Leo Bellon - John Davoudi All
MIAMI BEACH
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. ;
BELLON LEO
NAME OF LOBBYIST: (Last) (First) (M.1)
BELLON ARCHITECTURE, INC 13131 SW 132ND ST, SUITE104, MIAMI FL 33186
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-278-7776 305-278-7473 LEO @BELLONGLOBAL.COM
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this:offrce if Y'02 ur contact informal ion::changes;acldressjphone;:or.e-mail ad Tess:
I. LOBBYIST RETAINED BY:
JOHN DAVOUDI
NAME OF PRINCIPAUCLIENT:
19820 NE 14TH AVE, MIAMI FL 33179
BUSINESS NAME AND ADDRESS (Number and Street (City) (State) `Z Code
786-586-7747 ) FRANK.DAVOiI @GMAIL.COM
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section If principal is a Corporation,Partnership or Trust[Section 2482(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:
ii.SPECIFI:C LOBBY..ISSUE:
REQUESTING TO DEMOLISH EXSISTING STRUCTURE AND DESIGN APPROVAL TO BUILD —
Issue to be lobbied(Describe in detail):. NEW SINGLE FAMILY RESIDENCE.
Ill.CITY.�AGENCIEVINDl1/I.. S.'T:O BE_L'OBBIED: p®,,u-vsS', yl Zp( 1j �E� �cJ A�1331`{'a
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 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
X
DRB X
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
NONE
F:ICLERI$ALLIaFORMSILOBBYIST FORMS1Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) NO ADDITIONAL COMPENSATION
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): NO ADDITIONAL COMPENSATION
(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 XNo: Are you lobbying on a present or pending bid for goods,eauipment or services.or on a present or pendI -g
award for goods,eauipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes XNo: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map deslanation or change to the City's Future Land Use Map?
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 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 cleric as required by this section but,shall not be required to pay any registration fees.
YesXNo: 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 CO QE SATION RECEIVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SH E FILED EVEN IF T VE BEEN 0 EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
f -
Signature of Lobbyist
I do solemnly swear tha of a foregoing facts d correct and that I have read or am familiar with the provisions contained
in Section 2-482 of t Mia al equ' ments.
Signature of Lob ist:
Signature of Pd eip lient /
VI. LOBBYIST IDENTIFICA ION: PRINCIPAL IDENTIFICATION:
_Produced ID _Produced ID
Form of Identification Form of Identification
Prsonal) known(Lobbyist) /Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-MEE State of Florida,County MI
ublic State of Flemida
Sworn to and subscribe before m Sworn d subscribed b o�@� Netery Public State or Florid
Lascano ��
This_j day of ission EE084436 This day of - My�y d LasCeno a
5/10/2015 °��°� EX PI mission FEOU436
p 0511012015
Signature of Public Notary—State of Florida Signature of Public Notary--State of Florlda `-
Notarization of Lobbyist's signature Notarization of Principal's signature /^
TO BE COMPLEIQ BY CITY CLERK'S ST F ONL
Annual Registratlon fee:[ Yes[. `].No Arnaunt:PaId$ _ MCR#: Date Paid
Lolibylst Regishation Fo received and.yerrfied by:
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F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
V I AM" EAC H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachf.gov
CITY CLERK Office
Rafael E.Granado,City Clerk CityClerk@miamibeachA.gov
Tel:305.673.741 1 ,Fax:305.673,7254
LOBBYIST NAME:
N
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 30,shall be automatically
suspe m lobbying until all fines are,paid, unless the fine has been appealed to
the am!-Dad County C sion n Ethics and Public Trust.
7
Signatur Date
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