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2024 Lobbyist Registration Form - 6360 N. Bay RD (Gabriel Plotkin) � G3�o n1. 3� �-d . DocuSign Emelope I��.C�DCA9�]�63ECA961-A41F-OAAW3�D334C � � rz �= A�' �- y �P� 2� _ . - Office of the City Clerk 1700 Canvenlion Center Drive ,,CH Miami Beach, FL 33139 ,;� 305.6737411 � � LOBBYIST REGISTRATION FORM Lobbyist means all persons employetl or re�aineQ whether paitl or not, by a principal who seeks�o encourage the passage, tlefeat or modifration of any ortlinance, resoWtion, action or decision of any wmmissioner; any action, tlecisioq recommentlation of the Ciry Manager or any Ciry board or committee;or any action,decision or recommendation of any City personnel dunng the time period of the entire tlecision-making pmcess on such action, tlecision or recommendation [ha� fareseeably will be heard ar reviewed by �he City commission, or a Ciry board or committee. The term specifcally includes the principal as well as any employee engaged in lobbying activities. The term"LobbyisLs"has specifc exclusions. Please refer to City Cotle Chapter 2,ARicle VII, Division 3, entitled "lobbyisis," for atltli�ional information. Instmctions: Please complete all sections of this fortn and submit the completetl fortn,with lhe applicable(ee, to t�e O(fce of lhe Ciry Clerk. If you need more space to complete an answer, use a separate sheet(s)of paper. If you have no[hing to report in a particular sectioq you must wrile "none" or "nla" in tha� sec�ion. Any change to any infortnalian ariginally filetl, or any atltli�ional City Commissioner or personnel who are also sought to be lobbietl shall require ihat the lobbyist fle an amentlment to the registrdtion form. The lobbyis� has a mntinuing tluty �o suppty information antl amentl the forms fled lhroughout �he period �hat �he lobbying occurs. Separate registration fortns shall be requiretl for each principal representetl on each speci(ic issue. I. LOBBYIST INFORMATION: Fernandez Christophcr NAMEOFLOBBVIST (Lasl) (Flrst) (MIOtlIeNeme) CFZ Design 13300SW 52nd Court, Miramar, FL 33027 LOBBYIST BUSINESS NAME AN�HDDRE55 (NumOer and Slreep (Glry) (Slate) (Zip Coee) (239)898-7549 ChrisCcfzdesign.com LOBBYISTBUSMESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILA�ORESS II. PRINCIPAL INFORMATION: Plotkin Gabriel NAMEOFPRINGIPAL (Last) (Firsl) (MICEIeName) North Bay Palm Trust 6360 N eay Road Miami Bcach Florida 33140 PRINCIPAL9USWESSNAMEANDAOORE55 (Num�eran45treet) (Gty) (Sla�e) (ZlpCotleJ aabe(olcallwnotlscao.wm PRINCIPALBUSINESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILADDRESS Pursuan�to Ciry Cotle Sec�ion 2-482�hp1��ap A principal of any corpo2lion, patlnership, or olher enliry who appears as a lo�byist on behalf of�hal entity,wi�hout special compensalion or reimbursemen�for Ihe appea2nce,whelM1er tli�ecl, Intlirecl,or conlingenl,to express suppotl of w opposition to - an item shall�egisle�witM1�M1e qeik as reQuiretl Dy IM1is subuction WI shall no��e requiretl�o pay any regis�mlion fees. If the principal is a Corporetion, Partnership or Trust, the following informatian MUST be provided - pursuant to City Code Section 2-482(c): - NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARV(if none,wri[e N/A�: Gabriel Plotkin NAME OF ALL PERSONS HOLDING, DIRECTLV OR INDIRECTLV,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST(if none,writ¢NIA�: Gabriel Pbtkin,Trustee antl Beneficiary-100% � - Page 7 of 5 � � �o . _, , _ �ae�o,� aszti„�,E �III�� OocuSignEnvelopelD�.G00GA9D]�B3EC>961-A41FOM813DD33AC III. ISSUE TO BE LOBBIED: Describe with as much detail as is practicai, including but not limited ta a specific description where applicable of a pending request for proposal, invitalion to bid, or public hearing number. Development Approvals & Pcrmitting Issucs, including but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development,City Commission, and any City Workshops or Committees, if necessary,relafing to thc property locatcd at 6360 N Bay Road in Miami Beach, 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 general nature of the subject contractual relationship. Full Name of Individual and Contraclual Relationship (I(yes,explain) VES NO Title of Persan lo be Lobbied Staff for the Planning& Building Department None X Public Works &City AdministraHon, PB, HPB, BO None X DRB, City Commission, and Mayor as necessary None X Land Use &Sustainabili Committee IVone X Pursuant to City Code Section 2-482�g), every registrent 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 fortn filed. List any Business, Financial, Familial or Professional Relationship, or other relalionship giving rise to an a earance of im ro riet if none,write N/A : None „ 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): , 0 -NoAdtli�ionalCompensa�ion. Page 2 of 5 � rryl� L �E5�9<E5 C 9Bn6v0�E page[ol5 2'09B92GT/i�L ��y�� rt OowSign Envelope 10'.CODCA9D]-83EC-0961-A41 FOAAB]300334C The following siz(6)questions MUST be answered: 1) Pursuant to City Cotle Section 1�488,entitled'Prohibited Campaign Coniributions By LoObyists On Pmcurement Issues"' V¢s x No: Are vou lobbvinp on a oresen[or oentlina bitl for aootls. eauiomen[or services. or on a oresent or pendino award for 000ds eouiomen[or senice7 2) Pursuanl to Ci�y Code Sec�ion 2d90, entitled "Prohibitetl Campaign ContribWions By Lobbyis�s On Real Esta�e DevelopmeN Issues"'. Ves x No: Are vou lobbvino on a oendino aoolication for a Developmen[Aqreemen[with the CiN or application tor chanae of zoninq map tlesiqnation or chanae to the Citv's Future Lantl Use Mao? 3) Pursuanl to City Cotle Section 2-482�h�, any person (except those enempt hom ihe de(inition oF "lobbyisf' as se� forth in Section &481)who only aOPears as a represenlative of a nobfor-pmfit wrporalion or entity wi�hou[spe�al compensation or reimbursement for ihe appearance,whe[her tlirect or intlirect lo express suppotl of or opposition to any item,shall regis[er with the city clerk as required by�his sedion,bul shall not be required to pay any registretion fees. Ves XNo: Ar¢ vou reoresentinu a no4forv0�oFt co�po2tion o� entitY wi�houl so¢cial comoensation or reimbursement? 4) Pursuant ta City Cade Section 7181, the term "IobbyisP' speci(ically eaclutles the following persons'. Expert witnesses who provide onry scientific,technical or other specialized information or testimony in public meelings', any person who only appears as a representative of a neighborhootl association withoW compensation or reimbursemen[for ihe appearence,whelher tlirect, intlirect or mntingenl,to express support of or opposilion�o any item;an0 any person who only appears as a representative of no4for-pmfit community basetl organization for ihe purpose of requesling a granl wi�hout special compensation or reimbursement for ihe appearance. VesXNo: Are vou orovitlina onlv scientitic. technical or other soecialized iMormalion: aocearina as a reor¢s¢ntative af a n¢iohborhootl association without special comoensalion or r¢imbursement or reoresent'nq a noPior-proft based oraanization for [he oumose of reQuestinq a nrant withoul soecial comoensa[ion or reimbursement? 5) Pursuant to Ciry Cotle Section 2�691(1J, no campaign consultanl shall lobby�he City Commissian for a period of 12 months following the swearing in of any elec�etl official(s)for whom the campaign consultant provitleC campaign consulting services within ihe past election cy<le.See Section 249� for more information. Yes xNo: Have vou orovidetl camoainn consWtino servic¢s [o an incumben[member of ihe CiN Commission within the oasl election cvcle7 It ves please list ihe incumbant m¢mberlsl of the CiN Commission: Ves x Na: If ves has it been less than 12 months since ihe elected officiallsl whom vou orovitled campaiqn consultina services was sworn in7 6) Pursuant lo City Code Section 2�482(a�(4�a., a lo�byisl who has within the past election cycle providetl campaign consul�ing services ro an incumbent member of ihe City Commission (whlch lobbying activity is nol olherwise pmhibited by COCe section 2-491) shall disclose such pa�icular service on hislher lobbyist regisiration form antl shall orallv tlisclose such oarticular servce before labbv nq�he Cb Commission at a oublic meetina. - Ves x No: Have vou orov'detl camoa'qn consulfnu servic¢s to an in<umbent member of the CiN Commission within the oast election cvcle7 If ves please lisl the incumbent memberlsl of the CiN Commission: Yes x No: I( ves vrere vou orom'sed or did vou receive economic consitleralion in exchanne for camoaiun consultina services7 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY � /' o Annual Regislra[ion iee: � ]Ves �No Amom[Paitl�SJ• MCR p H�J��0ate PaiE � � - LobbyistRegishatlonFormrecHvetlanEveri(etlby: �� F�. S��e.\':..4iFpRMS'.Lp98YS5TFORMS Lcobe :' mNevltetl 09-20d8NEG.40[ ReviseG09/20/2018 _ Page 3 of 5 � o ... s , oe�isaaes c oaesaena e aeaaaors . oieezcnme �� DacuSign Envelope 10'.CDOCA90]-B3EC-0961-A01F-0AAB]30D334C VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CIN 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 LOBBVIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL 8E FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.' Signature of LobbyisC� �'d ecscaav — Date 4-�4-�024 I do solemnly swear or affrm that all of the foregoing facts, statements, antl disclosures in [his form are hue 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 Ciry Co�de�nd all re�otling requiremenls. SignaNre of LobbyisC I �/ �"`D�'{ Date a-z4-zoz4 Signature of PrincipaC ��f uh�� P(�aiti Date a-z4-z�z4 coeanzca�saoz VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of Florida Counry oc Miami-Dade Counry o[ Miami-Dade Swom ro(or aHirmed)and subscribed before me, Sworn to(or affrmed)and subscribed before me, by means of 0 physical presence by means of O physical presence ar�online notarization, or 0 online notarization, this 24 day of Aoril .2024, by this 24 day of narii ,20 2a,by Christopher Fernandez Gabrie] Plotkin NAME OF�OBBYIST NAME OF PRINCIPAL _Produced ID Produced ID FO F z personalty Kno � x personally Kno ' Id„]j�� r ui `; .. .= Signature of No�ary ublic � SignaWre of Notary ublic �� Veitly Mon�esina Perez Veitly Montesino Perex = Name of Nola , T� ed Printed or Stamped Name of Nolary,Typed, Printed or Slamped Yeitly Monlesino Parez Yeitly Monlesino Perez Commission k HM 08621� Commission#HH 00421] Notary Publk-Slate of Flontla Notary Public-State of Flontla _ My Commission Expires Jan 24,2025 My Commission Expires Jan 24,2025 �Th ., ., ,,,, ,. , .,_ . gpersans: Expeh witnesses who provitle only scientific,techniwl or other specialized information or teslimany in public meelings:any person who only appears as a representative o(a neighborhootl association without compensa[ion or reimbursement for ihe appearence, whether direct, indirect or contingent, to express support of or opposition to any ilem; and any person w�o onty appears as a representative of no4for-profl wmmunity based organization For lhe purpose of requesting a grant withoW special compensa[ion or reimbursemenl for lhe appearance. Page d of 5 �°w"e''��o �o„ oE_,,,,_,��o�e_,o,e�=�„a,t �III��11111 i � .1,�n� Pape<olfi �109B93fiP1]E OacuSgn Envelope 10'.CDOCA9�]-63EG4961-A4IROAAB]30D334C Ciy ef Miami Beoch, V00 Comem�o�Ceme�Drive,Mlaml eeoch,Flonda 33139,www.mlam16eachRgo� Office of ihe Ciy Clerk Rofoel E_Gmnodo,Ciy Clark GryClerk@miomibaachfl.go� Te1: 305.673J411, Fax�. 305.6737254 NAME OF LOBBYIST: Christopher Femandez 1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT Pursuant to City Code Section 2-485(d), the City Clerk shall noti(y any lobbyis[ (or principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement (Statement). In addition to any other penal[ies 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 aker notification. Any lobbyist, who fails to fle [he 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 immedia[ely fle 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-mon[h period .. commencing October 1 of each year, and [he fee for such annual registration shall be $500.00 pursuant to Section 2-482 of the Miami 8each City Code. oaas�e�=a ey: i^-ry/ G 4-24-2024 CILOOBnBFCL56iM19 Signature of Lobbyist Date F\CLERSPLLbFO0.M5LLOBBYIST FORMWOWyia�Regis�m4m Porm Bevise�l 0]-1L300.EG 0¢ � Page 5 of 5 'b«v�.nNPm�cmmcoE-sin-aese-eoca-�ovavacnae v,y.sors s�asaszsnme ,III� 3�.�'IIII � Misceilaneous Cash Receipt CITY OF MIAMI BEACH No, 433248 ❑Cash ❑Credit Card ❑Check# ' S � 20 Received of �� Address E-� �� For �� City of Miami Beach . Misceilaneous- MCR-2024 006955-0002 Maiszs G.. Mi28I2024 063bAM Mca o�eN�Mca� Office of Finance Director Paymenl Amount: 1.SSO.00 (THIS INFORMATION MUST BE COMPLETED) By Account number. � � � Preparer. � Depk �� EXT: »� ��n��itiun Center �r. Nia�ni Beach , FL 33139 . . 305-673-7420 Welcame �4�26/2�24 1G:3tiAM Maises C, � �1 OOfi957-0002 NISL'ELLANf(�IS g Reference 7; �dCR4332qB � MCR OpEN (ML'R) 2024 Item: MCH 1 N $1.550.00G0 � MCR OPFN (Mf,R) $1,550.00 __-��$I,550.00 Subtotal Total i1.550.00 5�,5�o.on CHECK Check Number0010U2 $�.550.On � , � Chanee due ----..___.__. k ao.ou ` Paid 6y; BERCOW RAUELL FERNANi7EZ LqHKIN & 7pPANES PLLC � iINII�IIIIIII�IVIIqIiIIIIdIIIINIVINRIIIIIIIGIIqllll�lllllll � �