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Matthew Amster - 1790 Alton Holdings, LLC f - fr ttl o" MIAMIBEACH City of Miami Beach Office of the City Clerk 17? 1))) 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a prncipal 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, PA 200 S. Biscayne Blvd, Suite 850 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377 -6236 (305) 377 -6222 mamster(abrzoninolaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: P /ease notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: 1790 Alton Holdings, LLC — Nathanael Cohen, Manager NAME OF PRINCIPAL /CLIENT: 1790 Alton Holdings, LLC 2337 NW 5 Avenue Miami Florida 33127 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (800) 606-7319 (866) 836-5751 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: Nathanael Cohen, Manager • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Nathanael Cohen (33.33 %); Yonel Fellous (33.33 %); and Steve W. Athea (33.33 %). C'D rs II. SPECIFIC LOBBY ISSUE: cm Development approvals and permitting issues for property located at 1790 Alton Road. �; C ^ri Issue to be lobbied (Describe in detail): r r r "i ( : ) 72: co III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: _ 7 cra — Pursuant to City Code Section 2- 482(a)(4) include the commissioner of personnel sought to be lobbied, and whe r talobbpipt has entered into contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 moms prfeding such person's commencement of service with the city to the present date, stating the general nature of the subj�.t coaracti e relationship. , r-7-1 Sec 2482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied Planning Department and Building Department None X Staff DRB, BOA, City Commission, as necessary* None X Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2- 482(g) Any Financial, Familial or Professional Relationship None. * Unless an issue is legislative in nature, DRB, BOA, & City Commission members are not lobbied outside of a public hearing setting. • r , IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $310.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $310.00 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 ": ❑ Yes X No: Are vou lobbying on a resent or pending bid for goods, equipment or services, or on a present or p P 9 Q , P 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 X No: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning 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 any registration fees.. ❑ Yes X No: Are vou representing a not - for - profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 REP TING 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 Be. h Ci o•e andp eporting requirements. Signature of Lobbyist: iJ �s Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: � PRINCIPAL IDENTIFICATION: 1 Produced ID Produced ID �r' UP l'C -eat C �.a tn41I Tr- i fi n ) Form of Identification Form of Identifra Str , WENDY SANDOVAL / li no Commission # EE 68802 Personally known (Lobbyist) Personally known (Principal) „ III 'r” February 28, Expires VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-I CRISTINA a ot'Florida, County of Miami -Dade Sworn to and subscribed before m g* n! :.= MY COMMISSION #Da &MITI d subscribed before me This day Of r ' ' 1 4 0 ' ' EXPIRES: M a r c h i day • j vl 20 1 � Bonded Thru Notary public Underwriters —.4111 . Signature of Public Notary L Stat of Flo Signature of • blic Notary der of Florida' Notarization of Lobbyist's signature Notarization •f Principa gnature FoRIANcis USE ON j ✓7 j E� Annual Registration fee: [ ] Yes [ ] No Amount Pai4 MCR # I 1 2, ,1 Dalie Paid • Lobbyist Registration Form received and verified by: 5 / Entered By: ,.L. Revised 1/11/2011 F City of Miami Beach, 1700 Convention Center Drrve, Miami Beach, Florida 33139, www.miamibeachfi gov CITY CLERK Office CityClerkCmiamineachfl.gov Tel- 305 673 7411 , Fax 305 673.7254 LOBBYIST NAME: Me 14I Arn s'ekr 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. 7/7/ Signature: Date: 1