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Michael W. Larkin - Villa Seis LLC • DocuSign Envelope ID:A94893B6-E363-4F8E-9DF3-9B9412F2E9BB RECEIVED m. 1 , 7' "V\IA imi 7,1-q) 7 �� ,f fi^t Office of the City Clerk APR 0 ZG71 1700 Convention Center Drive Miami Beach, FL 33139 CITY OF MIAMI BEACH 1 305.673.7411 OFFICE OF WE 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: Larkin Michael W. NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez Larkin&Tapanes,PLLC 200 South Biscayne Blvd.,Ste.300 Miami,Florida 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: Aguera Gimeno Jose Luis NAME OF PRINCIPAL (Last) (First) • (Middle Name) Villa Seis LLC, 1506 Collins Avenue Miami Beach FL 33139 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) T' (305) 331-4707 jlaguera@surinvest.cl 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. o If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): w U • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): Jose Luis Aguera Gimeno a NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH W CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): 5C.e,O `` C Its 3 U < ,o m 0 0 Page 1 of 5 !J , Ra 5T90-0� -� pA8-CECCEBBFDB6A 1 Page 1 of j 10ECCEBBFDB6A 1 1111 ,I III d • DocuSign Envelope ID:A94893B6-E363-4F8E-9DF3-9B9412F2E9BB 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 1506 Collins Avenue 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 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 NIA): None LL 06 Q1 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): $695 per hour 0 Page 2 of 5 DocVerify ID:C6107B6A-C6BE-4DD3-A6A8-CECCEBBFDB6A Page 2 of 6 2CECCEBBFDB6A ,III agy+ ,l II www.docverify.com AL1 • • DocuSign Envelope ID:A94893B6-E363-4F8E-9DF3-9B9412F2E9BB 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 xNo: 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 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 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 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: m03 CO 111 Yes XNo: If yes, were you promised or did you receive economic consideration in exchange for campaign — consulting services? U TO BE COMPLETED BY CITY CLERK'S STAFFONLY Date Paid -'7ONLY 7 0- 5°• MCR vl ✓ 02. O -7i( • Annual Registration fee: [ ]Yes[�No Amount Paid$ 3 • Lobbyist Registration Form received and verified by: c.)5 Revised 09/20/2018 • F: C9.eer\$ALL\arORMS\LOBBYIST FORMSS'Lebbgist Registration Form Revised O9-2O-18 5EG.doc Page 3 of 5 ify ID:C6167BBA-C6BE-4DD3-A6A8-CECCEBBFDB6A www.do ,III E ,I II www.docverify.corn I Page 3 of 6 3CECCEBBFDB6A • DocuSign Envelope ID:A94893B6-E363-4F8E-9DF3-9B9412F2E9BB 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.' DocuSigned by: 4/29/2021 Signature of Lobbyist: � Date 32B2B355D9E6410... 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. DocuSigned by: 4/29/2021 Signature of Lobbyist: ^ Date Signature of Principal: 3262B355D9E6410... Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of County of: Miami-Dade County of: Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of❑ physical presence by means of❑ physical presence or I1 online notarization, or 0 online notarization, this 29 day of April 2021, by this_day of ,20_, by Michael W. Larkin Jose Luis Aguera Gimeno NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Kno _Personally Known Signature of Notary Public Signature of Notary Public Diana Ramos Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped o Diana Ramos (NOTARY SEAL) m 1 Commission#GG 30835503 1 Motary Public-State of Florida 1 IS3y Commission Expires Apr 10,2023 Q 'They 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 0 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. 0 Page 4 of 5 DocVerify 66107B6A-C6BE-4003-A6A8-CECCEBBFDB6A Page 5 of 6 5CECCEBBFDB6A ,III ,I II I www.docvenfy.com • s DocuSign Envelope ID:A94893B6-E363-4F8E-9DF3-9B9412F2E9BB 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 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: a Date i , Signature of Principal: 1 Cil,, \\ F—,•-• V?,�-Th f Date t--1-- VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State ofq64(L1VA County of: Miami-Dade County of: rY\U'YY\\ tact Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of 0 physical presence by means off physical presence or 0 online notarization, or 0 online notarization, this day of , 20_, by this 1 ' y of pr13 YK�._. , 20-2i, by Michael W.Larkin Jose Luis Aguera Gimeno NAME OF LOBBYIST NAME OF PRINCIPAL V _Produced ID )(Produced ID IL_ A-262- -432 -Al-4 FORM OF IDENTIFICATION FORM OF IDENTIFICATION • Personally Known ___Per onally Kno j jk....N.._N C N Signature of Notary Public Signature o Not ry P lc N N oN to T d, Printed orStam•e• Name of Notary,Typed, Printed or Stamped ry, yp (NOTARY SEi Lr ray Notary Public State of Florida (NOTARY SEAL) ,. Karen L Carpenter m • :dp- My Commission GG 296039 w -,- ,, Expires 0210412023 w U th a 1 The term"lobbyist"specifically excludes the following persons: o WExpert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who 2 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 wocVerify ID:ww.do verfy com07B6A-C6BE-4DD3-A6A8-CECCEBBFDB6A Page 4 of 6 I 4CECCEBBFDB6A I ,III HI"III 1 DocuSign Envelope ID:A94893B6-E363-4FSE-9DF3-9B9412F2E9BB • City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk CityClerk@miamibeachfl.gov Rafael E. Granado, City Clerk 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 the Office ofghe Cby Clerk.concludd or I am no loner lobying n that issue, I shall immediately file a Notice of 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 0 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. LL DocuSigned by: 4/29/2021 37R9B355DOF641n • Signature of Lobbyist Date a •cn m F:\CLER1$ALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 DocVerify ID:C6107B6A-C6BE-4DD3-A6A6-CECCEBBFDB6A Page 6 of 6 6ECCEBBFD86A ,III gig ,I II I vnvw.docverify.com RECEIVED APR 30 2021 Exhibit A CITY CSFMIN ! '-� Ownership of Villa Seis,LLC: OFFICE rr • 100%of Ownership of Villa Seis, LLC is held by Florda Casa LLC o Florida Casa, LLC is owned 50%by Montesur Investments, LLC • Montesur Investments, LLC is owned 10%by Oviedo Investments LLC, • Oviedo Investments LLC is owned 100%by Inversiones Oviedo USA Spa. o 65%of Inversiones Oviedo Spa is owned by Jose Luis Aguera Gimeno. • Address: 1300 S Miami ave,STE. 3604, MIAMI, FL 33130 o 35%of Inversiones Oviedo Spa is owned by Maria Teresa Gimeno. • Address: 1300 S Miami ave,STE. 3604, MIAMI, FL 33130 • Montesur Investments, LLC is owned 90%by HPDM USA,which is owned 100% by Inmobiliaria • Inversiones Pie de Monte Ltda. • Inmobiliaria e Inversiones Pie de Monte Ltda is owned 93.93%by Inversiones San Luis S.A. o Inversiones San Luis S.A. is owned 98.72%by Tooshi Shintaku Co. • Tooshi Shintaku Co. is owned 100%by Zetaeme Fundacion Inc. • 33%of Zetaeme Fundacion Inc. is owned by Pilar Zabala. o Address:AVENIDA PRESIDENTE RIESCO NO. 5711 SANTIAGO, CHILE • 33%of Zetaeme Fundacion Inc. is owned by Mariela Zabala. o Address:AVENIDA PRESIDENTE RIESCO NO.5711 SANTIAGO, CHILE • 34%of Zetaeme Fundacion Inc. is owned by Maite Zabala. o Address:AVENIDA PRESIDENTE RIESCO NO. 5711 SANTIAGO, CHILE o Florida Casa, LLC is owned 25%by SounHonor Ltd. • SoundHonor Ltd. is owned 100% by Amicitia Investments Corp. • 51.98%of Amicitia Investments Corp. is owned by Enrique Hasbun o Address: Kennedy 7900 of. 301,Vitacura,Santiago, Chile • 22.02%of Amicitia Investments Corp. is owned by ELTA SpA held by Enzo Lubiano o Address: Del Inca 4421 dp. 161, Las Condes,Santiago, Chile • 25.99%of Amicitia Investments Co. is owned by lunctus SpA., o 50% lunctus SpA. is owned by Marisa Lubiano • Address: Camino La Villa 12.025 CASA 4, Las Condes,Santiago, o 50%lunctus SpA. is owned by Juan Fernando Lafuente • Address: Camino La Villa 12.025 CASA 4, Las Condes,Santiago, Chile o Florida Casa, LLC is owned 25% by Sasep Overseas Ltd. • Sasep Overseas Ltd. is owned 100%by Jorge Selume Zaror • Address: Kennedy 5454 of. 1701,Vitacura,Santiago, Chile ‘ ,... I . ! ,....... • lii MBF City Hall 1 , cts: :‘,-:).- 1700 Convention Center Dr. Miami Beach , FL 33139 305-673-7420 Welcome ..., ',1 004769-0033 Maria A. 04/30/2021 11 :14AM --‘, ,3 MISCELLANEOUS 5 Reference 1 : 427902 2021 Item: MCR . MCR OPEN (NCR) 1,900,00 i _ --- • „ ..... ...._..........._.... 1,900.00 Subtotal 1,900,00 ! .w „., .`-. ,P :3" '• i. ', ' Total 1,900.00 ., 'C C ' (--"` - CHECK 1,900.00 -- 7,.) -c,- . w ., . '.. Check Number000107 e• ....D Ig--- '„ :•?‘ i Change due 0.00 * c d--- ' 3 t • ,t -›- c. -la-- -, -‘ 1 ° ... Paid by: villa seis (a 1 ' - : ` -5 -7 -c---- 0 ‘,:\„) - 1,:-_, ,-, „..) ' ' ,d. i i , . ,.... ........... G. - .0v ,.., Z . I "?...44. ltff. ..tititata..— n ET* .-2) - i < I° tittao 141st soLialkwt---__ -- __ - 4. :,:qs.0,.....afittivAtitraiinkrzii•-:-.•..--2...."--------'÷-....a.z-z5Z....... _a '0 awumni ww, Amout4444,117,M' ,i,_,), __ 0 ' T., . Ii- ,2 i , . 7 _......_____. -7,-2.- -...ifyiiillirri.,:-,--1.1,-.44,-....4..---ir...2,:-"7:- Thank you for your payment CUSTOMER COPY A��/� mss `. dooty® c :z i, • Lobbyist Registration Villa_Seis_-_M._Larkin - fully executed.pdf DocVerify ID: C6107B6A-C6BE-4DD3-A6A8-CECCEBBFDB6A Created: April 29, 2021 08:56:42 -8:00 Pages: 6 Electronic Notary: Yes / State: FL This document is a DocVerify VeriVaulted protected version of the document named above.It was created by a notary or on the behalf of a notary,and it is also a DocVerify E-Sign document,which means this document was created for the purposes of Electronic Signatures and/or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to www.docverify.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. E-Signature Summary E-Signature Notary:Diana Ramos(dra) April 29,2021 08:57:30-8:00[8F974F3233F1][162.244.152.118] dramos@brzoninglaw.com 111111t 1111111111111 1111 1111111111 111111 111111111 11111 11111 10111 111111111111 DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. IDocVerify ID:C6167B6A-C6BE-4DD3-A6A8-CECCEBBFDB6A Generated Cover Page CECCEBBFDB6A ,IIIMOM"III www.docverify.com