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John J. McWilliams/Stiles Development Mark Van Dyke~ MIAMBEACH 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. McWilliams John J. NAME OF LOBBYIST: (Last) (First) (M.I) Kimley-Horn and Associates, Inc. 5200 NW 33rd Avenue, Suite 109 Fort Lauderdale Florida 33309 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (954) 535-5106 (954) 739-2247 iohn.mcwilliams@kimlev-horn.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Stiles Development -Mark Van Dyke NAME OF PRINCIPAL/CLIENT: Stiles Development - 300 SE 2"d Street Fort Lauderdale FL 33301 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954.627.9280 markvandvke@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 & 69`" 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 ,„ '~ s¢d ~ -1~o eooz -, _ * Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission m~ bes~ ~n~l~ir~outside of a public hearing setting. /J Y n IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $ 171 00 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 Citv or implication for change of zoning map designation or change to the City's Future Land Use Man? 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 snot-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 EXPf~1DITURES OR COMPENSATION DURING THE REPORTING PERIOD. ~ ~ ll n Signature~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 of Principal/Client: VI. LOBBYIST IDENTIFICATION: Produced ID -- entification Personally known (Lobbyist) VII. SIGNA TAMP OF NOTARY: State of I a, Co f Miami-Dade Swor ubscr~beri bore me j of Public lion of L ON N DD 498474 Aptll 4, 2010 y Pubpo PRINCIPAL IDENTIFICATION: Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me 'his day of , 20_ of Public Notary -State of Florida lion of Principal's signature FOR CLERK'S USE ONLY `7 / Annual Registration fee: [ ]Yes [ ] N~3 Amount Paid _~~ MCR ~l` ~~ D to Paid [ ~ l Lobbyist Registration Form received and verified by: Entered By: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04 IV. DLSCL05URE OF TERMS AND AMOUNTS OF LO88YI5T COMPENSATION (DISCLOSE WHETHER f>tiOdVRLY, /SLAT RATE OiR OTNERx A) LOi36YIST DISCLOSURE, (Required) S 1710Q oer hour 8) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Raqulred}. $ The following information must be answered: 1) Pursuant to Miami Beach Crty Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists Qn Procurement Issues": Yes X No• Are rou lohb ' on a present or uenslinq bid forfor goods. eauinrnent or services. or on a present or oendina award for goods. eguinment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions lay Lobbyists On Real Estate Development Issues": Yas X No• Are rou lob ing on a ne• nditZg aonlicafiioa for a Develaoment reemmt wit>< the City or ~nlication for chance of zo ing maw designation hanoe to the City's Futuro Land Use Man? 3) Pursuant tb Miami Beach City Code 2-484 (h) Any person (except those exempt from the deFlr~ition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-far-proTit corporation t>r entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or oppostifon to any item, shall register with the deck as required by this section but, shall not be required to pay any registration fees.. Yes X No• Are rQu reor+egen~n9 a not-for-fit ~or~oration or entity without soecia) oQmeelLSation Ql,reirnbursement. . V. SIGNATURE UNDER OATH: ON QCTOBER isr OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT il1NDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS OOMPENSATION RECEIVED, ]tIV THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL 1BE FILED EVEN IF THEME HAVE BEEN NO EXPf.~IDIRIRES OR COMPENSATION DURING THE REPORTING PERIOD. ~ / ~l ~ Signature'~Lobbyist I do solemnly swear that al! of the foregoing fads are true and correct and that I have read or am familiar with the provisions contained in Sectlort 2-482 of the Miami Beach City Cflde and ail reporting requiremerrts. /) ~_ Signature of Lobbyist: Signature of Principal/Client: VI. LOB)YIST IDENTIFICJITION: Produced ID _..... entification Personally known (Lobbyist) VII. SIGMA AMP OF NOTARY: PRINCIPAL IDEN7TFICATION: Produced ID fT Form of Identification Perswially known (Primp State of I a, Co Miami-0ade Sw~ bed bare me J Tit .ila~Anf .• 7 el~ceunollun~ .OOIIIE8i310N t DD IYQ+t74 blic ota F~ A~ 2D1~0~ of Lobby' FOR CLERK'S Annual Registration fee: [ J Yes [ ] Na Amount Paid State of Ronda, County of Sworn and~ubscribed befc Notary Public State of Florida ~ Eileen S Haustors ~ Aiy Commissior- OD600460 Expires 11J28/2d}tfi____._, - State of Florida d's signature ONLY MCR # Date paid Lobbyist Registration Form received and verified by: Entered By; F:1d.ER1;ALt1MARIA-MU-~Y~1l0aBYISTfoRM 05.doc Revised 1?104104 GtX of illGuwi Beatb, 170D Convention tertier Drive, Miomi Bench, Florida 33139, www.~niomibeactifl.gov CITY CLERK Office CiiyCterk(e~miamibeoc6fl.gov Tel: 305.673.Tb1 l ,Fax: 365.673.7254 LOBBYIsT NAME: ~©}Rr1 ~ • ~C ~ t , l ll a-~t1~S„_ I understand that no later than October ist of each yr, I must file the folbwing farms, pursuant to Section 2~k85 of the Miami Beach City Code, with the City Clerk`s OEfice for all active lobbying issues. 1 } lobbyist Expenditure Farm 2} Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-0ade Caunty 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 Clerk's Office of lobbyist withdrawal in writing. ~o- i- off' gnature: Date: Revised 62/Ddl20D8 3"~`,L:*-i";R`•.[.C~[i3i~'15TtT_~p: ndin;n K Di;clttsmu Fn~7n k:.dnc