Loading...
Joaquin Vargas - Yard House, USA, Inc. M1F MIAMIBEACH �ENo� 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. Vargas Joaquin NAME OF LOBBYIST: (Last) (First) (M.I) Traf Tech 8400 N. University Drive, Suite 309 Tamarac Florida 33321 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-582-0988 954-582-0989 JO/L,UI/V 6 Z TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,or e-mail address. I. LOBBYIST RETAINED BY: Yard House USA, Inc. (Scott Duffner,Vice-President) NAME OF PRINCIPAL/CLIENT: Yard House Restaurants 7700 Irvine Center Drive Suite 300 Irvine California 92618 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (949)727-0959,ext. 1103 (949)727-0831 Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] • NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY: Publicly traded on the NYSE under the symbol MAR. • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH- CORPORATION, PARTNERSHIP OR TRUST: Publicly traded on the NYSE under the symbol MAR. f II. SPECIFIC LOBBY ISSUE: Development Approvals for a Yard House restaurant at 1681 Lenox Avenue N Issue to be lobbied(Describe in detail): i. G7 III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4)include the commissioner of personnel sought to be lobbied,and whether the lobbyist has entered into 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 2482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Planning Staff,City Administration None X DRB, BOA, Planning Board,City Commission 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 wise 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 Any Financial Familial or Professional Relationship None. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $7,500 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $7,500 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 X 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 X 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 item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.. ❑Yes X 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 EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE UPORTING PERIOD. na re of Lobbyist I do solemnly swear that all of the foregoing f is are ue and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Mi m Beach Ci Cod an II reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: •N O ❑ Produced ID ❑ Produced ID Form of Identicati n° f %A.7� Form of Identification X�°c C /Personally known (Lobbyist) o d ❑ Personally known (Principal) VII. SIGNATURE AND STAMP OF NOT ' °0 0 N 3 N State of Florida, County of Miami-Dade N m m State of Florida, County of Miami-Dade Sworn nd subscriAkbefo re m e 0, Sworn and subscribed before me This day of , 20D?/ T 3. This day of , 20_ d Si nature of Public Notary—State of Florida Signature of Public Notary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S USE ONLY ) q/ Date __'7 Annual Registration fee: [ ]Yes[ ] No Amount Paid �� MCR# / Paid Lobbyist Registration Form received and verified by: A Entered By: Revised 1/11/2011 t";� :t 'i ti5dral:ic*n Fcwe�i.ctcc Revised 04/27/2012 f City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.741 1 , Fax: 305.673.7254 �. U LOBBYIST NAME: U,_1 C1 ar -o --t 1�13 I understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, 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 Miami-Dad County Commission on Ethics and Public Trust. Sig Date: C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGODDH\Lobbyist Registration Formrevised 5-30-2012.doc i ^•\xa•r�2�`:Y-:�6!�.a^.:e`.`.^�!ua',•=:%t.._.r.•'.,Tc•��..���a±:".ri•`..:a:�".T.�:_�'-LJ:-Ie'Ya_•..Z:-aJS1i=�F�:c!.a.:.�e—:<'R:z: �2`�.:��.�_aE�-:eel L•=:tii�.tl t:_:'•'�:iti S'tr[.. - :•L.:��L.:'•F_•:=.ra _ _ _ _ State of California ) CALIFORNIA ALL-PURPOSE Countyof U1 ) CERTIFICATE OF ACKNOWLEDGMENT - before me, rl , (here insert name and title of the officers personally appeared J co{i V11L 6015 CY) _ d , z who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s)is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their a authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity i - upon behalf of which the person(s)acted,executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. LINDA DKEITH - COMM. #1942343 a WITNESS my hand and official seal. Notary Public-California c' - Orange County My e Comm.EXDireS a 2015 Signature -�' (Seal) OPTIONAL INFORMATION s Although the information in this section is not required by law,it could prevent fraudulent removal and reattachment of this 4 acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. - Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document Method of Signer Identification titled/for the purpose of Proved to me on the basis of satisfactory evidence: L0 form(s)of identification O credible witness(es) - Notarial event is detailed in notary journal on: K containing pages,and dated Page# Entry# _ The signer(s) capacity or authority is/are as: Notary contact: ❑ Individtlal(s) Other ❑ Allorrley-in-Fact ❑ Additional Signer(s) ❑ Signer(s)Thumbprint(s) s Corporate Officer(s) _ Title(s) ❑ ❑ Guardian/Conservator ❑ Partner-Limited/General ❑ Trustee(s) ❑ Other: s representing: Name(s)of Person(s)or Entity(ies)Signer is Representing .4': - "1': - 1': "t: ]i _.11:i' G':- :::Y=:7':•• ,:7: �7�:::l r.:J.li :�7 :'A1!'.t -t ..7:tY0!:i 1 'it:•::::ii;�C1:•J.: :,1 ':1:�_�� -}]�':{�:.Y.t'�':aJ: rl:.: cl: .•7+J:i.:N, v3"' i:J;. :•7 i' :7 11 ,J::'::i.;.,. 7� Copyright 2007 Notary Rotary,Inc.92S 29th St.,Des Moines,IA 50312-3612 Form ACK03. 10/07. To re-order,call toll-free 1-877-349-6588 or visit us on the Internet at http://www.notaryrotary.com