2024 Lobbyist Registration Form - 2901-2911 Indian Creek DR (Jason Halpern) 290� - ��1 ?1
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! � � I � �,..-- Office of the City Clerk
�700ConventionCenterDrive ��T 072024
Miami Beach, R 33139
305.6737411
LOBBVIST REGISTRATION FORM CITY OF MIAMI BEACH
OFFICE OF THE CI(Y CLEHK
lobbyis� means all persons employed or retained, whether paitl or not, by a pnncipal w�o seeks to encourage the passage, tlefeat or
motlifcation of any ortlinance, resoWtion, action or decision of any commissioner, any action, decision, recommentlation of ihe City
Manager or any City boartl or committee;or any action, decision or recommendation of any Ciry personnel during lhe time periotl of Ihe
entire tlecisioo-making pmcess on such action, decision or recommentlation ihat foreseea0ly will be heartl or reviewed by the City
commission, or a City boartl or committee. The term specifcally inclutles �he principal as well as any employee engaged in lobbying
activities. The lertn "Lobbyisis" has specific excNsions. Please refer�o City Code Chapler 2, Article VII, Division 3, entilletl"Lobbyisls,
for atltlilional information.
Insimctions: Please complete all sections of ihis fortn antl submit ihe comple�ed form, with�he applicable fee, lo lhe OKce of the Ciry
Clerk. If you need more space ro comple�e an answer, use a sepa2te sheet(s)of paper. If you have nothing to report in a particular
section, yau musl wnte "none" or "n/a" in that section. Any change �o any information originally filed, or any atltlitional City
Commissioner or personnel who are also sought to be lobbied shall require that[he lobbyist fle an amendment to ihe regislration form.
The lobbyist has a con�inuing duty �o supply information and amentl ihe forms (letl throughout the periotl ihat ihe lobbying occurs.
Separate regisiration forms shall be required for each pnncipal representetl on each specific issue.
I. LOBBYIST INFORMATION:
Velez Sebastia�
NNMEOFLOBBYIST (Last) (Flrsq �MltltlleNameJ
Urban Robot Associatcs 420 Linmin Road, #600 Miami Beach Florida 33739
L066VISTBUSWESSNAMEAN�ADORESS (NumberantlSVeep (Glry) (State) (LipCoda)
756-246-4857 sebastian�urbanrobot.net
LOBBVISTBUSMESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILADORE55
II. PRINCIPAL INFORMATION:
Halpern iason
NAME OF PRMCIPAL (Last) (Pirst) (Mitltlle Name)
29 ICD LLC 41 Shom Road, Amiryville New York New York 71701
PRINCIPALBUSWESSNAMEANDAOORESS (NumberandSlreep (Clty) (State) (ZlpCotic)
91Z612-8181 jasonQjmhdev.mm
PRINCIPALBUSINESSTELEPHONENl1M9ER CELLULARTELEPHONENUMBER EMAILAD�RESS
Pursuant ro pty Cotle Seciion 2-002(h)(1�(a�: A pnndpa�o(any corporztlon, pannership, or oNer entiry who appears as a lobbyist on behal(of that
entlry,without special compensation or reim�ursemen[for the appearance, whelher direct,intllrecp or con�ingent,to express sappoN of or opposilion to
an I[em shall registerwiN lhe Clerk as required�y�his subsection W�shall nol be required to pay any registralion fees.
If the principal is a Corporetion, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
• NAME OF CHIEF OFFICER,PARTNER, OR BENEFIpARY(if none,write N/A): I� F�dI}>21'�l
. NAME OF ALL PERSONS HOLOING, DIRECTLY OR INDIRECTLY,A 5°o OR MORE OWNERSHIP INTEREST IN Sl1CH
CORPORATION, PARTNERSHIP OR TRUST(i!none,write N/AJ: P12d�C SC� thB alfaCh�C�
Page 1 of 5 �
III. ISSUE TO BE LOBBIE�:
Describe with as much detaii 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 & Pennitting Issues, including but not limited to the Historic Prescrvation
Board, Design Revicw Board, Planning Board, Board oE Adjustment, Land Use Development, City
Comtnission, and any City Workshops or Committees, if necessa�y, rclating to the propertics located
at 2901-2971 I�dia� Crcek Drive in Miami Bcach,Florida.
IV. CITY AGENCIESIINDIVIDUALS 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 generel nature of the subject contrectual relationship.
Full Name of Individual and Conlractual Relationship (If yes, ezplain) VES NO
Title ot Person to be Lobhied
Staff for thc Planning & Building Dcpartment Nonc X
Public Works & Cit Administration, PB, HPB, BO None X
DRB, City Commission, and Mayor as necessary No�e X
Land Use&Sustainabilit Committee None X
Pursuant to City Code Section 2-082(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 registra[ion form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
a earance of im ro riet if none,write N/A :
Nonc
I 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):
$ �.00 per hour
Page 2 of 5
The following six(6)questions MUST be answered:
1) Pursuanl to Ciry Code Section 2-088,entitletl"Pmhibi[etl Campaign Contributions 8y Lobbyisls On Pmcurement Issues"�.
Yes X No: I bbV' o t tl' b'tl f q d t rv'ces or on a oresent or
p d� q tl f OOtlS ¢q �P Cllt OI Servic2�
2) Pursuant to Ciry Code Section 2-490, entitletl 'Prohibited Campaign Contributions By Lobbyists On Real Estate Developmen[
Issues"
Yes X No: A v I bbv q p d' q ppl' t f D I o t A t 'fh th C'N ol' t
f h t d 'q t' h [ th C'IV' Future Lantl llse MaD7
3) Pursuant to City Code Section 2-082�hJ, any person (except ihose ezempt from the definition of "IobbyisP' as set foM1h in
Section 2-481)who only appears as a represen�ative of a no4for-proft corporalion or en�ity without special compensalion or
reimbursemenl for the apPearance,whether tlirect or indirec�to express support of or opposition to any item,shall register with
the city clerk as requiretl by this section, but shall not De required to pay any regisiration fees.
V¢SXNo: A f � ( P �'� P C tf '[h t p ' I COm nsafon 01
�eimbursement?
4) Pursuan� b City Code Section 2-481, ihe term "IobbyisT' specifically excludes the following persons'. Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings;any person who onty appears
as a represen�alive of a neighborhood associatian without wmpensation or reimbursement for the appearance,whether tlirect,
indirect or con[ingent,to express support of or opposition to any item; antl any person who only appears as a representative of
noFfor-profit community based organization for the purpose of requesting a granl without special compensation or
reimbursement for the appearance.
Ves X No: A o �d' IV t'f' t h ' I th ' I' d ' � t P � 4
p t C f 'qhb a d " C �th t ' I com nsafon or reimbursement or
p C i( P ft b tl ' t ( th P P ! Q f Q � w'thout
p ' I o fon or re'mbursement�
5) Pursuant�o Cily Code Section 2-497(1�, no campai9n consullant shall lobby the Ciry Commission for a period of 12 momhs
following Ihe sweanng in of any electetl official(s)for whom the campaign consullant pmvided campaign consWting services
within the past election cycle.See Section 2491 for more infortna�ion.
Ves xNo: H p 'd tl p ' It' t an "ncumbent m¢mber of the Citv Commission
'th" th p t I C V I �ItV pl f t�h 'ncumbent membedsl o(�he QN Commission:
Yes x Na: � �•^^ h 't b I [h 72 th th I t d Hii alfsl whom vou orovid¢tl camoaian
COnsul[�IIA 5¢rvices wd5 SwOfn in7
6) Pursuan��o City Code Seclion 2-082�a)(4�a., a lobbyis�who has wi[hin �he past eleclion cycle providetl campaign wnsul�ing
services ta an incumbent member of the City Commission(which lobbying activity is not othmwise pmhibited by Code section
2-491) shall discbse such particular service on hislher lobbyist registralion lorm d h II rall d'sclose such oarticular
b f I bb - fb Cl C mm ss'on at a ubl c meetinq.
Ves X No: H 'tl d It t umbenl m¢mber oi th¢ Citv Commission
'th' lh [ I [' I �If V I f t th " b t memberlsl o�th¢CN Gommission:
Ves x No: If � v a d tl'd 'tlerat'on 'n azehanue for camoaian
consWlina services?
TO BE COMPLETEP BY qTY CLERK'S STAFF ONLV y � /
AnnualRegisha9ontee: ]Yes[ �No AmountPaidS � MCRp�339t� �atePaitlh� � �`7
lobby t R glstration Fortn c ivetl antl fi tl by:
Y;\c' {.�L \n"pRH \ �S.-fIqANS\I Fh : t !�ivY.'aEOnFn `nAaysCE 09']P-IBREG.Cec QBVISlQO9�Z��Z�18
Page 3 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH VEAR 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 PRELEDING CALENDAR YEAR WITH REGARO TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBV. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR CO ENSATI I DU N THE REPORTING PERIOD.'
Slgnature of Lobbyist � Date
✓
I do solemnly swear or affrm that all of Ihe foregoing facls, slalements, and disclosures in this fortn are true and correct,
and that I have read or m familiar with the provisions wntained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach '�fK..v�e__ all repe�(�se u�emenlS
J
SignaWre of Lobbyis[�. Date �� �i�
Signature of Principa� Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST/: �� PRINCIPAL
State of 1 l0����^ State of
Counryof µ�Q.M� ` V�� Countyof'
Sworn to(or affr�d) and subscribed before me, Swom to(or affrmed) antl subscribed before me,
by means of Cy(hysical presence by means of 0 physical presence
or O o notarizatiq�r \�, �y or 0 online notarization.
this�day of V�/ `�� . 20z'Iby this_day of .20_, by
Sebastian Velez Jason Halpem
NAME OF LOBBVIST NAME OP PRINCIPAL
_Pro uce _Produced ID
RM OF I�ENTIFICATION FORM OF IDENTIFlGATION
J�J'Hoi.,
y`° Pers Ily o n _Personally Knawn
���� —
6 ........z
- ° Signature of t ry Public Signature of Notary Public
�� � `� �Ghw �G�n05
_ ` � "� Name of Notary.Typed, Printed or Slamped Name of Notary, Typed Printed or S�ampetl
"� �n�
e^�o (NOTARV E "1;� oinNnxnuos (NOTARV SEAy
�2 " ^ '?�' �;'. NotaryDublic-StateafFlaitla
� o N�� ''?.?�`; Commizslon M HH 1B69U
' � ` .ExOi�esApr16.3411
�ertn"lobb C'spe�iu4kHle�a�hdqBdY�rf4l�66yM5}9, rsons:
Expert witnesses who pwvitle onty scientific.technical or other specializetl intormation or testimony in public meetings; any person who
only appears as a represen�ative ot a neighborhood association withoul compensation or reimbursemen�for�he appearance, whether
direct. indlrect or contingent, to express support of or opposition to any item', and any person who only appears as a representative ot
not-for-proft community based organization for the purpose o(requesting a grent without special campensation or reimbursement for
the appearance.
Page 4 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 70 THE SPECIFIC ISSUE ON WHICH THE
L088YI5T HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
E%PEN�ITURE OR COMPENSATION DURING THE REPORTING PERIO�.'
SignaWre of Lobbyist: __ Dale
I do solemnly swear or affirm that all of the foregoing facts, statements, and disdosures in ihis form are Irue and correct,
and that I have read or am familiar with Ihe pmvisions contained in Chapter 2, Ad. VII, Division 3, entitled "Lobbyists" of
Ihe Miami Beach Cily Code and all reporting requirements.
SignaWre of Lobbyist Date
SignaWre of Principal: Date ��— i — 7�
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of State of 1" ��� ��� ��;� �I
County oE County of: �^� a �-�� �lQ�1�-
Swom lo(or affirmed)and subscribed before me, Swom to(or affi ed)and subscribed before me,
6y means of� physical presence by means of�ysical presence
or� online notarizatlon, or �o line notariz�op,�.rl/n� 20e�(oy
this_dayof 20_, by this�dayof �)�� � .�'4
Sebastian Velez Jason Halpern
NAME OF LOBBVIST NAME OF PRINCIPAL
Protluced ID _Pr uced ID
FORM OF IDENTIFlCATION O M OF IOENTIFICATION
_Personally Known _Person II w
Signature of Notary Public Signature of No ary Pu
a�o� �m�s
Name of Notary,Typed, Printed or Slamped Name of Nolary, Typed, Prinled or Stamped
(NOTARY SEAL) (NOTARY
,f✓� �. ouw�wtwos
"• Notary Vublic�Sta[e of FIMda
°'� � CommisslmMXN1B691]
- �'�wn�� MyCanm.EapiresApr16,20E1
' The�erm"IobbyisP'specifically excludes�he following persons: "�Bmaea tnrough uational Notary�ssn.
Expert witnesses who provitle only scientific, technical or other specializetl info�mation or testimony in public meetings; any person who
onry appears as a representative of a neighborhood association without compensation or reimbursement for ihe appearance, whe�her
direct, indirect or contingent, ta eapress suppon of or op0osition ro any item; antl any person who only appears as a representative o(
nobfoo-pro�t community based organizalion for the purpose af requesting a grant wilhout special compensation or reimbursemen� for
ihe appearance.
Page 4 of 5
,"�,IAM1BEd��N
Ciry ef Miami Beaah, I]W Conventlon Cen�er DrNa,Mlomi Beoch, Florida 33139,www.miomibexhB.gov
Office of rhe Ory Clerk
Rafael E. Gwnado,CiryClerk CiryClerk@miami6eachFl.gov
Tel: 305.673 741 1,Pax: 305.bi 37't54
NAME OF LOBBYIST: Sebastian Velez
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 fle 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 fne 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 notifcation.
Any lobbyist, who fails to fle the required Statement by April 30'" of each year, shall be
automatically suspended from lobbying until all fnes are paid, unless the fne has been
appealed to the Miami-Dade Counry 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 fle a Notice of Wthdrawal with the Offce 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
ursu nt to Section 2-482 of the Miami Beach City Code.
d O Lo `
Si � e of Lo � t Date
j
F�CLEP�EALL�eFORM6LL➢BHYIBi FORMSLLa��ylsl Regis�remn Poim RemseC 01'1-d0 REG doc
Page 5 of 5
DowSign Emelope I�'.C4F4DFFB-A]34A558-A9Afi-BB415fi69D�DE
SUPPLEMENTARY DISCLOSURE OFINTEREST
Interests in 29 ICD. LLC
Percentage of Interest
V And M 184, LLC 100%
41 Shore Road
Amityville, NY 11701
Interests in V And M, LLC
Percentage oflnterest
Jason Halpern 100%
41 Shore Road
Amityville, NY 1�70�
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