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David B. Gauld - Bass Museum of Art v. z g� A® City of Miami Beach Office of the City Clerk - 0 1700 Convention Center Drive, Miami Beach, FL 33139 C 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. 6- u L-p 171/1/4V t D 3 NAME OF LOBBYIST: (Last) (First) (M.I) 17&v I d- -i c_.l Are-An 337 roo rne_ N N3Y toad 2 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) eso-X-7 t s?(i . Laa ourcirlitect TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: V L e L i u!'e 1.2' r- d v- NAME OF PRINCIPAL/CLIENT: i BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) ( pt 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: INA • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 1"1/A II.SPECIFIC LOBBY ISSUE: Rtne,./ ()CD (c) prCle4 Issue to be lobbied(Describe in detail): ul.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 C- B0e-,21-4- 5( yr' tai rad��O� ^ VX 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 pity personnel who is sought to be lobbied as identified on the lobbyist registration form filed. TJ tea_ Sec 2-482(g)Any Financial,Familial or Professional Relationship rn VI 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) , 40 �,, �,r,'C C� [u C�-!J P B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): No(REQUIRED). � �� tie) (1. 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" No: 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. Yes No: 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 COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. n / 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 Code and all reporting requirements., Signature of Lobbyist: 1P � . Signature of Principal/Client: L VI. LOBBYIST IDENTIFICATION: °- PRINCIPAL IDENTIFICATION: /Produced ID JJ L t�1 ��o [ Produced ID Form of Identification Form of Identification Personally known (Lobbyist) Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State o1 t r• ,County of ;p�-:� .. ..a�.-. _ ._ �:,_. _�,�,t_.,- ._. State of Florida,County of Miami-Dade VANUS Sworn to a subscribed •efore e Sworn and subscribed before me This D- � day of a-� ,201 ry Public-State of New York This 24' day of 30.17vaV 201.$ A , N0.01HU6209138 ��•` °° Leilani h ■ *Qualified in Richmond County ��°�. �pp � ro� ► � '' scion Expires Jul 20,2017 - 10F,21-OMISSION Signature of P°blic Notary S p.--��+.A:��): P Sii nature of Public Notary—State � E''IRES• MAY 13.2017 Notarization of Lobbyist' signature+ 'o'arization of Principal's signa ,:t-'°�.,. ;'. ' ID no 0p0 }9 Ar4V.AARONNOTARY,COM TO BE COMPLETED BY CITY CLERK'S TAFF ONLY Annual Registration fee: [ Yes[ ]No Amount Pail $ ° 1[6 MVOS_ Date Paid _ 40 Lobbyist Registration Form received and verified by a. o . _aE F:\CL EFL\.AI L\a ORMS\LOBBYIST FORMS\Lobbyist Ann di''',:kgis-tration Forwi,eac Revised 0 /22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 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: ��-U U Go-u --� 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 2485.1, 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 the Miami-Dade County Commission on Ethics and Public Trust. 01- i 72- z /2oti5 Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 1 4 • ...--,,,, -,,,i'D..'----''',-1'.,:rd'.E..Z•...1••••,,,••4-7;1'•.F••"..ger-•.,,r,',._„ _•:,','.-• ' ' ''---• "'•-N."---'--Vt..f.-"...,7"-t,-,-.....-,,t,..4.1,:,....r.31,2).4.-;,,,•••••••-,e,-;•,,,,,,,ii;•,,,...1&i'4,-,,;4".7.".;;V:-..,,;6,..."1-Xl.4.'•-,47.44‘',,,,,q-A1..."",,,,",.1.-,,;4-:.,,,,,•7 4.,-,,t,E-VM?,,p="eAl-p.".--41,,,,,V,i-....4g.,:.,, -,---1..-•,•/.1"1-i..4,i,,,-,-40,••it,,...ir'6..i1-*'0,,i,:;;Z,F.:Nc&fi,r•i•iPF-.L.:,.....--..V-..-_,-,•-•4`.4.,51-1,,es.1.,,,,,•:":Ei.:7-,-",,.,:,-4,,,,,-2-7.00,-,,,,.,---" "4,•1.1"'"g",•e•,,,,,q..?,',4.-,,,T.,-,-;-• •••:,447.4,- -7,..}.1-",,,Di•,,Pial--0,-ii.•!:•t"0-•-,,,,,,,i.,,,il'e-,4,,,,,,t-A-24-...,,,,,,4-,0",:l rac44iii•i.rni-7.1,,,l'i-Viii;i1t-40,*:::4.1,1157f:474•%,44T"fik$4,7,L1.1-310.17,4•_44,41.X.igii•ai•ai-,41,U,KX,":""ft-- $:•:55••:t.01-A,-,k,;.•-4.1..ctik.--i84:7.0_4;:i.:,=aglagVetiqt,''.47.V.,,,P7'.-4V"L.&'-•:alt.CIA :4-V;Yatt:',. .*N1=4-Y-if:?-41'..P- P'.:1, ilieslia.`".NIF9141$1,4';;-,t-t_ii-3:*-;ttgitaV-,,,,f4ttiquat',10:`1.,itattyriiiar,I.S-WA),VM,Iaiii.155.4.itiq,A.JOZaltaZIVOZA.,EttFAintl-11**-NPAViwit=4:4::i*I", 1.,-,,,,,-4.--,.:,-.4,,,..,..,5„,,,,,,,,.a.--q. : - i . , - _ 24-. „.. ..•-..-H-a-,.IS,,,-.,' ...-5,...-'-- ,--:"-.-..44.,.■git,":".i-ii•-; .-ti--..'$•1"i:,,-;,a.t.,„;.,,,,,,,,,,=',•..,,,.•,„:..4.,„1,...,...f4,4„.4.-,,,,re,,,,:,,,,sie-,03,4,.:.....,74-,,,,:x4. 4.1,rod*,,,,;44..:-.11,44,-•..,4.0..v.,,■,,,,,t,..:;...c,,,,w P*i.Z.-,53,&1,i'Pt,,4,4?eiCT4r7t,fa•_/0741;,*•--,4";, f4--)470,41.',...6"-•4....2'-'43.--;,4'1-filla-Ai.7;•,.A, tAilr=0444-4-V.15128i.C•ZW10-,.',.,FY,tf;;;01f:t:TAZ":-.114.t:1,111"V.P-7M-','ItLi4Ati,)4;i'V'AftP411`46aqifie4 ;',.•i.02',;414/31•44a1,1:44-.Vr..te'ITtrk0EMIAMI:341;tA4n.'114.3;I.e-,0?0-5.,i.11;WIRILV".0•AgOr•?,,;514.51:404114.1-1XV,O,AW1)0MQ--40.*M16ktrliP.. 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'•-'"-,,. .- . •.\--,,,..i..... ,..,... - • , • ,. • . , • . • ' . Barbou, Regis From: Granado, Rafael Sent: Monday,January 26, 2015 2:13 PM To: Barbou, Regis Subject: FW: Bass Museum of Art Importance: Low y arm _ ...._..... 1915 GiN.1 Rafael E. Granado, Esq., City Clerk CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411 www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. From: David Gauld [mailto:d.gauld©davidgauldarchitect.com] Sent:Thursday, January 22, 2015 11:20 AM To: City Clerk's External Mail Subject: Bass Museum of Art Importance: Low Hello, I am the architect for the expansion/renovation of the Bass Museum, and we are submitting documents on February 6th for the Historic Preservation Board. I understand that I need to submit the Lobbyist Registration Form to you. Would you please let me know if the Lobbyist fee is waived because this is a City owned building and a City financed roject. If not please let me know what the� , p o at t o fee is. Thank you, David Gauld DAVIDv1_1-Ir ARLA David Gauld, AIA www.DavidGauldArchitect.com David Gauld Architect, PLLC 337 Broome Street, 2nd Floor 1 ,New York, NY 10002 212-627-0110, ext. 207 2