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Neisen Kasdin - Quadrum Miami Beach, LLC iii9z5 ca t \fiels e Mi AM I BEACH 2Gf6 JAN —7 f - 4e 08 City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 CITY CL.' OFFICE' 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 3 Ave Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305.982.5629 305.374.5095 neisen.kasdin a 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: QUADRUM MIAMI BEACH,LLC NAME OF PRINCIPAUCLIENT: QUADRUM MIAMI BEACH,LLC 407 LINCOLN ROAD,SUITE 304.MIAMI BEACH,FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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: 50 04401°1 t91(%4 • IDENTIFY ALL PERSONS HOLDING.DIRECTLY OR INDIRECTLY.A 5%OR MORE OWNERSHIP I ITEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: lI.SPECIFIC.LOBBY_ISSUE: _ Approvafs'related to the property located"at 1825 Collins Avenue,including items related to the hotel,cabanas,landscaping,food truck and other approvals for the property.r Issue to be lobbied(Describe in detail): ui.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 eneral 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 MEMBERS OF PLANNING DEPARTMENTAND PLANNING BOARIP NONE i I x MEMBERS OF HISTORIC PRESERVATION BOARD&NEIGHBORHOOD COMMUNITY AFFAIRS/NONE x I MEMBERS OF CITY COMMMISSION AND LUDC I NONE I I x I 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\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc , IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) ti6R0 CD LAW B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $690.00/hour (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 7es": _Yes_No: 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�_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 91;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 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 FILE i, EN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyi• I do solemnly swear that all of the foregoing fact- e 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 i:1 II reporting requirements. ii, , I Signature of Lobbyist: Signature of Principal/Client: — 9 P VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o H cn i______Produced ID Produced ID W o N . z Form of Identification °`•' Form of Identification - 7 ifil•P•rsonally known(Lobbyist) r� Personally known(Principal) a° W = a E VII. SIGNATURE AND STAMP OF NOTARY 4 C = c-)EE IS A State of Florida,County of Miami-Dade M 10 State of Florida,County of Miami-Da z i A Sworn a,d subscri.,-•,•,.: ere me "wo subsc fore me tfe&I oy�c ro' ; This _Y�_ day of !; !!�_ !_ ,201 " •ay ofd ,201 �_be 1 0 7 .: . ti:!*Thel Signature\T:f P`l'c Notary—State of Florida Signatu . Pu•-"Notary—State of Florida • °j"'" Notarization ,obb fist's signature Notarization of Principal's,signature TO BE COMPLETED BY CITY CLERK'S STAF O LY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid I I YI[! Lobbyist Registration Form receive and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FO MS\Lobbyist Annual Regis a a rm.doc Revi . 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MIAMIBEACH 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:305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Neisen 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 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 suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-i1 :-de County Commission on Ethics and Public Trust. 12- 23 -2-0 �5 Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc --.-Mitte-Ilaiieoliitaii-iteeeiiit-.: : -'::5.-7.,-r-11--"=.,:) .-'--,'''':,:c617-','"?'-!--_7-...( -1 :-/ -.1:-!Pi.•::-.r! ::s;::: - - ' - -- --:=-. •--Receipt -:---CIT1r OF MIAMI_BEACH :_-'. - ,,-,-- -. :- -"-,,-,' - - , ',. -:,-,' .....,..,-,-:-::: :,- 1-.'- .-:-: , '--. - - :- ,:e- --., -,,'• -- ------,i-, - ',.:. :---.:-..--. :: ' - ,- .- - ,-.-, '.. 7-".'''',,:•;',-; .--.-': ,:.,..--•....: --,-- :'' . ' ". -,:::: - 1. -)00‘ 7y --a5- -•-•':::;---,-',' :--- No.:,04,,..u*,..-0.3-.-0,.:-.,.,,,,, ) • ::: :-.---,,,:;:_4,4,i-i-4,,-,,,,,.11-i:,-,...-'•::--,-..:---.. : --•_-_, , - _ : : ,_ . _.:. .; __ -:--_, ..- -,,. . -• 5-',•''.-' '-. 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DIVISION OF CORPORATIONS $sinkz. 4'46 Detail by Entity Name Florida Limited Liability Company QUADRUM MIAMI BEACH, LLC Filing Information Document Number L11000035717 FEI/EIN Number NONE Date Filed 03/24/2011 State FL Status ACTIVE Last Event LC AMENDMENT Event Date Filed 10/13/2015 Event Effective Date NONE Principal Address 407 LINCOLN ROAD SUITE 304 MIAMI BEACH, FL 33139 Changed: 10/13/2015 Mailing Address 407 LINCOLN ROAD SUITE 304 MIAMI BEACH, FL 33139 Changed: 10/13/2015 Registered Agent Name &Address SCHUMER, SETH 407 LINCOLN ROAD SUITE 304 MIAMI BEACH, FL 33139 Name Changed: 10/13/2015 Address Changed: 10/13/2015 Authorized Person(s) Detail Name & Address Title MGR http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/7/2016 - Detail by Entity Name Page 2 of 2 MIAMI BEACH NAUTILUS LP 407 LINCOLN ROAD SUITE 304 MIAMI BEACH, FL 33139 Annual Reports Report Year Filed Date 2013 04/29/2013 2014 04/30/2014 2015 04/23/2015 Document Images 10/13/2015 -- LC Amendment View image in PDF format 04/23/2015 --ANNUAL REPORT View image in PDF format 10/06/2014 -- LC Name Change View image in PDF format 04/30/2014 ANNUAL REPORT View image in PDF format 04/29/2013 -- ANNUAL REPORT View image in PDF format 04/29/2012 --ANNUAL REPORT View image in PDF format 04/08/2011 -- LC Amendment View image in PDF format 03/24/2011 -- Florida Limited Liability View image in PDF format Y rf„ k i `aye Cope OI?va�Rd n k P Y V . h State of�Florida Cie Mrr§q of Scate wit r-. L-. „r. A,,,..:1>r>�,:.x.��_a��wa,�r._ava-,..,.zx.�..a+:�cea'. ,c..osxa. `' W: http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/7/2016 Camm, Patrick From: erin.sutherland @akerman.com Sent: Friday, January 15, 2016 3:27 PM To: Camm, Patrick Subject: RE: Lobbyist Registration Forms- Nautilis Hi Patrick- Thanks! The Chief officer is Seth Schumer, and no one holds 5%or more ownership. Erin 1.Sutherland Land Use&Zoning Coordinator Akerman LLP I One Southeast Third Avenue I Suite 2500 I Miami,FL 33131-1714 Dir:305.755.5853 I Main:305.374.5600 I Fax:305.374.5095 erin.sutherland @akerman.com From: Camm, Patrick [mailto:PatrickCamm@miamibeachfl.gov] Sent: Friday, January 15, 2016 2:32 PM To: Sutherland, Erin (Mia) Subject: RE: Lobbyist Registration Forms- Nautilis Good afternoon Erin, I have received the updated forms and processed the checks. Do you have the Principal Ownership information in Section 2-482(c) on the first page? Regards, Patrick From: erin.sutherlandOakerman.com [mailto:erin.sutherland©akerman.com] Sent: Friday, January 15, 2016 11:45 AM To: Camm, Patrick Cc: marissa.amuiak akerman.com Subject: Lobbyist Registration Forms- Nautilis Hi Patrick, Last week I spoke with Jason Salvatore regarding lobbyist registration forms for Marissa Amuial and Neisen Kasdin. We needed to swap out the signature page with the originals. Marissa, copied within this email,will be arriving at the City before 2 pm to swap out those two pages.We've already paid for the lobbyist registration fees. Thanks! Erin Erin 1.Sutherland Land Use&Zoning Coordinator Akerman LLP I One Southeast Third Avenue I Suite 2500 I Miami,FL 33131-1714 Dir:305.755.5853 I Main:305.374.5600 I Fax:305.374.5095 erin.sutherland @akerman.com 1