David R. Custin - G4S Secure Solutions (USA) Inc. .L
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BEACH
MIAMI
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FIC p-9, 2
LOBBYIST REGISTRATION FORM �'�10: 50
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks torencoura geittiec assage, defeat or
Y P P Y P P 9 � ,P ,
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.
Custin David R.
NAME OF LOBBYIST: (Last) (First) (M.I)
David R. Custin & Associates, Inc. 6401 SW 113 PL, Miami, FL 33173-1083
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-607-8576 N/A CustinDR @DavidRCustin.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address,phone, ore-mail address.
I. LOBBYIST RETAINED BY:
Eduardo Yero, General Manager
NAME OF PRINC PAUCLIENT•
G4S Secure Solutions (USA) Inc. 5820 Blue Lagoon or,Suite 300 Miami FL 33126
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)" (Zip Code)
(305) 266-2004 N/A Eduardo.Yero(a!usa.g4s.com
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:Chief Executive Officer Ashley Almanza
• IDENTIFY ALL PERSONS
P OR TRUST: ade DIROnTLondon�x�ha OWNERSHIP INTEREST IN SUCH CORPORATION,
--- Y �l� d d
n:SPECIFIC LOBBY ISSUE:;
RFP/procurement bid for contracted security services.
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
City Manager, administration staff, &City Attorney's office None
Mayor& Commissioner Grieco Consulting &communications services Q _
All other members of the Commission None I I 171
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
Not applicable.
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F:\CLER\$ALL\aFORMS\LOBBYIST 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) $30,000 flat rate fee paid in installments
B) PRINCIPAL' IrLJityREADFtLOBa eSI COMPENSATION):
(REQUIRED). Hj
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":
1-.ii Yeo: 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":
ElYello: 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.
[7YeJIo: 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 WEL _ .._0MP _>, ..,TION RECELMED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMEN ' SHALL M ► % —THER HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIO 1. - q• _Apr
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%111
Signature of Lobbyist
I do solemnly swear th t all of the fo -;•ing fats - true d corr: t and that I have read or am familiar with the provisions contained
in Section 2-482 of the i Beach ity Cod- a,a .'I °'orb --: -
�
Signature of Lobbyist: t\
Signature of Principal/Client: " 4'7 4C4i2,b )
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID r -- _Produced ID
• Form of Identification a s "' Form of Identification
�- 'n o►
a o A:
Personally known(Lobbyist) 16 g`t A Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY: ' $ it W
S IEE
State of Florida,County of Miami-Dade ri Q State of Florida,County of Miami-Dade
Sworn to and subscribed before me �, / or an subscrib • fore me
This day of r_Q.� ,201 _ hip, ; day of /i_ — 201
/ / ��qu�a�N4 ./ 1
/ / / - / • ' '' ,-- . �`0y\G I� `,/ /: A '- �• - - - -
AC-A./ gnature o Pu Iic Notary—State of Flo 9•a 4`I=,4 0:i Signature of Public.Notary—St.:e,,q,„1 idaNILLIAM L.WINSTEL
Notarization of Lobbyist's signature t. 5,,,;; Notarization of Principal's si•v ;,_, '�,e_ Commission#EE 189167
'r'"' Expires August 13,2016
TO BE CO - 1 - I CLERK'S STAFF ONLY 4-a.4,r Bonded Thru Troy Fain Insurance 800-3854019
Annual Registration fee: [ ]Yes[ ]No Amount P. .1 MCR# '• - - 1iii/Ift-
Lobbyist Registration Form received and verified b 4. ' ' _
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist An� Registration ��_� � Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ;'',,� ."''• WILLIAM L WINSTEL
` ,� = Commission#EE 189167
• ��.or Expires August 13,2016
',J;�°,p�\ Sor>ded Thru Troy fain Msuranoe 800 38�J01g
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M1AMBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office.
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: David R. Custin
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
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
au c suspended from lobbying until all fines are paid, unless the fine has been
ppeal, to/ MI, I ad, County Commission on Ethics and Public Trust.
‘i _!!""'': 0 2 <9 a/...5
Signature: Date: OPT
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
- Lobbyist Tracking System Page 3 of 13
Registration Date: 02/13/2015 Fee Date 02/13/2015
Collected:
Withdraw Date: Non-Withdraw
Date:
Not For Profit: No Financial Hardship: No
Development
Yes Expenditures: No
Agreement:
Pending Bid: No Disclosed Amount: $8,000 monthly
RFP/Procurement bid RFP/Procurement Bid
Item: for contracted Issue: for contracted
security services security services
City Manager,
Administration staff
Eduardo Yero, & City Attorney's
General Manager, Individuals To be Office, Mayor&
Principal: G4S Secure Solutions Lobbied: Commissioner
(USA) Inc. Grieco. All other
members of the
Commission.
5820 Blue Lagoon
Principal Address: Dr. Suite 300 Fees: $350.00
Edit New Delete Miami , FL 33126
Registration Date: 02/02/2015 Fee Date 02/02/2015
Collected:
Withdraw Date: Non-Withdraw
Date:
Not For Profit: No Financial No
Hardship:
Development
No Expenditures: No
Agreement:
Pending Bid: No Disclosed $30,000.00 flat rate
Amount: fee
Redevelopment of Redevelopment of
the 4000 Alton Road the 4000 Alton Road
Item: Issue:
property and Board property and Board
Approvals. Approvals.
City Manager,
Administration Staff,
City Attorney's
Camilo Miguel, Jr. Individuals To be Office, Mayor&
http://employee/LTS/Issues.aspx?LobbyistId=763 4/15/2015
- Lobbyist Tracking System Page 4 of 13
M-4000 Alton Lobbied: Commissioners
Principal:
Owner, LLC Grieco & Malakoff,
All other members
of the Commission
119 Washington
Ave., Ste. 505
Principal Address: Fees: $350.00
Miami Beach, FL
33139
Edit New Delete Registration Date: 11/13/2014 Fee Date 11/13/2014
Collected:
Withdraw Date: Non-Withdraw
Date: 02/20/2015
Not For Profit: No Financial Hardship: No
Development No Expenditures: No
Agreement:
Pending Bid: No Disclosed Amount: $30,000 flat fee
Redevelopment, and
licensing as
applicable of the Shore Club 1901
Item: Issue:
Shore Club- Zoning Collins Ave.
Text amendment for
RM-3
BOA, Dept of Public
Works, HPB, City of
MB Commissioners,
Shore Club Property Individuals To be City Manager, City
Principal: Owner, LLC Lobbied: Attorney, Fire Dept.
Planning Board,
DRB, Building Dept.,
Edit New Delete Planning Dept.
600 Madison Ave.
Principal Address: 15th Floor Fees: $350.00
New York, NY 10022
Registration Date: 10/21/2014 Fee Date 10/21/2014
Collected:
Withdraw Date: Non-Withdraw 02/20/2015
Date:
Not For Profit: No Financial Hardship: No
Development No Expenditures: No
Agreement:
Pending Bid: No Disclosed Amount: $60.000
http://employee/LTS/Issues.aspx?LobbyistId=763 4/15/2015
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