Kelly Ogden/TBS Realty, LLCMIAMIBEACH
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.)
Ogden Kelly
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ~ (Zip Code)
Architropolis Corporation, 911 N.E. Davis Street, Portland, OR 97232
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(503) 786-9007 kelly@architropolis.com
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
TBS Realty, LLC
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
200 West 55t" Street, Suite 42, New York, NY 10019 '
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(212) 474-9865 jstein@hh-r.com
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Rabinder Pal Singh, Vice President
• 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: I"IIStOfIC Pres@rVatlOn SOard and BOard Of AdjUStment appllCatlOnS
regarding certificates of appropriateness and variances in connection with renovations for 1111
and 1119 Collins Avenue (a.k.a., the Tudor and Palmer House hotels}
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
Mayor None
Commissioners
City Administration None
Cit Attorne 's Office
City Boards None
Cit Committees
MIADOCS 2259116 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Requtred) Normal Gom ensation
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) Normal Compensation
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 B 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 0 No: Are you lobbvinsi on a sending application for a Development Agreement with the Citv 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 H No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNQER OATH:
ON OCTOBER 1st 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 REPORTING PERIOD.
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Signature of Lobbyist'
I do solemnly swear that ail of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482,of tlmi Beach City Code and all reporting requirements.
Signature of Lobbyist: ~~~--~--'~ -.
~ -
Signature of PrincipaUClient:: ~
VI . LOBBYIST 1DENTlFICA N: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID ~~
orm of Identification Form of Identification ~L
Personally known (Lobbyist)
VII SIGNATURE AND STAMP OF NOTARY:
o~or~ Ch.>,,-~n~,cttialr~
State of ~3, County of Atian~ae
Sworn to a d subscribed before me
This _~ day of Qu~ua-~ , 20~
Signature Pu Notary -State of ~e~o n
Notarization of Lobbyists signature
OFFICIAL SEAL
KAXE CHUNG
NOTARY PUE)LIC-0REGON
COMMi5SiRN N0.381922
MY COMMISSION EXPIF4ES JUNE 17, 2008
Personally known (Principal}
-JCs+J~ORI~ WtZa `10RK-
State of Gleride, County of Miam>=B~Fe
Sworn to and subscribed before me
This ~_ day of /4VG- , 20~_
Signature of Public Notary -State of Florida
Notarization of Principal's signature
MUNtR ~1HM~#)
Notary Public State of New York
No. 01AN8t338953 ;
Commission Expiras March 20, ip
FOR CLERK'S USE ONL
Annual Registration fee: es [) No Amount Pai `~ MCR # Date Paid
Lobbyist Registration Form received and verified by:
Revised 12/08/04
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' STRUCTURE CHART -DREAM SOUTH BEACH •
• Pardarnan K. Chatwal Y~vek Chatoyal Vikram. Chatvval , •
• .,
• • •Chatvval~ Family, LLC ~ .
• ~ ~ ~ NY limited liability company ~ .
' - 140% ~ '
' - Channel Properties, LLC .
. _ NY Iimited liability compauy .
• ~ 100%
• ~ TBS Hotel -
Management Corp. , ' ~ .
• . • .FL corporation ~ . ~ • -
. ~1% 9~%
' TBS Realty LLC .
' ~ ~ FL limited liability cotbapaay
' ~ ~ Dreamt South Beach ,
. ~. . , 1111-~11I9 Collins Avenue _ '
. ~ ~ Miami Beach, FL .
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