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Alexander I. Tachmes - Goldman Properties of Miami Beach, Inc.~_ ~~ ~:~~ - ~- - City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM a-~-~ ~o~ 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. Tachmes Alexander NAME OF LOBBYIST: (Last) (First) (M.I.) c/o Shutts & Bowen LLP 201 South Biscayne Boulevard, Suite 1500, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) .__(305) 347-7341 (305) 347-7754 atachmes shutts.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED 8Y: Goldman Properties of Miami Beach, Inc. NAME OF PRINCIPAUCLIENT: c/o Marlo Courtney 804 Ocean Drive Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 531-4411 (305) 534-9080 marlo .goldmanproperties com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: R. Anthony Goldman • IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: t~ rv • R. Anthony Goldman and Charles J. Goldman -=i ° -~ ° ~` L rte- rte-- ' ~ r-,, _~ rn =i II. SPECIFIC LOBBY ISSUE: ~ ~ -~ fV "7~ Roof Top Ordinance issue in connection with The Hotel -801 Collins Avenue ~' c=; ~' ... 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) Any Financial, Familial or Professional Relationship City of Miami Beach Planning Board None City of Miami Beach Mayor/Commissioners None City of Miami Beach Committees None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Hourly - $450.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly - $450.00 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 lobbying on a present or pending bid for goods. equipment or services, or on a present or pendinst 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 ®No: Are you lobbying 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 "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profd 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. V. SIGNATURE UNDER OATH: ON OCTOBER 1ST 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 PRECE ING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE R COMPENSATJON'BIJRtNG THE REPORTING PERIOD. Sigiature of Lobbyist =Alexander I. Tachmes I do solemnly swear that all Hof 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 Mjd'jr ii~each City Codeeporting requirements. Signature of Lobbyist: Signature of Principal/Client: Alexander I. VI. Lpggggyy'~L ENTIFICATION: NOTARY PUBLIC - STATE DF F1+~~ ~rr~; ~-n~a Christian ;'~*':mis~b~~~3~16 " 23, 201 '•, ~' H,;xnires; MAC. Form.of Identification BCNt71'sD 7Hs~A~L~i'flC tiGNUiN6 CO., INC. Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom to and subsc ' ed before me This 7-/day of , 20`r10 ~ S~-Gv- Sign t re of Puiblic Notary -State of Florida rization of Lobbyist's signature PAL IDQNTIFICATION: ^ Prodk(ced ID - - - Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Swom to and subscribed before me This ~ day of .~Uh t/ t1 X01 Q, ~;:; Notarization of :,.." P ;, ~€Afi111QE a, aetrz~D '''~ ~r Iv1~ f6MMIliSION # DD 973sse _ ' ~'€ ~~Ihirfi, April 13, 2014 ~~~,,' __ BdiYdE18~'IIHiNBt~y9uWlcUnderwriters TO BE COMPLETED BY CITY CLERK'S USE ON Y Annual Registration fee: (]Yes [ ] No Amount Paid $ ~- MCR # $ Date Paid Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIS11Lobbyist Registration Form 32708.doc ~ _ _ , n ~ oe.a~sa n~~~~~~~„e ~ rV~IA~'V~IBEACH City of Miami Beath, 1700 Convention Center Drive, Miami Beoch, Florida 33139, www.miamibeochfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1. ,Fax: 305.673.7254 Acknowledgement of fines/suspension from lobbying for failure to comply with City of Miami Beach lobbying Laws LOBBYIST NAME: Al exanr9ar T Tar~hmPs I understand that no later than October 1st of each year, lobbyists subject to Ivbbyist registration requirements shall submit to the city clerk a signed statement under oath listing all lobbying expenditures, as well as compensation received, for the preceding calendar year with regard to the specific issue on which the lobbyist has been engaged to lobby. A statement shall be filed even if there have been no expenditures or compensation during the reporting period. The statement shall list, in detail, each expenditure by category, including food and beverage, entertainment, research, communication, media advertising, publications, travel, lodging and special events. Failure to timely file the expenditure. and fee disclosure report will result in a fine of $50.00 per day. Any lobbyist who fails to file the required expenditure report by December 1, shalt automatically be suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. In the event a lobbyist fails to either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust. 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. -~ t - b Signature: Date: