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Alexander I. Tachmes' ~~~~~~~~~~ City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM ~67~T ~~~~ /t/~f/pN~t C-1`~ol,~.l 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.) Shutts & Bowen LLP.. 201 South Biscayne Blvd. 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: New National, LLC. NAME OF PRINCIPAL/CLIENT: National Hotel 1677 Collins Avenue Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 206-8761 N/A NATHALIE@BRICKELLCENTER.COM TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section n, Partnership or Trust [Section 2-482 (c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: CLAUDE DRAY IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit "A" attached. SPECIFIC LOBBY ISSUE: Certificate of Appropriateness for interior demolition associated with lobby renovations and demolition of a portion of Mezzanine Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a 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 IndividuaUTitle B) Any Financial, Familial or Profe 'on I I i City of Miami Beach Planning Board ' None ~ - °~' ': _: ~~ City of Miami Beach Mayor/Commissioners None Cit of Miami Beach Committees None G~S ~Z ~a 6- 8~.~ ~~~ 6001 ,- ,~~ o ~~~y ~~~~ ~ MIADOCS 3316292 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 vou lobbvinq on a present or pendinq bid for aoods, equipment or services, or on a present or pendinu award for Goods, eauiament or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes 6a No: Are you lobbyinq on a pendinp application for a Development Aqreement with the Citv or application for chance of zoninq map desiqnation 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 "IobbyisY' as set forth in Section 2-481 above) who only appears as a representative of a not-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 vou representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 15L OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION RECEIYED 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 o obbyist Alexander I. Tachmes I do solemnly swear that all of the oregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2- f the Mi i City Code and all reporting requirements. Signature of Lobbyist: Alexander I. Tachmes Signature of Principal/Client: CLA , AGI MEMBER VI. LOBBYIST IDENTI PRINCIPAL IDENTIFICATION: ^ Produced ID ^ Produced ID Form of Identification ~ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTAR~ Np~Y pUBLIC - STATE OF FLO A State of Florida, Counf~C. ~ ~ami~~a Christian Sworn to and subscriki'~ ~l ~ssion #DD651416 This 9 day of ~` Fi: ' ••., ,,,, pires: MAR. 23, 2011 ' ~ ~,~7js ~+_~HRU ATLANTIC BONDING CO, INC. ~~~_~r-- ' a ure of Public Notary - State of Florida Notarization of LobbvisYs signature Form of Identification ~ersonally known (Principal) State of Florida, County of Miami-Dade Swor and s ribed e This ~ ay of ~~~-~TATE OFFI,pRIDA Karen Denis ~: Commission # DD836849 Signature of Pu lic Notar~~~9A OV 11, 2012 Notarization of Princiual's signature °~INCCO.,n~rc, TO BE COMPLETED Y ITY CLERK'S USE O Annual Registration fee: ] Yes [ J No Amount Paid $ -~ MCR #$ Date Paid Lobbyist Registration Form received and verified by: r F:1ClER\LOBBYIST1Lobb ist Re istration Form 32708.doc , `Revised 03/27/2008 MIADOCS 3316292 1 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.qov CITY CLERK office CityClerk miamibeachfl.qov Tel: 305.673.7411, Fax: 305.673.7254 Alexander I. Tachmes LOBBYIST NAME: I understand that no later than October 1St 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. ~~ 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. Signature: Alexander I. Tachmes z ~9/0 9 Date: MIADOCS 3316292 1 EXHIBIT "A" NEW NATIONAL, LLC OWNERSHIP INTEREST CLAUDE DRAY- Managing Member SIMONE DRAY- Member VANESSA DRAY MOUYAL Member DELPHINE DRAY Member ANNA DRAY Member ELISE DRAY Member 0.5~ 0.5% 24.75% 24.75% 24.75% 24.75~ MIADOCS 3316388 1