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Alex Tachmes/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. Tachmes Alexander I. NAME OF LOBBYIST: (Last) (First) (M.I.) c/o Shutts & Bowen LLP 201 South Biscayne Boulevard, Suite 1500, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 347-7341 (305) 347-7754 atachmes@shutts.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 PRINCIPAL/CLIENT: 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: Rabinder Pal Singh and Jay Stein • IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit "A" attached. ~ o -, ~ ao ~. c-• ~ ! , "j ~~ r.~ II. SPECIFIC LOBBY ISSUE: ~~ ~t~f -,~ .-- Conditional Use Permit r-, Issue to be lobbied (Describe in detail): -. N °-, t.n III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(8) include 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 Individual/Title B) Any Financial, Familial or Professional Relationship City of Miami Beach Planning Board None City of Miami Beach Mayor/Commissioners None City of Miami Beach Committees None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Hourly - $450 00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly - $450 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 lobbvinq 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 lobbvinq 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 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 anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced I~T IC • STATE OF FLORIDA .~""'Form c~j}j~ti~ `~t18 ~ ~=Commission #DD651416 ® Personally ,s y~tKVIAR. 23, 2011 ONBrs[?'CHRU ATI.ANTt6 gONBFNG CO., INC. VII. SIGNATU~2E AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This /4 da~y+ _of ~ySt 2/008 ture of Public Notary -State of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me This day of , 2008 Signature of Public Notary -State of Florida Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIS11Lobbyist Registration Form 32708.doc Revised 03/27/2008 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 2-48~•~pfttie Miami Bed-G~ty_Code and all reporting requirements. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): 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 6~ No• Are you lobbvinq 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 lobbvinq 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 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 snot-for-profit corporation or entity without special compensation or reimbursement. 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: °'~" `" Jay Ste}' on udo Resprf-N_orttf Condominium, Inc. VI. LOBBYIST IDENTIFICAT'~ON: ^ Produced ID Form of Identification Resort and Tudor ® 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 , 2008 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ ProducedlD Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me This ?~ day of a~vc~- , 2008 ~~~ ~ _ ED Signature of Public No~r ~ o Notarization of PrincipaPsys~n' ja e o New York ii8038953 Commission Expires March 20,)0 TO BE COMPLETED BY CITY CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid Lobbyist Registration Form received and verified by: F'\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc Revised 03/27/2008 MIADOCS 2973020 1 V. SIGNATURE UNDER OATH: m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.pov CITY CLERK office CityClerk(a).miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 Alexander I. Tachmes LOBBYIST NAME: I understand that no later than October 15~ of each year, 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. Signature: Date: ~~~~~~ MIADOCS 2969517 1 ~~ • •.~ . ' ~ S'I'~UCTURE ~~AR , ' Chatwal ~i~61; ~1~at~u~J ~7'iltraui C1aat~r~ , . 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