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Ralph Choeff - Dean Carr & Melissa Carr tAl M z Ar op7 City of Miami Beach Office of the City Clerk y 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. Choeff Ralph NAME OF LOBBYIST: (Last) (First) (M.I) Choeff Levy Fischman 8425 Biscayne Blvd. Ste. 201, Miami, FL. 33138 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-434-8338 rchoeff1choefflevy.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,ore-mail address. LOBBYIST RETAINED BY: bFAINI NW-2 - MeZ i.SA i' ■ NAME OF PRINCIPAUCLIENT:1 F SLbaga- a-totaz , MONTE CARLO , MONACO , q 00 BUSfNESSNAME.AND ADDRES ] (Number and Street) (City) (State) (Zip Code) 2— ?3— 99,3 / .r- vC_Aede -P q ro M EEL-EPEES/NUM/BEM FAX NUMBER:(Optional) EMAIL:(Optional) C Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] —� rri • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: NA. • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: i1/4V•4, II SPECIFIC LOBBY ISSUE:I Request for Design Review Approval for 19 Palm Avenue, Miami Beach, FL. Issue to be lobbied(Describe in detail): Ill.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 DRB NO 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 filed. Sec 2-482(g)Any Financial,Familial or Professional Relationship NONE F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $175/h r B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $175/h r. (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 XNo: 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 XNo: 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 Jo: 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 SLi• THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOB=YING EXPENDITURES AS WELL AS riI�»7'= •TION RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT --•" L ED EVE IF THERE HAVE BEEN NO EXPENDITURES OR . COMPENSATION DURING THE REPORTING PERI• Signa e of Lobbyis I do solemnly swear that al, ----'a-f• •• • facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of th= .-ami Beac '" 'i.e a, • all reporting requirements. Signature of Lobbyist: Signature of PrincipaUClient VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _Produced ID Produced ID — Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) i4) VII. SIGNATURE AND STAMP OF NOTARY: ' °' State of Florida,County of Miami-Dade •-State of Florida,County of Miami-Dade,, •' y •i d •-`or me -- - Sworn and subscribed before me if Sworn to a ubs rib � ;- ,,,, ,, AR$A®NA CA® ,�/ ,20 , ,;,er• This day of ;201 . This d �• , —., .. `''` •'= MY COMMISSION#EE099451 :AID IIII -v . t 'S EXPIRES June 02,2015 �' ''ta'rFI• '9:153 FloridatiotaryService.co8 'e of Public Notary-State of Florida Signature of Pu����� � , : f. Notarization o• , • i- s signature Notarization of Principal's signature . s ' TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ es[ ]No Amount Pa' $ - R# P P . • _ Date Paid oZ bis. /c Lobbyist Registration Form received and verified by:Aler. 0 jr . AC' ( _?fli r F:\CLERWALL\aFORAS FORMS\Lobbyist Anr E R gistration 7orm.doc 'I Revised 01/22/2014 F:\CLER\$ALL1aFORMS 1LOBBYIST FORMS\Lobbyist Registration Form.doc f - LaRosa, Clara From: Cody Thamann [cthamann choefflev .com ] Sent: Tuesday, March 10, 2015 8:44 AM To: LaRosa, Clara Cc: Ralph Choeff Subject: Lobbyist Registration for Ralph Choeff- Principal: Dean Carr& Melissa Carr Good morning Clara, If I remember correctly,the principals for this project are from out of town. It is customary for where they are from to notarize on the back of the documents. Please check and see if the rear of the sheet is notarized, and let me know if this will suffice. Thanks, Cody Cody Thamann Associate CHOEFF LEVY FISCHMAN A R C 4 I T E C T U R E + D E S I G N 8425 Biscayne Blvd.Suite 201 Miami,Fl 33138 (t)305.434.8338,ext. 124 (f)305.892.5292 cthamannachoefflevy.com www.choefflevy.com 1 LaRosa, Clara From: LaRosa, Clara Sent: Monday, March 09, 2015 2:57 PM To: 'rchoeff @choefflevy.com' Subject: Lobbyist registration from for Ralph Choeff- Principal: Dean Carr& Melissa Carr Attachments: Choeff, Ralph.pdf Dear Mr. Choef: A week ago you submitted a Lobbyist Registration form to the Office of the City Clerk at City of Miami Beach. The Principal's Notarized Signature is missing and this Lobbyist Form cannot be completed as it now appears. Please make sure you submit a notarized principal's signature page (page 2)and mail it to us as soon as possible. Regards, comaismamsmilisiLassmanarnsomik enti~egitegatouttgamfatimagragift o. wicapisimisamscatessumm jeft 0 $_] 2V5, 10\-: Clara La Rosa, Office Associate Ill - V� X°' OFFICE OF THE CITY CLERK ' �"°. 1700 Convention Center Drive, Miami Beach, FL 33139 V1 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. 1 MIAMIBEACH 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 ,Fox: 305.673.7254 LOBBYIST NAME: Ralph Choeff 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 re!. ired Statement by April 30th of each year, shall be auto•i -lly suspended fro l , .... ying until all fines are paid, unless the fine has been a• • the Mi: i- .=. County Commission on Ethics and Public Trust. , 1 ilk 2/2 Sig ur= ■ Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc •M1scelianeoue Cash Receipt t . .. ,. s:'. kv - - :, t40.7J711.:.1:4- : p CITY OF_MIAMI BEACH ' .::_.,_.,,,-1-ii7.,:,.--..,:-.--,-:. _.... ..,,.. , , .. 1 MI ..,:„..-.. .., ..,_:,: ....,:i.. ::._.- : ._,-.:..:::, ..., :: :--,-.-.:,.--L, -:,..-_,-:„.„-_,. ..:,.., No. Q Cash ' O Credit Card Check#. c 00 $•Received of °l '. t : , :� P .i' ,c.)'r An%i°N / Address / '\.. Li ,•-/!f '?-�, E L E.-7-FC•: '. - + P ,-`f' / °?r l; t 4 Y 7 � -1. For ,� is l; _�' ;::... l if . F. " . ',�..,� .$ '_ 1 �,�_, .. . , ' • ' (THIS INFORMATION MUST'SE COMPLETED) Office of Finance Director ,' is RI i i f' �7 - ;Account Number. . :'`t.,ia ,::,�)t o T. Prepares:. ' : i.- : ,..-''(_ x.r" t,F ." .1 Dept: ,� .:, A .! : K EXT ' L • ,..- r _:'t✓ , .-r--`] 'f J ,].:;�'^ ,. 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