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Gustavo Berenblum - Lease Florida LLC 9140 [s* S4- RECEIVED Office of the City Clerk JUN 0 2021 1700 Convention Center Drive Miami Beach, FL 33139 CITY OF BEACH 305.673.7411 OFFICE OF i HE CITY CLERK 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 "Lobbyist"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: $Eat_. 1m svm0 NAME OF LOBBYIST (Last) (First) (Middle Name) EKetske M sc+4 jHlcNlC -n 22.00YNw/40I/UE .51Z 211 MIQ'I` 1 F1 33/Z:7 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) t, — ZOO —5251 S- 331 -80"1L- 68@ggMIANI. wM LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: A' 4 NAME OF PRINCIPAL (Last) (First) ,J (Middle Name) !-eJ Gae. /ccxJ . /Lr, 6-70/ Ai It) /.°`/3' ./ 2 .b9i' .�,' Zs I�' 5 F( -,�J©/( PRINCIPAL BUSIN SS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) -72 � 34 S ' �s'�7. F� 7-1e 30S- Sg, -0 /...%/1 PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Cam ursuant(j @Sy Code Section 2-482(h)(1 Q • a-I C•2E10 corporation, partnership,ar(Chi dn�J ••-• m Ei lobbyist CTa behalf CiiQit_f -2W:be:MEER special compensation®i'Q u '- or ft appearance, indirect,CV contingent,Q�(-3,.11f ••• daj,o.•osition(ir ml3lmdn���the=3E11)re•uired( • - b`3iI mE a ILO re.ulredit)Dm mre.istrationi 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): r Iv t Lti �LS � • 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): AMS of at't-,M Page 1 of 5 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. t 1(o1J I eA,N Zoha.p 1cMn' ovkl. Toe ea.03ez r 940 0 '71 Sr S 7 - i&. U)1fic11-- (.3 C Anc I-h r&c1-5 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 S)t'S I iv IS i0,0110,0 160Al2-:0 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): IA 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): F1 X'O ' -jod- O‘wh&l 12dtcwt 4. emsos7A-1 oe11a DE:6 o 1 t117S- Page 2 of 5 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": _Yes 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 Z.No: 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. YesKNo: 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 YNo: 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: • _YesVo: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign conswltinq services was sworn int 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: _Yes KNo: f yes, were you promised or did You receive economic consideration in exchange for campaign onsulting services, TO BE COMPLETED BY CITY CLERK'S STAFF�FONLY�[' 7 Annual Registration fee: ]Yes[ ]No Amount Paid$ 5�- MCR#ao t ✓U i 0 Date Paid k G Lobbyist Registration Form received and verified by: F.dCLER\$ALL1aF4)RMS\LOBBYIST FORMS\Lobbyist Registrath n Form Revised 03-11-20 RiEG.doc Revised 03/11/2020 Page 3 of 5 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 PRECED • GLE i DAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGA= I •• LO:BY. A STATEMENT SHALL BE FILED VEN IF THERE HAS BEEN NO EXPENDITURE OR COMPE - • I Pio, I -irG THE REPORTING PERIOD.' Signature of Lobbyist: / '.0• Date E-3.-- ft I do solemnly swear or affirm I at a if t' -4for eoing facts, statements, and disclosures in this form are true and correct, and that I have read or am famili. •ith pr isions contained in Chapter 2, Art. VII, Division , entitled "Lobbyists" of the Miami Beach City Code and .1, : •oLi,• re irements. Signature of Lobbyist: Date °S- 2P" 21 Signature of Principal: _'�� Date 51 8 A:P-z:7 01 VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: r PRINCIPAL ti State of V f( State of /iCricia, 1 County of: a IM f . (� County of: —.),A a 0 Sworn to(or affird)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means ofl7' hysicai presence by means of 0 physical presence or 0 online notarizatioor 0 online notarization, this V,,' -clay of V ,20, by this,2 qday of /i-lici 20.-24, by Courkk,a -moi tO i D efrev1Hovv 4/ n3f e.,;J NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID i`-k ')31°"� -5g 2'"D _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Known ill L ersonally Known A... ! f Sign ure of No ary 'ublic I , Sign ure of ,o„h• �Yy`Q3 4ris,� //c., Name of�otary,Typed, Printed or Stamped Name 6f Notary,Typed, Printed or Stamped Rawilliwilolliwomdlimihmkaaimmishmisormor (NOTARY S�'A rpNotary Public State of Flonda (NOTARY SEAL) * 4 ''''''''• KURY1NDY CASTILLO ; z° Jaqueline Torres ;a° �.t\_ Notary Public-State,of Florida , c` My Comssion GG 208448 =, � commission#GG 171959 Ex•,res 04/16/2022Oat , `:v› ,=ply COMM.Expires Apr 28.2022 (• ,�•...,r.a1 e' . 1 �ocf,''• 1 The term"lobbyisf�spetitit�l •"11w n• persons: + ,�"'',,„�• Bonded;lhrodgh N8'IOn3 No:ary Assn. 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. Page 4 of 5 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: G u ST Mb Bete N6 L6)4 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 of each year, and the fee for such annual registration shall be $500.00 pu a o ction 2-482 of the Miami Beach City Code. 0 /21/1112) Signature of Lo b ist Date F:ICLERI$ALLIaFORMS\LOBBYIST FORMSLobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 MIAMI BEACH RECEIVED City of Miami Beach 1700 Convention Center Drive JUN 0 1 2021 Miami Beach, Florida 33139 www.rniamibeachfl.gov CITY OF ;v i���1i BEACH City Clerk's Office OFF.-, +r CT!CLERK Tel: 305-673-7411 Fax: 305-673-7254 Office Use Only ANNUAL LOBBYIST REGISTRATION FORM Name: 6705 TV10 R�IJBL' M Business Name: -6-N'6"M BSC{{ Q.E-t1rEL 3 Address: 2.7-Do 1'0 21/4 AUEs errs ZI► MIAMI 33iai Office Telephone Number: DCS f- 200 Cellular Telephone Number: boC -3 3 t --0J]" Email Address: 655_13 NcIMI,i-4k (-DP 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#: Amount paid: Date paid: Processed by: Date: R\CLER\$ALL\aFORMSILOBBYIST FORMSWNNUAL LOBBYIST REGISTRATION FORM reg.docx . ' MBE Finance 1700 Convention Center Or. 3rd Floor Miami Beach, FL 33139 305-613-7420 Welcome 004792-0006 Maria A. 06/01/2021 09:28AM 3 g .• c' m MISCELLANEOUS Reference 1: 428101 0 850.00 20111CR OPItlem(1:1C )R .., ,-z, Z , - ,;- ,,,,:, , - 850.00 t -'—' - -,-- ---Z. til , L '.'.•:::.--- . 1 """. '1 1 . ,,i, z: , pi ' i . Subtotal 850.00 Total 850.00 c. ' / mi CHECK 350.00 i t' t --'"- al ,,,, -.3 • - — Check Number003520 7 2 '\,:,) -• '( CHECK 500,00 .› ---,, i Check Note r001610 / ,,.. : Change due 0.00 ''''`,. I ..,. ", ''N W. Is ' C.1)' .''L ')'''' ''1'4 .s.'"\' il Paid by: ** MULTIPLE ** „..) '1 1 1.). ,.--„, , ,K-) 4- ' Lg.) ‘‘ . A.,.. 1;11 ,1 i ', -1 wra c..,t4 6F- pi,AL ecr,V11 ( A1 Pro 4 Othera : • - .0 11to, 4 fi 61:1 :-.,—--- Ocalpts 4 N.. .* ....- , _..... 0 ' rifazat1010 W.:wows-mina ma i . A.- Q- 4 l*); t-z ,...,--, --,',, -.Pk. '14,Kwydr,,,v ...... I P.V.t.,., oanymt ‘al...ea % Co 0 M...NO i ma 0000001100 rant.ar 141•M awn,rl. 13130 ;10.ii a 1-N N ._ NiI , 0 • ) 0 Pk\...j • Thank you for your payment CUSTOMER COPY