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Elena Bondarenko - HHG Holding I, LLLP AA I AAA BEACH 1,o ,tih(-01-"ReAL 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. Bondarenko Elena NAME OF LOBBYIST: (Last) (First) (M.I) Law Offices of Elena Bondarenko, P.A. 1395 Brickell Avenue Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-797-7909 e.bondarenko(ahotmail.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: Michael Wilkinas NAME OF PRINCIPAUCLIENT: HHG Holding I, LLLP 1111 Lincoln Road, 4th Floor Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and street) (Ulty) (state) (Lip code) c 416-889-3977 michaelRwilkinas.com _=r_ TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] t • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Michael Wilkings(President of the General Partner) • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORATION, PARTNERSHIP OR TRUST:See Attached Exhibit mom: •• II.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Board, Planning and Board of Adjustment approvals for the property located at 605 Lincoln Road. Issue to be lobbied(Describe in detail): Ill. 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 Planning Department and Building Department Staff None. X PB, DRB, HPB, BOA, FP, City Commission, LUDC, and None. X Commission Committees, as necessary None. X 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_ None_ 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)$300/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $300/hour (REQUIRED). The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes XNo: Are you lobbying on a present or oendina bid for goods.eauipment or services.or on a present or pending award for goods.eauipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes XNo: Are you lobbying on a aendina application for a Development Agreement with the City or application for change of zonina map designation or chanae to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees. _Yes XNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement., V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECE ED. IN THE CITY OF MIAMI BEACH EQ$ DE PRECEDING CALENDAR YEAR. A STATEMENT SHALL EVEN IF THERE HAVE BEEN NO, EXPENDITURES OR COMPENSATION DURING THE REPO G E . S' ture 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 B ch City Co all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: .714.. VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID VL b wee�S t( - or ID Otktg..1 CA earKIP45, Form of Identification ;`$4:`, Form of Identification c Personally known(Lobbyist) ,Q Personally known(Principal) r m Qo m, 4r °r (7 �s W , VII. SIGNATURE AND STAMP OF NOTARY: ,f1 • EE F .� 4 iecf 0 k r r State of Florida,County of Miami-Dade ' State of Florida,County of Miami-Dace` EE E Sworn and subscribed befo me •J��c��•�''-.-- a ��QQ Sworn subscrib-d befi re me This P� of ;‘N� ,20 4 s `� T da .� !. ,201 4 S1,�� Signature AID ra■Iiijr0 of • blic Nota —State of Florida " ""�, Signature o Mk. NW°'ublic Not.' "State of Florid'. �f � Notarization f Lobbyist's signature Notarizatio of • "I ' .. ' signature °ti i�°' TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee. [ ]Yes[ ]No Aniuunt Paid$ MCR# _Date Paid Lobbyist Registration Form received and verified by: 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: Elena Bondarenko 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. ;/ 028 09-D! Si ture: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc • • • • • • OWNERSHIP STRUCTURE' '60S tlfiC-OLN-ROAO UNITS SOO S.270 • • 14HG-HOIdIrsettrU.AP 100), • -1 , HMG Oeveloprotots Corp. HoWard Sitzer HHG Managernerd LALP (FL} 1' {Del) Gent'fa;Partner 1 11(04 ear Portrter linlited:POnner 21.1, 78% 20%. . • Howard Sitter W Capital Limited Howard Muer. W Capital Limited • _ (UK) • SO% tiinitect Partner titnited Partner - 4r4 49547, • Vitt hael Wilk; • I • • • sTRUcrt,PRE' • :61)S 1.INICQLN ROA0=----::UNITS.$0)14:2:7lij • -,ttheikiitggiAddirt4itz- .1111G 1412411Ft.fttit.p•- 1k14.0. • ..41h Ekr • ''MiRarit 15.eaett1,..:43151 • _ . • HIHG,MartagearienoillIP :1111111X9In 4th Floor • • • • • Miami Beach, Deveiopenono Corp.. • • • • 111 Lincoln ADati • £U Floor • Mini i Beach, rt.331T4 • W CMIII kiruktott. • 1.4 Hamptinr Sireek 3rtilfItY3f, Lonct W1S 1Y1•4 • Ereland Howard Sitter - 4485 Fltroyal Nam Ave. Miami Reath,Flt.33140 rtiliglaad Wile:Imp 1111 1,4ICOIP, 4th Floor. tWarrti Bead%FL33139-, • • • | -,,.....,,..,-.,,•,,„.,:„.„,._ . •.'••CITY'OF„MIAMI'BEACH' - --„,.,..-,....,-:::..--,.,r:,-.-. .. .„::-- - i;-_.-:___-,i--.::---,,•:-,', ._'-,'.r._'''-':.---:;',:,•.:-..i.7-.: .:-:-.;-',•-,•::-.,- .-..._...,;-..._-,- ;- tiii...:::_..:i-,,,..:.„.": ,,.,„,,-,_,,,,..„:„.:r...„-:=„:,:.,,.,--,. : . . . „srF.40,.„:„:._.,-.,,..•:,..- - -,. , ._,-.-„,..,. -..i...- ,-.. :-..:: -..._ _:„.. „...:.:....:::,....„-: ,,r,„;:.,,,_..... .:: ..,....,...;,- ,...,,, ,r• ..'.'..•'''':.r."' 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