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Robert Moehring - Phillipe Harari DocuSign Envelope ID:D707A4D3-2B08-45A2-9E03-744D1EA70243 A! V \I A/v\I [AC I�-I Office of the City Clerk OCT g 1700 Convention Center Drive g �022 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: Moehring Robert NAME OF LOBBYIST (Last) (First) (Middle Name) DOMO Architecture+Design 420 Lincoln Road,Suite 506 Miami Beach FL 33139 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)674-8031 robert@domodesignstudio.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Harari Philippe NAME OF PRINCIPAL (Last) (First) (Middle Name) 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 67 • PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS O *tars sari to€i y 0oa- Section 2-482(�h,(1 a)': A pri cipal of any corporation partnership, or other en ty ho ppears as a lobbyist on behalf of that emit s o e ial compensation Colt reimbursement for Qil»appearance ElligatTaaa,Lama Clr'coat agent 00C i + • @Qap o e oosi ion'o an(tern s,all register an the Cle as required by this subsection but hall not be required to pay any registra ion 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): Philippe Harari LL • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH 7 CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): See Attached 0 LL Page 1 of 5 (414.1" DocVerify ID:51EFF813-F0132.4FAFE-FA0D61AE170F ,III } M'I III Ld Page 1 of6 1FAOD61AE17DF tlRs-_i_L DocuSign Envelope ID:D707A4D3-2B08-45A2-9E03-744D1EA70243 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. 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 LL W 0 U Q LL LL V. DISCLOSE.RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a LL contingency fee is prohibited pursuant to City Code Sec. 2-485.3): $250/hr LL m LL LL Page 2 of 5 DwocVerify ID:ww.doerfycomFFB13-FDBO-0FA2-9FFE-FAOD61AE17DF I Page2of6 I 2FA0D61AE17DF I 'lllPI'IIII DocuSign Envelope ID:D707A4D3-2B08-45A2-9E03-744D1EA70243 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": —YesXNo: 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 it been less than 112 months since the elected official s) horn you provided campaign consulting services was worn inr 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 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. 0 —YesXNo: Have you provided campaign consulting services to an incumbent member of the City Commission a within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: N 0 LL O w Yes XNo: If y-s, were you promised or did you receive economic consideration in exchange for campaig consulting serviced. 0 w TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ` i i LL Annual Registration fee: [ ]Yes[ o Amount Paid$ �5� MCR# ©�� V Date Paid / �d` V1- o LL Lobbyist Registration Form received a d verified by: F';\CLER\SALE\aFORMS\LOBBYIST'FORMS\Lobbyist Registration Form Revised 09-30-:18 REG.doc Revised 09/20/2018 LL w W Page 3 of 5 LDocVerify ID:51EFFB13•FDB0.4FA2-9FFE-FAOD61AE17DF www.docverify.com I Page 3 of 6 I 3FA0D61AE17DF I ,III BERM'III DocuSign Envelope ID:D707A4D3-2B08-45A2-9E03-744D1EA70243 . 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.' ,-Docusigned by: 10/13/2022 Signature of Lobbyist: 7 71. Date •--OBA86ECD22A64AD... 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 regpir t,Q� by. 10/13/2022 Signature of Lobbyist: ` Date OBA86ECD22A64AD... DocuSigned by— 10/12/2022 Signature of Principal: tItciLif,Jt. tkoroiri 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 IXI online notarization, or El online notarization, this day of October ,2022, by this_day of October ,20 22,by Robert Moehring Philippe Harari NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID __Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Known " Personally Known , F T I it . ] io io Signature of Notary Public Signature of Notary Public 0 Yeidy Montesino Perez Yeidy Montesino Perez Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped o (NOTARY Yeidy Montesino Perez (NOTARY SE'•i xfidy Montesino Perez ,. I Commission#HH 084273 ..Commission#HH 084273 .l Ootary Public-State of Florida a My Public State of Florida y Commission Expires Jan 24,2025 , ,oy Commission Expires Jan 24,2025 u, 1 The term"lobbyist"s o Q 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 o direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of .73 not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for LL the appearance. W Page4of5 DocVerify ID:51EFF1313-FDB6.4FA2-9FFE-FA0D61AE17DF Page 4 of 6 4FAOD61AE17DF ,III „41'I II I • www.docverify.com DocuSign Envelope ID:D707A4D3-2B08-45A2-9E03-744D1EA70243 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: Robert Moehring 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 ifl 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. W LL —DocuSigned by:, ` 10/13/2022 LL Signature of Lobbyism°BA66ECD22A64AD... Date • LL LL m F:\CLER\$ALL\aFORMSILOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc LL LL Page 5 of 5 DocVerify ID:51EFF813-FDBO-4FA2-9FFE-FAOD61AE17DF Page 5 of 6 5FA0D61AE17DF ,III �'I III www.docverify.com • DocuSign Envelope ID:D7O7A4D3-2BO8-45A2-9EO3-74401EA7O243 Exhibit B: Disclosure of Interest "320 Aqua LLC" 7�E Nei ��x K � .. � a° � ty5320�AquaLL� 3 r °' _.,. ri 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 320 Maz Aqua LLC Philippe Harari 100% 1680 Michigan Avenue Suite 913 LL Miami Beach, Fl 33139 ❑ LL W LL LL LL Q Q1 LL m LL LL u-i DocVerify ID: er comFFB13-FDBO-4FA2-9FFE-FAOD67AE77DF Page 6.of6 I 6FA0D61AE17DF I ,III ,IIII doc's'erify• 5 p \O CCVER\� Lobbyist form Robert Moehring - 320 Aqua.pdf . DocVerify ID: 51 EFFB13-FDB0-4FA2-9FFE-FA0D61AE17DF Created: October 14, 2022 06:52:44 -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.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:Yeidy Montesino Perez(ymp) October 14,2022 06:56:10-8:00[F17E82E4D1 E0][162.244.152.118] ymontesino@brzoninglaw.com ! 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