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Alexander Tachmes~=` MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM 'YSSup /cx 6~ >?e~y Qnss ~oo~ aJai /~ 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.) Tachmes Alexander I BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Shuns & Bowen LLP 201 S. Biscayne Boulevard, Suite 1500 Miami, FL 33131 TELEPHONE NUMBER: FAX NUMBER: EMAIL: (305) 347 - 7341 (305) 347-7754 atachmes@shutts.com LOBBYIST RETAINED BY: NAME OF PRINCIPAUCLIENT: Hotel (Number and Street) Miami Beach. FL NUMBER: FAX NUMBER: (Optional) EMAIL: 305.531.6100 Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Jonathan Plutzik • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit "A" II. SPECIFIC LOBBY ISSUE: Flood Waiver application 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(4)(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 5t IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $ 450.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 450.00 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": ayes 6~ No: Are you lobbving on a present or pending bid for goods, equipment or services. or on a present or oendina 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 D4 No: Are you lobbvinq on a oendina application for a Development Agreement with the Citv or app ication or chance of zoning moo designation or chance to the Cltv's Future Land Use Mao? 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 ^ No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of Principal/Client: ~ ~ )~ VI. LOBBYIST IDENTIFICATION: ~ x PRINCIPAL IDENTIFICATION: ^ Produced ID ~ ^ Produced ID Form of Identification ~ ~~Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and su scribed before me This ~ day of, 2088 / u Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn to~nd sub ~f(bed before me This 7 day Of a ,~, No~ary Public Slate o/ Florida FMbrtd~mission DD897983 ,a, rovers 07/23201 t • -°~ °r tlt cvMt'Lt I t BY CITY CLERK'S USE ONLY ' Amount Paid E MCR U E Form received and verified by:.. r / I do solemnly swear that all of the to ping facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-4~'2 ~t Mi~ea~City~ode and all reporting requirements. MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office Tel: 305.673.7411, Fax: 305.673.7254 C ityC le rk(ril m i a m i beac hfl. qov LOBBYIST NAME: AlexanderTachmes I understand that no later than October 1" of each vear, I must fle 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 t have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office for lobbyist withdrawal in writing. Signature: l ~"1 `lam Date: MIADOCS 4031158 1