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Jose Gomez - JEL Development LLC 336 90-4s+ A/l,a r►' ac.in,fL • j=l t\/\I/\t\/\I BEACH City of Miami Beach Office of the City Clerk Q �� 9� Y Y 1700 Convention Center Drive, Miami Beach, FL 33139'1-.11,1-5- -- .;,r -,, O i=i= i r. 1_,1 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. Gomez Jose NAME OF LOBBYIST: (Last) (First) (M.I) Beilinson Gomez Architects 8101 Biscayne Blvd, Suite 309-310 Miami, FL 33138 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-559-1250 305-551-1740 JG(UJBeilinsonArchitectsPA.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: JEL Development LLC NAME OF PRINCIPAL/CLIENT: 1255 Sabal Palm Dr. Boca Raton FL 33432 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212)867-0800 kislin(atcnewuork.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: David Kislin • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:David Kislin 100% II.SPECIFIC LOBBY ISSUE: Development approvals and building permit issues concerning the propertu located at 330 76th Street, Miami Beach,FL 33141 Issue to be lobbied(Describe in detail): lll.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, City Commission, Development None. • X Boards, Land Use Development Committee None. X and 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 None_ None. None_ C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COM Ehe NSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $280°00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $250'00 A r- 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 XN0: Are you lobbvina on a present or oendina bid for goo a goods,euinmen services,t or or on a oresent or pending award for(oods.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 o• L - ■ •.• i1• •1 . •-1• /• - •• •1 • L: :_ ■•1•:1 _' --11'1, .• 1 1. • • �! ••1 • /.1t- • •■•■• u-! •- ••■; .l1 • 1-.1•: • 1i -. - - -.• .:1! - U:• 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 ffe es. Yes'No' l;_ '.• •. : :1 "1 t . /t - ■ _! • ••t " • • !.: 1 , V. SIGNATURE UNDER OATH: !■ : -: ,i ! r,- . fli : _ .__.. , . :14 ! _ - •: . _ ■ _•_ -- ► ,.....•_. • , :_, _ A ..__ . !li _►.. _ !. -ID ■ ■_ . b ! if ,i1 a EQB I.... -: a ■ ►!:: . _I : , .. _Uz► _ .- , _II ■ .t EXPENDITURES OR COMPENSATI•. DURING THE REPORTING PE %= Signature o obbyist - I do solemnly swear that all of the foregoing facts are true •-• ect and that I ave read or a famili with the provisions c:to:it:m;(1 in Section 2-482 of the Miami Beach City Code -'. a I --po •• e.' irements. Signature of Lobbyist: � -- � °• ��Signature of Principal/Client: 7 w' `•; MON�FF �� _.� .a- EXPIRE n � ,1°�, eoeaed Thru n S June 9,2019 VI. LOBBYIST IDENTIFICATION: h o N II PRINCIPAL IDENTIFICATIO - taryFuDlkUrtden � Produced ID L7v/ldrAlpvii%r '� -= c o Produced ID kaikrt liih .r Form of Identification /+- Form of Identification ,Personally known(Lobbyist) Eilli Personally known(Principal) E, _ VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade tY State of Florida,Flonda County of Miami-Dade •�•� • Sworn to and subscribed before me ' •,, Sworn and subscribed before me �` � ' This 24.1 day of Z .1L.-f ,2015 (3-113,--� , This i 7 day of �T�n.e ,2015 1 I : 01/-444,-.4 ____,,_ Signature •i� ublic Notary—State of Flori•�: +n Signature of Public Notary—State of Florida ' _ j= Notarization of Lobbyist's signature - Notarization of principal's signature ��;►�_i�• TO BE COMPLETRI]W nITY CLERK'S S _ "'"'°, �D- Annual RP©istratinn&F.- fes(' ]No Amount Paid$ 160/Iz, NICK# i`VTR �, Date Paid )5 Lobbyist Registration Forl((I received hd verified by: ,.' "2 S I...co ig A, W y r T i IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COM NSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $ 02,53.00 A i B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $ p_95. 06 A 1 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 lobbvina on a present or oendina bid for aoods.eauioment or services.or on a present or pending award for aoods.eauipment 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 lobbvina on a pending application for a Development Agreement with the City or application for, chanae of zonina map designation 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 XNo: Are you representina a not-for-profit corporation or entity without special compensation or reimbursement, V. SIGNATURE UNDER OATH: •► ► 1 ,7: • 0 - ■ _ ■ 0: : ■ 11 0 ■ I :• .. ► 9 1/. k I:9 : •1 ■. - \ _•■ : I _. 4.I :_ I___ 011 -_l 0► i._-._ _I I ■_ 1 • 11 LIJ _ _L ti iv" _ EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD, E-505.4.C .2_See 04/ter Pi°9eJ .. -__ 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 previsions contained.' in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: ..'. rP''•,, �,; VICTORA3SIS ik ';i MY COMMISSION#FF 238886 Signature of Principal/Client: i - EXPIRES:June 9,2019 P"' Bonded Thru Notary Public Underwriters VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION. Produced ID iPl/ ielieW//T%7 e%'4"-" 'Produced ID keedri BnieekeAr Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade' J ''� cil Sworn to and subscribed before me Sworn and subscribed before me This day of ,2015 This /7 day of crveLe. ,2015 44401S 0:F', Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida ` _ t Notarization of Lobbyist's signature Notarization of principal's signature X44=-1- .,, .,,,: 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: g 8 ` 2 IPTh9 L ir N T Vf r , r 10 I AAA! BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www.miamibeach0.gov CITY CLERK Office Rafael E.Granado,City Clerk CityClerk @miamibeachfi.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Jose Gomez 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 fr lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade ounty Commission on Ethics and Public Trust. 7/27h Signature- Date: C:1 Userslclerhatl\AppData\LocallMicrosoft\Windows\Temporary Internet FileslContentOutlook183LGQDDHILobbyist Registration Form revised 5-30-2012.doc ....,,,z,,,--,v ,-':,..-;..• ..,11,,tii:--"--'-'6ii,,,:...-:-..•=.---;•=:- -.:'.:-..ii--..'-'4..,...5.::::: :f.--:,':';,..';'is.- i (0' Y77..i.'"iiii'l,',... ..„:,..).,..,,,7.-,:i,1.i::;.;ifj.ir,-:''.',,': kiii- ..".:•.,..,.;;;;,,,..,:it.,;:ji:•:!.'i_:- .-,:,,,,,-7-7:r:',,;:,,....,„:71.-'..,..:•,,,',.......,',.ir:,-,::,,,.-,•1•,,,.....,':.:::1-:',7....,;....::::,'77,..,_.‘,.,,,,,;.,,,-,,4•J....-,.f;..-:•.:..,4,',';=;-..-,"..,:i;-..,:,,„ ,r•-2-i....:,._;_ii.-:;.1f•i,,s.,:.-..,..1-,:i.-...;,.-_,,-_„,,- ...,,,.i....,.9.71::;:fl',(.-7-:;- - :. s:n•-..,...-.:,..I.--;,:•=:::::7:,::,,..::::.1::::::.;,,,...„,. 6714--,,:?: ':'..tii:t...-‘- =-_,,;:-4:-..= :.._;.-:!:-,.,-,-;.::.,-;',:_:::=--,,::::,-..-.;:',,[,,..,-,--',J=:i:;,i-1::;-,:,:!i:..1.-....:,::=;,.. :.,:::•;:r.;:-_-'-,-;!-..,...:;:;:,,--}..,„-,-i._:,:I.,,„'::::e.-.-..:,,,z.(;i..;,-:.:,.--;[iiu ,;.•-' 154,--',;=,.-._:Jr-;. 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