Carter McDowell/Savoy Hotel Partners, LLC
l;6
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.
McDowell
NAME OF LOBBYIST:
(Last)
Carter
(First)
N,
(M.I)
Bilzin Sumberq Baena Price Axelrod LLP 200 S. 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:
Savoy Hotel Partners, LLC
NAME OF PRINCIPAL/CLIENT:
Savov Hotel 425 Ocean Drive. Miami Beach. Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City)
786-866-0071
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(State)
(Zip Code)
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:
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Extension of time to obtain a buildinq permit for Torino/Savoy Beach Club
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Miami Beach Historic Preservation Board and None
staff
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required)
Hourly $455.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
Hourlv $455,00
M1AMI12]4322.17333910356
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":
D Yes ~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 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 man designation or change to the City's Future Land Use Map?
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-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..
Yes ~No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1st OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT
UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATIO ECEIVED, IN THE CIT F MIAMI
BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE F D EVEN IF HERE EEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
D
0/'
Produced ID
Signa
I do solemnly swear that all of the foregoi
contained in Section 2-482 of the Miami a
d that I have read or am familiar with the provisions
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
C~~I/!L
Form of Identification
Personally known (Lobbyist)
D
VII. SIGNATURE AND
. ,'" '. I~ES PADRON
f .. ~f ~-rCb~T5S10N # DO 608768
t~ :*: EXPIRES: November 9,2010
~ , ~d Thru Plchan:llnsurance Agency
r 200{0
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ature of Public Notary - State of Florida
rization of Lobbyist's signature
Slg ature of Public Notary - State of Florida
Notarization of Principal's signature
/ FOR CLERK'~!.ISE 0~p-,)'2J"2-
Annual Registration fee: ~es [ ] No Amount PaiGkb:"'1V1CR #""Uate Paid l~ (p I (Xp
Lobbyist Registration Form received and verified by' ~~~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FOR~.doc Revised 12/08/04
MIAMI] 2 ]4322,] 7333910356
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Disclosure of Ownership Interest
for Savoy Hotel Partners, LLC
Savoy Hotel Partners, LLC, a Florida Limited Liability Company
7307 Somerset Shores
Orlando, FL 32819
A. Officers
Savoy Hotel Management I, LLC, a Florida Limited Liability Company, Manager
455 Ocean Drive
Miami Beach, FL 33139
B, Ownership
Savoy Hotel Management I, LLC, a Florida Limited Liability Company
455 Ocean Drive
Miami Beach, FL 33139
I. Officers
Avi Werjuka, Manager
455 Ocean Drive
Miami Beach, FL 33139
11.
Ownership
a. Savoy Hotel Management, Inc., a Florida Corporation
455 Ocean Drive
Miami Beach, FL 33139
(i) Officers
A. Avi Werjuka, President
455 Ocean Drive
Miami Beach, FL33139
B. Gary Cohen, Secretary
455 Ocean Drive
Miami Beach, FL 33139
(ii) Directors
A. Avi Werjuka, President
455 Ocean Drive
Miami Beach, FL 33139
B. Heller, Director
455 Ocean Drive
Miami Beach, FL 33139
C. Michelle Dryer, Director
103 Foulk Road, Suite 200
Wilmington, DE 19803
(iii) Ownership
A. Avi Werjuka
455 Ocean Drive
Miami Beach, FL 33139
100%
b. Savoy Hotel Partners !, LId" a Florida Limited Partnership
455 Ocean Drive
Miami Beach, FL 33139
(i) Partners and Ownership
A. Savoy Corporate Management, Inc,
a Florida Corporation
General Partner
c/o KDC
20 I S, Biscayne Blvd, # 1500
1%
I. Officers
MIAMI 958608.3 7653024060
1%
99%
100%
100'Vo
100%
MIAMI 958608.3 7653024060
A.
II. Ownership
A, The Amelin Trust
a British Virgin Isles Trust
(i) Ownershio
(a,) Avi Werjuka
Beneficial Owner
(b,) Lexinter Management, Inc,
Trustee
B. The Amelin Trust
a British Virgin Isles Trust
Limited Partner
I. Ownership
(a,) Avi Werjuka 100%
Beneficial Owner
(b,) Lexinter Management, Inc,
Trustee
c.
Jaymar Savoy Estate Company
a Trust
Limited Partner
I. Ownership
(a,) Mark Halpern
Beneficial Owner
(b,) Mordechai Halpern
Trustee
100%
100%
100%
80%
19%