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Allan S. Reiss~~ ~~~ ~~~~~ ~ ~ ~i ~~ ~~ ~ ~~~~~~ ~~ ~~ ~ ,~ t 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 inGudes the principal as well as any employee engaged in lobbying activities. The team "Lobbyists" has specific ezcluslons. Please refer to Ordinance 20043436. REISS ALLAN S NAME OF LOBBYIST: (Lass) (First) (M.I) Suite 700, Miami, Florida 33131 and Street) (Cltvl ~ist~'~o~ ~" 3n5-3~2_~~~n 3n~-42.3-3203 asr levinelawfirm com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: Slll'1GPf- Parki n~ R~c~PmS' Tnc_ AAA\AE ~C DPIN~IDAL.w LIEIi , . ~ 1674 Meridian Avenue, #106, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-216-2028 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) section If or Trust (Section 2-482 NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Ra f ae 1 Andrade IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 596 OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Ra f ae 1 Andrade 1 0 0 $ II.SPECIFIC LOBBY ISSUE: Planning Board File #1926 C~~ use permit apn for 400 Collins Issue to be Cobbled (Descnbe In detarq. ul. CITY: AGENCIESQNDIVIDUALS TO 'BE LOBBIED: Pursuant to City Code Section 2~as2(g) Include a statement of the extent of any business, flnanclal, familial, ,professional or other relationship, giving rise to an appearance of an Impropriety wRh any City personnel sought to be lobbied -further, pursuant to Clty Code Section 2- 482(a)(4) Include a statement of any contractual relationship (paid or unpaid) from 12 months preceding said City personnels' commencement of service with the City to the present date, stating the general nature of the subject contractual Halation. A Full Name of Individual Title City of Miami Bach Plamming B An Financial, Familial or Professional Relationship oard NONE City of Miami Beach Planning S taff NONE City of Miami Beach Mayer/Comm issioner NON~,`-~~-"::".~ c.~k!),:f~~ ~ {e~ City of Miami Beach Attorneys NONE hS '~ ~'~~ L I ~d~ 600Z (..J ~ t t ~ .~ ~~ :~ ~ ~, r,~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~l325.00 an hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 3 2 5.0 0 per hour 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 man designation or chance to the Citv'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 ENO: 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: ~ "G VI. LOBBYIST IDENTIFICATIO PRINCIPAL IDENTIFICATION: ^ Produced ID ,~ /'~ Form of Identification LL-Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: r ~ f Flori~~@~n ,p ' =':S rrrfo ~ bscrib~8` ~ ~~~bf~l ,~, ~~ ignature of ublic Notary orida Notarization of Lobbvist'~signature _/ TO BE COMPLETED BY C Annual Registration fee: [ ]Yes [ ] No Amount Pald S_ Lobbyist Registration Form received and verified by: 0 Produced ID '~ Form of Identification Personal) known Pri ' y ( nc~pal) Notarization of Principal's signs LERK'S STAFF ONLY f Q ~ MCR # _ Date Pald Form 21109.doc Revised I do solemnly swear that all of the foregoing f 'a're true and correct and that I ve read or am familiar with the provisions contained in Section 2-482 oft iam~eac.~i City Codei~r rting requirements. .. .... ~ City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Allan s. Reiss, Esq. I understand that no later than October 1st 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 of lobbyist withdrawal in writing. Sig ~ ~ o, << ~ ~ ~ Date: F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc