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Alex Tachmes' ~~~ ~~ b ~ t ~ ~' ,~ ~ 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. Tachmes Alexander I. NAME OF LOBBYIST:. (Last) (First) (M.I.) c/o Shutts & Bowen LLP 20.1 South Biscayne Boulevard, Suite 1500, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 347-7341 ~ (305).347-7754 atachmes shutts.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: - .. TBS Realty, LLG 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 N/A jstein _hh-r.com TELEPHONE NUMBER: _ FAX NUMBER: (Optional) EMAIL: (Optional) Fill. out.this section if principal' is a Corporation, Partnership.or Trust [Section 2-482 (c)] ' • ~ NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~~ ~ a ~'' "`~~ • IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5°~, OI~ MORE OWNERSHIP INTEREST IN SUCH.CORPORATION, PARTNERSHIP OR TRUSfT See Exhibit "A" attached. ~~ ~~;~ '~J 8~ _.~„_ ~n ~ L{ ` °`~„~. -,. '"s"j •• ~ c.,s II. SPECIFIC LOBBY ISSUE: ~ ~ ~ d Roof Top Ordinance issue in connection with Dream Soutli .Beach Hotel Issue to be lobbied. (Describe in detail): .III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a r 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 Ihdividual/Title B) Any Financial, Familial or Professional Relationship 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): S A} LOBBYIST DISCLOSURE: (Required)... ~ , Hourly - $450.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly - $450.00 . The following iriformation must be answered: ~ - . 1) .Pursuant to Miami Beach City.Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": j~Yes ®No: Are .you Fobbying 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 lobbying 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 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 ~ No: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH:' ON OCTOBER 15Y 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 EXPENDITURE OR COMPENSATION DURLNG THE. REPORTING PERIOD. ~ n ~ ~ ~'~~I Signature of Lobbyist -Alexander I. Tachmes 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 e Miami Bea ity ode and.all, reporting requirements. Signature of Lobbyist:' Alexander I. achmes Signature. of Principal/Client: Peggy Benua, General Manager VI. LOBBYIST IDENTIFICATION: ~ PRINCIPAL IDENTIFICATION: Produced ID ^ 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 Zt~day of 2Q A ~,', Y PUB~I . ~a.: _~. ~~I~gSllty.rll(Oi+WW. Y TO BE COMPLE~ Annual Registration fee: ]Yes [ ] No Amount Paid $ Lobbyist Registration Form received and: verified by: _ F:\CLER\LOBBYIST1Lobbyist Registration Form 32708.doc 'i ~ o~tR~Jbllt;~`I~Fo~~i ~ ~~ ~f Florida Not v ~n'o`f'Lrbbb',is''s~'~~ure Form of Identification ^ Personally known (Principal) State of Florida, County of. Miami-Dade Sworn to and subscribed before me This day of , 2010 Signature of Nublic Notary -State of Florida Notarization of Principal's signature BY CITY CLERK'S U.S ONLY MCR # $ Date Paid P ,, ,f7~.~1, l Revised 03 7/2008 °} A) LOBBYIST DISCLOSURE: (Required) Hourly - $450.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): {Required.). Hourly - $450.00 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 lobbying 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 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) Ariy 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:... ON OCTOBER 1St OF_ EACH YEAR, EACH LOBBYIST .SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER _~ OATH, LISTING _LOBBYING EXPENDITURES,- AS WELL AS COMPENSATION RECEIVE__D 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 -Alexander I. Tachmes I do solemnly swear that all of the foregoing #acts are true and correct and that I have read or am familiar with the provisions contained in.Section 2-482 ofithe Miami Beach City~Code.and all reporting requirements.. Signature of Lobbyist: . Ale der. I. T Signature of Principal/Client: ~ /J.--- - Marg e A. Benua; General Manager VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID ~ ^ .Produced ID Form of Identification. - Form of Identification ® Personally known (Lobbyist) ~ Personally-known (Principal) VII. SIGNATURE AND STAMP OF NOTARY:. State of Florida,. County of Miami-Dade. State of Florida,`County of Miami-Dade Sworn to and subscribed before me Sworn to and subscribed before me •,,,~~Y~P~.,,, VanesSa Suarez This day of , 2010 This ~ day of ~' , 2010 ,••o'~~ " U~~ ?• ~ :COMMISSION #DD786016 ~~ =; ~. •o~, EXPIRES: MAY 06, 2012 Si nature of Public Nota ~°t~°i ~~`'~ www.AARONNOTARYcom . _ g ry -„State of Florida Signature of'Public Notary -State of Flon~'~ Notarization of Lobbyist's signature Notarization of Principal's signature . TO BE COMPLETED BY CITY CLERK'S USE ONLY .>~: Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIST1Lobbyist Registration Form 32708.doc ~ Revised 0 /27/2008 I ~. ~ ~, ~~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, rvww.miamibeachfl•qov CITY CLERK office CityClerk ~miamibeachfl.gov Tel: 305.673.7411, Fax: 305:673.7254 Alexander I. Tachmes LOBBYIST NAME: I understand that no later than October 15` 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 withdrawal.in writing. . ~ ~ ~~ 'nature: Date: .OWNERSHIP STRUCTURE CHART - TBS REALTY, LLC PARDAMAN K. VIVEK VIKRAM CHATWAL CHATWAL CHATWAL Member ~ Member Member SO% 25% 25% Chatwal Family, LLC (NY Limited Liability. Company) Sant Chatwal -Sole Manager 100% Channel Properties., LLC (NY Limited Liability Company) Pardaman K Chatwal -Sole Manager I00% owner TBS Hotel Management. Corp. (FL Corporation) Rabinder Pal Singh -Vice President . of the Corp. - 1Vlanager Member 1 % interest 99% interest TBS Realty, LLC FL Limited Liability Company Rabinder Pal Singh -Vice President of the ~ . LLC . MIADOCS 3009786 1