Christian Luz - Alan Potamkin MIAMI toIAMIBEAcH
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.
Luz C(4 r15 -►.
NAME OF LOBBYIST: (Last (First) (M.I)
D es ir, S Ix i f C�I�'Z(a. A.,h, 1 2 0 9
BUSINESS NAME AND ADD ESS (Number and Street) (City) (State (Zip Code) ) E+ 1_,C1/4A-%
`30S—gi oo— 2(6)1 C Z-Uze DES/144Id r (vl& P� 3-3306
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address.
I. LOBBYIST RETAINED BY:
T 1 -�- D h INl. L
NAME OF PRINCIPAUCLIENT:
D C c u a r i y i c, C o n e U or r C , (/�0 rc4 (14:.b PS--f''t-- 3 3 1`3
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) -• `.=
'3o - KC C- (BOO 3 DS. - (a ,7- SoLll :.,
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) -
Fill out this section If principal Is a Corporation,Partnership or Trust[Section 2.482(c)]
0:
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, t'
PARTNERSHIP OR TRUST: , g'�ti Fg i
Y Y
II.SPECIFIC LOBBY ISSUE:
LO na t+iv,� 5€ ovc r cows.6-Qc."#, 6-F Se l - 5-b'f6S't
Issue to be lobbied(Describe in detail):
-�-_ _--_-,- . C ; k � at 633 Alton
ii.CITY_AGENCIES/INDIVIDUALS TO BE LOBBIED: Road.
Pursuant to City Code Section 2-482(0(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
Cc)M in I Pe S ociass. x
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o. I tss i
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A(1)rnrn;sf - ) x
Pursuant to City Code Section 2-482(g)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 flied.
Sec 2-482(g)Any Financial,Familial or Professional Relationship I
007 nT0 —
F:ICLERI$ALL1aFORMSILOBBYIST FORMSILobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST,DISCLOSURE:(Required)
gout,(,,t_
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATIQIj):
(REQUIRED). 5�f/��
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 ,o: 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 Section 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 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,1 o: 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 COMPENSATION : IVED.IN THE C I OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SH• _ I 1 -E HAV = 0 EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
��alim
Signature of Lobbyist '
I do solemnly swear that all of - forego' • fact - : =and Corr- -nd that I have read or am fami iar with the provisions contained
in Section 2-482 of the Mia =eac' City Cede -1 d all repo,ing r= ents.
Si nature of Lobbyist: •_.- -�: \11 ;� -� ZQO• `J -'3 �0 1 D 'l7-/2
4� 9 Yi
Wile■siMillromi..,Signature of PrincipaUClient: ..... p���
VI. 'LOBBYIST IDENTIFICATIO\: PRINCIPAL IDENTIFICATION:
_Produced ID _Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) =Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade „ ..,,,,:._F_.......,... _-. State of Florida,County of Miami-Dade
Sworn to nd subscribed before m : HOWARD E.FELIX ' Sworrund subscri•ed before me
This , - d. _ J .i..9.., �01;4`,16&' = public,Stat® Florida ` This day of _� ■Y '":�+,,,.,
Notary ti y M.K NAYLOR
`�iA'* k Commissions FF 65S7 ; `I ;: MY COMMISSION#FF 124168
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Si:1 ure of -i• c Notary State • FI•'!71. 'My comm.expires Mar.2 •• re if Public Not. ;-State of FIB i�J=�� ' EXPIRES.September 20,2018
ry— ,, ��;p. Bonded MN Notary Pudic Underwriters
Notarization of Lobbyist's signat �..---,.v-=° -•-,., Notarization of Principa's,signature
TO BE COMPLET BY CJY CLERK'S STAFF ONLY
Annual Registration fee: ]Yes[ ]No Amount Paid$ MCR#_40.14.41 Date Paid I 1 2 g I 1
Lobbyist Registration Form received and verified by:
F:\CLER\Val-WORMS\LOBBYIST FORMS\Lobbyist Annual Registration Forntr!oz Revised 01/22/2014
F:\CLER\$ALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form.doc
MIAMFBE.AC;H
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov -
CITY CLERK Office
Rafael E.Granado,City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: C&r i.Sal a.,v 1 v 2—
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$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist,who fails to file the required Statement by April 30th of each year,shall be
automatically suspended from lobbying until all fines are paid,unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
)(4Ele __� 7 (5
,' �� \ - - Date:
Signature.
F:\CLER1$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach-Florida
Finance Department
1 City Hall
1502813-1 01/28/2015 BR 1 T1:2,4
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Wed ,Jan28,2015 12:40PM Tran4L °4L
4' $850.00 MCRCLERK - MCR-City ',Mark
MCR#: 401431
1 ITEM(S): TOTAL: $850.00
Check (010101) PAID $850.00
Have a nice day!
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LaRosa, Clara
From: LaRosa, Clara
Sent: Wednesday, February 25, 2015 6:38 PM
To: 'cluz @desman.com'
Subject: Your latest Lobbyist Registration Form
Attachments: Luz, Christian.pdf
Dear Mr. Luz:
We received your Lobbyist registration form at the Office of the City Clerk at the City of Miami Beach on January 28,
2015.
There are two pending questions that need clarification.
1. Is there a specific address for your Specific Lobby Issue for New Self-Storage Facility?
2. For Sec 2-482(g) any Financial, Familial or Professional Relationship ... with any City Commissioner or City
personnel?
Please respond to these questions as soon as possible. If N/A or None is your answer, please state it so.
Regards,
Dim .dottiza,-
AI VBE - =-
Clara La Rosa, Office Associate ill
OFFICE OF THE CITY CLERK
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411/ Fax: 305-673-7254 / www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,
tropical, historic community.
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