Alyssa Kriplen - Betsy Ross Owner, LLC S w C7 VI
M IAM I B A`" 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.
Kriplen Alyssa
NAME OF LOBBYIST: (Last) (First) (M.1)
Shulman+Associates 100 NE 38 Street,Space 2 Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER:305-438-0609 FAX NUMBER: 305-438-0170 EMAIL:Alyssa cj�shulman-design.com
Please notify this office if your contact information changes: address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Betsy Ross Owner, LLC,a Delaware limited liability company
NAME OF PRINCIPAL/CLIENT:
Betsy Ross Owner, LLC 1841 Broadway, Suite 800 New York New York 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(917)414-8200 (305)416-6887 jonathanplutzik @gmail.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Ocean Court,LLC,a Florida limited liability company
NAME OF PRINCIPAL/CLIENT:
Ocean Court,LLC 1841 Broadway, Suite 800 New York New York 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(917)414-8200 (305)416-6887 jonathanplutzik @gmail.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECII=IC LOBBY ISSUE
All land use,zoning,permitting and code compliance matters relating to properties located at 1440 Ocean Drive and 1433 Collins Avenue
Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS 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,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
All elected and appointed officials of the City of Miami Beach and City None X
employees
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Pursuant to City Code Section 2-482(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(g)Any Financial, Familial or Professional Relationship
Not Applicable
IV. DISCLOSURE OF TERMS AND AMOU TS 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 (&No: Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
❑Yes ®No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation 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 ®No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WELL ATWMPENSATION RECEIVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALLAE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
ignat re Lobbyist
I do solemnly swear that aniB foregoing facts are true and correct a d that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia h titCode and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Cli
VI. LOBBYIST IDENTIFICATION: PRINCIPAL TIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification •'�• • ' c
-y Form of Identification
Personally known (Lobbyist) o' ❑ Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade 6.C,4
a State of Florida, County of Miami-Dade
Swo o a d subscribed befo a me o 1-t- and subscribed before me
Thi da of 2013 G ° This day of 2013
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Signature of Public Notary—State of Florida y Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
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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: r
s
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E.Granada,City Clerk C_ityClerkCa)_miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME Alyssa Kriplen
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 shall be automatically
suspe from lobbying until all fines are paid, unless the fine has been appealed to the
Mia 1- de County Commission on Ethics and Public Trust.
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Si turd Date
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