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Mathew Amster/Seth Gadinsky 745 Collinsm' MIAMIBEACH 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. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.I) Bercow, Radell & Fernandez, P.A. 200 S. Biscayne Blvd., Suite 850 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377 6236 (305377-6222 mamsterCalbrzoninolaw com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Seth Gadinsky, President NAME OF PRINCIPAL/CLIENT: Matacumbe Enterprises Inc 325 South Biscayne Blvd ,Suite 1724 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 347-5415 SethC~Gadinskyrealestate.com TELEPHONE NUMBER: 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Development approvals for property located at 745 Collins Avenue. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title Planning and Zoning Department Staff, DRB, BOA, Planning Board, City Commission B) Any Financial, Familial or Professional Relationship None IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, 'l~LAT RATE' OR OTHERJ: A) LOBBYIST DISCLOSURE: (Required) S 234 QQ ~r hour B) PRINCIPAL'S DISCLOSURE (DF LOBBYIST COMPENSATION): (Required). $ 230 00 oer hour The foQovving infiormatiion must be attisM-ered: i) Pursuant to Miami Beach City Code Section x-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": Yes „~ No• Aro you na an a ti~nesen~or g~ig~~, ~'Qr goods, enulinment or services, or on s ant nr oendin4 awa-M 1forr.ffii~Dment or servk:l~? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Reat Estate Devebpment Issues": o -. 52 ~ a ~O E.~i c f 2 F c IZ~~ ~•~f. ~,~s Ma°~ 3) Pursuant to Miami Beach City Code 2-~i84 (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-f~-profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition tt) any item, shall register with the clerk as required by this settion but, shall not be required to pay arty registration fees.. V. SI6NAT~lRE UNDER OATH: ON OCTOBER i~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS YIfELL AS COMPENSATION RECEIVED, IN THE CI1Y OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SMALL BE FILED EVEM IF THERE HAVE BEEN NO EXPEND OR OOMPENSATION DURING THE REPORTING PERIOD. ////~,~TT Signature of Lobbyist 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 ttte Miami Beach City Code and aA reporting requirements. ~, _ _ Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION; ^ ProdUCed ID ^ Produced m Form of Identification Form of Identification Personalty known (Lobbyist) „8-Personally known VIL SIGNATURE AND STAMP OF NOTARY: State of ,County Mi~m' ade State of Florida, County Sworn subscri fo m~~~ Sworn and subscribed b This dpiy of This _~day of _„~ ip~`Y" Notary Public State of Florida Marc R Helpom ~. ~ My Commission DD7t39014 ~Ipires 03/29/2012 of Public Notary -State of Flbfida Signature of Public Notary -State of Florida flan of Lobbyist's signature Notarizatlon of PrindpaYs signaturo FOR CLERK'S USE ONLY ~7 Annual Registration fee: [ )Yes [ ) No Amount Paid ~""~ MCR # ate Paid ~ ~/ a Lobbyist Registration Form received and verified by: Entered By: EXHIBIT B DISCLOSURE OF INTEREST Matacumbe Enterprises, Ltd. 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 NAME OF INTEREST HOLDER 1. Matacumbe Enterprises, Inc. Seth Gadinsky, President 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 Seth Gadinsky 50% 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 Lyle Stern 50% 1665 Washington Avenue, PH Miami Beach, FL 33139 Subtotal 100% 2. Seth Gadinsky 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 3. Lyle Stern 1665 Washington Avenue, PH Miami Beach, FL 33139 4. Marylyn Gadinsky 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 5. Bruce Koniver 1665 Washington Avenue, PH Miami Beach, FL 33139 INTEREST 1.0 24.5 24.5 25.0 25.0 TOTAL 100.0