Gustavo Berenblum - Sebastian Casano IV\ I AAA I BEACH 1,),e1,11,-A,toen
-
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.
Berenblum Gustavo
NAME OF LOBBYIST: (Last) (First) (M.I)
Berenblum Busch Architecture 2200 NW 2nd Avenue, Suite 203, Miami Florida 33127
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-200-5251 gbaberenblumbusch.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:
Sebastian Casano
NAME OF PRINCIPAL/CLIENT:
Washington 234, LLC 1395 Brickell Ave., Suite 925 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-351-7393
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
CJI
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: See Attached c- . - i`d
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY %OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:See attached
-0
ILSPECIFIC LOBBY ISSUE: ='
Development Approvals related to 234 Washington Avenue, Miami Beach
Issue to be lobbied(Describe in detail): vI
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 Department and Building Department Staff None X
PB,HPB,BOA, City Commission, as necessary* 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
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
5_ c,6 Mitc �e�
•
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION).
(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 X No: Are you lobbying on a present or pending bid for goods.eauioment 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 X No: Are you Iobbvina on a pending application for a Develooment Agreement with the City or application
fa change of zoning map designation or change 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 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
MR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
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: / 1
Signature of Principal/Client: . woo,/
VI. LOBBYIST IDENTIFICATION: 1 1 I PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identificat',�
lz
N
Personally known(Lobbyist) „VVV/// Personally known(Principal)
0
VII. SIGNATURE AND STAMP OF NOTARY:
ert Zto o �
State of Florida, County of Miami-Dade State of Flo ida, County of Miami-Dad- 3
Sworn to and subscribed before me -Sworn r,. d .ubscrib b for me z 0 w
This day of , 2012 This 1 day of IA , 2015 •ye%
Signature of Public Notary–State of Florida Signatu.” of Publi',, Notary–State of Florida "'kIt
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED LCITY CLERK'S STAF NL
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ $ MCR# ate Paid • ,._I
Lobbyist Registration Form received and verified by q 22 6 _'9
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDD Lobbyist Registration
Formrevised 5-30-2012.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ 1 (-.5 ift/Sy
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):4 l�S
(REQUIRED). l`6
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 X No: Are you Iobbvina on a present or pendina bid for aoods.eauipment or services.or on a present or
pendina 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 Iobbvina on a pendina application for a Development Aareement with the City or application
ism chanae of zonina map desianation or chanae 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 X No: Are you representina 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 C�l ri�'�y�:SA, • RECEIVED. IN THE CITY OF MIAMI BEACI-t
EQ$ THE PRECEDING CALENDAR YEAR. A ST' I `if ►1,' ,.--. BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR •ii ' ► _ •1 9 ► •: N. = LITITZTI
p ,
1
Signature • bbyist
I do solemnly swear that all of the fore►oin• fa s e t and ••rr ct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach 'ity 'god , IIIII r rting re uirements.
Signature of Lobbyist:
"if/I/i V'
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATIO PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
•�••�•••s ELIANA SOUS
�YP �Oi
Personally known(Lobbyist) •' i�t,, rsonally known(Principal)
• •t •s Fttlf
Notary Public•State of IMI
,• a My Comm.Expires Aug 14.2018'f
VII. SIGNATURE AND STAMP OF NOT k ii
a�� Commission!FF 151528
State of Florida,County of Miami-Dade :, - - ..Florida,County of Miami-Dade
Sworn to and subscribed before me Sworn and subscribed before me
This '7 day of M 4^1 ,201 This day of ,2012
•,: ...i'er.'•-,A,C2 12e/A---=1
Signature of Public Notary–State of Florida Signature of Public Notary–State of Florida
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$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
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Formrevised 5-30-2012.doc
IF:\CLE istration Form.doc Revised 04/27/2012 I
y' 4 1 ik 1
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www.rniamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Gustavo Berenblum
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
automati l y si ended from lobbying until all fines are paid, unless the fine has been
apps ale• t County Commission on Ethics and Public Trust.
difi -41 I mi-Dade o ty
7
Signatur_: Date:
ELIANA SOILS
144, Notary Public-State of Florida
I > My Comm.Expires Aug 14.2010
p Commission•FF 151328
t.
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City of Miami Beach-Florida
Finance Department
1 City Hall
1513120-1 05/11/2015 BR1 T131
-Mon May-11,-2015 02:43PM-Trans#26-26
26 $700.00 MCRCLERK - MCR-City Clerk
* MCR#: 404122
1 ITEM(S): TOTAL: $700.00
Check (0136) PAID $700.00
Have a nice day!
MIs Celia eous Cash Receipt
CITY OF MIAMI BEACH =
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(THIS.INFORMATION MUST BE COMPLETED) Office of Finance Director
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