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Keri Lynda Horvat - Villas of South Beach Condominium Association, Inc. L. it ,c H ,� - , � ,___, City of Miami Beach Office of the City Clerk i. , I - 1700 Convention Center Drive, Miami Beach, FL 33139 21.115NOV 0 14F1 9: 4} J LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained,whether paid or not, by a principal who seeks to encourage the assa e;defeat 0r. .- Y� Pe P Y 9 l'P 9 � U�� i- i c. i_ 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. Horvat Keri Lynda NAME OF LOBBYIST: (Last) (First) (M.I) 815 Ponce de Leon Blvd.Third Floor, Coral Gables, FL 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (rip Code) 305-631-2528 305.631.2741 LHorvat @trujillovargas.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,ore-mail address. I. LOBBYIST RETAINED BY: Villas of South Beach Condominium Association, Inc. Not for Profit Florida Corporation NAME OF PRINCIPAL/CLIENT: 635 Euclid Avenue Miami Beach,FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Tip Code) (305)535-3575 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] F. NAME OF CHIEF OFFICER,PAWNER,OR BENEFICIARY__^ 1 .e,e a J.LcI ck . IDENTIFY-ALL-PERSONS HOLDING,,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, L-= PARTNERSHIP OR TRUST: - _- _ - , II.SPECIFIC LOBBY ISSUE: HPB 7582-Association's objection to Anglers Hotel variance request to increase building height 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 KrA I Debbie Tackett Historic Preservation Board 'ryv(■) ___ X Jake Seiberling Historic Preservation Board 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 2482(9)Any Financial,Familial or Professional Relationship None. F:\CLERI$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc p . (11 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) Hourly Fee of$300 to be invoiced at conclusion of representation B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). Hourly pee of$300 to be invoiced at conclusion of representation 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 x 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": x Yes No: Are you lobbying on a pending application for a Development Agreement with the City or application for MINIM IIIMIND 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 xNo: 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 SHAL B Fl D = N IF THERE ',J BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. , -/ Sig ature of Lob.yis 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 B a h City •• :nd all feporting re,u' -ments. Signature of Lobbyist: / •, I J '4k, .1 a Signature of Principal/Client: VI. L BYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID r--; a�9... ..A.% �' L roduced ID ,Dri;kr-1,6,nsa2 Form of Identification Form of Identification `••••o��tY 7:4„-Bridget Estefanl Ortega Personally known(Lobbyist) Personally known(Princip A �eCOMMISSION#EE218754 : � ,:EXPIRES:JULY 23,2016 VII. SIGNATURE AND STAMP OF NOTARY: +�;,;��••• WWW.AARONNOTARY.com pu l rrq State of Florida,County of Miami-Dade ••.•`o�rRY Pie Bridget Estefani Ortega State of Florida,County of Miami-Dade Sworn to nd subscribed before me _: �� _COMMISSION#EE218754 Sworn an subscribed before me tali; day of 0or�r�1n.A,2015 9�..+�1`.Qo This ay of / „.bcr,201 5 ,,�....o�•. EXFIRES:JULY23,2016 -�� `� °'+ ►f:`�•• WWW.AARONNOTARY.co '/�4I�_% �/ Signatu ';' otary—State of Florida Signat. - .-••i., "otary-State of Florida Notarization of robbyist's signature Notarization of Principal's signature TO BE COMPLETEDBY CITY CLERK'S STAFF ONL Annual Registration fee: , Yes[ ]No Amount Paid$ 5'O 0 MCR# LA' Date Paid 1 1/13l/ 5- Lobbyist Registration Forn received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration orm.doc Revised 01/22/2014 F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc M BEACH 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: Keri Lynda Horvat 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 transmitter 4o 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)w ho 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 appeal d to e iami-Dade/ ounty Commission on Ethics and Public Trust. /! tai ko\kinRAZ 9, 2o,c Sig ature: / Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ' "��-- - CaSf1 _L r' 4. J C 6 Yv ane®us Receipt w t .• ®F°MIAMI BEACF� r s i r a } � r 8c.3 -i ;y.�a# � h. s 6 �� ii� 4 x��Q9E - h r{� Cash O Credit'Card . r •�,�-� - Check r t'; r =� Received of s r;' =�. I',>>a V ,-° , r °A f For b , , !F E y f Ft- }. .. �1 � 1 HIS•INFO �' RMATION MUST EE COMPLETED) ,S� ;�°�- ®Rice®f[°anance Detector ' .. Account Numbei: . ::3 c b.. $� i f�- Preparers . r` Ln . ; Dept :-:' y . . _ ' �f c i , , - , - I 1 J b _ �l.;i a y, Fs Camm, Patrick From: Lynda Horvat <Ihorvat @trujillovargas.com> Sent: Tuesday, November 10, 2015 12:07 PM To: Camm, Patrick Cc: Bridget Ortega Subject: Re: Miami Beach Lobbyist Registration Form The Condominium Association president is Charles Dobal and Vice President is Greg Brown. All Condominium Association unit owners have a financial interest. I am copying my paralegal to update the form with the information above to send to you. Can the revised form be emailed back to you? Thank you. Lynda Keri Lynda Horvat, Esq. Sent from my iPhone On Nov 10, 2015, at 12:01 PM,Camm, Patrick<PatrickCamm @miamibeachfl.gov>wrote: Good afternoon, I received your lobbyist registration for issues relating to the Angler's Hotel; before I can process this information, I need you to provide me the missing information for the [Section 2-482(c)] highlighted in orange. Regards, MIAMIBEACH Patrick Camm, Records Management Specialist 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. <Horvat_Angerl'sHotel.pdf� 1