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Todd Tragash - 1800 Bay Road Investors, LLC z MIAMI BEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 y; f� .J LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether aid or not, b a principal who seeks to encourage the t, ss� defeat or Y p p Y P P 9 � tom', 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. Traaash Todd NAME OF LOBBYIST: (Last) (First) (M.1) STA Architectural Group, 3526 North Miami Avenue Miami FL 33127 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-571-1811 305-571-1821 Toddnstaarchitecturalaroup.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: 1800 Bay Road Investors, LLC C/O Greenstreet Partners, LP NAME OF PRINCIPAL/CLIENT: 2601 South Bayshore Drive, 91h Floor Miami FL 33133 BUSINESS NAME AND ADDRESS(Number and Street) (City) (State) (Zip Code) (305)858-4225 c/o bsafchick&greenstreetl2artners.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: Jeffrey Safchik • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See the attached. ii.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to Design Review Board, Planning Board, Board of Adiustment and Citu Commission, if necessaru, relating to the nronerties located at 1800 Bau Road, 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 relationshi . Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES I NO title of person to be lobbied Planning Department and Building Department Staff None B, DRB, HPB, BOA, City Commission, and Land Use None Development Committee, as necessary 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 IVone lVone IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required): ®d•/4t«.. T� �. B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): I�®u.4.ts # I'�►5OAdw (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 K No: Are you lobbying on a present or pending bid for good s.equipment or services.or on a present or pendina award for goods.eauil2ment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes_K No: Are you lobbying on a gendina application for a Development Agreement with the City or application fs,C change of zoning map designation or chance 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 o: Are Xou rel2resentung 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 EM TUE PRECEDING QALENDAR YEAR. A STATE SHALL B -;Mbl IE THERE HAVE DEEN EXPENDITURES OR i Signature VAyist f� I do solemnly swear that all of. a foregoing ar, true and correct and that I ave�rj d br.,L familiar with the provisions contained in Section 2-482 of the Mia .'� ea, i de a d II I reporting requirements. f 1 Signature of Lobbyist- r ; .Signature of Principal/Clie VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification Personally known(Lobbyist) ,Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribed before me Sworn and subscribed before me This _day of L0jr,20 3 This day of 201 Signature of Public Notary—State of Florida Sioiatdre of Public Notary—State of Florida Notarization of Lob signature N tarization of Principal's signature BE COMPLETED-�Y CITY CLERK' ST F ONLY I L b 'st!1 e eive and ver' ed b '�Pa�Pve('4 S y' Notary Public-State of Florida ' : ommission EE108984 •; ;• My Comm.Expires Aug 1,2017 ar f/ es 1oro312015 :�r = Commission.#FF 012345 qr Q��� •iFOF fl(;,•• Bonded Through National Notary Assn. I T F:�CLE istration Form.doc Revised 04/27/2012 I B.Ek� AMAN City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeach0.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Todd Tragash 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-, de County Commission on Ethics and Public Trust. Signat re ;',' Da(e � � � ° -A�_ ` 1800 BaV Road Investors, LLC ,- � � Organization Chart � ( '^,."ven J. G'"e'' '""= > ' ' p� � inve-tment Partners. VO VII Bay, LLG _ C |L- I3333�6 Beach Investment Partners, LLLP (Florida Limited Partership) � � � 1OOY 1800 Bay Road Investors, LLC (Florida LLC) "Disregarded Entity for Tax Pur.poses" v � � ' - _--- — --r-- rr_-- 1204 4 001 Miscellaneous Cash .Recelp# ;; �.a�_ ..��r � ������*,.�.;. ., �p q�] M BEACH: CITY OF MIAMI No. .. g `Cash ❑Credit Card Check# P -- Received of ���} )r 5 S �' r r l I Address w'- rf. - r - f {' , f ; f 5f3 ' ; ®r,'r�� ?•��';. /: t: ,�t !��,/ter �f - ° � � �e 1 fA °"�- .r ,�_ t J ). ,-3 L f •i.:_?f^ .v. d 4?���d �f/'1-i--'�., �.�„-.s� ��� �Lje.�],.f���= ..Y �.� .✓� �^L��-'l! ff�PL s`_-•� F�re r' � i� q 1 r � �`4'� j 1 :'�.f... _Aj t �f •;: , '�� is ��? .,,�`�'•r���, � j`� � ��,� .s J1 J. (T�i1s iNF®RNF�►YIOIV MUST BfiELETED) '. Office of Fic�ance®irector By .-Account Number: Pro p �, f. �• # r . �, :.,:_�. Dept: f { ;r EXT t� l