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Kent Harrison Robbins (2)m .I;`,;.,,IBEACH ( ~ S, '~ s .. . 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. Robbins Ke NAME OF LOBBYIST: (Last) 1224 Washington Ave. BUSINESS NAME AND ADDRESS (Number and Street) (305) 532-0500 (305) 531-0150 TELEPHONE NUMBER: FAX NUMBER: ant Harrison (First) (M.I) Miami Beach FL 33139 (City) (State) (Zip Code) khrobbinsQkentharrisonrobbins.com EMAIL: I. LOBBYIST RETAINED BY: The Roney Palace Condominium Association, Inc. NAME OF PRINCIPAL/CLIENT: 2301 Collins Avenue, Unit#504 Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)538-9398 (305_) 538-9397 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: John Meszaros, President Brian Crone, Vice President/Secretary • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Non-Profit Condominium Association Corporation II.SPECIFIC LOBBY ISSUE: Appeal of January 26, 2009 Administrative Decision of the Planning Board concerning operating outdoor bar counter after B:OOPM - 2301 Collins Ave., Miami Beach, FL Issue to be lobbied (Describe in detail): ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city cods section 2.482(8) include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a-(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of Individual Title B) An Financial, Familial or Professional Relatlonshl Board of Adjustment None. Planning Staff None. -~ r .,. ; /l 1 ! ;~I go :rr~~ ~- ~~abooz S~ iV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): W m v m to d ~N t0 0 N A) LOBBYIST DISCLOSURE: (Required) $5,000.00 Retainer + $475.00/hr B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $5, 000.00 Retainer + $475. 00/hr 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 [~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 ~ 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 ~ No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification L~f Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This 2S+'' day offt~~~e~ r, 200' Signature of Public Notary -~TSte'afFlorida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: M~ Produced ID PassPo r+ Form of Identification ^ Personally known (Principal) MICHELLE CARINA DOMINCiUEZ State of Florida, County of Mi .~~ '~= MY COMMISSION # D0793271 Sworn and subscribed before ~ , - EXPIRES May 29, 2012 Thi~day of bi'r~ll' ~ ass FlaidaNotaryservlgr,COm Signature of Public Notary -State of Florida Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid S _ MCR # Date Paid Lobbyist Registration Form received and verified by: FsrtCt.InR~Ld~{313~'C~'r~€.at~bYl~i; a' ,• F~ars~ 3270$.afac ~ Re~ri:~ed 03/27/2008 n O 3 ~_ °o m W N v 3 n x m r r m D 2 D S C m N I do solemnly swear that all e f egoing s e true orrect and that I have read or am familiar with the provisions contained in Se 2 of the i each C C d all reporting requirements. Signature of Lobbyist: m City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, veww.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: Kent Harrison Robbins I understand that no later than October 1st of each year, I must file the following forms, 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 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 Clerk's Office of lobbyist withdrawal in writing. 2 ?s o9 SigrYature: CityClerk@miamibeachfl.gov Date: :i*"` -~.qwr, E _ F_: '"''. ~ i ?pr.g7 F...7CF3'1 32'7fl~.rtCJc