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Michael W. Larkin - Shore Club Property Owner, LLC 7 ke). DocuSign Envelope ID:CO1AFO3C-82B7-4E76-B806-F56B752FE5E8 t o I Co I I/IL RECEIVED M I AM I BEACH JAN 11 2022 Office of the City Clerk 1700 Convention Center Drive Miami Beach, FL 33139 CITY OF MIAMI BEACH 305.673.7411 OFFICE OF THE 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 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: Witkoff Alex NAME OF PRINCIPAL (Last) (First) (Middle Name) Shore Club Property Owner, LLC 233 Broadway,Suite 2305 New York,New York 10279 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 672-4750 alex@WITKOFF.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pu suan to City C-ode Section 2-482( '(1)`(a)• GQ principal of any corporal*', partnership or other entity who appears as a lobbyist on behalf of thai anti compensation 1+�1' - o for(lID-.+-. . - 111llpCMatiCtia, Cl?contingen,t}'- o(. +e• e(2 C17 O++OsitiOn to an item shall register with th-Clerk as required by this subsection but shall not be req ire.to pay an registration fees N 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. Witkoff N • 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 the attached. a7 c Page 1 of 5 iama Ramos J�4B-5CAB6C60728E I Page 1 of 7 I 15CAB6C60728E ,III 'I III S9 ) L ,.,-mnnme.i,�a8� DocuSign Envelope ID:C01AFO3C-82B7-4E76-B806-F56B752FE5E8 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 1901 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 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 0 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 ti 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 co Page 2 of 5 DocVerify ID:IBCA41BD-0510-4684-914B-5CAB6C60728E Page 2 of 7 25CAB6C60728E ,III M'I II I www.docvenfy.corn DocuSign Envelope ID:CO1AFO3C-82B7-4E76-B806-F566752FE5E8 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 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 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 X_No:• If yes, has it been less than 12 months since he elected official(s) whom you provided campaiq consulting services was sworn inf. 6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting g services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section re 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: 27. O W Yes X No: If yes, were you promised or did you recei.,e economic consideration in exchange for campaiq consulting servicesf U TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[y No Amount Paid$ 3� CO MCR# t�G 5 Date Paid 0( 'I'•7,2. Lobbyist Registration Form received and verified by: �] F\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form'Revised 09 20-18 REG:doc Revised 09/20/2018 U Page 3 of 5 t== Docverify lD:1BCA416D-0510.4684.914B-5CAB6C60726E ,III6�6�'IIII www.docverify.com Page 3 of 7 35CAB6C60728E _ - DocuSign Envelope ID:CO1AFO3C-82B7-4E76-B806-F56B752FE5E8 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 COMPENSAMON DURING THE REPORTING PERIOD.1 Signature of Lobbyist: Date 11/18/2021 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 ii ialits: Signature of Lobbyist: DocuSIgnedby: Date 11/18/2021 Signature of Principal: V ' Date 11/18/2021 88839DA589A241E... 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 lJonline notarization, or E:konline notarization, this 18 day of November ,20 21, by this 18 day of November , 2021, by Michael W. Larkin Alex Witkoff NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Know - x Personally Kn Signature of Notary Public Signature of Notary Public Diana Ramos Diana Ramos N Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped N Diana Ramos Diana Ramos Commission#GG 308355 I Commission#GG 308355 Notary Public-State of Florida 1 Notary Public State of Florida N Il3y Commission Expires Apr 10,2023 IO3y Commission Expires Apr 10,2023 Th ° g persons: 1 ° 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 9 direct, indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of m 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 DwocVerify ID:ww.docv n'fy.comA418D•C510-4684-914B-SCA66C60728E Page 4 of 7 45CAB6C60728E ,III MEMO III DocuSign Envelope ID:CO1AFO3C-82B7-4E76-B806-F56B752FE5E8 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: 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 $500.00 pursuant to Section 2-482 of the Miami'Beach City Code. DocuSig/nedbyby: co V " 11/18/2021 32D203;fD000410... 4 Signature of Lobbyist Date U m F:\CLER1$ALL1eFORMS\LOBBYIST FORMSVLobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 DocVerify ID:1BCA41BD-0510.4684-914B-5CAB6C60728E Page 5 of 7_ 55CAB6C60728E 111113.M11111 www.docverify.com DocuSign Envelope ID:C01AFO3C-82B7-4E76-B806-F56B752FE5E8 • The Shore Club, Miami Beach, Florida Monroe Capital.PrivateCredit Fund li(Unleveraged),LP . 5.576% Monroe Capital Private Credit Fund Ill(Unleveraged),..LP , - 6.908% ,Monroe Capital Private Credit Fund.11-0(Unleveraged Offshore)LP 5.096% Various funds managed and/or Monroe Capital Fund SV S.a.r.l.-Fund Ill(Unleveraged)Compartment 7.139% controlled.by Monroe.Capital Monroe Capital Private Credit Fund Ill'(Lux)Financing Holdco LP 7.958% -Management Advisors,LLC(or Monroe Capital Opportunistic Private Credit Master Fund SCSp 7.770% Steven Witkoff affiliates thereof)* Corbin Private Credit Opportunity Fund II,L.P. 24.932% CEOF Holdings LP 26.848% Corsun'LLC 7.773% Monroe CapitalCorporation (DE)* ' 100% MRCC Holding Company X, Monroe Capital Private Monroe Capital Private MC Industrial Blocker,LLC LLC(DE)" Credit Fund BD,*(DE) Credit Fund Ill,LP*(DE) (DE)* 0 15.86% 18.84% 11.48% 53.82% 0 r MC.Asset Management WG Shore LLC(DE) ci (Corporate),LLC(DE)*' 75%Financial Mem 25%Developer Member N N Shore Club Owners JV LLC(DE) co N ro U 100% m 0 Shore Club Property Owner LLC(DE) rn 4 m - m 6 *See page 2 for upper-tier holdings. **Managed by Monroe Capital Management Advisors,LLC. DocVerify ID:y 16CA41 BD-0510 4684-914B-5CA86C60728E Page 6 of 7 65CAB6C60728E www.do ,III ,I III Y www.docverif .com DocuSign Envelope ID: CO1AFO3C-82B7-4E76-B806-F56B752FE5E8 • Owners of Monroe,Management Holdeo,LLC: MSDJ Trust (36.87%) Monroe Management Holdco, LLC Bonaccord Mammoth (Delaware) Aggregator MH,LP (Delaware) 83.33% • 16.6 GP �LP 0 Monroe Capital Investment Holdings, L.P. (Delaware) 99 w 100% 100 N Monroe Capital Management Advisors, LLC Monroe Capital BDC Advisors, LLC Monroe Capital Fund 0, LLC (Delaware) (Delawa re) (Delaware) co Q Investment Manage Investment Manag r 100% U u� m 1, �, Monroe Capital Corporation Monroe Capital Income Plus Corporation � iMCJ Financing SPV LLC (Maryland) (Maryland) (Delaware) m CO DocVerify ID:1BCA41BD-0510-4684-914B-5CAB6C60728E ,III =C 'I III www.docverify.com Page 7 of 7 75CAB6C60728E t=* • y' • doolerify. Lobbyist Registration Form - MWL - executed.pdf DocVerify ID: 1 BCA41 BD-0510-4684-914B-5CAB6C60728E Created: November 18, 2021 13:09:17 -8:00 Pages: 7 • 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.docverifv.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) November 18,2021 13:12:09-8:00[B0762072A54D][162.244.152.118] • dramos@brzoninglaw.com • 111 • 1 F,� '1 r I IIIIIII IIII IIIII IIIII IIIII IIIIII IIII IIIII IIIIII IIII IIIII IIIIII III IIII • 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. 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