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Jaime Calabrese - Ophir Sternberg •�l AN MIAMI BEACH wv 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. Calabrese Jaime NAME OF LOBBYIST: (Last) (First) (M.I) 412 North Andrews Ave Fort Lauderdale FL 33301 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-462-0704 rrla @bellsouth.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: Ophir Sternberg NAME OF PRINCIPAUCLIENT: Lionheart Capital, LLC 4'218 NE 2 Ave, 2nd Floor Miami FL '7 „:3 /3 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-573-3900 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: O 1111r 5 • IDENTIFY ALL PERSONS HOLDIN ,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:\vO II.SPECIFIC LOBBY ISSUE:' Zoning Approvals for the former Miami Heart Institute located_atr4701-N,Me.ridiana-4ve,,,Miami Beach, FL 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 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 NO title of person to be lobbied Design Review Board, Planning Board, Public Works, X Board of Adjustments X r� ev Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familiakor 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. k— Sec 2-482(g)Any Financial,Familial or Professional Relationship r 140 r F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $102,500 (4x ) B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST OMPENSATION• ?fX \)(REQUIRED). $102,500 -ft 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)(No: Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending 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 XNo: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning 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. 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 COMPENSATIO RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL E FILED E N Ili T ERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signa re of o ' t I do solemnly swear that all of the oregoing ac .re true nd rrect and that I have read or-am familiar with the provisions contained in Section 2-482 of the Miami Bea p-City 'ode( n‘a repo ing requirements. Signature of Lobbyist: .L.Akdr /.../ Signature of Principal/Client ((=' VI. LOBBYIST IDENTIFICATION PRINCIPAL IDENTIFICATION: Produced ID-%)t∎dts' L\c.Ms�(C..116•y37.71•a43•() Produced ID Form of Identification Form of Identification Personal) known(Lobbyist) Personal) known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade Sworn to and subscribed before me -.;R∎ ?4;;t N.RAGONA Sworn nd subscribed before me day 201 S (:'•'? '" MY COMMISSION#FF 135008 This day of..J0111t C(V� 2015 This 5 da of SA AO�`0 ' t EXPIRES:August 14,2018 ' ,� 'OW�� 8 �:u.,,*r No ry• � .�derwriters�,, i �?e°' •:�:cCOMMISSIONEE611 � _ •�, l'A Signature of ublic Notary—State of Florida 5•y,.., ignature of Public Nota — ate o Florida Notarizatio of Lobbyist's signature EXPIRES:MAR,17,20 otarization of Principal's signature g �'s,,en'0 www.AARONNOTARYtom TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ' _ Annual Registration fee: [ Yes[ ]No Amount Paid V5r):_2711iFilLft Date Paid 1 (0 I Lobbyist Registration Form received and verified by: ---- F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MAMIBEACH 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: Jaime Calabrese 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 of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to th Miami-Dade County Commission on Ethics and Public Trust. /AV / /c/�/ig at.re D e: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc e. P. riffk CITY HALL CASHIER OFFI 1700 CONVENTION CNTR DR MIAMI BEACH, FL 33139 01/06/2015 09:58:56 Merchant ID: 000000005148978 Terminal ID: 02013135 . 1090573940 CREDIT CARD AMEX SALE City of Miami Beach-Florida CARD# 1007 Finance Department INVOICE 0008 Batch#: 001439 1 City Hall 1500613-1 01/06/2015 BR1 T121 Approval Code: 545213 Tue Jan06,2015 09:59AM Trans#3-3 Entry Method: Swiped Online 3 $850,00 MCRCLERK - NCR-City Clerk Mode: * MCR#; 36267 SALE AMOUNT $850,00 1 ITEM(S): TOTAL: $850.00 Credit Car PAID $850.00 Have a nice day! CUSTOMER COPY • ti .J:i : _ :.=, 01A.1612015 001 121 Miscellaneous Cash Receipt [[� rr }) ',jy� ( ar 1�P1`.tn1 ��•e• ��SI 5•..�Frei f^.�J9�t+•{��'�•I�y�l�{yEra0 CITY OF MIAMI BEACH 3 6 2 67 - • No. dit Card ❑Check# $ ❑ Cash Cre _ (g SO A Ii• Co 20 1 S- . r i4 i Received of „Ira-, cri_e_ .,.._ 62---ki a V 1-Giat Address i 1 . A A c r-( :.-)s A� f•* r ,,,,,, ,.-( ft 3 3 301 _ For A n 1,1 r ._.f Lo ii-",-1 . - r) -her :,-.L + 01.4 : .. h 'tr., (./,i2,0,1_,,,t` , + ' ,/� r' +_. Lik.' f',•rs 1 L ' ! 1 }�+rLl, mow. ✓'�4N I (THIS INFORMATION MUST BE COMPLETED) , Office of Finance Director By Account Number: {{ - d Dept: C Ail c.��-� EST: 1. '!I Preparer. 1 <`�r p ,