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Les Beilinson - Encotel, LLCMIAMI BEACH ( Prig bar '"''" City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 3813012 MAR ®,— AM I 1: 52 LOBBYIST REGISTRATION FORM CITY C- l k` ,,. ' S OFFICE. 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. BEILINSON, LES NAME OF LOBBYIST: (Last) (First) (M.I) BEILINSON GOMEZ ARCHITECTS P.A. 8101 BISCAYNE BLVD, SUITE 309 MIAMI, FL 33138 -4664 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305 - 559 -1250 X.207 305 - 551 -1740 LDB @BEILINSONARCHITECTSPA.COM TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. LOBBYIST RETAINED BY: ENCOTEL, LLC NAME OF PRINCIPAL/CLIENT: 298 W. McINTYRE STREET BUSINESS NAME AND ADDRESS (Number and Street) (City) 305 -215 -3680 KEY BISCAYNE FL (State) 33149 (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: ENRIQUE COLMENARES, MANAGING MEMBER • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: HPB APPROVAL FOR 2216 PARK AVENUE Issue to be lobbied (Describe in detail): lll. 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 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 title of person to be lobbied Contractual Relationship (Explain) YES NO N/A 1-11.614,To /ldM to.w ''` ici ,1 g,q 7L i % Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional relationship, or other relationship giving rise to an appearance of an impropriety, with any currpt,city commissioner or city personnel who is sou ghtto be lobbied as identified on the lobbyist registration form filed. .s 1 Q . 1.11 7 -, Sec 2- 482(g) Any Financial, Familial or Professional Relationship " ' J'' °''' A IJ N/A r j � ' ''` ici ,1 g,q 7L • n /1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $250.00 PER 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 ® 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 ® 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 ® 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 SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist LES BEILINSON, AIA, LEED AP I do solemnly swear that all of the foregoing acts are true and correct and that I have read or am familiar with the provisions contained in Section 2 -482 of the Miami Beach Ci ..d- .:.= -II reporting requirements. Signature of Lobbyist: Signature of Principal /Client: VI. LOBBYIST IDENTIFI"�ATIQ A ch y ❑ Produced ID o ° o r Form of Identification W LL N. N elf C c C z O m 7 G m 7 W w u, 2 > y N 0 . c? X VII. SIGNATURE AND STAMP OF NOTAR� > `> > .N o ¢ n. E 'E - m dot' kti,. X Personally known (Lobbyist) State of Florida, County of Miami -Dade Sworn to *ad subscribed before me This �3 day ofLth„.&6;4(201`R- 1' \it Signatur of Public Notary — State of Florida Notarization of Lobbyist's signat re w%., / /POOH •,,,n,a,,�. • PRINCIPAL IDENTIFICATION: ❑ Produced ID Form of Identificatio Personally known (Principal) State of Florida, County of Miami -Dad Sworn and subscribed before me This I IAday of '62. , 2011_ Signaturdjof Public Notary — State o4Florida Notarization of Principal's signatu e TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ] Yes No Amount Paid $ Lobbyist Registration Form recei ed and verified by: .1 S F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.doc a , Ci0 Mc_Re / Date Paid c fIl is Z 0.2- Revised 1/11/2011 'orm.doc Revised 1/11/2011 t_TA v V City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Le(i�r 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. Pursuant to Section 2 -485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2- 485.1, a fine of $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami -Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Mi mi -Dade County Commission on Ethics and Public Trust. Signature: F: \CLER \BALL \aFORMS\LOBB MIST FORMS\Lobbyist Registration Form.doc DC2 Date: