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Alex Mendez - Arnold M. Jaffee i _ : /\Ai :5 ABACE �- Office of the City Clerk 1700 Convention Center Drive JUN 30 2021 Miami Beach, FL 33139 305.673.7411 CITY OF mIAp�ll E3 �1(�[-� LOBBYIST REGISTRATION FORM OFFICE OF THF 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"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. 9. LOBBYIST INFORMATION: Mendez,Alex NAME OF LOBBYIST (Last) (First) (Middle Name) Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140 _ LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-674-2089 amold.jaffee©msmc.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INF*%RMATION: Jaffee,Arnold M. NAME OF PRINCIPAL (Last) (First) (Middle Name) 4300 Alton Road,Miami Beach,FL 33140 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)_ (Zip Code) 305-674-2444Gino.Santorio@msmc.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR . . u TELEPHONE NUMBER EMAIL ADDRESS Pursuant td City Code Section 48 (h)(1)(a) 'A pancipat of any corporation partnership ;or other entity who appeal's as a lobbyist on behalfof that entity without special compensation or reimbursement for the appearance whether direct indirect ar contingent to express support of or opposition to an nein shall regrsterwith the Glerkes,required,by thissubsection but shall not be required#iipay any registretion fees. 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 NIA): Gino R.Santorio o 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 Page 1 of 5 III. ISSUE TO BE LOB:IED: 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. Presentation and vote of the Health Facilities Authority and City Commission on the issuance of tax exempt bonds. 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 V Administration Mayor and Commission V J Health Facilities Authority 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 Le BBYIST COMPENSATION — Be Specific. (Note that a contingency fee is prohibited pursuant to City Code Sec. 2.483.3): N/A 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 1L/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 City Code Section 2-490, entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes ZNo: 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. ees_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. Yes_No: 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 ZNo: Have .ou •povided cam.•ai c onsultin' services to an incumbent member of the Ci ; Commission within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: Yes No: if.Nres.:has..it.sheen.less:than'<12:months.since the elected ofaicial(s).' horn.you:�rovided cam ai n consultir a services was sworn in? 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'/No: Have you provided campai n consulting services to an incumbent member of the City Commission within the •ast election c,cle?If es lease list the incumbent member s of the Ci- Commission: Yes No: it'yes. were lou cnroinised:or did._Vou receive_econonticeonsideration in exchenge4foi carrel eicin consulting.services? TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration roe )' ]Yes ]No Amount Paid$ MCR# � Date Paid' \� iG Lobbyist Registration Form received and verifiedby _'J .F..:\POR.\$ALL00.R.5 1,9ppylOtF:f3A0 S\Lobbyist Registration,Form i:hed 03711.20 RE.G e!oc Re sed 03/11/2®20. Page 3 of 5 • VI. SIGNATURES UNDEi': 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. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION D NG THE REPORTING PERIOD.' Signature of Lobbyist: l tel,I Date 05/30/2021 I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2,Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reporting".uirements. 01 Signature of Lobbyist: Date 05/30/2021 Signature of Principal: Date 0600/2021 VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of r 01-2_t D f State of P.402---1b f County of: M I Arm i - County of: N i 6rn 1 Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of I"physical presence by means of Riphysical presence or 0 online notarization, or 0 online notarization, this 50 day of 7 r ,202-i, by this 50 day of 3 t_CX1-2-- ,202J,by Alex Mendez Gino R. Santorio NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID _Produced ID FORM OF IDENTIFICATION 4ersonally FORM OF IDENTIFICATION ersonally Known Known La • CL-sC/Yz Signature of Notary Public Signature of Notary Public �' � ruLLicoe2__ 174Wi LOpE2_ Name of Notary,Typed, Privd or Stam „L _ ___ Mame of Notary,Typed, Printed or Stamped. ,64' e4 PAULINE LOPEZ (NOTARY SEAL) 1.4 .(,\^`: Notary Public••State of Fiori PTARY SEAL) Y p ?' ' I i �•'•• PAULINE LOPEZ ;9C `i Commission r HH 132456 =6• NotaryPublic State of Florida 'roF r:F/ My Comm.Expires May 30,2025 I , :'• • ^L • Bonded through National NotaryAssn. e• Commission a HH 132456 oiliVimossiourgirmoisomormonww g I '•••'o.p e/ My Comm.Expires May 30,2025 1 The term"lobbyist'specifically excludes the following persons: I •• •••Bonded through National Notary Assn. I 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 City of iltliami Beach,1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E.Granada,City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411,Fax: 305.673.7254 NAME OF L•BtYIST: Alex Mendez 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) I!OB'=MIST 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 LO z:>zYIST REGOSTRATI•}N 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 pursuant to Section 2-482 of the Miami Beach City Code. • 06/30/2021 Signature of Lobbyist • Date F:ICLERISALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc Page 6 of 5