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Neisen Kasdin / Wyndham Int'l tdb:t roll" m """-'11 H.' )If'l ":~llI : - 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 declsion-makmg 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.!) Gunster, Yoakley & Stewart, P.A., 2 South Biscayne Blvd., Suite 3400, Miami, FL 33131-1897 BUSINESS NAME AND ADDRESS (305) 376-6062 TELEPHONE NUMBER: (Number and Street) (City) 005} 376-6010 FAX NUMBER: (State) (Zip Code) EMAIL: I. LOBBYIST RETAINED BY: Wyndham International, Inc. NAME OF PRINCIPAl/CLIENT: Wyndham International, Inc., 1950 Stemmons Freeway, Suite 6001, Dallas, TX 75207 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: . IDENTIFY ALL PERSONS HOLDING, DIREffi Y OR INDIREffi Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPEaFlC LOBBY ISSUE: Historic designation and site plan approval for Wyndham Miami Beach Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Planning Department City Managers Office Historic Preservation Board City conunission IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RA TE OR OTHER). A) LOBBYIST DISCLOSURE: (Required) Hourly, $400.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly, $400.00 per hour 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": D Yes ~No: Are YOU lobbyinG on a oresent or oendinG bid for Goods. eGuioment or services. or on a oresent or oendinG award for Goods. eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled 'Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes '9"'0: Are you lobbyinG on a oendinG aoolication for a Deyelooment AGreement with the City or aoolication for chanae of zonina ma~ desiGnation or chanGe to the City's Future Land Use M.uZ 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.. D Yes .'9""0: Are you rearesentina a not-for-orant corooration or entity without saecial comoensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1ST 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 FILED EVEN IF THERE HAVE BEEN NO EXPENDIT OR COMPENSATION DURING THE REPORTING PERIOD. lure of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions n ined in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: 511P Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: [I Produced 10 ~,'\\\\>, R08~'11111. ~~*~ .;.....W.s'o.~~ ~ "S ..~~~y P118;...~ ~ ~ "~*i>" ~ i : Produced ID - . - Form of Identificat!in f ~ ~ - . . - - . . - ~..O} t?:>:~ ~ Personally known (Principal) ~... -1ft on€\-'l' ..' ~ /-, ~ ...~~PIR&~... ~ ~ ....... ~ ~///~ 12-7.?J:JSI ~",~ ~""'IIIIIII\\\\' \~\i05 l)" H 1\.5 State ofi'leFKla; County of ~iir:Ri-!;':aee Sworn and subscribed fore me This ~day of , 200 ON;~ # [i1 '1f?9 Date Paid PRINCIPAL IDENTIFICATION: ~ I ~~~~ ~...';:.~ ~~~j ~!if 1.',," l' \~~ -'" Form of Identification '~rsonaIlY known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: FOR C :E Annual Registration fee: [ Yes [ ] No Amou Lobbyist Registration Form received and verified by: F:\CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM OS. Revised 12/08/04