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Michael Madden/Margules Properties, Inc.a? MIA~'~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. Madden Michael NAME OF LOBBYIST: (Last) (First) (M.I) Shulman & Associates, P.A. 100 NE 38 Street, Space 2 Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 438-0609 (305) 438-0170 mike@shulman-design.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Margules Properties, Inc. NAME OF PRINCIPAL/CLIENT: 381 Park Avenue South, Suite 1420 New York NY 10016 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 684-7079 ext 19 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 Margules ~ +v -6 0° ..~ co IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST If?I.SUCF~ CORPORATION, PARTNERSHIP OR TRUST: Eric Margules mar= -.., t_ ~ II. SPECIFIC LOBBY ISSUE: ~ ~ -T ; Redevelopment of 1155 Collins Avenue N --~, Issue to be lobbied (Describe in detail): ~ - N ,~-•- III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title (B) Any Financial, Familial or Professional Relationship Planning Dept., HPB, BOA, Planning Board, City Commission * None * Unless an issue is legislative In nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting. Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Q ~ ° ~ ^ Produced ID ~ ~e ~ ° - Form of Identification ~ G M U wC.J~N ~ o ~ q b Personally known (Lobbyist) ~~~ ~ o ~ a VII. SIGNATURE AND STAMP OF NOTARY: N cn .. w ~ ~Q State of Florida, County of Miami-Dade Sworn to an subscribed b f re me ate. V W ~ b This day of s~~~ 20 v ~." ": ~ z `~ Signature of Public otary -State of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This day of , 20_ Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLER '-~NLY Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Lobbyist Registration Form received and verified by: Entered By: F:\CLER\;ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doC Paid Z ~ ~ Revised ~2i06/04 ~/ s IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf 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 XX No• Are you lobbvina on a present or pending bid for goods equipment or services or on a gresent or pendin4 award for goods, eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": C~Yes X No• Are you lobbvina on a pending application for a Development Agreement with the City or application for chance of zoning map designation or change to the City's Future Land Use Mau? 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.. 0 Yes X NQ Are you representin4 anot-for-profit corporation or entity without special compensation 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. 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/C VI. j~il~iCi~A1- IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (P(21McipA~..) VII. SIGNATURE AND STAMP OF NOTARY: ~~ ~ oak State of County of LVt~Y f'' l IDENTIFICATION: ^ Produced IDS ~ - ~- °m~,~~entification ^p qPers~`p~ppl~r ~r~dy~}~{+VJ~yg3+~(1~is~fe),~ t_:,, ,F~,~--,~Oy 6`'v b~ ira V;i.S+.E i~iA 1~ 'VoYJtl Is•~ . ,.~..:~l.~n Ex;~~i°t;s ®ct. ~~ 2i~~ State of Florida, County of Miami-Dade Sworn and subscribed before me This day of , 20_ Sworn t and subscribed efore me This ~~day of '~- f~1 20~~ Signatu ~~ -State of ~ VL signature Signature of Public Notary -State of Florida Notarization of l©Pyr>,yiST signature / FOR CLER( S,J,1~E ONLY ~ ~~ p nnual Registration fee: [ v ]Yes [ ] No Amount Paid ~~MCR # Date Paid Lobbyist Registration Form received and verified by: Entered By• F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIS? fORM OS.doc ~$~, ;,, ~ '„ r Revised 12/06/04 1V. Ul,(,LV~UKC Ut ItKMJAIVUAMVU1Vl~ Vt LVtftSYlJI I.VMF~tIV~AIlVIY (U1J(:LV~t WrItIrltK /'1(RJKLr, fLAT RATE OR OTHERf l /y ` J D {~y~ .p A) LOBBYIST DISCLOSURE: (Required) l C/I / /'C , / , ~O~~C/ 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 egg 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 X 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 Citv's Future Land Use ~? 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.. 0 Yes X No• Are you representing anot-for-profit corporation or entity without special comQensation 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. ~--~ ~----~ 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 contain Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Q ~ ° ,~ ^ Produced ID o c M ° Form of Identification wC.J~N ~ o ^ ra b Personally known (Lobbyist) ~' ~,~~° a: °'° c ~ ~ VII. SIGNATURE AND STAMP OF NOTARY: N .~ .~, w ~ ~¢ State of Florida, County of Miami-Dade Sworn to an subscribed b fq ~re ,m~.e ,a This day of 1~(~rr~.r " 20 ~~~~b o z ~ Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This day of , 20_ Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLERR-~NLY Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Lobbyist Registration Form received and verified by: Entered By: F:\CLER\;ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc ate Paid Z Revised 12/08/04