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Boni Real Estate, LLCCity of Miami Beach Office of the OW Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Email: dtyclerk@ci.miami-beach.fl.us LOBBYIST REGISTRATION FORM (City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) r~ Check Box if an Amendment ROSEN HAROLD NAME OF LOBBYIST: (Last) (First) (M.I) DATE QUALIFIED AS LOBBYI~-I' 407 Lincoln Road, Penthouse S.E. Miami Beach, FIorida 33139 BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code) (305) 534-4757 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Z. LOBBYXST RETAZNED BY: Boni Real Estate, LLC. NAME OF PRZN~PALJCLIENT: 530 Ocean Drive, Miami Beach, Florida 33140 BUSINESS ADDRESS: (Number and Street) (C!ty) (State) (Zip Code) (305) 761-1353 EMAIL: (Optional) TELEPHONE NUMBER: FAX NUMBER: (Optional) Fill out this section if pHndpal is a Corporation, Partnership or Trust [Section 2-482 (c)] · NAME OF CHIEF OFfiCER, PARTNER, OR BENEFICIARY: Saba Nissan * LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SPECIFIC LOBBY ISSUE: Request permission to demolish and modify the courtyard Issue to be lobbied (Describe in detail): IIX. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Relationship Historic Preservation Board [V. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBYZST COMPENSATZON (Dt'SCLOSE WHETHER HOUR£ ~ FLAT RATE OR OTHER~ A) LOBBYIST DISCLOSURE: $450.00 an hour B) PRINC]PAL~ DISCLOSURE (OF LOBBYIST COMPENSA'r[ON): $450.00 an hour l) 2) Pursuant to Ordinance No. 2OO3-3393 Amendina Miami Beach City Code Chaoter 2. Article V~T, Division Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled 'Prohibited Camoaien Contributions By Lobbyists On Procurement Issues": Are you Iobbvinq on a present or oendina bid for aoods, eeuioment or services, or on a present or aendin- award for aoods, eauiDment or service? O Yes n No Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach CiW Code Chaoter 2. Article VII Division 5 thereof Entitled 'Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaian Contributions By Lobbyists On Real Estate DeveloDment Issues": Are you Iobbvina on a oendina aoolicetion for a Develooment Aereement with the CRv or aoolication for chan,e of zonina mad desianation or chanqe to the City's Future Land Use MaD? nYes B No V. SZGNATURE UNDER OATH: ON OCTOBER ].~r OF EACH YEAR, EACH LOBBYIST SHALL SUBMTr TO THE CTrY CLERK A SIGNED ,STATEMENT UNDER OATH, LTSTiNG LOBBY'LNG EXPENDTTURES TN THE C~i'Y OF M~AMZ BEACH FOR THE PRECEDZNG CALENDAR YEAR. ! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am familiar with the provisions contained in Se~-'tion 2-482 of the Miami Beach City Code as amended, and all reporting requirements. Signature of Lobbyist: SignatureofPrincipal/Client: /~JJ'~ _~ / ~////.//~/~ -- ~)~ ~1%¢ , ~._~ ,.D. £~',~'~.'JI- Iytc~rto ~4.0 ~ - .... ;,,,,,,,..;.- ~ Produced :~D /~ !1-~' "'~'"'"*'"~'~""~.! ar4rersonallv Known ' Form or :aenaticati~. ~; ViZ. SZGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: State of Florida, County of Miami-Dade Sworn to and subscribed before me This ~ day of ~ 2003. Sig Pri: Registration: ~ ,[ If rejected, state reason: / Registration fee paid: ~c-,~¥es [ ] No DATA ENTRY DATE: ~-/.~ O[ 2nd Revision 3/[8/03 FOR CLERK'S USE ONLY ] RE3EL,, bD DATE: i]Cash [ ]Check MCR#~--~ ~/'0',~ ~ 2003 ENTERED BY: ~ ~ F:\CL~HATL\LobbyistsVegistrationa03.doc