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Ephraim J. Kadish/304-312 Ocean Drive, LLCm MIAMIBEACH 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 foreseeabfy 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. Kadish Ephraim J. NAME OF LOBBYIST: (Last) (First) (M.I) Ephraim Kadish & Associates 1317 Funston Street Hollywood, Florida 33019 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (954) 646-7509 cheffie1317@aol.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: 304-312 Ocean Drive, LLC NAME OF PRINCIPAL/CLIENT: 600 North 3rd Street 2nd Floor Philadelohia PA 19123 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (215) 625-9722 (215) 625-0167 louisjorocofskyl@earthlink.net 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: Phillip McFillin, Louis Orocofsky • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Phillip McFillin II. SPECIFIC LOBBY ISSUE: Redevelopment of 304-312 Ocean Drive - COA, Variance Approvals, and Conditional Use Permit 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 Planning Dept., HPB, BOA, Planning Board, City Commission * None ,:~, , ~~ ~.f ; ~: i I I . yy ~ .-~ 1 t ~,...f rY;. ~ P ~ .. ' .~...~ 4~ * Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting. `1 ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, ~ >_AT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $ ZS~per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ZS b 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": n Yes X No' Are you lobbving 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": ^Yes X No• Are you lobbving 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 "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.. ^ Yes X No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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 PERIOD. _ Signature of Lobbyist I Q o a ~~ ~ G ,y 52 g r,. ~~'~' ~- ~ E .x~ ~~ ~~ x°~~w I do solemnly swear that familiar with the provisions requirements. II of the foregoing facts are true and correct and that I have read or am contained in Section 2-482 of the Miami Beach City Code and all reporting Signature of Lobbyist: Signature of Principal/Client: ~~ ~ ;,/. PRINCIPAL IDENTIFICATION: n .s~` VI. LOBBYIST IDENTIFICATION: Produced ID ~° ~~ Form of Identification u Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to an ubscrib ~bef~o e' me This ~ ~Y h J y~f ~~~' 20_ i ;Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This day of , 20_ Signature Pu is o ary -State of Florida Signature of Public Notary -State of Florida Nota~izati f Lobbyist's signature Notarization of Principal's signature FOR CLERK'S~l SE_ONLY r' Annual Registration fee: ( ]Yes [ ] No Amount Paid ~~ MCR ~ / ~Qate Paid ~~ ~'` Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Entered By: Revised 12/08/04 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, %LAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $ 250.00 qer hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 250.00 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": ^ Yes X No• Are you lobbying on a present or pending bid for goods eauipment or services or on a present 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": ^Yes X No• Are you lobbying on a pending application for a Development Agreement with the Citv 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 "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of snot-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 X No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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 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 Lobbyist: Signature of Principal/Client: - ,Manager VI. LOBBYIST IDENTIFICATION: C Produced ID Form of Identification PRINCIPAL IDENTIFICATION: Produced ID Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This day of , 20_ Signature of Public Notary -State of Florida Notarization of Lobbyist's signature Form of Identification X Personally knowKt Ir~a1E1 LTH OF PENNSYLVANIA NOTARIAL SEAL HEATHER SCANLON, Notary Public City of Philadelphia, Phita. County State of PA, Co ,n ~3oPifT1~@i@ ~~ires December 11, 2010 Sworn and .subscribed before me This -•~>,,~dav of Jr'~.-'l ..2008 Signatire of Public Notary -State of Flertda f ~~' Notarization of Principal's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid _~_~'~'! '~ MCR #~~~/~ Date Paid ~ 9~7 ~~ Lobbyist Registration Form received and verified by: Entered By: I, / F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04 City of Miami Beach, 1700 Convention Center Drive, Miami Beoch, Florida 33139, www.miomibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 i ,Fax: 305.673.7254 LOBBYIST NAME: ~,Q~t2A-sir ~lS/`~ 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. ~-'.~ S i Z 3 o g' Signature: Date: I~~evisai.! 0?lQq;20~8