Bernardo Fort-Brescia - Raleigh Hotel I
MIAMI
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f Miami Beach Office of the City S
City o y 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. _
Fort-Brescia Bernardo
NAME OF LOBBYIST: (Last) (First) (M.I)
Ar uitectonica 2900 Oak Avenue Miami FL 33133
(Number ana Street) i (State) (zip o e
(305)372-1812 (305)372-1175 miami(W-arauitectonica.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:
Twice Around 1775 LLC
NAME OF PRINCIPAUCLIENT:
Same c/o SBE Hotel Group 8000 Beverly Boulevard, Los Angeles CA 90048
um er ano Streep i a e) (Zp Code)
(323)655-8000
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2482(c)]
C7 N
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: –� —
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST INCSUCh��RP6RATION,
PARTNERSHIP OR TRUST:
ii.SPECIFIC LOBBY ISSUE:
CD
Development approvals& permitting issues for Raleigh Hotel located at 1775 Collins Avenue n
Issue to be lobbied(Describe in detail):
r-- �
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Cr'
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
arson'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 Contractual Relationship(Explain) YES NO
title of person to be lobbied
Staff of Planning Department,Building Department,and Public Works None X
De artme t
PB,HPB,BOA,City Commission,as necessary None X
Pursuant to City Code Section 2-482(8)Every registrant shall be required to state the extent of any business,financial,familialor 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(g)Any Financial, Familial or Professional Relationship
None
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I
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER:
A) LOBBYIST DISCLOSURE:(Required) S ® Ar-
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENS N):
(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 X No: Are you lobbying on a pr sent or ding bid for goods eauipme[d or s 9AA Dresegl gr 2tu ing
awardfor goods.29jjjAment 2,r-Gewiml
2) Pursuant to Miami Beach City Code Section 2490 Entitled Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues
_Yes X No: Are you lobbing an-j pending ao®Iicatig for a QMEWORment Agreemen t wit ba.M or application for
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 2481 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 X No` ALq. g,Mpresen in a ngj fior RLojj car®oration or eLaU•Mhoig sLWJ:l c2MR2 +soon 2LL9j burseMC0t
V. SIGNATURE UNDER OATH:
Fes, THE IRRE9=0 CALEIIIDAR (EAR A STAB IT SHALL BE FILEP EVEN IF 1HERE FIVE BEEN NQ
EXPENDITURES OR
Signa a of
I do solemnly swear that all of the foregoing facts are true and correct d that I have read or am familiar with the provisions contained
in Section 2482 of the Miami Bea ity Code and all reporting r ements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID Produced ID ac
Form of Identification Form of Identification p
�
'�/Personally known(Lobbyist) Personally known(Principal) .z o
� 0
VII. SIGNATURE AND STAMP OF NOTARY: O
Ytkk /Lr64 %Pi*A '0 y
State of Florida, County of Miami-Dade ;;;�,�P�;•, to of Elena, County of�AAiami-fie i Z
?q.• �, CRIOT 'A D.GONZALEZ �- �•
Swom to and subscribed before me *: MY^;'�,:,+�SSION#DD 960888 m a�subscribed before me ce V a c
a o
This day of *201xPi;ES:March 23, o1a is day of , 201 g m o p b
� p� Bon:�e;'•i ivu Notary Public Z E
E
Signature of Public Notary—Egate f Flor' Signature of Plublic Notary—State of ;5 ® A
Notarization of Lobbvist,,s signature Notarization of Principals signatu
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
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Formrevised 5-30-2012.doc
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 COMP
(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 X No: Are you lobbying on a Dresent or Rending bid for aoods.eguipment or services.or on a Dresent or R2nding
award for goods.eguiRment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes X No: Are you lobbying on a Dendina application for a Development Agreement with the City or application for
change of zoning mat desianation or change to the City's Future Land Use MaR?
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 2481 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 X No: Are you representina a not:jor-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 CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH
EPg THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. r
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 Code and all reporting requirements.
Signature of Lobbyist: �er lS&L prCvtrus
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: . PRINCIPAL IDENTIFICATION:
Produced ID Produced ID .�
Form of Identification Form of Identification p
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Personally nown (Lobbyist) Zperson6lly known(Principal) z o
y ( y� ) ov
VII. SIGNATURE AND STAMP OF NOTARY: _a O N o to
State of Florida, County of Miami-Dade State-of F4er+ea, County of, made N ^ Z
o
Sworn to and subscribed before me Sworn an subscribed before me Q o S
This day of , 2012 This day of , 201 a Z m E
} v o
Signature of Public Notary—State of Florida Signature of Vublic Notary—State of
Notarization of Lobbvist's signature Notarization of Principal's signatu j i 0
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
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is::A10,1 FOMI,dOC Revised 04/27/201
City of Minmi Beach, 1700 Conviuntion Centur Drive.Miami Bcach, Florida 33139,
www-miamibeaclifl.gov
CI ' CLERK Office
Rafael L.Grwi'ado, City Clerk CO-C lerk.i4inia inibcac lit]. ov
Tel:305.673.7411 ,Fax:305.673;7254
LOBBYIST NAME: . Bernardo Fort-Brescia
I understand that no later than February 28 of each vear, 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 2-486.1, 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 falls 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.
Si ature:
batj:
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