Ruben Gomez - 4774 North Bay LLC 5 al- 0-1(02
RECEIVED
MI A MAR —1 2022
MI BEACH Office of the city Clerk
170(30Convention Center Drive CITY OF MIAMI BEACH
Miami Beach, FL 33139 OFFICE OF THE CITY CLERK
305.673:741 t
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 dommissiciner, 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 adtion, 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 exclusiens. 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 patter.'If you have nothing to report in a particular
section, you must write "One" or "Na" in that eection, 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 fonns 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:
NAME ORLOBBYIST (Last) 2111011
" (First) (Nliddle Name)
A-I2--DeSI 61.,) On-P. -363 t vfeam‘ilin.s A.0 C 33, 11-S/
LOBBYIST BUSINESS NAME AND ADDRESS (Number end-Street) (City) (State) (Zip Code)
e)5--tzo 305--394 LOGO rOiQSI9ft..COM
LOBBYIST BUSINESS TELEPHONE NUMBER 'CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
11 -1614,ftt
NAME OF PRINCIPAL (Last l (First) (Middle Name)
4at fobitTh en 6 tet-06 Su fixtr f1Meoti4. f/h4t-64H- 33131
PRINCIPAL BUSINESS NAME AND AD RESS (Number and Street) (City) • (State) (Zip Code)
3C3g-?.5-11 — 3L15- -71-3°1 ecos5eeki\t"co
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
.7;40•010 °° - -6tio 2 iTh lin at:1001M OM'''IrPco atto paf , e o ap.ea ozie, .e ta Asti at
rit 0 It1 co p sa 0 c6% tizitgreawntart.14eareemaifau di ec direct,01(itigriOil„f0(3.pr'ss o a op 0 Jim to
a it- s'all(eg„ qtaa r-qmst b _ salt I ;reqq Ca 0 • ai egis g.es
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,ORBENEFICIARY(if none,write NIA): /
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(it none,write N/A):
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.
21 - 0 4 6 Z. Mo)( 71 76-R4 OQ C .
51.Yn1`P 1 06\41 q i< S, 11 E"OjCG
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
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):
DJ . A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION—Be Specific. (Note that a
contingency feeds prohibited pursuant to City Code Sec. 2-485.3):
l? st 4r
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,2CNo: 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 11No: 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,onlyscientific,,technical or other specialized information.or testimony in public meetings;any person who only appears
as a re resentative'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 LNo: 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 fora 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.
an Incumbent.member of the.City Commission
_Yes No: with)the Pestiel election cycle?if yes,please list the incumbent member(s).'of the City Commission:.
_Yes No: If =s; as i bee le th.n 2 mo ince the electe official(s) o yp p o ided am.aign`
icons I in se. ice was o n tn7
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 lobbvina 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?,lives.please list the incumbent members)of the City Commission:
Yes No: =s, 'er= o pr•mised.or did .ou recel-e economi co si oration in e cha .e for ca"paign
co"P n l it a e, ices?,
TO BE COMPLETED BY CITY:CLERK'S STAFF ONLY
A n .1 egistration i t.o n aids V d i ` V.!kligtitall M°vlJ°S15
LOb,y�1`RLg\a OftMS,tra on�YIS®i ed,�OReS,at bby sme �by:
egistra„in_ (API f2evised 03-.�,20,ftEG.do Revised03 rii/12020
F OGLE_ . . � o �.
Page 3 of 6
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 THE REPORTING PERIOD.1
, , •
Signature of Lobbyist ---------- --).-- - ' Date "3/471/W2 Z
Z -"Z
I do solemnly.swear or affirm that all of the foregoing facts, statements,and disclosures in tbisjorrn are true and correct
and'that l have read or arn.farnifiar with the provisions contained in Chapter.2;Art VII, Division 3, entitled°Lobbyists'of
the Miami Beach City Code and a rep iting.r tire entt.
i ' -Signature of of Lobbyist ' Date r/V2. 2Z
Signature of Principal: Date .;- 1
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of flirdet- State of FL.04
County of: Mid144:aar -• County of: 16.2‘, .c-I!'"--‘-
Sworn to(or affirited).and subscribed before me, SWorri to(or affirmed)and subscribed before me,
by means of 0 physical presence by means Of physical presence
or 0 online notarization„ i or 0 online notarization,
this day of ir/at+dn— .20Z by this I. day of i‘lc'Mit"-
,...,A ,201.2-,by
irbek a014.,. _&2 ITA,‘, .t4 6 fstr,s
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID Produced lb
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Personally KBMW YPersc nally Known
1 -
Signature of Notary Public' Signature of Not ry Public
tRAktet 01?.4244-ehtue G 10. t-o &i
Name of Notary,Typed, Printed or:Starn_ged..____ , Name of Notary,Typed, Printed or Stamped
. .
Notary Public State of Florida 1
(NOTARY SEAL) °4 Rome!Marcel Perdomo (NOTARY S
4 rrni miingiren 00 kk, Notary Public Stale of Florida
/ Exp. 21712026 I f Nip 1. Gloria Bu
'ye, , i My Conimisslori HH 106701
'The term!lobbyist"specificar ly eXaJccitt
following-persons: "so, . Explun 03/21/2025
Off%
. -
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&neighborhood association without compensation or reimbursement for the appearance,whether
direct,indirect or'coritinOpt,:lo 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
AAIAAAIB_EACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miarnibeaclegov
Office olthe City Clerk
Rafael E.Granac19.,City Clerk CityClerk@miamibeachfl,gov
Tel:305.673.7411,Fax:305.673.7254
NAME OF LOBBYIST: 'P010 e•Nn 66 tk-I.E"
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.Cbunty 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 mmediately 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.
n I
Sigdature of Lo6byi t pate
FACLEAVALLWORMSALOBBYIST FORMS obbyist RegIstraVon Form Revised 03-11-20 REG.doc.
Page 5 of 5
"Miscellaneous Cash Receipt w 1�
;CITY OF MIAM{BEACH , F.
, No,429641
o cash Creai,Caro #
,
11tad g! e , s,^} t ''r ' '"" , 4
Miscellaneous IVICP. 2022 ? t•I€t{", . ` r 4tl f (,: _
r- 9 PJl:: A ._031O1f202212:rI= S „ I'
- e .J,' t�t //
F � ` •
Payment•A
"
„ t[l $1 FORMATION MUST BE COMPLETED) Offlci of FIaam*DJhctor/
d