Geoffrey Zakarian /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.
Zakarian Geoffrey
NAME OF LOBBYIST: (Last) (First) (M.I.)
130 West 30~h Street, Apt. # 12c New York, N.Y. 10001
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(917) 669-2570 N/A rossychef aol.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)
out this section if principal is a Corporation, Partnership or Trust [Section
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Jay Stein and Rabinder Pal Singh
IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See Exhibit "A" attached.
co e~
c
--t °m
II. SPECIFIC LOBBY ISSUE: f~--" ~
rrr N
NIE Conditional Use Permit for ground floor restaurant and rooftop lounge %~-~ Q, ;°,-~
~.
Issue to be lobbied (Describe in detail): cn -~
o _~
ijl
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g} inctl~le alb
statement of the extent of any business, financial, familial, professional or other relationship, givinq~rise~fb an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Cod'~Sec~i n 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
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):
A) LOBBYIST DISCLOSURE: (Required)
~A~-.-ya~..M
B) PRINC PA) L'S DISCLOSUR (~, OF L BBYIST C MPENSATION):
(Required). ~--~rut,,~,tc,.ti~ ~~xt.~S'~
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 6a No: Are you lobbvina 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 ba No: Are you lobbvina on a pending application for a Development Agreement with the Citv 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 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 6a No: Are you representing anot-for-profit corooration 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
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/Client:
Condominium, Inc.
VI. LOBBYIST IDENTIFICA
^ Produced ID
Form of Identification
® Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
and Tudor South Beach
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
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 Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 21 day of PNU~2008
\~~^" M E D
Signature of Public Not - o ~~~~f New York
Notarization of Princi ~~r~i ~ ~ 8038953
Commission Expirsa March 20,1 0
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\LOBBYIS11Lobbyist Registration Form 32708.doc Revised 03/27/2008
MIADOCS 2973020 1
08/21/2008 15:37 FAX 2123749163
I~oaz
Iv. t71scLD8URE OF TERMS AND AMOUNTS OF LOBBYrsT COMPENSATION (DISCLOSE tNHBTHEa
HOURLY, FLAT RATE t?R OTNE1~:
A) LOBBYIST DISCLOSURE: (Required}
Other -Norma! Com nsadon
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
{R®quired), Normal Cqm nsation
The following information must be answered;
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Gontributions By Lobbyists
On Prpcurement Issues";
Yea No: ou 1 in on nt or endin bi bode a ant or or on
rent or nendina_avuard for C3oods. eauiwnant or $ervl~g?
2) Pursuant to Miami Beach City Code 2-480 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
3) Pursuant to Miami Beach City Cade 2-484 (h) Any person (except those exempt from the definition of
"lobbyist' as set forth in Section 2-4$1 above) who only appears as a representative of snot-for-profit
corporation or entity without special compensatbn or reimtwrsement fur the appearance, whether dined, or
indirect, to express support of or opposition to any item, shall register with the dark as required by this
section but, shall not be required to pay any registration fees..
Yes 6~ No: Are you rsortrsentlna a notrfor-croft carraeratlon a entity without sDeclal comoensation or
[elmbursament.
V. SIGNATURE tJNUER OATH:
PERIOD.
I do solemnly swear that all of th fp Ding facts are true an tract and that I have read pr am familiar with the
provisipns contained in Section 2 the Ml;'rmi Beach City o and all reporting requirements.
Signature of Lobbyist:
Signature of PrincipaUCtient:
VI. LQBBYI8T IbENTIFlCA7tON:
1,~ Produced ID _~ l uR.tS ~ l~ ~
Form of IdentMicatian
~] PersonaUy fcnown (Lobbytat)
PRINCIPAL IDBNTra=lcgTION:
D Produced ID
Form of Identiflcatinn
~ Personalty knpwn (Princlpial)
VII. SIGNATURE AND BTAMP OF NOTARY:
state of Florida, County of Miami-Dade
Sworn to 8nd su cribg~before me
7 is ~
!~
Sr ~ ® lOrida
~aoxuen ratiu~'~~ ~~~
__ TO BE COIU
State of Florida, County of Miami-¢ade
Swam to and subscribed before me
This ~ day of ~, 2008
Signature of Public Notary ~- State of Florida
Notarization of Princloai'a signature
ONLY
Form n3celvad and verified
_ PAGE 214"RGVD AT 812112008 3:37:00 PM ~Eastem Daylight Time) r SYR:FAXSERVER111 ~ DNIS;7720"GSID,2123749163"DURATION (mm•ss):01.52
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
~L d--f ~ ~
B) PRINCIPAL'S DISCLOSUFE
(Required). '~'~-c¢.f rv~.,~,~1'
'Yr-~z~•(S ~2or--f
F LOBBYIST CO~ENSATIf
-~'~Xi1~i S w~..
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 ba 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 man 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 6a No• Are you representing 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
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/Client: (~-~~ ~ ^~x_D~.ndn~.
Rabinder Pal Singh on behalf of TBS Realty, L
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
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ day of ~AN t~- , 2008
.~\~- ~/
Signature o ublic Notary- State of Fferitfa~ try
Notarization of Principal's signature
Ml1NIR suucn
TO BE COMPLETED BY CITY CLERK'S USE ONLI(~„~..,,, prpl4c Stets of ~-
Annual Registration fee. [ ]Yes [ ] No Amount Pald S MCR # 3 Date ~ X863
Lobbyist Registration Form received and verified by: ~ rch 20,\~
F:\CLER\LOBBYISIILobbyist Registration Form 32708.doc Revised 0 /2 2
MIADOCS 2972884 1
• 08/21/240$ 15:37 FAX 2123749163
m MIAMIBEACH
City of Mieml Beach, 170Q Convention Center Drive, Mlaml Beach, Fbrida 33139, vrwW,mjemibeachfl.aov
CITY CLERK office
Tel: 305.673.74'11, Fax: 305.673,725~F
f itvClerk~miamibo~r LF fl.gov
~ 003
Geoffrey Zakarian
LOBBYIST NAME:
I understand that no later than October 1't of each veer, i must file the following forms, pursuant to Section 285 of
the Miami Beach City Code, with the City Clerk's Office for ali active lobbying issues.
1) Lobbyist Expenditure Form
2} DisGosure Form
Failure to file these forms 0!1 a timely basis will result in my name being transmitted tC the Miami-Dade Gounty
Commission on Ethics and far code violation evacuation.
In additbn, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the
City Cleric s'Qffice for lobbyist withdrawal In writing.
IJIWOOCS 2968721 1
~ sr ~
PAGE 314 ~ RCVQ AT 812112008 3,37,00 PM Eastern Daylight Timed"SVR:PAXSERVER111 r DNIS;li'20"CSID,2123749163 ~ DURATION tmm~ss~,01•~2
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