Youssef Hachem/Tudor South Beach Resort-North~(II y(((~~' ~``~
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City of Miami Beach Office of the City Clerk ~'
1700 Convention Center Drive, Miami Beach, FL 33139 ~-~ ~t
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LOBBYIST REGISTRATION FORM ~ ` ~ ,`"i~
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to ert'ourags the''.
passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner~ny ~tion;-~
decision, recommendation of the City Manager or any city board or committee; or any action,-tdecisttca~t or
recommendation of any city personnel during the time period of the entire decision-making process one' ch y ion,`
decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a ~y b~ 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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Hachem Youssef
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
_Youssef Hachem Consultin En ineering, Inc. 12151 SW 128 Court Suite 104 Miami FL 33186
TELEPHONE NUMBER. FAX NUMBER: EMAIL:
305.969.9423 305.969.4253 YH@Hengineerino.com
LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
Tudor South Beach Resort-North Condominium Association, Inc.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
1111 & 1119 Collins Avenue Miami Beach, FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional} EMAIL: (Optional)
(212) 474-9845 N/A jstein@hh-r.com
Fill out this section if principal is a
or Trust [Section 2-482 (c)J
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Jay Stein, President
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
Please see attached
II. SPECIFIC LOBBY ISSUE:
Ilrturii I'rCK'r~,7UUn li~~;n~l :gtphruutn rrgardint rrrUtiial~ ul~altltn>pnatrnr.: ut cunnccuun t~uh I I I I :ut~l I I lv (ulltn,
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Issue to be lobbied (Desc;ribe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(y) 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 Nante of Individual/Title B} Any Financial, Familial or Professional Relationship
Mayor ~ None
Comm~sstoners
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
s4
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
150.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $150.00 per hour
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 6z) No: Are you lobbving on a present or pending bid for goods equipment or services or on a
present or pendtno award for Goods egutpment or servtce~
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
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 tees..
Yes 6a No: Are you representing a not-for profit corporation or entity without spectal compensatton or
retmbursement.
V. SIGNATURE UNDER OATH:
PERIOD.
I do solemnly swear that all of the foregoing facts are true
provisions contained in Section 2-482 of the Miami Beach Ci
Sig
corr and at I have read or am familiar with the
rde d a reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IOENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~(] Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florda. County of Miami-Dade
Swo n to and subscribed before me
fhis~ day of t~ln~ . 2pOQ
S~ynatGre of Public Notary -State of Florida
Notarization of Lobbyist's~signature
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miarni-Dade
Sworn to and subscribed before me
This - day of __ , 2008
Signature of Public Notary -State of Florida
Notarization of Principal's signature
_ TO BE COP~IPLETED Y CITY CLERK'S US Y
Annual Registration fee: ( j Yes ( J No Amount Paid S_ _ MCR # s Date Paid '
lobbyist Registration Form received and verified by:
F r~~ER L~Bf3Y~5i.Lobb Est Registration Form 32708 doc Revised 03/27/2008
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EXPIRESt FEB. 22, 2013 !
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$150.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $150.00 per hour
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 aresent or sending bid for goods eauipment or services or on a
present or nendina award for Goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes 6d No: Are you lobbvina 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 Mau?
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 snot-for-profit corporation or entity without special compensation or
reimbursement.
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:
VI. LOBBYIST IDENTIFICA'
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
^ Produced ID
Form of Identification
[~ 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
Swom to and subscribed before me M U N i R /t[ H M E D
This~day of S?-.7F , 2008 Notary, Public Stsfe of Nsw York
\~~~ ~~jC'ommission~ xp~res March 2Q,)p
Signature of ublic Notary -State of Florida
Notarization of Princiaal's signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # S Date Paid
Lobbyist Registration Fwm received and verified by:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc Revised 03/27/2008
V. SIGNATURE UNDER OATH:
m Pv1iAMIBEACH
City of Miami Beach, 1700 Convention Center Drive. Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office CitvClerkta'~miamibeachfl qov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Youssef Hachem
I understand that no later than October 1s` 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 addition, once an issue I ha registered to
City Clerk's Office for lobffyist drawal in bcrt(
on has been resolved, I am required to immediately notify the
X ~
Date:
MIADOCS 3547791 1
Ownership Interest in Tudor South Beach Resort-North Condominium_Association, Inc.
Because the Tudor South Beach Resort-North Condominium Association, Inc. (the
"Association") is anot-for-profit condominium association, it has no shareholders or ownership
interests. All units are owned by TBS Realty, LLC. The President of the Association is Jay
Stein.
MIADOCS 3547852 l