Jose Gomez - Edward Gadinsky . m
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City of Miami Beach Office of the City Clerk 1 14�1,, _9 ,�,
1700 Convention Center Drive, Miami Beach, FL 33139 F� , .
LOBBYIST REGISTRATION FORM � i
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.
Gomez Jose
NAME OF LOBBYIST: (Last) (First) (M.I)
Beilinson Gomez 8101 Biscayne Blvd, Ste 309 Miami FL 33138
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-559-1250 305-551-1740 jg @beilinsonarchitectspa.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:
NAME OF PRINCIPAUCLIENT:
Mi-Lan Florida Investments, Inc. 325S. Biscayne Blvd, #1724 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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: MQri 1�p owl n,5y— ! �"Qo X d 4) X`
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: 4 � ,
Qr'k\�x C-iad 1 � 6 A10 S
n.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues for Property located at 5324 Pinetree Drive,Miami Beads,FL
Issue to be lobbied(Describe in detail):
nl. CITY'AGENCIES/IN.DIVIDUALS-TO BE.LOBBfED:
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 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
Tanning Department and Building Department Staff None
B, HPB, BOA, City Commission, as necessary* None
Pursuant to City Code Section 2482(8)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 RelatignsWo.
/A
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
I
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). 19so / I/�C]�C�'�
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 lobbvina on a present or pending bid for goods.eauinment or services.or on a present or pending
award for goods,eauinment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes X No: Are you lobbvina on a pending application for a Development Agreement with the City or application for
change of zoning map desianation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code 2-484(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 X No: Are You representing a not-for-profit corporation or entitv_without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 98th 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
EM THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
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:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known
(Principal)VII. a�p SIGNATURE AND STAMP OF
rot;.•.,��¢ TERESA MARIA
NOTARY: MY COMMISSION#FF 042188
* EXPIRES:December 2,2017
State of Florida, County of Miami-Dade",roi d"� BondedThroBudgetNotary Sei�ires State of Florida, County of Miami-Dade
Sworn to and subscribed before pe Sworn and subscribed before me
This day of This day of ,2012
Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Prince l''s,signature
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:
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)
250.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $250.00 per hour
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 lobbxdng on a present or pending bid for goods.eauipment ar services.or on a present_or_pendna
award tQr goods.eauilun t or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes X No: Are you lobbvina on a pending application for a Development Agreement with th City or apalication for
change of zoning map designation or change to the Citv's Future Land Use Ma®?
3) Pursuant to Miami Beach City Code 2-484 (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 X No: Are vau representing a not-for-profit corooration or entitvwithout special _nm ensatinn nr neimbur5ement_
V. SIGNATURE UNDER OATH:
ON FEBRUARY 281h OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
EQH IHE REECEDINQ CALENDAR YEAR, A SIAIEMEblj 5 L BE EILED 9VEN 1E MERE HAME BEEN NQ
EXPENDITURES OR
Signature of obbyist
I do solemnly swear that all of the foregoing re(e and c rect and that I have r ad or am familiar with the provisions contained
in Section 2-482 of the Miami B t ode an I reporting r uirements.
Signature of Lobbyist:
Signature of Principal/Client: �X
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
^o
Personally known(Lobbyist Personally known
(Principal)VII. ar p� SIGNATURE AND STAMP OF _€
?ot;.•.,e�% TERESAMAFM
NOTARY: # MY COMMISSION#FF 042188
�, EXPIRES:December 2,2017
°+r ��° Bonded Thru Budget Notary Services v
State of Florida,County of Miami Dade Fo�F� R State of Florida, County of Miami-Dade
Swom to and subscribe_d before a Sworn Enid subscribed before me
This day of This, day of�N UL y..,201
-cam %��—�?�G--a _�/ — °�A&2— �LAA L a 4D
Signature of Public Notary—State of Florida Signatur f Public Notary—State o Florida '••a; s
Notarization of Lok 3fl is signature Notarisation of g6fifilpa&signatu
Lol �lisc'
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: ( lye s o Amount Paid$,���` F17)MCR#_� � � Date Paid � f
Lobbyist Registration_Form recei d and verified by
I A/\A I B EAC H
City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139,www.iniainibeaclifl.gov
CITY CLERK Office CityClerk@miainibeacbfl.gov
Tel:305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Jose Gomez
I understand that no later than February 28th of each yeas, 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, 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-D de County Commission on Ethics and Public Trust.
1/7/2014
Signa e: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
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Cash E3 Credit Card ,heck# X15 1
20'/
Received of
Address
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(THIS INFORMATION MUST'EE COMPLETED) Office of Finance Director
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