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Alexandra L. Deas/Miami Habitat, Inc. Amended'AMENDED" 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. DEAS ALEXANDRA L. NAME OF LOBBYIST: (Last) (First) (M.I) Bilzin Sumberg Baena Price & Axelrod LLP 200 SO BISCAYNE BLVD. #2500 MIAMI. FLORIDA 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ~ Zip Code) TELEPHONE NUMBER: FAX NUMBER: ~ ~MAtL'.' --~ I. LOBBYIST RETAINED BY: ~'~ N `~`~ ~,- Q'~ ;~ Miami Habitat Inc. '~ 'S. t'~ ...-. NAME OF PRINCIPAUCLIENT: ~.,, ... 1329 Alton Road Miami Beach FL 33139 ~`- N BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip C~~ie) N 305-673-3948 305-673-4348 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: Eric Harari • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SPECIFIC LOBBY ISSUE: Participation in City Commision proposed short-term rental Ordinance 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 Planning Department & staff no City Commission no MIAMI 1641066.1 7817630513 ~ 9/25/08 `. , IV... DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $295.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $295.00 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 lobbyinp on a present or pendina bid for goods equipment or services or on a present or pendina 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 lobbyina on a pending application for a Development Aareement with the City or application for change of zoning map desianation or change to the Citv'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 representina a not-for-profit corporation or entity without special compensation or reimbursement? V. SIGNATURE UNDER OATH: ON OCTOBER 15~ 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. L Signature of Lobbyist -Alexandra L. Dean 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: C Produced ID Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swor to nd subscribe befo e p This day of ~b Signatu a of Public Notary -State of Florida Notarization of Lobb fist's si na re •,w:+.r~,~^, MERCEDE3PADRON ~::.~~ y ~ .r . .. MY COMMISSION # OD 608768 `~, •~y,,,:;= EXPIRES: November 9, 2010 i ,u ~'' ' :' ~~' Bonded Thm Picherd Insurence Agency E:.__Y.:~" . PRINCIPAL IDENTIFICATION: c-~ o -~ ' ^ Produced ID "~ to _ ~} Form of Identification ~ ~ ~ r C Personally known (Principal) rte, N '; J .U ~ "Y`~ cry -o ~` State of Florida, County of Miami-Dade a '~ Sworn and subscribed before me •• This day of , 20 c~i N w Signature of Public Notary -State of Florida Notarization of Principal's signature MIAMI 1641066.1 7817630513 9/ 18/08 .,- JUN/25/2t10$/WED 02:02 PM ' FAX No, 3058734348 P. 003 Jun-25-OB 12:54aa Froa-Bilzin 305 3P6 6148 i-98o P.003/004 F-628 ~, DISCLOSURE OF TERMS ANO AMOUNTS OF LOBBYIST COMPENSATION (DISCL05E ~~~ HOIJRL1f1 FLAT RATE GR OTHER) A) LOBBYIST 016CLOSURIA: (Requ-r9d) B) Pfi1NCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). The fdlowing Infvtmlation must be answered: ~~ • On 1) Pursuant M ;Miiami Beech City Cody Section 2.4879 Entitled "Prohibited Crernpaign Contributions >ay y~ procursmant Issues": ~•I No• Are bb in on s rv:en~ yr di award r - m nt or s8 cc ~ c' ' t Cede 2.490 Entitled "Prohibited Cempa~n Contclb~~~ By I.ebbyisos On .Real ~#fate ,"~ 2) Pursuant to ~ulramr B®ach City ~.r"ro ~'~ povslopntsnt (slues": -rt Yas ~ No: A labb in on a ends s i r a vel srrt reement wi i or a ~' ~ A,.. for chance of zoninst esi nati n or channe to the Gi_ 's Future ~ ~ ~ ~!" ~ t bone thosa exempt from ttk deAnltbn of "io°°Y~ ~ ~~ 3) Pursuant to;Miami Beach City Code 2~d94 (h) Ar1Y A~ (~~ forth in SeGtior- 2-481 above) why only appeat9 ss a tepncantativs ~e8rsd,•or indirect. b express ~Pi~. spedali compensation or ro~bursement for the sppearan ~ section buts ahetl not be required to '1~y ~Ib oPposttion ~ emr Rem, et>an resister with the d.~ ~ requ Y V, SIt3NATllRB UNDER OATH: ON OCTOBER 1°t AF EACH YEAR. FACH LOBBYIST SHAZl SUBMIT TO THE CITY CLERK A SIGNED $TATBMf1~ UNDER OATHTHi P7~CEDING CALNDA YEAR. A STATEMENT~SIiA1..L BE F11.Eb EVEN FDTNERLr HAVE BEENA~ BEACH FOR EXPENDITURES OR GOMPENSATbN DURING TFIE REPORTING PEIt10D• Sip ofnature~i,.obbyiat- ndra L_ Dees I do solemnly syvest chat aN or the foragving facts ~~ ~~ ell °re°p4 Tn9~~uirem~ts• ~d or am iart+iNar with the psbYis.~~ vontained in Sedioo 2-482 of the Mlsrnis+ach C~'ty . _ ~ . ~ ~ ' Signature of Lobbyist 3ignattue of PrincipaUClier~: PRINCIPAL IDENTIFICATION: p Produced 1D Form of Identficetiort perspnaliy luwrm (Principal) VI. LOe3B1fIST IDENTIFlCATION: p Produced !C Forth of ldentltlwti~ Aeraoaalty lmo~ (Lobby''sq VII. SIGNATURE ANP STAMP OR edPl~D{tON State of Florida, County of Miami-D 1AYCOMMisSIGNrD0~6 $wom to d subebi d brlora m p~SNowrrLrre,2mo Zg ooadld71~Ir1111Yd>•IVar~~ la day of 3ipna re of Putalid Notary - ~~ of Florlds Notarisation of Lobbyist's slBnatun Annual Rag'~~dn tee: [ ] Yes. ty 1 ~ ~O~ F_ CL~ERISALLUAA~W-MU~bbylstlLOBBYIST OFtM •"'~:e` Georgina O'Nei11 of Fbcn~rbd before r+~e f ~~'~~ ~ DD59174: y ` ~~,~~f~ines: SB'. 04, 20i-0 ~ Www.AMONNOTASrsom giNLY~R ~,SQt?ate Paid A/J1AM1 1587630.17817630515 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.~ LOBBYIST NAME: Alexandra L. Deas 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. Signature: Date: c~ ''' ca .. _-~ `~ m ~.~ -^~ ~ ~~ 5 p^, } ~ `fit ~`' ,,.- Gr, ~j "'Q 9..,. t MIAMI 1641066.1 7817630513 9/ 18/08 ~,