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Bill Plasencia - Steve Cerrato 6 101AM1 BE City of Miami Beach Office of the City Clerk �' E k�. V p 1700 Convention Center Drive, Miami Beach, FL 33139 ZQ j3 NOV _ 4� �►► 10: 0 1 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage fhe passag ,jCgefeat.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. Plasencia Bill NAME OF LOBBYIST: (Last) 50(First) (M.I) Ce 7700 North Kendall Drive Miami Florida 33156 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) ,(305)235-9211 wparchitectCabbellsouth.net TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Steve Cerrato NAME OF PRINCIPAL/CLIENT: 4560 Sheridan Avenue Miami Beach Florida 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 776-0704 StevecerrlaD-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: 0 ( A • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ii.SPECIFIC LOBBY ISSUE: Development Board Approvals for 4560 Sheridan Avenue, Miami Beach, Florida Issue to be lobbied(Describe in detail): Ill. 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 arson's commencement of service with the city to the present date,st ting the general nature of the suNect contractual relationship. Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Tanning Department and Building Department Staff None X B, HPB, BOA, City Commission, as necessary* None X Pursuant to City Code Section 2-482(8)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 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\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) mE? B) PRINCIPAL'S DISCLOSURE(OF LOBYIST COMPENSATION): (REQUIRED)._ $ 11')R`)2 - 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 pending bid for goods,equip nt or services.or on a present or Spending award for goods,eguipment 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 Develogment Agreement with the City or awlication f2E change of zoning map designation or change to the CitVs 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. _Yes X Now Are you representing a=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 EXPENDITURES OR -7,-,�� Signature of Lobbyist I do solemnly swear that all of the foregoi acts ar a and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beac G`ity Co and all redo 'ng requirements.` Signature of Lobbyist: v Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _Produced ID � � S �t v°��o ti o y4c roduced ID L JR�10e�S CU .. C Form of Identification Qr V •. 0i-egg Q` Form of Identification o a h co 03 h ° —Personally known(Lobbyist) ��"\ e o�m ®Personally known(Principal) Q W r Q j 4}.Oc;9 y y y W c VII. SIGNATURE AND STAMP OF NOT R�( FF F o°�' m State of Florida,County of Miami-Dade =�� a� State of Florida,County of Miami-Dade E Sworn 7jay scribe bef me """:' °c ~� E �� m wpm and subscrib!9;5mtd re me ° o a J� This of ,2013 *' ba STh day f 2013 0 Signature jopublic Notary–State of Flon Signatu of Public Notary–State of Florida Notarizatof Lobbyist's signature Notariz tion of Prin®signature °;;•SZP�� TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: es[ ]No Amount Paid$ CR# _Date Paid Lobbyist Wegistration Fp1m received and veri a by. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Te porary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F:\CLE istration Form.doc Revised 04/27/2012 MIAMIBEACH City of 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 LOBBYIST NAME: Bill Plasencia 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 $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc 001 122' Miscellaneous Cash Receipt r - .rw� :�.s _ :E$��b.:yat CITY of MIAMI BEACH k No. � Aw � ; Olp Q Cash ❑Credit Card D Check# i 20. Received of �- � °` r :. Address For ' 0 ANY 0t �``3i°F Y'rl YYY '�..�e F�`S"'a� �°�' �J' �.,,+` '�'#-- .sf 1 '!ii+l 9" �.,.. ?"".. J't �„�"�y� ��` t C. "y� t`�,:.� v i f•• (THIS INFORMATION MUST BE COMPLETED) - Office of Finance Director By Account-Number: , D .. arer• �'� � ��r �' t ' p ,._ n; �f Dept: Pre f; EXT:/