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Timothy Riera-Gomez - AIRBNB Ito '1 Q.Cd'1 4.4). • kS) MIAMI BEACH f ,d City of Miami Beach Office of the City Clerk 2016 AL'C - f Pr. J 1700 Convention Center Drive, Miami Beach, FL 33139 [ I r L 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. Riera-Gomez Timothy NAME OF LOBBYIST: (Last) (First) (M.I) Floridian Partners, 235 Catalonia Avenue, Coral Gables, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 461-4260 (305) 449-1128 Timgomez3 @gmail.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: Kevin Hneahan NAME OF P INCIPAUCLIENT: �:► : ::: i .011..1 -- .• .• • • • i 3 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) _A15-577-5318, kevin•heneghan @ airhnh.ayn 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: Brian Chesky • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Brian Chesky,Nathan Blecharczak,Joe Gebbia,and Sequoia Capital II.SPECIFIC LOBBY ISSUE: • (-Short Ierm_Rental-Regulation• Issue to be lobbied(Describe in detail): Ill.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 CITY OF MIAMI BEACH 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 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outtook183LGODDH\Lobbyist Registration Formrevised 5-30-2012.doc • • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $10,000 monthly B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). 11Q,000 monthly_._.._ 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 XNo: 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 XNo: 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)Quo: 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 FOA THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL r E FILED EVEN IF THERE AVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. I Si.wof Lobbyist , I do solemnly swear that all of the foregoing facts are true and corre t and that I have read or am familiar with the provisions contained • • in Section 2-482 of the Miami Be- h City_Caddeeian.,all '-porting re',u rements. Signature of Lobbyist: N11 -. ��� Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION:. •' 'CIPAL IDENTIFICATION: _Produced ID _Produced ID Form of Identification Form of Identification Personally known(Lobbyist) _Personally known(Principal) VII. SIGNATURE AND STAMP ti.�* MIREYA CARBALLOSA '� MY COMMISSION#FF 170941 State of Florida,County of Miami-Da. `•r lica '= EXPIRES:February 22,2019 State of Florida,County of '- i-Dade _Q Sworn to and subscrib•:• be .re me '+'���" Sworn and subscribed •- ore me Set, a��aC ent / i ' R.hQ;•' Boadad Thru Notary Public Undervniters i _ day o — 2�L�< This day of ,2012 .-. A. . _ GA .alto .. . `gn..ture of • blic N. - –State of Florida Signature of P •is Notary–State of Florida Not.rizatio 'f Lobbyist's signature Notarizati• of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes['p]No Amount Paid$ c MCR# 1-115:75? Date Pald •02'16 Lobbyist Registration Form received and verified by: ..189.0 S/YLvet-ToRc C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook183LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc • CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE§8202 t.c,•_c� 2T</,si<!�iC.v<.c�•_w.C�•.vC-cam _at.a•_c•.s�. _c� i.�_.� <�<.vat_ci. •.s�-.v •.at�<.s�t_c>�t•a•_sY_'�Ui�•_v�-.c�<. %See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) 1 2 3 4 5 Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California Subscribed and sworn to (or affirmed) before me County of Sam .f-atnC■Sco on this 2 3i day of J , 20_14 , by Date Month Year (1) k &1 14€0/I 1 ovi �� JEREMIAH EDWARD-DAVIS 11111,, (and Notary Public-California and 2) VV ), San Francisco County z Name(s) of Signer(s) V y!i/ Commission•2153470 M Comm.Ex s Ma 17.2020+ proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Signature t !Az, 1 gaZeL 9 / Signature of Notary Public Seal Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s)Other Than Named Above: wcsev,e/ ge/LVL&gdN.e.wd:erpw;'`"av-e'ti4'e/ a:4'e�.'ei.'!r,'r/:�%,'e.,'e/•'m,'t�•' ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5910 F:`.CLEI tistration Form.doc Revised 04/27/2012 MIAMIBEACH 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: TIMOTHY RIERA-GOMEZ 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 automatically suspended from lobbying until all fines are paid, unless the fine has been appe- ed to the Miami-I ade County Commission on Ethics and Public Trust. ,. Aj L/AA . 1 i.nature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc • k • Miscellaneous Cash Receipt CITY OF MIAMI BEACH No. In Cash E1 Credit Card 1Check# ) -)" I - $ 700 • a() ("5; 0 2 20 0 �, City of Miar>Re�1/ed of �Aa_L"i -� e ‘4..1‘.--a-1-- �"". C IJF= AT-, f ��- r - tom- {- .2i . 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