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Brent A. Lacy - Dubbin & Kravetz LLP 15 01 Co l,`+v' '^' a ' i 4 irk �`� I t � r V 1Ii ;s , ;I icy* t H 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. � � Bite& 4- NAME OF LOBBYIST: (Last) (First) (M.I) 700 Orf�lt Ft 3 .$oy BUSINESS 1:1'01 AME AND ADDRESS (Number and Stred j (City) 7 (State) 'Zip Code) [401) a iS—I273 (461) i»-`127� bl @ lea;Az.(Am TELEPHON NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,ore-mail address. I. LOBBY10 t+tb/AEi 0Avell liP - I . it;r, I. '1 NAME OF PRIfyCI �U0 IENT Od 1 g 4 Aft. Ile 3 b c J ( I !_ os L 3313y BUS1 E EA 7 (Number and Street) (City) blV3b J J t � 00 St j iv4 644pilhtJ¢ X G TELEPHONE UMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Sa u e ( V I. I 1P� Y°44 . IDENTIFY ALL PERSONS HOLDIN IRECTLY 0 D}IzE t,Y,A 14O M S1-11P I RE �,N S�UC%COF 'O � PARTNERSHIP OR TRUST: jµ1A$ 111A91)1%, ft/t* f�' • J�1 Y �✓ 4 Ii.SPECIFIC LOBBY ISSUE: C., 1 Lb NO;`c, 'a,. fDc 14.Siii641 t& Ieni l5o i &NJ Aenteie Issue to be lobbied(Describ 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 (1104YiVtiMi gpogit c 1 gtiFF o (AMPAA:456;WAS al.40 OlIFF . V Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or p efessional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city.perso�l wt%o fs sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial,Familial or Professional Relationship r-,7 F. —J F:1CLER1$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc a-=' 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. L4 , erect' ,.• NAME OF LOBBYIST: (Last) (First) (M.I) LiWeet, 161 S M ewgJer t.nh►e 'e. 7'°o °rla FG 3�-R o y BUSINESS N AND ADDRESS (Number and Stre ) (City) (State) (Zip Code) a15-1273 (( o1) V7S--12721 blacyg leainz.601.4 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYI T R AIMED LW 66\1 tune i • SGmk.te 11. 'U ; k /.4•, NAME OF PRINCIPAL/CLIENT J / W l�us*►s , . ge 3 0 o to I 6ruble5 �L 3313Y BUSI ESS ME A ESS (Number and Street) (City) ( t e) (Zi ode) TELEPHONE UMBER: 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: Saimu e I J _ t i ;r e4 i • IDENTIFY ALL PERSONS HOLDINGSIRECTLY OUND�'Ecr',A 4CopR MORF -S�iIP!WERE�l LN CII COf RATION, PARTNERSHIP OR TRUST: c ee( J h �lii L' aic 7� ' r Y II.SPECIFIC LOBBY ISSUE: Penv A L:0 i OC611-0,. c f �.aJ e6 I �f I so'i L /kfrs 6 t e,t4 Issue to be lobbied(Describ In detail): 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 person to be lobbied ROMA;MA LOA r r Ntwaio F �r a$J UHF. Lobimu,',XimeSS ue►Q ° 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 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc e IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) nn ' .D Ale\dofwoQ r 8NrI ra,-(-GS -jor rr �'o-�SSIohaf TryS JrTaTior, /--... /1 /In 5,-e ,vl/c12 S , B) PRINCIPAL'S D LOSURE(OF LOBBYiST COMPENSATION): / II::::. A..C.- d Se AA V/c a..S c4 b 4,1, i l�o 1 ng information m Afer answered: 1 Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contfbutions By Lobbyists On Procurement Issues": ow" • YessNo: 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 item,shall register with the clerk as required by this section but,shall not be required to pay any registration fees. YesNo: 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 EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. `' / ati:Sig"T( ‘,°bbyist \V' 1 I do solemnly swear that all of the foregoing facts are e and correct and that I have read or am famili- with the provisions contained in Section 2-482 of the i!'-■ I Br=ch a,ode and al 0:porting requirements. 'r �. Signature of Lobbyist _�', �\O.- �.A . . Signature of Principal/Client: :.1. ( 4 r fil1-1 VI. LOBBYIST IDENTIFICATION: 1• 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-ktianmBade-Oro c'ge. State of Florida, ounty of Miami-Dade Sworn to arid subscribed before me om al,. s -s• ibed before me This '^-� day of Stacie E.Woods �— �L.` is - d- of �>k _ `' g, s ` .�f`'` NOTARY PUBLIC ,�I!., ` _ ' r ilg - STATE OF FLORIDA S ' MARY ANN GRAUUCH ' ;� L�. I " ���:A--.�_ =_ _ / _- ��/�% a: ' COMMISSION Ii FF 131724 i ' Signature of Public No a State '4.n�"'-''J Comm FF154479 Signet •- of Public Notary State o ` �'' ' '�,,. �-r` - g rY- �1� � a: EXPIRES:August 9,2011 , , '•Notorizatigmpf Lobbyists signat , E 41 Expires 8/29/2018 No •-zation of Principals signat .-'4,10,, Bonded Thru Notary Public Untlenwriters'� TO BE COMPLETED BY C rY CLERK'S STAFF N a Annual Registration fee: g ]Yes[ ]No Amount Paid S %SOet' MC # bt0`'t� Y Date Paid )1 h 1 Lobbyist Registration Forr$received and verified by: Qi.O, T Annual rain Form.tior. Revised 01/22/2014 t�:�Ct.FRIsa�Ltrlo��'�S1�0t36YwST FORMS rtinrra Registration a F:ICLERI$ALL1aFORMSILOBBYIST FORMSILobbyist Registration Form.doc City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granada,City Clerk CityClerk @miamibeachfl.gov Tel:305.673.741 1 ,Fax:305.673.7254 LOBBYIST NAME: cg r tit' 1 A- . ,,c 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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th of each year,shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. 0, A, 41.J ■. 7 ,,, �►.:a.� 1 ' 0 2 - /5 3 a' re: W -1, Date: F:ICLERI$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc i em f. r1r4;iii , City of Miami Beach-Florida Finance Department 1 City 1-21a10 l 1518720- /06/2015 BR1 T137 Mon Ju106,2015 04;28PM Trans#23-23 23 $850.00 MCRCLERK - MCR-City Clerk . * MCR#: 404841 1 ITEM(S): TOTAL; $850.00 Check (001178) PAID $850.00 Have a nice day! 1 _____________,,-------_,------- .---,------- ,—.' ----.-----,7,777-7,-- .. ......--.77-7.--_, •-• ---7:777n AAie chllane0us,Cash. Receipt z�1 r =:1; . :' CITY OF MIAMI BEACH ,-;A-A . lz•-_ifr.'''''''''''''-'3-i?,;',:l.:,-,- _ . - Noy -: .:. ' . . '::'.-.. -1' : .. :. :.,..,--.=., ..'...'-... 1 9 0 Cash 0 Credit Card Check# :1 / I ,..," , e .. .., ----,-, , 1 i P r --/ , 7 / i 7 — ,k-f I "i" XI Le:',;'r;4 : Received of - :t E_ ;� Address ' 1.2'0 --f3 ' `, .. s (. _ - y - - •- "' � Y t � . r' f f f 1 t � ( , Cl 'p i t / Z-• D ‘-'4,4)/12.i? (,, • !�1.r` - {, - ms N , - : _ _ _ _ s%' ',F" i . Office N T CMD oa OETIOMUBE Fe c g,, Account Number: i- : Dept: f; Prepares: '' : ,..\.1;,,,;.',;(, e qtr • ,,,z,„;.,..,,,-, ..+v ,._. _-