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Lori A. Lynch - MDGLCC Foundation, Inc. MI AM 1 BEAC H pet 0'6G/14,Az': 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. L•yne /i Lo A h.. NAME OF LOBBYIST: (Last) (First) (M.I) E2d o b CC Zi er) .L/�e. tad tan Aiicaon �d�: //2n7t!!.', ,�i�� `,/ 3? BUSINESS NAME AND ADDRESS (Number/and Street) (City) (State) (Zip Code) 3D�S- 397. 8'9/1/ LloS'.• y3-g7S3 L®R,�®sja9�1/47ie707i'•ea/17 TELEPHONE NUMBER: FAX NUMBER: EMAIL: / Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: rnA 6'L cc FD//./147 z</An, 2.7e. NAME OF PRINCIPAUCLIENT: 50/rrJf 07A 07166 i)( BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]A • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: 3t4 o '/I Re/kin-5 ▪ IDENTIFY ALL PERSONS HOLDING,,RECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: re/9 Ore74 t /Git,e S/f 92.7Rete E,.5%i'J Issue to be lobbied(Describe in detail): Ill.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 /7/ ;47./27/ &®7C4 UM' Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or prcifessior±al� relationship,or other relationship giving rise to an appearance of an Impropriety,with any current city commissioner or city person&who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial,Familial or Professional Relationship 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) /116 Z (2)R prof; B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMNS�'I�OQN)��� ^'.� (REQUIRED). /Viol* f f- 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 jjNo: 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 f io: 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. / ,I-. ■ - . . ''r Sio''•r.ure •- obbyis'11.- 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 • Code and all reportin. requirements. Signature of Lobbyist: _�� Signature of Principal/Client: !� A� VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: =Produced ID F 131.. LS ZO$Z) 6 - . . 0 N, Produced ID PI)V* Lc2 s-2_j - .06 o Form of Identificatio ,,,%3 Form of Identific- I• Personally known(Lobbyist) o ,,► Personally known(Principal) (29-: „1 -'L� - VII. SIGNATURE AND STAMP OF NOTARY. 3�'�'.v 1 3 0 State of Florida,County of Miami-Dade ti;��c�� State of Florida,County of Miami-Dade o go r <<� Sworn to and subscrib before me . '> �1%0 T Sworn and subscrised before me 4.S `x'I This t'5 day of 201_ z This ($ day of t ,201E �0.'� `' m to i Si ature of Public •tary—State of Florida sv 1, �,�. - of Public Mary—State of Florida 1 -o '''6,fo + zation of Principal's signature s o Notarization of Lobbyists signature ,,,,oz, g °^, .. TO BE COMPLETED BY CLERK'S STAFF ONLY ° Annual Registration fee: [ Yes[ ]No Amount Paid$ At. -P MCR# A/ cam' Date Paid / Lobbyist Registration Form received and verified by: F CL_R\$AIL EaFOR.MS\LOBBYIS ORM5ZLc bbyist tuirn Registry s Fss �",^ Revised 01/22/2014 F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MIAMI I E AC H 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: Lô,?� 4it,i'4' 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 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. Signa ire: F Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Detail by Entity Name Page 1 of 3 FLORIDA DEPARTMENT OP STAT1? DIVISION Or CORPORATIONS PlintoZ Detail by Entity Name Florida Not For Profit Corporation MDGLCC FOUNDATION, INC. Filing Information Document Number N08000003040 FEI/EIN Number 262291157 Date Filed 03/27/2008 Effective Date 03/27/2008 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 04/28/2009 Event Effective Date NONE Principal Address 1130 WASHINGTON AVE. 1ST FLOOR NORTH MIAMI BEACH, FL 33139 Changed: 03/30/2010 Mailing Address 1130 WASHINGTON AVE. 1ST FLOOR NORTH MIAMI BEACH, FL 33139 Changed: 03/30/2010 Registered Agent Name &Address DAVIS, MARTY E 900 Biscayne Blvd Miami, FL 33132 Address Changed: 02/23/2015 Officer/Director Detail Name &Address Title P ADKINS, STEVEN N 1756 N BAYSHORE DR. 37G MIAMI BEACH, FL 33139 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/1 9/201 5 Detail by Entity Name Page 2 of 3 itle S, T Richa, Jorge A 1130 Washington Ave- 1st Fl N MIAMI BEACH, FL 33139 itle D NEARY, GEORGE D 700 BRICKELL AVE. 27TH FLOOR MIAMI, FL 33131 itle D LLER, MICHAEL 1700 CONVENTION CENTER DR. 4TH FLOOR MIAMI BEACH, FL 33139 itle Director Brown, Cindy 1873 NE 154th St. North Miami Beach, FL 33162 nnual Reports Report Year Filed Date 2013 03/22/2013 2014 04/10/2014 2015 02/23/2015 Document Images 02/23/2015 --ANNUAL REPORT View image in PDF format 04/10/2014 --ANNUAL REPORT View image in PDF format 03/22/2013 --ANNUAL REPORT View image in PDF format 01/23/2012 -- ANNUAL REPORT View image in PDF format 02/16/2011 -- ANNUAL REPORT View image in PDF format 03/30/2010 --ANNUAL REPORT View image in PDF format 04/28/2009 --Amendment View image in PDF format 03/19/2009 --ANNUAL REPORT View image in PDF format 04/24/2008 -- Article of Correction/NC( View image in PDF format 03/27/2008 -- Domestic Non-Profit View image in PDF format Copyright kC and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/19/2015