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Alexander I. Tachmes/TBS REalty, LLC Tudor South Beachm 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. Tachmes Alexander I. NAME OF LOBBYIST: (Last) (First) (M.I.) c/o Shutts & Bowen LLP 201 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: LOBBYIST RETAINED BY: TBS Realty, LLC; Tudor South Beach Resort Condominium, Inc.; and Tudor South Beach Resort-North Condominium, Inc. NAME OF PRINCIPAUCLIENT: 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: 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: See Exhibit "A" attached. r'j N --~ O .. W C`: ~7 ~ + I II. SPECIFIC LOBBY ISSUE: r- -~ rT; _.... ..~ Modification to Certificate of Appropriateness/Construction of ADA Ramp rv t i - 2 _. Issue to be lobbied (Describe in detail): v ~ ~° c3 _ III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-4820 in~de -~ statement of the extent of any business, financial, familial, professional or other relationship, givicig rise-to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Cd~'e S~'tc'ion 2- 482(a)(4) include a statement of any contractual relationship (q r, rtpaJyi,~ -fr 2 f~onths preceding the commencement of service of City personnel to be lobbied.) ~ ~~ ~ `~' ~~'' # ~' ~~ ~ ~ f J A) Full Name of Individual/Title B) An I mi o f nal Relationship City of Miami Beach Planning Board None City of Miami Beach Mayor/Commissioners None l~l ~ ~' 1 ~ ~ ~ ~ (~ N City of Miami Beach Committees .. ,;, one 1' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): 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 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 6~ 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 6~ No• Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1g~ 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 PERIOD. re 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 of~e~(lliami Bead Cj~ and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification DTOTARY pt7BLIC - STATE OF FLORIDA `" "'' I'iS~8I1 ® Person k , n (I.t~i~} ;Commissian #DI3551416 VII. SIGNA ,,,, ~Alittpi~'A~~I~RY: B ED THRU K['[ANTIC BOtiUI>!1G CO, INC. State of Florida, ~ounty of Miami-Dade Sworn to and subscribed before me This ~1 day of~~~, 2008_ PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me This _ day of , 2008 S ct~r ttire of Public Notary -State of Florida Notarization of Lobbyist's signature Signature of Public Notary -State of Florida 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 ,,r-y~ , Revised 03/27/2008 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER}: A} LOBBYIST DISCLOSURE: (Required) ~ +~ so B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION}: (Required}. '61 L(~ O. 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": I-lYes ®No• Are you lobbvina on a present or pending bid for goods eaui ment or services, or ot» present or pending award for Goods. equipment or service? 2) Pursuant to Miami Beach Clty Code 2-49t) Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": f-IYes ®No• Are You lobbvlna on a pending application for a Development Agreement with the City or application for chance of zoning map designation or chance to the Citv's Future Land Use Map? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definftion 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 opposldon to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.. I-lYes 6a No: Are vou_ representing snot-#or-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: I do solemnly swear that ail 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: jC Jay S half o odor South Beach Resort Condominium Association, inc. and Tudor 5 ch Resorl-North Condominium Association, Inc. VI. L088YlST IDENTIFICA ION: PRINCIPAL IDENTIFICATION: ^ Produced ID ^ Produced ID Form of Identification 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 Lobbvist's signature ~[ Personally known (Principal} State of New York, County of New York Sworn to and subscribed before me This ~ day of 130, tiL~" Signature of Public Notary - 91d1ti Df N~n+ llbFlt M E D Notarization of Princlpal~,~g~rtptlNlpc State of New York No. OaAHBI#'38953 . TO BE COMPLETED BY CITY CLERK'S USE ONLY commission txprres ixercn c~ Annual Registration fee: [ J Yes [ ~ No Amount Paid S MCR # S Date Paid Lobbyist Registration Form recalved and verified by: F•ICLERILOBBY19TLobbyist Registration Form 32708.doc Revised 03!27/2008 .10 MIADOCS 2973020 1 Signature of Lobbyist IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLATRATi; OR OTHJ:R): A) LOBBYIST DISCLOSURE: (Required) 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": I-1Yes ®N Are you lobbvinrt 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 I bb in on a endtn a licatio f r a Develo ment A reement wl h the Cit or ation for chance of zonin ma deli Hatton or chance to the Ci 's Future L d 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.. rlYes ®No: Are YOU representing snot-for-profit corporatl nor 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: Signature of Principal/Client: Pal Singh on VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ~ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom to and subscribed before me This -day of , 2008 Signature of Public Notary -State of Florida Notarization of LobbvlsYs signature ~f TBS Realty, LLC '~-' PRINCIPAL IDENTIFICATION: ^ Produced ID Form of identification Personally known (Principal) State of New York, County of New York Swom to and subscribed before me This _6 day of - , 2008 ._._._~ ~' ~ MUNIR ARMED Signature of Public Notary - S~3@a4~ Il~'~ilE°~iate of New York Notarization of Principal's signatur~;lo. OaAH6B38953 Commission Expires March 20,~p TO BE COMPLETED BY CITY CLERK'S USE ONLY Annusl Registration fee: [ ]Yes [ ] No Amount Pald S MCR # S Date Paid Lobbylat Registration Farm received and verified by: F•1CLER\LOBBYIST1Lobbyist Registration Form 32708.doc Revised 0312 712 0 0 8 MIADOCS 29728841 The following information must be answered: Signature of Lobbyist m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office CityClerkt~miamibeachfl.aov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Alexander I. Tachmes I understand that no later than October 1St of each near, 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: ~~~~b~' Date: MIADOCS 2969517 1 OWNERSHIP STRUCTURE CHART -TBS REALTY, LLC PARDAMAN K. VIVEK CHATWAL CHATWAL Member Member 50% 25% I 25% VIKRAM CHATWAL Member Chatwal Family, LLC (NY Limited Liability Company) Sant Chatwal -Sole Manager 100% Channel Properties, LLC (NY Limited Liability Company) Pardaman K Chatwal -Sole Manager 100% owner TBS Hotel Management Corp. (FL Corporation) Rabinder Pal Singh -Vice President of the Corp. Manager Member 1 % interest 99% interest TBS Realty, LLC FL Limited Liability Company Rabinder Pal Singh -Vice President of the TT(` MIADOCS 3009786 1