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Ralph Choeff - Lansdown Probuilt LLC %.• MIAMI S f 6-SS 2, g4c)-7-tL City of Miami Beach Office of the City Clerk 4_ 1 700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM ;ww +' �� ! Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the-pessage, defeat or m modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recoMendationLof ithe=City 1- I LE 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 foreseeabiy 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@clfarchitects.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: I PY()& (,jar iIANLE OF PRIPCIPAU_QLI NT:I laroha i 1'1- (-LC, 1 10 t it c p'\ 61 IA if 7 071;#w11 4-L 3313?---LBUSINESS NAME AND ADDRESS I [(Number and Street (City) ' (State) (Zip Code)_J 3c35 X31-5(-1 3Z eJ oorC ooL,c'r j [TELEPHONE NUMBER: I FAX NUMBER:(Optional) EMAIL:(Optional) _Fill out_thls se.ctionifprincipalls.a C.orporatlon,.P artnershIpo1ir ust[Section1-482_(c)Li • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: P?r/A/CO 5"crc' Aww, U;P L 50% • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Request for Design Review Approval for 5352 Pinetree Dr, Miami Beach, FL. 33140 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 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 Nonce _ F:ICLERI$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc f— 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: t • •... • •• 'l.! • ,. : i 1! .L•_L• •,' it •.-a. D ••ai - 1 • • e- ii- .1. 1 - C o - ! • ' ,. • , • c t•eo zon , • i= • • • '., - • 1 • .,.i• • o 1_ ' 's , re ndU eMa•? 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 co_rporation or entity without special compensation or reimbursement, V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT THE CITY CLERK A SIGNED STATEMENT UNDER OATH.LISTING LOBBYING EXPENDITURES.AS WELLAS AS COMP • *N.RECEIVED. IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR, A STATEMENT SkNAL1 B P EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. . d/OW\ Signature of Lo•: I I do solemnly swear that all of the foregoing facts are tru: n• 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 6 0•in• requ• em:t_ . Signature of Lobbyist: 4! ! LSignature PrincipaV_Cliend • VI. LOBBYIST IDENTIFICATION: PRINCIPAL iDE ce F , _Produced ID •„�Produced ID -)cc r E Form of Identification Form of Identification o N _Personally known(Lobbyist) �/ Personally known (Principal) 8 o 1 z ..-3 Q Notary Public State of Florida 0 z°Ayr VII. SIGNATURE AND STAMP OF NOTA Y, Juana Villalonga 0 - My Commission EE 224213 Z O a `o State of Florida,County of Miami-D of f d Expires 11/28/2016 Sta , of Florida,County of Miami-Dade w O w u- Sworn to and subscribed before me - w , - - d subscribed before me n 2 This //: d- 9f Nt'vr 6t_t,201 day of (Und•,.►i b -,201 ., , M • 6 1 , n _ �`:Obi_o_ _,.,Pdgli - - II 1 Sig :ture cf P, blic No -State of F on.- 1. 1 Sig to o '4"Public A:tary-State of Florida ariza'ion -,f Lob y�st's signature N ar zatio of P riff i•al's signature ...,...... TO BE COMP ETED BY CITY CLERK'S STAff ONLY Annual Registration fee: [ ]Yes[ i No Amount Paid$ MCR# �� `3 Date Paid 1�� / Lobbyist Registration Form receive and verified by: /��° ,n-- F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Reg s�at1 nlorm.doc Revised 01/22/2014 F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ' MIAMIBEACH 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: 305.673.741 1 , 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. i 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 -pended from lobbying until all fines are paid, unless the fine has been appealed Miami-Dade Coun ' Commission on Ethics and Public Trust. / Oat< Signatu "� 0l gr Date: I F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc - . - - •i t 1 - S' 00,54 ]:t 3 4,(!/► - ` . ;v: i rrf•.1 l F .r=? rid t X r11,.0Auti • :c Miscellaneous Cash.Receipt ^ CITY OF MIAMI BEACH , R:• ,y f- ?;j .ti tr di nil. - -----:' - _ . '_:-.- _ ._ -.: , 0 Cash 0 Credit Card ,Check# Z()6 .._ -.: . $. _ P.: ' -..: .- ..,. • . . 1 - . • :::. ''' . , ..,, ,,,r.. . . ' • s, ' •:/1),O:_\;) - -;2;, • 20 I- . Received of 1 .4\ i �! L..1'- 1 - • - Address 44-0---\` �fir' P -1-,.•et. .C.. --,t T� , 4 ,f,-,/,t t. a -s,L. ,, `��r-5. - _- - For : _ . . - _ .. -• '.•:-.: -,- .,-. ..',.; (-2 -NI, , . .- , - - s''''''''1-"—'''''''''-'''''''''''';'-'-';'`..-7 (THIS INFORMATION MUST BE COMPLETED) • 'Office of Finance Director.•-Mit cel Number:0/./ ` {_6O1 r'- d .. 4 L - - - Dept: \L/.(ice.. . •Pre arer. . �.�� � � Dept: (. 7 / wasagIMPRIMMINIMMPIIPINFI voramemmrszimmiffilm City of MiamiBeach-Florida Finance Department 1 City Hall 1533413-1 11/30/2015 BR1 T130 Mon Nov30,2015 03:24PM Trans#4-4 4 $1050.00 MCRCLERK - MCR-City Clerk * MCR#: 408338 1 ITEM(S): TOTAL: $1050.00 Check (2064) PAID $350.00 Check (0319) PAID $350.00 Check (001592) PAID $350.00 s Have a nice day!