Alex J. Duval-Arnould - Portman Holdings I
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 foreseeabiy 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 tern!"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last)ovvA-L-ONCO First) A.L•e-k (M.I)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
�- A104491/V&S 7%� rtnACk ry?&Z CWq r? 47z,47v7-79 604 &-10-3 0 3
TELEPHONE NUMBER: �/,y S�� FAX NUMBER: ?O� EMAIL
lease`t�ofifyafils o tc��f-your contac >�nformation Changes:addrwes .phone,or e-mail address.'
1. .LOBBYIST RETAINED BY:
PORTMAN HOLDINGS/CMC GROUP,INC.
flMe LTCAV9NUE, SUITE 2410 MIAMI FL 33131
B11�IN N�160 SND ADDRESS (Number and Street) (City) (State) (Zip Code)
.3 J /�LL UaJ
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:JACK PORTMAN/UGO COLOMBO/ART MURPHY
/ROGER ZAMPBELL
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
REDEVELOPMENT OF MIAMI BEACH CONVENTION CENTER(R.F.Q.)NO.22-11/12
Issue to be lobbied(Describe In detail):
� 2� '
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 sub ect contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
CITY MANAGER,CITY COMMISSION X
CITY DEPARTMENT LAND USE BOARDS X
CITY STAFF X
Pursuant to City Code Section 2-482(8)Every registrant shall be required to state the extent of any business,financial,familial or professional
I 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 2482 Any Financial Familial or Professional Relationship
NONE
r
i� C:\Users\clerhati\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
i Formrevised 5-30-2012.doc 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) PRINCIPAL
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): PRINCIPAL
(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":
X Yes No: Are you lobbying on a gresent or Pending bld for goods,eaulpment or services,or on a present or Pending
award for goods.eauipment or servile_?,
2) Pursuant to Miami Beach City Code Section 2-480 Entitled°Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
XYes No: Are gu lobbying on a pending application for a Development Agreement with the City or application for
change of zoning Map designation or chance to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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 mo: Are you representing a not-for-profit coruoration or entity without special compensation or reimbursement,
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 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
IHE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
In Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist
Signature of Principal/Client
VI. LOBBYIST ID NTIFICATIO PRINCIPAL IDENTIFICATION:
,/ 6�
Produced IDS 5�2 /Produced IDS s��leg'
.�
Form of Identification Form of Identification
Personally known(Lobbyist) Personally kno will
E Y COMM, O 7R ft
VII. SIGNATURE AND STAMP OF.Md Y: LI(1 ; , XPIRES:Feb N#ICE844865
Gtr..°
�' ''" ..61 /dYCO M�S0�� State of Florida,County of I �'dedmNNata1y'ableunde►°1-e,�
.of ,r'.
State of Florida,County of Miami-Da -,. :,,,,,�,;° EXP/RES.F N#EF�4885
Swosrn to and suubs r bed l me 01 s0" rntiNo% U e r� iSrn an day c b d b fore m201
�� 1 men
--
Sig ature of Public Notary—Stake of Florida ignature of Public Notary dda
Notarization of Lob signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
iva!-0R i rat[arii f • {: Yes{ {
No.. Antaunt Paid X1K 0. , MCR4 pate Paid
gft"tlon form recehred and werlfled by:
C:\Users\clerhati\AppData\Local\Microsoft\Windows\Temporary Intemet es\ContentOutlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
:1lti 19on Porm:Bcc
MIAMI BP"hE A(40�"'H,
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miomlbeachfl.gov
CITY CLERK Office
Rafael E.Granada,City Clerk CityClerk@miamibeachfi.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: X 1�7721VG�
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)
i to file the Statement or pay the assessed fines after notification.
Any lobbyist, who falls 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-Dade County Commission on Ethics and Public Trust.
Signature: ate:
i
f -
1
I
I
C:1Users\clerhatl\AppData\Local\microsoft\WindowslTemporary Internet Files\Content.0utlook183LGQDDH\Lobbyist Registration
IFormrevised 5-30-2012.doc