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Allan Shulman/Plaza Hotel, LLcm NiIAMIBEACH 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. Shulman Allan T- NAME OF LOBBYIST: (Last) (Frst) (M.I) Allan T. Shulman Architect, P.A. 100 NE 365treet Miami, Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 438-0609 (305) 438-0170 allan@shulmanarchitect.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Plaza Hotel, LLC NAME OF PRINCIPAL/CLIENT: 1691 Michigan Avenue, Suite 320 __ _ Miami Beach _____ _. FL._ __ 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership orTrust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Eric Margules • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATIDN, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Redevelopment of 418-422 & 426 Meridian 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 Planning Dept., HPB, BOA, Planning Board, City Commission None s~ a~ ~~ ~ .s V~ ,~ IV. DISGLOSURE OF TERMS ANP AMOUNTS OF LOBBYLST COMPENSATION (DI5GLOSE WHETHER HOURLY, FLAT RATE OR OTHE'RJ: `^/ rr-, //~1 /~~ A) LOBBYIST DISCLOSURE: (Required) s~r+~v .' '~ `~' -- B) PR]NCIPAL'S DISCLOSURE (CIF LOG6YIST CCiM~ENSATION): (Required). t The following information must be answered 1) Pursuant to Miami Beach Clty Cade Section 2-488 Entitied'~Prohibited Campaign Contributions 6y Lobbyists On Procurement Issues": 2) Pursuant to Miami Beach City Code 290 Entitled "Prohibited Campaign Contributions ey Lobbyists On Real Estate Development Issues": 3} Pursuant to Miami Beach City Code 284 (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 spedal 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.. V. SIGNATURE UNDER OATIi: ON OCTOBER 1n OF EACH YEAR, EACH LOBBYIST SHALL Sl16MIi' 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. ^~ Signature of\vLob'byist 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 Section 2-982 of the Miami Beach City Gode and all reporting requirements. ~ y ~ ~~ Signature of Lobbyist: Signature of Principal/C.lient: _,~„ %/~/ ~ :'%~/ ~l.t,....e_ 1V.Cc,~C.~,~,,.~, n VI. LOBBYIST IDENTIFICATION: PRINCIPAL ^ Produced ID ~ ~ Form of Identification Ff Personally known (Lobbyist) VII. SIGNATURE ANb STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom o a d subscri b fore me This da f 20„Q~ Signature of Public otary -State of Florida Notarization of obbyist's signature NOTARY PL',! h::-~1:~'~TE OF FLORID/ E~iza~eth Cox Commission # DD531412 Expires: 11~AR. 22, 2010 Bonded Thru Atlantic Ronding Co., II1C. /I1Ci ~~r~su, Ll L ~, l~l , LL. C Produced ID Form of Identific ti OFFiClAL SEAI- #~-Personally known (Principal) F°~id~E $UTOR NOTARY PU6LIC, STATE OF ILLINOIS MY COMMISSION EXPIRES 8.24.2011 it,U~1DtS C~X]K: 5~te of Ftvrida, County of-PQiartni=Bade Swom apCttsubscribed before me This c~ r da of bi~cr~ 20 ~~ (~ Signature of Publie Notary -State of Florida Notarization of Principal`s signature 03~~6/t~' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, SLAT RATE DR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~ 8) PRINCIPAL'5 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 X No• Are Vou Iobbyina 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 290 Entitled "Prohibited Campaign Contributions By Lobbyists On Rea! Estate Development Issues": Map? 3) Pursuant to Miami Bead 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 spedal 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 X No• Ar° you representing anot-for-profit comoration 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 SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING 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 Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ,.,_9, ~ ~~ PRINCIPAL /I?Ci~ /~/i ;«u; Ll G ^ Produced ID Form of Identification ^ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This day of , 20_ Signati,re of Public Notary -State of Florida Notarization of Lobbyist's signature Produced ID ~ • l_.- Form of Identific OFFICIAL SEAL :~-Personally known (Principal) RENEE SUTOR NOTARY PUBLIC, STATE OF ILLINOIS MY COMMISSION EXPIRES 8.24.2011 1u,1-~1~t5 C~~CK State of flori~a, County of-P4iamt~ade 5wom apd~subscribed before me This d da of b+~ r , 20 ~g ~~~ ~~ `. Signature of Public Notary -State of Florida Notarization of Principal's signature