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Allan Shulman/Seth Gadinsky/745 Collins Avenuem 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. Shulman Allan NAME OF LOBBYIST: (Last) (First) (M.I) Shulman + Associates 100 NE 38 Street, Space 2 Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)438-0609 TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: .Seth Gadinsky, President NAME OF PRINCIPAL/CLIENT: Matacumbe Enterprises Inc 325 South Biscayne Blvd Suite 1724 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 347-5415 SethC~Gadinskyrealestate.com 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: II. SPECIFIC LOBBY ISSUE: Development approvals for property located at 745 Collins Avenue. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title Planning and Zoning Department Staff, DRB, BOA, Planning Board, City Commission B) Any Financial, Familial or Professional Relationship None IV. DISCLOSURE OF TERMS AND AMOUNTS QF LOBBYIST COMPENSATION (DISCLOSE WHETHER HD//RLY, PLATRAIL~ OR OTNER~k A) LOBBYIST DISCLOSURE: (Required) 4 250 00 ce~ hour $) PRINCIPAL`S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). S 250.00 cer hour The f+olbwing infarmadon must be answered: 1) Pursuant to Miami Beach City Code Sectbn 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": g„Yes X No: I'~~ y~rw ~ a nr+esent or____n~erlcC a bid for q, eauioment ar ~Itviaea. ar on a or Dendinsi award for aeoeis. aouiulrletlt or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": 3) Pursuant to Miami Beach City Code 2-484 (h) Arty person (except those exempt from the detinitbn of "lobby~t" as set forth in Section 2.481 above) who only appears as a representative of anot-for-profit corporatbn or entity without special compensation or reimbursement far the appearance, whether direct, or indirect, to express support of or opposition 13o any item, shall register with the clerk as required by this section but, shat! not be required to pay any registration fees.. V. SIGNATURE UNDER OATH: ON OCTOBER 1~ Oil: 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 CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO ~XPENDIiURES OR COMPENSATION DURING THE REPORTING PERIOD. 1%~~ ~ Signature of Lobbyist I do solemnly swear that atl 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 (Lobbya~t) ~ ~ VII. ~ SIGNATURE AND STAMP OIF NOTARY: State o Ida, County of Miami-Dade z~i~~;'e Swom and subscri e ~~. ~ % ,day of 20~~ , PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identificatbn personally known (Pried 1 ~r Notary Publlc State of Florida Moro R Halp®m ~ ~ My Commission DD769014 State of Florida, County f~ ~ires o31zs~2olz Swom and subscribed This ~'' day of ~/ V . 20o Y of Publlc Nattily -State Kf Fbrida lion of Lobbyist's slgrtsture Signature of Publlc Nita"ry -State of Fbrida Notarizatbn of PMndpal's signature FOR CLERK'S USE ONLY ~~ Annual Registration fee: [ ]Yes [ ] No Amount Paid .~ $ •~"'~ MCR # lobbyist Registration Form received and verified by: Entered By: F;\CLER\;ALL\MARIA-M\LobbyfshlO88YLST FORM OS.dot ~b Date Paid Z' ~~ RM9ad 12/08/04 EXHIBIT B DISCLOSURE OF INTEREST Matacumbe Enterprises, Ltd. 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 NAME OF INTEREST HOLDER 1. Matacumbe Enterprises, Inc. Seth Gadinsky, President 325 S. Biscayne Blvd, # 1724 Miami Beach, FL 33131 Seth Gadinsky 50% 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 Lyle Stern 50% 1665 Washington Avenue, PH Miami Beach, FL 33139 Subtotal 2. Seth Gadinsky 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 3. Lyle Stern 1665 Washington Avenue, PH Miami Beach, FL 33139 4. Marylyn Gadinsky 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 5. Bruce Koniver 1665 Washington Avenue, PH Miami Beach, FL 33139 100% INTEREST 1.0 24.5 24.5 25.0 25.0 TOTAL 100.0