Diana C. Mendez - Michael Tillman MI AM BEACH e 1 1-104-ct 50,41 Pf7cick._
City of Miami Beach Office of the City Clerk ;,
1700 Convention Center Drive, Miami Beach, FL 33139 ' • " a
LOBBYIST REGISTRATION FORM Zn u Di i i�1 25 .E, I i; 29
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,trecommeridatibh,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.
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NAME OF LOBBYIST: (Last) first) (M.I)
PA /: P 4' s I ^st I it t A 10 III _..1 t% I `''r 1 LA1 ( Ut'tal 1 fL--
BUSINESS NAME AND AI DRESS (Number and Street) (City) (St-te) (Zip Code)
r • • 1 a 9 :_ — m • tio did (Iv" ' 4 t 0 a
TELEP • NU,,BER: FAX NUMB -: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAUCLIEN , Qe&cy4 f ,n` _ .r'' .. 4 0- 4 a ,n n`•
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BUSINESS NAC4 AND ADDRESS (Number and Street) (City) (State) (Zip Code)
( QtAI®® 42 - tc00
TELEP3710NE r[ ABER: 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: 't•f/PS
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWI'(ERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Ni/A
II.SPECIFIC LOBBY ISSUE:,
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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 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to b lobbied
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Pursuant to City Code ection 2-482(8 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
St\i/ih, _
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Q
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) f 1 mm( \'- I (' „
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ��/� /�I r-
(REQUIRED). �' "��' 1 r y
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
7sues":
Yes VNo: 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
D elopment Issues":
_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
com nsation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
ite ,shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
Yes o: 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. a (
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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: k ��` �.. �e,a� -
Signature of Principal/Client: _M,
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VI. LOBBYIST IDENTIFICATI•N: — ° ■ PRINCIPAL IDENTIFICATION:
_Produced ID ►�-i 0, —Produced ID
Form of Identification ,,�, �,,. Form of Identification
Personally known(Lobbyist) o o _Personally known(Principal) Mill�V`
VII. SIGNATURE AND STAMP OF NOTARY: 3 c, a
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4 Z.0 = " �^ O
State of Florida,County of Miami-Dade N T State of Florida, County of Miami-Dade m .,o
Sworn to and ubscribedAbefore me ` a - T o Sworn an ubscrib d before me ? q �,
This d y of f W ,201 a 7 ■Ca 2. s This o� y of ,201: § P y Er 22
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..... , A -I: p za a Ot/t .Signature of lit-lc No ary– -tate of Florida ,� v Signature of Public Notary–State of Florida a Q -n o
Notarization of Lobbyist's signature Notarization of Principal's signature f r 9. x
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TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ' "'
Annual Registration fee: [ ]Yes ]No Amount Paid .160 MCR# HO 712t( Date Paid 4g/z 5/61
Lobbyist Registration Form receiv and verified by: C4 1,,►i
F:,CLER\$ALL\aOORMS\LOBBYIST FO MS\Lobbyist Annual R, istration Form.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
MLAMIBEA.CH
City of Miami Beach, 1700 Convention Center Drive,Midmi Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
N WX"LOBBY IST NAME: IQ ")1 � k S S �i
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.
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Signature: te:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Miscellaneous Cash Receipt
CITY OF.MIAMI BEACH
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; -Cash D Credit Card Check# $ I 1 0 e
At-1 9 14(D 20/c
Received of inv,c, (, erJ c2 i ) t a s 16 LL, t V)4C
Address A i t k Al 1 i f► t 1
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(THIS INFORMATION MUST,BE C t E ) BEAG10 of Finance Director
By
- Account Number:
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Preparer. p
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Salvatore, Jason
From: Erin Hendrix <ehendrix @Isnpartners.com>
Sent: Thursday, August 18, 2016 5:11 PM
To: Salvatore, Jason
Subject: Final Version, please review: Requested Lobbyist Registration Information
Good afternoon Jason,
I hope you are well. Below are the responses to the information you requested in your letters
to Alex Heckler, Diana Mendez and Michael Llorente dated August 1, 2016. Please let me know if you
need any additional information.
Have a great day!
Erin
1. Security Alliance = In 2015, the monthly fee was $2,500; however, there is no fee for the City of Miami Beach
matter.
2. Ashbritt, Inc. = No additional compensation for the City of Miami Beach over our national agreement fee.
3. Clark Construction Group, LLC = $9,000 per month
4. Lincoln Road Business Improvement District = $50,000 fee in 2015. $10,000 per month fee in 2016 for legal
services.
5. 1052, LLC = $10,000 per month; however, no longer a client
6. Serco/Daria Van Engelen = $6,000 per month
7. Yachting Promotions = $5,000 per month
8. a Hotel South Beach = $7,500 per month
9. Greater Miami Tramlink Partners = $20,000 per month, including other jurisdictions
10. 1681 West Ventures = $3,000 per month
11. Setai Hotel Acquisitions = $15,000
one-time
pay
ment
agreement
12. Fort Partners = $20,000 per month
13. Harris Corporation = No agreement in place -
14. Collins Park Partners = No agreement in place
___.-__ Erin Hendrix
EDirector of Client Relations
LSN Partners
801 Arthur Godfrey Road,Suite 401
Miami Beach, Florida 33140
(305)673-2585, Ext. 315-Office
(561)358-1289-Mobile
(305)673-2588-Fax
www.lsnpartners.com
IMPORTANT-The information in this e-mail is :onf do :tat snrl may be legally privileged. It is intended solely for the eidi 3sse:.
Access to this email by anyone else is unauthorized. If yu.i are not the intended recipient,you are notified that any disclosing,
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