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Allan Shulman/Rita & Steven Starr & Kelapa Investments, Inc.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 teen "Lobbyists" has specific exclusions. Please refer to Ordnance 2004-3435. Shulman Allan T. NAME OF LOBBYIST: (Last) (First) (M.I) Allan T. Shulman Architect, P.A. 100 NE 38 Street Miami, Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 438-0609 (305) 438-0170 allan@shulmanarchitect.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Rita and Steven Starr & Kelapa Investments, Inc. (Rita Starr, President) NAME OF PRINCIPAL/CLIENT: 1810 Michigan Avenue Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)525-5535 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: Rita Starr • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Redevelopment of 604-08 Collins Avenue and 215 6 Street Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title I 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 OTHERt ~ ~1~-, A) LOBBYIST DISCLOSURE: (Required) $ ~J ~/ w B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ~~ `'~. 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 X No: Are you lobbying on a present or vending bid for goods,, equipment or services, or on a vresent 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 X No• Are you lobbying on a vending application for a Development Agreement with the Citv or application for change of zoning map designation or change to the Citv's Future Land Use Mav? 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 X No• Are you representing anot-for-vrofit corporation or entity without svecial comvensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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. ~ // ignat~e of Lobbyist o o~ ~• ~~ S' N Tgj~ ~~ IZtA~W ~q~t d ~'AV . s~ 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. `~~ ~/^~' ~~ Signature of Lobbyist: v/ Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID ^ Produced ID Form of Identification Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of I~oric~a, County ~f Mia of Stgfiature of Public Notary -State of RYor Notarization of Lobbyist's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [>ij No Amount Paid `~ MCR # ~9~~ ~ Date Paid d Lobbyist Registration Form received and verified by: ~~~ Entered By: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.da Revised 12J08/04 .yrun..rr..r Personally know ""' • al) IAYNEHARRI3 a,; Y COMMISSION # DD 534759 ~•., EXPIRES: March 30, 2010 ~''~•Rf,~i~` ,• BandedThru Notary Public Underwrkars State of Florida, County of Miami-Dade Sworn and subscribed before me This ~ day of ~_, 200 ~`~ ~.~Q ~i~ i, Signature of Public Notary -State of Florida Notarization of Principal's signature ~~ ~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miomibeochH.gov CITY CLERK Office CityClerk~miamibeachfl.gov Tel: 305.673,741 1 ,Fax; 305.673.7254 LOBBYIST NAME: ,L~~~Qn ~~~I~~ 1 understand that no later than October 1st of each Rear, (must file the following forms, pursuant to Section 2-4$5 of the Miami Beach City Code, with the City Clerk's ©ff ice for all active lobbying issues. i) Lobbyist Expenditure Form 2j Disclosure Form Failure to file these forms on a #imely 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 an has been resolved, I am required to immediately notify the City Clerk's C}ffice of lobbyist withdrawal in writing. ~ ~ r 2 °~~ Signature: Date: i~e~i~ed O~dG~~1I3rf18