2024 Lobbyist Registration Form - Lot Split for Lagorce Circle (Anand V. Khubani) Lo3� S� I �• �► �ro �
LaC7o�ce. L :c �lt
, pC ^ u RECEIVED
I D L /—�� 1 I ofFce or me ciry ae�k JUL 2 9 2024
1700 Convention Cenler Drive
Miami Beach, FL 33139
3a5.673.7ai� CITY O� pstAMl BEACH
LOBBYIST REGISTRATION FORM OFFICE O��THE CITV CLERK
Lobbyist means all persons employed or retained. whether paid or not, by a principal who seeks to enwurage ihe passage, tlekat or
modifcation of any ortlinance, resolution, action or decision of any mmmissioner, any action, tlecisian. recommendation o! ihe Ciry
Manager or any City board or commitlee�. or any action, tlecision or recommendation of any Gity personnel tlunng the time periotl of Ihe
entire tlecision-making process on such action, decision or recommendation that foreseeably will be heaM or reviewed by the City
Commission, or a City boartl or commitlee. The term specifcally includes ihe principal as well as any employee engaged in lobbying
activities. The term "Lobbyist" has specific exdusions. Please reter to City Code Chapter 2, AM1ide VII, Division 3, entitletl "Lobbyisis,"
for atltlitional information.
InsVuctions: Please complete all sections of this fortn anG submit ihe completetl form, with ihe applicable fee, to the OKce ot the City
Clerk. If you neetl more space to complete an answer, use a separate sheet(s) ot paper. If yau have nothing ro report in a particular
section, you must write "none" or "n/a" in that section. Any change ro any information originally filetl, or any atltlitional Ciry
Commissioner or personnel who are also sought to be lobbied shall repuire ihat the lobbyist fle an amentlment to ihe regisVation Porm.
The IODbyist has a cantinuing tluty to supply intarmation antl amentl ihe forms fletl Ihmughout the periotl that the lobbying occurs.
Separete registration forms shall be required for each pnncipal represented on each specific issue.
I. LOBBYIST INFORMATION:
Anand V. Khubani
NAME OF LOBBVIST (�xst) (Frsp (Mldale Name)
18 La Gorce LLC 584 Van Beuren Road Morristown, NJ 07960
LOBBVIST BUSMESS NAME AN�AD�RE55 INumber and SVaep (Ctty) (S�a�e) (Lp Cotle)
973-826-8408 andy@itleavillage.com
LOBBVISTBUSWESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILA�DRESS
II. PRINCIPAL INFORMATION:
Anand V. Khubani
NAME OF PRINCIPAL (LastJ (Flrsp (Miadle Name)
18 La Gorce LLC 584 Van Beuren Road Morristown, NJ 07960
PRINCIPALBUSWESSNAMEANDAD�RESS (Numbarand5lreep (Cl�y) (Stele7 (ZlpCotle)
973-826-8408 andyC�ideavillage.com
PRINCIPn�Bl15MESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILADDRESS
Pursuan��o GYy Code Secfion 2<82(h)(1)(e)'. A pnncipal oi eny corporation, patlnersM1ip. or olher entiry who appears as a IoObyist on behalf of�hat
entiry,wilhout special mmpensation or reimbursement for Ihe appearance,wM1ether tlirect intlirecl.or con6ngent to express suppotl M or opposi�ion ro
an i�em shall registerwil�ihe CIeM as requiretl by Ihis subsedion but shall no�be requiretl�o pay arry re9islration(ees.
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-062(c):
. NAME OF CHIEF OFFILER, PARTNER,OR BENEFIqARV(if none,wriM NIA�: Anand V. KhUbani 2nd Neeta A. Khubani
. NAME OF ALL PERSONS HOLDING,OIRECTLV OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A�:
Anand V Khubani (50°/) and Neeta A Khubani (50%)
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.
Lot s lit a lications for 16 18 22 & 24 La Gorce Circle and related matters.
IV. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482�a��4), list the City Commissianer or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contrectual 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 Intlividual antl Contractual Relationship(If yes, ezplain) �ES NO
Title of Person to be Lobbied
City of Miami Beach Committees and Boards X
City of Miami Beach Attomeys Offce and Administration X
City of Miami Beach Mayor and Commissioners X
Pursuant to City Code Section 2�82(g), every registrent shall be required to sWte 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 relations�ip giving rise to an
a earence of im ro rie 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):
N/A
Page 2 of 5
The(ollawin9 six(6)questions MUST be answeretl:
1) Pursuant to Ciry Cotle Section 2<88,entitled"Prohibitetl Campaign Coniributions By Lobbyisls On Procurement Issues":
Ve�o: A I bb ' u � n d' q b'd f n C �o �t or serv'ces or on a oresent or
p d' a dt a d 'o t rservice9
2) Pursuant to Gity Code Section 2d90. en[itled "Prohibited Campaign ConVibutions By Lobbyists On Real Es�a[e Development
Issuesr"'
_Vesl'�Jo: A I bb " d' n oof f f D I o t Aa t 'Ih M C'N 1'cafon
f h f o 7 C h o t N C'N' F ture LanO Use Map7
3) Pursuant ro City Code Section ]d82�h�, any person (except those exempt fmm the tlefinition of "lobbyisf' as set foM1h in
Section &481)who only appears as a representative of a no4for-pro(t caryoretion or entity withaut special compensation or
reimbureemenl for the appearance, whelher direct or intlirect to express support of or oppositian ro any item,shall register with
ihe city clerk as required by ihis section.. but shall nat be required to pay any regisiration fees.
I:I
_YesG1o: o C u t-f �o f't t' ar enCtv wthout soecial comoensation or
reimbursement?
4) Pursuant ro City Code Sedion PdBt ihe tertn "IobbyisC specifically exclutles ihe following persons'. Expert witnesses who
provide only scientifiq technical or olher specializetl information or testimony in public meelings; any person who only appears
as a representative of a neighborhootl association without compensation or reimbursement tor the appearance,whether tlirect,
indirect or wntingent, to express support of or opposition to any item�, antl any person who onty appears as a representative of
no4for-pmfit communiry based organization for the purpose of requesting a grent without special compensation or
reimbuRrse�ment forthe appearance.
VeseHo: A 'd' 1 R t h ' I th ' I' tl 'nformafon� aooearina as a
o tati f 'qhb a d ' t' 'th t o ' I m t' n or reimbursement or
p �' tf Ft b d a ' C ( lh o t u tn a aranl wthout
p ' I com fon orreimbureemenl�
5) Pursuant to Ciry Code Section 2191�7�, no campaign consultant shall lobby t�e City Gommission for a penod o( 12 months
following [he swearing in of any elected official(s) for whom the campaign consWtant providetl campaign wnsulting services
within the past election cycle. See Section 2-491 for more information.
_Yes✓�1o: H v 'd tl 'a It' q t 'ncum�enlmemberot[heCiNCommission
'th' ih t I t' 1 71f ol I' tth ' mbenlmemberlsloftheCiNCommissian:
_Vea✓�lo: If h 't b I th 12 th th I tetl H'c"allsl whom vou orovidetl camoaian
consult'nq serv'cea was sworn in7
fi) Pursuant b Ciry Cotle Section R18Y�a�@�a., a IobDyist who has within the past election cycle pmvidetl campaign consWting
services to an incumbent member of lhe City Commission (which lobbying aIXiviry is not otherv+ise prohibitetl by Gotle section
2-491) shall tlisclose such particular service on hislher lobbyist registretion tarm tl hall orellv d'sclose such oarticular
service before lobb 'm the Ci� Commission a�a ublic mee�in .
Ves o: H 'tl d �a It q 'ce t b t member of the C'N Commission
'th' the o t I Co v I �It ol I' t th ' b t membeHsl of the dtv Commission:
_Ves�✓ lo: If y d d'd ns'tlerat'on 'n exchanae for camoaian
consultina senices?
TO BE COMPLETEO BV CITV CLERK'S STAFF ONLY
Annual Registallon ire � ]Yes� ]No Amount Pd tl S 7�� � MCR p���+1G��Oi' Se�4 �ate Paitl� '- �
Lobbyis[Regis[retion Form receivetl antl varifeE by: /�Y"1
- v.. ...u-mnE¢.lo. Revised03/11/2020
Page 3 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMff TO THE OFFICE OF THE CITV CLERK A
SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENUITURES AS WELL AS COMPENSATION
RECEIVED FOR THE PRECEDING CALENDAR VEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH TME
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENS TION DU NG EPORTING PERIOD.'
SignaWre of Lob6yist .� _+sj�1 �� / Date / a 3 '� . ._
/
I do solemnly swear or aKrm thal all of the foregoing facls, statements, and disclosures in this form are hue and correc[,
and that I have read or am familiar with �he provisions c9�lained in Chap�er 2, Art. VII, Divisian 3, entNed "Lo�hyists" of
the Miami Beach City Code and a reporting uir fs. _
Signature of Lobbyist
� � IIGG! oata 7�a-3 a�
SignaW2ofPrincipaC /Date 7-a3-� �
;'
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
s�a�e ot I�(�Pn.1�ecSaeA� siate or '��' P�t.a � c� `.�t Y
Counry of: t'�S�wL Counry of' ` ��a. G
Swom to(or aR¢med)and subscribed before me, Swom ro(or affpmed)and subscnbed before me,
hy means of�physical presence by means of 6 physical presence
or�online nolariution, or O online notanza,tion,
Ihis a� day of _ ��L E�Z�Z'1 by tnis�' day of ����j 20�, by
—T�
G1r7C id ��l�u��� �-'�±�a,,l l��tubo,���
NAMEOFLOBBYIST NAM FP INCIPAL
Pmduced ID _Produced ID
FORM OF IDENTIFlGATION FORM OF IDENTIqCATION
5onally Known sonally Known
1 i � � �
Signature o(Notary P dic Signature ot Notary Pu lic
��'� �- ��� ��0.��
Name of Notary,Typed,Printed or Stamped Name of Notary,Typed. Printed or Stamped
(NOTAR SEAL) � (NOTARYSEA
ANITq MArtEO
nc�ary:uotiq State af New Jerse <NITA MqT{rp
Y �0[3!]PJp��<� $[ELP 01 Npv JplSPy
w Iras MaY�. 2@9
�ThE�ElT"IOb � 405 111¢�ollOwi peIS0051 MY��mmisslon Explres May 1, 3pjq
Expert wimesses who pmvide only sciemific.�echnical or o�her specializetl informaGon or�estimony in puD¢ � , on w�o
only appears as a representative of a neighbortwotl assocla�ion wiNout compensation or reimWrsemen�for ihe appearance, whether
tlirecl, in�irec�or mnlingent, to express support of or opPositian to any I�em; and any persan who only appears as a represen�alive of
no4tor-pro%communiry basatl organizatlon for Ne puryose of requesling a grant without special compensa[ion or reimbursemenl fo�
ihe appearance.
Page 4 0(5
. .��\. '��/� � �{.�! 1�. �
Ciry of Miami lw�F, 1]00 Convmnon G�rer Dd.e,h4aml Bm�A,Fhdda 33139,w+�w.mlamlbwchB.gov
OHice of the Ciy Clerk
Rokel E. Granada, City Clerk CilyGlerk�miamibeochfl.gm
?eb 305.6737A71, Fox� 305b73 725d
NAME OF �OBBYIST: Anand V. Khubani
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to Ciry Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal)who fails to fle 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 fne of $50.00 a day shall be assassed for Statements filed aker the
due date. The City qerk 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 aker notification.
Any lobbyist, who fails to fle the required Statement by April 30'" of each year, shall be
automatically suspended from lobbying until all fnes are paid, unless the fine has been
appealed to the Miami-Dade Counry 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 expendiWres, as well as compensation
received, for the preceding calendar year with regard to the spec�c issue on which I have
been engaged to lobby.
2) LOBBYIST WITNDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immedialely file a Notice of Withdrawal with the Offce 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 Sedio� 2-482 of the Miami Beach City Code.
�'� � � � �-�3-a�
Si a ure o Lo byi t Date
F:`CLER'yIPnFOFNSLLCBBvSlFORMSLo�Epa�FeqeVali�nFdmRBNse]OS113011EGda
Page 5 of 5
MIAM ! BEACH RE�E��t�
City of Miami eeach JUL 2 9 2024
1700 Convention Center Drive
Miami Beach. Florida 33139 CITY OF MIAMI BEACH
www.miamibeachfl.gov oFFlCe ^.�°���.-s�F c;m CLEaK
Ciry Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 �ce Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: Anand V. Khubani
Business Name: 18 La Gorce LLC
Address: 584 Van Beuren Road, Morristown, NJ 07960
Office Telephone Number: 973-826-8408
Cellular Telephone Number:
Email Address: andy@ideavillage.com
I/more fhan one lobbyist, please lisf:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the O�ce of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#: 16' it�G:�aI �'I� �C.�
Amount paid� � Da[e paid:
Processed by: �M Date: / — �-9 � oZ�'�
F��CLER\§PUnFORM3�lDB8VI5iFORMSUNNVPIIOeBV16iFE6i5iRP IaNFOHMrc9Jna