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Neisen Kasdin/Mallory Kauderer 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 dty board or committee; or any action, decision or recommendation of any city personnel dudng 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 en.qa.qed in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Kasdin Neisen O. NAMEOFLOBB~ST: (Last) (R~) (M.I) Gunster, Yoakley & Stewart, P.A., 2 South Biscayne Blvd., S. te. 3400, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (305) 376-6062 (_305) 376-.6010 TELEPHONE NUMBER: FAX NUMBER: (State) (Zip Code) EMAIL: I. LOBBYIST RE'rAINED BY: Mallory Kauderer NAME OF PR/NCIPAUCUENT: 3701 Chase Avenue, Miami Beach_, FL 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (7ip 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: · IDENTIPf ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP IN'FEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SPECTFZC LOBBY ISSUE: Site Plan Approval for 635- 643 JefferSon AvenUe and Related Matters Issue to be lobbied (Describe in detail): ~ AGENC/ES/INDZV~DUALS TO BE LOBBIED: A) Full Name of Individual/Title Planning Department Historic Preservation Board B) Any Financial, Familial or Professional RelaUonship None None Planning Board None DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBY[ST COlqPENSAT~ON (DZSCLOSE WHETHER HOURI FLA T RA TE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $400. O0 pez' b. ottz' B) PRINCIPAL'S DISCLOSURE (OF LOBBY[ST COMPENSATLON): (Required). $400. O0 pez' hot~z' The following information must be answered: Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": [] Yes Il/No: Are you Iobbyinq on a present or pendinq bid for goods, equipment or services, or on a present or pendinq award for qoods, equipment or service? 2) Pursuant to HJami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": aYes ~;~1~o: Are you Iobbyinq on a pendinq application for a Development Aqreement with the City or application for chanqe of zoninq map desiqnaUon or chanqe to the City's Future Land Use Hap? 3) Pursuant to Hiami 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 Ei~io: Are you representinq a not-for-profit corporation or entity without special compensation or reimbursement. . v. SZGNATURE UNDER OATH: ON OCTOBER Isz OF EACH YEAR, EACH LOBBYIST SHALL SUBf4TT TO THE cTrY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDTFURES, AS WELL AS COMPENSATION RECEZVED, IN THE C:[TY OF f4IAMI BEACH FOR THE PRECEDII~it~ CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITUJ~E~ ~(/COHPENSAT~ON DUI~NG THE REPORTING PERIOD. //~//~//. "Signature of Lobbyist ! 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 Section 2-482 of the Hiami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: LOBBYiST ZDENT~F[CAI~ON: State of Florida, County of Miami-Dade Sworn tc~ md subscribed before me / Signatu~ of~ublic Notary - St~ of Florida Notarization of Lobbyist's si ature ~,~.../~ FOR Annual Registration fee: [ ] Yes [ ] No Amount PRZNC[PAL ZDENT~F]CAT~ON: [] Produced ID Form of Identification ersonally known (Principal) I~..~' ~ t~"~ MY COMMISSION # DD 409709 II · I1,~~ EXPIRES' May 14, ~:X)9 State o~ Florida, ~unW o~ ~i~~-- ~~u~ ~ Sworn ~~r~'~fore ~ ~'-¥~ ...... -; :~'"" ' ~:~ _._ :_' _~_ ~','T" :", ,. II ~~ay of ~ ,20~ .............. Signature of ~~~ o~ Florida No~riza~on of~incipal's signa~re CLEI~I)'S. USE~ONLY ~A~/~ '~ //_~~../~ I Lobbyist Regi~afion ~rm r~eived and vedfi~ by: ~ HC~Date Paid ~ F: ~CLER~$ALL~MA~-M~Lob~i~LOBB~ ~RM 05.d~ '~ R~i~ ~2/08/~