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I AM I BEACH s , _.
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 20 15 DEC 0
LOBBYIST REGISTRATION FORM > J;re b �� „Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encouige l the passage, deat or l_
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.
Gomez Jose
NAME OF LOBBYIST: (Last) (First) (M.I)
Beilinson Gomez Architects P.A., 8101 Biscayne Boulevard, Suite 309, Miami, FL 33138-4664
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)559-1250 (305)551-1740 ianabeilinsonarchitectspa,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:
Neil and Elizabeth Rosen
NAME OF PRINCIPAL/CLIENT:
5642 La Gorce Drive Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-776-1414 nrmb(aatt.net
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: Gam' I l'►'
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
^.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to the Board of Adjustment, Historic Preservation
Board, Design Review Board, Planning Board, Land Use Development Committee, City Commission, and any City Workshops or
Committees, if necessary. relatina to the pronertu located at 5642 La Gorce Drive. 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
Staff for the Planning Department, Building Department, None. X
Public Works and City administration, PB, HPB, BOA, None. X
City Commission, and Mayor 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
Nnn.P_ -
None
None Y.
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBY COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$ O •
Li-
40 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $ 2�Q
(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 lobbvina on a present or pendina bid for aoods.equipment or services.or on a Present or pending,
_
award for aoods.eauipment 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 pending application for a Development Agreement with the City or application for
chanae of zonina map desianation or chanae 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 X No; Are you representina 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 COMPER ATION RECEIVED. IN THE CITY OF MIAMI BEACIi
EQg THE PRECEDING CALENDAR YEAR. A ST TEMEAL - ` ' BE FILED EVEN IF THERE HAVE BEEN NO
OCPENDITURES OR COMPENSATION DURING THE ORTIN r •. RIO 0.
— e
Signature of Lobbyist
I do solemnly swear that all o = i . •I• facts are a and co ect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mi- i Be-" I,C••e and all reporting requirements.
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Signature of Lobbyist: '�-
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Signature of Principa°-Clie ,: � � �
VI. LOBBYIST ID N 1 FICATION: PRINCIPAL IDENTIFICATION:
°Produced ID Produced ID Et— O ld W Li CAS!`'
Form of Identification Form of Identification -;.,,.;,,,,
e • a i
Personally known(Lobbyist) _Personally known(Principal) ,i :,..:00-:
• •mom.
VII. SIGNATURE AND STAMP OF NOTARY: "•,,
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State of Florida,County of Miami-Dade State of Florida,County of Miami-Da e s c 4
Sworn to a d subscribed before me Sworn and subscribed before me .,, a
y 3 C T
This . • y i f 15 day of'JN It !t2015.k o x 1
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Sin-.ure is .,of w•Sate of Florida Sign; ure � ...' •li• otary—State of Florida o d o z 9 Notarizati 02,.
Lobbvis�'A signature Notarizat'Sr principal's signature cc c' �+
N p 0.
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY co d
Annual Registration fee: [ ]Yes[ No Amount Paid$ SD MCR# go V 3 Vc1 Date Paid
Lobbyist Registration Fonn receiv and verified by.
/17IV C--- r2-' /2//r
M I AM I BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E.Granado, City Clerk CityClerkamiamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Jose Gomez
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 M ami-Dade County Commission on Ethics and Public Trust. •
I / 5/ /
S !flat, re: Date:
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Finance Department
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1533713-1 12/03/201 BRTra13#51-51
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51 t700.00 MCRCLERK - h1CR-C1 ty Clerk
* MCR#: 408349
1 ITEM(S): TOTAL: $700.00
Check (1678) PAID $700.00
Have a nice day!