Youssef Hachem/TBS Realty, LLC~«~ ~,I~q ~~~~
m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 bond 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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Hachem Youssef
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Youssef Hachem Consulting Engineering, Inc. 12151 SW 128 Court, Suite 104, Miami, FL 33186
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
305.969.9423 305.969.4253 YH@Hengineering.com
LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
TBS Realty, LLC
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State} (Zip Code)
1111 & 1119 Collins Avenue Miami Beach, FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(212) 474-9845 N/A jstein@hh-r.com
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Rabinder Pal Singh, Vice President
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
Please see attached
SPECIFIC LOBBY ISSUE:
Historic Preservation Board application regarding certificate of appropriateness in connection with 1111 and 1119 Collins
Avenue (a.k.a. the Tudor and Palmer House hotels).
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual/Title B An Financial, Familial or Professional Relationshi
Mayor None
Commissioners
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
~~
~?
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
150.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION}:
(Required}. $150.00 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 6a No: Are you lobbving on a present or aendina bid for goods eguiament or services or on a
present or aendtna 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 6a No: Are you tobbyina on a aendina application for a Develoament Agreement with the City o_r
appltcatton for chance of zoning maa destination or chance to the City's Future Land Use Map?
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 anot-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 6a No: Are you rearesentina anot-for-profit coraoration or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 15f [)F t=ocH vFeG
PERIOD.
I do solemnly swear that all of the foregoing facts are
provisions contained in Section 2-482 of the Miami Bea
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
[~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
correct an that I have read or am familiar with the
ode and reporting requirements.
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida. County of Miami-Dade
Swofn.~tQ,and sub cribed before me
T~sl.,t-r Uay of L. 2~OCYr~ t
Signature of Public Notary - date o~Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Princiaal's signature
_ TO BE COMPLETED BY CITY CLERK'S USE O Y
Annual Registration fee: [ Yes [ I No Amount Paid S MCR # S ate Paid
lobbyist Registration Form received and verified by:
F CLER LOBBYIS7•Lubb Est Re istration Form 32708 doc ) Revised 03 2712008
~4~Y Iy~ Stephaaie M. Bu>rto
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~~ I:XPIRf3t fER~ 22, 2013
WWW,MtiONNOTARI:ant
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION {DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$150.00 per hour
__ _ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $150.00 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 ~ No: Are you lobbvina on a present or pending bid for goods. equipment or services, or on a
present or pending award for Goods, eauipment or service?
2} Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ~ No: Are you lobbvina on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"IobbyisY' as set forth in Section 2-481 above) who only appears as a representative of anot-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..
f-lYes 6a No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
A\I A/~TACC~ Age AC CAf+l.1 VCAL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD.
Signature of Lobbyist
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.
Signature of Lobbyist:
Signature of Principal/Client: ~ ~
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~. Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 2 day of 3VW , 2008
• MUNIR AHMED
~ u^~~~y PuDlic State of New York
Signature of Public Notary -State of Flory, Q4 AH84-38953
Notarization of Principal's signafiaiemissiorr Expires March 2D, 1D
TO BE COMPLETED BY CITY CLERK'S USE ONLY /' / 9` /h 9
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # $ Date Paid
Lobbyist Registration Form received and verlfled by: -r~-
F:\CLER\LOBBYISlILobbyist Registration Form 32708.doc Revised 03!27/2008
m P~IAP/~IBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office CityClerkCo~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Youssef Hachem
I understand that no later than October 15` of each near, 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 re ~ tere
City Clerk's Office for lobbyist!Vvithd al in
X
Signature:
to~jy'on has been resolved, I am required to immediately notify the
MIADOCS 3547685 1
OWNERSHIP STRUCTURE CHART -TBS REALTY, LLC
PARDAMAN K. VIVEK
CHATWAL CHATWAL
Member Member
50% 25% I 25
V IKRAM
CHATWAL
Member
Chatwal Family, LLC
(NY Limited Liability Company)
Sant Chatwal -Sole Manager
100%
Channel Properties, LLC
(NY Limited Liability Company)
Pardaman K Chatwal -Sole Manager
100% owner
TBS Hotel Management Corp.
(FL Corporation)
Rabinder Pal Singh -Vice President
of the Corp.
Manager Member
1 % interest 99% interest
TBS Realty, LLC
FL Limited Liability Company
Rabinder Pal Singh -Vice President of the
LLC
MIADOCS 3009786 I