Arnold M Jaffee - Mount Sinai Medical Center /''o -S;no,i Mo,leckk( C.tA1-j
EKED
IA ' I 11) E�� Office of the City Clerk JAN 26 2022
1700 Convention Center Drive
Miami Beach, FL 33139 ®of
305.673.7411 n C MIAM'BEACH THE T1 LEFik
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 foreseeabiy 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:
• Jaffee,Arnold,.M
NAME OF LOBBYIST ' : (Last) (First) (Middle Name)
• Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140
LOBBYIST BUSINESSNAME AND ADDRESS • (Number and Street) (City) (State) (Zip Code)
305-674-2777 arnold:jaff.ee@msmc.corn
LOBBYIST•BUSINESS'TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
•
II. PRINCIPAL INFORMATION: • • •
Santorio, Gino.R:
NAME OF PRINCIPAL : (Last) • (First) . (Middle Name)
Mount Sinai Medical.Center, 4300 Alton Road, Miami Beach, FL 33140 • •
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) • (State) (Zip Code)
•
305-674-2777 gino:santorio@msmc.com
PRINCIPAL BUSINESS TELEPHONE NUMBER. : CELLULAR TELEPHONE NUMBER • EMAIL ADDRESS.
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•
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): Gino R:Santorio . . :
• 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):'N/A•
•
•
•
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•
•
•
•
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to aspecific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
All aspects of design, permiting and building of a parking garage and cancer center on Mount Sinai Medical
Center's Miami Beach Campus.
•
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 Department
Building Department
Administarion V
Mayor and Commission .
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):
N/A.
•
•
V. DISCLOSE:RATE AND AMOUNT OF LOBBYIST:COMPENSATION Be Specific. (Note that a
contin gene fee is ursuant to CityCode Sec:.2-485.3
9 Y: prohibitedp ) .
N/A . : •
• Page 2of5. •
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":
_Yeslo: 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 lo: 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 Citv'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. '
c'es .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.
\IYes 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. .
Yeslo: 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: I7_ Il: "1: o:n 1: 0: 1 'te- 1'174 M :`71.1: l ':) fl o p,o, 1.1411 071
. . u p; C c r-erliic c'wa`s ,0 ii11
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 et a public meeting.
Yes lo: 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: . 'i@-` e' "7o'1 04 O'd : coo I e`'ah , n o o o. 4 o: o I
it) . ettidMA : . : . .
•
• TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
AnnualIRegisfron1feen [i; )IYes;[ ,]JN6 Amount,Paidl$ ,MCR#1 J V I{) Dafe)Fai'dl
• Lobbyist}Registrati'onlFormlrecelvedlandlverifledlby;:; • .
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Page •
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 DURI G 2 HE REPORTING PERIOD.'
Signature of Lobbyist: Date January 24, 2022
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 p.ovisi ns contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all repo i, u• ments.
Signature of Lobbyist: Date January 24, 2022
24, 2022
Signature of Principal: 4R)
Date January
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of r( 0,4 State of floe IDR
County of: 14[Amc- DFttJE County of: N IR Y)l -- DR-DE
Sworn to(or affirmed)and subscribed before me, Sworn to(or affped)and subscribed before me,
by means of C'physical presence by means of Vphysical presence
or 0 online notarization, or 0 online notarization,
this 2.4 day of 3fW1 U PP 207 by this 24 day of gy L714-12C4 207,? by
rrrr`lo l d in , TA-Cc e e.
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID Produced ID
// FORM OF IDENTIFICATION FORM OF IDENTIFICATION
%l.Personally.Known .% /Personally Known
O
Signature of Notary Public Signature of Notary Pu lic
PA t, n e z PA-r,>_t r ne 1 z
Name of Notary, Typ `t'�i- - Name of Notary.Typed, Printed or Stamped
I ,,t r &",. PAULINE LOPEZ
r°• ': Notary Public•State of•Florida I •'jir'6� PAULINE LOPEZ • • I
(NOTARY SEAL)' I ?' ' (NOTARY SEAL) �;
t e•
Commission rY HH 132456 �m/•�`1n1 Notary Public-State of Florida
•••,.•oFf.,,'My Comm.Expires May 30;2025 A '•W Commission#HH132456'
Bonded through National Notary Assn. I ' OF n.°;' .My Comm.Expires May 30,2025. (
• — — — — — — w ( Bonded through National Notary Assn.
'The term"lobbyist"specifically excludes the following persons: omPerwmPloweriereloariursimmb•
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;of5
' II ;EACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeach8.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: Jaffee, Arnold, M
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 a h year, and the fee for such annual registration shall.be
$500.00.pursuant to -482 of the Miami Beach City Code. ,
January 24, 2022 .;
Signature of Lob st. Date
F;\CLER\$ALL\sFORMSILOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc
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