Neisen Kasdin/BLV Groupw..:aw.
-mss
sus Gty of Miami 9each Office of the City Clerk
1700 Convention Center Drive. Miarrd Beach. FL 3313
r,pBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to
encourage the passage, defeat or modification of any ordinance, resolution, action or decision of any
commissioner; any action, decision, 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 decision-making process on such action, decision or recommendation that foreseeably will
be heard or reviewed by the city commission, or a city board or committee. The term slucifically
includes the principal as well as arty employee engaged in lobbying activities. The term "Lobbyists"
has specific exdnsions. Please refer to Ordinance 2004-3435.
Kasdin Nelsen O.
NAME OF LOBBYIST: {Last) (First} (M.I)
Akerrnan Senterfitt, P.A. One SE 3`d Ave., Suite 2500 Miami FL 33131
BUSINESS NAME AND ADDRESS {Number and Street) {City) {State) (Zip Code}
{30S} 374-5600 (30S} 374-5045 neisen.kasdin@akerman.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
BLV Group
NAME OF PRINCIPAL/CLIENT: (Last) (First) (M.I)
13780 S.W. 26`~ St., Suite 201 Miami FL 33175
BUSINESS NAME AND ADDRESS {Number and Street) {City) (State) (Zip Code}
(305) 221-6000, Ext. 201 {30S} 221-6010
TELEPHONE NUMBER: FAX NUMBER: (optional) EMAIL: (optional)
Fill out this section if principal is a Corporation, Partnership or Trust (Section 2-482 (c}]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR
MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP
OR TRUST:
II. SPECIFIC LOBBY ISSUE:
3651 Collins Avenue Site Plan Approval
Issue to be lobbied {Describe is detail}:
iivtzt~a~~;i }
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A. Foil Name of
IndividuaUTitle B. Auy Finaneial, Familial or
Professional Relationaltip
Planning Department None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION
(DISCLOSEWHETHERHOURLY FLATRATEQRQTHER}:
A. LOBBYIST DISCLOSURE: (Required) ~SOOAO hourly __
B. PRINCIPAL'S DISCLOSllRE (OF LOBBYIST COMPENSATION): (Required)
Same
The following information must be answered:
(1) Pursuant to Miami Beach Ciry Code Section 2-488 Entitled "Prohibited
Campaign Contributions By Lobbyists On Procurement Issues":
^Yes ®Na Are you lobbying on a present or pending bid for goods,
equipment or services, or on a present or pending award for
goods, equipment or service?
(2) Pursuant to Miami Beach City Code 290 Entitled "Prohibited Campaign
Contributions By Lobbyists On Real Estate Development Issues":
^Yes ®No: Are you Lobbying on a pending app#icaiivn for a Development
Agreement with the City or application far Chance of zoning
map designation or chance to the City's Future Land Ilse
gyp?
(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 representaxive of a not-far-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 ®No: Are you represeutiog snot-for-prvflt corporation yr entity
without special compensation or reimbursement.
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V. SIGNATURE UNDER OATII:
ON OCTOBER I~ 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 COMPENSAT DURING THE REPORTING
PERIOD. rf]
5ignatwe of Lobbyist
I do solemnly swear that all of the foregoing acts are true and correct and that I have read or am
familiar with the provisions contained, r~ ion 2-482 of the Miami Beach City Code and all
reporting requirements. J // n
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICA'
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of ldentificarion
Personalty known (Lobbyist)
VII. SIGNATURE AND STAMP OF
NOTARY:
State of Florida, County of Miami-Dade
5warn d subscribed before me _ C)
Th~ay of~a'(~.~'1 , 20Cb"
Signature of Public Notary -State of Florida
Notarization at Lobbvists signature. _ _ _ _ _ _ _ _ _ .
Q Produced ID~a ~.~ V ZZO -SZ6 -~G-3~8 -O
Form of Identification
^ Personally lrnawn (Priocipan
State of Florida, County of Miami-Dade
Sworn and subscribed befo ~ me
This ~5day of /~a~ c 20 0~
Gam'' a~ ~~~~~-'
Si store of Public Notary -State of Florida
__.l~iotarizatioo of PriaciFal's sl~uttare __
1iLANCA E. FERNANDEZ ~• P ~^ Notary Public State of Florida
hfY C®MMiSS[ON # DD312914 :° ~~~ Mona M Goicouna
Iua 25, Zoos :~- ~ My Commission OD523057
FOR CLERK'S IJSE ONLY
Annual Registration fee: j]Yes ^No Aalount Paid ~ ~ 1vICR ~ ~~ ` ~~ Date Paid 3 ~ ~ O
Lobbyist Registration Form received and verified by:
Revised 22ASA4
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