Brad M. LeBeaw/M3 Productions, LLC
f '
tD
,..,.
MIAMIBEACH
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 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.
Le.-~~ ~e.d IV\
.."./
NAME OF LOBBYIST: (Last) (First) (M.!)
j)'\7frucWC\loN'5 ,- L~C- 47Y- qve.ei1W\Dh-- s--rdlA-5 ,J~~ cn/te.-f'.IV} lo-tll3-
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
'1--\ 2--- "2--2-b 5 :> 0 t 'Z12-- '2.. 7 If q 814 bvd e peq u eJ C{ ~ 1 . c" .IV\
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
(1/\"5 ~dcttfCf1)J $./ U.... c....
NAME OF PRINCIPAL/CLIENT:
11\> fVc1ctIALiflNkS J.-{, G- 474 t1{~tAr~ 41 J4.-4~
BUSINESS NAME AND ADDRESS (Number and Street) (City)
1---12-- "2--7...b nO f Z 12-- ~ 7Lf-q ~q c-r
TELEPHONE NUMBER: FAX NUMBER: (Optional)
N~~ /IItL- M1l (rt; 13
(State) (Zip Code)
~ \.Qbe?t If@ ~ol. Vl;~
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
.
NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY: /3>rMA1 L.el?eb'-t ~
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: > 1\ .. _I.
b6-;4~ee\ .
II. SPECIFIC LOBBY ISSUE:
VCA-t1v~ rBeAdhfermrb
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/TItle
B) Any Financial, Familial or Professional Relationship
\j CI+}?;o A rc:-D
. '
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
NaJ Q....-
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
]J 0 fl Q....
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":
D Yes ~: Are YOU lobbying on a Dresent or oending bid for goods. eauiDment or selVices. or on a
Dresent or oendina award for goods. eguiDment or selVice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes~: Are yOU lobbying on a oending aDDlication for a DeyeloDment Agreement with the City or
aDDlication for chanae of zoning maD designation or change to the City's Future Land Use
MaD?
3) Pursuant to Miami Beach City Code 2-484 (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..
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST 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:
Signature o~ Principal/Client:
VI. LOBBYIST IDENTIFICATION:
(~UCedID~ ~
Form of Identification
~
.~~
PRINCIPAL IDENTIFICATION:
~cedID~~
Form of Identification
, Personally known (Lobbyist)
Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to a d subsc bed bE1()r~ me
This p~,^, 2W
KERRY HERNANDEZ
State of Florida, County of Miami-Dade
Sworn a~ subscribed fore me
This ~da of .
/ ..:'" "l KERRY HERNANDEZ
i . ~ Y COMMISSION # DO 175491
Signat re of P
Notarization of
FOR CLE
Annual Registration fee: Yes [" ] No Amount Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 .
SEONLY ~
MCR # ~~ Date Paid 6 (:{Q
Revised 12/08/04
08/03/2013 0543 FAX 6464157533
LAW OFFICE ADAM DAVIDS
f4rhedu~ ,A
Capital Contributiona and Ih.....
Cia.. A Member Ownership Capital
Interest Contribution
David J. Prince 21.15%
111 East 14th Street, .138
'New York. NY 10003
Carolyn Clerkson 11.45%
351 w..t 12'" Street. #2R
New York. NY 10014
Felice Ecker 5.73%
c/o Girtie Action Media &
Management. Inc.
71 West 10111 Street
New York, NY 10011
Valerie SteUer 5.73%
c/o Girlie Action Media &
Management. Inc.
71 West 10ltl Street
New York. NY 10011
SascM Lewis 7.54%
cia Flavorpill Productions LLC
28 East 18111 Street, 2nd Floor
New York, NY 10003
Mark Mangan 7.54%
c/o FlavorpHl Productions LLC
28 East 181tl Street, 2/lC1 Roor
New York, NY 10003
Willie Mack 8.81%
594 Broadway, Suite 1212
.
Brad leBeau 25%
474 Greenwich St., I4S
New Yort. NY 10013
1lJ004/004