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Amy E. Huber - Fisher Island Club - lued miAlvd BEAcH , • : r 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. Huber Amy E. NAME OF LOBBYIST: (Last) (First) (M.I) 46 SW 1 Street,3rd Fl Miami FL 33130 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-381-6060 305-381-9457 ahuber @shubinbass.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, ore-mail address. I. LOBBYIST RETAINED BY: Marc Peperzak NAME OF PRINCIPAL/CLIENT: Fisher Iand Club One Fisher Island Dr., Fisher Island FL 33109 BUSINESS NAME AND ADDRESS (Numbet,and St eet1037 (City) (Sta a (Zip ode) 305 604 2315 3311115 6 MarcP @aodmil c.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: see 7'1C46 e1411 • IDENTIFY ALL PERSONS HOL•ING,_DIRECTLY R INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:� (��� T }¢-60 E.1LA41 t n.SPECIF.IC LOBBY ISSUE:._ . 41e;_-Annexation of certain_properties onFisher Island Issue to be lobbied(Describe in detail): In.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 r S ©CA , Gt r'lc Secs 0 (J._ C1i COM Mufti 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 NONE F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc s— • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE (Required) 95-0/11, B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 4 q co i (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 lo: 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": S.Yes_No: Are you lobbying on a pending application for a Development Agreement with the City or application for, change of zoning map desiunatlon 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$,No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY Z8 OF EACH YEAR.EACH LOBBYIST SHALL SUBMIT TO THE ITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES.AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH FOR THE . -ECED ,GC• -A D. 1 ► . SH. _ _. __, - IFT - A NNOE '; DT_ :E O COMPENSATION DURING THE REPORTINGPERIOD,, [ilil • l Signa o Lo•'yist I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City` •,- - d all reporting requirements. Signature of Lobbyist: - 'i , .l • Signature of Principal/Client: / VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification Personally known(Lobbyist) .1,_Personall known(Principal) ) VII. SIGNATURE AND STAMP.Qr liltO 1&Y:_ s. ... .. .. — ,.► — 4 AI RUTH OUINTAVALLI i State of Florida,County of Miami-Dad "�'A''e�'•'. ?.--.1 � Notary Public-State of Florida ptate of Florida, County of Miami-Dade Sworn to-a :;ubscrib=• before me 4 ,., •. - . . My Comm.Expires Mar 9.2017 �wom a d subscribed before me '� r ?In 201 re ',' hi �_ day of _ 1 201hp - „/ •ay of _ �� Commi'sston #EE 851527 y is .4, MI 0 1 a, '"'I 1 1 ionded Through National Nolary Assn F _ �,�� /4 C:. "e SHIRLEY BRION Sign-' ' b is Notary ate of Florida Signature jr"•l' : "ry- ate of lorida N �' MY COMMISSION#FFC Notarization of),Qittbvist s signature Notarization of Principals signature ;rFOi...'i.•° EXPIRES April 24,2( (407)398-0153 FloridallotaryService.c .TO BE COMPL 0 BY CITY CLERK'S STAFF ONL Annual Registration fee: Cu Yes[ ]No Amount Paid$ SO -0 a CR# .3 Date Paid ®-S'6 "-4:3,Lobbyist Registration Forth received and verified by: tJ v F:\CLER\SALL\aFORtlS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 F:\CLER1$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc VAN\ 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: 305.673.741 1 , Fax:305.673.7254 LOBBYIST NAME: Amy E. Huber 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 Y Y � q Y P Y 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. z I b Signatur- Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Salvatore, Jason From: Amy Huber <ahuber @shubinbass.com> Sent: Wednesday, May 25, 2016 1:30 PM To: Salvatore, Jason; Ruth Quintavalli Subject: RE: Lobbyist Authorization Letter Good Afternoon- Please enter that we will be speaking and working with the City Attorney's Office, City Manager's Office and the City Commission. Thank you. ShubinBass Amy E. Huber, Esq. Shubin & Bass, P.A. 46 S.W. 1st Street,Third Floor Miami, Florida 33130 ahuber@shubinbass.com Tel. (305) 381-6060 Fax (305) 381-9457 Attention: The information contained in this e-mail message is confidential information and privileged. The information contained herein is intended solely for the use of the individual(s)named above. If the recipient of this message is not the intended recipient, you are hereby notified that any distribution or dissemination of this communication is strictly prohibited. In the event that you have received this communication in error, please contact the sender by reply e-mail and destroy any and all copies of the original message. From:Salvatore,Jason [mailto:JasonSalvatore @miamibeachfl.gov] Sent: Wednesday, May 25, 2016 1:29 PM To: Ruth Quintavalli<rquintavalli @shubinbass.com> Cc:Amy Huber<ahuber @shubinbass.com> Subject: RE: Lobbyist Authorization Letter Hello Ruth, I will not be able to enter the registrations until the persons or groups to be lobbied is determined as this is a requirement of City Code Section 2-482(a)(4). Thank you, Jason Salvatore 1 Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411 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. From: Ruth Quintavalli [mailto:rquintavalliOshubinbass.com] Sent: Wednesday, May 25, 2016 12:27 PM To: Salvatore, Jason Cc: Amy Huber Subject: RE: Lobbyist Authorization Letter Good Afternoon Jason, I copied your questions below and incorporated responses in red, as follows: Yes or 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? NO Yes or No; Are you lobbying on a pending application for a Development Agreement with the City or application for change of zooming map designation or change to the City's Future Land Use Map? YES Also, we will need the full names of the persons or boards/committees that are to be lobbied, and any contractual relationships with those persons or boards/committees. TO BE DETERMINED identify all persons holding, directly or indirectly, a 5% or more ownership interest in Fisher Island Club, Inc. NONE If you need additional information, please let us know. Thank you! ShubinBass Ruth Quintavalli Shubin & Bass, P.A. 46 S.W. 1st Street,Third Floor Miami, FL 33130 Phone: (305) 381-6060 2 ShubinBass Ruth Quintavalli Shubin & Bass, P.A. 46 S.W. 1st Street,Third Floor Miami, FL 33130 Phone: (305) 381-6060 Fax: (305) 381-9457 rquintavalli @shubinbass.com Attention: The information contained in this e-mail message is confidential information and privileged. The information contained herein is intended solely for the use of the individual(s)named above. If the recipient of this message is not the intended recipient, you are hereby notified that any distribution or dissemination of this communication is strictly prohibited. In the event that you have received this communication in error,please contact the sender by reply e-mail and destroy any and all copies of the original message. From: Ruth Quintavalli Sent: Monday, May 23, 2016 3:07 PM To: 'JSalvatore @miamibeachfl.gov' <JSalvatore @miamibeachfl.Rov> Subject: Lobbyist Authorization Letter Good Afternoon Jason, Attached is a copy of the executed correspondence authorization John Shubin and Amy Huber to lobby on behalf of Fisher Island. I am forwarding the original correspondence to you via fed-ex for tomorrow delivery. As far as disclosure section — lobbyist disclosure for John Shubin, $650 / hour and for Amy Huber, $450 / hour. And, disclosure of lobbyist compensation is hourly. John Shubin, $650 / hour and Amy Huber, $450 / hour. • And response is no for representing a not for profit organization... Also, lobbying is for entire island. I will forward the board member's names and titles via separate email. If there is anything I've missed please let me know. Thank you! Sincerely, Ruth Quintavalli Shubin & Bass, P.A. 4 ''''46r-SW 1 Street Third Floor- =•. Miami,VFL 331.30 -,_i.i Ph. 305-381 606;0 Fx. 305-38179457 _ _ , r. t 1 l' + } y i t .k 't ::',..!"--,:=..„::-f J r i 1 1 5' • � r 1 l :e Ina. - 1 K . .. . 1 , 5 Fax: (305) 381-9457 rquintavalli @shubinbass.com Attention:The information contained in this e-mail message is confidential information and privileged. The information contained herein is intended solely for the use of the individual(s)named above. If the recipient of this message is not the intended recipient, you are hereby notified that any distribution or dissemination of this communication is strictly prohibited. In the event that you have received this communication in error,please contact the sender by reply e-mail and destroy any and all copies of the original message. From:Salvatore,Jason [mailto:JasonSalvatore @miamibeachfl.gov] Sent:Tuesday, May 24, 2016 11:23 AM To: Ruth Quintavalli<rquintavalli@shubinbass.com> Subject: RE: Lobbyist Authorization Letter Also, we will need the full names of the persons or boards/commitees that are to be lobbied, and any contractual relationships with those persons or boards/committees. Thank you, Jason Salvatore - Office Associate Ill Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411 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. From: Ruth Quintavalli [mailto:rquintavalliPshubinbass.com] Sent: Tuesday, May 24, 2016 9:03 AM To: Salvatore, Jason Subject: RE: Lobbyist Authorization Letter Good Morning Jason, As per our conversation of last week, the names of Fisher Island Club Board members, as follows: • Marc Peperzak, President • Roger Ward, Vice President and Treasurer • Albert Petichenskiy, Secretary • Larry Fletcher, Director Thank you for all of your help! Sincerely, 3 t-,-, )!-(7 ,1:', C el ; S a t J: ) . Attn.: City Of Miami Beach Monday, May 16, 2016 To Whom It May Concern: Please be advised that Mr.John Shubin, and Ms.Amy Huber, both of Shubin & Bass, P.A., are authorized herewith to lobby on behalf of Fisher Island Club, Inc. Sincerely, I' M.rc Peperzak President, Fisher Island Club, Inc. • eV3Onct\1 k�� Notary: y '''���" SHIRLEY ERIONES I i'= MY COMMISSION#FF011517 ' ',.!•f , ; ,,, EXPIRES April 24,2017 (407;398-0153 FloridallotaryService.com . 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