Rafael E. Andrade - Miami Jetski Exotic Rentals, Inc. •
Office of the City Clerk r - `
1700 Convention Center Drive
Miami Beach. FL 33139 2 2 r` 3r,
3016 06 T 1 2 P 11 3: 06
LOBBYIST REGISTRATION FORM 'i V i', „' J =i' i•N
Lobbyist moans at persons employed or retained, whether paid or not, by a principal who seeks to encourage he passage, defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City
kit:im.,ger or any City board or committee;or any action,decision or recommendation of any City personnel during the time period of the
• ;viii.(•:. 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
tiviti>;s. The, term"Lobbyists” has specific exclusions. Please refer to City Code Chapter 2,Article VII, Divisiorfl 3, entitled"Lobbyists,"
for additional information.
instructions: Please complete all sections of this form and submit the completed form,with•the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheets) of paper. If you have nothing to report in a particular
section, you must write 'none" or Ilia' in that section. Any change to any information originally filed, $r any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue,
I. LOBBYIST INFORMATION:
}
Andrade. Ra fael F.. r
NAME OF LOBBYIST (Last) (First) (Middle Name)
)
\)Beach Consulting& Solutions. Inc_. 1224 Washington Avenue, Miami Beach, Florida 3313,9 .
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)‘216-2028 ralpIi( mbi;achconsultint;.cona
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
it
• II. PRINCIPAL INFORMATION:
s IrtLirn_
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NAME OF PRINCIPAL (Last) (First) (Middle Name) 'I
1iun)i ,Ietski I'. otics Rentals. Inc. 1416 18th Street Miami Beach FL 33139
PRINCIPAL.BUSINESS NAME AND ADDRESS. (Number and Street) (City) (State)') (Zip Code)
(30.5) .397-88$8
PRINCIPAL.BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
is
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code
Section 2-482(c):
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:- Rani Hakim •
•
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Rani Hakim and Kamil Misztal
Y I
HI. ISSUE TO BE LOBBIED:
' Describe with as much detail as is practical,including but not limited to a specific description where applicable ofa pending request for
proposai,invitation to bid,or public hearing number.
Concession application for use of 1700 Purdy Avenue (Maurice Cribb public boat ramp)
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4),list the City Commissioner or City personnel sought to be lobbied,and whether the
lobbyist has entered into any contractual relationship(paid or unpaid)with said City Commissioner or City personnel from 12
• months preceding such commencement of service with the City to the present date, stating the generailnature of the subject
contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES l NO
Title of Person to be Lobbied
llt\car and City ( i111lnll'',lO 1. all City Boards and t X
( l)inmit ees. (:atv Attorney and stair. and City Manager i X
-
1:111(1 staff. „ k
i
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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of
irn ro riet : _
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2485.3):
None
The following five(5)questions MUST be answered:
Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
Yes x 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?
ii
Pursuant to City Code Section 2-490. entitled"Prohibited Campaign Contributions By Lobbyists On Ral Estate Development
Issues":
_Yes x 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?
Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of "Ibbbyist" as set forth in
Section 2-481) 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 anyitem,shall register with
the city 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?
41 Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings: any pt.;rson who only appears
as a representative of a neighborhood association without compensation or reimbursement for the apparance,whether direct,
indirect or contingent, to express support of or opposition to any item;and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
Yes x No: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensationsor reimbursement or
representing a not-for-profit based organization for the purpose of requeStinq a grant without
special compensation or reimbursement? j
5; Pursuant to City Code Section 2-482(a)(4). a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission shall disclose such particular service on his/her lobbyist registration
form and shall orally disclose such particular service before lobbying the City Commission at a public meeting.
Yes x No: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent memberfs)of the City Commission:
•
(
• ,4
id
VI. - SIGNATURES UNDER OATH:
y
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF +HE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.'-
l --------------"(:—"-"-----"-- ---------"------- ,
Signature of Lobbyist' Date
/C.%/22',H6
I do soiemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this formiare true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
• the Miami Beach City Code and all reporting! -quirements.
Signature of Lobbyist: .�_ Date
/7 2 if 7
Signature of Principal. _----=°°` V Date 10 i l f 1 i ?
VII. NOTARY SIGNATURE AND SEAL: 4 ''_ Bernadett Ferro
e. a„ _ COMMISSION NFF242352
mow c EXPIRES:June 21, 201
LOBBYIST: PRINCIPAL s� .r,,%�
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State of pp.c, State of 'TL )»A'D1ta
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County of: /A%kikk-`11K e_ County of: - \r\N 1'�'PC-E
,
Sworn to or affirmed) nd sub cribed before me Sworn to(or affirmed)and subscribed before me
this-.J day of Clt.,� ,2016, by this -t day of OCoY ti - :I 2016, by
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID roduced ID `. t i 25'474)2" t&c1C
1 FORM OF IDENTIFICATION FORM OF IDENTIFICATION
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4,4,4,,., ..4 .___,_Personal) nown Personally Known
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' I q 5 ' Ca--- I'D---'--T'w a§ .: "i
ign re of Notary Public Signature of Notary Public
ame of Notar j . 'rinted ARE / Name of Notary, Typed, Printed or Stamped
�4 G7 8 :. ,,M, • MY COMMISSION#GG 030527 T.
c a p m OTARY SEA 1 '• ' EXPIRES:September 14,2020 (NOTARY SEAL)
I_..41,1V Bonded Thru Notary Public Underwriters
_ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Registration fee: [ ]Yes€r]No Amount Paid$ 3J-0.0a MCR# 1 J9 LI(e Date Paid to-f.Z-((o
Lobbyist Registration Form received and verified by: JASON S.(-IAJAJQOF6
..-'----- —._�,_ ___i. .?_--._ ?r_.=k< ,Lui.t-a ibt,s>t�ii.z.is atria'' - : d Oil-d£is.7+au.[ior .._..__ Revised 08/18/2016•
The term"lobbyist"specifically excludes the following persons:
1
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings:any person who
only appears as a representative of a neighborhood.association without compensation or reimbursement for th'e appearance, whether
duel. indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-tor-profit community based organization for the purpose of requesting a grant without special compensatio'i or reimbursement for
•
City of Miami Bench, 1 700 Convention Ce.n'er Dave,Miami Beach, Florida 33139,www.rniomibeachfl,gov
the City
(irk
Cram ;J om. City Clerk CtyClerk@miameachfl.gov
1e': 5.673 4 II; ic.:z: 305.673.7254 I
NAME OF LOBBYIST: -_ /1- -1 C -
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notifyl-any lobbyist (or
principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statemepts 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 fhe fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no lokger lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office rf the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing •ctober 1 of each year, and the fee for such annual registration shall be
$500.01 =.rsuant to .-.n 2-482 of the Miami Beach City Code.
ol/
/6/2
'ignature of Lobbyist Date
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