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Gregory Kyle/Margules Properties, Inc.~- 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. Kyle Gregory S• NAME OF LOBBYIST: (Last) (First) (M.I) Kimley-Horn and Associates, Inc. 5200 NW 33rd Avenue, Suite 109 Fort Lauderdale Florida 33309 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (954) 535-5105 (954) 739-2247 greg.kyle@kimley-horn.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Margules Properties, Inc. NAME OF PRINCIPAL/CLIENT: 381 Park Avenue South Suite 1420 New York NY 10016 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 684-7079 ext 19 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Eric Margules • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Eric Margules II. SPECIFIC LOBBY ISSUE: Redevelopment of 1155 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 Planning Dept., HPB, BOA, Planning Board, City Commission ~ None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf ~ ~ IIPU ~ hr A) LOBBYIST DISCLOSURE: (Required) ~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ r ~, r 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 you lobbying on a present or vending bid for goods eaui~ment or services or on a aresent or pending award for goods eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled ~~Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes X No• Are you lobbvina 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 Man? 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 X No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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. 1 ~ /i Signatu~lof 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: PRINCIPAL IDENTIFICATION: ~~;: MYCOMMISSI 744- f Identification ~~ ~= EXP pril 4, 2010 ~~"`-- ~~R(i~d``~ NotaryPUblic ers Lobbyist VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn bscrib d f ~ e T 's ay of 0 f .~. Signatur f Pub is N t ry -State of Fiorida Notarization of Lobbyist's signature Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn 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 ~1 JJ/ .~ Annual Registration fee: [ ]Yes [ ] No Amount Paid -i--G~ MCR # / ~~!! "'~ Date Paid Lobbyist Registration Form received and verified by: Entered By: _ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.da Revised 12/08/04 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERr ,~ A) LOBBYIST DISCLOSURE: (Required) $ 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 X No Are you lobbying on a present or pending bid for aoods eauinment or services or on a present or Wending award for aoods eauinment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes X No• Are you lobbying on a nendina application for a Development Agreement with the City or application for change of zoning map designation or chance to the City's Future Land Use Man? 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-proft 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 X No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECENED, IN THE CT1Y 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: ^ 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_ Signature of Public Notary -State of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification personally known (Principal) - ~ ~ ~N ~ Z A U .F.a ~~~c0 ~m®~y ~~gc~Q if~ ~ v© cW Statue o , County of~~ ~ ~ ~ w o Sworn and subscribed before me rZ Z _~ 'cn This ~_day o~' 20~ ~' ~ `~ ra Signature Pub Notary -State of-F~e~ida~^•' `° C3 Notariz ion of Principal's signature FOR CLERK'S USE_ONLY 2 ~j Annual Registration fee: [ ]Yes [ ] No Amount Paid f .SU MCR #v ~ D ( Date Paid ~ ~ ~ Lobbyist Registration Form received and verified by: Entered By: F:\CLER\~ALL\MARIA-M\Lobbyfst\LOBBYISi FORM OS.doc Revised 12/08/04 Cit}r cf Miami Beath, 17~(? Convention Center Drive, Miami Beach, Florida 33134, www.miamibeachfl.gav CITY CLERK Office CityGlerk~miamibeachN.gav iel: 3{}S.b73.7411 ,fax: 3f7S_573.725d I understand that no later than +t.,~tber 1st ocr# +each~ E must file the k311+~wing farms, pursuant to Section 2-485 of the Miarni Beach City Code, with the City Clerk's t~FFice For al{ active lobbying issues. 1 } Lobbyist Expenditure Form 2j pisclosure Farm Failure to File these Farms an a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and Far code vialc~tian evaluation.. Fn addition, once an issue 1 have registered b tabby an has been resolved, 1 am required to immediately notify the City Clerk's CfFfice of lobbyist withdrawal in writing. ~! ~ ~~ Signature. t?ate; Rev:sea £12~^~~r2{~8 t f.. t=.~ ;=rsc