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Lucia Dougherty/James HotelhCgrrd Baach 1 1 ~~ 2003 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 ac'Uon, decision, recommendation of the City Manager or any city board or committee; or any action, decision or recommendaton 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. Dougherty Lucia A• NAME OF LOBBYIST: (Last) (first) (M.I) Greenberg Traurig 1221 Brickelt Avenue, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0603 305-961-5603 doughertyl@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: JHMB, LLC NAME OFPRINCIPAL/CLIENT: James Hotel, 100 21 Street Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Lp Code) 212-342-7300 212-342-7342 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fiil out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Igor I{rnajski • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Same as above II. SPECIFIC LOBBY ISSUE: Approval of Hotel Expansion Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Fuli Name of Individual/Title Planning Department /City Commission HPB Approvals B) Any Financial, Familial or Professional Relationship ZBA IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $550.00 Hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $550.00 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 lobbving on a Dresent or oendina bid for goods eguinment or services, or on a ^p~pnt or oendina 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": OYes ~ No Are you lobbving on a oendina aoDlication for a Development Agreement with the City or application for chance of zoning map designation or chance to the Citv'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 ~No Are you rearesentina anot-for-arofit coruoration 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 PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR NSATION DURING THE REPORTING PERIOD. Sigr~fure c~f Lo ~_~~~ ~~ ~ ~ia ~° ~~ ~~,~ a °' N j ~ o y c°o g m 0 T ~ s a m I do solemnly swear that all of the foregoing familiar with the provisions contained in Secti requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification Q~Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, Coun of Miami-Dade Sworn nd subscrib d b f e This day o 20_ igna a of Publk Notary -State of Florida Not r ation of Lobbyists signature are true and correct and that I have read or am }2 of the Miami Beach City Code and all reporting PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) ~~ ROYA VASSEGHI State of F ida, County of Nlia+~'- arII de Notary Public, State of New York Sworn and su 'bed byre me No. 01 VA6167201 This day.of"~20.~7 Cualified in New York County Commission Expires May 29, 2011/ Signature of Public Notary -State of Florida ~~ ~/~~~ G Notarization of Principal's signature L- FOR. CLEF U&E ONLY v ~ Annual Registration fee: [ ~-`] Yes [ ] No Amount Aaid,.t ~-~( IU MCR # o Date Paid Lobbyist Registration Form received and verified by: d F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05. oc Revved 12/08/04