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Patricia Baloyra/1680 Michigan Miomi BCiI!<h lei '11If 2IlW3 m - City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 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 defined In any manner in this section, 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. Baloyra, Patricia M. . NAME OF LOBBYIST: (Last) (First) (M.!) Broad & Cassel One Biscayne Tower, 21st FL, BUSINESS NAME AND ADDRESS (Number and Street) (City) 305-373-9470 305-373-9443 TELEPHONE NUMBER: FAX NUMBER: 2 S. Biscavne Blvd.. Miami. FL 33131 (State) (Zip Code) pbaloyra@broadandcassel.cam EMAlL: I. LOBBYIST RETAINED BY: 1680 Michigan Partners, LLC. NAME OF PRINCIPAL/CLIENT: 1680 Michigan Ave, BUSINESS NAME AND ADDRESS 305-:;-672-2227 Suite 730, Miami Beach, Florida' 33139 (Number and Street) (City) (State) (Zip Code) 305-672-2958 skonig@1680michigan.cam FAX NUMBER: (Optional) EMAIL: (Optional) TELEPHONE NUMBER: 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: Design Review Board Application #19081 Issue to be lobbied (Describe In detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Design Review Board IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly Yes No: X Are YOU reDresentina a not-for-DrofJt: COrDoration or entity without sDecial comDensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) eursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5 Thereof Entitled "CampaiQn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Campaiqn Contributions By Lobbyists On Procurement Issues": Yes No: X Are YOU lobbyina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a Dresent or Dendina award for aoods. eauiDment or service? 2) Pursuant to Ordin'ance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5 thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Campaiqn Contributions By Lobbvists On Real Estate Develooment Issues": Yes No: X Are YOU lobbyina on a Dendina aDDlication for a DeyelODment Aareement with the City or aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD? 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 ~P~DITURES OR COMPENSATION DURING THE REPORI1NG PERIOD. ~ ~ 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 Beach City Code and all reporting requirements. ~ Signature of LObbYi;l: ~. ~~ Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification Personally known (Principal) ~ VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribed before me Sworn and subscribed before me This I day of N~ . 20~ b \\\"''''''''''1 This _day of , 20_ ~,\\ 0 N Tt:" 1111. ~,,,, .. ~ e"' "" ~ \'1'........ "/~ "-,- te of FIIti ...~Ol AAj;......~~ature of Public Notary - State of Florida s Signat~l Evnires \ftD~rization of Principal's signature :: : MyComm. "'" ~ = ~ : Nov. 13. 2007 : :: ~ ~. No. 00267008.: S ~ -. ..~~ %U';;...~UB\..\~'~<:5.1 """:! ri 'OF f\.q "",~ .,/"" FOR C SE ONLY '")9<:<\ C::/-. J J Annual Registration fee: [VJ Yes [ J No A.!!!9unt Pa . MCR # ~ate Paid 5 2 J't:/'..("') Lobbyist Registration Form received and verified by: ' I Revised 02/10/04 -M\LOBBYIS1\LOBBYIST FORM 04 W 1lIUJ m t.4>..- City of Miami Beach Office of the City Clerk 1700 Convention Center DrIve, M"mmi Beach, FL 33139 LOBBYIST REGISTRATION FORM lobbyist means all persons employed or retained, whether patd or not, by a prfndpal who seeks to encourage lfle passage, defeat or modification 01 any ordinance, resolution, action or declslon or any CDlllmIssIoner, any ac:tIon, decIsIoo, recommendation of the City Manager or any dl.y board or committee; or any adIon, dedslon or recommendatfon of any dty personnel defined In any manner In this section, during the time period of the entire decIslon-maklng process on such adton, decision Or rac:ommendatton that foreseeebly will be heard or reviewed by the dl.y mmmllisJon, or II dly board or committee. The term'spedfk:aly Includes the princ;lpal as well liS any employee engaged In lobbying attiYlI:Ies. The term "LobbJl8ta" .... spednc exduslonl. "..........r to Ordinance 2004-3435. .' . Balopra, Patricia M. . NAME OF LOBBYIST: (Last) (FIrst) (M.I) Broad & Cassel One Biscayne 'l'l:Mer', 21st FL, 2 S. Biscavne 'Blvd.. Miami. FL 33131 BUSINESS NAME AND ADDRESS (Number IInd street) (cay) (state) (ZIp Code) 305-373-9470 305-373-9443 ];:baloyra@broadandcassel.can TELEPHONE HUMBER: FAX NUMBER: EMAlL: I. LOBBYIST RETAINED BY: 1680 Michigan Partners, IiLC. NAME OF PRINCIPAl/CUM: l680 Michigan Ave, Suite 730, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (aty) (state) (Zip Code) 305~72-2227 305-672-2958 skonig@1680midhigan.ocm TELEPHONE NUMBER: fAX NUMBER: (Optional) EMAIl.: (Optional) Fill out this sedlon if principal is a COrporation, Partner8hlp or Trust [Section 2-482 (e)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: . IDENTIfY ALL PERSONS HOLDING, DIRECllY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PAIITNERSHlP OR TRUST: II. SPECIFIC LOBBY ISSUE: Design Review Board Application U9081 Issue to be lobbied (DescrIbe In detaIl): m. CITY AGENClES/INDMOUALS TO BE lOBBIED: A) Full Name of Indlvidual/Tltle 8) Any Finanelll, Famllill or Profess1oml1 Rel8t1onshlp Design Review Board Yes lV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Requll1ld) Hourly B) PRINCIPAl'S DISClOSURE (OF lO8BYJ5T COMPBe.TION): (1l8quIred). Hourly No: X AnlI YOU rearenntlna a notofor-DrofIt coraoration or entItv without SD8da1 mmaensatlon or reimbursement. Pursuant to OrdInance No. 2004-3435. 1) eursuant to Ordinance No. 2003-3393 Amendlna Miami BelIch Ct:v Code 0Ia0b!r 2. ArtIcle VII. DMslon 5 Thereof Entitled "atmpalgn F1nMla! Reform-VIa The Addition Of Code Sedlon 2-488 Entftled "Prohibited Campaign Olntributlons BY lobbyists On Procunmlent Issues": . Yes No: X Are YOU IobbYIna on. Dresent or Dendlna bid for GOOd.. eaulDment or services. or on B Dresent or bendinG award for DODds. eaulDmenl: Dr service? Pursuant to Ordlriaifce No. 2003-3395 Amendlna Miami Beach Olv Code ChaDblr 2. ArtIcle VII ~on 5 thereof Entitled "Campaign Finance Reform". VIa The Addition Of Code Sedfm 2-490 Entitled "Prohibited CamD8la~ Conl:r\butlonS By lobbyists On ~ Estate DeYelQpment Issues": Yes No: X Are vou lobbYina on . IH!ndina aDDOtation for B DeveIoDlDlUlt: Aar8em8nt with the Citv or aDDIlc:atlon for chanae of zonlna maD desicmatlon or chanae to the Cltvls Future Land Use MaD? 2) V. ~GNATURE UNDER QATH: ON OCTOBER 1ST OF EAOi YEAR.. EAOI LOBBVISr SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, L1ST1NG LOBBYING EXPENDIlURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PREa!DING CALENDAR YEAR. A STATEMENT SHALL BE FII.ED EVEN IF THERE HAVE BEEN NO W!lJ)ITURES OR COMPENSATION DURING THE -- ~.- ~ SIgnature or LobbyIst I do solemnly swear that all of the foregoing fads are true and correct and that I have read or am familiar with the provisions con.J.i!ned In SectIon 2--482 of the Miami Beach Oly Code and an reporting requirements. Signature of Lobbyi . Signature of PrIndpal/Cllent: VI. LOBBYIST JDENTIFICA Produced ID Produced ID Form of Identification ~aIlyknawn (~ vn. SIGNAlVRE AND STAMP OF NOTARY: state of Florida, County of MiamI-Dade State of florida, County of Mlaml-Dade Swom to and subscribed before me SWorn and subscribed before me ~of M~ .20..!& l\\Ullllf'''''l Thls-Lclayof 20~ ~"\\~9.~r~';~",~ ~~ te of ...~01 AFt p....~ture of Public Notary - Sta1e rI 8 signa~ i EllPIres \ ~rlzatlon of Prlndpar.llignature ! $. My eomm. 2007 i = i : Nov. 13. 008. ! S ". No. 00267 .: ! ~ . . ;: ~ e. V .- ~~ ~ U',,:...fUB\..'i.... ~.1 ~ '.~." ........ ~ ~ """iE OF f\J..\,\'~ FOR c::LERK'S USE ONLY Annual Registration fee: [ 1 Yes [ 1 No Amount Paid MCR , Date PaId lobbyist Reglstnltlon Fonn received and VBril1ed by: Revised 02/10/04 F: Cl.ER\All\MARrA-M\lOBBYIST\l.OBBVIST FORM 04 Fonn of IdentIfIcation ~nally known (pri~ :\\\\\\'" I """, !to""".. t. 0 N T t ""''-' ~.. ~ \'4'........ 4'~ ~ $ <::) .~01 A.qj:.... ~ \. ~ ..... I .- " -. ~ ~ -....;;:.'. .-r.. ., ; :..y Comm. ExPires .~ 0 ~ : . IV' 7 . - = : Nov. 13, 200 : ; i ~ No 00267008: S 'S.. -... .: S ~ . n .... ,oUB' \~.., ^t:::t",S' ~v.).." \.-.' <1'''~'''' ...... ".i1h ........ O~\~.' ~"'l ~ OF ~ :\",'i. """"",,,\\\\: