Alyssa Kriplen Greystone Terra Firma, LLC ® f
MIAMI BE
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.
Kriplen Alyssa
NAME OF LOBBYIST: (Last) (First) (M.l)
Shulman and Associates 100 NE 38th Street, Space 2, Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-9216 (305)374-9217
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
1. LOBBYIST RETAINED BY:
Greystone Terra Firma, LLC
NAME OF PRINCIPAUCLIENT:
The Greystone Hotel c/o Trans Inns Management 31525 W. 12 Mile Road, Farmington Hills, MI 48334
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)438-0609 (305)438-0110 james.vosotas@transinss.com
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
C-) N
O
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:Laszlo Fazekas
C3
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN S EH CORPORATION,
PARTNERSHIP OR TRUST:Laszlo Fazekas - -i i
:'<
II.SPECIFIC LOBBY ISSUE: -
Development Approvals and Permitting Issues,including,but not limited to variance from the Board of Adjustment,floodplain va�ian(wHist r c
Preservation Board,and Planning Board approvals for the Greystone Hotel at 1920 Collins Ave., Miami Beach,FL CA
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 NO
title of person to be lobbied
Tanning Department and Building Department Staff None
B, HPB, BOA, City Commission, as necessary* None
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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$ /V0
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):A/0
(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":
Yes X No: Are you lobbying on a present or pending bid for goods,equipment or services.or on a present or pending
award for aoods.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 chanae 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 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 EXPEbIDIJURE,9. Ali E.LL^A QMEgbl5AIIQN RECEIME12, IN THE CITY OF MIAMI BEACH
FOR THE PRECEDING CALENDAR
EXPENDITURES OR C
Sign t e of byist
I do solemnly swear that all he foregoing facts are true and co ct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia ach City Code and all reporting req irements.
Signature of Lobbyist:
Signature of Principal/Clie 4_
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID m
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known cipal)VII.
SIGNATURE AND STAMP OF N / ¢ c Y
• CRISTINA D.GOMZALEZ M'c n 1 4✓� 0,RKIa S
State of Florida County of Miami-Dade {' lo"�'OMMISSION#DD 360888 State of.�larid County of Miami-Dade
FXS,IRES:March 23,2014 Sworn an subscribed of re me }
Sworn to and subscribed before me F dmvoea Thru Notary Public Underwrite a
This �r'D day of vcio ,2012 `; � --- y
,�;. This a da of S
Signature of Public Notary&State&f Flo r&a 9ktRattif,44 Public Notary—S e o lorida
8 C5
Notarization of Lobbyist's signature Notar' tion of Principal's sig uke Q
/,Yes TO BE COMPLETED CITY CLERK'S STAFF ON
Annual Re istration fee: No Amount Paid$ �^ MCR# 31 P2 d Date Fail
Lobbyist Registration Form received and verified by:
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MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfi.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAN H: Alyssa Kriplen
I understand that no later than February 28th ®f 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
automaticall suspended from lobbying until all fines are paid, unless the fine has been
appealed t th Miami-Dade County Commission on Ethics and Public Trust.
11) o2,
Signature Date:
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