Samuel A. Rubert - Pierre Heafey MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 3jjpp`U -5
LOBBYIST REGISTRATION FORM
{�^^ TTY CU -p� '.
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks td'�r�courage 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.
RUBERT, SAMUEL A.
NAME OF LOBBYIST: (Last) (First) (M.1)
SAMUEL A. RUBERT, P.A. , 3225 FRANKLIN AVE. , SUITE C-101, COCONUT GROVE, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 804-5141 (888) 344-1798 SRUBERT @RUBERTLAW.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:
PIERRE HEAFEY
NAME OF PRINCIPAUCLIENT:
HEAFEY/BENTLEY HOTEL, LLq 1717 N. BAYSHORE DR. , SUITE 213 , MIAMI, FL 33132
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 523-3347 (305) 523-2245
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: (D S• Diems- PC, 8g
VARIANCE FROM SETBACK REQUIREMENTS FOR SIGNAGE IN RPS-4j� f��e
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 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
PLANNING & ZONING X
BOARD OF ADJUSTMENT 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 An Financial,Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WIIETHER HOURLY,PLAT RATE OR OTHERI:
A) LOBBYIST DISCLOSURE:(Required) HOURLY ✓ �,(�j�
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): HOURLY
PP
(REQUIRED).
The following In(ofm211on must he answered:
1) Pursuant to Miami Beach City Code Section 2.488 Entitled'Prohibited Campaign Contributions By Lobbyists On Procurement
issuoe:
Yes XNO: Ara You IW&idna on a present or needing bid/for rloo.'rs eaulonlent or seryicss or on a grosent or pending
Award for goods 20WOMOM or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues`:
-„-Yes XNo: Are You lobbfdna oil a gendik►a appNaB�for a DsY9konmM Agreement with the City or application for
OWN of SOON MOO)dsshtnatlon or change to the CNY's EUkn Land Use Men?
3) Pursuant to Muni Beach City Code Section 2482(h)Any person(except those exempt iron,the definition of`lobbyist'as set
forth In Section 2-AS1 above)who only appears as a representative of a noMor profit corporation or entity without special
compensation or reimbursement for the appearance, whether direct, or Indirect, to express support of or opposition to any
Rem,shall register with the deck as required by this section tut,shall not be required to pay any registration fees.
YesXNo: Are You representing a notdor-profit corooratio,or entity Without smial cotn..�nsation or reimbursement,
V. SMATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST 8H ALL t SifDOT TO THE GITY"@RX A SIGNED STATEMENT LINDER
COMMENSATION DUR NG THE EPORTING PERIOD
elfin . Lebby(st
I do solomni)r swear that all of the foregoing kids are true and correct and that t have read or am familiar with the provisions contained
In Section 2-482 of the Miami I ch City Code and all reporting requirements.
Signature of Lobbyist:
Signature of PrincipaVCl
VI. LOBBYIST IDENTIFICATION: PRINCIP NTIFFiCATION:
Produced ID Produced ID
Form of Identification Form of Identification
_Personally known(Lobbyist) \ Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Mta -0 d State of Florida,County of Mioml-Dade
Sworn to and stu scribed bete n Sworn wo subscribs4l before me
This - _day of x,46` Notary Public State of Florida This 5" day of JJ J hllp
Maria Scilipoti Notary Public State of Florida
Y Commission OD941567
Maria Scilipoti
e a Pires 11/18/2013 PUbtlo NOFatY_ �PEZP�111SII'S8�1201 D941567
sw�qkffq of Notari:etlott of :lE rlZatletl of !pf h,aNs
TO BE COMPLETED BY CITY CLERK'S tiTAF Y
Annual illso*rtion fee: ( (Yes( I No Amount Paid$_aQ$_' MCR 0 V 0 Dote P Id
Lobbyist RoWWolion form recelved and verified by:
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FormmvkW 5.30-2012.doc
F:\CLEI listration Form.doc Revised 04/27/2012
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
LOBBYIST NAME: SAMUEL A. RUEERT
I understand that no later than February 28 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, or I am no
longer lobbying on that issue or for that principal, 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 lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
1�4�appealed to/)the Mi i-Dade County Commission on Ethics and Public Trust.
c, lql,
Sign ure: Date:
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