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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 331396 G`- i`f' -T i� F.d.l 1U: 20
LOBBYIST REGISTRATION FORM 1. I Y CL:_":.:: •S -f- 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" h specific exclusions. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First) £JIe(M I)Adp--Ss, LW 1/0 w, Auehc . elf Hism B FL3 °1
BUSINESS NAME AND ADDRESS (Number and Street) (City) (Stale) (Zip Code)
G` – 4. -jg3 IP)• riot C°•
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY: T
iô t
NAME OF PRINCIPAUCLIENT:
7 79'l OW c/ 1 S-fi� , - 30C. Hfain r' PL3?I C
BUSINESS NAME AND ADDRESS - (Number and Street) (City) l (State) (Zi de) I
'70.,S---11`17 -- L/�/ig' r� cct fret i0 ( o kncb/e,eof-ri
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:DI C 3,6 Gteft0-1-
• IDENTIFY ALL PERSONS HOLDI DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
• LSPEC I FIC LOBBY ISSUE: _----- -L___�_ -�----_-_-�,- .�------s).
Issue to be lobbied(Describe in detail): ■®� ° V/"�`) ,to-
\ ����/1...ter--�-�:V1 ,- '�, %_
Ill.CITY AGENCIES/INDIVIDUALS TO BE-LOBBIED:VVV��`
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
Cat (OK17rn5�1A9h -)r-
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
A iii 7.k...._
F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) , . Fee
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION) 10'4 fi
(REQUIRED). F---- >✓!
The following information must be answered:
1) ursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
Yes_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":
Yes1No: 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.
Ye 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-EVEN, THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobby-TO
I do solemnly swear that all of the foregoing fa 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 his•- - d all resorting requirements. i
Signature of Lobbyist: ` 1`�
' , • .
Signature of Principal/Client: 1 , !
VI. LOBBYIST IDENTIFICATION: ��--- `– PRINCIPAL IDENTIFICATION:
s`
Produced ID Produced ID .
Form of Identification Form of Identification
`!Personally known(Lobbyist) > .
Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
Julie Ruffolo
State of Florida, County of Miami-Dade ?•'.441:171,„o� j '= State lorida, County of Miami-Dade "
• . COMMISSION#FF021273 Y
Sworn tend subscribe be ore me �, :< ORES: MAY 23,2017 Sword subscribeeor- me / _/
This .j day-s , , 201 �.r' ,:•' This ,da. if i 20 '
vow, %%' WWW.AARON1dOTARY.com
All Sign:ture of Public Notary„1St"- of Florida .s ure of Public Notary– tat../of Florida
Not. ization of Lobbyist'- signature • ` —rization of Principal's sig ature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ¢
Annual Registration fee: [ ]Yes[ N`o Amount Paid 350-0 0 MCj?# it L q\ Date Paid �J S'°°9–I b
Lobbyist Registration Form received a'hd verified by: -'JD � ,
:'CLER\, LL\aFOk , \LOBBYIST FORMS\Lob yt;t Annual Registration Form.doc Revised 01/22/2014
F:\CLER1$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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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: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NA1VIE. 0,61
LI
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 Mi i-Dade County Commission on Ethics and Public Trust.
3-
Signature: ■ Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
BECKER & Roberto Chamizo III
POLIAIKOFF Department Assistant
Phone: (954)364-6056 Fax: (954)985-6814
rchamizo @bplegal.com
1 East Broward Blvd.,Suite 1800
Fort Lauderdale,Florida 33301
May 6,2016
VIA HAND DELIVERY
City of Miami Beach
Attn: Rafael E. Granado,City Clerk
1700 Convention Center Drive
Miami Beach,FL 33139
Re: Lobbyist Registration
Dear Mr. Granado:
Enclosed,please find Dana Pollitt's Lobbyist Registration Form on behalf of TSO Mobile/Diego
Capelluto. Also enclosed,please find a check(#1112)in the amount of$350.00 representing the"per issue fee"for
this matter.
If you have any questions,please do not hesitate to contact me.
Sincerely
Roberto Chamizo III
Department Assistant
Enclosures/rc
www.bplegal.com care @bplegal.com
Florida New Jersey New York Virginia Washington, DC Prague
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Salvatore,Salvatore, Jason 1 0_51
From: Dana Pollitt-Adept <dana @adept.co>
Sent: Monday, August 15, 2016 11:21 AM
To: Salvatore, Jason
Subject: Re: City of Miami Beach Update of Lobbyist Registration Information
Streetcar "Connect Miami Beach: Flat Rate $12,500"
TSO, None.
On Aug 15, 2016, at 10:41 AM, Salvatore, Jason<JasonSalvatore @miamibeachfl.gov> wrote:
Hello,
Here is a PDF copy of the letter that was sent. Thank you for the prompt reply.
Thank you,
<image001.jpg>
Jason Salvatore
Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,
historic community.
From: Dana Pollitt [mailto:dana@adept.co]
Sent: Monday, August 15, 2016 10:32 AM
To: Salvatore, Jason
Subject: Re: City of Miami Beach Update of Lobbyist Registration Information
Hello, I never received any notification. Can you please email me whatever you need verified? Thank you.
Dana Pollitt
ADEPT Strategy& Public Relations
W: 954-769-1533 I C: 954-937-9403
Sent from my iPhone
On Aug 15, 2016, at 10:26 AM, Salvatore,Jason<JasonSalvatore @miamibeachfl.gov>wrote:
Good morning,
On August 3, a letter was mailed to your business address of record requesting updated compensation amounts for
certain issues that you have registered to lobby on with the City of Miami Beach. Our office has yet to receive a
1
response to the letter. Please be advised that this information is a requirement of your registration and as such, if the
information is not received then you will be suspended from lobbying the City until your registration is updated.
Please respond by August 19,2016 to avoid a suspension status. If you have not received the letter, please respond and
advise so we can provide you with a copy via email. The information can either be provided by a letter mailed to our
office or by email.
Miami Beach City Code Sec. 2-482(a)(6) states the following must be disclosed: The terms and amount of compensation
to be paid by each principal to the lobbyist with regard to the specific issue on which the lobbyist has been engaged to
lobby.
Thank you,
<image001.jpg>
Jason Salvatore
Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,
historic community.
<Pollitt,
Dana.pdf
2