2024 Lobbyist Registration Form - 1691 Michigan Ave (Robert Rivani) � � �(>`-� � F'[ ' c.�,;g�`r' '4v� •
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��CtiVED
MIAMI �EACN ��� 262024
Office of the City Clerk
1700 Convenlion Center Drive GTY OF MIA'dl BEACH
Miaml Beach, FL 33138 OFFlCE OF?I7�CITY CLEFiK
305.6737411
LOBBYIST REGISTRATION FORM
Lobbyis� means all persons employetl or reWlnetl,whelher paitl or no�, by a pnncipal who seeks to encourage�he passage, defea�or
modifiwlion af any ortlinance, resolu�ion, ac�ion or tlecision of any commissioner, any ac[ion, tlecisioq recommentla�ion o( �he City
Manager o�any City boartl or cammittee',or any ac�ion,decision or recommendation of any City personnel tluring Ihe�ime period of Ihe
entire decision-making pmcess on such action, tlecision or remmmenaalion [ha� foreseeabty will be heartl or reviewetl by the City
commission, or a Ciry board or commillee. The �erm specificalty inclutles Ihe principal as well as any employee engaged in lobbying
ac�ivilies. The�erm"Lobbyists'has specific exdusions. Please refer lo Cily Code Chapter 2, Article VII, Division 3,en�itletl"Lobbyis�s,"
for atltli�ional information.
Insimctions: Please complele all seclions of Ihis form and submit Ihe comple�etl fortn,with Ihe applicable fea, to�he Offica of�he City
Clerk. If you need more space�o comple�e an answer, use a sepa2te shee�(s) oF paper. If you have noNing to report in a particular
section, you mus� w�i�e "nane" o� "n/a" in Ihat secHon. Any change ta any information originally fileQ or any additional Ci�y
Commissioner or personnel who are also soughl�o be lobbietl shall require�hat the lobbyist file an amantlmen��o�he regis�2tion form.
The lobbyist has a continuing du�y lo supply information and amend the fortns filed �hroughoul �he penotl �ha� the lobbying occurs.
Separale regis[ra�ion forms shall ba required for each pnncipal represenletl on each specific issue.
I. LOBBYIST INFORMATION:
Gomez Iose
NAME OF LOBBVISi (Las�) (FIrsQ (Mitldle Neme)
81018iscayneBlvd. Suite309 Miami FL 33138
LOBBYISTBUSINESSNMAEANDADDRESS (NumberendS[reeQ (Clry) (Sla�e) (LipCOGe)
305-559-1250 jQomezCnJbeilinsonarchitectspa.com
L06BVISTBUSINESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILADDRESS
II. PRINCIPAL INFORMATION:
2ivani 2obert
NAMEOFPRINCIPAL (Lesl) (Rrst) (Mid�leName)
RK Rivani LLC 201 S Biscay�e Blvd Suite 1440 Miami Florida 33131
PRINCIPAL BUSWESS NAME AND ADDRESS (Number and S�ree[) (Gty) (S�a�e) (Zip CotleJ
424 284 7787 robertQblacklionie.com
PRINCIPALBUSINESSTELEPHONENUMBER CE�WLARTELEPHONENUMBER EMNILAO�RESS
Pursuen[�o Giry Cotle Sec�ion 2>82(M1)(Q(a)'. A pdndpal of eny wryora�Ion, patlnersMp.or o�M1ar en�lry w�o eppee�s as e lobbylst on beM1ett of�M1a[
en�ity,wi[�oul special compensa�ion or reimbu5emen�tor t�e appearance,w�etM1ar tlVect,intlired,o�contingen�,b express suppotl W o�opposition to
an i[em sM1all reg'�ster witM1 I�e Cled as repuiretl by IM1is su�sec�ion bW s�all no�be requiretl lo pay any regis�ration fees.
� If [he principal is a Corporation, PaRnarship 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): It. alV2n1
� . NAME OF ALL PERSONS HOLDING, UIRELTLY OR INDIRECTLV,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
- CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A�: R�M�� Riv -�00% _
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III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specifc description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
Development Approvels & Permitting Issues, includi�g bat not limited to the Historic Preservation
Board, Design Review Board, Planning Board, Bwrd of Adrystment Land Use Development Citv
Commission, a�d any City Workshops or Committees, iE necessary, relati�g to the property locnted
at 1691 Michigan Ave in Miami Beach, Plorida.
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
lob6ied, and whether the lobbyis[ 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[he present date, stating the general nature of the subject contractual rela[ionship.
. Full Name of Individual and Contractual Relationship Qf yes,explain) VES NO
Title of Persoa to be Lobbied
Staff far the Planning& Building Department None X
Public Works &City Administration, PB, HPB, BO None X
DRB,Citv Commission, and Mayor as necessary None X
Land Use &Sustainability Committee None X
Pursuant ro 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 [o an
appearonce of an impropriety, with any curren[ City Commissioner or City personnel who is sought to
be lobbietl 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 of im ro riet if none,write N/A :
N one
- V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Soecifia (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
� 5300.00/hr
Page 2 of 5
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The following six(6)questions MUST be answered:
1) Pursuanl�o Cily Code SecGon 2-488,enti�letl'Pmhlbi�ea Campaign Con�nbutions By Lobbyists On Pmcuremenl Issues':
Ves XNo: A I bL ' q t d' A b'd f q C nl or serv'ces or on a oresent o�
tl' df ds e n[orservice7
2) PursuaN to Ci�y Code Seclion 2-690, entided "Pmhibi�etl Gampaign GonMbulions By Lobbyisfs On Real Eslate Developmen�
�660E5��:
Ves x No: !v I bb ' d' f C f D I t A ent w'th the CN or aoolication
t h p f ' a d f h t [h Ct 's Future LanE Ose MaoP
3) Pursuanl la Cily Cotle Sec�ion 2-982�h), any person (excepl those exempl from the tlefinilion of "IobbyisC' as set forlh in
Seclion 2-481)who only appears as a representa�ive of a no4for-pro(�mrporalion or enlity wilhoN special compensalion or
reimbursement tar lhe appea2nce,whether direcl or intlirecl lo express support of or opposi�ion to any ilem,shall register with
[he city clerk as requi�etl by Ihis section,bul shall no�be required lo pay any regislration fees.
VesXNo: A V f bf oft E or enCt w'ihout special comoensation or
�eimbursement'l
4) Pursuan[ to Ciry Cotle Section 2-081. the lerm "IobbyisC specifically encludes Ihe following persons Expert wi�nesses who
provitle anly scien�ifc, techniral or o�her specializad information or lestimony in public meelings;any person who only apPears
as a representa�ive of a neighborhootl associa�ion wi�hoN compensation or reimbursement for Ihe appea2nce,whether direcl,
intlirect or contingen�,�o express support of or opposition�a any i�em;and any person who only appears as a representative of
nobforvpmfit mmmuniry based organization for the purpose af requesting a granl wi�hout special mmpensa�ion or
reimbursemen�for Ihe appearance.
Yes x No: A p 'd- I E! t h ' I th ' I' d ' formafon� aooear'na as a
1 [ f ' hbo h tl ' C 'th t 'al com ensation or reimbursement or
( t t f't b d f f th f C a arant w'thout
p ' I m f norreimbursementl
5) Pursuant lo Ci[y Code Seclion 2-491�1�, no campaigm m�sWtan� shall lobby�he City Commission for a penotl of 12 months
fallawing Ihe sweanng in of any elected official(s) for whom the campaign wnsWlan� pmvided rampaign consulling services
within the pas�election cycle. See Sec�ion 2d91 for more Informalion.
Ves XNo: X 'd tl Il' t an 'ncumbent member o!ihe Citv Cammission
'th' th t I f 1 71fV I f lth ' umbentmemberlslo(theCiNCommission:
Ves X No: It h �t b I ih 12 ih ih I t tl oT!'c'allsl whom vou p�ovided camoainn
consult na services was sworn in7
6) PursuaN to Ci�y Code Sec�ion P-482(a)�4�a., a lobbyist who has wilhln �he pasl election cyde pravided wmpaigm m�sul�ing
services�o an incumben�member of the Cily Commission (which lobbying activity is not o�herwise pmhibi[ed by Cade seclion
2-491) shall disdose such paNcular service on his/her lobbyist regisVafion form tl h II rall d'sclose such parlicular
b f I bb ' th C� Commssona[aoublcm�.
Yes x No: M �d d if t mbent member ot the Cilv Commission
. 'th' [h 1 I F I ?It I f t th ' bent memberlsl otthe LiN Commiss�on:
- Ves X No: Ii d dtl 'tlemfon 'n ezchanae for camoainn
ConsWti�A services?
- TO BE COMPLETED BY CITV CLERK'S JSTAFF ONLY
, Annual Regis4ation fee: [ ]Yes(�No Amowl Paitl 5��7 V MCRM I��S�'I�I L Dn[e Paitl ����'E� /���
Lobbyis�ReglsVrtionForm vedanEverifMby: 1` • I )C P-�O-G
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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 LOBBYING 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 LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITl1RE OR COM fiRS1ON�-0URING THE REPORTING PERIOD.'
SignaWreofLo6byisC �S� �� Dale 6-122o2a
I do solemnly swear or affirm ihat all of ihe foregoing facls, stalements, and disclosures in Ihis form are true and correct,
and that I have read or am familiar with Ihe provisions contained in Chapter 2, AA. VII, Division 3, enlitled "Lobbyisls" of
Ihe Miami Beach Ci�y C �tW�l6cepoding requiremenls.
SignalureofLobbyisC �N' ��U oa��am�==e.: Date s-i2-2o2a
/
SignaWreofPrincipal'. ' � Da�e 6-�Z-Zo24
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VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
Counry ot. Miami-Dade Counly oE Miami-Dade
Swom [o(or aBirmed)and subscribed 6efore me, Sworn to (or affrmed)and subscribed before me,
by means of� physical presence by means of� physical presence
or�online nolarizalion, or� online notarization,
�his 12 day of June 2024, by Ihis 12 day of June 2024, by
Iose Gomez Robert Rivani
NAME OF L09BVIST NAME OF PRINCIPAL
Produced ID _Produced ID _
— F _. Fo �
x Personalty Kn � � x Personally Kno ' �y,�
— `I"U1
SignaWre of Notary 'uoGc"� ���� Signature of Nolary u61ic ��� �
Veitly Mon[esino Parez Veitly Mon�esino Perez
- Name of No�ary, Typed, Prinled or Stamped f 1 T e r' t o t
� Yeidy Monlesino Perex Yeidy Monfanino Perez
- CommissionpHH0963]3 Commizaion%HH0892]J
Notary Public-S�a�e of Florida No�ary Publlc-State oi FlonEa
MY Commission Expires Jan 24,2@5 My Commission Expires Jan 24.2025
- ' Th 9 Persona ._.._<n,e,.. _, _..,.._
�: Ex ertwM1nes'.�. �... ,.....�.....
- p ses who provitle only sciemific. lechnical or olher specialized infortna�ion or testimany in public meatings;any person who
` only appears as a representa�ive of a neighborhood aswciatian wilhout compensation or reimbursemen�for�he appearance,whe�her
- dired, indirec�or conlingeM,�o express supporl of or oppasi�ion�o any ilem; and any person who ony appears as a represenlaeve of
- not-forproft community based organiza�ion kr�he purpose af reques�ing a grant withou�special compensation or reimbureemen� for
� [heappea�ance.
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Ciy d Miami leath, 1100 Convenno�Cemer Drive,Mloml Beach, Floada 33139,www.miamibeo<hN.gw
Office oNhe Clry Clerk
Ralael E. Granado, Clry Clerk CityClerk@mlomibeachfl.gav
Teh 305 673 7d 1 1, Fax:305.673 7254
NAME OF LOBBYIST: Jose Gomez
t) 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 fle 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 registretion shall be
�- $500.00 pursuant to Section 2-482 of the Miami Beach City Code.
- ��eu,SGow,�y s-iz-zoza
"1°'°" Date
_ Signa�ure o� obbyist
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