Les Beilinson/Rosa Martinez
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MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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 indudes the principal as well as any employee engaged
in lobbying activities. The tenn "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Beilinson
Les
NAME OF LOBBYIST:
(Last)
(First)
(M .1)
Beilinson Gomez Architects, PA
BUSINESS NAME AND ADDRESS
790 NW 107 Avenue, Suite 306
(Number and Street) (Oty)
Miami, Florida
(State)
33172
(Zip Code)
(305) 559-1250
TELEPHONE NUMBER:
(305) 551-1740
FAX NUMBER:
Idb@beilinsonarchitectspa.com
EMAIL:
I. LOBBYIST RETAINED BY:
Rosa Martinez
NAME OF PRINQPAL/CUENT:
845 82M Street
BUSINESS NAME AND ADDRESS
Miami Beach Florida
(Number and Street) (Oty)
33141
(State)
(Zip Code)
(305)343-0979
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
rosamartinez@snappydsl.net
EMAlL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY:
. 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 with regard to Property located at 845 82 Street, Miami Beach, Florida
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $ 225.00 oer hour
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired). $ 225.00 oer 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":
[] Yes X No: Are you lobbYin9 on a Dresent or Dending bid for 900ds. equipment or services. or on a
oresent or pending award for goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
ores X No: Are YOU lobbyinG on a Dending aDDlication for a DeveloDment Agreement with the City or
apolication for chanGe of zoning maD 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
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..
o Yes X No: Are you reDresenting a not-for-Drofit corDOration or entity without sDecial comDensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING 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 EXPENDITU OR COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear th~t al f the fo
familiar with the provision n ined
requirements. A
Signature of Lobbyist: --::--
Signature of Principal/Client: rj).,~-L/.i2; d&,
VI. LOBBYIST IDENTIFICATI:::--jl' ':.' / PRINCIPAL IDENTIFICATION:
J Produced ID ~LJ 0 7
Form of Identification- (
oing facts are true and correct and that I have read or am
ctjon -482 of the Miami Beach City Code and all reporting
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i. Produced ID
Form of Identification
Personally known (Lobbyist)
X Personally known (Principal)
",\\I~I;:"" Geysel Ortega
$~~..fI#;.'"
i?{A'~~commission #00501265
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;,,;.:...... (p~ Expires: DEC. 21,2009
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State of Florida, County of Miami-Dad~""""\\\" www.AARONNoTARY.com
Sworn and s scribed before me
This '1:1 a. of ' \ /, 20 0&
SIGNATURE AND STAMP OF NOTARY:
tate of Florida, County of Miami-Dade
worn to and subscribed before me
his l-f1t day of ,,}rJJ . 20 0 to
. / FOR CLERK'S. USE ONLY 'J~_~
Annual Registration fee: ['v] Yes [ ] No Amount Paid 2'5 a~ MeR # L-LJtS) ~-~ T Date Paid ~
Lobbyist Registration Form received and verified by: <---P Kr:s: Entered By:
F:\CLER\$ALl\MARIA-M\lobbyisl:\LOB8YIST fORM OS.doc Revised 12/08/04