John V. Chibbaro - John Jansheski 1• b J �1 f,
MIAMI BEACH, fr-
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL A1#0V -5 AM I 10
LOBBYIST REGISTRATION FORM _ _CITY CLERK'S OFFICE.
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.
Chibbaro John V.
NAME OF LOBBYIST: (Last) (First) (M.I)
Akerman LLP One SE Third Ave Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.374.5600 305.349.4676 john.chibbaro @akerman.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: t
John Jansheski
NAME OF PRINCIPAUCLIENT:
Starboard Florida IV LLC PO Box 31408 Knoxville TN 37930
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
415.720.2277
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: John Jansheskl
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: John Jansheski
ii.SPECIFIC LOBBY ISSUE:
Design Review approval for a new two-story residence located at 27 Star Island
Issue to be lobbied(Describe in detail):
m.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 relationship.
Sec 2.482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Members of Design Review Board 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 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 Any Financial,Familial or Professional Relationship
None
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
$380 hourly
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).smho-ly
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:
_YesE 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_YesQNo: 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 Citv'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.
_YeC]No:Are you representing a not-for-profit cor22ration 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
THE PRECEDING CALENDAR YEAR. A STATEMENT—SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIO
Sig at re of Lobbyist
I do solemnly swear that all of the foregoing facts are tru a co ect and that 1 have read or am familiar with the provisions contained
in Section 2-482 of th i i each City Code all re rting r u'a ents.
Signature of Lobbyist:
Signature of Principal lien y j
VI. LOBBYIST ID TIFI ATI N: PRI IPAL IDENTIFICATION:
Produced ID Produced ID U h l.)l rise
Form of Identification Form of Identification
Personally known(Lobbyist) _Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County,of mi-Dade State of Florida,County of Miami-Dade
Sw m to and subscribed prregne Sworn a d s spribed before me
This of CJ�i ,2013 d of 6 ,201
r of li Not — t of Florida Si lic a fate of Florida
ari do of Lobb ist' g ture ri tin of Princi I' gnature
TO BE COMPLE3P PY CITY CLERK'S STAFk ONLY -
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by.
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City of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida 33139 www.miamibeachfl.gov 2013 NOV -5 AM 1: 10
City Clerk' Office
Tel: 305/673 - 7411 Fax: 305/��7:YJ7�254�' f E
F ICE-
ANNUAL LOBBYIST REGISTRATION FORM
Name: John V. Chibbaro
Business Name.
Akerman, LLP
Address.
One SE Third Ave
Phone.
305.374.5600
Email.: john.chibbaroaakerman.corn
If more than on Lobbyist, please list:
1)
2)
3)
MCR #: 2<0
Amount paid: (5D0 Date paid:
Processed :b �� Date: `� ` 1
Y .
S ' d this form with a check for $500 payable to
the City of Miami Beach for each lobbyist
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CITY-OF.MIAMI BEACH
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