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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.
ILUtSi\/111-N rit%0 S
NAME OF LOBBYIST: (Last) (First) (M.I)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ;Zip Code)
CIA (f)(A 2 X 1,2 2 --0.2 2 ,,IV/NI 11 a,--ro cpaiw i caw)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
StUcrSUPQtL M1�-rni i eJi
NAME OF�PRINCIPAUC IEnNT�: 'f n A 4 p cam- �1��1
su 1 m lIIIt 4 o1...e 4,cj tC7�i "i s- I, e , ' (Zip ode)IC S
BUSINESS NAME AND ADDRESS (Number and Street) (City) (St t ) ( p
212— �2?3 -- 1 --hUc'i.e30Sut - A 1212,1j cirri
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 BENEFICIA
R5
Fo4
4V--L M. -dc 1 COCA
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
P_AE TTTN,ERSHIP OR TRUST:
NN a coy i rudiao. In ii.SPECIFIC LOBBY ISSUE: 5y �'►��-P-,r,�ctri i* Y22.-
inJ`1cwwildn a-F- (9, &M R!) 04(6 or isai1
Imo 1 3A-001-1. m mom r1G1-4 FIA3 1339 , in ii coi cn c.F ( ) (,,i.5jrlt }law) -finr a v► styc+cri rr'
Issue to be lobbied(Describe n detail): ,'.i n r�1'ic,11 c> on o Sic k-1 i\Nunn to cOrecl ti 1161.1g. or 3rd
III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Qct(s ` ap '
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
Citti GI 1nin-(n i tertOrk Et51oN1 (R\\JIEW eci912AD 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:,person el who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOB IST DISCLOSURE:(Required)
NO amitien al. nfol vmOion eikkAat C li ra - Par arc hi �; oral_ 1'o,b
B) PRINCIPAL'S D SCLOSURE(OF LOBBYIST COMPENSATION): L.0
(Required).IN1(1 Withon ILL (G(Y pnsa1d1 d, 6c CeillitYA 0 4r afair1c itra, .zonkl)C.Q.O.
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 E' 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":
El Yes a 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 ANo: 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 AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. ,
i 4 o, /4,4444,..,,
lature 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 a and all reporting requirements.
Signature of Lobbyist: `1,
Signature of Principal/C ent:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
EI ersonally known(Lobbyist) ❑ Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
N e.4.447 -e-g-5 ai:' i.Ba
State of Fta,County de P/q.-5gq�� , State of Florida,County of Miami-Dade
Sworn to and subscribed efore me Sworn and subscribed before me
This o29171-day of ,281- a O/5 . , This day of ,2011
Signature of Public No ary—State of-F ail- 17,. _ Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature �• . . . . ' Notarization of Principal's,signature
TO BE COMPLETO BY,C!TY CLERK'S STAFF ONLY `
Annual Registration fee: [ Yes[ ]No Amount Paid$ . 1 I`;,r''"°C # 4®-S 4 g e( Date Paid If Y// I—
Lobbyist Registration For rr received and verified by:= . . . ,
I°:CLER\SALL aFORMS;LOBBYIST FORMS Lobbyist Annual Registration F'o .do Revised 1/11/2011
y ..
. :
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: -TA.SO/k) k'/SMA r'J
I understand that no later than February 28th 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, I am required to
immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
011, 023. /5
;nature: Date:
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) ,
Mo &.fir I ;anal_ (,mn�-v(tthttfl ( 5-ytt. t a -6 - Prx- alai i ll,rtL s'orvi(�n
B) PRINCIPAL'S DI LOSURE(OF LOBBYIST COMPEN ATION): s
(Required) lat)irt �Korn �� (z()f, Ct A- ( a( i i-7,tr l, , i'{t..D
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 lo: 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 AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX PENDITURES OR
COMPENSATION DURING THE REPORTING PERIO .
'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 a reporting requirements.
Signature of Lobbyist: ,
_. SIGN HERE
S g UCn
atucg of:Principal et .v -_;� v. I A
VI. LOBBYIST IDENTIFICATION: PRINCIPAL-IDE-NT-IFICA=TION:- I
jilt
❑ Produced ID i ❑ Produced ID i
iii
Form of Identification 1 Form of Identification
1 f) ,'
f I❑ Personally known(Lobbyist) Personally (Principal)
1
VII. SIGNATURE AND STAMP OF NOTARY: I IRA COHEN
State of Florida,County of Miami-Dade I State of Florida, CountV9TAYT- I �STATE OF NEW YORK
Sworn and subscri ed b-�• - '
Sworn to and subscribed before me ! 02C 118260
This ' day of•.`''. ,2015 This day of ��R\ _ ,� N�NEW YORK COUNTY
l I li _ ; -•'D =N EXPPIRES 11/01/2015
`1 I
Si•i�F ure o' - blic Notary-State off ida l.1e ` Net. �'.nature of ublic Notary-State � �p,�C,
Notariza •_ •►Lobbyist's signature �'Notariza on of Principal'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:
F::CI E:..$ALL\aFORMS\LOBBYIST FORMS;Lobbyist iAnnuvl Registration Fotm dec Revised 1/11/2011
liscellaneous Cash Receipt . -
CITY OF MIAMI BEACH
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.0..Cash - Credit::0:.—a:rd Check# $
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•(THIS INFORM .LION MUST BE C OMPLETED) Office.of Finance Director
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Account-Number:
Prep�rer: � C..�'� � Dept. � � �
DATE - - i - _•. .
INVOICE NO.
02/18/2015 021815 COMMENT
AMOUNT '''
850.00
)ATE 02/18/15 VENDOR City of Miami Beach
TOTAL 850,00