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Matthew Leibowitz - Recharge Solutions, Int'l • w,Aldeit • - -" NO l°6 G 0,b eri MIAMIBEACH 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, def: at 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 bf 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. Leibowitz Matthew NAME OF LOBBYIST. (Last) (First) (M.I) Recharge Solutions Intl, LLC 4400 Biscayne Blvd., #880 Miami FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305 - 530 -9415 305 - 530 -9417 mleibowitz @rechargesolutionsintl.com TELEPHONE NUMBER. FAX NUMBER. EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: � m N/A -< %O NAME OF PRINCIPAL/CLIENT: rr ^"; N BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) %C to U; — V TELEPHONE NUMBER. FAX NUMBER: (Optional) EMAIL (Optional) O -a Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] cn • 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: II.SPECIFIC LOBBY ISSUE: Electric Vehicles, electric vehicle charging, green technologies Issue to be lobbied (Describe in detail) lll. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: Procurement, City Attorney, City Commission 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 Mayor, Vice Mayor, Commission X City Manager, CFO X Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2- 482(g) Any Financial, Familial or Professional Relationship My Law firm, Leibowitz and Associates, has represented the City on Telecommunications matters IV. DISCLOSURE OF TERMS MD AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE (Required) No additional compensation B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): No additional compensation (ietuired)• • 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 lobbvina on a present or pending bid for goods. equipment or services, or on a present or pending . award for goods. equipment or service? 2) Pursuantto Miami Beach City Code 2-490 Entitled 'Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues': p Yes No: Are vou lobbying on a pending application fora Development Agreement with the City or application for change 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 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, shall register with the deck as required by this section but, shall not be required to pay any registration fees. Qi Yes ElNo: Are you representing a not-for-profit corporation or entity withoutspecial compensation pr rplmlSrrsement..1 - V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH xEAR. EApH LOBBYIST SHALL ELL AS COMPENSATION TiON RECENE • IN SIGNED STATEMENT OF MIAMI BEACH FOR OATH. LISTING I EXPEJ pITURES, _ - 2 - A/ _ CEi1 iG _ 1 • '_I / ■ _ '-� - -- .. IF rr13i L = ■ i • -- !ill_ • COMPENSATION DURING THE REPORTING PERiOD • Signature of Lobbyist 2 Na I do solemnly swear that ell of the foregoing facts are true and correct and that I have reed or am familiar with the prgsionrco ntal d in Section 2-482 of the Miami Beach City Code and all reporting requirements. r r s. Signature of l obb j . 7; - E) Signature of PrindpalrClleM: to 2 • v , VI. LOBBYIST IDENTIFICATION: PRINCIPAL. IDENTIFICATION: k . � . -- Q Produced ID a Produced ID - '~ Form of Identification. Form of Identification o `Q 1i Persorlatly known (Lobbyist) Personally known (Principal) • d I• ° ' J al VII. SIGNATURE AND STAMP OF NOTARY: i State of Florida, County of Miami-D - __ -_ r of Florida, County of Nlaml -Dade ` ' before ' . Sworn to and subscribed before me . x:, g ataxia is 1� • a of f and subscr u ;" me 2011 o This day of "Tv/ y f '. _ y -, �� • li Cron, l 8. 3 . ,,,„4 • grature of Public • •- ry - State of lo C' .' 4; ' '' ' '. 1Br Sinegh of Public Notary - of Florida ` o ; 1. $'= Fs z Notarization of).,obbvist'e sig = - on of Principal's signature V ' t ) COMM TO BE o BY CM CLERK'S STAFF ONLY - . Annual Re *i[on fee: j j Yes [ 3 No Amount Paid $ F.' - 11i ?' Paid - ' i i 4 ` _ 4 `� � � Lobbyist Registration Form received and verified by: _ ..2....-. •c- -, f7!l #�.'.'' - , k IFACLER \$Ar L\e S\L BBYIST FORMS\RobbAst A l Reglhtra !on Form.doc Revised 1 11/2011 . , • . I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE. (Required) N/A B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION) N/A (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 ❑ 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 \ No: Are you lobbying on a pending application for a Development Agreement with the City or application for — change of zoning map designation or change 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 fprth 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, shall register with the clerk as required by this section but, shall not be required to pay any registration fees 1 ❑ Yes \ No: Are you 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 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 C) N I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the prc sionS d in Section 2 -482 of the Miami Beach City Code and all reporting requirements. C-- . Signature of Lobbyi5 . . . t■ Signature of Principal /Client - VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: - v-1 ❑ Produced ID ❑Produced ID rn rn Form of Identification Form of Identification '0 Personally known (Lobbyist) ❑ Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami -Da, - •tate of Florida, County of Miami -Dade Sworn to and subscribed before me •'., rA • ESTHER HERNANDE2 worn and subscribed before me This .2 day of - Tdf7 , 2' Notary Public - State of Florida ' his day of , 2011 • •: Mty Comm. Ex$.s Jan 6, 2013 �. Commission I DO 530255 S gnature of Public Notary - State of lorfcr,,..a• sows Through Nate Nlfdlg� of Public Notary - State of Florida Notarization of Lobbyist's sig . to �— _ < <� _ -- -- — pozn Lion of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY �/� Annual Registration fee: [ ] Yes [ ] No Amount Paid $ 1 ' _ /0"M" Date Paid l/ Lobbyist Registration Form received and verified by: • ""r . M.__ • F : \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.doc Revised 1/11/2011 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 3: 139, www.miamibeachfl.Gol CITY CLERK Office CityClerk @miamibeachll.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Matthew Leibowitz 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 or has been resolve, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. 1 r-- rc ` - 7/ ; �rr Signatu . Date: a e • fi v, nechar July 27, 2011 l ' City of Miami Beach Office of the City Clerk � 1700 Convention Center Drive Miami Beach, FL 33139 Re: Lobbyist Registration Form • Ladies and Gentlemen: I Enclosed please find completed and executed Lobbyist Registration Form together with Recharge Solutions LLC, check No. 1050 in the amount of $850.00 representing the lobbyist registration form annual fee of $500.00 and the lobby issue fee of.$350.00. Please contact me with any questions. c- o Sincerely, '< �. c c i Tl rn UZI 1' T1 Esther M. Hernandez <( Asst. to Matthew L. Leibowitz `'' _ iTl F r ) OINNO rn • EMH Encls. • 4400 Biscayne Boulevard, Suite 880, Miami, FL 33137 Telephone 305 - 530 -9415 / Facsimile 305 - 530 -9417