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Gregory Fontela - 2035 Meridian, LLC ao3s MIAMI BEAC City of Miami Beach Office of the City Clerk 6 li ft 17 PH 17 1700 Convention Center Drive, Miami Beach, FL 3313 LOBBYIST REGISTRATION FORM �' I L . 1- ! '- 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. Fontela Gregory NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell & Fernandez, PLLC 200 S. Biscayne Blvd, Suite 850 FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (305) 374-5300 (305) 377-6222 gfontela @brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address,phone, ore-mail address. I. LOBBYIST RETAINED BY: 2035 Meridian, LLC NAME OF PRINCIPAL/CLIENT: 170 SE 14th Street, Suite 1002, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 361-0971 pascal @ki2f.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: Pascal Nicolai, Manager • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Pascal Nicolai: 50% ; Radi Koytcha: 50% ii.SPECIFIC LOBBY ISSUE: Development approvals and-permitting matters for property d-at-2035_Meridian A unev e. Issue to be lobbied(Describe in detail): .. lll.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 Staff, City Commission, Development None. X Boards, Land Use Development Committee None. X and Commission 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 N/A F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 615/ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $1 85/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $1 85/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 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: 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 I-and 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. —YesXNo: 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 C•LENDAR YEAR. A STATEMENT -HALL B IL 1 E , T.ERE HAVE BEEN N• •_ • E 0- COMPENSATION DURING THE REPORTING PERIOD. / . . —le • 1 IL Sig 1f l o'Lobbyist I do solemnly swear that all of the foregoing facts are .nd correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami eachi Cit ode :-":porting requirements. •Signature of Lobbyist: -4 0I( 7' ,�Signature of PrincipaUClient: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _Produced ID ea —Produced ID Form of Identification Form of Identification Qi vrr If<z c� eil1 g L Personally known(Lobbyist) _✓Personally known(Principal) g VII. SIGNATURE AND STAMP OF NOTARY: D It n w o 6 c m c m State of Florida,County of Miami-Dade . m r a State of Florida,County of Miami-Dade .. .. 0 Sworn to a subscribed before me : r Sworn - d subscribed bef•re me ; 1 z -< This IQ day of ma,' .201k 5 1 This d'y of • , ,201cp ` Pala ro Signature of Public No ry–State of Florida ' ` • Signature of Pub Ic Nota "ate of Florida Notarization of Lobbyist's signature Notarization of P nci•a - signature • 'rte'' TO BE COMPLETED BY C CLERK'S$ AFF ONLY Annual Registration fee: ( )Yes( No Amount Paid$ MCR p 0 Date Paid Ob-II-112 Lobbyist Registration Form received verified by: F:\CLER\BALL\aFORMS\LORRYIS1 FORMS\Lobbyist Annual Registration For rn.tloc. Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $185/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $185/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 pending bid for goods,equipment or services,or on a present or pending award for qoods,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: 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. YesXNo: 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 FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Vete II ■ Sig J!;o'Lobbyist I do solemnly swear that all of 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 Miami :each Cit/Code ..:• : I reporting requirements. • t _ Signature of Lobbyist: Signature of Principal/Client: Le . prurrs per= "3 VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: _Produced ID y _Produced ID Form of Identification %A.? Form of sdte)ntification m _Personally known (Lobbyist) o c(0.2 _Personally known (Principal) o3R�'ic VII. SIGNATURE AND STAMP OF NOTARY: ia,6 cn State of Florida, County of Miami-Dade co-11 iu ° State of Florida, County of Miami-Dade Sworn to a subscribed before me A o Sworn and subscribed before me This ICI day of 11.40‘.1 201 N a This day of ,201_ 1 Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.cloc Revised 01/22/2014 F:\CLER\$ALL\a FORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MIAMI BEACH 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: _ Gregory Fontela 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. Mid I.6 Sig re: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Miscellaneous Cash Receipt CITY OF MIAMI BEACH 409 No. 's ,, 0 Cash D Credit Card ].Check# j-2.`77 $ `--100 . 00 �C 1` 20 �� City of Mian p ed of '1.>:;( - -t �aJ c.L - ' !ii 4-Yri-hr-1 i 4" c-7f F Miscellaneot,Add 2p1k,o V 1.)-(7.4 If Ad f if3 .4l;ip ys a, fr l,4 pi ! c'L_ i/ f,." 000203-0057 Jenel F... 06/1 7/201 6 03:18PM MCR OPEN For - ;..ice'..t f- , ( I „=Fra`Lr Payment Amount: 700.00 (THIS INFORMATION MUST BE COMPLETED) —f Finance-- Office of Finance Director 1 By Account Number: I%- ca Cr C ..S6 Li C-/ 00_ 365--- CC .•,,,..x i f v='. Preparers -. ;-'c�,�.=° r'�1.t.� -" FP ( Dept: I (' EXT•--)L1 I •( S C7 —I CID = O CM 3 S O 0 !-! O_ —' 3) m r-1- CT —. N3CD C.03 G 'I I Iz i 1Z O 3 C] 1-1-A J 0 AG :J -i C7 ii Z7 CD m G Cr CD n r-r C-.) T,p & C v o CD r - Q ! 7 CD = O O -0 Z CD T �w a rr D ter-! al m o ,--•■ Z G hO CD C!) 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