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Alexander Tachmes/Altos Del Mar, Ltd.m ,MIAM,IBEACH 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 201 S. Biscayne Blvd. Miami FL 33133 #1500 TELEPHONE NUMBER: FAX NUMBER: EMAIL (305) 347-7341 (305) 347-7754 atachmes@shutts.com I. LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: Altos Del Mar, Ltd. BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 8500 S.W. 8th Street Suite 238 Miami FL 33144 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) (305) 262-6533 Fill out this section if principal is a Corporation, Partnership or Trust [Section 2482 (c)] • NAME OF CHI_ FF C~FFICFR, PARTNER, OR BENEFICIARY: AgUStln I-ierran • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5 % OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Ste Attached ll. sPECIFIC LOBBY IssuE: Historic Preservation Board application for property located at 7833 Collins Avenue 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 Mayor None Commissioners City Administration None Cit Attorne 's Office City Boards None Cit Committees MIADOCS 2392152 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $350.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) 350.00 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 l~ 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 D No: Are you lobbying on a pending application for a Development Agreement with the Citv or application for change of zonin4 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 "IobbyisY' 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 D No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1~` 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 REPORT~IG PERIOD. `"( V Signature of Lobbyist I do solemnly swear that all of the foregoing facts are tr nd correct and that I have read or am familiar with the provisions contained in S 2-482 of e Mi City Code and all reporting requirements. Signature of Lobbyist: -~ Signature of Principal/CI VI . LOBBYIST IDENTIFICATION: , ;% -~ PRINCIPAL IDENTIFICATION: Produced ID / Form of Identification ,~, ~ Personally known (Lobbyist) ~. R VII SIGNATURE AND STAMP OF NOTARI~ ~ o ~ '~ ~ State of Florida, County of Miami-Dade ~•~ ~ ' n ~•~ ~.~ ~ Sworn to and subscribed befor me This ,30 ~- day of ~~,(~~'' , 20~~ ~ ~ O ~ ~Q4 m. 5' r~ d w ~ 6c..- ~%~'G'lifii.~-- m ~' ~ ~ r Signature of ublic Not -State of Florida ~ o °~° ~ ~ Notarization of Lobbyist's signature S o a°, ~ a Produced ID ~orm of Identification _ __ Personally known (Principal) ~ ANAMARI~IGUERRA-VERA `_, ,`~'• MY COMMISSION # f)[' ~'i1"9'! :.? _ ~•. ;~ :o EXPIRES: August 28, 2009 z,F ~r_ F ~~ Bonded Thru Notary Public Underwriters State of Florida, County of Mia • Sworn to~ry~ subscribed before me This C-f day of ~0~}~~_, 20 ~'~ t-~ ~~~t" Signature ublic Notary -State of Florida Notartzation of Principal's signature FO L!~'S USE ONLY Annual Registration fee: es [ ] No Amount Pa' MCR # ~ ~ ~~ate Paid Lobbyist Registration Form received and verified b . Revised 12/08/04 MIADOCS 2392152 1 m MIAMIBEACH 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 201 S. Biscayne Blvd. Miami FL 33133 #1500 TELEPHONE NUMBER: FAX NUMBER: EMAIL (305) 347-7341 (305) 347-7754 atachmes@shutts.com I. LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: Altos Del Mar, Ltd. BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 8500 S.W. 8th Street Suite 238 Miami FL 33144 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) (305) 262-6533 Fill out this section if principal is a Corporation, Partnership or Trust [Section 282 (c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: AgUStln Herran • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Attached Il. sPECIFIC LOBBY IssuE: Historic Preservation Board application for property located at 7833 Collins Avenue 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 Mayor None Commissioners City Administration None Cit Attorne 's Office City Boards None Cit Committees MIADOCS 2392152 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $350.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) 350.00 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 ^D 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 ^D No: Are you lobbvinq on a pending 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 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 ^O No: Are you representing anot-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 REPORZt~IG 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 S~Ck~pn~1 2-482 of~e Meth City Code and all reporting requirements. Signature of -~ Signature of Principal/Client:: VI . LOBBYIST IDENTIFICATION: Produced ID -~ PRINCIPAL IDENTIFICATION: Form of Identification ~ z Personally known (Lobbyist) ~. za -C VII SIGNATURE AND STAMP OF NOTAR ~* ~ ~ 'b 0 ~' P'~-s State of Florida, County of Miami-Dade ~ y ~ ~ ~.~ ~ Sworn to ands-ubscribed ~efor~ ~r 20 0 a ~ ~ _ 9 This .30 day of (x-TO ~ t~ Q ~ m. ~ ~~ E'er d ~ ~ Signature of ublic Not -State of Florida ~ o °~° ~ ~ Notarization of Lobbyist's signature ~'--' ° ~ d ornw a Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me This day of , 20 Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid Lobbyist Registration Form received and verifed by: Revised 12/08/04 MIADOCS 2392152 1 CITY OF MIAMI BEACH Lobbyist Registration - Disclosure of Interest for Altos Del Mar, Ltd. ENTITY % OF STOCK General Real Estate Corp. 19.80% Agustin Herran 100% 8500 SW 8th Street Miami, FL 33144 Pedrena Development Inc. 19.80% Manuel Herran 100% 8500 SW 8th Street Miami, FL 33144 James Dorsy 19.80% 8500 SW 8th Street Miami, FL 33144 Armando J. Guerra Revocable Trust 19.80% Sole Beneficiary: Armando J. Guerra Armando J. Guerra & Maria C. Guerra Revocable Trust Sole Beneficiary: Maria C. Guerra 8500 SW 8th Street Miami, FL 33144 Oscar Barbara 19.80% 8500 SW 8th Street Miami, FL 33144 MIADOCS 2392152 1