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Fernando U. Diez - Coalition Against Causeway Chaos, Inc. MIAMI B EAC 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. # :CZ ,-144.0166 NAME OF LOBBYIST: (Last) (First) (M.I) 1 • Also %d /es ` ZItC. 3coo ,t/. f 3 =-4' D.;V4 gem 47 /(f 33033 BUSINESS NAME AND ADDRESS / (Number and Street) (City) (State) (Zip Code) 301— 9(11" 77.2f :N 4 0 el;e Z a Pd alsacA 71-0:coin TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Ca et << 11;o41 Apt/Iasi Caace ce.ay Ga&os 2roc. NAME OF PRINCIPAL/CLIENT: 110 ,QHQf k G;a Ave. 3ao Coal 64 61es 33/ 3 L/ BUSINESS NAME ND ADDRESS (Number and Street) (City) (State) (Zip Code) 796- 3 Ql- 3 S ca 66"6"-69.3o-s6-34- 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: 5 G a 71 cA,jpf • IDENTIFY ALL PERSONS HOLDING,DI CTLY OR INDIRECTLY,A 5° OR M RE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIIFIC LOBBY ISSUE: L u d s- M 4-S (c Q vdo p,^n&Ai , Tc 4 4 . t r P.;5"444 U.4 h l rSI c[ , Issue to be lobbied(Describe in detail): nl.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 Ma yar. I G;)t, Cd w4 04..SS_044 X 44a = I ! 7 ! ` 1-4 r A4 ex ^r 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 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc C IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) t (/ Soo . ge Pal B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ‘; s.00• o (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.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": _YesiNo: 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 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. Signature o 4.:' 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 re. ;gents. Signature of Lobbyist: _i _ . '/' -m� Age.Signature of Principal/Client: _ _ / ■ _ -=J VI. LOBBYIST IDENTIFICATION: ' -INCIPAL IDENTIFICATION: Produced ID 1)r.vP_ftat't.r1Se. C.C(6 f Produced ID — Form of Identification AI ^ go 8 Form of Identification 151 O H •Personally known (Lobbyist) b Personally known(Principal) u . z VilI VII. SIGNATURE AND STAMP OF NOTARY: 1 .1 .. State of Florida,County iami-Dade g hi State of Iorida,County of Miami-Dade n scrib before me S or d subscribed before me gSli►u;�% Sworn and 0*.lig This day.o ,201 T i day of Mac Ch 201 `' Sig e c(f Public Notary-State of Florida '4.' Signature of Public Notary-State of Florida l<4.11" ,,,1n ''+ Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ �51)' MCR# �' Date Paid 7-- 1% Lobbyist Registration Form received and verified by: C- iis�-�X� 4.0a111 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 2015 FLORIDA NON PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT#N14000008009 Feb 23, 2015 Entity Name:COALITION AGAINST CAUSEWAY CHAOS, INC. Secretary of State CC0099504753 Current Principal Place of Business: 1200 ANASTASIA AVENUE SUITE 300 CORAL GABLES, FL 33134 Current Mailing Address: 1200 ANASTASIA AVENUE SUITE 300 CORAL GABLES, FL 33134 US FEI Number:47-1721437 Certificate of Status Desired: No Name and Address of Current Registered Agent: SAMUEL J.DUBBIN,P.A. 1200 ANASTASIA AVENUE SUITE 300 CORAL GABLES,FL 33134 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail : Title PRES Title TREA Name CRAVER,ROGER Name JULI,HERBERT Address 1000 VENETIAN WAY Address 720 NE 62ND STREET,APT.407 804 City-State-Zip: MIAMI FL 33138 City-State-Zip: MIAMI FL 33139 Title SEC Name PASCOE,ED Address 108 SOUTH HIBISCUS DRIVE, HIBISCUS ISLAND City-State-Zip: MIAMI BEACH FL 33139 t`J C11 �"r iV-, r f: e ee rri I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that l am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:ROGER CRAVER PRESIDENT 02/23/2015 Electronic Signature of Signing Officer/Director Detail Date ( KAM I 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: 305.673.741 1 ,Fax:305.673.7254 LOBBYIST NAME: r 06 O , 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 the Miami-Dade County Commission on Ethics and Public Trust. v Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ;F :s .,..____._,,,....,:-..;.;:z-1,,,,.1.,,.,,,,,:_-,5 T ..................... ,................. ,...................„ ............. City rf Miami Beach-F1orlda Finance De�ar�trnent 1 City Hall 1506113-2 03/02!2015 BF1 7130 P�1on h1a r02,2015 04:09PM 7rane##18-;18 18 $500.60 MCRCL�RK - MCR-Cit clerk * MCR#: 402718 1 ITEM(S): TOTAL: $500.00 , Check (0104) PAID $500.00 Have a nice day! Miscellaneous Cash Receipt - i . , . CITY OF J No. 0 Cash Credit Card Che — Z-= : 20 _ Received of V - - 3 �� rte` -� , ` 0 r,n:i " ` .: C, ; S tM I U CA.. W - � D) ' - "Office of Finance Director ; (:). 'Account Number: {i� = , d �.. L =- �:..���-- Dept: - Preparer: ,: ,, Lc • City of Miami Beach-Florida Finance Department 1 City Hall 1505113-2 03/02/2015 BR1 T130 Mon Ma r02,2015 04:10PM Trans#19-19 19 $350.00 MCRCLERK - MCR-City Clerk MCR#: 402719 1 ITEM(S): TOTAL: $350.00 Check (0105) PAID $350.00 Have a nice day! i r; 001 9 03,102/2015 no 1 {:3RJ .. Miscellaneous Cash Receipt A F ,Y, V. F ri�0 � Y:: CITY OF MIAMI BEACH '4027 No: - 2 SO - 0 Cash 0 Credit Card Check# $ '2— 20`15- Received of e AC-S D t a - � - . n � t� I_. Address . 9j. C . ` -3 /� • For L., ~, '3 t{}y'7 I jr, - s 3 ,. J c / C A J • 1`S { (THIS INFORMATION MUST SE COMPLETED) Office of Finance Director • a By Account Number: €. f t.. ` 0 - ` -7 • Preparers . Dept: • EXT.