William A. Lai/KAAMOS, LLC (2)m `IAP~IIBEACH
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.
LAI, WILLIAM A.
NAME OF LOBBYIST; (Last) (First) (M.I)
1101 BRICKELLAVENUE, SUITE 1401N MIAMI, FLORIDA 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-376-8889 305-397-1208 WLAI@DYNAMICAGRP.COM
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
KAAMOS, LLC
NAME OF PRINCIPAL/CLIENT:
650 WEST AVENUE, SUITE 1712 MIAMI BEACH, FLORIDA 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-793-4437
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: TED SNIDER
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE ATTACHED.
II.SPECIFIC LOBBY ISSUE: CONDITIONAL USE APPROVAL FOR A NEIGHBORHOOD IMPACT ESTABLISHMENT
FOR RESTAURANT AND ACCESSORY BARS AT 1650 JAMES AVENUE.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City code section 2-4s2(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise 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 Individual Title B) Any Financial, Familial or Professional Relationship
PLANNING BOARD NO
t~ =~~ ~~~ q~ ~~~ B~~Z
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ¢ ~~ ~' ~ SG. oe rfLAr~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ 1 13 a j0 ~ ~~ C F ~~ 1
(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 CJ 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 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 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 L~No• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
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: !iG
Signature of Principal/Client:
VI
- ~ --,
L BYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID ~ • ~ ~"-~ ~L~ ~- _ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII.
RE AND STAMP OF NOTARY:
to of Florida, Co my of Miami-Dade
Swor~~~pd subs rib d before e
This ~~``~~'"''' , 2008
~,St, at~es_~~.ulal~~Pi _. tate of Florida
,~i Lis ignature
MY GOMMISSIOI<I +~ DIk7210~30 TO BE COMPLETED BY
Form of Identification
^ Personally known (Principal)
State of Florida Countj(
S ~d sub r'b ore me
T day ~. _~"~
`,.
Signature of Public Notary ~~
Notarization of Princi al' '
LERK'S STAFF ONLY ,....,...
Rt~L ANN i1AO~iR~
Y COMMISSION # DD721090
EXPIRES October 02, 2011
n `#~e:~ C ~ 1 ~'es I 1 No Amount Paid ~
~~~i•'' Z_-_
Signature of Lobbyist
~v~ i~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME:
~ru.~aM LAI , /41~F
CityClerk@miamibeachfl.gov
I understand that no later than October 1st 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 of lobbyist withdrawal in writing.
~~~~
Signature:
~~Zs/~o$
Date:
F:1Ct_EFt1LOBSY3ST1Lobbyis# Registration Form 327f1'8,doc
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
KAAMOS, LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
Snider Miami Beach, Inc.
650 West Avenue, Suite 2712
Miami Beach, Florida 33139
Managing Director
OF MEMERSHIP INTEREST
15%
Eclat Holdings, LLC
7511 Miami View Dr.
North Bay Village, Florida 33414
Managing Director
Metcalfe Miami Beach, Inc.
927 Lincoln Road, Suite 118
Miami Beach, Florida 33139
Managing Director
Packley, Ltd. Inc.
1111 Lincoln Road, Suite 400-KLFPA
Miami Beach, Florida 33139
Managing Director
Enlow, Inc.
650 West Avenue, Suite 2712
Miami Beach, Florida 33139
Member
Pommes, L.L.C.
927 Lincoln Road, Suite 118
Miami Beach, Florida 33139
Member
Inception39, L.L.C.
927 Lincoln Road, Suite 118
Miami Beach, Florida 33139
Member
25%
20%
10%
10%
5%
15%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
OFFICERS OF KAAMOS, LLC:
Ted Snider
650 West Avenue, Suite 1712
Miami Beach, Florida 33139
Managing Director
Jean Francois Mourier
7511 Miami View Dr.
North Bay Village, Florida 33414
Managing Director
Suzzette Metcalfe
1111 Lincoln Road, Suite 400-KLFPA
Miami Beach, Florida 33139
Managing Director
Debra L. Packley
1111 Lincoln Road, Suite 400-KLFPA
Miami Beach, Florida 33139
Tax Matters Director
lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE; Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SNIDER MIAMI BEACH, INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Ted Snider
100%
650 West Avenue, Suite 1712
Miami Beach, Florida 33139
President
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
ECLAT HOLDINGS, INC.
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
Jean-Francois Mourier
7511 Miami View Dr.
North Bay Village, Florida 33414
Manager
OF MEMERSHIP INTEREST
50%
Anette Mourier
7511 Miami View Dr.
North Bay Village, Florida 33414
Manager
50%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
METCALFE MIAMI BEACH, INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Suzzette Metcalfe
927 Lincoln Road, Suite 118
Miami Beach, Florida 33139
President
100%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
PACKLEY, LTD. INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE
Debra L. Packley
1661 Stony Brook Ln.
Morris, Illinois 60450
President, Secretary and Treasurer
OF STOCK
80%
Thomas F. Packley
1661 Stony Brook Ln.
Morris, Illinois 60450
Vice President
20%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE,
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
ENLOW, INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Mirielle Enlow
650 West Avenue, Suite 2712
Miami Beach, Florida 33139
President
100%
lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnerships} or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
POMMES, L.L.C.
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
Alex De Pommes
927 Lincoln Road, Suite 118
Miami Beach, Florida 33139
Managing Member
100%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page S
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
INCEPTION39, LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
Fred Olsson
927 Lincoln Road, Suite 118
Miami Beach, Florida 33139
Managing Member
100%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6