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Max Sturman/TBS Realty Tudor South Beachm 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 bond 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. Sturman Max Wolfe NAME OF LOBBYIST: (Last) (First) (M.I.) Max Wolfe Sturman Architect, Inc. 2997 Day Avenue Coconut Grove, FL 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 441-1171 N/A maxwolfe@aol. com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: TBS Realty, LLC; Tudor South Beach Resort Condominium, Inc.; and Tudor South Beach Resort-North Condominium, Inc. NAME OF PRINCIPAUCLIENT: 1111 & 1119 Collins Avenue Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 474-9845 N/A jstein@hh-r.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: Jay Stein ( IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 0 See Exhibit `A" attached. ~~ ~ _.~ a •I .7 C ~ II. SPECIFIC LOBBY ISSUE: rY r\a '~-i Q'~ '~ i NIE Conditional Use Permit for ground floor restaurant and rooftop lounge ~J; -~ Issue to be lobbied (Describe in detail): T, N Tt ,; .. 111. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-4~g) i~c ude a statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of IndividuaUTitle B An Financial, Familial or Professional Relationshi City of Miami Beach Planning Board None City of Miami Beach Mayor/Commissioners None Ci of Miami Beach Committees )gone ~~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Hourly - $185 00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly - $185 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": r1Yes ®No• Are you lobbyina on a present or pending bid for goods equipment or services or on a present or pending award for Goods eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": I-IYes ®No• Are you lobbying on a pending application for a Development Agreement with the City or application for chance of zoning map designation or chance 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.. ~lYes ®No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: PERIOD. I do solemnly swear that all of the fc provisions contained in Section 2-482(( Signature of Lobbyist: J` 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 Swom to and subscribed before me This _ day of , 2008 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature Signature of Lobbyist are true and correct and that I have read or am familiar with the ieactyCilar Code and all reporting requirements. PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification J~ Personally known (Principal) State of Florida, County of Miami-Dade Swom to and subscribed before me T is '~ day of , 2008 r.•~"""•~•, • ,s~~~•o~a,, Vanessa Suarez' _~: .CoMMISSiON xDD786p16 ~~' ~' EXPIRES: MAY 06, 2012 ignature of Public Notary -State of ~~~M~~~ o~~ ~vW AAROnNoraRr.~om Notarization of Principal's signatu'~e TO BE COMPLETED BY CITY CLERK'S USE ONLY Annual Registration fee: [ ]Yes (] No Amount Paid 5 MCR 8 S Date Paid Lobbyist Registration Form received and verified by: F:\CLER\LOBBYtSIILobbyist Registration Form 32708.doc Revised 03/27/2008 tV, t~fSC:!_f~SUft[ Qi° TC=t2t~1IS Rt+1C} Af~IC~UNTS {~f~ 1.C}C3tY'IST Ct~tittr'EN5r~T1{7N {(~t5Ck05t_ V+dtiFTNEE. A} l.C7t3t3YtST C}LSGLQSUftE' (Required) I{aurl}r - at85 ~(} q} Pf~1NCIK~{tL"S gtSGLt3SUt2E {C}F Lt}B~YtST CC}f~tPENSATI(}N} (Required}. Hauriy - 5165 UU ---_--_- .- 7hrf fa!'.csrirmed intarmatian must be en5!~sered° i) pursuant to h1E~mi Reach City Code Section 2-466 Entitled `f'rat~rbited C.arl~pait~rt Cantrirautiars;~ By Labbysts On Pracurerttsrat Dues": (~1Yes Na: Are au tabu in an ~ resent or endln bid far ands. a ur ment ar services, ar on a prrvsent ar otandir~ct !ward far Goods euuissment ar ~crvtee? 2} Pursuant to t~+liarni Reach Ciiy Cade 2450 Entitled "f~ralrihited t:amp.tign Cnntrit3ulans E3y Lrahhyi5t5 can f~t..tt Cstr~le [~evalopn~cnt Ist>ues": hTYcss '.~' Na~ Arg you lahbVinq a€t a pendintt applicatiart far n nnvrrtapmant Aaarectrnan# with that City or ~pticatioct far chartcc of zontnrt map designatiart ar chance to the Citv's Euturct land Use tViat~? - ~} PurSUant to Miami Beaeh City Cade 2-~16d {h} Arry pc~rsan {rtxcepi Lhasa exempt frarrt the definilian of °lobbyist" as set Earth In Sectian 2-~'r61 above} vrha anty appears as a representative of snot-for-profit carparatiorr ar entity without speciat carnpensatian ar reimburserrtent far ttte appearance. 4vhether direct. ar indirect, to express support of or apposition to any item,: strati register faith the Glen as required by this r:r:ction but, sltatt not be required to pay any registration tees.. (°"lYes ~ No: A, au rr. rasan in no -for- rafit r are Ian ar enti with ut s acial care cn*tatian ar reimbur2sertrent, V. StGNATURt~ URtDER t}ATH: Sis,}nature at t.ot~byisi: Signature of i'tint~ipallCliemt: Vt, Lf~88Y15T t1~ENTIFICATICIN: '° © Praduced ip Farm of Identif"icetian PersartalBy knatvn (t_abbytst} VIE. SIGNATURE ANC} STAtti~P 4F NOTARY: PS~tNCIPkL tDEf~TIF1CATIt7N: [} I'raduecd R~ FQrin of tdentificatan ,• _~, t'arsanalty knav7n (Principal) ~ .j State of Florida, County of f~iami•Dade State of F14rida. County of f,~iami-C?ade 5wom to and subscribed before me,~,~,~ S+vant to and subscrrbed before me Thi~,cri .d.~y at~~. ~UdII~~~;;~~'o~ . VanBSS~ ~UdJ`eZ T2tis ~~, ct<ty of j~:(X ...._ ~t7tt6 ~ ~~.'~~~., t',iriCSS;~ Stt~e~7 ~." -`~`~', ~~ ` t ~ <~CaMM!$$ ^y pr,?378$a!b ~j~~~ ' t ~ vYl'~ °*... '~ ~. ~` _r ~'~ ~ :; ~, f" Cd;1 a ~: eXr tFES A'AY Q~, tCI.~~F~~„~ e .-I, ~-~ ~ ~Ex tt ~ t C ~'tt 2 Signature of PuUfic Notary - Stag ~ ~# 2at2 ifinatu:e of F ubtre i~7olnry - St.rle o[,t~,cu~; 4 ~~'.Anotcnh`otARXcana Notarize#ian of Princtaat', stgnat~e ~"~'~`"~`r`..~•~.~'~'ca,~ Notarization of t_abbvtsYs st{}nature Tt} 6E CChtPIETE~ SY CITY GLEf~K`S tJSt~ C7h1LY nnnuaa 3tc*Ot~€r~tion tai. C 3 vas C 13to Amount ~atd s ~c~ ~ s our Sara LObbyi,t Regiatr3tigrr Form rsttteTixad andvtrPftad txy: F ~t"t t tt~~ f)$itiYt`it~i nbtryt t ~eg~*'r~t+en Farrn 327~i8 acre Ravtaed 43727!2(30® _ Signature ai t_attttyi t Ida salemnty swear Ihat ail of the faregamg facts era true and Correct anrt th<rt t h~rve rr:ad ar am farrtiiiar evith the: praviia3ns a:antoi7rad in Section 2-4ft2 at tt?ts•fltiami ~eactt'City Gram and sill ref>artinrg rct;uirernts, City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www miamibeachfl.aov CITY CLERK office Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Max Wolfe Sturman CityClerk(a~miamibeachfl.gov I understand that no later than October 15t of each near, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office for lobbyist withdrawal in writing. Sig ~~ Date: MIADOCS 2969662 1