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Miguel A Diaz de la Portilla - Royal Polo Hotel, LLC ci i .ce5/ir Vri o'W k ii City of Miami Beach Office of the City Clerk 2-7-.fipti 1)) 1700 Convention Center Drive, Miami Beach, FL 33139 C/ 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. Diaz de la Portilla Miguel A. NAME OF LOBBYIST: (Last) (First) (M.I) Arnstein&Lehr LLP 200 S.Biscayne Blvd.36th Floor Miami,FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-428-4543 305-374-4744 mdportilla @arnstein.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: - Please notify this office if your contact information changes: address,phone, or e-mail address. I. LOBBYIST RETAINED BY: ROYAL POLO HOTEL,LLC NAME OF PRINCIPAUCLIENT: 3785 NW 82ND Avenue,Suite 204 Miami,FL 33166 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-747-6153 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: Chris Desai F -itL, AMST id. ar-- ,-%1 ) r-• • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR.TRUST: 100",t, • i.SPECIFIC LOBBY ISSUE: °�'y " i° ' Setback variance request „tr. Dru ,I0 c e 2I` 0 Co 1I, A-t - K10.4. Issue to be lobbied(Describe in detail): 1 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 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Jimmy Morales,City Manager Joe Jimenez,Assistant City Manager X Thomas Mooney,Planning Director Carmen Sanchez,Deputy Planning Director x Gary M.Held,Assistant City Attorney • Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial r`'rofessional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city pernnel.:who is sought to be lobbied as identified on the lobbyist registration form filed. ° (T Sec 2-482(g)Any Financial, Familial or Professional Relationship ' �r ~J: no =-- —_ c.:7, d P r...) F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc :77 '...A . f IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) Hourly a 4. 59s - B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Paying the attorney the hourly rate (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": _Yes x 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": x Yes_No: 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 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 x No: Are you representing a not-for-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 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 IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reimlinq requirements. Signature of Lobbyist: )0 Signature of Principal/Client: �.y.,. VI. LOBBYIST IDENTIFICATION: •�� PRINCIPAL IDENTIFICATION: """"•• MARIA RU810 ,,�lPµ.PVH•• • ` Produced ID Produced ID •�-�,' utNlc-State ot.ftolr�s •Form of - Fo . t:�, 'i ¢'�omm.,Elc�ites Jrin,28;20.1? Notary Public State of Florida =s -p. .�.- Commission 0' E J 00' Blanca E.Fernandez %,f�;,�«�.•• Personally known (Lobb Q My Commission EE 206369 Personally know • � •'aI Bonded Through Waal A n. of pow Expires 06/25/2016 VII. SIGNATURE AND STAM "`. " §iat`of Merida State of Florida, County of Miami-Dade fiii3ixdet :te of Florida, County of Miami-Dade Sworn to d subscribed before me "12'1,::8i"riFHls.sE i! 206369 orn and subscribed before me GF i s ois r/T*day of Dece ber 2014 Ofte ' This � day of December ,2014 ! Y Signature of Public Notary—State of Flori Signature of Publicic ary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED ,ITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ ) MCR# (QZ'-5°l Date Paid i 21 Lk it■ Lobbyist Registration Form received and verified by: C-k F:\CLER\SILL WORMS\LOBBYIST FORMS\Lobb 1st Annual Registration Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Mik I AM, B E AC H 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: Miguel Diaz de la Portilla,Esq. 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 of each year, 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. I A. I S gnature: D te: • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc • , .,,_,, , f\A1At\A1 B E 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: Miguel Diaz de la Portilla,Esq. 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 of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade i-Dade County Commission on Ethics and Public Trust.Signatur 'it : F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc l� City of Miami Beach-Florida Finance Department 1 City Hall 1433813-1 12/04/2014 BR1 T113 Thu Dec04,2014 03:22PM Trans#47-47 47 $850.00 MCRCLERK - MCR-City Clerk * MCR#: 36237 1 ITEM(S): TOTAL: $850.00 Check (009269) PAID $850.00 Have a nice day! i2/04:12014 001 113 Miscellaneous Cash Receipt `` o_ f8w0.00 CITY OF MIAMI BEACH No 36237 ® Cash ❑Credit Card re Check# - $ . • 4. 20 ( �1 Received of M . c - ��:. -a C) A E r„ .:.. - Address °,J c., ,1(,, .. ` _, ./ c- 4 t F L 1 For 1. - f xf } { � � f. p 29'1(THIS INFORMA TIO N MUST B E COMPLETED) Office of Mance Dir ector By . i Account Number t r s _, `;c if Preparer: L- , :- ti p " Dept: '� EXT: I R AA , Ati\A' BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.gov City Clerk's Office Tel: 305-673-7411 Fax: 305-673-7254 Office Use Only ANNUAL LOBBYIST REGISTRATION FORM Name: Miguel Diaz de la Portilla,Esq. Business Name: Arnstein&Lehr,LLP Address: 200 S.Biscayne Boulevard,Suite 3600 Miami,FL 33131 Office Telephone Number: 305-428-4543 • Cellular Telephone Number: 786-218-1889 Email Address: mdportilla@arnstein.com If more than one lobbyist,please list: otxta �, 1) r 0 - 2 Ii 4) &()4) - 5) Anz , aL2L 7) Submit this,form to the Office of the City Ch lobbyist. Please make the check(s) payable to t..._- For City Clerk's Office Use Only MCR#: Ce 2 �� j S l' Z Amount paid: �� Date paid: 4 t Z t 1�( Processed by: -°`^"� °"` -` Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\ANNUAL LOBBYIST REGISTRATION FORM reg.docx