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Carter McDowell/Zedek AssociatesCity 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 Sumberg Baena Price Axelrod LLP 200 S Biscayne Blvd 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: Zedek Associates NAME OF PRINCIPAL/CLIENT: c/o Jean Pierre Rein 18851 N.E. 29`h Avenue Suite 901 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) {305) 931-4959 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SPECIFIC LOBBY ISSUE: Representation of Zedek Development approvals for 321 Ocean Drive ,Miami Beach and representation regarding accessory use ordinance for RPS District 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 Commission, Plannin , Zonin None S ecial Master None MIAMI 932732.1 7647223722 2/ 12/08 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $535.00 ___. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) 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 •~N~o: 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 D elopment Issues": i Yes WNo: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning man 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 snot-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 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 COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHA FILED EVEN IF THE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PE _ _ / _ _ Signature of Lobbyist I do solemnly swear that all of the foregoing fay contained in Section 2-482 of the Miami B Signature of Lobbyist: f Signature of Principal/Client: y- t VI. LOBBYIST IDENTIFICATION: ~ ' Produced ID Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: are true and correct an/d ~that I have read or am familiar with the provisions Code anc~ all reportinq,~quirements. PRINCIPAL IDENTIFICATION: Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade S~,,i Sworn and subscribed before me by rr~.,,•1'K~'t ~~'~,~~~ Thi .,~:~i~,~ of ~'-9u This day of F25,~ ~nr.ry , 20~ Sig ~ u ~ ~6 I ~ Signature of Public Notary -State of Florida Not ~`~~ Notarization of Principal's signature _ ~ chi z~~~ ~z o ~_~ ~~ ~.~ oCO~" z '~ ~ ~ w'~ ~ ~ ~~~ ~~~ ~~ "-;',;fit`'' FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid Lobbyist Registration Form received and verified by: yt F:ICLER\$ALLIMARIA-M\LobbyistlLOBBYIST FORM 05.doc Revised 12/08/04 ~r IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $535 00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $535.00 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 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 man 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 No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 15t 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 CIT~f;OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL~j~ILED EVEN IF THERE J,iA BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PE 9 I do solemnly swear that all of the foregoing facts are true and correct an ~°I have read or am iar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporti r men s Signature of Lobbyist ~ d~-l Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: I Produced ID Form of Identification I~' Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subs abed betore me This 1 xJ daV Of_ " ~ '" as_.~ASr~ 1 Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This day of , 20_ ,'r~'P~~~'~2A2SRat of Florida ~~ '~ ~ Signature of Public Notary -State of Florida pr~atio~plt9~es~gn ure Notarization of Principal's signature n~ eonded Ttru p~chard haunnce FOR CLERK' USE ONLY Z, J 3 ~ a Annual Registration fee: Yes [ ] No Amount PaidZ~ MCR # Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc ~ „+ ;. Revised 12/08/04 2/ Feb-i3-2008 10:34am =nom- T-84ii x.003/003 ~-260 IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) L066YIST DISCLOSURE: (Required) Sd35 00 H) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION}: (Requir®d)- 5535.00 Th® following Information must be answered: 1) Pursuant to Mlaml 9®ach Gity Code Secilcn 288 Entitled "Prohlblted Campaign Contributions By Lobbyists On Procurement Issues": ;-? yes D No: Are you lobbying on a present or pending bid for Gnods, equipment or services, or on a present or pending award for goods, ®qulpment or service? 2) Pursuant to Miami beach Clty Code 2-490 Entitled "Prohlblted Campaign Contributions By Lobbyists Cn Real Estate Development issues": ~7 Yea t.I No: Are you lobbying on a pending application for a Development Agreem®nt with the Glty or application for cihange of Zoning rnan daglgnatlan or change to the City's Future Land Use Map? 3) Pursuant to Miami i3each C1ty Code 2-4Bg (h) Any person {except those ax®mpt from the definition of "lobbyist" as set forkh 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 it®m, sha11 register with the clerk as required by this section but, shall not be required to pay any registration fees.. ~I Yes ~ i i No: Are you representing a not-for-profit corporation or entity without special carnpensation or reimbursem®nt. V, SIGNATURE UNDER OATH: ON OCT08ER 1H' OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LiST1NG LOBBYING EXPENDITURES, A5 WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL SE FILED EVEN IH THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist do solemnly swear that all of the foregoing facts are true and oarrect and that (have read or am familiar with the provisions contained in 5®ction 2-482 of the Miami Beach City Code and all reporting requirements. Signatur® of Lobbyist: Signature of Principal/Cli®nt: ~,_.._.,~~~.~ VI. LOBBYIST IDENTIFICATION: ~^ ~ Produced ID Form of identiflcatlon [_ Personalty known (Lobbyist} VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of PAlaml-Dade Swann to and subscribed before me This _ day of , 20_,,.,_ Signature of Public Notary --State of Florlde Notarization of Lobbyist's signature C Produced ED Form of Identiflcatlon Personally known (Principal) Stat® of Florida, County of 14iami-Dade Sworn and subscribed before me by 7~w•~•P'c~rc>'ei~~o~, This 13~ day of FeS~h~v~! , 20~ ~'~.....~.- `t0.~~ :.-a~~' Signature of Public Natery - 5tete of Florida Notarizatian of Principal's signature ~, co ~~~ _ g ~ ~~ ;~ ~~ ~'t~'~' ~` FOR CLERK'S USE ONLY Annual Registration fee' [ ]Yes ( ] No Amount Paid t~3. ~MCR ~ Date Paid ~.~~ ~~ ~ i~ Lobbyist Registration Form received and verlfled by: ~; -~ r:-r'~- °~-' ~:•L."` `' Revised 12103(04 vt F:\CLER\3ALL\MARIA-MlLobbylst~LOBBYIST FORM o5.doc !/ PRINCIPAL IDENTIFICATION: LOCAT I ON ~ Ru T I f1E Ci2i13 ' Q8 D9 ~ 25