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Javier F. Aviño - Carino San Marino LLC to ,L AAA I BE cH L City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 313'9 41 19 p LOBBYIST REGISTRATION FORM Cr n' n' v Ili- (;(r'r' 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. Avinb Javier F. NAME OF LOBBYIST: (Last) (First) (M.I) Bilzin Sumberg Baena Price&Axelrod LLP-1450 Brickeil Avenue,23rd Floor,Miami,FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-7202 305-3512275 javino @bilzin.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: CARINO SAN MARINO LLC NAME OF PRINCIPAL/CLIENT: 1749 NE Miami Court,Suite 608, Miami. FL 33132 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-673-1101 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) t) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] K ^ 3Tf • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Alain Degraeve r �• Fr- - • l0 • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CQ,R�PATI ORON, PARTNERSHIP OR TRUST: ` n. SPECIFIC LOBBY ISSUE: cJ� co Dispute regarding proposed construction of stormwater lift station Issue to be lobbied(Describe in detail): lll.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 x Mayor,Commissioner,City Attorney x Planning/Zoning and Staff 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 MIAMI 4526993.1 86133/46160 "RITS • IV.DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$525/hr B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):(Required) $525/hr 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 "I 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": ❑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 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 V 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 ILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. 271 'n ra � Signature Lobbyist Javier F. Avino a s 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 Bea.- City Code and - -•• g requirements. �y t Signature of Lobbyist: - �'- - �; ' vier F. A aa■N‘ r. Signature of Principal/Client: . N Al.• Degr,, N VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification Form of Identification Personally known(Lobbyist) ❑ Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribed before me Sworn and subscribed before me This :� �ay of irk , 201 likokY.Puk BISDIAZ This day of , 2011 c MY COMMISSION#FF 111262 * EXPIRES:May 24,2018 • Signature of Public Notary State o I .' ,o� 9 rY- BondedThruBudgetNotaryServices Signature of Public Notary-State of Florida Notarization of Lobbyist's signature Cf`o Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# L(OL 76? Date Paid '5//V/5 Lobbyist Registration Form received and verified by: Revised 4/27/2012 MIAMI 4526993.1 86133/46160 Iv.DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$525/hr B) PRINCIPALS DISCLOSURE(OF LOBBYIST COMPENSATION):(Required) $525/hr 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 1Y 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 4No: 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 "1 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 ILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature Lobbyist Javier F. Avir O 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 Bea City Code and -...._.a'1 g requirements. Signature of Lobbyist: vier F. A :two Signature of Principal/Client: Al r egg ` VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: 0 Produced ID D Produced ID Form of Identification Form of Identification r r Y Personally known(Lobbyist) xr Personally known(Principal) CD — � i VII. SIGNATURE AND STAMP OF NOTARY: - ' , -T; 40 Pot, Notary Public State of Florida State of Florida,County of Miami-Dade State of Florida,Coun •` itaiiipelynBagge Sworn to and subscribed before me / Sworn and subscribed - •Ettg My Commission EE 197526 This mi stay of ,201 la*pY ou BS OIAZ 'This _ •. of ►i A' • xpires 05/23/2016 S MY COMMISSION It FF 11126 r ... ' > EXPIRES:May 24,2018 • , , Signature of ublic Notary–State o I: 9ondedihruf3udpeiNoisryServices Sign- re o l•ublic Nota State of Florida Notarization of Lobbyist's signature °F` No • .do •f Prin i•a's ignature TO BE COMPLETED BY CITY CLERK' • AFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ %bor a) MCR# 1.40 0 b9 Date Paid 3/)q[/3 Lobbyist Registration Form received and verified by: Revised 4/27/2012 MIAMI 4526993.1 86133/46160 erl 1\ A A, A D p Fa :, City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK OFFICE Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305-673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Javier F. Avino I understand that no later than February 28th of each year, I must file the following forms, 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 Form 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 immediateJy;notifyithe City Clerk's Office of lobbyist withdrawal in writing. 1 . 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 2-45.1,.a'fine of $50.00 a day shall be assessed for all Statements) filed after the due date. The City Clerk shall nosy th.e.`;Miami- Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or princip ) to--file the Statement or pay the assessed fines after notification. ra.) Any lobbyist, who fails to file the required Statement by April 30th of each year, 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. At 1 . 3-10-/‘ Signs . --. 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C-.3 --, CD --", 7,- Camm, Patrick From: Ibis Diaz <idiaz @bilzin.com> Sent: Friday, March 20, 2015 4:08 PM To: Camm, Patrick Subject: RE: Lobbyist Registration/Carter McDowell and Javier Avino 100% Bilzin Sumberg Ibis Diaz Legal Assistant Bilzin Sumberg Baena Price&Axelrod LLP 1450 Brickell Avenue, 23rd Floor Tel 305.374.7580 x 3065 Miami, Florida 33131 Direct Fax 305.374.7593 www.bilzin.com idiaz c�i,bilzin.com From: Camm, Patrick [mailto:PatrickCamm@miamibeachfl.gov] Sent: Friday, March 20, 2015 4:05 PM To: Ibis Diaz Subject: RE: Lobbyist Registration/Carter McDowell and Javier Avino Good afternoon, I just had one last question, does Alain Degraeve obtain 100%ownership of the business, or is the business divided amongst other people? In section [2-482(c)] on the first page his name is listed with no percent value. Regards,ulas NNW 4111•15Millialidinai Patrick Camm,Administrative Aide I OFFICE OF THE CITY CLERK 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411/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: Ibis Diaz [mailto:idiaz@bilzin.com] Sent: Thursday, March 19, 2015 4:56 PM 1 To: Camm, Patrick Subject: RE: Lobbyist Registration/Carter McDowell and Javier Avino Thank you for catching that and calling us. `'. Bilzin Sumberg Ibis Diaz Legal Assistant Bilzin Sumberg Baena Price&Axelrod LLP 1450 Brickell Avenue, 23rd Floor Tel 305.374.7580 x 3065 Miami, Florida 33131 Direct Fax 305.374.7593 www.bilzin.com idiaz@bilzin.com • From: Camm, Patrick [mailto:PatrickCamm@miamibeachfl.gov] Sent: Thursday, March 19, 2015 4:54 PM To: Ibis Diaz Subject: RE: Lobbyist Registration/Carter McDowell and Javier Avino Thank you, I have received the information I need.Also, I will give this packet to the mailroom tomorrow,once they are in office. Regards, • who* 1001110111011S ram Patrick Camm,Administrative Aide I OFFICE OF THE CITY CLERK 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411/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: Ibis Diaz [mailto:idiaz©bilzin.com] Sent: Thursday, March 19, 2015 4:41 PM To: Camm, Patrick Subject: Lobbyist Registration/Carter McDowell and Javier Avino Patrick Attached are the revised first page as discussed earlier. Once filed,please forward receipt copy in envelope provided . Please confirm this is all you need. Thank you for your assistance. 2 Bilzin Sumberg Ibis Diaz Legal Assistant Bilzin Sumberg Baena Price &Axelrod LLP 1450 Brickell Avenue, 23rd Floor Tel 305.374.7580 x 3065 Miami, Florida 33131 Direct Fax 305.374.7593 www.bilzin.com idiaz @bilzin.com This message contains information which may be confidential and privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in this message. If you have received this message in error, please advise the sender by reply e-mail or reply to info @bilzin.com, and delete the message. Thank you very much. 3