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Jorge Kuperman - Sixt Rent A Car LLC , p _.,_,.,.. /165 Abb 0+4 A MIAAAIBEACH ... _ _. ., , ..., y P • City of Miami Beach Office of the City Clerk 2016 I�",,f� ?r qe _� I: L 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 spec'ically includes the principal as well as any employee engaged in lobbying activ'ie . The term"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435. NINE OF�B Y ST: (Last) (First) (MA)rV -C\()Fifi .T-e-t2-1— 1W i.reei(1)-A,k) (0,1 G2 taec.ft -,i-3. BUSINESS NAME AND A DRESS (�( umber and Street) (City) (State) ( 'p C de) -ce \00,}14.3r-iiilevy_tc.xt,14k TELEPHONE NUMBER: FAX NUMBER: EMAIL. Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: A //���l NA i All IPA�J NI � s� �1-oq eh La(//ii if7 ' f `31 ( BU" k,:-. �o� p ESS ber and Street) (City) (State (Zip ode) `,%9 �. �- COIM91.t a lice. g,s f A�.�.o r� T EPHONE 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: v V`G1€ 4-. 6o`rnk � Pfr � Cl -1-R-ki\l 5 A- TLIoNiti IL &raw • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR I DIRE TLY,A 5%OR MORE OWNERSHIP INTERE r IN SUCH CORPORATION, PARTNERSHIP OR TRUST: if 1/1 •L%c,L.Y 74.i74 II.SPECIFIC LOBBY.ISS�UE:; _ - )._ Issue- a lobbied(Describe in detail): ill CITY 4G E NC I ES I�DI'I�_�U A L S.a_TO SE_;LOB-Bit-0: E® : 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 _ V7Attt-k t-4 446itti l • 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 . 42‹• 's c IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Require C�0 14 B) PRINCIPAL'S ISCIAS R fiF L S ST COMPENSATION): (REQUIRED). V/42 0 The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement I ues": _Yes_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": _Yes 'y 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 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 i m,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 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSA ION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE Fl EVE - :VE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. — — /Ad Signature of Lobby ' i . I do solemnly swear that all of the forego.•• -.. is are true and corn- -•, at I have ma', r r am f.m'.iar with the provisions contained in Section 2-482 of the Miami Bch City Cod: and all reporting requirements. Signature of Lobbyist: ' Signature of Principal/Client: ® A �� . � VI. LOBBYIST IDENTIFICATION: / . 1 PRINCIPAL IDENTIFICATION: 1 a I ``. Q Produced ID \ e �roduced ID ��- ���tIGkS Lk,„ c ,y, �L S IJL215 �_(.rhl1- Form of Identification = w - .� • Form of Identification � � � Q= : e Q Q N,_a , lk y C c� Personally known(Lobbyist) .. .� c ° Personally known(Principal) Q N Q j .O .. >1.J■ t3 h J Li N VII. SIGNATURE AND STAMP OF NOTARY:. y F oc' a z o,a o p - -c7)Q m State of Florida, County of Miami-Dade State of Florida,County of Miami-Dade g w Sworn t• . d subscribed •efore me 5�' \11111,.,,'m Swor and subscribed before me g Q This - day of _ 1 ,201 QUO` *1►�boa. , This !/, , day of ,201 ' w dill'i° 4- Ile&A + ..:'"..:Signature;if Public Not -State of Florida - .. S"" • Signa 1 - of Public Notary-St a of Florida "�b"6•" -.`S 111\\ } =Q ,•w Notarizairon of Lobbyist's signature 'p,,. F� Notarization of Principal's signature ..''u .$ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY / Annual Registration fee: [ ]Yes[t ]No Amount Paid CO vO MCR# . • Date Paid i!M /r Lobbyist Registration Form received and verified'by: ./,,_ , _:JI _4 ._:.. 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 AA Aitt\i\ I ; EACH • 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: K017- 4111--- 1 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. Signatur-• Dat . F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 12/10/2015 Detail by Entity Name $ FLORIDA DEPARTMENT OP STATE D1\ lsioN OF CORPORATIONS y Detail by Entity Name Foreign Limited Liability Company SIXT RENT A CAR LLC Filing Information Document Number M11000000034 FEI/EIN Number 27-4394382 Date Filed 01/05/2011 State DE Status ACTIVE Last Event LC AMENDMENT Event Date Filed 02/18/2011 Event Effective Date NONE Principal Address 1850 SE 17th St Unit 207 Fort lauderdale, FL 33316 Changed: 03/20/2015 Mailing Address PO Box 460967 FORT LAUDERDALE, FL 33346 Changed: 03/20/2015 Registered Agent Name & Address CORPORATE CREATIONS NETWORK INC. 11380 PROSPERITY FARMS ROAD #221E PALM BEACH GARDENS, FL 33410 Name Changed: 02/21/2013 Address Changed: 02/21/2013 Authorized Person(s) Detail Name & Address Title MGRV SAZERA, VINCENT TODD http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=SIXTRENTACAR%20... 1/2 • 12/10/2015 Detail by Entity Name 1489 SE 17th Street Unit 2A FORT LAUDERDALE, FL 33316 Title MGRP BOEINGHOFF, JOHANNES A 1489 SE 17th Street Unit 2A FORT LAUDERDALE, FL 33316 Annual Reports Report Year Filed Date 2014 01/13/2014 2014 02/13/2014 2015 03/20/2015 Document Images 03/20/2015 -- ANNUAL REPORT View image in PDF format 02/13/2014 -- AMENDED ANNUAL REPORT View image in PDF format 01/13/2014 -- ANNUAL REPORT View image in PDF format 02/21/2013 -- ANNUAL REPORT View image in PDF format 02/14/2013 -- Reg. 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Li, I ' - . , •• (THIS INFORMATION MUST BE COMPLETED) ' Offic =of Firkance Director -‘ , N i. \s, . . Account Number: 0/I i-00 C) .--;6 I .:-',:..--.., • Preparer: X6t,141.0Y) ? Dept: e-C;iq 67:e.1 k EX1 -i----#.1 A. ,),-) . . ..___ -,..,.... . . Detail by Entity Name Page 1 of 3 • FLORIDA DEPARTMENT OP STATE e . DIVISION OF CORPORATIONS fain h Detail by Entity Name Foreign Limited Liability Company SIXT RENT A CAR LLC Filing Information Document Number M11000000034 FEI/EIN Number 27-4394382 Date Filed 01/05/2011 State DE Status ACTIVE Last Event LC AMENDMENT Event Date Filed 02/18/2011 Event Effective Date NONE Principal Address 1850 SE 17th St Unit 207 Fort lauderdale, FL 33316 Changed: 03/20/2015 Mailing Address PO Box 460967 FORT LAUDERDALE, FL 33346 Changed: 03/20/2015 Registered Agent Name &Address CORPORATE CREATIONS NETWORK INC. 11380 PROSPERITY FARMS ROAD #221 E PALM BEACH GARDENS, FL 33410 Name Changed: 02/21/2013 Address Changed: 02/21/2013 Authorized Person(s) Detail Name &Address Title MGRV SAZERA, VINCENT TODD 1489 SE 17th Street http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/27/2016 Detail by Entity Name Page 2 of 3 Unit 2A FORT LAUDERDALE, FL 33316 itle MGRP BOEINGHOFF, JOHANNES A 1489 SE 17th Street Unit 2A FORT LAUDERDALE, FL 33316 nnual Resorts Report Year Filed Date 2014 01/13/2014 2014 02/13/2014 2015 03/20/2015 Document !alas es 03/20/2015 --ANNUAL REPORT View image in PDF format 02/13/2014 --AMENDED ANNUAL REPORT View image in PDF format 01/13/2014 --ANNUAL REPORT View image in PDF format 02/21/2013 --ANNUAL REPORT View image in PDF format 02/14/2013 -- Reg. Agent Change View image in PDF format 01/16/2012 --ANNUAL REPORT View image in PDF format 02/18/2011 -- LC Amendment View image in PDF format 01/21/2011 --Amendment View image in PDF format 01/05/2011 -- Foreign Limited View image in PDF format Copyright©and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/27/2016 i Detail by Entity Name Page 3 of 3 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/27/2016