2024 Lobbyist Registration Form - 2901-2911 Indian Creek DR (Jason Halpern) ` .�901 - � 911
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" � ��° j -� °��� � � Offce of the City Clerk
1700 Canvention Center Drive ���'T �� 2024
Miami Beach, FL 33139
305.6737411 CI�I�Y '.+�- Id�IAPAIBEACH
LOBBYIST REGISTRATION FORM �FR:]F �� . ._ ..."�.^I E?w
Lobbyist means all persons employetl or retained, whether paid or no[, by a principal who seeks to encourage the passage, defea� or
motli(cation of any ordinance, resoWtion, action or decision of any commissianer. any action, tlecision, recommendation of ihe City
Manager or any Ciry board ar committee;or any ac�ion, tlecision or recommendation of any City personnel during the time period of the
entire tlecision-making process on such action, decision or recommentlalion ihat foreseeably will be heartl or reviewetl by Ihe Ciry
commissian, or a City board or committee. The term specifcalry indutles ihe principal as well as any employee engagetl in lobbying
activi�ies. The tertn "Lobbyists" has specific exclusions. Please referto Ciry Cotle Chapter 2, Article VII, Division 3, entitled "Lobbyisis,"
far adtli�ional info�ma�ion.
Instmctions: Please complete all sections oi this fortn and submit the completetl form, with�he applicable fee, to ihe OHce of the City
Clerk. If you neetl more space ta complete an answer, use a se0arete sheet(s) of paper. If you have no�hing to report in a particular
section, you must write "none" or "n/a" in �hat section. Any change to any information originalry filetl, or any adtlitional City
Commissioner or personnel who are also sought ta be lobbied shall require that the lobbyist file an amendment to the regis(ration form.
The lobbyist has a continuing duty to supply information antl amend ihe fortns fled throughou� Ihe periotl �ha� Ihe lobbying occurs.
Separate registra[ion forms shall be requiretl for each pnncipal represented on each speci(c issue.
I. LOBBYIST INFORMATION:
Sullivan [�ndy
NAMEOFLOBBYIST (Lasi) (First) (MldtlleNama)
McNamara Salvia Structural Enginccrs 1 Biscayne Blvd., #3795 Miami Florida 3313]
LOB9VISTBUSWE55NAMEANOA��RE55 (NumOerend9Vee1) (Gfy) (Stata) (ZlpCodo)
305-579-5765 asullivanC�mcsal.com
LOB6VISTBUSMESSTELEPHONENUMBER CELWLARTELEPHONENl1MBER EMAILAD�RESS
II. PRINCIPAL INFORMATION:
}{alDcrn �ason
NAME OF PRINCIPAL (Lasl) (Pi�st) (Mitltlle Namo)
29 ICD, LLC 41 Shorc Road, A�nityville New York New York 11701
PRINCIPALBUSWESSNAMEANDAODRE55 (NumberentlSUeeQ (City) (S�ate) (ZipCode)
917-612-8181 jasonQjmhdev.com
PRINCIPALBUSINESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMHILA��RESS
Pursuan�[o City Cotle Section 2A82(h)(ij(a�: A pnncipal ofany corporation, patlnersbip, or otheren[iry w�o appears as a lobbyis[on behalfotlbat
en�iry,wiMON special compensa�ion or reimbarsement for Ihe appearance, w�ether direcl, indirect,or contingent,to express support of or opposilion to
an ilem shall registerwith the CIeM as repuired by ihis subsection bul sM1all not be requiretl ro pay any regislretion 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 BENEFIdARV(if none,write N/A): I� }i��Peln
• NAME OF ALL PERSONS HOLDING,DIRECTLV OR INDIRECTLV,A 5°o OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(i(none,write NIA�: P]CasC SCC khe aftac]lCd.
Page 1 of 5 ��
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is prectical, including but not limited to a specific description where
applicable of a pending request for proposal, invitalion to bid, or public hearing number.
Dwelopment Approvals & Permitting Issues, induding but not limited to the f 3istoric Preservation
Board, Design Review Board, Planning Board, Board of Adjustment Land Use Development City
Commission, and any City Workshops or Committces, if necessary, relating to thc properties bcated
at 2901-29ll Indian Creek Drivc in Miami Beach, Florida.
IV. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-082�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 Ciry to the present date, stating the generel nature of the subject contractual relationship.
'� Full Name of Individual and ContraMual Relationship Qf yes, explain) YES No
Title of Person to be Lobbied
Staff for the Planning & Building Depaztment None X
Pablic Works & City Administration, PB, HPB, BO None X
DRB, City Commission, and Mayor as necessary IVone X
Land Use &Sustainabilit 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
appearence of an impropriety, with any current City Commissioner or City personnel who is sought to
be 1o66ied as identified on the lobbyist registration form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
a earance ot im ro riet it 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 2 015
The tollowing six(6)questians MUST be answered:
1) Pursuant to City Cotle Section 2-486,entitled'Pmhibiletl Campaign Con�ribWions By Lobbyists On Pmwrement Issues"�.
_Ves x No: Are I bb ' t tl' b'd ( q d t t
oentlina awartl for noods equ'pment or s¢rv'ce'+
2) Pursuant to City Code Section 3-090, entitled'Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues':
_Ves X No: Ar¢ o I bb ' y p d' I' f ( D I t A t 'th th C'N ppf C
(or ehan f ' q p d t' h G t th C'� ' F � L d ll M �
3) Pursuant to Ciry Code Sec�ion Y-082(h�, any person (except those exempt /rom ihe definition of "IobbyisP' as se[ forth in
Section 2-481)wha only appears as a representalive of a no4for-profd corporetion or entity without special compensation or
reimbursement for ihe appearance,whether direct or intlirect to express suppotl of or opposition ro any item,shall register with
[he city clerk as required by this sec�ion, but shall not be requiretl to pay any regisiration fees.
_YesXNo: Are [' 4( - /'t C �'t 'th t ' I t
reimbursemenl?
4) Pursuant to City Code Sec�ion 2-081, the lerm "lobbyisf' specifically exclutles ihe following persons: Expert witnesses who
provitle only scientific, technical or other specializetl information or testimony in public meetings; any person who only appears
as a representative of a neighborhootl association wi�hou�compensation or reimbursement for the appearance,whelher direcl,
indirect or contingent,to express support of or opposition to any item; antl any pereon who only appears as a representative o(
no4for-profit community based organiza�ion tor ihe purpose of requesting a grent withoN special compensation or
reimbureement for�he appearance.
_Yes X No: Are p 'd' q I t'f' � h ' I th ' I' d ' ! t' pp " q
representativ¢ of a neiohborhootl association without soec'al comoensaCon or re"mburs¢ment or
rep f q M1f - (t b tl q ' C f ih p f C q [ "th [
soecial comoensa�ion or reimbursemen��
5) Pursuan� [a City Cotle Sec�ion 2-097(1), no campaign cansul�an� shall lobby �he City Commission for a period of 12 mon�hs
following Ihe swearing in of any elected oHicial(s)for whom the campaign consul[an� provided campaign consul�ing services
within the past election cycle. See Sec�ion 2-491 for more infortna�ion.
Ves XNo: Have vou orovitled camoainn consult'na serv'ces to an 'ncumbenl member of the C'tv Comm'ss'
within the oast election cvcle? I/ves olease I'st th¢ 'ncumbent memberls)of the C't Comm'ss'on�
_Ves X No: I�s has 't b¢¢n less than 12 months s'nca the I t d ff ' I( 1 h 'd d '�
consullina servic¢s was sworn in?
6) Pursuanl to Ci�y Code Section 2�82(a��4)a., a lobbyist who has wi�hin the pas� election cycle provitletl campai9n cansulting
services to an incumbent member af Ihe Cily Commission (which lobbying activiry is not otherwise pmhibitetl by Code section
2-491) shall tlisclose such particular service on hislher lobbyist registration Porm antl shall orellv disclose such oanicular
service befom lobbvina the C iv Comm ss'on at a oubfc meefng.
Ves X No: Hav¢ vou provided camuaian eonsultinn services to an incumbent member o(the C'iv Comm'ss"on
within the oast election cvcle?If ves.please list th¢ineumbent memberlsl o(the C'tv Comm'ss'on�
_Yes X No: If yes, w¢re vou oromisetl or tlitl vou rec¢iv¢ ¢conomic considerat'on 'n ezchanae tor camoa'nn
eonsul[ino servicas4
TO BE COMPLETEO 9V LITV LLERK'S STA^F�F ONLY --7
AnnulRg t tanfe [ ]Yes[ �No Amoun[PaidS n� MCR# J�9� / DatePald �� �— ��
Lobb ist Re islra[lon Form racel tl antl i tl b �
Y 9 Y
v.�a \� i '�v+v mcti. ^. b rzov�sed o5-2o-1@ReGAo: ReviseEU9/l0/2036 �
Page 3 of 5
VI. SIGNATURES UNDER OATH:
l
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL Sl1BM1T TO THE r� CE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH LISTMG LOBBYING EXPENDITURF" (► SLL AS COMPENSATION
RECENED FOR THE PRECEDING CALE AR YEAR WITH REGARD TC � Q�q�O � ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGEO TO L BY. A STATEMENT SHAL �� .cN IF THERE HAS BEEN NO
EXPEN�ITURE OR CO PENSATION O RING THE REPORTING P .�
�
SignaWre of Lobbyist�_ ��� d�e � D 7�
.. ..._ - —���
I do solemnly swear or affrm Ihat al e foregoing facts, sta�ements, and disc this form are hue and correct,
and Ihat I have read or am famili w Ihe provisions contained in Cha _ %��,�j . � ision 3, entitled "Lobbyists" of
the Miami Beach City Code a all r o ' g requirements. 1'� ^
Signawre of Lobbyist ate ` �// �Z�
Signature of Principal' Date U� `�� Z
VII. NOTARY SIGNATURE AND EAL:
LOBBYIST: ,.I PRINCIPAL 1
State of � �'� � V1 �i State of V�I V`N
County of: M.��l—���-� County of: N\ �U�..��'V a �L
Swom to(or aff� ed)and subscribed before me, Swom to (or affi ed)and subscribed before me,
by means of�sical presence by means of�sical presence
or� o e notarizatio �. L I � � . or ❑�7�+ne notariz (y
Ihis�day of �l/T D�'J��� 2�_�y this `�day of � pp�l py
Andy Sullivan Jason Halpern
NAME OF LOBBYIST NAME OF PRINCIPAL
_Pro ced ID _Produced
RM ID TIFlCATION F RM OF IOENTIFICATION
... Personally Kn y Person I n
�""%` _
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��4'°,.'�� ignature of Notary Pu li SignaNre of t ry Publ
�� �
�3�� ,.,�1 � vn dI �ZaNF. �wnaJ
3 3 0� ame o( otary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
w m�'q� F'z�
5 y=�� OTARY (NOTARY SE
W OIANARAMOS ✓� pIANAp1yp5
9 '" _`^ +fj � NouryPubllc�Staleelilorl0a +° �4 NolaryPubtic-Suteoiflotl�a
.2 � Commisslon p NH 386931 y Cdnmisi on p HH J869P
� V^�e� m"lobbyi "s�EC �� Y � � y ������� �sons: ��0�'� MyComm E�ImApr16,i011
BonEeO[Mouqh Nallonal NofaryAssn.
Expert witnesses who pmvide only scientifc,�echnical or other specialized information or testimony in pub ic g , son who
only appears as a represen�a�ive ofa neighborhood association wi�hout compensation orreimbursementforthe appearance. whether
tlirect, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
no4for-prof� community basetl organization for the purpose of requesting a grenl wi�hoW special compensation or reimbursemen� (or
�he appearance.
Page 4 of 5
i . . �� r I ���... I� J� F'.. �.....
Ciy ol Miami Beoch, 1700 ComeNion Cemer Drive,Mlaml Beach, Fbrida 33139,ww.�.mlomibeach0.go�
Offlce of ihe Ciy Clerk
Rafael E. Gronodo, Ciy Clerk CityClerk@miomibeachfl.gov
Tel: 305.6737411, Fax: 305.673725d
NAME OF LOBBYIST: t\ndv Sullivan
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STA7EMENT
Pursuant to City Code Section 2-485(d), the Cily Clerk shall notity 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 30'" 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 ihe City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understa annu registretion of all lobbyists shall be required for each 12-month period
comm cing O ber 1 of each year, and the fee (or s�.;� � nnual registration shall be
$50 . 0 purs nt to Section 2-482 of the Miami 8ea �Sr�. 'e.
Ne<
— � � a 'I 26��
Signature of Lobbyist Date
t�c�ea�sauuroamsuoeansr roHms�omw:�a¢a�:o-aua�ro,m a�m.oa m-i�-zo aec ao�
Page 5 of 5
DocuSr�n Emelme ID:C4Po�FFB-A]34455B-A9A6-88415669DDDE
SUPPLEMENTARY DISCLOSURE OFINTEREST
Interests in 29 ICD. LLC
Percentage ofinterest
V And M 184, LLC 100%
41 Shore Road
Amityville, NY 11701
Interests in V And M. LLC
Percentage of Interest
Jason Halpern 100%
41 Shore Road
Amityville, NY 11701
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