Josua M. Benaim - 321 Ocean Holding, LLC MIAMI B
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.
NAME OF LOBBYIST: (Last) (First) (M.1)
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BUSINESS NAME AND ADDRESS �(Aumber and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL: 1J
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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: tfl� 6W Q,�,(fJL ry
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUC CORPORAN,
PARTNERSHIP OR TRUST:
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u.SPECIFIC LOBBY ISSUE: 7C aj
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Issue to be lobbied(Describe in dey):
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nl.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: ~'
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the Tobby st 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
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Pursuant to C ty Code Section 2-482(g)Every regist a t shall be required to state the extent of any business,financial,familial or professional
relationship, r other relationship giving rise to an a pearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship it�V L Z
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) k , \ f t estn 4 tI
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): /►
(Rquired). 1 ,C)
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The following information must be answered: UV
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
Issues ":
❑ Yes l ❑ No: 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
Dev opment 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
comp sation 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 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 RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT ' LL BE ILED - N IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
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Sign. ure o obbyist
I do solemnly swear that of the foregoing facts are true - Id c. rect and that I have read or am familiar with the provisions contained
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in Section 2 -482 of the M m' Beach Cit e and all reporting requirements.
Signature of Lobbyist: — "
Signature of Principal /Clien�
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VI. LOBBYIST IDENTIFICA , ON: PRINCIPAL IDENTIFICATION:
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Form of Identification Form of Identification .
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❑ Personally known (Lobbyist) ,,ptttiltttiiiiel� ❑Personally known (Principal) ; GOMMiSSIpN••' VII. SIGNATURE AND STAMP OF NOT :.• � SSio ` °• ( 4 %: : — * • - j . c, �a 1I d . .;. .... z ® *- State of Florida, County of Miami -Dade a �` °,..- — « State of Florida Count of Miami- ��ga« # D D 8 3 236 Sworn to and subscribed before me �r « ® . - Sworn and subscribed before me This :- 9` • :I, o mro t ��5: ; „?- day of , 201 z ,, # DD 832367 ti This j day of) 2011 ° � ,•� ' O G • • a {
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Si nature of Public Notary — St a Florida ° ''i A UQ • ° ` () ub — ��
� '''',/,41 ��C STATE- •��`� Signatur of ublic Notary State of lorida
Notarization of Lobbyists ; signature �16�gi91ti110, � Notarization of Principal's signature
TO BE COMPLET D BY CITY CLERK'S STAFF ON_Y / / / -
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ -^'1VICR # /P ��+�ir�� Date Paid) ! /
Lobbyist Registration Form received and verified by: 1
F: \CLER \$ALL \a FORMS \ LOBBYIST FORMS \Lobbyist Annual Registration Form.doc ' Revise 1 /1 11
CA MIAMJBEACH
BEACH
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: , P
1 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 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.
ers i, 'gna ure: D te:
Miami Beach Lobbyist Registration Form
Joshua M. Benaim
321 Ocean Holding LLC
May 17, 2011
Item I
Manager: 321 Ocean Manager LLC
Persons holding 5%or more interest:
E's Legacy Fund LLC
Westbury Investments Ltd.
SOFT Ocean Drive LLC