Ralph Choeff - 6 Star Island (� 5-1 P+.rL sin r b
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2012 SEP -7 AN n• ity of Miami Beach Office of the City Clerk
70�convention Center Drive Miami Beach, FL 33139
CITY C L _ C F V {_:t. LOBBYIST REGISTRATION FORMA
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 foresesably 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 ref or to Ordinance 2004-3435.
e-A21E IFIS I.A[.P%l
NAME OF LOBBYIST: (Last) (FlrsU (M.1)
L{ t L. t tp
BUSINESS NAME AND ADDRESS (Number and Street) I (City) (State) (rip Code)
3122t iL L f-r=
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please nod&this office If your contact lnihrmadon changes:address,phone, or e-mail address.
1. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
Ze.J a eel. t FL
BUSINESS NAME AND ADDRESS (Number and Street) (CRY) (Stdo) (p Cam) 37 V5
TELEPHONE NU R: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section If principal is a Corporation,Partnership or Trust[Section 2482(c)]
Y NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
O IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Issue to be krbbled(Describe In detail):
CITY AGENCIEStINDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2482(aX4)Include the commissioner or personnel sought to be lobbied,and whether the lobbylat has entered
Into any contractual relationship (pall or unpaid) with said city commissioner or personnel from 12 months preceding such person's
comment of service with the Sft to the pressit dabs stating the goneral nature of the SUN2q contrarbual
Sec 2402(a)(4)Full Name of Individual and Contracbmi Relationship(Explain) YES I NO
title of person to be lobbied
Pursuant to City Code Section 2482(g)Every megb*unt shall be required to state the extent of any bossiness,financlel,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 2452 Any Financial,FamlIW or Professional Relationship
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i
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST CO ENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION.
(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 to Are You lobbying on a P[2sent or pending bit!for synods.Squioment or services,or on a Rresent or oendina
r gg2dg.eauiRMenj or service?
2) Pursuant to Miami Beach City Code Section 2-480 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development issues":
_Yes o: on n l I cats f9r a 011yelopMgnt Agreemeat City or agplicatign for
change of zoning n=de:eigng!jon or change to the City's Fire Land Us2K4P?
3) Pursuant to Miami Beach City Code Section 2482(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.
Yes No: u rapresenting a ag&for7mrofit cgimoration r engtv ylithout c t compal3sation or t.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH Oi_ BBYI T SHALL SUBMIT TO THE CITY CLERK A SIGJVF[?ST EE T UNDER
TH.LqTING LOB§IYING E U E S,AS.MLL EMMIlgIf RECKWED,IN TIJE CITY QF MIAMI JJCACH FOR
THE PRECgDINIQ CALENPAR YEA& A§MLYAENI LL cud N I E INERE
OF
COMPENSATION DURING THE REPORTING PERIOD. de, li
Signature of twey---
I do solemnly swear that all of the foregoing fa are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Co d 11 reporting requirements.
Signature of Lobbyist: ke
Signature of Principal/Client: �✓
VI. LOBBYIST IDENTIFICATI PRINCIPAL IDENTIFICATION:
Produced ID L Produced ID
Form of Identification Form of Identification
_Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida my of Miami-Dade blot County of Miami-Dade
Sworn t and b be befo me .• •' ARiADNA Cubscribed before me
This d y f ,201 :' MY COMMISSION# ay of 12C ESCRIBANt}CR9
EXPIRES June 02 ? ' MY COMMISSION I EE 12M
I 98 0153 Floridallotaryse # * EXPIRES:September 14.2015
Signature of bli to --State of Floilvis i OFOublic Notary—State ThmgKIP ftry savws
Notarizatio st's sl re NotaN.a on of Princtaal's signatt�f ��`
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Ye9[ ]No Amount Paid$ MC d Date Maid
Lobbyist Registration Fo reyce ed and ve,ritied by: _
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ReWsed 04/27/2012
City of Miami Beach, 1700 Convewlun Centel biwe, Miarrn Beach, Florida 3313Y, www m am beachfl goy
CITY CLERK Office
Rafael E Granado, City Clerk CityClerk @mia+nibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: e
I understand that no later than February 28 of each,year, I must file the following form,
pursuant to Section 2-455 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 2-455 (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 50th, 20129 shall be
automaticalViepspended from lobbying until all fines are paid,unless the fine has been
appealed Miami-Dade County Commilesion on Ethics and Public Trust.
Signal ' Date:
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