Jorge Kuperman - Cueto Miami, LLC '4
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City of Miami Beach Office of the City Clerk
1700 Convention Center Dhma, Miami Beooh, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by principal who neoxo to encourage the paaoogo, defeat or
modification of any ondmanoe, reoo|ubun, action or doo|a|on or any commissioner; any act|on, gecioion, recommendation ofthb City
Manager or any uuv board or committee-, or any act|on, decision or recommendation of any city personnel during the time period of the
entire decision-making process on such action, decision or recommendation that foeoeeob|y will be heard or reviewed by the
city commission, or city buon1 or committee. The term specifically includes the principal as well as any employee engaged in
lobbying activities. The term"Lo*byimto^ has specific exclusions. Please refer mo Ordinance o0o4-343m.
NAME OF LOBBYIST: (Last) (First) (M.1)
� uSK Architecture cno
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-674-8549 775-206-2139 Jffi�verrnan Lci'�LskarchitectuL���m_
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 PRINCIPAUCLIENT:
10 773 NW 581h Street, Unit 603 Dora/ Florida 33178
BUSINESS NAME AND ADDRESS(Number and Street) (City) (State) (Zip Code)
(305) 742-2142 oscar�-64astaudo.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: Vidal Bada Vazquez-55%and Alejandra Bada Vazquez 45%
IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See Attached
x.SPECUFUC LOBBY ISSUE:
Development Approvals and Per-nitting Issues, including, but not limited to Design Review Board, Planning Board, Board of
(Describe AdjUstment and Citu Commission, iL necessaru, relating to the provertu located at 1759 Bali Road, Miami Beach, FL
Issue to be lobbied
m.CITY AGENCUES/UN DIVUDUALS TO BE LOBBIED:
Pursuant to City Code Section 2482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual nuomonomp (paid or unpaid) with said ouv oomm/om/ono, or no,aonmo/ from 12 months pmoaumm 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 I NO
title of person to be lobbied I
Planning Department and Building Department Staff None X
PB, DRB, HPB, BOA, City Commission, and Land Use None X
Development Committee, as necessary None
Pursuant to City Code Section shall be required to state the extent of any business,financial,familial or professional
,o/ouonumn or nma,"o/ouonamn o/mnm nao to on opnooronoe of an /mnmn,iety,with any current city commissioner or city personnel who is
sought muuo lobbied ao identified on the lobbyist registration form n/eu. A]I ��0 �^)���l� �
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Sec 2-482(g)Any Financial,Familial or Professional Relationship
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Xone
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST,CDOMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required): $����fr�-
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ,�
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Ccde Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes J�C No: Are you lobbvina on a present or oendina bid for aoods.equipment or services.or on a present or
pending award for aoods.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 J�C No: Are vou�yig on a oendina application for a Development Agreement with the City or application
�change of zoning reap clzsianatior:or cltanae to the Citv'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.
_Yes aC o: Are you representing anot-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
FQB
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. _--
Signature of Lobbyi
I do solemnly swear that all of the foregoing facts are correct and that I have read or a amiliar with a provisions contained
in Section 2-482 of the Miami Beach Cit and all reportin requirements.
Signature of Lobbyist:
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Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: � PRINCIPAL IDENTIFICATION:
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G G "" N
Produced ID � Produced ID ` � �� � ��
Form of Identification Form of Identification � .��z
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Personally known(Lobbyist) Personally known(Principal) ,� ��
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VII. SIGNATURE AND STAMP OF NOTARY: v, •.�"""�•,,
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State of Florida,County of Mi r}�"D State of Florida, County of Miami-Dade �=
Sworn to and subscribed bef -'m _�'`_ RAY CC314lME5.�lt�.`�-=E�1225$� Sworn and subscribe be ore me �°�'`oM:n�'�;'.••
This day of EXP>�iES�ugusY �q:2�'i5 This�d of M ,2013
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Signature of u is — to of Florida Signature of Public Not � —State of Florida
Notarization of si nature Notarization of signature
TO BE COMPLETED Y CITY CLERK'S T�F QTY � / � 3v
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Lobbyist Registration Form received and verified by:
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