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Ralph Choeff - 2228 Park Avenue, LLC CI' 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 th=; passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recom endation of the City Manager or any city board or committee; or any action, decision or recommendation of any city personnel I 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. Choeff Ralph 1 NAME OF LOBBYIST: (Last) (First) I (M.I) Ralph Choeff Architecture & Interiors 8425 Biscayne Blvd., Suite 201 Miami Floriia 33138 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 892 -6262 (305) 892 -5292 rchoeff(&choeffarchitect.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I I. LOBBYIST RETAINED BY: 2228 Park Avenue, LLC, contact: Todd Glaser, Managing Member NAME OF PRINCIPAL/CLIENT: 1 2228 Park Avenue, LLC P.O. Box 402249 Miami Beach Florida i 33140 BUSINESS NAME AND ADDRESS (Number and Street) . (City) (State) I (Zip Code) (786) 208 -2113 (305) 538 -4302 tmgeng64@ 1 ol.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) i Fill out this section if principal is a Corporati n, Partnership or. Trust [Section 2 -482 (c)] • NAME OF CHIEF OFFICER, PARTNER, 0 BENEFICIARY: Todd Glaser, Managing Member I • IDENTIFY ALL PERSONS HOLDING, DI CTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST 'IN SUCH CORPORATION, PARTNERSHIP OR TRU : See Exhibit A II. SPECIFIC LOBBY ISSUE: Development approvals for conversion of two 4 -story townhouses to a restaurant and entertainment establishment located at 2228 Park Avenue Issue to be lobbied (Describe in detail): III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: I A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relationship Planning Department Staff, HPB, BOA, Planning Board and . ' .. ,4 City Commission* None c-, - r— ' i * Unless an issue is legislative in nature, HPB, BOA, Plann ng Board, and City Commission members are not lobbied outside of a public hedifing se IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $ k ' J© 7 ii2. • B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ I f � � The following information must be ansered: t 1) Pursuant to Miami Beach City Code Section 2 -488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues ": ❑ Yes X No: Are you Iobbyina on a pr esent or ea ndi na bid for goods, equipment or�seniices. or on a present or nendina award for goods. equipment of service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues ": ... L O• - • U • • • * 1 • • _ • ` 1 .. • • ,_ • • h _., 1 • .1 • . _ * =1o! net .: ' L - i . l l . : l i _.l t i CI _ ppniication for change of • ning man designation or change to the City's Future Land Use ap? 3) Pursuant to Miami Beach City Co. e 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section -481 above) who only appears as a representative of a not - for -profit corporation or entity without specia compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or •. pposition to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.. N es N.. :.z... O_ .L' C__.• 1. ! 1.' - • - o. - • • CO • • • o • e1 S it t.I •u . • - _. ..._•1 • =1 - - 01 . or reim 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 EXPEN a ITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR PRE' DING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN EXP ' U ' 5 OR COMPENSATION DURING THE REPORTING PERIOD. n ,. *V Si . ature of Lobbyist 1 do solemnly swear that . • . the foregoing facts are true and correct and that 1 have read or am familiar with the pro . ns c• tained in Section 2 -482 of the Miami Beach City Code and all reporting requirements. I i Signature of Lobbyist: 4 Signature of Principal /Clien : _....` d der VI. LOBBYIST 1 • ENTIFICATIO PRINCIPAL IDENTIFICATION: 0400 Pu ARIA', ilrfaciVad I • ho I2 i 0 AC i .__ Produced ID V17;) MY CO 1 -.I +N A DD641184 Form of Identification Form of Identi e` ' s EXPIRES February 15, 2011 t �r 0�lD .ONlCA! • 1 A F,, W Rsasaaal! • c•wn (Lobbyist) Personally known (Principal) N ro • Shim of i s : • MY Comm. Wires Aug 10.2011 VII. SIGNATURE AND STAMP OF NOTARY: ' .. :!•: Commisolon 0 DD 987266 ;„ State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade Sworn II subset efgre me Sworn, and subscribe. bef•re This day • . , )1) V , 20 This Jday of . il 0 A Y Ma - Signature of Pu ► ry —State of Florida Signature of Public No ` tate of lorda Notarizatio • f • ., ' 'st's signature Notarization of Pri i . _ • s signs re FOR LE USE ONLY oh .,., r Annual Registration feet ] Yes [ ] No Amoun j aid . ih. OO CR # Date, Paid it IZ /lo Lobbyist Registration Form received and verified by: ■ a. deAk 4,.... / Entered By: F: �CLER \$ALL�MARIA-M1LflbbyisALOSBYIST fORM 05.doc --- Rlevfsed 17/08/04 ,IV. DISCLOSURE OF TERMS AND AMOU TS OF LOBBYIST COMPENSATION (DISCLOSE WHETHE • HOURLY, FLAT RATE OR OTHER) A) I,.OBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COM (Required). $ The following information must be ans eyed: 1) Pursuant to Miami Beach City Code Section 2 -488 Entitled "Prohibited Campaign Contributio s By Lobbyists On Procurement Issues ": p Yes X No: Are you lobbying on a present or pending bid for goods, equipment or servic --, or on a present or pending award or goods, equipment or service? fi 2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues ": ■Y k_ •• - o , • • in o a ' - in a• Ali i• fir • Dev-lo. z „e : h- ', • application for change of z • ning map designation or change to the City's Fut re Land Use Map? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from t e definition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of : not - for - profit corporation or entity without special compensation or reimbursement for the appearance, wh-ther direct, or indirect, to express support of or opposition to any item, shall register with the clerk as I • uired by this section but, shall not be required to pay any registration fees.. T3 Yes X No: Are you representing a not- for - profit corporation or entity without special • mpensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLE • K A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS CO PENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION ' URING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that I hav: read or am familiar with the provisions contained in Section 2 -482 of the Miami Beach City Code an • all reporting requirements. Signature of Lobbyist: Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification Form of Identi r�. =;t OM .Oil ❑ Personally known (Lobbyist) Personally known (Principal) WM/ Public • State of t My Comm. Expires Aug 10.201 VII. SIGNATURE AND STAMP OF NOTARY: Corr p 00 907288 •n Bonded Wong Asir State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade Sworn to and subscribed before me Swor and subscribe• bef This day of , 20 This 1\day of tt.TA s /0 1 ®111 Signature of Public Notary — State of Florida Signature of Public No I r of I rids Notarization of Lobbyist's signature Notarization of Pri s signa . - FOR CLERK'S USE ONLY Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # Date Paid Lobbyist Registration Form received and verified by: Entered By: F: \CLER \$ ALL \MARIA -M \Lobbyist \LOBBYIST fORM 05.doc Revised 12/08/04 V x.. S A /\ / i B , / i City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax:, 305.673.7254 • LOBBYIST NAME. RA r A 1 140 , e, 1- 4 1 P 1 understand that no later than February 28th of each year, I must file the following form, 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 and Compensation Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami -Dade County Commission n Ethics and for code violation evaluation. In addition, once an issue 1 have registered to lobby on has been resolved, I arr required to immediately notify the City Cle k's Office of lobbyist withdrawal in writing. • i li . �/ ((.* ( ' Igo Signa ure: Date: Exhibit A Disclosure of Interest 2228 Park Avenue, LLC c/o Todd Glaser, Managing Member P.O. Box 402249 Miami Beach, Florida 33140 OWNERSHIP ENTITY % OF STOCK 1. Mitchell Rubinson & Edda Rubinson, tenants by the entireties 50 3525 Flamingo Drive, Miami Beach, FL 33140 2. The Glaser Children Irrevocable Trust (2/2/2005) 5,0 3681 Flamingo Drive, Miami Beach, FL 33140 Trustees: Kim Glaser & Todd Glaser Beneficiaries: Levi Cole Glaser Chloe Pearl Glaser Stone David Glaser Coral Sky Glaser Total 100 . . . . • . . • • ( 2., y 10 . v%ao . . . . . , Miscellaneous Cash 'Receipt . . 6_,/, i 1 vo :1 _ CITY OF MIAMI BEACH . .. V j 7 . , „:, , ,f..; -",...-. : :',!' ,, ;, • 1 3.0 7200 l35 0 cfir5c t lo. . • ,..,,,:,,, ,, .... :5'...i.7 • .. . . . . .:..„.______.-._......._ ._., . .. . 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