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Carter McDowell/Miami Beach Marina Associates Ltd ~s 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 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. (First) N. (M.I) NAME OF LOBBYIST: McDowell (Last) Carter Bilzin Sumberq - 200 South Biscavne Boulevard. Suite 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: cmcdowell@bilzin.com EMAIL: I. LOBBYIST RETAINED BY: Miami Beach Marina Associates Ltd. NAME OF PRINCIPAL/CLIENT: 300 Alton Road. Suite 303. Miami Beach. FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305/672-5588 TELEPHONE NUMBER: 305/673-5995 FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)) i · NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ,i' . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Development Review Board - entrance renovation Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of IndividuallTitle B) Any Financial, Familial or Professional Relationship Development Review Board and staff None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) Hourly $455.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly $455.00 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 [R]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 [R]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 [R]No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1st OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNE STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMP SATION RECEIVED, IN H CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SH BE FILE VEN IF H HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING P Signature of LobByist I do solemnly swear that all of the foregoing facts are true contained in Section 2-482 of the Mia' ach Ci Code d correct and that I have read or am familiar with the provisions all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: :I' Produced ID :J:roduced ID Form of Identification Personally known (Principal) c.o'/anOO 269'\1& sa~~ '01' 00 ""\1 ". ~ c,o<f't'lI\~ '20. '2"" I ~. . ~ "O'Ielf\'o8l . ~I ~~{e' State of Florida, County of Miam~~ ~~drr~~~~ Signature of Public Notary - State of Florida Notarization of Principal's signature ature of Public Notary - State of Florida No arization of Lobbyist's signature FOR CLERK'S USE ONLY Annual Registration fee: [ es [ ] No Amount Paid -25.00 MCR #~ Lobbyist Registration Form received and verified by; ~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM"US".doc' . Date Paid c2Jcpf Ol() I Revised 12/08/04 [AMI ]21 c - I?UC\..~ e~ ~ IrA "" l# (OlD CITY OF MAIMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of the application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which disclosed the identity of the individual9s) (natural persons) having the ultimate ownership interest in the entity).* Miami Beach Marina Associates. Ltd. a Florida limited liability company CORPORATION NAME NAME, ADDRESS,AND OFFICE % OF STOCK SaSe Marina, Inc.. General Partner fowned by Robert W. Christoph. individually - 100%1 1% 99% Christoph Family Trust. Limited Partner [beneficiaries Hunter Christoph and Robert Christoph, Jr.1 ftrustees - Robert W. Christoph and Carter McDowel1l % OF STOCK IF THERE ARE ADDITIONAL CORPORA nONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 \73190\11125\ # 326303 v 1 M1AMI1210612.17333925844 8