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Perry M. Adair - Guy Malul e ineril-- c Code,EAC H @� sn Su� o$etS 1\AIAMI i,,,<: City of Miami Beach Office of the City Clerk U15 0CT 1 Li `g,. 10: 1 c 1700 Convention Center Drive, Miami Beach, FL 331 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. Adair, Perry M. NAME OF LOBBYIST: (Last) (First) (M.I) Becker& Poliakoff,P.A. 121 Alhambra Plaza, 10th Floor, Coral Gables, FL 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 262-4433 (305)442-2232 Padair @bplegal.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: Guy Malul NAME OF PRINCIPAL/CLIENT: Soho Realty, LLC 961 Teaneck Road, Teanek, N.J. 07666 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (201) 862-9200 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: • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY, 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Guy Malul (50%) forit Cohen (50%) n.SPECIFIC LOBBY ISSUE:; Commission Agenda Item R5P(9/2/15) Arlen/14A erl Code Se‘Pcsftofrk 0-4 V,, e 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 City Commission 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) Hourly, $385.00 per Hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). Hourly, $385.00 per hour 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,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": _YesyNo: 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 SHA L `UBMIT if THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS7CO 'P N . ■ ON RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL n- I E'; EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. / /(________-------- Signa • e of Lobbyist I do solemnly swear that all oft - • -:• ng .cts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami F.-.7 !.'y ode and all re•o g requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: oduced ID Produced ID I Form of Identification N Form of Identification ���, 0-c9 Pers��nally known (Lobbyist) 4' , Personally known (Principal) ao'� VII. SI 'TURE AND S 'AMP OF NOTAR : (w cc z oa_ State of 'lorid• , cunt .f is i-Dade Y State of Florida, County of Miami-Dade Sworn and -AI,b. -'•:�• b:forms m Sworn and subscribed before me This � ��=i of , :i1, 'r, 201 .., �"-,,, This day of ,201_ �,, " Signature of Public Notary State of Florida Signature of Pus •Notary-State of Florida ,.,*„��:• g ry- Notarization of •bbyist's signature - Notarization of Principal's signature �, TO BE COMPLET ,D BY CITY CLERK'S Sj"l V a �O �/'�Q�/ Annual Registration fee: [ 4]Yes[ ]No Amount Paid$ �> 0 MCR#. Date Paid Lobbyist Registration For received and verified by: fif i.°°_• F:\CLER\$ALL\aFORI S\LO!MIST FORMS\Lobbyist Annual Regi∎ratio Farm.doc Revised 01/22/2014 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) _ ._ _iourly__$385.00 por-. {_.our___ B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). Hourly, $385.00 per.hour 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 lobbyinq_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": _YesNo Are you lobbying on a pending application fora Development Agreement with the•Cityor application for change Of.zoninq 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 UBMIT THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS'CO P NSA ON RECEIVED, IN THE CITY OF MIAMI.BEACH FOR L,---------'' THE:PRECEDING CALENDAR YEAR. A STATEMENT SHALL 'E ',L'E. EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. I �� /. /f Signa e of Lobbyist I do solemnly swear that 511 of ty(e f of cts are true and correct and that I have read Or am familiar with the provisions contained in Section 2-482 of the Miami Bea, {y, de and.all re••a' g requirements. I / Al Signature of-Lobbyist: Signature of Principal/Client: l',"'i C'\r'9 '.4ji,, VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ®Produced ID I Produced ID �.J't�((Q L.i CO-0 Se Form of'Identification Form of Identification _Personally known(Lobbyist) Personally known(Principal) VII-. SIGNATURE AND STAMP OF NOTARY: NS cQ State of Florida,County.of Miami-Dade Sta orida,Court -cri liami=Dade. c Sworn to and subscribed before me Sworn an subscribed before me' ' This _ day of .,201 Th. $l day of 3R ,2b t_ , - Signature of Public Notary--State of-Florida Signature of Pu•- "Notary—State o•Fla; v Notarization of Lobbyist's.signature Notarization of Principal's,signature TO BE COMPLETE, BY CITY CLERK'S STAFF' NLY Annual Registration fee: ]Yes'( I No Amount Paid:$' a MCR# Date Paid _____ _-pN:_Z3—=— Lobbyist'Registration Fo received and verified by .011W - f:\L€ \VII.\aFO .1 \i ..93BYIST Oi;i \Lob a'iis Arint)81 Regis,047-F.s tii,doc. .. Revised 01122/2914 KEVIN KARRON F:\CLER\$ALL\aFORMIS\LOBBYIST FORMS\Lobbyist Registration Form.doc N tary Public. Stato of.New Jersey Lic# 2410684 Qualified in Bergen-County Commission Expires 7/21/016 s` . tv 1 , -, \ IAM BEAC . _. _ 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: 305.673.7411 ,Fax:305.673 54 LOBBYIST NAME: ((7 - Oa) ) 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 lob i oho f/.s to file the required Statement by April 30th of each year, shall be autom:tic.. . s ended from lobbying until all fines are paid, unless the fine has been Y 9 P appe led ,o f iami-Dade County Commission on Ethics and Public Trust.ki - /.6) I Sign!re: a e: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ' Miscellaneous.Cash Receipt _,y=: i jrm i it, ,t;AtiE . un 1...si_ CITY OF MIAMI BEACH it:: ,,�x t,:,r ,;, ell,. 4 "g 4; 8 ;ii:00¢. - I _y g5o Cash redit Card Check# $ r - ., ' : . - - ' ' ::::::- -:;f: OHH: ° - 20 ` Received o I °tPS C:Y /Li -A C Address 'a\ i k? i , t_ tC'' . '?ta7cc /64" rf( ./(o r a f 61 t ; • For NN (i1 , -e,%. - f , (c (1C Set-4 ,®� , 0 $ 4;° . 43c4e.� - - -- - . ("--\ ic.-21J-f)-1-cel-t- ,-- cc.-1.17-4-5 -1-&- [1:'" - ,i' )',5-ri.::---t-Z:.-.: --- - -:'.:--=..- . .. -, , . . . (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director:" ,1:- 1, Account Number �- O 01 ,---,---,-3-::;,--,,.-,-,:,::: , Pre parer.`: ra- Dept: v,. r" let t :: EXT _ . CITY HALL CASHIER OFFI 1700 CONVENTION CNTR DR - _ MIAMI BEACH, FL 33139 10/14/2015 10:13:00 CREDIT CARD MC SALE XXX)000(X00U0(1663 CARD# 0010 INVOICE 0008 SEQ#: 001265 City of Miami Beach-Florida Batch#: 090638 Finance Department Approval Code: Entry Method: Manual Mode: Online 1528720- 1a 10/14/2015 BR 1 T131 Tax Amount: $0.00 Wed Oct 14,2015 10:13AM Trans#11-11 SALE AMOUNT 11mc$R845:04.000804t,�50 �O 8 CRCLERK - MCR-City Clerk 1 ITEM(S): TOTAL: $850.00 Credit Car PAID $850.00 CUSTOMER COPY Have a nice day!