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Charles H. Benson - 940 Ocean Drive, LLCm MIA^.I ~E~`,I'C~ 1 y ~ `I ~~O City of 3l'f!I B~~G~1 "~~ O~ ~~i~ ~1 ~~8t`~ n enter C~rivgg Mi~r~ ~~~ch~ FL X313 )BI~Yl~T RE!i~iSTRAT1O1~ F~-R11i1 Low rn~ana ~~ ~~~d t~e~air~ed, any aa~dlnaae. resctuiicn, ~~ ter detrists ~f rorns~e; ~ ~aap .~, deals or r~r~rnanda! acticsn, s~~~n ~ tears~r'neatao~t ~t iore~ s~'aatl~ ir~lt~d the atrra9 ~ as any e~-t~ ~fer to 4rdtnance 2t~#w3d35. ~~ ail ~ . 6y a ~ainc~aa ~~ro saw ~ ~a~e ~~ passage. defeat ~r ~scdi~~ation Ot~!'l~Si0Ae1': any $t'f, @;tt5r1, cer,l~t8ndat# i~ ~t8 ~~y tam CNf T2I {N" ~ a~-y saiy p et d~ttin8 ~e tense p3od iak` entia~e dscsa~ ~naaess cru s+,afi ~~i tie #~ or ~~red by ~ ~~cs, or a btaard tax c~rraa. '~hhe ~n» y et~greaf ~ by~ng a~a. Ttte ia~n `"Lat~~yists" has sific exofu~na: Preaa~r Benson Charles H. Charles H. Benson & Associates, Architects, P.A., 1665 Washington Avenue, 2"d Floor Miami Beach, FL EU~INF.~ i~4tE;1~ QI~E~~ { ~ and 5~r~t~ ~~~~ C~~ ~~ ~3 O (305) 532-6161/ C (786) 246-8180 / F (305) 532-6151 carkitect@aol.com E #~Tg~tse rt~t~fy t~i~ r~~ce' if your ~r~t~ act' it~f~rr~ratit~n cr+rattges: ~ddress,,.~l~ron~, ~r ~r~elt ~ddss. i. t`r3881(I~T RETAif~Ei~ BY. 940 Ocean Drive, LLC 1~ c/o Nakash Holding 1400 Broadway, 15Th Floor, New York, NY 10018 BU~I~IE~S ~~E ANC ~®~E~ i' er atu! eetl {Cty'3 ~) ~,~ ~~ . ~ t.:~ ~~ 1`i1t out thte hon ~ prCnclpa! is a Corp ioti~ Partnerehlp or' Trust ~S~ction 22 t~~l NICE C~ CHEF rr9FFtCE1~, PAS , Oft BENEFICt~€'Y: Joe Nakash +~ tCJEt~"iPY . ~ER31~~ C..~9!tAt a DIR~TLY t3R IIiTECTL°Y, .~- 53~o- Chi ~'E C~',#~E~IP tNTERE~1` t~ S#~JCH CORP4RATtt3hl, P~.R~'NE~tP OR T~tU~'T: n.S~E~IF~C ~t~~~Y ~SS~~.~> quo (.,P~~~p~~ Request for varianceMto maintain existing floor plan construction. To be heard by the Board of Adjustment Flood Plain / ~~~. ~Ci~"'~f `~~~~~1~3tl~~?IV~U ~ LS Td ~~ L~~~~~; Pursuustm t~s ~Ciiy ~~ Simon ~-4~g~ include a z~iat~rrn?trt of the ex~nL of qty 1~n ~ fnanc~al~ t~mliral, p~sicntal or +c~?te7r r"s!a#r~nrrh~~, gtvir~ r3~ to an appearanr~ ©f ara irr~ropri~y Frith any Ci personnel ~ou~ht tv be lobed - fer, pursuant to City Carle section 2- A82{a~~4y crude a statement of any con dual ~t~elsttionshlpr d or ur~~aid~ #rorn 1.~ rrronths precedir~ City r6uarCrnel' c~nnn~encerr~nt o~F a~rrriCe wi~h the Clty t+a the went ~, ~ir~ tl'~e per°reral mature of the sut~ . contra+r~ua1 rrelation. ,~ B~~ .-, ~, I ~~ ~~ - ' ~ y~ ` ~ a ` ~ Wit. `~,,.. -;; ~ '~; ~,, .. ~ -~ ;.~7 ~ a ":: . 1' " ~ IV. DISCLOSURE OF TERMS AND '~ RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYI T COMPENSATION): ~~~ (Required). ,, The following information must be ans ered: 1) Pursuant to Miami Beach City C de Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": U Yes L~J No: Are you lobbyinq on alpresent or pending bid for goods, equipment or services. or on a resent or endin away for oods a ui ment or service? i 2) Pursuant to Miami Beach City C de 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issue ": ^ Yes L"J No: Are ou lobb in on endin a lication for a Develo ment A reement with the Cit or a lication for chap e o zonin ma . desi nation or chan a to the Ci '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 Secti n 2-481 above) who only appears as a representative of snot-for-profit corporation or entity without sp cial 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 require to pay any registration fees. ^ Yes ~No: Are ou re resentin not-for- rofit cor oration or entit without s ecial com ensation or ' reimbursement. ' V. SIGNATURE UNDER OATH: ON .OCTOBER 1ST OF EACH YEAR EACH LOBBYIST SHALL SUBMIT.. TO THE .CITY CLERK A .SIGNED STATEMENT UNDER OATH LISTI G LOBBYING EXPENDITURES AS WELL AS COMPENSATION RECEIVED IN .THE CITY OF MIAMI B ACH FOR THE PR EDIN CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BE N NO EXPENDIT E O O SATIO_N DURING THE REPORTING NTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, F~T ~~ PERIOD. I do solemnly swear that all of the fore provisions contained in Section 2-48 Signature of Lobbyist: / Signature of Lo ~g facts are e a coi e Miami B~i ode Signature of Principal/Clien ~ ,! VI. LOBBYIST ID ICATION: nd that I have read or am familiar with the III reporting requirements. ~l PRINCIPAL IDENTIFICATION: ^ Produced Form of Identification VALERIE HANSEN~ Personally known (Principal) Notary Public; State of New York . No. 43803689: Qualified in :.Richmond Courtly; Certificate, _. in Nawr::Ycuk`COv N ~ ':=~ ConunissionMlas DsC. 3t, ~ . J~ ~~t ofr; County of Ib i an subscrib befor m Tlbs dayAOf ~~10 ^ Produced ID Form of Ident fication I Personally known (Lobbyist) i ~ VII. SIGNATURE AND STAMP OF NOTARY: ° 1!~IAR! A JAKONI State of Floridan County of Miami- hh~, c0~5~t~5to~ ~ op$; Swor Ito and subscribed befolre ~x~t~t~S tvovember 16, ; This ayr.a` o .~. ~~'rn~`' F? ~~Jo~eq Discount Acsi v Signature o Publi N t ry -State of Flo ids Signatur of Public Notar - tate of Florida Notarizatio of Lobbyist's signature Notarization of Principal's signature TO BE OMPLETED BY CIT CLERK'S STAFF ON Annual Registration fee. ] des.[ ] No Amount P $ MCR .Date Paid ,Lobbyist Registration'Form ecelved and rifled by. ;~~}~t~~~yL~es~~ sit.. t~, ,F N_ - • ~ Revised 05/28/2010 a- e~~ f ~ - }: i i I I /A{ ~ ffAA\\ T . !' i City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@migmibeachfl.gov Tel: 305.673.7411 Fax: 305.673.72 4 5 L®BBY15T N~A11AE: ~ r ~ ~ ~'U~ /2-L,f~S I , (understand that no (ate,r than. February 28th of a®Ch~year, I must file the following form, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1 J Lobbyist Expenditur and Compensation Form r. Failure to file these forms on a timely basis will result in my name being transmitted to the. Miami-Da ~ e .County Commission on Ethics and for -code violation evaluation. In addition, once can issue I have registered to lobby on has been resolved, I.` am required to immediately notify the City Clerk's Office of lobbyist withdrawal ~ in writing.. ,~ a I, ~ ~~ ~ ~~ Signature: ~ Date: Revised 09/24/2010 - R P ~:\CLER1~ Oi3BYIST\Exp ndifiur~ ~ Disclosure Form Itr.doc i We are committed to providing excellent pubic service and safety to olf who live, work,.-and play in our vibrant, tropical, historic community. I _---