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Orlando Comas/C&D Miami Real Estate LLC 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 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 specifically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Comas Orlando NAME OF LOBBYIST: (Last) (First) (M.I) 7105 SW 8th Street Suite 407 Miami, Florida 33155 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) ocomas@bellsouth.net TELEP FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: C. & D. Miami Real Estate L.L.C. NAME OF PRINCIPAL/CLIENT: 5767 NW 151 Strggt Miami Lakes, Florida 33014 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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: Speak in front of the Historical Preservation Board to obtain a certificate of appropri Issue to be lobbied (Describe in detail): Hess for demolition on 355 Washington III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-482(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 72 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of Indi vidual/Title B) Any Financial, Familial or Professional Relationship ~~ 1`/. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). onw payment or o yist activity 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 ~NO' Are you lobbvinq on a present or pendinq bid for goods equipment or services or on a present or pendinq 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 ®No• Are you lobbvinq on a pendinq application for a Development Agreement with the City or application for change of zoning map designation or chanae to the City's Future Land Use Map? 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 snot-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 ®No• Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: Signature of Lobbyist: X Signature of Principal/Client: _~ VI. LOBBYIST IDENTIFICA ^ Produced ID Form of Identification PRINCIPAL IDENTIFICATION: Produced ID ~'~ ~~L~~1 (Qa<a~i~+C~l J Form of Identification Personally known (Lobbyist) ^ Personally known (Princ a~r~e~ .IACQUELINE M. PIMENTEL ~ MY COMMISSION # DD512080 VII. SIGNATURE AND STAMP OF NOTARY: ?ar~o~Q EXPIRES: Jan. 29, 2010 (40~ 398-0153 Florida Notary $arHC~,otxn State of Florida, County of DOSE A. RODRIGUEZ State of Florida, County of a I- Sworn to and subscribed b .r€'~t NdaryPubNc,3te40ofFlpddtt Sworn ~d subscribed before me This~y of ~ ``'O~i` Q'~ommissbn#Dp79670g This day of ' ~n~.' , 2008 / ) ~~ ~ My commiuba Exples ,1~. 29, 2ot2 r'_ _ ~ z -~ Signaturd of -State of Florida Si re f Public Notary -State of Florida Notarization of Lobb is 's signature Notarization of Principal's signature i` TO BE COMPLETED Annual Registration fee: [ es [ ] No Amount Pa Lobbyist Registration Fo received and verified by: ~ Paid l~ ~, ~„a noi~~i~nnn / 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-~2pf the Miami Beach City Code and all reporting requirements. City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: Orlando Comas CityClerk@miamibeachfl.gov I understand that no later than October 1st of each year, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1 ~ Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. ~~~R_~nnR Sign Lure: Date: F:1~L.~1L<(~f.3E3Y i°T`1L_~b~ayisY Regi~tr~tis~s~ f=rsrr~s 327t~~.cfoa