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Jose Gomez - Marjorie O'Neill-Butler • 603 d ; LiJo DocuSign Envelope'ID:2A9F0A92-E632-41C2-B2F3-8216DD252074 RECEIVED '�° 0 2023 /V\I A�I .1' r~ FEB 1.. Office of the City Clerk - 1700 Convention Center Drive Miami Beach, FL 33139 CI OFMIAHEM B CLERK 305.673.7411• OFFICE TY • • 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"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, 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: Gomez . Jose • NAME OF LOBBYIST . (Last) (First) (Middle Name) • Bercow Radell Fernandez Larkin&Tapanes,PLLC 200 S. Biscayne Blvd., #300,Miami,FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS . (Number and Street) (City) (State) (Zip Code) • 305-374-5300 jgomez@beilinsonarchitectspa.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER • EMAIL ADDRESS • II. PRINCIPAL INFORMATION: O'Neill-Butler Marjorie NAME OF PRINCIPAL (Last) . _ (First) (Middle Name) Marjorie O'Neill-Butler TR 603 E. Di Lido Drive . Miami Beach Florida . 33139 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip'Code) 305-458-0604'• dramamarj@yahoo.com • PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE.NUMBER EMAIL ADDRESS Rffizgarm m l Code 2 482( no ofia.stam coroor.'on, p. er hip ,t o er t jZail0..m 8g1El toobyist cm I Q3 ha' e i special comeensation oQj 'jgp nfl Xa.o� .gaga'z+'1n 7Co indirect,CR cents gent m p to a•o ate a o o. - Tnl[Magi lial.gaNda C az -•fSjfllmitmEilfiCr@'l titil1bGC tdiC-Atb=a. Ireo'stratie Qom: 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): M. O'Neill-Butler U • 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): M. O'Neill-Butler-100% • N Page 1 of 5 • • • DocVerify ID:A40DD586-942A-4566-BC81-05AB75666D6A - I . Page 20 of 24 f 20C5AB75666D6A 1 ,III kill III www.docverify.com DocuSign Envelope ID:2A9F0A92-E632-41 C2-B2F3-8216DD252074 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. Development Approvals &Permitting Issues,including but not limited to the Historic Preservation Board,Design Review Board,.Plannng Board, Board of Adjustment,Land Use Development,City Commission, and any City Workshops or Committees,if necessary,relating to the property located at 603 E. Di.Lido Drive in Miami Beach, Florida. 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 Staff for the Planning&Building Department None X Public Works &City Administration,PB, HPB, BOA None X DRB,City Commission,and Mayor as necessary None X Land Use&Sustainability.Committee None 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 M 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): None U 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): N 275.00 th $ per hour N ❑ Page 2 of 5 DocVerify ID:A40DD566-942A-456B-BC61-CSAB75666D6A Page 21 of 24 t 21C5AB75666D6A ' ,III ES 1I III www.docverity.com ' DocuSign Envelope ID:2A9F0A92-E632-41 C2-B2F3-8216DD252074 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 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 x 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 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 x 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 orreimbursement? 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: Yes XNo: . If yr"lashes ii:tibsenilessTfhianTll2 naamthWirWifheTel drffi.'ciaBarwhom you promi ed cam aKn cons Icing serawices ..as , nn'n . - 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: • O _Yes XNo: If yes, were you pro se;o or o i o 'yo, reoei,.e Boon:o is oansi a oration in exchange for campaign m so"�n�s"u tinq a uices9:` —- — u> m TO BE COMPLETED BY CITY CLERK'S STAFF ONLY . m Annual Registration fee: [ ]Yes[ ]No AmountPaid;$ ;MCR,# Date Paid - Lobbyist Registration Form received and verified by,:, �?4::AkelLLz.Z_d$L �'i3Ifn I11L Revised 09/20/2018- o Page 3 of 5 DocVerwww.doify nfy.co DD586-942A-456B-8C81-05A875666D6A Page 22 of 24 I 22C5AB75666D6A ,III 5F.''LrM'I III www.docvenfy.com - • DocuSign Envelope ID:2A9F0A92-E632-41C2-B2F3-8216DD252074 • . 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 COMP-ENEARGAI:DURING THE REPORTING PERIOD.' Signature of Lobbyist: ibSt' (,' Gbwtt11 - Date 02/08/2023 -87139C8245C448A... 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-an¢l;raNi J rting requirements. . • • Signature of Lobbyist: Jost, (.. ,�Owtt/Lj Docusignedby: ' Date 02/08/2023 811dlL824b(44eA... ltiq Signature of Principal:""" Date 02/08/2023 DeDE,FEr5A0A44o... VII. NOTARY SIGNATURE AND SEAL: • 'LOBBYIST: PRINCIPAL State of Florida State of Florida • • County of: Miami-Dade County of: Miami-Dade Sworn to(or affirmed)and subscribed before me, , Sworn to(or affirmed)and subscribed before me, by means.of 0 physical presence . . by means of 0 physical presence . or l online notarization, • or C2 online notarization, this day of 02/0A/2073 t 20_, by this_day of 02/08/2023 ,20_, by Jose Gomez • Marjorie O'Neill NAME OF LOBBYIST • . NAME OF PRINCIPAL Produced ID . . _Produced ID • FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Knowr - _ 0Personally Kno `sbwemz¢xuzxarx1':es aw _ sq.amzmavzm+_rtaveo Signature Diana Ramos .Signature at Uiana f�amos • U N . • Name.of Notary, Typed, Printed or Stamped " Name of.Notary, Typed, Printed or Stamped 10 ..116_i o 4-Diana Ramos / Diana Ramos 1 Commission#GG 308355' ' 1 Commission#GG 308355 N 1 Notary Public-State of Florida. N'otary Public-State of Florida. 1 IVIy Commission Expires Apr 10,2023 r y Commission Expires Apr 10,"2023 • z The t� o persons: a m Expert�a^ :-� _ '�' ` `-- or other specializetb :�"',... ., „ , ,.7 t., . g�;`nny person who N • 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 g the appearance. a Page 4 of 5 DocVerify ID:A48DD586-942A-456B-BC81-05AB75666136A Page 23 of 24 l 23C5AB75666D6A ,III IM 'I II I www.docverify.com.com - - DocuSign Envelope ID:2A9F0A92-E632-41C2-B2F3-8216DD252074 • • M1AMI . EAC ti-EAC • 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: 3.05.673.741 1, Fax:305.673.7254 • NAME OF LOBBYIST:. Jose Gomez 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. DoeuSigned by: . • • r)bSt, G• abWtV 02/08/2023 07138CO243C440A... Signature of Lobbyist Date • Q. . O) • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc 0 0 0 Page 5 of 5 ty „II �'IIII DocVerify ID:A40DD586.042A-456B-BC81-05AB7566606A I Page 24 of 24 j -24C5AB75666D6A i www.docverify.com ,-, Miscellaneous Cash Receipt . CITYOF�MIAMI`BEACH ` �� ' � "�. No 431279��y ❑Cash CreditCard� ❑Check# $' t) t s" a •,::5 -' e e f • `f� ,� F '� ?�I l \• r`z+"f7,... Re`ce�ved:of , /,r -1e� , —, �' 1 '�r ,,, �,, �.�, ,, -, :: "°v' .. � �Address'� ��o �; '� � ° ` d ry ti ` Ci Y,;i '' - ` ra „e -f.P 3 iF� ' i , P P P 'eAO 3 g' . .: 1- FEB1yQ'33 ,• —,\� \ g\ 9' b. _ � \ �f a , ;..`;'-', ,''..'' .:,tf.;-'--; , 7-'::',1%:..";;',_:-',,.1,;,,-, ',,:;„ ' I'.';.";:,,:--,..-: ',,.,-j-; .." '..' ''' '-',':- l'' ,-' (THIS INFORMATION MUSTT'BE COMP E E ..,,,,,,,, , . ,Office of Finance Director Account number ,,,,„ ,,,,:,,,,,.._,,,,,,,;.1,,,,,,: By ,,,,:„ ,,,,, ,,,,i,,..,,,,,,„ ,,,, 4,.: P,reparer ¢� ,t Dept C '1 EXT,,,, '(I l 3 :. .. „ p gr a x � . $ pit. ° fw _..: ., t a ? ? „ ,�4 t v i #r s ' ,r, ;0 a � ,'� € lf .,P N 31, +i. ..Y�%; s CMB CITY HALL CASHIERS 1700 CONVENTION CNTR DR MIAMI BEACH,FL 331391819 • 3056737466 Cashier:Ebani Transaction 102993 Total $1,050.00 • • CREDIT CARD SALE S1,050:00 MASTERCARD 1853 Retain this copy for statement validation 10-Feb-2023 2:55:04P S1,050.00 I Method:EMV MASTERCARD • XXXXXXXXXXXX1853 MARJORIE O.NEILL BUTLER Reference ID:304100520433 Auth ID:05118Z ********0886 • MID: AID:A0000000041010 AthNtwkNm:MASTERCARD SIGNATURE VERIFIED Online:https://clover.com/p /Q6DEVR5A000JB . P iumpnt nFflFVRr,Af:On,1A