Neisen O. Kesdin - Mendy Boymelgreen .)I_O lu- c; A- 2<
MIAMI BEACH
RECEIVE!)
Office te Cite Clerk 2(!I� APP, � 2 PN 151
1700 Convention Center Drive
Miami Beach, FL 33139 r cit" ;_ j ..:-y BEACH
305.673.7411 _ 1Y CIS:'P:
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, derision 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
Cleric. 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:
Kasdin Nelsen
NAME OF LOBBYIST (Last) (First) (Middle Name)
Akerman LLP 98 SE 7 Street,Suite 1100 Miami FL 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-982-5629 neisenkwm@ekerman.mm
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Boymelgreen Mendy
NAME OF PRINCIPAL (Last) (First) (Middle Name)
JP Roosevelt LLC 9380 Collins Avenue Surfside FL 33154
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-787-3998
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, PARTNER,OR BENEFICIARY(if none,write N/A):
Sarah Boymelgreen
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A):
Sarah Boymelgreen
Pagel of
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 heating number.
Site plan filing for a conditional use and Design Review Board aooroval. PR18-0183 and
DRB18-0225
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
Design Review Board _ None _ _x
Planning Board None x
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(if none,write N/A):
None
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):
$775 hourly rate
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•
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2488,entitled'Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes 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 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 Mao?
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
reimburseme 1 for the appearance,whether direct or indirect to express support of or opposition to any item,shall register with
the city cle 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?
4) Pursuant to City Code Section 2481, 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-pro t community based organization for the purpose of requesting a grant without special compensation or
reimbu ment for the appearance.
Yes No: 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 2491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the ast election cycle.See Section 2-491 for more information.
_YesiNO: 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 members)of the City Commission:
_YesQNo If yes, has it been less than 12 months since the elected officialls) whom you provided campaign
consulting services was sworn in?
6) Pursuant to City Code Section 2482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall isclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service be lobbying the City Commission at a public meetinq.
_Yes°No: Have you provided campaign consulting services to an incumbent member of the City Commission
/p within the past election cycle?If yes,please list the incumbent members)of the City Commission:
C5
_Yes `o: If yes, were you promised or did you receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Repbtmtion fee: [ J Yes{`1�/,.,�No Amount Paid$ ASO•V., MCR if 4 L c L�T- Dab Pald �'`'� - ! f}
Lobbyist Registration Form nnN9tl and verified by: €4k,OAU Lit.14—•'[
F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Fon Revisal 01-01-18 REG.doc Revised 01/01/2018
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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 :' :Y. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION I /}; r THE REPORTING PERIOD.1
Signature of Lobbyist: Il Date 3/rch//G
I do solemnly swear or affirm that all of the •regoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar .i• th= •rovisions contained in Chapter 2, Art. VII, Division 3, entitled"Lobbyists"of
the Miami Beach City Code and .I r rtti • re• 'cements.
Signature of Lobbyist: // Jr _ Date 4 I'S
qq
Signature of Principal: offer Date Y/D//C
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST•:.r.1 /� ^ PRINCIR
State of ` \O(I�\�(//��+'l �(��/ State of , 'Eta"11,t/
County of: y( yy• V.� —Wit----"
V 1 " County of: \t:1 ,I"
Sworn or off IiSari before mga S rto(or affinne pl s�,�bscdbed beforcre
this da of U 20 by this Ayday of ly4 by
NAMEELY" ) T c 0 NAMEOF PRIN�PgL S"
Produced ID Ptpduced ID
//
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
iarsonally Known / \ 3 Frersonal Kfiow�l ,.
Iyy
Signature of Notary Public Signature of Notary Publlo
DOTH YP
lt!` NOTARY PUBLIC -
Name of Nota M��. SFSLBSOKI F Name of Nota • ,.. Mewed
II. STATE OF FLORIDA
Expires 6/8/2019 ..ct J--
(NOTARY SEAL) (NOTARY SEA.. .
Expires 8/8/2019
I 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.
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/v/v /H 3 EACH
City of Miami Yash,1700 Convention Conan.Delve,Miami Beach,Florida 33139,www.miamlbeochH.gov
Office of the City Clerk
Rafael E.Granada,City Clerk CiyClerkOmiamiheachA.gov
Tel: 305.673.741 1,Fax:305.673.7254
NAME OF LOBBYIST: Nelsen Nasd in
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
$500.00 pu �ll{nt to Section 2-482 of the Miami Beach City Cod-.
r
Signature of Lobbyist Date
FCLER$ALLMFORMS&OBBYIST FORnstabotl R.9kRton Fam neaten 01.01.10 REG don
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