Ralph Choeff - Thomas R. Kennedy, Jr. /\/\1AMIBEACH Ac H
4Oct er Di
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 3313 I5 0l.f 1 r
LOBBYIST REGISTRATION FORM i..1 :_f S `,. f_i v
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. Ste. 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,or e-mail address. :.
I. LOBBYIST RETAINED BY:
"(yr\Arna 3 12, VIVA;knr {•
(titAME QF=PRINCIPAL7CLIENT_;]
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BUSINESS-NAMEAND-ADDRESS (Number and Street) (City) (State (Zip Code)
305-tP 1 0°4 l ov 3 0 3 C li l-∎a u DV tit■avw,► &et-at - 3s 13
ErEEEPEICNEISIUMBEM FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• INAME-OF-CHIEF OFF-ICER-PARTN€R OR BENEFIGIAR-Y=-1 -113M teeNt,Ieb"4
• LIDENTIFY ALL PERSONSJiOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: -rU Wl K OV 'tom 1Ce1414€15%;
II.SPECIFIC LOBBY ISSUE:
Request for Design Review Approval for property located at 409 E. Dilido Dr. Miami Beach
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 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:ICLERI$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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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 LOBBYIS 9rMPENSATION):
(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 Z(No: 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.
YesNQVo: 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 SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE F D EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. /
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Signature of Lobb.- , ■
I do solemnly swear that al f the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mi Bea h City Code and all reporting requirements.
t
Signature of Lobbyist: 4 b •
Signature of Principal/Client • A.LA_ -
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
®Produced ID '+/ Produced ID D r i V OA l/I 0`
Form of Identification Form of Identification
Personal) known(Lobbyist) 2p`�`Y ,- Notary Public State of Florida
-rsonally known(Principal)
Y ( Y� ) . Juana Villalonga
or�o ExpCes 11/28/2016 224213 .
VII. SIGNATURE AND STAMP OF NOT' - .
ML1Sf414110 ern i ilAdiA,
State of Florida, County of Mia lade Stat: V Fier County ofAttiarlii-Dade .
Sworn to and subscribed before me Sw�� =nd subscribed before me
This , day of subscribe. ,201. 1 Th ,jjof SI f G PAIR 201 S
ililM .
Signature of Public Notary—State o•Florid. Signa .re FP'•lic Nota'''—State of flu►idd Sf((AuR t
Notarization of Lobbyist's signature Notari ti•n • Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY i ��`j
Annual Registration fee: [ ]Yes[ ]No. Amount P MCR# 8-1 0`�3'S� Date Paid :.,i V 3
Lobbyist Registration Form receiv : nd verified by ,
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Notary Public
F:ICLERI$ALL1aFORMS'iLOBBYIST FORMS\Lobbyist Registration Form.doc l )COMMONWE TH OF = " •
y My Commission Expires •
Au! st 8, 2021
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WV ML EACH
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: 305.673.7254
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) LO BYOST EXPEW OTURE AND COmPENS,1 TION F� ARM
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), a 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 .=:s 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 a=,ch year, shall be
automatically suspended from lobbysn si until all fines are paid, unless the fine has been
appealed to the \, 'ami-Dade County Commission on Ethics and Public Trust.
Signature: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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mummimpommillmomwmpr
City of Miami :Beach-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
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Have a nice day!