Carter N. McDowell ti
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City of Miami Beach Office of the City Clerk
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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.
MCDOWELL CARTER N.
NAME OF LOBBYIST: (Last) (First) (M.I)
Bilzin Sumberg Baena Price & Axelrod LLP , 1450 Brickell Avenue, Suite 2300, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code)
305 - 350 -2355 305 - 351 -2239 cmcdowella,bilzin.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Versailles on the Ocean, LLC
NAME OF PRINCIPAL /CLIENT:
404 Fifth Avenue, Suite 600 New York NY 10018
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
646- 230 -9360
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: Joseph Chetrit
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP
• INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
•
II. SPECIFIC LOBBY ISSUE:
All land use /zoning matters regarding application for property at 3425 Collins Avenue, Miami Beach, FL
Issue to be lobbied (Describe in detail):
111. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relationship
Planning Board, Historic Preservation Board and n/a
staff
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) $595/hr
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $595/hr
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 'N/No: Are you Iobbyinq 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 ":
Yes 'JNo: 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 'N/No: Are you 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 ITY CLERK A SIGNED STATEMENT
UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENS •N RECEIV -D N THE CITY OF MIAMI
BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL ILED EVE HERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PER . a
Signatuu - of L.:byist
I do solemnly swear that all of the fore oin• . : are true an• •%r - ct and that I have read or am familiar with the provisions
g � p
contained in Section 2 -482 of the Miami : - -c. ity Co•e - , :"•orting requirements.
Signature of Lobbyist: 7%
Signature of Principal /Client: ,
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identificati
Personally known (Lobbyist) �✓ Personally known (Princip Yl� MUTTER SANCHEZ
, poe Public, State of New York
4° ....... et IBIS DIAZ No. 01 HU5042516
VII. SIGNATURE AND STAMP OF N MY COMMISSION # OD 994845 Qualified in Queens County
Hi EXPIRES: May 24, 2014 W.-. t V< Commission Expires April 24, 20.(1
State of Florida, County of Miami -Dad r F �F F`o � � °< BondedThwBudgetNotaryServices of F 9144a, County of AAian i -Berle Que�zY, s
Sworn to and sub ibed before me Sworn and subscribed before me
This - ■ay of v• r, , _ -t,, 201k • This >-1 da. of At-,, Atr- , 20 li!
��% _ 4111■ '''S -1,1 -.).-k.....-
Signatur- • Public Notary Z Notary - of Florida Signature of Public Nota - Sta df Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
i
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid # 3 X 50 / MC' # . / /+ C
J Date Paid II
Lobbyist Registration Form received and verified by: • .
&r, • 1 70 5/2010 5W/ 05/05/2010
•
f
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,
www.miamibeachfl.gov
LOBBYIST NAME: Carter N. McDowell
I understand that no later than October 1st of each year, I must file the following forms, 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 Form
2) Disclosure 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 -ity Clerk's Office of lobbyist withdrawal in writing.
13
1
Signature: Date:
III
MIAMI 2622407.1 7000060139
8/18/11
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