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Carter McDowell/Ark Developers, Inc. ;.... ,-. 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. NAME OF LOBBYIST: McDowell (Last) Carter (First) N. (M.I) Bilzin Sumberq Baena Price & Axelrod LLP. 200 So. Biscavne Blvd.. Suite 2500. Miami. FI33131 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: Ark Developers. Inc. NAME OF PRINCIPAL/CLIENT: 701 W. Cypress Creek Road. Suite 300. Ft. Lauderdale. FI 33309 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) @p~) ~ ~ ::u -< c- . ~ rt1 EfJAIL: ptio.~) ~ t. m ?:: <.f) o -r\ --n ~ 3 N .. <: rn o 954-707 -5000 TELEPHONE NUMBER: 954-707 -5001 FAX NUMBER: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Sean Tanner (") . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Permit issuance and Desion Review Board for property at 1225 20th Street and 1237 20th Street 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 Design Review Board and staff none Building Department staff none Public Works Department Fire Deoartment none ~ ......... IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATlul.J (DISCLOSE WHETHER HOURLY, FLA T RA TE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $500/hr. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $500/hr. 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": DYes I:8J No: Are you 10bbvinQ on a present or pendinQ bid for Qoods. eQuipment or services. or on a present or pendinQ award for Qoods, eQuipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": o Yes ~ No: Are yOU 10bbvinQ on a pendinQ application for a Development AQreement with the City or application for chanQe of zoninQ map desiQnation or chanQe 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.. DYes [gI No: Are yOU representinQ 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 COMPENS ON RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL ILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PER Signature of Lobbyist Signature of Lobbyist: ect and that I have read or am familiar with the provisions porting requirements. I do solemnly swear that all of the foregoin contained in Section 2-482 of the Miami Signature of Principal/Client: Sean Tanner VI. . LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o Produced 10 o Produced 10 Form of Identification Personally known (Principal) ~ Form of Identification Personally known (Lobbyist) o VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swor.n)o and sub ibed before me This ~ day of ,20~, State of Florida, County of Miami-Dade Sworn and subscribed before me This _ day of , 20_ Annual Registration fe: es [ ] No Amount Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FO Signature of Public Notary - State of Florida Notarization of Principal's signature YC~ 7 Revised 12/08/04 IAMI ,...... J""""'o.. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATIL-,.. (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $500/hr. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $500/hr. 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": DYes ment or services or on a resent or 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes Iication 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 e'.(press 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.. DYes 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 COMPENS ON RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL ILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PER ect and that I have read or am familiar with the provisions porting requirements, I do solemnly swear that all of the foregoin contained in Section 2-482 of the Miami Signature of Lobbyist: Signature of Principal/Client: VI. Sean Tanner . LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o Produced 10 o Produced 10 Form of Identification }( Personally known (Principal) ~Cl,~~.y. ~~~" PEGGY PACHECO :M. '.. MY COMMISSION' DO 359~O S t f FI 'd C f M' . 0 EXPIRES: October 4, 2008 ta e 0 on a, ounty 0 laml- ",<>~ Bond!d Thru Budget Notary SeNices Sworn and subscribed before me ~OFl'o T~ day of Fl!...bn,)Q('1 ,20--0, s;gn~= - State of Floc;da Notarization of Principal's signature Form of Identification o Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before'me This _ day of , 20_ Signature of Public Notary - State of Florida Notarization of Lobbyist's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # Lobbyist Registration Form rec.eived and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM OS.doc Date Paid Revised 12/08/04 IAMI