Elan Blumberg - Aria Mehrabi L. cs`6 14-bbo - -Je,.`ue--
-- RECEIVED
MIAMI.BEACH Office of the City Clerk JAN 1 7
1700 Convention Center Drive 2020
• Miami Beach,FL 33139
•
305.673.7411 Cr
LOBBYIST REGISTRATION FORM - OFF E OF TMHEM BEACH
Lobbyist means all persons employed or retained,whether paid or not,by a principal who seeks to encourage the passage,defeat or ry
CLERK
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 terni'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, usea separate sheet(s)of paper.:If you have:nothing to report ina 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:
'6r_u n I err) Etas
NAME OF LOBBYIST ' (Last) (First) (Middle Name) •
Cu1e23 .. Itl Sw 3.4 St tr.cloor - M iGoli6� FL 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (3tate) (Zip Code)
�05�°I2 5- il00 : 1 _ —21 _.(Iy y Pbiurn, errc (3Cu19e3- cern
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER • E AIL AD ESS
II. PRINCIPAL INFORMATION: •
Metmi�i . Ptda
NAME OF PRINCIPAL (Last) (First) (Middle Name)
kA(i P1c? SW( -COpi vc,I q()(4wochi to-r Ave. Sui Fe 150 M'Gwi reGck FL 33 l' ci
PRINCIPAL BUSINESS NAME AND AQ DRESS (Number and Street) (City) (State) (Zip Code)
L 1110 i — 0L- 5(000 ir °# : .• . ~ Ir pitc(� .col,
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): Ari 0 • M eh 1 c o i .
• 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): 1(IIr(G - Me h t�V1 b i
Page.1.of 5
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.
JeS icer\ rev%e w ►nee r inq reCbyeS f a p prove l o p
-� N®aeCoq? Watt- Avenue MtCIntll 6 ccs 9 FL
3; IL-1I ConSic tzin ieqourli 3 nq 9 310 sr.b. Pi-.
(1)Perrier rod b RAS i Iden tIcd spGCc
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
?Sign Qev,ew Board tilemYierS
PK n nilq ?cad
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):
til A
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):
cc1d HOLArlUI S30o ( Inr
Page 2 of 5
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By.Lobbyists On Procurement Issues":
_Yes p1o: 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_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 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.
YesVNo: 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
reimbursement for the appearance.
_Yes1o:. Are_you providing only scientific, technical or other specialized-information; appearing as a
.representative of a neighborhood association without specialcompensation 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 ilphby the City:Commission for a period of:12 months
following the swearing in of any elected officials)for whom the campaign consultant provided campaign consulting services
within the past election cycle.See Section 2-491 for more information. .
_Yes&o: Have you provided campaign consrilting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbentmember(s)Of the City Commission: -
•
Yes No: '"If yes, has it been less than 12 months since the elected officials)whom you provided campaiq
consuitina services was sworn int.
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 lobbyistregistrationform and shall orally disclose such particular
service before lobbying the City Commission at a public meeting. ,
_Yes'ONo: Have you providedcampaign 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:
•
_YesNo: If es, were you promised or did you receive economic consideration in exchange for campaiq
consulting servicesr
•
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: f Yes[,.]No Amount Paid$ 50a.040 MCR# ?•S I L Date Paid 01-17-2-0Z) •
Lobbyist Registration Form received and verified by: ---1J
re:VCLusySACTAiirfoom>\LeSSYIST FoRMssLobhi t Registra'tian rar'm Revised 0.1,0148 rtEc_,(.cc: 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, 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 J-REPORTING PERIOD.'- 1 /'\
Signature of Lobbyist: Date V 1 ` l0 12220
I do solemnly swear or affirm that all of the foregoing facts,statements,and disclosures in this form are 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 r..pro's. i ^�/� P,
Signature of Lobbyist: Date 1 I `6 20 2.V
Signature of Principal: Date
( I j/-1,0 VO
1
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST:
(fUU State of,.% PRINCIPAL •
State of rtl1IDrI
County of: 1V1(GYY\1 — Gtp 0QCounty of: MAarv'k -cbLake.
Sworn t (or affirme and subscribed before me Swor to(or affirmed)and subscribed before me
this X�18 day of nUGr 4 ,2020 by this l`t day of Tot+nocttr � - ,200 by
�!o�oBBYisTIur e,cg �r is H - rob 1
NAME OF PRINCIPAL
-.•roduced ID • _ _ _Produced ID
FORM OF IDENTIFICATION FOR ,OF IDENTIFICATION
Personally Known /Personally! nown1 \
`
?' A • ♦ V
Signa Jre of Nota P -� Signature of N Itary Public
Samc(ntho SilcVee Ge)' I. , e,r1,s
Name of Notary,Typed,Printed or Stamped Name of Notary,Typed,Printed or Stamped
(NOTARY SEAL) (NOTARY SEAL)
;o, 14*,, CLELY MARISOL MERLOS
-ct,`Notary Public-State of Florida
%lig� Commission#GG 918066
1 The term"lobbyist"specifically excludes the following persons: 1N"l'''I My Com mission Expires
4/4.A.k` October 05,2O2
Expert witnesses who provide only scientific,technical or other specialized information or testimony i
onlyappears 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-profitcommunity based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance. .
. Page 4 of 5
MI.BEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www,miamibeachfl.gov
Office of the City Clerk
Rafael E.Granada,City Clerk. CityClerk@miamibeachfl.gov:
Tel:305.673.7411,Fax:305.673:7254
NAME OF LOBBYIST: E I,C({� B 1UYY\ ` i (�J
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
$500.00 pursuant to Section 2=482 of the Miami Beach City Code.
�0 2°Z°
- � I
Signature of •b Date
F:ICLERI$ALL1aFORMSLLOBBYIST FORMS1Lobbyist Registraten Form Revised 01-01-18 REG.doc
Page 5 of 5
7.
1
Miscellaneous Cash Receipt
rrvK'-'f?.i-;-.'';.:,;,-1_
+CITY OF,MIAMI BEACH ,
No 425184
v a n v w,
:; ;4i
t 3 \\ t 4 cU ` \\ \ s t V'1
Cash ❑Credit Card Check# ' , 4 $ ,v
t-. 20 ° i
R ived of `,.,, , ,_ '1\'1 -
t�tsee11 ° s MCR 2020 x ( ,
\ F R OPEN((',SCR}F a',\ 1; f -,_, ` ', . r . ,, 'r,� . y ,` ,K, ; ` r ?..-;,t,7,'-VN' .
` Paymer�Amount v° 8�Q t10�� i..../
!f,..:-.,:;,-..-4,:,',.,-,7,114!....'- -,-,-R5A Rk �� o
..,,..-„,:.,...',.-:1 ,:\ / ,$i� 1 �t�F r, \ :•!,,'.''''',16;:::',
,a �,d :-','"*...''-1,; \,S,
4 n
(THIS INFORMATION MUST BE COMPLETED) Office of Finance;Director 'a
\G /Account Number' w\ f j £ �: r , ; " ,a < w
rr.::;-,,-',-;'-.tlPreparer, v. ,- k Dept °` EXT ,. "
ha n . Baa 6 .
(a... tit s _ "w.w.. � .�..,.. �. ',.._°:.�`�, .,__.._.,.....��..