Alyssa Kriplen - David Martin 'MIAMI BEACH
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.
Kriplen Alyssa
NAME OF LOBBYIST: (Last) (First) (M.I)
Shulman +Associates 100 NE 38 Street, Space 2 Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)438-0609 (305)438-0170 alyssa@shulman-design.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:
David Martin
NAME OF PRINCIPAUCLIENT:
Terra Group 2675 S. Bayshore Drive Miami Florida 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 416-4556 (305) 777-3040 DMartine-terraaroug.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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Land Development Approvals for 8701 Collins Avenue, Miami Beach, Florida
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 relationship.
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 None X
PB, HPB, BOA, City Commission, as necessary* 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(g)Any Financial, Familial or Professional Relationship
w ► .
I 5..� e. f`ti ,i ..F � •`1 J.r tl
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobb ist Registration
Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ •'
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). $ -j ?o S
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 oendina bid for goods,eauinment or services,or on a Dresent or
Bending award for goods,eauipment or 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 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 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 special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON BR 28 !2F EACIJ YEAR, EACH LOBBYIST SHA UBMIJ TO THE CITY CLERK D SIATEMENT UNDER
G LQBBYINQ2 EXPENDITURES, AS WELL Ab domPENSATIQN RECEIVED IN THE CITY OF MIAMI BEACH
FOR THE PRECEDING CALEbjDAR YEAR. ST6IBMEAT SHALL BE FILED EVEN 1E IHER9 H6VE N NO
EXPENDITURES OR CQMEENSATION DURING THE REPOFkTIJQC PERIOD.
Signat of L bbyi
I do solemnly swear that all of the regoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Bea Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID NOT F4 DI LIC-STATE OF FLORIDA Produced ID
Form of Identifigatft iiaa�;,th CoX Form of Identification
n#DD980857
Personal) known(Lobbyist) .,,.•`'` Lxpi.es: APR.12,2014 � Personal) known(Principal)
Y ( y ) BONDED THRU ATLANTIC BONDING M.INQ Y ( P )
VII. SIGNATURE AND STAMP OF NOTARY:
SANDRA RAMOS
State of Florida, Count of Miami-Dade =`'p to of Florida, Count of Miami-Dade
County _ Commission# EE 178548 Y
Swor to arid subscrib b e me '-_� My Commission Expires orn and subscribed before me
This d o , 2013 April 30, 2016 ida of DQe�tbG�' , 2013
Signature of Public tary—State of Florida Signp u e P lic Wary—State of Florida
Notarization of Lob is 's signature Notari ation of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# ._3 2,83 IV Date Paid
Lobbyist Registration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
F:�CLE istration Form.doc Revised 04/27/2012
M I AM I BEAC H
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
miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Alyssa Kriplen
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 iami-Dade County Commission on Ethics and Public Trust.
2- h
Signature: Da e:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
L !
Q
N
W
o4
CL
q �
r W �•.
ul
CL
CL
V r W
`w 1
0 LL. f
LL.
d0 a m c m
) U • L = O A
ca a LL ~ a a
a