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Ethan B. Wasserman - Solid Investment & Development LLC MIAMI BEACH : 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. Wasserman Ethan B NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig P.A. 333 SE 2nd Ave,4400 Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-5749-0784 wassermane @gtlaw.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: SOLID INVESTMENT&DEVELOPMENT LLC NAME OF PRINCIPAUCLIENT: 255 Alhambra Cir,700 Coral Gables Florida 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) -(Zip Code) 305-445-3800 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: Alexandre Souza Lima • PARTNERSHIP IDENTIFY ALL PERSONS S HOJ @@,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, II.SPECIFIC LOBBY ISSUE: 538 Meridian Avenue 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 Board of Adjustment,Depth of Public Works,Historic Preservation Board -� City of Miami Beach Commissioners,City Manager,City Attorney ; Planning Board,Design Review Board,Building Dept,Planning Dept. N-) 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_.perso nel who is sought to be lobbied as identified on the lobbyist registration form filed. C Sec 2-482(g)Any Financial,Familial or Professional Relationship NONE F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc r IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $395.00 hourly B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED).$395.00 hourly 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,equipment or services,or on a present or pending award for goods,equipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": • —. Yes No: 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 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. _YesXNo: 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 FOR 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. Signature of Lobbyist: �^ Signature of Principal/Client: VI. LOBBYIST IDENTIFICATIO 4 PRINCIPAL IDENTIFICATION: Pro ced ID Produced ID — Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF I Y: r v ••i , V•AMIE-GARCIA �`''�:•.; , V.ALZATE-GARCIA State of Florida, #.-t_ *;MY COMMISSION#FF 114833 , h- MY COMMISSION#FF 114833 County of Miami-Dade State of Florida,County of Mi.��' : EXPIRES:Apr8 22,2018 ?�� EXPIRES:April 22,2018 Sworn to and subscribed before me S 'r ThroBud NON Servkes Sworn aril subscribed before •This day. M " , ,201 °F"' ry •' 2 day of 2i9:ate eonoe0ThruBudgetNotary Servltes .• • 11/111r. e.-.-4—.L.., M ignatv ..--=...: ary— a r- o bride :ignatu •f P otary—State Florida Notarizatio' of Lobb ist's si• ature Notarizatio P of P i i•al's sig ture TO BE COMPLETED BY CITY CLERK'S STAFF ONL Annual Registration fee: [ ]Yes[ No Amount Paid$ Zi SO 10 MCR# `A 0 3411 Date Paid 1/ `�/J Lobbyist Registration Form receive and verified by: r , a F:\CLER\$ALL\aOORMS\LOBBYIST FO MS\Lobbyist Annual Registration orm.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MIAMI BEAC 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:305.673.741 1 ,Fax:305.673.7254 LOBBYIST NAME: Ethan Wasserman 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 of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade C•unty Commission on Ethics and Public Trust. At 11/3/1r Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc - Miscellaneous Cash Receipt • 4_:, -)ir .a ¢.,.... CITY OF MIAMI BEACH • • 403495 NO. 3S El Cash O Credit Card EliCheOk# $ 2.q . 2015 of 64110,V ��1SS4.r YEA Received o Address, '7)3 1> 5 6 2.0a.. Atia, For S '% .Mec AUentite—. COMPLETED)INFORMATION MUST BE COMPL ) O ce�(fpFinan a Director (THIS /� f J amAccount Number: � /OO i P repa rer: 1,J CI ol Dept --- REORDER 805•U.S.PATENT NO.5538290,5575508,5641183,5785353,5984364,6030000 Vendor No. 02571 Check No. 666329 T R AU Fi1G Vendor Name:CITY OF MIAMI BEACH Check Date:04/28/15 GREENS ERG .......... 04/27/2015 01042715350 City of Miami Beach - Lobbyist Registration for Ethan Wasserman - 538 Meridian $ 350.00 Avenue