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Michael T. Andrews - South Beach Chamber Ensemble CLIi I-ittJ G1c o•kf i f MIA/01 BEACH 0 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"Lobb 'sts" has specific exclusions. Ple a ref r to Ordinance 2004-3435. 1 NAME OF LOBBYIST: (Last) (First) (M.I) 1 0 �tilG114 fr✓re i- Ai 0 PL 33/x' BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 30 1 " q vi w y- I s h l (- TELEPHONE NUMBER: FAX NUMBER: EMAIL: J (--D Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: tAitii 6. ch C6 en br l_r) s Z) .CL NAME OF PRINCIPAL/CLIENT: -5.'", BUSINESS NA1G1E AND ADDRESS (Number and Street) (City) (State) (Zip Code) �a TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) c_n r F' •ut this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] •ME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: fcL. ,_,::: . , Y • ID NTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRE ,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, 'ARTNERSHIP OR TRUST: II.S'ECIFIC LOBBY ISSUE: 7 '_f1 1jj1 & qt7 (L - 15 Issue to be lobbied(Describe in detail): ssue o b ( ) 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 pers o be C(A H"(/1 Yal )) P ' -') i 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 NA' ea-d---)4 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc C f ?(.--- I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) Q B) PRINCIPAL'S DISCLOSURE(OF LOBBY SS.T COMPENSATION): (REQUIRED). 7 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": —YesX 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _YesNo: 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 ti but, shall not be required to pay any registration fees. Item,shall register with the clerk as required by this section bu, q p Y Y 9 EYes_No: 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 RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EV IF T E HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. A4Z Signature of Lobbyist I do solemnly swear that all of the forego' g facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miam:Beach Cit Po•e • all reporting requirements. Signature of Lobbyist: I ' Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID F 1 A 53 5 ,: '-s�►'� V /Produced ID ■ ' i T. ‘,74 , �'��.„ ^0 Form of Identification f 'TS Form of Identi 1 d • " Personally known(Lobbyist) rr Personally known(Principal) ,o S 0 9 0 ° �O - VII. SIGNATURE AND STAMP OF NOTARY: s 3^Q� oj 'o - o '`o. 9 i w* � N State of Florida, County of Miami-Dade 9 A G State of Florida, County of Miami-Dade c y Sworn to And subscri•y• before me o� Sworn subscr red before me ?�S�,AC+� This -8 ' day of 7.6_,..,&.,4 ,201 �1 •o ,4. . This ay of .,�_ ,201 03.9; /� •o t!` o I 1 ,^ •O 9.. 0 ...iirp--_,_,..-_, N..../ ,4 , ,... ,_... . _,.........Sig ature of Public otary—State of Flon a •nature of Pu•lc otary—State of Flori•'. `DO 0.�d Notarization of Lo•byist's signature Notarization of 'rincipal'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:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MiAMI B E 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: jV1g1M /r Vi de w 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 o e i-Dade County Commission on Ethics and Public Trust. C /z3 Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Detail by Entity Name Page 1 of 4 FLORIDA DEPARTMENT OP STATE 4444‘.V O P R TIO . 1 Detail by Entity Name Florida Non Profit Corporation SOUTH BEACH CHAMBER ENSEMBLE, INC. Filing Information Document Number N01000000509 FEI/EIN Number 651087701 Date Filed 01/22/2001 State FL Status ACTIVE Principal Address 1350 EUCLID AVENUE #2 MIAMI BEACH, FL 33139 Changed: 02/05/2015 Mailing Address 1350 EUCLID AVENUE #2 MIAMI BEACH, FL 33139 Changed: 02/05/2015 Registered Agent Name &Address ANDREWS, MICHAEL T 1350 EUCLID AVENUE #2 MIAMI BEACH, FL 33139 Name Changed: 02/14/2003 Address Changed: 02/05/2015 Officer/Director Detail Name &Address Title D ANDREWS, MICHAEL T 1350 EUCLID AVENUE #2 MIAMI BEACH, FL 33139 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/2/2015 Detail by Entity Name Page 2 of 4 Title D STOLTZ, RUTH 705 SE 3RD COURT DANIA BEACH, FL 33004 Title D SELIGMANN, PAUL 1790 NE 137th Terrace MIAMI, FL 33138 Title D COLLINS, ALAN 16425 COLLINS AVE #811 MIAMI BEACH, FL 33160 Title D COLLINS, DIANE 16425 COLLINS AV#811 MIAMI, FL 33160 Title Director Sands, Israel, Mr. 3520 E Fairview St Coconut Grove, FL 33133 Title Director Tomlin, Claire 238 E San Marino Miami Beach, FL 33139 Title Director Orbon, Julian 5101 Collins Ave, #6K Miami Beach, FL 33140 Annual Reports Report Year Filed Date 2013 04/08/2013 2014 02/06/2014 2015 02/05/2015 Document Images 02/05/2015 --ANNUAL REPORT View image in PDF format 02/06/2014 --ANNUAL REPORT View image in PDF format 04/08/2013 --ANNUAL REPORT View image in PDF format 02/07/2012 --ANNUAL REPORT View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/2/2015 Detail by Entity Name Page 3 of 4 03/23/2011 --ANNUAL REPORT View image in PDF format 01/06/2010 --ANNUAL REPORT View image in PDF format 01/22/2009 --ANNUAL REPORT View image in PDF format 01/28/2008 --ANNUAL REPORT View image in PDF format 01/20/2007 --ANNUAL REPORT I View image in PDF format 02/13/2006 --ANNUAL REPORT View image in PDF format 03/08/2005 -- ANNUAL REPORT View image in PDF format 04/26/2004 -- ANNUAL REPORT View image in PDF format 02/14/2003 -- ANNUAL REPORT View image in PDF format 05/01/2002 --ANNUAL REPORT View image in PDF format 01/22/2001 -- Domestic Non-Profit View image in PDF format Copyright and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/2/2015 Detail by Entity Name Page 4 of 4 • • • http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/2/2015