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Bjarke B. Ingels - Portman Holdings/CMC Group 1 1 BEACH 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 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. -S BE �• NAME OF LOBBYIST: (Last) (First) (M.1) __9 t A A'4 1-5 &=&i2 &Q I tj2-, a 64 %t 1=( BUSINE&Q4j4AME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE N MBER: FAX NUMBER: EMAIL: laseoUfyfhlsiffJce If.your contact Iriformafion changes:eddr+ess,.phone;of a-mail address: I. .LOBBYIST RETAINED BY: PORTMAN HOLDINGS/CMC GROUP,INC. BVIIe LEc��NUE, SUITE 2410 MIAMI FL 33131 B�1alNESS,N�I�D ,AND ADDRESS (Number and Street) (City) (State) (Zip Code) T3EilL1EJJPHSO�/NGNEUUNUMBER: 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:JACK PORTMAN/UGO COLOMBO/ART MURPHY /ROGER ZAMPBELL • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:, REDEVELOPMENT OF MIAMI BEACH CONVENTION CENTER(R.F.Q.)NO.22-11/12 Issue to be lobbied(Describe in detail): III. R W, 8 : 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 itatIna the eneral nature of the sub ect contractual relationship. Sec 2.482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied CITY MANAGER,CITY COMMISSION X CITY DEPARTMENT LAND USE BOARDS X CITY STAFF X Pursuant to City Code Section 2-482(8)Every registrant shall be required to state the extent of any business,financial,familial or professional relationship,or other relationship gluing 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 Any Financial Familial or Professional Relationshi NONE i 71 w ,7 71 1"1 t i 9 C:\Userslclerhab\AppData\LocallMicrosoft\Windows\Temporary Internet Files\Content.Outlook183L Q_DDH\Lobbyis�Registration Formrevised 5-30-2012.doc 4ti� r 'i qr n1:: IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) PRINCIPAL B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): PRINCIPAL (REQUIRED). 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": X Yes_No: Are you lobbying on a present or p2ndino bid for goods,eauipment or services,or on a present or pending award for hoods,eauloment or service? 2) Pursuant to Miami Beach City Code Section 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": XYes No: Are you lobbying on a nendina application for a Development Agreement with the City or application for chan,,ge of zoning man designation or change to the City's Future Land Use Man? 3) Pursuant to Miami Beach City Code Section 2.482(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 a not-fgr-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR,EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERIC A SIGNED STATEMENT UNDER OATH: LISTING LOBBYING EXPENDITURES,AS INIELL AS COMPENSATION RECEIVED.IN THE CITY OF MIAMI BEACH FOR THE.PRECEDING CALENDAR YEA13. A STATEMENT SHALL - ILE EVEN'IF THERE HAVE BEEN NO EXEENDIJURES O COMPENSATION DURING THE REPORTING PERIOD. Signature Lolffylsf do solemnly swear that all of the oregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami B achy-ity Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: V1. LOBBYIST IDENTIFICATION: PRINCIPAL IDE TIFICA ION: `Produced ID _Produced ID Form of Identification Form of Identification Personally known(Lobbyist) ,Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: JAIME DARROW NOTARY PUBLIC-STATE OF NEW YORK State of Florida,County of Miami-Dade No. O1 DA6201045 tats of Florida,County of Miami-Dade Sworn to and subscribed efore me Qualified In Kings Count wor nd subscribad b e me Thi ,��,,,__da of �( . 2012 M Commission Expires April 11,X201 day of �..J�l 2012 Y p JANET GONZALEZ NOTARY PUBLIC Sig ature of Public Notary–State ofd �e(g�,,voaf� Signs ublic�otary State ST ATE OF FLORIDA N rization of Lobbylst's signature Nota a f r signs Comma EE866818 TO BE COMPLETED BY CITY CLERK' STAFF ONLY Tres 1/26/2017 �pr} uat,iRegtstreon fea:. Yes IN AM Aititount Patd$ MCR 8.. Date'Paid ` Lobbyls.iReglstraUon Form received and verified P. ' C:\Users\clerhat\AppDataXLocal\Microsoft\Windows\Temporary Internet Files\Content.Outlook183LGQDDH1Lobbyist Registration Formrevised 5-30-2012.doc J' :_�cx,st �t� aon Fo .Qa� . :., 'Revr9ea o /i /zaia MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Mlami Beach,Florida 33139,www.miamibeachfi.gov CITY CLERK Office Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: I understand that no later than February 28 of each year, I must file the following form, pursuant to Section 2485 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 l 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 falls 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$60.00 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 falls 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 the Miami-Dade County Commission on Ethics and'Public Trust. Signature: Date: C:\Users\clerhafll AppData\Localxmicrosoft\Windows\Temporary Internet Files\ContentOutlookl83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc I t • A ^ O d • �. -:. Z Z t a c, to O :.- - ❑ 3 0 a W y ZY T 0 [. r r" ca FL CD r* ; r n. j m : t= _ �:.. .... } 0 `J, O Im CD L'. {