Mark Goldman/TBS Realty, 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 bond 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.
Goldman Mark
NAME OF LOBBYIST: (Last) (First) (M.I.}
c/o Sound Components, Inc. 1533 Madruga Avenue Coral Gables, FL 33134
BUSINESS NAME AND ADDRESS {Number and Street) (City) (State) (Zip Code)
(305) 665-4299 (305) 663138 mark.goldman@soundcomponents.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
TBS Realty, LLC; Tudor South Beach Resort Condominium, Inc.; and Tudor South Beach Resort-North
Condominium, Inc.
NAME OF PRINCIPAL/CLIENT:
_ 1111 & 1119 Collins Avenue Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 474-9845 NIA jstein@hh-r.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2~t82 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Rabinder Pal Singh and Jay Stein
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: c-~ c
--~ ~
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See Exhibit "A" attached. r : it
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II. SPECIFIC LOB Y ISSUE:
Conditional Use Permit~U p~pk
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C; ~` ~ ~'~
-._y N .~
Issue to be lobbied (Describe in detail): ,`---',
I11. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482{a){4} include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of IndividuaUTitle B An Financial, Familial or Professional Relationshi
City of Miami Beach Planning Board None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (R iced) ,.
B PRINCIPALS - IS LOSUR (OF LOBBYIST COMPENSATION): ~~ ~~~~
(Required). `~"~~~ ~ C .~
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 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 ®No• Are you lobbvinq on a pPndinq application for a Development Agreement with the City or
application for chance 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 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 ®No• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist
I do solemnly swear that all of the fo
provisions contained in Section 2-482
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of
® Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of `r' , 2008
Signature of Public Notary -State of FI
Notarization of Lobbyist's signature
TO BE
ng f are true !correct and that I have read or am familiar with the
e I~Ifar"' Bah bode and all reporting requirements.
PRINCIPAL IDENTIFICATION:
^ Produced ID
of Identification
^ Personally known (Principal)
~ ~ g ~ State of Florida, County of Miami-Dade
i=i' Sworn to and subscribed before me
~ ~, ~j This _ day of , 2008
.°vm~
P ~ ~ S
o a _ Signature of Public Notary -State of Florida
~ N ° Notarization of Principal's signature
~o
CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # S Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc Revised 03/27!2008
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
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: ()2equired)
B) PRII
(Required).
LOBBYIST COMPENSATION):
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 ~I No: Are you lobbvinq on a present or pending bid for goods equipment or services or on a
present 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":
L]Yes ®No: Are you lobbvinq on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the City's Future Land Use Maps
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 6a No• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
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: ~=~-- ..,~
Ja~'efhalf of~tfdor-Sot
~.-Resort-aN"orth Condominium, Inc.
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 , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Beach
and Tudor South Beach
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 2t day of AyG- , 2008
~~.-,...~ `ate/
Signature of Public Notary -State of Fla Ny
Notarization of Principal's signature
I U Bt CUMI'LETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Dat
Lobbyist Registration Form received and verified by: - Aln~ar~ auniic crate sf New Yotk
F:\CLER\LOBBYIST1Lobbyist Registration Form 32708.doc _ R9Vised'Q$i•Y60T~53
Commission Expires Merch 20, \C
MIADOCS 2973020 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'$J~ISCLC~SI}I~E (LOBBYIST COMPENSATION):
(Required). (- /C /~~~C~-
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 6a No: Are you lobbvinq on a present or pendina bid for goods, equipment or services, or on a
present 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 6Z1 No: Are you lobbvinq on a pending application for a Development Agreement with the City or
application for chance 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 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 ~ No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
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: j
^ Produced ID
T --~ -
Rabinder Pal Singh on behalf of TBS Realty, LLC~
VI. LOBBYIST IDENTIFICATION: PRINCIPAL 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 , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Form of Identification
® Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This '~-\ day of ABU G- , 2008
Signature of Public Notary -State of FleFida- Ny
Notarization of Principal's signature
MUNIR euu~
TO BE COMPLETED BY CITY CLERK'S USE ONLY -- - " ' " ^ " "' c
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid ~61'AH6036953
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIS11Lobb ist Re istration Form 32708.doc Revised 03/ 0 >~P~fes Mar
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MIADOCS 2972884 1
m MIAMIBEACH
City of Miami Beach. 1700 Convention Center Drive, Miami Beach. Florida 33139, www.miamibeachfl.pov
CITY CLERK office CityClerk(a~miamibeachfl.gov
Tel: 305.673.7411. Fax: 305.673.7254
LOBBYIST NAME:
Mark Goldman
I understand that no later than October 1~ 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 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 for lobbyist wit awal in writing.
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Signature: Date:
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