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Sandra Kragnert - H&M Hennes & Mauritz, LP p tiv 0 , e011 4 4RIUSN ��► BSI A . MIAMJBEACH %9 City of Miami Beacll Office of the City Clerk 1700 Convention Center prive, 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 r recommendation of any city personnel during the time period of the entire decision- making process on such action, decision or re mendation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specificall includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Ple se refer to Ordinance 2004-3435. Kragnert Sandra NAME OF LOBBYIST: (Last) (First) (M.I) H &M Hennes & Mauritz AB, Interior Department, Master Samuelsgatan 49, SE -106 38 Stockholm, Sweden BUSINESS E AND ADDRESS (Number and Street) (City) (State) (Zip Code) +46 8 578 070 16 SANDRA. KRAGNERT c@HM.COM TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: H & M Hennes & Mauritz L.P. NAME OF PRINCIPAL/CLIENT: H & M Hennes & Mauritz L.P., 47 W 34 Street, rd Floor, New York, NY 10001 BUSINESS NAME AND ADDRESS (Number and Street) ( ity) (State) (Zip Code) 212 -2$7 -1974 212- 287 -19 0 brian.rgwan(hm.com TELEPHONE NUMBER: FAX NUMBER: (Opti 1) 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: Daniel Kulle, Country Manager, Domestic CEO • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INOIRE(GTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Publicly Traded Corporation ,.SPECIFIC LOBBY ISSUE: Partial Demolition, Renovation and Restoration oe Lincoln Theater, 551 Lincoln Road, Miami Beach, FL ssue to be lobbied (Describe in detail): CITY AGENCIES /INDIVIDUALS TO BE LOBliiIED: Pursuant to City Code Section 2- 482(aX4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with saki city ; commissioner or personnel from 12 months preceding such person's commencement of service with the ci to the . resent dab statin eneral nature of the au ect contractual relationshi Sec 2.482(a)(4) Fu I ame of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied Historic Preservation Board x William Cary, Asst Dir, Planning and Zoning Dept City Planners - Michael Belush, Deborah Tackett n Pursuant to City Code Section 2- 482(g) Every registrant shall be gpired 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 Iobblsd as identified on the lobbyist rsgistratlon form filed. Sec 2- 482(g) Any Financial, Familial or Professional Relationship None In) .i i , ., • • — d3S 110Z Al:ij "3 8 diA4 , f 1 ,V. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST C • PENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR ()THEM: A) LOBBYIST DISCLOSURE: (Required) Not Applicable - : mployee i 8) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): of Applicable - Employee (Required). 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 ": - i . . ; � 1• .i t. •. • . ' ' .. 1 1 * 'II .. "_ '. .: ',. fit: J. •. ..:.S! • .. • • • •yy: :fit. ,•..11. • •... -- SIR. " - • •_l • A. = 11 • - .•� • 1. • ;ward for cootie• eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues ": D Yes Ea-No: Are you lobbvino on a oendino -aar; Iicatiop for a Pevelooment Aareement with the Citv or aoolication for chance of zonina map desionation or chance to the Cttv's_future Land Use Man? 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 repre 3entative of a not-for-profit corporation or entity without special compensation or reimbursement for the appearance, wt ether 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. al -t ► . • ' : 1 = t• t_ 1 &.; - 11 11• 1 • 1• • t• 1 •_i'4.• r • 1 • - 1 . 4 ./t 1 •t - •,•x • 11 '. 1' ' • 1 • , 11 V. SIGNATURE UNDER OATH: QN FasguAtty 28th OF FAckl MM. EACH LOBVIST OH4Li,, SUBMIT TO THE CITY CLERK A §IGNED STATEMENT U iDEIZ RUTH .14SVIG LO NG EXPE D) p AS 9QMJ' NSATiON MEW,. j 'q CM ©F MU CH 9R ama COMPENSATION DURING THE REPORTING PERIOD. lure of Lobbyist ( "7/7 7 4"1 - I do solemnly swear that all of the foregoing facts are and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code a all reporting requirements. Signature of Lobbyist: il )7". , Signature of PrincipalClient VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ri Produced ID 693983205 a Produced ID Form of Identification Form of Identification Q Personally known (Lobbyist) a Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: tocholm Sweden kico yofv` iVe,„r -N St -, l o i •Kcie, County onaiiiiaffiebK State of Ronda, County of Miami -Bede �,• - = , u • ribed before me Sworn and subscri • _ • before e n117741/111! e - f SP pt , 2011 This ` ' de of WI', 201 ! ifil ► Stockholm - i ... , (� , Sig - re of Public Notary — State Signature of Public Notary — State of- Florids- N €�- V 0,10. -- Nota • Lion of Lobpvist's signatu - Notarization of Princloals signature abr`ie 1 Rudbec TO BE COMPLETED BY CLERK'S STAF ONLY Ct /! / Annual Reglstrat on fee: ] Yes ( ] No Amount Pald $ MCR # Date Paid <l Lo yis #Registration Form recehred and verified by: F : \CL 1ALL \aFORMS\LOBBYIST FORMS \Lobbyist Annual Registration Farm.doc .. � � ;� , - ® . S i , _ f /./ CLARISSA ESTRELLA 'c a ® ‘ NOTARY PUBLIC STATE OF NEW YORK ill KINGS COUNTY 4 LIC. #01ES6136087 * t10 COMM. EXP. OCTOBER 314 1.4.3 • • 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: Sandra Kragnert I understand that no later than Februa Sth of each yea 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 ! have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. z q W/ Signs re: A ate: 4,41tNRlUS I l or 4 3/49. 0"