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Kevin Kline - Marilyn P. Tepperbergm !Vii~'v\r,,'BEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means ali 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. KL1NE KEVIN F, NAME OF LOBBYIST: (Last) (First) (M.I) KLINE, MOORE & KEVIN; P.A. 2600 S. BUSINESS NAME AND and las Road, Suite 902, Coral Gables, Fla. 33134 (City) (Zip 305-441-0006 305-441-0043 kfk]~tk@bellsouth.net TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or a-mail address. LOBBYIST RETAINED BY: Marilyn P. Tepperberg NAME OF PRINCIPAUCLIENT: t3U51NESS NAME AND ADDRESS (Number and Street) (City) (State) ~ (Zip Code) 305-807-9277 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: NSA • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ;_. II SPECIFIC LOBBY ISSUE Relatir~ to efforts to establish illegality and unenforceability of the Barginning Issue to be lobbied (Describe in detalq: Agreement negotiated with the. FOP and the City of -Miami Beach z,. ~.. _ III.;CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(g) includep~7D 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- C3]3.]S~C~lI1 482(a)(4) include a statement of any contractual .relationship (paid or unpaid) from 12 months preceding said City t0 the personnel' ,commencement of. service with the City to the present date, stating the general nature of the subject contractual relation. VOting Upon, A Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Mayor Matti Bower None Con~nissioner Jer Libbin None Vice Mayor Jorge Exposito nmai~sioner Michael Gongora None None omtnisssoni/r:~ Jon ~ Wo ~fson C i Novel ] _1 ~ ~ c onun s~~,otzer Edward L . Tobin ;.° .: ~ ~; f~ ? ; ~1 None passage and approval of Agenda Item R5E on the City Con~uniss ion Agenda for October 27, 2010. City Manager, Jorge M. Gonzales ivvi~~~ '~ ~~~ ~ ~ ~ ~ ~ ~ ~~ City Attorne~Z, Jose Smith None None .,.I ,.. ~..,9 .~~h 7~f 1. y ,,.~ ' '~ a ;~ .i t L .....s IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Compensation based on hourley rate of $350 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST~OMPEIVSATIONtlOn paid aS of yet. (Required).~~.~,,~.~ .~~~~~ ~ ~„~.1~,~r~f fi3r~~ n~~~r hc~i~rr nn compensation The followir~rr~in~ti2S'ti`~hPG§t 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 lobbvinq on a present or pendina bid for goods eauipment or services or on a Aresent 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 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: Sigr~ture of Lobbyist - / I do solemrily swear that all of t e fore oing facts re tr ue and correct and that I have read or am familiar with the provisions contained in Section of the Mi i evdz='and all reporting requirements. Signature of Lobbyist: '-~~ I~TIN F . KLINE f, Signature of Principal/Clien .~~-,~ ~~,~~ MARILYN P . Z'EP ERG!` . VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICA ION: ^ Produced ID ~ Produced ID i d Form of Identification Form of Identification t p p N _ g ~ ~ ' ~ Personally known (Lobbyist) ~ Personally known (Principal) at ~~" ~ ~ ' ~ ci ~„ - ~ ' VII. SIGNATURE AND STAMP OF NOTARY: ' S~w~~ ~ W ~ State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade ,. Sworn to and subscribed before me Sworn and subscrib befor ~ This 21 s-~day of tober , 2010 This ~. G r , 2010 „t11~~ ~. ~ \~/^) • f~~ ~ .~ y .~ 1 ` ~'``~~VVIINN~I I. +. ?:~.'~ ~ gnature of Public Notary -State of one a Signature of Public Notary -State o '~~~~•' ,~ Notarization of Lobbvist's si nature Notarization of Principal's signature TO BE COMPLETED BY C ITY CLERK'S STAFF ONLY ' Annuat Registratiomfee: [ -] Yes [ _ ] No Amount Paid $ o- ^ MC # D Date Paid Lobbyist Registration Form received and verified by:' F:\CLERi$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 2010.doa (, D ReViSed 05/05/2010 ~ ~ 0 ~T~ pNjNy ~ O C ~ Q N ~ ~ap~a LLO ~Z, Zv7 mm ~O~ ~ou }~;. ~;.,.:! ~~ a- P~ ~ ~ ` iii I ~ f ` , s . ~ ~- F~'v City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 C ityClerk@m iam i beachfl.gov LOBBYIST NAME: KF~TTN F _ KT,TNF I understand that no later than February 28th of each year, I must file the following form, 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 and Compensation 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. .- J ., I ~`~~.~ ~~ 'I S""ti . .; . I ~ E ~, _~ " ~ ! ~ ,ti3 ',° ~ ~ ~. ~ `{ ~ fi V ~ ~' 3• a ~ i ~ k4 1 , U a ~ i9.i m ~ ~ <, ~ t ~\ ~ O ~ ~. t ~ ~ ~ r ~O U m ~ ~ . { ~ V ~ ~ L a ~ ~ ' f ; .~ . ~~ f ~, ''.. 0. ~ F ~. . ~~ C3 ` ~ "W/ , o ~` ~.. 7 ` M~ .~ ~~yA Q ` 1 i ] \. }.. ~ ~\ LLI ~ J ~ ~~ F ` ' ~' 'j , , j V t^~ , - } ~ ~ ~ I ~,. ~ ~ . i r~' ~ .. t_ z p :-, ``'-- ~r ~ _ ~ Q ` ! ~ ~ ~ i a ~ ; ~ ~, ~ a m' ~ ~ a m a _ ~ ~ t -a <. -;~ ~ ,~:. a