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Javier E. Fernandez - Lincoln Road Business Improvement District, Inc. py4ocel-- i ri City of Miami Beach Office of the City Clerk r • • • 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. Fernandez Javier E NAME OF LOBBYIST: (Last) (First) (M.I) Stearns Weaver Miller, et al. , 150 W. Flagler St. , Suite 2200, Miami, FL 33130 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-789-3200 305-789-3395 jefernandez @stearnsweaver.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: Lincoln Road Business Improvement District, Inc. , a not for profit corporation NAME OF PRINCIPAUCLIENT: 801 Arthur Godfrey Road, Suite 600, Miami Beach, FL 33140 Etll1$J/NWBN/VE,A4ND ADDRESS (Number and Street) (City) (State) (Zip Code) steve.gombinski @gmail.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: Steven Gombinski, President • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Establishment of Business Improvement District 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 Nick Kallergis, City Attorney's office Raul Aguila, Chief Deputy City Attorney X Jimmy Morales, City Manager 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 2-482(g)Any Financial,Familial or Professional Relationship n/a F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 4J/ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) n/a B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): n/a (REQUIRED). 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. XYes 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. Signal e of Lobbyi 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: 1C - Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID— Form of Identification Form of Identification x 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 t subscrib-• •-fore me Sworn and subscribed before me Thi d of C✓r ,2015- This day of ,201_ 1 /ir rr I i / A , ignature of Pu i No ary—State of Florida Signature of Public Notary—State of Florida otarization o obbyist's signature Notarization of Principal's signature TO BE COMPLETE' BY CITY CLERK'S ST F L Annual Registration fee: [ ]Yes[ No Amount Paid •.. A -MCR# / Date Paid• Lobbyist Registration Form receive nd verified by: WT i . _ F:\C E \$ALL\aFORMI \LOBBYIST FO iS\Lobbyist Annual Re��;tratian s oc < Revised 01/22/2014 �K f�2� F CLER1 ALL\aFORMS\L` : I~ _O ti Form.doc :t= °""' EXPIRES:July 13,2018 • Rf,:r or/ Bonded Thru Notary Public Underwriters W. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) n/a B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): n/a (REQUIRED). The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled Prohibited Campaign Contributions By Lobbyists On Procurement /lo:_Yes JNo: 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": =NM 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. XYes 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. Signat a of Lobbyi 2.---;---- _f 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: AI.. P 1 Signature of Principal/Client: �.C. Ct fr VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID _Produced ID LIHnw(7)(MIMMIIM 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 t• -f,• subscrib-• s-fore me ;worn and-ubscribed before me Thi , d.- of 47141 ,206 ■� •d; ► ��ay of OCX02,2015 I k �/ - jk-,ignature of Pu i. o n ry—State of Florida Signatu - of 'ub is "o -ry—State of Florida otarization o obbvist's signature Notariz: ion ,f ':rincipal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL WORMS\LOBBYIST FORMS\Lobbyist Annual Registration Forrn.doc Revised 01/22/2014 tom., i '• 42: ON F\CLER\$ALL\aFORMS\L 1, - OI4 ri,.,+ �: .,.• • :tpti Form.doc *; Ilk' :ice v• :.f EXPIRES:July 13,2018- • A MIAMIBEACH 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 Fernandez 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. - f 10-15-2015 Signa Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Detail by Entity Name Page 1 of 5 FLORIDA DEPARTMENT OP STATE ..144C DIVISION OF CORPORATIONS t "inkz. Detail by Entity Name Florida Not For Profit Corporation LINCOLN ROAD PROPERTY OWNERS ASSOCIATION, INC. Filing Information Document Number N13000002719 FEI/EIN Number 46-2030763 Date Filed 03/20/2013 State FL Status ACTIVE Last Event NAME CHANGE AMENDMENT Event Date Filed 06/28/2013 Event Effective Date NONE Principal Address 801 ARTHUR GODREY ROAD STE 600 MIAMI BEACH, FL 33140 Mailing Address 801 ARTHUR GODREY ROAD STE 600 MIAMI BEACH, FL 33140 Registered Agent Name &Address M & W AGENTS, INC. 2101 CORPORATE BLVD STE 107 BOCA RATON, FL 33431 Officer/Director Detail Name &Address Title President Gombinski, Steven Gombinski Properties Limited Partnership 3737 Collins Avenue Suite 1504 Miami Beach, FL 33140 Title VP Schlesser, Mel Lincoln Center Associates, LLC 1300 Collins Avenue Suite 100 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/26/2015 Detail by Entity Name Page 2 of 5 Miami Beach, FL 33139 itle Secretary einstein, Jeff M Beach 1, LLP 1111 Lincoln Road Miami Beach, FL 33139 itle Treasurer Dominguez, Ozzie erranova Corporation 810 Arthur Godfrey Road Suite 600 Miami Beach, FL 33140 itle Director Brody, Sherna 1000 Lincoln Road, LLC 1000 Lincoln Road Suite 210 Miami Beach, FL 33139 itle Diretor Cejas, Trudy 20 Lincoln Road Assoc/PLC Realty -20 Lincoln Road Suite 2D Miami Beach, FL 33139 itle Director Chera, Richard RC Lincoln Road Holdings, LLC, do Crown Realty 767 Fifth Avenue 24th Floor New York, NY 10153 itle Director Comras, Michael Ungar-Marshall Co., do Jonathan Fryd 523 Michigan Avenue Miami Beach, FL 33139 itle Director Goldman, Jay Seven Hundred Realty Corp. 15499 West Dixie Highway North Miami Beach, FL 33162 itle Director http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/26/2015 Detail by Entity Name Page 3 of 5 Kovel, Kim South Florida Arts Centger 924 Lincoln Road Miami Beach, FL 33139 Title Director Do, Richard The Sterling Building, inc. 927 Lincoln Road Suite 214 Miami Beach, FL 33139 Title Director Sherman, Scott Thor ABS 605 Lincoln Road, LLC 605 Lincoln Road Miami Beach, FL 33139 Title Director Stein, Cliff SRA Lincoln Theater, LLC 5345 Pine Tree Drive Miami Beach, FL 33140 Title Director Stern, Lyle 730 Corporation 1800 NE 114th Street Suite 1510 Miami, FL 33181 Title Director Karam, Simon Americas Trade Center 3191 Coral Way Suite 406 Miami, FL 33145 Annual Reports Report Year Filed Date 2014 04/28/2014 2015 02/22/2015 Document Images 02/22/2015 --ANNUAL REPORT View image in PDF format 04/28/2014 --ANNUAL REPORT View image in PDF format 06/28/2013 -- Name Change View image in PDF format 03/20/2013 -- Domestic Non-Profit View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/26/2015