Judith Hogan Frankel - Power Access, Inc. C1W Gfi
AA 114 A 'I, 1 ti-eq,EAr H EcEivE®
Office of�the City Clerk TY MAY ^,2 2022
1700 Convention Center Drive
Miami Beach, FL 33139 � i� Ml BEACH
305.673.,7411 FFC OP'T! 5.CITY CLERK
LOBBYIST REGISTRATION FORM
modification of any ordinance; re olution; action or decisionp of any,commiss one r any action; decision, recommendation e, defeat Cityor
• Lobbyist means all persons employed or retained,whether aid or not b.y a principal who seeks to encourage the"passa
any City.personnel duringthetime of the
Manager or any City board or committee;or any action, decision or recommendation
�, g' 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 information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office-ofthe City
Clerk'. If you need more space to complete an answer,.use'a separate•sheet(s)Of paper. If you have nothing to report in a particular
section, you must write 'none" or "n/a" in that section. Any change to,any .information originally :filed, or any additional .City
Commissioner:or personnel who are also sought to be lobbied shall require that the lobbyist 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 represerited on each specific issue.
I. LOBBYIST INFORMATION:
Flf- NIA K2 1 . . Jueit i Pla t-i-o a 1,I
NAME OF LOBBYIST (Last) (First) (Middle Nam
9OW-ell 'Gc,� + ��. 1(�IPhG�t �� .e 'r o 13j FL 13 13e'
LOBBYIST BUSINESS NAME AJD ADDRESS (Number and Street) " " (City) (State) (Zip Code)
\LAddli-},AAketeifif-Ait.
LOBBYIST BUSINESS:TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS edit
II. PRINCIPAL INFORMATION:
Ajejiyp. DAv-, ,A .
NAME OF'PRINCIPAL. (Last) ' (First) (Middle Name)
o � A c e��s tee. I �� Ec,�t; u� ;r� � FL- 3 '3
PRINCIPAL BUSINESS NAMEAND.ADDRESS (Num er and St (City)(City) (State) (Zip Code)
s 561 - / 03- ell 1c.
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PRINCIPAL BUSINESS TELEPHONE'NUMBER` CELLULAR TELEPHONE NUMBER EMAIL ADDRESS i?`
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Pursuant to.City Code Section 2,482(h)(1)(a): A principal of any'corporation; partnership,or other entity who appears as a lobbyist on behalf Of that
entity,without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to express support of or opposition'to s
an item shall register with the Clerk as required by this subsection but shallinot be required to,pay:any registration fees.
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c): t
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write NIA) t': . 6 i of e,
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR ORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): IV
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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 ntimber.
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IV. CITY.AGENCIES/INDAVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2482(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. I
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Full Name of Individual and Contractual Relationship(If yes,explain) YES NO •
Title of Pettorilo be Lobbied. ,
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Pursuant to City Code Section 2-482(9)i every registrant shall: be required to state the extent of any f
business, financial, familial or professional relationship, or other -relationship giving rise to an
appearance of an impropriety,With any current City Commissioner or City personnel who is sought to
be lobbied as identified on the lobbyist registration form'filed.
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List any Business, Financial, Familial or professional Relationship, or other relationship giving rise to an ri
appea n e of impropriety Oco f'dne,write N(A)
Af :
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V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be,Specific. (Note that a 1
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contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
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The following six(6,),guestions MUST be'answered;
1 1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues':
, . .• .
Yes plO:' Are you lobbying on a present or pending bidl for goods, or services,or on a present or '
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t pending award for goods;equipment or service?
i 2)
Pursuant to City Code Section 2,490;entitled'Prohibited Campaign Contributions By Lobbyists On Real Estate bevelopment
i Issues: . , .. . .. . , .
i Yes iNo: Are you lobbying on-a pending aPrilicatiomfora Development Agreeinent with the City or application
, — a ' • 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" as'set forth in
i Section 2-481)who only appears as a representative of.a.not-for•-profit corporation or entity,without,special compensation or '. , ., ,
reimbursement for the appearente;'whettier direct or indirect to express support of or opposition to any item,shall register with
the city clerk as required by this Section,'but shall not be required to pay any registration fees.
, . .. , . . ,
lc,,,,Yes_No; Are representing .not-for-profit corporation or entity- without special or
No: Are y.ou ' .. a
compensation
reimbursement? • - - ,- - - -. - - , . . ,
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4) Pursuant to City Code Section,2481;the term"lobbyist' specifically excludes the following persons: Expert witnesses who • $
provide only'scientificctechnical 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 fof 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 ;
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not-for-profit community based,organization for the purpose of requesting a grant without,special compensation,or
reimbursement for the-appearance. . • ' ' • '' .. 1
—Yes1No: Are-you providing only-scientific, technical or other specialized information; appearing as a
representative of a'neighborhood association without SpeciatcOMpensation,or reimbursement or i
representing 'not-for-profit based.'organization for the purpose of"requesting a grant without ' •
• .t compensation ... .. . , , ... • . . . ,
soemanr reimbursement? - , - - • - ' ' , -, • ',.
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5) Pursuant to City Code Section 27491(1),-,no S for a period of 12 months
,campaign consultant shall lobby the City-'COmrnision.
"following the swearing Inof.any elected official(s)for-whom the campaign consultant provided campaign consulting services
within the past election cycle.See Section 2491tor more-information.
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Yes Have you provided campaign consultinct services to an incumbent of the City Commission il
, . .. „within the past election cycle?if yes,please list the incumbent rnember(s)of the City Commission: ):
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Yes_No; If yes, has It been less than 12 months since the elected official(s)whom you provided campaign
kfx., donuitincii,.aarvices was sworn in? - 1 -`„ ' ; - • - -' ' ' .' ' - -
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8) ' Pursuant-to City Code Section:i-t1:82(a)(4)e.,,a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Cctintnissionwhich lobbying activity is notctherwise: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,theCity Commission at a public meeting:
._Yes No;) 'Have you provided campaign'consulting services to an incumbent member of the City Commission
Within the east election cycle?If yes,please list the incumbent member(s)of the City Commission; . 11
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_Yes No; If'yes. were you'proMised or did'you receive economic consideration in exchange for campaign
AfrA consulting services? .
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.TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ I Yes No Amount Paid$ MCR# Date Paid ' - --
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Lobbyist Registration Form received and verified by:
14:1,CI,Ellk,SA't.K.1, FORMS'tt.06EVIS.T FOgr,IS\1‘.1-4*-t,irorsioiratimi Form Rooi-r,•or:,03-11-20 ReG.dor: ' Revised 03/1112020'
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL•S_UBMIT 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 BEN NO
EXPENDITURE OR COMPENSATE N DURING THE REPORTING PERIOD.'
Signature of Lobbyist Date 7-2._
(-1
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 VIE Division 3,entitled Lobbyists"of
,
the Miami Beach City Code a II report g. uirements.
Signature of Lobbyist ' Date 1-1 61 f 2.-e 2-1_
signature of Principal: 41Z, 9' Date / 1 & o 4-
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VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
- State of PI 0 Q
State of -F10 11._OR
County AA•i(744A-Dila County of HIQ1rt1
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• Sworn to(or affirmed)and subscribed•before,me, Sworn to(or affirmed)and subscribed before me,
by means of El physical presence' by means of 0 physical presence
• or 0 online notarization, or 0 online notarize*,
this day of .20 ,by this __.a.ciay of • (../t ,201cNy
UwVIA FottAkel
- NAME OF LOBBYIST NAME OF PRINCIPAL
• Produced ID 4`"L. l)1.-- --(t.fif LAS (\
Produced ID • INT 6
FORM OF IDENTIFICATION FOAM OF IDENTIFICATION /
* 1/0 L cince
jsRsonalty.Known- P rsonally Known
G• ' '4> •
4'40,4 * . •
o Signature'4,14.--otarY, Sign ure Note ,Public
m •' , k('‘C",, SaP;0 c I
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Name offtary,Typid,Printed or Stamped Name of Notary,Typed,Printed or Stamped
(NOTARY SEAL) Commonwea of Penn vania con
. anWigt444114/tymnie-tiotelyseat
BonrilJ.Pienn,Notary Public .
o •
County of d'iiiimitti..45,01ftliltr FbuadelphIecounty
comtntsakin expires June 22,2023
- PrAw—Pca
'The term"lobbyist'specitcally excludes the following peg ons. CCInU1118810fInumber 1234269
',Umber.PannsYlv•ofoAogoolation of Notarise
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 awitingent.ta express sugport of or opposition to any item;and any person who only appears as a representative of
• riot-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
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city of Miami beach,1700 conyention'Center Drive,Miariii Beach,Florida 33139,VAVvi,erliarnibeaahil:gav .
Offite of the City-Clerk
Rafael•E:bi6rtodq,.city Clerk; .. .., CityClerk@tniorrtibeact-41.goy-
i Tel:305,6737411.,Fax.:305.6717254
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1,11/„‘ '--:,-`-' - . A'. le,c,,,
NAME,OF.LOBBYIST: ,(.ie(A.a1 I - ," .',10.• -t.y
1) ' ATION-STATEMENTN C XP T LOBBYIS FEE EXPENDITURE AND COMPENSATION, . ..,.. . . - . .
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Pursua,rt, to City Code Section 2-485(d) the Q,ity :Clerk sia11 0otify;..,a.ny:
lobbyist (or r
principaowh9fail ,lofletoelya,L6byist,FeeExp6poit6reind,C3nonsation Statement '
KStafeinent).. In addition tO any Other penalties that may be imposed as 'provided in
Section;2-485.1; a-firie of,8-50:09.a day shall be assessed fior'• taterrientS,filed after the
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• duedate; The City Cleric Shalt hotify;the.Miami-Dade County Commission On Ethics: and
Public Trust of the failure of•a'. lobbyist (or principal) to.2file-,the Statemeht or pay the
asbessecifirieS:after,nOtifiCatiOri:
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Any lobbyist,- who,fails to file the required Staternerit)DY,April Wh:.of each year, shall be,
automatically suspended from lobbying. until all'finds'are paid; unless the fine has been
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appealed'tolhe:Mjarhi-bade County Commission on Ethics and Public TruSt.
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I-hereby acknowledge that on February 28 of each year,T.shall submit to the City Clerk a
Sighed' Statement under oath::listing all lobbyist expenditures, as well as compensation
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received,for the preceding calendar year with regard to the specific issue on which,I have
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been.engaged to,loply'.. . ,,, .
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2)- LOBBYIST WITHDRAWAL
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Once an IstUe 1 have registered to lobby has. concludeo,.or, [am. no loriger:lobbying on
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that issue, I shall,immediately file a..NOtice.6f,Withdra*al Wittrthe:Offica,Of the City Clerk:
. ANNUAL LOBBYIST REGISTRATION,FEE
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I-understand anniiar registration4of.all lobbyists shall be racipiredfpr paoh.12-rppnth period
commencing'October 1 of each.year; and the fee for such annual registiatiOn shall be
$500:.00 pursuant tO'Section'2-4.82 of the,Miami,Beach'eitjtpode. !,
Si ature.of Lobbypt 9, , Pate
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FAcistil.s...,,..,FoRiom..08ByisT'FORMS.I1L9L-pyist Registration Form Revised 01-11-20 REG.doo
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