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Carter McDowell/Miami Habitat, Inc.City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, Ft 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 pf 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 foreseeabiy 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. MCDOW ELL CARTER N NAME OF LOBBYIST: (Last) (First) (M I) 8ilzin Sumber Baena Price & Axelr d LLP 200 So. Bisca ne Boulevard Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) (3051350-2355 305 351 2239 CMcDowellCa7biizin com TELEPHONE NUMBER. FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: MIAMI HABITAT INC. NAME OF PRINCIPAUCLIENT: 1329 ALTON ROAD MIAMI BEACH FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-673-394$ 305-673-4348 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 BENEFIGARY: Eric Harari iDENT1FY ALL PERSONS HOLDWG, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ar~4~riL LUEfBY ISSUE: Zonin violation on ro ert located at 1032 Michi an Avenue Issue to be lobbied (Describe in detail): Ill. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title ; B) Any Financial, FamiliaE or Professional Relati Code Compliance Division 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 ci#y 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. MCDOW ELL CARTER N. NAME OF LOBBYIST: (Last} (First) (M.I) Bilzin Surnbe9 Baena Price & Axelrod LLP. 200 So. Biscayne Boulevard, Miami. Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street} (City) (State) Zip Code) (305)350-2355 305-351-2239 CMCDowell~a bilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: MIAMI HABITAT INC. NAME OF PRINCIPAL1CLlENT: 1329 ALTON ROAD MIAMI BEACH FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-673-394$ 305-673-4348 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: Eric Harari • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Zoning violation onproperty located at 1032 Michigan Avenue Issue to be lobbied {Describe in detail): III. CITY AGENCIESlIND1VIDUALS TO BE LOBBIED: j A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship y ~~ i Code Compliance Division i 4 r IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $535 00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $535.00 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": Yes /No Are you lobbvinq on a present or pending bid for goods equipment or services, or on a present or pendina 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": ~l Yes / No Are you lobbvinq on a pending application for a Development Agreement with the City 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.. i l Yes /No Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? V. SIGNATURE UNDER OATH: ON OCTOBER 15` OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPEN TION RECEIVED, IN THE CI Y F MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SH , FILE ~~~ N IF T E~H EEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING P O _f~•1 Signature of Lobbyist I do solemnly swear that all of the fo contained in Section 2-482 of the fjQi~ Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: i / ~/ Produced ID Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: PRINCIPAL IDENTIFICATION: Eric H ~~ari ~ -r; L' ProducedlD -"+ Form of Identification c=~ N p[ Personally known (Principal) T State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and sub cribed before me Sworn~d subscribed before me Thi of ~ , 2008. This ay of ~ 300$,; n . .•~ ' ~.F t.M:~~{~rflsi~;C~7 0 Neill ~, „ 4. _ Signatur _ f~~, ~ .,,:: ~ 59174E Notariz n o P nci al's •' ~ R Signature Public Notary -State f F ida p ~ ~~t~S, 44~. ~-'~; 201L ~~t~neee'~~# WWW,~`ii;i;il.UilitiRV:50fT, Notarization of Lobbyist's signature ~ ,,~ ~ FOR CLERK'S US ONLY p (~ ~ ~ ~~ Annua r o~Yf I S ~g ~, p~o Amount Paid MCR # / ,~/ Date Paid t ~~ Lobbyi ; ~ •~ ,F,~ati _ v ified by: T FORM 05.doc Revised 12/08/04 IAMI I E ~~~ > _ ii Dios are true and c rr t a that I have read or am famili~ittf~e provisions C e I rti requirements. ~ m ~ ~ ~ ('Tl rr"': 1 . ~ ~- CJ'+