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Thomas Robertson - Washington Gardens, Inc. 5-0c, — 15156-164, MIAMI BEACH „ . , City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 U5 DEC -8 El 2: / 0 LOBBYIST REGISTRATION FORM CITY 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. Robertson Thomas NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell&Fernandez, PLLC, 200 South Biscayne Boulevard, Suite 850, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-377-6226 305-377-6222 MLarkin(i,BRZoninaLaw.corn TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Andrew Resnick NAME OF PRINCIPAUCLIENT: Washington Gardens Inc. 1228 Alton Road, Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 673-4981 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:See Attached. S phq�� �c51AACK, • IDENTIFY ALL PERSONS HOLDING,DIRE TLY OR INpIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: '£ 1NAN II.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or Committees. if necessaru. relating to the propertu located at 1509-1515 Washinaton Avenue. Miami Beach. Florida. Issue to be lobbied(Describe in detail): In.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2482(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 Staff for the Planning Department, Building Department, None. X Public Works and City administration, PB, HPB, BOA, None. X City Commission, and Mayor 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 p Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$350.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $350.00 per hour (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 pendina bid for goods.eauipment or services.or on a present or pending award for goods,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 Iobbvina on a nendina application for a Development Aareement with the City or application for - chance of zonina man desianation or chanae 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. Yes X No: Are you reoresentina a not-for-profit corporation or entity without special compensation or reimbursement., V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SH' •UBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL • •F•MEENSATION RECEIVED. IN THE CITY OF MIAMI BEACH, FOR THE PRECEDING CALENDAR YEAR. A STS SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR,C•►i'-►S k O. DU: ►G . : •:Tr • 3 yaw ver Signature of Lobbyist I do solemnly swear that all of the f•, ./.oing f.cts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami B:: ,' ode and all reporting requirements. Signature of Lobbyist: " \\( ,\\ Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _Produced ID '"a _Produced ID Form of Identification a Form of Identification _Personally known(Lobbyist) mt>i $Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: 5 k 23.3 c N 4 01 g State of Florida,County of Miami-Dade 0 d State of Florida,County of Miami-Dade Sworn to d subscribed before e TN Sworn and subscr...ed bef• e me This day ... 015 This -7 day o, 11� _. !" - gib ..: CLAUDIA SALDARRIAGA • . � ..;...1) i�_ / ii t_j���S.a� •r. MY COMMISSION ft EE 836893 Signature 0/Public No ry-State of Florida Sig .ture of Public Notary-Sta ;. `'¢ EXPIRES:September 25,2016• Notarizat on of obb is signature Notarization of Principal's sig �''`� ondedlhniN°taryFubhcunderwriters L . TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ Yes[ j No Amount Paid$ 58 MCR# 40$)Sck Date Paid 1 qv/s-- Lobbyist Registration For received and verified by: r . M I AM I BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITE' CLERK Office Rafael E. Granath), City Clerk CityClerkCu,miamibeachfl.gov Tel: 305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Thomas Robertson 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 sus "nded from lobbying until all fines are paid, unless the fine has been appealed to the 11 : i-Dade County Commission on Ethics and Public Trust. /* /Z-.A7//'‘r. Z-.A7 `s— Signature: i' Date: C:\Users\clerhatI\AppData\LocaI\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc WASHINGTON GARDENS INC. SARA RESNICK FAMILY TRUST- 40% GREEN ARM FAMILY LTD PARTN- 10% JAMES& LIDIA RESNICK- 25% FR SPOUSAL ACCESS TRUST- 25% J_ Tr,� - ';.:342.1 ti e:24 d- .YU.s ir+r'!�ik.��J L v..b ifl t I's4 Y Miscellaneous Cash Receipt _ .: _ 6: g b z CITY OF MIAMI:BEACH +1 y.:ar No. 0 Cash 0 Credit Card Check# _ I -0 _. .: ,_ ::�j : . \ .-e /1 20 A3 j'- - `Received of r�v!t 1 l(a te=( .0'l i k ill '�If.0 I. �i - _)t'r. ` ;:4 .:} _ - '--Address Zt , t. (°6, ;;C: ,' �:,(1 -' l', ()_�L-e. - � 1 - ' , " `s - - or . i � N -1.z-F _;";V'.f l-Ec-4;-M ` fe (( � 1 - ::.,. -., . .-_-':: i I I- , riiiv-i.)()E40, : _ , - _. , 1 cs.,-,..)Lik: ,) _.. - :- --, : : . .---- -• , , ---'.f ( 7 ) - , ,. . .,._ . . . _ . . . ,. ' :`Q{ ;-- (THIS INFORMATION MUST BE COMPLETED) , :. office of Finance Director ..i ,tom ,,+ j Via. , Account Number ,. `, ( )(c.,- f -3 ` _ r i Preparer. --ti .4. V1 . - • Dept: 1 -�f • I is �' - .. 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YW:� 3u' Sx . - Y l City of Miami Beach-Florida De Finance p artment 1 City Hall 1534213-1 12/08/2015 BR1 T137 Tue Dec08,2015 02:09PM Trans#24-24' 24 $1200,00 MCRCLERK - MCR-City Cler * MCR#: 408359 1 ITEM(5): TOTAL: $1200.00 Check (00001804) PAID $500.00 Check (001060) PAID $700.00 Have a nice day!