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Michael Larkin - Amit Khurana 11005 s DocuSign Envelope ID:DAA5D9FD-8974-46E7-81DA-18FC56C03217 RECEIVED AA I AM I BEACH Office of the City Clerk NOV 14 2022 1700 Convention Center Drive Miami Beach, FL 33139 CITY OF MIAMI BEACH 305.673.7411 OFFICE Or 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: Khurana Amit NAME OF PRINCIPAL (Last) (First) (Middle Name) The Alton Venture LLC 55 E.59th St.,24th Floor, New York, NY 10022 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 603-9988 x 1006 amit@sumaidakhurana.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS f , - ter o e-@agiail 2-482 A l Q pr ci•al dhf147 cor.oration partnership,CO CO=Gift to a opears M a lobby s DriliEtff GQ DON takca soeeial compensat on 07 reimbursement for ilke appearance,zgatilagv 011 ndirect GP conti gent,OD @wital2 NM-Ada?Op aosit(en 1 ff ul l 1• alIll1 C 3reouiredL'Was bsection ou eglIGu'i•il -o :mpaaveseragga 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): Amit Khurana a 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): See attached. O Page 1 of 5 '7 .,,.v,,,;a,in.moonnln not^ C.58Q-7FAe42A04F2e ___ __ _ . _ __— , 'II[SEMI' III 11 Page 1 of 6 17FAB42A04F2B DocuSign Envelope ID:DAA5D9FD-8974-46E7-81DA-18FC56C03217 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 1100 5th Street 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 LL Q co 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): $715 per hour o Page 2 of 5 DocVerify ID:D7224A19-0216-45D1-A58D-7FA642A04F2B Page 2 of 6 27FAB42A04F2B I 'III NEAR,II www.docvenf.com DocuSign Envelope ID:DAA5D9FD-8974-46E7-81DA-18FC56C03217 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 XNo: 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 x 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 x_No:• If yes, has it been less than 12 month s since th• elected official(s) whom you 6 rouided campaign con lilting ser nce was sworn info 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 o 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 x 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: N _Yes x No: If yes, were yo prom'sed or did .ou receive economic consideration in e change for campaiq, nsulting services: TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ 'No Amount'Paid$ 350 d-614) MCR# 6 ' 6 ct 0 i Date Paid 0. 111.22. Lobbyist Registration Form received and verified by: z�,rS a et‘,,t'a .,`i', , T:{:;" = r pia^,i>il ,s sn€ri Revised 09/20/2018 o Page 3 of 5 ily ID:D7224A19-0216-45D1-ASSD-7FAB42A04F28 www do ,III +F�'I III www.docveofy.com - Page 3 of 6 __� 37FAB42A04F2B DocuSign Envelope ID:DAA5D9FD-8974-46E7-81 DA-18FC56C03217 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 Ducualyned uy. Signature of Lobbyist: [ t.kL,OLL UJ. (A,41V- Date 11/8/2022 CDFF0F6E5B38470... 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 II reistfi hisg'requirements. Ittic6dSignature of Lobbyist: w" t'4AM�t� 11/8/2022 Date CDFf01-0E.B38470... oocusignen by: Signature of Principal: �tMt� attrtuAA, Date 11/8/2022 111111 962AA4EF34524EF... 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❑ physical presence by means of❑ physical presence or x❑ online notarization, or M online notarization, this 9 day of November L 2022, by this 9 day of November ,2022, by Michael Larkin Amit Khurana NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Known yw� _Personally Known AP 66 Signature of Notary Public Signature of Notary Public Yeidy Montesino Perez Yeidy Montesino Perez Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped (NOTARY"'" ,� c - - c (NOTARv�aa °s e e s s e e e o e e Cidy Montesino Perez a '((eidy Montesino Perez A > ommission#HH 084273 a gommission#HH 084273 LL Notary Public-State of Florida 1 Notary Public-State of Florida 1 The term"lobo l y Commission Expires Jan 24,2025 4 Itgy Commission Expires Jan 24,2025 4 Expert witnesses ecialized inform n rn i nu r ra n c• a a c MAIN) only appears as a representative of a neighborhood association^wvit out'eompensation 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 DocVerify ID:D7224A99.0216.4501•A58D-7FA642A04F26 Page 4 of 6 47FAB42A04F2B ,III E 'I III 1 www.docverify.com llL..111 DocuSign Envelope ID:DAA5D9FD-8974-46E7-81 DA-18FC56C03217 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 rn 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. LL DocuSigned b/IyII:11 bkod tt, W. (,AYf &, 11/8/2022 DrrurnEoBa8470... Signature of Lobbyist Date a a, N O 91 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc o Page 5 of 5 • Doc do ifyerD:D77224A19.0216-45D1-A58D-7FAB42A04F2B Page 5 of 6 57FAB42A04F2B ,III ER'l 11 l DocuSign Envelope ID:DAA5D9FD-8974-46E7-81DA-18FC56C03217 Disclosure of interest "The Alton Venture LLC" Altori Z=Ellg LLC 14 y: �, ,55,E 59th;St.,Ralk.Floor, New Yo k, NY 1©®2i2.:: The Alton UT JV LLC 51% Gateway MB, LLC 49% art 4 14he-Alton'`UT JU LLC '4 4# • n r Y The Alton Sponsor LLC The Alton BP LLC Bizzi & Partners Realty LLC 50% 100% 50% D. Bizzi A. Pallaoro 50% The Alton SK LLC The Alton SS LLC 50% 50% S. Sumaida The Alton AK LLC 50% A. Khurana Gateway MB, LLC Norton Nesis Irrevocable Trust 2018 50% (Malia Reichmann.Trustee: 41 Bayard Street, New Brunswick, NJ 08901) Gateway MB Trust 50% (Malia Reichmann Trustee: 41 Bayard Street New Brunswick, NJ 08901) 0 O N LL O Q LL Q 0 th 9 Q N N r Dww erif y IrDf DD7224A19-0216-45D1-A58D-7FAB42A04F28 ---- --'- --- ---"— -----�, 'III ��'I III Page 6 of 6 _ 67FAB42A04F26 • y - }1 -si Miscellaneous,Cash Receipt `. 1 CITY OF`MIAM1-BEACH r il ': Na 430907 , . ❑Cash ❑��Credit Card �L]Check# ��� ,.� $ �:.. ,,� °���;..��,,�� - . - „ ;20 fi - . . r f Received of t `> Q 09Z8 , ' /'; ufn"Address . T , GI -":", J :' � 1-For 3 _ • • . r;,:-.:: ,;.,--.„':0_;0.;','-‘, '",,,•;,..-..,S---"-.'.."• 7.-;',"-,;•:-; ' :.:.;-:::"-%.,:;'. 47-;.,:,:l.,-:;."..::S.---",,,•••,--,.:?;,•,-',J.-..",;,in:•:'•-...-::::;.,•••••.• -,:4-,',„•147 ,,:,•:::':,J,1$ • d8W p � lc, ,�: a (THIS INFORMATION MUST BE COMPLETED Office of Finance Director, Account number ! tq./ - �' i"3 -., _ e ° a ,tee B�/ � � '" * �� t Preparer � � , , ,; � � "Dept .� EXT -. ,. .- '';'41':,,,.'i:.:",;:.7-4,'Nii \\ a k .}t '` '. . 4 Y v `� p4\ i� e" L k ',O �A a 0