira NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Knoy (44 x Personally Kno ��- 11 N y. N Signature of Notary Public Signature of Notary Public 71 Yeidy Montesino Perez Yeidy Montesino Perez CI Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped N COCO (N 'eidy Montesino Perez eidy Montesino Perez l o Commission#HH 084273 1 gommission#HH 084273 o Notary Public-State of Florida 1 votary Public-State of Florida W 1 My Commission Expires Jan 24,2025 — My Commission Expires Jan 24,2025 ` The ter o ersons: 0 1 Expert wunCS5Cs wnu piuviuu uiny belelnuiG, iCunnR7di ur other specializ€:.",,.,.,,,,.., ,,,., :...,:;,...,,,, :..,,...,,,..,,,,,.,., y.,3ny person who 0 only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether w direct, indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of o not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for co r. the appearance. Page 4 of 5 DocVer doweID:r 637B73D-E910.4548.9A45-EBF4DFD46C8B Page 4 of 5 4EBF4DFD46C8B 1111 FISMSkS11111 1 DocuSign Envelope ID:AB793D5A-62D1-4A5B-A342-4D6DD93BF549 •.T MIAMI A City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E.Granath:), City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: JJ Wood 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. 0 86 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. LL DocuSigned by: h 046 1, 3/31/2023 Signature of Lobbyist B251822A3A8D48F... Date m O F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 DocVerify ID:0637B73D-E910-4548-9A45-EBF4DFD46C8B Page 5 of 5 5EBF4DFD46C8B www.docverify.com Miscell•aneous Cash Receipt>: CITY OF,NIIA• MI BEACH No 431433 O Cash 0 Credit Card ICheck# t $ e$ r ar 20` , ` �is lam' r ° 2e k "� `Received of t -, . j r * h n ut•s aye �l: tj ' Address -e } P f _a x ; ss 9w , Fors e s ,t ,3 • F : r APR 04 2023 i IBEACHOffice(THIS INFORMATION MlBEIC•�,' �L of Finance D�rectoYr "� Account�number '` `^ f By Preparer:�� ' ,,� w� ,a ,, � , /, Dept.'' EXT -• . - a33 " '.ra r f >? .• �. .. '•1 �.r_ .•. , x#i ...•:, ._ .. ___ ltF�w. �fi .�^•:i� s., ..� max.. � � �,,"a ..c,.. �,s4�,� z ,s �, • .57 Disclosure of Interest Qriar Island Corp NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP BATISTA SILVEIRA,VIVIANNE M 100% 5004 NORTH BAY ROAD MIAMI BEACH,FL 33140