Mathew Amster/Plaza Hotel LLC11i11AMl BEACH
City of Miami Beach Office of the City Clerl~; ~ ~~° ~- ~ ~., ~ ~,~
S.f ..:
1700 Convention Center Drive, Miami Beach, FL 33
~~9 Q~ ~ 2 6 P~~9
LOBBYIST REGISTRATION FORM 7 ~/ 12 42
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to enwurage th`E~g~;d¢f~a~t~~
or modification of any ordinance, resolution, action or decision of any commissioner; any action, deasion, recommendation of the "
Gty Manager or any city board or committee; or any action, decision or recommendation of any dty personnel during the time
period of the entire decision-making process on such action, decision or rewmmendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically includes the prinapal as well as any employee engaged
in lobbying activities. The term °Lobbylsts° has speafic exclusions. Please refer to Ordinance 2004-3435.
Amster Matthew
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6236 (305) 377-6222 mamster@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Plaza Hotel, LLC
NAME OF PRINCIPAL/CLIENT:
5151 Collins Ave - Penthouse H Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (Gty) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Krzysrtof Karbowski, Jakub Kosiba & Simon Nemni -See Exhibit
B.
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: See Exhibit B.
II. SPECIFIC LOBBY ISSUE:
Extensions of Time for development orders for 418-422 & 426 Meridian Avenue
Issue to be lobbied (Describe in detail): +
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Fuli Name of Individual/Title
Planning Dept. staff, HPB, BOA, Planning Board, City
Commission*
B) Any Financial, Familial or Professional Relationship
* Unless an Issue is legislatlve in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting.
~~
s
IV: DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERr
A) J_OBBYIST DISCLOSURE: (Required) $ 230.00 oer hour
8) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 230.00 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 lobbying on a present or pending bid for goods, equipment or services, or on a
present or vending 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":
oyes 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 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 X No: Are you representing anot-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. il_ ~ _ _ /I
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 IDENTIFICI
^ Produced ID
0
~'~l its
. // '!~`
Form of Identification
Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
Miami-Dade
of Public Notary -State df Floi
Lion of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identificati
11!CPersonally known (Principal) ~®NBE 8UTOR
NOTARY PU6LIC~ STATE OF IIIMlDI8
OOt~i118810N EIfiPIRE8 8.24-2011
~I1~nO~s
State of-Wer~.#a~, County of P4+ami-Bede C.O~~
Sworn an~subscribed before me
This ~~-day of , 200
~ ~~~~
Signature of Public Notary -State of i=1e+~ic#s~ IU..iNcx S
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [~No Amount Paid MCR # ~ Date Paid
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc
Revised 12/08/04 ~ -
Iy. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 230.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 230.00 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 tobbving on a vresent or pending bid for goods, equipment or services, or on a
present or pending 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":
oyes X No• Are you lobbying on a vending application for a Development Agreement with the City or
application for change of zoning map designation or change to the Citv's Future Land Use
Mav?
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-profrt
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 anot-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
RECENED, 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.
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 alt reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
vI. Lo66YIST
^ 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 ,, 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~! Personally known (Prin ~" `~'~`~
MICHAEL ESTEF~1
irocay Public - sacs or vrc ~ . ; a
My Cantu. Expires Nov ? ~ z o ~ 2
Canrt1i06bn I OD 4..~;:?27
State of Florida, County of -
Sworn and subscr(~ dof~re~me "'"-""
This day of; ~T~"'-' 2009
Signature of Public N ry -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY (~ / G
Annual Registration fee: [ ]Yes [ ] No Amount Paid _ C~ MC ~ ~+ ~ Date Paid 1 d 2 a
Lobbyist Registration Form received and verified by: c~ ntered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.da Revised 12/08/04
I!!. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) .LOBBYIST DISCLOSURE: (Required) $ 230.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 230.00 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 lobbying on a present or Wending bid for goods, eguipment or services, or on a
present or pending 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 apWlication for a Develoument Agreement with the City or
apWlication for change of zoning map designation or change to the Citv's Future Land Use
MaW?
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 anot-for-Wrofit corooration or entil~y without sWecial compensation
Q~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.
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.
PRINCIPAL IDENTIFICATION:
nnnnnn~rw~Nw
Produced ID ~ ,lALSEAL
Fo m of Identi~r~ORZEC
NOTARY PUBLIC -STATE OF ILLINOIS
^ Personally kr10Wn rinc7MISSION EXPIRES:11116/09
C~ CsJO~
State of F~idrr, County of-P4ia+t}i-9ade-
Sworn nd subscribed before me
This ~ day of .~/L~.-- . 20 b~
Signature of Pub4~c Notary -State of €ierda ~~,,.~~
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\Lobbylst\LOBBYIST fORM OS.doc Revised 12/08/04
Signature of Lobbyist:
Signature of Principal/C
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 , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
~' ` I ~ j}gt4 ~Sg }pi gg`
L
City of Miami Beach, 1700 Convention Center Drive, Miami Beoch, Florido 33139, www.miamibeachH.gov
CITY CIERK Office GtyClerkf~miamibeochfl.gov
Tel: 345.673.741 1 ,Fox: 305.673.7254
LOBBYt57 NAME: /" ~ ~; l 7 v` ~~~I
I understand that no later thon October 1st of each yeor, 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 J 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-0ade 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.
9 2l o `~'
Signature: Date:
~8~I3C'c'L,1 Z2 ~~~1 ~f.{)FS
_.
EXHIBIT B
' ~ DISCLOSURE OF INTEREST
Plaza Hotel, LLC
1691 Michigan Avenue, Suite 320
Miami Beach, FL 33139
MCM Miami, LLC
45% owner of Plaza Hotel, LLC
Sole Managing Member: Krzysztof Karbowski
NAME OF INTEREST HOLDER
1. Krzysztof Karbowski
1691 Michigan Avenue, Suite 320
Miami Beach, FL 33139
TOTAL FOR MCM MIAMI, LLC
Ocean Drive, Inc.
45% owner of Plaza Hotel, LLC
President: Jakub Kosiba
NAME OF INTEREST HOLDER
1. Jakub Kosiba
1811 West North Avenue Suite 401B
Chicago, IL 60622
2. Christine Kosiba
1811 West North Avenue Suite 401B
Chicago, IL 60622
TOTAL FOR MCM MIAMI, LLC
Pres. Properties Corp.
10% owner of Plaza Hotel, LLC
President: Simon Nemni
NAME OF INTEREST HOLDER
1. Simon Nemni
5151 Collins Avenue, Suite H
Miami Beach, FL 33140
TOTAL FOR PRES. PROPERTIES CORP.
INTEREST
100.00
100.00
INTEREST
50.00
50.00
100.00
INTEREST
100.00
100.00
1