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Craig H. Blinderman - Robert & Marisol Beharal 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, 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. Blinderman Craig H. NAME OF LOBBYIST: Kurkin Forehand Brandes LLP (Last) (First) (M.I) 18851 NE 29th Avenue #303 Aventura FL 33143 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)929 -8503 (305) 675 -0564 cblinderman @kfb- law.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: Robert and Marisol Behar NAME OF PRINCIPAUCLIENT: 2375 Magnolia Drive North Miami FL 33181 BUSINESS NAME AND ADDRESS (Number and Street) (City) (305) 863 -5700 TELEPHONE NUMBER: (State) (Zip Code) 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: Permit Application -co c c \aG 4 %-+ s C,l bid 0.. 4 fLo Issue to be lobbied (Describe in detail): iii. CITY AGENCIES /INDIVIDUALS 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 general nature of the subject contractual relationship. Sec 2- 482(a)(4) Full Name of Individual and title of person to be lobbied Contractual Relationship (Explain) YES NO Planning Board Members OG • I 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. `" ,J I •j•_t 1) tm. -, -� Sec 2- 482(g) Any Financial, Familial or Professional Relationship ' " --` `0 A113 N/A OG • I L2 fV Zln7 < F: \CLER\$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc FL- IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) `°kr- I Hourly compensation DQS �/ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly compensation 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 ENO: 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 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 i em, shall 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 S MIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMSATION 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 forego g in Section 2 -482 of the Miami Beach Cit Cod- and all reporting requirem- s. gnature o%obbyist, /Craig I . Bl inderman fac - are true and correct and that I have read or am familiar with the provisions contained Signature of Lobbyist. Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: VII. Produced ID &s tiOlid Q'GXb Form of Identification ,.4,011111 i Hilo/ 9 e \\ \P R. H Fj , sir ••dc-' „Nary 1g2 oi' SIGNATURE AND STAMP OF NOT4Fr&. �Tr State of F ©rida, County of Miami -Dade o #DD 832367 Sworn to and subscribed before me ' 9�'• a ecntledlhN e�5•• °�' This 4? day of 201 "/,..-i0• .Aithicundeo -o. 49, € Personally known (Lobbyist) coot attk Notarizat PRINCIPAL IDENTIFICATION: jJ i3 6 -74o -Q € Produced ID Form of Identification 0( € Personally known � i �C STATE 0?FLQRi�?, Craig H. Blindeilxnan 'd;;,. ii Commission #DD873427 '' .,..,,,,.••'' Expires: MAR. 23, 2013 e of Florida, Coun ?y ofi F Hi BONDING Co.,ma d subscri. �d before me day of I I (L CAA , 201/ 1—‘-' Sta Swo This otary — State of Florida Signature • Public Notary — obbvist's s{ nature Notarization TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ IV ] Yes [ ] No Amount Paid $ S'5/9 MCR # Lobbyist Registration Form received and verified by: ate of Florida signature ' e Paid /c- / / F : \CLER \$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Form.doc Revised 1/11/2011 iI 1 , l I . ■ phi Miami Beach, Florida 33139 www.miamibeachfl.gov Drive, M 9 City of Miami Beach, 1700 Convention Center , CITY CLERK Office Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Craig H. Blinderman CityClerk@miamibeachfl.gov 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. Pursuant to Section 2 -485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2- 485.1, a fine of $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami -Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobby'. , who fails to file the required Statement by April 30th, 2012, shall be automati •Ily s spended from lobbying until all fines are paid, unless the fine has been appeal; d to the Miami -Dade County Commission on Ethics and Public Trust. J Signature:: rai Blinderman Date: F: \CLER \$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 0 .m 0 G T: 3 0 -1 w m 0 G 0 0 N 0. CD C):: 2 0 00 0 3 0 C W V--1? H • CD" tiitt • G