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Stanley B. Price - Greater Miami Hebrew Academy t t 771 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 penod 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 indudes the principal as well as any employee engaged in lobbying activities. The tern " Lobbyists" has specific exclusions. Please refer to Ordinance 2004.4435 PRICE STANLEY B. NAME OF LOBBYIST: (Last) (First) (M I) Rim Sumbero Baena Price & Axelrod LLP . 1450 Bridrell Avenue. Suite 2300, Miami. FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) 305-350-2374 305-351-2204 soriceeilzin.com TELEPHONE NUMBER' FAX NUMBER EMAIL I. LOBBYIST RETAINED BY: Greater Miami Hebrew Academy NAME OF PRINCIPAUCLIENT' 2400 Pine Tree Drive Miami Beach Fl 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-672 -8200 305-6U:8400 TELEPHONE NUMBER- 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 LEAH kLEily fAa/DF^'T` • • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST. TH /S Nol" Fo.e Piafrr Cogivibtwoni AND HAS No 5NA6tiot•oEiz vi„„„leselp II. SPECIFIC LOBBY ISSUE: Expansion Project at 2400 Pine Tree Drive. Miami Beach. Issue to be lobbied (Describe in detail) III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Titte B) Any Financial, Familial or Professional Relationship Planning Dept. Public Works and City Attorney 3aHd0 S.)413/ .1 AllO SZ :II WV L- AON 1102 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE (Required) $2.500.00 flat fee B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION). (Required) 52.500.00 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" Fl Yes `INo: Are you lobbying on a Present or tending bid for goods. sauioment or services. or on a present or pendlna award for aoods. eauiomsnt 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 tending application fora Develooment Agreement with the City or application for change of zoning mao deslanation 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 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 clerk as required by this section but, shall not be required to pay any registration fees. n Yes 'INo: Are you rearesentinn a not4or•orofit corporation or entity without stecial comoensston or telmbursamant? V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 HE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE • - • 0" • HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPOR ERIOD. �• Signature of • .. I do solemnly swear that all of the foregoing facts a tn.. and correct ■ . I have read or am familiar with the provisions contained in Section 2-482 of the Miami Bea�MC1 yle..- • all reporting requirements. Signature of Lobbyist. V Signature of Principal/Client 6 . ,}1 • \ � VI. LOBBYIST IDENTIFICATION: © PRINCIPAL IDENTIFICATION: L' Produced ID n Produced ID Form of Identification s Form of I.. _' '' Personaly known (Lobbyist) /Personally known (Pre . pill ° oi. Notary Public State of Flonda ` r , Elena Holand VII. SIGNATURE AND STAMP OF NOTARY: iii My Commission DD752921 to Ar P re., ? Expires 03/23/2012 State of Florida, County of Miami - • • '"•.`4 State of Florida, County or `, ."`. S and su •.: - • • - • before `, , * MY CMMIS O SION f DD 9 6 r 9 Sworn subscribed before me IA day of 1 '1 , . ,1 i Y �, EXPIRES: February 20, 2014 ms d of OG7mpfs 20 ilE b.„ �9I /�' ' °F r tiagrd 11 " MO NcWp BaMhw �\c, ` 11 S 'nature • bhc N. r" " - .: to of Florida ` _ Notary . . • of Lobbyist's signatur Notarization � s signature ,/ // FOR CLERK'S E ONLY // y� 7 Annual Registration fee 11 Yes ( 1 No Mount Paid Q — MCR /345, Date Paid Paid r v // Lobbyist Registration Form received and venfied by: s A Mir ,�l , .• 0 Revised r= •512010 MIAMI BEACH H City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www mwmibeachfl gov CITY CLERK Office CityClerk @miamibeachfl gov Tel 305 673 7/411 , Fax 305 673 7254 LOBBYIST NAME: S' n LAI 3. Prr cL� 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 immediately notify the City Clerk's Office of lobbyist withdrawal in writing. II'I1 1I Signature: Date: J