Youssef Hachem/Tudor South Beach Resort Condo Association, Inc.,,
1'II~ ~ li~~ ~~~~ a',.~
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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Hachem Youssef
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Youssef Hachem Consulting Engineering, Inc. 12151 SW 128 Court, Suite 104, Miami, FL 33186
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
305.969.9423 305.969.4253 YH@Hengineering.com
LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
Tudor South Beach Resort 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 Corporation, Partnership or Trust [Section 2-482 (c}]
• 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:
Historic Preservation Board application regarding certificate of appropriateness in connection with 1111 and 1119 Collins
Avenue (a.k.a. the Tudor and Palmer House hotels).
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 An Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
l
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). _ _ $150.00 per hour
The following information must be answered
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^Yes 6a No: Are you lobbying on a present or pending bid for goods equipment or services or on a
present or pendtng award for Goods equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
3) Pursuant to Miami Beach City Code 2-484 (h) Any person {except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^Yes 6a No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1$` OF EACH YF~t~
I do solemnly swear that all of the foregoing facts
provisions contained in Section 2-482 of the Miami
Signature of Lobbyist:
Signature of PrincipallClient:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Fk~nda County ul f~Lami-Dade
S.vorn i~cy~nd suhs~;nbed before me
Tl,rs ~' '~i;i - or Z
Signatur; of Public Notary -Mate of Florida
Notarization of Lobbyist's signature
TO BE COMPLETED
Annual Registration fee: ( ]Yes [ ] No Amount Paid S
Lobbyist Registration Form received and verified by:
F .CLER~,LUBBYIST Lobbyist Registration Fonn 32708 doc
Stephatile M. I3ust4
~[; tbMMISSI01tifDiJ66,~2i 77
ptp1RES~ FEB, 42,2018
~'a, ~ NANYI.AAROtiNOTARItaom
sect and that ve read or am familiar with the
and all rting requirements.
PRINCIPAL IDENTIFICATION:
^ Produced ID
^ Personally known (Principal)
State of Florda. County of Mrrmr-Dade
Sworn to and subscribed before me
This _ day of _ .2008
Form of Identification
Signature of Public Notary -State of Florida
Notarization of Principal's signature
ITY CLERK'S USE
Revised 03!27/2008
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":
pYes 6a No: Are you lobbvina on a present or oendina bid for goods eauipment or services or on a
present or oendina 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 6a No: Are you lobbvina on a oendina application for a Development Agreement with the Citv or
application for chance of zoning map desianatton or chance to the Citv's Future Land Use Man?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except chose exempt from the definition of
"IobbyisY' 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..
1]Yes ba No: Are you representing goof-for-profit corooration 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: ~l
VI. LOBBYIST IDENTIFIGA
PRINCIPAL lDENTIFlCATION:
^ Produced ID
Form of Identification
~- Personally known (Lobbyist)
^ Produced iD
- Form of Identification
~. Personally known (PrinciRal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 2-day of ~s+~ , ?_008
Signature of Public Notary - Sfate of Florida
Notarization of Lobbyist's signature
State of F!orida, County of Miami-Dade
Swarn to Bpd s~ •;i:;cfibed before me M U N ! R ~ H M;f p
This ~ day of _..~i*f~, 2008 Notar Public Stefe et
y New York
~~\ N0. O~AH89i38953
-------~i'- ~`' ' Commission Expfres MarcA 20.1!7
Signature of Pu:~tic Notary -State of Florida
Notarization c' i7rincipal's signature
TO BE COMPLETED BY CI CLERK'S UE_I~ ONLY
Annual Registration fee. [ j Yes [ ] No Amount Paid S MCR # $ ~ Date Paid
Lobbyist Registration Form ceceived and veriflod by:
F:ICLER\LOBBYIS'RLobbyist Registration Form 3270$.doc Revised 0/27/ Oe
V. SIGNATURE UNDER OATH:
m ~:~iAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.aov
CITY CLERK office
Tel: 305.673.7411, Fax: 305.673.7254
CitvClerk(c~miamibeachfl Uov
LOBBYIST NAME: Youssef Hachem
I understand that no later than October 15~ of each year, t 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 i ue I have regi d to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for bbyist with I in writing.
X ~ ~
Signatu Date:
MIADOCS 3544419 1
Ownership Interest in Tudor South Beach Resort Condominium Association, Inc.
Because the Tudor South Beach Resort 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 3547845 1