Les Bellinson (2)ANN~~I. + ~ss~e.
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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, 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:
Betsy Ross Owner, LLC
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
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:
"A"
I1. SPECIFIC LOBBY ISSUE:
Conditional Use Permit 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)(4j 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 Relatlonshi
Mayor None
Commissioners
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
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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 pending bid for goods eauipment 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 6a No: Are you lobbvina on a pending application for a Development Agreement with the City or
application for chance of zonfna 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..
^Yes ~ No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Principal/Client:
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VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VI(. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn~~~~QQ and subscribed before me
This (ZT"day of 3~1r, P968~~.p f p
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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
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of Public Notary -State of Florida
ion of Lobbyist's signa ure
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 [ j No Amount Paid S MCR 3 Date Paid
obbylst Registration F rm received and verified by:
F:\CLER\LOBBYISTLobbyist Registration Form 32708.doc oe.,iesa n~ie„~~~e
I do solemnly swear that all of the re oing acts are true and correct and that I have read or am familiar with the
provisions contained in Section a iami Beach City Code and all reporting requirements.
Signature of Lobbyist:
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 X 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 ~X No: Are you lobbvina on a pending application for a Development Agreement with the Citv or
application for chance of zoning map desianation 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 X No: Are you representing snot-for-profit corporation or_ entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 151 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
Signature of Lobbyist
I do solemnly swear that all of the foregoin acts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of the Mi i B ch City Code and all repotting requirements.
Signature of Lobbyist:
Signature of Principal/ le
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENT[FICATION:
17 Produced ID ^ Produced ID
Form of Identification Form of Identification
C Personally known (Lobbyist) ^ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me Sworn to and subscr'be afore
This _ day of , 2008 Thi ~ a 0~
~~r °OS~^ Notary Puol+c State of Florida
Si nature of Public Nota
9 ry -State of Florida
' ~ MY Comm~ssian DD697983
Si ature of Pu c Not a ~~ ~d~Xpires oli23no~
Notarization of Lobbvist
s signature o artzation of Princ' al's si
i v oC ~.vlvirLC I cu CST VI I Y llLCKF<J UJt UNLY
Annual Registration fee: Yes [ ] No Amount Paid $ ~ SC7 MCR $ Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIST\Lobb ist Re istration Form 32708.doc Revised 03/27/2008
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City of Miami. Beach, 1700 Convention Center Orive, Miami Beach,. Florida 33139, vrww.miamibeachft.oov
CITY CLERK office CitvClerkC~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:. Les Beilinson
1 understand that no later than October 1°` 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, I am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
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Signature: Date.
MIADOCS 3952573 1