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Barry Miller - Camilo Miguel Jr. M-311 Meridian Owner, LLC. 7Z9-.73, -�tt MIAMI BEACH - �' City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 ��" 'ri 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. Miller Barry NAME OF LOBBYIST: (Last) (First) (M.1) Savino & Miller Design Studio 12345 NE 6 Avenue Miami Florida 33161 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 895-9082x. 302 barrv@savinomiller.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: Camilo Miguel Jr. NAME OF PRINCIPAL/CLIENT: M-311 Meridian Owner, LLC 1691 Michigan Avenue, #215. Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 531-2426 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: Development Board Approvals for 729-735 Third Street, 311-321 Meridian Avenue—M-311 Meridian Owner, LLC 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 Staff, PB, HPB, BOA, DRB, Commission None 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 NONE C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$ 49,0C) 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 X No: Are you lobbying on a present or pending bid for goods.equipment or services, or on a present or pending award for aoods.eauioment 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 chanae of zonina 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 FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDIT R AS WELL AS COMPENSATIQU.IggCEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING- CALENDAR YEAR, A STATEMENT B E HAVE BEEN NO EXPENDITURES OR COMPENSATIQN DURING THE REPORTING PEOIOD Signature of Lobbyis I do solemn) swear that all of th foregoing acts a true and corre nd that I have read or am familiar with the provisions contained Y 9 9 P in Section 2-482 of the Miami Beach •ty de and fill reportin u• emen Signature of Lobbyist: 1 Signature of Principal/Client: / ` VI. LOBBYIST IDENT IC ON: PRINCIPAL IDENTIFICATION: m 0 Ch 0 F ] � Produced IDhdeV' l��c% v• Produced ID U CO Form of Identification Form of Identification w o Q N V N•y� Personally known(Lobbyist) Personally known(Principal) a'Q E g Z-5 o m VII. SIGNATURE AND STAMP OF NOTARY: o M a zU2w State of Florida, County of Miami-Dade �4dr'rh�, State of Florida, County of Miami-Dade Sworn to and subscribed before me �b Sworn and subscribed before e o This day of �� , 2014 ' �� This day of .lv e , 2014 �o®�f�` • ►a ►� � O c� Signature of Puble Notarij State of Florida Signature of Public Wary—State of Florida Notarization of i ignature Notarization of Principal's signature TO BE COMPLET D BY CITY CLERK' T F F O L Annual Registration fee: [ ]Yes[ ]No Amount Paid$ 2j5bl M C R# Date d eal Y. Lobbyist Registration Form received and verified by: C:\Users\clerhatMppData\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 101A/01 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@,m iam i beach fl.gov Tel: 305.673.7411 , Fax:305.673.7254 LOBBYIST NAME: Barry Miller 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 sus ded from lobbying until all fines are paid, unless the fine has been appealed to Mia i-Da ommission on Ethics and Public Trust. 7 111Z zo Signature: PaW C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc +II 1 ILL LU LU •ws n. NJ I 12 ca r : :m_ JUL. CL - a