Ralph Choeff - Starboard Florida IV, LLC MIAMI BEACH
City of Miami Beach Office of the City Clerk U)r
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORMA
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.
Ralph Choeff
NAME OF LOBBYIST: (Last) (First) (M.I)
_Choeff + Levy p.a. 8425 Biscayne Blvd. Miami, FL 33138
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.434.8338 30.5.892.5292 rchoeff @choefflevy.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address;phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City (Slate) (Zip Code)
Lt 1 .:!5 27y =-7
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: v�� )+o.o►� ���.-�
• IDENTIFY ALL PERSONS HOLDIN ,DIRECTLY OR INDIfECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: o
ii.SPECIFIC LOBBY ISSUE:
Design Review Al2proval for a new 2-story Residence z �- -
Issue to be lobbied(Describe in detail):
Ill.CITY AGE' NCIESANDIVIDUALS 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 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 NO
title of person to be lobbied
Design.Review Board none X
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
NO
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ 75/Hr
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Q 75/Hr
(REQUIRED). •V
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 XNO: 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 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 for
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.
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
THE PRECEDING CALENDAR YEAR. A STATEMENT SHAWRE F112ED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature Lobbyist
I do solemnly swear that al oregong facts are true and Corr ct and that I have read or am familiar with the provisions contained
in Section 2-482 of the ami B a tiC o de and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATIO v� PRINCIPAL IDENTIFICATION: e
C9 CV
Produced ID Te n hes'CP e rI)e ��L6 Produced ID CL-0e(OA- �-I
Form of Identification z 9 Form of Identification
7 7
Personally known(Lobbyist) -i m W Personally known(Principal)
a:
oQ�
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,Co my of Miami-Dade ��` ``m State of Florida,County of Miami-Dade
Sworn to and subs ibed before me Sworn and subsc4 ed before e
This of v J�� a9 f �o• .�- This day of 201
�'.
Signature of P blic Notary-State of Florida Signature of Nota r -State f = MY COMMISSION ff EE09^'
Notarization t f Lobbyist's signature Notanzatio al's signal EXPIRES June 02,201::
(407)3?"153 Ftoridallota .ot)m
TO BE COMPLE BY CITY CLERK AF Y 4 la
Annual Registration fee: [ ]Yes, ]No Amount P id$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
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4 ,
F:\CLEI listration Form.doc Revised 04/27/2012
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miomibeochfl,pov
CITY CLERK Office
Rafael E. Granada, City Clerk 0tyClerk®miomibeochfl,9ov
Tel: 305.673.741 1 ,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 2485 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 on has been resolved l have registered to lobby , or I am no
longer lobbying,on that issue or for that principal, I am required to immediately notify
the City lerk's Office of lobb ist withdrawal in-writin .
Y
Y g
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, 20129 shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
ap t the Miami-Dade County Commission on Ethics and Public Trust.
� • tip` i3
i nature: Date:
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