Richard McCalla/Kevin, Brian and Matthew Heinlein and Diamond Capital ® MIAMI BEACH
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, recommendat' n of,the City
Manager or any city board.or committee; or any action, decision or recommendation of any city personnel during the ti erioT,�i the
entire decision-making process on such action, decision or recommendation that foreseeably will be heard or gview y the'city
commission, or a city board or committee. The term specifically includes the principal as well as any employee engage • lobbying
activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Li
�Cl Q1IQ1CV�r�
NAME OF LOBBYIST: (Last) (First) (M.I) T
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
-q 0-4 - �s�a2- �rn Q-1 PIC�A ,c
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Kp�m , Y 1 I M riya ffin 41
NAME OF PRINCIPAUCLIENT:
C Ou r dal S 04YLUN 11`&
Ba(��S �� f�P���S (Num rand Street) ( ity) (State) (Zip Code)
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:
n.SPECIFIC LOBBY w 5 ve 4a l0uiUing v Io1a�-(oT5, SPeC A Ag�er/S
ofbr� , Li pn� r rdp trnays Ly uAA .• X113b Win•,6.�r. �M f�tYVl t �y)t_I , FL
Issue to Me lobbied(Describe in detail):
III-.CITY AGENCIESANDIVIDUALS 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
(
Pursuant to City Code Section 2-482(g)Every r istrant 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(8)Any Financial, Familial or Professional Relationship
ft� of k6ma� 6A%4w&*,D 11)& Oak o� Abe- ellaP4
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,F4AT F t OR
OTHER): �/�
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): v'
(Required). O ��
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 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 Contributions By Lobbyists On Real Estate
Development Issues":
€Yes No) Are you 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
rie
m, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
4E Yes N : Are vou representing a not-for-profit corporation or entitV 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 EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIO
Signature of LftbYiSt
I do solemnly swear that all a fore oing facts are true and rrect and that I have read or am familiar with the provisions contained
in Section 2 482 of the Mis i Beach C' y Code and all r porti g r qu' Ten s.
Signature of Lobbyist: j ��- o
Signature of Principal/Client:
�
25
C:3
VI: LOBBYIST IDENTI-ICA, ION: PRINCIPAL IDENTIFICATION: °UJ C)
v �
N � Z
€ Produced ID € Produced ID v a
Form of Identification Form of Identificatio N a
€ Personally known(Lobbyist) € Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY: U
State IOQ� State of N `1> —
n to d s ribe befor mega Sw n su cr'b d b fore me
T is d of , 201 , 204912
ture o is tate of Si gnat i Public War;—State f'�Ivrfti'a r,
Y 9 Y
otarizati f Lobb fist's ignature • Notarization of Principal's signature
Rte
-7/1 �
TO BE COMPLETED BY CITY CLERK'S STAFF QJMLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ r MCR# s / Sqlt Date Paid
Lobbyist Registration Form received and verified by: SSIf L Z s.,
F:\CLER\$ALL\aFORMS\LOBBYIST FORWI-obbyist Registration Form.doc /
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY, rLAT RATE OR
OTHER):
,71
N/21 011131'IS I DISCI 1�,S�UjHF:(Required)
13))PRINCIPAL'S DISCI.OF LURE (OF l_011I3YIS1 COMPENSAI ION):
The following information must be answered:
I) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurerncril
Iss
°G Yes €No: Are you lobbyin_q on a present or pending bid for goods,equipment or services or on a present or pendiaq
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code 2.490 Lntitled"Prohibited Carnpaign Contributions By Lobbyists On Heal L-stale.
D nefoO ent Issues
4EYes € No: ,Are you 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
shall register with the clerk as required by this section but. shall not be required to pay any registration fees.
€ es € 1
: Are you representing a not-tor-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 SHAL!5Agr1L—Ettf XN IF TKERE HAVE BEEN NO EXPENDITU13ES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signatur6 of Lobbyist / a/
I do solemnly swear that all of the foregoing facts are true nc] correct and that I have 1e c�i-fin familiar with the provision contained
in Section 2-482 of the Miami Beach Cit�Qocle and all r�r{tng requireme
Signature of Lobbyist: r/ i-- 'J '—' =� -----.-- --- ----- -- - --- - --
Signature of PrincipallC'lient: ,f,..--•°,,..,,r.-� .,�__ _ ____ _ `��_
SN
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
E- Produced IF) --- Produced ID
Form of Identification Form of Identiiication
�.._F'er'sonally known(Lobbyist) � � � � € Personally known (Principal)
VII.'--�I.GNAT11RE-AND-ST�A1t1CM5 OF NOTARY
Siai v1tvrtda-(3rn7ri1q of't�tiarrrY-�adc S1a1e of mar Gciy-cif-}EPriatr�+ ici
rn to subscrib eforwe Sworn subsc d b re me
ay of � [ t, 201,d� Tf�ts f 2( t1 --
nai of Public Notary--State of Florida S' n re of P c Notary - tale of Florida
9 Y )
Notarization o1 Lobbyist's signature otarizaiion o 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:
F:\CLLR\$ALL\aFORMS\]_OBBY]ST F0Rf\1S\Lnhhyisl Registration Forrn.doc
C � MIAMIBEACH -rorm.doc Revised 1/11/2011
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 � 'n
LOBBYIST NAME: C 9
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.
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
automatic suspended from lobbying until all fines are paid, unless the fine has been
Opp ared to the Miami-Dade County Commission on Ethics and Public Trust.
.A -3
Signatur : IDafe:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc