David Martin - 120 Ocean Drive, LLC A
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City f Miami Beach Office of the City Clerk
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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.
Martin David
NAME OF LOBBYIST: (Last) (First) (M.1)
120 Ocean Drive, LLC -2675 S. Bayshore Drive, Coconut Grove, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)416-4556 _ (305) 377-3040 DMartin @terragroup.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL:(Optional)
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
I. LOBBYIST RETAINED BY:
120 Ocean Drive, LLC .
NAME OF PRINCIPAL/CLIENT:
120 Ocean Drive, LLC -2675 S. Bayshore Drive, Coconut Grove, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)416-4556 (305) 377-3040 DMartin @terragroup.com
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:David Martin I coo
kTVct Peet ro A-f,rb vl , a
IDENTIFY ALL.PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUC CORPORATI
PARTNERSHIP OR TRUST: See attached`-
II.SPECIFIC LOBBY ISSUE:
Legal representation concerning development approvals and permitting Issues,including,but not limited to Historic Preservation Board,Planning Board
and City Commission,relating to approvals for modifications to design and robotic/mechanical parking for the property located at 120 Ocean Drive,Miami
Beach,FL
Issue to be lobbied(Describe in detail):
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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
Planning Department and Building Department Staff,Mayor's None
Office,City Manager's Office,and City Attorney's Office
PB, DRB, HPB,BOA,FP, City Commission, Mayor, as None
necessary* _ - .q n q,v).1 I-
Pursuant to City Code Section 2-482(g) Every registrant shall be required Pursuant to City Code Section 2-482(g) Every r6giirrafitUh1I be
required to state the extent of any business,financial,familial or professional relationship,or other relati ip i i rise to an appearance
of an impropriety,with any current city commissioner or city personnel who is sought to be lobbied as id�fi on[The tbgbyR°s�rr'e�Wtion
form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
NONE ®se :a %-I
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$N/A
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $N/A
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 X No• Are you lobbvina on a present or pending bid for goods,eguipment 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 X No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map desianation 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 2481 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 X No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON EMORY 281b QE EACH YEAR, EACU C
OATH, LISTING LOBBYING EXPENDITURES, S WELL AS COMPENSATIQN RECEIVED. UM T ITY OF MIAMI BEACH
EM TLIE PRECEDINQ OLENDAR YEAR, 6 SIATEMENT ALLBE
EXPENDITURES OR
T
Signature of pb 'gnt do solemnly swear that all of the foregoing facts are true d cd that ave read or-am familiar with the provisions contained
in Section 2-482 of the Miami Beach Cit a nd all re rting r ents.
Signature of Lobbyist: x
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICA I N: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
[Personally known(Lobbyist
SANDRA RAMOS �,�`o.Pa'
SANDRA RAMOS
`'p`(P�et'�i -
(Principal , _ Commission#EE 178548 * TI L�R4&9T ► 10f548
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5* *: ,a My Commission Expires
My Commission Expires +� cP�;�`
10 NOTARY: - °,;;;�.�• April 30, 2016
of. April 30, 2016
State of FI My on iami- a e State of Florida, County of Miami-Dade
Sworn t and subscribe before me Sworn and subscribed before me
This day of ,201 3 day of 20>e3
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t e of 'ubli N tary—State of Florida Si(tar a re of P lic ary—State of Florida
ota iza of signature N zation of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes[ ]No Amount Paid$ 5U MCR# Z D Date Pal
Lobbyist Registration Form received and verified by:
® I I B EAC H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,w%Ny.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: David Martin
I understand that no later than February 28th of each year, I must file the following
form, 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 and Compensation 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.
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.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to tI 1VIi i-Dade County Comm ion on Ethics and Public Trust.
Signature• ate:
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