David E. Sacks - Response to RFQ 22-11/12 Convention Center Development Z7 - // / 7--
m MIAMI BEACH
C-0* 41
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.
Sacks David E.
NAME OF LOBBYIST: (Last) (First) (M.1)
Pathman Lewis, LLP, 2 South Biscayne Boulevard, Suite 2400, Miami, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-379-2425 305-379-2420 dsacks @pathmanlewis.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
1. LOBBYIST RETAINED BY:
CConnectMB
NAME OF PRINCIPAL/CLIENT:
1) Plenary Group (USA) Ltd 2) Tristar Capital and 3) Jones Lang Lasalle
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
See Attached Information
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
See Attached Information
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: See Attached Information
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:1) Plenary Group (USA), Ltd., 2) Tristar Capital, and 3) Jones Lang Lasalle
II.SPECIFIC LOBBY ISSUE:
Response to RFQ 22-11/12 - Development of Miami Beach Convention Center District
Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)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 general nature of the subject contractual relationship.
Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES I NO
title of person to be lobbied
Evaluation Committee X
Mayor and City Commissioners X
City Manager's Office, City Attorney's Office, City Staff X
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: 0 S,P T,17 D
N/A ,
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) $375.00 Per Hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375,00 Per Hour �✓�Z�l _
(Required). ,
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-486 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
4D Yes 0 No: Are you lobbying on a present or pending bid for aoods equipment or services or on a present or Pendina
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":
O Yes 0 No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning may 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.
Q Yes ® No' Are you representina 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,IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING ALENDA YEAR. A STATEMENT SHALL BE FILED EMEN I ERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERT
ure of Lobbyis
I do solemnly swear that all of the foregoing facts ar a and correct and that I have read or am familiar with the provisions contained
in Section 2-482 oft ach City a all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFIC ION: PRINCIPAL IDENTIFICATION: AA//��
16 Produced ID Produced ID S APQJ10��rr--
Form of Identification ))J Fornh of Identification
Personally known(Lobbyist) '� Personally known(Principal) �;str>,''•, ANGELICA GARCIA
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VII. SIGNATURE AND STAMP OF NOTARY: MY COMMISSION#DD96555
";%"' EXPIRES February 24,2014
State of Florida,County of Miami-Dade late k rida,County of Miam ,098-0153 FlonoaNOtarySOMCO oOm
Sworn to and subscribed afore me wor subscrib d before me
This day of 2011 is day of�i�,�9'h1&0%10-
Si ature of Public Wiry—State of Florida Signature f Pu c Notary—State of Florida
Notarization of Lobbyist's signature Notarizati n o Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFE ONLY
Annual Registration fee: [ J Yes[ i No Amount Paid t MCR# Date Paid
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) $375.00 Per Hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375,00 Per Hour
(Required).
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":
0 Yes O 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":
O Yes O 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.
O Yes O 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, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILE IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PE
,nature of L yis
I do solemnly swear that all of the foregoing facts e d correct and that I have read or am familiar with the provisions contained
in Section 2-482 of ch City Co all reporting re ' ments.
Signature of Lobbyist:
Signature of Principal/CI ent:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
€ Produced ID Produced€ Produced ID
Form of Identification =2 Form of Identification
Personally known(Lobbyist) I Ix a Personally known(Principal)
I ;,
VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida,County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed efore me k.�„,, Sworn d subscri b f re me
This day of 2011 ..... This da of 2011
S nature of Public N tar§—State of Florida Signature of Public Notary—State of 51orida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beath, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME: David E Sacks
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.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addition to any other penalties which may be imposed as
provided in Section 2-485. 1 , a fine of $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
s � �L-
ignature: Date.
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
LOBBYIST REGISTRATION FORM ADDENDUM
CCONNECTMB'S RESPONSE TO RFQ 22-11/12 —
DEVELOPMENT OF MIAMI BEACH CONVENTION CENTER DISTRICT
1. Plenary Group (USA), Ltd.
400 Burrard Street, Suite 2000
Commerce Place
Vancouver, BC V6C 3A6
Canada
T: 416-309-2208
F: 416-638-3906
E-mail: Paul.dunstan(a),plenarygroup.com
Name of Chief Officer, Partner or Beneficiary: Paul Dunstan, President
2. Tristar Capital
830 Lincoln Road
Miami Beach, Florida 33139
T: 212-521-4488
F: 212-521-4489
E-mail: dedelstein @tricap.com; davidedelstein(c�earthlink.com
Name of Chief Officer, Partner or Beneficiary: David Edelstein, Principal
3. Jones Lang Lasalle
1221 Brickell Avenue, Suite 200
Miami, Florida 33131
T: 305-728-7392
F: 305-728-3699
Email: Shannon.Crowell(cram.11l.com
Name of Chief Officer, Partner or Beneficiary: J.Shannon Crowell, Vice President
rAlane star partners\lane star partners-rPq convention center\docs\lobbyist registration form addendum.docx