Jamie M. Larson - Portman Holdings/CMC Group, Inc. l�
MIAMI 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.
�Lo�soa Jamie _ �"�
NAME OF LOBBYIST:. (Last) (First) (M•I)
VYes+ g Unbar, besiw, Lowdscm,A"aic4iA PC 333 Nuibbi S+., S+e•10S. Newyork, NY 10013
BUSINESS,;NAME-AND-'AD, _ESS, (Number and Street) (City) (State) (Zip Code)
(212)2s5_00S% (al�)2�5-0228 i:tm�slvh�?a�resl�8.ccrh
TELEPHONE NUMBER: "FAX NUMBER: EMAILt_
-please notify this office If your contact information changes:address,phone,or e-mail address.
I. LOBBYIST RETAINED BY:
PORTMAN HOLDINGS/CMG GROUP,INC.
WflMeffL'f'AV9i4UE, SUITE 2410 MIAMI FL 33131
BUS ,N NJOND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) -
Fill out this section If'pdnclpal'Iwa Corporation;Partnership or Trust[Section 2482•(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):.
nl.C,$YALA_"C-0-$_lfi�f D V'IQ,�,Pd L`:S 10,� LaE3�lE�:
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:statin .the. eneral nature of the sub ect contractual relatlonsfilo.
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 Ix
1
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(g.)Any Financial Familial or Professional Relationship
C:1UserslclerhatllAppDatalLocallMicrosoftlWindows\Temporary Internet FileslContent,0 1 k QDDH1Lobbyist Registration
i Formrevised 5-30-2012.doc L
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(nhhvinn nn a nr @S@nt Or p @ndinq bid`for nooda.equipment or services or an 06resent or bendina
award for goods,eaulpment 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 pen�,ind application for a Deve oament A reement with the.City or application for
changeof`zinAmaa deslanat(on or chance to the City's Future Land Use Maa-7
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 Areyou SepresenttnQ a not for t-rofit corporation'or entity without susclal comp®nsat9on or reimbursement.
V. SIGNATURE UNDER OATH;
ON FEBRUARY 28 OF EACH`YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UND1=R
OATH, LISTING LOBBYING EXPENDITURES.AS WELL."COMPENSATIQN,RECEIVED. IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES-OR'
'COMPENSATION DURING THE REPORTING PERIOD.
Signature of ob
do solemnly swear that all of the foregoing facts are true and come nd that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Mach City Cotle.and'all reporting requirements.
Signature of Lobbyist
l
Signature of Principal/Clien
nCATklN VI. LO BBYIST IDENTIFICATION: R�NCIPAL IDENTIF :
Produced ID �r ��'�f l �'C'I f e ®Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF N rNotary VICTOR J DEANS State of Florida,County of Miami-Dade Public-State of New Yo]Th
Florida,County of Miami-Dade
Sworn to and subscribed before me d subscr' before me
' This _day of P 201
NO. 01DE6254149 2012
Qualified in Kings County JANET GONLqLE2
My Commission Expires i NOTARY tw®LIC
Signature of Public Notary=Suite of Florida -Si n r Ilc ate of Flo CSTTAATT E�OF FLORIDA
Notarization of Lobbvli3t's gnature Notarization of signature
• EE866818
TO BE COMP L CITY CLERK'S'STAFF N es"1/26/2017
`;AnjivaLRegittratlon fee: ( j Yes( ]No Amount Paid$ �' MCR 0 Data id
J.'obbylst Registration.Form received and verified by
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH1Lobbyist Registration
Formrevised 5-30-2012.doc
I'a.FACLE1 listmUon Form.doc Revised 04/27/2012Li
MIANAlbro' EACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www,miamibeachfl.gov
CITY CLERK Office
Rafael E.Granado,City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME:: Mctslyh Larsoi
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
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 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 the Miami-Dade County Commission on Ethics and Public Trust.
Signatur Date:
i
C:1Usersl clerhatil AppDatal Local\Microsoft\WindowslTemporary Internet FileskGon tent.0utlook183LGQDDHILobbyist Registration
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