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Jamie Maslyn Larson - David Martini V 0 1AM1 BEACH Q101 City of Miami Beach Office of the City Clerk ao 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. Maslen Larson Jamie NAME OF LOBBYIST: (Last) (First) (M.I) West 8 333 Hudson Street, Suite 905 New York NY 10013 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 285-0088 i.maslvn(amest8.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 DMartinCaD-terragroup.com TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) rc- � Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Ui , • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH-qPRPORATION, PARTNERSHIP OR TRUST: ILSPECIFIC LOBBY ISSUE: Land Development Approvals for 8701 Collins Avenue, Miami Beach, Florida ° Issue to be lobbied(Describe in detail): lll. CITY AGENCIEVINDIVIDUALS 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 B, 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 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $ at B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). 6L�©_ ml--- 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 lobby,ing on a present or pending bid goods,eaunment or services.or on a present or pgnden$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 X No: Are you lobby,in9 on a gending application for a Development Agreement with the City or aDDllc^ ation &change of zoning map designation or change to the City's Future Land Use Mao? 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 yQu reore, sentinq a not-for-orof�noration 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 Ma THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR Signature of obb I do solemnly swear that all of the foregoing facts are true and corre 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 IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID /✓`/�L Produced ID " SANDRA RAMOS Form of Identifi igal��''�•;c Form of Identification Commission#EE 178548 My Commission Expires Personally known(Lobbyist) April 30, 2016 Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dad VICTOR J DEANS State of Florida, County of Miami-Dade Sworn to and subscribed before me Notary Public - State of New York Sworn d subs i e before me This _ 3 r! day of � ,20 N0. 01 DE6254149 This a f N _,2014 Qualified in Kings Cou ty My Commission Expires cJl �7 Signature of Public Notary—State of lorida g is ary— to f Florida Notarization of�j�yist's signature Notarization of signature TO BE COMPLETFD BY CITY CLERK'S T FFIN� Annual Registration fee: ]Yes[ ]No Amount Paid$ MCR# (�l _Date id Lobbyist Registration Form received and verified by: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDD Lobbyist egid stration Formrevised 5-30-2012.doc F:\CLE istration Form.doc Revised 04/27/2012 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax:305.673.7254 LOBBYIST NAME: Jamie Maslyn Larson I understand that no later than February 28 of each year, 1 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 2485 (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-Dade County Commission on Ethics and Public Trust. f lo )A-m �1 Signatu tole Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc N Q • k` a CL W to Mo amok ' X - j44 yS ,Tft.