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Jeffrey B. Friday - ABFF Ventures LLC 2bj ANu',rca.. /jtci, MIAMI BE142F1 r: l`� "S' v`•` Office of the City Clerk i 1700 Convention Center Drive Miami Beach, FL 33139 2011 C,. y 305.673.7411 jQ: 4 f Orir 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 City Code Chapter 2, Article VII, Division 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 sheet(s) of paper. If you have nothing to report in a particular section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or 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: /D JEFFIE gdY NAME OF LOBBYIST (Last) (First) (Middle Name) Fn ie �v7v� s .��-� 6i o 120dj4u1IMF/ v NY / d11 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) / (State) 1 (Zip Code) I7_ USI,76 1.5k1 c.O(aO7 - i 75 jelio a �O Uto�lt(+res. con LOBBYIST B SINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIP L ✓�INFORIV�4T�N Jf,ffgf7 NAM OF PRINCIPAL (Las t) 7 (First) (Middle t9ame) orp (NE94 k?feJ Li. C_ Q Q m56 y �v� : 1 ivisy d d/6 PRINCIPAL BU SS NAME AND ADD RESS (Number and Street) (City) ( tate) (Zip Code) 1 2 0 0 S d o f (2/6 -).-4,'CO 45 .CdM PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS 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, PART IER, OR BENEFICIARY: • NAME OF ALL PERSONS HOLDING, DIREC LY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 614/ 0rgoes (Jr1 2 hi/r III. ISSUE TO BE LOBBIED: Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for proposal, invitation to bid, or public hearing number. V C A- Gran - --v r / 7 #fricieffii-4t) 6tAct f-r l r'1 FiFS f7 u /4-1 ( Er) • 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 general nature of the subject contractual relationship. Full Name of Individual and Contractual Relationship(If yes,explain) YES NO Title of Person to be Lobbied fki 1 l/ tc c,z( aoq u- z 01,-) 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 impropriety: o„kJ& V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a contingency fee is prohibited pursuant to City Code Sec. 2-485.3): r) The following five(5)questions MUST be answered: 1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes 1,4o: 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 City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues",: Yes 1/ho: 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 City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" 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 any item, shall register with the city cler s 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? 4) 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 person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,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 reimbursem t for the appearance. _Yes J.�'1o: Are you providing only scientific, technical or other specialized information: appearing as a representative of a neighborhood association without special compensation or reimbursement or representing a not-for-profit based organization for the purpose of requesting a grant without special compensation or reimbursement? 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 cumbent member of the City Commission shall disclose such particular service on his/her lobbyist registration form and sh orally disclose such particular service before lobbvinq the City Commission at a public meeting. _Yes o: 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 member(s)of the City Commission: If yes,you must also orally disclose such particular service before lobbying the City Commission at a public meeting. • VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE 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 COMPEN ION DURIN REPORTING PERIOD.' Signature of Lobbyist: ` Date � 7 I do solemnly swear or affirm that al of the f,'r oing facts, statements, and disclosures in this form are true and correct, and that I have read or am f-• iliar with t - • •visions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code :nd -II repo ing r-•uirements. Signature of Lobbyist: 41, �1 Date (7 9 Y ru1� � Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of State of County of: County of: Sworn to(or affirmed) and subscribed be •re me Sworn to(or affirmed)and subscribed before me,./- this day of 20_, by this_day of 20 /by NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FO"' OF IDENTIFICATION FORM OF IENTIFICATION _Personally nown _Personally Kno Signat e of Notary Public Signature o otary Public Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped (NOTARY SEAL) (NOTARY SEAL) TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [''Yes[ ]No Amount Pai. o 0_ M,R# Air Date Paid Z/i(/,/! Lobbyist Registration Form received and verified by: r__ d,A _■_1111 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 0:-18-16 REG.doc Revised 08/18/2016 1 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 person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, 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. Sae_ 14,( 12cf-tea[ CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE §8202 o,•.- -. cwt_ .,-_n,c-c.=_ec:cn-cc-c.-c. .. f�hSsS.�Y ,c{} .sx .w r 6Y>—,a C,cxrcrdS c&sAs 42c ,c:_tsL,".noSei l l See Attached Document (Notary to cross out lines 1-6 below) ❑See Statement Below (Lines 1-6 to be completed only by document signer's], not Notary) 3 Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy,or validity of that document. State of California Subscribed and sworn to (or affirmed) before me County of L-c A--\ eJ r on this O"1 day of k , 20 11, by Date Month Year (1) -( rz�,i g �'� ctQ- 1 HERMELA TESFAYE (and (2) - \J - ), Commission # 2035201 Z Name(s) of Signer(s) a -m 4.4 i Notary Public-California z z ` ! "'' Los Angeles County r proved to me on the basis of satisfactory evidence My Comm. Expires Jul 30,2017 to be the persorl(5'f who appeared before me. OA Signature Signat - _ otary Public Seal Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document c_„� v-{- M.a 1 B o.o c>^ p Title or Type of Document: ,s-f Qe',S a- r-oe - Document Date: 0 of D) J Number of Pages: Signer(s)Other Than Named Above: 'N-C•'W'tl/' 6"t'W"G/W d''d''H''Ar-G••6 'd-'Y'Y'N'M=N'd M'S'•'S'O-'N'6 'S W-'CP . 5''_'er'f 5 N'N d'fl•&F A•-4!- ©2016 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827 • Item #5910 . . CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 -a —'ire.-e. i..L'_C.eC_�i ,�0 �i .f A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy.or validity of that document. State of California /n County of 1_1:7 s 4-, R I On D o� I d `‘ 1 I rl before me, 1-}Q_ i' A 2.10-, (Q e_ /V o{ r i�U�o,r C, Date Here Insert Name a Title of the Ohicer personally appeared T:2_,.4 t-e� p P--1-2) 0)-0- - - �J Name(s) of ner(s) who proved to me on the basis of satisfactory evidence to be the person(, whose name(*(3 subscribed to the within instrument and acknowledged to me that sb /they executed the same in &..rn.l eir authorized capacity(le),and that by i Jet/ttaeir signature on the instrument the person(8), or the entity upon behalf of which the persona) acted, executed the instrument. . I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. HERMELA TESFAYE WITNESS my d and official seal. C Commission # 2035201 a Notary Public California D Los Angeles County Signature My Comm. Expires Jul 30,2017 Sign f Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: c -1 t---t:�..Aef 8e a-C k L_ob6 eI(S� �.2P� -tioff y^ F ' Document Date: u Qp"�1__{�n )_o.A tom.. ___ Numbervof Pages: l.__a___.._ Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: TQ---r 6 FA d-Q- Signer's Name: ❑Corporate Officer — Title s): - _ ❑Corporate Officer — Title(s):- . _ — ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited D General ,®Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: - • ❑ Other: Signer Is Representing: 5 si I-- • - Signer Is Representing: , 'tl: •'tl..tl'tl"tl,-tl,V tl..-.-tl._tl.tl.-tl. tl.•tl.tl..tl..tl_.tl.tl .b tl..0...0. e..Or,•tl , _ _ ©2016 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 ., ,_ - MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.741 1, Fax: 305.673.7254 • NAME OF LOBBYIST: V eFFei LS • 7 f-t 07 1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT Pursuant to City Code Section 2-485(d), the City Clerk shall notify 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 Statements 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. 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 longer lobbying on that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk. 3) ANNUAL LOBBYIST REGISTRATION FEE I understand annual registration of all lobbyists shall be required for each 12-month period commencing October 1 of each year, and the fee for such annual registration shall be $501 to lAP urs ection 2-482 of the Miami Beach City Code. 2 A /7 . Signature o'tT I Date \ F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc • Miscellaneous Cash Receipt an, OF MIAMI BEACH - . No. 413895 1/. 0 Cash In Credit Card ' Chad(# n.0 6osfr 1 $ . . 6- 2017 Received of Xe,11( ct I clo•-■/ . ,. Address - ,..' , . , ! ._ _ , ...-. , . I t , :. / .' . . . /- , City of Miami Beach MiSCellarleOFSQrrOCR-Vnl IV,- f-t, ,6 i Ov) 4- i d,„),,,,,,. 1 gt s ,s 7,/,..4.0(1i 4. 1_5 5.50,e. 001039-0057 Adrian ...02/16/2017 02:47PM MCR OPEN kMt...11) Payment Amount: 850.00 MCR413895 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By - . . Account Nurnber: ;, ' - — ' _ ) ..: . Preparer: -. -\ : -, 5, ‘ l ' .. , ..... Dept: (._ . . ., ( - ,- . EXT: , . •1 -. ; . • . ,., .. -± rZ r"' = 7 5 ‘: :— ' = -.--- ...---z., t iN•r-''' '-:'71.-,•-' 1.1 - -..•- ,rD , .--) C r.L.^ ..=._,' ; :-•-■ ,-. • ' : --•..:-.4.,_R.-.0,3,..--,.4.,-' ___. __--- ; - . --_- Z.V.........--- , E ="."'—.-. F tll - "::.-=''--Z-;-= g h j —_—_-. - .-- — =.7 il' ..-: — , -.....- 1 C :' I 71-11 \ ! IF,4 '-.--• ifl i - ..,... 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