Louis Terminello - Engine Shop, LLC. 3`
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 z� //(n2)
LOBBYIST REGISTRATION FORM oc6 l ozzo 14
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.
TERMINELLO LOUIS J.
NAME OF LOBBYIST: (Last) (First) (M.1)
Terminello&Terminello, P.A. 2700 SW 37 AVENUE, MIAMI, FLORIDA 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) .
(305)444-5002 (305)448-5566 Ijt @terminello.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:
Engine Shop, LLC
NAME OF PRINCIPAL/CLIENT:
Engine Shop, LLC 150 5th Avenue, 3rd Floor, New York, NY 10011
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212)691-6292 Brian @engineshopagency.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: Brian Gordon, CEO
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Brian Gordon; Ryan Schinman
ii.SPECIFIC LOBBY ISSUE:
RFQ 2014-182-LR, and any other matters relating to event planning and marketing services for the Miami Beach Centennial.
Issue to be lobbied(Describe in detail):
III.CITY AGENCI ES/IN DIVIDUALS 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 — —
Procurement Management Director and his staff None X
Mayor and City Commissioners and staff None X
City Manager/Assistant City Managers and their staff 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 —
None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) $525/ flour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $525 I hour
(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'.
Q Yes ❑No: 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 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues°:
Q Yes V1 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 2-484(h)Any person(except those exempt from the definition of°Iobbyisf as set forth in
Section 2481 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.
D Yes 0 No: Are You representing a not-for-profit corporation or entity without special compensation or reimbursement .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th 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 FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL B ENLED 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 Be h ity Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFIC -10 PRINCIPAL IDENTIFICATION:
❑ Produced ID 0 Produced ID
Form of Identification Form of Identification
ersonally known(Lobbyist) ��� ���� IAN GnUTMA Pe nally known(Principal)
•�•�� pv i���
�' Notary Public-State o r10a
VII. SIGNATURE AND STAMP OF NOT My Comm.Expires Jun S,201$
Commission#EE 185194
State of Florida,County of Miami-Dade s�''y�;pFF�d:O,•
Bonded throngs►Nat nal NsOf Iorida,County of Miami-Dade
Sworn toXd subscribed before me subscribed before me
1S, dhy of MAY 201 This 1 day of MAY ,2014
44
IS' ure f u a — tate of Florida Sig ture of Pub — to orida
rizatl n obbylst's signature Not ization of Principal s signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: ( ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbylst Annual Registration Form.doc Revised 1/11/2011
•••' + D.NUNO
A MY COMMISSION#FF 117714
PB: EXPIRES:April 29,2018
yAf„ �'``, Bonded Thru Notary Public Underwriter&
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) $525 / hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $525 / hour
(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":
x❑ Yes ❑No: Are you lobbying on a 12resent 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 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 2-484(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 0 No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th 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 FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL 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 of Principal/Client:
VI. LOBBYIST IDENTIFIC PRINCIPAL IDENTIFICATION:
❑ Produced ID El Produced ID
Form of Identification Form of Identification
❑ Personally known(Lobbyist) IAN GRUTMA Per nally known(Principal)
VII. SIGNATURE AND STAMP OF NOT Notary Public-State-of Florida
_. .? My Comm.Expires Jun S.2016
Commission#EE 185194
State of Florida, County of Miami-Dade %o „ : Bonded Through Nat nal Ntll �of lorida, County of Miami-Dade
Sworn to and subscribed before me subscribed before me
This day of MAY , 2014 This 1 day of MAY , 2014
Signature of Public Notary—State of Florida Sig ture of Pub to orida
Notarization of Lobbyist's signature No ization of Principal's signature
TO BE COMPLET D BY CITY CLERK'S STAFF ONLY ke-A.)
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by: a
F:\CLE R\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc t?Revised 1/11/2011
a
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax:305.673.7254
LOBBYIST NAME: LOUIS J. TERMINELLO
I understand that no later than February 28th 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, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
Signature: D4e.
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