Paul B. Steinberg - Kevin, Brian & Matthew Heinilein & Diamond Capital MIAMI BEACH 7 ► ��` I� �:- f;
City of Miami Beach Office of the City Clerk 0/1
1700 Convention Center Drive, Miami Beach FL 33139
LOBBYIST REGISTRATION FORM x
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the pas�'ae, d eat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation 4'fAe 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.
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NAME OF LOBBYIS (Last) (First) (M.1)
vpfa4 Llayink- PA , 1(01 Ok 'c ��F-Y-p[A RA M I]OW I BA Ink . —f-j- o
BUSINESS N#ME AND ADDRESS (N tuber and Street) (City) (State) (Zip Code)
=�c5-5�w-oM4 l "J-5[4-OlIIq TBS �Sena�-oY�QIU (�'►��
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Kejin Y an nnA McAetj I-N�r In cInA 'Tlaffln-ni I&P I�oj
NAME OF RINCIPAUCLIENT:
i ja-azz
BU IN beNA mr and t eet) ity
(Zip Code)
ca5, �
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)r� 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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
u.SPECIFIC 1_011303Y ISSUE: re'- AD )00k\&Ln�Uko\aAtav\s,
1.i�n g cc�nd. C elate h�a x'S V 13LP tom' m (n , FL-
Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS TOM 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 eneral 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
'DA0 omd ion aq--k&b 1pa-9_6a4
Pursuanlrto City Code Section 2.482(g)Every regist t 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.
Sec 2-482(g)Any Financial, Familial or Professional Relationship
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of �4_&Mo-el 1&0 (in SWO- -� �
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHEHOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): `�U, •��
equired).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
I
46 Yes € re vou lobbying on a present or pendinci bid for aoods.equipment or services or on a present or penging
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
slop ent Issues":
€ � No:Yes re Vou lobbying on a pendina 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
(71�1 shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
es 4ENL Are you 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 TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION EI ED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHA ILE N IF XKERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signat of Lobbyist
I do solemnly swear that all of the foregoing facts are true correct nd that I have familiar with the provisio contained
in Section 2-482 of the Miami Beach fCit a and all r o ng requireme
Signature of Lobbyist:
i�
Signature of Principal/Client: -
VI. LOBBYIST IDEN FICAT PRINCIPAL IDENTIFICATION:
Produced ID 4E Produced ID
Form of Identification Form of Identification
4E-Pe s�lly known(Lobbyist) I € Personally known(Principal)
VII. OF NOTARY
Stat Xbscrf,l a State of
rn beef�or�jme Sworn subsc ' d be re me
A 20,E TFaics f na tar —State of Florida AS' nwre of P c Notar — ate of Florida
9 Y y
Notarization of Lobbyist's signature tion o Principal's signature /�7 v
TO BE COMPLETU BY CITY CLERK'S STAFF ONLY /
Annual Registration fee: [" ]Yes[ ]No Amount Pal MCR#1 b Date Paid
Lobbyist Registration Form received and verified by: -;I &7Z 3 e
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc L
�
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST GOMPENSATION1(DISCLOSE WHETHER HOURLY, FLAT RATE OR
or*en):
A) LnHanaTu|nm.osonE
--pod,- --------- -- -' ------_---'
G) Pn|NC|Pxc8u|SCL03U (OF LOBBYIST cVwpEmSxT|oN):
(Required).____ _-_k]l��J ��� -__-_'__ �__- --- --- --'--- --- ---- -- -- -----' - '--
The following information must bmanswered:
1) PomxanimK8iumiBoavhQ|yCodeSoction2'488Enh1|od'9rohibi|edCampaignConkibu|ionuByLobbyic|uOnPm6ummen|
|n0000':
Yes 4`No:r Are you 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 Coniiibutions By Lobbyists Oil Real Estate
Dovo|opmont |aeuos^:
4EYes No.,' Are vou lobbyin-q 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 24D4 (h) Any person (except those exempt from the definition of ^|obbyi$^au xoi bUh in
Section 2-481 above) who only appears as o representative of u not-for-profit corporation or entity without special
compensation nr reimbursement for the appoomxua, whether direct, o/ indirno\ \o express support ,dor opposition |oony
ite,rn, shall registei with the clerk as required by hi s section but, shall not be i d to pay any reqistralion fees.
4E Yes No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT,SHALL BE FILED EY-EN IF THEF3F_ HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIO
Signature of 6 R�ist
I do solemnly swear that all gf1f`f6'f-6-�4oirig facts are true andcqriect and that I have lead o! am tPrililiai with the provisions contained
in Section 2-482 of the MiaK1 Beach Cyy Code and all r porti g,r�qujii�,ments.
AIF
Signature of Lobbyis (D
V1. LOBBYISTIDENTIFIC��TION: PRINCIPAL IDENTIFICATION: C)
Produced ID Piodijoed ID
Form of Identification Foirn of Identificatio i
Personally known (Lobbyist) Personally knowli (Principal)
VII. SIGNATURE AND STAMP OF NOTARY: I
Ile
State State
54df Public ar�y State bf"mTd-a Nil
ot rizati Lobbyist's signature My'. Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STArFOwLv
Annual Registration fee: I ]Yes No Amount Paid$___—MCR —--_---.—Date Paid
Lobbyist Registration Form received and verified by:
F:\CLEK$ALDuF0R&1S\L0B8Y]STFORK88\Lohbyiw Registration FormJoc
C rorm.doc Revised 1/11/2011
ID MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME: 11 '6f'. 'p
I understand that no later than February 28th ®f 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.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addition to any other penalties which may be imposed as
provided in Section 2-485. 1 , a fine of $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Mia County Commission on Ethics and Public Trust.
�U(�1
Si ure: Date:
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