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Daniel Vasini - Portman Holdings, LLC (aevikcuo- v ,'y\j (Go veal-.on ballet MIAMI BEAC r 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. Vasini Daniel NAME OF LOBBYIST: (Last) (First) (M.I) West 8 urban design &landscape architecture b.v. Schiehaven 13M 3024 EC Rotterdam The Netherlands BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) +31 (0) 10 485 5801 d.vasini @west8.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: Portman Holdings, LLC NAME OF PRINCIPAUCLIENT: 303 Peachtree Center Ave.NE. Ste 575.Atlanta,GA. 30303 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 404.614.5252 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: CEO:Ambrish Baisiwala • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Portman Family Investments,LLC; John C. Portman II;Ambrish Baisiwala ILSPECIFIC LOBBY ISSUE: Development of a Convention Headquarter Hotel adjacent to the Miami Beach Convention Center 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 Mayor and City Commisioners,City Commission,City Manager and None Staff,Convention Center Advisory Board,Planning Director and Staff, Planning Board,Design review Board,Board of Adjustment,Procument Director and Staff,City Attorney and Staff. 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 - ; 1-1 (1 A L1 ?VOA Si tit tic F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc " ' • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): • A) LOBBYIST DISCLOSURE:(Required) Salaried Employees B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Salaried Employees (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 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": x 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. YesX 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 T. THE CITY CLERK A SIGNED STATEMENT UNDER OATH,LISTING LOBBYING EXPENDITURES,AS WELL AS NSATI' RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE F Hb E1 N IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. '� € I\AN �t Signature of Lobb t I do solemnly swear that all of the foreg 'ng-facts\r- .true and correct and thS I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beac .,City ••de a dal -.. ••• requirements. Signature of Lobbyist: /1114/0 Signature of Principal/Client: � _r� VI. LOBBYIST IDENTIFICATION: - PRINCIPAL IDENTIFICATION: _Produced ID _Produced ID %N `NA M41/III Form of Identification Form of Identificati�l .q �t� �SSIpj,�•k,C .i� • _Personally known(Lobbyist) Personally known(Principal) •�, ‘4OTA,9 �% VIi. SIGNATURE AND STAMP OF NOTARY: IMP T's 1. ilia L\G s State of Florida,County of Miami-Dade State of Florida,County of Miami-D1,A0•••PeER 6:$0.4(5) b � Sworn d subscri :• •efore me Swor subscr.-' •efore me a C�•••••••'• This S iL_`'^aay of I :. ,2011 This day of ' ,20��i,//UNTI w��� Signature of Public Notary—State of Florida Si tu e • Public Notary—State of Florida Notarization of Lobbyist's signature N t•ri tion of Principal's signature TO BE COMPLETED B' ITY CL r K'S STAFF ONLY Annual Registration fee::[ ]Yes:[ ]No Amount Paid$ -# • Date Paid • Lobbyist Registration Form received and verified by: :_: F:ICLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 F:ICLERI$ALL1aFORMSILOBBYIST FORMSILobbyist Registration Form.doc • • City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E,Granada,Cily Clerk CityClork©miamibeachfl.gov Tel:305.6/3.7411 ,Fox:305.673.7254 LOBBYIST NAME: Daniel Visisni 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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who falls to file the required Statement by April 30th of each year, shall be automatically suspeided from lobbying until all fines are paid, unless the fine has been appeal d-t the Miami-Dade County Commission on Ethics and Public Trust. Signature: °� �.. .._ �' CO:VAS l s .. F:ICLERI$ALLIaFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc • . ~ . ` .--.:�' -`- . 1.-!;;:rr:;:'-:-:...,:',.:::::,ii.':::::4V.'-'-: -.:,,,::',',',..:'.:::-.::::-:ciiii.al:.14F01401A..i'll■614;:fiitlA*...13E,'COMOLETED);!. ::.:i1:-:::;....,'...;:::::::';..-- -:.'..--..::-;,..,:-::::: ::::1,_,,,',:::,Offiae:-Oi,Firi rf:i'l?,i7k ,,''4AY"IW''':-''''.i:;:::q1.'''''A.Cyc::'.O.:ii.'n.'i.N'''iim'':''ii ii.e.4 .,-;:._6.,:: _ _.,,_a-- '' '--- ----_E i,3-' -- '-'' •' . ."' '5,"' ',-;__:-.,-.::,....,.',-,:-.,-,;:..":._;:::::::;.:;:::,:,„:::;,=..:_.: .-;': ,'.'-:::...-':'--: 0 --_ , _. . . ' _ `. / -. . 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' - `. ^ ` . ~ LOY E N S L LO E F F POSTAL ADDRESS P.O.Box 2888 3000 CW ROTTERDAM OFFICE ADDRESS Blaak 31 3011 GA ROTTERDAM The Netherlands TELEPHONE +31 10 224 6536 DHL COURIER FAX +31 10 412 5839 E-MAIL erik.uljee@loyensloeff.com OFFICE OF THE CITY CLERK—City of Miami Beach INTERNET vwwv.loyensloeff.com Attn. Mr Patrick Camm, Administrative Aide 1700 Convention Center Drive, Miami Beach, Florida 33139 UNITED STATES OF AMERICA FROM Erik Uljee—Paralegal REFERENCE 19058275-v1 3000621 (40006729) DATE 16 June 2015 RE Legalisation Dear Mr Camm, At the request of Mr Daniel Vasini of West8 urban design & landscape architecture b.v., please find enclosed a legalised document, provided with an English apostil. Should you have any further questions, please do not hesitate to contact me. Best regards, Loyens & Loeff N.V. A� ErikAtiee /s f �: The public limited liability company Loyens&Loeff N.V.is established in Rotterdam and is registered with the Trade Register of the Chamber of Commerce and Industry under number 24370566.Solely Loyens&Loeff N.V.shall operate as contracting agent.All its services shall be governed by its General Terms and Conditions,including, inter alia,a limitation of liability and a nomination of competent jurisdiction.These General Terms and Conditions may be consulted via www.loyensloeff.com.The conditions were deposited with the Registry of the Rotterdam District Court on 1 July 2009 under number 43/2009. AMSTERDAM • ARNHEM • BRUSSELS • LUXEMBOURG • ROTTERDAM • ARUBA • CURACAO • DUBAI HONG KONG • LONDON • NEW YORK • PARIS • SINGAPORE • TOKYO • ZURICH 1/1 f �1 LOYENSi LOEFF • tp-, ° rri et'10E97' c • Z/ck/40006729 19055677 STATEMENT The undersigned: Catharine Elisabeth Parlevliet, hereafter referred to as: "civil law notary", as substitute of Dominique Francois Margaretha Maria Zaman, civil law notary in Rotterdam, the Netherlands, hereby certifies that: the signature appearing on the attached document is the true and genuine signature of: Daniel Rafael Vasini, born in Maracaibo, Venezuela, on 10 November 1980, holder of an Italian passport with number YA2282441, valid until 28 December 2021 (Signatory). Furthermore, the undersigned civil law notary hereby declares that the Signatory has made no statement under oath as referred to in the Act form of the oath ("Wet vorm van de eed') (State Gazette 1911, 215) before me, civil law notary, with respect to the attached document. The significance of this statement is strictly limited to the ascertainment of the identity and the signature of the person mentioned herein. No judgements are made by the undersigned, civil law notary, with respect to- inter alia -the content and possible legal consequences of the attached document or any other aspects thereof. This certificate may only be relied upon on the express condition that any issues of interpretation or liability there under will be governed by Dutch law and be brought exclusively before a Dutch Court and is subject to the General Terms and Conditions of Loyens & Loeff N.V. (lawyers, tax advisors and civil-law notaries)' which include a limitation of liability clause. Signed in Rotterdam, the Netherlands, on 16 June 2015, at: (LI .5 Z 11 4to Vag 11. :.: � ;� �� iii•;�• * C.E. Parlevliet * i, 'These conditions were deposited with the Registry of the Rotterdam Districf bo • . !}c(0 .er number 43/2009 and can be found at http://www.loyensloeff.com. .., E R APOSTILLE • 1. (Convention de la Haye du 5 Octobre 1961) Country:NETHERLANDS This public document 2. has been signed by mr C.E.Parlevliet 3 acting in the capacity of junior notary 4. bears the seal/stamp of Prof. mr. D.F.M.M.Zaman at Rotterdam Certified 5. at.Rotterdam 6. 16 June 2015 7. by the Clerk of the.District Court (Griffier van de Rechtbank) 8. No. HA RP 15 3759 • Seal/stamp 10. Signature 0.1 .11 COP ) 00 • • N 1 x\11 ( Q IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) Salaried Employees B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Salaried Employees • (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 No: Are you lobbying p on a resent or p g endin 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": X Yes_No: Are you Iobbvinq on a_pendinq application for a Development Agreement with the City or application for change of zoning ma designation or change to tip 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, w Yesx No: Are ou re•resentin• a not-for-•rofit cor•oration or entit witho t s'eclat co •e sati•n or rei bursement, V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAREACH LOB:YIST SHALL SUBMIT 7' E CITY CLERK A SIGNED TEMENT', NDER OATH LIS ING LOBBYING EXPEND! •.S .S ELL AS CO • r,, ATIQjt - T II 1 . ` ♦1160:0117VAH FOR THE PRECEDING CALE DAR YEAR. A ST'TEMENT SHAL BET.N IF THERE HAVE BE N NO XPE DITURTIT COMPEN PTION DURING ThE REPORTING PERIOD., \ Signature of Lob.r.tt `: r' ' ' �r— / 1 ,; i I do solemnly swear that all of the regbing.facts kr true and correct and thN I have re or am familiar . ."!2 ovisions contained in Section 2-482 of the Miami Beach.City rode a dal .. ,. requirements. Signature of Lobbyist:y - A� N _ 11 ►1. i • Signature of Principal/Client:_ affropligurowl _ ! Mr \� _ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: i Produced ID Produced ID 1�.',1 I ffi/�®o Form of Identification �.. o Form of Identifica�lg�1 �`••••.•.• .. •o - ; �4 e•tt, ON•.oC •OiP , Personally known(Lobbyist) Personally known(Principal) c /A. oT,q, %ss VII. SIGNATURE AND STAMP OF NOTARY: :7 s �e ' �ni Q : 17.,:,...%00�/BLVG t t. , State of Florida,County of Miarni-Dade State of Florida,County of Mlaml-DS •�'•:OhSR a 9,'S'•f O�� Sworn d subscri" .afore me r- Swor subscrp,-• .efore me �i �•'•••••'• 0� This` ay of li A ,20'it This day of ' _,20' /t�V N ,.0 ...r 1�Au �ff11f1111��� . Signature of Public Notary ry-State of Florida SI s to a • Public Notary-State of Florida Notarization of Lobbyist's signature N t.ri .lion of Principal's signature TO BE COMPLETED B` ITV CL :K'S STAFF ONLY :Annual Registration:fee::_[ ].Yes[:;:`]_No:. Amount Paid_$` ::`' ,i Lobbyist Registration Form received and verified bbl F:I CLERI$ALLcaFORMS\LOI3BYIST;FORMS\LobbylstAnnual Registration Form.doc:, '. . :.::.:: ..:.:::.::..:.:: ::.%. :Revised:0112/2014.:* L F:ICLERI$ALLIaFORMS\LOBBYIST FORMSILobbyist Registration Form.doc I i