Sherri Gutierrez - Ben Shmul 1
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 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.
Gutierrez Sherri
NAME OF LOBBYIST: (Last) (First) (M.I)
Arquitectonica 2900 Oak Avenue Miami Florida 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)371-1812 (305)371-1175 squtierrez @arguitectonica.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Ben Shmul
NAME OF PRINCIPAL/CLIENT:
Insite Miami Beach LLC 1825 Main Street, Suite 235 Weston Florida 33326
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)377-6238
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:
Development approvals— 1825 Collins Avenue
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
HPB, BOA, PB None
o
Planning Department staff None -, i 1 C i�:
dia nil
City administration None
*Unless an issue is legislative in nature,HPB,BOA,Planning Board,and City Commission member$,a e'�no. ledbied outsid lzga public hearing setting.
scanned
&F9
A
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 445.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $ 445.00 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 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 may 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 1sT 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.
Sig pre of Lobbyist
I do solemnly swear that all of the foregoing fa true and correct and that I ave read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Cod and all reporting
requirements. I
s
Signature of Lobbyist:
Sig ature of Principal/Client:
- Q
° RVI. LOBBYIST IDENTIFICATION: PRINCIPAL IDE TIFICATION:
LL N
° ° a
m o ❑ Produced ID ❑ Produced ID LL N
E o Form of Identification Form of Identification g OD
y O
co a'X Eo // g wr'
E m L/Personally known (Lobbyist) : Personally known (Principal) 0 o a N
�` CU= u E'wo
O.M ?.X N•y•-
a
Z �t0I . SIGNATURE AND STAMP OF NOTARY: a E°
`C p y
U.m
a of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Z° w
Dh, rn to and subscrib of re me Sworn nd subscrib d before me
117 day of n , 20 i2 This day of , 20_
e
Signature of Public Notary—State of Florida Signature f Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
FOR CLERK ;USE ONLY (f
Annual Registration fee: [ - Yes[ ] No Amount Paid MCR# / / � / Date Paid�D
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04
C =orm.doc Revised 1/11/2011
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miomibecichfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tei: 305.673.7411 , Fax: 305.673.7254
1 �
LOBBYIST NAME: 1� e 1 6> " 2 rr{ 2
.I understand that no later than Eebruary 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 Miami-Dade County Commission on Ethics and Public Trust.
Sign Lure: Date:
F:\CLEk%ALL\aFORMS\L.OBBYIST FORMS\Lobbyist Registration Form.doc