Marcie O. Nolan - G200 Exchange LLC 9'orc c i4 b
I1ot C6(Li"5AVC)
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach; FL 33139 j
LOBBYIST REGISTRATION FORM
Lobbyist means ad persons employed or retained.whether paid or not,by a principal who seeks to encourage the passage,defeat or
modifiuiti;on 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.
NAME OF LOBBYIST'��• o #•••®•". (First) �� `a••_
(M I)
1� h
(Number and . .
BUSINESS NAME AND ADDRESS `,nd Street) •Q /(City) (State) (Zip Code)� ' '''Sc!)
TELEPHONE NUMBER. FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address.
I. LOBBYIST RETAINED BY:
NAME t:tF PRINCIPAUCLIENT:
1 V_ IC U' it/erg b rr,�n 1 t t
BUSINESS NAME I ADORE (N
a.,. • b^ v (Number and Street) • (cily) (Slate • (Zip Code)
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TELEPHONE NUMBER FAX NUMBER-(Optional) MAIL'(Optonal)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2.482(c))
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: At n 0 i d 5. L e h rI6 A
. IDE=NTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIII��ECTI,Y,A 5%OR MORE OWNERS IP INTEREST IN SUCH CORPO TION.
t'ARTNERSHI,IPP.ORRTRUST: jr� L a.00 is Fan.. 'Tr�lt NIL 2,010 Exe4,' -Pot 40iO: tin e4-t
ii,SPECIFIC LOBBY ISSUE:
•
issue to oe 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 tho 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 ci to.the rosent dal, statln the enera l nature of the sub act contractual rolatlonshi
Sec 2-482(x)(4)Full Name of individual and Contractual Relationship(Explain) YES NO �
title of person to be lobbied_
•
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 currant city commissioner or city personnel who Is
sought to he lobbied as identified on the lobbyist registration form filed,
Sec 2.48210 Any Financial,Familial or Professional.Relationshi
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:1717771 _
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F_1CLERt$ALLtaFORMS1l.OBBYIST FORMSILobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAY RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ►IOVf 1 .,
(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":
Yes4klo: Are ou lobb in• on • •resent or • ndin . f• •oods e•ui•ment or - lc; or on ; •r;_=n •en•In•
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":
XYes_No: Ar; • I..1:1 4 • a • , ;•!lit: • • a t+<< ••m:n A• .,: L. , WI h: CI • or••• Ica 1•t for
c an.e of zoning ma• ,nation'Dr • .:•,!._•to i: CI _ t=,u : ,and•Use ;a!?
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 notdor-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,
Yos No: Are our:•r senti • a not-for-•rofit • ••ratio •r:n•, • out 'e is om•ensatio!or reimbu : e t.
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V. SIGNATURE UNDER OATH: l
ON FEBRUARY 29 OF EACH YEAR,EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
O;,TH L STING L.BBYI, EXP N' T E L - COMPENSATION RECEIVEQ,IN THE CITY OF MIAMI BEACH FQI
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyi
.1 dc 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 reporting requirements.
:..1i' .Signature of Lobbyist;
signature of PrincipalIClient:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID _ -Produced ID
Form of Identification / Form of Identification
✓
Personally known(Lobbyist) Personally known(Principal)
VII,. SIGNATURE AND STAMP OF NOTARY:
Allv144
State of Florida.County of Miami-Dade State of ROM.County of Mierniftd5r.wro-Ir°'4
Sworn to and subscribed before me Sworn and subscribed before me
This day ol .201 A This 44 day of _/dlA 201
Pub!. State of NM YOlk
Signature of Public Notary=State of Florida Signature of Public Notary-State of ,• •+
Notarization of Lobbyist's signature Notarization of Principal's,signatur- -' In New York County
• m. Sires Det:.16,2017
_ • TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
A Annual Registration Foe: ( )Yes( ]No Amount Paid$ MCR# Date Paid
Lobbylzt Registration Form received and verified by:
r .7 .'3!.;;;V 1(J1t'-t;c}Lofhirri.'t.Anhui+f r{4:gisii tiure t urt:I.du(_ Revised 01/22/2014
F:1CLERSALL1aFORMSILOBBYIST FORMSitobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). 4-vc.1.)•L`
The following information must be answered: I
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
Yes, No: Are ou lobb in• on a 'resent or •endin bid for •oods e•ui•ment or services or on a 'resent or •endin•
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_No: Are you lobbying on a pending application for a Development Agreement with the City or application for
chan•e of zonin• ma desi•nation or chan•e to the Cit 's Future Land Use Ma.?
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-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 reporting requirements.
Signature of Lobbyist: 'd)(1.
Signature of Principal/Client: _
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID _ _ Produced ID
Form of Identification Form of Identification
/Personally known (Lobbyist) Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade •ok,r pyay,, COLLEEN LAPLANT State of Florida, County of Miami-Dade
Sworn to and subscribed before me • 'A
(i s Commission#EE 880483 Sworn and subscribed before me
nu
This S day of (na.1 , 201S r��a'= Expires June 16,2017 This day of , 201
4 q, '
R��F�°.• Bonded Thru Troy Fain Insurance 800.385.7019
Signature of Public Notary—State of Florida. Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principals signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by: •
F:\CL.E' �.. LOBBYIST FORMS\Lo Lobbyist Registration Form.do
Revised 01/22/2014
F:ICLER\ ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
•
City of Miami Reach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.mtamibeachfl.gov
•
CITY CLERK Office
Rafael E.Granada,City Clerk CityClerkGmiamibeachfl.gov •
Tel:305.673.7411 ,Fax:305.673,7254
LOBBYIST NAME: arc)!\) &v
I understand that no later thanFebruary 2S 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 2-455.1, a fine of$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist,who fails to file the required Statement by April 30th of each year,shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
5/6i 6
Signature: Date:
F:\CLERI$ALL1aFORMSILOBBYIST FORMSILobbyist Registration Forrn.doc
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BECKER Colleen LaPlant
Phone: (954)987-7550 Fax: (954)985-6814
P OLIAKOFF CLaplant @bplegal.com
1 East Broward Blvd.,Suite 1800
Ft. Lauderdale, Florida 33301
May 5, 2015
Via Federal Express
City Clerk Office
Attn: Patrick Camm, City Clerk
1700 Convention Center Drive
Miami Beach, FL 33139
Re: Lobbyist Registration
Dear Patrick:
Enclosed please find our Firm's in the amount of $2,550.00, along with the
Lobbyist Registration Forms representing lobbyist registration fees for Marcie Nolan,
Allen Levine and Kevin Markow on behalf of our client G200 Exchange LLC.
Thank you for all your help and assistance. If you need additional
information, please feel free to contact me.
Sincerely,
614.Lee„)
Colleen LaPlant
Executive Assistant
Enclosures
ACTIVE:5753230_1
www.bplegal.com care @bplegal.com
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