Neisen O. Kasdin - 1701 Miami (Operator), LLC ti)61C6t(to 5
AdetAitL
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.
Kasdin Neisen O.
NAME OF LOBBYIST: (Last) (First) (M.I)
Akerman, LLP 1 SE 3rd AVE,25th Floor Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.982.5629 305.374.5095 neisen.kasdin @akerman.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:
1701 Miami(Operator), LLC
NAME OF PRINCIPAL/CLIENT:
#39,St. Peters House, Le Bordage, St. Peter Port,Guernsey
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
+44(7971)343-832 dt aeaoldenpeakscapital.com
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] CA—VA CAC* red
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: �'x `� b rl A -
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
1701 Collins Avenue CUP Modification
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
Planning Board,Design Review Board,Board of Adjustment,City Professional Staff and
Planning Department None ISI
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
.
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
1�-
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) 67 5.00
Hourly
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). $675.00
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✓I1o: 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes IS 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:No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO T CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENS' `*4 7 ECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILE r►, IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
/ ,.
Signature of Lobbyist
I
I do solemnly swear that all of the foregoing fag' •,r4 true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Cod:/-r 0 . !reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: / h„• „
+S »
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _r:
Produced ID .;�` •ter Produced ID
�:.� . , i' m c�G�
Form of Identification l: =;� Form of Identification
Personally known(Lobbyist) ,,, Personally known(Principal) c o-
Esc- . a� = D
nZ7� : pp4t j;13
VII. SIGNATURE AND STAMP OF NOTARY: g m o a ; - to m
cnCcn a omm
gC7yi ' O d-�(V
State of Florida, County of Miami-Dade . o g S :te of Florida, County of Miami-Dade P O
Sworn artd subscribed before me Q Q f orn acid subscrib d before me c e.
This '-1 da of,._ "A 01' ' SP, m is 2`1 day of 1 ,201 S ii., ,--,,-,-„,rn
Sig :tur, of P►f•lic Notary%ate If Floridaa----- ''ure •f Public Notary- to - of Florida
Notarization of Lobbyist's signature Notarizat'•n of Principal's si•j•.ture
TO BE COMPLE ED BYSITY CLERK'S S AFF ONLY
Annual Registration fee:1[ ]Yes[, -No Amount.Paid$ ./ MCR# �d' 'f%1 Date Paid l/�7/l S
Lobbyist Registration Form receive and verified by: �X , r• _
>,CL?:R\$ g.\., .,0IS;,9 M. f=,t AnrnW Regi5tra,ion kyaildn Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
pa°r 3 y
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax 305.673.7254
LOBBYIST NAME: Nelsen Kasdin
•
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
P P � $ y
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 of each year, shall be
automatically susp ed from lobbying until all fines are paid, unless the fine has been
appealed to the Mi.: 41.'-Dade County Commission on Ethics and Public Trust.
Signature: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
satimIIMINIIIIII■ i
•
•
•
. j
a .
-`ai
HV ILH KVIJKIl7UCL ricruwwwcz.MtPIM Ea 1tRKI LLF• •
OPERATING ACCOUNT 14621
Vendor: 896.00 City of Miami Beach
Date Description Invoice# Amount Disc Net Amt
04/23/15 Lobbyist Registration Form 350.00 350.00
Check Date Check# Gross Amt Disc Amt Net Amt
04/23/15 14621 350.00 0.00 350.00
[L1445MGN]5270735
AVILA RODRIGUEZ HERNANDEZ MENA&FERRI LLP 1 4622
OPERATING ACCOUNT
'endor: 896.00 City of Miami Beach
Date Description Invoice # Amount Disc Net Amt
04/23/15 Lobbyist Registration Form 350.00 350.00
Check Date Check# Gross Amt Disc Amt Net Amt
04/23/15 14622 350.00 0.00 350.00
[L1445MGN]5270735
•
•
•
-, " . - '' . ' • ... .• ': '',1,!'"11.-71:.5-',I _Citai;:S 04/7,,,ej201.5 00L,-,1.- 5 ': •-• '.-. ',: , , -
Miscellaneous Cash Receipt,.. ..,,, til:-.1-:::-47,J :v, It-,1 i2",,,'1"1-(', 403,8 1_,:'..$7.00,VA-'- ,--.- -, - --•=1,•:::.-,''',,'.,..; . ., :
e' e
.' CITY OF MIAIVII ElEACH ,.,, - - ..fi.,... :: :-. '.:- . : -:'. --. ' -_-i. 'r.:-.. : -',-; , ' -r: ti
. .: ..- •
::-.... . No.--::'-''_.. -.: - --.
":,,:';',''3irl'''''''''.'";.;': .'. , . . 1 '. . ■ ....■ .:‘., .,..' , ' t, 1'' . . ,...3... . Al i t)C:t7,'::::- • ' .;.:_.
, . we./...-. 1 .. # 4-16.2.1. 1,...4(.:„.:.„.6 c.,, . . ._ .:1:., e :.-,. Lit,/
, ''.::;;;;--.. i ‘• . 0 Cash 0 Credit Card .L ,t;necK g i- 1 ! .„s: , ,,' W
' ' ' " : / : .': ..':::-;4' )t-:;1 .Z[I '' '.'261-5
•- i
A i1
, 1 y)
I'S CI
Received of Av,x.CC 1
, •;.-: :-... ,--ii, P - !
Address , ((- 4A c-... ' r 1, ii) 4, J -, i: of'41 0 1,-N ''
I se: . t A ., /2c)-ti,,tt,:Lc/ ,.4.1.c,i,.,-, I r.4
,...,,, I ,,,"4.6"4„,....r - , •-
For 1 /0-1 LO I I , t''q 5 v vl (,d
-- - -- 1 ________, ,-___6____5_,___476__4,; 2,.. _ ...
J.- i 6 , 6-i .....i I , i . ...! .."
__ _______)4
(I'1 1 C,5 1 /lir,et 1',Th ! (0 tAiv'ter '1...1.i... ,
(THIS INFORMATION MUST BE COMPLETED) . .,, ; . Office of Finance Director-
'.- :: ' , .,.- : •: - -. : . By.
Account Number I —A600 '-- ii;9-
- --" - ■, ' . , . ' . 1,.. ,
' . ,F.,
''';41.;.;.,'!•,a',$.,'71;',...:,,,'.,::, .. ': 1....' . '. '■.' .':'. '' .:' '''.:. ' ' tt . fr r-tik . ' 00"-•
(
.;,-.-_7-:,,.;-,,-,::.--..,',..,' .,' . - ' - r•-i:)?„.veci 11.„ -,- ... - . ::, .,Dept' 1 / . ' '
PreParer: ‘.-' 1 ,,-4 -- 't '1'. vl • ' ' -- ' ' " ' - •' - '• - — — '
',..,,.; -;] .::.„--3,..:.s-, - :.-- : , . •.,.-,'., 1.,-. .,-,.. ',-::-.:',_-..j :. '..',.L...., , .• -,. :,'.::.,:',-:....,•••;,;',':,‘' ,'.,-.•:-,..,'.-,..4-...,_..i.:---:::.., „,,. _,.'„:,-,-,,,:.,,,,..'''''',,,,_,-,:„.:,..,.,-.-:,::,.-,n,-.:.:1-,-..!:: ,,,-.:.,,'. -,-„,,;-",-;,-,.',,,---..-.-:,•-•,' ,„;::,,,
•,,-...-.,..-,i„,•,,.-.;-.,...:::;:,_--,..,:/,,------;--.•;*:...i.,-,;,-,-;..------,-1...,„:;-..-:.-•:.--..,-..1,-i:,..-J,,,,...-1:.r,-:-..,,-.„,.....:-..-,,,,,,,,,:,44.,,,,...:,:.,„,,,,,,...„,..,...,,...„.„2,-;,-,..-.„....,,-,...„.,:,„,,„,.:„,_,.,,,..,,,,,.,,,„,,.,,,,,,, , , „ .,it, , , ,_ „. _,.., ,_
--,
. - -