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Matthew Amster BH 4000 Alton, LLC MIAMI BEACH Id 0, AL} 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. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.1) Bercow Radell & Fernandez, PA 200 S. Biscayne Blvd, Suite 850, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6236 (305) 377-6222 mamste[O)brzoninglaw.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: 131­14000 Alton, LLC NAME OF PRINCIPAUCLIENT: Same 2711 South Ocean Drive, Suite 2404, Hollywood, FL 33019 um er an ree i y (State) (zip Code) (954)416-3140 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: Dan Lebensohn,President of CLR Realty South,Inc.,the Manager of BH3 400 Alton,LLC,the Manager of BH 4000 Alton,LLC IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Code amendment, land use amendment, rezoning application, development approvals& permitting issues for redevelopment of the property located at 4000 Alton Road 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 arson's commencement of service with the city to the present date,s ting the general nature of the subject contractual relationshi . Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES I NO title of person to be lobbied Staff of Planning Department, Building Department,and Public Works None X Department PB, HPB, BOA,City Commission,as necessary None X Pursuant to City Code Section 2-482(8)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 rsonnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial, Familial or Professional RelationshipN None 7tl -h WA C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc PV_"L_-0 oil 3 �l IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHERI: A) LOBBYIST DISCLOSURE:(Required) $350/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $350/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": _Yes X No: Are you lobbying on a present or pending bid for goods,eaulpment or services.or on a present or pending award for goods.gauipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbying on a pending anallcatlon 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 X 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 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 CO 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 and all reporting requirem Is. Signature of Lobbyist: Signature of Principal/Client 8,A Vi. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _Produced ID _Produced ID Form of Identification Form of Identification ZpersonaUy X.�M 2 known(Lobbyist) _Personally known(Principal) m• VII. SIGNATURE AND STAMP OF N $' GRISTINA D.GONZALEZ ! 4 .c MY;;OMMISSION q DD 960888 State of Florida,County of Miami-Dade ;_,. ,f tate of Florida,County of Miami-Dade N m EXPIRFS:March 23,2014 9 fi o . worn n ubscri d b o me I Sworn to d subscribed befo me '.,,;F;:„ Bonded 1 h:-,Notary Public Underwriters This day of 2013 his of w' ,2013 Signature of Public Notary—(State Florid Sign re o lic Notary—State of Florida Notarization of Lobbyist's signatu/re Notarization of Principal's signature J TO BE COMPLETED B CITY CLERK'S STAFF ONLY D Annual Re istration fee: Yes No Amount Paid MCR# Z a Date Pai 113 -obbi qst: egWm on' 1m-Tectived and uerffla by: C:\Users\derhatllAppData lLocaDMerosoft\Windows\Temporary Internet Files\Content.Outlook183LGODDH\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) $350/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $350/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": _Yes X No: Are You lobbvina on a present or nendina bid for aoods.eauioment or services.or on a present or Dendina award for 000ds.eauipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbvina on a Dendina aoolicabon for a Development Aareement with the City or ao_Dlication for chanae of zonina maD desianation or chanae 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 X Now Are you representina 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 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 REPORTING 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 and all reporting requirements. e_ . Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: S+�•NO� _Produced ID _Produced ID ° Form of Identification Form of Identification �+Mxz T,� A p _Personally known(Lobbyist) _Personally known(Principal) o m 3 a Cn VII. SIGNATURE AND STAMP OF NOTARY: N 7 f7j � State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade N M m Sworn to and subscribed before me Swor n ubscrib d befo9�me w �; This day of 2013 This y of �! 2013 OD m Signature of Public Notary—State of Florida Sign ure o lic Notary—State 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# Date Paid 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:\CLE istration Form.doc Revised 04/27/2012 MIA/01BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Matthew Amster I understand that no later than February 28 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, 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) 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. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be 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. ,J/ Z1_? Signa ure: Date: C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc