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Emily Kay Balter - Phillipe Harari 3,9b . k),L1‘6D D,. DocuSign Envelope ID:18E4E15B-BB8B-4969-83E9-5F726A3922A8 RECEIVED MIAMI BEAC H °0T 1S 2o22 Office of the City Clerk 1700 Convention Center Drive CITY OF M�AM' 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: Baiter Emily Kay NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez Larkin&Tapanes PLLC 200 S.Biscayne Blvd.Suite 300 Miami FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)374-5300 ebalter@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Harari Philippe NAME OF PRINCIPAL (Last) (First) (Middle Narile) 320 Aqua LLC 320 West Di Lido Drive Miami Beach FL 33139 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)672-3232 aquabluedesign@gmail.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS O urs ant OD My @big gtialil 2-482 h 9Q) 111• I i.:l cgaiv corporation partnership,©F n• -e. -Irs3E0p lobbyist CI@=fig di that - tity" a n. r A compe cation CH reimb rsement for Qgr_,; atligat-- indirect,Q7 contingent 10 ex.ress gagait(.fit•f o.•osibon to an item shall .egister with the®e •as equine• b this subsection hut shall not be required to pay any registration ees. 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): Philippe Harari • 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 co �// co Page 1 of 5 DocVerify ID:68307311-9267-4102 •EB61A958C574 Page 1 of 6 1 EB61A958C574 1111 KM:21I II I • • DocuSign Envelope ID:18E4E15B-BB8B-4969-83E9-5F726A3922A8 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. Design Review Board approval for new-single family homes including understory and waiver for additional height for 320 W Di Lido Drive. 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. N List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety(if none,write N/A): N/A U co 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): $375.00/hr Page 2 of 5 DocVerify ID: Page 2 of 6 2E861A958C574 ,III rt r e l III www.docverify.com . DocuSign Envelope ID:18E4E15B-BB8B-4969-83E9-5F726A3922A8 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 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 'r been less than 12 months since the elected official(s whom you provided campaign consu ting se vices was saMilii4 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. Ni. Yes 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: a N N O N ,r, _Yes XNo: If yes, were you promised or did you receive economic conside ration in e change for campaign consulting serviced. a m w o TO BE COMPLETED BY CITY CLERK'S STAFF / ONLY ) � • Annual Registration fee: [ ]Yes[ o Amount Paid$ c.�S- ' N - MCR# "1 3€7-7 1 Date Paid LV'15" 2? m Lobbyist Registration Form received and verified by: , j 5 7 - F:\CLER\$ALL\a FORMS LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20718 REG.doc Revised 09/20/2018 0 Page 3 of 5 L DocVerify ID: er com07311-9287-4102-97D3-E861A958C674 I Page 3 of 6 3EB61A958C574 I 1111 pfgzN 'I III - DocuSign Envelope ID:18E4E15B-BB8B-4969-83E9-5F726A3922A8 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 Doousigned by: 10/6/2022 Signature of Lobbyist: bar,- b , Date 61A1A14495944E6... 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 reportiragiggladyements. ��L�� 10/6/2022 Signature of Lobbyist: 000ds,gned b St i5Att�1' Date �j� -61A1A 4495944E6... 10/7/2022 [!6-itirrt- [401�A.VlSignature of Principal: Date B3DA56443AD842A... 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 IN online notarization, or I1 online notarization, this 12 day of October ,2022, by this 12 day of October ,20 22, by Emily Baiter Philippe Harari NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Known u� x Personally Known va„ • 1- I I I o. Signature of Notary Public Naw Signature of Notary Public 0 Ei Yeidy Montesino Perez Yeidy Montesino Perez Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped 0 N (N eid Montesino Perez _w_w w A A NOTA e e e e s e A e cc. cy F Yeidy Montesino Perez ommission#HH 084273 < Commission#HH 084273 a Notary Public-State of Florida rotary Public State of Florida m My Commission Expires Jan 24,2025 < My Commission Expires Jan 24,2025 ui 1 The to alsons: < o 0 0 Expert witnesses who provide only scientific,technical or other specialized informs on or iesumony in puouc 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 0,1 not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for 0 the appearance. Page 4 of 5 DwocVerify ID:ww.doercom07311-92B7.4102-97D3-EB61A958C574 Page 4of6 4EB61A958C574 1III6h1IIII 11 • DocuSign Envelope ID:18E4E15B-BB8B-4969-83E9-5F726A3922A8 MIAMI BEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E.Granath),City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: Emily Baiter 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. O 0 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. DocuSigned by: batitx 10/6/2022 5 i A1,+,4tv95evvE5... Signature of Lobbyis Date . n7 W F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc M r 0 Page 5 of 5 DocVerify erD:66o07311-92B7-4102-97D3-E661A958C574 Page 5 of 6 5EB61A958C574 1��'�c'IIII • DocuSign Envelope ID:18E4E15B-BB8B-4969-83E9-5F726A3922A8 Exhibit B: Disclosure of Interest "320 Aqua LLC" 3211AquaL`LC PHFT Investments LLC (Philippe Harari Family Trust) 90.8% 1680 Michigan Avenue Suite 913 Miami Beach, Fl 33139 320 Maz Aqua LLC 9.2% 1680 Michigan Avenue Suite 913 Miami Beach, Fl 33139 PHFT Investments LLC (Philippe Harari Family Trust) Emma Harari, Beneficiary 33.33% 1680 Michigan Avenue Suite 913 Miami Beach, Fl 33139 Gabriel Harari, Beneficiary 33.33% 1680 Michigan Avenue Suite 913 Miami Beach, Fl 33139 Sophia Harari, Beneficiary 33.33% 1680 Michigan Avenue Suite 913 Miami Beach, Fl 33139 O 0 320 Maz Aqua LLC Philippe Harari 100% 1680 Michigan Avenue Suite 913 Miami Beach, Fl 33139 0) m Co m 0 6;, m NI Dwww.docveD 07311-9267-4102-97D3-E661A958C574 Page 6 of 6 6EB61A958C574 ,III �#a'I III o' docv'erify ( e , OsicVECV Lobbyist_form_EB-_320_Aqua.pdf DocVerify ID: 68307311-92B7-4102-97D3-EB61A958C574 Created: October 12, 2022 07:42:03 -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:Yeidy Montesino Perez(ymp) October 12,2022 07:44:45-8:00[4CFF6D15DBE9][162.244.152.118] ymontesino@brzoninglaw.comI _ l , • �L I IIIIII IIIIII IIIII IIIII IIII IIIIII IIII IIIII IIIIII IIIII IIIII IIII IIII 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. DocVerify www.docverify.00m07311-92B7-41112-g7D3-E861A958C574 ,III Ma tall III I Generated Cover Page EB61A958C574 • :.. -, . , . :... ,r. , � sew f "-y neous Cash � Receipt ;CY OF•MIAMI BEACH . 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