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Kent H. Robbinsi /~ ® ~ C.r~l/~0/" o fi~.L ^~ ~ ./ ~' 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 deasion of any commissioner; any action, decision, recommendation of the City Manager or any cky board or committee; or any action, decision or recommendation of any aty 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 indudes the prindpa! as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to OMinance 2004-3435. Robbins Kent H. NAME OF LOBBYIST: (Last) (First) (M.I) Law Firm of Kent Harrison Robbins, 1224 Washington Ave, Miami Beach, F1 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 532-0500 (305) 531-0150 khrobbins@kentharrisonrobbins.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Miami-Dade Historic Neighborhood Preservation Coalition, Inc. a non-profit charitable organization NAME OF PRINCIPAL/CLIENT: 1224 Washington Ave, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) (305) 352-0501 MDHNPC@gmail.com Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Chri St lna Labuzetta • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: _. u.SPECIFIC LOBBY,ISSUE: legal representation concerning the preservation of the Simone Hotel and related matters Issue to be lobbied (Describe in detail): ul. ~ClTY AGENCIES/~IND1VlDUALS TO~BE LOBBIED,: Pursuant to city code section 2.4e2(g) include ..r~_.._ _._ _ _.._ . . a statement of the extent of any business, financial, familial, professional or other relationship, giving rise 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 said City personnels' commencement of service with the City to the present date, stating the general nature of the subject contractual relation. A Full Name of Individual Title B) An Financial, Familial or Professional Relationshi Historic Preservation Board None Building Department None City Manager's Office None tf yy!! 'S~ ~ "711 ~,i%"`u~-°~~ l~.P.! Planning Department Mayor and Commission None None ~~ ~~ ~~ ~- ~~~ ~BQZ ~~1 I ~.° ` ~ .~R''.~ .., ~. S IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $300.00/hr B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 5 3 0 0. 0 0/ hr The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2~L88 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ~~~ _~~~ ~~ J ^ Yes ®No: Are you lobbvinq on a present or pending bid for Qoods, 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 lobbvinq on a pending application for a Development Agreement with the City or application for change of zoning map designation or chance to the Citv's Future Land Use Maa? 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 snot-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 coraoration or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Produced ID Form of Identification ... ~. k~ :~ Personally known (Lobbyist) VII.. ;:: SIGNATURE AND STAMP OF NOTARY: ~; State, of Florida, County of Miami-Dade Swom and subscribe~,c before me This• day oft1206i /p 5igndfure of Pu514ery = State of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: F~'Produced ID T( ~ ~ Form of Identification g111N11117 ^ Personally known (Principal) ~~~~~~~~~~UA(v! H~~~~risj ~`~~ ' ~oMM ''' yq ~', .>,~o State of Florida, County of Miami-Da~e° t ~ ° ~ ; ` Sworn and subscribed before me ~ : '~0 ~~ `"' y; ~ ~ -.. This day of , 2 '` " ~ ~ G ; ~~i;°~. Ur ~0w .~ OPT .- ~~ i~ STATE OF f~-OP'~W~. Signature of Public Notary State of Flondi~ir/'ff111tta«~~1~ Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ ~ MCR # Date Paid Lobbyist Registration Form received and verified by: ~:`ci.~R~sA~i.~aFORiws~w_oesYZSr PpRMSOLobbyist Registration rwrm 21io9.doc Revised 02/11/2009 I do solemnly swear that of he regoi fa are a correct and that I have read or am familiar with the provisions contained in S c>jio 82 of i mi Be de and all reporting requirements.