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Alexander Tachmes (3)~SS.re /c~.-4~ MIAMI~EA+~N ~Q~ 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.) Tachmes Alexander I and Street) (C ioulevard. Suite 1500 I tLtl'HUNt NUMBtH: FAX NUMBER: EMAIL: (305) 347 - 7341 (305) 347-7754 atachmes shutts.com LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: -- INESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Botsy Hotel 1440 Ocean Drive Miami Beach, FL 33139 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) 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: _Revocable Permit 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(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) $ 450.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 450.00 per hour The following information must be answered: t) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": iYes n No• Are you labbvina on a present or pendina 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': Yes •_i No: Are you lobbying on a pendina application for a Development Agreement with the Citv or application for chance of zoning map designation or chance to the City's Future Land Use Maps 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.. nYes n No• Are you representing goof-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: I do solemnly swear that all of the ford' provisions contained in Section 2-482 0 Signature of Lobbyist: and correct and that I have read or am familiar with the ity,ZiKj@ and all reporting-requirements. Signature of Principal/Client: X VI. LOBBYIST IDENTIFICATION t' Produced ID I_~Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY; IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and su scribed before me This 21 day of , f20~99 j O Sign re of Public Notary -State of Florida ~ ization of Lobbyist's signature TO BE COMPL lip Amount Paitl i and verified by: State of Florida, County of Miami-Dade Sworn to and subscribed before me Nota~ q •'ucn.. State of Florida ~.Caamission DD697993 Notarization of CLERK'S 2011 INC. Signature of Lobbyist ~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl aov CITY CLERK office CityClerk@miamibeachfl gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Alexander Tachmes I understand that no later than October 1~ of each vear, 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 requiretl to immediately notify the City Clerk's Office for lobbyist withdrawal in writing. (,-,~z , ~`--__ Signature: ~Z.~ (~~ Date: MIADOCS 4013979 1