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Jose Felix Diaz - Sunshine Gasoline Distributors, Inc.
en1 , E s MIAMI BEACH City of Miami Beach Office of the�CIty;Clerks.;r c 2g16 ARE? it 3 1700 Convention Center Drive, Miami Beach, FL 33 ° F7 10:'139' ; LOBBYIST REGISTRATION FORM `_r ''1 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. Diaz Jose Felix NAME OF LOBBYIST: (Last) (First) (M.I) Akerman, LLP 98 SE 7th Street, Suite 1100 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-755-5825 jose.diaz @akerman.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: Sunshine Gasoline Distributors, Inc. NAME OF PRINCIPAL/CLIENT: 1650 NW 87th Ave Doral Florida 33172 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-477-5800 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: Maximo Alvarez • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%Op MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See_ a A4acAle. er'1z►: I II.SPECIFIC LOBBY ISSUE: Planning Board-875 71st Street 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 Board N/A 0 Administration N/A Fl 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 N/A F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc W. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 41 4Oa per hGAE B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). v' Li O® per kat/C The following information must be answered: T' 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _YesL No: Are you lobbying on a present or pending bid for Goods,eauipment 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": _Yes�lo: Are you lobbvina on a pending application for a Development Aareement 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. _YesJ lo: 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. Signature of Lob. ' I do solemnly swear that all of the foregoing facts are true and correct :0. at I have read or am familiar with - .visions contained in Section 2-482 of the Miami Beach City Code and all orting requirements. o_cep., Signature of Lobbyists /_ Signature of Principal/Client: 17,/. k VI. LOBBYIST IDENTIFICAT'•N: PRINCIPAL IDENTIFICATION: \. Produced ID !, Produced ID Form of Identification I R I Form of Identification '� LL ��Personally known(Lobbyist) o o It Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: s(1-.) a �w z o State of Florida,County of Miami-Dade >- x I State of Florida,County of Miami-Dade Sworn to And subscribe• before me m" °D ' Sworn and subscribe for me •'s ' c-' day of ii,f ,2014 Yea This/1— day of ', ,201c? if .r/ .��. '• ,,. h S.CUMMINS Signature of Pub, otary—Si Florida 04, /t Signature of Public Notary— 4�a 1.'� �,. •.: •mmission#FF 022155 Notarization of Lobbyist's s'.. ture * Notarization of Principal's s •',is'�e Expires September 29,2017 '4,Qt.1t. Bonded T ru Troy Fin Inswia 800 7019 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY - AnnUat Reglstradon fee. [ I Yes[ y�No Amount Paid IdMCR;# ' 44 CI) � Date Paid ± % f((� Lobbyist RegistEation form-receiv and verified by` ,Mid' -k •.Fi1CLEEi IP)rALL\,aFORMS4Lp/MISr F Lobbyi tAnnual:R ;psi 1!T Tr..ix Revised 01/22/2014 F:ICLER\$ALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form.doc MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado,City Clerk CityClerk©miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Jose Felix Diaz 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. /4/21// Sign- -: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ;Tr; ,'J `_.I` a>f i 4;1201 p 001 .1, . Miscellaneous Cash Receipt ``r � g y s • CITY OF.MIAMI BEACH _ :. ` - ,[,,;46',.;,;i: , ,, , Z is - O u - Q El Credit Card Check# t 1 $ Cash �� ' 1 ct 20 - - Received.of } -z_.,,._ , 1 c— �.�:, r i �.� } f'(�C.� Ole��t+� Address . q ; -)-Ir r 4 ct.,. r tt i Gct, (+ 0 )i /l5 / ( ) i C C 4,1 e___ , . 1 For .. � � . � ffECg of Finance Director (THIS INFORMATION MUST BE COMPLETED) 1 - 0 I I 5'060 -56c(y J . . Account Number:, • '-� }�;4. c$i" Dept: (t° �*r(eit, n Prepares: , . .. 0 S CD — * CSS —I _s —• •l CD W :- O D- O) Z3 < CD r-1 3 O r+ —. CD C7 —I C7 O C D 13) .•C _ T-m 70-83 D 0-1 —.• O CD JJ) 3 4=r GJ-D —+ r+ 0 O Cu •-•e•"r-- cr r G3‘C CD —1, .•+ O C3 C/] O —. 1 CD —• 0,---- -J,- - —• S 0 3 Q O •- 00•- C) CD - CD •- CD O N O D o) co —I — O J ca) CL N.) O CD ---• CD CO — 1J 3 0) —, r+ •— r' 7D O - CD CD •- CDNN = Ja) Z7 r' -- O r+ Q a m Cs1 --• = I-I CO 0 CO CD I Q CJ J -0 T O 3 07 J fg - 1 .T) O COO --I —• CSi O 3 -s O CD DJ ---I O_ = O 1 CA N -- C n r+ O ''•C I (` 1 CD O CD F Camm, Patrick • From: jose.diaz @akerman.com Sent: Tuesday,April 19, 2016 2:07 PM To: Camm, Patrick Cc: Salvatore,Jason Subject: Re: Lobbyist Information for Planning Board (875 71st Street) Maximo Alvarez owns 100%. Sent from my iPhone On Apr 19, 2016,at 1:28 PM, Camm, Patrick<PatrickCamm @miamibeachfl.gov>wrote: Good afternoon Jose, I spoke with one of your assistants last week and they were supposed to mail me the breakdown of ownership for Sunshine Gasoline Distributors Inc.As of now, Maximo Alvarez is the only name listed; if he owns 100%,then please send an email stating so. Regards, M I A M I B E ACH Patrick Camm, Records Management Specialist OFFICE OF THE CITY CLERK 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411/ Fax: 305-673-7254/ 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. vCard I Bio I LinkedIn CONFIDENTIALITY NOTE:The information contained in this transmission may be privileged and confidential,and is intended only for the use of the individual or entity named above.If the reader of this message is not the intended recipient,you are hereby notified that any dissemination,distribution or copying of this communication is strictly prohibited.If you have received this transmission in error,please immediately reply to the sender that you have received this communication in error and then delete it.Thank you. 1