R. Krawceck/Maria Pellerin
.~\~~(Iy
,l'
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
** AMENDED*
LOBBYIST REGISTRATION FORM
Lobbyist mE;!ans 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.
NAME OF LOBBYIST:
Krawcheck
(Last)
(M.I)
Robert
(First)
L.
Bilzin Sumbera Baena Price & Axelrod LLP 200 S. Biscavne Blvd. Suite 2500 Miami. Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
Zip Code)
305-350-2357
TELEPHONE NUMBER:
305-351-2130
FAX NUMBER:
rkrawcheck@bilzin.com
EMAIL:
I. LOBBYIST RETAINED BY:
Maria Pellerin Barcus. President & CEO
NAME OF PRINCIPAUCLlENT:
Carrfour Supportive Housina. 155 South Miami Avenue
BUSINESS NAME AND ADDRESS (Number and Street)
Miami
(City)
FL
(State)
33131
(Zip Code)
(305) 371-8300
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:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Land Use applications pertainina to Hardina Villaae. Hardina Avenue & 86th Street. Miami Beach
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndividuallTitle B) Any Financial, Familial or Professional Relationship
Planning Board, Victor Diaz, Chairman, and other
members; City Attorney, Murray Dubin, Assistant, None
City Attorney; Gary Held and staff; Planning
Director, Jorge G. Gomez and staff; Zoning Board
of Adjustment, Jason Loeb, Chairman, and other
members; City Manager, Jorge Gonzalez and staff;
Mayor, David Dermer and City Commissioners.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) $450 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$450 per hour
..
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":
DYes ""0: 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 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
o Yes~: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning man designation or change to the City's Future Land Use Map?
3)
Pursuant to Miami Beach City Code 2-484 (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 !ndirect, 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 ~o: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement.
o
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1st 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 P~ ~~
Signat1fre of Lob yist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions
contained in Section 2-482 of the Miami Beach C' de and all r orting requirements.
Signature of Lobbyist:
PRINCIPAL IDENTIFICATION:
~ Produced ID # f6todd.6
Form of Identification
o Personally known (Principal)
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
~oduced ID
Form of Identification
" Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
FOR CLERK'S ~E ONLY \l/l
Annual Registration fee: Yes [ ] No Amount Paid 50MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc \J...c.~ :zs 1\T~
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":
o Yes ~ 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 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
o 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 Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "Iobbyisf' 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 ~ Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement.
o
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1st 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 PERIO~ ~
' h,Z;
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions
contained in Section 2-482 of the Miami Bea y Code an~ I reporting requirements.
Signature of Lobbyist:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Signature of Principal/Client:
;j
Produced ID
o Produced ID
/' Form of Identification
~ Personally known (Principal)
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed byfor_e me
~daYOf ijo~~' __
Signature of Public Notary - State of Florida
Notari . ., .
FOR CLERK'S USE ONLY
Amount Paid MCR # Date Paid