Jose Gomez - Ron Schreiber Scltils . (.5i-'
Office of the City Clerk
1700 Convention Center Drive JUN 7 ZOO
Miami Beach, FL 33139
305.673.7411 CITY OF MIAMI BEACH
LOBBYIST REGISTRATION FORM OFFICE OF THE CITY CLERK
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 City Code Chapter 2,Article VII, Division 3, entitled"Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee, to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
Gomez, Jose L.
NAME OF LOBBYIST (Last) (First) (Middle Name)
Beilinson Gomez Architects P.A, 18101 Biscayne Blvd # 309, Miami, FL 33138
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ' (Zip Code)
(305) 559-1250 (305) 778-7955 jg@beilinsonarchitectspa.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE.NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Schreiber, Ron
NAME OF PRINCIPAL (Last) (First) • (Middle Name)
3101 S. Ocean Dr. Apt. 2308, Hollywood, FL 33019
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(716) 861-9777 (716) 861-9777 ronlaseedcp.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
•ursuant(b •• i 2-482(h)(11)(a): G•.1 principal @QErie corporation, partnership,ar Cid C-tn 7 cs2D ••® - Ma lobbyist •r =al di'(Rd
gift&kg special compensation CP - oar for SID appearance,VaGinGg'CRICA indirect,Cif contingent,ibai° •,o ( o0 position
CD215)1 { (c '3m o o b Qa`1subsection leCit nl I. l l [ 79[3MOre'istration{ •
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): N/A
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): N/A
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,i.
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
5245 N. Bay Road, Miami Beach, FL 33140 I Demolition of an existing house (circa 1951) and
approval of design and necessary variances for construction of a new 2-story residence.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship (If yes, explain) YES NO
Title of Person to be Lobbied
Design Review Board N/A 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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety(if none,write N/A):
N/A .
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
$250/Hour
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The following six(6)questions MUST be answered:
1) ; Pursuant to 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 City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
_YesXNo: 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 City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481)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 city clerk as required by this section, but shall not be required to pay any registration fees.
—Yes KNo: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
_Yes XNo: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the past election cycle. See Section 2-491 for more information.
—Yes ,,No: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
Yes XNo. If yes, has it been less than 12 months since the elected official(s) whom you provided campaign
consulting mu' was sworn im '
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service before lobbying the City Commission at a public meeting.
_
Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes.please list the incumbent member(s)of the City Commission:
YesX No: If yes, were you promised or did you receive economic consideration in exchange for campaign,
consulting services,
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ fDI No Amount Paid$1 '6�' MCR# �'! �tl b •Date Paid 01-)C4
Lobbyist Registration Form received and verified by: 4zz,fJ
F:\CL'ER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration'Form Revised 09-20-18 REG.doc Revised 09/20/2018
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VI. SIGNATURES UNDER OATH: .
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL.SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. , STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSA • ` DU-+' • . " REPORTING PERIOD.'
1
Signature of Lobbyist: Date 05\31 '"/..4.7 L1
I do solemnly swear or affir that all if the foregoi g factstatements, and disclosures in this form are true andcorrect,
and that I have read or am f iliar wi to: =.= o • ,, fined in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code an. all rep. ing require :nts.
i_— 1
Signature of Lobbyist: Date OSi 3( ?.c ( .61t
Signature of Principal: J Date 1(2 9
VII. NOTARY SIGNATURE A D SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of New York
county of: Miami-Dade County of: New York
Sworn to(or affirmed)and subscribed before me Sworn to(or affirmed)and subscribed before me
this 73\sr day of ANA • 2011;by , this day of ,Apc:( , 20R by,
Jose L. Gomez : ' Ron 'Schreiber ' 1
NAME OF LOBBYIST • NAME OF PRINCIPAL
•
_Produced ID Produced ID {iG(r5"2
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Personally Known )G Personally Known
U
Signature Notary Public '. Signatu e of Nota ublic_
inPiR4.-EE VEAR`I G s ' K,rt L- -. .dJo-tw S V.
Name of Notary, Typed, Printed or Stamped Name of Notary,T�ped, Printed or Stamped
MARY-EVE VENDRYES I
NOTARY SEA`` _"�� : Notary Public-State of Florida I_ (NOTARY SE L1berly R.Borowski
( 1):` Commission#GG 083866
=; P MyComm.Expires Jun 17,2021 Notary' ublic, State of New York
. •. OFF`.-`. . Bonded through N oialNotaryAssn. I Qualified in Erie County.
Commission Expires 11/9/202&
'The term'lobbyist'specifically excludes the following persons:
Expert witnesseswho provide only scientific,technical or other specialized information or testimony in public meetings; any person who
only appears as a representative of a neighborhood association without compensation orreimbursement for the appearance, whether
direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance. '
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. .
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov
Tel:305.673.7411,Fax:305.673.7254
NAME OF LOBBYIST: Jose L. Gomez
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the .City Clerk shall notify any lobbyist (or
principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an.issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 o e:ch year, and the fee for such annual registration shall be
$500.00 pursuant to - ion -482 of the Miami Beach City Code.
O 3( Y2—e..)(..7
Signature of L• •byist Date
F:\CLER\$ALL'aFORMS\LOBBYIST ORMS\Lo.•yist Registrati. Form Revised 09-20-18 REG.doc
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