Todd B. Tragash - Sandy Lane Development, LLC MIAMIBEACHGPi�
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 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.
X S N oD 0
NAME OF LOBBYIST: (Last) (First) (M.I)
3 6" 26 fit, tom /4M 1 AZ. 1.14. (AAA I 33) 27
BUSINESS NAME AND ADDRESS Number and Street) ) (City) (State) (Zip Code)
305 5 / /8/
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
LOBBYIST RETAINED BY:
.etu a y L'd DaNfre +-0 P /4/ 431/4v r, LL L
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Z12. 325 l000 gl4 3z6 8090 Sf•c.?4,444• 1 7 otf .au4. -s44 ss2.cA41
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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
5-4 AisL -Yv'o 2� d ✓1- c4.t►4 G' P4-. 40- TTAri(rt i o f-11>a 4 3
Issue to be lobbied (Describe in detail):
III p .,,,., ,. Sae,,,... >_ ,......x,.r> .... B:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
FLOWN flcr f F0#J /A/G- 3 tl/t..D N f 64114K S V
*- W#6 PLeu 84144) g60
ti n s• ±I; �� A,ll?
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any busi aa(, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner o r p I who is
sought to be lobbied as identified on the lobbyist registration form filed. fig :6 WV
U� 1
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
.4 . C]3AIB3 .38
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) --ttr //40... •
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). l ? S N4—
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 ":
[I] Yes L`SNo: Are you lobbying 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 /No: Are you lobbying 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 [V6 Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECE • D, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL B ED EV IF T E' E AVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
a / . , 0
Signature � .f Le., / ist Fr
1 do solemnly swear that al • the foregoing f cts are true and Lfrect and that I h or am familiar with the provisions contained
in Section 2 -482 of the M', :each Gilt C• , : an all reporting requirements.
Signature of Lobbyist: 4 /
Signature of Principal/ -nt: Sif1.r • wall kcb S./gt'1' rAt AI44PAL. ArP1.1 10./b v7
4r
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID 0 Produced ID
Form of Identification Form of Identification
L7 Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAM' get [Wary Public State of Florida
el William Pinkus
State of Miami -• _ . ` My Commission DD72185
County Expires 10/03/2011
tate of Florida, Count State of Florida, County of Miami Dade
Sworn to,and subscribe before m: Sworn and subscribed before me
This d' day of FBRv*& , 2011 This day of , 2011
Signature of Public Notary — State of Florida Signature of Public Notary — State of Florida
Notarization 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 $ 3.50 MCR # ' 0 t— Date Paid '/ / 0 / /
Lobbyist Registration Form received and verified by:
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.dor 2 Revised 1/11/2011
4. COMPENSATED LOBBYIST:
The City of Miami Beach Code sub - section 118 -31 requires the disclosure of any individual or group which has been, or will be,
compensated to either speak in favor of or against a project being presented before any of the City's Development Review
Boards, or not to speak at all. Please list below all persons or entities encompassed by this section.
NAME ADDRESS PHONE#
a. CLC) G a ar-FACZ. 333 Asenoe tkor eas IA iAy►! F( 3313 (305) 519• a5$8
b. 1_iit i,$ A. haug koz - 333 A wen ue ac Aw eeie.Irs pikµt El 33131 (305)571
fc:TockrikAsrw,ln 35a U. at INµl; L Otim y (3 511- /8l1
Additional names can be placed on a separate page attached to this form.
* Disclosure shall not be required of any entity, the equity interest in which are regularly traded on an established securities
market in the United States or other country, or of any entity, the ownership interests of which are held in a limited partnership or
other entity consisting of more than 5,000 separate interests and where no one person or entity holds more than a total of 5% of
the ownership interests in the limited partnership or other entity.
APPLICANT HEREBY ACKNOWLEDGES THAT ANY APPROVAL GRANTED BY THE BOARD SO APPLIED TO, SHALL BE SUBJECT
TO ANY AND ALL CONDITIONS IMPOSED BY SUCH BOARD AND BY ANY OTHER BOARD HAVING JURISDICTION, AND THAT THE
PROJECT MUST ALSO COMPLY WITH THE CODE OF THE CITY OF MIAMI BEACH AND ALL OTHER APPLICABLE LAW.
APPLICANT AFFIDAVIT
STATE OF Floe c A
COUNTY OF •14.1 •
I, S \ Y1 iRVY. A v e f- , (list name of corporation and office designation as applicable) being first duly swom, depose and say that I am
the applicant, or the representative of the applicant, for the subject matter of the proposed hearing; that all the answers to the questions in this application and
all sketches, data and other supplementary matter attached to and made a part of the application and the disclosure information listed on this application is a
full disclosure of all parties of interest in this application are true and correct to the best of my knowledge and belief.
•GNATURE
Sworn to and subscribed before me this \ day of g ..�c e , 20W . The foregoing instrument was acknowledged before me by
4 SNe3R\ - .'cokeN, ,ve's who has produced ' 5 S. . h► ` as identification and /or is personally known to m - • 'o did /did I take an oath.
r • ...61_111MOIRMAPI
NOTARY SEAL OR STAMP ? JOSP 1, OTARY PUBLIC
1 ' � Notary Public - stab of Florida 0.v"�� _ �O� e , 1
Dec 3, 2012 PRINT NAME
��i► 013000 DD a6
My Commission Expires: TMM11111M11 Assn.
F:IPLANI$ALLIFORMSIDEVELOPMENT REVIEW BOARD APPLICATION JAN 2010.DOCX
January 8, 2010
8
,.
AA
1
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: °- re;•,D b 6-Ati 541
I 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 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 t4 City Clerk's Office of lobbyist withdrawal in writing.
1
r
�. .r 8 z o r
Si Signature: i � ,
9 7 D