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Nicholas Rodriguez - MAG NBR LLC C • rDocuSign Envelope ID:DOBDIDOD-OF49-409E-8115-39B52CFC690F LiJ70- '-{A° tbrt1 15 • RECEIVED MIAMI I)EACH FEB 22 2022 Office of the City Clerk 1700 Convention Center Drive CITY OF MIAMI BEACH Miami Beach, FL 33139 OFFICE OF THE CITY CLERK 305.673.7411 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: Rodriguez Nicholas 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 nrodriguez@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Komisar Howard • NAME OF PRINCIPAL (Last) (First) (Middle Name) MAG NBR LLC 8 Wright Street Westport CT 06880 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) hk@bertralaw.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant(f5l j @tap(agglinz 2-482(h tlatt GQ pr ncipal C lt44/corpo ation partnersh p,CIF. a GtitifiD din appears a lobbyist Cti3 C• CQQi G " - tity,dipxagi spec a compensation cif reimbursement o (1b2 appearance eifillig7C124 07contingent illjargEmi izE022c2cai(sinatattboN a, i em hall ,egtster with the Clerk as required b this subsection bu sae!, ,of be required to pa 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): H. Komisar • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH N CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): Please see the attached. Co 03 Page 1 of 5Stipa:Med • MAR 3 0, 2022 _ L aRamoS J{�6-C7D3F4CB4527 ,III RP �'IIII 71 Page 1 of 6 1C7D3F4CB4527 DocuSign Envelope ID:DOBD1DOD-0F49-409E-8115-39B52CFCB9OF 4- 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 4570 North Bay Road and 4580 North Bay 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 N LL 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,73 $325.00 per hour LL Page 2 of 5 DocVerify ID:DBD2F67E-6865-4921-A008-C7D3F4CB4527 Page 2 of 6 1 2C7D3F4CB4527 'III � ,I III www.docverify.com DocuSign Envelope ID:DOBD1DOD-0F49-409E-8115-39B52CFCB9OF • 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 qoods,equipment or service? 2) Pursuant to City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes XNo: 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 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 XNo: If yes, has it been less than 1 months since the elected officials) whom you provided campaign consulting services was sworn ii 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: N N _Yes X_No: If yes, were you promised or did you receive economic consideration in exchange for campaign LL con"'sultinq'Tsgr,'vices?1 — M U TO BE COMPLETED BY CITY CLERK'S STAFF ONLY • �f q6Annual Registration fee: [' ]Yes[.No Amount Paid$J 3�`� MCR# "'� ` Date Paid Z-2� Lobbyist Registration Form received and verified by: JS LL F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/203.8 ❑ Page 3 of 5 DocVerify ID:DBD2F67E-6865-4921-A008-C7D3F4CB4527 www.docverify.com Page 3 of 6 I 3C7D3F4C64527 1111 � 'I II I DocuSign Envelope ID:DOBD1DOD-0F49-409E-8115-39B52CFCB9OF . • 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 COMPENSAIRON__iDURING THE REPORTING PERIOD.1 Signature of Lobbyist: �Du'l Date 02/15/2022 D1A69D5439244EC„. • 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 requ It�i4fl€hf%!,eddyb�y: • ikaSignature of Lobbyist: DocuSigned by: D1A65D61 239244CC. � Date 02/15/2022 gy .. ri owGld, ..OwtiSaY' Signature of Principal: 6100023314C2419... Date 02/15/2022 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❑Konline notarization, or OF online notarization, this day of 07/15/2077 ,20 , by this day of 02/15/2022 ,20_, by Nicholas Rodriguez ' Howard Komisar NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Kno - ---- X Personally K - —i — 0 Signature of Notary Public Signature of Notary Public 0 Diana Ramos Diana Ramos Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped h. Diana Ramos (0 Diana Ramos m I Commission#GG 308355 4 Commission#GG 308355 / , 1 Notary Public-State of Florida 1 1 Notary Public-State of Florida 1 c, 1 lily Commission Expires Apr 10,2023 / r y Commission Expires Apr 10,2023 1 U 1 The' g 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 o the appearance. o Page 4 of 5 DocVerify eD:coBm2F67E-6865.4921-A008•C7D3F4C64527 Page 4 of 6 4C7D3F4CB4527 III ��,I III DocuSign Envelope ID:DOBD1D0D-0F49-409E-8115-39B52CFCB9OF 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 CityClerk@miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: Nicholas Rodriguez 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 0 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. a • DocuSigned by: • r ' -"0_ ,U 02/15/2022 DIAUD5499244CC... Signature of Lobbyist Date rn co F:\CLERV$ALLVaFORMSVLOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc co co Page 5 of 5 DocVerify ID:DBD2F67E-6865-4921-A008-C7D3F4CB4527 Page 5 of 6 5C7D3F4CB4527 1III a3�1:1 ~, 1I II I www.docvenfy.com it' • r DocuSign Envelope ID:DOBD1DOD-0F49-409E-8115-39B52CFCB9OF Page 6 of 8 DISCLOSURE OF INTEREST CORPORATION, PARTNERSHIP OR LIMITED LIABILITY COMPANY If the properly that is the subject of the application is owned or leased by a corporation, partnership or limited liability company, list ALL of the owners, shareholders, partners, managers and/or members, and the percentage of ownership held by each. If the owners consist of one or more corporations, partnerships, trusts, partnerships or other corporate entities, the applicant shall further disclose the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity. MAG NBR LLC • NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP Marc Gardner 100% 8 Wright Street Westport, CT 06880 • • • NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP 0 0 N 0 O N_ O N N N u'1 m U M O U 0 If there are additional corporate owners, list such owners, including corporate name and the name, address and percentage of ownership of each additional owner, on a separate page. N 0 DocVerify ID: 2F67E-6665-0921-A008-C7D3F4CB4527 I Page 6 of 6 I 6C7D3F4CB4527 I ,IIIEMIII I • • Miscellaneous Cash Receipt . . crtr Of IMAM BEACH - r ��Pi � : ,. L r � ,r , "°Credit Card Qt e ^ f y s f �C1V� '_ .i tC�,� i wn r ,�c�( .,� t j_t,� t lC It,( •, J t Miscellaneous ,CR 2022 J )`'i ,' 1 , .For ---4 (t ,�,�=,. �-f.,.� r '. r `. ; . 5 , .;Payment,Amount: , 2;750:00 ' (THIS*FORMATION MUST BE COMPLETED). . AccountNumbir , . 1• '� .., . - s