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Ralph Choeff - Ami Shashova dig .0 Zaf Rte' MIAMI BEAC (Warn, vectcv FC3711110 City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 331Y915 ir, 28 P, 3: b.,9 LOBBYIST REGISTRATION FORM C I ! `w' CI 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. Choeff Ralph NAME OF LOBBYIST: (Last) (First) (M.I) Choeff Levy Fischman 8425 Biscayne Blvd. #201 Miami FL. 33138 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-434-8338 rchoeff @choefflevy.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, ore-mail address. I. LOBBYIST RETAINED BY: la Mt \r\9,5\f\G\?:k NAME OF PRINCIPAL/CLIENT: i • V A o o 15 ccioke.Q p k t\. ,'<., 1-e �'0? . IAA k cif otAk 1 L- 5 \ Fl ['BUSINESS NAME AND ADDRESS[ Number%and Street / Cit I State t Zi.Code '154- 5? 111 ['TELEPHONE NUMBER: I FAX NUMBER:(Optional) EMAIL:(Optional)•• • 1• ••• • •1 1 ••- •I.••r,-._ •I •■1" 1•• • ( -.1••1 •.. • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: A • IDENTIFY ALL PERSONS HOLDING,DI ECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, ' PARTNERSHIP OR TRUST: ILSPECIFIC LOBBY ISSUE:I Request for Design Review Approval for 5718 N. Bay Rd. Miami Beach, FL. 33140 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 Design Review Board No 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 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) $175/ hr. B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $175/ hr. (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,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 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 S.BMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COM ENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SH FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. .• f Signat re of obbyist 1 I do solemnly swear that all of th- r:p: oing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami =.1 '(tity Code and all reporting requirements. I r ' Signature of Lobbyist: //�� aII W VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: 0 Produced ID Produced ID J ° m Form of Identification Form of Identification t N o m m W b / ig s • �/ Personally known (Lobbyist) 4 Personally known(Principal) ' ',I 0 E s r # zmSe 0_i VII. SIGNATURE AND STAMP OF NOTARY: ;( !a 3 State of Florida, ' •• my of Miami-Dade 0-44("N, Notary Public State of Florid. to of Florida, County of Miami-Dade Sworn to nd s •'b before a . Juana ViII. •nga •,w_.i n and subscribed before me This •. of 6-ti aj 201 1:.... � My Commies o , 3 i y day of VA ,201_ °' or a Expires 11/28/20 #% O h. L A-l.) . i'i►irk \� ( °w.s Signature of Publ•-• No . = = •f Florida Signa re r Pu•k o -6 —State of Florida Notarization of Lobbyist's signature Notarizatio of • cipa signature TO BE COMPLETED BY CITY CLERK'S S F ONLY (, Annual Registration fee: [ ]Yes[ No Amount Paid$ R# `-r'G�1 C 5� Date Paid 2c(26/l5 Lobbyist Registration Form receive and verified by: C F:\CLER\$ALL\aFORMS\LOBBYIST FO MS\Lobbyist Annual Registrat n Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ., . , , MIAMI BEA H City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E.Granada,City Clerk CityClerk @miamibeachfl.gov Tel;305.673.7411 ,fax; 305.673.7254 LOBBYIST NAME: Ralph Choeff 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 automaticall suspended from lobbying until all fines are paid, unless the fine has been appeal:ii e Miami-Dade County Commission on Ethics and Public Trust. / '' di 7 Signat !.r Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 1 Miscellaneous•Cash' Receit- ,. o p 3, 1 -.26.' . . CITY OF MIAMI BEACH - M1 z3 w f _ 4: ci7 ! :......-:•,,,...,;,..-..-,,,..'004-.7,t.:::',.--..,:•-.:.:!-•••.i.-t n,s7 , _ D o I 7/1 �7/3 r , Cash Credit=Card ..Check# $ . � 1 ci 20 l • r-- 'al-p-k : 'Jr:11h. .. .:•.:.- . '.- •: - • - __•--• - - .---. ._-_-:•-•-•-_-_-_:---,-,- • ....._ •_•-•-•:-..., ,..,:- -.- • •••• - -,:•-•-.,...---. . =,- • . ,... .__,.... ••. . , , . _. . .• . . . .. . .. . . . ... . . . . . . . ..... ._. .,. . . •,.•,...•.• • . _ ........,... _.. ....: ''''' '''.--'... - :' .. - - --Jr'K A4y.of. - ...Address_. -M 1 6,41'4,113c- • 1...?-it 1, '`. .1 9; -, . ao3 . 6 ?" i �-� -- For- D) ) d i - ( _ 52) g .,.Vp ",P-4Y' ,- ;4 `_ ..1-.4 9. - '.• -... • :- - . . .••- '- -•--4),..;;..--:'1,. ,4....... - .. ,.....,t.,, -.--1.-- v•,) ..-- • ..ii . • /A. .... .•;-')--.4,,.._f.t.s.' '.''''',...--.,-, .•:',2, .----\.. .:-..,. .•-i-c...---'-',5-:'-,,,..,--,.--:,..sH-..';'.--:-.-•_:.:•---.-..,-i-_, --...-- ,l ' (THIS INFORMATION MUSTAE'COMPLETED) .• - • ffic of•Finance Director E te,,,.. ,.„,..,,,,_,, Account Number: ': % °` �1 Liy • ,.- --, --- • - 1 Pre arer..•, ®.:�..: Dept: ° to EXT: _ .e-N. 1 fir•- ,,,= .,�.,..3: • •