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Neisen O. Kasdin/Investcorp ~ It".om. ~~-:u:" b::t:td mr; ~UJ to - - 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 princlpal who seeks t!J encourage the passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the aty Manager or any city board or committee; or any act/on, dedslon or recommendation of any city personnel during the time period of the entire decisIon-making process on such action, decision or recommendation that foresee ably will be heard or reviewed by the clty 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. Kasdin Neisen o. NAME OF LOBBYIST: (Last) (First) (M.I) Gunster, Yoakley & Stewart, P.A., 2 South Biscayne Blvd., suite 3400, Miami, FL 33131 BUSINESS NAME AND ADDRESS (305) 376-6062 TELEPHONE NUMBER: (Number and Street) (aty) (305) 376-6010 FAX NUMBER: (State) (Zip Code) EMAIL: I. lOBBYIST RETAINED BY: Investcorp NAME OF PRINOPAl./CUENT: Investcorp, 280 Park Avenue, New York, NY 10017 BUSINESS NAME AND ADDRESS (212) 599-4700 (Number and Street) (City) (212) 983-7073 (State) (Zlp Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principalls a Corporation, Partnership or Trust [Section 2-482 (c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: IDENTIFY All PERSONS HOLDING, DIRECTlY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC lOBBY ISSUE: W Miami Beach site Plan and Related Issues Issue to be lobbied (Describe In detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/TItle B) Anv Financial, Familial or Professional Relationship :Planning Dep:lrt:ment Mayor and Commission City Managers Office IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Requited) Hourly, $400.00 per hour Hourly, $400.00 per hour B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (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": o Yes 'J~o: Are vou lobbvlna on a present or pendinG bid for Goods. eauipment or services. or on a present or oendina award for aoods. eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By lobbyists On Real Estate Development Issues": oYes }fNO: Are vou lobbvinG on a oendinG aoolicatlon for a Develooment Aareement with the Cltv or aoolication for chanae of zonina mao desianation or chanGe to the Citv's Future Land Use Mao? 3) Pursuant to Miami Beach City Code 2-484 (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-fur-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 derk as required by this sectIon but, shall not be required to pay any registratIon fees.. V, SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CI1Y CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE crrv OF MIAMI BEACH FOR THE PRECEDING CALENDA EAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT S OR SATION DURING THE REPORTING PERIOD. I do solemnly swear that all of the foregoing facts familiar with the provisions contained' Section requirements. Signature of Lobbyist: re true and correct and that I have read or am of the Miami Beach City Code and all reporting Signature of Principal/Client: I . U C0' c~ ~,-/ 2<:c'/ ~ h~ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: iJ Produced ID o Produced ID Form of Identification [v./~er50naIlY known (Lobbyist) I. SIGNATURE AND STAMP OF NOTARY: Form of Identification ~rsonally known (Principal) gnature of Public Notary - State of Florida Notarization of Lobbyist's signature FO CLE Annual Registration fee: [ Yes [ ) No Am t a Lobbyist Registration Form received and verIfied by: F:\ClER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM .