Loading...
Richard Garcia - Meir Srebernik Ivo( 411 MIAMI BEACH )(0' o4a)m City of Miami Beach Office of the City Clerk 1 1 c• 1700 Convention Center Drive, Miami Beach, FL 33139 ,or 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. Garcia Richard NAME OF LOBBYIST: (Last) (First) (M.I) Richard Garcia & Associates, Inc. 13117 NW 107 Avenue, Unit No.4 Hialeah Gardens Florida 33018 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 595 -7505 (305) 675 -6474 RGarcia©rgatraffic.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Meir Srebernik NAME OF PRINCIPAL /CLIENT: Palau Sunset Harbor, LLC 900 Biscayne Blvd., #2802 Miami Florida 33132 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305 514 0818 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: II. SPECIFIC LOBBY ISSUE: Zoning Memorandum Involving Development of the Property at 1201, 1225, and 1237 20 Street, Miami Beach, Florida 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 C"3 � Ill J * Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a pub nearing setting_, —r7 a • r • ,,. IV•' DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) '''ip'`P A) LOBBYIST DISCLOSURE: (Required) $ ( B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ \v �� / u 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, 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 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 X No: Are you representing a not - 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 PRECE • G CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEN' 1 • - OR • ' .A -P• • N DURING THE REPORTING PERIOD. ` �0" Signatu - 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 co, in Sectio, 2 -482 • the Miami Beach City Code and all reporting requirements. ' ,.,..�'' Signature of Lobbyist: r ..../ � ,P4 . Signature of Principal /Clie � VI. LOBBYIST IDENTIFICATION: / PRINCIPAL IDENTIFICATION: CARLOS4 1 aim, r„ / •r 7777 4 MY COMMIS r' 1 ■,, i Produced ID EXPIR ES.June26,2Q12 Form of Identification F m.ctt r LEVANA COHEN 1410.3.lorARY FI.N'.ry D'scountAilOG d r •' � = Notary Public - State of Florida - - • • 4 , own (Lobbyist) 'ersonally known p' `' ,. , My Comm Expires Apr 3, 2013 '.;, � o Commission # DD 842824 VII. SIGNATURE AND STAMP OF NOTARY: Bonded Through National Notary A ssn ■ —- State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade Sworn to and subscribed before me Sworn and subscribed before me This 21 day of NOVErABEt 2 1 This (relay of •]. �' T01A Signature of Public Notary tate of Florida Signature of Public •tary — State of . i . Notarization of Lobbyist's signature Notarization of Principal's signature 4 5 3/ 3,0 FOR CLERK'S USESNLY 22 G Annual Registration fee: [ ] Yes [ o Amou aid .1 i to MCR #J O 3 Date Paid ///0 Lobbyist Registration Form receiv d� and verified by: o.� • s ` _rn . tered By: 111 2/11 F. \CLER \$ALL \MARIA -M \Lobbyist \LOBBYIST fORM 05.doc �� Revised 12/08/04 • CA MAMI City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeZ /I�� CITY CLERK Office CityClerk @miamibeachfl.gov 23 Pti I' 15 Tel 305.673.7411 , Fax: 305 673.7254 C1TY" LL .id ,S OFF IC LOBBYIST NAME: Richard Garcia, P.E. 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 the City Clerk's Office of lobbyist withdrawal in writing. I # " Pr i7;7c2/ ( Sign. ture: Date: