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Alexander Tachmes/The Palms South Beach•~ ~~~~~ ~~~~~ ~ , 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 Gity 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 speci~c exclusions. Please refer to Ordinance 2004-3435. NAME OF LOBBYIST: (Last) (First) ~M ~~) Tachmes Alexander ~ • BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Shutts & Bowen LLP; 201 S. Biscayne Blvd., Suite 1500, Miami, FL 33131 TELEPHONE NUMBER: FAX NUMBER: EMAIL (305) 347-7341 (305) 347-7754 atachmes@shutts.com I. LOBBYIST RETAINED BY: NAME OF PRINCIPAUCLIENT: The Palms South Beach, Inc. BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) The Palms Hotel 3025 Collins Avenue Miami Beach FL 33140 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) 305-534-0505 305-534-0515 Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Hans Joachim Krause, President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°/a OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: H211S J08Chlm KfBUSB (50%1 811d U~SUIB M8f12 Kf2uSe ~50%1 n. sPeciFic ~ossY issue: Zoning variance for rooftop addition. 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 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): . I A) LOBBYIST DISCLOSURE: ~Rey~~rea- $400.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) ~400.00 p@P F10Uf 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 E3 No: Are vou lobbvin4 on a present or pendins~ bid for s~oods. eauipment or services. or on a aresent or pendins~ award for aoods, 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 vou lobbvins~ on a pendins~ aaplication for a Development As~reement with the Citv or apulication for chans~e of zonin~ map desiqnation or chanqe to the Citv'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 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 C~f No: Areyou representinq a not-for-profit corporation or entitv without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 151 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 ERIOD. l3~-~~ 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 Sectiory2-4~2 of the Miami B_~ity Code and all reporting requirements. Signature of Signature of Principal/Client:: VI . LOBBYIST IDENTIFICATION: Produced ID Form of Identification PRINCIPAL IDENTIFICATION: Produced ID Form of Identification Personally known ( bbyist) Personally known (Principal) VII SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribed efore me Sworn to and subscribed before me This l~''` day of ,~- ~} day of __ rr~ LIZEffE PERE2 ^ aY ~ .. ~ "''~~n MY COMMISSION #DD334163 + D(PIRES: JUN 30, 2008 ianat o ublic Notarv - ate Bond~ through 1st State Insurd~, at ra nf P ~ ~ ~ an~ __ o., of LobbyisYs pal N;°,tar,r p~.blic State o( Fiorida ~ riier~,~ ~n::=tinez-Cedrez = Mv Cor;,~r;r~<ion DD579217 a Ext;r;~sU7%;~ IZO10 FOR CLERK'S USE ONLY '/ / ~ Annual Registration fee: [] Yes [) No Amount Paid ~/ ~ MCR # Z~~ /~+ Date Paid ~ ~ ~~ Lobbyist Registration Form received and verified by: Revised 12/08/04 MIADOCS 2532121 1 A) LOBBYIST DISCLOSURE: ~Reyu~~ed~ $400 00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) ~400 00 peC hOUI" 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 J No~ Are vou lobbvina on a present or pendinq bid for aoods equipment or services or on a present or pending award for qoods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes C~J No• Are vou lobbvina on a pendinq application for a Development Aqreement with the Citv or application for chanqe of zoninq map desiqnation or chanqe to the Citv'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 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 ~ No~ Are vou representina a not-for-profit corporation or entitv without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 151 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 REPORfi{V~ 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 Sec~joy.~-482 of the Miami ch City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client:: VI . LOBBYIST IDENTIFICATION: Produced ID Form of Identification Personally known (Lobbyist) 0 ~ p - ~ Hy ~ ~ VII SIGNATURE AND STAMP OF NOTA c ~- RY ~~°~~ State of Florida, County of Miami-Dade ~ y' ~~. ~ Sworn to and subscribed b~fore me S~f ~-- ~~,~ day of ~an~a r , 200 This ~3 ~ II~~ O ti . ~ w ~~ ~ ~ t7 ~„ o °°.~'d~~ Signature o Public No ry- State of Florida o N~ ~ o Notarization of LobbyisYs signature r,,.• ~ o~ d ~orna~ a PRINCIPAL IDENTIFICATION: ProducedlD 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 verified by: Revised 12/08/04 MIADOCS 253212~ 1