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Neisen O. Kasdin - The Witkoff Group, LLC ilDso�OA .� , MIAMI BEACH 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 board 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. Kasdin Neisen 0. NAME OF LOBBYIST: (Last) (First) (M.1) Akerman Senterfitt One SE Third Avenue,25th Floor Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305.982.5629 305.374.5095 neisen.kasdin @akerman.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: ' Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: The Witkoff Group, LLC NAME OF PRINCIPAL/CLIENT: 130 East 59th Street,15th Floor New York NY 10022 c/o Steven C.Witkoff -UU51Nt55 NAME ANU AUUKESS (Number and Street) (City) (State) (Zip Code) 305.982.5579 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] ) M i {I r— 'V • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: ' cam ) • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH COORATJON, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Y Approval of renovations and additions to 1020-1050 Washinqton Avenue by the HPB and BOA Ln Issue to be lobbied(Describe in detail): III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date,stating the eneral nature of the subject contractual relationship. Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Historic Preservation Board None Board of Adjustment None Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial,Familial or Professional Relationship None. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $615.00/hr B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $615.00/hr (REQUIRED). 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 pending award for goods,equipment or service? 2) Pursuant to Miami Beach City Code Section 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 change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482(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 a not-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 a not-for-profit corporation or entity without special compensation or reimbursement V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CL K A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION RECEIMEWIN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF T BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoing facts are tr a d correct I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code a ep rting requi Signature of Lobbyist: Signature of Principal/Client: .' LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: 0 LO N N N Produced ID Produced ID n W m Form of Identification Form of Identification O 0 � �' 3 .o m= c En Z 12�R, Co known(Lobbyist) Personally known(Principal) U. Z-n � Cn Q° 2: 0 : SIGNATURE AND STAMP OF NOTARY: m u5 1JGWt k lieu; k W C ,,St�t�,o lorida, County of Miami-Dade State of-Fle4de;County o W � and subscribed befor �``� Sworn and subscri ed before me N ° �^ day of / This In day of , 2012 `° o o m mm OD a D O`er O Signature oTPublic Not dry—SVcfte ri a Signatur o ublic otary—State of+Iarid k)EL& 214 F ' Notarization of Lobbyist's sigpQkffe Notarization of P ' cipal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Pa Lobbyist Registration Form received and verified by: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F;\CLEI ,istration Form.dac Revised 04/27/2012 MdAPOIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miomibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: Neisen O. Kasdin understand that no later than February 28 of each year, 1 must file the following form, pursuant to Section 2-435 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) LOBBYIST EXPENDITURE AND COMPENSATION 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, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist(or principal)who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all Statement(s) led after . t( ) the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, wh ails to file the required Statement by April 30th, 2012, shall be automatically su ded from lobbying until all fines are paid, unless the fine has been appealed to the i i-Dade County Commission on Ethics and Public Trust. Signature: Date: C:\Users\clerhab\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc