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Alfredo Gonzalez/JHMB, LLCnr~; e~~n pus ~- 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. Gonzalez Alfredo J NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig 1221 Brickell Avenue, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0588 305-961-5588 gonzalezaj@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: JHMB, LLC NAME OF PRINCIPAL/CLIENT: James Hotel, 100 21 Street Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) 212-342-7300 212-342-7342 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: Igor Kmajski • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Same as above TI. SPECIFIC LOBBY ISSUE: Approval of Hotel Expansion Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship Planning Department /City Commission HPB Approvals ZBA IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $345.00 Hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $345.00 Hourly 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 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": oyes ~ No: Are you lobbying on a Dendina 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 Man? 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 anot-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 [y~No• Are you representing snot-for-~rofit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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 PRECE ING CALE DAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX~ENDI~RbS pR~~MPENSATION DURING THE REPORTING PERIOD. // , /// i / /I of I do solemnly swear that all of the familiar with the provisions contain requirements. ` Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ~~~ Produced ID Form of Identification o~.,~~ Personally known (Lobbyist) ?~ VII. SIGNATURE AND STAMP OF NOTARY: ~a.o`~ , State of Florida, County of Miami-Dade "',~ ~ o Swor d subscribe b¢fo me o ~ ,~ Thi day ofc/ ll 20_ o~ ~_~, N N n ~ ,'-, ~ ~ %'. Si n t re of Pu • lic Nota 9 ry -State of Florida o ~ Note ization of Lobbyists signature a o ~ ~ °v' ~ F °' ~ Annual Registration fee: [ }-Yes [ ] No Am Lobbyist Registration Form ~ceived and verified by: F:\CLER\$ALL\MAR111-M\Lobbyist\LOBBYIST FORM D facts are true land correct and that I have read or am i 2-482 oft -Miami Beach City Code and all reporting PRINCIPAL IDENTIFICATION: 'Produced ID Form of Identification Personally known (Principal) ROYA VASSEGHI State o Co Miami-Dade Notary Public, State of New York Sworn ands ribe a me No. 01 VA6167201 This .~-" day of Qualified in New York County CcR1R11ppiAn ~xpirap May 29, 2911 Signature of Public Notary -State of Florida ~;~/~, I " L`~ li~ Notarization of Principal's signature ~f'~ ~.. ILY MCR # Date Paid Z 12/08/04