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• .. • ..•• . f .I AM--! lBEACH' . Office of the City Clerk •
. 1700 Convention Center Drive O FF!C 7F..E OF THE THF CITY CLERK • •
13 AGH
•• Miami Beach, FL 33139
17FFIC
305:673:7411 • •
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LOBBYIST REGISTRATIO NFORM
Lobbyist.means all:pe sons:employed or retained :whether:paid:or:not;:by:a:pnncipat.who seeks la 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"Lobbyist"has specific exclusions. Please refer to City Code Chapter 2,Article VII, Division 3,entitled"Lobbyists," .
for.additional. qn that for •
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Instructions::.Piease:com plate.ell sections of:this:form:and:submit the:coiripletedform :with:the.applicable fee;:to:the Officeofthe:City
Clerk::if.you:need:morespace to compJete an answer, use a separate sheet(s)of paper If you have nothing to'report in•a particular
section; you-:must write "none"-::or"nla".in that section: Any change to any information originallyfiled;:::or::any::additional:::City -
Commissioner.or.personnel.who.are..also.sought.to.be.lobbied.shall..require.thattheaoblayist:file..an..amendment.to•the registration•form.
The lobbyist has a continuing•duty to supply information and amend the forms filed throughout the period that the lobbying occurs. .
• Separate registration forms shall be required for each principal represented on each specific issue. • . ••
I. LOBBYIST INFORMATION:
G 18135 W .'NL .
NAME-OF LOBBYIST (Last) . (First) • (Middle Name) -
r, tAI.TVG{ t 41 5 P; 3S3Sr.:lPt 1 Gt7v1 GaD►JilT 4i2re-,::(%i:3313:
• LOBBYIST BUSINESS NAMEAND/ADDRESS (Number.and Street) • (City) (State) (Zip.Code)
•
414&-Kt-t • ar 7�1g-L7 70 -f'ue. E 1,4),4 7-14.:bbc.-t-ilii . •
LOBBYIST BUSINESS TELEPHONE NUMBER • CELLULAR TELEPHONE NUMBER I AIL ADDRESS• •
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....... II PRINCIPALIN.FO:RMATION:
071413:1ilass—V3 ,
NAME OF PRINCIPAL . 1 (Last) (First) • (Middle Name) •
SIAR,86A(20 RDA D A 101 .t I c m, PSS 2b. 0132, io36 )I LL4 1--13 R-79 23 .
PRINCIPAL BUSINESS NAME AND ADDRESS • . (Number and Street) (City) (State) (Zip Code)
PRINCIPAL.BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER W EMAIL ADDRESS
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P y .4 3' t`9° ° v �. .y ; 1' as a 1'1 C 0 Tv b,,. �" `Y9 sy�y[c,
r 1 Q" f ya a �" i 1. �f a} a` $ '4k„ F rs .. aI t+�" "A"'s
��� �i���� �� � 4 a x a'�t �,"" 8 +_, 9 h� a 'e9r ,c 3 �.'��r��,��.z 1¢y�
' aA i 1 o yg it:j 0.�`b. g,e t ,' t F,ti•('`e� ,? a ael •o ,t,...„.4..,*,..' a s0.41,!..,:,1 _.•`.A o T•1 :X ..Q
,_:,—.W.'''`8ii: b{i°!I-q. n '' t.t, („1 :�il !P _i,, gyp .111.1 o t'7...,r•li f •=L al`_ '.. .
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2.482(c) . . . .
• NAME OFCHIEF:OFFICER;PARTNER;iORBENEFICIARY(if none;:wnteN/A): John:Jans•
heski
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• NAME:OF:ALL:PERSONS.HOLDING,:DIRECTLY.:OR:INDIRECTLY;.A5%:OR:MORE:OWNERSHIP:INTEREST.IN:SUCH • ..
CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): John Jansheski • •
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III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid,or.public hearing number.
•
)R,02l -Diva— ?_&:::51 isoi D..
DESi4 a) ,Radte.A1 60420 irLAi,a.__ C.nr:w.°G:rlc..aF
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14G.01)1 kl4. 01J,i;" a NWAr oh ►o s nr+JA 1 antcerzsazt ►31l11.
IV.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date,stating the general nature of the subject contractual relationship.
Full Name of individual and : Contractual Relationship:(If yes,explain),; ::YES NO
Title of Person to be Lobbied.
(N11Gl a e( 640 h C6►�� 03-pliklAi'6•- bV‘11/Vi.
Dejlivi 10-PAA e..7 1304rit at241 4i •
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Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of any
business, financial, familial or professional relationship, or: other relationship giving.::Ilse to::an
appearance of an impropriety;with:any current:City::Commissioner::or:City:personnel who:is:sought.to
be lobbied as identified:on the'lobbyisttregistrationform filed.
List any Business, Financial, Familial or Professional"Relationship; or other relationship giving rise to an
appearance of improprietyi (if none,write N/A):
I`�f
V....DISCLOSE:RATE:AND'AMOUNT OF•LOBBYIST COMPENSATION —Be Specific:•(Note that a
contingency fee is prohibited pursuant to CityCode'Sec.2.485:3): , •
0141,0142/
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The following six(6)questions MUST be answered: • • •
1) • Pursuant to City Code Section 2-488,entitled Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes:1No; Are you lobbying•on•a.presentor pending.bldfor.goods,..equipment.or services..or.on.a present or
pending award:for:goods.:equipment:or:service?
2) Pursuant:to CRY:Code:Section 2-490 entitled Prohibited Campaign Contnbutions By.Lobbyists.On Real:estate=Development
Issues". .
_Yes No: Are you lobbying on a pending application for a Development Agreement with the City or application
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for change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant•to City Code Section 2-482(h),any.person (except those..exempt from the definition of lobbyist' asset..forth..in •
Section:2481)who only appears as a representative of:a:not-for-profit Corporation:or entity without special compensation or
..._ reimbursement for the::appearances:whether direct or:indirect to:express support of or opposition to any irtew shalt register:with
the city:clerk as:required by this section,but shall not be required to.pay any registration:fees
_Yes IkNo: Are you representing a :not-for-profit corporation•or entity' without..special...compensation..or .
• reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings;any person who only appears
• as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct, . .:
.
. ... indirect or contingent,to express support of or opposition to any and any person who only appears as a representative of
..... not-for=profit....communtty based organization for,:the purpose•'of requesting a grant without special compensation• or
reimbursement for the appearance •
YesXNo. Are you providinji only scientific:::technical or:::other::specialized::information;::appearing as a •
representative.:of neighborhood a. eighborhood.association-without•special compensation or reimbursement:or
representing a not-for-profit based organization for the purpose of requesting a'grant without •
special compensation or reimbursement? •
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5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months • ••
following'the•swearing in of any elected officials)for whom the•campaign.consultant provided campaign consulting services
within the past election cycle:See Section 2-491-for more information. •
.. .. • _•Yes ,No ••Have you:provided:campaign:consulting:services:to:anIncumbent•member of•the City Commission'
within the past election cycle?if yes,please•list:the:incumbentmember(s).ofthe.Citv:Commission: .
•
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m •e15 -MZS IrC }y t, s a' "?,' �iIA,5"++�`�h�a��4 IOWAn i! rt f; '�PMIA?�'y+3^F'C ' b q�`' miff 1n •
_Yes No: esti° 'as t` . milt s han,a1 rmontihs sinF hh�h"etected bf ciaaifs ,whteki, brr iprO l � .)�an .
tlri :s'e r s: ii kr�i)in
6) Pursuant to City Code Section 2-482(a)(4)a.,a lobbyist who has within the past election:cycle pro •
vided campaign consulting • •
services:to.an:incumbent:member:of:the:City Commission:(which:lobbying activity:i¬ otherwise:prohibited:by:Code section.
2-491) shall disclose such particular service•on"his/her lobbyist registration form and shall•orally disclose such.particular
• service before lobbying the City'Commission:at:a public meeting.
_Yes X1o: Have you provided campaign consulting services to an incumbent member of the:City::Commission .
within the'past election cycle?If yes,please list the incumbent member(s)of the City Commission::
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tc� Yi� f ' r`k n,"�aa* n 1 °w`d �' t+ s rcF,st'uy4��itri .+. W ,i 5: tr. 04. .3 k+�r'xY• flX'+f p Mc 5 47 .*ISi4x .
g 1�Y"` 'Z, y��'1.`L ��'!?r. �°�UI�-Fu�3``ri� '. 7} i a7 ! "h ngJ -#Sa. 5'� h.Zs. a '�� q Y'�:y
Yes No: : , water: opi prom sedoyraddlt) ' ive`o on c"cconsioh'iiiaexch`a'``n e7`toiw.aa t_p_torx . ..
#./ ..j,, ra�suftl iu rv. _ .._
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY • , : •
xy�Y -. a Saye of%h� Sa :t: '.!l�; St k �1`i. �� x i �2 )< �: � 1 5� � `` �^ ;FL 'Kt��` �R �'�..
Annual EtegfatratCooi6e, Ijf` 'y'gs L" f+(ch i9::iird{a1d4:S M4# r y illate:;alp .
� i �,c r4 t f 3 �P t .'xF s �'a�' z'� . s.�a
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¢. f v' <kf to rt'4ly'0l i� as R � a''xif f c.ya...�a �, .,i C 3 �r�i e C .� .,'x rf..
lob isti'tegistration For W.eceived and verified by'£' '. ' ��
,.F:CLE#tv$At L\eFORMiaktoiB. IST,F9!W�tmosg ist Registraeom Form kcvisedr 03 13.30,REG*c.,..: . '..aNE `. .:: ,Revised03/11x/2020: :: .
Page 3 of 5
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE'OFFICE OF THE CITY CLERK A •
SIGNED STATEMENT UNDER OATH LISTING LOBBYING::EXPENDITURES AS WELL AS COMPENSATION
RECEIVED:'FOR'THE"PRECEDING CALENDAR'YEAR'WITH`REGARD•TO THE SPECIFIC ISSUE ON WHICH•THE
LOBBYIST:HAS:BEEN::ENGAGED::TO>:LOBBY:A::STATEMENT:SHALL:BE.:FILED:EVEN IF THERE HAS BEEN::NO... .. . .
EXPENDITURE'OR COMPENSATION DU RI` •
NGITHE'REPORT]NG PERIOD:
Signature of Lobbyist: 4r,. ce Date 6-3_:2 .
� V .
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and-that I have read•or am familiar with:the provisions•contained in Chapter-2,•Art,VII,Division 3, entitled"Lobbyists".:of •
the Miami Beach City Code and i al[reporting:requirements. . , •' .
Signature of•Lobbyist: 1://1 Date -. • /
Signature of Principal: /,, Date. 5/3 2421
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VII. NOTARY SIGNATURE AND SEAL: '
LOBBYIST: PRINCIPAL
of: � State of.,.....i /a
State
• County of: 1/qC County of: �� /�- •(Jdv
Sworn to(or affirmed)and subscribed before me, Sworn.to(or affirmed)and:subscribed before me, • .
by:me'aris::of: hysical:•presence by means of t physical presence
or onhne:notarizatio. or Donline notariz^at-lo9,
this ''j day:of_ cy .201'by: .... .✓...this dayof '/'L• . .201gyty
U d j E4Cki?>..:6,93S 07:A t' ' J , :' 1 . .•.
NAME OF LOBBYIST' NAME OF PRINCIPAL - •'
Produced ID Produced ID LejtiZ a 65a /DrIV4t teas
• FORM OF IDENTIFICATION� . . 'FORM OF IDENTIFICATION •
• .::Personal) ' ► .n Persona Known
.
Signatur f:Notary:Public - • Siggnatur •of Notary Public
Name of Notary,Typed,Printed or Stamped • Name of Notary,Typed, Printed or Stamped
(NOTAR = c' .,,, PAiRICKD•C NOTARY.:SEAL °o;�' u� • REBECCA NAVARRO
� q� ( � �� Notary Public •State•of•Flo.'da
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.,% IJIY.COMMISSION#9, �
o Commission�.GG 2C6729
j�L o` SPIRES:Apn .. .. c. My Comm Expires A r 12;2022 :r..
of
pu66oU� Bonded.thrnu hNational:Nota Assn,..
m Notvlr l3 ry
Thoterm ulobb `: ,wmg.persons
Expert witnesses who provide only scientific,'technical or other specialized information or testimony in public meetings;any person who. .
only appears as a representative of a neighborhood association•without compensation or reimbursement for'the appearance,whether
direct, indirect or contingent,to express support of or opposition to,any'item;and any person who only appears.as a representative of_
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance. . ' .
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M1AM:' BEACH
City of Miami Beach,1700.Convention Center Drive,Miami Beach,Fiorida.33139,www.miamiBeachfl.gov
Office of the.City Cletk
Rafael E.Granada;City.Clerk CityCleilaridamibeachfl.gov
Tel:305.673:n11, Fax:305:673.7254
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NAME OF LOBBYIST: WI W'- - kWI
1) LOBBYIST FEE.EXPENDITURE ANDCOMPENSAT1ON STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition, to any other penalties that may. be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall,be assessed for Statements filed after the
due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics,and
Public Trust the failure of a lobbyist (orprincipal). to file the Statement or. pay :the
assessed fines after notification.
Any.lobbyist, who fails to file the required Statement by APtil:30th of each:year, shall be •
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February,28 of each year, I shall submit to the City Clerk a
signed'Statement:under oath listing all lobbyist expenditures;.as:well as compensation
received, for the.precedingcalendaryear with regard to.the.specific issue.orywhichl have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue,.I shall immediately file a.Notice of Withdrawal with the Officeof the CityClerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 Of each year, and the fee for such annual registration shall be
$500,00 pursuant to Section 2-482 of the Miami Beach City Code.
5.-3- J •
Signature of Lo yist Date
FACLER1SALMFORMS5LOBBYIST FORMS.Lobbyist Registration Form Revised 03-11-2D REG.doc
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. , ,MlsceillaneoUs-Cash Receipt -
CITY OF MAIM,BEACH No. 427903
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