Ralph Choeff - Eric Barubkhin A .\ el.,,, t
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City.of Miami Beach_Office ofthe•City Clerk
1700 Convention Oehter Drive, .Miami`Beach, FL 3.31'39
LOBBYIST REGISTRATION FORM - _ ' :t
Lobbyist means-all persons employed or retained, whether paid-or riot, 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. •
NAME OF LOBBYIST (Last) (First) (M.I)
} (ANN kO.AC . €34-/-s a( t t'F SUM / t M t 4vVt( 'P.. X314
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
& s) 474-633e ( om ircoec-Fe c e ej. cwTELEPHON UMBER: FAX NU R: EMAIL.
•
Please notify this office if your contact information changes:.address,phone, ore-mail address. ; ,
I. LOBBYIST RETAINED BY:
NAlk OF PRINCIPAL/CLIENT
of■flhc., e#9 SS fa S , �E,I S 0"102 1
•zUSINES�S"INAME AND ADDRESS (Number and Street) (City) (State) (Zi Code)
�l13Xo • 6-1�CO 6G� cs , N e-v1Mi Z043 . Wet"
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
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%-OR MORE OWNERSHIP INTEREST.IN SUCH CORPORATION,
PARTNERSHIP OR TRUST
II.SPECIFIC LOBBY ISSUE:: i " 2'''s ----17-(-1. 22-1' fLcfriti0-7C.CIV
M
Issue to be lobbied(Describe in detail):
Ill.CITY AGENCIES/INDIVIDUALS;TO" BE.:LOBBIED:
'Pursuant to City Code Section 2-482(a)(4)-includethe 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
wiradirr.Attothatesi,,••,,..,,,,,,,..r,. .•, .; .,,e city to the present date,stating the general.nature of the subject contractual relationship.
?i ,9cI Aau Sec 2-482(4)(4A:Ful4•, ame of-Individual and Contractual Relationship(Explain) YES NO
st.itoil;),?�^ . .,;ln,.a.•E-,,•." t$}r"oi ii n to be lobbied
'U C ;cr", 1'? XY IliiC,.,ia l W.' P P\n c) ^,p
g,.. .ev �tlil it l%•` ,y/A�, ` �- +'K
Gi+9•^� °i v.•r" Q' .11. 11 !Y;v.yl:,t �/�1 ^� . f Y
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Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financiatamii1 or p f
;,f essional
relationship,or other relationship giving rise-to an appearance of an impropriety,with any current city commissioned4r cit3tpersonnel.who is
sought to be lobbied as identified on the lobbyist registration form filed. G
Sec 2-482(g)Any Financial,"Familial or Professional Relationship 00 Tai CD 'j-
oft yt€sC ri ,ow- -co iXS l.Uv3 S key -
, () /
IV DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER)
A) LOBBYIST DISCLOSURE.(Red).1 _ ' C Qi 4
B) PRINCI S DISCL SUR (OF • B I T C M NSATION) r (/( y,� '� � C
(Required) rS� � d�d ��� l t�fn/6 �� 1 LL�y�� '�'
I' 4412- ( 0 . C A“ST sc:7�o N •
The following information mus •e swered.
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" - ,
El Yes sigr No: Are you lobbying on a pending application fora 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 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.
CI tt //
Yes L(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 LOBBYISTS - L SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WEL ' = COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEME, S A BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PE' •D.
•natur- •.--..�
I do solemnly swear that - •• : foregoing facts are true a 2 correct and thaaI have read.or am familiar with the provisions contained
in Section 2-482 of the ■la, =-a, Ci •- and all reporting re•uirements.
Signature of Lobbyist:
sr_ror , , , .
Signature of Principal/Cli nt: - `J-
VI. LOBBYIST IDENTIFICATION• PRINCIPAL.IDENTIFICATION:
roduced ID C loo"'7D9b-UCD'og- (Produced ID C '
Form of Identification Form of.Identification
Ar/
❑ Personally known (Lobbyist) ❑ Personally know LISA ROCCO
VII. SIGNATURE AND STAMP OF.NOTARY t• )
My Comm.Expires May 20,20
•.r� CCommission#EE 89420
State of Florida, County of Miami-Dade State of Florida, Co ty • = i-Dade
Sworn to and subscribed before mn e Sworn�nd subscri
This - ..• day of ,\h°(nPr e/ 2011 Thi day of tJOV`�/A , 011
4110 . L0, - L .. \ 1 i & ( II i )
Signs • e if Public No -State of Florida Trtipr P Tic Notary-State of Florida
Notarization.of Lobbyist's signature Nota - ion of Principal's signature
■ TO BE COMPLETED BY CITY CLERK'S.STAFF NLY
Annual:Registration fee: ;[ ;]"Yes;[ .]'No .Amount P.aid:$ d.•°° MC - Date Paid 7...1*--. a"//
Lobbyist:Registration Form;received and.verifiedby•. i' z�---' Ri
F:\CLER\BALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc 'Revised 1/11/2011
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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: � _
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
imme•' ely notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature: Date: