Charles H. Benson - Pennsylvania MB Investments, Corp (2). Nl�
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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.
Benson Charles
H.
1°sL9.BBI $on & Assec �.�5 � r.ch.i,tects, ?.r, (First) (M.I)
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1.565 ilash.inaton Avenue. 2nd Floor Miami Beach FT 3313°
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
�?l1S; S?7-r"7�."I f"i�St -^7 t'I�l rk'" rri and rrntt
TELEPHONE NUMBER. FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Pennsylvania MB TnvesT„nent.s, Corp.
NAME OF PRINCIPAUCLIENT:
1001 3r-:i.ckc].]. Bay Drive., Suite .1808 M.i.am.i FL 331.3 a.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code
:`.30) 674-4424 (786) 758-2994 chrisd@100lbrickellbay.com
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:.
��.nton:ia Sa;i.ad.'i.a:o
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Antonio Saladino
II.SPECIFIC LOBBY ISSUE: Requesting extension of time from Histo:is Preservation Board and Board of
Adjustment for pr.evi.ously approved certificates of appropriateness and variances for property located
at 1509 -Peru'is,%lvania Avenl.:e, Miami- P. .each, FL 33139.
Issue to be lobbied(Describe in detail):
Ili.CITY AGENCIES/INDIVIDUALS TO 13E 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 Contractual Relationship(Explain) YES I NO
title of person to be lobbied
Historic -reservation Board done X
Board of Adjustment. None {
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 current city commissioner or city personnel who is
sought to be lobbied as Identified on the lobbyist registration form filed.
Sec 2-482 Any Financial,Familial or Professional Relationship
None.
.� qd
'Ili JIM
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) $250.00/hourly
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $250.00/hourly
(Required).
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 LJ 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 M 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 EV,51N IF TLERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature ofLob5_Y_1ST Charles H. Benson
I do solemnly swear that all of the foregoi q1f cts are ru orrect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City and orti requirements.
Signature of Lobbyist:
'Signaturejof Principal/Clients
._M. _. Christian Dri si, ManagCOF�3=ennsylvania_MB Investments, Corp.
VI. LOBBYIST IDENTIFICATION: ±PRINCIPAL I DENTIFICATI(5N.)
❑ Produced ID ❑'`Produced ID
Form of Identification ;Form of Identification)
❑ Personally known(Lobbyist) ����ti'oti� ;personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY: �R,* 6�p
State of Florida, County of Miami-Dade �`���?�a� rState of Florida County of Miami Da_de_;
Sworn to and subscribed before me 'Sworn,aubscribe before met
This `� ay �,�n.�2,,0.1�Q AQJ�� ��� This ay of 01
,L� JUDITH DIAZ
2 ^eMMISSION N DD 864481
Signature of Public Notary State of Florida �' Signa _re _ Public Notary fFIES:February.25,2013
Notarization of Lobbyists signature Nof zation of Princi al r8mdedThruNotary PubkUrdmv to
TO BE COMPLETED BY CITY CLERK'S STAFF O L
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ CR# Dat Paid
Lobbyist Registration Form received and verified by: ,
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\lobbyist Annual Registration Form.doc d Revised 1/11/2011
F:\CLEt tislmlion Form.dac Revised 04/27/2012
e J A F ° H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: Charles H. Benson
I understand that no later than February 28 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, or I am no
longer lobbying on that issue or for that principal, 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
falls 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.
Signature: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
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