Jason Ronald Hagoplan - Juan Pablo Julia Blanch ?CI P. -9 P1.112: 05
MIAMIBEACH Office of the Clty Clerk
1700 Convention Center Drive
Miami Beach,FL 33139
305.673.7411
LOBBYIST REGISTRATION FORM
Lobbyist mesa all persons employed or retained,whether polo or not,by a p nelpal who seeks to encourage the passage,defeat or
n odffbtion of any ordinance,resolution. action or decision of any commissioner,any action.decision, recommeMstlon of the City
Manager or any City board or committee;or any action,decision orrewmnendalion of any Cay personnel during the time period of the
entire dedsion-making process on such action,decision or rewnvnendagw that foreseeably Wit be heard or re eeved by the Cay
cornu isson,ore City board or committee.The tem specifically includes We principal as well as any employee engaged in lobbying
activities.The term'Lobbyists'has specific rmLsion.Please refer to Cay Code Chapter 2.Article VII,Division 3,edited'Lobbyids;
for addition:bbmadon.
pnvuctlons: Please complete all sections of gds fpm end submit the completed tem.with the applicable lee.to the Office of the Ciy
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 -M' In that wetter. Any change to any klfomatlon originally flied, or any additional ay
Commissioner or personae who are also sought b be lobbed shell require that the lobbyist Me an amendment b the registration tem.
The lobbyist has a continuing duty to supply information and amend the forms Ned evoughout tie period that the bbbying occur.
6epemte regMrlbn bas shall be required for each principal represented on each specific Issue.
I. LOBBYIST INFORMATION:
Hagopian Jason Ronald
NAME OF LOBBYIST (Lest) IFint) twiddle Name)
TSAO Design Group,Incorporated 7610 NE 4th Court,#5,Suite 101 Miami FL 33138
LaOBYIST BUSINESS NAME ANO ADDRESS (NnbOr led Sine) (Ory) (Sale) MD Code)
305-576-2006 x15 305-215-2739 jhagopiangatsaodesIgn.com
LOBBYIST BUSINESS TELEPHONE NUMBER CaLUAR TELEPHONE NUMBER EMAIL AOONESS
II. PRINCIPAL INFORMATION:
NAME OF PRNCPAL -y (Len) (Phi) paddle tent
VULIA 1LAu GN SvdIJ PA81-O
PRINCIPAL Buapi $S NAME AND ADDRESS (Number and Swat) Tay) (Sew) I$Cala)
33 A4\BAU 3A¢LELouA Geo l l
PRINCIPAL BUSINESS TELEPHONE waren <aLLIMR TELEPHONE_Me•eaR EMAIL AOORESS
434 93 3Z32.ia o •]"Ae•J,AQas-skwclk,Ttts.cew..
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 SENEFICWIY(R non.,concis NIA):
AxcL loQQbQAZrDAJ 6Qv(% HocELESt�e L,•
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR ItWIRECTLYLA S%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHP OR TRUST(S nae,ryas WA):
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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.
HPB 18-0207 APPROVAL OF THE CERTIFICATE OF APPROPRIATENESS AND VARIANCE WITH CONDITIONS
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
HISTORIC PRESERVATION BOARD x
Pursuant to City Code Section 2482(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):
N/A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2485.3):
$225.00/HOUR
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The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-088,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues
_Yes XNo: 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 XNo: 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
reimbursement for the appearance.whether direct or indirect to express support of or opposition to any item,shall register with
the city clerk as required by this section,but shall not be required to pay any registration fees.
Yes )tio: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the tens "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.
Yes XNo: 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 2-491(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 past election cycle.See Section 2-491 for more information.
—Yes )(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 member(s)of the City Commission:
_Yes_No: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign
consulting services was sworn in?
6) Pursuant to City Code Section 2-482(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 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 XNo: 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:
_Yes No: If yes, were you promised or did you receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S ST F ONLY Q/
Annual Registration fee: Yes[ J No Amount Paid$ 05C-� MCR# 3d Date Paid 01-01-IU
Lobbyist Registration Form received and verified by: ----4—S SA-I-a IAT°" -
F:\CLER\FALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc Revised 01/01/2018
Page 3 of 5
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. USTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
:YI'T - - . a . ?.. ,1 B FILE. v. , ERE NNO
EXPENDITURE m • - ,E SATION DU-.40THE REPORTING PERIOD,
li
Signature of Lobb t _// Date J U CIL/ 71* _z 01 C;
I do solemnly swear or affam that all of the foregoing facts,statements,and disclosures in St form are bee and correct
and that I have read a am fernier with the provisions contained in Chapter 2,Art.VII, Divabn 3,entitled*Lobbyists'of
the Miami Beach C,• ••- m• e8 reperti a requirements.
Signature of Lobbyist . - _ Date VCT 1 Tu is 1 IC
Signature of Principal: �t.
U Date Oil Ly qt- 9O f f
VII. NOTARY SIGN ' RE AND SEAL: VV
LOBBYIS : PRINCIPAL
state of FLOEiflA State of FL-LEXICA
County of M W M-wipe County of: M\AMi --k-ADE
Sworn tq for affirmed)and subsab
ed before me Sworn to for affirmed)and subscribed before e
this /)b day of .\VLy 2012 by Wsf)fa day of aULy 20a by
,Wiyu HAf opjAN ,1u4J PABLO .)UI-VV RLANCH
NAME OF LOBBYIST NAME OF PRMCPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
I/Personafy n Personally K
Signature o ry Inc Signature of N�
J \SSE �A/E2 J1°6ETts 1\44CNCt
N. ••' ' -• r•t • ' Name of Notary,Typed,Printed or Stamped
JISSETTE JIMENEZ
AP '$_Stats of Florida-Notary Public ••"'•• JISSETTE JIMENEZ
mmission N GG 185383
( 0Dir to pt Enon tle-Notary Public
`r0°`ll y Commission Expires = Commission M GG 195383
March 13. 1012 Dirt
My Commission Expires
March 13. 2022
I The tarot lobbyist'specifically excludes Na fdiawing persona:
Expert witnesses who provide only scientific,c,leoMoal or other specialized Worm/lion or testimony hi public meetings;any person who
only appears ase represenNtive of a neighborhood assotlNbn wUort compensation or reimbursement for the appearance,whether
direct,Mired or contingent,to empress support of or opposition 10 any Nan;and any person who only appears as a representetha of
not-for-profit community based orpanlzation br the purpose of requesting a grant without special conversation or reimbursement for
the appearance.
Page 4 of 3
IV, AM BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeochfl.gov
Office of the City Clerk
Rafael E.Granado, City Clerk CityClerk@miamibeachfl.gav
Tel:305.673 7411, Fax: 305.673.7254
NAME OF LOBBYIST: JASON HAGOPIAN
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 30`h 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 pursuant to Section 2-482 of the Miami Beach City Code.
'07.07. 1 Y
SI o byist Date
F',CLERt9ALL eFORMSILOBBYIST FORMsmbbylm Registration Form Revised 01-01-+e REG drc
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