Alexander Tachmes/Ocean-Fairwind LLC^IA,!,°,'BEACH
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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Tachmes Alexander I.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Shutts & Bowen LLP 1500 Miami Center, 201 S. Biscayne Blvd. , Miami, Florida 33131
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(305) 347-7341 (305) 347-7754 atachmes@shutts.com
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
Ocean-Fairwind LLC
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
605 Lincoln Road #320 Miami Beach FL 33139
TELEPHONE NUMBER- FAX NUMBER. (Optional) EMAIL: (Optional)
(305) 777-7373 (305) 777-7389
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Clalre Callen, Manager
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See attached
ll. SPECIFIC LOBBY IssuE: Fairwind Hotel -Flood Plain Management Board Elevation Waiver
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) FuII Name of Individual/Title B) Any Financial, Familial or Professional Relationship
City Administration
Cit Attorne 's Office None
Mayor and City Commission
Cit 's Boards and Committees None
To the Extent Permissible
MIADOCS 2167094 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) X400 00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) $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":
^ Yes ~ No' Are you lobbvinq 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 ~ No• Are you lobbvinq 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 Maps
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 snot-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 ~ No: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 15` 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 EXPENDITURES OR COMPENSATION DURING THE REPOI~fiMIG PERIOD. ,-.
Signature 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 contained in Sects-482 of the Miami-;~s.~ch City Code and all reporting requirements.
Signature of Lobbyist: "
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Signature of Principal/Client:: ~ ~
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VI . LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: '~ "
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Produced ID a ~ Produced ID = ~ w
Form of Identification „~~ ~ Form of Identification ~ ~
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Personally known (Lobbyist) ~.~_ ~ ~ ~ Personally known (Principal)
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VII SIGNATURE AND STAMP OF NOTARY: ~ ~' ~.`~ v a:~ LL
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ICY ~ .'7 0 y `~o,~, .~P
State of Florida, County of Miami-Dade ~ ~ moo o State of Florida, County of Miami-Dade * 5
Sworn to and subscribed before me ~ ~ b Q' '~ Sworn to and subscribed before me
This /`f'`~` day of ~.e.. , 20~ ;Z ~' ~ ~ o This / ~'L~ day of ~~vt~~ , 20 O 7
tV OD ~
Signature of ublic Notar -State of Florida Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature ~~ Notarization of Principal's signature
F ERK'S USE O
Annual Registration fee: `[ es [ ] No Amount d MCR # ~ I' Date Paid C~
Lobbyist Registration Form received and verified b
Revised 12!08/04
MIADOCS 2167094 1
OCEAN-FAIRWIND LLC
DISCLOSURE OF INTEREST
Member Name, Address & Office
Oceanside Resorts, Inc.
605 Lincoln Road, #320
Miami Beach, FL 33139
Disclosure of Interest for Oceanside Resorts, Inc.
Name, Address & Office
David Callen
8870 North Himes Avenue, #242
Tampa, Florida 33614
Robinson Callen Trust A
PO Box 403367
Miami Beach, Florida 33140
Beneficiaries: Claire Callen
c/o Oceanside Resorts Inc.
605 Lincoln Rd, #320
Miami Beach, FL 33139
Lana Callen
865 North Shore Drive
Miami Beach, FL 33141
Robin Callen
1507 West River Lane
Tampa, FL 33603
Casper R. Callen Trust
618 East Broughton
Savannah, GA 31401
Beneficiaries: Andre Callen
c/o HI Development Corp.
1 1 1 West Fortune Street
Tampa, FL 33602
Sean Callen
c/o HI Development PR
1004 RH Todd Avenue, 3'd FL
San Juan, PR 00907
Ian Callen
c/o HI Development Corp.
1004 RH Todd Avenue,
San Juan, PR 00907
Dorian Callen
PO Box 2669
Winter Haven, FL 33880
Desiree Callen O'Neill
425 Lake Ned Road
Winter Haven, FL 33884
of Ownership
100%
of Ownership
8%
46%
33.3%
33.3%
33.3%
46%
14.29%
14.29%
14.29%
14.29%
14.29%
Tarquin Callen 14.29%
c/o Callen Trust
PO Box 8747
Savannah, GA 31412
Justine Callen Bohannon 14.29%
P O Box 7142
Winter Haven, FL 33883