Sebastian Velez - 2901 JMH, LLC MIAMI B EAC zcl AGE FL,
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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'pa image,.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 tinae'periodlof the
entire decision-making process on such action, decision or recommendation that foreseeably will be heardTor reviewed kby 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. r, --O
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Velez Sebastian re.? .
NAME OF LOBBYIST: (Last) (First) (M.I) _ IV
Urban Robot Associates 420 Lincoln Road Miami Beach Florida 33139 N.)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 246-4857 sebastiane,urbanrobotoper
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Jason Halpern
NAME OF PRINCIPAUCLIENT:
2901 JMH, LLC 184 Kent Avenue, C706 Brooklyn New York 12249
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5300 iason.(cr�imhdev.com
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: 4¢ /4411P&sedtot /O %
- IDENTIFY ALL PERSONS DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II SPECIFIC LOBBY ISSUE: /
Development Board Approvals for 2901-11 Indian Creek Drive. Miami Beach. Florida
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
Planning Staff, PB, HPB, BOA, DRB, Commission None 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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST C MPENSATION(DISCLOSE WHETHER HOURLY,FLATCRATE` t OTHER):zit
A) LOBBYIST DISCLOSURE:(Required):$ 7hie� _
,_ -. 11
,----- ,.-,,,, ,_._,
, ,
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPEN ATION):$ X75/it '- _
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists Oi Procurement
Issues": 111
_Yes X No: Are you Iobbvina on a present or pendina bid for aoods.eauioment or services.or on a present or pending
award for aoods.eauioment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes X No: Are you lobbvina on a pending application for a Development Aareement with the City or application for
chanae of zoning map desianation or chanae to the City's Future Land Use Mao?
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 X No: Are you reoresentina 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 BEACI{
EQE _ - -- - - - -- _ - - - - - •
EXPENDITURES OR - •'Li •-■ s • ■ • : ■ ■_ :_•• ► a:.!! 4•0111111110
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Signature of •.•
I do solemnly swear tha all of the foregoin• .cts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mi. - • Ci � ;- • all reporting requirements.
Signature of Lobbyist: �/ 1111_,„00i
Signature of Principa 'lient:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
f Y O
V �'Ie e Sue Produced I D } >N
Produced ID ,--
Form of Identification Form of Identification z N 0
V�2/ 7 $0 oo� C3)
w Personally known(Lobbyist) Personally known(Principal) m -u'=Q
VII. SIGNATURE AND STAMP OF s i 4;' Z 6,—-S•Q-
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State of Florida, County of Miami-Dade =•��;�, State • , County of - e m a Z o
Sworntp an• . bscrib-d before me "'""'"' ' Sworn subscri•ed p=fore me Z•
Th's�`7� •- �R1•� ,2015 is day of 1�•l r ,2015 o C�E-
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1111 Z �, o..,
Si nature of Public Nota —State of Flo aM ,'nature of ` 'ic N ary—State • • i•a N
9 Notary
Notarization of Lobbyist's signature g 1 •, I otarization of • "1 '•-. signature
T** �_,� P TED BY CITY CLERK'S STAFF LY
Annual Registration fee: [ ]Yes[ No T IS :"• c, MCR# L� `f 6 Date Paid L( 44//5
Lobbyist Registration Form receivehand ve fia tr a cv
P N O
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Formrevised 5-30-2012.doc — ��∎
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, 4 www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @.miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME Sebastian Velez
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, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Mia i-Dade unty Commission on Ethics and Public Trust.
el Oil. 2
Signat -. Date:
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Miscetianeous Cash Receipt ._ -5•
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CITY OF MIAMI BEACH
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(THIS INFORMATION MUST BE COMPLETED) '_ Office of Finance Director
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,, CITY HALL CASHIER OFFI
1700 CONVENTION CNTR DR
MIAMI BEACH, FL 33139 IiiiiiL
04/14/2015
12:20:42
CREDIT CARD ,
VISA SALE
CARD#
INVOICE •• •5672
SEQ#: 0005 '4°"°°”"
Batch#: 0005
Approval Code: 001127
012042 City of Miami Beach-Florida
Entry Method:
Mode: Swiped Finance Department
Tax Amount: Online 1 City Hall
X0.00 I 1510420-2 04/14/2015 BR1 T131
SALE AMOUNT 35� Tue Apr 14,2015 12:20PM Trans#3-3
3 $350.00 MCRCLERK - MCR-City Clerk
MCR#: 403446
1 ITEM(S): TOTAL: $350.00
CUSTOMER COPY Credit Car PAID $350.00
Have a nice day!