Brian S. Adler/16th Street Partners, LLCCity 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.
Adler Brian S•
NAME OF LOBBYIST: (Last) (First) (M.I)
Bilzin Sumberg Baena Price & Axelrod LLP 200 S Biscayne Blvd Suite 2500 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code)
305 350 2351 305-351-2206 badler(a)bilzin.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
16`h Street Partners LLC
NAME OF PRINCIPAL/CLIENT:
1601 Washington Avenue 8`h FL Miami Beach Florida 331.39
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-672-9602
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:
Property located at• 1601 Washington Avenue
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Fernando Vasquez, Public Works
Jose Perez, Public Works
..~ .c u.i 7.1 `~
IV.• DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) $430 Hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)
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 lobbvina on a present or pending bid for goods eauipment or services or on a present or
pending award for Goods, eauipment 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 lobbvina on a pending application for a Development Agreement with the City or application
for chance of zoning map designation or change 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 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 ~ No• Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1gt 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.
Signatu a of L byi
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:
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swor o and sub ribed be ~ re me
Th' day of
-;"•,:, CHRISTINE A. BOWER
Sign ture f Public Nota ';df F~61°igB6: February 20, 2010
of ron of Lobbyis ur@pndi°n""~'""'~°'~N16~'
Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 20
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ f Yes [ ] No Amount Paid~O = MCR #G' / Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M1Lobbyist\LOBBYIST FORM 05.doc ~ Revised 12/08/04
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N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION {bISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) 5430 Hourlv
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Sector 2-488 Entitled `Prohibited Campaign Contributions By Lobbyists On
Procurement Issues": .
^ Yes '~ No: An you Iobbving on a present or pending bid for goods. eauipment or services, or on a present or
gylnding sward for goods. sauipment oT service?
2) Pursuant to M[ami Beach CIty Code 2-490 Entitled "Prohibited Campa~n Contr[butbna By Lobbyists On Real Estate
Development Issues":
^ Yes '~ No: 9L4 you lobbvtng on a pendMsa appticaNon for a Development A merit with the Cltv or applicatiofa
r chance of zoning mao designation or ~hanae to tFte CitV's. Futufe Land Use Map?
3} Pursuant to Miami Beach City Code 2-484 (h} Any person (except those exempt from the definifion of "lobbyist` as set
foith in Section 2-481 i above) who only appears as a representative of a not for-profit corporation or entity without
spedal.compensation or reimbursement for the appearance, whether direct, or indirect, .to express support of or
opposition to arty item, shall register with the deck as required by this sectioh but. shall not be required to pay any
registration fees..
^ Yes '~ No• Are you representing a not~or-profit corpor~fon or entity without soeclal com~nsation or
reimbursement?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1n OF .EACH YEAR, EACH LOBBYIST SHALL SUBMIT TD THE CITY CLERK A SIGNED STATEMENT
UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECENED, IN THE CITY OF MIAMi
BEACH FO>R THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN iF THERE HAVE BEEN NO
EXPEtDITURES 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 familiarwith the provisbtrs
contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
Si~ature of Lobbyist:
Signature of PrincipaVClien
Vl.
0
Il.
LOBBYIST IDENTIFlCATION:
Produced ID
Form of Identlficatlon
Perronaily known {Lobbyist)
VIL SiGNATURt? AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swrom to and subscribed before me
This day of , 20
Signature of Public Notary -State of Florida
Notarisation of Lobbyist's signature
PKINGIP ~Ir~IJi11~Jiid
.~~~~~~~., ISAURA SCANDELLA
~ PrOd '.~,,a. n~~`~ ~- Nota Pub1iC -Slate of Fbrida
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• : ~/ ~i~pires Sep 9, 2009
~}(~ °' (pion # OD 427603
T _ "~^~^"•• Bonded By National No'3ryAssn.
State of Florida, County of Miami-Dade
Swom and sut>scrl d be re me
This ~~ .day of,r2~0d~~
~~7' ll•I~CG~s2°ll~°-~
Sig%fattire of l~(ibtic Notary -State of Florida
Notarisa8on of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: j.) Yes j ) No Amount Paid MCR ~~ Date Paid
Lobbyist Registration Form received and verified by:
F:ICLERIZALUMARiA-M1LobbyistlLOBBYIST FORM 05.doc Revised 12/08/04
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,
www.miamibeachfl.eov
LOBBYIST NAME
I understand that no later than October 1st of each vear, 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.
-~
Signature:
~J ~u it" 40~ ~U~
Date:
MIAMI 1614201.1 7319010719