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Carter McDowell/Robert Burns, LLCCity 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. McDowell Carter N• NAME OF LOBBYIST: (Last) (First) (M.I) Bilzin Sumber - 200 South Bisca ne Boulevard Suite 2500 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) 305 350 2355 305/351-2239 cmcdowell(a~bilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: Robert Burns LLC NAME OF PRINCIPAL/CLIENT: Robert Burns LLC 360 Hamilton Avenue White Plains New York 10601 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 212-307-8000 212-307-8009 FAX NUMBER: (Optional) EMAIL: (Optional) TELEPHONE NUMBER: Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Officer: Todd Kamelhar • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 100% William Joel SPECIFIC LOBBY ISSUE: Conditional Use Permit - 82 La Gorce Circle Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Planning Board None Department Staff IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) Hourly $500 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly $500 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": IAMI 1 ;/28/07 :_7 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": Yes ^ ~ 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 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 t]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 SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENS ION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHA FILED EV N IF E AVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING P Signature of Lob yist I do solemnly swear that all of the contained in Section 2-482 of th,~IG Signature of Lobbyist: Signature of Principal/Client: facts are trlye and c ect a that I have read or am familiar with the provisions ~C~12o end requirements. Carter N. McDowell VI. LOBBYIST IDENTIFICATION: Todd Kamelhar, Officer and Authorized Signatory PRINCIPAL IDENTIFICATION: Todd Kamelhar Officer/Authorized Signatory ^ Produced tD Form of Identification Form of Identification Personally known (Lobbyist) ^ Personally known (Officer/Authorized Signatory) ^ Produced ID a"'"",,• IBIS DIAZ VII. SIGNATURE AND STAMP O :~ ~My~MISSIQNItDD529254 EXPIRE y 18, 2010 State of Florida, County of Miami- TM~~^w~~' to of New York, County of Sworn and sub ribed b fore m orn and subscribed before me This day of ~ uS , 20 0 . \ This day of , 20 ~l9`~ Signature of Public Notary -State of Florida a ~- Signature of Public Notary -State of New York Notarization of Lobbyist's signature Notarization of Officer/Authorized Signatory FOR C~ US NLY ~ Q'J ~ Annual Registration fee: [' es [ ] No Amount aid ~ MCR #~~1jJL-~ Date Paid Lobbyist Registration Form received and verified by: i F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FOR 05.do Revised 12/08/04 al;G. -~Q' O ITHI)) ll): ~~ _„P. 00?/003 . AuQ-2A-01 02:t)lpm rrom-ORdF Testanl/Kamelhar 212 361 9066 T-186 P•002/009 F-028 City of Miami Beech Office of the Clty Clerk 1700 Convention Cantor Drive, Mlaml Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist meona ell rarsons employed or retained, whether paid of not, py a principal who seeks to ancourape the passage, defeat or modifiglion of any ofdinanco, resolution, action or derision of any commlceioner; any anion, tleoislon, recommendation of the Clry Manm~er or any city board or committee; or any action, deci&ion or recommendation of any city personnel during the time period of the entlro decision-making process c~i such action, decision or recommendation that foreo®eebly wpl be h~3ard or reviewed by the city commission, or a city board or committee. The term specifically includes the principal ds we!I as any employee engsgod in lobbying nclivitios. The term "l_obbyistri" has specific exclusions, Plutaoe refer to Ordir~pnoe 2004-.;435. McDewell N. NAME OF LOBBYISM: (Leal) (First) (M.I) l31<zlt] Sumb~ry - 200, So 's e o fever S ' ? t] I o a 33 3 BUSINESS NAME A~fO gDDRFBS (Number and Street) (City) (Stste) 21p Cods) TEL FAX N Ro o^t t7ume, LI_C NAME OF PRINCIPAI.ICLIENT: BUSINESS NAME ANP;) ADDRESS (Number and Street) (Ci r ~ c N k OrEi tY) (S18te) (Zip Code) 212-307.40001 212.3fl - TELEPHONE rdUMBEft: FAX NUMBER: (Optional) ~ FMnIL: (OpUonaq Fill ouk this section if principal is a Corporation, Parinerbhip or YruLC (Sdction Y-4B2 (o)] ^ NAME O~ CHIEF OFFfCER, PARTNER, OR BENEFICIARY; Offict7r; Todd Kam®Ihar • iDEN'I'It=Y ALL PkRSONS HOLDING, DIRECTLY OR INC)if~ECTLI', A 5% OR MORE OWNERSHIP INTEREST W SUCH CORPORATION, PARTNERSHIP OR TRUST: 100% Wihtarn Joal I.ODpY18T RETAINED BY: It. SPECIFIC LOIi3BY ISSUE: Conditional Uste it - 2 La Go ce Ci I Issue to be labb~ed (Dt3:~cribt3 In t7etail): III. CITY aGENCII::StINDIVIDUALS TO BE LOBBIED: ECG. -31~' Q ITHI!) 10 ; 55 Auo-26-O7 02:01pm From-OR&F Testanl/Komelhar P. 00~/OQ3 212 aD7 8066 T-196 P DD3/00'a F-026 !V. D19CLOSUIRp Op TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCL06E WHETHER HOURLY, FLAT Rd 1'.!: OR OTHER) A) L086YIST DISCI,DSURE: (Required) o rl .60 B) PRINC)PAL'S DISCLOSURE (OF lOeE3YIST COMPENSA710N}; (Required}. Howe y,~50(3 Tha following InFomrrotion must bo answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions ay Lobbyists On Procu,emenl Issutlr°; lJ Yes ®No: Are you lobbying on a present or pending bid for good, equipment or services, or nn a present or pending aW;;trd for goods, equipment or sarvioo? 2) Pursuant to Miami Beach City Code 2~i90 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes ~~ t~l No: Aro you loboying on a pending application for a Development Agreement with the City or rpplication for change of zoning map designation or change to the City's Future Land Uxn Map? 3) Pursuant to h4laml Beach Clty Code 2-464 (h) Any person (except those exempt from the definition of "lobbyist" es uet forth m Sodi~:,n 2-481 8bovo) who only appears as a representative of snot-for-profit corporation or entity without special compensation or reimbursement for the appearancrt, whether direct, or indlr6et, to express sypport of or opposiilon to any Itrm, shall register with the clerk ae required by thin aoction but, shell not be required to pay any registrarJon fe~,s.. i-- Yoer ®No: Are you raprosontin9 a not-for-profit eorporttion or entity without special compensation or reitnbur9ement V- SIGNATURE I.INDER OATH: ON OCTOBER 1" OF EACH YEAR, EACH LOBBYIST SHALL. SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING L09EiYING EXPENDITURES, AS WELL AS COMPENSATION RECE'.IVED, IN THE CITY OF MIAMI BEACH FOR THE PRE?;CEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE: HAVE BEEN NO EXPENDITURES OR C,~MPE=NSATION DURING THE REPORTING PERIOD. Signature of Lobbylat I tlo solemnly swear that ~,II of the foregoing fuel. are true amd correct and that I have read or am familiar with the provlslona contained in Section 2'32 of the Miami Cieoch City Code antl 911 roportina requirements, Signature of t_oht~yist: ~q~~Ci ~~• mcuoweu ~(,~ Signature of Principal/Clksnt: Y- t oqq Komelhar, Officer anb Authorized signatory VI. LOt38YIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Todd Kamelhat Produced ID OfficerlAuthorizod Signatory Form of IrJen6ficatlon '-~ Produced Ip I:' Personally knour~n (Lobbylsq Form of Identltlr~tion Personally known (gNlcor/Authorized Signatory) VII, SIGNATURE AND 5'L'AMP OF NOTARY: State of Florida, County of Miami-Dade sworn to and subscribed i>efore me This ~ dpy pl ~_ 20_ Signature of Public Notary -State of Florida Notarization of Lobbyist's signature State of New York, County of bsF, rr /~~ Sworn End subscribed before m This ~ ddy of ~t.{~yL_, p ~oR*a ~ aooorwn r~.wr~•~erc • oor d rr..o,. -O 6 Ig ature or Public Notary - 9ta NoWtlzdtlon of OfficerlAuthori Annual Registration fe~a: Yes FoR CLERK'S Use ONLY Lobbyist Registration Form recelveo and verifed byrn Pald MCR Imo` ^ato Paid ti o7 13 F:~CLERtsALL1MARIA~.MtLobbyi9t~LODDYIST FORM 05.ooc f~~rvirod 12/OtlrOa P.OOIii)i)3 ~~ ~ilZll~ ~t1111U('T'~ ~, i' r r; i. r~ ~. ~ .. ~, - i. 1. W FAx - : ~. ient's Naine: Recl Com an : Fax: Phone3_ _....---- 1. _ Robert Parcher, Clerk _ ...............- Cil of Miami Beach 305-673-7254 - 305-673-7411 • 1' ,;. eyi~ Y.e. t ,~V EIS ~~~From ,, ~ : tRva~ ~'. ~i: asp ka_~ h,.l f.4 ,.~ .~ ° @ qty k Mir~'~ -L.t i ' []tract Fax- _,__ P .i }~ N .; 1''-~, ~ c.- ~, •, , il~-- -F~h~ane: Carter McDowe.Il, Es Bilzin Sumber 305-351-2239 305-350-2355 •_ # of Pa eg s: - Date: __ Client #: ___ Matter #: 3 Au ust 30, 2007 _.13706 RE: RobECrt Burns. LLC NI~SSag® Attached ple2se find addendum to the lobbyist registration filed on B28/0T by Carter McDowell as lobbyist retained by Rcabert Burns LLC. Thank you. Call us at 305.374,7580 if you have any difficulties with this transmisslon. THE INFORMATION COh1TAiNED IN THIS FACSIMILE MESSAGE IS ATTORNEY PRIVILEGED AND CONFIDENTIAL INFORMATION INTENDED ONLY FOR Tt•IE USE OF THE INDIVIDUAL OR ENTITY NAMED ABOVE, IF Tt-IE READER OF THIS h1ESSAGE IS NOT THE INTENDED RECIPIENT. OR THE EMPLOYEE OR AGENT RESPONSIBLE TO p~LIVER IT TO THE INTENDED RECIPIENT. YOU ARE HEREDY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMP~IUNICATION 15 STRICTLY PROHIl3iTED IF YOU HAVE RECEIVED T,11S COMMUNICATION IN ERROR, PLEASE IMMEDIATELY NOTIFY US BY TELEPHONE, ANp RETURN ThIE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA THE U.S. POSTAL- SERVICE. THANK vOU. i_. _. -_ . ORIGINAL QOt~UMENTS: WILL O WILL NOT ^ FOLLOW BY MAIL ^ BiLZIN SuMetAG (3AENA PRICE r4 AXELROD LLP 200 5. Biscayne Boulovard, S~~ite 2500, Mieml, FL 33131.5340 t~.a 3~5.37aJ580 i",« 305.374J5D9 :vva'. i;u: ~i~ ,:r~ui