2024 Lobbyist Registration Form - 761 Jefferson Ave (Jefferson 745 761 LLC) ��� �2rFerton .4ve ,
��,�� lAM ! �EAGH �E��'°�°
Office of the City Clerk
1�00 Convention Center Drive SEP 09 2024
Miami Beach, FL 33139
305.673.7ai i GTY OF MIAMI BEACN
LOBBYIST REGISTRATION FORM OFFICE OF 7HE CITV CLERK
Lobbyist means all persons employed or retaineQ whether paid or not, by a principal who seeks lo encoura9e the passage, tlefeat or
modifcation of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendalion of the Cily
Mana9er or any City board or committee;or any action,decision or recommendation of any City personnel during ihe time period of the
entire decision-making prxess on such action, decision or rewmmendation that foreseeably will he heard or reviewed by the City
Commission, or a City board or committee. Tha �erm specifically includes ihe principal as well as any employee engagatl in lobbying
activities. Tha term "LobbyisY has specifc excWsions. Pleasa refer to City Code Chapter 2, Article VII, Division 3, entitled "Lobbyisls°
tor additional information.
Instmctions: Please complete all sections of this form and submit the completed form, wi[h the applicable fee, to the Off�ce of ihe Ciry
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nolhing to report in a particular
section, you must wnte "none" or "n/a" in that section. Any change to any information originalty fled, or any additional City
Commissioner or personnel who are also sought ro be lobbied shall require that the lobbyist file an amendment to ihe registration form.
The lobbyist has a con6nuing duty to supply infoimation antl amend the forms filetl throughout the period that the lobbying oaurs.
Separate registration forms shall be required for each principal represenletl on each specifc issue.
I. LOBBYIST INFORn�ON: �t,,�
1�SCz��ll� �t S�P�(
NAME OF LOB6YIST (Last) (Flrst) (Mitldle Neme)
�L+ slv�to, u� 2� ��wn�. �I�d- �l�arri� �— �i 37
LOBeVIST BUSWE55 NAME AND AO�RESS (Number antl Street) (Ciry) (State) I (Zi0 Cotle)
��S) �4C�—�fU �� � .��c.�� �LS'�lbs� G(isrna.�c� �al.S�tud�c�
LOBBVISTBUSINESSTELEPHONEN MBER CELLULARTELEPHONENUMBER EM ILADORESS
II. PR CIPAL INFORMATION:
��=�rJ 1�5 7f�� LI.G
NAME OF PRINqPAL (LasQ (First) (Mitltlle Name)
'aZ► !A-�n �• #4fo5 �(am i �er� ��-- �3 f q 1
PRINCIPALBUSMESSNAMEANOAD�RESS (Numberen 3lreet) (Clty) (State) ��IoCode)
NN�1-- ��n m�� ,�d���II"1 ) 593 - )c�44 I��m����t��
PRINCIPALBUSI SSTELEPHO N MBER CELWLl... ,«cPHONENUMBER EMAI�AD�RESS C,
Pursuant to City Cotle Sec�ion 2d82(b)(i)(a): A principei af any mrpordtion, Oertnership, or o[her entily who appeaa as a lobbyist on bahaM of[hat �
entity,wNMuI special wmpensalion or reimbursemen�fw[he appearance,whe�har tlirect,iMirxt,or con�ingenl,to express suppotl of or opposition�o �
an item shall regis[er wRh ihe Clark es requlretlby Nis subsection bul sheli no[ba reQuiratl to pay any reglstration tees.
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2�82(c):
. NAME OF CHIEF OfFICER, PARTNER, OR BENEFICIARV(if none,write N/A):
. NAME OF ALL PERSONS HOLDING, DIRECTLV OR INDIRECTLY,A 5°/, R MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A�:
Page 1 of 5
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III. ISSUE TO BE LOBBIED:
Describe with as much detail as is prectical, including but not limited to a specific description where
applicable o a pending request fo� roposal inv'tation to d, or public hearing number.
All � �la�ed -� �S�.oc« ��es.e�Jaa��-c) G��c�
� � �
`l'� � I ��m
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 lobbylst 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 sub]ect contractual relationship.
� Full Name of Individuel and Coniractual Relationship (If yes, explain) YES NO
Title of Person to be Lobbied
_ �ivd�o �
C�
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 lobbied as identified on the lobbyist registration torm filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
a earance ot im o rie if none, write N/A :
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Soecific. (Note that a
contlngency fee is prohibited pursuant to City Code Sec. 2-485.3):
� �,utll serve a� � �chi(ac.roF' �ew��P �;r `7ae c�,AolceGn�,_t�ha��
a ��uG� �n �Pc�/rr'1 (.�rc`���aQ �UI (9�/ a✓kQ rro .�CuT2C_
� �S �c� �n re��ion � T'�.s �',U�. v
The following six(6)quastions MUST be ensweretl:
1) Pursuant t�o City Coda Section 2-088,enti�led "Pmhibitetl Campaign Contribu[ions 8y Lobbyists On Pmcurement Issues":
_Ves�1Jo: Are o lobb ' a oresent or cend' 4'd fo aootls a ' t o se 'ces orese t o
pentlina awartl for aoods eauloment or service9
2) Pursuant to City Code Section 2d90, entitled "Prohibited Campaign Contributions By Lobbyisis On Real Estate Development
Issues":� �
_Yes�No: Are v labbvina o dina oolicatlon fo D I nt Aore e t ith the CIN or nll tl
Qr yhan4e of zonina mao des'anaCon or chanae to the C'tv's Fut re Lantl U e Mao?
3) Pursuant to City Cotle Section 2-082(h�, any person (ezcept those exempt fmm the defnition of "IobbyisY' as set forth in
Section 2-481) who onry appears as a reprasentative of a not-for-proft coryoration or entlty without special compensation or
reimbureement for the appearance,whalher tlirecl or indirec�to express support of or opposition to any i�em,sha0 register with
Ihe ciry cle�rk as required by this section, but shall no�be requireA to pay any registation fees.
_Yea 410: Are v reor s tl a ot-forvorofR c a H r endtv Ith t ueclal como n f o
reimhursement7
4) Pursuant to City Code Section 2d81, the tertn "lobbyist" specifically ezdudes the following persons: Expert witnesses who
provide only scienlific,technical or olher specialized informalion or testimony in public meetings; any person who only appears
as a representative of a neigh6orhood association without compensatlon or reimbursement for ihe appearance,whether direct,
indirect or contingent,to express support at or opposition to any item; and any person who only appears as a representative of
not-forvproft community based organization for the purpose of requesting a grant withoul special compensation or
reimbursement for ihe appearance.
_Yes�la: Are vou or v'di Iv sclentlfic t h ' I th sce i I' d i f tlon� aoo rin
reoresentat've of a ne'ahborhootl assoc at on witho t soec'al satlo o e'mb t or
r� Y � a ot-for-o o!t b d o a ' afo fo th o e oi ea esC o t 'tho t
soecial comoensation or reimbur5emeni7
5) Pursuant to City Code Seclion 2191(1), no campaign consWtant shall lo6by the Cdy Commission for a penotl o( 12 mon�hs
following the swearing in of any elected offcial(s)for whom the campaign consWtant provitletl campaign consWting services
within th'e/p�s�election cycle. See Section 2-491 for more information.
_Ves lMo: Have you orovided camoalan consWtina services to an Incumbant member ot the CIN Co I
within the oast elect'a cvcle'+I( es le s I' t the' cumbent membe (s)of the Citv Comm's '
_Yes_No: If ves has 't 6een less Man 12 months s'nce the elected oK ' Ilsl ho vo oro id d ion
co�suNina servlces was sworn In7
6) Pursuant b City Code Section 2-462�a�(4)a., a lobbyist who has within Ihe past election cycle provided campaign consulting
services to an incumbent member of the Ciry Cammission (which lobbying activiry is not otherwise prohibited hy Code section
2-497) shall disclose such partialar service on his/her lobbyis! registretion form and shall oralN discbse such oarticular
service be re lobb in [he Cit Commission at a ublic meefin .
_Yes o: Have vou orovitletl camoalun consultina services to an 'ncumbent member of th CIN C mmissfon
within the oast electlon cvcle� If ves olease Ilst[ha Incum6enl memberfsl ot lh CIN C mmisslon'
_Yes_No: If ves. were vou oromised or tlid vou rece've economic consideratlon In eachana f r ain
5on5UlflnO Servicea?
TO 9E COMPLETED BV CITV CLERK'S STAFF ONLY
Annual Regis[ra[lon he: fX1 Yes[ ]No Amount Paid{ MCR# �-I33 7 37 Date Pald `� �9 2
. t /
Lobbyist Regie[roHon Fo�m received and verifietl by: � . Q('�p�
e',.aert ai rovrns',t.r,nns roanc� i r� �o��o-. , v, , �+ i; cwcae,. Revisetl03/11/20Z0
Page 3 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 LIS7ING LOBBYING EXPENDITURES AS WELL AS COMPENSATION
RECEIVED FOR THE PREC G CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN A TO LO Y. A STATEMENT SHALL BE FILED EVE IF THERE HAS BEEN NO
EXPENDITURE OR CO P AT DUR G THE REPORTING PERIOD.'
Signature of Lobbyist Date L �
I do solemnly swear or a II of h foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or m a i� itl t e provisions contained in Chapter 2, Art. VII, Divi ion 3, entitled "Lobbyists" of
the Miami Beach City an all i g requirements. � � �
Signa[ure oi Lobbyist: Date
Signature of Principal� � �'ti ��------ Date �������
VIi. NOTARY SIGNATURE AND SEAL:
LOBBYIST: I1 PRINCIPAL .
State of�0��0.�� State of �h�n�
CounryoC Qmi Q� CountyoE (tsn�Yl
Sworn to(or affirpYed)and subscribed before me, Swom b (or aff ed)and subscribed before me,
by means of Ud�physical presence , by means of physical presence
or❑ I'ne notarizaUen, or❑ line no[ar ti
this�day of � 2�, by thi '�day of � 20� by
CC S le
NAME OF LOBBVI T NA OF PRINCIPAL
_Prod e ID Protlu d ID
OR OF IOEN F CATION OR OF I N FICATION
_Pe sona y P ow so ally (n n
�
Signa re o�ot �ry Public "gn Nre of otary P blic
f��LG
Name o(Notary, Typetl, Printed or Stamped Name of Notary, Typed, Printed or Stampetl
(N uvi�owea �
' t� �nPveuc.sutw/FIMG (NO � ' A1�1 Gwllown[u
� j� Canmiulon X HH�90h19 d4ry GUEIic�5bb o/FIMd�
� P�, MYCanm.ExpirnFHA.203/ ���� ,yyCpnm�(v0lresFMI630i�
Hatary bfn. ....9mEM thrwln uatlm�l Notary.lvn.
� The ter c e t e ollowing persons:
Expert witnesses who provide only scien[ific,technical or other specialized information or testimony in public meetings; any person who
only appears as a representa[ive of a neighborhood associa�ion without comDensation or reimbursement for�he appearance, whether
tlired, indirect or contingent, to express support of or opposilion to any itam; and any person who onty appears as a rapresentalive of
noPfor-profit community based organization for Ihe purpose of requesling a grant without spacial compansation or reimbursement(or
the appearance.
Page 4 of 5
i ia �!~�� � �
Ciy of Miami Beoth, V00 Convention Center Drive, Miami Beoch, Florida 33139,www.miamibeachfl.gov
OHice of tha Ciy Clerk
Rafoel E. Granado, City Clerk CiyClerk@miomibeachfl.gov
Tel: 305.673J411, Fox: 305.6737254
NAME OF LOBBYIST: �X�l��`l�J+�IJ �l�t�P �__
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 $50.00 a day shall be assessed for Statements filed after the
due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and
Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30'" of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fne has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUA� LOBBYIST REGISTRATION FEE
I und nd annual registration of all lobbyists shall be required for each 12-month period
me in O tober 1 of each year, and the fee for such annual registration shall be
50 . 0 p s to Section 2-482 of the Miami Beach City Code.
p � � 2
a yi t Dat
F'.0.ER15f�LLaFORM5�L086V1$TFOR SLLobbp¢iNcg6�TlanFom�ReNsetlUJ-tl-NIHEGOac
Page 5 of 5
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH No, 433737
❑Cash ❑Credit Card ❑Check# $
20
Received of
Address
For
City of k9iamiBeach
Miscellaneous-MCR-2024
00]302-0�31 Cxrmen V...09/09/2024 01:37PM
MCR OPEH(MCR) Office of Finance Director
PaymerrtAmount 85000
(7HI5INFORMATION MUST BE COMPLETED) By
Account number:
Preparer: Dept: EXT:_
� City ot Miami 6each
City Natl
� 11(Nl f.iNivent9nn Cenitn Dr.
M�ami f�;acli , Ft 3373�i
" 305-673�)420
Vlelr.nme
U'I�09�20?4 OI :J7('�4 Gsnueq V.
00730Y-9G31 �
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Referer,ce 1: MCRq:)37s1 �
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1 � $ASUAOGp
MCR OPEN (Mf,R) 58^�0 GU �
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- Suhtutel $85D.00 �
lotal $H50.00
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Miscellaneous Cash Receipt
CITY OF MIAMI BEACH No. 433737
❑Cash ❑Credit Card ❑Check q 5
20
Received of
Address
For
City of Mieml Beach
Miscellaneous- MCR-2024
0 0 7 30 2-003 7 Carmen V...09/0920240137PM
MCR OPEN(MCR) Offl[E Of FIf13fIC0 DI�BCYO�
PaymentAmounk' 85�00
(THIS INFORMATION MUST BE COMPLETED) By
Account number. �
Preparer: Dept EXT:
City of Hiarai Beach
City Hall
1700 f,iuivenl�ion I;r.ntr.r Ur. .
Miaa�i Near.h , Fl :i3199
- :1(Y�-673-7A211
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