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Mathews Amster - CG Sunny Isles, LLC, CG Sunny Isles 1-0 4 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. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell & Fernandez, PA 200 S. Biscayne Blvd, Suite 850, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6236 (305) 377-6222 mamster0bizonino law.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: CG Sunny Isles, LLC, CG Sunny Isles I. LLC. & CG Sunny Isles II. LLC—Joseph Chetrit& Meyer Chetrit, Manaoers NAME OF PRINCIPAUCLIENT: Same 2915 Biscayne Blvd, Suite 300, Miami FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)747-6408 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 and Meyer Chetrit,Managers and Authorized Signatories • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached. II.SPECIFIC LOBBY ISSUE: Development approvals and permitting issues for one hotel project located at 2000 &2030 Park Ave, 2035 Washington Ave. 425 &43520` Street. and 430 21st Street Issue to be lobbied(Describe in detail): lll. 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 NO title of person to be lobbied Staff of Planning Department, Building Department,and Public Works None X Department PB, HPB, BOA,City Commission,as necessary* None X Pursuant to City Code Section 2482(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 citylcTmqu sio.geryor,¢ity`personnel who is sought to be lobbied as identified on the lobbyist registration form filed. J Sec 2-482(g)Any Financial, Familial or Professional Relationship { None *Unless an issue is legislative in nature,PB,HPB,BOA,&City Commission members are not lobbied outside of a public hearing setting. C/ C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $325/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED)._$325/hour 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 you lobbvina on a present or pendina bid for goods,eauipment or services.or on a present or pending award for goods.eguipment or service? 2) Pursuant to Miami Beach City Code Section 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 Section 2-482(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 you representing a not-for-profit corporation or entity without special compensation or reimbursement_ V. SIGNATURE UNDER OATH: ON FEBRUARY 28 !2E EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER QATH. 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 C 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 Beach City Code and all reporting re uir Signature of Lobbyist: Signature of Principal/Client.( VI. LOBBYIST IDENTIFICATI PRINCIPAL IDENTIFICATION: ��pr o� No�ry Public State of Florida Ana Hernandez —Produced ID a My commission EE075919 Produced ID Form of Iden fic pmcP� Expires 04/29/2015 Form of Identification Personally known(Lobbyist) Y35—e—rsonally known(Principal) VII. SIGNATURE AND STAMP OF •s,"av Pv 00 JEANINE RODRIGUI Z = Notary Public-SOW 01 466d State of Florida, County of Miami-Dade :r: ';,= y 264 to of Florida, County of Miami-Dade Swo d subscribe fore me =,y. ,o; My Comm.Expires Jan 14, or and subscribed before me This day of ,2012 %',;off �a�' Commission#DD 851762 is day of ��2012 Signatur of Public of tate.of rids Sign r Pu o ary—State of orida Notarization of Lobbyist's signature Notarization of Principal's signatur TO BE COMPLETED BY CITY.CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ .]No Amount.Paid$ MCR:# !3j Date Paid ta- Lobbyist Registration Form received and verified by: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F:\CLE istration Form.doc Revised 04/27/2012 MIAMSEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachll.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411 , Fax:305.673.7254 LOBBYIST NAME: Matthew Amster I understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, 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. 124,- 2- Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc EXHIBIT B DISCLOSURE OF INTEREST NAME OF INTEREST HOLDER % INTEREST 1. CG Sunny Isles,LLC,a Florida Limited Liability Corporation 51% 3200 Stirling Rd Hollywood,FL 33021 Judah Chetrit,Manager 100% 3200 Stirling Rd Hollywood, FL 33021 2. CG Sunny Isles I,LLC,a Florida Limited Liability Corporation 20% 3200 Stirling Rd Hollywood,FL 33021 Joseph Chetrit,Manager 100% 3200 Stirling Rd Hollywood,FL 33021 3. CG Sunny Isles II,LLC,a Florida Limited Liability Corporation 29% 3200 Stirling Rd Hollywood,FL 33021 Meyer Chetrit,Manager 100% 3200 Stirling Rd Hollywood,FL 33021 TOTAL for Applicant 100% a