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Neisen Kasdin/Crescent Heights R&D, LLCi • /.. . ,'.. ` ~~~!~ '' ©~ ~,~.,,.. ~;,~ ~'/ ~,'t , , City of Miami Beach Office of the City Clerk. ~1 hj ~/-c 1700 Convention Center Drive, Miami Beach, 1=L 33139 ~ ~ ~C~` 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. Kasdin Neisen O. NAME OF LOBBYIST: (Last) (First) (M.I) Akerman Senterfitt, P.A. One SE 3`d Ave., Suite 2500 Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5600 (305) 374-5095 neisen.kasdin@akerman.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Crescent Heights R&D, LLC NAME OF PRINCIPAL/CLIENT: (Last) (First) (M.I) Crescent Heights R&D, LLC 2200 Biscayne Blvd. Miami FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 573-4127 (305) 573-8489 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Alton Road Development Issue to be lobbied (Describe in detail): l ' ~~ {M2745894;1 } III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A. Full Name of Individual/Title B. Any Financial, Familial or Professional Relationship City Commission and Mayor None Planning Department None City Manager's Office None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A. LOBBYIST DISCLOSURE: (Required) $550.00 hourly B. PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) Same 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 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 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 snot-for-profit corporation or entity without special compensation or reimbursement. {M2745894;1 } 2 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 RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FI ED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION D~ ~G 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 Se on 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 Swot and subscribed before me This day of ~IOV~P~rn.~f', 20~ 3 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 gnature of Public Notary -State of Florida Notarization of Lo y~t" Itt~tul"@ua~iC St•q or F1°~~ tarization of Principal's signature ~~ BlOncs E Psrnendex My Commiaelon DQ799478 ~eind~ Expires 08/25/2012 FOR CLERK'S USE ONLY Annual Registration fee: ^Yes J~]No Amount Paid . ~ MCR # o~~C~ %~J" Date Paid ~~ ~D Lobbyist Registration Form received and verified by: ~C~ Revised 12/08/04 {M2745894;1 } 3 ~'. ti1C;~A'I'l'Itl~. t~\UEK OA"1'N: ()N OCTOI3f:R lit ()P FACI[ VF.,~R, i:,lCll I.O(i(3YtST Sit:11.t. SUlilbilT TO "f11E CITI' CLERK .4 ti1G\l:D tiTATl:tlf•:`T t!NDF.R 0.4TIt, LISTING I.Oli13Y1\C EXPF;\UI~t'l:tt~;5, ati lVF.l.1. AS CO~IPC:NS:~TiO\ RFCFI~T17, IN 'I'ItE C17')' ON ~t1A~'ti KEAC'H t:Ott THE 1'Rt:('rUIN(; C'A(.F\DAR 1'`rAR. A STATr~1F\T SI1A1.[. BE FILEU EVEN tF '[`1-E(:KE II~V1: T3FFN NO fXPF.\D1TLRFS OR COlttPt`S.17'1O\ Ul,'~t11~,G '1'NE KEI'OK"I'11(; PG:RIOt). fir; " 7~ Si~naturc M-I.ohb+ist I do solznuth~ ;++~ear that afl of dte torez?oin~ tact; arc true and correct anJ that 1 havr read «r ;:nt familiar ++°ith the provision; crntrtined in ScGtjon 2-<18_' of the Miami f3cac b Cite Cud and all reporting rc+)uirements. ~ ~ . 1 5i,nature of Lohb} isc ~ ` ~ ' /j ___ . Si~~naturr ul-Principal'('lirnt: ._~._.___. _ VI. LOt313~'IS"t' 1t)E~7'fN[CA'I-ION: PKtNCIYAL [UE~TIFIC.aTI(}`: Prud(tce+l !U _ _ Form oC fdentilicatitu~ ^ !'ruduced tU F~onn of Idrntilicatiun (~] Prrsvrrtll~ I;n(r++n (t.obb~•ist) Vlt. SI(;NA"1'UK~:.~\U S"I'AMiF' OF N OT:1 R'4': State o1 ftorida. t'ouutc of \•liauti-Dade S++~orn W and subscribed hetixe me ~ r' . !S -Chic ._ ~ day of {~; :~,1 ~'-y+." .~ . _'(!.!` ~ersunalh I~to++n (Yrincip.tl) .''state of Florida. Ctnatl+- ul"~~tiami-Uadz S+varr and ,ubscrihed h~ ti~re me _~• `. Sir~naturv ut' Public . "I~d ~ ---r_nattt *t~c °ta:r, ,.r o-.:.n~ Nutarizatiuu of Lu t~~F~ gti#tutcr::. otari; - ~ e" ~.~;.. ~ :~ ~az~ananz ;i. ,; ~ :~3-G,^,~m~ssranhr:-a3c~s 1~~ l:~gli*s Ut812012 ~~ ~Ytin. ito ('(3R Ct.EI2K'ti t:SF.O\Lti• ~~+. \n:.u:rl Itc~~i~trati~u; Ycc: ^1"r~~\c~ .\nwunt I'ai~~~~~ \I(~1::: ~ /67/~ n:n: Psid___1_/ /D ~O Luhb~i;t ft~:~:ai:3lum r'UYIII rci.i~rJ sn.! ~triticd b~:. _ ~/ C~~„~~ _. Revisrit I:i[13i(i~ m MIAIVdBEACH City of Miami Beaeh, 1700 Convenfion Cenler Drive, Miami Beach, Fbrida 33 i 39, www.miomibeochfl.gov CITY CLERK Office CityClerk~miamibeachN.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: ~.-tS ~ ~ ~ ~~'L'n I understand that no later than Qctober 1st of each year, 1 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. /i -~ ~~~ Signature: Date: Revised 02/04/2008 r ~:1'"T.i?R~f.C1riTS'1tiT~,Tiepcndin~rc k: Disclosuiv form ]tr.dnc