CSM - Collins Equity, L.P. EOEIVED
03 .)i. IN -9 P~ 3:26
City of Miami Beach Office of the City Clerk ~ i i !' C L E It K' S 0F F I C E
1700 Convention Center Drive, Miami Bach, FL 33139
Emaih cityclerk@cL miami-beach.fi.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
[] ~ Check Box if an Amendment
Larkin Michael W.
NAME OF LOBBYIST: (Last) (First)
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. Biscayne Boulevard, Suite 850 Miami
BUSINESS ADDRESS: (Number and Street) (City)
Florida 33131
(State) (Zip Code)
(305) 377-6231
TELEPHONE NUMBER:
(305) 377-6222
FAX NUMBER:
EMAIL:
LOBBYIST RETAINED BY:
CSM-Collins Equities, L.P.
NAME OF PRINCIPAL/CLIENT:
670 White Plains Road, Suite 305
BUSINESS ADDRESS: (Number and Street)
Scarsdale New York 10583
(City) (State) (Zip Code)
(914) 722-4400
TELEPHONE NUMBER:
(914) 722-4496
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 OF BENEFICIARY: See Exhibit A
LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Modification to Certificate of Appropriateness for demolition and desi.qn
Issue to be lobbied (Describe in detail):
III. CITY AGENClESIINDIVIDUALS TO BE LOBBIED:
A) Full Name of Indlvldualrrltle
Jorge Gomez, Director
Thomas Mooney
None
None
B) Relationship
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYI'ST SU PPLEM ENTAL I'N FORMATtON
1)
2)
Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2,
Article VI1, Division 5 Thereof EntiUed "Campaign Finance Reform" Via The Addition Of
Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On
Procurement Issues":
Are you lobbying on a present or pending bid for goods~ equipment or
servicets,.or on a present or pending award for goods, equipment or service?
n Yes,/~lo
Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City Code Chapter 2,
Article VII Division 5 thereof Entitled "Campaign Finance Reform", Via The Addition Of
Code Section 2-,i90 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Are you lobbying on a pending application for a Development Agreement with
the City or application for change of~zo~mng map designation or change to the
City's Future Land Use Hap? BYes
V. SZGNATURE UNDER OATH:
ON OCTOBER 1; OF EACH YEAR, EACH LOBBYZST SHALL SUBt41'T TO THE CZTY CLERK A SZGNED
STATEMENT UNDER OATH, I.Z:~IING LOBBYZNG EXPENDI'TURES t'N THE CI'TY OF I*tZAI~! BEACH FOR
THE PRECEDZNG CALENDAR YEAR.
! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
LOBBYZ$'I' ZDENT~FZCATION: / /
Vt,
o Produced ID '-T~ ~¢'~,) [] Personally Known
Form of Identification
SI'GNATURE AND STAt4P OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subsc~,J~ed before me
This ~r~ day (~_../~Lg_~" , 2003.
F:\CLER\HATL\Lobbyists\Supplemental.doc
~'~[~re of Public Nota~ State of Florida
Print, stamp or typ~ ~a"~rne'""~'l~'l~o"~r~c
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE VVHETHER
HOURL Y, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: $275.00 Hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIESTCOMPENSATION):
$275.00 Hourly
V. SIGNATURE UNDER OATH:
ON OCTOBER 1s~r OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE
PRESEDING CALENDAR YEAR.
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
[] ~ Produced ID
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 as
amended, and all reporting requirements.
Signature of Lobbyist: ,~X (/.,,,1. / ~ ~' o~ ~- ~..~'7- ~3
Form of Identification
[] ~ Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn~o and subscribed before me
This ~ day of ~./.~.,~_, 20d~.
n~ur~ of Publi~c.~.~a_~m~!~ ti~.~r Florida
Print, stamp or typb'r?~m~'~'t~o~YP~l~h~
Registration:
FOR CLERK'S USE ONLY
~ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registretion fee paid: -'1~ Yes []No MCR# (~'~
[]
pATA ENTRY DATE: {2- / 0 ~ ,2002 ENTERED
1 First Revision - 05-17-02
EXHIBIT B
DISCLOSURE OF INTEREST FOR
CSM-COLLINS EQUITIES, L.P.
Percentages
Names
and Addresses
GENERAL PARTNERS
CSM-Collins Equities, Inc.
Maidad Rabina is the sole
Shareholder of CSM-Collins Equities, Inc.
CSM-Collins Realty Corp.
Howard Pames is the sole
Shareholder of CSM-Collins Realty Corp.
LIMITED PARTNERS
Maidad Rabina
Rabina Realty
670 White Plains Road, Suite 106
Scarsdale, New York 10583
Samuel D. Rabina
c/o Rabina Realty
670 White Plains Road, Suite 106
Scarsdale, New York 10583
Thomas H. Vogel
c/o Rabina Realty
670 White Plains Road, Suite 106
Scarsdale, New York 10583
Lynne Lawrence
c/o Rabina Realty
670 White Plains Road, Suite 106
Scarsdale, New York 10583
Lisa Murray
c/o Rabina Realty
670 White Plains Road, Suite 106
Scarsdale, New York 10583
of Partnership
Interest
0.500%
0.50O%
30.750%
6.250%
0.500%
0.125%
0.125%
Joshua Rabina 1993 Trust
Joshua Rabina is the sole
Beneficiary of the Joshua Rabina
1993 Trust.
Ellen Rabina is the Trustee.
Danielle Rabina 1993 Trust
Danielle Rabina is the sole
Beneficiary of the Danielle
Rabina 1993 Trust.
Ellen Rabina is the Trustee.
Talya Rabina 1993 Trust
Talya Rabina is the sole
Beneficiary of the Talya Rabina
1993 Trust.
Ellen Rabina is the Trustee.
Howard Parnes
455 Central Park Avenue
Scarsdale, New York 10583
Robert V. Tiburzi
455 Central Park Avenue
Scarsdale, New York 10583
Fred Stahl
455 Central Park Avenue
Scarsdale, New York 10583
Theodore Sannella
455 Central Park Avenue
Scarsdale, New York 10583
Edward A. Friedman
300 East 40th Street
New York, New York 10016
0.250%
0.250%
0.250%
24.500%
1.000%
1.500%
1.000%
32.500%
100%