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Walter Trujillo - Meltzer Management Corp r V� MIAMI BEACH Office of the City City of Miami Beac h O y Clerk 1 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. Truiillo Walter NAME OF LOBBYIST: (Last) (First) (M.I) Gensler 801 Brickell Avenue, Suite 2300 Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-7070 305-304-7071 walter trudllo(alaensler.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: Adam Meltzer. President NAME OF PRINCIPAUCLIENT: Meltzer Management Corp.—2001 Biscayne Blvd., Suite CU-7 Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 573-4535 (305) 573-4575 c/o adam(i?thedailumiami.com 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: Adam meltzer, President(100%owner) • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Planning Board, Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 957 West Avenue.Miami Beach. FL._ - Issue to be lobbied(Describe in detail): III. CITY a 4GENCIEWINDIVIDUALS 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 relationshi . Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Planning, Building, Public Works and Fire Department None Staff B, HPB, BOA, City Commission, and Land Use None Development Committee, as necessary Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,f� ilial 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(8)Any Financial, Familial or Professional Relationship None `x � � Q � ILO T� . IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Requiredy 2� 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 X No: Are you lobbying on a present or pending bid for good s.equipment or servic es.or on a present or ggndana award for goods.eau apment 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 pending application for a Development Agreement with the City or application fgC change of zoning map designation or change to the City's Future Land Use Man? 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 X on Are you representing 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 CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSAN N RECEIVE12. IN IME CJJY OF MIAMI BEAQH EM IHE PRECEDING CALEN12AR YEAR, A STATEMENT HALL ME FILED EVEN—IE THERE HAVE BEEbj NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist do solemnly swear that all of the fore ng facts are tru d correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach C ode a reporting requirements. Signature of Lobbyist: Signature of Principal/Client: 4 VI. LOBBYIST IDENTIFICATION: - PRINCIPAL IDENTIFICATION: k :o <_ Produced ID �<� Produced ID �Ps� ,'•�'b, .•� Form of Identification •,.•,0. Form of Identification Personally known(Lobbyist) $ LPersonally known(Principal) 3 C Q o n o• 3 .p cc VII. SIGNATURE AND STAMP OF NOTARY: 3. N. °- x ci n C CA r State of Florida, County of Miami-Dade �. �-. State of Florida, County of Miami-Dade T Sworn to and subscribed before me T w Sworn and subscribed efore me v This qof6 2�<<'P' o _ 0 is ay of w ,iB-Fa► o a�N ., Go C." No • N c $ � m° Signat r o — ate of onda a, ig atur o u li Notary— ate of Florida Notari ion ignature o r iza ' Principal's signature TO BE COMPLET �f CITY CLERK'S S F lel [Annual Registration fee: Yes No Amount Paid$ �MCR# to Paid �✓ Lobbyist Registration Form received and verified by. F:\CLE istration Form.doc Revised 04/27/2012 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachf.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBY IS T NAME: Walter Trujillo 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 s pended from lobbying until all fines are paid, unless the fine has been appealed to the iami-Dade County Commission on Ethics and Public Trust. Signature Date CL jo IW k� ti to [PE- _ � � _ .yam R •'-f�f _ z, _ tx