Loading...
Gilberto Pastoriza/1201 Chelsea, LLLP/Variance 1201-1215 West Ave~ ~~=~~t~ 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 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 specrfically inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435. Pas or;za Gilberto NAME OF LOBBYIST: (Last) (First) (M.I) Weiss Serota Helfman Pastoriza Cole &_Roniske, PfA,,,,,,,,,, ADDRESS (Number and Street) (City) (State) (Zip Code) (3051854-08O~ (3051854-2323 at?astori za(dwsh-l aw_enm TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: 1201 Chelsea, T,T.T.p NAME OF PRINCIPAL/CLIENT: 1395 8rickell Ave., #826;. Miam; FT. 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (3051579-h21h C305)529-6215 __ TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: See attached • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Extension of variance for 1201-1215 West Ave., Miami Beach, FL Issue to be lobbied (Describe in detail): lll. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-482(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of Individual Title B) An Financial, Familial or Professional Relationship Board of Ad'ustments N/A 6Q ~6 ~~ 6- Jl~~i 9001 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): ~1~ A) LOBBYIST DISCLOSURE: (Required) Hourl ~ ~/~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ 3~ (Required). Ht»~rl v 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 o• Are you lobbvina on a aresent or aendina bid for goods equipment or services or on a present or aendina award for aoods equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes ~ No• Are you lobbvina on a aendina application for a Development Aareement with the City or application for chance of zoning map designation or chance to the Citv'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 anot-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 ~ No• Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of Principal/Client: _ VI. LOBBYIST IDENTIF Cam~flebn Expi-es MM 22, C.ar4n~eion;r DD 40D032 of Identification VII. SIGNATURE AND STAMP OF NOTARY: PRINCIPAL IDENTIFICATION: ~ Produced ID Personally Form of Identification Nowy Pubic - SYM d Flodd~ Comnanl0n ~rpbrs Mrir 22, S CoinnMlon N 00 X32 State of Florida, County of Miami-Dade State of Florida, Cou ty iii-D~i Sworn t nd subscri before me Sworn sub 'b This , 2008 This ~ y ~, 2008 Signature is to -State of Florida SigJ~at o Public Notary - Sta e o Notariz ion of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ D - MCR # Date Paid 9 Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc Revised 03/27/2008 I do solemnly swear that all of th~~~fQi'ego' facts r~ an !~~ta hak~aarel~d or am familiar with the provisions contained in Section 2 iFF~~ he Mil ch C9d all r porting requirements. ~ ~ a ~, i ~ ~r''t~'r~ t ! r ~ fat '~ ~ ~ ~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: Gilberto Pastoriza I understand that no later than October 1st of each year, I must file the. following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. ~' ~ ©~ Signature: Date: F:ICLERILOBBYIST\Lobbyist Registration Form 32708.doc W W W W w w ~ 0, ~ c~~ (D O N CD O ~ ~ o c~ ~ v ~ ~ o m w n G~ ~ ~~ woo= wv~c~ ~c~~ O N ~ O W W W W W W W ~ C O ~ (LZ (D O v (D O ~ ~ O CD ~ ~ ~ ~ O (D C7 ~ W ~ ~ _ W ~ CD woN~ 0 O r = ~ ~0 0 ~n~~ o ~~ ~ cn ~C~~ ~G~ N O < ~ O ~~ (D ~ ~, o ~ ~ CD `~ C7 D N ~ ~ ~ (p Q. ~ ~ ~ ~ r~ 0 r r n r ~ `C ~ c ~a oQ ~~