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Miguel Concha Loyola - 4350 Nautilus LLC L'I -3So coki-,i,, 0 rg.�. RECEIVED ���BUE BURGos. t\/\ l/\t\/\ J BEIAFi .. ��NIDOSM ��2 Clerk'! i ,,sere•� W� �n �ZO Office of the City Clerk 7 Ct�C? :A 1700 Convention Center Drive ��" ;' `U� Miami Beach, FL 33 39.-- ` �i7 vf- iv1lANil Ear=ACH C° �`" 305.673.7 i 5 .- '%`' ��r�:CE OF THE CITY CLERK �q } '°; ��`'-��' LOBBYIST REGISTRATION FORM `'s. �" c - o. Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage l• _ saW.„• � or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommen.. 'b - City Manager or any City board or committee: or any action, decision or recommendation of any City personnel during the tim= •: •d of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or review, • •y the City Commission, or a City board or committee. The term specifically includes the principal as well as any employee enga.-d in lobbying activities. The term "Lobbyist" 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. ( ' �/1' I. LOBBYIST INFORMATION: p.> 0��2, �,/� CONCHA LOYOLA MIGUEL O<c O ��, NAME OF LOBBYIST (Last) (First) (Middle Name) '�2.�,.9A- I ii MORELOS 29-A, CENTRO. QUERETARO QRO c" - it !O LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip` •d'e) +52 442 274 3544 arq@miguelconcha.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: / I-\;Ae{- C�� _,cG_ \ NAME OF PRINCIPAL (Last) (First) �j(Middle Name) S 127 S-0 1U O-..)V,\..i� J_Q--- `d;, L6 ik:vo 1� 1\ \\\i )R',n r.-3 ec.-L_ ��— "7-)3\ 5 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) qn - ? L S D 54 yo7- 3to - s1c7 \o..,rr. --\,,, kt,,, : 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 Cleric as required by this subsection but shall rot be required to pay 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 DFFICER, PARTNER, OR BENEFICIARY(if none,write N/A): S. AT"�C 4 Ci f . • 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): /" im. - Page 1 of 5 0gVE BURG Os <4 VNIUOS 34, 1,12 III. ISSUE TO BE LOBBIED: -12 >i ‘C Describe with as much detail as is practical, including but not limited to a specific ripfiof where applicable of a pending request for proposal, invitation to bid, or public hearing n • q.. P trio. IMV•no\ ¢er proQ¢r nceL+ 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 19 2 �P N 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): M �Ft ) 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): (0/,4 Page 2 of 5 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 jNo: 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 1,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. _Yest_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)(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&No: 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_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 KNo: 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 No: If yes, were you promised or did you receive economic consideration in exchange for campaign consulting services? TO BE COMPLETED BY CITY CLERK'S STAFF ONLY A �f �7 Annual Registration fee: N]Yes[ ]No Amount Paid$46�-t° MCR# N 3t51 1 Date Paid [0-2('22 Lobbyist Registration Form received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised 03/11/2020 Page 3 of 5 \cot guRGP-s C' S v�;lDOS,��, ?'i VI. SIGNATURES UNDER OATH: ft,r= � 'c, Zoe, N ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK • SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATIO,, o RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH E) LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF TH I NAS BEEN ,_:+ EXPENDITURE OR COMP S/l►TION DU NG THE REPORTING PERIOD.' 'cl ti,. Signature of Lobbyist4.)12(74 (7 - V Date 10 i n- i e 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 itiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Cod aII re 'n requirements. Signature of Lobbyist: Date I I I3'L 22 Signature of Principal: Date k0 ( 14 `2:7-- VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of State of f 4f County of County of ,A4..•CA• Ali Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, Fby means of 0 physical presence by means of I,physical presence or 0 online notarization, or 0 line notarization, I . 14- ,: day of 0e-i-uh'e 20 by this day of o c�U 6Ql 20 by #� ; r uel Concha Lo 5ola �q u l�} ��t till E OP LOBBYIST NAME OF PRINCIPAL o�: Oliva/ ,�Pe- _ Produced ID _Produced ID t or'�� fn� �i,' FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally tcr{ciwn _Personally Kno Signature of Notaigigmblic Signature of Notary Public I Enr►que. 122)ur9oS i-lernanrk7 ,4✓l CtddCol Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped GOS H (NOTARY SEAL) ":..° RAUL CHAVARRIA � , COMMISSION#GG 953280 o`' 1. '}) o .: � EXPIRES:March 6,2024 � �t. , ' >o.,i�+<'�P.ontiud Mar budget Nuraiy Services 1 The term"lobbyist"seep* call excludes the following persons: — :4' o -- Expert deir wilxtessoato ionly scientific,technical or other specialized information or testimony in public meetings;any person who only appears • tative of a neighborhood association without compensation or reimbursement for the appearance, whether direct, indirect'• , .f=nt, to express support of or opposition to any item; and any person who only appears as a representative of not-for-profit comet ,. based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 5 G,`E BURG OS yF �- vNlD05,y '�9 MIAMI BEACH ' `` �, Z° ... ,.,,,, ,,, City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,ww.miomibeachH.gov Znq °off^ o� v+ Office of the City Clerk 1', -` %� 1' Rafael E. Granada, City Clerk CityClerk©miami ps9 Tel: 305.673.7411, Fox: 305.673.725.11 NAME OF LOBBYIST: MIGUEL CONCHA LOYOLA 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 tGos tiF/?ti automatically suspended from lobbying until all fines are paid, unless the fine has been i0S fe./;;,, -12o 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 v signed Statement under oath listing all lobbyist expenditures, as well as compensation C\�' o received, for the preceding calendar year with regard to the specific issue on which I have �� been engaged to lobby. No.38(3`‘)--. 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. OCTOBER 17, 2022 Signature o Lobbyist Date / F\CLERISALL\aFORMASILOBBYIST FORMSLLobbyist Registration Form Revised 03•1 t-20 REG.tlx Page 5 of 5 / SO1DOS Aik 91.. l';1',)OstKir i I.70*1) .AI . ! tp -,?-[ 1,--k,--i)0- C4 No.38 C`'4/ C ENRIQUE BURGOS HERNANDEZ, notario titular de la notaria numero treinta y ocho de esta demarcacio,' notarial, CERTIFICO: Que el senor MIGUEL CONCHA LOYOLA,de cuya identidad me asegure conforme al documento que corre agregado al apendice del acta que 1: mas adelante se relaciona y a quien conceptuo capacitado legalmente para la celebracion . i__ti_ i" de este ado, reconocio como suya la firma que aparece en este documento, ratificando su ill-WO.�� contenido. 1,:i,%A.A7 �i��- Todo to anterior consta en el instrumento marcado con el numero VEINTIDOS MIL . waarozzw TRESCIENTOS SESENTA Y OCHO, de fecha veinte de octubre de dos mil veintidns, --monsw•�` ._ Poder ��. ;..;.; � �;.' ante mi. Doy fe. Del ,. r r. DC Queretaro, Estado de Queretaro, a veintiuno de octubre de dos mil veintidos. t...w. 4 'f'0 oosye� JVP/aaa Sf Tf.,yi i de'G'ru!Grro _MF�' Zo .+`All N N cJ,��JRGOsh,� }� Cry',e o '` LIC. ENRIQUE BURGOS HERNANDEZ -e q� 4/C4 No.38a3� NOTARIO TITULAR r IIMN • • "n1 SECRETARIADE QUERETARO GOBIERNO JUNTOS,ADELANTE. QUERETARO ESTADOS UNIDOS MEXICANOS APOSTILLE (Convention de la Hoye du 5 octobre 1961) /In Mexico,this public document has been signed by/Ce document a did signe au Mex(que par En Mexico el presence documento publfco ha sido firmado per LIC.ENRIQUE BURGOS HERNANDEZ quienles)actua(n)en calfdad de/acting in his capacity as/ag,ssant en Cant que: ��AA ��,T,Y i �'11 a L i NOTARAO TITULAR DE LA NOTARIA PUBLICA NUMERO 38 DE LA DEMARCACION NOTARIAL DE QUERETARO 1-1 'I t'1 ry i. y esta ravestldo del Bello correspondiente a/Beating the seal of/F_t revel le sceau correspondent au: yy LIC,ENRIOUE BURGOS HERNANDEZ NOTARIA PUBLICA N0,38 QUERETARO.ORO. �� P /Certified b / par _•�•'Z:A:'armax�_ �VE Certificado or Y Certdie r ��'rt�(�S�* Licenciatlo Marco Antonio Vertiz Vargas Pode E �-,,s,;vE�, v� HQ'.µ Cel ES`, n h F/ n 23 Emitida en /Issued in/emts e: fy o � QUERtE i.- C:Z Z Santiago de Queretaro,Qro.,a 25 de Octubre de 2022 O > FOLIO NO. : 60195 t6lyCqN, DSeeprartmrieand oef gGoouvevermmenetn ot fd teh er Satt ed eo fQ QuueererroLIC. ARCO ARGAS JEFE DEL DEPARTAMENTO ORPORATIVO DIRECCION JURIDICA Y CONSULTIVA DE LA SECRETARIA DE GOBIERNO Luis Pasteur Norte No. 3-A, Queretaro, Qro. C.P. 76000. T. 442 238 5030 10/27/22,9:19 AM Detail by Entity Name FLORIDA DEPARTMENT O[SfATEI DIVISION OF CORPORATIONS DIVISION of fta4jzc` t CORPORATIONS 4.000000.."70.00*0.014144% an official Slate of Florida website Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Limited Liability Company 4350 NAUTILUS LLC Filing Information Document Number L21000528084 FEI/EIN Number 87-4187254 Date Filed 12/15/2021 Effective Date 12/15/2021 State FL Status ACTIVE Principal Address 4350 NAUTILUS DRIVE MIAMI BEACH, FL 33140 Mailing Address 431 W RIVO ALTO DRIVE MIAMI BEACH, FL 33139 Registered Agent Name&Address LAURADEV LLC 431 W RIVO ALTO DRIVE MIAMI BEACH, FL 33139 Authorized Person(s)Detail Name &Address Title AMBR LAURADEV LLC 431 W RIVO ALTO DR MIAMI BEACH, FL 33139 Title AMBR GOOSE DEV LLC 5825 LAGORCE DRIVE MIAMI BEACH, FL 33140 Title AMBR WAR DEV LLC https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=4350NAU... 1/2 1 U/Zf/LZ,y:l`9 AM Detail by Entity Name 606 PINEGROVE AVE JUPITER, FL 33458 Annual Reports Report Year Filed Date 2022 02/07/2022 Document Images 02/07/2022—ANNUAL REPORT View image of PDF format 12115/2021 —Florida Limited Liability View image in PDF format Florida Department of State,Division of Corporations https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=4350NAU... 2/2 10/27/22,9:19 AM Detail by Entity Name FLORIDA DEPARTMENT OfSTATA DIVISION OF CORPORATIONS �� 11114C DIVISION of fto4 .o CORPORATIONS an official State of Florida website Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Limited Liability Company LAURADEV LLC Filing Information Document Number L21000505229 FEI/EIN Number 87-4296974 Date Filed 11/29/2021 Effective Date 11/29/2021 State FL Status ACTIVE Principal Address 431 W RIVO ALTO DR MIAMI BEACH, FL 33139 Mailing Address 431 W RIVO ALTO DR MIAMI BEACH, FL 33139 Registered Agent Name&Address MILLER, LAURA 431 W RIVO ALTO DR MIAMI BEACH, FL 33139 Authorized Person(s)Detail Name&Address Title AP MILLER, LAURA 431 W RIVO ALTO DR MIAMI BEACH, FL 33139 Annual Reports Report Year Filed Date 2022 03/07/2022 Document Images 03/07/2022--ANNUAL REPORT View'.'.lath PDF Ic;rnal 11,/2912021--Florida Limited Liability View.n=ye:n PDF fo:m.;i https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&SearchNameOrdei=LAURADE... 1/2 10/27/22, 9:19 AM Detail by Entity Name Florida Department of State,Division of Corporations https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResu ltDetai I?inqu i rytype=EntityName&directionType=1 nitial&searchNameOrder=LAU RADE... 2/2 Miscellaneous Cash Receipt CITY OF MiAPW/ BEACH pJm' 430788 ^ El Cash []Credit Cand OCheck # � Received of 20� Address — For MBF --' ' 005761'8002Connen / MCR OPEN(MCR) ` Payment Amount: 850.00 (THIS INFORMATION MUST BECOMPLETED) i , Office of Finance Director Account number: By Pneparer: Dept: EXT:`7J� / � � / | � | 1 J n '