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Rafael E. Andrade - American Riviera Real Estate Co. /V\ I AJV� I B EAC H 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. Andrade Rafael B. NAME OF LOBBYIST: (Last) (First) (M.I) Law Offices of Rafael E. Andrade,P.A., 1111 Lincoln Road, Suite 400,Miami Beach,Florida 33139 BUSINESS NAME AND ADDRESS (Number and Strut) (City) (State) . (Zip Code) (305) 531-9511 (305) 673-5_734 rat h o randradelaw.com TELEPHONE NUMBER: FAX NUMBER, EMAIL: Please notify this office if your contact Information changes:address,phone, or e-mal!address. I. LOBBYIST RETAINED BY: American Riviera Real Estate Company NAME OF PRINCIPAUCLIENT., 309 23rd Street Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305 992-8980 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: Ronald Bloomberg, President • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. PBCIFIC LOBBY ISSUE: Parking Permit Agreement dated April 19,2011 by and between the City of Miami Beach and American Riviera Real Estate Company Issue to be lobbied(Describe in detail), III.CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(aK4)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 Msent dats,,statiiig the eneral nature of the subject contractual relationship. Sec 2-482(x)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Mayor&City Commission,City Manager's Office,and X City Attorne'y's Office X Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,famlllal-or profe$aional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or-ity i5tisonne1who is sought to be lobbied as Identified on the lobbyist registration form filed. r, y-y See 2482 Any Financial, Familial or Professional RelationshipI 1 To-ne .. C:\Userslclerhatl\AppDataNLbcaINMicrosoft\Windows\Temporary Internet Files\Content.Outfook\83LGODDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF L.OB13YIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE'(Required) $5,000 flat fee S) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $5,004 flat fee (REQUIRED), The following Information must be answered: 1) Pumant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes XNo: Are you lobbying on a pMg ntor Rending bid for Good 'r went or services or can a r nt or Rending award for goodg,eauioment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yea X N$: ou.iobbying mn a pendina ftmlicatioln for a Deveiaatlnemt Agreement With the City or application for h n designation gr!;hanue to the QjUs Future Land 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. YssXNo• -for- i I omplMeation or reimbursement V. SIGNATURE UNDER OATH: Obj F ACH YEAR.EACH LOB13YIST SHALL SUBMIJ TO THE reITY T UNDER OATH. LISTING BYIN EX N A N REGEIVED. IN TkIE CITY OF MJMJBFACH F R .F„j%FrzEDING CALENDAR YEAR. A STATEMENT,,§IIALL BE FILED EVEN IF THERE HAYS BEEN,.Ng EXPENDITURES DR COM PENWION DURING THE REPORTING IRELUOD. Signature of Lobbyist I do solemnly swear that all of the foregoing facts 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 reporting raqu' ants. Signature of Lobbyist: Signature of PrincipaUCli Vt. LOBBYIST IDENTIFICATION. PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification ""''•► ALBERT GONZALEZ •t,"•„Personally known(Lobbylst) //personally _ s t ry P„p,;c_stare of Florlea • My Comm,Expires Nov 8,2013 vil. SIGNATURE AND STAMP OF NOTARY: Cor�lmission DD 929913 .. ; ��``` Bonded Through National Asian. State of Florida, County of Miami-Dade State of Florida Sworn to and subscribq0efore me Sworn an subscri before me This day of 2012 T ay of .2012 F-eLILIAM R.HA"F,f.;s MY COMMISSIOP�a E 486 b; EXPIRES:February 1F. re of PUbiic Notary—S "ie of Florida '''`� B0"�mNNotM Public Un let a of public Notary ry—State of Florida Notarization of Lobbyist's signature Sri ation of Principal's signature TO BE COMPLETED BY CITY CLERK'$STAFF ONLY Annual Registration fee: [ j Yea[ No Amount Paid MCR# gate P >Lr�bbylst Registration Farm received and veeift$d by: C:1 Usersl cierhatl\AppdatalLouallMicrosQftlWindvws\Temporary Internet Fiiesl Content.Outlookl$3LGOODHlLobbyist Registration Formravised 5-30-2012.doc F:�CLEI iistr'ation Forrri.doc Revised.04/27/2012 t a �� 3 �r City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfi.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.741 1 , Fax:305.673.7254 LOBBYIST NAME: � G 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 the Miami-Dade County Commission on Ethics and Public Trust. Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc Pi V LL LL ul a _ j r V - _It m a jj U : AN � 2_4 CO) cn