Sherri Gutierrez - Twice Around 1775, LLC U0
MIAMI BE U
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 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.
Gutierrez Sherri
NAME OF LOBBYIST: (Last) (First) (M.I)
Ar uitectonica 2900 Oak Avenue Miami FL 33133
(Number an ee i a e (zip Mae)
(305)372-1812 (305) 372-1175 miami(a)-arauitectonica.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:
Twice Around 1775 L C
NAME OF PRINCIPAL/CLIENT:
Same c/o SBE Hotel Group 8_000 Beverly Boulevard, Los Angeles CA 90048
um Der ano Street) i a e (Zip Mae)
(323)655-8000
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:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH_CORPORATION,
PARTNERSHIP OR TRUST: ' s
II.SPECIFIC LOBBY ISSUE:
Development approvals &permittina issues for Raleiah Hotel located at 1775 Collins Avenue
Issue to be lobbied(Describe in detail): ;
lll. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: 4
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
arson's commencement of service with the city to the present date,st ting 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
Staff of Planning Department, Building Department,and Public Works None X
Denartment
PB,HPB,BOA,City Commission,as necessary 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(g)Any Financial, Familial or Professional Relationship
None
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ 220 Ar
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST CO NS N):
(REQUIRED). 7:
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:
2) Pursuant to Miami Beach City Code Section 2490 Entitled'Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes X No: Are,vou io b3dng on a_oendino aRRIj2ati20 inr a DeveloRment A®reemen, with„the Gitlf ppJcAti
ohanae of qnatign a„r change to the EULU "ad Use Ma®? .
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 2481 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•
V. SIGNATURE UNDER OATH:
QN FEBRUARY 28 OF EACH YEAR,R EACH LOBBYIST fiL1 L SUBMIT TO TLIE CITY CLEF,A SIGNED STATFMFNT UNDER
PATH. LIUM.LQWMQ U ENDJJUREs M JZLL M COMPENSATION RECEIVED: IN.IHE, E MIAW.
FHB O
�I�; ROES
signs a of Lobbyis
I do solemnly swear that all of the foregoing facts are true correct and that I have read or am famili r with the provisions contained
in Section 2482 of the Mia i Beach City Co a and all reporting requirements_
Signature of Lobbyist:
Signature of Principal iient:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: � �
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_Produced ID Produced 1D Z Au
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Form of Identification Form of Identification
ZPersonally � O N a. tip known Lobb •st(Lobbyist)
} known(Principal) z 1-5 1 z ;K
VII. SIGNATURE AND STAMP OF NOTARY: (j o S c
y . CRISTINA D.GONZALEZ ' Yd�'L Nom✓f J�� a Z E
State of Florida, County of Miami-Dade = '"' State ofa
Sworn to and subscribed before me _ MY COMMISSION#DD 960888 , County of
EXPIRES:March 23,2014 Sworn an�..subscribed before me
This �-1�, day of 2013 OF F���` Bonded Thru Notary Public Underwriters This �- i ay of 444\ 204y Q
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Signature of-Public Notary ate bf Flo OM Signature of Pu lic Notary—State of.lalef ft1VA,✓XA
Notarization of Lobbdist's signature Notarization of PRal_s signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee;I I Yes I I No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and.verified by:
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Formrevised 5-30-2012.doe
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ 20
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COI1�WA ):
(REQUIRED). G
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 lobbydpgon a present or Rending bid for aoods.eguiRment or services.or on a Dresent or ending
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 lobby 0 oc�n a pending application for a Develo went agreement with the City or application for
change of zoning map designation or change to the CitW's Future Land Use Mao? .
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 2481 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-f2r-2rofd corDOration 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
ME THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD,
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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 2482 of the Miami Beach City Code and all reporting requirements.
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Signature of Lobbyist: � rr( &�dc C 0�
Signature of Principal/Client:' \�
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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Produced ID Produced ID W o'
Form of Identification Form of Identification � LL o v
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ZPersonally y Personally known (Lobbyist) known(Principal) z y � z° x
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VII. SIGNATURE AND STAMP OF NOTARY: Q U ° C o
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State of Florida, County of Miami-Dade State of-Fk*ida, County of AiliawWDa4e- E
Sworn to and subscribed before me Sworn anPubscribed before me of
This day of ,2012 This J'may of,122&hl. , 2013 ® O
G✓U Z Is
Signature of Public Notary—State of Florida Signature of Pu lic Notary—State ofZ4efidt/Vjr,.✓�
Notarization of Lobbyist's signature Notarization of Prin®signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes I No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
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istration Form.doe Revised 04/27/201
City of Miami Bcath,..1700 Convention Center llivc-M.ialni Beach, Florida 33139, www.miarnibeachil.-ov
CITE' CLERK Officc
Rafael E. Grmiadc),City Clcrk-
Tel:305.673.7411,Fax:305.673.7254
LOBBYIST NAME: , Sherri Gutierrez
I understand that no later than February 28 of each vear, 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 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 2-486 (d), the City Clerk shall notify any lobbyist (or principal) who
falls 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 Commisision 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 falls 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.
1,3
Sig ature: Date:
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