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Richard J. Heisenbottle - 3425 Collins Ave. a3ot RECEIVED MIAM I JUN 10 2020 I Office of the City Clerk 1700 Convention Center Drive CITU OF MIAMI BEACH Miami Beach, FL 33139 OFFICE OF THE CM'CLERK 305.673.7411 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 dedsion 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 "Lobbyist"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: Coviello David J. NAME OF LOBBYIST (Last) (First) (Middle Name) Shutts & Bowen LLP, 200 South Biscayne Blvd., Suite 4100 Miami Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-415-9437 dcoviello@shutts.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMA L ADDRESS II. PRINCIPAL INFORMATION: Tsay Belsa NAME OF PRINCIPAL (Last) (First) (Middle Name) Tsay International Inc., 2301 Normandy Drive Miami Beach Florida 33141 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-376-1124 btsay@gmail.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to City Code Section 2-482(h)(1)(a): A principal of any corporation, partnership, or other entity who appears as a lobbyist on behalf of that entity;without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to express support of or opposition to an item shall with_the Clerk as required by this subsection but shall not be required topay any registration tees. 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): Belsa Tsay,President Ricky Tsay,Vice President - 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): Belsa Tsay 100% Page 1 of 5 .tr ' 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. City's proposed historic designation of International Inn located at 2301 Normandy Drive. 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 City of Miami Beach Committees and Boards None ✓ City of Miami Beach Attorneys Office and Administration None ✓ City of Miami Beach Mayor and Commissioners None ✓ 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 NIA): 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): $575.00 per hour 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 I/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? 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. _Yes✓No: 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 exdudes 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✓_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 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 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. 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 Registration fee: [yC]Yes[ ]No Amount Paid$ v5'� MCRC# 1r )( ° Date Paid CAD-1°-20 Lobbyist Registration Form received and verified by:_ � ''� -�+`�'` • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised 03/1112020 Page 3 of 5 VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SH ALL 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 THE REPORTING PERIOD.' Signature of Lobbyist: , Date -510 L.9-,02-0 I do solemnly swear a 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 requirements. I Signature of Lobbyist: .,, n)---- ..-€--..e, Date `',1 G7_[ ' Signature of Principal: ..... .........._�. - Date 06/02/20 VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of T1QY� .aa—..„.._I State of Texas County of:__.11V\(XCI County of:. Denton Sworn to(or armed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of�j physical presence by means of 0 physical presence or 0 Arm notarizatk , or tfonline notarization, thtz,is��t day of V"1 l .,20�by this_9ndday of June — ,2020 by ► & 1_� ICAO_ Ricky Tsay "AME OFLCeBYIST NAMECtf PRINCIPAL Produced ID Produced_ ID Driver License FORM s IDS 11FICATION FORM OF IDEN11 F I CATI CN V/Pet:-..al Ktl► r _Personally nown 1 el S4$$ re of otary " clic Signa re o Notary Public al, Eyda Esquivel Name of Notary, yped, 'rinted orStamped Name of Notary,Typed, Printed orStanped (NOTARY ` )„"""`:' ,', ,,, SLUNG,MACET (NOTARY SEAL) U `';"- ..* Eyda Esquivol ' •4' MYCOMMISSIONtiGG928116 ;sb.F r^It ' ,, **I R '� IO IlJ1�0CR 5.*�,,x, EXFI;68;February ll 2D24V.,;. ;,'� 12115207-9 {�{�,� p ��� t3Cf,Qd 17yu Notary Publ{o lhldelyvtran412?„.a r,,-A ' caHru.sion cxwvCs i The term"lobbyist •.. , `•• , l •A c.v,.a+ li1T'a AYn0,,2021 uY � ary��u�uwv"�,iv.� ry�.n 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. Page 4 of 5 Notarized online using audio-video communication Electronic Notary Public • t'V\t 1 1,\ 1 .. City of Miami Beach,1700 Convention Center Drive, Miami Beach,Florida 33139,vwww.miomibeachfl.gov Office of the City Clerk Rafael E.Granado, City Clerk CityClerkCmiamibeachfl.gov Tel:305.673.741 1, Fax: 305,673.7254 NAME OF LOBBYIST: David Coviello 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 30h1 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. Signature of Lobbyist Date • F:ICLERLSALL1,FORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 MiscellaneousCash Receipt a CITY OF MIAMI BEACH ,. No.426650 D Cash O Credit Card 171Check#,00,x'2,1 J $ Rived of l } � :1 t r; ,+t +r . ,.. , Af+ilCeilaneous= M{dA 2020 l ` c J1!V.)C Li i '` ' �A •' 44 uz4 wiarta A..}UblIUI2u2u U1 53PNf ,.,/ • FOICR OPEid{MCR) I .l 7\J� JC" .. Vii- f g, /�'` " ,10.0y . '‘,(1\ Payment Amount: 850 00 j rA (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director � ' ' ft/� k .1jAccount Nwtber be - EXT: RECEIVED /\/\I,Afv'\I BEAc H JUN 10 2020 Office of the City Clerk 1700 Convention Center Drive Miami Beach, FL 33139 CITY OF MIAMI BEACH 305.673.7411 OFFICE OF THE CITY CLERK 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 "Lobbyist" 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: Heisenbottle Richard J. NAME OF LOBBYIST (Last) (First) (Middle Name) 2199 Ponce De Leon Boulevard Suite 400 Coral Gables FL 33134 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-446-7799 Ext. 14 786-218-6722 Richard@rjha.net LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: 3425 Collins, LLC NAME OF PRINCIPAL (Last) (First) (Middle Name) 3425 Collins, LLC 3201 Collins Avenue, Miami Beach FL 33140 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-534-8800 908-251-7702 sgeraghty@faena.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant fl)City Code TeZtion 2!482(h)M5): A principal of aiv corporation, partnership,( C 'G 7 who ellalig F}3 p lobbyist CW behalf of that entity,without special compensation Cl?reimbursement for the appearance,Ma `- q "j;direct,indirect,CH contingent, ( {oM .e e @Q[jj'o 0.osition to an item shall register with the,Clerk as required byithis subsection but shall not be required to pay any registration fees. 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): Leonard Blavatnik • 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): Leonard Blavatnik Pagelof5 f III. ISSUE TO BE LOBBIED: Renovation of historic Versailles building and construction of new multifamily building at 3425 Collins. 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. Modification of Faena Zoning District Overlay. 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 Planning Dept. staff x Historic Preservation Board members x Mayor and City Commissioners 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 rstmlobbied 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): 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): Lobbyist is compensated at a rate of$250.00 per hour not to exceed$50,000.00 Page 2 of 5 r 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 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? 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 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. _Yes X_No: 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. _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 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: !'�.'Ge _� �fir'.z a*;��ye• ._�, .,-.as- 7F�z..:� s:S'tt ,��;y �. ''.. ♦s...' e i F,�� v ".- ....__. -:' Yes XNo: f es has it'been less than ,1>22imonths since the elected,officials whom ou +rovided cam'ai d n onsultin.'services was sworn'im 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 XNo: Ifafyes, were you promised or didrvou re receive:economic^consideration'in_exchange for campaigi consulting services.+ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY t/ Annual Registration fee: t]Yes[ ]No Amount Paid$S5°-� MCR# -lL1(. "i�� t T lib q Date Paid o&1 o Lobbyist Registration Form received and verified by: — wkj SA-4--kit"-/-‘5 t Fi\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised 03/11/2020 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 CO N ATION DU THE REPORT!‘ G PERIOD.' Signature of Lobbyi t: __ •✓.,i:r/��./ Date & • f' 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 Co._ -nd all reportin., _• ,irements /,, Signature of Lobbyist .. LA/i, /�./�...Lt./Late� 0 Date ' Z irk Signature of Principal: =cif , Date /4/.2(e) / , VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of d l`'I/n� State of to ndq County of: Pl.lAfit-aACounty of:.ar r}f Sworn to(or affir(d)and subscribed before me, Sworn to(or affi ed)and subscribed before me, by means of tiphysical presence by means of Vphysical presence or 0 onl' notarization or O online notarization, this day of -TO Nt. ,20a by this L d= of 3u IV_ .20.by Ft ATLP - EieiC NC crrTLE . ,, i)in NAME OF LOBBYIST NAM F PRINCIPAL Produced a _Produced ID l Gi ri vc,,ir}-1 Cf it iz FORM OF IDE IFICATION FORM OF IDENTIFICATION Perso Known __Per alb own p4 i/4 I �.,., !1i n-0 �i��_ .i- •"-1'..—.A:1001%..- ti - - S.f'r-'Te of Note •XIic l'+' Signa - of otary Public ame of Nota ' Name of Notary,Typed, Printed or Stamped i,pfDONNA HEISENBOTTLE (NOTARY S : , ? MY COMMISSION 800920888 (NOTARY SEAL) ! :may./,� EXPIRES:February 8,2024 .b tie Nary Put Rade ,.2*O e. Unclad Thru Notary Public Underwriters 1,N. ,..,.,4•• My CalinkatinErglkes8alttl2022 'The term"lobbyist'specifically excludes the following persons: COnrdsi10 No.6G251258 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 whoonly appears as a representative of not-for-profit community based organizationfor.the<purpose of requesting a grant without special compensation or reimbursement for the appearance. Page4of5 MIAMIBEACH 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: iG-tf 2-1) .1 . Lc eL 1 Tt 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. - I - ‘ .. Signature of Lobbyist Date F:\CLER\$ALL\aFORMS\LOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 hF`> .t‘:.,2,:,.,,,:-'1.';;‘.5.7.,.:-',';'''.--'.::.:: \ eM 7:'7'7.,7'''7'',7'''75,'7'','...,':7' 7',;','-,-','-:,'-','- tt.b Miscella IAMISCash Receipt CITY OF MIAMI BEACH 426648 CC0 hah 0Credit Card ?Ceck # aC aa ,.. £v, 3 , r$ „1„,,,,....:::„;,,;;,•„-.:,i,..„..,.., '„'.-,',... w v , : ) x \ i, £ L , f R iYeCii , ' r " s i. „ x s m " . , £ } : e �fLi4I' %I .,.!,...,,,,.....;,.,,,;,,,..4i.,„ciii,iiA outC20 ' ° " L ° ' 7 s c f , . t" 9 ot s k " ai om. 't ryyvppcpp14qq ggxx„ f�F .', • Ty-,-z!,-'4-"4”:a \ , Paymentr,4:6oun ;„. : ,0 .. i d 500 ' Y v � "` q tV��$�\� v A\ 6 AAA v \ , t i y,pa, v ,', e £ v'VAA ' v 3` (THIS INFORMATION MUST BE COMPLETED): t� Office of Finance Director s v AccountNumber ;f; � ` �; � ri , � -.� 3 , � Preparer,° <:,`),;-.4.1,:,,:.',„,,,,,,k.,,-,,f,'-,,,,,:"‘":";:iii.',‘"'i,„Vel4.,',$,J,,,,,,,t,,,,,„,,,,,:'''',",',"'''',?.,,,,i � � �` C # , ha � .,\3#,, `Deptlafi "," z :a.„„,,..„-, __ v �\ Z 0 \av A w 3v w� v v Avu adz"\ gg �..... >...�:...:.,.�,�•q�1,.1;-•.._... vvv�AVA\v _...��r �w. , vv� .s. ar\vv .. °..a.,..e._s.._ .._...w...»�......,..,.� e. .:,l i, ......�._.,,.')',_..r,. ..._.._ - t.to Miscellaneous Cash Receipt CITY OFMIAMI BEACH :: No. 426649 d 0 Cash ❑Credit Card Iasi Check# $ R [veedof 1C_ ' Addrego7 Maria^A, il{R4012d2:i Q t t J;.{ "t) LI CR OPEN,(MCR} t Payor amount. .. 500.rsn �J (THIS INFORMATION MUST BE COMPLETED) . Office of Finance'Director Account Number: 3 , Preparer. ( f" , , ` F, ".. . '_ , Dept. _; EXT.. .f ':