Steve M. Polisar - Ilias (USA) LLC Club Nowhere MIAMI �
City of Miami Beach Office of the C � 4� �, p�� 2: 36
1700 Convention Center Drive, Miami Bea' L 3-3 39
LOBBYIST REGISTRATION FORNN+�} r L``i; 'S Di li;F_
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.
S►E�E M.
NAME OF LOBBYIST: (Last) (First) (M.1)
E 7o L A IZ A 2 0 k�T Z' `4 i '> - ??III
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
-?0_51- & x'11 ri 11 o� —�O 3 S'�c 7r�L t C,4 i2 6P tTT k04,L_.G6 At
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, ore-mail address.
I. LOBBYIST RETACtU54fl ED BY:
-=L t La-S L L- L
NAME OF PRINCIPAI LIEN
C L v T3 (A)A5 �r7�AU WI �t 1 =l . 3 3 1,10k
BUSINESS NAME A,bV ADDRESS (Number and Street) (City)
Z (State) (Zip Code)
GZS L_4 4 2, a 2 O 37
TELEPHOffE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust Y�',[SSection 2-482(c)] C
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: L t S L v ` A I
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY I SUE:
e!, ��Afj$t#`ra
Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS 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 eneral 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
V L C, P V E
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 a ' entified-_en the lobbyist registration form filed.
Sec 2-482(g)An Financial, milial or Professional Relationshipd '
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration 1 l�
Formrevised 5-30-2012.doc , I
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) .
=L 0
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATIO[1U:2
(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�00_ 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? ,-J U
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes_ Are you lobbying on a pending application for a Development Agreement with the CitV or application for
change of zoning map designation or change to the City's Future Land Use Map? -j C)
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 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 SHALL BE FILED EVEN IF ERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of bb st
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 Beac ,ity ode and all rr ort• g requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. ;Produce BYIS (IDENTIFICATION: -�; S .`1 C��S p PRINCIPAL IDENTIFICATION:
s ID Zproduced ID __
Form of Identification Form of Identification
Personally known(Lobbyist) \\\�� 0�pllCfiA;41° v,,,� _Personally known (Principal)
\Sg\ON Eyp�9• ��
VII. SIGNATURE AND STAMP QF :2014 Fs 6=
O
State of Florida,County of Miami Dads �oOg�0 ,,,::o Sworn°and subscribed bed beforeianm1e Dade
Sworn to and subscribed before me '�`
This day of ,20Y� ° ° B.be\V p�`� This day of 2012
AD/21 i 9��IllBll i1111�
Sig ature of Public lAotary-State of Flori Signature of Public Notary-State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED By CITY CLERK'S STAFF ONLY
Annual Registration fee: [%I]Yes[ ]No Amount Pai $ CR# Date Paid
Lobbyist Registration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doC
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required).X
�S 0
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATIO �' fir•
(REQUIRED). . 2 j O
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On rocurement
Issues": "o - -
_Z
_Yes Are you lobbying on a present or pending bid for g G oods,equipment or services,or on a preset or p Bing
award for goods,equipment or service?
�D
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes 4P. Are You lobbying on a pending application for a Development Agreement with the CitV or application for
change of zoning map designation or change to the City's Future Land Use Map? /-j C)
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.
_YesC;N _Are_Vou 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 SHALL BE FILED EVEN IF ERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of llbblSyVt
I do solemnly swear that all of the foregoing facts are t nd rect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beac ,ity ode and r ort' requirements.
Signature of Lobbyist: /UI
Signature of Principal/Client:
VI. LO BYISST IDENTIFICATION: �; E RS _L t c/1-1 t P PRINC AL IDENTIFICATION:
_Produced ID �a {�_ - +t -� Produced ID
Form of Identification Form of Identification
\\��ej111ttttlliel/f��i
Personally known (Lobbyist) �"a" �E....... A o�z,�i _Personally kno
wee NQ \1, EXp7• �� G n Notary Public State of Florida
"� 2014 9Fs•••* _ �; Neil A Milestone
VII. SIGNATURE AND STAMP t�_tr, A
�� .� •�o-- OFPeF Expires 8/16/2015119790
State of Florida, County of Miami-Dads ° 1p1 State of Florida, Co
Sworn to and subscribed before me speg8�r� :�°` Sworn and subscribed fore me
This 4 day of 1120 a de�o,¢; p`�� This Zt ay of 201
/�T• one, �, �.. ' J
��f�i 9�••BLIC,S�Pe�""�\
rH�tnt+►N���°\
Sig ature of Public Notary-State of Flori Signature o Pu lic Notary--State-of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED By CITY CLERK'S STAFF ONLY
Annual Registration fee: [v/]Yes[ ]No Amount Pai $ Jrw FU CR# Date Paid a�
Lobbyist Registration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised b-30-2012.do�
F:\CLEI listration Form.doc Revised 04/27/2012 EAL m �-.
'� N B/\
2013 MAY 24 Pry 2. 36
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CI T' L 'iit ; Vi Ir
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miomibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
r
LOBBYIST NAME: ,S-T�
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 the M' 1-Da County Commission on Ethics and Public Trust.
3
gnature: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content:Outlook\83LGQDDH\Lobbyist Registration
FGmirevised 5-30-2012.doc ,