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City of Miami Beach Office of the City Clerk j,r
1700 Convention Center Drive, Miami Beach, FL 3313
LOBBYIST REGISTRATION FORM
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.
YA Fes-NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) 'Zip Code)
t) J 7 2 522-2— q(4.- (� ScxUo� Z S cOvi .. Co wj '.5 t3Z
TELEPHONE NUMBER: FAX NUMBER: AIL:k
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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: 5e6 AsA-c-v.k-0-0
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST SUCH CORPORATION,
PARTNERSHIP OR TRUST: !_A [� J
II.SPECIFIC LOBBY ISSUE: °o we
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
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
F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach Office of the City Clerk ^�� ;i.[ � ? ;'ii 1' 40
1700 Convention Center Drive, Miami Beach, FL 3313
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LOBBYIST REGISTRATION FORM
Lobbyist means all persons empieyed 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 hoard 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,
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YA. AQ— 004-
NAME OF LOBBYIST: (Last) (First) (!M I)
BUSINESS NAME AND ADS (Number and Street) (City) (State) Zip Code)
TELEPHONE NUMBER: FAX NUMBER: AIL:
Please notify this office if your contact information changes:address,phone, ore-mail'address.
I. LOBBYIST RETAINED BY:
0
NAME OF PRINC
4.002 TON .ROAD . MGM' BEACH _ .FI 33-140 . .. -
BUSINESS NAME.AND ADDRESS (Number and'Slreet) ('ity) (Slate) (tip'Code)
3.05-534-7050 _ 305-534-8444
TELEPHONENUMi3ER: FAX NUMBER:(Optional) EMAIL:(Optional) -
Fill but-this section If principal}is a Corporation,Partnership or Trust[Section 2-482(c)] —— —
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:CORPORATION/ RABBI YITZCHAK ZWEIG
• IDENTIFY ALL PERSONS HOLDING DIRECTLY OR INDIRECTLY.A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: .
u.SPECIFIC LOBBY ISSUE: �----_
iM.QDI:FICATI_QN=T_O--P_RE-VI=OUSLY—AP.PROVED-APP-L-I CAT-hO.N�Gv�_�T',,��,Nt��1L �,�4u�R,S
Issue tie lobbied,(Describe ih detail): C�oC�C LTD '!4'i)}
III.CITY AGENCIES/INDIVIDUALS TO BE:LOBBIED:
Pursuant to City Coda Section 2-482(a)(4)include the commissluner•or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual rciatlonship (paid or unpaid) with said city cornrnlssloner or.personnel.hi-pm •12 months preceding such person's
commencement of service with.the city to the present date,static the general nature of the.subject contractual relationship.
Sec 2-482(a)(4)Full Name.of Individual and 1 Contractual Relationship(Explain)– YES NO
title of person to beaobbied iXX
PLANNING DEPARTMENT NONE . - __—[XX__
ORB MEETING --:._-._... NON.E __ XX
Pursuant to City Code Section 2-482(g)Every registrant shall he required to state the extent of any business,financial,.familial or professional
relationship,or other relationship gluing 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 24182(g)Any Financial,F_amiltal or_ProfessionalReiationship _
NONE __----=-- —_—_ --—
_------ -
F:ICLER\SAI_I_IaFORMS\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) •
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_No: Are you lobbvinq 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
Dev lopment Issues":
Yes No: Are you lobbvinq on a pending application for Development with the City or application for
_ _ Agreement
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
7Yes' item,shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
No: 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.
ature L b s
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 Mia • ach City Cod and all reporting requirements.
Signature of Lobbyist:
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"Q Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: r
Produced ID Produced ID
Form of Identification Form of Identification
1 Personally known(Lobbyist) /Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade
Sworn to a d subscribed before me Sworn and subscritd before me
This I day of W- .,201 This 1 day of <c 201 S
Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
50,4a fr.‘ 1r-vl c.o
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ r+ '# A Date Paid
Lobbyist Registration Form received and verified by: :1t`0`E--t•' . • ' . M _
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IV: DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION[DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER);
A) LOHDYIST DISCLCSUR.E:(Required) N/A - _-
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).. N.L_A_ ---__._.-.__—__ ._.—.—.._.._ .T --_
The following Information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Eniilled"Prohibited Campaign Contributions By Lobbyists On Procurement .
Issues": .
•
Yes No: Are you lobbyfna on a present or,pendinq bid for goods,eoulprnont or services.or on a present or pendina
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award for goods,equipment or service?,
2) Pursuont to Miami Beech City Coda Section 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate ;
Uevy;o,rntent Issues": ` ;
Yes No' Are you lobbyintt on a pendlnq aptilication fora Dovelopnment Agreement with the City or aopllcndorn 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"lobbylsl`as sat
. forth in Section 2-481 above)who only appears as a representative of a not-for-profit corporation or.entity a;ithout 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 cc regiilred by flits section but,shall not be required to pay any registration fees. I '•
Y Yes No: Are you representing a not-for-aro it co .oration or enttt without s octal conmensation or reimbursement, i
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.
/4/C y -S,gn 9 L;
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 Mia. i•5.ac,City Cody and all reporting requirements. ,
Signature of Lobbyist:
---_---,d " /4—'_.-
Slgnalule of Principal/Client: ._. 4 ._._
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VI, LOBBYIST IDENTIFICATION: �4110 PRINCIPAL IDENTIFICATION; I . '
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Produced ID _ _,•__Produced 1D __,_-_..__ •
,
Form of Identification Form of Identification i
rssnatly known(Lobbyist)
!I/Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade Slate ci Florida,County of Miami-Dads • .
Sworn o and subscribed before ma Sworn and subscrlbed before me
This
Sworn of �— . ,2015 This_))- day of vac• ,201_?._.
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Signature ublic Notary—State of Florida T Signature of Public Notary—State of Florida '
Notarization of Lobbyist's signature Notarization of Principal's signature
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TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration tee: [ )Yos[ )No Amount Paid$ __MCR I, --'
Lobbyist Registration Form received and verified byu:._ —
p c.eP. ahL\aroru \LonYssi tra1i%L 1r)ist At ,I FtyicttaL on trn.;!:,r. • --
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Revised 01/2Z/2014 i .
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granath), City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: (/(/•i Oil Q a V
I understand that no later than Febru ry 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.
`�`� /2//t O/5"--u Date:
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