Jaya Kader Zebede - Ahavas Torah Congregation Inc. s.
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 2015 Nov -3 A[;i 9: 07
LOBBYIST REGISTRATION FORM J I �:
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.
Kader Zebede Jaya
NAME OF LOBBYIST: (Last) (First) (M.I)
KZ Architecture 7580 NE 4th Court, Suite 116, Miami, FL 33138
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-865-9911 (305) 865-0572 Jauaakzarchitecture.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Ahavas Torah Conareaation Inc.
NAME OF PRINCIPAUCLIENT:
424 W. 40th Street Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 528-2275 Akivashawel(avmail.com
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 BENEFICIARY: Jamie Tarich,Shimon Segelman and Rabbi Hersh Neuhaus,Directors
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:NON-PROFIT
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Design Review
Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops
or Committees, if necessary, relating to the property located at 424 W. 40th Street, Miami Beach, Florida.
Issue to be lobbied(Describe 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
Planning Staff City Commission, Development None. X
Boards, Land Use Development Committee None. X
and Commission as necessary None. 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.
None.
None.
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST OMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) d A Ir
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $ /k1/ AP
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 lobbvin_a an a oreseat or oendina laid for goods m
.eauioent or services,or on a oresenfor oendina
award for moods,eauioment 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 lobbvina on a oendina application for a DeveloomentAareemenf with the City or application for
change of zonina man desianation or chanae to the City's Future Land Use Man?
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 XNo; Are you representing a not-for-profit corporation or entity withoulsoecial compensation or reimbursement,
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH_YEAR.EACH LOBBYIST SHALL SU _MIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH
ME THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPOR b. . PERIOD.
Signature • obbyist
I do solemnly swear that all of the foregoing facts are true a . orrect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Be- h City Code and all reporting requirements.
Signature of Lobbyist: J .41111
Signature of Principal/Client: _ �-.
VI. LOBBYIST IDE • 1- ...••N;,--'''''--- PRINCIPAL IDENTIFICATION:
Produced ID e)4 Produced ID
Form of Identification Form of Identification
_Personally known(Lobb . . Personally known(Principal)
r� CYNTHIA ROMAN .. '' ANNA E.ALAMED'•. o0PaY Pue, ) .....
VII. SIGNATURE AND STAM, =;i V - :Notary Public=State of-Florida' • MY COMMISSION#FF 0:1.�,.
a• ; •- Commission I FF 2041.05 . • EXPIRES:September 12,;ii. ;.,;
State of Florida,County of Miami-D.dAa+. -�� A;� My ,. EXPIRES: 12,2017
,,Fa dr•. Y Comm.mm.Expires Feb 26,2019 ®dn i n1 o�'19 Detdel qu'lit Naar.Emit"
Sworn t and subscribed f re m-•
Bonded through National Notary assn . sworn and subscribe before me
This /7 . day of , .I _ This 2 t day of ,2015
CeCi i
Signature of Public Notary—State of Florida ign_ - - . ,. bf Notary—State of Florida
Notarization of Lobbyist's signature otariza •. :• ripcioal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF O LY
!.. :-•' . '•• -:' `l : .• .n• . .. • 0 •C)0 11 : . O O i. . • •,
Lobbyist Registration Fo Veceived and verified by: '1f`; , .1A
•
City of i\1lami Beach. 1700 Convention Center Drive, Miami Beach, l-.'rids 3313q. www•.mi:imiheachll.go
CITY CLERK Office
Rafael E. Granado. City Clerk CityC!crk:%::niat»ih�ttc htL_�c>t
Tel:305.673.7411 . fax: 305.673.7254
LOBBYIST NAME: Jaua Kader 2Q,10 e..cA e
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, 2012, 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. 2 Z. - I c
Signature: /' Date:
•
C:\Users\clerhatl\AppDatalLocallMicrosoft\Windows\Temporary Internet Files\ContentOutlook183LGQDDH\Lobbyist Registration
Form revised 5-30-2012.doc
C' ilaneous Cash Receipt
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City of Miami Beach-Florida
Finance Department
1 City Hall
1530720-1 11/03/2015 BR1 T131
Tue Nov03,2015 09:10AM Trans#1-1
1 $850.00 MCRCLERK - MCR-City Clerk
* MCR#: 408081
1 ITEM(S): TOTAL: $850.00
Check (001073) PAID $350.00
Check (001256) PAID $500.00
Have a nice day!