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Matthew Amster - Greystone Terra Firma, LLC LJ City of Miami Beach Office of the City Clerk D 1700 Convention Center Drive, Miami Beach, FL 33139 (mil 1A�� 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. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 (305)377-6222 mamsterQ_brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please.n®tify this office if your contact information changes;address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Greystone Terra Firma, LLC NAME OF PRINCIPAL/CLIENT: The Greystone Hotel c/o Trans Inns Management 31525 W. 12 Mile Road, Farmington Hills, MI 48334 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (248) 489-4333 james.vosota @transinns.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: 4:�.C,e, c1 ckeJ • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPE'C1F:IC LOBBY-ISSUE: Development Approvals and Permitting Issues,including,but not limited to variance from the Board of Adjustment and Historic Preservation Board approvals for the Greystone Hotel at 1920 Collins Ave., Miami Beach,FL Issue to be lobbied(Describe in detail): Ill. CITY AGENCIESANDIVIDUALS 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 general 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 lanning Department and Building Department Staff None PB, HPB, BOA, City Commission, as necessary None Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of a'rty'bugi' ess,,"fliha i,c'ia�,f� l or professional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner of ersonnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(8)Any Financial, Familial or Professional Relationship onw FXLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$350.00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $350.00 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 X No. you lobbyina on a present or pending bid for goods,eguipment or services.or on a present or gentling award for aoods.eauipment 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 pending application for a DevelopmentAar_eement with the Citv or application for change of zonina map desianation or chanae 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 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 X No: Are you representing a not-for-profit corporation or gntitywithout special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FFRRUASY 28th 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 EM THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPQRTING 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 a reporting r uirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATI N: PRINCIPAL IDENTIFICATION: Produced ID � Produced ID (.7L v� Form of Identification Form of Identification Personally known(Lobbyist) Personally known (Principal)VII. CRISTINAD.GON7ALEZ SIGNAT STAMP OF .sY.Pv�P: MY COMMISSION M DD 960888 NOTARY: - ' ' EXPIRES:March 23,2014 , "�+ Off' Public Underwriters ti ��,, o?'.� Bonded Thru Notary � c State of Florida, County of Miarn � State of 0 Sworn.to and subscribed qefore me Sworn and su 8 This a- i4-_day of •e. ,2013 This day of J EC Z Signature of Public Not —S to of F rida Sign ure of Public Notary— ate of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ � MCR# 32-/ Date Paid Z Lobbyist Registration Form received and verified by: F' Cite of Miami Beach, 1700 Convention Center Drive. Miami Beach,Florida 33139,w%vw.miainjbcach11.gov CITY CLERK Office CitvClerk(&niiamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Matthew Amster I understand that no later than February 28th of each year, I must file the following form, 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 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, 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 Statements) filed after 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. the required Statement b Aril 30th 2012 shall be Any lobbyist, who falls to file q y p , automatically 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. 'i � 13 Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of the application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity).* Gremstone Terra Firma, LLC CIO Trans Inss Management, Inc. 150 Davie Blvd. Ste 401., Fort Lauderdale, FL 33316 CORPORATION NAME and ADDRESS NAME, ADDRESS, AND OFFICE %OF STOCK Greustone Hospitality, LLC, Managing Member SO% 4111 Andover Road, Suite 110-W Bloomfield Hills, MI 48302 BBM3, LLC, Managing Member 50% 235 West 48th Street.,Apt. 37C New York, NY 100036 Grey stone Hospitality, LLC 4111 Andover Road, Suite 110-W, Bloomfield Hills MI 48302 CORPORATION NAME and ADDRESS NAME, ADDRESS, AND OFFICE %OF STOCK James D. Vosotas, Managing Member 50% 4111 Andover Road, Suite 110-W Bloomfield Hills, MI 48302 Dan Vosotas, Member 50% 4111 Andover Road, Suite 110-W Bloomfield Hills, MI 48302 BBM3, LLC 235 West 48th Street.,Apt. 37C, New York, NY 100036 CORPORATION NAME and ADDRESS NAME, ADDRESS,AND OFFICE %OF STOCK Branden Muhl, Managing Member 33% 235 West 481h Street.,Apt. 37C New York, NY 100036 Blaine B. Muhl, Member 33% 2402 West 114th Street Leawood, KS 66211 Britain B. Muhl, Member 33% 2402 West 1141h Street Leawood, KS 66211 IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S)AND EACH INDIVIDUAL'S NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARA TE PAGE. NOTE.•Notarized signature required on page 8 6 t a. •„� L 10 �`. s!p - �- W ,C 4_ J ° CLL -W , - .� '46 C) ¢_ V C) e i fx �` mom f• .. .®. do cc . .Ca C 0