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Mathew Amster/1600 Lenox Investors, LLC Greenstreet Partners, LPm MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM (G uc ~2z~c K ~VP {fee ~o~i ue ~' ~~~ 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 Ordinance 2004-3435. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.I) Bercow, Radell & Fernandez, P.A. 200 S. Biscayne Blvd., Suite 850 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6236 (305) 377-6222 mamsterCalbrzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: 1600 Lenox Investors, LLC c/o Greenstreet Partners, L.P. NAME OF PRINCIPAL/CLIENT: 2601 South Bayshore Drive, Suite 800 Miami Florida 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)858-4225 (305)858-2334 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Jeffrey Safchik, President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~ ~~~ II. SPECIFIC LOBBY ISSUE: Historic Designation, revocable permit, flood plain variance and redevelopment issues concerning 1600 Lenox Avenue Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title Planning and Zoning Department Staff, HPB, BOA, City Commission * Unless an issue is legislative In nature, HPB, BOA, B) Any Financial, Familial or Professional Relationship None City Commission members are not lobbied outside of a public hearino setting. S~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf ,' /~ A) LOBBYIST DISCLOSURE: (Required) .00 er hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $,36.00 per hour The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes X No• Are you lobbving on a present or pending bid for goods equipment or services or on a present or Wending award for goods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes X No• Are you lobbying on a Wending application for a Development Agreement with the Citv or ~~lication for change of zoning map designation or change to the Citv's Future Land Use Ma°? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of snot-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 clerk as required by this section but, shall not be required to pay any registration fees.. ^ Yes X No: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. ,. ,. /1 Signature of Lobbyist 'g .~' r- o. t. R, r v: z ~ ;g ~t ~d~` I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. /J ignature of Lobbyist: ~~C~ ignature of Principal/Client: I. LOBBYIST IDENTIFICATION: ^ Produced ID ~ Form of Identification ~ , ` Personally known (Lobbyist) VII. GNATURE AND STAMP OF NOTARY: •~ State of I ida, County is ad ` -i Sworn u scrib r This ay of , ,- tea. :, ~~_ Signature of Public Notary -state of FlfSrida Notarization of Lobbyist's signature FOR CLE USE ONLY 1 Annual Registration fee:, ]Yes [ ] No Amo Paid MCR Date Paid Lobbyist Registration Form received and verified Entered By: _ ^~- F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04 PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification C.~Personally known (Principal) State of Florida, County of Miami-Dad OTARy PL}BLIC-9'ft~'F np FLORIDA Sworn an subscribed before me Georgia V'sr111iamS This ?fray of ka.r , 2009 Commission # DD456~~05 Expires: AUG. O1, 2009 Q,y~ Bonded Ttu-u Aflantic Bonding Co., Inc. Signatur of blic Notary -State of Florida Notarization of Principal's signature ~ '~ € ~ 2 1 ': ~' , a a' ~!h i F -~. City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 CityClerk@miamibeachfl.gov LOBBYIST NAME: /~" `~~1~~`~ /~~`' ~' I understand that no later than October 1st of each year, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. _ ~ ~ ~P t> Signature: Date: F:ICLER1LOBi3YIST1Lobbyist Registration Form 32708.doc E~E)~rP B Organization Chart - 18U0 Lenox Investors LLC Steven J. Green - i00•/ shareholder Jeffrey A. 5afchFk - President/Tre asurer/ Secretary i "Genera! Partner" Greensireet Management, Inc (Delaware Corporation) 1% "Umtted Partners" Greenstreet Capital, LP - 32.00% Knowledge Industries. LLC- 67 00% 99% MG Real Estate Partners, L P (Delaware Limited Partnership) 100%/Sole Member Greenstreet SORE Inves#ments. LLC (Delaware Limited Liability Company) 1 i00%ISole Member 1600 Lenox Investors. LLC (Delaware Limned Liability Company) Property