Kobi Karp/Maefield Holdings
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a prindpal 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 defined in any manner in this section, 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 prindpal as well as any employee engaged in lobbying activities. The term
"Lobbyists- has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
Kam
(Last)
Kobi
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
17100 Collins Avenue
BUSINESS ADDRESS: (Number and Street)
Sunnv Isles Beach Florida
(City) (State)
33160
(Zip Code)
305-945-3636
TELEPHONE NUMBER:
305-945-3737
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
Maefield HoldinGS LLC
NAME OF PRINCIPAUCLlENT:
1526 BlueiavWav
BUSINESS ADDRESS: (Number and Street)
Los Anoeles
(City)
Califomia
(State)
90069
(Zip Code)
310-360-7712
TELEPHONE NUMBER:
31 0-360-7711
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 OF BENEFICIARY: Marl<. Siffin
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Desion Review Board Aooroval
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndlvlduallTltle B) Relationship
Joroe Gomez Director None
Thomas Moonev None
William Carev None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF JOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
I
A) LOBBYIST DISCLOSURE: (Required) i $150.00
B) PRINCIPAl'S DISCLOSURE (OF LOBBYIST COMPEN~ATION): (Required). $150.00
~ Yes Jt::.::::~,:~:.e:~~:n~ ~ ~~~~:::tt~~~=~:~~r entity without sDecial comDensation or
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Rnance Reform" Via The Addition Of Code Section 2-4B8 Entitled "Prohibited
Camoaion Contributions BY lobbYists On Procurement Issues":
i Yes ~NO: Are YOU 10bbvinG on a Dresent or mindinG bid for Goods. eGuiDment or services. or on a Dresent
J or oendinG award for Goods. eauiDment or service?
2)
i i n
aDDlicatlon for chanGe of zonina maD desianatlon or chanae to the City's Future Land Use MaD?
..
~
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYXST SHALL SUBMIT T E C
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, WELL
IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALEND Y
EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COM PEN N DU
[.<<ERK A SIGNED
<:OMPENSATION RECEIVED,
ATEMENT SHALL BE FILED
G THE REPORTING PERIOD.
cor ect and that I have read or
iami Beach City Code and all
Signature of Lobbyist:
Signature of Principal/Clien
VI.
o Personally known (Lobbyist)
CATION:
~ucedID IAd;;m (}t/ Ire.
Form of Identification r-..-.......,
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Signature 0 Public Notary - State of Florida i..!..............J
Notarization of Principal's signature
o Personally known (Principal)
r..........I....i1VII. SIGNATURE AND STAMP OF NOTARY:
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1:-0: i l! Jistate of Florida, County of Miami-Dade
! ~ 8 ~ ~ISwom to~subscribed before me rY' /
:~J '!! IE Jl This (11 day of H?;::RI/. 20.f:Y
iiSJ1 I ~~(I~
i ~ ) Signature of Public Notary - State of Florida
iif ~h'" . Notarization of Lobbyist's signature
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FOR CLER}h~~NZk t 99 ~ 5i'VR i?
Annual Registration fee: [] Yes [~Amount Paid ~l MCR #;;;Jt;, 9 '3m Date Paid \ frr/tJY
lobbyist Registration Fonn received and verified by: (~ /
Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04
1 First Revision - 05-17-02