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Graham Penn - Capital One Financial Corporation iOo1ci-- 1031 Loco MIAMI City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 JAN 114 ��f,.� 3e LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage`flie 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. Penn Graham NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell&Fernandez, PLLC, 200 South Biscayne Boulevard, Suite 850, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-377-6229 305-377-6222 GPenn(d$RZoninaLaw.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: Capital One Financial Corporation NAME OF PRINCIPAUCLIENT: Capital One Financial Corporation, 15000 Capital One Drive, Richmond, VA 23238 IUSINESS NAMt ANU AUUKbSS (Number and Street) (City) (State) (Lip Code) (661)466-6910 (312)260-2728 ruth.newell(d apitalone.com 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: Capital One Financial Corporation is publicly traded corporation on the New York Stock Exchange(NYSE). � d • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: C'u iS�L, �, -� p�� II.SPECIFIC LOBBY ISSUE: �`�J (Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustm`ent;Land Use Development Committee, City Commission, and any City Workshops or Committees, if necessary. relatina to the propertu located at 11.029-103I Lincoln_Rod, Miami Beach,'Florida Issue to be lobbied(Describe in detail): nl. 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 Staff for the Planning Department, Building Department, None. Public Works and City administration, PB, HPB, BOA, None. X DRB, City Commission, and Mayor as necessary None. X 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 None_ None. None. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc f IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$475.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $475.00 per hour (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)(No: Are you lobbying on a Present or pending bid for aoods.eauipment or services.or on a present or pending award for goods.eauipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes XNo: Are you lobbying on a pending application for a Development Aareement with the City or application for change of zoning map desianation or change to the City's Future Land Use Mao? 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 A§-COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH, EQR THE PRECEDING CALENDAR YEAR. A STATEMENT .SHALL BE FILED/EVEN IF THERE HAVE BEEN NO, EXPENDITURES OR COMPENSATION DURING THE REPO RT-#NG ERIO15„-- • Signature of Lobbyist I do solemnly swear that of o the foregoing facts are/rue and correct and that I have read or am familiar with the provisions contained in Section 2-482 of th Miami each City.Gotle an II reporting requirements. Signature of Lobbyist: P—LAkL f Signature of Principal/Client: 1244\I- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ;•;S tia% • Produced ID CA— D�-► Ls� Produced ID aq a.. Form of Identification ! %°;,,,,,,;:m, Form of Identification ,,,,,,,, z sa Personally known (Lobbyist) 4 o o Personally known (Principal) 0 0 3 a ( 3 c m b N. 3 Q m n.•VII. SIGNATURE AND STAMP OF NOTARY: H ,,, Q -4 o ;� State of Florida, County of Miami-Dade H = m State of Florida, County of Miami-Dade t , Sworn to -nd subscribed before me o o m Sworn and subscribed before me o d s z This Ii�,S ay of a• I , 2015 030, D This day o c�C). �' -ri 1157 ' K) Ns Al Sig, at re o b c 7:'Pry-State of Florida Signa• r; of Pit votary—State of Florida Notariz= i V- of L.bbvist's signature Notarizat =• 'Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$1 L.I 350(CO MCR# 4 0g 6.9-7 Date Paid 01-14-it Lobbyist Registration Form received and verified by: JWOA,) S L.V kC6 . MI AM I 1. EACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK 0 Rice Rafael 13. Granath), City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME Graham Penn 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 automaticall ded from lobbying until all fines are paid, unless the fine has been appealed the Mia - i-Dade Coun . Commission on Ethics and Public Trust. Signature: Date: . C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc 1 I THE,fACE}Octrils DOCUMENT HAS A COLORED:BACKGROUND.ON,WHITETAPERAND ORIGINAL DOCUMENTi:SECURITY! N ti. " r ..�,-:a.,�_-_��, SCREE,,ON BACKWITiH.PADLQCK SECURITY 1CONi, DYNAMICA ARCHITECTURE&INTERIOR DESIGN CORP. BankofAmerica 2223 888 BISCAYNE BOULEVARD,SUITE 201 1 SE 3rd Ave MIAMI,FLORIDA 33132 Miami,FL 33131 63-27/631 12/17/2015 950 PAY TO THE City of.Miami Beach $ **2,400.00 ORDER OF tY - Two Thousand Four Hundred and 00/100**************" ******************************************************************************************* DOLLARS Security feaiwes 1700 Convention Center Drive °Details bay. Miami Beach, FL 33139 VOID AFTER 60 DAYS V PQ P c+�1 CCte L an �1 e t�HE N F �O 0 y MEMO Lobbyist Registrations and Annual Fee Y�,.W oa: NP Y 1 AUTHORIZED SIGNATURE 11900 2 2 2 3119 '®063X00277'® 2290523739E1011® i 1<HE FACE F PHIS DOCUMEN7>I AS ACOLORED BACKGROUND ON WHITE PAPERAND ORIGINACbOCUMENTSECURITY SCR N' T' -, _._ . , 'Q .. ......_�_ ..x r �.:.-._ ._..-.,T _.---- -. _, . �_- __- �--.. SEE aN.BACK'UVITH'PADLOCKSECURITYaCONi DYNAMICA ARCHITECTURE&INTERIOR DESIGN CORP. BankofAnrierica 2226 888 BISCAYNE BOULEVARD,SUITE 201 1 SE 3rd Ave MIAMI,FLORIDA 33132 Miami,FL 33131 63-27/631 12/21/2015 950 OR ER OF City of Miami Beach $ **350.00 Three Hundred Fifty and 00/100************************************************************************************************************************* DOLLARS rt Security features 1700 Convention Center Drive n be ads o�hack. Miami Beach,FL 33139 VOID AFTER 60 DAYS �NEN yF_ o lfeEeal�� IVP g C MEMO 1508.02 Capital One-Lincoln Rd-Additional Lobbyist Registra 'o a AUTHORIZED SIGNATURE 11'00222611® '®06 3 100 2 7 7I: 2290523739E0119 i;4 : • s a ..::: ,-,; - 8 ,-.., . .....„,., 0 13.. 42 _.: 0 . 4 woe I [::-:--- . ‘;‘: cr9 '• :. - - %-,ca 2 -0. :: 0 > co___„ O Li) .r =• 0 E g ----- ,s. . , ... ,.• 34— 1--,...,,,._ 2`-`, -6 , -, — — -.--- ' Q , � y .Ir z ti, -----. .r.:, f..---,' -.-A: .. - ; it? --,-- • [ .....-.., c € a = 0 m ,, (D k a - - ,y ,. iR r r-- -I - _- LA ,..., -..- ..f., -:•,- „:„...,..,,.i ti C p - t - —! tk— y ;] T jai _. - - . - . f,. - - 0-� s'� '� :i. 'n _ I. i1 a 3 S+