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Vic Granowicz/Maria Perez ' 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 principal who seeks to encourage the pa000ge, defeat or modification of any ondinonce, naan|ubnn, action or decision of any commissioner; any oction, docioion, 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 foreoeeab|ywill be heard or reviewed by the city oomminoion, or city board or committee. The tann specifically includes the principal as well an any employee engaged in lobbying activities. The term "Lobbyimta" has specific exclusions. Please refer bo Ordinance 2O04'3435. GRANOWICZ Vic NAME OF LOBBYIST: (Last) (First) (M.1) GMAARCH|TECTS 1ZZ0 APOLLO BEACH BLVD APOLLO BEACH FL 33172 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 813-995-1172 813-645-0760 VICG1@MAC.COM TELEPHONE FAX EMAIL:— � Please notify this office if your contact information changes:address,phone, or e-mail address. |. LOBBYIST RETAINED BY: MARIA PEREZ-VP NAME OF PRINCIPAUCLIENT: 1ZO7 VENTURES Lu[ zs2s PONCE os LEON BLVD SUITE zz2s CORAL GABLES FL 33146 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-389-4103 JIM@SOLOMGMT.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: PORTER STANSBERRY IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ii.SPECIFIC LOBBY ISSUE: 2,6 Y Pe*c^r/ FL 3�/70 DESIGN REVIEW BOARD-REMOVE EXISTING STRUCTURE AND BUILD A NEW STRUCTURE Issue to be lobbied(Describe in detail): III. CITY AGENCIEWINDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied,and whether me/oubyieuxmmnntemm into any oo,unumma| 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 or 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 MIAMI BEACH BUILDING AND ZONING DEPT NO Pursuant to City Code Section 2-482(g)svon/registrant shall be mmuimu to state the extent orany business,nnanoio|,nmmma|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 mmue lobbied oo identified mn the lobbyist registration form filed. Sec 2-482(g)Any Financial, Familial or Professional Relationship C:\Uonrs\c|erhat|V\ppDote\Loma|\K8iomooft\Windowo\Tamporary Internet Fi|esVContent.DudooN&3LGODOH\LobbyistRegistration Fnrmnevioed5'30-2012don IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) �0 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ko (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 X No: Are you lobbying on a present or pending bid for goods,eguipment or services,or on a present or Dendina award for goods,eauipment or service? 2) Pursuant to Miami Beach City Code Section 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 change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482 (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 FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER LISTING B IN EXPENDITURES, AS WELL COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED E4tN IF THERE HAYg=UEN NO EXPENDITURES COMPENSATION DURING THE REPORTING PERIOD. Signature of Lo yist I do solemnly swear that all of the forego' facts are true a correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach C' ode a reporting requirements. Signature of Lobbyist: — �v Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: f 1 roduced ID L �R�lees / - Produced ID Form of Identification ^o Form of Identification - o ?4 Personally known (Lobbyist) cli`r 3 Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY:f `=C State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribed before a ;:= °. / Sworn a d subscribed beforejne o m This da of 2012 a%;.' i Vd a f 2012 te S ure of Pul8tic -State of Florida Signa re of Pu Notary-State of Florida J Nota ization of Lobbvist's signature Nota zation of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: es[ ]No Amount Pai C # Date Paid Lobbyist Registration rm received and verified by: ZZ C:\Users\clerhatl\AppData\Local\Microsoft\Windows\ emporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc Revised 04/27/2012 r 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: 305.673.7411 , Fax:305.673.7254 LOBBYIST NAME: VIC GRANOWICZ 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 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 su pended from lobbying until all fines are paid, unless the fine has been appealed to th"iami-Dade County--Commission on Ethics and Public Trust. Sign e: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Forrnrevised 5-30-2012.doc