Simon Ferro Code Lien 800 Collins P MIAMIBEACH g o o „41;pi
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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.
NAME OF LOBBYIST (Last) (First) (M.I)
Ferro Simon
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
100 SE 2nd Street Miami Florida 33131
TELEPHONE NUMBER: FAX NUMBER: EMAIL.
Please notify this office if your contact information changes: address, phone, or e-mail address.
1. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT
The GAP, Inc., a Delaware corporation
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
2 Folsom Street San Francisco California 94105
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL. (Optional)
415- 427 -0111
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY. Glenn K. Murphy
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST
The Gap, Inc is a publicly- traded corporation
II.SPECIFIC LOBBY ISSUE:
Mitiaate Code Enforcement Lien on 800 Collins Avenue. Miami Beach
Issue to be lobbied (Describe in detail):
lll. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
All City departments having jurisdiction in matter None X
Special Master None X
All City Commissioners None X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety„ with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed. JJr .Jdo C.)41.310 AEI,
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
None f lh .i 14d ZZ Nor Iioz
__ 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE. (Required) Hourly rate of $475.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). Hourly rate of $475.00
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 vou 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 IN No: Are vou 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 a not - 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 IN No: Are vou representing a not - for - profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT 0 - ERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENS/ 0 RECEIVED. • THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FIL -••• EV : N IF THERE HA E BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
4
•
� of- Lobbyi Simon Ferro, Esq.
I do solemnly swear that all of the foregoing fac re t e and correc = •d that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Cod nd all r.-porting requireme 'ts.
Signature of Lobbyist:
i • •
Signature of Principal /Client: / ///
VI. LOBBYIST IDENTIFICATION: Ike Krasniewia PRINCIPAL IDENTIFICATION:
Senior Director
❑ Produced ID Associate General Counsel El Produced ID
Form of Identification Form of Identification
❑ Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
ap ii P MIA ALFONSO
State of Florida, County of Miami -Dade * _� * MYCOMMISSIONAEE053675 State of Florida, County of Miami -Dade
Sw- to and sub " •bed before me ' EXPIRES: February 19,2015 Sworn and subscribed before me
Ty is a d- • 3.UN , 2011 ' ` Baled lMueudpetNoarySenNes This day of , 2011
- re o • u ■ i • ary - State of Florida Signature of Public Notary - State of Florida
No.. ization • obb 'st's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ a5:0 r MCR # - - S II Date Paid 2- 2
Lobbyist Registration Form received and verified by: i A P %
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \ Lobbyist Annual Registration Form.doc f f Revised 1/11/20 1
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
STATE OF CALIFORNIA )
) ss:
COUNTY OF SAN FRANCISCO
On June 21, 2011, before me, Octavia Cruz, Notary Public, personally appeared Ike Krasniewicz, who proved to me
on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and
acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the
instrument the person, or the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of Califomia that the foregoing paragraph is true
and correct.
WITNESS my hand and official seal.
OCTAVIA CRUZ
:& Commission #E 1911185
�_ s•i' e0 Notary Public - California
(SEAL) z San Francisco County
Notary Public Signature ° M Comm. Ex inn Oct 30, 2014
.,
CA MIAMIBEACH
City 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
LOBBYIST NAME: Simon Ferro
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 nth • • Clerk's Office of lobbyist withdrawal in writing.
1 . �
Signatur:. Date: