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Joaquin E. Vargas (2)m 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. Vargas NAME OF LOBBYIST: (Last) Go Traf Tech Engineering, Inc. 400 North University Drive, Sui~ BUSINESS NAME AND ADDRESS (Number and Street) (954) 582-0988 (954) 582-0989 TELEPHONE NUMBER: FAX NUMBER: Joaquin E. (First) (M.I.) :e 202 Tamarac FL 33321 (City) (State) (Zip Code) joaq u i n @traftech. biz EMAIL: LOBBYIST RETAINED BY: South Beach Resort Development, LLC NAME OF PRINCIPAUCLIENT: South Beach Resort Development, LLC 420 Lincoln Road, Suite 357 Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 672-4554 (305) 672-4553 gene@southbeachrd.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: Louis Taic IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached. I1. SPECIFIC LOBBY ISSUE: Application for Conditional Use Permit for Neighborhood Impact Establishment at 1458 Ocean Drive (a/k/a 1437 Collins Avenue), Miami Beach, Florida 33139. 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 Individual/Title B An Financial, F il'a ro o I e nshi City of Miami Beach Planning Board None -~ -• ° ' City of Miami Beach Planning Staff None ~ ` ~~~ 61j(~Z City of Miami Beach Mayor/Commissioners None (-, :~ ~~ City of Miami Beach Land Use & Development None Committee ~~ ~ ~ ~ ~ ~~ ,~ City of Miami Beach Committees None J~f 'IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): LOBBYIST DISCLOSURE: (Required) $7,100 flat fee. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $7,100 flat fee. 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, eauigment or services, or on a present or Wending award for goods, eauigment 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 lobbvinp on a vending aoolication for a Develooment Agreement with the City or application for change of zoning maa designation or change to the City's Future Land Use Maa? 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 anot-for-arofit corporation or entity without special comaensation or reimbursement. V. SIGNATURE UNDER OATH: ON_OCTOBER 1°`OF EACH YEAR _E_A_CH LOBBYIST SHALLIISUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPEN URES AS WELL AS OMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH FOR THE PRECEDI CALENDAR YEAR. A ST T NT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES O COMPENSATION DURIN _ T _E__ _EPORTING PERIOD. / ~- Sig t re of Lobbyist(- Joaqui argas I do solemnly swear that all of the foregoin facts are true and provisions contained in Section 2-482 of the iami Bea City Cc Signature of Lobbyist: .- Signature of Principal/Client: Louis Mang VI. LOBBYIST IDENTIFICATION =" VI~ S _ ,~( and t t I have read or am familiar with the all r p rting requirements. as Manager ` of .Beach Hotel, LLC, on behalf of and as Aemoer of South Beach sort Development, LLC PRIN IPAL IDENTIFICATION: Produced ID ~ ~-- ~ ^ Produced ID Form of Identification Personally known (Lobbyist) SIGNATURE AND STAMP OF NOTARY: of F rids, Co~un~ty~of Miami-Dade 0 ~ ~daY 4f, ~r~_LLbe~l e " * ~ %'~I turd'of Public Notary -State of Florida ~~+ ~ rization of _L_obbvist's~gnature TO BE Lobbyist Registration Form received and verified by: _ F:\CLER\LOBBYISTLobbvist Registration Form 32708.doc ~' Y Mir ~~R~i. ~ ,k, q4~.- - - F,' _ Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me This _ day of , 2009 Signature of Public Notary -State of Florida Notarization of Principal's signature MCR # ONLY 03/27/2008 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): LOBBYIST DISCLOSURE: (Required) $7,100 flat fee. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $7,100 flat fee. 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 6a No: Are you lobbvinq on a pending application for a Development Agreement with the City or application for change of zoning map designation or change 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 anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 15` 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 EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist -Joaquin E. Vargas 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~liami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: Louis Tai~,,~-a~ Manager of So. Beach Hotel, LLC, on behalf of and as Managing Member of South Beach Resort Development, LLC 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 _ day of , 2009 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature Form of Identification Personally known (Principal) State of Florida, County of Mialli-Qa~ _ _ _ Sworn tpp and subscribe efG This r` da f /G 5'~~' Signature of Public Nota -•°. Notarization of Princip ,r®Pr,Oe MARIA V. ERRICKSON 44¢•. Notary Pubbc -State of Fkxida • EMy Commission Ezpires Apr 10, 2010 `~:' Commission # DD 526009 'of BlmidetbBy National Notary Assn. 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\LOBBYISlILobbyist Registration Form 32708.doc Revised 03/27/2008 m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov CITY CLERK office C~Clerk _miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Joaquin E. Vargas I understand that no later than October 1st of each vear, 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 ad~ition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Jerk's Office for lobbyist withdra al in writing. re: Joaquin E. Vargas Date: CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* SOUTH BEACH RESORT DEVELOPMENT, LLC, a Florida Limited Liability Company LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE SO. BEACH HOTEL, LLC 58 East 79th Street New York, New York 10075 Managing Member OF MEMBERSHIP INTEREST 66 2/3% GENE GRABARNICK & PAULINE GRABARNICK, HIS WIFE, AS TENANTS BY THE ENTIRETY 6480 Allison Island Miami Beach, Florida 33141 Members GARETT GRABARNICK 5700 Collins Avenue, No. 5L Miami Beach, Florida 33140 Member 25% 8 1 /3% 1F THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. Last page must be signed and notarized Page A-5(1) CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* SO. BEACH HOTEL, LLC, a Delaware Limited Liability Company LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF MEMBERSHIP INTEREST TRUST F/B/O THE CHILDREN OF CHANTAL 50% AND LOUIS TAIC U/A DATED APRIL 2, 1998 58 East 79th Street New York, New York 10075 Member OCEANFRONT EQUITIES CORP. 50% 58 East 79th Street New York, New York 10075 Member LOUIS TAIC 0% 58 East 79th Street New York, New York 10075 Manager lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH /NDIV/DUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. Last page must be signed and notarized Page A-5(2) CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* OCEANFRONT EQUITIES CORP., a Delaware Corporation LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF STOCK LOUIS TAIC 58 East 79th Street New York, New York 10075 President and Secretary 100% lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. Last page must be signed and notarized A-5(3) CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 2. TRUSTEE If the property which is the subject of an application is owned or leased by a TRUSTEE, list the beneficiaries of the trust and the percentage of interest held by each. Where the beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* TRUST F/B/O THE CHILDREN OF CHANTAL AND LOUIS TAIC U/A DATED APRIL 2 1998 TRUST NAME NAME, ADDRESS, AND OFFICE JASON TAIC 58 East 79th Street New York, New York 10075 Beneficiary ALEXANDER TAIC 58 East 79th Street New York, New York 10075 Beneficiary STEFANIA TAIC 58 East 79th Street New York, New York 10075 Beneficiary LOUIS TAIC 58 East 79th Street New York, New York 10075 Trustee OF INTEREST 1/3 1/3 1/3 0% 3. PARTNERSHIP/LIMITED PARTNERSHIP If the property which is the subject of the application is owned or leased by a PARTNERSHIP or LIMITED PARTNERSHIP, list the principals of the partnership, including general and limited partners. Where the partner(s) consist of other partnership(s), corporation(s), trust(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity* NOT APPLICABLE PARTNERSHIP or LIMITED PARTNERSHIP NAME, ADDRESS, AND OFFICE % OF STOCK NIA N/A Last page must be signed and notarized A-6 -~ m 3 _ Z r n O ~ -~ ~, '° 'O ~ ~ ~ a. ~ Z n m ~ ~ Q ~'; ; ~ ~ z ~ - ~ O ~ ~ : ~ _ «~ ~ o a. _ m _ ~ z ~ 3 , ` c ~. ~~ m `° a. ~ n ~ ~ p ~ . ~ a t ~ ~ ~ m ~ . o ` a _ ~ ~,~ ~. _° _. ~~ 'p -.. C1 Q .~ m O a N ~ N ~ 0 0 j ~ ~_ 3 a ~ ° ~~ ~ $ y ~~ ~, ~ $ 3 ^~ ~ ~ n 3~ ~ ~ ~d ~ n ~ ~ _ ? N ~ c7 Q m 'rt ~° ~ ~ o r• t•3 /4 n ~~ O `~r~ ~ ~ O J ;~- --, ~ ~ ~ ~° L` ''-. n -.~ t`1 ~ z bP ~ O crn o "1 °o N `" s~ , ^ ,W^ ~ W N W o W (?, V Q