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Matthew Amster - Beta Epsilon Cadillac~ MlAI~~IBEA~H ~a~;~~` 3~zs 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 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. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.I) Bercow, Radell & Fernandez, P.A. 200 S. Biscayne Blvd., Suite 850 Miami Florida 33131 BUSINESS NAME - and Street) (City) (State) (Zip f305) 377-6236 (305) 377-6222 mamsterCa~brzoninalaw com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Beta Epsilon/Cadillac, LLC, contact: Dan Economos NAME OF PRINCIPAL/CLIENT: Beta Eosilon/Cadillac. LLC 4000 N Federal Hiahwav Suite 206 Boca Raton Florida 33431 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) NUMBER: FAX 361-3945 Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Nicholas Economos, Manager • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit B 361-3918 II. SPECIFIC LOBBY ISSUE: New ground Floor addition, including mechanical parking, at the Cadillac Hotel located at 3925 Collins Ave Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title Planning Department Staff, HPB, BOA, Planning Board and City Commission* * Unless an issue is legislative in nature, HPB, BOA, Planning Board, B) Any Financial, Familial or Professional Relationship None members are not lobbied setting. ~~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $ 285.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 285.00 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 X No• Are you lobbvina on a present or pending bid for goods eauiument or services or on a present or pending award for gQOds, eauiument 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 lobbvina on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the Citv's Future Land Use MaQa 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 X No• Are you representing anot-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 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. ~1 _ ,. 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- of the Miami Beach Code and all re rting requirements. Signature of Lobbyist: ~„ _ ,,,, ~~ Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Produced ID ~~o _ Form of Identification o a~ Personally known (Lobbyist) a VII. SIGNATURE AND STAMP OF NOTAR~~ State of Florida, County of Miami-Dade Sworn to nd su scrib before me aY f ~-, 20 I o nature of Pub " tary -State of Florida Notarization of Lo s signature M ~ o ~ fc N E yo =v°a c ~, °-. Q ~ WI ~``' rOw n~ o~ ~o ~N . S«C'. (~Im, CPs.I~ cditk•. PRINCIPAL IDENTIFICATION: ClC Produced Form of Ide tification Personally known (Principal) State of Florida, County of Miami Sworn and subscribed before me This ~ °) da>~nf *u /-/ ~~ ~.~~,RV Pue~'E+ DEBRA ~ L~II6~N~7 ~ yn i ~ * MY COMMISSION t DO 687826 ~, ~ EXPIRES: May 13, 2011 ?7sc~ Fl,oP`O Bonded Tlwu 9udget Ikti«y Servlcoc / t` Signature of Public Notary `Mate of Flor Notarization of Principal's signature FOR CLERK'S USE ONLY m Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid 1c Lobbyist Registration Form received and verified by: F:\CLER\;ALL\MARIA-M\LObbyist\LOBBYIST FORM OS.doc Entered By: Revised 12/08/04 ¢ ~ ' ~ ~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florido 33134, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 Acknowledgement of fines/suspension from lobbying for failure to comply with City of Miami Beach lobbying Laws LOBBYIST NAME: ~~~~~ ~ `"`sUV I understand that no later than October 1st of each year, lobbyists subject to lobbyist registration requirements shall submit to the city clerk a signed statement under oath listing all lobbying expenditures, as well as compensation received, for the preceding calendar year with regard to the specific issue on which the lobbyist has been engaged to lobby. A statement shall be filed even if there have been no expenditures or compensation during the reporting period. The statement shall list, in detail, each expenditure by category, including food and beverage, entertainment, research, communication, media advertising, publications, travel, lodging and special events. FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI-DADE COUNTY COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust. IN ADDITION, ONCE AN ISSUE 1 HAVE REGISTERED TO LOBBY ON HAS BEEN RESOLVED, 1 AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING. Signature: 72~~0 Date: EXHIBIT B DISCLOSURE OF INTEREST for Beta Epsilon/Cadillac, LLC 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 NAME OF INTEREST HOLDER 1. Stanley Daniel Economos 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 INTEREST 24.75% 2. Nicholas Economos 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 3. Alexandra Yessios 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 4. Chris Yessios 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 5. George Bavelis 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 6. Beta Epsilon/Cadillac, Inc. a Florida Corporation 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 a. Nick Economos 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 TOTAL for Beta Epsilon/Cadillac, Inc. 24.75% 35.00% 7.50% 7.50% 0.50% 100% 100% TOTAL for Beta Epsilon/Cadillac, LLC 100.00%