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Atlantic Indian Creek, L.C. ..~llmllJ/;ll\ldl , 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 principal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action, derision, recommendation of the City Manager or any city board or committee; or any action, decision or recommendation of any city personnel defined in any manner in this section, 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. MCDOWELL NAME OF LOBBYIST: (Last) CARTER (First) N. (M.I.) Bilzin Sumberg Baena Price & Axelrod LLP. 200 So. Biscayne Blvd., Suite 2500. Miami. Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-2355 TELEPHONE NUMBER: 305-351-2239 FAX NUMBER: cmcdowell@bilzin.com EMAIL: I. LOBBYIST RETAINED BY: ATLANTIC INDIAN CREEK. L.c. NAME OF PRINCIP ALlCLIENT: 18851 NE 29 AVENUE. SUITE 901 BUSINESS NAME AND ADDRESS (Number and Street) AVENTURA, FL 33180 (City) (State) (Zip Code) 305-931-4959 TELEPHONE NUMBER: (305) 931-4606 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: JEAN PIERRE REIN IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Application (Variance) Board of Adiustment - 6529 Indian Creek Drive Issue to be lobbied (Describe in detail): III. CITY AGENCIESIINDlVIDUALS TO BE LOBBIED: A) Full Name ofIndividual/Title B) Anv Financial, Familial or Professional RelationshiD Board of Adiustmen.!_& Staff NONE MIAMI 884646.1 7319010200 -- IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) B) LOBBYIST DISCLOSURE: (Required) $425.00 per hour PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $425.00 per hour Yes No: X Are you representine: a not-for-profit corporation or entity without special compensation or reimbursement. Pursuant to Ordinance No. 2004-3435. I) Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2. Article VII. Division 5 Thereof Entitled "CalllPaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": Yes No: X Are you lobbyine: on a present or pendine: bid for e:oods. equipment or services, or on a present or Plmdine: award for e:oods. equipment or service? 2) 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 2-490 Entitled "Prohibited Campaign Contributions Bv Lobbyists On Real Estate Development Issues": Yes No: X Are you lobbyine: on a pendine: application for a Development Ae:reement with the City or application for chane:e of zonine: map desie:nation or chane:e to the City's Future Land Use Map? V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK 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 EXPENDifURES OR COMPENSA T N DURING THE REPORTING PERIOD. .. / // Signature of Principal/Client: PRINCIPAL IDENTIFICATION: I do solemnly swear that all of the for provisions contained in Section 2- 0 Signature of Lobbyist: VI. LOBBYIST IDENTIFICATION: o Produced ID Form of Identification ~/ Personally known (Lobbyist) o Produced ID Form ofIdentification ~ Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me <::: This 'l( da h\Jtio , 20 0--::1 / FORCLE~'S J~ONLY Annual Registration fee: [y..'f"es [ ] No Amount Pai .. 0 u, €Y 713 '5 {Date Paid Lobbyist Registration Form received and verified by: Revised 02/10/04 F: CLER\ALL\MA YIST\LOBBYIST FORM 04