Loading...
Jack P. Hartog - Douglas Conner 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 Wli 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. HARTOG JACK P. NAME OF LOBBYIST: (Last) (First) (M.I) Gray Robinson,Attys at law 1221 Brickell Ave. Suite 1650 Miami R. 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Lip Code) 305 951 9172 305 416 6687 ihartog@gray-robinson.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. 1. LOBBYIST RETAINED BY: Douglas Conner NAME OF PRINCIPAUCLIENT: Centerplate Inc 9800 Intemational Drive Orlando FL. 32819 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 407.685,5797 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section it principal is a Corporation,Partnership or Trust[Section 2-a2(c)) -- o • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: — �t7 • IDENTIFY ALL PERSONS HOLDING;DIRECTLY,OR I40IRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORAON, PARTNERSHIP OR TRUST: - u.SP.ECIFIC LOBBY ISSUE: Food and Beverage Services for the Miami Beach Convention Ceriter i Issue to be lobbied(Describe in detail): uL CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: . ca 7,1 Pursuant to City Code Section 2482(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 2-462(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied City Attorney's Office, Including Raul Aguilar X Procurement officials(names unknown) X City Manager X 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 current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(8)Any Financial, Familial or Professional Relationship C:\Users\clerhaV%AppData\Local\Microsoftt\IYindowsiTemporary tntemet Files lContenLOutlooM83LGQ00H(Lobbyist Registration Formrevised 5-30-2012.doc 2013 APR -4 PM 3: 20 tV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER: A) LOBBYIST DISCLOSURE.(Required) CITY c; $345 hourly B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $345 hourly 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": 2L 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? 2) Pursuant to Miami Beach City Code Section 2-496 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues': _Yes Mo: 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? 3) Pursuant to Miami Beach City Code Section 24162(h)Any person(except those exempt from the definition of"lobbyist"as set forth in Section 2-461 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. YesXNo- Are you representing a not for-profit cotpotation or entity without special compensation or reimbursement V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 1 THE E HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Sign ureo' obbyist I do solemnly swear that all of the foregoing facts are ue a d rrect and that I ha a read r am familiar with the provisions contained in Section 2-482 of the Miami Beachyl Code and I repo ng requirements. Signature of Lobbyist. Signature of Principal/Client VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICAMOM _Produced ID _Produced ID w�gkri Form of Identification Form o i = Personally known(Lobbyist) Personally known( I nrhoaA'.•'My"C��'� C VII. SIGNATURE AND STAMP OF NOT)JtV, N^•P �z'D N %miss. de b( State of Florida,County of Mami-Dade State of Florida,County of Maori-Dade dSj �bIQ Sworn to and subscribed eforg me 3 + ga�°a Swor min subscri d before me 3 This y d of I" e d+ ,201rPP This day of 201 GZ_ ffn o::- , I I fil - i�� Signature of Public Notary¢State of Florida gnature of Publh Notary—State of Fl Notarization of LabbvisVs signature otarization of ncipal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY IAnnual Registration fee: l l Yes l hNo Amount Paid$ MGR# Date Paid. Lobbyi§f Registration Form received and verified by. C:\Users\clerhatl\AppDatalLocaRMcrosoftlWindows\Temporary Internet Files\ContentOutiook\83LGQDDH\Lobbyist Registration Formrevised 5-30-20f 2.doc C. Revised 04/27/2012 -Cay ci Micinli SC-CA'R, 1700 Convetion Cenler 39, 01V CLFRK UP(R Rofnel E.Gronodo.C4y Clerk Tel:305.673,7411 ,Fax:305.673.7254 LOBBYIST NAME.. JACK HARTOG I understand that no later than February 28 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 I 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, or I am no longer lobbying on that issue or for that principal, 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 MiamkDade 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 the Miami-D e County Commission on Ethics.and Public Trust. S i7n' a/tull`6: Date: C:\Users\clerhafl\AppData\Local\Microsoft\Windov,s\Temporary Internet FileskContent.Outlook\83LGQDDH\Lobbyist Registration Forwevised 5-30-2012.doc