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Rafael E. Andrade - Parc Place Development, LLC .5( frt ire t . , ,, ... o 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. Andrade Rafael E. NAME OF LOBBYIST: (Last) (First) (M.I) Law Offices of Rafael E. Andrade, P.A. 1 1 11 Lincoln Road, Suite 400, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 531-9511 (305) 673-5734 ralph@randradelaw.com randradelaw.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: Parc Place Development, LLC NAME OF PRINCIPAUCLIENT: Parc Place Development, LLC 26 Harbor Park Drive Port Washington NY 11050 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (516)626-5643 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:.Bert E.Brodsky,Manager • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:Bert E_Brodsky,David C.Brodsky,Jessica H.Miller,Jeffrey H.Brodsky and Lee J.Brodsky ',.SPECIFIC LOBBY ISSUE: ^}� Land Use Issues at 220 21st Street/2000 Collins Avenue 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 su&person's commencement of service with the city to the present date,stating the general nature of the subject contractual relationship. r: Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) -- YES NO title of person to be lobbied - 4- Mayor&City Commission,City Manager's Office, X City Attorney's Office,and All City Boards and Committees X 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 None C:1UserslclerhatI AppDatall_ocal\Microsoft\WindowstTemporary Internet FilesiContent.flutiook183LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION DISCLOSE WHETHER HOURLY,,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $10,000 flat fee B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $10,000 flat fee (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,equipment or services,or on a present or pending award for goods,equpment 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 COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE Fl. t24, ' IF THERE HAVE =.___.;- •0 EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoing facts ar- e and correct a•- al..---ve read or am familiar with the provisions contained in Section 2-482 of the Miami Beach Ci -•-''-.all repo - • r-• --- - Signature of Lobbyist: �,�%�/. ,�[j Signature of Principal/Client: �� " "771/t:" LOBBYIST IDEN !CATION: PRINCIPAL IDENTIFICATION: e iZ Produced ID Produced ID 3„N L3j Form of Identification Form of Identification a *y-' _Personally known(Lobbyist) Personally known(Principal) gib. SIGNATURE AND STAMP OF NOTARY: AdPee4.*0 /V GO r 4;%.%) f 1 to of Florida,County of Miami-Da• State of Flend�a,County of i-Dade �•...,,,S orn t• --• subscribed before me� Sworn and subscribed before me S i�'�.`z •I s L:: __ ,e 11\� of` Notary Public,State of New York ,r" !;nature of"ublic o ry State o Iorida Signature of u lic Notary—Slate of Fluid o.02GE6060086 Notarization of Lobbyist's signature Notarization of Principal's signs Nassau County Expires June 11.20 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[r]No Amount Paid$ • MCR# 1.4 i./s--Li Date Paid MI Lobbyist Registration Form received and verified by: . t 9 ✓! t 3 f C:IUsers\clerhatllAppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook183LG000HILobbyist Registration Formrevised 5-30-2012.doc 9 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: 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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. / - Signature: ate: F:ICLERI$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc I CITY HALL CASHIER OFFI 1700 CONVENTION CNTR DR MIAMI BEACH, FL 33139 04/15/2015 12:13:14 Merchant ID: 000000005148978 Terminal ID: 02013135 1090573940 CREDIT CARD AMEX SALE )000000000(X2010 CARD# �0000000(X2010 INVOICE 0024 Batch#: 001513 Approval Code: 523642 Entry Method: Swiped Mode: Online SALE AMOUNT $350.00 CUSTOMER COPY • r, Miscellaneous Cash Receipt .. I --,--4 OW4 4.:f4 r i f2O 1 OC _134 CITY OF MIAMI BEACH « ( , �x clerk }}..;_, F5sr_ 0 films N°• 0 Cash . Credit Card C7 Check# - $ .3 Ju #//; 20 ti Received of / An .., Address L — OM ce---.. /11/ Z• )X54 4 0 0 . /pi%s , For ,Z0 eh ,i / S ()f Sr / 0 0 G ///-, > f (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director 0,,„, ,.. Account N / - ----.---- , - C. /4----------------------,._ 6,. 2 Dept: 0,...,4_ •EXT. c///