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A I AM I B EAC H

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City of Miami Beach Office of the City Clerk

1700 Convention Center Drive, Miami Beach W Alf,,.,

9C
LOBBYIST REGISTRATION

FORMIC

1%

1'

C L E r=,,

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;

decision,

action,

any

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.
Av06
NAME OF LOBBYIST:

Javier

F.

Last)

First)
Bilzin Sumberg Baena Price& Axelrod LLP, 1450 Brickell Avenue, Suite 2300, Miami, FL 33131
BUSINESS NAME AND ADDRESS( Number and Street)
( City)
State)
305- 350- 7202

305- 351- 2275

TELEPHONE NUMBER:

FAX NUMBER:

I.

M. 1)

Zip Code)
javino _bilzin. com
EMAIL:

LOBBYIST RETAINED BY:

SEE ATTACHED EXHIBIT" A"

NAME OF PRINCIPAL/ CLIENT:
Number and Street

BUSINESS NAME AND ADDRESS

TELEPHONE NUMBER:

City)
tY)

State

FAX NUMBER:( Optional)

ZipP Code
)
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: See Attached Exhibit" B"

e

II.

SPECIFIC LOBBY ISSUE:

All land use/ zoning and permitting matters regarding property at 2377 Collins Avenue, 2340 Collins Avenue and 2322 Collins
Avenue, Miami Beach, FL
Issue to be lobbied( Describe in detail):

CITY AGENCIES/ INDIVIDUALS TO BE LOBBIED:

III.

Pursuant to City Code Section 2-482(a)( 4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has

entered into any contractual relationship( paid or unpaid) with said city commissioner or personnel from 12 months preceding such
person' s commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482( a)( 4) Full Name of Individual and
Contractual Relationship( Explain)
YES
NO
title of person to be lobbied

City

of

Miami Beach

Planning

Department

staff and

Zoning

Department staff

City

of

Miami Beach Commissioners,

Planning

Board,

and

Board of Adjustment

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 rise to an appearance of an impropriety, with any currenticity commks ion,erlor
city personnel who is sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482( g)

Any

Financial, Familial

none

MIAMI 3840444. 179794/ 42069

or

Professional

Relationship

1 ,,

L -

airy

DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION ' DISCLOSE WHETHER HOURLY,

IV.

FLAT RATE OR OTHER)

A) LOBBYIST DISCLOSURE: ( Required)

475/ hr

B) PRINCIPAL' S DISCLOSURE( OF LOBBYIST COMPENSATION):( Required).

The following information must be answered:

Pursuant to Miami Beach City Code Section
1)

2- 488 Entitled "

475/ hr

Prohibited Campaign Contributions By Lobbyists On

Procurement Issues":

Yes

No:

Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or
pending award for goods, equipment or service?

Pursuant to Miami Beach

2)

City

Code 2- 490 Entitled "

Prohibited Campaign Contributions By Lobbyists On Real Estate

Development Issues":

Yes

3)

VNo:

Are you lobbying on a pending application for a Development Agreement with the City or application
for change of zoning map designation or change to the City's Future Land Use Map?

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 a not-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

not-for-profit

corporation

or

entity

without

special

compensation

or

reimbursement?

SIGNATURE UNDER OATH:

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
IOD.
EXPENDITURES OR COMPENSATION DURING THE REPORTING P

V.

ON FEBRUARY

28T"

Sig

ture

Lobbyist Javier F. Avino

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:
Javier

MIAMI 3840444. 179794/ 42069

FQn

2377 Collins Resort,L.P., a Delaware limited partnership

By:2377 Collins Resort GP, L.L.C.,

limited

a- Del'

bility company, its General

f

By:
Camille D las

VI.

LOBBYIST IDENTIFICATION:

Produced ID

Personally

r 1' V;,, Im

PRINCIPAL IDENTIFICATION:
0

Form of Identification
known tLobbyist)

Produced ID
Form of Identification

Personally known( Principal)

VII. SIGNATURE AND STAMP OF NOTARY:

State of New York, County of New York

State of Florida, County of Miami- Dade

bed befo me
Swo t and sub
20 )
This

Signature of
Notarization

ry State
of
pRY

of

SwornSworn
This

0 FF`

20

IBIS DIAZ
MY COMMISSION# DD 994645

39

before

of

Signature of Public o State of New York

Notarization of PrInerpare signature

FI

Lobbyist's signature
Pie

subscribe

EXPIRES: May 24, 2014

Bonded Thru Budget Notary Services

No"

Vb*

N0. a1MA5MMO
tn

MW A 2014

TO BE COMPLETED BY CITY CLERK' S STAFF ONLY

Yes(
Annual Registration fee.
Lobbyist Registration Form n= lved

No

Amount Paid

and verified by:

Revised 4/ 27/ 2012

MIAMI 3800121. 179794140353

MCR N

Date Pai

MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl. gov
CITY CLERK Office

CityClerk@miamibeachfl. gov

Tel: 305. 673. 7411 , Fax: 305. 673. 7254

LOBBYIST NAME:

that

Javier F. A066

later than February

28th

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.

understand

1)

no

Lobbyist Expenditure Form and Compensation Form

Failure to file these forms on a timely basis will result in my name being transmitted to the MiamiDade 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.

Pursuant to Section 2- 485 ( d), the

City Clerk shall notify any lobbyist ( or principal) who fails to

timely file a Statement and in addition to any other penalties which may be imposed as provided
in Section 2- 485. 1, a fine of$ 50. 00 a day shall be assessed for all Statement(s) filed after the due
date. The City Clerk shall notify the Miami- Dade County Commission on Ethics and Public Trust
of the failure of a lobbyist ( or principal) to file the Statement or pay the assessed fines after
notification.

301h

of each year, shall be

Any lobbyist, who fails to file the required Statement by April
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.

3S'

natu e:

MIAMI 3840444. 1 79794/ 42069

Date:

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