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Ian Grocher - Irie Music Corp V I: . i City of Miami Beach Office of the City Clerk ~' y �'.._. ,,.a 1700 Convention Center Drive, Miami Beach, FL 331392014 FED 10 Ptl 12: 09 LOBBYIST REGISTRATION FORM e,,. L,i Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, 66featror 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. Grocher Ian NAME OF LOBBYIST: (Last) (First) (M.I) Irie Music Corp 1410 Sunset Harbor Drive,Suite 212. Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-986-2325 irie @djirie.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: 'Please notify this:office if your contac#information changes:address hone,or a mail address. ._. __. . ,p_ - - I. LOBBYIST RETAINED BY: Irie Music Corp NAME OF PRINCIPAL/CLIENT: Irie Music Corp 1410 Sunset Harbor Drive,Suite 212. Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-986-2325 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: Ian Grocher • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Ian Grocher II SPECIFIC LOBBY ISSIJE 1 VCA Grant for He Weekend X Issue to be lobbied(Describe in detail): ll CITY AGENCIES/INDIVIDUALS T® 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 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 VCA Authority �( 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 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist 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) None B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): None (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": _Yes XNo: Are you lobbvinq 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": _Yes XNo: 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. _YesNo: Are you representing a not-for-profit corporation 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 COOPWATION RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL 13 ED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of th o egoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Be h ity Code and all re ing requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identific Form of Identification DONNA PETH 14ORTELL 'ersonally known (Lobbyist) Notary Public-State of Flori sonally known(Principal) C. •: My Comm.Expires Jul 9,2016 VII. SIGNATURE AND STAIVIP-OF Nib �;:•' Commission#EE 215156 Bonded Through National Notary Assn. State of Florida, County of Miami-Dade of Florida, County of Miami-Dade Sworn to and subscribed before me Sworn and subscribecibefore me Thi;,41day of r I- oijap I ky This_ day of re e, , Signature of Public Notary—State of Florida Signature of Public Notary t rida DONA UM NOA?H.l Notarization of Lobbyist's signature Notarization of Principal's i Notlary h0ft•Oft of Fkw* • • My c4m. id!.2019 TO BE COMPLETE BY CITY CLERK'S STAFF ONLY 0 a 215156 Annual Registration fee: Yes[ ]No Amount Paid +DO MCR# �2 i rbM. 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 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) None B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): None (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": _Yes XNo: 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": _Yes jNo: 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.2S(No: Are you representing a not-for-profit corporation 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 CO ATION RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL B ED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Y Signature of Lobbyist I do solemnly swear that all of t o egoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Be h ity Code and all re ing requirements. Signature of Lobbyist: Signature of Principal/Client: !/ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identific Form of Identification DONNA PETH NORTELL ,/Personally known(Lobbyist) 16 Notary Public 6.State of FIOLI& rsonall known(Principal '_' •= My Comm.Expires Jul 9,2016 VII. SIGNATURE AND STAMP-OF N ��°:' Commission#EE 215156 �•` Bonded Through National Notary Assn. State of Florida, County of Miami-Dade of Florida, County of Miami-Dade Sworn to and subscribed before me Sworn and subscribed before me This day of This day of , 2012 Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida Notarization of Lobbvist's signature Notarization of Principal's signature TO BE COMPLETE BY CITY CLERK'S STAFF ONLY Annual Registration fee:: Yes[ ' ]No. Amount Paid - �DL MCR# oZ 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:\CLEI 1istration Form.doc Revised 04/27/2012 MIAMIBEAC 9 H. City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 ,Fax:305.673.7254 LOBBYIST NAM E: ago 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 appe to a Miami-Dade County Commission on Ethics and Public Trust. ................. /C( Signatu : D te: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc Detail by Entity Name Page 1 of 2 i ' P jv CORP OR d a c- Detail by Entity Name Florida Profit Corporation IRIE MUSIC, CORP. Filina Information Document Number P03000109956 FEI/EIN Number 200766074 Date Filed 10/06/2003 State FL Status ACTIVE Effective Date 10/02/2003 Princi al Address 1410 SUNSET HARBOUR DR UNIT#212 MIAMI BEACH, FL 33139 Changed: 04/11/2008 Mailina Address 1410 SUNSET HARBOUR DR UNIT#212 MIAMI BEACH, FL 33139 Changed: 04/11/2008 Re istered Agent Name &Address ADILLO, MANUEL JESQ. . 11402 NW 41ST STREET SUITE 207 DORAL, FL 33178 Name Changed: 02/17/2009 Address Changed: 02/17/2009 Officer/Director Detail Name &Address Title PVT GROCHER, IAN 1415 20TH STREET, UNIT#402 MIAMI BEACH, FL 33139 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/domp-... 2/10/2014 Detail by Entity Name Page 2 of 2 Title PRES GROCHER, IAN S 1415 20TH STREET, UNIT#402 MI&MI BEACHq&1taaW9 E-Filing Services Document Searches Forms Help Annual Reports Report Year Filed Date 2011 04/05/2011 2012 04/10/2012 2013 02/04/2013 Document Images 02/04/2013 --ANNUAL REPORT F View image in PDF format 04/10/2012 --ANNUAL REPORT F View image in PDF format 04/05/2011 --ANNUAL REPORT,F View image in PDF format 03/17/2010--ANNUAL REPORT F View image in PDF format 02/17/2009 --ANNUAL REPORT View image in PDF format 04/11/2008 --ANNUAL REPORT View image in PDF format 04/30/2007 --ANNUAL REPORT . View image in PDF format 09/05/2006 --ANNUAL REPORT View image in PDF format 06/09/2005 --ANNUAL REPORT View image in PDF format 01/08/2004--ANNUAL REPORT View image in PDF format 10/07/2003 -- Domestic Profit View image in PDF format Corwriah ©and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/domp-... 2/10/2014 '1Fs Miscellaneous Cash Receipt EP {� _, y.m 1t }» r� =. CITY OF MIAMI BEACH - No. L7 Cash 12 Credit Card 1�Check# .> 2� A_ Received of :I ,66 t ' t C Address a t��y°'.�,...� .ems /'` : c,'y{ yi t F ! S ,r,+� �` .a-� — 1 rte. ��, _ •�.:it'/{} 3s_ '� f For 4�' ..'•,1�._•'` f'{. d_L• 6 f �d ! �e1 (THIS INFORMATION MUST BE COMPLETED) Office®f Finance Direct®r Account Number: Prearer. Et -} `. ; � ?; Dept: r '`4 l