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City of Miami Beach Office of the City Clerk n
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM 21115 NOV Q �g t �
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,leeommendation 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.
Mosscrop Iliia
NAME OF LOBBYIST: (Last) (First) (M.I)
Mosscrop Associates 460 NE 59th Street, Miami FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 751-6529 mosscron(aJamail.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:
Adam Greenbera
NAME OF PRINCIPAL/CLIENT:
3193 Royal Palm Avenue Miami FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Lip Code)
(305)350-0927 AGreenbera(alnakf.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: j/,
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: !i AG
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Board, Planning Board, Board
of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 3193
Roual Palm Avenue, Miami Beach, FL.
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, Building,Public Works and Fire Department Staff None X
PB, DRB, HPB,BOA, City Commission, and Land Use None X
Development Committee, as necessary
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
1 _•i
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required): $ Soo ' '
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):$ 5 OQ
(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 lobbvina on a present or pending bid for goods.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 X No: Are you lobbvina on a pending application for a Development Agreement with the City or application
fa change of zonina map desianation 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 o; 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 COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACF1
MS THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HA BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
P •
__1 (--------
Signature of Lobbyist
1 I do solemnly swear that all of the foregoing facts are true and correct and that I hay:. read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all reporting requirements.
.( /
Signature of:::: ent:t: ii,1—
Signature of
I
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
if—Produced ID ri JI . roduced ID
Form of Identification • Form of Identification
Personally known(Lobbyist) Personally known (Principal)
VII. SIGNATURE AND STAMP OF N
.tk .° ''s JULETT K ROBLETO
State of Florida, County of Miami-Dade �''+r �''
� $ Notary Public•state 01 Ffori�*of Florida, County of Miami-Dade
Sworn,to�qnd subscribed beforgg��me * '; My Comm.Wires Sep 7,2diBrojrn nd subscribed before me
*Is ,3`' day of/f/t1tJr?'M!) i-2016 ,, Commission I FF 151501Thilto day of OCk'�MA ,2016
Signature of Public Notary—State of Florida Signature Publi h Notary—State of Florida
Notarization of Lobbyist's signature Notarization of P incipal's,signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONL�� r
Anneal Reggistratinn hap. ( Ya [ ]Nn Amniint Paid$ s J MCP# c O flat Paid I 1// /)
Lobbyist Registration Fo received and verified by: m■ '
1
• 4
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office •
Rafael E. Granado, City Clerk CiiyClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: I L I J A H.n S S C(-o('
•
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
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust
(6 .3o 5- .
Signature: Date:
•
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City of Miami Beach-Florida
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1531313-1 11/09/2015 BR1 T137
Mon Nov09,2015 03:32PM Trans#36-36
36 $1200,00 MCRCLERK - MCR-City Cler
* MCR#: 408091
1 ITEM(S): TOTAL: $1200.00
Check
(001124) PAID $350.00
Check 00
( 00002025) PAID $500.00
Check (001123) PAID $350.00
Have a nice day!