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Carter Mcdowell / HSDC, LLC 1olI~1I!I1I9\I<II " lD - 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, derision, recommendation of the City Manager or any city board or committee; or any action, decision or recommendation of any city personnel defined in any manner in this section, 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. NAME OF LOBBYIST: MCDOWELL (Last) CARTER (First) N. (M.I.) Bilzin Sumberg Baena Price & Axelrod LLP 200 So. Biscavne Blvd. #2500. Miami. Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-2355 TELEPHONE NUMBER: 305-351-2239 FAX NUMBER: cmcdowelllaibilzin.com EMAIL: I. LOBBYIST RETAINED BY: HSDC.LLC NAME OF PRINCIPAL/CLIENT: 55 EAST SUPERIOR SL 3RD FLR.. CHICAGO. IL 60611 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 312-266-2000 TELEPHONE NUMBER: 312-266-2062 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: THEORDORE NETZKY IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE ATTACHED EXHIBIT "A" MADE PART OF THIS FORM MORE II. SPECIFIC LOBBY ISSUE: Land Use and Zoning issues associated with 315 & 321 Ocean Drive Issue to be lobbied (Describe in detail): III. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: A ,\." , .- ,. MIAMI 843032.17319010200 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLA T RATE OR OTHER): A) B) LOBBYIST DISCLOSURE: (Required) hourlv J l..f 2S" /PO PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). hourlv Yes No:X Are vou representin!! a not-for-profit cOrPoration or entity without special compensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2. Article VII. Division 5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Campaign Contributions Bv Lobbvists On Procurement Issues": Yes No:X Are yOU lobbvin!! on a present or pendin!! bid for !!oods. eQuipment or services. or on a present or pendin!! award for !!oods. eQuipment or service? 2) Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City Code Chapter 2. Article VII Division 5 thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Campaign Contributions Bv Lobbvists On Real Estate Development Issues": Yes No: X Are yOU lobbvin!! on a pend in!! application for a Development A!!reement with the City or application for chan!!e of zonin!! map desi!!nation or chan!!e to the City's Future Land Use Map? V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK 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 FILED EVEN IF THERE HAVE BEEN NO EXPENDIT OR COMPENSATION DURING THE REPORTING PERIOD. LOBBYIST IDENTIFICATION: d correct and that I have read or am familiar with the ity Code and all reporting requirements. I do solemnly swear that all of the provisions contained in Sectio Signature of Lobbyist: ~ Signature of Principal/Client: VI. PRINCIPAL IDENTIFICATION: ,2~ o Produced ID Form of Identification X Personally known (Principal) ~'-LINt:TS State ofFl",;dd, County ofMiltl'l'li Dud6 COOl< Sworn and subscribed before me This 1114 day of ~l\tlUA~'1 ,20 O~ Si~~~~UUINNS Notarization of Princi aI's si nature :"'FFTCIALS~)<i~' ~ , 1~:\,~~J~~~~~V~;~;;~~~:;~~n~1 o Produced ID Form of Identification ~ Personally known (Lobbyist) MY COMMISSION # DO 113548 EXPIRES: May 18, 2000 Bcndelj Thru Plchard Insurance Agency . _~ FOR CLERK'S U Annual Registration fee: [-fYes [] No Amount Pai Lobbyist Registration Form received and verified b Revised 02/10/04 F: CLER\ALL ONLY /"I 2-"7/ -- MCP.::R/J)/b Date Pa~"" /-&1