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Todd Tragash 1600 Lenox Investorsm MIAMIBEACH rj City of Miami Beach OfFce of the City Cierk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM l6 d ~ Cc~ o~ Lobbyist means afl 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 ~ty personnel during the time period of the entire decision-making process on such action, deasion or recommendation that foreseeabty will be heard or reviewed by the city commission, or a city board 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) Todd STA Architectural Group 3526 North Miami Avenue ~ Miami Florida -33127 BUSINESS.. NAME AND ADDRESS (Number and Street) ~ (City) {State) {Zip Code) (305) 571-1811.. (305) 571-1821 - todd staarchitecturalgroup com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: 1600 Lenox Investors. LLC c/o Greenstreet Partners, L.P NAME OF PRINCIPAL/CLIENT: 2601 South Bayshore Drive Suite 800 Miami' Florida 33133 BUSINESS NAME AND ADDRESS (Number and Street) ~ (Crty) (State) (Zip Code) (305) 858225 (305) 858-2334 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: Jeffrey Saf~ik, President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°lo OR MORE OWNERSHIP INTEREST IN-SUCH CORPORATION, PARTNERSHIP OR TRUST: ~~ t ~ ~ 1 L , s ~- K Q' II. SPECIFIC LOBBY ISSUE: Rezoning and redevelopment issues concerning 1600 Lenox Avenue Issue to be'lobbied (Describe in detail): III. CITY AGENCIES/INDIIOIDUAIt,S TO BE LOBBIED: A) Full Name of Individual/Titre B) Any Financial, Familial or Professional Relationship Planning ~rtment Staff, Planning Board, and Gty Commission * None - - ---- - -- --a------- ... .-___. .., .._.......y w.,,v .a..u ~.,a., w..n...a~w~~ ~~~~~~~~~ a~~ ~iv~ <vuu~cu wuwe v~ a Nu~nc neanng Seinng. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERJt A) LOBBYIST DISCLOSURE: (Required) ~ !!~0 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ~T~ 00 per hour o. o tO ao ~... N o ti m o~ o~ 0 (~ 7 CO N U y y t7 ~ d ~ ~ a ~~om ~° ~0 U 'n z°s~w d~~ ~ ~A4' 4 °~. 0 ~.~ 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 X No: Ar~you lobbying 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": oyes X No: Are you lobbyinc~on as pending app0ication for a Development Agreement with the City or a~aDlicatiion for change of zoning map designation or change to the City's Future Land Use ~~ 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 cormsration or entity without speaal 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 X No: Are you representin®avot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST .SHALL SUBMIT TO THE CITY CLERI(A SIGNED STATEMENT UNDEER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CETY AF MII~MI BEACH FOR THE PR E YIVG CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE. BEEN NO EXPE IYU S ® OM ATION DURING THE REPORTING PERIOD. n ~ ~,~ ~/Signat0're of obbyi I do solemnly swear that all of the foregoing facts are and correct that I have read or am familiar with the. provision. ntained in n -482 of the Miami Beach City Code and all reporting requirements. j~ ~ , Signature of Lobbyist: Signature of Principal/Clie~ VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification personally known (Lobbyist) \ PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) VII.. SEGNATURE AND STAMP OF NOTARY: State of .Florida, County of Miami-Dade Swom to and subscribed fore me This _~~~day of ~ 20 ~ v Signature of Public Notary -State of Florida Notariaation of Lobbyist's signature State of Florida, County of Miami-Dade Swom and subscribed before me This day of , 20_ Signature of Public Notary -State of Florida Notarization of Principal's signature FO LE E ONLY Annual Registration. fee: ~ ]Yes [ ] No Am nt Paid ~ MCR # ~ Date Paid Lobbyist Registration Form received and verified b • Entered By: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04 YV. DISCLOSURE OF TERMS AN® AMOUNTS QF lOBBYYST COMPENSATION (DISCLOSE WHETFIER HOURLY, FAr4T RATE DR ®THERf `7~ A) LOBBYIST DISCLOSURE: (Required) . '~_ $ .00 :per hour B) ;PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $11.00 der hour • The following information must be ans~+rered: 1) Pursuant to Miami Beach. City Code Section. ~-4'88 .Entitled "Prohibited Campaign Contributions By Lobbyists • On Procurement Issues": ^ Yes X No• Are you lobbying on a present or pending bid for goods~quipment 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~ X No: Are you lobbyinc,~on a._,_pending application for a Development Agreement with the City or application for change. of zonings. 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 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 ariy registration, fees.. ~ . ^ Yes X No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SYGNATURE'UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACIi LO~~YIST SHALL SUBMIT TO THE CITY CLERK A -SIGNED STATEP~IEIVT UNDER OATH, LISTING. LOBBYING .EXPENDITURES, AS IA/ELL AS COMPENS~-TION RECEIVED, IN .THE CITY t~F MIAMI. BEACH fOR THE PRECEDING CALENDA6t YEAR. A STATEMENT SHi4LL BE FILED EVEfV IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION ®URING THE REPORTING 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 al reporting , requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IIDENTYFICATION:. ~ PRINCIPAL IDENTIFYCATYON;. ^ Produced ID ~ ^ Produced ID Form of Identification Form of Identification p Personally known (.Lobbyist) VIh• SIGNATURE A(dD STAhIP OF ~NOTARV: State of Florida; County of Miami-Dade Sworn to and subscribed before me This day of ~ , 20_ Signature of Public Notary -:State of Florida .Notarization of Lobbyist's signature FOR CLERK'S USE ON'_Y Annual. Registration fee: [ ]Yes [ ] No Amount Paid . MCR # _ Date Paid Lobbyist 'Registration Form. received and verified by: Entered. i3y: !~'ersonally known (Principal) ~'t1TARY PL'3LIC-STATE OF' FLORIT?A ~~""~•- Georgia Williams State of Florida, County of Miami-Dade = Commission ~ DD902690 Sworn a subscribe before me = ,`Expires: ~tiG. O1, 2013 Th15 .~ day Of , ZlJ `I(~. BOM"DED THRU ATI..9Iv"I'IC $0~"DING:CO., INC. / r Signature o Pu is Notary -State of Florida . , Notarization of Principal's signature ` I f:\CLER\$ALL\MARiA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04 11 ~~~~ 1 ~ . -City a~€..Al~ae~aa Bush, ~) 70p Convention :Center Onve; M~amiBeoch, Florida •33 i 3'9; w~ntw,rniamib~ach~l.gov . - _.. , CITY CLERK Q~~ce CtjiClerk@m~a'mibeachFl.gav Tel _ 305:.673 7411 , :Fax 3,05 b73:725'~` - , ~ ~-nderstflnd that no- later #~or~ -~~~a~~ea' ~1~~~ ®~t esa~~ . 9: - ~~®~ ~ musfi fide ;the- fvljowi'n arms; pursuant to :See#on 2-48A5 ,of fihe- Nltami Beach C~fy 'Code, wi;#h fie C'rfy G.lerk's . Offr~ce for a!1 active lobbying :iss,ues,. ~ ~ . - 1) lobbyist ExPendi ure Form :2~) Disclosures form Fciilure 'to file fl%ese ;Forms: on a timely basTi,s will: result in my name; bong transm~ te`d to ~fhe . , ~ItA~arni Dade County Commission ion Eth~,cs~ cn~d for .code violation evalugtio.n. - ... ~,an addition, -once an issue 1 hove registered to lobby .on has been resolved;.l qm required to rmme ; lately notify ;the-=Cifiy~ Clerk's Of#tce.~of lobbyist wthc~ra.wal in writing. Z6 ~,~ Date:. - ~ EXHIBIT B Disclosure of Interest - ,_~ --~ ..-_: 1-6Q0 Lenox Investors'LLC - . Flo ida Limited Liab' 'ty _ ..._ . . .. Company). ~.._ .. - - ~ 100%...Owner. &Sole- Member--- -- .. . .. ._ - Greenstreet SOBE . Investments, -LLC (Florida , Limited Liability Company) . . ~ - ~ - 100% Owner & Sole Member . -~ MG Real Estate- Partners, " LP (Delaware Limited - ., ~ Partnership) .. - ~ % - 67:0% 32.0% General Partner ~ ~ . ~ :Limited Partner Limited Partner `' Greenstreet .Management, Inc.. - Knowledge .Industries, LLC - - . - (Delaware Corporation). ~ {California .Limited-Liability Greenstreet Capital, LP - - , . . ~ Com an P Y) (Delaware Limited - , . ~ Partnership) ..~~ ~..._ ~ ~ - ' 100% shareholder . ._ . _. -~ ~ 100% shareholder . Steven J . Green. .. _: 2601 South Bayshore Dnve ~ _ - Michael R. Milken . - -~ th _ 9 Floor,. Suite.800. 1250 Fourth Street, 5th Floor - See page 2 . .. ~ ` ` Coconut Grove, Florida 33133 ~ ~ Santa Monica, CA 90401 - - . Jeffrey A, ,Safchik, ~ , „ _President/Treasurer/Secretary ~ ~ - - - Page 1 of 2 ~~ ~ ' EXHIBIT B continued Greenstreet Capital, LP ;- Greenstreet Capital, LP