Dean Lewis - Samy Dihouri MIAMI
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.
Lewis Dean
NAME OF LOBBYIST: (Last) (First) (M.I)
DBLewisArchitect-Thresholds Intl. Inc. 5910 N. Bayshore Drive Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(3051456-7252 dblewisarch@gmail.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:
Samv Dihouri
NAME OF PRINCIPAUCLIENT:
SS2D, LLC 701 Brickell Avenue, Suite 1650 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 456-7252
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) ' o
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] °� 4y
rte+
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:
O
ii.SPECIFIC LOBBY ISSUE: rO
Develol,mgnt Board Aoarovals for 330 76th Street. Miami Beach. Florida '
s
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
arson's commencement of service with the city to the present date,stating the general nature of the subject contractual relationshi .
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
_T_
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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COCPENSATION): �0
(REQUIRED). (�/'t s 1
The following information roust be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lob
sts On Proci7rement
P-Issues":
CD
_Yes X No: Are you lobbying on a present or pending bid for aoods,eguipment or se rvices.or on a present or �-
pending award for goods.eguipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By LobPsts(AM Real state
Development Issues": m
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_Yes X No: AL2,you lobbying on a pending application for a Development Agreement 3MIlb the City or application
fgr chanae of zonina 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.
_Yes X Nod,Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON EEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERIC A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS W9LL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH
FQB
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
I
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 2-482 of the Miami Beach City C ipd all reporting requirements.
Signature of Lobbyist: �'� �—L=W�S •
a
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICAT4 PRINCIPAL IDENTIFICATION:
Produced ID `Produced ID Y
Form of Identification Form of Identification NA
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Personally known(Lobbyist) _Personally known(Principal) 3
VII. SIGNATURE AND STAMP OF NOTARY:
°ooN MM m
State of Florida, County of Miami-Dade o m N W State of Florida,County of Miami-Dade g g
Sworn t nd sub cribed"�eyf�gre me o Swornd subscri �gfore me o
This of y�// , 2014 o Thi day of VV ,2014
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SignaiuA bf PLIblic Notary State of Florida Sig re o ublic Notary—State of Florida
Notarization of signature Notarization of Princ�iall's signature
TO BE COMPLETkDj3Y CITY CLERK'S STAFF ONLY /� [/ /
Annual Registration fee: [ j Yes[ No Amount Paid$ `� MCR# 4 Dat Paid ?
Lobbyist Registration Form received and veriflied by:
kul__fee)
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F:\CLE istration Form.doc Revised 04/27/2012
* PACH
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: Dean Lewis
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- ade County Commission on Ethics and Public Trust.
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Signature: Date:
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