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Carter N. McDowell - Kevin Colket V5& +' N/g MIAMI BEACH 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. McDowell Carter N. NAME OF LOBBYIST: (Last) (First) (M.I) BILZIN SUMBERG BAENA PRICE & AXELROD .LLP, 1450 Brickell Ave. , 42300, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 350-2355 (305) 351-2239 cmcdowell @bilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes.address,phone, or e-mail address. I. LOBBYIST RETAINED BY: SEE ATTACHED SHEET NAME OF PRINCIPAUCLIENT: BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section If principal is a Corporation,Partnership or Trust[Section 2482(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: KEVIN COLKET • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 110"15 00- Governmental Viand use and permitting issues for The Perry South Beach and the properties located at 201 Collins Avenue; 2377 Collins Avenue, 2340 Collins Avenue and 2322 Issue to be lobbied(Describe in detail): Coilins venue, am each, FI gl.DITI(AGE # MNOMDUALS TO=BE Pursuant to City Code Section 2-482(ax4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered Into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date,stating the eneral nature of the subject contractual relationship. Sec 2-482(ax4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Building Department; Fire Department; Planning and Zoning Department; City Manager's Office; Planning Board; Histori Preservation Board Pursuant to City Code Section 2-482(8)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 Any Financial,Familial or Professional Relationship- i. :17 t f �Z_! J IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE:(Required), $625/hr B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $625/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 ®No: Are you lobbyinc on a present or pending bid for goods equipment or services, or on a present or pending award for Bloods equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": i ❑ Yes ©No: Are you lobbying on a pendina 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 r 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,. r ❑ Yes ®No: Are you representing a not for profit corporation or entity without special compensation or reimbursement? V. SIGNATURE UNDER OATH: ON FEBRUARY 28TH OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES,AS WELL AS COMPENSATION RECEIVED,)N THE CITY OF MIAMI ` BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL DIFFILED EVEN IERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERK Ca er N, McDowel 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 ` ity Code a nd al j re ,rng requirements. Signature of Lobbyist: Carter N. McDowell 2377 Collins Resort, L.P., a Delaware limited partnership By: 2377 Collins Resort GP, L.L.C., a Delaware limited liability company, G Partner j Signature of Principal/Client: By: t vi Colket,Vice President Vl. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification // Form of identification Ip 'I Personally known (Lobbyist) Personally known(Principal) r�O VII,SIGNATURE AND STAMP OF NOTAPrT-"`,,r IBIS DIAZ 004f N�1 k'4t) h MY COMMISSION I DD 994845 i0 rS S State of Florida,County of Miami-Dade �t, * EXPIRES:May 24,SlAte of �, County of 1 - piRF 9S ZiOl �, P sanded Tnn Budget Nota y S�pgrd}n subscri d efore a Sq Sworn to and sub ibed before meoFF�� UG This y 2012 This day of , 2012 3r,�r6 Signature o-PU lic Notary—State lorida St u of Public Notary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S USE ONLY Annual Registration fee:[]Yes[ ]No Amount Paid MGR# Date Paid Lobbyist Registration Form received and verified by: Revised 05!05!2010 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 th ity Clerk's O 'ce of lobbyist withdrawal in writing. a Qgna ure: Date: MIAMI 2913929.1 7957236593 I 2377 Collins Resort, L.P. Sandy Lane Master Association, Inc. 591 West Putnam Avenue 2377 Collins Avenue Greenwich, CT 06830 Miami Beach, FL 33139 Telephone: 203-422-8195 Telephone: 203-422-8195 West Collins Land Investors, L.P. 591 West Putnam Avenue Greenwich, CT 06830 Telephone: 203-422-8195