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Paul R. Jankowski - Ric-Man International r N � A C - i BEIi 5�y i$ A City of Miami Beach Office of the City Clerk q v� 1700 Convention Center Drive, Miami Beach, FL 33139 I M 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. Jankowski Paul R NAME OF LOBBYIST: (Last) (First) (M.I) Ric-Man International 2601 NW 48th Street Coconut Creek Florida 33073 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-505-6601 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Ric-Man International NAME OF PRINCIPAUCLIENT: Ric-Man International 220 71 Street,Suite 609 Miami Beach Florida 33141 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-505-6601 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: Pall) R. Jankowski • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: .��� 97 ON Jf Ll irvv S 3 y� NF�ASfiW/4JtJRE u.SPECIFIC LOBBY:I$S - E. � ® l�iy pro✓�M oFE)#29-141220-66-S R 6 adl ���� 0651. �7�/l/' ✓ l I s Issue to be lobbied(Describe in detail): III.CITY.AGE'NCI'ES/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 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 Board of Adjustment,Dept of Public Works,Historic Preservation Board City of Miami Beach Commissioners,City Manager,City Attorney,Fire Dept. Planning Board,Design Review Board,Building Dept.,Planning Dept. I 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 f • F:\CLER\ ALL\aFORMS\L B $ O BYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) Owner of the Company B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). Owner of the Company The following information must be answered: 1) P rsuant to Miami Beach City Code Section.2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement sues": 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) P rsuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate evelopment Issues": _Yes_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 Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set forV in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special c pensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any em,shall register with the clerk as required by this section butt,,shall not be required to pay any registration fees. Yes No: Are you representing a not-for-profit corporation or efility without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST,, HALL UBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS W AS COMPENSATION R1fCEIVED. IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMEWr SHAICIL B9 Fit EVEN THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERI Signature of LVyis do solemnly swear o e foreg 'n are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of t i B ch City o d a reporting requirements. Signature of Lobbyist. Signature of Principal/Client: VI. LOBBYIST IDENTIF TION: PRINCIPAL IDENTIFICATION: �•.p1 N�� n, r4. Produced ID �~ Produced ID ..T CD. Form of Identification m� Form of Identification �HUaN m VPersonally known(Lobbyist) ;.o ✓Personally known(Principal) ;o 007 VII. SIGNATURE AND STAMP OF NOTARY: 3 3`` 0 3 B o 3 c 3 Q 7t7 State of Florida,County of Miami-Dade I L State of Florida,County of Miami-Dade d ' �. : Q Sworn to and subscribed before me + cn c°n Sworn and subscribed before me m� ,`;; This A day da ,201 m ,201�' aD d o o G o � p • c..coo, � o t, o+ Nro m rr r_1 All i e Pub' =ts ate of Florida u ro o a nature of Pu is Notary— a_te of Florida N r CL No ariza ion Lobby nat ure " °' No ' TO BE COMPLETED BY CITY CLERK'S STAFF NLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# o Paid Lobbyist Registration Form received and verified by: F;\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Forrn,do �/4t-o_f-v Rev ised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc r y $ as 3 £. E$ 4Y City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 331.39,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.741 1 ,Fax:305.673.7254 LOBBYIST NAME: Paul R. Jankowski 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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. An o fails to file the required Statement by April 30th, 2012, shall be to tic ly su ended om lobbying until all fines are paid, unless the fine has been p aled t the M m - e County Commission on Ethics and Public Trust. Signature: Date: FACLERULL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc r ......... `� W '�.�9y � beg.- E 1 y r rt co � co IQII r i m O 0. .� Uj 609�- P. i.� ppp1 . LU J ' E to LL off,` .-. V. D O ZZ -a �. � - L .................................................................................................. .................................. ...................................... ............................................ Vendor No. 02571 Check No. 630470 GREENBERG TRAURIG Vendor Name:CITY OF MIAMI BEACH Check Date:07/29/14 3, 2 "IZIN MEOW 07/29/2014 010729143508 Rush, rush Annual Lobbyist Registration for Paul Jankowski Ric-Man International 500.00 ................ TOT'AL: 1$ 50 .............. 0.00..... ..... .....