2024 Lobbyist Registration Form - Water Taxi Infrastructure (Sam Payrovi) �� Te,x :
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RECEIVED
� �i� t I !`��t�� f.,.���� ��- oflice of tne Ciry Clerk A�� 13 2024
1700 Conven�ion Cenler Drive
Miaml 6eacn, FL sst3s GTY OF nf iAMI BEACH
� 305.6737411 OFFIC� -�' ' ,=CITVCLEFtk
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or nol by a principal wha seeks ro enmurage the passa9e, tlefeat or
modificalion of any ortlinance, resolution, action or decision oF any commissioner, any ac�ion, decision, recommentla�ion of the Ciry
Manager or any Ciry boartl or commitlee;ar any actioq decision or recommentlation of any City personnel tluring the time periotl of the
entire tlecision-making process on such actioq deasion or recommentlation ihat foreseeabty will be heard or reviewed by Ihe City
Cammission, or a Ciry board or committee. The�erm specifically includes the principal as well as any employee engagetl in lobbying
actrvltles. The lertn "LobbyisP has speci�ic exclusions. Please refer to City Code Chapler 2, Article VII, DIvlslon 3, entltled "Labbyists,'
for atltli�ional informalion.
InsWc[ions: Please complele all sections of this form and submi�the comple�etl form,wi�h Ihe applicable fee, �o the Of�ice of the Ci�y
Clerk. If you need more space to comple�e an answer, use a separate sheet(s)of paper. Ii you have nothing �o report in a particular
section, you mus� wn�e "none" or "nla" in �hat section. Any change �o any intorma�ion originally fled, or any addi�ional City
Commissioner or personnel who are also sought to be lobbied shall require ihat Ihe lobbyist fle an amendment to the regis�ration form.
The lobbyist has a con�inuing tlu�y b supply Information antl amend the forms filed throughout the period lhat ihe lobbying occurs.
Separate regisUa�ion forms shall be requiretl for each principal represen�ed on each specifc issue.
I. LOBBYIST INFORMATION:
Payrovi, Sam
NAMEOFL0B8VIST (Lest) (Frs�) (MitltlleName)
E-lixr Inc 2150 N Bayshore Drive #120�, Miami, FL 33137
LOBBVISTBUSINESSNAMEANDADDRESS (Numbe�antlSlreel) (Cl�y) (State) (ZipCotle)
(917) 684-5222 (917) 684-5222 sam@elixr.miami
LOBBVISTBUSMESSTE�EPHONENUMBER CELLULARTELEPHONENUMBER EMAILAODRE55
II. PRINCIPAL INFORMATION:
Payrovi, Sam
NAMEOFPRINCIPAL (La51J (Flrsl) (MltltlleName)
E-lixr Ina 2150 N Bayshore Drive #1201, Miami, FL 33137
PRINCIPAL BUSMESS NAME AND ADORESS (NumOer antl Slreep (GityJ (S�a�e) (Zp Cotle)
(917) 6845222 (917) 6845222 sam@elixr.miami
PRINCIPALBUSWESSTELEPHONENUMBER CELLULARTELEPHONENUMBER EMAILAD�RESS
Pursuant b City Cotle Sedion 2-082@)�1)(aj: A principal of any m�poration, paMership, or olher en�ity who appears as a lobbyis�on behalf of�hal
enlity,witM1OW special compensalion or reimbursemenl for IDe appearence,whether tlirxt,Indirecl,ormn�ingent to express support of or opposition�o
an item shall register with the Cled as requiretl by Ihis subsxtion but sM1all not be 2quiretl to pay any regisValion fees.
If [he principal is a Corpora[ion, Partnership or Trust, [he following information MUST be provided
pursuant to City Code Section 2-462(c):
• NAME OF CHIEF OFFlCER, PARTNER,OR BENEFICIARV(i(none,write NIA): N2Ih81ie P31V2
• NAME OF ALL PERSONS HOLDING, OIRECTLV OR INDIRECTLV,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
GORPORATION,PARTNERSHIP OR TRUST(if none,write NIA�: N/A
Page 1 of 5 ��
� III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including bu[ not limi[ed to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
We are discussing lhe development of, and infrastmcture requiretl for, a water taxi service. This water taxi service
aims to evenlually be an all-electric service. It will, however, launch, on iraditional fuel 6ased boats during ils pilot phase.
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 genemi nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship (If yes, explain) YES NO
Title of Person to be Lobbied
Vice Commissioner Alex Femandez 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 wrrent City Commissioner or City personnel who is sough[ [o
be lobbied as identified on the lobbyist registration form filed.
Lisl any Business, Financial, Familial or Protessional Relationship, or olher relationship giving rise to an
a earance of im ro riet ii none,write N/A :
N/A
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):
No compensation _ _ _ _ _ . _ —
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The(ollowing siz(6)questions MUST be answered:
1) Pursuant ta City Cotle Sec�ion 2-488,enli�letl'Pmhibited Campaign Conlributions By Labbyists On Procuremen�Issues":
_VesXNo: A I bb ' � d' b'tl f d �p t s or on a oresen[o�
p d tl t ods e ent or service�
2) Pursuant to Ciry Cotle Sedion 2-d90, enli�letl'Pmhibi�etl Campaign Conlributions By Lobbyists On Real Esta�e Developmenl
Issues'.
_Yes�lo: A v I bb ' q d' q I' [' f D 1 t Aq t 'th lh Cb I'caCon
( h ( P d C h q t lh Cf ' F Wre Land Use Map7
3) Pursuanl to Ciry Code Section 2-482�h), any person (except Ihose exempt fmm the definition of "IobbyisY' as set farth in
Section 2-481)who only appears as a representative oF a no4lor-pmfit wipore�ion or entiry without special compensation or
reimbursemen�for the appearance,whether direct or indirect lo express support of or opposition to any item,shall register with
the city�/cle'rk as required by ihis section,bu�shall not be required to pay any regis�ratian(ees.
_Yes/�vo: A v C if ft t' fN lh [ p ' I com ensafon or
reimbursemenC?
4) Pursuant to City Code Section 2-481, Ihe lerm "IobbyisP specifcalty exclutles ihe following persons'. Expert witnesses who
provitle anly scienlifiq technical or ofher specialized informa�ion or testimony in public meetings;any person wha only appears
as a representative of a neighborhootl association without compensalion or reimbureement for the appearance,whether tlirect.
indirect or contingent,�o express support of or opposition to any item;and any person who only appears as a representa[ive of
nobfor-pmft wmmunity based organization far ihe purpose of requesling a grant withaut special cam0ensation or
reimbursemen�for the appearance.
_Yes�(Jo: A 'd I Cf t h ' I th p ' I' d ' f f pp r'nq as a
p t f f 'qhb h tl � f 'lh [ p ' I comp at on or reimbursemen[ or
p f t f ft b d q ' C f lh p f q t n a arant w thout
p ' I Olflp [ fl Of f¢imbul5¢ffl¢n[�
5) Pursuan�lo Ciry Cotle Section 2-491�1�, no campaign consul�ant shall lobby�he Gity Commission for a periotl of 12 monNs
following the swearing in of any elected official(s)for whom�he campaign consul�ant pmvided campaign consWting services
within�th/e p'ast elec�ion cycle. See Sec�ion 2-491 for more information.
VeyWo: H 'd d IC t 'ncumbent member of the CiN Commission
'th' th t I f I �If 1 f t th " b nt memberlsl of[he C[v Commission:
Ves No: � h '[ b I th 12 th fh I [ tl H'c'al(sl whom vou provided camoainn
^ IEnq 'ces was swom in�
6) Pursuanl lo Gity Code Sec�ion 2-08P(a)�4�a., a lobbyisl who has wi�hin lhe pasl election cycle pwvided campaigm m�sulting
services�o an incumbent member of the Ciry Commission(which lobbying adivity is not otherv✓ise prohibited by Cotle seclion
2-491) shall tlisclose such particular service on his/her lobbyist reglsUation form tl h II r II d'sdose such pa�iculer
b f I bb � lh C C t bf ln .
_Ves�(Jo: H 'tl tl If t b n[member of the Clv Commission
'th' th t I C I '+If 1 f t lh ' b nt membedsl o(ihe CiN Commiss�on:
Ves No: If tl d'tl �d t' n 'n ezchanue for camaaian
consultina services?
TO BE COMPLETED BY CRV CLEftK'S STAFF ONLV
Annual RegiS��aGon fee: � ]Ves[ �No Amounl Paitl$ ` f MCR# '•V �S Oa�e Paitl �3 �G
Lobbyist Regisha�ion Porm receivetl antl verifetl by: r`
. . �� . :: �i... Revisetl03/11(2020
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNEO STATEMENT UN�ER OATH LISTING LOBBVING 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 L0B8V. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERI00.'
Signature of Lobbyist
�"'''' /`ro�`� Date 08/13/2024
I do solemnly swear or affirm �hal all of the foregoing facts, slatements, and disclosures in Ihis form are true and correc[,
and �hal I have read or am familiar wi�h �he provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
Ihe Miami Beach Ciry Code and reporting requiremeNs.
��'-��-j�`�v" 08/13/2024
Signature of Lobbyist: Date
�a^'� �`ro�" OS/13/2024
SignaWre of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
Slate of
Rorida State of Florida
Coun�y of: Collier County oP Collier
Swom to(or affrmed)and su6scribed before me, Swom lo(or affumed)and subscribed before me,
by means of� physical presence by means of 0 physical presence
or E�online no�arizalion, or E�online nolarization,
lhis �3th day of August pp24, by this�3th day of August p024, by
Sam Payrovi Sam Payrovi
NAME OF LOBBYIST NAME OF PRINCIPHL
� Produced ID DRNER uCENSE J p�oduced ID DRNER uCENSE
FORM OF IDENTIRCATION FORM OF IOENTIFICATION
��on�y Known, �P�nally Kno�
r tl{ �)
���,. � 1�
SignaWre of Notary Public SignaNre of Notary Public
Wlllie B Webb Willle B Webb
Name of Notary, T Name of No�ary,Typed, PriNed or Slamped
(NOTARYSEAL) '�� ve� r a (NOTARYS L� e °+ :onMqWEeB� aa
c y� �
�0/ ci
t e^�
'The term"lobbyist spe i�call @'FE�des ihe followin ersons'. �-
Expert witnesses who provitle only scientific,technical ar other specialized information or teslimony in public meetings;any person who
only appears as a representative of a neighborhood associa�ion without compensafion or reimbursement for the appearance, whether
tlirect, intlirect or contingent, to express support of or opposition lo any i�em; and any person who only appears as a representative of
nobforvprofil communiry basetl organization for the purpose of reques�ing a gran�without special compensation or reimbursemenl for
�he appeatance. p q
Nolarized remotely onllne usltl�r�urTcation technology via ProoE
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. . r i. . ... ., i
Ciy of Miami Beach, 1]00 Convem�on Cemer Dnve, M�aml Beach,Flonda 3J 139,www.miomibeochfl.gov
Offt�e ofrha Gy Cle�k
Roloel E. Gronodo, Ciy Clark CiryClerk@miamlbeachfl.gov
TeP. 305 6737411, fax�. 305.6737254
NAME OF LOBBYIST: Sam Payrovi
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
(StatemenQ. In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $W.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 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 Ihe Miami Beach City Code.
, `� August 13, 2024
Sig ature of Lobbyist Date
rec�tA�sAu�wwns�oeens Fowmsa000�inrz�y�:wrz��vo�R.m,.e m.i izo aec ea�
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