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Kyle Jones'~ f ir1 t1, i r 1 ~ ~f ~. b RaeB" City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM y/~' ' r ~ , . „tt.. ~y ~ ~~ (' ~3..(_ 1, a Z. G `t'..~. (: V Lobbyist rreans all persons employed or retained, whether paid or not, t:y a princpal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, adion or decision of any commissioner; any adion, decision, recommendation of the City Manager or any city board or committee; or any adion, decision or recommendation of any city personnel during the time period of the entire decision-making process on such adion, decision or recommendation that foreseeat>fy will be heard or reviewed by the city commission, or a dty board or committee. The term specifically includes the principal as well as arty employee engaged in lobbying activfties. Tha term "Lobbyists" has speclllc exclusions. Please refer to Ordinance 2004.3436. Janes K le N OF LOBBYIST: (Last) (First) (M.I) Stiles Corporation 300 SE 2.nd Street Ft. Lauderdale, FL. 33301 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-627-9278 954-627-9288 Y.yle.Jones@stiles.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Publix Supermarkets NAME.OF PRINCIPAUCLIENT: Publix Inc 3300 Publi.x Corporate Parkway Lakeland, FL. 33815 BUSIAI~SS DI,Q~i1,E AND,P,DDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: / FAX NUMBER: (OptionaQ EMAIL: (Optional is a Corporation, Partnership or Trust [Section 282 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Publix Supermarkets, INC. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRF~~TLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: t/A II.SPECIFIC LOBBY ISSUE: Publix Super Market-6876 Collins Ave.- Redevelopment Issue to be lobbied (Describe in detail: iii. CITY AGENCIES/INDMDUALS TO BE LOBBIED: (Pursuant to City Code Section 2~s2(g) 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 Cky Code Section 2- 482(ax4) 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) Any Financial, Familial or Professional Relationship City Staffe N/A Ma or Matti Herrera Bawer N A Commissioner Saul Gross N/A Commissioner Jerry Libbin 1~?/A ommissioner is or iaz Commissioner Edward L. Tobin T?/A Commissioner Deede [nTeithorn r?/A Commissioner Jonah Wolfson N/A Commissioner Richard Steinberg ~?/A Planning Board I~TzA Design Reveiw Board D?/A Board of Adjustments '~?"jA yP~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RnreoROrHER~: $100 per hour, this fee is inclusive in the client/principle service A) LOBBYIST DISC SURE: (Required) agreement for the redevelopment of the property. same as alb°ove ^ Produced ID Form of Identification Personally known (Lobbyist) E AND STAMP OF NOTARY. ~~s oU " Notary~u is ~e ii Fliiri - r ~ Lisa M Hof Florida, C my of Miami-Dade ~ o~ MY Co ~ t~~~b ribs before me for r~°p Expire ~0 f , ~- S)' n furs of Public Notary State of Florida ~-~Flotarization of Lobbyist's si ature TO BE COMPLETED B Annual Registration fee: [ ]Yes [ ] No Amount Paid Lobbyist Regishation Form received and verified by: ,_ F;\CLER\HATL\Forms\Lobbyist Registration Form.doc B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). The following information must be answered: 1) Pursuant to Miami Beach Ciiy Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists On Rrocurement Issues": ^ Yes ~ No: Are you lobbying on a present or pending bid for roods. 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 M8D? 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 a not for-profit corporation or entity without special compensation or reimbursement. . V. SIt3NATURE UNDER OATH: ON OCTOBER 1sr OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED I do solemnly swear that all of the foregoing provisions contained in Section 2-482 of th~)1 are a and L~orrect n that I have read or am familiar with the Be City Code an reporting requirements. Signature of Lobbyist: Signature of PrincipaUClient _ VI. LOBBYIST IDENTIFICATION: TION: Produced ID Form of Identfication Personally known (Principal ,ti~;~~.,, PATRICIA COOLEY ~` Commission DD 749385 ~= Expires August 20, 2010 State of Florida, County of ~1 '' ~ e°°°°°n'"r~oyF.~,in~an~eoo•~es~ois Swo b ed be T ' ~ ay of , 2 8 '~ ignature of Public Notary -State of FI ri Notarization of Principal's signature n~~ s i Arr vnLr MCR # Date Paid R;eybad 03/27 m CiFy of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 Kyle Jones LOBBYIST NAME: I understand that no later than October 1st of each year, I must file the following forms, pursuant to Section 2-4.85 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 hav registered to lobby on has been resolved, I am required to immediately notify th~City~erk's Office of lobbyist withdrawal in writing. Signature; ~Z ^~~ -off Date: F:\CLER\LOBBYIST\Lobbyist Registration form 32708.doc