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Les Bellinson/760 Collins Associates, Ltdm 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. NAME OF LOBBYIST: (Last) (First) (M.I.) Beilinson Les BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Beilinson Gomez Architects 8101 Biscayne Blvd. Miami Florida 33138 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) (305) 559 -1250 (305) 551-1740 I. LOBBYIST RETAINED BY: NAME OF PRINCIPAUCLIENT: 760 Collins Associates, Ltd. BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) c/o Mario Courtney 804 Ocean Drive, 2nd Floor, Miami Beach, FL 33139 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) (305) 531 - 4411 (305) 534-9080 marlo@goldmanproperti es.com Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: R. Anthony Goldman, President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Please see attached Il. SPECIFIC LOBBY IssuE: Variance from Section 130-35 in order to remove parking spaces. 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 Mayor None Commissioners City Administration None Cit Attorne 's Office City Boards None Cit Committees MIADOCS 2882985 1 ~~~~ ~~8 a IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER}: 5~v ! c,~= ~ BEJ N C~ /P~F©d~1 ~~ AS P~ /LT U F' A) LOBBYIST DISCLOSURE: (RsquirWi ~~Ct' S?llJ6u OL.JiJ ~/V RCN rTC= ~ ~ ~ ~-~"~~ ~ ~~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST GOPAPENSATION): (Requirod) 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": p Yes M No. Are you lobbvin on a present or pending bid for goods $auitxnent or services. or on a present or pe do Ina rd for goods eaulnmen or service? 2) Pursuant to Miami Beach City Gode 2-490 Entltled "Prohibited Campaign Contrtbutians By Lobbyists On Real Estate Development Issues°: q Yes ®No. Are you lobbvin on a nding anpltcati n for a Develonment Ag a wit Citt[ or appiication for chance of zoning man designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Seach City Code 2-484 (h) Any person (except chose exempt from the definition of °IobbyisP as set forth in Section 2-481 above) who only appears as a representative of snot-for-profit corporation or entity without spedal compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the deck as required by this section but, shall not be required to pay any registration fees.. Q Yes M No Are you representing a n t~fit coraoration or entity without spec[al compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1" EACH YEAR. EACH LOBBYIST SHALL 5UBMIT 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 B FILED EVEN IF THERE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PE Signature c obbyist I do solemnly swear that all of the ng facts are true and c d that I have d or am fami-iar with the provisions contained in Sectio -482 o e i Beac ode and all reporting requirements. Signature of LAbbylst: Signature of Principal/Client:: X Vi . LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ProducediD ProducedlD Form of Identification Form of Identification Personally knawnl Lobl}yist) Personally known (Principal) VII SIGNATURE AND STAMP OF NOTARY: ' State of Florida, County of Miami-Dade Sworn to and subscribed before me This __]_Q}~_ day of ~l9L.y , 20 08 -~~ . Signature Public Notary -State of Florida Notarization of Lobbyist's signature State of Florida, County of Miami-Dade Swom to and subscribed before me This day of , 20_ Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLERK'8 USE ONLY ~ O v i Annual Registration fee: [ ]Yes [ ] Na Amaunt Paid ~~ `~ MCR # Date Peid Lobbyist Registration Form received and verified by: Revised 12!08/04 MIADOCS 2882985 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) 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 0 No• Are you lobbvina on a present or pendina bid for aoods equipment or services or on a present or pending award for aoods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes ®No• Are you lobbvina on a pending application for a Development Agreement with the City or application for change of zoning map designation or chance 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 snot-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 0 No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement V. SIGNATURE UNDER OATH: ON OCTOBER 18t 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. 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. Signature of Lobbyist: Signature of Principal/Client:: VI . LOBBYIST IDENTIFICATION: Produced ID Form of Identification 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 OS Signature of Public Notary -State of Florida Notarization of Lobbyist's signature Annual Registration fee: [ ]Yes [ ] No Amount Paid Lobbyist Registration Form received and verified by: PRINCIPAL IDENTIFICATION: Produced ID !'~C.-• ~~Gt~C6aG~) .Gl~eh~-e. Form uxr nw Notary Public State of Florida Personally known (Princ pa#j `f` Rodolfo Perez c` My Commission OD554416 ~or a°~ Expires 07/2612010 State of Florida, County of Miami-Dade Sworn t and subscribe efore me This ~ day of _~u y , 200}' Signature of Put Notarization of s signature FOR CLERK'S USE ONLY MCR # Date Paid Revised 12/08/04 MIADOCS 2882985 1 ~~~~~~~ City of Miami Beach, 1700 Convention Center Drive, Miami beach, Florida 33139, www.miamibeachfl.aov CITY CLERK office CitvClerk ar''Imiamibeachfl.aov Tel: 305.673.7411, Fax: 305.673.7254 Les Belinson LOBBYIST NAME: I understand that no later than October is~ of each year, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure Form 2) Disclosure Farm 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 sue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's ar lobbyist withdrawal in wr' ' g. pate: July S, 2008 MIADOCS 2884866 ] 760 Collins Associates, Ltd. Disclosure of Interest 760 Collins, Inc. Charles Joseph Goldman Jessica Goldman Janet Goldman R. Anthony Goldman 760 Collins, Inc. General Partner 25% Limited Partner 25% Limited Partner 25% Limited Partner 25% President 100% MIADOCS 2882985 1