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City of Miami Beach Office of the City Clerk »
| 1700 Convention Center Drive, Miami Beach, FL33139
|
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by principal who seeks to encourage the passage, defeat or
modification of any ordinance, resolution, action mdecision of any commissioner; any action, decision, recommendation of the City
�
Manager or any city board or committee;or any auUon, decision or recommendation of any city ponmnno| during the time period of the
| onbm decision-making pmuoau on such action, decision or recommendation than fnmnoeob|y will be heard or reviewed by the
city commission, or o city board or committee. The term specifically includes the principal an well as any employee engaged in
lobbying activities. The term "Lmbbyisto" has specific exclusions. Please refer uo Ordinance 20O4-3435.
Choeff Ralph
NAME OF LOBBYIST: (Last) (First) (M.1)
Choaff+ Levy P.A. 8425 Biscayne Blvd #201 Miami FL 33138
BUSINESS NAME AND ADDRESS (Number and Street) (CRY) (State) (Zip Code)
305-434-8338 rchoefflQchoefflevy.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office/f your contact information changes:address, phone, or e-mail address.
|. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
PO Box 4O224Q Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786-208-2113 tmenq64@aol.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: -TCdO Cj IQAQA
IDENTIFY ALL PERSONS HOLDING,.DIRECTLY OR INDIRECTLY'r4 50%OR MORE OWNERSHIP IN)�EREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: CC" Soa n
ii.SPECIFIC LOBBY ISSUE: ns
Development Board aggroval for the grogeU located at 5446 N Bay Road, Miami Beach
Issue to be.1lobbied(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 the lobbyist has entered
into any contractual nmauunomn (paid or unpaid) with said ouv commissioner or pommnno| from 12 mommy preceding such
person's commencement of service with the i the date,stating the |nature of the
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Planning Department and Building Department Staff None X
PB, HPB, BOA, City Commission, as'necessary* None X
Pursuant oo City Code Section u4m Every registrant shall uo required to state the extent o,any business,financial,familial n,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|oumou as identified on the|ouuviot mwg/mtmuon,onn filed.
Sec 2482(g)Any Financial, Familial or Professilonal Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
$ 1
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). 0S
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 ending bid for aoods,equipment 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 X No: Are you lobbying on a pendina application for a Development Agreement with the City or application
change of zoning man designation or change to the City's Future Land Use Maw
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$IGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVE12, IN THE CITY OF MIAMI DEAgLi
EM THE PEECEDING CALMAR YEAR, A 5 T SUALL BE EILED
EXPENDITURES OR D U TINGPERIOD.
Sig ure obbyi
do solemnly swear that all of for oing facts are true and correct nd that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia Be ch i C and all re orti requ' ments.
Signature of Lobbyist
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
/Personally uced ID 2 `, ° Versonally ced ID o ��
Form of Identification o o a, Z Form of Identification
0
O yp o an`Co
known(Lobbyist) ° `;' a z known(Principal) a � o a
D j o �_ n o
VII. SIGNATURE AND STAMP OF NOTARY: c a E H � y. x Q
E � z � g ei o
o
State of Florida, County of Miami-Dade o ;, State of Florida,County of Miami-Dade o y =°
Sworn to nd subs bed before me z m Sworn n subscribe before me o 3Z
This a Gr" ,203 ��G*4 bp This f �-� ,201 4 Cc
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Signature of ary—State of Florida "�°�"*StiP�' Signature of Public pry—State of Florida A
Notarization o signature "" Notarization of Principal's signature
TO BE COMPLETED BY C CLERK'S STAFF ONL
Lobbyist Registration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\831GQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
istration Forrn.doc Revised 04/27/2012
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V
City of Miami Beach, 1.700 Convention Center Drive, Miami l3eaeli, Florida 33139, www.mianii'beachfl.gov
UFY CLERK Office
Rafael E. Granado, City Clerk CityClerk tviniarnibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Ralph Choeff
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 suspended from lobbying until all fines are paid, unless the fine has been
appealed t e Miami-Dade County Commission on Ethics and Public Trust.
SignAl,r-4 Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Forwevised 5-30-2012.doc