2024 Lobbyist Registration Form - 1691 Michigan Ave (Robert Rivani) �
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MIAMI BEACH off��of,he���Y��e,k ��N zsZoz4
1700 ConveNion Center Drive QIIY OF MIAP;11 BEACH
Miami Beach, FL 33139 nFFICE!'F�'.�NE:CIIY CLERK
305.6737411
LOBBYIST REGISTRATION FORM
Lobbyis�means all persons employetl or relained, whelher paitl or not. by a pnncipal who seeks lo encourage [he passage, defeat or
motlifica�ion of any oMinance, resolNion, ac�ion or decision of any commissionar', any ac�ian, tlecision, recommentlation of Ihe Cily
Manager or any Ci�y boartl or commitlee;or any ac�ion, decision or recommentlalion of any Cily personnel tluring the lime periotl of Ihe
en�ire decisionmaking pmcess on such ac�ion, tlecision or recommentlation tha� fareseeabty will be heard ar reviewatl by ihe City
commission, or a Ciry boaN or commit[ee. The tertn spacifiwlly includes Ihe principal as well as any employaa engagetl in lobbying
ac�ivities. The lertn"Lobbyis�s"has specific exclusions. Please refer lo City Cotle CM1apter 2, Atlide VII. Division 3,en�i�led"Labbyists;'
for atltli�ional informalion.
Insimctions: Please complele all seclions af Ihis form antl submi��he compleled fortn,wi�h�he applicable fee,to the Office a(the City
Clerk. If you neetl more space to complate an answer, use a separate sheet(s)of paper. If you have nottiing �o repoh in a par�icular
settion, you must write "none" or "Na" in [hat sec�ion. Any change lo any informa�ion originally filetl, or any addilional City
Commissioner or personnel who are also sough��o be lobbietl shall require Ihat the lobbyis�file an amendmenl lo Ihe registra�ion farm.
The lobbyis� has a mntinuing dury m supply informa�ion and amentl [he forms filed �hmughoul the periotl �ha� the lobbying occurs.
Separa[e registra�ion(orms shall be required for each principal represenletl on each specific issue.
I. LOBBYIST INFORMATION:
RodriQuez Carlos
NAMEOFLOBBYIST (Last) (Hrst) (MltldleNama)
Escala Forma Studio 8650 Biscavne Blvd., Suite 2 Miami FL 33138
LOBBVISTBUSINESSNAMEANDAD�RESS (NumberantlS�reel) (GIry) (Ste�e) (ZipCatla)
7863483608 infoQescalaforma.com
LOBBVIST B1151NES5 TELEPHONE NUMBER CELLULAR iELEPHONE NUMBER EMAIL AD�RESS
II. PRINCIPAL INFORMATION:
Rivani 2obert
NAME OF PRINCIPAL (Las�) (FirsQ (Mltlale Name)
RK 2ivani LLC 201 S. Bisca}me Blvd., Suite 1440 Miami Florida 33131
PRINCIPALBU31NE55NAMEANDADDRESS (NumberandSVeet) (Q�y) (Sleta) (ZipCotle)
424-284-7757 robertQblacklioni .g com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLUL4R TELEPHONE NUMBER EMAIL ADDRESS
� Pursuant lo Clry Cotle Saclion 2 4B2(M1)(t)(a)�. A 0����Pal of any coryoralion. partners�ip,or ot�ar antiry wM10 appears as a IOGEyist on behalt of IM1a�
' en�i�y,wl��oul special mmpensation or reimUursement tm IM1e appearance,wM1e��et Gired.Intllrec(o on�ingen�,�o express suppotl of or opposition lo
an item sM1all register wi��[M1e Cleih as requiretl Ly IM1Is suLsec�ion Gut s�all nol�e requirea ro pay anyrregislrs�ion 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 BENEFICIARV(if none,write NIA�: R. RiV8n1
• NAMEOFALlPER50NSHOLUING, DIftECTLVORIN�IRECTLY,AS%ORMOREOWNERSHIPINTERESTINSIICH
- GORPORATION,PARTNERSHIP OR TROST lit none,write N/A�: IZobett Rivani - 100%
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III. ISSUE TO BE LOBBIED:
Describe with as much detail 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 & PermitNng Issues, incloding bat not limited to the Historic PreservaHon
8oard, Design Review Board, Planning Board, Board of Adjustme�t Land Use Development, City
Commission, anc� any City Workshops or Committees, if necessary, relaHng to the property located
at 1691 Michigan Ave in Miami Beach, Florida.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-082(a)�4), list the City Commissioner or Ci[y personnel sought to 6e
lobbied, and whether the lobbyist has entered into any contrectual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the presen[da[e, stating the general nature of the subjec[ contractual relationship.
Full Name o/Individual antl Contractual Relationship(I(yes,explain) VES NO
Title of Person to be Lobbietl
Staff for the Planning & Building Department None X
Public Works & City Administration, PB, HPB, BO None X
DRB, City Commission, and Mayor as necessary None X
Land Use &Sustainability Committee None X
Pursuant to City Code Section 2-482(g), every registrent shall 6e required to sta[e the extent of any
business, financial, familial or professional relationship, or o[her relationship giving rise to an
appearance of an impropriety, with any current Ci[y Commissioner or City personnel who is sought to
� be lobbied as identifed on the lobbyist registration 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 :
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�:
- S 275.00 per hour
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The(ollowing six(6)questions MIIST�e answered:
1� Pursuan[to City Cotle Seclion 2de8,enti�led"Pmhibi�ed Campaign Con�nbNions By Lobbyisis On Pmcuremen[Issues":
Ves X No: Are ou lobbv'na on a oresent or pend'nu b'O(or uaads eouioment or servicea, or on a oresent or
oend'na awara for aoods.eauioment ar serviceP
2) Pursuan�lo City Cotle Section 2-490,entilled"Prohibitetl Campaign ConlnbWions By Lobbyisls On Real Es�a�e Development
Issues':
Ves x No: Are vou lobbv'na on a oend'na aool'caTon(or a Uevelooment Aareement with the CiN or aoolication
for chanpe o(zon'na mao des anaEon or chanae lo the CiN's Future lanG Use Mao9
3) Pursuanl la Cily Code Section 2-482�h�, any person (excepl Ihose exemp� from Ihe tlefinl�ion of"lobbyisl" as se� forth in
Sec�ion 2361 j who only appears as a represenlative of a noFfor-pmft corporation or en�ity without special mmpensation or
reimbursement for�he appearance,whelher tlirect or intlirect to express suppotl of or opposition�o any item,shall register wi[h
Ihe city clerk as required by this section,bu[shall nol be required to pay any regisha�ion fees.
VesxNo: Are Vou reoresentnu a nobfor-Drof't corooratian or entiN without soecial comoensation or
reimbursement9
4) Pursuant to Ci�y Code Seclion 2-481, Ihe [ertn "lobbyisl" spec�calty exclutles ihe following persons. Exper� witnesses who
provide onty scienti(ic, lechnical or other specialized information ar teslimony in public meetings;any persan wha anly appears
as a represenlative of a neighborhood association wilhout compensalion or reimbursamenl far the appearance.whether Qiract,
indired or conlingenl,lo express suppotl of or opposi�ion la any ilem; antl any person who only appears as a representa�ive o!
not-for-profil community based organiza�ion for the purpose o( reques�ing a grant wilhou� speual compensation or
reimbursement tor�ha appearance.
Yes %No: Are vou omv'dnn onlv sc'enCfc technical or o[her soecializetl information; aoaearinA as a
t t ( ' hb h E � t n 'thoul s ' 1 ton o� reimbursement or
p t Ft ft b tl [ t ih ! Cn t w'ihout
soecial comoensation o�reimbursement"l
5) Pursuan� to Ci�y Code Seclion 2-091�1�, no campaign consult2nl shall labby�he Ci�y Commission for a penotl of 12 moNhs
�ollowing �he sweanng in of any electetl official(s) for wham Ihe campaign consultan� pmvitletl campaign consulling services
wi�hin tlie pasl election cyde. See Sec�ion 2-091 For more Informalian.
Yes xNo: H 'C tl II to an -ncumbent member of the CiN Comm-ss on
w'th'n ihe oast elect'on cvclei If vea olease list the incumbent memberlsl of ihe Citv Commission:
Ves%No: I!yes has �[ been less ihan 12 months s'nce the elecletl oTliciallsl whom vou orovideE camoainn
consultino services was sworn inT
6) Pursuant to City Code Section 2-4ffi�a�(4)a.. a lobbyis�who has within tM1e past eleclian cycle provitletl campaigm m�sulling
services lo an incumben�member of Ihe City Commission (which lobbying acOvily is nol olherwise pmhibited by Cotle section
2-091) shall disdose such parlicular service on his/her lobbyist registration form and shall orallv d'sclose such oarticular
service before lobbvina IM1e CiN Comm'ssion at a oublic meetina.
Ves z No: H 'd d IT t b t b f th C'N C ' s'on
� 'th' ih t I f 1 ?It I I' �the'ncumbent memberls)of the C'N Comm'ss'on'
Ves X No: I( V d tl'd ou rece ve econom'c cons'tlerat'an 'n exchanae (or camoaiun
- eonsWtinu services?
T08E COMVLETEO BY LITY CLERK'S STA"�FF O`N,LY /
- Pnnual Regisbation fae: [ �Yes�No Amount Paitl S � �%�� MC/R M� J� ly �. Da[e Paitl�i� � > �
- Lobbyis�RegbUMionFormreceivetlantiverifetlby: � , `�-(,�`�JfJ4
- F�¢ER�SPLL`.aFORMSLLOBBYISTFORMSRabbyis[0.e istralionFmmRevireJ 0940-180.EG.tloc RdIYL09/IO/2018
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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
SIGNED STATEMENT UNDER OATH. LISTING LOBBVING EXPENDITl1RES. AS WELL AS COMPENSATION
RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR CO S0.fi10IN�,,D•'U�.R,ING THE REPORTING PERIOD.'
Signature of Lobbyis�'. �S ��""�"7 Da�e b-2a2024
I do solemnly swear or affirm ihat all of the foregoing /acls, slatemenis, and disclosures in this form are true and correcl,
and ihal I have read or am familiar with ihe provisions conlained in Chapler 2, Arl. VII, �ivision 3, entitled "Lob6yisis" of
the Miami Beach City C /�a�w{6��aN�Ip�o� Ring requiremenls.
SignaWre af Lohbyis�'. `�""`"S '��l o'��, �.0 e : Dale 6-2a2o24
i
Signature oF Principal: �� � - Dale 6-2o-2o2a
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Plorida State oi Plorida
County oL Miami-Dade Counry oP. Miami-Dade
Swom�o(or efllrmed)and subscribed 6efore me, Sworn �o (or affirmed)and subscribed before me,
by means of O physical presence by means of 0 physical presence
ar 0 online no�ariza�ion, or�online notarization,
�his 20 dayof �une , p0 z4. bv this Zo davof June , 20_24, by
Cados RodriQuez Robert Rivani
NAME OF LOBBVIST NAME OF PRINCIPAL
_Produced ID _Praduced ID
FORM oF ._.. Foann oF i .._.
x Personally Known /�' W � =Personally Known /�J� �
�1�Vl �l�Vl
SignatureofNolaryPubli -��-�-�-�•�� ��� Signa[ureofNotaryPublic �������-�-����
Veidy Montesino Perez Veidy Manlesino Perez
- a oa T d Pi � d r5 ed
� Yeitly Montesino Perez Yeitly MOMesino Verez
- Commission%HH0062]] CommisslonMNH0862]0
Nolary PUDIIc-Stele of Flod�a NotaryPublio-Sta�e of Floritla
My Commission Expires Jan 26.2025 My Commission Expires Jan 24.2025
; ' Th . s. . . .. . .. . . . .. . ng persons: ....,..n�,:....:, ......
- Experl witnesses who provitle only scienlifiq technical or other specialized in(ortnation or lestimony In public mee�ings;any person who
only appears as a represantalive of a neighborhootl associa�ion withoW compensation or reimbursemenl for Ihe appearance,whelher
tlirec�, intlirec�or con�ingenl, �a express suppoh of or opposilion lo any ilem; antl any person who only appears as a represen�ative of
- nob(orvprofil community based organiza�ion for the purpose of reques�ing a grant without special compansa�ion or reimbursement for
� the appearance.
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Ciry of Miami Bea<h, I�00 Convemion Cenkr DrHe,Mlam�i Beach, Flo�ida 33139,www.miomlbeachfl.gov
OHice of the Ciy Clerk
Rofael E. Granado,City Clerk CiryClerk@miami6eachfl.gov
Tel: 305.673 J411, Pax: 305 673 J254
NAME OF LOBBYIST: Carlos Rodriguez
7) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
pnncipal)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 notifcation.
Any lobbyist, who fails to file the required Statement by April 30'" of each year, shall be
automa[ically suspended from lobbying until all fnes are paid, unless ihe 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 expendiWres, 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 Withdrawal 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 registretion shall be
- $500.00 pursuant to Section 2-482 of the Miami Beach City Code.
�(ar�es Koc�+�!M��y s-zo-zoza
Signa'�`ure o�obbyist Date
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Miscellaneous Cash Receipt ' .
CINOF MIAMI BEACH ryo. 433442
❑Cash ❑Credit Card ��4Check N' ' $ ���
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Received of� � � � �
Address � ,'��� e � � �
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(THIS INFORMATION MUST BE COMPLETED) By
Account number: ' � � � � � �
Preparer. � � � � Dept: ' � �' EXT: