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Reinaldo Borges - Hassan Jalali la MIAMI BEACH 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. Boraes Reinaldo NAME OF LOBBYIST: (Last) (First) (M.1) Borges +Associates, P.C. 1200 Brickell Avenue, Suite 1525, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-9216x 108 305-374-9217 RBoraesnaBroaesArchitects.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: Hassan Jalali NAME OF PRINCIPALlCLIENT: 45 East Rivo Alto Drive_ Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-477-3136 305-477-7496 hialali 123Cawmail.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section If principal Is a Corporation,Partnership or Trust[Section 2-482(c)] o • NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUQH?CORPORATIQN, PARTNERSHIP OR TRUST: — cI ii.SPECIFIC LOBBY ISSUE: Development Board annrovals for 45East Rivo Alto Drive Issue to be lobbied(Describe in detail): Ln III. CITY AGENCIESANDIVIDUALS 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,st ling the general nature of the subject contractual relationshl . Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES I NO title of person to be lobbied Planning Staff, City Commission, Development None. Boards, Land Use Development Committee None. and Commission as necessary 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 Any Financial, Familial or Professional Relationship �l!� 1*7 sue, C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Form revised 5-30-2012.doc i�� O IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(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)Mo: Are y2u lobbying on a present or oendina bid for goods.eauioment or services,or on a present or pending award for aoods.eauipment 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 lobbyina on a oendina application for a Development Aareement with the City or application for chance of zonina map des*anation or change to the City's Future Land Use Maps 3) Pursuant to Miami Beach City Code Section 2-482(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)Mo• Are you representina a not-for-profit corporation or entity without special compensation or reimbursement V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE QITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS CITY OF MIAMI BEACH EM THE PRECEDING CALENDAR YEAR, A STATEM E F HAVE BEEN_bQ EXPENDITURES OR COMPENSATION DURING THE REP FITING PERIOD, Signature of Lo ist 1 do solemnly swear that regai cts are true and correct and that I have re d or am familiar with the provisions contained in Section 2-482 of the Mi m' e a eporting requirements. Signature of Lobbyis . i Signature of Principal/Clien VI. LOBBYIST IDENTI ICATI N: PRINCIPAL IDENTIFICATION: _Produced ID _Produced ID Form of Identification Form of Identification XPersonally known(Lobbyist) .Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribed before me Sworn ar�d subscribed before*Expires KEVIN MCUWEY This 3QP day of Z v�A.E ,2013 MARLENE ALLENDE This j4Lday of N� NOTARY PUBLIC STATE OF FLORIDA NOTARY PUBLIC Comm#EE223467 Signature of Public Notary—State of Flori STATE OF FLORID ignature of Public Notary—State of F Notarization of Lobbyist's signature Comm#EE069831 Notarization of Principal's signature 8/8/Z016 Expires 3/2/2015 TO BE COMPLETED BY CITY CLERK'S STAFF Y Annual Registration fee: [ ]Yes[ ].No Amount Paid$ MCR#, Z ate Paid Lobbyist Registration Form received and verified by: fl MIA/\A1 BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachf.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk0amiamibeachfl.gov Tel: 305.673.7411 , Fax:305.673.7254 LOBBYIST NAME: Reinaldo Borges 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 appealed to he Mi mi-Dade County Commission on Ethics and Public Trust. Signatu Date: C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Form revised 5-30-2012.doc i