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Robert Moehring - Domo Design Studio Air.. �4 J AA, I AAA1_ BE AC Y City of Miami Beach Office of the City Clerk � �`� I 1700 Convention Center Drive, Miami Beach, FL 33139 �V/ 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. Mbehrina Robert NAME OF LOBBYIST: (Last) (First) (M.1) Domo_Design-Studio, 420 Lincoln.Road, Suite 374, Miami Beach,.FL 331.39 I BUSINESS NAME AND"ADDRESS____---- (Number and Street)- " - -( �y)---____ - -- — (Stale)--- /3051 674-8031 rob!aa a�domodgsignstudio,com TELEPHONE NUMBER: FAX NUMBER: EMAIL: :l Please notify this offlce If your contact information changes:address,phone, or a-mall address. I. LOBBYIST RETAINED BY: Rene Katz NAME OF PRINCIPAL/CLIENT: _. 5,1.51 Fa fet , uite 2325._Houston,TX S y -�SfQES uan ree - 'a e ip o e .786-275-6739 &A r-ene.kat&&Wrtek.fr TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this se. on :pr cipal.fs s Corporation,PaKnership or Trust,(�te. on 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:;. n.SPECIFIC LOBBY ISSUE: Development Approvals ar :Plermitiirig.Issues,vOiidt but hbt liniitecl to:Hrstonc Preseruation Board,Planning and Board ofAdiustment yroe�als P-aW Ihitie.:Midml'Beacii.FL. Issue to be lobbied(Describe in detail): 111.'CITY AGENCIES/,INDIVIDUALS•TO EELOBBIED: 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 "onVs commencement of service with the clt��to the: r+s$ent.data etatln the a ral nature of thesub eii contractual relationshl _- Sec 2482(a)(4jFull'Name of Individual and - Contractual Relationship(Explain) YES NO- -- title of,person to.be lobbied. ---- Planning Department and Building Department Staff None. B,DRB,HPB, BOA,FP, City Commission, LUDC, and None. Commission Committees, as necessary None. Pursuant to City Code Section 2.482(8)Every registrant shall be required to state the extent of any business,financial,famIQ or p"ssional relationship,or other relationship giving rise to an appearance of an Impropriety,with any current city commissioner or city-personnel who is sought to be lobbied as Identified on the lobbyist registration form filed. Sec 248 -,An V;Financiah;Farnilial-or Prof esslorial Relations„i-:: - - -� l - C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist-Registration °--, Formrevised 5-30-2012.doc T � IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$ Z� B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): , (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 eauinment or services or on a present or pending award for aoods.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 JCNo: Are you lobbying on a pending application for a Development Agreement with the Citv or application for change Qf 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)No, 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 COMPENSATION RECEIVED IN THE CITY OF MIAMI BEACH LQ$ THE PRECEDING CALENDAR YEAR A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobb : Robert Moehring I 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 Beach City Code and all reporting requirements. Signature of Lobbyist: Robert Moehring Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Vproduced ID Ol LAI 0 Produced ID Form of Identification Form of Identification Personally known (Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade ,``,,••Neeeeegy MARIA JAKQNIUK ate of Florida, County of Miami-Dade Sworn to and subscribed before me a Notuy Public-State of FWWa orn and subscribed before me This - ay , 2014 =. •s My Comm.Expifes Jan 9.2017 is day of ,2014 - (� = Commission#►EE#68721 ��r Bolded Through National Notuy Assn. •uea Signature of ublic No -State of Flor ignature of Public Notary-State of Florida Notarizatio of signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual'Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Pa' Lobbyist Registration Form received and verified by: v f I I 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). _:-_._._....__._..._... - ---- -- ----- 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)No: Are lob y_orLa present or pending bid for goods.equipment gr services,or on a present gr pending award for goods.eguinment or service? 2) Pursuant to Miami Beach City Code Section 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues': _Yes)MO: Are vo_, l bb it p on a pending application for a De3jelooment„1,aMgment with the City or agnlication for c ange of zoning map desi nation 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,.XNo�:�vnt!'renr+aser>Hna annt-for=uratit�cernoradon ne®itlttkv Witt±n�rt SQeciAl•coi�nndns_�IQn or relmtiL`rs`emeriL V.; SIGNATURE UNDER OATH: ON FEBRL RY 28 OF EACH YEAR.EACH LOBBYiT SHALL SUBMIT TO THE CITY CLERIC A SIGNED STATEMENT UNDI<R QATH I ISTINQ I nRIBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH EM THE PRECgDING CALENDAR YEAR, A STATEMENT S ALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I 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 Beach City Code and all reporting requirements. Signature of Lobbyist— Signature . Signature of Principal/Client::- Vl. LOBBYIST IDENT(FICAT N: PRINCIPAL IDENTIFICATION: _,Produced ID. _ XProduced ID Y/�•J r�.��`� -Q 'p" Form of Identification Form of identification •.•.0;= _Personally known(Lobbyist) Personally known(Principal) o o n °3 VII. SIGNATURE AND STAMP OF NOTARY: 3 3 " 3 3 m H Cr -4 State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade o x Sworn to and subscribed before me Sworn nd subscri ed efore me *°' So. ------ --_day of -- - _ -- 2014 his day of 2014 „ '" w =r. CD M CD 4 r a Signature of Public Notary—State of Sign W6 ry—State of Florida N o Notarization of LobLob®signature Notariza signature CO CL TO'BE;;C6MPLETED'8Y'CITY..CLERK'S,,STAPF ONLY Annual Registration fee: ]Yes[ ]No Amount Paid S - MCR# -- Mate._. - - Lobti R Istratlon�Forrn irecetved!arid v®ilfied by.- -- - - �0 2— s 9. _ 7 C) ; x '{ z1 4.g City of Miami Beach, 1700 Convention Center Drive, Miami Beach. Florida 33139. Nvwxv.miamibeachfl.gov CHN CI-:I:_RK Office Rafael f.;. Granado, City Clerk CItvClerk'ir!miamibeachil.-, Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST'NAME: Robert Moehring 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 l 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-Dade County Commission on Ethics and Public Trust. Signature: 'Robert Moehring Date: 6/30/14 -n m pA a .� soon ;i D. _ •� � tr E O � C . 1 a CP z �F �\ -_ ,.1