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Matthew Amster - 2156 Sunset Lake, LLC pi City CfMiami Beach OffiCe [fthe City Clerk � 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or no\, by principal who seeks to encourage the pnnooge, defeat or modification of any ordinance, naao|ution, action or decision of any commissioner; any octinn, deoioion, 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 pm000a on such oc\ion, decision or recommendation that fonaoeaab|ywiU be heard or reviewed by the city commission, or m city board or committee. The harm specifically includes the principal as well as any employee engaged in lobbying activities. The tmnn "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.1) Bercow R d ll & Fernandez, PA 2OO South Bi000 Blvd., Suite 850 Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 (305) 377-6222 mamster�D_brzgain TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office/f your contact information changes: address, phone, ore-mail address. /. LOBBYIST RETAINED BY: 2156 Sunset Lake, LLC NAME OF PRINCIPAL/CLIENT: 215O Sunset Lake, LLC O4O Fifth Avenue, 20th Floor New York New York 10018 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) O88255O 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.- Jeffrey Altman IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: JeffreyAltman 100% x.SPECIFIC LOBBY ISSUE: Developmental Board Approvals d Permitting Issues for 2156 N. Bay Road, Miami Beach, FL 33139 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 |nature of the Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Commission, Planning Staff, Building Staff, None Development Boards X11 Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,fa--miflialfor profdl�sional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or-dity personnel-who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial, Familial or Professional Relationship F:\CLEK\$ALL\uFOKMS\LOBBY|STFORMS\Lobbyist Registration Form.duc kA �� x ^ " "^�y~� IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$400.00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required)._1!100.00_ 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: AM you lobbying on a pCesgrit r pending bid for goods,eguipment or§2rvices,or on a present pending awaro for goods,eguipment 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 chancie of zoning map designation or chance to thrCity'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 cleric as required by this section but, shall not be required to pay any registration fees. Yes XNo: 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 LQBBYING EXPENDITURES AS WELL AS COMPEN§ATION RECEIVED IN THE CITY QF MIAMI BEACH Eft, THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR,CQMPENSATION DURING THE REPORTING PERT 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 a ortin 'Signature of Lobbyist: Signature of Principal/Client: t� VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: �o �z�«M Produced ID _ Produced ID �`-' o a 4 Vol Form of Identification Form of Identification � Z m uJ .r= ers Lobbyist ersonaCly known .y 7 U F (Principal)VII. fio`'a..`' t CRISTINA DIANA GONZALEZ SIGNATURE AND STAMP OF r NOTARY: °i MY COMMISSION#FF083128 `•'Z'oFd!•'r EXPIRES March 23,2018 State of Florida, County of i6m*-hem FtoridallotaryService.com State of Fte4da, County of h44R+-9ede v Sworn to and subscribed before me Sworn and subscribed before me This 3 - day of{,loA�-doe... , 2014 This 3 day of��mW , 2014 r Signature of Public Nota Stat of Flo i a Signature of Public otary—State of FJQida NQ,w�rk� Notarization of L9bbyist's signature Notarization of Principal's signature I()RE-CAaQpl FIED BY CITY Cl FRK'S SIAEEONLY Annual Registration fee: ( ]Yes[ ]No 'Amount Paid$ SD MCR# r ��� 9 Date Paid l , Lobbyist Registration Form received and verified by: IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$400.00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $400.00 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 pending bid for goods,eauiament or services.or on a present or pendina award for goods.eauiament 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 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 XNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: I 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 FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. 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 requirements. Signature of Lobbyist: Signature of Principal/Client: .; -S' t � VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: 3 c o o?��a Produced ID Produced ID o - Form of Identification Form of Identification L_U z c Personally known (Lobbyist) ersona y known Z _E (Principal)VII. SIGNATURE AND STAMP OF © a 1 z NOTARY: 5 o ' State of Florida, County of Miami-Dade State of F49 da, County of Waw4-9-ede Sworn to and subscribed before me Sworn and subscribed before me This day of 2014 This 3� day of►AogemW , 2014 NA�� All Signature of Public Notary—State of Florida Signature of Public otary—State ofFJodda $ Notarization of Lobbyist's signature Notarization of Principal's signature ' /�C Annual Registration fee: [ ]Yes[ ]No Amount Paid$ � M C R# (/✓ Date Paid Lobbyist Registration Form received and verified by: A City of Miami Beach, 1700 Convcmfion Center Dive, N/Iiaari Ft-ach,floricia 33139, www.nJamfibead-iflgsly (,-.,Tfy 0(lice 0tyC1erk@)i-da mibea ch 11,gov Tel: 10 5 0 7 3.7 4 11 , F a x: 3 0 5.6 7 3.7 2 S4 LO B 13 Y IS 'F N A M E: Matthew Amster I understand that no later than February 28th of each year, I must file the following forni, purl-LLant to Section 2485 of the Miami Reach City Code, vvitl-i the City Clerk's Office f-bi- all active lobbying issues. 1.) Lobbyist F"xpenditure 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 a d d itio n, once. an issue I have registered to lobby on has been resolved, I am required to im in e d is to ly notify the C ity C lerk's 0 ffice o f lob b vist w ithd ra w a I in w riting, Pursuant to Section 2 -4 8 5 (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 2485 . 1 , a fine of $50.00 a day shall be assessed for all Statement(s) Filed afterthe due date. 'I'lie 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 a fter notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically suspended fi-oi-n lobbying until all fines are paid, unless die fte has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. Signature: Date: FORMS\Lobbyist Registration Forrn.doc N - 1 = LL k-� V--C S15 zip � n LA ` LU i IL CL - o 'L - z fln as rm