Jennifer McConney - Sadigo Hotel LLC • 33 9 aoiL Shre5F;
MIAMI BEACH
City of Miami Beach Office of the City Clerk c ;
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM ���� �t l Z
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeksIto encourage;th'e'pasage, 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.
NC- n,1 /
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NAME OF LOBBYIST: (Last) (First) • (M.I)
V bi \1a r c A-A-4 Aeccv rT_ 2.1i5 Wtscav L Bkicl/ Hiam1 ,1 L 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (Cate) (Zip Code)
305-51:3- 1818 Sf 1 C.C.0 n91 6 111661 Ih p. C r
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAIN D BY:
i,T1 1 ;-(/( LL C-
NAM OF P NCIPAL/CLIE T: / �� j
(�/ Till-.Q_ •i Cif✓ V�r S 2-1 ), 14,-4
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) •
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: yka.c.j4Av,"Q/1Q,t/(
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OJ INDI ECTLY,A 5°/ OR MORE Ow ERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: ./or/f $�u/ cJLi., Ten triaJv
II.SPECIFIC LOBBY ISSUE: I
Issue to be lobbied-(Describ -detail):
ul.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
or Cyr Co...µ.fS �^ C,4,,) 141), .vi X
1-1'(13 n r
P1ZVlni1 £P) i�, vb),c Oo -k S
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
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
, •
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) it, 556 /hx
B) PRINCIPAL'S DISCLOSURE(OF LOBBY LOBBYIBT C�OMPAENSAT ON):
(REQUIRED). ",5 0 / hr
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 Po: 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":
_YesJlo: 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.
_Yes blo: 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.
fi - r41If
Signatur- of Lo..yist
I do solemnly swear that all of ti- : =•oin• acts are true - • corr t and th. have read or am familiar with the provisions contained
in Section 2-482 of the Mia Beac of ' e- : • all repo ing requirements.
Signature of Lobb '-
Signature of Princip. Client: Mr'
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID [i , o _Produced ID
Form of Identification i m N Form of Identification
• gun'� ®
V Personally known (Lobbyist) B a -
Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY =° x
•�• p b W
i d E E
State of Florida, County of Miami Dade -' =o o State of Florida, County of Miami-Dade
Sworn to a d subscr'b;�' bef.r- 6 e 1811 Sworn and subscribed before me
Thisda ,.�
i '7
:,.L._ 20� ���,,,,,,,,,, This day of , 201_
litilY ... =, -
gnature of Publi Ma;. otary—State of Florida Signature of Public.Notary—State of Florida
No - ' -tion . b ist's signature 4.„;„, •+' Notarization of Principal's signature
TO BE COMPLETED BY-CITY CLERK'S STAFF ONLY
Annual Registration fee: [11.4[ ]No Amount Paid$ • MCA�# Date Paid
Lobbyist Registration Form received and verified by: tc:s�.cs+ A,'
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): i
A) LOBBYIST DISCLOSURE:(Roqutrod) 366 /hV
B) PRINCIPAL'S DISCLOSURE(OF LOABYJ T CQMPENSAT'Or:
REQUIRED). ! C 1 I
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 4No: 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'lo; Are you lobbying on a pending application for a Development Agreement with the City.or application for . j
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'lo: Are you representing a not-for-profit corporation or entity without special componsation or reimbursemont.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR,EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER t
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. \ __
•
Slgnalur of 1.o yist
I do solemnly swear that all of I e-ter.'.oin t acts are true corr t and th have read or am familiar with the provisions contained
in Section 2-482 of the Mia Beacl :t ' .,de : • all repo/ing requirements.
Signature of Lobb '
��� � — .
Signature of Princip 1 Client: i
PP-
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID °' Produced ID
Form of Identification m~
V:1: Form of Identification
✓Personally known(Lobbyist) . ±!'J: ersonally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY. 1$g ,
•')W
gg
State of Florida,County of Miami Dade g State of Florida,County of Miami-Dade
P ;�• bef.r: , e Sworn and subscribed bef're me
Thisrn to Idsddascr_b,114:,.4t..._ •.201X) ,,,,,,'ills" Is 1 day of -
!�"'i �� JAZMIN SAVLOFF fJ
/f�`,'�� u�P,,,
• • '� � i //f , , ,,rj,Zt• Notary Public-State of Florida ►
� ' .1 ��.
nature of PubllM! ootry-State of Florida ' ig lure : M, •Cary- t:,of; '` •`- Commission s FF 901639
Notarla lion o b Ist's signature .,,,,�,,,,.+ Notari •n of Princlpal's n:t. • � My Comm.Expires Jul 20.2019 t
9 ''Z°Nio''�, Bonded through National Notary Assn. )
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY — — — — '
Annual Registration foe: ( )Yes I I No Amount Paid f
I Lobbyist Registration Form received and verified by:
MCR II Dato•Pald
1°:\f.I,IiR\:y111.1.\af ORf•IS11.Qnnve;T t ORf ;\I,ul,l,yist Alumni It I.Ir OJon roun.do- Revised 01/22/2014
F:ICLERI$ALLIaFORMS\LOBBYIST FORMS1Lobbyist Registration Form.doc
•
MIAMBEACH
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: 7e,V)Yt( F e< tkC CO Afty 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.
6711(1
Si nat e: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
MIAMI BEACH 7) 7 ; n
City of Miami Beach • ZD(6 AUG -9 PM 1: 21 .
1700 Convention Center Drive
Miami Beach, Florida 33139 CITY CI_E ,;; ; .; OFF I C E
www.miamibeachfl.gov.
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM •
Name: Je ill `
Business Name: l 0T3 I -P Arc i4-cC{vre
Address: 2-57 S S t'llzwl I'> C 3i'/3�
Office Telephone Number: • 3 o5 _573 lb ej
Cellular Telephone Number: 3a 5 - (v 06. - 7 H OS
Email Address: , ) M cc—on J *831 k. �� r /
V
If more than one lobbyist, please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#: y// � l I
Amount paid: c66.00 Date paid: g/9//‘
/ D
Processed by: At 14151" Date: g/9/1‘
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\ANNUAL LOBBYIST REGISTRATION FORM reg.docx
Miscellaneous Cash Receipt -
CITY OF MIAMI BEACH . I!? f ' r-
No. 4 1 9 1
❑ Cash ❑Credit Card ACheck ('X 5 126 $
4/9 20/h
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MCR OPEN YY1l KK''v-
Payment Amount: 850.00
MC$411911
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
!' By
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Account Number: oil 1
Preparers iG 14't_ C Dept:(''''Y 6-4--`' EXT: 2��!l 1
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