Marcel Tampied/Brad Meltzerm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a prinapal who seeks ~ enrnurage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, deasion, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time
period of the entire deasion-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a dty board or committee. The term spedficalty indudes the prirxipal ~ well as any employee engaged
in lobbying activities. The term'Lohbyists° has speafic exdusions. Please refer to Ordinance 2004-3435.
Tampied Marcel
NAME OF LOBBYIST: (Last) (Rrst) (M.I)
Blitstein Design 285 Sevilla Ave. Coral Gables Rorida 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City} (State) (Zip Code)
(305) 490-5997 MTampied@tampied.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Brad Meltrer
NAME OF PRINCIPALJCLIENT:
50 North Hisbiscus Drive Miarrrk Beach Ronda 33137
BUSINESS NAME AND ADDRESS (Number and Street) (Gty) (State} (Zip Code)
(786)693-8701 (786) 693-8751 bmeltrer@km-plaza.com
TELEPHONE NUMBEfL• FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if prinapal is a Corporation, Par6tersfiip or Trrrst [Sedson 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR SENEFiCUiRY
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE 05M1RVERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Variance Requests from the Board of Adjustment
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
BOA, DRB
B) Any Financial, Familial or Professional Relationship
None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATF OR OTHERx i
' A) LOBBYIST DISCLOSURE: (Required) S ,99-~er'f~~'"I~ OO~ -F `Q'1
B) PRINCIPAL'S DISCLOSURE (oF L088YIST COMPENSATION): (Required). $ ~~-`l, oob .~ ia-~ ~-
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-458 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurerrtieent Issues":
^ Yes X No: Are you lobbrina on a present or oendina bid for Goods, eauiam~t or serves, or on a
present or oendhxl award for Qoods, eaubrnaurt or sennce?
2) Pursuant tp Miami Beach City Code 2-490 Errtitled "Prohib~ed Campaign Contributions By Lobbyists On Real
Estate Devebpment Issues":
^Yes X No: Are you lobbvirw on a oendina application for a De~elopni~ert Agreement with the City or
application for chance of zon'sw map desiaftation or dwnge ~ the t5tr's Future Land Use
Mau?
3) Pursuant to Miami Beach City Code 21184 {h} Any person (except those exempt from the definition of
°lobbyist" as set forth in Section 2-481 above) who only appears as a refxesentative of anot-for-profit
corporation or entity witl~out special corr>pensation or reimbursement for the appeararxe, whether d~ect, or
indirect, to express support of or opposition m arty i#em, sha11 register with the ctertc as required by this
section but; shall not be mired to pay any registration fees..
^ Yes X No: Are vmr reorg a rwt-for-w'ofit corooratan or erttitir wilfioat specaa! ~moensation
or reimbursemer-t. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING GLENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMQENSATION DURING THE
REPORTING PERIOD.
~~
e yist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in of Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client;
N:
VI. LOBBYIST IDENTIFICATIO
~ I
.
~ Produced ID t/
o ~
00 Form of Identiffication
~~
sa ~ ~
^ Personally known (Lobbyiist)
a Eva
0
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VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom subscri me
fi~ ~ lliis of 20
Sign re lic ry -State of Florida
Nota LobbTrst's signadrre
PRINCIPAL IDENTIFICATION:
^ R~oed ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Swom and subsa~bed before me
This day of . 20
SigtnahRe of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLE 'S USE ONLY (ry'4 ,t,
Annual Registration fe~ ]Yes [ ] No A aid MCR J ate Paid ~ ~ v
R
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyst\LOBBYISTfORM OS.doc Revised 12/08)04
~1/. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER).
A) LOBBYIST DISCLOSURE: (Required) $ .00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ .00 Der hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled 'Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes X No• Are you lobbying on a present or pendina bid for goods equipment or servicesi or on a
present or pending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled °Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No: Are you lobbying on a pending application for a Development Agreement with the City or
application for chance of zoning ma designation or change to the City's Future Land Use
Ma°?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^ Yes X No: Are you representing coot-for-profit corporation or entity without special compensation
or reimbursement .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements. ~--
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Princi
a.~" v'""u•,,2 KEVIN D. HUt3i~8
~• ~ ~ Notary PuONc -State of Fbride
• - My Camnwefon Erpiree Dec 14, 201
State of Florida, County of M' ~~a Ceie~eierion ti DD ti227st3
Sworn and subscribed befor "' tloiWNltMapANetionMN°terpApr
This 2c +~' day of 7ti H w , 206'7
Signature of Public No -State of Florida
~ Notarization of Principal's signature
FOR LE 'S USE ONLY
Annual Registration fee ]Yes [ ] No Amo Paid MCR #~3°~ Date Paid
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\;ALL\MARIA-M\Lobbyist\LOBBYISi FORM OS.doc Revised 12/08/04