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Jerry Rowland - Twenty-two Star Island LLCI MIAM-1BE H s Miami Beach Office of the City City of Mia y Clerk I) 1700 Convention Center Drive, Miami Beach, FL 33139 v 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. Rowland Jerre NAME OF LOBBYIST: (Last) (First) (M.1) 1498 NW 3rd Street, Deerfield Beach, FL 33442 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 561-901-9663 Jerru(&handcraftcorps.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: Stuart A. Miller NAME OF PRINCIPAUCLIENT: Twenty-Two Star Island LLC 700 NW 1074 Avenue Miami FL 33172 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-229-6554 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:See attached. • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, -PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to Design Review Board, Board of Adjustment, Planning Board, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 22 Star Island Drive, Miami Beach, Florida. Issue to be lobbied(Describe in detail): Ill. 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 Planning, Building and Public Works staff None. PB, DRB, BOA, City Commission, and Land Use None. Development Committee, as necessary Pursuant to City Code Section 2-482(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 city commissioner or city 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 None- IVone- C:\Users\clerhatlW PP Data\Local\Microsoft\Windows\Tem ora rY Internet Files\Content.Outlook\83LGQDDH\Lobb ist Registration Formrevised 5-30-2012.doc OR3 i IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): , /hour­7 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 XNo: Are you lobb 8nng on a present or ending bid for goods.eauipment or se rvices.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)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: QU FEBRUAIJY 28 OF EACH YEAR, EACH C OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPEN EIYE12, IN THE CITY OE MIAMI BEACH EM THE PRECEDING SHALL EXPENDITURES OR COMPENSATIOU DURING THE REPORTIbIG PERIOD. Signature of Lobbyist 1 do solemnly swear that all of the foregoing facts are true and correct and Vhave r am fami liar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requiremen Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATIO : PRINCIPAL IDENTIFICATION: LProduced ID ;••?o`er `e��;. BETTY LLEREdA-__Pro ced ID Form of Identification .; .? Notary Public-State of Flor Form of Identification �, r= My Comm.Expires Mar S 018 %�' •'• Commission s FF 0 Personally known(Lobbyist) er nally known(Principal) VII. SIGNATURE AND STAMP OF NOTAR R.MUELLER z;r4 State of Florida, Count of Miami-Dade State of Florida, County of Miami-Dade MY COMMISSION#FF052706 Y Sworn t a d subscribed before me EXPIRES:SEP 25,2017 wor ubscrib d before This day of , 2014 Bonded through 1st State Insu a his �ay of• Gov , 2014 • . OV Sig atu bill otary— tate of Florida Si atur of Public Notary—State of Florida Notarizatio f ignature tari ation of Principal's signature TO BE COMPLET ITY CLERK'S S FF N Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Pa' Lobbyist Registration Form received and verified by: i I AIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@rniamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Jerm Rowland 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 suspe from lobbying until all fines are paid, unless the fine has been appealed to the Mi ade County Commission on Ethics and Public Trust. f� �s y Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc I DISCLOSURE OF INTEREST Twenty Two Star Island, LLC 700 NW 107th Avenue Miami, FL 33172 100% SM Alpha LLP 700 NW 107th Avenue Miami, FL 33172 98 % Stuart A. Miller 2010 Family Irrevocable Trust 700 NW 107th Avenue Miami, FL 33172 1% S. M. Stuart Miller Irrevocable Trust 700 NW 107th Avenue Miami, FL 33172 1% SM Alpha, LLC (owned 100% by Stuart A. Miller) 700 NW 107th Avenue Miami, FL 33172 PPC i As CL Zf 0 > c� i Aj c, Vl, _ m } Z�D4 17t —Ca AD _ s