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Javier F. Aviño - West Collins Land Investors f f /\A I AM I B EAC H F-C 3 0 1 Qd City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach�W Alf,,.,9C LOBBYIST REGISTRATION FORMIC 1 %1' C L E r=,, 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. Av06 Javier F. NAME OF LOBBYIST: (Last) (First) (M.1) Bilzin Sumberg Baena Price&Axelrod LLP, 1450 Brickell Avenue, Suite 2300, Miami, FL 33131 BUSINESS NAME AND ADDRESS(Number and Street) (City) (State) Zip Code) 305-350-7202 305-351-2275 javino _bilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: SEE ATTACHED EXHIBIT"A" NAME OF PRINCIPAL/CLIENT: BUSINESS NAME AND ADDRESS Number and Street (City) State (Zip Code ( ) ( tY) ( ) ( P ) 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP ® INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Attached Exhibit"B" e II. SPECIFIC LOBBY ISSUE: All land use/zoning and permitting matters regarding property at 2377 Collins Avenue,2340 Collins Avenue and 2322 Collins Avenue, Miami Beach, FL 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 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 City of Miami Beach Planning Department staff and Zoning x Department staff City of Miami Beach Commissioners,Planning Board, and x Board of Adjustment 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 currenticity commks ion,erlor 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 ' ; (,.1 �, ,� ►s none L -airy U MIAMI 3840444.179794/42069 d IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION 'DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A)LOBBYIST DISCLOSURE: (Required) $475/hr B)PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):(Required). $475/hr 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 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ❑ Yes VNo: 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 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�No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? V. SIGNATURE UNDER OATH: ON FEBRUARY 28T" 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 PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING P IOD. i Sig ture o Lobbyist—Javier F.Avino 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. Signature of Lobbyist: Javier FQn MIAMI 3840444.179794/42069 f 2377 Collins Resort,L.P.,a Delaware limited partnership By:2377 Collins Resort GP,L.L.C., a-Del' limited bility company,its General By: f Camille D •las VI. LOBBYIST IDENTIFICATION: r 1'V;,,Im PRINCIPAL IDENTIFICATION: L Produced ID 0 Produced ID Form of Identification Form of Identification Personally known tLobbyist) Personally known(Principal) VII.SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of New York,County of New York Swo t and sub bed befo me Sworn subscribe before e This 20 ) This Sworn of .20� Signature of ry—State of FI Signature of Public o —State of New York Notarization of Lobbyist's signature Notarization of PrInerpare signature �pRY Pie IBIS DIAZ * * MY COMMISSION#DD 994645 No" Vb* EXPIRES:May 24,2014 N0.a1MA5MMO 4�0 FF`39 Bonded Thru Budget Notary Services tn MW A 2014 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee. Yes( No Amount Paid MCR N Date Pai Lobbyist Registration Form n=lved and verified by: Revised 4/27/2012 � MIAMI 3800121.179794140353 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Javier F.A066 I understand that no later than February 28th of each year, 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 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 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 301h of each year, 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. /-3- S' natu e: Date: MIAMI 3840444.1 79794/42069 I I � I { I I r� (�rLf t I 5 i WOM-PutioM:Avenuo S��y1t�r ��tl�y rn�, Miami #fit,FIL. 331,19 WOV(0v911n.44 Lp. 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