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Graham C. Penn - David Martin (TCH 500 Alton, LLC) RECEIVED DocuSisn Envelope ID:FDAA3FBE-7C37-410E-8160-7E1ECA3A8B4C APR 04 2023 /V\ Office of the City Clerk IAMI BEACH � 'LTyCIFMBEACH I= 1700 Convention Center Drive Miami Beach, FL 33139 305.673.7411 (p )C OF THEHE I 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: Penn Graham C. NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez Larkin&Tapanes,PLLC 200 S. Biscayne Blvd.,#300,Miami,FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) - 305-374-5300 gpenn©brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Martin David NAME OF PRINCIPAL (Last) (First) (Middle Name) TCH 500 Alton,LLC 3310 Mary Street,#302 Coconut Grove Florida 33133 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-416-4556 DMartin@terragroup.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS ►L f3lb aiy @Yb RagEtjz 2-482(h)(1)(a): Q prin sal ci?cig corporation,partnership,cy carrGEZ dip-••r as CI lobbyist(.;8( C7cflr( • giffirkdiliollu.NAD compensation t7?lc iufwiti-iau d orQliatTe:4;10111€4, t indirect,CL'contingent, 94_,&0300,0..ositiont • TIHi E liai eaffi araCaU ljaJl siEdb iti#d: DGERC:a °• ibt•xa,/iMain. If the principal is a Corporation, Partnership or Trust, the following information MUST be provided 3 • pursuant to City Code Section 2-482(c): • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write NIA): D. Martin • 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. LL Page 1 of 5 akt `i ^-v"^-"•, " 663-E818-41F0-A6AD-6448141FC194 Pagel of 40 I 16448141FC194 I ,M 'IIII DocuSI n Envelope ID:FDAA3FBE-7C37-410E-8160-7E1ECA3A8B4C 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 properties located at 710-720-740 Alton Road 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 U LL C) 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): w $750.00 per hour Page 2 of 5 t e ID r com91663-E818-41 F0-A6AD 6448141 FC194 I wwww do I Page 2 of 40 L 26448141 FC194 I „I l ,l III I , DocuSign Envelope ID:FDAA3FBE-7C37-410E-8160-7E1ECA3A8B4C The following six(6)questions MUST be answered: 1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions 8y 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 x No: 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 X No: Are you providing only scientific, technical or other specialized information; appearing as a representative of a neiahborhood 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 12 months since the elected officialts)whom 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 0 2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular service before lobbvinq the City Commission at a public meeting. _Yes X 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: 0 -Yes X Nb:• If yes, were you promised or did you receive economic consideration in exchange for campaign consulting seryicesi e 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 09-20-18 REG.doc Revised 09/20/2018 Page 3 of 5 DocVerify ID:4F691683-E818-41 F0-A6AD 6448141 FC194 L Page 3 of 40. L 36446141 FC194 I ,II 1 ,I II I www docvenfy.com �i� DocuSign Envelope ID:FDAA3FBE-7C37-410E-8160-7E1ECA3A8B4C 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 CO NSAnTKIN DURING THE REPORTING PERIOD.' Signature of Lobbyist: r t'tn'n' Date na/na/2n71 2-1U6(1UUJU148S... 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 Sffdsgitietbporting requirements. Signature of Lobbyist: DocuSigned by: Date 04/04/2023 21-10077D03C4400... C Signature of Principal: 9G;P� y Date 04/04'2023 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 M online notarization, or I I online notarization, this day of n4/n4/2n23 ,20 , by this—day of 01/01/2023 t 20 , by Graham C. Penn David Martin NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION Personally Kno .---' _Personally Kno �--- V \i, q 5¢sOm Y101,04/¢.,.M<.m 50-Om M.fbib,¢IGN 4¢0 Signature of Notary Public Signature of Notary Public Diana Ramos Diana Ramos 0 Name of Notary, Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped N iana Ramos o iana Ramos mmission#GG 308355 commission#GG 308355 1 z lgotary Public-State of Florida I votary Public-State of Florida 1 Illy Commission Expires Apr 10,2023 My Commission Expires Apr 10,2023 o Th o 'ng persons: Expt,"":::::@ ''" T,.,,,,�.r'.�..,:, ., ;. '�T.:� `tal or other specialized9mtormation 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 z 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 DocVerify ID:4F691663-E818-41F0-A6AD-6448141FC194 I. Page of 40 I 46448141FC194 ,el �ifiY ,llll www docverify.com DocuSign Envelope ID:FDAA3FBE-7C37-410E-8160-7E1ECA3A8B4C 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 CityClerkt miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: Graham C. Penn 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. 8 0 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. DocuSigned by: If:JI tMM1AMm pul an, 04/04/2023 2r10o77Do3cuo3:.. Signature of Lobbyist Date LL CJ C+ W F:ICLERISALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc cc m Page 5 of 5 DocVerify ID:4F691663-E818-41F0-A6AD-6448141FC194 I Page 5 of 40 1__5644B141FC194 II I II III I www docvenfy.com LjL>��7VR , ' DocuSign Envelope ID:FDAA3FBE-7C37-410E-8160-7E1ECA3A8B4C DocuSign Envelope ID:A78280A6-015C-44E0-8BC0-24A117B906E6 SUPPLEMENTARY DISCLOSURE OF INTEREST- TCH 500 Alton, LLC. Percentage of Interest TCH 500 Alton Holdings, LLC 100% 2200 Biscayne Blvd. Miami FL 33137 Interest in TCH 500 Alton Holdings, LLC. Percentage of Interest Park on Fifth, LLC 50% 2200 Biscayne Blvd. Miami FL 33137 T 500 Alton Member, LLC 50% c/o Terra Group 3310 Mary Street, #302 Coconut Grove, FL 33133 Interest in Park on Fifth, LLC. Percentage of Interest Sonny Kahn 2004 Irrevocable Trust 16.10% 2200 Biscayne Blvd. Miami FL 33137 • 09 Russell W. Galbut 2004 Irrevocable Trust 55.60% 2200 Biscayne Blvd. Miami FL 33137 0 Bruce A. Menin 2004 Irrevocable Trust 16.10% 2200 Biscayne Blvd. Miami FL 33137 David Galbut 12.20% 2200 Biscayne Blvd. Miami FL 33137 Co Beneficiaries of Sonny Kahn 2004 Irrevocable Trust I www docverify.com ily ID:4F691663-E818-41 FO-A6AD-6448141 FC194 -page 6 of 40 66448141 FC194 I III ammo,l III www do DocuSicn Envelope ID:FDAA3FBE-7C37-410E-8160-7E1ECA3A8B4C DocuSign Envelope ID:A78280A6-015C-44E0-8BC0-24A117B906E6 Percentage of Interest Elliott Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Joshua Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Naomi Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Rachel Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Avigail Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Beneficiaries of Russell W. Galbut 2004 Irrevocable Trust Percentage of Interest Marisa Galbut 50% 2200 Biscayne Blvd. Miami FL 33137 Jenna Galbut 50% 2200 Biscayne Blvd. Miami FL 33137 0 Beneficiaries of Bruce A. Menin 2004 Irrevocable Trust Percentage of Interest 33.33% Maxwell Menin 2200 Biscayne Blvd. Miami FL 33137 Mason Menin 33.33% LL 2200 Biscayne Blvd. DocVerify ID:4F691663-E818-41 FO-A6AD-6448141 FC194 Page 7of 40 76448141FC794 �.I� ,IIII www docventy.com iILSS� ,` docusj n Envelope ID:FDAA3FBE-7C37-410E-8160-7E1ECA3A8B4C DocuSign Envelope ID:A7B280A6-015C-44E0-8BC0-24A1178906E6 Miami FL 33137 Lucas Menin 33.33% 2200 Biscayne Blvd. Miami FL 33137 Interest in T 500 Alton Member, LLC. Percentage of Interest T 500 Alton Member Holdings, LLC 100% c/o Terra Group 3310 Mary Street, #302 Coconut Grove, FL 33133 Interest in T 500 Alton Member Holdings, LLC Percentage of Interest T 500 Alton Member Parent, LLC 100% c/o Terra Group 3310 Mary Street, #302 Coconut Grove, FL 33133 Interest in T 500 Alton Member Parent, LLC Percentage of Interest • Pedro A. Martin 50% c/o Terra Group 3310 Mary Street, #302 Coconut Grove, FL 33133 David P. Martin 50% c/o Terra Group 3310 Mary Street, #302 Coconut Grove, FL 33133 LL O LL 0 0 e T 0 DocVerify ID: LL wwww dower fy com91663-E81 Q-41 FO-A6ADFi448141 FC194 � •M EMI'II III I Page 8 of 40 86448141 FC794 tL�fiMC , i mOF �� r �,� t i, ;.� a m -� o �. -'��� ,, � � �,� City Hal l L. - ° - a �' . �' ' -< E 1700 Convention Center Or. ' es.: z = ,. ' y �o Ell -„I Miami Beach , FL 33139 .r, -� -- °1 305-b73-7420 ( > 3' ' 70 ='x '� ` .-'' `� a c • . Welcome ( D 7 < N }a n 04/04/2023 04:00 o W v PM Carmen V. „ O _ ,,� a . ; _ - ,° zm v, 3 006034-0047 z MISCELLANEOUS . C• o N J n t " , f s,�°� .� Reference 1: MCR431438 : � vo o `� �+ MCR OPEN (MCR) "'� 2023 Item: MCR ! -' ! ; �z • 1 @ $350.0000 • MCR OPEN (MCR) $350.00 /_'` rn ` - 1 �' _ $350.00 ( '� t Subtotal $350.00 1 o, Tatal m, a f a $350,00 , ` • CHECK ,W - $350,00 '� '• ,� Check Number000500875 Chan e 0 due $0.00 ,i,:;‘,..„,,,,,,,.,...;tiicii,s,,„,...,_,,,,,:,,,-„,,,,,,o,_,,,,,- Z 4 ; tt •'4 ° Paid by: TCH 500 ALTON LLC 4 r <O �' fs 3 r j k IllIlI01llllllllllllIIlIIll1II111llllllllllll1011IIIIIIIIIIIIIIII ' �"" .. ,ice f � �"�` c� �� cwo � ,�k V � rcHc�o .uc,..,„ . v ,.. A _� �...m fq+ iv � y �H M1i71M z � ""`*. � � s �. ,� ,! ^,•aHwm ruro-aw nm nYJ oJIiJO OJ[4ANJ a)ft)/YUYY l3eu.90••••• .a 017Y Of{{iA!!I BCIIJH 1/(1/ ., � pItOJ FOWYIIS iCH CCYTCY Oi1YY /4 ; 4 ▪ * ENO Y 07+CH Y5 3l779M1AHI,h €, $ `:=:fit :i °v -. 4 �. .,�L;r3 'six.....r. s .-��... .c.. w..iws� x�:"d':.;L#..r:...s.:,s"v-Iasi.+.:w.-e. :;i4=�'ae 4�"`.2:ie+wva:.tw' ;"•'i; k- Thank you for your payment CUSTOMER COPY