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Alexander Tachmes - Phillips South Beach The Shore Club (2) ro0 ac f I \M I BEAC H 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. Tachmes Alexander NAME OF LOBBYIST: (Last) (First) (M.I.) c/o Shutts & Bowen LLP 201 South Biscayne Boulevard, Suite 1500, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 347 -7341 (305) 347 -7754 atachmes @shutts.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Phillips South Beach, LLC d /b /a The Shore Club. NAME OF PRINCIPAL /CLIENT: The Shore Club 1901 Collins Avenue Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 695 -3236 (305) 695 -3255 tim.nardi @morganshotelgroup,com 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: • See attached. II. SPECIFIC LOBBY ISSUE: Food Trailer on beach approximately east of Collins and 20`" street 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 Individual/Title B) Any Financial, Familial or Professional Relationship City of Miami Beach Planning Board None City of Miami Beach Mayor /Commissioners None City of Miami Beach Committees None ' ' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Hourly — $495.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly - $495.00 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 ": r lYes 6a No: Are 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 ": fYes 6a 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 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 any registration fees.. fYes 6a No: Are you representing a not - 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 PREC • ING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE = • - COMPENSATION DURING THE REPORTING PERIOD. 0 $ ,.—aik I ,' ..i, III Signature o obbyist — Alexander I. Tachmes 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 -4 of the Miami B ach City Code and all reporting requirements. o = N Si gnature of Lobbyist: 0 o..; of Alexander . Tachmes o - ca A `!° Signature of Principal /Client: NC..) k 7 Tim Nardi, General Manager - LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: r Produced ID ❑ Produced ID • ^ #,; z Form of Identification Form of Identification o " • z ® Personally known (Lobbyist) ❑ Personally known (Principal) z g VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade Sworn to and s 'scribed before me Sworn to and subscribed before me This Co day ofo A.;,r , 2011 This _ day of , 2011 Si ure of Public Notary —State of Florida S of Public. Notary — State of Fl Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED 0 Y CITY CLERK'S USE ONLY � Annual Registration fee: [ ] Yes ( 1 No Amount Paid $ ' CR # $ Date Paid /// //// Lobbyist Registration Form received and verified by: F: \CLER \LOBBYIST Lobbyist Registration Form 32708.doc Revised 03/27/2008 I • VV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Hourly — $495.00 - B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly - $495.00 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 ": flYes I1 No: Are 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 ": I 65 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 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 any registration fees.. J /Yes 6a No: Are you representing a not - 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. Signature of Lobbyist — Alexander I. Tachmes 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,r orting requirements. Signature of Lobbyist: Alexander I. Tachmes Signature of Principal /Client: Tim Nardi;_ General Manager VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID Produced ID J1.. M 630 2'13.7361 Form of Identification Form of Identification ® Personally known (Lobbyist) ❑ Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: 2 -_i• ig State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade "•••`'� Sworn to and subscribed before me Sworn to and subscribed before me b ° This day of , 2011 This 1 day of , 2011 - 175111 w � c6 Signature of Public Notary — State of Florida i rof Public c5 r z cI o g`g Notary State of Florida r Notarization of Lobbyist's signature Notarization of Principal's signature 2 ivy —• P N o TO BE COMPLETED Y ;ITY CLERK'S USE ONLY 5 Annual Registration fee: [ 1 Yes [ ] No Amount Paid $ JOU MCR # $ Date Paid 1f41 // p -' °` Lobbyist Registration Form received and verified by: Of I " F: \CLER \LOBBYIST\Lobbyist Registration Form 32708.doc Revised 03/27/2008 s M City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Alexander I. Tachmes I understand that no later than February 28th of each 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) Lobbyist Expenditure and Compensation 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 of lobbyist withdrawal in writing. *Od`4 41927 January 6, 2011 Signature: Date: 0 • S . • AI OF INTEREST The Shore Club, located at 1901 Collins Avenue, Miami Beach, Florida, is owned by Philips South Beach, LLC, which in turn is owned as follows: I. Ninety -three and twenty -one hundredths percent (93.21%) of Philips South Beach LLC is owned as follows: 1.00% SB Realty Corp., which in turn is owned as follows: 90.00% Philip Pilevsky 417 Fifth Avenue New York, NY 10016 10.00% Sheila Levine 417 Fifth Avenue • New York, NY 10016 36.04% Philips SB Associates, LLC, which in turn is owned as follows: 90.00% Philip Pilevsky 41 Fifth Avenue New York, NY 10016 • 10.00% Sheila Levine 417 Fifth Avenue New York, NY 10016 56.17% Clark SB II LLC, which in turn is owned as follows: 3.32% Jonathan A. Bernstein 993 Park Avenue New York, NY 10028 96.68% Clark SB, LLC, which in turn is owned as follows: 32.05% The Clark Foundation One Rockefeller Plaza New York NY 10020 -2102 (this is a 501(cX3) charitable foundation) Directors/Members: Kent L. Barwick Felicia H. Blum • • • • • Jane Forbes Clark William M. Evans, Jr. Gates Helms Hawn Archie F. MacAllaster Joan S. McMenamin Kevin S. Moore Thomas Q. Morris Anne L. Peretz Edward W. Stack • John Hoyt Stookey Alexander F. Treadwell Clifton R. Wharton, Jr. 25.64% James F. Clark c/o The Clark Estates, Inc. One Rockefeller Plaza New York, NY 10020 -2102 15.38% The Scriven Foundation One Rockefeller Plaza New York, NY 10020 -2102 (this is a 501(cx3) charitable foundation) Directors/Members ' Robert G. Campbell, M.D. Jane Forbes Clark Edward Gozigian • J. Michael Moffat Kevin S. Moore Thomas Q. Morris, M.D. Marian G. Mullet Edward W. Stack 7.05% Trust for Anne Peretz, 1 944 c/o The Clark Estates, Inc. One Rockefeller Plaza New York, NY 10020 -2102 ,Income beneficiary: Anne Peretz 2 f ' • • • Residuary beneficiaries in equal amounts: Jesse Peretz Evgenia Peretz David Farnsworth Anne E. Farnsworth (addresses for each are set forth below) 3.21% Trust for Martin Peretz, 1976 c/o The Clark Estates, Inc. One Rockefeller Plaza New York, NY 10020 -2102 Income beneficiary: Martin Peretz Residuary beneficiaries are: 50% in equal amounts to: Jesse Peretz Evgenia Peretz David Farnsworth Anne E. Farnsworth (Addresses below) 50% To charities to be designated • 1.28% David L. Farnsworth 9 Brantwood Road Arlington, MA 02476 1.28% Anne E. Farnsworth 4001 Virginia Street Chevy Chase, MD 20815 1.28% Jesse W. Peretz 533 Canal Street Unit 3 New York, NY 10013 1.28% Evgenia Peretz 171 Duane Street No. 2 3 New York, NY 10013 5.13% Edmund S. Twining III P. 0. Box 8 Driggs, Idaho 83422 3.85% Eve C. Labouisse 1 Sutton Place South New York, NY 10022 1.03% Edward W. Stack 25 Waverly Street Glen Head, NY 11545 0.515% . Kevin S. Moore • 79 Norfield Road Weston, CT 06883 0.51% Richard C. Clarkson 24 Roxbury Road Garden City, NY 11530 0.515% Anne B..Moore 418 East 59 Street #24A New York, NY 10022 • 11. The remaining six and seventy-nine hundredths percent (6.79 %) ofPhilips South Beach, LLC is owned as follows: 100% Hotel Parent LLC, which in turn is owned as follows: 80.38% NorthStar Hospitality LLC, which in turn is owned as follows: 100•% NorthStar Partnership L.P. which is in turn owned as follows: • 73.34% NorthStar Capital Investment Corp. 527 Madison Avenue, 16th Floor New York, NY 10022, which in turn is owned as ° set forth on Exhibits "A" and "B" attached hereto 4 • • o 9.44% Sorco Interfund LLC Sorco Fund Management 888 7 Avenue New York, NY 10022 8.43% NorthStar Operating LLC, which in j turn is owned as follows: 48.58% David Hamamoto 527 Madison Ave 16 Floor !' New York, NY 10022 • 48.58% W. Edward Scheetz 527 Madison Ave 16 Floor New York, NY 10022 • 1.58% David G. King Jr. 527 Madison Ave 16th Floor New York, NY 10022 0.36% Peter W. Ahl 527 Madison Ave 16 Floor New York, NY 10022 0.22% Marty Lamb 527 Madison Ave 16 Floor New York, NY 10022 022% Keith Meister 521 Madison Ave • 16th Floor New York, NY 10022 • 0.08% Greg Peck • 527 Madison Ave 16th Floor New York; NY 10022 5 . 40 0.11% Adam Anhang 527 Madison Ave 16 Floor New York, NY 10022 0.11% Charlie Humber 527 Madison Ave 16th Floor New York, NY 10022 0.08% • Harriet Z. Stamatakos ' 527 Madison Ave 16m Floor New York, NY 10022 0.06% Glenn Levin 527 Madison Ave 16th Floor New York, NY 10022 0.02% Denise Olsen 527 Madison Ave 16th Floor New York, NY 10022 4.83% NorthStar Capital Partners LLC, which in turn is owned as follows: 50% David Hamamoto 527 Madison Ave • 16th Floor New York, NY 10022 50% W. Edward Scheetz 527 Madison Ave • 16 Floor New York, NY 10022 2.25% DB Alex Brown Exchange Fund II L.P. DC Investment Partners 10 Burton Hills, Suite 120 Nashville, TN 37125 6 • • • 0.88% DB Alex Brown Exchange Fund I L.P. DC Investment Partners 10 Burton Hills, Suite 120 Nashville, TN 37125 0.33% David G. King Jr. 527 Madison Avenue, 16th Floor New York, NY 10022 0.29% Marc S. Gordon 527 Madison Avenue, 16 Floor New York, NY 10022 0.10% Richard J. McCready 527 Madison Avenue, 16 Floor New York, NY 10022 0.08% Peter W. Ahl 527 Madison Avenue, 16th Floor New York, NY 10022 0.02% Richard Sabella 527 Madison Avenue, 16 Floor New York, NY 10022 0.01% . Kevin Reardon 527 Madison Avenue, 16th Floor New York, NY 10022 • 19.53% RSA Associates, L.P., which in turn is owned by the Ian Schrager family entities listed below, as follows: 0.781609% RSA GP Corp. (General Partner) 47510th Avenue New York, NY 10019 7 • • 7.579319% Ian Schrager (Limited Partner) 475 10" Avenue New York, NY 10019 11.400956% RSA New York Associates, LP (Limited • Partner) 475 10 Avenue New York, NY 10019 0.238116% RSA New York Corp. (Limited Partner) 475 10" Avenue New York, NY 10019 65.00% RSA FamilyHoldings, LLC (Limited Partner) Managing Member: Ian Schrager Non- Managing Schrager Family 1999 Trusts UTA dated August 29, 1999, Trustees: Ian Schrager and Rita Schrager, 47510'" Avenue New York, NY 10019 15.00% ISB Family Holdings, LLC (Limited Partner) Managing Member: Ian Schrager Non- Managing: Schrager Family Spray Trust UTA dated Sept. 29,1999 Trustees:Bernard Schrager And Stuart Kotler • 47510 Avenue • New York, NY 10019 0.09% By the following Philip Pilevsky entity: Century Operating Associates 47510 Avenue New York, NY 10019 8 . • ' ' " `: ' ta-05-01 01140* i*:'i Proi-I ' -!: ' .. .:i 7f . . ... ". ' '. • ! 012217421* T-210 P.02/05 F-102 - Pia r . % .uvutaa rma ; SEP-01-01 14114 I • = vs . i ; X I tgo L_______.....,_____ • 0 . : sa W sa.stia m g bl 1 1 = a a * Olt IC a ...WI ;cogn ii k NOV' Imo aTu o lio* i a r r i kli 2 g Gil gral MC r im_ 11 I oil 11.11 2 1:1 in4g 4N N a • -I ap = a ea ea . 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