John R. Hall - Carino San Marino LLC 51-orm 1444er
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.
Hall, John R. (Exempt per Sec 2-481, form provided per Sec 2-482(h)) •
NAME OF LOBBYIST: (Last) Ed)Palermo Avenue 2na I loor .
Ludovici & Orange Consulting Engineers, Inc.
Coral Gables, A 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-448-1600 305-446-3876 jrhall @ludovici-orange.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, ore-mail address.
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I. LOBBYIST RETAINED BY:
Carino San Marino LLC - Property Address: 430 W San Marino Drive, Miami Beach, Fl 33139
NAME OF PRINCIPAUCLIENT:
Carino San Marino LLC 1749 N.E. Miami Court, #608 Miami Fl 33132
BULtIESS NAME AK ADDRESS (Number and Street) (City) (State) (Zip Code)
Q' " Q
TELE H NE 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: co G,4*hey! e -
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Stormwater improvements proposed on San Marino, Di Lido, and Rivo Alto Islands
Issue to be lobbied(Describe in detail):
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lll.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 •b
title of person to be lobbied
Capital Improvements, City Commission, X •
Ciy Manager, Public Works Dept. 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 D
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) Retained on an hourly basis @ $250 per hour •
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). Retained on an hourly basis @ $250 per hour
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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 El 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? • 4
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
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❑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 2-484(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 ou re•resentin• a not-for-•rofit cor•oration or enti without s•ecial corn•ensation or reimbursement. .
V. SIGNATURE UNDER OATH: •
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ON FEBRUARY 28th 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 EV' IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. .// John R. Hall, P.E.
Si nature of obbyist
I do solemnly swear that all of the foregoing facts are - and ••rrect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City ••d- : • /,.o • g requirements.
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Signature of Lobbyist: ohn R. Hall P.E.
Signature of Principal/Client: kNs— • • '• 1 j. / • Nite . 0 arb4eier ,
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VI. LOBBYIST IDENTIFICATION: . PRINCIPAL IDENTIFICATION:
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' ❑ Produced ID t , 0 Produced ID
Form of Identification i :&rte` .- Form of Identification
a Personally known(Lobbyist) '
y ( y ) ��1 X Personally known(Principal) i
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VII. SIGNATURE AND STAMP OF NOTARY: lg o Pu�1cs��of
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State of Florida,County of Miami-Dade .*2 a State of Florida,Co. tyo i miss'ono,e
d subscri before me m g Sworn and subscrib-- 5e , - ;-My X50512312
This day of ;X61-1 3.Q 1,5 �8 m a' This day of t.'ii, ,:,;;.,•�'0 _ • "`
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Signature of Public Notary-State of Florida Si.n. ure ,, -ublic ota -State of Florida
Notarization of Lobbyist's signature ----- - N•tar.ati• •f Princip ' signature
TO BE COMPLETED BY CITY CLER .TAFF ONLY
Annual Registration fee: [ ]Yes( ]No Amount Paid$ ?Sp-v`' M R# 0 e Date Paid ("to—(6
Lobbyist Registration Form receive and verified by: _.#0. 5"'d 1117/11x-
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 1/11/2011
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov .
Tel:30.673.741 1 ,Fax:305.673.7254 '°
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LOBBYIST NAME: John R. Hall, P.E.
I understand that no later than February 28th of each year, I must file the following form, pursuant a
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, I am required to •
immediately notify the City Clerk's Office of lobbyist withdrawal in writing. .
z/e/te John R. Hall P.E.
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►Signat re: Date:
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Camm, Patrick
From: Ory Dawes <orymdawes @ludovici-orange.com>
Sent: Tuesday, December 08, 2015 2:09 PM
To: Camm, Patrick
Cc: 'John R Hall'
Subject: FW: Carino San Marino Lobbyist Form
Hi Patrick, regarding the Carino San Marino, LLC Lobbyist Form we spoke about, there is only one member at 100%
ownership,Alain Degraeve, Manager.
Thank you for your help, and please let me know if there's anything more you need.
O ry
Ory M. Dawes
Business and Project Administrator
Ludovici & Orange Consulting Engineers, Inc.
329 Palermo Avenue
Coral Gables, FL 33134
Phone: 305 448-1600
Direct Line: 786-580-4509
Email: Ory @Ludovici-Orange.com
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' :_. ENGINEERS- SURVEYORS
The information contained in this e-mail,with all its attachments is intended for the use of the individual or entity to whom it is addressed,and may have confidential
data.If you are not the intended recipient,please immediately send back and delete the received message.Any retention,dissemination,distribution or copying of
this message is strictly prohibited and sanctioned by law.
From: alain Degraeve [mailto:adegraeve@me.com]
Sent: Tuesday, December 08, 2015 1:59 PM
To: Ory Dawes
Subject: Re: Lobbyist Form
IT IS ONLY MY NAME
I OWN 100%
On Dec 8, 2015, at 1:54 PM, Ory Dawes <orymdawes @ludovici-orange.coin> wrote:
Hello Mr. Degraeve,
I sent the forms to the City Clerks office and there is a portion of your form that wasn't completed.
There's a box in the middle of the form that pertains to corporations, partnerships, etc. They need this
information:
1
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i i r F F,rs nL y600.0
Miscellaneous Cash Receipt
' - CITY OF MIAMI BEACH . {,
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7° No
/ la\ $ 6,00, °()
0 Cash 0 Credit Card litiCheck#
0/ 6 ~ 20
Received of IA _
Address 3-7,2
d o A tz ''`' I r ;,p f ��� _.s.c,l_ 1
For - c� ��, ; 1 cc-' �9A4c t � ac t5 i 5
(THIS INFORMATION MUST BE COMPLETED) - \ Offic of Finance Director
3 69 4111'1 By —..M..
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Account Number t .,
Preparers .i A3 5A V fflO Dept. CI J CI. EXT. I,
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