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Kobi Karp/Alton Sobe, LLC ~.jami BCQ(:h bad V mil ~ - City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 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 Ordinance 2004-3435. NAME OF LOBBYIST: Karp (Last) Kobi (First) (M.!) Kobi Karp Architecture & Interior Design, Inc. 2915 Biscayne Blvd., Suite 200, Miami BUSINESS NAME AND ADDRESS (Number and Street) (City) FL (State) .33137 (Zip Code) (305) 945-3636 TELEPHONE NUMBER: (305) 945-3737 FAX NUMBER: kobikarp@kobikarp.com EMAIL: I. LOBBYIST RETAINED BY: Alton Sobe, LLC, a limited liability company NAME OF PRINCIPAL/CLIENT: Alton Sobe, LLC, a limited liability company 730 I Belle Meade Island Drive Miami BUSINESS NAME AND ADDRESS (Number and Street) (City) Florida (State) 33138 (Zip Code) 305-347-7328 TELEPHONE NUMBER: 305-347-7701 FAX NUMBER: (Optional) l11gralia@shutts-Iaw.com EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY: See Exhibit "A". . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit "A". II. SPECIFIC LOBBY ISSUE: Obtain Design Review Board approval for project to be located at 929-939 Alton Road. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Design Review Board None. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL ti FLAT RATE OR OTHER). 31S,rrD A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": D Yes ~ No: Are YOU lobbyinG on a Dresent or oendinG bid for GOods. eauiDment or services. or on a Dresent or DendinG award for Goods. eGuiDment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes ~ No: Are yOU lobbyinG on a oendinG aDDlication for a DeyeloDment AGreement with the City or aDDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) 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 clerk as required by this section but, shall not be required to pay any registration fees.. DYes EI No: Are you reDresentinG a not-for-Drofit corDoration or entity without sDecial comoensation or reimbursement. . v. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECE C NDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPE URES COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist: Signature of Principal/Client: VI. ru d correct and that I have read or am he Miami Beach City Code and all reporting PRINCIPAL IDENTIFICATION: o Produced ID o Produced ID Form of Identification Form of Identification ~SOnallY known (Principal) o Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: J>"""" jilt\. Ana C Escribano-Cruz . " ; My Commission 00224831 iami-Dad~"~.~>~l Expires September 14, 2007 fore me 20~ Signature of P blic N ry - State of Florida Notarization of Principal's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR# Lobbyist Registration Form received and verified by: F: \CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Date Paid Revised 12/08/04 SEP-30-2005 FRI 11:23 AM Shutts and Bowen FAX NO. 3053819982 P. 02/02 EXI-IIBIT "A" Disclosure of Interest Q\VNERSHIP STRUCTURE Entitv Name Ownershill ALTON SOBE, LLC 1000/0 Evergreen Overseas Holdings, Inc. EVERGREEN OVERSEAS IIOLDINGS, INC. lOOOA) Victor Uzan .l\.L TON sonE, LLC Managing,Member (sole nlenlber) Evergreen Overseas IIoldings, Inc. EVERGHJtEN OVERSEAS :HOLDINGS, INC. President Sole Director Sole Shareholder Victor Uzan tvllADOCS 83%05 I SEP-30-2005 FRI 11:23 AM Shutts and Bowen FAX NO, 3053819982 P, 01/02 SH~TTS j3 0 ~;-E"N- __.N('N''''~- LLP ~___,,,,.,..'.''''_'.'''''''_N.....,.II>''I''II''''''''-- A TIOR-NayS AND COUNSeLORS AT LA W FAX TRANSMISSION Fax: 305-673-7411 305-673-7254 To: Company: Liz Gibson City of Mian1i Beach - City Clerk's Office Phone: Fronl: Phone: Mm-ia A. Gralia (305) 347-7328 User 1D: Fax: 5813 (305) 347-7701 Date: Pages: Septelnber 30, 2005 2 (inc1uding cover sheet) Clicnt/Mntter No.: 23523-0002 S II bj ect: Disclosure of Ownership for Lobbyist Registration Fornl for Kobi I(arp to represent Alton Sobe, LLC NOTE: PLEASE CALL ANA ESCRIBANO-CRUZ AT 305-415-9008 IJVIMltOlATELY IF ALL ,PACES ARE NOT RECEIVED. lVIessage: This facshnile contains privileged and confidential infonl1atiol1 intended only for the use of the addressee na11l.ed above. If you are not the intended recipient of this facsi111ilc, or the employee or agent responsible for deliverillg it to the intended recipient, you are hereby notified that any dissemination. or copy of this facsilnile is strictly prohibited. If you have received this facsilnile in error, please notify us in1111ediately by telephone and retU111 the oliginal facsin1ile to us at the above address via the U.S. Postal Service. Thank YOll. lSUU t\.!L\J-,H CI1N1T.n. -101 SOLJTl'! IH$CAYNIZ UOULnVARD . MtAMI.I'!.OllJDA :i.llll -I\HAt'll[ PUS) J51:1-(I}jlll -jll\C--.fMItJ: PUS) 3t11.(j')82 · WEllSl'fL: w\~w,sh\JI:tI'.lnw".i1m 1\11 AMI r-Ol\.T '-,\UJ.)I::lll.),\l.l~ \'='I\ST PA l.fI,i t1l!ACf r o Il f...~ t.Jl') (') TAI.l..;\lli\S:;I:I' -\}"r:-\Tl~\H).\~1 !lINI')()l" SHUTTS & BOWEN LLP ATTORNEYS AND COUNSELLORS AT LAW ANA C. ESCRIBANO-CRUZ (305) 415-9008 Direct Telephone E-MAIL ADDRESS: aescribano-cruz@shutts-Iaw.com September 29, 2005 VIA FEDERAL EXPRESS Bob Parcher, City Clerk City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 Re: Lobbyist Registration Form Dear Mr. Parcher: Enclosed please find a check in the amount of $125.00 representing the City of Miami Beach annual lobbyist registration fee for Kobi Karp of Kobi Karp Architecture & Interior Design, Inc. Also enclosed is a Lobbyist Registration Form together with a check in the amount of $25.00 to register Kobi Karp as a lobbyist on behalf of Alton Sobe, LLC. Please confirm receipt of this letter by sending me your receipt in the enclosed self-addressed envelope. If you have any questions regarding this matter, please do not hesitate to contact n1e at 305-415-9008. Ana C. Escribano-Cruz laec Enclosure MIADOCS 840027 I 1500 MIAMI CENTER · 201 SOUTH BISCAYNE BOULEVARD · MIAMI, FLORIDA 33131 · TELEPHONE (305) 358-6300 · FACSIMILE (305) 381-9982 · WEBSITE: www.shutts-Iaw.com MIAMI FORT LAUDERDALE WEST PALM BEACH ORLANDO TALLAHASSEE AMSTERDAM LONDON