Jorge S. Kuperman - ASR Berwick Family LTD B EAC H
City of Miami Beach Office of the City Clerk 191?J
1700 Convention Center Drive, Miami Beach, FL 33139 qN�y
LOBBYIST REGISTRATION FORM �( y: /2
(rff.• ,
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passarbiq cttfpt or
modification of any ordinance, resolution, action or decision of any commissioner-, any action, decision, recommendation of hg•l�ity
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)
J s►c .- 137 C►r 74 �941, Cv�LE5-
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
L J Ku- M _;c kancl ijeju 4@ rau o A
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
BUSINESS NAME AND AD RESS (Number and Street) (City) (State) (Zip Code)
10?0*7^ o a
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:
aA � C;K—
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
n.SPEC F:CC'LOBBY ISSUE
Issue to be lobbied(Describe in detail 7.
III.CITY ACEN:CIEVIN DIVID.U.ALS TO=BE=LOBBIED:
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 eneral 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
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
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR '
OTHER):
P_ _OBBYIS T DISC;_ ;SURE (Required) ---
31 PRINCIPAL' DIac SU (OF LOBBYIST COMPENSATI ION)
(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 lobbvinq 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":e .
Yes , No Are you lobbying on a pending application for a Development Agreement with the CitV 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 hall hall register with the clerk as required by this section but, shall not be required to pay any registration fees.
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.
I do solemnly swear that all of the foregoing facts are true and correct and t ave read or am familiar with the provisions 7,ontained
in Section 2-462 of the Miami B - o and all reporting requireme
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced IDS b' -J T �- El Produced ID r G� 5-45i�7-M _v
)Form of identification Form of Identification
Personally known (Lobbyist) ❑ Personally
t ,E��9�g� .a�'.oi, ISABELSATCHELL
VII. SIGNATURE AND STAMP OF NOTARY: �gE�SONypO 2J)N3 e� *: ,_ A�YCOMMISSION#DD 879891
MtCA�P�S•PPQ�c��ec �Hpd�dQ BondedThlruNotary PPubl'�cUnderwriters
State of=lodda. County of Miami-Dade ,� }Y°x. �yQ�NNo�aN State of=1ori
Sworn to and ubscribed before me ,_ gedtt Sworn And kd cribe ' before me
This y of d 20 Vic` Thi lie
20111.
5ianature o Public ry- State of. rida Signature ubiic No ry- State of Florida
Notarizati of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes [ J No Amount Paid CR# Date Paid l
Lobbyist Registration F m eceived and verified by:
t__FP.1S4L11a=�RM51L06B`�ST FORw!S'L000vis.pnnua': ke isration Fortr.ua Revised 1/11,12011