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David H. Nevel - 1747 Bay Road Properties, LLC C)./D , rr MIAMIBEAC 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 includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435. ///eve/ Dav %d 1. NAME OF LOBBYIST: (Last) (First) (M.I) ThvW fl Neve/ PA. ° 950 £, Rne E /a/x/Ref t1-�.So P/a�fa 'ors L 2332 BUSINESS NAME AND ADI • (Number and Street) (City) / (State) • (Zip Code) (35 1 /23 -r' 408 C95`) 777-8250 /auv �dt'evet et LE E NUMBER: F BER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. 1. LOBBYIST t YIST RETAINED BY: / 7 NAME � INCIPA el T: Aael P/op��P —s� LL ,B 17/7 &y Paw/ Mia ac Fl 33/3 9 BUSINESS NAME AND ADDRESS (Nu Bay and Street) (City) (State) (Zip Code) TELEPHONE NUMBER 3_336q 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: titY l l$-t3 reea,r i n9 5 s •r• • 4 , l res m ct � tea. min r Issue to be lobbied (Describe in detail): e ' S (V 1')5 -th e " • / it 5 ran L. III. CITY AGENCIES /INDIVIDUALS TO ENE tOSSIED: Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date, stating the general nature of the subject contractual relationship. Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied C s7Ini y�a lei gamy &ac/ amlrrist'iPti t/ i %vn' � (ke C°otrvid ee t/ Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the 4 a&y @ , J(nppgial, familial or professional relationship, or other relationship giving rise to an appearance of an impropriety, with current city comm s r or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. ;11R t �+ Q3 � Sec 2- 482(g) Any Financial, Familial or Professional Relationship `] v 11111 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): J A) LOBBYIST DISCLOSURE: (Required) )$ 275 frw ?4 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 7'� 2 2� r ) (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 Issue "• ❑ Yes No: Are vou lobbying on a present or pending bid for aoods. equipment or services. or on a present or pending award for goods. eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled Prohibited Campaign Contributions By Lobbyists On Real Estate Devel ent Issues ": ❑ Yes No: Are vou lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change 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 a not - 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, all register with the clerk as required by this section but, shall not be required to pay any registration fees. ❑ Yes No: Are vou representing a not - for - profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS W __ - i.m;,i;ri.r , :,_.. ECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATE ->irigt0,1974/1t Iii;. . _ BEEN NO EXPENDITURES OR COMPEN ATION DURING THE REPORTING PE 'T'. , Signature of Lob. I do solemnly sw - at all of the fo - • • - - - ...:- - • _ •rrect and that I have read or am familiar with the provisions contained in Section 2-482 0 -44-0,1;0; - - M i ode and all - porting re•uirements. Signature of Lobb st: Signature of Principal /Client: - SkG'•re n A W ( Alta."P(.' Alt el% <.r VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID 41" ESTHER WILYAMOWSKY MY COMMISSION # DD698085 0 Produced ID Form of Identifi -' "- _nor EXPIRES: September 23, 2011 Form of Identification I400 37NOTARY Fl. Nary Discount Mist Ca D il Personally known (Lobbyist) *Personally known (Principal) VII. SIGNATURE AND STAMP OF N TARY: A. EL R. State of Florida, County of Miami -Dade 4._ MY COMMISSION N DD VINES 723811 State of Florida, County of Miami -Dade Swom to and subscribed before me . -_�_ EXPIRES: October 14, 2011 Swom and subscribe, b -fore me This day f roll , 2011 ` . , `'` e4ndedrnn'Neta Pubic This 1' d ( • , AL• -a , 2011 �I` il< fi aillri�� Signature of Public Notary - State of Florida Signature of Public No ary - Stat " ;.a Notarization of Lobbyist's signature Notarization of Principal's signature r TO BE COMPLETED BY CITY CLERK'S STAFF ONLY // Annual Registration fee: [ ] Yes [ ] No Amount Paid $ 'V S 3 MCR # d ' S 9V Da te Paid _,,,_../ AV Lobbyist Registration Form received and verified by: F:\CLER\ ;ALL \aFORMS \LOBBYIST FORMS \lobbyist Annual Registration Form.doc � Revised 1/11/2011 J M IAMIBEACH City of Miami Beach, 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: Dcw, 77. /L/eye I understand that no later than February 28th of each year, I must file the following form, 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 and Compensation 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 immedi. - y noti t e • Clerk's Office of lobbyist withdrawal in writing. 41111■— 2/0 O// Signature: Date: