Jeremy Shir - G200 Exchange LLC •,
1,0 ,
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL233139 •
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.
5 in,•r cern n
NAME OF LOBBYIST: (Last) (First) (M.I)
6c1ex IN-1(0,10-4 P-4. / e. 1 (Blvd 5f / ) P1. L,lercia BUSINESS NAMAND ADDRESS / (Number and Street) (City) (State) (Zip Code) 3 33 v 1
gsti-qg9 - ? 553 q5ev- 6r/q
A' s lit 19p) a,) - czy-,
TELEPHONE NUMBER: FAX NUMBER: HAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
G► al 6D E K Gee, L L
NAME OF PRINCIPAL/CLIENT: � � /���,�
see . a�a /o DV- /30(-141 Dr e 5/-. CJ;1►�;� / ej( A no.�
BUSINESS NAME AN ADDRESS (Number and Stree - (City/ State) / (Zip Code)
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: (\b I d S.
• IDENTIFY ALL PERSONS HOLDING DIRECTLY OR I IRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: aS 5L. �0 p 6 i` Kj�1 'i�t.5 f- WT-1_ ,2o/0 �rC f-fr�5 j -T- 6.2D/'D
,J I E.Kz.►, 71,4-51-
II.SPECIFIC LOBBY ISSUE:
L6LeLa zo S {e_ (. ` o/ co i t,45 44,,
Issue to be lobbied(Describe 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
i.-k s+ n'c P`e_s eX 6 -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
>t) /4
F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE.WHETHER HOURLY,FLAT RATE OR OTHER):9 A) LOBBYIST DISCLOSURE:(Required) `;i`'f ° '
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): r) ^ '' !=-
r
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�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":
XYes_No: 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.
YessNo: Are you representing a not-for-profit corporation or entity without special compensgtion or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHAL SUB IT TO THE CITY CLERK A SIGNED STATELE T NDER
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.
14-
Sign re of obbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach Ci, Code and all reporting requirements.
Signature of Lobbyist: �►�r /
Signature of Principal/Client:' ; - f o&at-•,
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) /Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
Air
State of Florida,County of Miami-Dade State oral a,County of Ali-Oe eNew
Sworn to and subscribed before me Sworn and subscribed before me
This day of , 201_ This 1/..A clay of Fcd f�'ar y,201
Signature of Public Notary-State of Florida Signature of Public Notary-State of -IUEcvYeteIC
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAF •NLY
Annual Registration fee: ( J Yes[ J No Amount Paid$ 0•rig MCR# • 0 F Date Pald' �-
Lobbyist Registration Form received and verified by T41.143111&_i
r:\CLt,n\ .ALL\afORRIS\LOBBYIST FORMS\Lobbyist Annual Registration Farrn.doc Revised 01/22/2014-.
F:ICLERI$ALLIaFORMSILOBBYIST FORMS\Lobbyist Registration Form,doc PATRICE
Notary Public,State tale of of New York
No 24-4989909 ►`
Comm Dec.16,�2(L_.
•
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER.H,OURLY;,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) 146ki l t � i
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): � ) L`i i 6
(REQUIRED). l u',�, - ,1 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 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":
XYes_No: 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.
_Yes 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 IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
r
Sign t re of obbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach Ci Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:'' _
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
/Personally known (Lobbyist) Personally known (Principal)
VII. SIGNATURE AND STAMP OF O.:ARYL -----
P 4
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl. ov
2016 FEe -9 F =i 10: 14
CITY CLERK Office
Rafael E. Granado, City Clerk r, ,-' . CityCle0k@miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
'
LOBBYIST NAME: cA f.ce_K-K' k 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 30' 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.
7,72_Alo
Sig Iturzi Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
City of Miami Beach ?
1700 Convention Center Drive
Miami Beach, Florida 33139
II ;`.�
i-{-fir.E1,61. �:V� F`� lJ! I 1 �-
www.miamibeachfl.gov
City Clerks Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: & v�.
Business Name: e Po I T e. 6- -
Address: ) �. £(ZLad o cste 1oV F • CAA.thidoi_l l 333 oil.
Office Telephone Number: ! 5-1/ – � q o �.-s7
Cellular Telephone Number:
Email Address: ,sk► ( losp)tet-i • ace-1.-1
if more than one lobbyist, please list:
1)
2)
3)
4)
. 5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR #: �� 6 `7 �
Amount paid: CSC) Date paid: W- - I
Processed by: .i o c � -� Date: 0 09- l(-,
F:CLER\BALL\aFORMS\LOBBYIST FORMS\ANNUAL LOBBYIST REGISTRATION FORM reg.docx
BECKER Colleen LaPlant
POLIAI(O�1 �.� f,��_ ��? ��#'�, I`~� Phone: (954)987-7550 Fax: (954)985-6814
CLaplant @bplegal.com
2016 FEB -9 AM 10: 15
1 East Broward Blvd.,Suite 1800
CITY C J:;-6 °S O F F Lauderdale, Florida 33301
February 8, 2016
Via Federal.Express
City Clerk Office
Attn: Patrick Camm, City Clerk
1700 Convention Center Drive
Miami Beach, FL 33139
Re: Lobbyist Registration
Dear Patrick:
Enclosed please find our Firm's check in the amount of S850.00, along with
the Lobbyist Registration Forms representing lobbyist registration fee for Jeremy Shir
on behalf of our client, G200 Exchange LLC, together with Expenditure
acknowledgement forma
Thank you for all your help and assistance. If you need additional
information, please feel free to contact me.
Sincerely,
Colleen LaPlant
Executive Assistant
Enclosures
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Salvatore, Jason
From: LaPlant, Colleen <CLAPLANT @bplegal.com>
Sent: Monday, August 15, 2016 10:58 AM
To: Salvatore,Jason
Cc: Bailey, Michelle; Chamizo, Roberto
Subject: Hi Jason, nice speaking with you...
Sorry for the delay. Please see below and let me know if you need any other information from us.
G200 Exchange, LLC
Hourly
Kevin M. Markow$450 per hour
Jeremy B Shir$300 per hour
Ygrene Energy Fund Florida, LLC
Flat Rate
$3,000
Jose Bermudez
Jose Fuentes
Connect Miami Beach
Flat Rate
$12,500
Jose Fuentes
George Burgess
Jose Bermudez
Thanks again.
c
Colleen LaPlant
Executive Assistant to Bernie Friedman, Esq. and Jeremy Shir, Esq.
1 East Broward Blvd., Suite 1800 I Fort Lauderdale, FL 33301
Tel: 954.985.6804 I Fax: 954.985.6814 I E-Mail
Website
BECKER&'
POLIAKOFF
The Becker & Poliakoff Client CARE Center is here to serve our valued clients. If we can be of assistance in any
way, please call us toll-free at 1-844-CAREBP1 (1-844-227-3271) or by email at care@bplegal.com.
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