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Carlos Ramos / Cocomare, LLC �ql SEA PI City of Miami Beach Office of the City Clerk33?7nI JIL 19 Ph11�= o I 1700 Convention Center Drive, Miami Beach, FL 19 LOBBYIST REGISTRATION FORM CITY CLLR K'S OFF ICE 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. RAMOS CARLOS _ NAME OF LOBBYIST: (Last) (First) (M.I) RUIZ BRITO ARCHITECTS 267 MINORCA AVE. SUITE 301 CORAL GABLES, FLORIDA 33134-6737 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305 441 9116/305 527 1260 305 441 9577 ruizarch @bellsouth.net TELEPHONE NUMBER: FAX NUMBER: EMAIL: Phase i�atl'iy tl>s.once ff your contact nfarrrta�bor chr� es:.:address; hon®;or;e-mil:a�ddriss I. LOBBYIST RETAINED BY: COCOMARE LLC,A FLORIDA LTD. LIABILITY COMPANY NAME OF PRINCIPALICLIENT: 2121 PONCE DE LEON BLVD.CORAL GABLES, FLORIDA 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305 446 1621 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(cu • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: ALFREDO TAVERNELLI • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ILSR�Cl�'lC.LD'�k�Y 15St�� , PRESENTATION FOR APPROVAL BY DRB FOR A SINGLE FAMILY RESIDENCE f• - Issue to be lobbied(Describe in detail): AT 441 N. HIBISCUS DR. MIAMI BEACH , FLORIDA 33139 III.CtTf AGEI1iCES1NE�h/IDtJ/�tLS :.E�E: O BIED: Pursuant to City Code Section 2-482(aX4)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 eneral nature of the subject contractual relationship. Sec 2482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied DESIGN REVIEW BOARD X 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 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 o� C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGODDH\Lobbyist Registration Formrevised 5-30-2012.doc f i IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) NO ADDITIONAL COMPENSATION B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): NO ADDITIONAL COMPENSATION (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 lobbvina on a present or pendina bid for-goods,egulpment or services,or on a present or Pending award for goods,equipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes XNo: Are you lobb Ang on a mndlna application for a Development Agreement with the City or application for change of zoning map designation or change to the Citws Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2482(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. YesXNo: 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 OATH.LISTING LOBBYING EXPENDITURES.AS WELL AS COMPENSATION RECEIVED,IN THE CITY OF MIAMI BEACH FOR HE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN Ic Irruffi E HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature 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 contained in Section 2-482 of the Miami ach City Code II reporting requirements. Signature of Lobbyist: Signature of Principal/Client: Li Y P 0 A- VI. L BYIS ENTIFICATION: PRINCIPAL IDENTIFICATION: F L-, Q9 N LI CeWC. _Produced ID _Produced ID Form of Identification Form of Identification ,Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade Sworn to-and subscribed before me Sworn and subs(.04d before me This day of ,2012 is day ok P42j�:,2012 ,tolli,,, ,•,,, ,,, :e ILLO f Ail, .••tip► ANA M.CASTILLO Signa s 01, Signature o u lic Not — ri mmission#EE 033680 Notari 4 Notarization of Principal's C ' xpires November 24 2014 •.,pa��,,. fnlnwrenoe800�38&7010 �,p,P��"F Bonded Thm Troy Fain insurance 800.3&rr7o1A TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Antfual Registration fee. YcS[. ]No: Ambilr�t Pa M # ' Date Paid Lobbyist Registration Form:received apd::ver{fied;by? C:1UserslclerhatRAppData\Local\MicrosoftlWindows\Temporary Internet Files\Content.Outlook183LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc r I City aF 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 CARLOS RAMOS ARCHITECT LOBBYIST NAME: I understand that no later than February 28 of each yyMr 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) L®SRYIST EXPENDITURE ARID 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 2-455(d),the City Cleric 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 9 a fine of$50.00 a day shall be assessed for all Statement(s) filed after to 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 notorpaythe a fines alto 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:\UsersWerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc