Jennifer L. Kuzler - Art Directors Club (ADC) MIANAd
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.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: U EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address.
I. LOBBYIST RETAINED BY:
G�4.G D YP-A n
NAME OF PRINCIPAL/CLIE T: `` }} {
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBE 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. t d0 GIC,,+0 Of(CO K4 VVIO
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
ii.SPECIF'IC LOBBY ISSUE:
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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
Pursuant to City Code Section 2482(g)Every registrant shall be required to state the extent of any business,financial,famllial 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 flied.
Sec 2-482 Any Financial,Familial or Professional Relationship
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F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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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). A,O (.O VL—�/t-S
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 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development 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
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: 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 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 Lob .i t
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:
Vl. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
NJ_Produced ID (ri Produced ID 2 DL
Form of Identification Farm of Identification
_Personally known(Lobbyist) _Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
N W i V
State of Flct-",County of Mie4 a State of FJL4da,County of Miimk4ede
Sworn to and subscribed efore me Sworn and subscribed before me
This d of y 201 This day of _,201
nature of Public Nota State off a X,/ Sign a of Public Aotary—State of
Notarization of Lobbvist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ._ , 1!2- ///4(
Annual Registration fee: )Yes[ j No Amount Paid$ MCR# f Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL ka FORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc I Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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MIAMIBEACH
City of Miami Beach, 1700:Convention Center Drive,Miami Beach;Florida.33139,www:miomibeachA.gov
CITY CLERK Office
Rafael E.Granada,City Clerk CityClerk @miaMibeachfl.gov
Tel:305.67-3.7411 ,Fax:305.6 73.7254
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LOBBYIST NAME: V� -
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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.
'I) 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.immedi"ately notify.
the City Clerk's Office of lobbyist withdrawal in writing.
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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 24851, a fine of$50.00 a day shall be assessed for all
Statements) fled 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) t
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to file the Statement or pay the assessed fines.after notification.. �
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Any lobbyist, who fails to file;the required Statement by April 30 1n of each year, shat be
automatically sus pended from lobbying until all fines are paid, unless-the fine has been
appealed to the Miami-Dade.County Commission on Ethics and Public Trust. i
Signat_, e: Date:
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FACLER1sALL1aF0RMSIL0BBYIST FORMS\Lobbyist Registration Form.cloc
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106 W 29th St, NEW YORK, NY 10001
United States of America
ADC is the proud founder of the "Let's Make the Industry 50150"Initiative
5050INITIATIVE.ORG
Join the Club!
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Prieto, Silvia
From: Jen Larkin Kuzler <jen @adcglobal.org>
Sent: Friday, November 07, 2014 9:24 AM
To: Prieto, Silvia
Subject: Re: applying for lobbyist registration for 2014-2015 VCA grant
Attachments: info@ adcglobal.org_20141106_165904[2].pdf
Hello Silvia!
Here it is. Let me know what else you may need in order to process.
Thanks so much!
All the best,
Jen
JENNIFER LARKIN KUZLER
— Director of Awards Programs/ADC/Global Awards& Club
T + 1 212 643 1440 x30
ADCGLOBAL.ORG
ADCAWARDS.ORG
—ADC
106 W 29th St, NEW YORK, NY 10001
United States of America
ADC is the proud founder of the "Let's Make the Industry 50150"Initiative
5050INITIATIVE.ORG
Join the Club!
From: "Prieto,Silvia" <SilviaPrieto@miamibeachfl.gov>
Date: Tuesday,November 4,2014 5:05 PM
To: Jen Larkin Kuzler<jen(a,adc lobal.org>
Subject: RE: applying for lobbyist registration for 2014-2015 VCA grant
1
Yes,you may email it to me,this way I can complete the processing.
...
. .
lM1`:.S•
Silvia Prieto,Administrative Aide I
CITY CLERK'S OFFICE
1700 Convention Center Drive,Miami Beach,FL 33139
Phone: 305-673-7000 ext.6269/ Fax:305-673-7254
www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
From: Jen Larkin Kuzler [mailto Jen @adcQlobal.org]
Sent: Tuesday, November 04, 2014 2:25 PM
To: Prieto, Silvia
Subject: Re: applying for lobbyist registration for 2014-2015 VCA grant
Thanks, Silvia!Will get it notarized tomorrow and then shall I email or fax a copy to you?If memory serves,last year
I faxed it and then sent a hard copy. Please advise and many thanks again!
Best,
Jen
JENNIFER LARKIN KUZLER
— Director of Awards Programs/ADC/Global Awards& Club
T + 1 212 643 1440 x30
ADCGLOBAL.ORG
ADCAWARDS.ORG
—
ADC
106 W 29th St, NEW YORK, NY 10001
United States of America
ADC is the proud founder of the "Let's Make the Industry 50150"Initiative
5050INITIATIVE.ORG
Join the Club!
2
From: "Prieto,Silvia" <SilviaPrieto@miamibeachfl.gov>
Date:Tuesday,October 28,2014 5:16 PM
To: Jen Larkin Kuzler<jengadcglobal.ora>
Subject: RE: applying for lobbyist registration for 2014-2015 VCA grant
Dear Ms. Larkin Kuzler,
Yes, that is the correct Form, please make sure you complete all the fields, on the 1St page in the middle, please enter
the name/names on the section if principal is a Corp. Partnership or Trust.
Do not hesitate to call me if you may have a question
Regards,
MIAMI BEACH
Silvia Prieto,Administrative Aide I
CITY CLERK'S OFFICE
1700 Convention Center Drive,Miami Beach,FL 33139
Phone:305-673-7000 ext.62691 Fax:305-673-7254
www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical, historic community.
From: Jen Larkin Kuzler [mailto:jen adcglobal.org]
Sent: Tuesday, October 28, 2014 3:04 PM
To: Prieto, Silvia
Subject: applying for lobbyist registration for 2014-2015 VCA grant
Hello Silvia!
Hope this finds you well. I am back again this year, and wanted to inquire about registering once again this year to
be a lobbyist, as required by the VCA to apply for their grant.
Can you confirm that the attached is the most recent form I need to provide?Is there anything else I need to know?
Our first deadline for the grant is November loth.
Thanks,and I look forward to hearing back!
Best,
Jen
JENNIFER LARKIN KUZLER
— Director of Awards Programs/ADC/Global Awards&Club
T + 1 212 643 1440 x30
ADCGLOBAL.ORG
ADCAWARDS.ORG
—
ADC
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