Jay Stein/TBS Realty, LLCm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION FORM tom' pp
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to ertdP~ura the
passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner any ~cfion, : t
decision, recommendation of the City Manager or any city board or committee; or any action, ~cisi4yt? or j
recommendation of any city personnel during the time period of the entire decision-making process on h
decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a 'y bd~ 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.)
Stein Ja
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State
(Zip Code)
200 West 55`" Street, Suite 42 New York, N.Y. 10019
TELEPHONE NUMBER:
(212) 474-9865 FAX NUMBER: EMAIL:
N/A jstein@hh-r.com
LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
TBS Realty, LLC
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
is a Corporation, Partnership or Trust [Section 2-482
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Rabinder Pal Singh, Vice President
Please see attached
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
11. SPECIFIC LOBBY ISSUE:
Ilisturic Prrservation 13oarcl application regarding certificate of appropriateness in connection ~~~ith I I I I and I I I'J Collin;
1~rnur la.k.a. thc'f~udor and Palmer House hotels).
Issue to be lobbied (Describe in detail):
Ilt. 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
Mayor B) An Financial, Familial or
None
Commissioners
~.
City Administration; City Attorney's Office; None /
Cit Committees; Cit Boards ///
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
No special compensation (lobbyist is an employee of the Principal)
B) PRINCIPAL'S DISCLOSURE (OF LOBB_ YIST COMPENSATIONZ
---- -----_ - -- T ( y --- -----p -- ___ _ .
I~r--h7o sped ca ompensabon-Robb ist is an em lovee of the Principal)
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":
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 apposition 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 a not for profit corporation or entity without special comuensation or
reimbursement
V. SIGNATURE UNDER OATH:
Signature of Principal/Client: d G
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
(~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade f Florida, County of Miami-Dade
Sworn to and subscribed before me M U N I R /~ F1 and subscribed before me
This ~ day of ~~j Notary. Public State 9f~)f4ew Y~r of
N0. QiAH6038 53-' ~ .2008
Commission Expires March 20,10
Signature of ublic Notary -State of Florida Signature of Public Notary -State of Florida
Notarization of Lob signature Notarization of Principal's signature
TO BE COMPLETED BY CITY
Annual Registration fee: r/j Yes (] No Amount Pai<
Lobbyist Registration Form received and verified by:
F ~CLERILOBBYISTILobbyist Registration Form 32708.d
I do solemnly swear that all of the foregoing facts re true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of the a e Ciry Code and all reporting requirements.
Signature of Lobbyist: ~(
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
No special compensation (lobbyist is an employee of the Principal)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): __ _____
(Required). No special compensation (lobbyist is an employee of the Principal)
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, equipment or services, or on a
present or pending 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 ~ No: Are you lobbying on a pending application for a Development Agreement with the City or
application for chance of zoning map 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 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 ~ No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
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:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Produced ID
Form of Identification
^ Personally known (Lobbyist) ~ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Da~U N I R A H M E D
Sworn to and subscribed before me Sworn to and subscribed before Rl~ary. Public State of New York
This _ day of , 2008 This 2 day of 3t)tJ,~'~,""OS No. 01 AHet#38958
CC Commission Expires Marcb 2Q, fp
M
Signature of Public Notary -State of Florida Signature of ublic Notary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Pald S MCR # S 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.gov
CITY CLERK office
Tel: 305.673.7411, Fax: 305.673.7254
CitvClerk(a~miamibeachfl.gov
LOBBYIST NAME: Jay Stein
I understand that no later than October 1't 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 have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
x ~~
Signat
x ~~~
Date:
MIADOCS 3547683 1
OWNERSHIP STRUCTURE CHART -TBS REALTY, LLC
PARDAMAN K. VIVEK
CHATWAL CHATWAL
Member Member
50% 25% I 25%
VIKRAM
CHATWAL
Member
Chatwal Family, LLC
(NY Limited Liability Company)
Sant Chatwal -Sole Manager
100%
Channel Properties, LLC
(NY Limited Liability Company)
Pardaman K Chatwal -Sole Manager
100% owner
TBS Hotel Management Corp.
(FL Corporation)
Rabinder Pal Singh -Vice President
of the Corp.
Manager Member
1 % interest 99% interest
TBS Realty, LLC
FL Limited Liability Company
Rabinder Pal Singh -Vice President of the
LLC
MIADOCS 3009786 1