Jose A. Bermudez - Ygrene Energy Fund Florida, LLC •
yoce, . Y reosk
• I Q�- l Proaci-evi
p Lam.
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139,,E „_� ,., r r �,
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the P assa e,`defeStar
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.
I3rriodez A
NAME OF LOBBYIST: (Last) (First) (M.I)
8ecker Po 1;a.k0 PA, 121 Iharibra P(a.za�arca Gab/ s + 3313C-/
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) I (Zip Code)
30 a Z(00. 1018 .3DS. NZ. 3.2 3L
•
J barn a c(e z&b )Qe J Cr
TELEPHONE NUMBER: FAX NUMBER: EMAIL: 0 q
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NA Our€ r)e &her ru�c,1 (''Pori cPo. LC. C
PRINCIPAL/ IENT:
rcr\e. E ner• rued 7lori I4.. LLC 33'0 Mc r St _ _ - ILL- 33/_
BU NAME AND RE (Number and Street) (City) ,'State) (Zip Code)
-� 0 � kim
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: RA.(1' k ?ere Z
• IDENTIFY ALL PERSONS HOLDINQ, R CTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: ll
II.SPECIFIC LOBBY ISSUE:
- - or r��. , -�C®:ro1 erc is -
C� - dPv•e C 1e. �—e�>n a r-,- -`h nth c�-�e- -- � ' D- �' j_-
Issue to be lobbied(Describe in detail): _I
� �ro v Jr-h p -e�to�t
nl. 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
(14-> Comm;ssiow
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
Y � � p
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
19-
F:ICLER\$ALL1aFORMS\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) rf / , le
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). �I
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 o: 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 o: 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.
Yes o: 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 C K A S, NED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMP . • IN RECEI • D, .N THE• ITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL B' __,LED : EN IF ERE AV EEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of o.: t
I do solemnly swear that all of the foregoin:. fac : are true -•... , rect an, that ave re-d • am f-- ith the provisions contained
in Section 2-482 of the Miami Beach C , C,d: and .0 requir- ent .
ISignature of Lobbyist: - Oillillk-
ilitSignature of Principal/Client:
VI. LOBBY(. ' (CATION: PRINCIP. IDENTIFICATION:
••.--d ID F' Produced ID
'�8��, JESSICA H E R N AIJ D E Z --- ---------.
Form of Identifi az
/ � _ *�. Notary Public-State of Florida �� Form of Identification
/ N. is L.
Q? My Comm.ExpH-
ires Jun 1,207
✓✓✓ Personally known (Lobbyist) :%�".a7-0. Commission#FF 019344 ,zspersonall known (/Principal
�,F OF FL�� Y (Principal)
)
',,,,1�, --
VII. SIGNATURE AND STAMP OF N• ,R : - -
on
'' Soya Yordi
State of Florida, County of Miami-Dade
(44.111
-%, :COMMISSION#FF051080 State of Florida, County of Miami-Dade
• Sworn to and subscribe before me ` Sworp -nd subscribed befor- me
�.,,, �,EXPIRES; SEP.04,2017
This ■ b'"° ..ay of � ) 201 ,°y o.�° 1NWW.AARONNOTARY.00m This P'•-' : .,*, 1 , 2011
Signature •v'c Notary—State of Florida r�na • e o Publ , _ :-. _�• - of Florida
Notariz-• o •f Lobbyist's signature Notarization of • ••_ipal's sig .ture
TO BE COMPLETED BY CITY CLERK'S TAFF NL
Annual Registration fee: ['1(es[ ]No Amount Paid$ O.CO MCR# q Date Paid O5'O-1b
Lobbyist Registration Forn9 reZ�ived and verified by: _Wok) SAW I T J1 -
.:'TIER V4, ,_ F C;f4;.'i \LOn\IST-;a S\Lobbvsc An t.i?, Regi isation Form.doc Revised 01/22/2014
F:ICLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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: 305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME: J o SC_ vM tide_ Z
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 th eq ,fired Statement by April 30th of each year, shall be
automatically suspended from 'obb mg until all fines are paid, unless the fine has been
appealed to th mi-D e C u Commission on Ethics and Public Trust.
q. z0 .(
Signa re: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
y • .A,,,'-.'t _ 1 ! �M.Y BEAC.,s y H. "
4 p
� ` 1 r
n i cellneous Ca Receipt 1 1 ' ( k• k S Msa r : L J � � r i F r.s . : CITY OF 1_�/ .: J - } �0.= 7 -_. , , ,! ! .1 . r 1 - Vr L y r t% r i w G � !,!v.7 sa yY r -s. Z _ 1 -lq. t _ .{
,','.;,',;:i.,,-.1 illif;';i;;-..§:f,t-..F.-`-�= Q Gash 0 Credit`Card °Check-# f . , , : - s u'. _ . -"f ., x
� _ -J. ;;-,=,..-:-:• '..:1.::4,,'.,.'s.,:,;',,7',...!'....',::'r - '4 1 7 _t• 1 i �.r•
�r e '! r , �r. 5 , a -r ,t r 0_s o f r ZQ;; s..t`,} a
1::-:....,::::1•i::: ::-,':',.'1;.1. :-..:;-",-.":".' 1 y' City of ia 0d Of. 1 ' -, � -,--.7
! e(� , .Y81 i_:i..-,..''. f`r�:gidS.s7'.` Y.,4:.. , f > c. . • •:' t A FI t
1:!-''...,-_.-.....:,'
Miscellaneous'� ` 2 6. -_ -
-r � ° 'x.yG ,' �•�:�Ydli1. eY�' �f ,� .,, `.£ -::��.> . 1 _ _ t . r .
:•) 000045 002 _ y• a r t '
r i ,'t 't. 1
MCRiOPEN - } )
+ -'r ' 1 J i 1 ,, e } '{, t .31 :-.,...-%,{-,..:,:..... I.: ; ry h fi 7 1 � 4 t
'' Payment Amount 850 OQ =. '` •3
C r y i r ' `,' N I
� f MCR4094s6' (THIS;INFORMATION MUST SE COMPLETED) Office of Finance Director
.;ti�..i.: { Y ••,v �� 4...'I -r - mil.- - ' _. + r _ q ^'h -- - •r} ?- -r! 4 e _yr
h Tom.r a J - -� 6 .e t J - -. - - _i ,
:` n` Number.= .J'r :. �� ;: ± )°I•ii Accou t � r
} rk':y} 'f_ n .r t v _sr 5 Z, r i n r 't, 1 , �- i _r j .s\ r ? s ,.' .
:a
,/-Fi °Jt�Ti� s •�•„^ r a r .9 `7 y r ,,, -' :' .. rn _: t s 1i
p Pre arer. . ., < :. ' , . �,. D®jit.. . .. :EX >,. f l ,
)} ,,::- 73 6 J, r ,, .1 �} fr r - t ,,-:..,:::,-,::::::,-,..'„:-_,,,,,.:,,.ii, rr y�' ;! ;J` -L r -Y '} t.
E at f r 'f tJ ) IJ
1 ' l F �! I � ��r R J ,- A.r i 1 , ur -� 1J•
r:.rt' t i•f,: Ar..:.. -; --f`-7 1 r -� Jw �- )„ ;c°-, :.� •7! -Ti r .e i F *.:R .�-t v t rsl Y 45 •• } E t
,.-:...; ....�- �•-. • -
y.._,.^. = ,, :.f., ,--:� r.. _ fax 1 t•�:.. 4 ....y: .rrr!.s:,. . - ...s', _
, C
n s 3:i CQ CD ?� �r G ] -is C
f
—, D C O r Z' CD CD
m ° 1-a C r .) ` O o n r./3 if' a k;
C w rj n O C LT1 to o Lfl
s._.. f
0. i
m
F T 0 ems.
—n
— c.) - —cc
-<
i. i 2 Ln
■
F/, ! 1 ! Cr)
LT: L.71 CJ1! #i C O LT! f G
I.Li,_ ° C ..i.
CD
CD ° o - 1 ti
° ° C CD ' ° 3
•
U4-04, 6-ntry
Salvatore, Jason
'
From: LaPlant, Colleen <CLAPLANT @bplegal.com>
Sent: Monday, August 15, 2016 10:58 AM
To: Salvatore, Jason
Cc: Bailey, Michelle; Chamizo, Roberto
Subject: Hi Jason, nice speaking with you...
Sorry for the delay. Please see below and let me know if you need any other information from us.
G200 Exchange, LLC
Hourly
Kevin M. Markow$450 per hour
Jeremy B Shir$300 per hour
Ygrene Energy Fund Florlda`,1-L"C?
Flat Rate
$3,000
Jose Bermudez
Jose Fuentes
Connect Miami Beach
Flat Rate .
$12,500
Jose Fuentes
George Burgess
Jose Bermudez
Thanks again.
c
Colleen LaPlant
Executive Assistant to Bernie Friedman, Esq. and Jeremy Shir, Esq.
1 East Broward Blvd., Suite 1800 I Fort Lauderdale, FL 33301
Tel: 954.985.6804 I Fax: 954.985.6814 I E-Mail
Website
BECKER&-
POLIAKOFF
GM I
The Becker & Poliakoff Client CARE Center is here to serve our valued clients. If we can be of assistance in any
way, please call us toll-free at 1-844-CAREBP1 (1-844-227-3271)or by email at carePbplegal.com.
1