Truly Burton - Builders Assn. of South Florida •
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 3313416 JUN -3 Pri 3: 140
LOBBYIST REGISTRATION FORM ;' „ a -
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"LL11 has specific exclusions. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number(Numberandttreeet) (Cityy)) (State)I (Zip Code)
os-5s6-�03oO Xo�b I5I - 3 1- /io 1 fYOVr�l�� bas? nfine.•' Of�
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
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N E OF PRINCIP CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
3 05-5S -(03 00 c)S N— 41.3 —11 v-1
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.aSt3 SOLIDI-A(3 13
• IDENTIFY ALL PERSONS HOLDING,DIRECTLt'QR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: DIRE .31_1(
ii.SPECIFIC LOBBY ISSUE: ►JD CO l7S7E,OCTLOr0-K.EL ADD ISS 5�1iJGcw.D�►a
5EF ( �1/1✓i�1 lets 0.-i;?61—a NTE.-t':e0 f— r
Issue to`e 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
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gov 12o9■1 REPIT AL— fJ�t2£.c∎TD2S WO 1o2 s'IAFF
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 „re IJ D `i r) A Nc I F- m L i AL O f& 9 o hE S Iv iV Ki— L p a>s}1 l�s
. `J —o e. D1�i1 �S
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS1Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCL SURE:(Required)
Pt WOuAI— SALAL,9 F12OM ME-obi:RSt4I0 UtSF No ,oIJUSEs ai oT& SPEC)Al- C,01-WIJs AT)O,.D.
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). 45ALA Q.t€D Fit•n PC-0l/E.,E_
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":
_YesV_No: 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":
_Ye _No: 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 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
,a.... ,COMPENSATION DURING THE REPORTING PERIOD. 4
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Signature of Lobbyi
I do solemnly swear that all of the foregoing facts are true and correct nd that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beac• City Co.e and all repo ing requirements.
Signature of Lobbyist: ,.! ��' "4
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICAT N: PRINCIPAL IDENTIFICATION:
_Produced ID —Produced ID
Form of Identification Form of Identification
•
t!Personally known(Lobbyist) jersonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
i• .P.°'1, SUSAN E.BURNS
State of Florida,County of Miami-Daii- t: - * MY COMMISSION A FF081671 State of Florida, County of Miami-Dade
Sworn ,o aid subscri•ed •efore me ,r,''flu.' :.r EXPIRES:January 19,2018 Sworn a 11 subscri•ed before me
This day of 20 F% <° BondedThruBudgetNotary Services his�i/–day of , i , ,2016
/ �\•••••B�� SUSAN E.BURNS
_ Q�4_, * (.,'�* MY COMMISSION#FF 081671
Si. ature of Public N. ary–State of Florida Sgifature of PL9Mtc N•tary–Sta ?!!;. d�XPIRES:January 19,2018
• otarizatiortt,o Lobbyist's signature otarization of Principal's signitlaiees Bonded Thru Budget Notary Services '
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.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
MAMBEACH
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: Joeroi
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.
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Signature. Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
• Tom F.Murphy,Jr. Main Office
Honorary Chair 111 NW 183rd Street,Suite 111 0411 BASF
Ben Solomon,Esq. Miami D Gaarde:dens,305-556-6300 FL,33169
President Broward:954-399-9233
Al Zichella Fax:954.639.7107
First Vice President BUILDERS ASSOCIATION OF SOUTH FLORIDA Brickell Office
1200 Brickell Avenue
Truly Burton B U•I, L D' I N G G R E A T C I T I-E S Penthouse Suite-20th floor
Executive Vice President WWW.BASFONLINE.ORG Miami,FL,33131
May 24, 2016
City of Miami Beach
Office of the City Clerk
1700 Convention Center Drive
Miami Beach, FL 33139
Reference: Lobbyist Registration Form
Dear Office of the City Clerk:
I am enclosing my executed and notarized City of Miami Beach Lobbyist Registration Form.
If there are any questions or concerns regarding the enclosed document, please contact me at
305-556-6300, ext. 206.
Since ely,
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Ms. Truly I r on
Executive ice President
DISTINGUISHED BASF INDUSTRY LEADERS
6U4DIUG REUrIOaSMPS FOR OVER 30 YEARS L E N N A R. Coastal ASSLAW
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