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City of Miami Beach Office of the City Clerk
1.700 Convention Center.Drive, Miami Beach, FL'33139 21116 LIU,' -> p.; 1: c7
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.
Benson• Charles H.
NAME OF LOBBYIST: (Last) (First) (M.I)
Charles H. Benson & Associates, •
Architects, P.A. 1665 Washington Avenue, 2nd Floor, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) . . , (Zip Code)
(305) 532-6161 ' (305) 532-6151 - • carkitect a(�.aol.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: .
MBR Consulting Group, LLC
NAME OF PRINCIPAL/CLIENT: -
801 S. Pointe Dr. • Miami Beach, FL • 33139
BUSINESS NAME ANU AUUKtSS (Number and Street) (city) (State) (Lip Uccle)
(786)608-5667 • '
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:(if applicable) Mikhail Feldman .
•
- IDENTIFY ALL PERSONS HOLDING,DIRECTLY R INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:(if applicable) /v ,
u.SPECIFIC LOBBY ISSUE:
`Development Approvals and Permitting Issuesincluding,but_not-limited-to-Design Review Board and Planning Department approvals
for the-propertv(s)-Iocated at)801 South Pointe Dr. Miami Beach. FL 331391
Issue to be lobbied(Describe in etail): -
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 Department and Building Department Staff. _ None. X
ORB • 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.Outiook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc /S/
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $275.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $275.00 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 lobbvina on a present or oendina bid for aoods.eauioment or services.or on a present or pending
award for aoods.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 XNo: Are you lob•vina on a oendina application for a Development Aareement with the City or application for
chanae of zoning map desianation or chance 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 XNo; 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 BEACI{
EQB THE PRECEDING CALENDAR YEAR. A STAT ,.1.6, , •NT Si,'L FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR •ii •_► s • ► I ■ ■ •_ C_•• ilT _, • .
iwr Tit
•
Signature of Lobbyist: Charles H.Benson
I do solemnly swear that all of oreg . g f are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami eac Cit o an all reporting requirements.
Signature of Lobbyist:
Charles H. Benson `
Signature of Principal/Client: 1, /(nt / ' ` (S��L�('� /tee _'/� 1
VI. LOBBYIST IDENTIFICATION: l • / PRINCIPAL IDENTIFICATION:
_Produced ID S 11Y Vnown AZProduced IDQr 435 5406.,3 0 6 -O
Form of Identification Form of Identification
w A Jy r's
Personally known(Lobbyist) o r a _Personally known(Principal) "'
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VII. SIGNATURE AND STAMP OF NOTARu•Z ° b 2 Z . Y „° m •
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;R Y :r, - W o i j 6 . aD Z i.
State of Florida, County of Miami Dade y n Z State of Florida, County of Miami-Dade $ H W
Sworn to-and subscri d before me a ° W y a, Sworn and subscri ed before me . ' " a# A
This 9l da of ,201E, fi E .a E E This/. of R� , 2010 a j u, .y o Ilk ib&ouftat
Signature Public• ry-State of Florida Z g m Signature of «ublic Notary-State of Florida o
Notarizatio of J.obbvist's signature ' ,0;c��:��`o s Notarizatio of principal's signature Z m
TO B-'cif
z.,�''-'�l;:F T'CLERK'S S FF ONLY m ' �/',,:,`,,,....,f t
Annual Registration fee: Yes No Amou k P': `'� MCR# M al 1I 1 Date Paid (1+.;►. -':7 r'�l='��o•
'i N 'tP.`-
Lobbyist Registration Form received and verified by: -.m "'o.It,_;.,
/\\t‘ I I . I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami 13each, Florida 33139. www.miamibeachll.aov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk'ii.miamibeachll.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Charles H. Benson
I understand that no later than February . .8 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
bee cppeale to the Miami-Dade County Commission on Ethics and Public Trust.
1- - 5/25/ge .
Signature: Date:
!
1\A i AM 1 BEACH r'■ r • \ ;•-•
City of Miami Beach 2016 LIM -2 P!', I: 5]
1700 Convention Center Drive
.,',v'S
Miami Beach, Florida 33139 CITY CLL C'Fr ICE
www.miamibeachfl.gov
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: Charles H. Benson
Business Name: Charles H. Benson &Associates, Architects, P.A.
Address: 1665 Washington Ave. 2nd Floor Miami Beach, Fl 33139
Office Telephone Number: 305-532-6161
Cellular Telephone Number: 786-246-8180
Email Address: carkitect3 @aol.com
If more than one lobbyist, please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
i • For City Clerk's Office Use Only
"
MCR#: oat co-19 •
Amount paid: 99° Date paid: b 6 -02 . it
Processed by: . .1\-5=4J EA GWV=(l- Date: 06 - o2. 4
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