Les Bellinson__-
1ss~e e"-lY
:_,
®MIAMIB~A~H ~ ~
- ~~~
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 ariy 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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Beilinson Les
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Beilinson Gomez Architects, P.A. 8101 Biscayne Boulevard, Suite 309 Miami FL 33138
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
305-559-1250 305-551-1740 LDB@BeilinsonArchitectspa.com
LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
Ross Owner
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
_Betsy Hotel 1440 Ocean Drive Miami Beach FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
305.531.6100
FiA out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Jonathan Plutzik
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See Exhibit "A"
11. SPECIFIC LOBBY ISSUE:
Flood Waiver application
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) 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 IndividuaUTitle B An Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
5~
;,
n~n~
~~~
,.n~«•~
n
~~~g~
~~~~
$~~i
~~Ng~
e
~~
r~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$250.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $250.00 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 6a No: Are you lobbying on a present or pendina bid for goods equipment or services or on a
present or pendina 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":
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"IobbyisY' 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 opposftion to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^Yes 6a No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
I do solemnly swear that all of the
provisions contained in Section
Signature of Lobbyist: ~
-~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
are true and correct and that I have read or am familiar with the
Beach City Code and all reporting requirements.
PRINCIPAL IDENTIFICATION:
^ ProducedlD
Form of Identification
^ 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 , 20pg
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
TO BE COMPLETED BY
Annual Registration fee: ]Yes [ ] No Amount Paid S
Lobbyist Registration Form received and verified bv:
^ 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
V. SIGNATURE UNDER OATH:
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
250.00 oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $250.00 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 lobbying 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 ~1 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 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 6zl No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 15L 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES. OR COMPENSATION DURING THE REPORTING
PERIOD.
I do solemnly swear that all of the foregoing fac are
provisions contained in Section 2-482 of the Miami
Signature of Lobbyist:
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
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Signature of Lobbyist
and correct and that I have read or am familiar with the
19C Code and all reporting requirements.
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and sub~ibed before me
This Z ~ day of aw.tiBA?^'"~''~`°
/f ~ .~Ar P ~ ~blic State of Florida
~,' Adam ~ ..~rarry
ommission DD897983
re of blic ~__ fa c~X6Setud~23/20~
of
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\LOBBYIS11Lobb ist Registration Form 32708.doc Revised 03/27/2008
.i
_.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CityClerkr7o.miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Les Beilinson
I understand that no later than October 1 a1 of each vear, 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, ! am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
~ ~~ ~a
Signatur : Date:
MIADOCS 4031159 1
fU~J~I1-1 t7JIt• ~~,~~~,`201C~ C~01 F;
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
t4C:~-%;i~sr ~ut~r}: ~u:rcVt~ ;rt~u.~t~ r? (~ 6
~~3
No.
^ Cash ^ Credit Carder Check #_~______ $ ~ ~' ~
b .~ 20~--
(THIS INFORMATION MUST BE COMPLETED) Offic nce Director
B3'
' Account Nu er: ~ - " ~~~ y
Preparers Dept: ~ , ~~ ~ ~~ P,r2-~ EXT:_
i
For ~. P S ~~e -~~-i NSA ~ -1- ~~X,.~~11LDpiP -~-A rllnn a c
~ ~~ e Ac.h I S5~ ~
d
BETSY ROSS OWNER, LLC GiTBANK 7 4.$1
d!b/a°BETSY ROSS HOTEL _
,1440 OCEAN.DRIVE 63-8655/2fifi0
MIAMI BEACH, FL 33139
(305):537-3934
PAY.Seven Hundred and 00/100.Dollars '
CHECK NO. DATE AMOUNT
m 007481 2/1/2010 $700.00.
'4k
N'
TO THE CITY:OF -MIAMI BEACH ~~
,ORDER 1100'WASHINGTON AVENUE
Oe: MIAMI BEACH, FL 33139
~t SECURITY FEATURES INCLUDED. DETAILS ON BAf
11'00748 LII' 0:266086554: 9 ~ L601714411'