Christina Cuervo - M-4000 Alton Owner, LLC go ®o
iMIAMI BEACH
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City of Miami Beach Office of the City Clerk
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.
Cuervo Christina
NAME OF LOBBYIST: (Last) (First) (M.1)
The Development Group of South Florida 2800 Biscayne Blvd., Suite 1010 Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 576-1430 (305) 576-1435
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 PRINCIPAUCLIENT:
M-4000 Alton Owner, LLC 119 Washington Avenue, Suite 505 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 531-2426 (305) 675-8447
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: Camilo Miguel,Jr.
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Mast Property Investor II, LLC W 45 e
PECIFIC LOBBY ISSUE.-
Development Board Approvals for 4000 Alton Road, Miami Beach, FL
Issue to be lobbied(Describe in detail):
nl. 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 ,
a
_ s e
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 commissionercor city-gersonnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
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I y
Sec 2-482(g)Any Financial, Familial or Professional Relationship "
NONE
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$ per hour ��Y
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.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: All 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
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 EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH
MI THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSAIIQN 12URIbIG THE REPORTING PERIO11
( I 4�—,V� (" -
Signatu 6615yist
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 ch City Code and all r porting requirements.
Signature of Lobbyist: o 0 r A
Signature of Principal/Client: •
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
m
Produced ID `,Qw11PF is LAG �``�o����R�yc Produced ID
Form of Identification �e C6 0� o Form of Identification
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Personally known(Lobbyist) ���qj ��4�0°.�� Personally known(Principal) U.t
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VII. SIGNATURE AND STAMP OF NOTARY:�`�°vo ar G
0 0 O N
State of Florida, County of Miami-Dade ;�'Q�0*c} 0°cD State of Florida, County of Miami-Dade z
Sworn to and subscribe before me �" Sworn and subscribed before me ;,Q o
This Of 201 *, ��= Thisd of, oJe.•rb�r, 2014 0 ;,X
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Signature of Public Not —State of Florida Signature of Public Wotar§—State of Florida n%643.
Notarizatio of Lobb)list;s.signature Notarization of Principal's signature OA JT "t
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ' h'
Annual Registration fee: [J(1 Yes[ ]No Amount Paid$ q,6Z MCR# Date Paid it
Lobbyist Registration Form received and verified by: a -
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istration Form.doc Revised 04/27/2012
MIAMIBEACM
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, 4 www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST DAME: Christina Cuervo
I understand that no later than February 28 of each veal, 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 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.
Signat Date:
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Formrevised 5-30-2012.doc
MAST PROPERTY INVESTOR 11 LLC 1182
City of Miami Beach 11/5/2014
Original Amt. Balance Due Discount Payment
850.00 850.00 850.00
Check Amount 850.00
City of Miami Bea:-h-Florida
r i narlce Depa rt meri t
1 City Hall
'1430320-1 11/05,2014 BR1 1.128 400o Alton 850.00
Wed Nov05,2014 02:48PH Trans#7-7
7 $350.00 MCRCLERK - MCR-City Clerk 118 2
MCR#: 37055
1 ITEWS): TOTAL: $850,00 11/5/2014
Check (001182) PAID $850.00 Original Amt. Balance Due Discount Payment
850.00 850.00 850.00
Check Amount 850.00
Have a r7 i ce day!
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