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Thomas Telesco - Z Ocean Hotel 1L4 37 Cobsails 4ve ,PAAMI BEACI [ / 6 citt".3 kv City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 2G16 Juc,1 _6 i'1 9: 49 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage tlie-pasage,'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. TELESCO THOMAS NAME OF LOBBYIST: (Last) (First) (M.I) TELESCO ASSOCIATES 1111 KANE CONCOURSE SUITE 301 BAY HARBOR ISLANDS FLORIDA 33154 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-866-1014 305-866-3317 tom @telescoassociates.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: LOUIS TAIC / T3Q p `-�.,� '�Ip�'C N 1521t4Gt 1 17.6�!'ort-t v6 1+OS M Erie- J NAME OF PR/INCIPAUCLIENT: Z OCEAN HOTEL 1437 COLLINS AVE MIAMI BEACH FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-672-4554 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) 41 — 517 - 4t FIll out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: LOU (`S Tot • IDENTIFY ALL PERSONS HO4DINp DIIjE O TLLY_OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: /F'' l (, A—(G II.SPECIFIC LOBBY ISSUE: is - 1°la p° ;SUPeR 4rt-APL+ic. L .E. . 6c.$2 mss t N N6TE 1.1-rsa __ HISTORIC PRESERVATION BOARD CERTIFICATE OF APPROPRIATENESS FOR 0437COLLINS.AVENUE.(2 OCEAN HOTEL)&-1669 LOLL-INS.AVENUE,(TAT.EL.RESTAURANT), 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 ' 1 title of person to be lobbied 1-t i STcarir Pie sev✓Ali ./ 3 oar-c.1 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 N/A F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc • •a . 'IV.. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) I t o,xyt).°° d 4...vigeo.ED •Fog A tcut-t 6'C.'tLAZAL. lr . B) PRINCIPAL'S DISCLOSURE(OF LOBBYIS COMPENSATION): (REQUIRED). k b. C,44 ' p�t r7 -rca A-R-C-41 l 17ECC(AEM... Vie. . . 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": —Yes_'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 ALL BE FILED VEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. tr.,---ty Signature of Lobbyist I do solemnly swear tha all of the foregoing fac s are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of th iami Beach City Cod and all reporting requirements. Signature of Lobbyist: erws I. 6-----f..._____------ . Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: — PRINCIPAL IDENTIFICATION: .4::l.vor� , Produced ID ,,-1 Produced ID— Form of Identification s °*o;' ' Form of Identification /Personally known(Lobbyist) o o,� ' ersonally known(Principal) � Z 3 VII. SIGNATURE AND STAMP OF NOTARY: `D ° 3 • Q _, w m 0. ,_�e$'ITEL I. - State of Florida,County of Miami-Dade cD cn D State of Florida,County of Miami-Dad.?":.,.••-••'• %�i� Sworn to and subscribed before me °, T Sworn and scribed before me ∎ "�. • •'; 0 This ' r day of i-1E ,20110 c V 73 This 12 day of ,201 ;m,c E*s • 4��� v N CrmA \ 6w' = Mo.EE NOTARY�C1 vti wpTARv Si., a y!.f. ubli a Notary-State of Florida Signature of Public Notary-State of Florida .• •' � ' .4 ri ation of Lobbyist's signature Notarization of Principal's signature �','s,,` "• . �,`,� 1/•,,gIOFF Or.; TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: ['Yes[ ]No Amount Paid$ (j50. MCR# 1'[©t,qf1 Date Paid `06•-O6-( Lobbyist Registration Fo received and verified by: .. dU 5,4- }-MA-c., F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granath), City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: 1,‘4d-AAgS-Ta 6CCr 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. c3"..'‘F-,lS1.n(ij ?==.A/16 Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Miscellaneous Cash Receipt CITY OF MIAMI BEACH No.4 0 9 7 Cash Credit Card1 1Chek# 5 S ' . ;S� of-) .. oc . 0G 20 City of Mian egVed Of 1 / A,t / L 6 5 C r Miscellaneous=OR O/C / 1 4'1vF C oiu C Ow'SC Cae 01 , c7 tom' T c L 3,3 /5 000155-0026 end r...A-4)los t i�D 00:9 M C )i�' t MCR OPEN l 7 Payment Amount: 850.00=' MCR409957 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director 011 Cc)00- a 7. 3� - Account Number: .3V-1141-1(-1-� �o .S a� - °� oO f 6,0- - Preparers _)A O)J 5,1-1--v4-71-A6 Dept: C--C., EXT:`' i I I j7 = (� S = 0 Cl) CD i 6 re i .. 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