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Neisen O. Kasdin - Criag Robins 5f� 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. Kasdin Neisen O. NAME OF LOBBYIST: (Last) (First) (M.I) Akerman LLP One SE Third Ave,25th Floor Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305.982.5629 305.374.5095 neisen.kasdin(cDakerman.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,or a-mail address. I. LOBBYIST RETAINED BY: Craig Robins NAME OF PRINCIPAL/CLIENT: 3841 NE 2nd Avenue,#400 Miami FL 33137 _ BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-871-4804 mayda@dacra.com TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal Is a Corporation,Partnership or Trust[Section 2-482(c)] - `% 1�0 • 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: s �' iiAPECIFIC LOBBY ISSUE: Variances for subject roe !/ P P rty Issue to be lobbied(Describe in detail): III.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 2482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Board of Adjustment Members and City Professional Staff in Planning Department None Pursuant to City Code Section 2482(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. Sec2-482 Any Financial Familial or Professional Relationship None F:ICLERI$ALL1aF0RMSIL0BBYIST FORMS\Lobbyist Registration Form.doc I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) �k��hourly B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED).$645 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": _YesE]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 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes✓ONo: 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 2-482(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. YesE]No: Are you representing a not-for-profit corooration or entity without special compensation or reimbursement V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUB MT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOB13YING EXPENDITURES,AS WELL AS COMPEWSATION RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PIR ICD G C LENDAR YEAR. A STATEMENT SHALL 13E Flt",/EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. 1,i F_/ Signature o Lo byist I do solemnly swear that all of the foregoing are true and d that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code II reportin a ts. 1 Signature of Lobbyist: Signature of Principal/Client: .t } VI. LOBBYIST IDENTIFICAT PRINCIPAL IDENTIFICATION: Produced ID p� Produced ID Form RAR e. Form of Identification C U84 IC �4 +Personally known(Lobbyist) Fj�l FF�0�01gjOq Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: e/8j?OAS State of Florida,County of Miami-Dade ,��►;`:°��� ALWALONSOVEM of Florida,County of Miami-Dade Sorn and subscri e MY COMMISSION f EEMOOn d subscrib�before me INW s day of 20H * * EXPIRE Aril 18,1068 day of V eJ E ,20,y ��A�os iti a Bonded ft S r l of Public Notary—State of Florida Signature of Public Notary—State of Florida riz a n of Lobbyist's signature Notarization of Principal's signature BE.COMPLETED BY CITY CLERK'S STAFF ONLY Ann eglstration fee: [ ]Yes[ Loo Amount Paid$ R 0 Date Paid Lobbyist Registration Form received and verified by: F:\CLER\;ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Regist on Fonn.doc Revised 11/18/2013 F.\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MIAMI BEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfi.gov CITY CLERK Office Rafael E.Granodo,City Clerk CityClerk@miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Neisen O. Kasdin I understand that no later than February 25 of each y, eair, I must file the following form, pursuant to Section 2-435 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 2-455(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 2-455.1,a fine of$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist,who fails to file the required Statement by April 30,shall be automatically suspended lobbying until all fines are paid, unless the fine has been appealed to the Miami-Q . unty Commission on Ethics and Public Trust. 6/5/14 Signature Date FACLERI$ALL1aF0RMSIL0BBYIST FORMS\Lobbyist Registration Form.doc I AJ-4. 12A Miscellaneous s, F Cash Rec eipt ", U CITY OF MIAMI BEACH No: 0 Cash D Credit Card D Check# ' • Received of s-c I f�,1 Address For�' C) .C)M y � :A V r I (TlIIS INFORMATION MUST BE COMPLETED) Office of F16ance Director 1 Accpunt Number:. f i -Preparers ' -' Dept: ?y. EXT• ,