Manuel Arencibia/Stiles Development - Mark Van Dykem 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.
Arencibia Manuel
NAME OF LOBBYIST: (Last) (First) (M.I)
Kimley-Horn and Associates, Inc. 1691 Michigan Avenue, Suite 400 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 673-2025 (305) 673-4882 manuel.arencibia@kimley-horn.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Stiles Development -Mark Van Dyke
NAME OF PRINCIPAL/CLIENT:
Stiles Development - 300 SE 2nd Street Fort Lauderdale FL 33301
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
954.627.9280 markvandyke@stiles.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Redevelopment of Southwest Corner of Collins Avenue & 69d' Street - Variance Approvals, and Conditional Use Permit
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
Planning Dept., HPB, BOA, Planning Board, City Commission * None
6Z ~h Eyd 9? ~fl~ ~'~~?
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and CIty Commission members are not lo~,die~Oyi~fSlde o;: ~ubticaring setting.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) ~ 13246 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (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 X No• 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 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Yes X 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 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 anot-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 anot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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. , . ~~ _-. /1
~ignature 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. ,~j~ ~ n ~-~„
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID
Produced ID
` / Form of Identification Form of Identification
x Personally known (Lobbyist) Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
"""'~,- Amy M. Lledo Sworn and subscribed before me
Sworn and subscribe before me ;•`' •~.
Thy day of ~ ~" ~ `~:COMrnissioN~DD681o6~his day of . 20_
~~~ ~' ~ ~ ~ ~ ~• ..~~° FJ(P1RES: JULY 23, 2011
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Signature o ublic Notary -Sate of Florida Signature of Public Notary -State of Florida
Notarizat' n of Lobbyist's signature Notarization of Principal's signature
FOR CLERK'SNLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by: ntered By:
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Fsta#e i~eyetoprtrerit3ssires"`:
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Gty of Miami Beach, 1700 Convention Center Drive, Miami Beoch, Fbrido 33134, www.miamibeochN.gov
CITY CLERK OiFice CityClerkE~miomibeachFl.gov
tel: 305.673.7411 ,Fox: 305.b73.7254
~oBBinsT NaME: ~~c~.--~~.u.~.-e. AY-2.n ~-~e-~~
I understand that no later than October 1st of eoch yeyr, l must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for ail active lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure 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, I am required
to immediately notify the City C{erk's Office of lobbyist withdrawal in writing.
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Signatu e: Date:
Revised 02/04!2008
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