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Robert L. Switkes - Z Capital Florida Resort, LLC 6(6°\ trA MIAMIBEACH Pe City of Miami Beach Office of the City Clerk 2016 JUL 1 9 rd;-i PCB' 'Li 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. Switkes Robert L. NAME OF LOBBYIST: (Last) (First) (M.I) Robert L.Switkes&Associates, P.A. 407 Lincoln Road, Suite PH SE, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)534-4757 (305)538-5504 RSwitkes @SwitkesLaw.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: Z Capital Florida Resort, LLC NAME OF PRINCIPAL/CLIENT: The Carillon Hotel, 6801 Collins Avenue, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (847) 235-8100 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: SAC- W44111 II.SPECIFIC LOBBY ISSUE: Certificates of Appropriateness partial demolition and public space design and\ariancesfor area setbacks,accessory structure construction,and signage,and all other land use,zoning, development,and licensing matters related to the property commonly known as76801 Collins Avenue.P 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 City Attorney and his staff Planning Director and his staff 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 D li,(/ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) /i/dKr /�, 350 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): -35o/ (Required). //owe)V /1' 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 El 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 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 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 13 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 EXPENDITURES, AS WELL AS COMPENSATIO CEIVED, IN THE CITY OF MIAMI BEACH FOR • THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN4 THERE H: :- N NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Air III Signa ure of Lobbyist I do solemnly swear that all of the foregoin., . s . e rue-an• correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach Ci .de a all reporti.. ec,,irements. Signature of Lobbyist: �����IIIIIII►�i Signature of Principal/Client-- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID sr co.5 El Produced ID E Form of Identification o o Form of Identification LA i , as N �9 y IN. Personally known(Lobbyist) - ErPersonally known(Principal) m m c0 65 = ¢zed VII. SIGNATURE AND STAMP OF NOTARY: g o a e s Q E State of Florida, County of Miami-Dade # ' State of Florida, County of Miami-Dade Sworn to an subscribed before me ��>° e% Sworn and subscribed before me S This ._y of 201{, r ;'.. )1-his I . . 5f jl1Ly , 201 ,-, , 4 g , -,‘Signa ure o—u. ' otary–State of Florida Signature of Pubic ,,Mary–State of Florida -:/:,;qt' Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF NLY Annual Registration fee:rMI e Yes[ ]No Amount Paid$ (7 MCR# ►{]0_i8 F{iO 71,1 Date Paid 9`I-19/o7-�i Lobbyist Registration Fo received and verified by: lb It, F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration orm.doc Revised 1/11/2011 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 Robert L. Switkes, Esq. LOBBYIST NAME: I understand that no later than February 28th 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, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. 2 /4 ` Signature: bate:bate: . • . .:. „ - Miscellaneous Cash-Receipt . . .. . .CITY OF MIAMI BEACH • • . • . . . . .. '4 1 0754 . ..., . • • . , No. . . cz, - , • . . , . .. •-:;,- . ik -,,-. ,. • . .--:-', -,.- • 0 Cash 0 Credit Card Check# —7 03,,;.. . $ • .._3 )0 . u---, ,• i ,.. . 0-7 I c( 201b City of MianagROAred of Ckoo.C4*. L. <3\14k3 • ••, MiscellaneouAddrA520161 C)1 L..,,--\ c t,5 14 0 ,.\„ c.,,,,,,:._ I 1.4 s 6 , AA e 0.... • ., 000320-0029 Jenel FA. 07)19/2016 10:23AM • - . ... MCR OPENF°r t . Payment Amount: 350.00 :-.. MCR410754 • • • - (THIS INFORMATION MUST BE COMPLETED) _ .._ V Office of Finance Director . • . . , By ,.. Account Number: ti) J- (-)C)0 Q ' -3 6cit 14 LI°- 0-C). 3 )- -3 6 r -b 0 -0 c. - t'0- ., . •• ___JA-sc,A.1 - ...-- ,. . , --.. •,-,,.., • Preparers .)41..—k-r<M.( Dept: N..._ C__ DM 71-/ II . . ., • . -' • . .'. r • ■ , . • . ■ • . 'r , . . r • • . , I! ''• '''' -D --.! t., I, it if i . [ „ .-„,-- .. :.-,..:7, Ili 1' _. ,- ,.... E;;. M ;17 il vt irl l' --=---- .7.-.1 F-; 7=7 C7 -. .7- .= "7 ,■ 7........ -72. 0'. 'I ' 7 i.- [ t-,--__.= ---, ,---, cr, •- :-.7--; c_ c., CD -, ▪ Fli F-:•-; o `,:: ,--, . . :: , I :; I ! .."....,--.....7— ..—.,-2 ■J•■••• ,J Tr.7<1. -(.. L'' -C: •.- ..7.,'■ y 1 ._-:-7---_ . ______ I gt. .1 i -----.7.-.th--- : , •-=-", r`,""-:' — a: 7- 1 `', 1! 1 -- --...._ • -__ "•.' :.•.t c--) N,...s 7:3 I =—• . . _1 -. f 1 1 ' . . • . , ; ,... '...... _7,_. .. .. S w, -_ ::-- , -.=, ' • ,....., ; (-..... .:,...., , •, 1 Miscellaneous Cash Receipt CITY OF MIAMI BEACH • . No. f In Cash ❑Credit Card Check# 9591 $_ S ' ne 0� . . _ . 20 .1 b City of MianR8GOOKed of ow.Lc,'C Ski i i icEs MiscellaneoLAda8S5 204O1 (..F 13C, lz-A) ),b S`E 17" 6 /A , t. {37 2 000360-0064 Jenel F}.. 07/29/2016 01:5 PM NCR OPENFor / f-1,-)OtkiiC_ (C.9 7.5 45 ) Payment Amount: 500.00 410780 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By Account Number: Oil o�,:x. `j . 3L`) LiWt," oo- 30`7 - 36S . cxa- Oc?-oo s Pre arer•. 4 P,1 ski.i=fir'-( Dept C•� • EXf: —I L I I • . P • - i Cu om Y T c v = , x a a: n m 20 I..r r, & t I ,__-=.---- )1 a air a Q _ f n c ii;- f T- _ O n asTro rr, c �c J r I !Dili a :.---'-=- � c,.r ^ m n z CD T :4 1• 1.i: ,{ O CD z C C =• ' J —I, i - - :1 v CaSG C70 71 -' . CD C al n r G I w •' S 7. C c....1 O = d. F 13 ti CZ. ,--1- � � M. ' •`" -z 9y • r'. 5y� Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • Name of Chief Officer, Partner, or Beneficiary: Thomas P. Wicky, Manager James J. Zenni, Jr., Manager Andrei Scrivens, Manager Neal Nath, Manager Matthew Kane, Manager • Identify All Persons holding, directly or indirectly, a 5% or more ownership interest in such corporation, partnership, or trust: James J. Zenni. Jr.