Deena D. Falce - Tom Muia ` ' AU� I BEACH A�
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City of Miami Beach Office of the City Clerk Pc 0 �'P
1700 Convention Center Drive, Miami Beach, FL 33139 ��S tC
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LOBBYIST REGISTRATION FORM �y
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.
Falcg Deana D
NAME OF LOBBYIST: (Last) (First) (M.I)
Shubin & Bass, P.A. 46 SW 1st Street, Td Floor Miami Florida 33130
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
_(305) 381-6060_ (305) 381-9457 dfalce @shubinbass 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:
Tom Muia
NAME OF PRINCIPAUCLIENT:
Seville Acquisition, LLC 10400 Fernwood Road Bethesda Maryland 20817
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
301 380-7972
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:
ii.SPECIFIC LOBBY ISSUE:
BeachwalIdBoardwalk Issues for MarrioLSeville
Issue to be lobbied(Describe in detail):
III. CITY AGENCIESANDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(x)(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,st ting 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
Planning Staff, Public Works Staff, Parking Dept. None
HPB, BOA,Planning Board,City Commission None
Pursuant to City Code Section 2-482(8)Every registrant 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. 4 h
Sec 2-482(g)Any Financial, Familial or Professional Relationship
None .r l ``
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required Al
B) PRINCIPAL'S DISCLOSURE(OF LOBE �J NSATION):
(REQUIRED). `i
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 y u IObbving on a present or pending bid fo,rr goods eauio ent or services.or on a present or
Bgnnc award for goods,equipment 2E service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes X No: Are you lobbvina on a pending apei olicatign for a D velooment Agreement with the Citvnr application for
c,hange of zoning.Mao desigination orchange to the CitVs Futurg,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 X No• Are you representing a not-for-profit corporation or entity without sl2ecial compensation er rMjmbursgjment,
V. SIGNATURE UNDER OATH:
ON-EEBRUABY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CLTY CLERKA__SIGNED STATEMEN'LUNDER
QATH. LISTING LOBBYING EXPENDITURES.—AS WELL AS COMPENSAT ON RECEIVED, IN THE CITY OF MIAMI BEACH
EM
EXPENDITURES OR
— I)g&N
Signature of Lobbyist
1 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 B _ ch City Code all p g requirements.
Signature of Lobbyist: �Ij.
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
V Personal) known L b RUTH OUIHTAVALLI Personally know rhR�,pa
y { ?? ' t �B`c'�.Notary Public-State of Florida ,,��,�r pLeL, RUTH OUINTAVA!!i
m Expires Mar 9,2017 Notary Public-State of FIO��i
VII. SIGNATURE AND S VQ1 . . .•_ M Comm.Expires Mar 9.2C
Comm�sslon # EE 8552? _ _ y P
Commission #EE 85 1 52
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State of Florida, County of M '-D i3cned ' r ' State of Florida, Co �6#, aii- ,
ty` ThrOU�, 121 on;
S ubsGar befo a rn,4 d
This d ,201 ` This ay of 2
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Signature of Public o ary=State of Florida §i7g—natdre of Public Notary—State of Florida
Notarization of vtst's signature Notarization of signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 00, 3
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ c��d ' MCR# Z q1 3 Dat Paid
Lobbyist Registration Form received and veri ie y: '
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F:\CLE Registration Form.doc Revised 04/27/2012
BEAC �i
City of Miami Beach, 1700 Convention Center Drive. Miami Beach, Florida 33139, www.rniamibeachfl.gov
CITY CLERK Office
Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Deana D. Falce
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-D de County Commission on Ethics and Public Trust.
May 17, 2013
Signature: Date:
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Formrevised 5-30-2012.doc