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Michael Gil/Thor ACQ, LLCm 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. Gil Michael A NAME OF LOBBYIST: (Last) (First) (M.I) Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite 850 Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-8690 (305) 377-6222 mgil@brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Thor ACQ, LLC NAME OF PRINCIPAL/CLIENT: 25 West 39`" Street New York NY 10018 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212)529-7415 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: Joseph J. Sitt • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Joseph J. Sitt II. SPECIFIC LOBBY ISSUE: Redevelopment of 910 Lincoln Road 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 Planning Dept., HPB, BOA, Planning Board, City Commission ~ None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERJ: A) LOBBYIST DISCLOSURE: (Required) $ 220 00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 220.00 per hour The following information must be answered: 1) Pursuant to Miami Beach Ciry Code Section 2-488 Entitled °Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes X No• Are you lobb~na on a present or pending bid for goods equipment or services or on a present or pending award for goods eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes X No• Are you lobbying on a pending application for a Develoament Agreement with the Citv or application for change of zoning map 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 anot-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 X No• Are you representing anot-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 COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. 1 `f`.." 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 the Miami Beach City Code and all reporting requirements. ~~ _ ~ n . ' n Signature of Lobbyist: nature of Principal/Client: 4 ~ I. LOBBYIST IDENTIFICATION: 'S ao ~; o ~ Produced ID Y _3 .Q ,;,, Form of Identification ~~'~E= ~ ~ d ~ Personally known (Lobbyist) Z `" ~ "' VII. SIGNATURE AND STAMP OF NOTARY: ~~'''`'` State of F orida, County of Mia Dade ~"`= Sworn ubscrib efo e~'/~ °" •'`~ This day of f d0 D~ f[Ge of Public Notary ate of~lorida rization of Lobbyist's signature PRINCIPAL IDENTIFICATION: Produced ID Form of Identification .vf~ersonally known (Principal) STATE e of nEw Yoarc ~ I~fARY PU8L1C ~ or++ti+•~a~ ~~. N2W `~OYk- NQyV `I DY~=i ~'. N~utiois ,. State of Weritla, County of A4ia~-Bede- %, ~i~`'~.. ~ '~~ i s ~..........•..'' ~o`' ~a Sworn and subscribed before me '.,,sk~N EXp~{tES``~.•~~ This ~'1G~day of .1G~m.~ , 20~ ~~''~~~~~~~~~~~~"~~ ~ ~ Signature of P is Notary -State of F/~}P•W=~Di(k- Notarization of Principal's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [~No Amount Paid C MCR # a~ Q ~ ate Paidy /; ~ ~^ ~L Entered B -.<-~7'~.-~-e .~"-rLc~ Lobbyist Registration Form received and verified by:`~l y: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST foRM 08.doc Revised 12J08/04 City of Miami Beach, 1740 Convention Center Drive, Miami Beach, Fbrida 33 T 39, www.miomibeachfi.gov CiIY CIERK Office CihfClerk@miamibeachfi.gov Tel: 305.673:741 1 ,Fax: 305.673.7254 LOBBYIST NAME: ~ < < R~.1 y ~ I understand that no later than Qttober ! st of each dear, I must file the following forms, pursuant to Section 2-4$5 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. i ~ Lobbyist Expenditure Form 2J Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue i have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Signature: Date: