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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,

lobbying

city board or committee. The term specifically includes the principal as well as any
The term " Lobbyists" has specific exclusions. Please refer to Ordinance 2004- 3435.

or a

activities.

J.

Michael

Marrero
Last)

NAME OF LOBBYIST:

employee engaged in

M. 1)

First)

Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Miami, Florida
Number

BUSINESS NAME AND ADDRESS

and

Street)

State)

City)

305) 377- 6222

305) 374- 5300

mmarreroa-brzoning law.com
EMAIL:

FAX NUMBER:

TELEPHONE NUMBER:

33131
Zip Code)

Please notify this office if your contact information changes: address, phone, or e- mail address.
I.

LOBBYIST RETAINED BY:

Don Peebles
NAME OF PRINCIPAL/ CLIENT:

550 Biltmore

Bath Club Entertainment, LLC


BUSINESS NAME AND ADDRESS

Coral Gables, Florida 33134

Way, Ste. 970

Number and Street)

State)

City)
305) 442- 4345

305) 442- 4342

FAX NUMBER:( Optional)

TELEPHONE NUMBER:

Zip Code)

peeblesl( d)-aol. com


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: Don Peebles
i

IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INT

So

PARTNERSHIP OR TRUST:

EST IN SUCH CORPORATION,

tz I

ii.SPECII=IC LOBBY ISSUE:


Board

of

Admustment A

eal regarding Use of Pool Deck and Facilities

Issue to be lobbied( Describe in detail):

CITY AGENCIES/ INDIVIDUALS TO BE LOBBIED:


Pursuant to City Code Section 2- 482(a)( 4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship ( paid or unpaid) with said city commissioner or personnel from 12 months preceding such
person' s commencement of service with the city to the present date, stating the general nature of the subject contractual relationshi .
Sec 2- 482( a)( 4) Full Name

of

Individual

Contractual

and

Relationship(

Explain)

YES

NO

title of person to be lobbied

Commission,

Pursuant to

Planning

Staff, Development Boards

City Code Section

2- 482( g)

Every

registrant shall

be

NONE

required

to

state

relationship, or other relationship giving rise to an appearance of an impropriety,


sought to be lobbied as identified on the lobbyist registration form filed.

the

extent of

with

any

any business, financial, familial or p


city commissioner or city person

current

ssiq
o is
Vol',

Sec 2- 482( g) Any Financial, Familial or Professional Relationship


NONE
A

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Formrevised 5- 30- 2012. doc

DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION( DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER):

IV.

A) LOBBYIST DISCLOSURE:( Required):$ 395. 00

PRINCIPAL' S DISCLOSURE( OF LOBBYIST COMPENSATION):$ 395. 00

B)

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 lobbvina on a present or pending bid for goods. equipment or services. or on a present or pending
award for goods. equipment or service?

Pursuant to Miami Beach City Code Section 2- 490 Entitled" Prohibited Campaign Contributions By Lobbyists On Real Estate

2)

Development Issues":

Yes X No: Are you lobbying on a pending application for a Development Aareement with the City or application for

change of zoning map designation or change to the City' s Future Land Use Mang

Pursuant to Miami Beach City Code Section 2- 482 ( h) Any person ( except those exempt from the definition of" lobbyist" as set
in Section 2- 481 above) who only appears as a representative of a not-for-profit corporation or entity without

3)

forth

special

compensation

or

for

reimbursement

the

appearance,

whether

direct,

indirect,

or

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 a not-for-profit corporation or entity without special compensation or reimbursement.
SIGNATURE UNDER OATH:

V.

ON FEBRUARY 28 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
A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
THE PRECEDING CALENDAR YEAR,

EM

EXPENDITURES OR COMPENSATION DURING THE REP

ER1011

Signature of Lo byist

I do solemnly

swear

in Section 2- 482

of

that

all of

the

foregoing f cts
City C de

are

true

the Miami Beach

an dd

rect and that I have read or am familiar with the provisions contained

eportiquirements.

Signature of Lobbyist:
Signature. of Principal/ Client:

C_

Zut_&

"

LOBBYIST IDENTIFICATION:

VI.

PRINCIPAL IDENTIFICATION:

n
o

00

Jr

IDA''

Produced

Produced ID
Form

ZPersonallyPersonally

Identification

of

a.,

R 0

known( Lobbyist)

SIGNATURE AND STAMP OF NOTARY:

VII.

'
o

State

of

Florida,

Sworn to

and subscribe

Sig

County
y

ature of

Notarization

Public
of

of

of

Notary State

Lobbyist' s

2012

of

ci

j N

Cn

me

tWL4V-,

co

M-,%.,

C3

A0N.
3- m3 g

known ( Principal)

m
m
OOD +

State of Florida, County


Sworn
ci subscribed
This

day

of

of

Miami- Dade

cc

m
2012

of Public
otary State of Florida
Notarization of Principal' s signature

Paid$

MCR#

QN

DatVqaid

Lobbyist Registration Form received and verified by:

C:\ Users\ clerhatl\ AppData\ Local\ Microsoft\Windows\Temporary Internet Files\ Content. Outlook\ 83LGQDDH\ Lobbyist Registration
Formrevised 5- 30- 2012. doc

Oi

Signature

Florida

ignature

Yes

Identificatio

N 2j U ca

TO BE COMPLETED By CITY CLERK' S_ST F


Annual Registration fee:

of

Nm

Miami- Dade

before

Personally

3
a' 0

N
H.

Form

F!

ct

Revised 04/ 27/ 2012

istration Form. doc

City

of

M JB,
!

Miami Beach,

1700 Convention Center Drive, Miami Beach, Florida 33139, www. mianiibeachfl. gov

CITY CLERK Office


Rafael E. Granado,
Tel: 305. 673. 7411 ,

City

LOBBYIST NAME

CityClerkamiamibeachfl. gov

Clerk

Fax: 305. 673. 7254

understand

that

Michael J. Marrero

later than February 28 of each year, I


of the Miami Beach City Code, with

no

to Section 2- 485

pursuant

must file the following form,


the City Clerk's Office for all

active lobbying issues.


LOBBYIST EXPENDITURE AND COMPENSATION FORM

1)

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

that issue

for that

registered

lobbying
Office of lobbyist withdrawal in writing.
on

or

principal,

Pursuant to Section 2- 485 ( d), the

City

Clerk

timely file a Statement and in


imposed as provided in Section 2- 485. 1,
Statement(s) filed after the due date.
fails to

lobby on has been resolved, or I am no longer


I am required to immediately notify the City Clerk's
to

shall

notify any lobbyist (or

addition to any other penalties which may be


a fine of $50.00 a day shall be assessed for all
The City Clerk shall notify the Miami- Dade

County Commission on Ethics and Public Trust of the failure of


to file the Statement or pay the assessed fines after notification.
Any

lobbyist,

automatically
appealed

who

'

from

required

Statement
fines

by

lobbyist (or

April 30th, 2012,

principal)

shall

until all

are paid,

ate:

C:\ Users\clerhatl\ AppData\ Local\ Microsoft\Windows\Temporary Internet Files\ Content.Outlook\83LGQDDH\ Lobbyist Registration
Formrevised 5- 30- 2012. doc

be

unless the fine has been

lobbying
Dade County Commission on Ethics and Public Trust.

suspended

to the Mia

Signature:

fails to file the

principal) who

EXHIBIT" B"

67K7 COLLINS D VELOPKENT


CORPORATION. a Florida eorporatinn

Madison State USA Haldings Cnrpnration. it


Florida

corporation

100% Owner

mom

MADISON USA HOLDINGS

LIMITED.

uti

STATE USA HOLDINGS, 1AMITEU,

Ontario Carporatian

an Ontario Corpar Lion

5vip owncr

1014; Owae.r

Miguel Sitrger, Cltairtttt" I

Barry Z,ngdattski. Chairnum

369 Rinurock Road

3700 Durfarin Sirerm, Unit 34

Tomato, Ontario M3J. 402

Ttimnto, Omprio M6B 473

COUNTRY OF CANADA

1
ss:

PROVIYC'E 01- O,N UARIt)

The roregoIng imartiltiel t w;Is ocknowledgcd h-fore me this Lam'( by 4) l' Jime, 2D13. by;.`iiguel Singer.
as

President

pl-

mionully

of

6747 Collin., Devaloprt;erit Curpun.tion. u Florida

known

to

nx

or produwcd

neiic: Sid/ I lr,O,


NoUry Public, Country

h[?

ov rni5sit n'

corporation, on

xpit

s:

THE dept/ 3354/ 3354 9/ i.1129428G. DOCx. I

beltnir

nt- mid

tmaity,

11e is

nS id0atlfica,Lyrt,

Cumminsion No.

of

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