David R. Custin - TECO Peoples Gas •
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 2015 DEC -8 PH 12: -�
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.
Custin David R.
NAME OF LOBBYIST: (Last) (First) (M.I)
David R. Custin & Associates, Inc. 5001 SW 74th Court, Suite 209, Miami, Florida 33155
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, or e-mail address.
I. LOBBYIST RETAINED BY:
TECO Peoples Gas
E05 P oCpIP4eUs CeaNs T:
702 North Franklin Street, Tampa, FL 33602
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(813) 228-4111 N/A Sabreu@tecoeneray.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:
N/A. Publicly traded company.
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: N/A. Publicly traded company.
II SPECIFIC LOBBY ISSUE::
December 9, 2015 Commission Item #R5N, Natural Gas Franchise Agreement and future conclusion.
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 LI it/
Mayor& Commissioners Grieco, Aleman, &Arriola Consulting &communications services [ -
All other members of the Commission None 1-1 (
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. None.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $30,000 flat rate fee paid in installments.
B)(REQUIRED).QUIRED). U,�$�JUE,(patLrateStee COMPENSATION):
paw in istallments.
(REQUIRED). � , rjj p
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":
FlYes."o: 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":
ElYe{o: 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.
[7YeEJo: 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 COMPE TION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT LLB LEO N IF T E HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIO .
l
Signature of Lobbyist
I do solemnly swear th II of th forego'. acts -re true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the iami Bea h Cof'e all re,. -• irements.-rn•A
Signature of Lobbyist: Z _
Signature of Principal/Client: _r.. --,y. __`/1 /2/ /Z0/6—
C.J/cP /7r5tie4i- TiE Lo ?e h"s c € ,.7#vc.
VI. LOBBYIST IDENTIFICATI N: PRINCIPAL IDENTIFICATION:
Produced ID a ..k. -q-6.2._-0 Produced ID
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Form of Identifi1 atior% ° o / Form of Identification
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Personally known(Lobbyist) W d o'- I V Personally known(Principal)
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VII. SIGNATURE AND STAMP OF ;'•TiARYS, e
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State o F: ida,Coun , of Mia i-Dade r E 'E P State of Florida, County of Miami-Dade
Swor.(�%1; : cri., ,� • or- me / �' ; a..o. �- Sworn and subscribed before me
ri is # y o'., le,201 1-• g ,,� ) This y day of skAa.r,201,
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Sign.ture of Public Notary State of Flo I '�' ! Signature of Public Notary-S ate of Florida
Notarization of Lobbyist's signature 4:14Wij ` Notarization of Principal's signature
_' •,, ETED BY CITY CLERK'S STAFF ONLY i
Annual Registration fee: [ ]Yes[ , No Amount Paid$ 1) MCR# 40 p7,59., Date Paid 12 )_I.V""
Lobbyist Registration Form receive nd verified by
i "..R\:', ,.t{ a z.r 4. ,U; .t, i:a ,;..,_ .:.:10° ..,; a,.;0, i' _; Revised 01/22/2014
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*• Commission#EE 158006
- -4 Expires March 30,2016
-,44,10 Bonded Thu Troy Fain Ingnanoe 800-385-7019
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City of Miami Beach, 1 700 Convention Center Drive,Miami Beach, Florida 33139, www.miornibeochfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , 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
automatically suspended from lobbying until all fines are paid, unless the fine has been
ap• . ,d t. =mi-Dade Coun Commission on Ethics and Public Trust.
/ 12/07/ 15
Signature: Date:
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CONVENTION CNTR DR
MIAMI BEACH, FL _- S,
33139
12/08/2015 '
12:53.?8 :sr' . _
CREDIT CARD
AMEX SALE
CARD#
Chip Card: XXXXXXXXXXX4000
Chip Card AID: AMERICAN EXPRESS
ATC: A000000025010801 City of Miami Beach-Florida
0008 Finance Department
TC: OBF150E52E82B5A1
INVOICE 1 City Hall
#: 0004 1534220-2 12/08/2015 BR1 1114
Batch#: 0003 Tue Dec08,2015 12:54PM Trans#8-8
Approval Code: 001300 8 $350.00 MCRCLERK - MCR-City Clerk
Entry Method: 858139 * MCR#: 408358
Mode: Chip Read 1 ITEM(S): TOTAL: $350,00
Issuer Credit Car PAID $350.00
_ r SALE AMOUNT
350'U0 Have a nice day!
CUSTOMER COPY