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Kent Harrison Robbins - Sunset Parking Systems, Inc. • USA e . NI— City of Miami Beach Office of the City Clerk t, "A) 1700 Convention Center Drive, Miami Beach, FL 33139 ■0�cies 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. Robbins Kent Harrison NAME OF LOBBYIST: (Last) (First) (M.I) 1224 Washington Avenue Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 532-0500 (305)531-0150 khr @khrlawoffices.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: Sunset Parking Systems, Inc. NAME OF PRINCIPAL/CLIENT: ' 1111 Lincoln Road, Suite 400 Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) . (State) (Zip Code) (305) 674-8667 ralph@sunsetparkin.gsyems.com TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] I � i o NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: m C�: ;°; Rafael Andrade, President - C' .J-- • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH-CORPORATION, PARTNERSHIP OR TRUST: Rafael Andrade, 100% n.SPECIFIC LOBBY ISSUE: Legal Representation of Sunset Parking Systems, Inc.concerning impacts related to Historic Preservation Board File No.74717Eucli&6arden Hotel's A. lication for Certificate of A..ro.riateness for the .ro ert located at 426 Euclid Avenue Miami Beach, Florida 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 Zoning Board of Adjustment None x Planning Board None x •esign-eview.oar. Land Use-Board None x City.Commi:rmion -Naas x Planning Staff None x Mayor _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 2-4820 Any Financial, Familial or Professional Relationship City Ayen,,iesihi duals to be:Lulit.iec;. City Mragef'9-Gffiee City Attnrney'c('ithrn Historic Preservation Board F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc C-R13 IV. DISCLOSURE OF TERMS.AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $595.00 / per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $595.00 / per hour 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 XNo: 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 XNo: 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. YesXNo: 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 COIF PENSATION ECEIVED, IN_TIOE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL /c E FILED E,VEIF THERE WA .I BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. '; , ' 7 ' , r 4 ii // a Sig ‘ature of obbyist I do solemnly swear that all of the foregoin facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Bea .* .ity rode and all .-,•o g requirem s / Signature of Lobbyist: ..A.-.. ._...admow - Iiiriiiiip.,, r f Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: I Produced ID Produced ID Val Form of Identificati�gW ANIE't,'" r ni, d Form of Idef���,i�°� �e,;r. Personally known(Lobbyist) °�y0,2" ;.,� `•, Personally known (Prr' pat)h R' %,y ,.3 Tsai+,Yi5' L .. v o cr: ''''"'0,;-. , ,c VII. SIGNATURE AND STAMP OF OT; Y• 4, ° 2 , = `"'" y State of Florida, County of /I L. ��A.ade' r ' ,T State of Florida, County of Miami-Dade S. y �'�°°- ;,;��'�''.,` 'f' �� �`' �? •°w Sworn • 5nd subscr••-�,• •ef•r me `:°.°, ��-,, `? Swor d subscri• •efo�. -21e �.�rz IA day of III. :.:a 201 T is day of` !/A 6f- ,r;0)\- "'. 3 _ ' p_ii 41.,,,r, .1: .„,,,h pp s �� igniure • 'ublic Notary—State of Florida Signat're o •ublic Notary at-if Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual:Registration fee: [ Yes[ ]No Amount Pa'• $.. 11 " . "' .. f Mr_ Date Paid WI IL Lobbyist Registration Form received and verified b y: _. I' y ,. : _ '�ry ��� F:\ L R\$ LL\ ,. M3 _dx3YwS T F OR a ;9..L; xS esi: SC;I 0egis L aL;s.:. ;:,,;,s,_,•,«. Revised 01/22/2014 F:ICLERI$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miomibeachfl.gov CITY CLERK Office Rafael E. Granada, City Clerk CityClerk©miamibeachfl.gov Tel:305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Kent Harrison Robbins 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 Staternent(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. lobbyist, who fails to file the required Statement by April 30th, 2012, shall be Any y q y p automati,r ally suspended from lobbying until all fines are paid, unless the fine has been r / 3� ap•-eal=�e to ' ;oaani-D - ounty Commission on Ethics and Pubic Trust. i f' -- --- • 3/ 7 . 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