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2023 Lobbyist Registration Form - 1 Collins Avenue Drive (Abraham Merchant)DocuSign EnJelope ID: EEDCF950-20BD-476B-B5A0-A022F0210D91 RECEIVED MIAMI BEACH Office of the City Clerk 1700 Convention Center Drive Miami Beach, FL 33139 305.673.7411 LOBBYIST REGISTRATION FORM AUG 00 2023 CITY OF MIAMI BEACH IFFICE OP THE CITY CLERK 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: Larkin Michael W. NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez Larkin & Tapanes, PLLC 200 South Biscayne Blvd., Suite 300, Miami, FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-5300 mlarkin@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Merchant Abraham NAME OF PRINCIPAL (Last) (First) (Middle Name) Philippe Miami LLC 48 Wall Street New York New York 10005 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 212-871-5601 aerchant@merchantshospitality.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to City Code Section 2-482(h)(1)(a): A principal of any corporation, partnership, or other entity who appears as a lobbyist on behalf of that entity, without special compensation or reimbursement for the appearance, whether direct, indirect, or contingent, to express support of or opposition to an item shall register with the Clerk as required by this subsection but shall not be required to pay any 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) A. Merchant 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 DocVerify ID: 6E05AEOE-6F33-419E-95F8-A96279112215 Page 1 of 10 1A96279112215 ,III,I II www.dwvedfy.com DoeuSign Envelope ID: EEDCF950-20BD-476B-B5A0-A022F0210D91 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 1 Collins Avenue 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 Title of Person to be Lobbied Contractual Relationship (If yes, explain) YES NO 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 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): $825.00 per hour Page 2 of 5 DocVenfy ID: 6E05AEOE-6F33-419E-95F8-A96279112215 Page 2 of 10 2A96279112215 `,III www.docvenfy.= ,III F-4 DocuSign Envelope ID: EEDCF950-20BD-476B-B5A0-A022F0210D91 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 lobbvinq 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 XNo: Are you representinq 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 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 ves, has it been less than 12 months since the elected official(s) 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 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 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: _ Yes X No: If yes, were you promised or did you receive economic consideration in exchange for campaign consulting services? 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: \CLE R\$ALL \a FORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 Page 3 of 5 DocVerify ID: 6EO5AEOE-6F33-419E-95F8-A96279112215 Page 3 of 10 3A96279112215 ,III CiRiZ -F II www.docvedfy.com DoeuSign Envelope ID: EEDCF950-20BD-476B-B5A0-A022F0210D91 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 COMPENSAT4Gf+0URI1NG THE REPORTING PERIOD.' Signature of Lobbyist: i QLAd (AAA, Date 8-8-2023 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 CS600psolling requirements. Signature of Lobbyist: rk&4d (,6AiW Date 8-8-2023 DFFO 6E B38470... Signature of Principal: VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: State of Florida County of: Miami -Dade Sworn to (or affirmed) and subscribed before me, by means of ❑ physical presence or D online notarization, this 8 day of August , 2023 by Michael W. Larkin NAME OF LOBBYIST _Produced ID FOR X Personally Know Signature of Notary ub'Iic N Yeidy Montesino Perez Name of Notary, Typed, Printed or Stam Yeidy Montesino Perez Commission # HH 084273 Notary Public - State of Florida My Commission Expires Jan 24, 2025 persons: Date PRINCIPAL State of County of: Sworn to (or affirmed) and subscribed before me, by means of ❑ physical presence or ❑ online notarization, this _ day of Abraham Merchant NAME OF PRINCIPAL _Produced ID FORM OF IDENTIFICATION _Personally Known Signature of Notary Public 20_, by Name of Notary, Typed, Printed or Stamped (NOTARY SEAL) 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 4of5 __ -- 1 DocVerify ID: 6E05AEOE-6F33-419E-95F6-A96279112215 Page 4 of 10 4A96279112215 ,III ,I II www.docvedfy.com 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: Date 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 and all reporting requirements. Signature of Lobbyist: Signature of Principal: VII. NOTARY SIGNATURE AOD SEAL: LOBBYIST: State of Florida County of: Miami -Dade Sworn to (or affirmed) and subscribed before me, by means of ❑ physical presence or ❑ online notarization, this day of 20_, by Michael W. Larkin NAME OF LOBBYIST _Produced ID FORM OF IDENTIFICATION X Personally Known Signature of Notary Public Name of Notary, Typed, Printed or Stamped (NOTARY SEAL) The term 'lobbyist' specifically excludes the following persons: Date 1 Date PRINCIPAL State of Nr'hi y 0 ILK County of: N f W y D Sworn to (or affi ed) and subscribed before me, by means of Chysical presence or onl'p a notarization, thii2LO%ay of C& 204"Py Abraham Merchant NAME OF PRINCIPAL _Produced ID FORM OF IDENTIFICATION _i/ersonally Known Si r of Notary Public I f 194P t C o /`l•✓ Name of NotaiRjCry WWi0WM& Stamped NOTARY PUBLIC -STATE OF NEW YORK (NOTARY SEA". 02CO4876952 Qualified in New York County My Commission Expires 12-14-2026 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 DocuSign Envelope ID: EEDCF950-20BD476B-B5A0-A022F0210D91 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov Office of the City Clerk Rafael E. Granada, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.741 1, Fax: 305.673.7254 NAME OF LOBBYIST: Michael W. Larkin 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. Zd ned by: FtotOti, 8/8/2023 Signature of Lo yis Date FICLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 DocVerify ID: 6EO5AEOE-6F33-419E-95F8-A96279112215 Page 5 of 10 5A96279112215 ,III ,I II www.docvenfy.com EXHIBIT Disclosure of Interest for Philippe Miami LLC C,7 TRUST PANDA REPLACEMENT TRUST Trttal 9blo MuMare� Truss twO Coh~,ty CAPO'AI SEVEN LLC LLC PANDA INMNATIONAL LLC culManagar ADlaham Me1CIWa F Onwer/Manager RhnuCCDW ARAEqulflas LLC (NY) EIN: 81-2095968 OtbcwlManagar. AbrW-n Merchant & xnud Cohn Phlllppe Ealultlee LLG (NY) EIN: 453793566 OMmlManagan Abraham Metchanl& ROMOCohn Ion, '�r.���•..eo PnIIIpPo Chow Holdings LLC (NY) EIN: 81-2218833 OMCer/Managar, ADm%rn Mefchanl& Richud Cohn I V.T+ � N+iwrwq Phlllppe MIAMI LLC (FL) EIN: 92�I5,"" Olhcer"Wagel. AErahom MDILhant$ Richard Cohn NOIE5 1, Emily Colu Legend a. PURPLE: Holding CompanY(a) b. GOLD: OPenling RaalWOnr EnIiI Miscellaneous Cash Receipt 1 CITY OF MIAMI BEACH r a `j No. 432013 ❑ Cash ❑ Credit Card ❑Check # j $ 20 Received of Address For MBF Miscellaneous - MCR - 2023 006294-0007 Ebani Th... 08/09/2023 09:15AM MCR OPEN (MCR) Payment Amount: 1.050.00 Office of Finance Director (THIS INFORMATION MUST BE COMPLETED) By Account number: Preparer: Dept: EXT: S = = = a = �= oM a c�m�m�m r+ ra3m to rn� CD 7c CD 7c CD ;xl- O 3 N) :;;o CD lD CD E Cy- 0n C7 r•h M W ^ 1— A 7` T 7- :;V O CD v=3 a o ma i IV o0 ora S cc z z z —0_0 CID m F-+ O v CD W 3 O (Cr ^ C CDO II T— LD CDD CD CD CD 3 CJS i r_� s ^ c I -0 (Z C a m 0 �c3s"�� 3 om< o 0 v� :a:LTI CD CID + O W A N i� b 1 D v3r� W A CD W rt CD ' i O W I = -oLn w !rj _ p_ CD iie ! :�I:, i« O � O O O O O O C �