Kent H. Robbins - 120 Ocean Drive, LLC MIA/\A1
City f Miami Beach Office of the City Clerk Of
Y Y
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.
Robbins Kent H.
NAME OF LOBBYIST: (Last) (First) (M.I)
Kent Harrison Robbins,Attorney at Law, 1224 Washington Avenue, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 532-0500 (305) 531-0150 khr(a).khrlawoffice.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:
I. LOBBYIST RETAINED BY:
120 Ocean Drive, LLC .
NAME OF PRINCIPAL/CLIENT:
120 Ocean Drive, LLC-2675 S. Bayshore Drive, Coconut Grove, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)416-4556 (305) 377-3040 DMartin @terragroup.com
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:David Martin
IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See attached
II.SPECIFIC LOBBY ISSUE:
Legal representation concerning development approvals and permitting Issues,including,but not limited to Historic Preservation Board,Planning Board
and City Commission,relating to approvals for modifications to design and robotic/mechanical parking for the property located at 120 Ocean Drive,Miami
Beach,FL
Issue to be lobbied(Describe in detail):
III. 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 relationshi .
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Planning Department and Building Department Staff,Mayor's None
Office,City Manager's Office,and City Attorney's Office
PB, DRB, HPB, BOA, FP, City Commission, Mayor, as None
necessary* I � , r %0 7 f
Pursuant to City Code Section 2-482(g) Every registrant shall be required Pursuant to City Code Sec ion -482(j)Seery-registrant shall be
required to state the extent of any business,financial,familial or professional relationship,or othe el tionship ivi r s t n appearance
of an impropriety,with any current city commissioner or city personnel who is sought to be lobo i "g1vtifi �r l il�R st registration
form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
NONE
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$475.00/hr
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $475.00/hr
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 vending bid for goods.eauinment or services.or on a_nresent or aendina
award for goods,eauinment 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 aendina annlication for a Development Agreement with the City or annlication for
change of zoning man designation or change to the City'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 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 renresentina a not-for-profit corporation or entity without special comgensation9r reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 281h OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
EM
EXPENDITURES OR CQ1dEEbjSATIQbj DURING IIJE tj. T!NGPERfOD.
'A Tj�
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Si ature of obb st
I do solemnly swear that all of th foregoing s re true and corre d that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia a ch City Co d all reporting rET1ire n
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
SANDRA RAMOS
Personally known(Lobbyist) '* Commission#EE 1 78548 Personally known
° My Commission Expires
(Principal)VII. %�°fM1 Aprll 30, 2016 S NATURE AND STAMP OF
„�������
NOTARY:
State of Florida, County of Mi m V. ROSELYN SAVINION State of Florida, County of Miami-Dade
Thisrn o uabscorib . efo a MY COMMISSION#EE859742 ws and subscri efore me
y LF-)A t�20,20.1:f day f 20 ,2'3
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Signa re of P i o ar — Sig at of Pu c N State of Florida
Notarization of Lobb iv st's signature N tari ati Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ (5. 5 IV MCR# 0 Date 'd /
_j�j�Lobbyist Registration Form received and verified by:
/`A . BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beacli,Florida 33139,www.miamibeaclifl.Roy
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Kent Harrison Robbins
I understand that no later than February 28th of each year, 1 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
appeal d to the Miami-Dad ounty Commission on Ethics and Public Trust.
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Si nature: )ate:
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CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION, list the principal
stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of
another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which
discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity).*
120 Ocean Drive, LLC
2675 South Baushore Drive, Coconut Grove,FL 33133
CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
Terra 120 Ocean Drive Investments,LLC 100%
2665 S. Baushore Drive, Suite 1020
Coconut Grove,FL 33133
Terra 120 Ocean Drive Investments, LLC
2665 South Baushore Drive, Ste 1010Coconut Grove,FL 33133
NAME,ADDRESS,AND OFFICE %OF STOCK
Terra 120 Ocean Drive,LLC 100%
2665 S.Baushore Drive, Suite 1020
Coconut Grove, FL 33133
Terra 120 Ocean Drive, LLC
2675 South Baushore Drive, Coconut Grove,FL 33133
CORPORATION NAME and ADDRESS
Pedro Martin, Managing Member 50%
2675 S.Bayshore Drive
Coconut Grove,FL 33133
David Martin, Member 50%
2675 S.Baushore Drive
Coconut Grove,FL 33133
IF THEREAREADDF170NAL CORPORATIONS, LIST OTHERS,INCLUDING CORP. NAMES)AND EACH INDIVIDUAL'S
NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARA TE PAGE.
NOTE:Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION, list the principal
stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of
another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which
discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity).*
120 Ocean Drive, LLC
2675 South Baushore Drive, Coconut Grove, FL 33133
CORPORATION NAME and ADDRESS
NAME,ADDRESS,AND OFFICE %OF STOCK
Terra 120 Ocean Drive Investments,LLC 100%
2665 S. Baushore Drive, Suite 1020
Coconut Grove, FL 33133
Terra 120 Ocean Drive Investments, LLC
2665 South Baushore Drive, Ste 101OCoconut Grove,FL 33133
NAME,ADDRESS,AND OFFICE %OF STOCK
Terra 120 Ocean Drive, LLC 100%
2665 S.Baushore Drive, Suite 1020
Coconut Grove,FL 33133
Terra 120 Ocean Drive, LLC
2675 South Baushore Drive, Coconut Grove, FL 33133
CORPORATION NAME and ADDRESS
Pedro Martin, Managing Member 50%
2675 S. Baushore Drive
Coconut Grove,FL 33133
David Martin, Member 50%
2675 S. Baushore Drive
Coconut Grove,FL 33133
IF THERE A RE A DD17YONA L CORPORATIONS, LIST OTHERS,INCLUDING CORP. NAME(S)AND EACH INDIVIDUAL'S
NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPAR4 TE PAGE.
NOTE.•Notarized signature required on page 8
6
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